Family Medicine Clinic Adopts a Program for the Books

This article originally appeared in the National Commission on Certification of Physician Assistants’ April 2019 newsletter and is reprinted with permission from the organization.

Clinically-practicing certified physician assistant Joanna Hebgen is doing her part to change the lives of children through a simple-yet-effective method: books. 

At the SSM Health Family Medicine Clinic in Oregon, Wisconsin, Hebgen implemented the Reach Out and Read program, which strives to incorporate books into the daily lives of children and encourages families to read aloud together. 

Staff members including Physician Assistant of SSM Health Oregon clinic at Wellness Expo showcasing their Reach Out and Read program
SSM Health Dean Medical Group Oregon staff at the Oregon Wellness Expo

The clinic has distributed more than 450 children’s books and created a literacy-friendly waiting area and exam rooms. By adding books and comfy, child-size chairs, children can relax and read before their appointments. 

During wellness visits, providers give each child a book they can take home. Upon presenting the book, providers can observe the child’s and parent’s reactions, which offers insight about the child’s development and the parent’s comfort with reading to the child.  It also paves the way for discussion about the importance of daily reading. 

According to the American Academy of Pediatrics (AAP), benefits from reading can begin as early as infancy. Kids who are read to regularly have a stronger bond with their parents and learn valuable language and literacy skills. Reading also improves their social, vocabulary, and writing skills, and it can make kids kinder and more empathetic individuals as they grow.

“I love giving out books that I read as a child and also read to my children,” said Joanna Bisgrove, MD. “Parents and kids love the books. I find that the book is a good way to calm a child during an appointment and build rapport with both the children and parents.”

The clinic’s interprofessional staff all contributed to the program’s success, dedicating an estimated 40 hours to the project last year. Three staff members attended the annual Reach Out and Read conference to share experiences with others implementing the program. 

Additionally, the clinic participated in the Oregon Wellness Expo, a free event for families to visit local wellness vendors. Clinic volunteers distributed free books to kids and network within their community.

Due to the program’s overwhelming success, SSM Health plans to make the Reach Out and Read program available at their 25 family medicine and pediatrics clinics in Wisconsin; and funding for the books will be included in the annual budget.

“’Reach Out and Read makes appointments fun.” said Bisgrove.

This project was funded in-part by the NCCPA Health Foundation’s Be the CHANGE grant. Learn more about the Foundation’s grant programs here.

young boys read books aloud together

Reading programs are really about supporting strong parent-child bonds

This article was originally published by the Cap Times on April 23, 2018.

Toddler at well-child visits at doctor's office receiving a book from her provider. Reading programs often are supporting of parents and children.
PHOTO BY COBURN DUKEHART — WISCONSIN CENTER FOR INVESTIGATIVE JOURNALISM

Recently, I encountered a new-to-Wisconsin mother and toddler who had left behind a not-so-good environment. As we established trust with one another, it came out that she was concerned about her child’s mild speech delay. The upheaval in their lives meant they hadn’t been able to find a primary care clinic and schedule his regular checkups yet. What could I do that might offer some immediate benefit for them?

As many know, I do a lot of work around early literacy promotion. In the last few weeks, there have been two relevant, notable studies released in this field. The first article is a meta-analysis — a combining of several studies together — showing interventions in parent-child shared reading have clear benefits, not just to the child’s language and literacy skills (we’ve known this for some time), but also psychosocially. There were better social and emotional skills and improved behavior in the children. Less expected was the benefit to parents, who had less stress, less anxiety, and greater confidence in their ability to parent.

The second study was on the Video Interaction Project (created by an NYU friend and colleague, Dr. Alan Mendelsohn). It uses video recording of a parent playing and reading with their child, followed by watching the recording together with a parenting coach who points out notable moments in the interaction. The researchers found decreases in child aggression, hyperactivity, and difficulty with attention.

These both support the value of working on early literacy skills, the foundation of the almost-30-year-old Reach Out and Read program, which makes discussion about early literacy an integral and routine part of checkups in early childhood. (Note: I am the founding medical director of Reach Out and Read Wisconsin, and serve on the national board.)

