Conclusion

The local ROR family literacy program, part of the national Reach Out and Read (ROR, 2003-2006) organization, had a positive impact on the community, reaching the families most in need of literacy assistance. ROR site parents had an education level of 7.6 years and reflected an underinsured population. The Reach Out and Read Assessment project evaluated and found the following key points:

• The strongest finding was that of the ROR parents reading in a greater proportion by the time their children were 12 months of age when compared to the control parents.
• The number of books given out by the program, the volunteers reading in the waiting room, and the very young children listening to stories being read in the waiting room were all significantly greater at the ROR location.
• The local ROR program was shown to be evidence-based. Overall, trends in the data were positive, with some findings being statistically significant. Results supported the ROR program model.
• The ROR intervention appeared to have no effect on PLS-4 (Zimmerman, 2002) scores from 6 months to 12 months of age. At this youngest age group, it may be too early for the PLS-4 to be a valid measure for an invention impact, or with assessing just a 6 month interval. The children as a group assessed at their appropriate age equivalents, a positive outcome for the families.

The quasi-experimental study added to the early literacy research base. In comparing published data results from the similar BABAR parent survey by Needlman (ROR, 2001), one of the significant findings from both studies was identical. Results with the BABAR instrument in ROR sites, with 1,006 children from ten sites, indicated that 93% (from 88%, p< .02) of the parents reported reading to their child. The RORA project, with 23 children, had the same 93% response (from 50%, F = 2.69, df = 1,21, p = .10) with the same question. The BABAR study differed by including children, aged 6 months to five years, and a follow-up interval of one year. Because parents are more likely to read more to older children, the findings are more interesting than analogous.

Another ROR research paper by Weitzman (2004) also found 93% parents reporting to be reading to children. The study used a waiting room interview and a home visit to collect data using the Home Observation for Measurement of the Environment (Caldwell, 1984) instrument.

Key to the RORA findings was the positive trend in physician and volunteer readers modeling; and the giving of a book to the child. These were contributing factors for the significant gain in reading to their children by the ROR group when compared to the control group. ROR training video resources mention an inappropriate “lollipop” strategy of giving books at the end of the visit as a “reward,” with no modeling (ROR, 2003-2006). The RORA data emphasizes how significant the pediatrician modeling with a book is to success in parents reading more to their children. The reading volunteers reinforced this crucial aspect. Local ROR physicians model at the end of the visit so it would be the last thing the parent hears.

Assumptions and Limitations
Assumptions were that the treatment and control sites served a similar population, with only the treatment site receiving early literacy information. The local ROR program not only provides books, volunteer readers, and research-based information, but a structure for delivery of a literacy program to provide additional positive outcomes from the pediatric clinic. An assumption was that parents are typically enthusiastic about cooperating with a professional demonstrating a sincere interest in their child.

Limitations were expected due to the transient nature of the population. Until the project was well underway, the full impact of the limitations was not known. The lack of phones, language barriers in general, and not attending to well-child appointments promptly all contributed to the difficulties of contacting many participant families fitting the specific age groups needed. The logistics of the follow-up visits were more difficult to overcome than expected.

The small sample was a limitation. Literacy markers were to be identified by asking the parents if they had used a magazine, newspaper, book, or pen and paper in the last week. No findings were identified to substantiate the literacy markers because of the small sample size and the fact that some parents were still in school.

Information about other adults in the home, such as another parent, siblings, or extended family may impact literacy in the home by providing more family to read, sing, and tell stories to younger children. The answers to the questions were mostly affirmative to other adults and siblings being in the homes and to them reading, singing, and telling stories to the infants. However, the small sample size did not allow for any relationships to be seen.

A limitation results after asking parents questions about their parenting activities and in doing a child assessment with the parent. This phenomenon is especially evident when working with infants and toddlers. Parents are often so involved with daily caring responsibilities that they are unaware or not expecting their child to reveal logical play patterns during the assessment activities. When the questions and child activities are conducted, the parent views their child in a new way. All of the families in the RORA project may have increased parent-child reading and play activities after the first visit, regardless of which group they were in.

Finally, another limitation was revealed during the follow-up visits at the control site. The control site was less than ideal in that the medical staff did encourage families to read to their children. In addition, at least three of the control site parents were enrolled in high school programs designed to assist teenage mothers with infants. These factors may have influenced the control group. In a way the control group did provide a contrast by showing how important ROR may be with families that have less opportunities and education.

Next Steps
Next steps can be drawn from the qualitative information and quantitative findings for program improvement. When a father was present, those few fathers chose not to take the lead in answering questions, but typically seemed to know more English. Comfort levels were always in the primary home language, even with the bilingual participants. Research indicates that learning strategies are not diminished when a home language is maintained rather than extinguished (Tabors, 1997; Goldstein, 2004). Therefore, ROR books that are bilingual would be a better choice. ROR may find locating English Language Learner classes important information to provide. Collaboration with or information about other community resources for families could be investigated to provide more literacy support for families (Harvard Family Research Project, 2005).

After interacting with all of the families, some multigenerational, it was clear that expectations were for the infants to learn English and be successful in school. ROR, even when not known by name, was a type of program welcomed by the families. While the naming of the family literacy program may be unimportant to program outcomes, a suggestion is to have a colorful Reach Out and Read “Reading Corner” label be placed in the waiting room reading corner. This label could be painted on the wall or on a small, colorful bookcase. A colorful bookcase is suggested as the books and reading corner purpose would be more evident when the volunteers are not reading. A small selection of books would be more visible and encourage children to look at the books. Parents may choose to read to their children while waiting as well. The environment needs to be print-rich.

One method to consider for on-going program success may be to target well-child visiting hours for reading volunteers. A record could then be kept, documenting hours spent reading. The hours may be counted or assigned a monetary value for reporting and/or recognition of the volunteer groups or individuals.

A revised and redesigned literacy survey, Family Literacy—Short Survey (FL-SS) (Gramann, 2007), is suggested and can be found in the appendix for program evaluation. A few of the questions from the RORA survey are included with a new question. The addition of “have you used the reading corner in the waiting room to read to your children” would add another piece of information to program evaluation. FL-SS is a revision in answer to the call (ROR, 2001) to develop workable methods for monitoring ROR, and with modification, other family literacy programs, in an on-going basis.

Best Practices in Family Literacy
One goal of this study was to summarize how its findings inform best practices for application in family literacy programs. Findings support the following best practices in family literacy:

• To encourage parents to read early and often to their child.
• To model ways parents can read a book to their child.
• To repeat the reading message multiple times to the parents.
• To provide and assist the parents in locating children’s books for the child.

Parent perceptions are vital when educating about why it is important to read to the very young child. Early literacy begins at birth and is a lifelong endeavor (Neuman, 1998). Reinforcing that the very young child is ready to learn and methods to engage the child in literacy and learning activities should be repeated messages. Family strengthening and increasing family resiliency are indirect outcomes of an integrated family literacy program (Shonkoff, 2000). Literacy is a family affair, with modeling of reading being the critical element.

In conclusion, a Reach Out and Read participant shared the following comment about the ROR family literacy program:

“me ayuda para saber como mi hiña puede aprender mas cosas, y tambien a saber como se desarrollan sus avilidades como, leer, mirar colores y haser o tras cosas—

It helps me because my daughter can learn more things, and she also knows how to expand her abilities, like how to read, see colors, and other things.”

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