Quality Improvement project to increase the rate and quality of pediatric residents’ discussion with patient and family on the topic of literacy

Background: Early language and literacy skills in kindergarten and 1st grade predict later reading success but more than 1/3 of children ages 3-5 years old were not enrolled in school in 2017. 37% of 4th graders are also performing below basing reading levels on national standardized tests. Pediatric providers see children 0-5 years old 10x via well-child checks (WCC) can evaluate the language skills of children and give parents the tools and resources to prepare their children for kindergarten.

Aim: By July 2020, 100% of residents will complete Reach Out and Read (ROR) program training to facilitate literacy discussion and 100% of patients 6-month to 5-year old at Sacramento County Health Center (SCHC) will receive language-appropriate developmental surveillance and promotion.

Methods: Conducted semi-structure qualitative interviews with parents, collected self-reported baseline and post-intervention rates of discussion on literacy and book distribution during WCC, ran four PDSA cycles to identify ways to increase the rate and quality of literacy discussion.

Results: PDSA1: Identified need and desire among parents for discussion on literacy and 0% of residents received formalized training in facilitating discussion on literacy. PDSA2: Identified lack of age-appropriate books at the clinic and the need for literacy materials in Dari and Pashto (spoken by 33% of the children at SCHC). Prior to providing the residents training on ROR, 54% of parents report receiving books and 38% report having literacy discussion. PDSA3: Applied and received a CMN grant to purchase >400 books in Dari and Pashto and translate literacy materials. Held multidisciplinary meetings between community leaders to identify additional resources for the Dari/Pashto-speaking families. PDSA4: Implemented Dari and Pashto interventions. 100% of residents had received training on ROR, 95% of parents reported receiving books and 80% reported discussion on literacy.

Conclusion: This project helped to better understand the diversity of the patient population served by the SCHC, identify a disparity in language-appropriate resources, and provide opportunities for collaboration between FQHCs and UC Davis Health. Residents received training to facilitate discussion on literacy, which can promote kindergarten readiness over time. The next steps are to address the sustainability aspects of promoting literacy discussions while continuing to meet with community groups as the community grows and changes

Resident Statement of Involvement: I conceived of idea for this project, applied/obtained multiple IRB approvals, enrolled subjects, conducted several PDSA cycles, performed data analysis.