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181st New York State Legislature

From Wikipedia, the free encyclopedia

181st New York State Legislature
180th 182nd
The facade of the New York State Capitol building in bright daylight
Jurisdiction New York, United States
Term January 1, 1975 – December 31, 1976
Members 60
President Lt. Gov. Mary Anne Krupsak (D)
Temporary President Warren M. Anderson (R)
Party control Republican (34–26)
Members 150
Speaker Stanley Steingut (D)
Party control Democratic (88–61–1)
1st January 8 – July 12, 1975
2nd September 4 – 9, 1975
3rd November 13 – December 20, 1975
4th January 7 – June 30, 1976
5th August 4 – 5, 1976

The 181st New York State Legislature, consisting of the New York State Senate and the New York State Assembly, met from January 8, 1975, to August 5, 1976, during the first and second years of Hugh Carey's governorship in Albany.

YouTube Encyclopedic

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  • New Perspectives on Health & Literacy


>> From the Library of Congress in Washington, DC. >> John Cole: Well, good morning everyone. Good morning and welcome to the Library of Congress for the first time for several of you. And welcome back to those of you who are able to join us last night. I'm John Cole. I'm the Director of the Center for the Book in the Library of Congress an organization was created by Dr. Daniel Boorstin back in 1977 to reach out on behalf of the Library of Congress to promote books and reading and to promote the study and encourage the study of books and reading. To that menu since 1977, we've added literacy which was not discussed much in 1977. Another major topic that where there's difference but similarity was the threat in 1977 of technology. Everyone was worried but the technology we were worried about was television and Dr. Boorstin created the center, in part, I learned after accepting his offer to become the founding director. He had an idea and that was to start using commercial television to promote books and reading. And we were able to do that through-- for 10 years through a project with CBS television called Read More About It. And we put those from reading messages at the ends of major CBS programs and start with the programs. And if you enjoyed the program, the Library of Congress suggests these books and we have books that came across the screen that the message was go to your local library or bookstore, not the Library of Congress. Go to your library or bookstore, they will be happy to help you read more about it. And from that grew one of our reading promotion networks with not only television and technology involved. But booksellers and librarians and gradually we are Center for the Book will have its 40th anniversary next year in 2017. But the project that brings us together is a special project that came to the Center for the Book through David Rubenstein, a philanthropist who's doing some many wonderful things for our country but in Washington, DC in terms of helping support government institutions that have a relationship to American history, largely and that appeal to Mr. Rubenstein in terms of his interest. And we did not know when Mr. Rubenstein first started giving help to the National Book Festival which is another major Center for the Book endeavor, now in its 16th year that Mr. Rubenstein had this interest in literacy. And that came a little later and he is the one who initiated this project and he's funding it. And I'm so pleased to have you here and to be able to explain a little bit about the framework that's brought us here. We have aboard, the Literacy of Advisory Board to help us during the 5-year pilot grant from Mr. Rubenstein. And he has encouraged us to think about the future in the hopes that this will be extended and maybe developed in a permanent way that might be endowed, but that the first 5 years would be almost a period of experimentation in trying to embrace awareness of the problem of literacy and by doing award work but also by symposium and by other means that are kind of generic to this Center for the Book. We also have affiliates in every state. So everyone of your states has a partner with us to promote books, reading, literacy, and libraries in the state. So, this is the second symposium held by the literacy-- advisory of our literacy program and we're so proud to have Nemours as a partner in this. The first symposium was literacy and poetry and we learned about a number of organizations in poetry that have common interest with us and have been able to bring several of them into our network of reading and literacy promotion partners and Laura Bailet from Nemours is on our board and she was someone who when we had our first board meeting was talking about what we're talking about today. How important literacy is to health and in many ways, and this was news to other members of the board, and we immediately put this on the agenda for a future symposium and we're here today and I thank you for your participation and I will, I'm afraid, tell you a little bit more about the overall endeavor as we move ahead. But now, I am going to move ahead and follow our program. We-- I would like to introduce, however, a special guest Dr. Louis Sullivan who has joined us today. He was unable to join us yesterday. I met Dr. Sullivan for the first time just a few weeks ago when we had him as a speaker about his new book at the Library of Congress, his memoir. And he pointed out and I stand up straight when he said so that the Georgia Center for the Book has-- was featuring his book on his website as part of their program of putting up on the website books every Georgian should read. And this is a rotating list of course. But nonetheless, it still is headlined by Dr. Sullivan's memoir. He was the secretary of health and human services during the administration of George H. W. Bush and is the chairman of the boar of the National Health Museum in Atlanta and what? He talked about a lot was being the first president of the More House School of Medicine. He also is the head of the deep Washington, DC based Sullivan Alliance to transform America's health professionals and he's going to be with us all day. I'd like him just to stand and be acknowledged please. [ Applause ] Last night, we had a wonderful keynote address by Dr. David Bailey and I know that a number of you were not able to join us. But we're very fortunate that he is today going to be the introducer of the keynote today. But I just wanted to thank him publicly for getting us off to such a good start because his talk, no surprise, really was a wonderful keynote that focused on how and why reading proficiency and literacy are such strong indicators of-- actually of overall health through adulthood and that is what we're trying to bring together as we do in these symposia are fields and learn about other fields from the perspective of literacy to see how we not only conform new alliances. But perhaps look ahead together for new ways of solving some of the problems that we were faced with. And last night, Dr. Bailey nicely lined up the alignments of various worlds that we occupy and literacy and in education and in health and pointed to this is an opportunity for us to think about coming together in ways that would affect policy and to try to keep the broadest possible perspective on this on behalf of our society rather than what we all tend to do and we're all guilty of this is spending so much time on our specialties and trying to prove ourselves and prove our organizations that we often forget the broader picture. So this is an attempt to talk about and learn about and do something about the broader picture. Dr. Bailey is the president of Nemours Foundation, which he became president in 2006. He is leading light and we-- the whole world of health with many honors and for those I know a few of my friends are here today who don't know about Nemours is an integrated children's health system with two hospitals in the Delaware Valley in Florida and it serves children from across the United States and internationally. Nemours also operates 45 primary, specialty and urgent care clinics in 4 states and is responsible for the website Kids Health, which we have all learned about through Laura in our work on the Literacy Advisory Board. And I am very pleased to present Dr. David Bailey who is the distinguished introducer of a-- our distinguished keynoter for the morning. David Bailey. [ Applause ] >> David Bailey: Well, good morning. I am Dave Bailey. And I would just like to add my welcome to Dr. Cole's to this summit on literacy, health, and new perspectives. You know, the Library of Congress staff, Dr. Cole, have been extraordinarily kind and accommodating. They arranged the great weather. The only thing they forgot was to get cherry blossoms blooming. >> And the trains. >> The train-- Yeah, the trains are another thing. Yeah, we're delighted that you've all joined us for this I think very important symposium and the connections between literacy and health. In this morning, I really have the distinct honor and personal pleasure to introduce our first speaker, keynote speaker, Dr. Sandra Hassink. Dr. Hassink is a pediatrician's pediatrician. She is consummate physician and she's what we know as a triple threat. A superb clinician, a esteemed researcher, and admired educator. And it's been my great fortune to be able to associated with Sandy over several years at the Nemours Alfred I. duPont Hospital for Children. Dr. Hassink is the Immediate Past President of the American Academy of Pediatrics. An organization composed of 64,000 pediatricians and an organization that has an aggressive child health policy agenda both nationally and internationally. Sandy has testified for congress on childhood obesity, food security, and hunger focusing on supporting the foundations of child health. She has dedicated her entire professional career to caring and advocating for children with obesity and is the director of The American Academy of Pediatrics Institutes for Healthy Childhood Weight. Under her direction, the institute is focused on translating research into practice for pediatric health care providers, families and children. Dr. Hassink founded the weight management clinic at Nemours Alfred I. duPont Hospital for Children in 1988. She has lectured widely on this topic and has published many books. Among them, "A Parent's Guide to Childhood Obesity", "Pediatric Obesity, Prevention, Intervention and Treatment Strategies for Primary Care", and "The Clinical Guide to Pediatric Weight Management". And if all of this weren't enough, Dr. Hassink has served on the Institute of Medicines committee on accelerating progress on obesity prevention and was an author on the expert recommendations for obesity. And probably a reason she's been able to get through all of this and maintain such a calm exterior and that she holds a master's of science in pastoral care and counseling. Please help me welcome Dr. Hassink. [ Applause ] >> Sandra Hassink: So David, thank you. I wasn't sure exactly who you were speaking about for a moment, but thank you very much. So as Dr. Bailey said, I spent this several years as president elect, president, now past present of the academy speaking wildly around the country and internationally, and speaking about the foundations of child's health. And I love this quote by Louis Pasteur that I think typifies how we as pediatricians and how we really feel all of us about children. "When I approach a child he inspires in me two sentiments; tenderness for what he is, and respect for what he may become." And I think that holds the hopes of all of us that in the moment we can respond to the needs of the child in that very moment that we all are encountering the child and their family. But we hold the hopes for the future of that child. And we know without a doubt that what we do in this moment is significant for that moment but significant for the child's future and I hope to illustrate that as we move through this talk. So I always start my talks by asking how are the children? How are the children doing? And you can look at this through many lenses and I picked out a few things to look at just nationally how we're doing. And you know this varies widely state to state, but our diet quality only 50% of children are now meeting federal standards, diet quality standards, 18% of our children have obesity, 30% nationally have overweight and obesity, and 9% of our children have activity limitations from some other chronic condition. When we look at emotional and behavioral health, we see the parents are reporting significant serious emotional and behavioral problems in 5% of their children. And our adolescence, 8% of them, 12 to 17 have had a major depressive episode in the last year. I think we need to just pause a moment on that one. 10% of our children have asthma and 52% of our children, ages 3 to 4, are not enrolled in quality or any preschool. And I think you'll see today how literacy interweaves itself among all these childhood problems. And almost half of our children, 0 to 6, lived 200% are below of the poverty level with 11% of our children living under 50% for the poverty level. So, when we think about the foundations of child health, I've been using a framework from the Harvard center for the developing child because I want to be able to have a conversation about every child in this country and what every child in this country needs. Because I think, as Dr. Bailey, so rightly pointed out that we often live in our silos and live-- and look at the world through the-- our own particular lenses. And I think we need to broaden this conversation and now think about what every child needs. Every child needs sound and appropriate nutrition. That means that if we combine food and security, hunger, obesity, and overweight, 50% of our children are suffering from a nutritional hardship. Every child needs stable response of nurturing relationships at home, early childcare and education at school and in their community. And every child needs safe supported physical, chemical, and built environments and you'll see how literacy weaves itself through these foundation elements of child health. And so at this conversation in this country right now, should be about what every child needs and how we all together can build those foundations. So the academy of pediatrics has it's strategic plan and about 10 years ago we renamed our strategic plan the Agenda for Children. And you'll see in this circle some of our guiding principles, Medical Home, Health Equity, our own Profession of Pediatrics. You'll see pillars, Access, Quality, and Finance, which really mean the ability of children to access health and health care. But those elements in the middle really are a pivot for us. So 10 years ago, you might have seen oral health, immunizations, tobacco, very important child health topics on this list. But what you see now are Epigenetics, Early Brain and Child Development, Poverty and Child Health. And we just released our poverty statement this month. We are now looking carefully at the foundational elements that build health for children. And I think it's a very important pivot for us to have taken. And it's out of our anxiety that children are not receiving these foundational elements that build good health. So our agenda now speaks to the socioecologic framework of children because you build health everywhere for children. You build it in the home with your families. You build it in the community. You build it with infrastructure. You build it with literacy. You build it all together for children. And so you can see the socioecological model, just some elements that are important to child health and they really run the gamut from school nutrition which I've been speaking about extensively this year to injury prevention, taking care of the mother infant dyad, taking care of the intrauterine environment. You can see them there and how it calls us to work in a cross-sectoral fashion. So, why are we speaking today about health and literacy? Well, we know as physicians low health literacy-- low literacy is associated with low health literacy. And so, more than 90 million US adults at least in 2003 lack the literacy needed to effectively negotiate the health care system. So those of you who have high literacy, know how difficult it is to negotiate the health care system. It can be sort of a laboring thing process of paper work and phone calls and appointments. And if you have basic or only basic literacy, you are significantly at risk for not being able to get the healthcare you need. And you can see that if you look at below basic and basic literacy, basic literacy is searching a short simple text to find out what you as a patient might be allowed to drink before a medical test, signing a form, adding the amounts on the bank deposit slip, finding a pamphlet for jurors, using a TV guide to find out what's on the program, comparing ticket prices. So if you don't have these skills above basic skills, you simply can't negotiate the health care system with any efficacy. And then we write a lot of things in the health care profession for patients. We write a lot of patient education. But you can see here the percentage of the population of each state that has below a 5th grade level of literacy, the darkest red is the 30% or greater, the orange is 20% to 30, 15 to 20 in the green, and 10 to 15 in the blue. And you know that many patients can't literally read the information that we're putting out. So I was in one of our clinics in North Wilmington and we were handing out an obesity paper that's said 520, fruits and vegetables, exercise, juice, and TV had very simple information and