Maximizing the impact of reach out and read literacy promotion:anticipatory guidance and modeling.

BACKGROUND: Reach Out and Read (ROR) is a multi-component pediatric literacy promotion intervention. However, few studies link ROR components to outcomes. We examine associations between receipt of (1) multiple ROR components and (2) clinician modeling, a potential best practice, with enhanced home literacy environments (EHLEs) among Latino families. METHODS: We conducted secondary analyses of cross-sectional enrollment data from a randomized clinical trial at three urban community health centers between November 2020 and June 2023. Latino parents with infants 6-<9 months old were surveyed about ROR component receipt (children's book, anticipatory guidance, modeling) and EHLE (StimQ2- Infant Read Scale). We used mixed models with clinician as a random effect, adjusting for covariates. RESULTS: 440 Latino parent-infant dyads were included. With no components as the reference category, receipt of 1 component was not associated with EHLE. Receipt of 2 components (standardized beta = 0.27; 95%CI: 0.12-0.42) and 3 components (standardized beta = 0.33; 95% CI: 0.19-0.47) were associated with EHLE. In separate analyses, modeling was associated with EHLE (standardized beta = 0.16; 95%CI: 0.06-0.26). CONCLUSION: Findings support modeling as a core ROR component. Programs seeking to enhance equity by promoting EHLE should utilize such strategies as anticipatory guidance and clinician modeling in addition to book distribution. IMPACT: Reach Out and Read, a multi-component literacy promotion intervention, leverages primary care to promote equity in children's early language experiences. However, few studies link Reach Out and Read components to outcomes. Among Latino parent-infant dyads, we found that implementation of two and three components, compared to none, was associated with enhanced home literacy environments, following a dose response pattern. Parent report of clinician modeling was associated with enhanced home literacy environments. Literacy promotion programs seeking to enhance equity by promoting enhanced home literacy environments should utilize strategies in addition to book distribution, including anticipatory guidance and modeling, to maximize impact.

Feasibility and Acceptability of an Online Family Literacy Program in an Under-Resourced Community During the COVID-19 Pandemic.

OBJECTIVE: The objective of this study was to examine the feasibility and acceptability of an online family literacy program (FLP) among low-income Latino families during the COVID-19 pandemic. METHODS: We conducted a mixed methods pilot study. Latino parent-child dyads participated in an 8-week online FLP conducted on video conferencing software, developed through a cross-sector health care-education partnership. We conducted surveys and structured observation to assess feasibility and acceptability and in-depth interviews to gain insight into the context of participants' experiences during the pandemic. RESULTS: The 35 participating parent-child dyads all identified as Latino, 83% reported limited English proficiency, and 60% of parents did not achieve a high school diploma. Nearly two-thirds of families participated in at least half of the sessions. On average, parents welcomed, liked, approved, and found the program appealing. While 86% experienced a technology problem at least once during sessions, all were resolved with minimal assistance. During qualitative interviews, we identified 3 themes that provide insight into their experiences with the FLP within the broader context of the pandemic: (1) disruption in family routine and financial strain caused by COVID-19 intensified family stress, (2) the forced transition to remote learning highlighted the inequities experienced by Latino preschool children, and (3) the FLP empowered parents and enhanced health and education experiences. CONCLUSION: Latino families had high participation levels in an online FLP and found it acceptable. Additional work is needed to understand how similar primary care programs can be leveraged to promote optimal development during a time of heightened need.

Reach Out and Read Implementation: A Scoping Review.

