It’s no longer enough for students to show up to kindergarten able to tie their shoes and share classroom toys. With formal reading instruction starting earlier than ever, kindergarten readiness expectations have expanded to include foundational early literacy skills, such as recognizing letters of the alphabet and rhyming. Students who enter kindergarten without these precursory literacy skills may soon fall behind.
There’s no guarantee that preschoolers are learning these skills at home or at a school-based program. Nor, until recently, was there a way to reliably assess whether preschoolers were learning them. Leaders at Nationwide Children’s Hospital in Columbus, Ohio, saw the need for this to change.
The hospital recently launched a kindergarten readiness program that integrates early literacy screening into routine pediatric visits for 3- and 4-year-olds at its clinics serving primarily families enrolled in Medicaid. During the brief interventions, families also receive easy-to-apply literacy strategies and resources to use at home, and connections to local education resources.
The screening assessments address an immediate need in the community that feeds into Columbus City schools, which most children screened through the hospital program will eventually attend. More than 63% of the district’s kindergarteners tested below grade level on language and literacy skills during the 2024-25 school year, according to state kindergarten readiness assessment data.
Education Week spoke to Dr. Sara Bode, medical director for the hospital’s school-based health program, about the initiative bringing literacy screening to pediatric checkups. Bode explained why the hospital took on an initiative generally reserved for educators, how the program works, and why she sees health-care providers as natural partners in supporting young children’s literacy development.
The interview has been edited for length and clarity.
Where did the idea for Nationwide Children’s kindergarten readiness program originate?
We partnered with Dr. John Hutton, a pediatrician who was at Cincinnati Children’s Hospital Medical Center when he developed the Reading House, a children’s book designed to be used to assess emergent literacy skills in 3- and 4-year-olds during pediatric well visits. Hutton published a study on how it could be used as a screening tool in pediatric settings, but he implemented it only in a research setting that served as a specialty reading clinic.
We decided to see if we could use this screening tool in a traditional pediatric setting, where providers are busy seeing all these kids for well checks. We wondered: Is this even feasible?
What kinds of skills do these early literacy screening assessments look for?
Even when the kiddos are just 4, we’re trying to see if they recognize rhyming patterns and letters, and whether they are starting to sound out their letters. An example of a question this literacy screening tool asks is: Can you find an object on the page that sounds like the one that we’re pointing to, like “ball” and “wall.”
When did the literacy screenings get underway, and where do they stand now?
We launched in November of 2023, and we’re in seven clinics right now. These are traditional, busy pediatric practices that are owned by Nationwide Children’s Hospital. About 75% of our families across these practices are on Medicaid; the clinics are located in areas of pretty high need. We screen every child when they come in for their 3- and 4-year check ups.
Do the families know in advance that this early literacy screening will be part of the well visit?
They don’t typically know when they check in for their visit. After the [health care] provider does everything they need to do, one of our kindergarten readiness coordinators comes into the office and introduces themselves to the family, describes what the program is and what we’re doing, and then conducts the screening with the child. It lasts about five minutes. Most of our coordinators have a certification in early childhood education, like preschool teachers. The best thing about this exchange is that the parents are watching.
Why is this important?
It becomes a teachable moment. The parents see, as the screener is turning the pages of the book, what a 3- or 4-year-old should know, what questions we’re asking the child, and how we’re working with that child. There are a lot of “aha” moments that go on in the clinic.
What happens after a child completes the literacy screening?
The coordinator spends about another five to 10 minutes with the family, describing activities they can do at home to get their child ready for kindergarten. They give them a kit with workbook activities and materials to use. And then they talk with the parent or caregiver about the child’s education. They ask: Are they in preschool? Have they done any home programming? And, because the coordinators are experts on their local community, they work to think about what available resources would be best for this family.
Does any follow-up take place?
Yes. The coordinator works to get families connected to local educational resources. Rather than just giving them a referral, they actually work to connect families to programs. They follow up with the family afterwards by phone over the next three months to make sure they are actually linking to those services.
