Pulse
The Power of Books
Physicians are discovering that books can be valuable tools for monitoring their patients’ development.
For Laurel Wills, M.D., children’s books are more than a waiting room distraction: they can help her screen for health problems.
Wills, a developmental and behavioral pediatrician at Hennepin County Medical Center (HCMC), recalls a visit with a 22-month-old patient, during which she handed the boy a book—something she does with all her young patients. “A typical 22-month-old would look at the book, move it, point, turn the pages, and use words to label pictures,” she says. “This child didn’t engage or show interest. To him, the book was an object, not a book.” The boy was later diagnosed with autism.
Wills first saw how books could provide clues about a child’s development while doing a fellowship at Children’s Hospital Boston in the early 1990s. As part of a team doing developmental evaluations, her job was to observe what a child would do when given a book: Did he make sure it was right-side up? Was he able to turn the pages? Did he name the objects on a page? Did he point to things on the page? Did he try to tell mom or dad a story, even if he couldn’t read the words? The child’s actions would help Wills assess his fine motor skills, speech and language skills, cognitive abilities, and memory. In addition to helping physicians identify speech impediments, eye tracking problems, hearing loss, or even autism, “it gives us an idea of whether a child will need extra support,” she says.
Become a Reach Out and Read Clinic
In order to implement Reach Out and Read, a clinic needs to:
- Identify a champion for the program. This could be a physician or nurse who is responsible for getting colleagues excited about Reach Out and Read and teaching them how to incorporate it into their daily routine. Free on-site training is provided to clinics whenever possible; video and online CME courses for physicians and other providers are also available through the program.
- Get administration and staff support. “Getting involved has to be a decision the clinic makes as a whole,” says Lynne Burke, coordinator for the Reach Out and Read program in Minnesota. “You need to have everyone on board.” She says the administration at HealthPartners Central Minnesota Clinics in St. Cloud held a media event to kick off the program during which the clinic’s executive director sat on the floor and read to kids. “That really helped everyone in the community understand the program and how they could get involved,” she says of the coverage it received.
- Gather demographic information about the children younger than 5 years of age served by your clinic. Burke says knowing who your clinic serves is a required part of the program application and helps when applying for grant money to pay for books.
- Think creatively about funding the purchase of books. It costs about $8 to provide a child with a new book at their two well-child visits each year. Fairview Health Services, for example, funds its program by allowing physicians to cash in vacation hours and earmark that money for Reach Out and Read books.
You can learn more about Reach Out and Read by going to www.reachoutandread.org or by contacting Lynne Burke at lynne@rorminnesota.org.—K.K.
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Today, Wills serves as medical director for the Minnesota branch of Reach Out and Read—a nationwide program that enlists pediatric and family medicine clinics in promoting literacy. Founded in 1989 by a group of pediatricians and early childhood educators at Boston City Hospital, Reach Out and Read targets children 6 months to 5 years of age. It trains physicians to advise parents about the importance of reading aloud to their children, provides children with a new, developmentally appropriate book during each well-child visit, and encourages clinics to put up posters that promote reading, make gently used books available in their waiting areas, and, if possible, enlist the services of volunteer readers.
First introduced at Children’s Hospitals and Clinics of Minnesota-Minneapolis in 1997, Reach Out and Read has since been adopted by 60 clinics in the state ranging from large sites such as Mayo Clinic in Rochester to small ones such as the clinic on the Cass Lake Indian Reservation in northern Minnesota. The program touches about 11 percent of all children and 23 percent of low-income children in the state, according to Lynne Burke, Minnesota’s Reach Out and Read coordinator.
“We’re training providers to empower parents to help their kids learn to love books,” says Burke, who also runs the Reach Out and Read program at HCMC. Hennepin County Medical Center has adapted the program for its patient populations. For example, it offers books that have been translated into Oromo, Somali, Hmong, Ojibwe, and other languages. It also gives books to older children and adolescents.
