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Published in Print: January 21, 2015, as Doctors Enlisted in Early-Literacy Campaign

Doctors Enlisted to Deliver Early-Literacy Message

Palmira Miller holds her daughter, Isabelle, at a wellness checkup with nurse Tesfa Gemechu at UCSF Benioff Children’s Hospital in Oakland, Calif. They are accompanied by Isabelle’s half-sister, Mayah, 3. A project at the hospital promotes the value of reading, talking, and singing to young children.
Palmira Miller holds her daughter, Isabelle, at a wellness checkup with nurse Tesfa Gemechu at UCSF Benioff Children’s Hospital in Oakland, Calif. They are accompanied by Isabelle’s half-sister, Mayah, 3. A project at the hospital promotes the value of reading, talking, and singing to young children.
—Ramin Rahimian for Education Week
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Doctors are the newest group of proselytizers to join the national Too Small to Fail campaign encouraging parents to talk, read, and sing to their infants and toddlers as a key precursor to literacy.

The American Academy of Pediatrics has long recognized the importance of telling parents to talk to and read with their children. But it has only recently begun advising its doctors to deliver that message for the first time at a child's two-month checkup. What has been less clear, and never studied systematically, is how to deliver that information in a way that sticks during the 12- to 18-minute visits physicians generally have with families for well-baby checkups.

That's where Too Small to Fail comes in. Working closely with doctors in Oakland, Calif., and Tulsa, Okla., leaders of the nonprofit effort hope to prove that medical professionals can provide parents with the tools and information they need to improve their child's vocabulary and early-literacy skills. Researchers at the University of California, San Francisco, will be tracking the results of the program, which is rolling out at two hospitals in Oakland right now.

"In order for this to be effective across the country, it needs to be honed down to its key elements," said Dr. Kelley Meade, the associate director of primary care at UCSF Benioff Children's Hospital, one of the participating hospitals. "Hopefully, our evaluation will inform which messages stick with parents."

Firsthand Look

Efforts to improve early literacy are underway in a number of cities, including Providence, R.I.; Camden, N.J.; and Huntsville, Ala. Each city is taking a slightly different approach to the problem—from Sunday school classes to book giveaways—but all involve parent education about what they can do to help their children succeed.

Five-month-old Anselmo Santos, nicknamed "King" by his mother, is one of the participants in the Oakland initiative. Hand him a book, and he glances at the pictures. More pressingly, he'd like to know how it tastes.

Seated in his mother's lap in the primary-care clinic at USCF Benioff Children's Hospital on a recent day, Anselmo chewed on a cardboard book as his pediatrician, Dr. Dayna Long, explained the importance of talking, reading, and singing to brain development.

Despite Anselmo's apparent lack of interest in the conversation, the number of words he hears between now and his 3rd birthday will contribute significantly to this critical period in his brain's development, Dr. Long told the boy's mother, Nicole Wright. Eighty percent of a child's brain develops by age 3, Dr. Long said.

"You taught me something I didn't know," Ms. Wright said when she heard that figure. "I talk to him from the time he gets up until the time he goes to bed. It's something we're already doing, but we'll do it even more."

That's exactly the response Dr. Long had hoped to hear.

Word Deficit

Research has shown that children who grow up in families on public assistance are exposed to as many as 30 million fewer words than their peers in families holding professional jobs by the time they're 4 years old. Ninety-five percent of the Oakland clinic's patients are enrolled in MediCal, California's version of Medicaid.

An insufficient vocabulary can slow children down so much that they're not reading on grade level by the time they reach 3rd grade. Children who don't hit that milestone are more likely to drop out before high school graduation. The theory behind the growing number of early-literacy campaigns is that closing the word gap before children start school will help keep them on track to graduate.

Too Small to Fail's doctor strategy banks on two key facts: Doctors are one of the most trusted sources of information for new parents. And doctors have nearly immediate access to new parents, allowing them to deliver the message early enough in a child's development for it to make a difference.

While the research is clear that children who know more words when they start kindergarten are better off academically, an understanding of how to ensure they know enough words is still emerging. Adding a few more minutes of doctors' time and a tote bag of goodies to one of the 12 regularly scheduled well-baby visits before a child turns 3 is just one attempt to remedy the problem.

