Healthy Schools

Early education…in the doctor’s office

Stepheny Renteria, six months old, tentatively took the brand new board book from pediatrician Meghan Treitz just as the check-up began. It was called “Dulces Sueños,” or “Sleepy Heads.”

Sitting in her mother’s lap in a sunny exam room at the Child Health Clinic at Children’s Hospital in Aurora, she gazed wide-eyed at the book’s baby faces. She turned it upside down. She brought it to her mouth as if she might take a bite out of it. A few minutes later, she dropped it on the floor.

Stepheny Renteria, who is six months old, takes a new board book from Dr. Meghan Treitz at a Children's Hospital clinic in Aurora.
Stepheny Renteria, who is six months old, looks at a new board book held by Dr. Meghan Treitz at a Children’s Hospital clinic in Aurora.

While Stepheny played with her new book, Dr. Treitz spoke to Stepheny’s mother Maria Giron about the importance of reading, using a phone interpreter to translate her words into Spanish.

It only took a few minutes, but Dr. Treitz and others who hand out free children’s books and reading advice at routine doctor visits through the “Reach Out and Read” program believe it makes a difference for the low-income families it targets.

The same is true of another early childhood program called Colorado Bright Beginnings, which encourages all parents, regardless of income, to talk to, read to and play with their zero to three-year-old children, usually through doctor’s office visits or home visits by volunteers.

As advocates pay more attention to the power of early exposure to language, many of the most well-known programs are far from meeting demand. In Colorado, only a small fraction of young children are served by programs like Early Head Start, Head Start or intensive home-visiting programs.

Programs like Reach Out and Read and Bright Beginnings step into that void with a unique offer: to reduce early literacy deficits at a much lower cost and on a greater scale. Plus, by connecting with so many families at clinics or other medical establishments, both programs capitalize on the fact that during the early years of their children’s lives, many parents have their only contact with trusted professionals in health care settings.

The importance of starting early

It may seem strange that babies would be the focus of school readiness efforts when they are years away from entering a classroom, but there’s lots of evidence to support the idea that the first years of a child’s life are critical to future success.

One often-cited piece of evidence is a book published in 1995 called “Meaningful Differences in the Everyday Experience of Young American Children.” In it, two university professors, Betty Hart and Todd Risley, share findings from their painstaking study examining how and how much parents of difference socioeconomic statuses talk to their babies and toddlers.

A stack of Bright Beginning bags containing books, learning games and parent guides.
A stack of Bright Beginning bags containing books, learning games and parent guides.

“It was an amazing study,” said Treitz.

One of the most jarring results from the research, she said, demonstrated that babies of higher-income parents begin pulling away from the pack in terms of vocabulary size at just 14 months old. Children of working class families pulled away from their low-income peers when they were 22 to 23 months old.

In other words, massive differences in literacy can be traced back to the parent-child banter that takes place before most children celebrate their second birthdays. By four years old, Hart and Risley assert that children of professional parents hear nearly 45 million words compared to about 13 million words for children of low-income parents.

It’s statistics like this that drive programs like Reach Out and Read and Bright Beginnings, as well as others such as Parents as TeachersHIPPY and the Parent-Child Home Program.

Dr. Stephen Berman, chair of general pediatrics at Children’s Hospital and a founding member of the Bright Beginnings board, said the idea behind Bright Beginnings is to give parents and caregivers the tools they need “to lessen the socioeconomic influence on school readiness.”

And while intensive preschool programs such as Head Start attempt to compensate for deficits accumulated in early childhood, they are very expensive relative to programs like Bright Beginnings, he said.

In 2011, only about 16.5 percent of low-income Colorado children aged zero to five were served by Head Start or Early Head Start, according to data from Kids COUNT, an annual report on the well-being of children. In addition, 51 percent of the state’s three- to four-year old children didn’t attend any kind of preschool program between 2009 and 2011.

Low intensity and low cost

At baby Stepheny’s check-up, Treitz spent only a few minutes at the beginning of the appointment talking about the benefits of reading. She explained to Giron that reading to Stepheny would improve her vocabulary and make it easier for her to learn to read. She noted that babies Stepheny’s age are likely to put books in their mouth.

“That’s normal. That’s a six-month-old’s way of getting to know things” said Treitz,who is also an assistant professor of pediatrics at the University of Colorado.

While Treitz and others hope the impact of those bite-sized Reach Out and Read sessions will last a lifetime, their short-and-sweet nature is part of what makes the program inexpensive and scalable.

All told, Reach Out and Read includes eight to 10 doctor visits in which children get free books and parents get free advice on reading to their children. The cost, which is covered through private grants and donations, is $5 per visit or up to $50 per child over five years. About 86,000 children in 48 of 64 Colorado counties receive new books through the program annually. 

Bright Beginnings, which  can include up to three annual sessions in which parents receive advice and age-appropriate kits containing children’s books, learning games and parent guides, has a similarly modest price tag. It costs about $55 per visit or $165 per child over three years.

Last year, just over half of Bright Beginning sessions took place at medical clinics. About one-third took the form of home visits led by volunteers and the rest occurred in group settings at libraries, museums or other locations.

