Reaching for funds: The fate of the Massachusetts program of Reach Out and Read hangs in the balance

“Chicka Chicka Boom Boom! Will there be enough room?” ask Bill Martin Jr. and John Archambault in Chicka Chicka Boom Boom, a children’s book about anthropomorphized roman alphabets trying to climb a coconut tree. The book is part of the recommended readings for infants and toddlers given by the Reach Out and Read program — a program that is currently asking the same question – will there be enough room? — of the budget in 2018.

When Massachusetts Governor Charlie Baker announced budget cuts in December 2016, members of the Reach Out and Read (ROR) program were surprised to find their program’s funding eliminated. “It’s such a non-controversial and beloved program,” says Dr. Seeta Badrinath, medical director of the program at the Boston Children’s Hospital. “It was definitely a surprise that our funding was slashed.”

Now a national program, ROR first began at Boston City Hospital (now Boston Medical Center) in 1989. Its aim was to promote school readiness and early literacy skills among children between 6 months and 5 years old, particularly those who are at increased risk for reading failure- low vocabulary and communicative skills causing increased difficulties such as poor grades, a dislike of school, frustration, low self-esteem, and behavioral problems. It does that by training doctors and nurses to encourage reading and making it a part of regular health check-ups. The program showed dramatic growth by 2001, ultimately bringing the model to all 50 states- 14 of which, including the Massachusetts program, were government funded. By 2015, there were approximately 5,800 Reach Out and Read programs in the U.S.– 6.5 million books distributed to 4.5 million children.

At each check-up, physicians give children their own brand new, developmentally and culturally appropriate book to take home. They also encourage parents to spend time with their children and engage in the reading process. “It’s just such an important experience between parent and child,” Badrinath says. “I personally think that even at zero months, parents should read to their kids. Not only have studies shown that this helps with bonding, because children instinctually recognize their parents’ voices, but it also helps stimulate areas of the brain that pertain to literacy and language skills.”

Her favorite books to hand out are Dr. Seuss titles. Badrinath says that not only do Seuss’ books establish likeable and recognizable characters, but their content is informative and presented in rhymes, which help aid phonological awareness.

When a four-year-old boy whose development Badrinath has been closely monitoring picks up Ten Apples Up on Top! and successfully pronounces the name of the fruit, her face lights up in tandem with the boy’s mother’s.

Kids like him populate the waiting room of the Boston Children’s Hospital. The program runs out of its primary care wing, a bright corner of the hospital located on Longwood Avenue. The walls have hues of purple, pink, green and blue. Large stickers of potted plants, polka dots, butterflies, and birds decorate them. A stitched collage of animals hangs in a corridor. Across from it sits a young mother, cradling her infant son against her chest. Her daughter sits beside her and counts the animals on the collage. To keep the young girl further occupied, the mother asks her to identify the animals. She identifies the first one as a kangaroo, then sings Happy Birthday to it. A physician walks up to them and smiles at the mother, “Are you ready to go in?” He’s carrying a book.

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But why doctors and nurses? Why not mailmen, or ice cream sellers, or anybody else who can hand a child or a parent a book? “It’s because as pediatricians we’ve got, essentially, what is a captive audience”. Badrinath explains.  “We’ve done the research; we know the developmental signs. The parents rely on us for knowledge about health and vaccines, so why not even books?”

The doctors’ crucial insight becomes even more significant in the case of special needs children—those suffering from autism, cerebral palsy, attention deficit hyperactivity, low vision or blindness, and hearing loss or deafness.  ROR has special recommendations for all–each category further divided by age groups. An infant or toddler with autism should have Lots of Feeling by Shelley Rotner read to him or her, according to the program, while a school-aged child should be read Bernard Waber’s Lyle Lyle Crocodile.

Brain imaging studies by Dr. John Hutton, demonstrated that reading aloud increased development of regions of the brain associated with learning to read and higher thinking processes. Dr. Adriana Weisleder used a device that digitally records and analyses the number of words heard by young children (known as LENA), to show that ROR successfully stimulates an overall increase in the number of words and conversational turns between families and their young children. A separate assessment of the training for resident physicians (which is conducted online) on how to implement ROR for children by Dr. Anna Miller-Fitzwater, found the program applicable and practical and that families were receptive to the concept.

Studies advocating for the program have been aplenty, bringing gravitas to the program’s motto: Reading is doctor recommended.

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In Massachusetts, ROR sets up programs in “gateway cities” such as Brockton, Fall River, New Bedford, and Quincy – former manufacturing towns that once acted as a “gateway” to the American dream, but now face socio-economic challenges. “Most of the practices the program partners with also have about 70 percent of their patient populace receiving health through Mass Health or Medicaid,” Badrinath says. “And even for the 25 to 30 percent that have private insurance, buying books can be a luxury. So it’s great that we can provide the books until they get to kindergarten and begin officially learning.” Lyra, Badrinath’s four-year-old daughter, gets a book every time she visits too (Badrinath’s colleague is Lyra’s pediatrician), and finds it to be the highlight of her visit.
Studies have shown that low income families are less likely to have books in their home, Badrinath says. The lack of books and reading time means a lack of brain stimulation and exposure to language, eventually leading to falling behind more privileged students, before they even begin schooling. “But once we have the child come in, it doesn’t matter what their background is, we give books to all who fall in the age group.”