Burke says implementing Reach Out and Read costs about $8 per child per year, which covers program operations as well as at least two books per child per year. (The Reach Out and Read National Center has information about age-appropriate books available at a very low cost.) She says 26 of the participating Minnesota clinics are in areas where the average household income is low enough that they were awarded federal dollars from Reading is Fundamental to help pay for the books. Other clinics have received funding from philanthropic organizations, businesses, and individuals. For example, a Rotary club buys books for the Albert Lea Medical Center, and a Kiwanis club is helping fund the program at St. Luke’s in Duluth. Physicians have also opened their wallets. Burke tells of a pathologist in Grand Rapids who made a donation to Grand Itasca Clinic’s program in a grandchild’s name.
Little Time, Big Value
Wills notes that pediatricians and family physicians have an opportunity to oversee and foster child development from very early infancy that no other professionals have. But how do busy physicians incorporate literacy and books into well-child exams that are already packed with discussions about physical and emotional development, medical issues, immunizations, nutrition, sleep, oral health, car seats, second-hand smoke, lead exposure, and behavioral concerns?
During a visit with 4-year-old Henry and his father at HCMC’s pediatric clinic, pediatrician Sarah Lucken, M.D., shows how it’s done. Lucken walks into the room, introduces herself, and hands Henry a book, Dot, El Perro Bombero (Dot, the Fire Dog), a story about a Dalmatian who lives in a firehouse. Henry immediately begins paging through the book. Lucken watches him as she asks his father through an interpreter about Henry’s health. She then turns to Henry and asks whether he likes the book. He nods. She tells him through the interpreter that he can take it home. She then asks his dad whether they read at home and explains to him that reading or even looking through books will help Henry in school. The exchange lasts less than two minutes.
“The challenge,” Wills says, “is to learn to multitask.” As an assistant professor of pediatrics at the University of Minnesota, she teaches pediatric residents and practicing physicians how to introduce the book early in the visit and make observations of the child while talking to the parents.
In addition to helping physicians evaluate a child’s development, books can help patients and their families in other ways, she tells them. HCMC, for instance, has a bilingual picture book that walks children through a visit to the doctor’s office to teach them and their parents, who may not be familiar with the idea of preventive care, what to expect during a well-child visit.
Wills gave a copy of The Runaway Bunny to a mother whose young son kept trying to run away from home. The book helped the mother learn how to convey to her son that she cared about him and didn’t want anything bad to happen to him. “By taking the story and reframing it, all that behavior quieted down tremendously,” Wills says.
She also used a book from the Dinofours series to help a child with severe separation anxiety get over his trepidation about starting kindergarten. In addition, she has recommended books to parents whose children are dealing with the death of a pet or grandparent, divorce, or illness as well as books that address issues such as toilet training or picky eating.
What's Your Clinic Doing?
At its 2008 annual meeting, the Minnesota Medical Association adopted a resolution urging physicians to talk to their patients about the importance of reading to children and to encourage clinics to develop programs that foster reading to children. The resolution was brought forward by retired pediatrician Robert Fisch, M.D.
The MMA has embraced the Reach Out and Read program, as 60 clinics in the state are already taking part in it. However, other groups may have their own way of promoting literacy and reading among pediatric patients. If you are doing something that you think others ought to know about, please contact Lorrie Holmgren at lholmgren@mnmed.org. We may wish to feature your ideas on our website.
For ideas about how your clinic can promote reading, visit the MMA’s website www.mmaonline.net and click on “Physician Resources.”
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“Books help children be more relaxed during a visit,” says Steven Shelver, M.D., a family physician at Affiliated Community Medical Center’s New London-Spicer clinic. Shelver, whose clinic has been participating in Reach Out and Read for about three years, admits he was skeptical of the program at first. “I really didn’t see how giving a 6-month-old or a 1-year-old a book would have much meaning for them. But when we started giving the books out, I found the kids were very interested, and it was an opportunity to talk to parents, especially dads, about the importance of reading to their children,” he says. “There’s evidence that says if parents are reading to their children, children value education more. And there’s especially good evidence that says if a dad reads to his kids, the kids will see it as a message that education is important and will do better in school.”
Since the book program started at HCMC in 2003, Wills has noticed a lot more smiles on the faces of patients, parents, providers, and staff. “I think it’s a major morale booster for everyone involved,” she says, “and it’s so much healthier than giving out lollipops like they did in the old days.”—Kim Kiser