BACKGROUND: Reach Out and Read (ROR) is an evidence-based literacy promotion intervention that leverages the near-universal access to children of primary care practices to promote optimal child development. While several studies document ROR's effectiveness, its implementation remains understudied. OBJECTIVE: This scoping review examines the existing literature to better understand ROR implementation. DATA SOURCES: PubMed, ERIC, Web of Science, Academic Search Premier, ProQuest Education Database, and CINAHL. STUDY SELECTION: We included peer-reviewed English-language papers focusing on ROR in an ambulatory setting in North America. DATA EXTRACTION: Extracted variables were informed by the Template for Intervention Description and Replication checklist and included publication year, title, author(s), clinic location, study design, study aim, ROR implementation, modifications, implementation assessment, barriers, facilitators, and outcomes. RESULTS: Seventy-one papers were included, of which 43 were research articles. We identified substantial variation in ROR implementation including differences in components delivered. A considerable number of research articles did not assess ROR implementation. The most common barriers to ROR implementation were at the system level (ie, financing and inadequate time). Modifications and enhancements to ROR are emerging; most address barriers at the clinician and family level. LIMITATIONS: This review was limited to published English language papers focusing on ROR. CONCLUSIONS: ROR implementation varies across studies, and many did not assess implementation. Consistent reporting and assessment of ROR implementation could create opportunities to better understand the mechanisms underlying ROR's effects and inform other early childhood interventions that seek to promote optimal development at the population level.

A Mixed-Methods Investigation Examining Site-Level Variation in Reach Out and Read Implementation.

OBJECTIVE: Reach Out and Read (ROR) is an evidence-based early childhood intervention that has been implemented at scale, yet description of ROR implementation is inconsistent. This study engages implementation science to examine ROR delivery and site-level variation. METHODS: As part of an ongoing clinical trial, we conducted a mixed-methods study in 3 community health centers (CHCs) that serve low-income Latino families. We integrated quantitative parent survey data, qualitative data from monthly key informant interviews with ROR site leaders over 1 year, and in-depth interviews with 18 additional clinicians. At enrollment, parents reported whether they received a children's book, guidance on reading, and modeling from clinicians. We analyzed quantitative data using descriptive statistics, and qualitative data iteratively engaging emergent and a priori codes drawn from the Template for Intervention Description and Replication Checklist. RESULTS: Three hundred Latino parents (mean age: 31; 75% ≤HS education) completed surveys. The mean child age was 8 months. Overall, most parents reported receiving a book (84%) and guidance (73%), but fewer experienced modeling (23%). Components parents received varied across CHCs. Two themes emerged to explain the variation observed: 1) differences in the perceived purpose of shared reading and book delivery aligned with variation in implementation, and 2) site-level barriers affected what components were implemented. CONCLUSION: Because of substantive variation in ROR implementation across sites, systematic descriptions using established frameworks and corresponding measurement to characterize ROR implementation may enhance our understanding of mechanisms underlying ROR's effects, which clinicians and policymakers can use to maximize ROR's impact.

Parental Depression Screening in Pediatric Health Care Settings: A Scoping Review.

BACKGROUND AND OBJECTIVES: Parental depression affects as many as 1 in 5 US families. Pediatric professionals can play an important role in detecting parental depression, yet most studies on parental depression screening focus only on the postpartum period. The authors performed this scoping review to understand the existing literature on parental depression screening outside the postpartum period (child >12 months old) and to identify knowledge gaps. METHODS: Sources for this research include PubMed, CINAHL, SCOPUS, Web of Science, and APA Psych Info. We included English language papers concerning screening for maternal and/or paternal depression or mood disorders outside of the postpartum period by pediatric clinicians or in a pediatric health care setting. Extracted variables included publication year, title, author(s), country, geographic setting, clinical setting, child age range (in years), parental focus, sample size, study type, approach, screening instrument(s), and findings. RESULTS: Forty-one papers were included. The proportion of positive parental depression screens was consistently high across the included studies. Relatively few structured screening programs outside of the postpartum period were identified, especially for fathers. The included studies suggest that screening can be accomplished in pediatric settings, but appropriate referral and follow-up of positive screens poses a major challenge. This review was limited to English language papers concerning parental depression outside of the postpartum period. CONCLUSIONS: These findings suggest that screening for parental depressive symptoms outside the postpartum period could identify families in need of support. Research is required to identify best practices for referral and follow-up of parents who screen positive.