Reach Out and Read, United States of America

  • Date published:
    1 December 2015

Programme Overview

Programme Title Reach Out and Read (ROR)
Implementing Organization Reach Out and Read, a non-profit organisation
Language of Instruction English
Funding Since the existing infrastructure of the primary care system is leveraged, the literacy intervention has low overheads. To provide resources for the programme, donors at national, federal and local levels all come together, including in particular:
  • local and national foundations and corporations in eleven states such as book publisher Scholastic, the W. K. Kellogg Foundation, Target and Primrose Schools;
  • the ROR National Center itself, which typically raises about US$ 4 million each year;
  • regional coalitions, which collectively raise about US$ 8 million annually;
  • the actual ROR programme sites (the hospitals, health centres, and paediatric clinics), which raise several million dollars as well for books for their programme; and
  • corporations, foundations, individuals, in-kind book donations, and in some cases, government grants.

In former years the U.S. Department of Education used to support ROR.

Programme Partners volunteering paediatricians and paediatric nurses (using the good and trustworthy relationship between medical providers and parents), publishers (providing discounts), a network of private and public supporters, corporations, foundations and individual donors, 5,000 hospitals, paediatric clinics, and health centres nationwide
Annual Programme Costs about US$ 20 per child
Date of Inception 1989

Context and Background

The United States of America (USA) is a rich, industrialised country with a gross domestic product (GDP) per capita of US$ 51,749 in 2012 (World Bank, 2012). Since compulsory education lasts 12 years, from age 6 to age 17, educational attainment in terms of enrolment rates in primary and secondary education is at a reportedly high level. However, while there are no international literacy proficiency data available, according to the U. S. Department of Education (DoED) (National Center for Education Statistics, 2013) as much as 17.5% of adults (aged 15 years and older) in the United states hold insufficient literacy skills of level 1 or below . According to the 2013 OECD Programme for the International Assessment of Adult Competencies (PIAAC) (OECD, 2013), literacy performance in the United States is below the average of all OECD countries participating in the PIAAC survey. The literacy proficiency of 82% of Hispanic or Latino fourth-graders was not sufficient in terms of the Basic achievement of reading up to 129 words per minute in 2011. It is known that socio-economic background has a major impact on literacy skills and the PIAAC study shows both below-average performance in literacy as well as large social disparities in the United States’ educational sector.

Illiteracy is said to have has an impact on the ability of the United States to compete in the global economy. According to James Heckman (2011), the return on investment generated in the USA is 7% to 10% per year with every dollar invested in high-quality early childhood education. There are several family literacy approaches, such as the federal initiative Adult Education and Family Literacy Act (AEFLA), launched in 2001 to broaden the scope of educational activities to adults from deprived areas and their children, including those who speak languages other than English. In 2013 the USA adopted the Strong Start for America’s Children Act (Committee on Education & the Workforce, Democrats, 2013), which aims to foster high-quality early childhood education towards success in school as well as promoting parental spiritual support of their children in obtaining basic skills.

Addressing especially families with a lower socio-economic or migrant background, the family literacy programme Reach Out and Read (ROR) aims to contribute to improving the situation regarding primary education in the USA. Enabling young people to function in society, ROR also promotes family interaction through the access to and use of books.

The Reach Out and Read Programme

Reach out and read, a non-profit organisation, was founded in 1989 at Boston City Hospital in Boston, Massachusetts by paediatric physicians Barry Zuckerman and Robert Needlman as well as early childhood educator Kathleen Fitzgerald-Rice. Its national literacy programme tackles the problem that many children entering school are unprepared to learn. In recognition of the fact that parents are young children’s first and most important teachers, ROR was implemented as a national and federal family literacy programme. Based on the statements that early childhood experiences significantly affect achievements later in life and that young children learn best from caring parents, the programme intends to improve early language skills and fosters family communication and interactivity. At the core of ROR is the power of parents and the influence of children’s doctors, giving parents the main role in this programme through reading aloud to their children. This is complemented by encouragement and advice by medical providers, relying on their positive influence on children. In short, ROR helps prepare young children for school and life through providing developmentally-appropriate books (in some cases also bilingual books) and advising their parents about the importance of reading aloud.

Setting and Target Audience

The interventions take place in the setting of regular paediatric check-ups within the existing healthcare infrastructure, but the learning environment in the home of the families also plays an important role, because at home the parents take an active role when they are reading to their children. The programme is focused on families with a low socio-economic or migrant background.

