Early Literacy Research Library (ELRL) - Article

A Combined Reach Out and Read and Imagination Library Program on Kindergarten Readiness

Szumlas, G.A., Petronio, P., Mitchell, M.J., Johnson, A.J., Henry, T.R., DeWitt, T.G. (2021) A Combined Reach Out and Read and Imagination Library Program on Kindergarten Readiness. Pediatrics, 147(6), e2020027581.,

Access: Institutional Access

Publication year


study description

Quasi-experimental intervention study.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Kindergarten , Urban

Exposures, Outcomes, Other

Anticipatory Guidance , Dolly Parton Imagination Library , Language and Literacy Development , Programs and Interventions (other) , School Readiness and Educational Outcomes


We developed a novel combined ROR/DPIL program and examined the effect on kindergarten readiness assessment (KRA) scores.


Reach Out and Read (ROR) and Dolly Parton Imagination Library (DPIL).

outcomes evaluated

Kindergarten readiness.


Urban ROR primary care clinics throughout Cincinnati, Ohio.


At urban ROR primary care sites, patients <5 years living in the city school district were enrolled from July 2015 through January 2019 in the ROR/DPIL (Reach Out and Read & Dolly Parton Imagination Library) program when seen for a clinic visit. The literacy subtest of the KRA was examined for participants entering kindergarten in the fall of 2016, 2017, and 2018. The “on-track” rate of participants was compared with nonparticipant groups.

sample size

n=797 (kindergarteners)


Measure of Kindergarten Readiness: the Language and Literacy Subtest of KRA (Kindergarten Readiness Assessment). A scaled KRA score >263 indicates a student is “on-track” for kindergarten.


A total of 797 kindergarten-aged ROR/DPIL participants were matched to Ohio KRA scores for 2016, 2017, and 2018 school years. The percentages of students “on-track” on KRA literacy subtests increased significantly by cohort (2016, 42.9% [95% confidence interval (CI): 34.9%–50.9%] versus 2017, 50.9% [95% CI: 44.9%–56.9%] versus 2018, 58.3% [95% CI: 53.3%–63.3%], P = .004). ROR/DPIL participants were compared with a proportionate stratified random sample of 1580 non-ROR/DPIL peers. On-track in literacy did not significantly differ between groups (2016 [P = .262], 2017 [P = .653], 2018 [P = .656]), nor did they differ after restricting analysis to economically disadvantaged children (2016 [P = .191], 2017 [P = .721], 2018 [P = .191]).


With these results, we suggest that a program combining literacy anticipatory guidance at clinic visits and more books in the home can potentially improve kindergarten readiness. Pediatric health care providers can play an important role in promoting kindergarten readiness through literacy promotion.


First, we could not control for exposure to other programs promoting kindergarten readiness or for preschool participation, although there was no other known widespread programming. Similarly, the cause of improvement in comparison groups is unknown... Finally, we are unable to identify exact causes for KRA literacy improvement in ROR/DPIL participants. There are several possibilities based on program design: more books in the home, more motivation to read, and more reminders to read. Furthermore, we cannot draw conclusions on the exact impact of each individual program. Although ROR had been in operation and the change was the addition of DPIL, it is unknown how much program effect was due to DPIL, ROR, or synergy between the two programs. The number of participants matched to a CPS KRA score was significantly lower than the total number of enrollees... Finally, accurately matching to KRA scores was difficult. We erred on the side of more accurate matching, so differences in names used to enroll in ROR/DPIL versus CPS could result in no match.