Christopher Price, chief operating officer at Colorado Bright Beginnings, said the program reached around 19,000 parents and caregivers last year.

Like Reach Out and Read, Bright Beginnings relies on private grants and donations to cover costs. Leaders of both organizations say they don’t anticipate receiving funding from President Obama’s early learning initiative, which proposes a variety of investments in early education efforts.

While the low-intensity aspect of the two interventions are part of what makes them easy to disseminate, there is sometimes skepticism about the impact of  programs that take only about 15 to 45 minutes a year to administer to a family.

Price said his organization must constantly overcome the question: “How much difference can you really make with a single visit?”

New research

Guidelines on Reach Out and Read posted  at the Child Health Clinic at Children's Hospital.
Guidelines on Reach Out and Read posted at the Child Health Clinic at Children’s Hospital.

More than a dozen studies have been done on Reach Our and Read since its creation 24 years ago. They have found that parents served by the program are four times more likely to read aloud to their children and that preschool children served by Reach Out and Read score three to six months ahead of peers who have not participated.

While there have been a few studies on Bright Beginnings and several surveys that generally show positive feedback from participants, the organization continues to seek evidence supporting its model.

“We have validity to what we’re doing,” said Price. “What we need is credibility.”

New studies underway on both Bright Beginnings and Reach Out and Read in collaboration with Children’s Hospital  may strengthen those findings and explore new ways of reinforcing the early intervention message with parents.

Dr. Treitz is just beginning a $15,000 study that will determine whether a video tutorial demonstrating a technique called “dialogic reading” will help parents engage their children in conversations about books.

“You don’t necessarily read every word that’s on the page. It’s kind of a dialogue between the parent and child,” said Treitz. “The more we can get parents to talk to their kids the better.”

The study will examine whether the video is effective in teaching parents of two- to three-year-olds dialogic readings skills.

The goal, Treitz said, is to “take Reach Out and Read to the next level.”

“[Treitz’s] research, I know for a fact, it will impact our clinics across Colorado, but we’ll share that nationally as well,” said Megan Wilson, executive director of Reach Out and Read Colorado.

Osvaldo Narvaez-Huerta, two, looks at his new book while Dr. Meghan Treitz looks on.
Osvaldo Narvaez-Huerta, two, looks at his new book while Dr. Meghan Treitz looks on.

Wilson noted that because Reach Out and Read occurs in a health care setting, “we have unprecedented access to children…and also the parents themselves.”

She cited a Colorado Trust brief stating that while 90 percent of children ages five and under go to the doctor for preventive care, less than 30 percent are in a child care setting, the next most common contact with a “formal service system.”

Dr. Maureen Cunningham, co-investigator on a planned study of 2,000 Aurora and Denver children in Bright Beginnings, agreed that doctors’ offices are an ideal vehicle for disseminating early learning materials.

“Everybody brings their child to the doctor,” said Cunningham, a primary care research fellow at Children’s Hospital.

Dr. Cunningham and Dr. Berman are collaborating on the Bright Beginnings study, which will pilot an effort to reinforce the program’s face-to-face parent interactions with text messaging and social networking.

For example, researchers may include daily text messages reminding parents to read with their children or suggesting learning games from the Bright Beginnings kits, which come in brightly colored cloth bags. They may also organize “virtual playgroups” of six to eight moms with babies the same age who will share their experiences with Bright Beginnings games and books through online posts or photos.

The additions “will speak the language of young moms,” said Dr. Berman.

The study will initially target families with children in the 12-24 month age range, with follow ups into their school-age years.

Dr. Berman said the study will help answer the question, “Can we strengthen the ability to change parent behavior?”

Price said if the study by Dr. Berman and Dr. Cunningham goes as planned, it will provide indisputable evidence that the effects of early disadvantages can be eliminated with a program that costs around $150 per child

“Where else are you going to get that impact with so little cost?” he asked. “We can change the world with that.”

Coverage of early literacy is supported in part by a grant from Mile High United Way. EdNews Colorado retains sole editorial control over the content of this coverage.

 

Not long for this world

Denver teen pregnancy prevention organization to close its doors at the end of the year

PHOTO: freestocks.org

A Denver-based nonprofit focused on teen pregnancy prevention and youth sexual health will close its doors at the end of 2017 after losing two major grants.

Andrea Miller, executive director of Colorado Youth Matter, announced the news in an email to supporters Monday afternoon.

The organization, begun in the 1980s as a volunteer-run group, provides teacher training and assistance in picking sex education curricula for 10 to 25 Colorado school district a year.

Miller said she’s hopeful other organizations will pick up where Colorado Youth Matter leaves off — possibly RMC Health, the Responsible Sex Education Institute of Planned Parenthood of the Rocky Mountains or the state-run Colorado Sexual Health Initiative.

Colorado Youth Matter’s biggest financial hit came in July when federal officials announced the end of a major teen pregnancy prevention grant mid-way through the five-year grant cycle. That funding made up three-quarters of Colorado Youth Matter’s $1 million annual budget.

“It feels like we’re getting cut off at the knees,” Miller said.