what was happening is we were finding those pamphlets in the trash can in the waiting room. People simply couldn't process that. And we had tried to be very careful about the language we used. So we decided then we have to model the behavior we wanted, but this is a huge handicap for our adults and our adults or the parents of our young children. So low literacy and related low health literacy and parents of young children increases developmental risk because they can't access what they need to support their children and something very mundane in the health care system but incredibly important. They can't negotiate medication dosing or adhering to routines or goals or-- are preop preparation or goal setting around the chronic illness. They can't adhere to that because they don't have the health literacy skills. And then the perpetuation of this really perpetuates the cycles of poverty, poor health and dependency across the life course. So it's really important for us. Adults with limited health literacy, and you'll hear this probably over and over today, have diminished diseased knowledge. They don't use preventive services at the same rates. They have increased hospitalizations, poor health status, poor control of chronic illness, and you know we have an epidemic of chronic illness in this country. Globally, we would call this noncommunicable disease, lifestyle-related diseases, and the ability to control chronic illness is crucial to your ability to prevent early death and severe morbidity and, of course, and mortality. So reading a routine for a person with type 2 diabetes and managing insulin dosing is actually quite a complex set of interactions that have to occur and can occur in adults with limited health literacy. So in 2014, we put out a statement at the academy on literacy promotion and just highlight some of the things that you all know that greater than 1 and 3 US children start kindergarten without the language skills needed to learn to read. Reading proficiency by third grade is the most important predictor of high school and career success. And 2/3 of children each year, 80% of whom live in poverty fail to develop reading proficiency by the end of third grade. Saw a father in my office and he was-- actually was a grandfather raising his grandson and his grandson wasn't learning to read in school and he had begged the school to hold him back so he could learn to read. But the school had-- your own promotion criteria and were set on promoting the young man. So I have the situation of a grandfather pleading with the school and pleading essentially with me for some help in helping his grandson learn to read because he knew if he got farther into school without learning to read that was a sentence for him and it was a sentence about not being able to complete high school, not being able to get a good job, not being able to execute on the dreams the grandfather had for him. So, we talked about early childcare and education. This is the early learning unmet need in our country. And you see the maps, the light pink here is a 0 to 25%, the dark is 76 to 100% and it's a map that looks a little different than some maps. So, when we look at these maps of the United States, the health disparities and the disparities in accessing solutions to health problems often look the same. This looks a little different but we had a lot of 4-year-olds that don't have about preschool education. And this is sort of an interesting map about the change in preschool enrollment. So some preschool enrollments have gone down in the orange, some have gone up in the dark blue. We don't have a uniform approach to this. So merely by being born in your county, in your town, in your state really sets your health trajectory for the rest of your life because these disparities are reproduced on every health measure that we can find. So no one state is doing perfectly on everything but I think that that leads to our saying that the zip code it-- maybe your most important health indicator as a young child. So, where does literacy start? Well, we look at young children. This is a slide courtesy of Pam High from presentation to us at our national meeting that language environment of children at home is highly variable and really tracks with socioeconomic status often. So the vocabulary at age 3 and the parent words per hour, you can see how that track. So the ability to be in a high word environment or not will set your word gap by kindergarten entry. So, there have been studies that show the kind of talk that happens in families. So some families talk a lot to their children, some families talk very little. Business talk gets things done. Brush your teeth. Sit at the table. Finish your vegetables. Don't say I said that. But nonbusiness talk is sort of that chitchat, the mother or father leaning over the child and just having a conversation, talking about what's in their environment, talking about a book for instance. Business talk was constant across families but it was this nonbusiness talk, this sort of relational talk that really made the difference and you'll see here. So the talk of the families had more praise than prohibitions. The more silent families more prohibitions than praise because if you're doing a lot of task-oriented talk, that's what happens. At 3 years, the IQ correlated with nonbusiness talk. And at third grade, the receptive language. So even very, very early on and this is what makes early reading and early relational attention to those early relationship is so important for our young children because long before they can read your laying the groundwork for literacy and reading. So talkativeness predicted IQ and vocabulary. I want to talk a little bit about literacy and poverty because as I told you, half of our child-- almost half of our children live 200% or below the poverty level. Children from low income family have fewer words in early childhood know fewer word by 3 years, have fewer literacy resources which-- within their home and you'll hear a lot more about that less likely to be read regularly and more likely to experience early childhood adversity and toxic stress and we'll talk about that. And these are our poverty rates in these countries. So this is the dark red are the 20 to 30 Percent of poverty and you can see courtesy of the 2008 recession what has happened to child poverty in this country. And so children are sort of the first affected and the last to be lifted out of poverty. So I want to talk a little bit now about some of the science that's emerging about what happens in early childhood and the impact for later health trajectories. And many of you are familiar with Vince Felitti study on Adverse Childhood Experiences. And Dr. Felitti was a physician at Kaiser Permanente and study over 17,000 adults and many of whom had chronic illnesses including obesity and he merely asked them what happened to you as a child? So he asked them about abuse, emotional, physical and sexual, household dysfunction, mother treated violently, household mental illness, divorce, incarcerated household member, and later about emotional and physical neglect. And in this study, these were the percentages of adults who reported having experienced one of these adverse events in their childhood. And I would say if you'd look at this, you would say this is pretty high. Physical abuse, 29%. Mother treated violently, 27%. This is pretty and is disturbing in and of itself. But what happened when he looked at their current health status, he realized that the current health status of these adults had a graded relationship to the adverse experiences they experienced in childhood. So if you experience more of these adverse events, you're more likely to have chronic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. If you experience more adverse childhood events, you would have more risk factors for chronic disease, smoking, alcoholism, promiscuity, obesity, substance abuse. These ACEs, this Adverse Childhood Experiences were associated with general health and social functioning, poor general health and social functioning, poor mental health, depression, sleep disturbance, anxiety, poor anger control, and memory disturbances. So this takes us right back to where we started which was what's happening to the child as a child immediately is so important and needs to be attended to. But what happens to that child imbeds itself in our biology and has lifelong health effects. So this was a study of a maternal report of ACEs at a 5-year followup study and these were fragile families at risk. It was a fragile family and child well-being study. And these were mothers of children age 5 reporting maltreatment in their families. Physical, sexual, psychological abuse and neglect and I think that you can look at this numbers and say that's really disturbing. How many of these children had experienced this ACEs household dysfunction? And then, the children that had no ACEs were 45%. But over half the children in this study had one or more adverse childhood experiences, 27%, 1; 2, adverse childhood experiences 16%; 3, 8%; 4, 3%; and 5 ACEs 1%. And so they connected these adverse childhood experiences to their experiences with literacy. So children who had not yet or not began to understand and interpret a story or other text that was read to them, if you had one adverse experience, you had a slightly higher odds ratio of not being able to understand and interpret a story. If you had 3 or more, you had an odds ratio or 2.2. Not yet or beginning to easily and quickly name all upper and lower case letters. You can see that the trajectory, the trend for more ACEs less ability to do that. Not yet or beginning to read simple books, you can see the trend. Not yet or beginning to demonstrate understanding of some of the conventions of print. So, we know that literacy is interwoven here with the experiences of childhood that can either promote literacy, prevent literacy, interfere with literacy. And we know that this is also affecting children's brains. So the first years of life hold the most critical periods for brain development. This is the classic slide that shows the synapses you have at birth and then you develop a lot of them at 6 and then they're pruned by 14. And the pruning is really the refinement of the circuitry of the brain. So-- And that refinement is experience-based. It doesn't happen the same for every person. Based on your experiences, your brain is altering your synaptic connection and literally its anomaly. So, the regions of the brain that are most affected by these toxic stress and adverse childhood experiences are the hippocampus, learning, memory, discrimination of danger and safety. The prefrontal cortex, impulse control. The amygdala, increase in impulsive behavior and that mediates fear and anxiety. So these toxic experiences are shaping the children's brain development, shaping their exposure to protect the factors like literacy and the context from which the child comes is so important. So part of what we're asking pediatricians now and all of us is to not just deal with that immediacy of what the situation is when the child walks into your clinic, but ask what's happening to that child? What's the context of the child? What's the state of family? What's the state of their experiences? And we're trying to build resilience. And so the flip-side of this is how do we build resilience in our children and you'll hear later on this conference how literacy is a promotion in children is a powerful skill, tool, and pathway to build resilience in children. It's powerful. It's something every parent can do. And it involves building relational support for the children. It actually I think and maybe Bob-- we don't know this, Bob. But it forces-- I think it reduces stress in the adult to have these quiet moments with children. So I used to literally prescribe time to my parents. So I was in clinic. We were trying to do a hard thing. We were trying to really shift lifestyles to promote a healthy weight. And any of you who've tried do that that is very hard. So I literally would prescribe 15 to 20 minutes a day for the parent and they were not allowed to do tasks like you couldn't be 15 minutes on the homework or 15 minutes on, you know, what you're going to wear tomorrow, it had to be this engagement time. You could read. You can paint each other's fingernails. You could hair and the children were delighted and the parents were often astounded. First that I would ask that they spend this time and they started ask, well, how can I get that 15 minutes? And we figured that out and then when they would come back, they were astounded because what happened with that time was that they remembered the joy of being a parent. They remembered how fun it was to engage to child. The children of course were delighted because it was never a child I never met that didn't want to spend more time with their parent. And then-- So, I think that this building resilience is not rocket science. But it often feels like rocket science to families when they're trying to carve out this time, time to read, time to be with their children from very busy, highly stressful life and you add on those ACEs that not only are occurring now but the parents experience, you can see that this is-- that we need to be absolutely supportive of our families here. Increase sensitivity to the child's needs and that relational time that time with the child increases that sensitivity. And then when we spend the time to address the problem in its immediacy that the parents are having so we can become solution oriented for the parents. So this is a handout that I would often give parents. And again, not rocket science but often hard to imagine doing when you're in a highly stressful situation. Share your feelings, play, set consistent expectations, protect the child from adult concerns, encourage small goals, try something new, keep healthy, try something relaxing, things we would all sort of endorse and sort of basic foundational elements are often hard for parents to do unless they're supported. So our literacy promotion recommendation for pediatricians were to promote literacy at health supervision visits. Really inform parents, advice parents that reading it loud can enrich the relationships. Counseling about what are developmentally appropriate literacy activities and provide books and you'll hear more about that as well. We also said make your office literacy friendly. Use posters and inform parents about the importance of literacy. Partner with advocates like we're doing today to promote literacy. Incorporate literacy in our training programs. Sports-- Support funding for children's books and research. So we call out our profession to really do a 360-degree support of literacy. And we have some tools. So we have bright futures that has literacy and woven into it. And also the ability now the new addition to detect these adverse childhood experiences and build resiliency. Promote Reach Out and Read, which you'll hear about. And many, many pediatricians are doing this in their offices and address these toxic experiences that prevent the building of resiliency, the building of literacy in our families. And this is just an interesting map of the book deserts in the United States. And so you'll see that the orange is percent of homes with more than 100 books. And 100 books is a lot. For some of us, I don't think 100 books is a lot in my house but it is a lot and you'll see that they're-- very map reproduces itself, overlays many of our maps of chronic illness and health disparities in this country. So we have on our website literacy building tools, books building connection toolkit. This is for professionals and families and just to highlight that. And then we talk about and help pediatricians understand and parents why books, what a child can do with a book, how parents can enjoy the book, and when to share, and how to weave literacy into your house. And so supporting evidence for professionals because our docs like to know why they're doing it and then what-- ask about and what to do. And then promoting the five Rs; reading, rhyming, routines, rewards, and relationships. And you can see how integral literacy and literacy promotion is into building these really foundational elements of family relationships. So, all families need to understand and hear the important message that literacy is important. So-- And we said that in our policy. But I was taking the red-eye to Chicago and I jumped into a cab and the driver and I were chatting and he learned that I was a pediatrician and many of you who are pediatricians know this happens, people find out you're pediatrician and they really want to tell you about their children. And so he began telling me about a 6-month old daughter and he's working two jobs and he's not at home with her very often and he wanted to give her the best possible life. But he said, "I am working to give her a better life but I don't have a lot of time," and he was really lamenting that. And he asked me, "What I should do?" And I said, "Well, read to her." And he looked puzzled. And he said, "But she's only 6 months old like what are you crazy, read to her?" And I told him how reading builds brains, vocabularies changes behaviors, sets up children for success. And we wound up discussing early child development, literacy and learning, and the cab ride from O'Hare to our headquarters at Elk Grove Village. And he was amazed. And he was grateful. And he was grateful that he could do something for her even in the little time he had. And we arrived at the hotel. He couldn't stop thanking me and shaking my hand. He said, "I will read to her." And he said, "There's something I can