Reach Out and Read Colorado is encouraging expectant moms to read aloud to their babies in utero as a pathway to improving literacy through the New Parent Empowerment Initiative. This pilot project is the first known program of its kind to introduce the concept of reading to baby during the prenatal period. Currently, Reach Out and Read Colorado programs, and others like it, target women and families with infants six months and older.
Improving Literacy by Reading Aloud
Since 1997, Reach Out and Read Colorado has worked to give young children growing up in poverty a foundation for success in two ways: incorporating books into routine pediatric care and encouraging families to read aloud together.
Historically, we have provided health care providers with the opportunity to prescribe books to children at health check-ups from six months to five years of age. By building on the unique relationship between parents and health care providers, Reach Out and Read Colorado has helped families and communities encourage early literacy skills so that children enter school prepared for success. The books encourage reading and serve as reminders to parents about how babies explore the world (i.e., don’t be alarmed when your baby puts the book in her mouth). With more than 1,800 health care providers participating in our program, 230,000 brand new, developmentally-appropriate books will be prescribed to Colorado families along with a prescription to read in 2018.
Empowering Expectant Mothers
Reach Out and Read Colorado recognizes that the prenatal period is a natural time of information gathering for expecting mothers. At first, targeting expectant mothers may seem out-of-scope with our mission of incorporating literacy into pediatric care. However, we also believe in finding innovative and thoughtful new ways to facilitate a pipeline for literacy learning. So, with the aim of creating a strong foundation for early literacy in mind, targeting patients during the prenatal period seemed to be a natural extension of the program.
During the development of our newest program, we identified a few potential drawbacks to waiting until after birth to introduce the concept of reading.
- A new wave of programming was emphasizing “reading aloud starting from infancy,” yet books were not being provided to families by their health care providers until the age of six months. Will parents feel “behind the curve” if they haven’t been reading to baby?
- Health check-ups in the first six months are typically packed with pressing information about the daily care of baby. Will the idea of reading to baby be diluted because of more immediate health and development concerns?
- During the prenatal period, research has shown that any verbal communication with baby is important. By encouraging pregnant moms to talk, sing, and verbalize by reading street signs, menus, and more, moms can connect with baby during their everyday activities. By meeting parents where they are, rather than prescribing a one-size-fits-all model, Reach Out and Read Colorado hopes to help forge connections that can be built upon once baby is born.
Targeting the Prenatal Period
A 2008 UK-based1 survey about the prenatal, routine care of healthy pregnant women underscored the need for good communication between health care professionals and women. Both men and women surveyed during the postnatal period would have preferred to receive more information about caring for their baby during the prenatal period. While this wish was apparent throughout the survey, 86% of participants mentioned this topic in response to an open-ended question.
Because the prenatal period is a natural time of information gathering for expectant mothers, Reach Out and Read Colorado believes that this is an ideal time to target new parents, as they are beginning to form their parental identities. The question we examined became: Would introducing reading during the prenatal period help families form new habits and traditions before the overwhelming first few months of baby’s life?
Determining the Most Effective Format
The aforementioned UK-based survey concluded that good communication between health care professionals and women is essential, and emphasized the need for evidence-based, written information to support patient education.
Additional studies also confirmed the benefit of using written communication to educate pregnant women.
- Using leaflets to support information given first-hand and explained by midwives has been shown to make health information more accessible for childbearing women.2
- A US focus group study suggested that written information should accompany specific advice from a health care professional.
Creation of A Story About Reading
Reach Out and Read Colorado created an interactive storybook entitled A Story About Reading to start a conversation with mom and family about the importance of introducing baby to as many words as possible during the first years of life. The storybook itself serves as a tool for pregnant women to guide reading, talking and singing to their baby in utero, with the hope of developing a habit of positive interaction that will continue during the child’s early years.
Using thoughtful language and illustrations, A Story About Reading aims to help expectant mothers feel confident, empowered, and well-prepared.
Using Metaphor to Explain Science
To demonstrate how a baby’s brain develops, A Story About Reading makes use of a well-known child’s toy (building blocks). The block tower base is equated to the 100 billion nerve cells a baby is born with and the story conveys how it’s up to parents to connect those nerve cells through human interaction and learning.
Actionable Tips Help Mom Immediately Connect with Baby
Early literacy interventions typically use messaging that equates a parent’s reading recommendation to time (e.g., read for 20 minutes each day) or instance (e.g., read every day). A Story About Reading centers on word count messaging as an easier, tangible measure with instant gratification. For example, while encouraging mom to read paragraphs of the story aloud to her growing baby, it follows with active encouragement through statements like “Way to go, you just read 140 words!” The storybook also focuses on speaking to baby in utero using everyday experiences, such as reading aloud street signs and menus or singing songs like I’m a Little Teapot. The text suggests singing this song once a day, every day for one year, while explaining to mom how this equates to exposing baby to 22,000 words.