Within special initiatives targeted at communities, such as Spanish-speaking, American Indian or Alaska Native populations, and children with developmental delays, the ROR intervention has been especially beneficial.

Aims and Objectives

ROR’s main aims:

  • to contribute to the advancement of sustainable literacy in the USA and
  • to ensure that all children grow up with a love of books and parents who read aloud to them.
    ROR’s objectives:
  • delivering literacy intervention to families;
  • changing parental attitudes and practices and promoting better parental care;
  • developing early reading skills and school readiness;
  • improving reading skills and literacy-related outcomes in school;
  • improving book availability and serving all children living in poverty by providing access to books to underserved families with limited access to print materials;
  • improving the overall well-being of the participating paediatric clinics’ communities; and
  • reducing the need for costly remedial education through preventative measures.

Programme Implementation

The programme was first implemented in 1989. In the beginning it focused only on providing books for paediatric waiting rooms, but it has since grown and today includes integration into the developmental surveillance element of regular so-called «well-child» check-ups for children aged from 6 months to 5 years. In the course of each visit, families are given one new and culturally as well as age-appropriate book so that they build up a home library of at least 10 books before the child enters school.

Teaching–Learning Approaches and Methodologies


With a special emphasis on children growing up in low-income communities, families are guided by paediatricians through the essential early years, engaging parents to become their child's first teacher by demonstrating how enjoyable and effective reading aloud with their children can be. In particular paediatricians ensure that families have developmentally-appropriate books at home and they show parents how to incorporate books into their daily life so that both parents and children discover the joy of the written word. Medical providers communicate to parents that reading aloud is just as vital to their child's school success as vaccinations, healthy food, and physical activity. Because of the trust inherent to the doctor-patient relationship, parents are more likely to take this read-aloud advice to heart than if they were approached by someone they do not know.

Using the book as the tool and the training from ROR, medical providers offer parents literacy advice which is incorporated into the well-child check-ups. Talking to the parents, they emphasise the importance of reading aloud as a way to help children develop foundational language skills, because most of the parents underestimate the importance of early exposure to language for brain development and its relation to the child’s success in school and beyond.

Training and Recruitment of Medical Providers and Volunteers

All ROR doctors and nurses are trained in the training model, which is being improved by ROR continuously. They learn how to choose age- and developmentally-appropriate books for children, and how to best introduce a new book during the well-child visit. There are also comprehensive training modules for special initiatives within the programme, which meet the needs of particular interest groups such as Spanish-speaking participants.


To take part in the programme, medical providers have to fill in an online application form and state their commitment to the Reach Out and Reach programme. Before starting to implement ROR in their medical practice they have to complete online training. While staff training is primarily done online, in some instances, face-to-face training sessions are held by medical providers experienced in the ROR model.

Volunteer readers – who may be retired professionals, young adults performing community service, stay-at-home mothers, or other individuals with daytime availability – spend time in the clinic or hospital waiting room and read to children who are waiting to see the doctor. These volunteer readers demonstrate a positive reading experience with children and model reading aloud for parents, providing helpful tips for getting children excited about books. They engage children around a story by pointing out pictures, using different voices for characters in the books, and ask questions about the story. These techniques, known as dialogic reading, help children learn from the books through their active involvement.

Institutional Arrangements between ROR and the Medical Partners

Approaching the target group is particularly easy using the existing medical infrastructure. None of the participating 20,0000 medical providers receive any payment because they include the programme in their work on a voluntary basis and incorporate the literacy intervention into their paediatric care. They do this because they believe in the power of literacy and the importance of reading aloud in the home.

Most of the medical providers have a local or state contact they can turn to with questions or thoughts about the programme, books, events and marketing materials. If there is no local contact in the state or region where the provider lives and works, they can contact the National Center in Boston from where they will be directed to the appropriate person.

Reaching the Learners

Parents and their children are only approached by participating paediatric clinics or offices. All visiting children from the ages of 6 months to 5 years and their parents automatically participate in the programme, receive books during the well-child visits, and advice from the medical provider about the importance of reading aloud in the home. Since the children and families, even those from poor socio-economic backgrounds, visit their paediatrician regularly (approximately twice a year) for well-child check-ups, follow-up during these visits is guaranteed by the medical providers. Each child takes part in the programme for 5 years.