do to help her and help her have a better future and I will do it." So, I think we can underestimate the importance of this for our children, the importance of this for our parents, the importance of this for our families, and the importance of this for building the foundations of child health in our country. So, thank you very much. And I'm pleased to be here. [ Applause ] >> John Cole: Well, thank you very much for that wonderful beginning, followup to what we've started last night. I'm pleased that we can approach this subject from so many points of view and there are many points of view to come. I want to say just a word about today's schedule and logistics. We-- Last night, those of you who are not able to join us, I'm sorry, did not have a chance to see the Library of Congress' historic building, the Jefferson Building which opened in 1897. Instead we're-- in our newest building, which opened in 1980, the Madison building. We're proud that all three of our buildings across the street, the second building, we're not visiting at all is called the Adams Building. But we were created in 1800. It was the first federal culture institution and our three buildings on this campus are named for book loving presidents. And Jefferson had a special role in founding the Library of Congress by selling at his-- at cost really his library, his comprehensive library to the fledgling Library of Congress in the Capitol after the British had burned it in 1814. And from the comprehensiveness of his collection came the comprehensiveness of the approach of the Library of Congress which meant we collect in all subjects and we try to share resources. We are in effect the National Library even though because we're legislative branch and have congress as our most important client, we don't have the official name National Library. But that gives us feeling that we can reach out through educational outreach and other activities that cover many different subjects and are national place to bring together groups that normally would not come together and it's in that spirit in which the Center for the Book was formed and also in which we are needing today. Now down to the nitty-greedy. The restrooms are just outside. There is a lunch for the speakers and their guests next door. But members of the public who will be coming and going all day our cafeteria is just a step away. So it's close by. All of our talks are in this room. Is that-- That's right. We are featuring panel discussions that have been organized with experts on the various aspects and approaches to our topic. We also will have a couple of specialized sessions of one with our Robie Harris who will speak about-- an author who will speak about her perspective, is a wonderful author of books on our subjects. The second one is something we talked about and are going to have a short presentation and the general idea was the role of health in a crisis in kind of a policy crisis or a different kind of national crisis and we are going to have a short presentation 1:10 today by a specialist from the World Bank about Ebola, literacy in the Ebola crisis to try to bring us up to date on another way of looking at what we're talking about. And in our keynote this morning, it's interesting, you know, that we really are talking not only about research for specialist but in fact real life for cab drivers and for providing advice. And that was another point that came out last night is that first confrontation with an adult about a very young child and what time are you spending together. And Dr. Bailey made the point at least to me in another conversation that sometimes he knows immediately or maybe with someone else last that if there's no reaction at all, you know there's work to be done. And when someone thinks about their youngest child and that's an opening, I think, for all of us. Our second-- Let me see if I-- Now when we-- We'll have a chance with-- We'll have a chance for conversation depending on-- and I'm not going to quiet anyone now. We have the time to speak. But at the very end of the day, we'll see how it works and we have some free time for conversation and questions. But I will encourage the chairs to use that time now to the best of their judgment whether you want to take questions or not. And we also will not spend much time on biographies because biographies are in your handout along with some general information about our program about the Center for the Book, but also about the literacy awards program. And you'll see those handsome-- we've now had three years of literacy awards and I urge you to take a look at the handouts because we have developed a plan that goes beyond the cash awards which Reach Out and Read, I should note was the first winner of the Rubenstein award. So maybe this is prophetic that we are all coming together with this particular focus. It shows how we really are, I believe, beginning to learn from what we're doing and using the literacy awards connections with organizations as a way for us and you if you're here to see what how big this world really is. But we developed something called best practices obviously. And we-- it goes beyond the three large cash awards and these are recognitions from the Library of Congress. So far, it's just with the certificate. But we're hoping that as our program evolves we can do more in helping out some of the smaller organizations that are getting best practices awards. And beginning with our second year, we really expanded, figured out what to do with best practices. And each time we've given between 12 and 15 organizations from around the world best practices acknowledgments and been able to bring them here to the library to talk about their programs and we are filming our programming in the process, developing our website which one of this days when we crash-- not crash, went-- wrong verb-- when we penetrate the Library of Congress' web services to the point that we can move our results up a little faster. We'll be showing you some of our-- the website films from some winners. And for us, it's a great stimulation to have people from other countries come and just have their 10 or 15 minutes of recognition and we film it and we also have a page for each of them in our last two annual books which they can use to promote themselves. So, this is an ongoing process and you are now part of it and we will move to our first panel. The panel is Child and Adolescent Health and Literacy Issues. and the panel consist of Libby Dogget who will be the chair. Laura who is part of it. Lindsay Carter and Dr. Needleman. And I would like them to come up and I will introduce Libby a little bit but not much. Come on up. Everybody come up. Libby will have the panel members say a little bit about their own backgrounds. But Libby herself is with the Department of Education. She's an assistant-- Deputy Assistant Secretary for Policy and Early Learning in the Office of Elementary and Secondary Education. And we are all meeting-- some of us are meeting each other for the first time. >> Libby Dogget: That's right, we are. >> Trying to figure out who's sitting-- >> Libby Dogget: We actually met on the phone because we are prepared. So I think what we'll do is I'm going to introduce the panel a little bit or the frame of the panel although Sandy did an incredible job of really introducing the whole topic and it was just a beautiful presentation. So, thank you for your presentation. But more importantly, thank you for what the American Academy of Pediatrics is doing in this country. They are making a difference. [ Applause ] >> Laura is going to help with timekeeping for you. >> Libby Dogget: OK. So, one of our panelists couldn't come but we promised that we would make sure that her message on diversity in books would be heard. So, Ellen Oh was not able to join us today. I regret that because she would have been incredible person. She is an author as well as the CEO of a group called We Need Diverse Books. And we do need more diverse book. So, we will try to work her message into what we're saying. I'm delighted to be here. It's such an honor. I think the Library of Congress is the most beautiful place in the entire world and the idea that we have so many books available here and electronically now and then in libraries all across this country is just pretty incredible. We have a program at the Department of Education called "Race to the Top: Early Learning Challenge." And we have spent a billion dollars funding 20 states. And one of the states, Maryland, has worked really diligently to get families engaged in their children's education and to just establish stronger partnerships. And one of the things they've done is to actually introduce families to the library. And I think we all take libraries for granted. When I was a little girl, my family-- my mother took us to library every week and beside her bed was always a stock of books this high and I don't know how she got through them with four kids. But she somehow at least got through a lot of them because she was always reading and reading to us and so we all got used to bringing home a stack of books. But in Maryland, some of the newer families, the new immigrant families didn't know that the library was free. They hadn't used the library because that they thought that that incredible resource was something for others, people who could pay. And so they had event at the library, made sure the families got a library card and taught them how to use it and I thought that was such a great way to make a difference in families' lives. I remember very well when the first time I learn to read, I grew up in a family that I had no excuse for not reading. Family that did very well. I was raised to Marywell, which a little-- fortunately, I did but I did more than that hopefully. But I didn't know how to read when I get to first grade and I've gone to kindergarten, I've gone to preschool at the church, Norton's Preschool. But I had no idea how to read and I remember sitting in the reading group, have this vision so clearly in my mind and the teacher put a book, a little book in front about eight of us and asked if anybody knew what TIP meant. And there was of course a beautiful cute picture of a dog and my friend Mark Blumenthal who is still a friend said, "Tip." And I just looked at him like he was the smartest person in the world because I had no idea. No one had ever taken the time to teach me to decode the letter and the sounds. And I was in first grade and, of course, once I've learned, it was very easy but it was so interesting because learning to read is not easy. And some kids just automatically get it. But most children do not and it is very difficult. So we're going to have a change with Laura to go into depth about that. And then we've already heard about how important it is to have books and that that reading and the relationship that develops between the parents and the child sitting close, talking about things, slowing down is so very, very important. We know to do that. We still aren't doing it. It's just amazing to have-- we have Reach Out and Read. We have RIF still. We have all kinds of ways to get children books. But we're not doing a very good job of getting those books into the home yet. But we have one great way to do it and I'm glad to see it's expanding. So Robert will tell us about that. And then, I think it's interesting that other countries are using our great research and are doing all kinds of wonderful thing. And so we're very fortunate to have Lindsay from the Department of Agriculture to help us frame this not just in the United States but globally. And so she'll talk a little bit about what we're doing here and abroad. Before I turn it over to my incredible panel, I want to just give you a little bit of background about what's happened in the last seven years in early childhood education, because that's what I do. We have been fortunate to have a president who really did focus on this. I can remember sitting around the table in Austin, Texas where I actually live with some of my friends thinking "Who can we get to champion early childhood education?" We didn't-- You know, there was no city council person, certainly not the mayor. There was no member of house or senate in Texas. There was certainly no one in congress, no senator. We wouldn't have thought of the president championing in this. We did find a business leader or the wife of business leader Ronya Kozmetsky whose husband was present at the Business School of University of Texas. She was incredible advocate for us. And we wouldn't have dreamed of where we would be now. I was sitting just across the way at the Capitol a few years ago watching the state of the union. And I had been told that there was going to be a special announcement about early childhood education. Little did I dream that the president would set such an incredible goal. But we have the goal of providing pre-K for every 4-year-old in this country. We're not there yet. But we keep-- the president keeps coming back with it year after year. We know that's not a silver bullet. But we know that's doable because Oklahoma is doing it, because West Virginia is doing it. Georgia, Vermont now is offering pre-K for every 3 and 4-year-old. So we know how to do this. States are getting in line. It's not a silver bullet. We need to do pre-K for 3 and 4-year olds. We need to improve the whole childcare system and make it into an early learning system where every setting for children is a learning setting and that's going to take a lot of money. But there is a proposal on the table also to improve the quality of childcare across our country. And then, there's a wonderful piece of the president's agenda which talks to parents because we know that every parent wants to do the best possible job for their children. You never talk to a parent who hasn't said, "I want to do a better job." I thought your story about the taxi cab driver was so wonderful because we all hear that and every parent wants that. They just don't know how. And even our middle-income families and upper-income families are stressed now because mothers are working and fathers are working and their lives are so very complicated. I have two young daughters and I just marveled at how they carve out time for everything. So, with the president's agenda, we have money set or asked-- we're asking for a great increase in the home visiting money. It is come down through this president where it's exciting because we have home visiting now which is really parent coaching in every single state. But we know it's only reaching a small portion of the families that need it. It's all voluntary. But you know what, every family's asked, "Would you like some help? Would you like coach or a mentor?" They all-- Nearly always say yes. So there is an agenda on the table. We have people at the highest levels now talking about it. We had more recently in the New York, really a competition between the governor and the mayor of New York City about who is going to pay for the pre-K program. We need more arguments like that to raise this up. I do think the American Academy of Pediatric is really made-- been a great advocate for this. Because it's not people like me who are advocate but it's really the business leaders, the doctors, the-- actually, the flag officers, generals, and the naval officers who have come in and have really made the case that we need this not just for the kids and for the parents. We need this for our country and for the future of our workforce. So, it's been a great ride. I hope we can continue the momentum because there's-- we've just barely started. The growth is way too small. It's way too late. These first five years disappear like that. For us, five years is nothing. But five years, children are already in kindergarten and then in first grade and we've missed an incredible opportunity. So now, we're going to go in depth. And we're going to start off with Laura. I mean with-- I'm sorry-- with Robert. And he's going to tell us about a great Reach Out and Read which Sandy mentioned and he'll tell us more about it. And they're limited to three or four minutes and they're going to introduce the topic and then we're going to just kind of have a conversation among us but we are reserving 20 minutes for you to have a conversation with us. So, write down your questions, be thinking about this because we really do want to engage the audience. And we have incredible experts here. So, Robert. >> Robert Needleman: Thank you very much. It's wonderful to be here seeing old friends making new friends, realizing that our vision is shared and it's very powerful. Now, I-- my heart is thinking though, Sandy while you were talking because I'm thinking she's saying everything I was going to say. And my only consolation is as a pediatrician, I know that learning is closely connected with repetition. So, this will give you an opportunity to master some of this material a little bit more. And I have written my comments down because I didn't want to go over. I could easily talk for the hour myself. But this is to keep me in line. So, Reach Out and Read is an approach to pediatric primary care that puts the connection between health and literacy, front and center. We do this in several ways. First, we create literacy-rich waiting rooms. In the best situation, we have volunteers who are reading with the children. And more importantly, demonstrating to the parents two things, one that it's easy and two that their children love it. In the situation in which Reach Out and Read developed which was a large clinic serving a low-income urban population Boston City Hospital now Boston Medical Center. Parents regrettably would often wait