Rx Read: Perri Klass and Reach Out and Read at Bellevue Hospital

The Manhattan hospital's far-reaching implementation of this early literacy initiative, in which pediatricians hand out books to babies and young children during checkups, is changing lives.
Claudia Aristy, director of Bellevue’s Reach Out and Read (ROR) literacy program, with pediatrician Perri Klass, national medical director of ROR. Photo by Spencer Sheldon

Claudia Aristy, director of Bellevue’s Reach Out and Read (ROR) literacy program,
with pediatrician Perri Klass, national medical director of ROR.
Photos by Spencer Sheldon

It’s a typical day in the pediatric department at Manhattan’s Bellevue Hospital Center, the oldest public hospital in the country. In the bustling waiting area, overlooking Bellevue’s vast atrium, volunteers are reading picture books aloud to children and the occasional parent, sprawled on soft gym mats. At tables set up for toddlers and older children, kids are absorbed in writing and drawing pictures.

Hospital staff roam the area, some conversing in Spanish; 70 percent of Bellevue patient families are Spanish speakers. Staff members check in with parents about their family reading habits, feel out which parents might themselves need literacy support, hand out information about public libraries, and chat about what has been going on since their last visit.

Back in the examination rooms, pediatricians hand out new books to all children between the ages of six months and five years during well visits. They talk to parents about the importance of reading aloud, and use the books as developmental assessment tools during the exams.

How Bellevue embraces books, reading, and early literacy is a vibrant example of Reach Out and Read (reachoutandread.org; ROR) in action. This national literacy organization, cofounded by pediatricians Robert Needlman and Barry Zuckerman at Boston City Hospital (now Boston Medical Center) in 1989, works with pediatric doctors to promote reading during doctors’ visits.

Among ROR’s nearly 5,000 programs, Bellevue’s initiative, called "Children of Bellevue's Reach Out and Read," is one of the most comprehensive in the country. That program is led by Perri Klass, Bellevue pediatrician, professor in the department of pediatrics at New York University (NYU) Medical School, and ROR national medical director. While Klass led ROR’s National Center (1993–2006), it expanded from one program to more than 3,000 sites.

A prolific writer whose mother, Sheila Klass, was a YA author, Klass also directs NYU’s Arthur L. Carter Journalism Institute. Bellevue’s dynamic director of ROR, Claudia Aristy, has worked at the hospital for 14 years. Bellevue also employs two full-time ROR parent educators, bilingual in English and Spanish, and has up to 70 volunteers annually.

“I don’t have to exaggerate. It’s my favorite part about working here,” says Bellevue pediatrician Andra Fertig. Pediatricians there give out 12,000 to 14,000 books annually, printed in 13 languages, including Spanish, Bengali, Chinese, and Russian, to serve the hospital’s families. The picture books depict ethnically and racially diverse children.

Aristy reads aloud to a young Bellevue patient. Photo by Spencer Sheldon

Aristy reads aloud to a young Bellevue patient.

Using books during pediatrician visits

During standard pediatric exams at Bellevue, doctors provide parents with a lot of positive reinforcement about reading aloud. “When a one-year-old comes in and picks up a book, you can say, ‘Oh my gosh! I bet you’ve been reading books with him. It looks like you’re doing a great job. He loves it, and he loves your voice,’” Klass says. “Those are really good messages.”

Klass also instructs doctors to “use the book to do the things you’re already doing around language, development, behavior, routines, bedtime, and school readiness,” she says.

Good Medicine

Studies (http://ow.ly/ACOsC; http://ow.ly/ACOyE) have shown that ROR-served families are four times more likely to read to their children. Preschoolers exposed to ROR scored three to six months ahead of other peers on vocabulary tests. Hispanic families receiving bilingual materials were more likely to report reading books at least three days a week. English- and non-English speaking parents increased bedtime reading and were more likely to report reading as a favorite activity.

It can be a challenge. “The time in a well-child visit is really pressured. There’s a huge list of things I’m supposed to do,” Klass adds. “The case we have to make is not that this is one more thing on the checklist”—along with reminding parents to install smoke detectors, have the child eat more vegetables, and lock up any guns in the house—“but that this will help you do the things you are already trying to do and that you think are very important.”

For instance, a pediatrician assessing the developmental skills of a six-month-old can use a book to determine, “Does she fix on the book with both eyes? Does she vocalize?” Klass says. “She should be able to reach out for it. She doesn’t have a pincer grasp yet.” Or, “She grabs it with both hands and puts it in her mouth. If she does that, I’ve seen a bunch of things I’m looking for in my developmental surveillance. Then I can see if her mom is tracking, following it, and we can talk about how it’s fine that she puts things in her mouth; this is what babies do.”

In another doctor-patient scenario, “When you’re with the two-and-a-half-year-old and have the endless, repetitive conversations about sleep,” Klass suggests advising, “Read the book [at bedtime]. Ask him questions; let him point to the pictures; calm him down.”

A watershed statement

ROR’s proven impact on literacy largely led to a new policy statement about reading released by the American Academy of Pediatrics’ (AAP) Council on Early Childhood in June. The statement, “Literacy Promotion: An Essential Component of Primary Care Pediatric Practice” (http://ow.ly/Brs2C), recommends that pediatricians encourage literacy and parent-child reading during doctors’ visits.