Learning Outcomes

Schools conduct external vocabulary tests as entrance criteria. These tests are outside the scope of ROR, but they provide a good opportunity to assess the impact and success of the project.

ROR is an evidence-based intervention supported by 15 independent published research studies related to the medical sector. It is known that parents served by ROR are up to four times more likely to read aloud to their children than they would be without having participated, and that the programme really does reach the child through effectively teaching the parent to start lifelong learning in the home.

Monitoring and Evaluation of the Programme

Monitoring of the programme happens through bi-annual progress reports submitted by clinics, annual medical provider surveys and face-to-face evaluations. This allows for a nationwide comparison of clinics, identifying trends and addressing problems, coordinated by the ROR staff.

Impact and Achievements

Most families regularly visit paediatric clinics for well-child check-ups, although it is not compulsory to do so. This is the key for the programme’s great impact, because the result is that paediatricians are using a broad and powerful opportunity to reach children and families.

The programme is continuously expanding and new programme sites and medical providers are brought aboard each month. Without a doubt, ROR is making an impact on the participating children. During the preschool years, children served by ROR score three to six months ahead of their non-ROR peers on vocabulary tests. These early foundational language skills help start children on a path of success when they enter school.

ROR is endorsed by the American Academy of Pediatrics (AAP) and the National Association of Pediatric Nurse Practitioners (NAPNAP). Furthermore it received a four-star rating from Charity Navigator, denoting exceptional performance which exceeds standards and outperforms most charities in its cause. In 2013 the Library of Congress devoted the David M. Rubenstein Prize to the organisation.


In the course of one year, 4 million children have been served by means of 6.5 million distributed books and 20,000 medical providers. There were five thousand programme sites in 50 states and districts of the USA. Parents taking part in the programme were rated more receptive and mothers stated that they were two times more likely to read with their children than before taking part in the programme (Jones et al., 2000). Carrie Byington et al. (2008) indicate that the families were grateful for the engagement of the staff in the clinics and for the books received as well as doctors’ and nurses’ support in their family’s literacy advancement.

Research has shown that promoting literacy readiness according to the ROR model has affected parental behaviour and attitudes towards reading aloud as well as improving the language scores of young children who participate. As many as 15 independent peer-reviewed studies have proven that ROR has a positive effect on early development and the corresponding learning outcome. Research also found that the programme changed parents’ way of thinking, because they did not only read more often to their children (High et al., 2000), but also purchased more books (Theriot et al., 2003), improved their own language skills (Mendelsohn, 2001) and reported that reading was one of their three favourite things to do with their child (Golova, 1989).


ROR has been found to improve the receptive and expressive language scores of high-risk urban families as well as achieving that parents read out more often to their children. Moreover it has been established that there is a positive correlation between advancements in receptive and expressive language scores, the number of books purchased by a family and the number of read-enhanced well-child visits children have attended (Theriot et al., 2003). In cases where bilingual material is provided, the parents are also more likely to read out to their children than before (Golova, 1989).

In conclusion, while ROR reaches the child through effectively teaching the parent to start lifelong learning in the home, parents served by ROR are up to four times more likely to read aloud to their children than before, while the children are being well prepared to start school on target.


«My kids actually look forward to going to the doctor because they know they’re getting a book.»

  • A ROR mother –

«It is overwhelming to see my kids grow, to watch them learn, to know that I am a part of this process with them.»

  • A ROR father -


It has been difficult to engage medical providers in the project, since there is no direct advantage for them and besides they have to schedule extra time for their own training and for advising parents. Though initially the organisation faced a challenge in reaching the parents most in need because they are often the most socially isolated and might not come to a paediatric clinic, ROR is now operating in all 50 states and serves children in both urban and rural communities. Working through paediatricians is effective, because more children see a paediatrician in the early years than any other service provider.


For any non-profit organisation, funding is always a challenge. ROR is continuously seeking out new funding sources to further strengthen and expand the organisation. Given that ROR is a national organisation which has grown in a somewhat organic manner, keeping programme delivery strong and consistent across all providers has been a challenge. A few years ago, a Quality Improvement Initiative was established to ensure that high-quality delivery of the programme is maintained and to enable the medical providers to strengthen both their connection to ROR and the literacy culture of their clinics, because the success of the implementation is related to the culture of the clinic. In fact there were clinics which struggled to implement ROR, but in these cases a lack of communication was reported and the staff found their job burdensome. King et al. (2009) stated that in successful clinics the staff worked as a team and expressed strong commitments to their communities.

