Reach Home and Read

The ROR-h Toolkit: The toolkit currently includes one age-appropriate book along with a set
of educational pamphlets explaining the importance home literacy. These educational materials
focus on appropriate literacy milestones and descriptions of how parents can engage with
their children around books. The investigators will conduct pre-study, preliminary testing of
the toolkit among at least five families and EDCI staff participating in EDCI's Parent Café,
and incorporate changes. In addition, the investigators will create an information sheet
outlining zipcode-specific community literacy resources, including location and information
on how to access the library, where to obtain low-cost books, and a schedule of literacy
promotion activities in their community (e.g. community reading sessions). All materials will
also be translated into Spanish by a certified interpreter, and will be reviewed to ensure
that they are written at a fifth grade reading level using web-based technology (Microsoft
Word). Additionally, EDCI families receiving this intervention will also receive an
additional new book at each home visit conducted during the study period.

The baseline cohort of 50 families will be recruited from families receiving EDCI early
childhood home visits. Families will be approached by EDCI staff and will be asked whether
they are interested in being contacted about participation in the study. Because our
intervention includes children aged 6-12 months, EDCI staff will approach all families with
children aged 5-11 months who participate in the early childhood program. If a family agrees
to be contacted, a trained research assistant will contact and consent the family by phone.
Once consent is obtained, baseline demographic information will be collected via REDCap. This
information will include patient age, patient race, number of children in the family, parent
age, parent education, insurance, and primary language spoken in the home. Baseline StimQ
assessment data will also be collected and entered into REDCap. When possible, information
will be entered into REDCap electronically by the family from their own electronic device.
When this is not possible, the research assistant will collect this data electronically in
person or by phone.

Once the family is enrolled and baseline StimQ data has been collected, EDCI staff will
continue to provide their standard home visiting services. After three months, families will
be sent a follow up StimQ assessment to be completed electronically via REDCap. If the family
does not complete this follow up, they will be contacted by the research assistant to
complete this follow up at two week intervals for 6 weeks.

Once the baseline cohort has completed their 3 month study period, EDCI staff will receive
tool-kit training. The study PI (Erickson) will conduct a one-hour training session with all
EDCI home visitors. The training will cover the importance of literacy in health and
wellness, the impact of exposure to books and reading in children and how this affects their
social and emotional development, and how to implement this model of teaching in their home
visit. EDCI home visitors will also complete online modules validated by ROR.

Once training is complete, recruitment and enrollment for the intervention group will begin.
Families will be approached by EDCI staff and will undergo the same recruitment and
enrollment procedure as above. We plan to enroll and additional 50 families in this cohort.
Demographic information and baseline StimQ data will be conducted as above. Once families are
enrolled, EDCI staff will provide the literacy toolkit described above at the next scheduled
home visit and engage actively with the family around the importance of early literacy using
the kit as a tool to model positive interactions. EDCI staff will provide an additional book
at each scheduled monthly visit over the next 3 months and an additional fact sheet outlining
age appropriate literacy milestones at 3 months. At the completion of the 3 month
intervention period, families will be sent a follow up StimQ assessment to be completed
electronically via REDCap. If the family does not complete this follow up, they will be
contacted by the research assistant to complete this follow up at two week intervals for 6
weeks. Families will also be provided with acceptability surveys at this time.

For the qualitative portion of this study, 15-20 key informants will be recruited. Interviews
and/or focus groups will be held at the EDCI office and facilitated by a member of the DOCR
research services team versed in qualitative data collection and analysis. The facilitator
will utilize a guide during group discussions and/or interviews which will serve to structure
conversations around relevant questions. Study participants will be asked to answer a few
demographic questions before sharing experiences and perspectives. The groups and/or
interviews will be recorded on a secure digital recorder; the audio file will be uploaded
immediately to a secure Duke server. Individual participation will last approximately 1 hour
and refreshments will be provided.

Inclusion Criteria:

- Families who live within the EDCI zone Families who can read and write in English
and/or Spanish Families with children aged 6 months to 12 months at the time of
enrollment Children born at >37 weeks gestation

Exclusion Criteria:

- Parent with severe medical or mental health condition limiting ability to attend
appointments Child with severe medical or mental health condition limiting ability to
attend appointments or participate in behavioral therapies Parent and child plan to
move out of state in the next 6 months, or plan to live in another state for 2 months
or longer within the next 6 months (ex., summer vacation).