What if a routine pediatric checkup could help shape a child's success in school — and throughout life? In this conversation, Nationwide Children's Hospital's Sara Bode, M.D., pediatrician and medical director of School Health Services, and Carneshia Edwards, lead of the Kindergarten Readiness program, share how pediatric providers are using literacy screenings during routine well-child visits to identify developmental needs early, connect families with resources, and improve long-term outcomes. From the exam room to the classroom, discover how early literacy is transforming children's health and future success.

Tom Haederle

Welcome to Advancing Health. A child's ability to thrive starts long before the first day of school. Early literacy and language development have the power to shape their lifelong health and well-being. That's why the experts we hear from today are encouraging pediatricians to make literacy screening part of routine care.

Julia Resnick

Pediatric hospitals are increasingly looking beyond clinical care to support the longterm well-being of children, and literacy is emerging as a critical part of that work. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association, and this is the Advancing Health podcast. Today, I'm talking with Dr. Sara Bode, pediatrician and medical director of School Health, and Carneshia Edwards, lead of the Kindergarten Readiness program, both from Nationwide Children's Hospital in Columbus, Ohio.

Julia Resnick

They're working at the intersection of healthcare and education, helping children and families build the foundation for success through literacy and school readiness programs, that extend beyond the hospital and into the community. So to get started, why is early childhood literacy so important for children's health and long-term outcomes? Sara, we'll start with you.

Sara Bode, M.D.

Well, as pediatricians and working in the healthcare sector, we know that there are so many factors that affect whether kids thrive, grow up and are healthy, and their education is actually one of those most important determinants of if a child is going to thrive long term. And so we really care a lot about getting that start right off the bat.

Sara Bode, M.D.

So we know that if kids start kindergarten with the skills they need ready to learn, they're much more likely to succeed in school. And if they start behind it can be very hard to catch up. So those early years are critical to make sure that they're getting those early literacy skills and that when they start, they're ready to go.

Julia Resnick

Absolutely. And how did that connection lead Nationwide Children's to invest in literacy and kindergarten readiness?

Sara Bode, M.D.

Well, one of the things that we found is that when you are coming to Children's or any pediatric practice, you're getting checkups every couple months when you're first born, and actually you come to the doctor 15 times for checkups before you start kindergarten. So at a healthcare clinic, we have really like frequent repeated, you know, meetings with these families.

Sara Bode, M.D.

It's a trusted environment. And so we really want to make sure that we're addressing these early literacy skills as we have families come back. So it really is such a great place for us to address this, and traditionally, this has not been something that has been really looked at in the primary care clinic. We see if you walk on time, you talk on time, we check your development, but we've never really assessed reading skills.

Sara Bode, M.D.

And so this is a new idea and an addition to kind of help make sure families have what they need.

Julia Resnick

Yeah, this certainly is unique for children's hospitals, which is why we are so excited to talk to you. Carneshia, anything you want to add to that?

Carneshia Edwards

I think Dr. Bode hit it right on the nail. But just to add, like we recognize that healthy children need both medical care and developmental support. Our main goal is to really help families feel supported, empowered, equipped to really help get their child ready for kindergarten.

Julia Resnick

Amazing. And can you walk us through what those programs look like in practice?

Carneshia Edwards

Absolutely. So we go into the primary cares, and we see children preschool-aged between the ages of three and five, and we go in right before the physician goes in at their well-check visit. And so we'll go in and do a literacy screening on the kiddos. The screening looks at early literacy, language, fine motor, school readiness skills.

Carneshia Edwards

And so we use the book, The Reading House book to just really demonstrate for the families what they can do at home as well. And so after that screening is completed, we will connect the families to community resources. We're talking to them about their concerns. Every family receives a kit from us. And so we'll provide little things in the kits just to kind of help.

Carneshia Edwards

We put scissors in there, fine-motor skills that they can work on. Every child receives an individualized literacy plan as well, and so we walk the family through things that they can do to work with the child at home.

Sara Bode, M.D.

I mean this is really, it's a partnership. It's having this addressed in the primary care clinic really helps to show the importance of this, so those three components. It’s coming in doing the screener, and that screener's directly with the child. So it's an aha moment for the parents because our coordinators are specialists in early childhood development, and they're testing the children to see what they know.

Sara Bode, M.D.