Furthermore, the text aims to empower parents. Traditional early literacy messages instruct parents to read aloud to baby 20 minutes every day, but failure to accomplish this task may leave them feeling defeated. A Story About Reading refocuses mothers by using messaging that reminds them that being a mother can be hard, but “you’re enough” and “you are great.”
Active Encouragement to Reduce Stress and Create a Plan
Often, patient education neglects to take patient experiences into account when offering advice. A Story About Reading encourages its reader by identifying common, daily experiences as methods of connecting with baby. It acknowledges that being pregnant is hard work, and encourages mom to practice self-care. While some suggestions are provided, such as deep breathing or calling a friend, the storybook invites mom to participate by writing down things she can do for herself during pregnancy and beyond. It also encourages mom to create a plan about when she will talk, read, and sing to baby – during pregnancy and after baby’s birth – using daily activities as triggers (bath time, bedtime, before doctor’s appointments, etc.). And, because so much of the research was centered on women seeking ways of not feeling alone in the parenting journey, the storybook’s messaging also includes statements such as “it takes a village” and introduces ways new parents can connect with baby in group settings, such as story time at local libraries.
Expanding Distribution for Meaningful Interaction
Launched in April 2018, the New Parent Empowerment Initiative is currently being piloted by eight Front Range health care clinics and 22 Nurse-Family Partnership sites across Colorado. Sites were selected based on their commitment to the Reach Out and Read program model and their track record of results. A training module was provided to every person who will distribute the storybook.
Our current pilot sites include: Children’s Hospital Colorado’s CAMP (Colorado Adolescent Maternity Program) Program3, Rose Midwifery, Clinica Family Health – Pecos, Clinica Family Health – Westminster, Florence Crittenton High School School-Based Health Center | Denver Health4, Montbello Family Health Center | Denver Health, Fort Collins Blue Spruce | Salud Family Health Centers, and Fort Collins West Clinics | Salud Family Health Centers.
Created in Collaboration The traditional Reach Out and Read Colorado program is prescribed by health care providers. However, the flexibility of the New Parent Empowerment Initiative allows for a wider, more diverse distribution network. This corresponds with the literature, where many women indicated a preference for receiving prenatal information in group settings. The storybook is being distributed during individual appointments and in prenatal group care settings, by social workers, care managers, and health care providers. Because each pilot location is unique, we work with each individual site to identify the best person/role, logistics, and timeframe for distribution.
The prenatal population is a new audience for Reach Out and Read Colorado, so we worked with existing services to ensure our program wasn’t duplicative. Our aim was to create a complimentary program that leveraged existing services to maximize impact and efficiency. Once this was determined, A Story About Reading went through an extensive review. Feedback was solicited from the Early Childhood Colorado Partnership’s Shared Messaging Team, the Nurse-Family Partnership Nurse Advisory Council, local health care providers, prenatal experts, community partners, and parents.
Incentivizing a Feedback Loop
Reach Out and Read Colorado is soliciting feedback from expectant moms through an online survey. Anyone completing the online survey has a chance to earn up to $20 in gift cards from King Soopers or Walmart.
Measuring Program Success
Reach Out and Read Colorado has contracted with an external consulting company to measure and evaluate the program using a blended methodology of quantitative and qualitative research. The aim is to receive results and impact data as well as improvement suggestions from both the expectant mothers and the storybook distributors.
Quantitative methodologies will include telephone interviews, online surveys, and/or mailed surveys with families who received the storybook intervention. Qualitative methods such as professional phone interviews with health care professionals aim to provide in-depth information regarding impact and suggestions for improvement.
A full report on pilot measurement and evaluation is expected to be released December 2018.
Questions, comments or thoughts? Please contact Maureen Maycheco or 303-623-3800.
1 National Collaborating Centre for Women’s and Children’s Health (UK). Antenatal Care: Routine Care for the Healthy Pregnant Woman. London: RCOG Press; 2008 Mar. (NICE Clinical Guidelines, No. 62).
2 Information Giving and Education in Pregnancy: A Review of Qualitative Studies. Mary L. Nolan, PhD, MA.
3 The on-site Alethia E. Morgan, MD Health Center is operated by Denver Health in partnership with Denver Public Schools and Florence Crittenton Services. Through this partnership, Florence Crittenton Services ensures that teen mothers receive high-quality, timely pre-natal and post-partum care, ongoing preventive and curative appointments, comprehensive pediatric care for their infants and children, and health counseling.
4 Children’s Hospital Colorado’s CAMP (Colorado Adolescent Maternity Program) Program is helping young mothers see pregnancy as more than a medical event. The program digs deeper and looks at not only prenatal and postnatal treatment, but also the social and emotional needs of young mothers and their families. Social workers will present the storybook at the patient’s second OB/GYN visit.