“We’ve been working on it for years,” says Klass, the document’s contributing author. Pamela High, director of developmental-behavioral pediatrics at Hasbro Children’s/Rhode Island Hospital, is the lead author. “It is a serious process before the AAP makes a policy statement,” Klass says. “They want to make sure the evidence is solid.”

The directive also states that “the AAP supports federal funding and state funding for children’s books to be provided at pediatric health supervision visits to children at high risk living at or near the poverty threshold.” The ROR National Center received federal funding from 2000 through 2011, according to ROR executive director Brian Gallagher.

“We know it’s not just low-income families that participate,” High adds. “Families that have the books and resources see that this is a marvelous opportunity.”

“We have the delivery network—the primary care system,” Klass says. “You don’t want to [support] it bake sale by bake sale.” When physicians or facilities want to join ROR, Klass asks them to think hard about how they will support it financially in the long term.

National sponsors currently include Target, MetLife, and the Arthur M. Blank Family Foundation, among others. In addition, Scholastic donated a million books in the last fiscal year and has committed 500,000 so far this year, according to Kyle Good, senior vice president, corporate communications, at Scholastic.

ROR’s Far Reach

Reach Out and Read’s nearly 5,000 national program sites range from bustling urban facilities like Bellevue to small practices.

ROR distributes 6.5 million books a year to 4.2 million children and their families in 50 states, reaching one-third of all US children living in poverty, according to the organization’s website. The program extends to American Indian, Native Hawaiian, and Alaskan Native populations, with doctors distributing culturally appropriate books. ROR also reaches military families through the AAP Section on Uniformed Services (http://ow.ly/zR5SM) division.

“Nice ladies” push literacy

Back on the ground at Children of Bellevue's Reach Out and Read, Klass and Aristy’s job is often simply to convince parents of the value of reading to pre-verbal babies. “An infant won’t understand the words, but they will understand the emotion in your voice, the expression on your face, your own excitement in the process,” says High. “They’ll be interested in the colors over time; they’ll learn to orient the book, to turn the pages, to develop interest in some of the things in the book.”

The literacy push at Bellevue goes far beyond ROR’s basic directives, due to Klass and Aristy’s determination. On-site pediatric dentists hand out kids’ books about dental hygiene, along with titles advising parents to replace the milk bottle with reading a book at bedtime. An adult literacy initiative helps parents decipher prescription information, often a challenge whether or not adults are native English speakers.

Aristy says that patients open up easily to her, the volunteers, and the parent educators. “We’re the nice ladies,” she says. “[We are] out here, always smiling and talking about books,” so “they don’t see us as the authority.”

Throughout the day, at the waiting area’s “Reach Out and Write” tables, “We don’t say, ‘Would you like to write?’ No one’s excited about that,” Aristy explains. “We say, ‘Come draw a picture!’ Once they are at the table, we say, ‘It looks really good! You have a wonderful story right here. Shall we put it together and write it down?’”

The Spanish-speaking community at Bellevue has shifted from Puerto Rican and Dominican families to more from South America, Aristy adds. She adapts her approach to their needs. “In Ecuador, it is very common that the moms did not go to school,” she says, and they don’t feel confident looking at books with their children. “I tell them, ‘Talk about the pictures.…They’re like, ‘Really? I don’t have to worry about those black things on the pages?’ I say, ‘No, forget about those things for now.’”

As part of a healthy-eating initiative, Aristy arranged for a farmer’s market to set up in the waiting area once a week. Parent educators speak to families about healthy food in order to address obesity, which is widespread among Bellevue’s young patients.

A hospital-library connection

Aristy and the parent educators also urge parents to use their local libraries, providing storytime schedules and suggesting parent-child groups. They assure those who are worried about their immigration situation that the library is a welcoming place. “We don’t care about your immigration status at the hospital, and at the library, they don’t care, either,” Aristy and staff tell families.

Once a month, Ruth Guerrier-Pierre, senior librarian at the nearby Kips Bay branch of the New York Public Library (NYPL), reads aloud at Bellevue. She also leads a separate storytime for adolescent parents at the clinic. Once annually, representatives from NYPL, as well as the Brooklyn Public Library and the Queens Library, visit to promote library services.

The waiting room is Guerrier-Pierre’s storytime area. “I read picture books that they can sing to,” she says. Favorites include titles by Mo Willems; Hush, Little Baby by Brian Pinkney (Greenwillow, 2006); and He’s Got the Whole World in His Hands by Kadir Nelson (Dial, 2005). An interaction with a young boy while Guerrier-Pierre was reading a counting book exemplifies her experience. “I could tell that English was his second language. I was going, ‘One! Two! Three!,’” she says. “He was excited, repeating after me. It was cool.”

With every new program, Aristy says, “We say, ‘Great. We’ve got that down. What else?’”

All of these initiatives bolster big-picture literacy goals. “The point is not just to have a wonderful, enhanced visit while they’re here,” Klass says. “We’re looking for ways to change the texture of children’s lives so it includes more books and reading.”

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Jean Reidy

It's important to note that Reach Out and Read does not simply hand out books to kids. With programmatic training, medical providers model and deliver an important message - reading is part of the health of the whole child. I'm proud to say that in 2014 Reach Out and Read Colorado will distribute more than 165,000 books to more than 90,000 children. Currently the program is administered at 235 clinics in 55 of Colorado’s 64 counties. Through partnerships with book publishers and distributors, we have the ability to provide books in over 60 languages to our families through our partner clinics. This is great news. Thank you, Sarah, for spreading the word.

Posted : Nov 18, 2014 12:16



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