And parents have one of two reactions. Either the child starts answering all the questions and the parents sometimes say, “I didn't even know my child knew that. And it's amazing,” or sometimes they're saying to us, “Wow, I didn't understand I was supposed to be teaching my child that. Isn't that something they learn in kindergarten?” And that opens up the conversation for us to say no,

Sara Bode, M.D.

there's a lot of early literacy skills you have prior to kindergarten. And so here's what those are. Once they finish that screening tool, then just like Carneshia said, parents are their first teachers. So then they're giving them a bunch of materials, ideas, activities, kits, of what they can do at home, and then they're actually coordinating and connecting them to programs too.

Sara Bode, M.D.

So, they work really hard to get them into preschool and other library programs, different resources they need. So it's a really comprehensive program.

Julia Resnick

That's amazing. So when you detect that a kid is like a little far behind on their literacy, like what happens? How do you support them and their families so that they are ready for kindergarten?

Carneshia Edwards

I feel like everyone learns different at different paces, at different rates. And so it's not to really stress the families out about the child necessarily being behind, but more so what we can do to help support them to make sure when they get into kindergarten, they know all the things that they need to know. And so really just providing the materials that they can use to help get them there is huge for us, especially when we have major concerns.

Carneshia Edwards

I feel like we catch a lot of developmental delays when we're in the primary care setting too. And so really getting them connected to the resources is huge. So we make referrals for preschool. Special-needs preschool is a big one too. And just kind of going about those steps of making sure that they get enrolled into special-needs preschool.

Carneshia Edwards

We also refer to SPARK program. That's a huge one for us, because they actually go out to the family's home and work with the child one-on-one in the house, which is very helpful for families. And so I think the resources is really the huge piece of getting families the help and the support that they need.

Sara Bode, M.D.

And part of it is just working with the families to understand that, like, this is fun. Early learning is fun. So they're not sitting down completing hours of workbooks, right? So, you know, for example, we have these like, you know, magnetic letters that can go on the refrigerator. And so what are games they can play with their kid as they start to learn and understand, you know, letters, having that pencil with the grip they can use to start to think about how they doodle and trace things.

Sara Bode, M.D.

So it's really empowering families to understand, here’s some things you can do at home and engage and play with your child. Not only are they learning those skills, but that time in relational attention between the caregiver and the child is so important. Families are busy, competing priorities. You know, we have a lot of electronics available for kids, which are really not the greatest, you know, forum for this age to learn from.

Sara Bode, M.D.

So it's like turning that off, sitting down, playing together. And here's some ideas of how to do that, that’s going to support that home learning environment.

Julia Resnick

Incredible. And just so important for the long-term health and well-being of kids. I'm sure there are barriers that have made this program hard to start or been challenging for the families that you work with. Are there any things that other hospitals should anticipate when they're thinking about integrating childhood literacy programs into their clinics?

Sara Bode, M.D.

A couple things I'll say to start. One is that, you know, clinics and pediatricians have been doing developmental assessments and support for years. So sometimes people will say, well, we kind of already do this, right? We're checking on their development. We're talking to them about this. Why do we have to add an additional component? And one thing I will say is we did a lot of research before we started this, where we actually were assessing our own kids that were coming in and we were checking their developmental screening.

Sara Bode, M.D.

We were seeing all the advice we were giving in clinics, and we were doing great. We were checking their development and they were doing well. And then we said, okay, you're so healthy. We talked to the family, you're doing a great job. And then what happened is we had all of those kids take a kindergarten assessment when they started kindergarten in the state of Ohio.

Sara Bode, M.D.

And what we found is they were a majority of them failing the test. So to me, that was an aha for us that what we're currently doing isn't enough. We're not, we're making sure they're not behind, but we're not seeing if they're thriving. And that's a very big difference to be developmentally on track, but to be thriving, that's different with those early skills.

Sara Bode, M.D.

And so I think one is just an awareness that this is important. The second thing I'll say is that anytime you talk to anyone in the healthcare setting about adding in something, whether that's a screening tool or a new component to the well-check, there's concern because families know this too, right? You go in and you have like eight minutes for your well-check and there's so much going on.

Sara Bode, M.D.

But what we found, and the first thing we tested, was an ability to do this quickly with our coordinators. And so we did a feasibility study to say, can we do this at these checkups in the clinic without slowing things down? And we were able to find that, yes, we can when we're thoughtful about it. And so sharing that advice on how to incorporate it, how to get it done quickly so that it's not disrupting everything else you have to do, and then really the outcomes, it's just so worth the time and the investment for this.