for an hour for their visits. So instead of that hour being filled with the kind of control speech that you talked about, it was an hour now filled with observing their children responding to books and somebody who could present them in a happy way. And we discovered a form of waiting room contagion which was that as parents were watching one person interacting with children about books, other kids would come along and then the parents would hang in the back would start picking up the books and looking at them with their children. So pretty soon we created a milieu in which literacy fused the waiting room. And we also noticed that things got quieter because the kids weren't running around and the parents weren't yelling at them. They were engaged. We have a new developmentally and culturally appropriate picture book at every visit to the pediatrician, every Well-Child visits starting at six months of age. That's important for a lot of reasons; one, is because the books cost money and so we have to raise money. Two, the more importantly, it's not about giving books to families. It's not about getting books into the home. There are many more efficient ways to get books into home than having a pediatrician hand them about. It's about having the book in the clinic to use together with the parent and the child. And I'll say a little bit more about that. And specifically the most important thing I think that we do is we provide individualized one-on-one guidance to a parent with a child about how that child and parent are together using literacy to creat connections, to enrich their language, and to establish an optimistic outlook for the child. So a great pediatrician told me something at the very begging of Reach Out and Read he said, "You know, when I bring the book into the room, we have conversations with the parents that we never had before. And the conversation is about my child growing up to be a learner." And that was sort of a world-changing perspective for us is that we were tapping into a very, very powerful strong current within the parents of optimism and hope and also fear. Parents would not had good experiences themselves in the educational world, those were our patients, could see as your cab driver could see there is something I can do tremendously powerful. Reach Out and Read reaches 4.4 million mainly low-income children. It's about 25% of the low-income children in the country. That's awful. I mean, it's wonderful, right, 25%. It's awful. What about the other 75% who receive care at some 5500 clinics around the country? And we have affiliated programs now in many other parts of the world. Italy and Germany are on board and some places where books are being used specifically to help the most stressed kids like the Philippines where we've been involved with kids who are affected by the storms there and Haiti. We embrace a wholistic view of health which includes physical, social, and emotional well-being. And I won't go into more of that because it's been talked about. And importantly physicians, pediatricians, family doctors have a special opportunity because of our contact with parent at 10 regularly scheduled Well-Child visits because they're in the room with us one-on-one and because parents we know come to us not only for advice about health but also for advice about their children's development and what they can do. Reach Out and Read rests on a strong base of evidence. We have 14 and now maybe 15 studies published in the peer-reviewed literature that demonstrates some very important outcomes. Most importantly parental attitudes towards reading aloud, including the judgment when you asked parents in a sly way that doesn't sort of prejudice their answers. The judgment that reading aloud is one of the favorite things that parents do with their child, so a source of joy together. And correspondingly increases in the frequency with which parents read aloud and in the number of books in the home. And then most importantly, we've been able to document through several studies, five at last count, improvements in children's language development, specifically vocabulary. And that's because vocabulary is both a direct result of reading aloud that we know that as parents read aloud children's vocabulary increases the number of words that they're exposed to increases. And it's also a very robust predictor of later school success. So that when we can show experimentally that institution of a Reach Out and Read program increases children's vocabulary, which has been shown, then we know that we're setting those children up for later success. A new evidence, including a marvelous report published in pediatrics awhile ago increasingly shows that literacy acquisition, listening to stories, engaging with literature changes the structure of the human brain, specifically the parts of the brain that are engaged in listening to stories. So when we talk about literacy in health, we're really talking about the health of a very important organ, the brain. And now increasingly we're able to see through technology how literacy changes the brain. No mystery there. But it's quite clear that a healthy brain is important if you're going to become a literate and successful member of society. So, our intervention is specifically health-related in the sense that we have a target organ, the brain, that we're changing. And also, as you mention, Sandy, very importantly, shared enjoyment of stories strengthens attachment and emotional health. And I believe builds resilience. So, recognizing this into a connection between literacy and health, Reach Out and Read is an answer to one very specific question. What can doctors do? What can doctors do concretely everyday in their offices? There are many things we can do. We can advocate. We can educate. But what can we do everyday in our office day in and day out to move children towards greater literacy and thereby greater health? I just want to end-- I probably talked long-- saying one thing about the name Reach Out and Read, all right. I would say it in this context. It's a little in-joke for me. The name was thought off by my wife, who is a surgical pathologist. And is she sees children in her professional life, that's little, tiny pieces of children. And she thought off the name because we wanted a cool acronym so it was R-O-A-R, Reach Out and Read. That only lasted until the mayor of Boston informed us that R-O-A-R also stood for Restore Our Alienated Rights, which is anti-Boston group in south. So we became the first maybe only literacy organization that's spells its name wrong. But it also turned out to be prophetic in the sense that we're learning that reaching out is not only reaching out to parents and connecting with their aspirations for their children, but that this enterprise for pediatricians requires us to reach out to other professionals who have other expertise to business people, to educators, to policy people. The program really only works when we cross boundaries. Pediatricians cannot and do not do it alone. And giving pediatricians, family doctors a tool that they can use everyday also encourages them to look beyond the walls of their clinic, because they need to make common cause with others in the community. So in that sense, we're reaching out as well and that's the reason that I'm especially delighted to be here to have this discussion with you. >> Libby Dogget: Thank you so much. You know, we wouldn't have Reach Out and Read if it weren't for Robert, because he's one of the cofounder. So, the fact that your wife got the name, obviously, tells us how imminently you were involved in the beginning of that. I think he's given us a challenge. Only 75% of the kids don't have this and we know how to do this. This is doable. I think the other challenge that we all have is getting time for pediatricians to do this. Because I know I have a son-in-law who's a pediatrician and he is challenged and my daughter did family-- it has family practice and, you know, that challenge of having the time to do it. They both do it but it's very difficult, so. Thank you. So, Laura is next and she's going to take a little bit different tack and talk a little bit more about literacy but you'll see how it all comes together. >> Laura Bailet: Good morning. I'm Laura Bailet and I direct the Nemours BrightStart program. Nemours is an integrated children's health system and Nemours is recognized reading failure as a major child health issue several years ago. Given a really significant health educational and truly life consequences of poor reading ability, Nemours identified that it couldn't just sit on the sidelines of this issue. And this has been so reinforced to me just in the last 12 hours listening to Dr. Bailey's wonderful talk last night and then Dr. Hassink this morning. And these are two of our physician leaders at Nemours. Dr. Bailey is our President and CEO. And their pediatricians and to hear them talk about literacy issues with such in-depth knowledge and emphasizing all the ways and how much that's important for pediatric health care is just stunning to me still. And it just reminds me what an honor and privilege it is to work at an organization like Nemours that really does value the whole child and helping every child maximize their potential. So I just had to give that commercial for Nemours. It's stunning. So, for the past 11 years, Nemours BrightStart has developed and researched new tools for educators, parents, and health care providers because as we know all of those folks in our community have a big role to play. And we want to help each of these folks understand what it takes for every child to become a strong reader. And Sandy did a great job of reminding us. We need to talk more about what all children need. And there's still is a lot of misunderstanding about what every child needs to thrive. We also focus a lot on how to identify those children who maybe at risk and what to do to catch them up before they have a chance to fail. So we've developed educational tools that through our research have been proven highly successful in reducing that reading readiness gap in these vulnerable children before they even get to kindergarten. I wan to talk a little bit about one of our current project which is a website for parents of children from birth through 5 called On that website we've really taken everything that we've learned from our work with thousands of children. We've worked with children our selves. Parents and teachers direct work with all of these people. And put all of that content into a website with the goal empowering parents, really putting them squarely in the driver seat in preparing their own child for reading success. One of the best features of our website is our preschool reading screener for 3 to 5-year-olds. This is a simple check list that helps the parent find out if their child is on track in their reading readiness or maybe needs more help. After the parent completes the screener, they receive a customized action plan for there child. All aspects of the website are currently free and we've optimized the site for smartphone to make it as accessible as possible to people across the income spectrum. So today, in this setting we're releasing our very first national reading readiness snapshot. So through the website thousands of parents from all 50 states and Washington, DC have completed that screener. And thousands of them have given us there permission to use their child's data for research purposes. So we're sharing with you our very first set of result as a springboard to our goal ultimately of universal reading readiness screening for every 4-year-old in the country. We have copies of our reading readiness snapshot document out on the table. So, please grab one. We're happy to discuss the result and answer any questions you have about that. And we think this screener as well as the website as a whole can work really, really well with programs like Reach Out and Read and other community initiatives to strengthen early childhood programs and resources. Thank you. >> Libby Dogget: Great. Thank you. We want to hear more about that because I do want to hear the results. >> Laura Bailet: OK. >> Libby Dogget: So where-- as I mentioned in my intro Lindsay Carter is here from the USDA, University-- US Department of Agriculture. So we have education and we talked about health and we have agriculture. And they're doing amazing stuff. We were really excited when we were talking and just hearing all what's going on abroad. So Lindsay, give us a little taste. >> Lindsay Carter: Thank you very much. Yes, I'm here today from the US Department of Agriculture. And many of you maybe aware of the National School Meals Program and School Breakfast Programs that we implement here in the US. But over what-- that's with the food and nutrition service. But coming over to another part of USDA, we have the Foreign Agricultural Service which has a mission to improve agricultural trade and reduce world hunger. And one of the programs under our agency is the McGovern-Dole, full title, International Food for Education and Child Nutrition Program. Which I think even in the title alone really ties in the health and then nutrition. Our program began bin 2003 after being authorized under the Farm Bill. And our mission is to help promote education, child development, and food and security in some of the world's poorest countries. This is done through the use of US agricultural commodities as well as technical and financial assistance to initiate, start, and continue with school meals programs. And it's through this provision of school meals that we look for an initial increase in school enrollment and school attendance rates, which is very visible visiting programs in Malawi you suddenly see a lot more children being sent to school when their parents realize "Hey, our kids are going to get a free meal." And sometimes that is the only meal that they receive in a day. And we-- through programs as well, we're improving enrollment, increasing attendance rates, and then also reducing school dropout rates. Our program is implemented by our private voluntary organizations and also international organizations like the UN World Food Program. Our program is running from three to five years, sometimes potential for continuations. And at present, we have 33 active agreements in 25 countries across Latin America and the Caribbean, all parts of Africa and Southeast Asia. And what we find through our programs is, well, we saw initial increases enrollments, our program is doing a great job about getting children into school. It's when you got their butts in the seats, how do you start teaching them to learn? So in 2012, we developed two results frameworks, which include increase literacy and increase the use of health and dietary practices. And this is through how sort of school feeding leads to at more children being well fed, being at active and attentive, ready to learn. A hungry child is going-- is not going to have the same learning capacity as a child that is well fed. Improve nutrition that comes from providing a daily nutritious meal. But we found that in order to reach these goals we needed to have complementary activities. So, what we have a lot under our program is an addition to the providing a school meal. We're bringing the parent-teacher organizations together usually to prepare the meal, to serve the meal as well as to support the school. We'll introduce school gardens which include a-- the FAO has developed the school gardens curriculum. This isn't for the children to be, you know, out of the classroom, but it's the opportunity for the children to use the garden to be out learning about what's being grown. I've seen school gardens where they create the planting beds in different shapes, so the children can learn shapes. There's a whole way of developing a constructive curriculum. We then talked about in order for the children to get the nutrition and the meal, building routines, teaching handwashing, making sure there's access to safe water, so that the school meals can be safely prepared and the overall health of child is going to be supported. We're also doing teacher training and we're making sure that there are books in the classrooms. For example, Room to Learn is working in Laos to make sure there are school classrooms. And a lot of these communities there's usually a generation of parents where a large proportion of them are illiterate. So, how do you bring them in? Our program in Mali has developed report cards, which is landmark report cards for illiterate parents. That connects the parents with the goal of the child because we believe a parent doesn't necessarily need to be literate to understand the value of education and want their child to be literate. So, we have brought all of those together. We encourage our organizations to build capacity at the national, regional, and local level, which usually involves developing a national school feeding policy and understanding what is the benefits. So we try a lot of-- there's a lack data connecting really what is the value of providing a school meal to improve literacy and health and nutrition of the school age child and how those two objectives support one another. So, we have-- we have baseline, midterm, and final evaluations building a base of data as well as taking our own initiatives within our office to develop systematic reviews of what's already been studied out there across the world. And then build upon that, by building our own learning agenda. What do we need to know and what pathways of attribution do we need to learn so we can provide this data to foreign government to further support their school meals programs and