P0080 - Promoting Health Equity of Dari and Pashto-speaking Children by Adapting Established Literacy Resources

Introduction: In 2017, 35% of 3-5 year old children were not enrolled in school. Of those entering kindergarten, 35% were unprepared, most lacking the language skills that are the prerequisites of literacy acquisition. Children in families who are minoritized or experience Limited English Proficiency are at greater risk, due to documented disparities in their language and cognitive development by 3 years old. Pediatricians may see a child ≥10 times before kindergarten via well-child checks (WCCs). WCCs provide opportunities to evaluate children’s language skills and to provide parents with tools that encourage kindergarten readiness through implementation of evidence-based literacy programs, like Reach Out and Read (ROR). We sought to improve the frequency and quality of literacy discussion during WCCs using ROR at a local federally qualified health center pediatric training site.

Description: Our goal was to adapt and improve an existing ROR program to increase rates and quality of literacy discussions during WCCs in any threshold language for children between 6-months and 5-years old. We conducted four multidisciplinary Plan, Do, Study, Act (PDSA) cycles to achieve this aim.

Evaluation: PDSA1: Assessed parents (N=12) and pediatric trainees (N=35) self-reported rates of discussing reading and literacy and trainees’ reasons for not discussing literacy during WCCs. Identified a need and desire among parents to have literacy discussion with providers. No trainees reported prior formalized training on how to facilitate literacy discussions during WCCs.
PDSA2: Assessed clinic demographics, which revealed a growing Dari and Pashto-speaking refugee population (33% of the total 700 WCCs per year). Identified that the clinic lacked the materials necessary to implement ROR for all children served by the clinic, including a lack of books available for different ages, cultures, and languages and a lack of literacy promotion handouts in Dari/Pashto. Baseline measurements revealed 54% of parents (N=12) reported receiving books and 38% reported having literacy discussions in WCCs.
PDSA3: Translated literacy promotion handouts and purchased 400 bilingual English-Dari and English-Pashto folktale books for children 2-5 years old via grant funding. Held multidisciplinary meetings with leaders from the Dari/Pashto-speaking community to assess translated materials and identify additional culturally appropriate literacy resources.
PDSA4: Implemented Dari/Pashto-adapted ROR interventions. At the end of this cycle, 100% of residents (N=52) received ROR training, 95% of parents (N=110) reported receiving language-concordant books, and 80% of parents reported having literacy discussions at WCCs.

Discussion: Monitoring patient language diversity is an integral part of intervention implementation planning and evidence-based programs may need to be adapted when a disparity in language and culturally-appropriate resources is identified. Pediatric trainees were taught to facilitate discussions of literacy, which over time, can lead to increased kindergarten readiness for their patients. All outcomes are particularly important for the growing under-resourced and language-isolated refugee population.