Promoting Early Literacy: Implementing “Reach Out and Read”

Lisa Ball, DO, and W. Michael Brown, MD

Reach Out and Read is a national program whose mission is preparing the United States’ youngest children to succeed in school by partnering with health care providers to prescribe books and encourage families to read together. The program serves more than 4 million children and their families across the country.

A special emphasis is on serving children and families in low-income communities. Families served by the Reach Out and Read program have been shown to read together more often; what’s more, their children enter kindergarten with larger vocabularies and stronger language skills, which makes them better prepared to achieve their potential in school and beyond.


The family medicine residency program at Bayfront Health in St. Petersburg, Florida, has participated in Reach Out and Read for years with the goal of supporting the program’s mission of serving low-income families and improving young patients’ potential by providing them with resources to help them excel in school. To that end, Bayfront Health pediatrician W. Michael Brown, MD, and the family medicine residents participated in a 6-month-long quality improvement (QI) project that launched in January 2013.

The goals of the QI project were to assure that 100% of well visits for children from 6 months to 5 years of age included a new, developmentally appropriate book that a child could take home and keep, and to assure that at 100% of these visits, the physicians encouraged parents to engage in daily reading with children, as well as read aloud to the children in the examination room. This provided an opportunity for the physicians not only to assess development but also to engage children and praise their parents’ reading.


Some of the results of the QI project were expected, while others were somewhat surprising. During the QI project, data were collected about the number of books distributed compared against the total number of well-child visits, along the percentage of parents who stated that their child had received a book, the percentage who stated that they received advice about reading aloud, and the percentage who said that they read aloud to their child at least 4 days a week.

The data from parents was collected by way of a parent survey administered at each well-child visit. Parents were asked how many nights a week they read aloud with their children; they could answer 0, 1, 2, 3, or 4 or more.

At the end of each month, the total number of well child visits and books distributed was calculated, and the answers to the parent survey questions were tabulated.

After 4 months of data collection, we found, unsurprisingly, that residents provided books at 100% of well-child visits, and that 100% of parents said they had received a book and advice and encouragement to continue reading aloud with their children. We were surprised to find, however, that despite our advice, not all children had been read to daily by their parents.

In the first month, only 71% of parents said they had read to their children 4 or more nights a week. In the second month, 74% of parents responded with 4 or more nights a week, and the third month, 60% responded as such. In the fourth and final month, 84% of parents stated that they had read with their children at least 4 nights a week. The increase in the percentage of parents who read to their children 4 or more nights per week was unexpected, largely because the project spanned only a few months (Table).

We compared our results to national data for the Reach Out and Read program, which has been completed by 353 physicians in 131 practices in 38 states. In the 4 iterations of the QI project to date, 79,167 books have been given at 84,709 well-child visits, and 23,804 parents have provided feedback on the examination-room interaction and their weekly reading behavior.


The most surprising and positive change resulting from the QI project was the unexpected change in parents’ behavior. Before participating in this project, a physician commonly provided children and parents a book and reading advice at the end of the encounter—in fact, often a book was given as a reward after a child received vaccinations.

Part of the QI project, however, was to provide the book at the beginning of the visit, and to use the first moments of seeing the child as the time to assess their development. Not only was this found to be an ideal time to review a child’s development, but also it was a good way to earn trust in a child, who now saw a physician offering a gift, not as someone who only wanted to look in their ears before the nurse administered immunization shots.

It was heartening to see how children warmed up to physicians after reading with them; this generally made the rest of the encounters more enjoyable for the patients as well as for the physicians. 


Lisa Ball, DO, is a third-year family medicine resident at Bayfront Health in St. Petersburg, Florida, and is the residency coordinator for the Reach Out and Read program (

W. Michael Brown, MD, is the associate director of the Family Medicine Residency Program, chairman of the Department of Pediatrics, and director of pediatric education at Bayfront Health in St. Petersburg.