there improve literacy. And I think this is important. The final note that I want touch upon is, here in the US our school meals program is housed within the Department of Agriculture. This isn't the case in many of the countries that we work. The school feeding unit is usually housed within the Ministry of Education. So working on curriculum development, when we need to advocate for why that should be a national school feeding policy we're talking to the education ministry. So coordination with them and recognizing the connection of how school feeding can lead to improvements in literacy and health. But that touched upon today especially the pediatricians between the connection of literacy and health and health and literacy. And then my final thing is that-- my final point is the connections that we need to making as far as fought for coordination in order to supplement these impacts. Providing a school meal alone is not going to improve literacy. There need to be complementary activities and our office has benefitted from the memorandum of understanding with US Aids Office of Education who have a goal one to have improve the literacy, early grade reading of 100 million children worldwide. Working with them, the literacy experts will able to improve the quality of our program and further providing a school meal helps to bring those children to school. So thank you very much. >> Libby Dogget: Thank you Lindsey that was amazing. Yes clap. [Applause] I think it's incredible for us to be reminded again how important food is. It is the very basic medicine. I mean it's so basic and we don't worry as much about that because of the great school meal programs although I think we worry over the summer and over vacations because some children even in our country aren't getting the nutrition they need. That was incredible. So we're going to go a little bit more in-depth to be thinking of your question because you all are next. But I want to go back to you and talk a little bit about intergenerational poverty. I mean, you're working-- you're working with the parents and the children and right now there is a resurgence on what we call two-gen programs. Programs that don't just focus on the children don't just focus on the adults but focus on both because we know they are important. So, how does Reach Out and Read fit into that? >> Robert Needleman: Many years ago I had a study underway through Maternal and Child Health Bureau in which we enrolled several hundred mothers of children coming for their five month Well-Child visit. And part of what we did in the study was we gave the mother very simple reading test, the Wide Range Achievement Test, which is nothing but a list of words that you have to read you get a score. 50% of our mothers in that study were untestable. Their scores were below the bottom of the test. So, the problem with literacy is extreme. Many of the graduates from our public schools graduate without the ability to read well. My own take on it is that having low literacy skills as a parent contributes to a sense of despair in terms of your ability to help your child see a better way. And at the same time, every time you pick up a book you're reminded of your own history of frustration and discouragement growing up in school. So, one of the things that we try to do in Reach Out and Read is be aware of that and understand that telling a parent in that situation you should read to your child is not a benign thing to do. It's actually very bad thing to do. And that the message needs to be, you can help your child love books by having fun with your child with the book. Don't focus on words. Make it fun and talk about the pictures and enjoy it together. So that-- we have a problem in terminology. We call it reading aloud. But what we're really talking about is not reading at all. What we're talking about is a joyful interaction between parents and children and books. And to convey that to parents, what we find is most helpful is not really to say very much at all but to do it. So, our methodology at least what I think is most effective is to watch the parent looking at the book of child for a very short period of time. One can get a good sense of it in a very quick interaction. To notice when it looks beautiful and be a witness to that this is beautiful. Or when it doesn't look beautiful to be able to right there demonstrate how to do it. And it is as simple as stepping and saying, "Why don't we try this?" And then you do something. And it may be just looking at a picture and saying, "Hey, where is the boy? What's he doing? Where is the dog? Can you show me the," right. And you play that game for a minute. And then when the child is engaged and happy we say, "This is what we mean when we talk about reading, now you do it." And then giving another parent a chance to mimic what we've done. So, that's a very concrete approach to this question of interrupting a transgenerational transmission of not only literacy is an inability to read but literacy as an unhappy relationship with books. And I think we can do that because of the power of the relationship between the doctor and the parent where the relationship is one of appreciation without judgment and of collaboration. We are in this together to help your child to be the most wonderful person that can be. So your quote from Dr. Pasteur was exactly right. That's exactly what we're about. >> Libby Dogget: So Laura, talk us more about the reading. I mean it's difficult to learn to read. We know from Bob a lot of families can't read and we have to teach them how to read the pictures and tell the stories and use their words in other ways. But how hard is it to learn to read and what is that-- what's going on in the brain and what does the research tell us? >> Laura Bailet: Well, learning to read is really a very challenging task for the brain. And I think we're reminded of that with the statistic that Sandy showed in one of her slides that by the end of third grade 2/3 of American children-- we're a very affluent country on an international scale. Two-thirds of them are not proficient in reading. That does that mean 2/3 of all of our children are disabled or that there's something wrong with them. What's wrong is that they're not getting the kind of instruction starting early and you have to help them become proficient readers. And one of things that the basics that we have sort of forgotten is how challenging a task this is for the brain. You know, reading occurs very late in the course of human development and you know I think a lot when I'm at the Library of Congress about Gothenburg and I once heard a brilliant neuroscientist, Dr. Gordon Sherman say, "You know what really cause dyslexia was Gothenburg because when he invented the printing press all of a sudden the masses are sort of expected to be able to read, whereas before it was only the elite few that could read. But now that everybody has the opportunity to read, the expectation goes up, well, then everybody should read and it's not a natural easy thing for the brain." And so I think there's a lot to that. But we still have this prevailing myth that children do learn to read naturally if they just sort of have books around them and a reasonably supportive environment. Now children do learn to talk in this way but most children don't learn to read in this way. For most children learning to read in English takes about three to four years of intentional systematic high quality instruction. If you're Italian it only takes about one to two years to learn to read. If you're Chinese it takes about 10 years. So it definitely varies depending on the complexity of the written language system. And even many educators don't fully understand this. Learning to read requires several parts of the brain which are built to do something else to learn a new skill and then synchronize with these other brain areas. They're also learning something new at the same time. So it's pretty darn complicated and we really shouldn't be surprised that so many children struggle with it. Now I do want to emphasize that success with reading instruction is really predicated on a lot of high quality talking, reading, singing and playing that parents and other caregivers will do with young children starting from birth. So that is absolutely necessary and lays down that solid brain foundation so that the child is ready and able to benefit from that high quality instruction. So it takes both sides of that and the earlier that we start providing that evidence-based developmentally appropriate reading instruction the stronger the reading outcomes. I do want to go back to a point that Libby actually mentioned. I can't believe she said it. But another really important-- because we didn't talk about it in advance and I already had this typed, you can look. Another really important point about reading is that it tends to be viewed as a proxy for intelligence. So it works like this, if you're a good reader you must be very smart. And that's exactly what Libby said that kid who know the word tip she said he must be very smart! >> Libby Dogget: He was and he still is. >> Laura Bailet: That's-- And he still is. But you're no slack and you weren't reading that word, so. But if you're not a good reader maybe it's because you're just not very smart. And this is the message that struggling readers receive over and over and begin telling themselves. And those of you who work with adults with low literacy skills, you know what I'm talking about. I can't tell you how often I have heard from children, teenagers, and adults that they think they are not smart no matter what other evidence there is that they are incredibly bright and talented. And once they start to think that they're not smart, it's like it become sort of seared into their psyche. And they just can't stop believing that. And it has so profound an impact on their confidence, on their willingness to ask questions in institutional situations or with authority figures like a doctor. They are terrified to read with their children because they think they can't do it well enough. And that if they don't know a word or make a mistake that's the worst thing that can happen. We spend a lot of time and effort on our website and in our direct interaction with parents talking exactly about what Robert said. It's not about reading every word on the page. It's about engaging around that book, having fun, having a loving supportive conversation. That's what's important with the babies not reading every word on the page. That's what really motivates us at Nemours BrightStart well stuff there. >> Libby Dogget: So Lindsay, we've talked to all about the intersection of health and literacy and you added really nutrition because we know that's important too and Hassink talked about it. What if you learned from abroad that we should know or heed? >> Lindsay Carter: It's-- Across all programs depending on the other, there's a lot of differences. But sometimes I'm struck by when I'm in the field when I hear very similarities, a lot of sort of qualitative discussions I have with a parents or a community member really drives home and be like, I'm pretty sure I could be having this conversation with the parent in the US. A lot of it having to do with-- we taught a lot about early childhood development. Hearing teachers Burkina Faso where childcare and early childhood development is certainly not common feature. But we do part of that. Our activities there is we do support early childcare centers and provide training to caregivers. And hearing the parents there and the teachers talking about these children they arrived and they already know their letters and they're ready to read. In the community where many of the households have notebooks, whatsoever, but a well-supplied early childcare center has the same impact, very similar impact to what it can have in Burkina Faso to what it has in Oklahoma. So there are lot of similarities as well as some differences. But what really strikes me is the conversations today as far what I've seen is literacy is not restricted to the classroom. It's what happens in a pediatricians' offices, what happens in a childcare, what happens a lot in the home. And when we talk-- working in very remote and isolated locations around the world, a school is important because a school is where a community can come together in a place where they may not be a health clinic but there is usually a primary school. So I think it's important to remember that a school and education system is a resource of the community where it can be a location but it's not those-- the boundaries of the school go beyond the school gate. So that's really how [inaudible] of providing a school meal and addressing nutrition heath and literacy that sort of our entry point. But we really try and develop programs that go beyond the school gate and that engages with-- engaging with parents and doing nutrition trainings and working-- if there's a preschool working with a preschool. And developing that sort of sustainability and really trying to save a community which I think is probably true in the US. And I'll just use this as another places. We found that the school is incredibly useful on these very remote and isolated locations as also an entry point for providing certain aspects of health education and health services. And I didn't get a chance to mention during my introduction. But another part of the ability of a child to take in the nutritional quality is something like providing de-worming campaigns. So that's actually a way that a Ministry of Education may coordinate with a Ministry of Health as far as if there's a national de-worming campaign having that entry point into a community not be through the health center that doesn't exist but being through to school. And by providing nutrition and education and health education to a child is kind of a twofold effect because you both-- you reach the parents and also you're reaching the future parents through the children. >> Libby Dogget: Great. Thank you. Laura? >> Laura Bailet: Can I share with the audience a little bit of-- a conversation that the three of us had as we all met first thing this morning and Lindsay that was the point that you made that sometimes inadvertently, a literacy program or a feeding program because of time and resource constraints end up one supplants the other. And it may be inadvertent or you-- you know, organizations may know that this is going to happen but feel like, "Well, we can't do both, so we're going to have to pick one over the other." And I think in some ways that happens a lot in this country, too, where we sort to have the "Tyranny of the OR." We think we can do this or we can do this. But there's no way we can do both together. And I think that's where, you know, some creative thinking and thinking across traditional boundaries and silos could really help us do both in a very resource-efficient and time-efficient. Well, I don't know if you-- either of you we all talked about. >> Robert Needleman: Well, I think that the key insight is you can't be healthy if you can't read. And you probably can't read if you're not healthy. So the OR proposition is a nonstarter and we need to just be really clear about that. >> Libby Dogget: I think it brings us back around, actually what Dr. Hassink was saying which is zip code and community and how important all the services are in that community and how we need to really work to bring it all together and make sure that it's efficient. That there's not duplication but that we're reaching all the families. So I have one more question then we're going to throw out open to the audience and this for any of you. Given that, that we need to breakdown these silos and that we need to do AND instead of OR. What advice do you have? >> Lindsay Carter: Research. It's understanding the school feeding. It's the hardest thing as far as we can collect to all the data but especially even though there have been few random control trials when we work in schools, when you're providing a school meal to a child, having-- developing random control trials that already helps us draw that f attribution is difficult at best and we need more data and research in order to tell our story of seeing not only the intended impacts but some of the unintended impacts and making sure we're designing the best set of-- the best package of interventions to reach our goal. >> Robert Needleman: So, if your answer is research. My answer is bookkeeping. In particular because our focus is on very children, very young children tend to be served through the health system and older children tend to be served through the education system. And it makes very difficult to do a cost-benefit analysis if the cost are being born in one system and the benefits are being realized in another. So we need to do some creative bookkeeping where we recognized that investments that may flow through a doctor's office might have payoffs that show up later in school. >> Libby Dogget: I love it. Laura you want to come in? >> Laura Bailet: Sure. I think both of these are so important and I think also how we talk about issues of literacy and health, just how we frame the issues and the terms that we used have such impact on the structures that we set up, so it's really struck again by what Lindsay said, you know, in the united States, the school nutrition program is housed in Department of Agriculture. Whereas in many countries oversees, it's housed in the Department of Education. And the very fact that it's an agriculture ports-- and I'm not saying that's bad or that's wrong. But there's historical precedence and decision making that have implications down the road that we may not have