Early Literacy Research Library (ELRL) - Article

The Reading House: A Children’s Book for Emergent Literacy Screening During Well-Child Visits

Hutton, J., Justice, L., Huang, G., Kerr, A., DeWitt, A., Ittenbach, R. (2019) The Reading House: A Children’s Book for Emergent Literacy Screening During Well-Child Visits. Pediatrics, 143(6), e20183843.,

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Publication year


study description


core topic(s)

Early Literacy , Pediatric Primary Care

Population Characteristics


Exposures, Outcomes, Other

Anticipatory Guidance , Clinic-Based Programs and Interventions , Language and Literacy Development , Screening and Tools , The Reading House , Validity, Reliability, Feasibility, and Acceptability


Our objective was to develop and validate a children’s book designed to directly screen emergent literacy skills during well-child visits as early and enjoyably as possible, providing a potential catalyst for anticipatory guidance that complements existing reading programs.


The Reading House (TRH)

outcomes evaluated

TRH development, validation, and feasibility.


Healthy children between 3 and 4 years old were recruited at 7 pediatric primary care clinics in a large Midwestern city.


The Reading House (TRH) is a children's book designed to screen emergent literacy skills. These are assessed by sharing the book with the child and using a 9-item, scripted scoring form. Get Ready to Read! (GRTR) is a validated measure shown to predict reading outcomes. TRH and GRTR were administered in random order to 278 children (mean: 43.1 ± 5.6 months; 125 boys, 153 girls) during well-child visits at 7 primary care sites. Parent, child, and provider impressions of TRH were also assessed. Analyses included Rasch methods, Spearman-ρ correlations, and logistic regression, including covariates age, sex, and clinic type.

sample size

n=278 (total children)


TRH Measure: a children’s book and screen for emergent literacy skills including a 9-item scripted scoring form.


Comparison Measure: GRTR (Get Ready to Read!), a validated measure known to predict reading outcomes.


Psychometric properties were strong, including item difficulty and reliability. Internal consistency was good for new measures (rCo- α = 0.68). The mean TRH score was 4.2 (±2.9; range: 0-14), and mean GRTR was 11.1 (±4.4; range: 1-25). TRH scores were positively correlated with GRTR scores (r s = 0.66; high), female sex, private practice, and child age (P < .001). The relationship remained significant controlling for these covariates (P < .05). The mean TRH administration time was 5:25 minutes (±0:55; range: 3:34-8:32). Parent, child, and provider impressions of TRH were favorable.


The Reading House is a children’s book specially designed to directly screen emergent literacy skills in 3- and 4-year-old children that is feasible for primary care, enjoyable, and useful for families, reveals promising psychometric properties, and complements existing reading programs.


Although construct validity was established, its cross-sectional nature cannot be used to establish predictive validity, which would require a longitudinal design. Because of feasibility constraints, we did not explore test-retest reliability, although this is planned. To expedite screening in busy clinical practices, we collected limited demographic information. However, this served the aims of this study, and clinic type is a reasonable proxy for SES given the population served by our hospital based clinics. TRH was administered by CRCs, and it is possible that the results would not generalize to clinical providers, although at this preliminary stage, fidelity with administration was paramount and provider impression was surveyed. Indirect assessment of feasibility and utility was likely a major driver of the sizable percentage of “not sure” responses for these items, which we believe would skew favorably in actual practice given the appeal of book distribution and discussion of reading documented in the Reach Out and Read program.9,72 Similarly, we suspect that more parents may have rated TRH as useful if it was administered by providers1,72 rather than CRCs trained to not discuss results or give them the book to take home. GRTR was our sole external criterion,34,47 and exploring relationships between TRH and other standardized measures would be useful. Although it revealed solid internal consistency and reliability, TRH was administered to a broad age range when skills evolve rapidly. In addition to determination of risk strata for older and younger age ranges, development of alternate forms for 3- and 4-year-old children may be useful.