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The Elephant in the Clinic

Early Literacy and Family Well-Being

by Dipesh Navsaria, MPH, MSLIS, MD and Amy Shriver, MD

Twitter: @navsaria and @shriver_amy

@AspenAscend and @ReachOutandRead

Promoting early literacy directly with families in primary-care clinic settings is a concept that stretches back over twenty years. One of the best-studied and widespread interventions is Reach Out and Read. Well-documented with a strong evidence base, Reach Out and Read has enjoyed popularity among many front-line providers offering preventive care for children. However, the "book giveaway" aspect has been so striking that many have not recognized that much more is possible through this approach.

With proper training and careful implementation, the model offers a number of different strengths: a path to proactively address school readiness, conduct developmental surveillance, make relational health assessments, build parental capacities and capabilities, help buffer toxic stress in families, integrate public health principles into clinical care, and use an inexpensive, scalable, evidence-based model.

This report, written with a powerful mix of storytelling, scientific evidence, and data, highlights the types of interventions we need in today¹s busy environment to work meaningfully with children and their parents.

Click to download report here.

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For additional resources on family health and well-being and early literacy:                                                                                            

In a parable originating from the Indian subcontinent, a group of blind men gather around an elephant, not knowing what is in front of them. Using only touch, they attempt to determine the nature of the mysterious entity. One feels a leg and declares it is like a tree trunk. Another touches the tip of the tail and says it is like a brush. Another feels the trunk and states it is like a tree branch. Another strokes the ear and likens it to a hand fan. Another touches the sides and determines the elephant is like a wall. Finally, another feels the tusk and says the elephant is like a pipe.

This report begins by relating the parable of the elephant and the blind men to explore the misconceptions behind early literacy promotion in clinic settings. In a variation of this tale dating from the 13th century, sighted men enter a dark room where the elephant is kept and feel it, with similar results. The parable ends with these lines:

If each had a candle and they went in together
The differences would disappear

The lamp and the wick change
but the light’s the same
See the light within the flame

When it comes to the children in our society, we should all walk in with candles and illuminate the strengths and challenges from our own perspectives while appreciating those of others. Contemporary, complex challenges such as school failure; long-term cognitive, emotional and physical health problems secondary to early adversity; and chronic, unremitting poverty require approaches that are efficient, broadly based, and universally implementable.


Creative Commons License This work is licensed under the Creative Commons Attribution-Noncommercial 3.0 United States License. To view a copy of this license, visit creativecommons.org or send a letter to Creative Commons, 171 Second Street, Suite 300, San Francisco, California, 94105, USA.

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