recognized. And so by put-- by having it in agriculture, in some people's mind we think of that as strictly a food program and a farming issue and not an educational issue. And so to be aware of how the structural barriers prevent us thinking differently, which then prevents us from acting differently. And I think blended funding streams where, you know, or recognition that dollar spent in one system may have their greatest dollar savings long term in a very different system but that-- that that is good, that that's not bad. And how do we have that sort of joint accounting monetarily and also in terms of the broader goals of what we're trying to accomplish. And I keep coming back to what Sandy said. We've sort of taken our eyes off the fundamentals and what does every child fundamentally need. And they need food and nutrition and they need to learn to read. I mean those should be fundamental things that no matter what else is happening nationwide, we don't take our eye off that ball. And I think that's happened a lot. >> Libby Dogget: So you could see we have an excellent panel. It's your turn now and what questions you have? What's raised and will go to the very back. >> Laura Bailet: Yehey. I love the hands going up. >> Libby Dogget: And tell us your name and where you from just so we have a contact. >> Sandra Charles: Sure. Good morning. I'm Dr. Sandra Charles. I'm actually the physician here at the library running the Occupational Health Program. >> Laura: Bailet: Oh great. >> Sandra Charles: And you're coming at it from the child literacy point of view. We try to come out from the health and literacy for the adults who are our employees. But I'm really fascinated by this because I couldn't agree more with the whole the premise of getting not only to the nutrition but the literacy combined. And to that end, the responses to that last question where we talked about we need more research and data. I would say you have enough of that to try, start the collaboration between the USDA programs and the eduction programs and try to get that out there where people are making the connection. So put what you already have out into the community. I guess that sort of like the practical application of the research that you've done. So make it more out in the community and I think that we will-- I'm sitting here thinking of all kinds of possibilities in terms of programs that people could start. And I actually have a child, a daughter who's-- she aspires to be where you're in terms of pediatrics and dealing with the childhood problems of literacy and health and nutrition. And so I'm been hearing this for sometime from her and I just think that you have enough to start making the collaborations and implementing some of the programs. And one of the things we've start to do here is starting a family health and wellness day. We encourage employees to bring their families in and introduce them to different health and wellness things and I think this is a real key component that we could incorporate. And commend Dr. Cole because ever since I've been here, you know, start with the reading. It's fundamental and it's come a long way and it is fundamental to both health and wellness. Thank you. >> Libby Dogget: Thank you. Anyone want to comment? >> Laura Bailet: I'll just say stick around. We have an adult panel right after lunch, so. [ Inaudible Remark ] OK. >> Libby Dogget: Robie, the floor is yours. >> Robie Harris. Hi. Can I ask one question-- >> Libby Dogget: Stand up and tell them who you are. >> Robie Harris: All right. I'm Robie Harris [inaudible]. Oh. [ Multiple Speakers ] -- show the people out there. I'm just sorry that Ellen Oh can't be here today. The founder and a marvelous children's book author run around and just wondered, started with other, mostly librarians but people with children's book field, we need diverse books for children. And I just wondered if the panel could maybe comment on the issue of diversity and how you see it fitting in what you have to say. >> Robert Needleman: I'll start. >> Libby Dogget: Thank you very much. >> Robert Needleman: So in the course of the work in the clinic, especially for older children. My clinic because of funding issues relays on donated books. And so the books that we have for children 6, 7, 8, 9 are whatever we can get. And very few of those books are Afrocentric books and very many of our patients are African-American. And so I'll ask parents when their child is, you know, holding that book and being very excited about it, "Do you know about Afrocentric books, do have any?" And for most of the parent they don't. And it really is a problem because the message to a young child who has a beautiful book that has people in it who are not identified with that kid is that these books are written for somebody else about a world that is not your world. And the shame of it is is that there are many, many, many wonderful Afrocentric stories and books that our parents don't know about them a lot. And so, you know, if I can wave my magic wand and get a budget to do it, I'd be buying a bunch of those of books. I would make sure that I have [inaudible] beautiful daughters. I would make sure that I have the people could fly. I would make sure that I have Ezra Jack Keats' books. You know, the "Snowy Day" in winter and "Whistle for Willie" in summer in perfusion so that every kid with darker skin in my clinic who identifies as African-American could have some books like that. I make sure that I have some biographies of great African-American leaders that the little kids who I see who filled, you know, sort of disenfranchise can read about Malcom X who was sometimes angry, you know, just like they're sometimes angry. But he took and he made it pretty powerful. So just to echo, we need it and we need to be aware of it we need to fund it. >> Libby Dogget: Thank you for reminding us that. I think it's important. Do you want to mention something? >> Lindsay Carter: I think this is a wonderful question because it's a challenge that we face with the McGovern-Dole program. But we're trying very hard with our implementing partners to address because not only are we trying to make sure that we have appropriate books in an international context. And this helped by our colleagues at the USA Office of Eduction and Laura alluded of how difficult it is to learn to read is we're trying with a lot of these countries where there's usually a colonial language. And then there's a mother tongue. So often children are being asked to learn to read in a language they haven't even learned or spoken until the age of five. So trying to-- usually we're having to actually seek out to be very creative and being able to produce both textbook and fictional books for the community in a language that is understood. And there's some very creative ways that our projects are doing the most as far as finding a affordable and ego-resource. My favorite is in some West African countries, Peace Corps volunteers who are working with a program to help and produce books because they know the local language. They've learned it. They can read and write it and they're producing these books that can go out in communities and then tying and in with the health aspect making sure that the message of this book is not only enticing to children but making sure it address issues such as handwashing, improved nutrition, working with others in the community. So I think there's the language that we choose as well as how the books look, making sure they're exciting its-- and accessibility issues. But there are lots of creative ways that we can make these resources available. >> Libby Dogget: And we want the diverse books for all children because I don't want my Anglo kids to not just see-- >> Lindsay Carter: Right. >> Libby Dogget: -- themselves. I want them see others. Dr. Sullivan. >> Laura Bailet: And can I just say one other thing though. >> Libby Dogget: Sorry Laura. >> Laura Bailet: I think it's important to remember diversity is there's so many types of diversity. So there's diversity of race and ethnicity. There's linguistic diversity. There's also health diversity. And Robie is going to do a talk on her books where she writes about children with different health issues. But books are a fantastic way for children teenagers and adults to see themselves if they have a health condition or a learning challenge through characters in a book and to broaden their world perspective. See a world that-- without limits instead of the limitations and the helplessness that they often feel when they have a health or a learning condition. And stories just can open a person's eyes to broader, a broader world view. And if nothing else books are a great companion for sick days. And we don't want to forget about the joy of reading and actually an author ambassador, former one for the Library of Congress, Kate DiCamillo who wrote the story "Because of Winn-Dixie". She talks about as a young child, she was sick a lot and books are what kept her saying it, open the world of possibilities to her. So I don't want to forget that. Sorry Dr. Sullivan. >> Libby Dogget: So books are windows and they're mirrors. Way to see out, way to see yourself. Dr. Sullivan, we're so glad you're here. >> Laura Bailet: Yes. >> Libby Dogget: We're all honored. >> Louis Sullivan: Thank you. First of all this is really an excellent panel and I'm very pleased to be here. And one of the reasons I'm here is because of the well-established known relationship between level of education literacy and health. And I maintain that while we really have as a nation had tremendous development of our scientific knowledge and new therapies et cetera. We really haven't done as much or as well as we should on improving health literacy and health behavior. Well, I'm please that that's getting some recognition. Having said that, I have several questions or comment I'd like to make. First, I have specific question for Dr. Hassink. I'm curious is to what happen to that grandfather who wanted his grandson held back, because it sounded as if that didn't happen. And I meant the system was not responsive here and it bothers me because often we find that rules and our regulations or bureaucracy get in the way of good decision making and that really is one of the issues that I worry about. The other comment I want to make is this with tremendous programs that you have. I'm bothered by the fact that we don't, as a country, support education strongly as we should. Everyone knows that we are really in a new era that we really are moving towards an educate-- system where those who have good education are going to do well, those who do not really falling by the wayside, part of the income gap that we refer to now. So, the question I have is with the programs that we have, what's being done to really let the public know and generate support for them so that our legislators in our states or in our school systems or in the congress really support them. Because the paradox is we have these tremendous programs. But yet we have a real problem really getting the kind of support for our education systems. So I'd be interested in knowing what have your experiences has been or what are your thoughts, how can we really take these tremendous programs that you have and generate the kind of support that we need so that they will really be promulgated around the country as they should? >> Libby Dogget: So, Dr. Hassink is going to help us. >> Sandra Hassink: Well, but-- >> This was on? >> Sandra Hassink: I don't know if I can help you. But the grandfather was not able to get his son held back because his was not a behavior problem. And did what-- you know, was a quiet little boy who sort of was there in class and we tried and didn't have any other feature that would have allowed us to advocate except that he couldn't read and we couldn't do it. We couldn't solve that problem for the grandfather, so. >> Libby Dogget: So, anyone who want to address that complicated difficult question? >> Robert Needleman: I am speechless. >> Libby Dogget: We need everybody here to help us because this is not going to happen easily. I think in other countries they do it because of-- it's a moral obligation to take care of your kids. But somehow in United States we've got to proved that's it cost effective, that we're going to save money and even though know, even for something as simple as preschool, there are people that say that the results fade, it doesn't make a difference, and we're trouble selling it. So, it is an uphill battle here in United States and we need everybody here to speak out repeatedly and your voice would be a particularly helpful one. >> Louis Sullivan: Well, thanks I really would not hesitate to do that in every opportunity. And one other comment for Dr. Needleman, with lack of diversity, ethnic diversity of your books and the need for them, I wonder you're in Cleveland, I'm sure you know Reverend Otis Moss. And the Cleveland urbanely I know for years has been one of the strongest urbanely chapters around the country. So, I guess my question is have you raised this question with some of the black leadership in your community because these are people who really ought to be responsive to that. And you could tell them that I sent you. Reverend Moss happens to be a Morehouse college graduate. So, I know him. He was two years behind me in college. >> Libby Dogget: So, we have a quick answer and then actually we're out of time. So I'm going to let the panel wrap but-- >> Robert Needleman: I will be glad to convey your message to the reverend. There is a very small health center in the Fairfax neighborhood of Cleveland called the Otis Moss University Health Center and they support us fantastically by allowing as to store our books in their basement. Just to clarify the Reach Out and Read program as organized through our national center and is supported in our local chapters does raise lots and lots of money to purchase culturally appropriate ethnically diverse books for our target audience which is children from birth to age essentially six. That's the sweet spot for us because that's when we see kids frequently. And we think that's when the foundations of literacy are laid down. So, on the good side, I would say, that we do have a wealth of beautiful culturally appropriate books, largely through generation-- generosity too of Scholastic which makes these available to us at great discounts and also supports their generation. So that's the good side. And the bad side is we're limited by our budgets to books that are not terribly expensive. And so the books that we can provide at every Well-Child visit retail for somewhere between five and six bucks. And to our nonprofits cost us somewhere between two and three bucks. But that prices those kids out of a lot of the very best literature that's out there for children. So, when I was raising my kid, I didn't only get books that cost five and six bucks. >> Libby Dogget: Right. >> Robert Needleman: So, there's a great disparity and injustice even as we try to do our best. We could do a whole lot more to make the full range of beautiful literature available to the full range of our kids. >> Libby Dogget: So, I told them they could have one last word. Anyone want to last word? >> Laura Bailet: I just want to thank everyone for being here. I think in response to your question of how can this feed better publicized. I think by being here today and then going out and messaging and continuing to work together will start plant some seeds and funding is always an issue. But thank you all and hopefully you learn a lot today that you can message about. >> Libby Dogget: Thank you panel. Thank you audience. Thank you all for being here. >> John Cole: Thank you. Thank you. I'd like to thank you everyone and just make one more-- before we take a little break, very short break before we hear from Robie. On the diverse books issue, tomorrow here at the Library of Congress we will giving the-- hosting an event at which the first diversity award in children's books will be given by an award by the American Library Association. And this is moment of know, OK, Karen is going to correct me. >> Karen Baicker: We Need Diverse Books. >> John Cole: We Need Diverse Books is the name of the group which is carrying on in this whole area and the first awards will be given and it's going to be called the Walter Award in honor of Walter Dean Myers who is our National Ambassador for Young People's Literature. And Walter sadly passed away soon after his two-year term. Kate DiCamillo followed Walter and our new of-- our new Gene Yang is our new National Ambassador. But tomorrow, it's a public event. It's at 10 o'clock in the room where we were last night. It's in room 119 and you would all be welcome to come and learn more about we-- give me the phrase again, We Need Diverse Books which is the name of the group. So this is very a theme of what we're doing and thank you for bringing it up indirectly and directly to everyone here. I thought Robie we're going to take a five minute break and start with Robie and when you comeback the restrooms are right next door. Please be back in five minutes and we'll continue with the program. Thank you for the wonderful morning and first panel. Well, we have special author's perspective on our topics today. And from the beginning we had the notion of having an author's perspective and we have been exceptionally lucky to have Robie Harris here who is known for, to many of you, as a very prolific and thoughtful writer and author about books relating to families, childbirth, sexuality. She, in fact, has been at this for so long. And some of her books are having anniversary editions and there is a