Early Literacy Research Library (ELRL) - Article

Reach Out and Read and Developmental Screening: Using Federal Dollars Through a Health Services Initiative

Dunlap, M., Lake, L., Patterson, S., Perdue, B., Caldwell, A. (2021) Reach Out and Read and Developmental Screening: Using Federal Dollars through a Health Services Initiative. Journal of Investigative Medicine, 69(4), 897-900.,

Access: FREE/Open Access

Publication year


study description

Secondary data analysis.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Infant/Newborn , Medicaid , Urban

Exposures, Outcomes, Other

Home Language/Literacy/Learning Environment , Language and Literacy Development , Technology and Digital/Screen-Based Media


The purpose of this study is to see if using federal funding would facilitate ROR expansion and if this expansion would improve developmental screening and EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) visits in Oklahoma.


Reach Out and Read (ROR) during infancy.

outcomes evaluated

Diagnostic developmental screenings performed and EPSDT visits.


Primary care providers throughout Oklahoma, ROR providers compared against non-ROR providers.


Medicaid billing data for state fiscal year (SFY) 2018 and 2019 were analyzed. Standard statistical methods were used to analyze the data descriptively to determine the proportion of developmental screenings performed and EPSDT visits. Comparisons were made between ROR and non-ROR sites. Nine new ROR sites were added with 26 new providers/staff and 130 providers/staff at existing sites trained in ROR from November 2018 to June 2019.

sample size

n=156 (providers' Medicaid billing data)


Measure of Screenings and Visits: Providers’ Medicaid billing data reviewed for paid claims for Sooner Care members used to determine percentage of members receiving developmental screenings during WCVs; procedure codes used to identify screenings and WCVs. Specific diagnosis codes used to identify EPSDT visits.


In SFY 2018, the developmental screening percentage at non-ROR sites was 33% vs 47% at ROR sites (p<0.0001), in SFY 2019 non-ROR sites were 36% vs 48% at ROR sites (p<0.0001). The EPSDT visit percentage in SFY 2018 was 50% at non-ROR sites vs 69% at ROR sites and in SFY 2019 was 51% at non-ROR sites vs 72% at ROR sites.


HSIs (health services initiatives) are an effective way to fund ROR. Additional funding allowed for increased ROR sites and training. ROR sites are more likely to perform developmental screenings and EPSDT visits. One of the significant challenges of ROR sites across the country is funding. HSIs can be an effective way to fund the ROR intervention by using federal funds. This model of funding could be replicated in every state in the country as an aspect of strategies to improve the literacy, health and well-being of young children.


Billing providers were limited to hospitals, clinics, advance practice nurses, mid-level practitioners, public health agencies and physicians for claims with any paid service. We used Medicaid billing data to determine developmental screening rates. This requires providers to enter an extra code for the screening to be billed. Some providers may be performing developmental screening but not billing. However, this could occur in both the ROR and non-ROR groups. Medical residents and providers who do not bill Medicaid were excluded from the analysis. While there is no satisfactory way currently to capture providers that do not bill Medicaid, resident physician billing should be captured under their attending billing.