"Is it the polio vaccine? No," said Crystal Gariano, the program assistant for the new effort at the Oakland clinic. "Is it just as important? Yes."

The book Anselmo was chewing on was one object in the tote bag parents in the participating clinics will now receive. Also inside was a baby blanket printed with the message, "Let's talk about bedtime," and prompts like, "Let's read a bedtime story." An infant bodysuit with similar language, a "Sesame Street" cd of "silly songs," and some handouts explaining early brain development were included as well.

Mayah Miller, 3, right, spells out the words on a sign as she waits with her half-sister, Atalina Carter, to see a doctor for her wellness checkup.
Mayah Miller, 3, right, spells out the words on a sign as she waits with her half-sister, Atalina Carter, to see a doctor for her wellness checkup.
—Ramin Rahimian for Education Week

Much of the program was paid for with a $3.5 million donation from private funders Marc Benioff, the founder and CEO of Salesforce.com, a global cloud computing company based in San Francisco, and his philanthropist wife, Lynne Benioff. Additional donations for the program have come in from the George Kaiser Family Foundation, the Bay Area Council, and others. The messaging—which can also be found on billboards and at bus stops throughout Oakland—was coordinated by the organizations collaborating on Too Small To Fail, primarily the Bill, Hillary & Chelsea Clinton Foundation and Next Generation, a San Francisco nonprofit focused on early learning and climate change.

In a companion undertaking, Oaklandish, the local retailer that designed the blankets and clothing in the tote bags, is selling them online in hopes that its trendy clientele will buy them for their own children. When they do, Oaklandish will donate a matching item to a family at the clinic, thereby privately funding the distribution of the items to families in need.

The Tulsa campaign, meanwhile, is being spearheaded by the religious community. In that city, a group of pastors with weekly access to nearly 14,000 families there have taken up the talk-read-sing mantle alongside their medical brethren. In addition to working the message into their weekly sermons, pastors at several churches have started family nights for their parishioners focused on teaching parents not just to read to their children, but to read with them the way a preschool teacher might. That means pausing to ask their children questions about the story or to count the windows in an illustration of a house.

Counting Words

In Providence, researchers are conducting a randomized study that involves electronic counters to measure the number of words children hear on a daily basis, as well as support for the families. Some of the 81 families in the study are simply using devices to keep track of the number of words they exchange with their children, while others are getting support to help them increase the quantity and quality of those words.

In Camden, N.J., efforts involve exposing children to books as early and often as possible with book-giveaways at local family centers and through a Head Start program. Huntsville, Ala., officials have started holding parent-child group meetings focused on encouraging talking and reading.

And in Chicago, another study is underway which begins offering support and education to women mere hours after they first become mothers—right in the maternity ward.

Kathy Hirsh-Pasek, a psychology professor at Temple University in Philadelphia, said that while talking to toddlers is important, too much emphasis on "filling a gap" in vocabulary could lead to the belief that just raining words down on a child is enough to build language.

Ms. Hirsh-Pasek was the lead author of a study that found higher-quality parent-child interactions at age 2—in which parents ask children questions, for example, instead of just talking at them—were more proficient at age 3.

"It goes way deeper than language," Ms. Hirsh-Pasek said. "Children are not going to be ready [for school by age 5] if we don't build relationships between adults and children early."

Dr. Long and her team in Oakland seem to have received that message.

Related Blog

"Our focus here at Children's is to really look at the social determinants of health—where a child eats, sleeps, plays, prays, and goes to school," Dr. Long said. "It's about building resilience."

Early language and the steppingstone to education it provides is "inextricably linked to health," she said.

The Oakland team hopes to enroll 500 to 1,000 families in its talk, read, sing program this year by handing out the tote bags at two-month and 18-month checkups and asking families to participate in a series of surveys to determine what they know about brain development and how, if at all, the information and tools they receive at the hospital change their level of knowledge or their behavior.

"It's such a simple thing," said Dr. Bert Lubin, the hospital's CEO and a champion of the program. "If [parents] appreciated the value of it, they would do it."

Vol. 34, Issue 18, Pages 1,14-15

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