brochure for both "It's Perfectly Normal" and "It's So Amazing" 20th anniversary of "It's Perfectly Normal", 15th anniversary of "It's So Amazing". And those brochures plus a display of a number of her books are on the table in the back. When we spoke on the phone which is the first time we met to talk a little bit about her presentation, I was struck how she emphasized that in the research for her books she often started by whatever the topic talking to kids and talking to children about the topic that she was about to write about. And I thought, "Well, may we call this a perspective from the childhood?" And she said, "No, it's going to be my perspective, but I want you to know that I do my background research, you know, with the real thing with the children." And when I've seen the range of the books that she's put out and heard her speak a little bit about these I know we're in for a treat. Let's welcome Robie Harris. [ Applause ] >>John Cole: I'll take my notes. Sorry. >> Robie Harris: So I'm feeling a little speechless. And for those who know me well I'm really not just because so much has been said already, which has been so wonderful. So I want to join Dr. Needlman in the repetition model here and John you mentioned that I might be able to go on just a little bit longer. OK. So, I have permission to do that. So it's an absolute privilege to be here, at the Center for the Book at the Library of Congress. And to be able to thank you John Cole and I've written at my words, too, so that I won't too, too long. The founding and current director of the senate for the book for your critical support and the center support for the work all of us do in the world of children's books and children's health. I want to thank Dr. Bailey, for last night, for your leadership in the world of child health, the BrightStar Program, and your wonderful words, "Everything we do must be for the child" and I quote here. "If it's not, then we need to reconsider why we are doing it." And also Dr. Hassink for your leadership in the field of pediatrics, for mentioning the ACEs study and literacy this morning, which I think is very important. Critical work on childhood obesity and the link between health and literacy and it goes on and on the toolkit. And all of you in the audience, you know, I'm behind my computer and then let me out every once in awhile to do-- to speak. But you're on the front lines. And all of you for your leadership in the field of pediatrics, your critical work on childhood and to all of you in the audience to care about or give care day-in day-out to our nation's children from infancy through adolescence, and actually prenatally because that certainly is a part of health, to help them and their family to stay healthy. So I gave John Cole a title which is up there "Read Well, Be Well, Stay Well". And I'm going to continue to look at the question which I also sent to Dr. Cole. What real can children's books play in helping kids of all ages and their families stay physically and emotionally healthy? I'm a children's book author. I have a strong interest and background in child development. And I think children are so wonderful. I can't stop watching them, listening to them, hearing their words, watch their play, watch them when they get angry, watch them when they get upset, get worried, concerned, and so on. So-- But in order to creat the books I write I still find it extremely healthy-- helpful, not only to talk with kids. And I have conversations with the kids. I don't sit them down and I don't have a tape recorder and interview, you know. We just sit and talk about a topic. But I also find it extremely helpful to consult with librarians, teachers, scientist, health care, mental health child development professionals, and also with parents who often know their children the best. I do this to make sure that the non-fictions books I write have the most up-to-date, age-appropriate, medically and scientifically accurate information. And we do this every time we go back to reprint on my non-fiction books every time. And if some big change came through, my publisher for those books, Candlewick Press has said, "Yes, we will go back to reprint right away," because kids have the right to have the latest and most accurate information. And I do this also so that the picture books stories I write reflect with honesty and that's very important word for me, honesty. The powerful and yet perfectly normal emotions, that most young children experience day-in day-out because I think we all in this room believe if we're not honest for there kids, then we lose them in a conversation, of a book that just doesn't being honest in what they know in life, they turn away from the book. The books I write, the words I write are my way of having a conversation with children. And they include-- you know, but what I chose to write that includes the values that I have. So they are my way of having a conversation with children about staying healthy. And as I said earlier that includes their physical and their emotional health which everyone in this room we all know. We're so interconnected. I've been told that the books I write and this is all anecdotal, spark many questions from children. And it's true for many children's book authors. So I'm really speaking for all of us, as a gang together. So it's not just my books. So they often lead to conversations between a child and a parent or caregiver or another trusted adult in that child's life. And that these books that I'm talking about this morning and-- not only provide access to information for a child, but also for that child's parents. Information that kids need and have are right, and I say that really loud, "Have a right to have". So, that they're be able to stay healthy and eventually make healthy decisions for them selves, not only for them selves but for there friends. Or the picture book story I write sparks a responsive core that is what I hope for in a child that might help that child stay emotionally healthy and reaffirm that the strong feelings they have and I write about in different books, all of these feelings from love to anger to joy to fear, jealousy, sadness, lost, yes, even hate. Our legitimate feelings and more often than that emotionally healthy feelings. And the book about hate is really a book about love, when those words just pop out of your mouth and then this little child in this book, what does he want to do? He wishes that moment he can stuff them all back in, but it's too late. Onward on to some of my books as examples of some of the ways in which children's book can contribute to literacy, hopefully, and potentially the other healthy or healthier outcomes. And just so have a chance as Dr. Cole said there are books back there that if you fee like it, you may have time today, you can take a look at and ask me any questions about. Let me first note that for parents and for there kids, kids of all ages, and especially for kids and parent with low literacy skills, hen the words in the children's book are married to the art in the book and I can't draw for beans, I work with amazing, brilliant, wonderful illustrators. I'm so lucky. And they bring a whole new dimension, but we work very closely together that doesn't always happen for other authors. The art is another way to pass on the information and could help kids and teens and parents become visually literate as well. Since today so much of the information, they and we seek is a visual. And we get it through the visual world. Together words and art in the book often bring both kids and adults like in-- engage both kids and adults alike in multiple ways. Now, I don't travel everywhere with copies of my books, but I-- you can see an image on the screen. I had 200 5-year-olds in a gym outside of Illinois a year ago. And I-- So that I think couldn't see a book if I opened it. And I-- what I loved about it and you'll see this a little bit later, is that, I had-- they had a huge screen. And so I had kids come up and hold books and I said "So what's the difference?" And this child said "You can't hug that" looking at the screen, he said and he went like this. You can hug a book. And that to me-- and it was before-- the last book that I was going to show. It was before I showed them the whole story which is the last book that you'll get to see. That-- I think that tells us something about books. This book is-- that I'm going to talk about. It's perfectly normal and I have to remember to do two things at once. This is just a range of the different kinds of books I write, but here is the cover for it. It's perfectly normal. It's illustrated by the amazing friend and my dear friend Michael Emberley. We worked hand and hand together on these books-- on this book and on many other books. But this book is now, talking about the international, in more than 35 languages and pirated in some countries. A country now I can't remember. In Eastern Europe there's-- do you know the photographs by Ann Geddes of a baby in an egg shell, that's the cover which is total not science. He and I-- it's so crazy. I have a copy of it. Someone brought it back to me. So-- And the art and text in every book as I said are vetted by kind specialist I've mentioned a minute or so ago and if need be are updated every time one of our books is reprinted, which happens often. You know one such example, but there are tons of them. You know them in the pediatric world or the medical world, you know, the HPV vaccine and now was approved for boys then. You know, we know not enough kids are getting it, am I correct, the pediatric world? So that's in there plus so much more. I began knowing that I wanted to write a comprehensive book though but answer almost not every, but almost every question kids and teens would have about sexuality. I chose the title "It's Perfectly Normal" because the truth is that most, not all, things about sexuality are normal. Except of course those aberrant things such as abuse, infection, becoming pregnant, when one is too young to take confident care of a child, the list goes on. But we all know this when the topic engages kids they want to know about the topic. And most often so do their parents. So here we have a book that is about sex and human biology for kids roughly 9, 10, and up. And I would pause at the following. When a preteen-- What preteen or teen does not want to read about the perfect combo, sex and science. In this case human biology and, yes, health. This is also a book about them and what they are experiencing as they begin and then go through puberty and adolescence. What pre teen or teenagers does not want to read about one self, right? A little egocentrism here. I would also pause at the experience for an adult who read such a book with or before their child reads. I always-- I give one piece of advice. I also tell everybody who I'm not. I'm not a pediatrician. I'm not health care provider. Child's book author. But I say one for-- to the parents says what should I do, what should I said? Read it through any book on this topic, not just mine. Read it through first on your own, you'll have a temporary leg up on your child, right? That's the only piece of advice I give. So a parent who reads a book with or before their child read this can help build literacy. Not only for the kids who are reading this book but for their parents as well who use a book such as this to get information they may find too difficult to deal with. I understand that completely. It's easier for me to talk about other peoples children when one talks about mine are grown up now. But when my kids we're young it's harder to talk to your own children. Very own children being a parent. So but for parents as well who use a books such as this to get information they may find too difficult to deal with or hard to access and going back to trauma or may have had a traumatic experience in their own lives. We're talking about health and sexuality. It's just-- It's too painful. It's too traumatic. And then they can go to the rest of-- the health world to get that information passed on. We have told-- been told over and over again that the words in this book and other books I have written and the art Michael created, gives parents permission to talk about. And I hate these word "tough" topics. I talked about-- was writing about tough topics. These are the normal everyday topics that every family deals with and, yes, many of them are difficult. And in this case given the words parents, a language they can use to talk with their kids about sexual health. This means that parents are reading, too, and modeling reading for their kids as well. A road to literacy. I think I know what this room would say. Would we call it family literacy? And it's also a way for parents and kids to become or continue to be emotionally attached to one another through a shared experience of reading the same book. And by the way often they're not reading it together at that age. You know, child-- parent-- I say to parents-- they say, "What do you do?" I can say that you have more than one piece of advice. I say, "You know, it's OK if your child reads it on their own." You just can say, "You read it. You know, I care about you. I love you. I want you to stay healthy. You might find this interesting and of course the kids all they say, "I know all this stuff. I don't have to do it." You know, parents leave them back of the toilet or next to the computer and its gone. We've been told that. So through a shared experience of reading the same book that can lead to talking together about so many topics including parents on family values. Fostering this kind of attachment between a parent and one's child certainly seems to me to be an added positive literacy outcome. Our children's book librarians and teachers and daycare providers and so many more I probably not listed, also provide this day-in day-out by having my books, but not just mine and others in their classrooms as Bob said, "If they can afford it [inaudible]." And their collections in an open shelf, not in a hidden shelf under lock and key that the librarian keeps up up on top, so-- and accessible to kids. So here we go. Here are some images from the recently completed 20th anniversary edition and I chose these. I could have chosen a million. So let's see. So this is from the first chapter called "What is Sex", OK. Yes, these are cartoon characters. I had a boy and a girl and then I couldn't use a boy and a girl because-- I mean, girls would think one thing and boys would think others and not all the stuff about gender. I mean, it gets just very complicated. So they might not know the bird and bee are-- bird, the kid who wants to know everything, ask every question can't stop. The bee thinks it's all gross and disgusting except gets fascinated by the science. I was more of the bee than the bird. So here is just a little text from there. This is the opening. Sex is about a lot of things bodies growing up, families, babies, love, caring, curiosity, feelings, respect, responsibility, biology and health. There are times when sickness and danger can be from her sex, too. Most kids wonder about and have lots of questions about sex. It's also perfectly normal to want to know about sex. You may wonder why it's a good idea to learn some facts about bodies, about growing up, about sex and about sexual health. It's important because these facts can help you stay healthy, take good care of yourself, and make good decisions about yourself as you are growing up and for the rest of your life, besides learning about these things can be fascinating and fun. So on to-- this was a change in the chapter on straight, gay, trans, bisexual, LBGT. And this is just newer art that was done. And here are some texts. Many people use the term LGBT, these initials L for lesbian, G for gay, B for bisexual, and T for transgender, our way of referring to people who are lesbian, gay, bisexual, or transgender. And then I give a definition of transgender which I'm not going to go to now-- not. I mean I'm happy to, but we need to move on. And then it goes on to the end of the chapter to say if a person has any questions thought or concerns about his or her sexual feeling or gender, talking to someone you know and trust, a parent, relative, therapist, doctor, nurse, teacher, or clergy member can be helpful. No matter what some people may think it's always important for every person to remember and treat all people with respect. And it's important to know that a person's daily life, making a home, having friend and fun working being in love, being single, being a partner, being married, raising children is mostly the same whether he or she is straight, gay, bisexual, or transgender. OK. Oops. OK. This, five years ago put it in chapter, began about the internet. Absolutely critical. The chapter is "Become Larger and Larger". And Michael and I worked out what-- I can't draw as I said. But we work out what we want the image to be and then he does his brilliant work. Once your words are on the internet they're there forever and you cannot get these words back. Others who we do not want to see these words may end up seeing them. There is no way to guarantee what you will have sent will be private. And think about the emotional implications. And if you say online that someone is fat or skinny or sexy or ugly or beautiful or handsome. What you said is never really private once those words are in the internet. Saying-- And here we're talking about the emotional health of kids. Saying something mean or bullying someone, or spreading any kind of gossip, even sexy gossip or about another person can make that person feel really crummy can hurt that person's feeling. When someone does this online