Do the coordinators talk with families about reading at home?
Yes, that’s a huge part of it. We definitely are promoting the idea that parents are the best first teachers. Coordinators talk to families about letting children explore books, and they talk about how to read to children, covering things like: How do you share a book with a 3-year-old who has a very limited attention span? What kind of questions do you ask on each of the pages of a book? The education that goes on with families is key.
What kind of feedback are you getting from families?
It falls mainly into two buckets. Sometimes we see kids who may be in a preschool program, and they are knocking it out of the park: They’re answering the questions, they’re telling us letters, and the caregivers are just astounded. They didn’t know their child knew any of that, because maybe they’re not doing those activities at home. That gives us the opportunity to say to them: “Look how amazing this is! Your child is doing great, but this is what you need to build on at home.”
If we have a child who maybe is not answering any of these questions, it’s a light bulb moment for the parents, as in, I didn’t know my child was supposed to be able to do this. Then there’s a sense of urgency from the parent, like: “K, what do I need to do next?” That’s another reason that doing these assessments in front of parents is a key part of the process.
Do you partner with schools in any way?
There are a couple ways we partner with schools. Columbus City school district is our local public school district. They have some preschool classrooms, and the majority of the kids we’re seeing are going to attend kindergarten within that district. So when we first started this program, we met with folks in the district’s kindergarten program to understand, from the teachers’ perspective, what they are looking for in early literacy skills. We used that feedback when we were coming up with activities and recommendations for parents to do at home with their kids, so it aligns with what the kindergarten teachers will expect that first quarter. It’s really helpful to make sure we’re all on the same page.
Are you tracking the program’s effectiveness?
Yes. We have a data-sharing agreement around every kindergartener in Ohio who takes a readiness assessment in the first quarter of kindergarten, administered by a teacher. We’re tracking the results of that test and following the kids who took our screening assessment when they were 3 or 4. We want to see how effective our program was in both connecting families to resources and what happened when they started kindergarten—were they ready or not?
Our first glance looks good; we’re definitely seeing a lot of gains. But we have to do a little more analysis on the data.
Where does support for the program come from?
Nationwide Children’s Hospital has prioritized thinking about how we, as a health-care institution, can influence what we call pediatric vital signs: measures of the well-being of children that aren’t part of traditional health care. The hospital picked kindergarten readiness as one of eight initiatives. So it’s been a commitment of the hospital to get this kindergarten readiness program off the ground. We’ve also been able to get some local philanthropy dollars from different organizations to help grow and expand the program. And we partnered with Future Ready, a nonprofit that advocates for school readiness in our community.
Approximately how many children have been screened so far?
We’ve done over 3,000 screenings since the start of the program, and it’s growing quickly. We started with one pilot site. Now we’re in seven clinics. At this point, we’re screening several hundred kids a month.
Do you see this initiative as a logical part of pediatric care?
I think it’s such a natural fit. As a pediatrician, you see a child for all of their checkups—15 times before they start kindergarten. You have a trusted relationship with the family, which is bringing their child to you to make sure they’re healthy. Educational success is one of the most important determinants of a child’s health. In pediatrics, we are already doing this developmental screening. This is just really adding an additional layer of awareness for the family.
How do you see initiatives like this bringing pediatrics and early educators closer together?
This has really opened up some channels of communication. We’re getting better at communicating with school districts, but we have a lot of work to do. For instance, we aren’t sending the [early literacy assessment] scores to whatever school program a family decides to enroll their child in because we don’t have that structure set up yet.
The early childhood space is even more fragmented than K-12. There are so many pockets of private, local preschool programs. And a lot of these early child care programs don’t communicate with the local school district. So when you go from preschool to kindergarten, there may be zero communication about what teachers found in the preschool setting. We’re trying to think about how we can get a coalition of folks together that can all talk and think about how we are sharing good communication. What I think we still need to solve, overall, is how the health-care system can better communicate with the education system.