But those who fall outside the age group get books too. The waiting room has a stack of gently used donated books—carefully monitored so as to not include any that are sexist, racist, or otherwise inappropriate.  These books are separate from those on a “recommended reading” list the program follows, and include classics like Black Beauty. Their purpose is to minimize addiction to “screen time.”

Alex Grun, a sophomore at Northeastern University who volunteers for the program, knows the struggles of competing with technology. “I don’t stand at chance when there are too many distractions like iPads or cellphones that [kids] would rather play games on,” he says. As we speak, the TV in the waiting room is turned on. Mickey Mouse Clubhouse has the kids’ attentions.  “The older kids get distracted by the TV or other technology. The younger ones sometimes would rather just draw.”

He asks a girl (one who isn’t busy doing the ‘hot dog dance’ to Mickey Mouse’s commands) “Hey, would you like to read a book?” She sticks her finger in her mouth and shakes her head no. “You get used to the rejection,” Grun adds with a shrug.

He decides to try his luck with a kid who’s busy watching the TV. This time, his question receives a different answer. Although hesitantly, the young boy nods his head and turns his body slightly away from the TV.

Grun begins to read Scooby Doo! Snack Snatcher. As the tale moves forward, so does the boy. His body has now turned completely away from the TV, and his eyes move along with the lines on the page. “Did you like that?” Grun asks the boy when he’s done. He gets two thumbs up in response, which he returns with a comical grin. The girl who had rejected Grun’s offer giggles. She has been listening this whole time.

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But what is the fate of the program in Massachusetts, where doctors serve 204,927 children at 295 clinical locations, now that the budget has been axed for the second time? Baker’s first veto, which cut $300,000 for the 2016 financial year, was overridden by the House and Senate, as was his first attempt to eliminate, in the 2017 fiscal year, the entire million-dollar state funding the Massachusetts program used to receive. Baker cut the funding again in December under Section 9C of the state finance law, which allows cuts when state revenues don’t match the budget.Staff has been laid off (including four regional coordinators) and hours have been cut back. The program is now entirely dependent on donations — both that of old books, and monetary generosities by private institutions. Their “recommended reading” stack is dwindling.

“We did an inventory just before the cut, and had ordered some books beforehand, so we haven’t quite run out yet,” Badrinath says. “But if you do the math, it comes down to around 700 books a month that we hand out just at BCH as a location. Overall, it’s hardly a sustainable number without state funding.”

The governor’s office, in its defense, said that lower than expected revenues, previous veto overrides by the legislature, and costs associated with the Department of Corrections and Medicaid led to the larger $98 million cut, which involved slashing funds to Reach Out and Read. Colleen Quinn, Communications Director of the Executive Office of Education said that “while Reach out and Read has a track record of success, it operates independently as a successful non-profit organization, and is not part of the Department of Early Education and Care’s competitively bid early education grant programs.” Quinn further added that the governor’s 2017 budget endured a continuity of services for all children served in state-subsidized early education, including $12 million to support the continuation of child care for 1,700 children from homeless and low-income families.
Yet, the state decided to waive $839,000 in fines for Keolis Commuter Services’ train delays and poor service during the winter of 2015 (which Baker labeled as the “acts of God”)- an amount that could easily have sustained ROR services for the fiscal year.

So how has ROR responded? Remaining staff and volunteers have sprung into action: calls to the governor and legislators, book drives, and calls for private donations are on the rise.
Reach Out and Read Massachusetts held four “flash briefings” for legislators on March 21 to spread the word to elected officials and their staffers about the importance of funding needed for the development of the Commonwealth’s youngest children. Legislators attending included Representatives William “Smitty” Pignatelli, (D) 4th Berkshire; William Crocker, (R) 2nd Barnstable; Christine Barber, (D) 34th Middlesex; and Natalie Higgins, (D)  4th Worcester.

The program’s Director of Development for Massachusetts, Christine Garber, and Director of Leadership Giving, Kelly Taranto, acquired an emergency grant from the Funder Collaborative for Grade Level Reading. “The focus right now is to just make it to the next year without disrupting operations, in the hopes that our funding will be re-established,” Badrinath explains.

But that is easier said than done, since “all the time our residents or volunteers spend lobbying, or organizing book fairs, and finding other resources for private donations is time they could be spending reading to kids.”

Ann Piccione, a senior in Health Science at Northeastern University, is trying to find a solution to this problem. She’s been shadowing Badrinath, observing, and volunteering for the program as part of her capstone thesis, and is essentially looking into ways to improve quality, efficacy and delivery.

“I’m still working on the recommendations, but where I truly see potential is in partnerships with public libraries,” Piccione says. “So that’s what I’m personally working to organize, because I have seen the difference it has made in kids’ lives. I really do believe in the research that stands behind the program.”

04/21/2017

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