About the same time, the organization lost a family foundation grant that made up another 10 percent of its budget.

Miller, who took the helm of the organization just 10 months ago, said one of her primary goals was to diversify funding, but there wasn’t enough time.

Miller said with a variety of factors playing into the state’s teen pregnancy rates, which have been at record lows in recent years, it’s hard to say what the impact of the organization’s dissolution will be.

She said Colorado Youth Matter has worked successfully with school districts with different political leanings to find the right policies and resources to address the sexual health of their students.

“We have been masters at meeting the school districts where they are,” she said.

Wanna go outside?

Less plastic, more trees: New effort seeks to reinvent preschool playgrounds and capture kids’ imaginations

This play structure at Step By Step Child Development Center in Northglenn will go away under a plan to create a more natural and engaging outdoor play space.

Michelle Dalbotten, the energetic director of a Northglenn child care center called Step by Step, doesn’t like her playground.

Sure, it’s spacious, with a high privacy fence bordering an adjacent strip mall parking lot. It’s also got a brightly colored play structure surrounded by lots of spongy rubber mulch.

But Dalbotten and her staff have long noticed that the kids get bored there. They clump together in the small shady area or on a few popular pieces of equipment. Sometimes, they start throwing trucks off the play structure or shoving their friends down the slide.

Something about it just doesn’t work.

Recently, Dalbotten found a solution in the form of a new grant program called the ECHO initiative, which aims to reinvent more than 100 preschool and child care playgrounds across Colorado over the next few years. Think mud kitchens, looping tricycle trails, vegetable gardens, stages, shady reading nooks and dump truck construction zones.

The idea is to create outdoor spaces that capture kids’ imagination, connect them with nature and keep them active in every season. Such efforts grow out of a recognition in the education field that healthy habits start early and boost learning.

The current preschool playground at Step by Step is covered by rubber mulch.

Step by Step staff members had talked many times about their stagnant play space. But it was hard to envision anything different until they attended a design workshop with experts from ECHO, a partnership between the National Wildlife Federation, Qualistar Colorado and the Natural Learning Initiative at North Carolina State University.

“We knew we were missing the boat somewhere because (the children) weren’t super-engaged and we had a lot of behavioral issues,” Dalbotten said. “But we just couldn’t see past it, I guess.”

For child care providers, it’s a common challenge, said Sarah Konradi, ECHO program director with the regional office of the National Wildlife Federation

“This is a very new idea to a lot of folks,” she said. “It’s hard to sort out as a layperson.”

ECHO, borne out of a decade of research from the Natural Learning Initiative, will hand out $355,000 in grants over the next three years. The initiative prioritizes centers that serve children from low-income families or other vulnerable populations.

Fourteen centers — Step by Step and Wild Plum Learning Center in Longmont are the first two — will get $10,000 awards for serving as demonstration sites willing to host visits for other Colorado providers.

Leaders at Step by Step say kids and teachers often congregate in the limited shady spots.

Around 100 other centers will receive ECHO’s $5,000 seed grants and expert assistance to revamp their outdoor spaces.

Such transformations can have a big impact on children who may spend thousands of hours a year at such centers, said Nilda Cosco, director of programs at the Natural Learning Initiative.

“When we do a renovation of the outdoor learning environments as we call them — not playgrounds — we see increased physical activity … more social interactions among children … less altercations,” she said.

“The teachers have to do less because the children are so engaged. There is so much to do.”

ECHO, which stands for Early Childhood Health Outdoors, is the latest iteration of a program Cosco started a decade ago called “Preventing Obesity by Design.” That effort revamped outdoor space at about 260 child care centers in North Carolina, South Carolina and Texas.

Cosco said such makeovers can ”prevent obesity by counteracting sedentary lifestyles. Children walk more, exercise more, are conversant with healthy eating strategies.”

Dalbotten and her staff have big plans for their play areas, which sit behind a plaza that houses a bingo hall, Dollar Tree and Big D’s Liquor store. They’ll get rid of the colorful play structure and the rubber mulch in favor of a more natural look. There will be trees, shrubs, small grassy hills and a winding trail leading to a wide array of activity areas.

This porch will get new lighting, fencing and foliage to make it a more attractive outdoor space at Step by Step.

The center’s smaller toddler playground will get a similar reboot and its tiny yard for babies — mostly bare except for a couple low-hanging shade sails — will be expanded to include a shaded deck where teachers can sit or play with babies. A barren concrete porch on the side of the building will be remade into a cozy activity area decorated with bird houses, planter gardens and butterfly-attracting foliage.

At the recent design workshop Dalbotten attended, ECHO leaders displayed photos from other centers around the country that have gone through outdoor transformations. She saw one that stuck with her.

“There were kids everywhere,” she said. “It was super cool looking. I was like, ‘Oh look, we can be that. We can have kids everywhere.’”

PHOTO: Natural Learning Initiative
The play space at Johnson Pond Learning Center in Fuquay-Varina, NC, after a makeover.
PHOTO: Natural Learning Initiative
The outdoor play space at Spanish For Fun Academy in Chapel, Hill, NC, after a makeover.