Reach Out and Read Healthy Eating Initiative
Children of Bellevue’s Reach Out and Read (COBROR) developed a comprehensive initiative to support healthy eating/active lifestyle messages given to families in the clinic by pediatricians who continue to see an increase in childhood obesity, particularly amongst Latinos. This program was developed with the help of a 2010 United Hospital Fund Health Care Improvement Grant Promoting Voluntarism. While the initiative is a “work in progress”, we are happy to share the ideas and materials so far developed. They may be adapted to meet the needs of your program. For materials we have created, we appreciate being credited as “Children of Bellevue’s Reach Out and Read Program.”
There are four components to this initiative:
- Healthy Eating Farmers Market Component
- Volunteer Reader Healthy Eating Component
- Parent Educator Program Component
- Pediatricians Give Books With Food Themes
Healthy Eating Farmers Market Component
This part of the initiative was designed to coincide with a newly formed Harvest Home Bellevue Farmers Market. Between July 2010 when the market opened and November 2010 when it closed, we developed a replicable model for integrating healthy eating concepts into a pediatric setting with a market at its core. COBROR and Health Education and Literacy for Parents (HELP) Project volunteers worked with COBROR Parent Educators each Friday to make this pilot project a success. Fresh produce bought in the Farmers Market and plain language healthy eating materials were displayed on the market table in the entrance area of the pediatric clinic, visible to all. In English, Spanish and Chinese, volunteers and staff engaged parents and children in discussion guided by core obesity prevention concepts but driven by the family’s interest and experience. Families were invited to go on the market tours when they finished their appointment with their pediatrician. Approximately 65 tours were conducted during the pilot.
By mid September, it became clear that market tours were not feasible for afternoon clinic because parents were rushing home to pick up children at school or to make dinner. Therefore, the market table was brought into the main waiting room where dynamic family health eating counseling was conducted by staff and volunteers. Because of this experience with the “no tour” afternoon clinic program, we surmised that the materials and much of the market curriculum that had been developed could also be used if there is no market connected to an institution.
When the Bellevue Farmers Market was not renewed for the 2011 season, we had the opportunity to try the programming without the benefit of an onsite market. Since our afternoon clinic waiting room program using fresh produce had been so successful, we elected to bring produce in from a farmers market at a different location. This did add time and energy for the staff and volunteer who had to shop and deliver the produce from the market over one mile from the clinic. But, they were highly motivated and made it work. We were able to show that the model can be successful for programs that do not have markets at their hospitals or clinics. This is the model currently used in Bellevue’s clinic.
Volunteer Reader Healthy Eating Component
Volunteer readers in Reach Out and Read programs transform clinic waiting rooms into literacy-rich areas for children and parents, and help families learn the joys and the techniques of reading aloud. Children of Bellevue’s Reach Out and Read (COBROR) has also been a leader in training and retaining large numbers of volunteer readers who model literacy activities for parents in the waiting room. In 2009, when we were planning this initiative, 67 volunteers read for approximately 2,027 hours at the Bellevue clinic to 16,000 children of all ages.
This experience made us well placed to engage volunteers in this new preventative health initiative. One of the ways to make reading an engaging activity for children and to encourage language development is to elicit conversations about the book by asking the children questions or responding to their questions or comments (Dialogic Reading).
Regular COBROR volunteer readers were given special training in using children’s books that have discussion points on healthy eating and active lifestyle issues. An interactive Google Document provided for sharing of ideas and opportunities for supervision.
Dialogic reading questions for 7 children’s books were developed. Field testing demonstrated strength of interactions around these questions but also indicated that readers either inserted too many or no messages while reading. We then developed simple, key take away messages for specific books that volunteers can use when appropriate. The suggestions are not meant to be a script but just guidelines. It was key that readers stayed true to the Reach Out and Read mission of having fun while reading with children. The discussions about healthy eating should happen within this context and should never be meant as a “lesson”. Volunteers could pick only one or two healthy eating “messages” to introduce into the story, when appropriate.
- Messages for Healthy Eating Volunteer Readers
- Sample “Dialogic Reading” Suggestions
- Interactive Google Document for Readers
Parent Educator Program Component
Anticipatory guidance is a key component of ROR—at Bellevue this guidance is given not only by the busy pediatricians but also by our bilingual parent educators. These parent educators, an addition to the ROR model instituted at Bellevue, offer counseling on a broad range of language and literacy related topics to families as they wait to see their pediatricians thus setting the stage for the doctor’s intervention.
In the same way, anticipatory guidance to improve parental knowledge about nutrition has tremendous potential to improve children’s health and reduce the risk of obesity. Actually, the impetus for this was the increase in parent initiative questions about healthy eating during routine literacy counseling. We created enhanced content, including simple, clear ideas for making healthy nutritional choices and lifestyle changes for families, for use by ROR educators counseling parents of young children in the pediatric waiting room. The primary focus will be children between 2 and 5 years of age.
A binder of materials and articles related to healthy eating was added to the Parent Educator counseling bag, along with their literacy, language and behavior materials.
Pediatricians Give Books With Food Themes
As part of Reach Out and Read, Pediatricians give parents age appropriate advice about the importance of reading aloud and give children a new book to take home at every check-up, from six months to five years. On Market Day, special food themed books are given as well as routine literacy and obesity prevention counseling.
Funding for Bellevue’s Reach Out and Read Healthy Eating Initiative Provided by:
- United Hospital Fund Health Care Improvement Grant Promoting Voluntarism
- Reach Out and Read, Inc.
- The Dreyfus Corporation
- The Brack Family Foundation