However, I’d like to point out that these studies emphasize a critical element that’s not always present in the countless literacy programs out there. While you may view Reach Out and Read as a child literacy program, it’s really secretly a parenting program: a program designed to gently and collaboratively support strong shared reading between a parent and a child.

I don’t object to programs that bring high-quality books into a child’s home, but that emphasis is often misplaced; the book itself does little if handed to a child without any other interaction. A child learns the magic and power of reading only when a loving, nurturing, responsive caregiver (usually a parent, but could be anyone) reads aloud with them. A book that sits on the shelf is useless — it only does its magic when open in the hands of a parent and child reading together.

Equally important is a parent who knows how to read effectively to a young, squirmy toddler, a technique known as dialogic reading. Simply reading at a child doesn’t work for a child with a naturally short attention span. Knowing how to read with them and interact is an important learned skill. Merely providing books accomplishes only part of the job — supporting parenting confidence is absolutely essential.

It’s not just about the books. It’s about the act of reading together. A book without a caring adult…is just a book.

The key point: Parents benefit most when we offer clear modeling, coaching and encouragement. It’s not enough to say what to do; careful intentional skill-building is crucial for success. This explains the incredible outcomes seen from high-quality home visiting programs, for example. So question projects and recognize that they are not all the same. Ask yourself if they merely provide resources or whether they are building capabilities or capacities in families

So what of the family I encountered? I took the board book we had given him and pointed out her child’s brief interactions with the book. Then I modeled talking about illustrations and I reassured her that his turning away quickly was just his normal short attention span. Finally, I complimented her on her good parenting when she described how he would bring a book to her and “ask” to be read to.

She beamed with pride. And that’s how I knew we were doing right by her.

Dipesh Navsaria, MPH, MSLIS, MD is the medical director of Reach Out and Read Wisconsin
Dipesh Navsaria, MPH, MSLIS, MD is the medical director of Reach Out and Read Wisconsin

Book’em now or book’em later

I really don’t know what possessed me to become an Appleton police officer after graduating from UW-Madison with a degree in sociology. Little did I know when I retrieved the police officer job posting from the garbage can and applied for the position, my life would forever change. Thus began my 11 year odyssey in law enforcement. My first seven years were spent as a patrol officer. I then decided to specialize in juvenile law and sensitive crimes. The last three years of my career were spent in a local Division 1 high school where even a seasoned officer got an eye-full of serious teen problems. There were the regular thefts, fights and car accidents in the school parking lot; but, who would have guessed the amount of truancy, illegal drugs, teen pregnancy, suicide attempts and more that I frequently encountered.  

The power of reading first-hand

Mom reading to her two sons, librarian
Me reading to my boys, Nicholas and Steven

By the time I had one little boy and another on the way, I made the decision to leave law enforcement to stay home with my boys. My boys are in college now and I miss having their fat cheeks to kiss.

My favorite thing to do with my boys was to read to them. We all loved it. I would bring armfuls of picture books home from the library. One of my boys would sit for long periods of time focused on our books. The other was busy with toys as he listened, but he did listen. After everything I had seen as a police officer, I knew my boys were lucky. Some of you might be thinking, “Well, that’s what mom’s do. What’s the big deal?” 

Older brother reading to his younger brother, librarian
Nicholas, reading to his younger brother, Steven

To be perfectly honest, I thought I was just doing what comes naturally. I was wrong. Adults don’t just naturally “know” their relationships with their children, and shared activities like  talking, singing, reading, writing (scribbling qualifies) and playing are so critical to everything in life that comes after. Parents learn how to do this, by observation and learning at some point in their own life. But not all parents have had this behavior modeled for them. It would be great if every child in the world grew up in this type of environment. It would be ideal if parents themselves had these secure, healthy experiences during childhood so they were confident in their abilities to read aloud and felt empowered as their child’s first teacher.

When I look back, everything in my life led me to become a children’s librarian. Many people chuckle, scratch their head and ask, “Why would you do that?” or “That’s kind of a radical career change, isn’t it?” I smile and occasionally tell people that it makes perfect sense to me. I am now in the business of crime prevention. I became a librarian for many reasons, but that is one of the outcomes of my work now.