Lessons Learned

It has been experienced that the most likely problem ROR encounters relates to illiteracy or inexperience of parents in the role of a teacher. Therefore reading volunteers were engaged to support particularly those parents who were in need. Possible language barriers of parents and children are successfully addressed through providing bilingual books and encouraging parents to read out loud using their mother tongue in addition to the English language.

Furthermore, clinics struggling with implementation or programme quality receive additional, targeted support from ROR. Many parents think education starts in school. ROR is trying to combat that notion and engage parents to serve as their child’s first and most important teacher. Learning begins in the home, and begins with exposure to reading and language skills from birth. Accepting this idea can be a challenge for some parents, and ROR is always working to improve the delivery of that message.


The first indicator for a certain level of sustainability is the fact that ROR has been running continuously since 1989 and has been extended to its current nationwide operation. Second, it has achieved considerable increases in both receptive and expressive language scores for high-risk children. The responsible organisation Reach Out and Read has furthermore secured the sustainability of its programme through its cooperative agreements with various partners and support from the U. S. Department of Education. The strength of the organisation lies in its partnerships and its continuous efforts towards alignment with other like-minded organisations, foundations and individuals. ROR is thrilled to be celebrating its 25th birthday this year (2014) and is looking forward to one day serving even more children in the United States with literacy problems, especially those affected by poverty.


  • Byington, C. L. et al. (2008). The good habit of reading (El Buen Habito de la Lectura): Parental reactions to an enhanced Reach Out and Read program in a clinic for the underserved. Journal of Health Care for the Poor and Underserved. 19(2), 363–368.
  • Committee on Education & the Workforce, Democrats (2013). Support for the Strong Start for America's Children Act of 2013. Washington DC: Committee on Education & the Workforce Democrats. Available at: (Accessed: 25 February 2014).
  • Golova, N. et al. (1998). Literacy promotion for Hispanic families in a primary care setting: A randomized controlled trial. Pediatrics, 103(5), 993–997.
  • Heckman, J. J. (2011). The Economics of Inequality: The Value of Early Childhood Education. American Educator, 35(1), 31–35.
  • High, P. et al. (1998). Evaluation of a clinic-based program to promote book sharing and bedtime routines among low-income urban families with young children. Archives of Pediatrics and Adolescent Medicine, 152(5), 459–465.
  • Jones, V. F. et al. (2000) The value of book distribution in a clinic-based literacy intervention program. Clinical Pediatrics. 39(9), 535–541.
  • King, T. M. et al. (2009). The role of clinic culture in implementation of primary care interventions:
  • The case of Reach Out and Read. Academic Pediatrics, 9 (1), 40–46.
  • National Center for Education Statistics (2012). Program for International Student Assessment (PISA). Reading Literacy: Proficiency Levels. Alexandria. U. S. Department of Education. Available at: (Accessed: 25 February 2014).
  • OECD (Organisation for Economic Co-operation and Development) (2013). OECD Skills Outlook 2013: First Results from the Survey of Adult Skills. OECD Publishing. Available at: (Accessed: 25 February 2014).
  • ROR (Reach Out and Read) (2013). About us. Boston: Reach Out and Read.
  • Theriot, J. A. et al. (2003) The impact of early literacy guidance on language skills of 3-year-olds. Clinical Pediatrics. 42(2), 165–172.
  • World Bank (2011). World Databank: United States. Washington DC: World Bank. Available at: (Accessed: 25 February 2014).
  • World Bank (2012). GDP per capita, PPP (current international $). Washington DC: World Bank. Available at: (Accessed: 25 February 2014).


Judith Forman
Reach Out and Read National Center
56 Roland Street, Suite 100D
Boston, MA 02129-1243
info (at) reachoutandread.org

Phone: 617.455.0600
Fax: 617.455.0601
Web page: http://reachoutandread.org/

For citation please use

U. Hanemann (Ed.). Last update: 25 July 2017. Reach Out and Read, United States of America. UNESCO Institute for Lifelong Learning. (Accessed on: 31 May 2020, 16:52 CEST)

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