Carneshia Edwards

I would also add partnerships are essential with developing a program within the primary care settings too, like schools, libraries, early childhood programs, community organizations, like really knowing what's in the community that can really help serve the families, and being able to share that with the physicians because everybody's working together to help serve the family. A story pops in my mind as I'm talking about this. Being in the clinic,

Carneshia Edwards

I had, shout out to Dr. Urs, he's a great physician. He's in the clinic, and a lot of times the physicians here, they actually have to really be sensitive to families because families are hearing for the very first time that their child may have a developmental delay, or there are some concerns. And a lot of times you might see families, especially moms, crying and very just devastated about the news.

Carneshia Edwards

And so Dr. Urs, I was in there one time and he was in there and mom's crying. She’s just received bad news. Not necessarily bad news, but just hearing this for the first time that there's developmental concerns. Immediately he got the social worker involved. He got me involved to help with getting the child connected to special-needs preschool.

Carneshia Edwards

And the social worker was also there to just kind of help with housing concerns because mom had like a lot of things on her plate, and he was just so sensitive to her. And just to see that, that does something for me because I think families need that support. And just to have everyone all together in the clinic working to help support that mom, she left, she actually left smiling.

Carneshia Edwards

So I think that's a huge win, and I think physicians just knowing that you're giving this kind of news to families, just being sensitive to that, I think that's helpful being in the primary care setting, doing this kind of work too.

Julia Resnick

Caring for kids just as much as you're caring for their parents.

Carneshia Edwards

Absolutely.

Julia Resnick

And giving the parents the tools to help their kids thrive. So how do you track the impact of these programs and like, what does that look like long term over a child's life?

Sara Bode, M.D.

We are tracking outcomes. When we are connecting these kids to resources and they're seeing the coordinator, we’re taking a look at these kids and their eventual scores when they take that kindergarten entrance assessment, when they start school in the state of Ohio. And so we're really excited as we continue to follow this, because we want to make sure we're moving the needle.

Sara Bode, M.D.

And we got our first set of results back last year. So kids last November took that assessment by their kindergarten teacher. And what we found is if they had gone through our program, where they actually had a 10 to 25% increase in their literacy score for kids, that didn't. And so we're just really excited to continue to pull in those results and track it and really understand how are we doing with moving the needle and getting these kids ready, so.

Julia Resnick

That's incredible. And is there any data? And I know this hasn't been going on for 18 years, so it's hard to tell. But like, how these early childhood literacy interventions impact health as they become adolescents and adults.

Sara Bode, M.D.

There's quite a bit of literature to show a couple of things. One is when you start kindergarten ready to learn, and specifically with literacy skills, you're much more likely to by third grade, be a fluent reader. And what we know for kids, you learn to read initially, but then after third grade you have to read to learn. So at some point, every subject that you're learning, whether that's math or science, you need to be a fluent reader in order to process that information.

Sara Bode, M.D.

And so what we know for kids and even teenagers, if we can get that early literacy going so that then their fluent readers later, they are so much more successful in all of their academic ventures throughout school. And kids that can like complete high school and graduate are actually less likely to have a host of health conditions. It's even associated with, like the rate of heart disease in adults.

Sara Bode, M.D.

So if you are healthy and graduate high school, you're much more likely to meet your potential and be a healthy adult. You have better health behaviors, health literacy, less likely to have any of those chronic diseases we talk about like diabetes or heart disease. So this is very much linked to ultimate adult health outcomes. And so, you know, it's interesting to think about this, but we tell this to parents, if you can sit with your child and do these fun activities now, they might be less likely to have a heart attack in their 50s.

Sara Bode, M.D.

I mean, it is totally linked.

Julia Resnick

Talk about return on investment. Read fun books with your kids. They don't have a heart attack.

Sara Bode, M.D.

Exactly. Keeping kids healthy and really meeting their potential learning. It just has huge ramifications for us. And that's what we're all about in pediatrics, it's all about prevention. And so this is what we want to kind of work on with our families when they're coming into the office.

Julia Resnick

That is the whole point. And Dr. Bode, Carneshia, thank you so much for sharing this and for all the work that you're doing to help parents and kids in your community thrive. It's just really incredible work that you're doing. I'm inspired. I'm sure our listeners will be inspired as well. So thank you both.

Carneshia Edwards

Absolutely.

Sara Bode, M.D.

Thanks for having us.

Tom Haederle

Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.