I have always loved young people and wanted to make a difference in their lives. I want to help them stay on the path to happy, healthy and productive lives. Of course, the factors that lead people down different life paths are varied and complicated. I was never under the illusion that I would save the world after I earned my master’s degree in Library and Information Science, but I hope I can contribute and make a difference.

The evidence is clear. Reading to children helps them develop print awareness, vocabulary and letter identification as well as letter sound recognitions. It also helps children learn to tell stories from beginning to end. These skills are all necessary before reading can begin. Unfortunately, the achievement gap starts early. Love of reading must be learned at an early age and failure to instill a love of reading can impair long-term interest in learning. Over half of all parents don’t read to their children every night. The percentage gets higher for families living in poverty.

Reading difficulty contributes to school failure, truancy, school dropout, juvenile delinquency, substance abuse and teenage pregnancy. Here are some staggering figures:  

  • Seventy percent of all incarcerated adults cannot read at a 4th grade level
  • Eighty-five percent of children in the juvenile court system are functioning at a low literacy level
  • The cost of incarceration in the United States is estimated to be between 80 billion and one trillion dollars each year

However, every $1.00 we invest in quality early childhood programs, society gets back $4 – $9. Even if you look at the situation from a purely economic standpoint, investment in quality early learning programs makes sense. Through programs like Reach Out and Read (ROR) we can provide children in our communities with an evidence-based and scalable program that helps start children off on the right track in life.

The wonderful thing about ROR is that it reaches so many families with small children. Who do you think is best equipped to influence parents’ child rearing practices….a librarian, a teacher or a physician? I think we all know the answer to that. When doctors talk, we listen. Here in the Fox Cities, the United Way, public libraries and area health systems are all pulling together to expand ROR throughout the region. Our goal is to have all potential well-child visit sites in the Fox Cities implementing ROR by the end of 2018. It’s spreading fast. I think we’ll reach our goal.

Please give all children a fair chance in life and support quality early childhood education programs like Reach Out and Read.

How to support literacy in Wisconsin

Whether you choose to support a literacy organization or donate your gently-used books, there are plenty of opportunities to promote literacy and a love of reading to last a lifetime. Check out this list for ideas to get involved in Wisconsin.

Volunteer:

  • Adult literacy: Use Wisconsin Literacy’s map to contact a program near you and become an adult literacy tutor. Tutors are needed to assist adult basic education learners, GED preparation and English language learners.

Wisconsin Literacy's regional map
Wisconsin Literacy’s regional map

 

  • Early literacy: This list can help you find a Reach Out and Read program in your county. Contact your local clinic and ask what volunteer opportunities are available.  

Volunteers can assist clinic staff with:

  • Book ordering, sorting and labeling
  • Hosting a fundraising event in your community to raise money for the clinic’s new book purchases for well-child visits ages 6 months to 5 years
  • Organizing a book drive to collect gently-used books appropriate for any age
    • Our book guidelines provide helpful tips about which types of books are acceptable
    • Collaborate with schools, churches, community groups and workplaces
  • Help create a literacy-rich environment by donating:
    • New bookcases or child-sized furniture (benches, tables, chairs)
    • A story time rug
    • Children’s or parenting magazines
    • Bulletin boards or other displays
  • Become a volunteer reader
    • Keep in mind not all clinics can accommodate volunteer readers and there may be an extensive volunteer screening process

 

  • Offer to read aloud at your child’s school or at the local library. Not only will you get to spend more quality time with them but you will also help their peers succeed too.

    Kids in library setting with books
    Volunteer with kids and help them learn important literacy skills

    Advocate for literacy:

  • Even though it may not be an election year, contacting your state and federal representative to talk about the importance of literacy is always relevant.
    • To find your representative, enter your address using this tool
    • For data specific to your county or region contact our office

Donate:

  • Looking to declutter? Give your much loved gently-used books to a friend, a child or a Little Free Library

Little Free Library near Milwaukee, WI
Little Free Library

  • If you live near Madison, WI the Madison Reading Project accepts book donations for children and teens. They share these books with non-profits, social workers, schools and shelters.

Do you support literacy in other ways? Comment below with your ideas.