by texting, posting, or e-mailing, it called cyber bullying. To cyber bully means to mistreat another person. Cyber bullying means mistreating another person online, to bully means to mistreat. Cyber bullying means doing it online. And then here's just another way to get information across. And we certainly want to pass these on the kids. These are things that were in the book. Miss that I'm told. Kids still think, right. Here's a way to talk about that you need a condom for protection, right? And it's a smart thing to do. So to call kids smart, if you did this-- this is smart, something you can do. OK. This was where they fit. I think boys, men, as well as women and girls, need to know this. Sometimes people don't know it. And this is just one piece of contraception here. And then this is what our look like and I have a grandmother. And this is the last chapter called "Staying Healthy Responsible Choices". And I couldn't write this without saying-- without ending like this. Everyone makes mistakes and has bad judgment once in a while. I didn't want kids to think that, you know, I am through the word that I write saying, you know, you don't have to do this, and this, and this, and this. I don't want to ask the audience about what mistakes you may have made during those years. We won't do that. And you probably will, too, but most of the time you can and will make responsible choices, ones that are good for you, right for you, and healthy for you and your friends. So that's-- it's perfectly normal. OK. On to some of my-- here's a quote I just want to post it. And by the way, I've done books that now go down to three to five year olds on this topic. One called "Who Has What?", naming all the parts of the body. Not just the wonderful song we all love it, head, shoulders, knees and toes but seems to me maybe some parts are left out. And the kids, too, they know at a very young-- well, they don't immediately, almost right, right, right, infants, that's [inaudible]. So here's a quote from Dr. Alicia Lieberman and a gifted clinical psychology at UCSF for the book-- for his quote I think it's the emotional life of the toddler about words young children and about young children and I quote "When a parent is able to translate" and she says the infants and toddlers and I have the privilege of knowing Alicia. And I talked to her about this. I said, "How about children of all ages are able to translate the words of children of all-- able to translate children of all ages experiences in the words of understanding. This helps contain the child's negative feelings and makes them bearable." In this sense, this is her quote, "Talking can represent relief from amorphus feelings because it puts some order into chaos." I find these words "put order into chaos" central to my writing for children and particular writing about the emotional life of children. I feel that children's books can provide those words, words that can help to meliorate the perfectly normal and terrifying feelings that children often have. And for most children can help make fearful feelings bearable including the traumas that we talked about. And here, what I want to ask you, it's OK to use R-O-A-R and would Mayor Tom Menino of-- the late wonderful mayor of Boston. So here's a little bit from the incredible illustrator. If you don't know his work, Chris Raschka, he's a joy to work with. So here we go. OK. When lions roar and monkeys screech, when daddies yell, when mommies holler. There's a lot left out of here of the pages of the [inaudible]. Chris understood that these parents were not yelling at the child as parents who yell. And it's scary to hear a child-- a parent out of control. When daddies yell, when mommies holler, the scary is near, the scary is here. So I sit right down, shut my eyes tight. Go away I say, scary go away. And then the quiet is back. A flower blooms, an ant crawls by. A mommy sings, a daddy dances. The scary is gone, and I go on my way. Chris is brilliant [inaudible] Nadine Bernard Wescott. So I wanted to do a book on healthy eating and nutrition. And this is [inaudible] Gus and Nelly and their parents I hope are in here. This fall, here's another initiative, somebody you may or may not know about maybe you do. First book and the Mario Batali Foundation, he's the famous, you know, New York City chef. But I think in [inaudible] launched their healthy kids collection. And "What's So Yummy?" was one of eight wonderful books for young children on healthy eating and exercise. And it's perfectly [inaudible] I'm proud to say was one of them. And they did that as their way of ensuring that all children are well-read, well-fed, and well-cared for and to show kids the importance of healthy eating and nutrition. I'm just going to show you a little bit on sugar. I got a lot of help, our wonderful people over in the congress senator-- Congressman Rosa DeLauro on the Agriculture Committee which was chair, now I forget when you're not ranking member now of the Agriculture Committee, put me together with a-- consulted on this book we talked about sugar but also so many other. It's fun to eat a sweet like ice cream or a cookie or a piece of cake, pie or candy. Most sweets have a lot of sugar in them. But too much sugar is not good for your teeth or the rest of your body. So it's OK to eat some sweet sometimes but not too many and not too often. And eating a sweet is almost always a special treat on birthdays and holidays. Again, I don't want to put the shame and guilt there. And there's Gus, these cookies are done, let's try one. There's Nelly, these chocolate chip cookies are so yummy it's time to pack them all for our picnic. And [inaudible] something, OK. And there they are and on their picnic. And it's so it's fruits and juices also have sugar in them. A lot of fruit drinks and soda even have more sugar added. They have too much sugar in them. So it's better for your body to eat a piece of fruit and drink water than have a drink of soda. And there's a whole range of every issue, water, you know, everything, allergies, you got it in this book. And here is my latest book which is coming out again [inaudible], which is coming out two week-- a week. And I wanted to thank Ellen Oh again, creator of "We Need Diverse Books" for opening out the critical dialog about children's book and diversity and also the publishing world-- the children's publishing world. They are doing a really fine job. But we're working on all of those of getting more people in the publishing industry who are people of color and therefore more sensitivity of the need for books that shows all of us and what America really looks like. Michael Emberley and I am proud to say did that and people stand up and say thank you and we don't know what to say. We say, you know, it's just what America looks like. It's who we are. Here we are with the title. So this is Gus and Nelly again and I actually sold this book way before "We Need Diverse Books" began. People say it and that was fine, you know. We just did it because of "We Need Diverse Books". But I applaud so much what they are doing because children need to find themselves not just in the words but in the images and it's kids of color and as Libby said, all of our kids need to find them. So because it has to do with our kids' emotional health, big time, to find themselves, to validate them and that you count, you matter. And here's-- and I take on what some people would call tough issues. I talk about how you talk to each other. How a person walks or talks or the clothes the person wears or the color or shade of their skin, hair, or eyes can't tell you what a person's really like. These books are for 3s, 4s, 5s, 6s, and 7s, it's a big range. The holidays a person celebrates or the people in a person's family or the food the person eats can't tell you what a person's really like. That person may be a lot like you in some ways and different from you in other ways. You may have freckles, another person may not. That person may speak Spanish, you may not. You may use crutches wheelchair, another person may not. That person may like to sing, you may like to tell jokes or both of you may wear orange sneakers. See if you can find two sets of orange sneakers here, or have the same backpacks-- see if you can find that-- or brown eyes or curly hair. And then we spend weeks on end. This is published by Candlewick Press as with the books in essential health and "What's So Yummy?" We spent ages just looking at the diversity in this art which we did with "It's Perfectly Normal". And we have people of everywhere looking at it and say, you know, do we leave anybody out? When you meet another kid for the first time, you may want to play with that person right away, or you may not want to because he or she is someone you have never met or seen before. You may feel furious or even shy or nervous or surprise, they're a little afraid of someone you don't know yet or who looks different from you. Hey guys-- Hey, I'm Gus. This jogger is so cool. This juggler is so cool. And if I go back just to this one, now, he's saying, "All I know about someone new is what they look like." And Gus says, "You may not even know strawberry ice cream is their favorite ice cream or chocolate." If you do play with each other, you might find out that something he or she thinks is scarier something you think is scarier. You might find out that's something you think is silly is something he or she thinks is easily. And before now-- know what you're talking laughing and having fun with each other. It's possible, often happens. Let's-- Bob you were talking about the positive outcomes, the resilience, but the-- how kids see it. So I really-- I did a movie years ago. Something with the first Head Start-- one of the first Head Start programs in the Nation of Filmes. And we certainly talked about these issues back then and here we are still needing to talk about them today in this nation. And I think particularly with what's going on in our nation right now, issues of race and diversity, our young children feel it greatly. And so if this is a way to talk, maybe it'll help some families. That's my hope. So last book, published by Scholastic. Karen, you're from the Scholastic, shout out to Scholastic and [inaudible] was also published at Scholastic with my wonderful editor Ken Geist. So, here's a story about a pediatrician. Many of you may know as the medical director of Reach Out and Read is that still Perri Klass's directly-- Perri Klass and the breakfast we had together several years ago. I have consulted with Perri on many, many of my books. And she would have been here today but she's out of the country. If she could have been so she sends her best. And Bob we want to give a shout out to Reach Out and Read as one of the founders in keeping it going. And Brian Gallagher who's here from Reach Out and Read. At that breakfast Perri asked me of Michael Emberley and I would be willing to create a new poster for Reach Out and Read and we can go right to it. Just sticking with this slide it really take on all the issues about diversity and I like books that are a challenge, but I think they're books that I would have conversations. My kids are grown up with now-- now. But I would have had-- I did have conversations with my kids about. And as a grandparent I can know what's happening today. So, here we go, if we would do a poster for Reach Out and Read-- so Perri and I were having breakfast which was the way we mostly meet talk about nutrition, she also help with "What's So Yummy?" And I said, "Well, wait a minute, why-- let's do a book. Let me do a book." And then I said, "I don't want to do a book by comedia, I want to do an actually trade book," meaning that it would be a book that I would do anyway that will go into a bookstore. But I will consult with people on this and this is a different kind of take. So I said,-- and I came up with an idea at the table. I have often come up with an idea but then, oh my God, you signed a contract and you have to write it, none of this really. So I-- so my immediate response is why not a book? It could be about a young child who loses its favorite book at the moment and can't go to sleep without it. I'd have that happened. My kids have that happened. And since this book came out I would say 9 or 10 librarians have said to me-- had librarians at library say, you know, I get to work at whatever time I get to work, we open the door and there are three or four people maybe once a month, you know, adults come in and say, I was just reading x and I can't find the book and do it and they're totally panic. So it's not just kids. OK. And so the book you love, love, love, love the most it, just to that moment, right, because the next what you love is coming up soon. Before sleeping into bed and you have to have is gone and panic sets in, "Maybe A Bear Ate It". You know, maybe that's what it happened. I knew that Michael Emberley would draw the most marvelous bear, and he would say yes. And luckily Scholastic published it. Perri and I spoke the other day about this book and we talked about how picture book cannot only help kids become literate but as we talked about contributed to even more kinds of healthy outcomes. Just for starters and "Maybe A Bear Ate It", feeling that's OK to be very upset over a loss. And then I read a book called "Goodbye Mousie" which is a different loss about a book about that-- a child who discovers his mouse is dead. He doesn't know it. He thinks it's just sleeping. But it's about death. It's not about dying, it's about death. It's a picture for young children over there. Learning the bedtime routine such as getting into bed with a book and other bedtime routines is a good thing and a sleep matters. Giving a child a book into a sense of agency, the child in this book whose character right here is-- you know, the child in this book really does something about finding his book. So I can do that, too. [Inaudible] I answer to such questions as who did it? Do you think a bear ate it? Which can provide the [inaudible] back and forth between a bear and child? Giving the chi-- giving the children new vocabulary in the way to understand the story, drift on the story, you just read to them and then make up their own stories, or go onto another book to ask questions to fantasize. And as all of you to spoken about so eloquently to help parents have access to information and kids. So in the end books matter-- we're finishing up here to children even more than we ever imagine because they can be part of many healthy outcomes for children and children's families and sharing a book with a child can help them become literate. And I just wanted to say thank you Sandra Hassink for your [inaudible] article, Literacy and Health. It's a must read. Sandra Hassink and Perri are two of the co-authors. It was really important if you haven't read it. I'm going to end by asking you to pretend the right now, you're about to hop on the bed and maybe my talk is making you sleepy. And if you can't find your favorite book at the moment, the book you love so much. Well, here's a story about that that I would love to read to you now. This will take about one minute. "Maybe A Bear Ate It". Is it moving? OK. So there we go. You can read it. Michael calls me up and he said, "How could we do that this whale?" And I said, "Well, that's the way I'll, you know, swallowed." But he could draw a shark and terrible things really awful. All these ridiculous places there about be. That's it. >> John Cole: All right. Robie thank you so much. >> Robie Harris: Thank you. >> John Cole: Good afternoon everyone. Time to stretch it again to try to stay close to our schedule. We're very pleased to have some visitors this afternoon, some students who are interested in our-- the topic and we also have part of the panels are still meeting getting ready for this afternoon's performance. But we're going to start and this was the special brief presentation I told about where we are taking a look at our overall topic which is literacy and health and how they relate or should relate and taking another look at literacy, health public policy project of immediate concern and that is the literacy in the Ebola crisis. And we're fortunate to have a speaker from the World Bank. One of our board members Mike Trucano is from the World Bank. But Mike having a World Bank member as a panel, as a member of our advisory board has great advantages. But a disadvantage is he's traveling a good deal of the time. And he has asked and Kaliope Azzi-Huck who is a Senior Educations Specialist at the World Bank has agreed to come and talk to us a little bit and about literacy in the Ebola crisis. So let's give her a little encouragement. Thank you. [ Applause ] You're all set. >> Kaliope Azzi-Huck: All right, great. Thank you very much. Hi everyone. I promise I'd only talk first about 10 minutes. So I'm just going to set myself a timer. I'm Kali and I cover the education portfolio for the World Bank. I work on a number of countries mostly slay throughout west and central Africa but I specifically cover Sierra Leone portfolio which is the one in question here. So to delve right into it, I just wanted to give you some background on Sierra Leone. It's nothing that you don't know because it's been in the news quite often at the past year or so. Small country, population of 6 million about 42% of people are literate. So-- And that number-- sorry-- I meant as high as 75 are not literate in rural areas mostly women. So they're out of school rate which means kids who are still growing up not literate is about 25% of school age children. And their infant mortality rate which given the subject if today is relevant it's about 117 in 1000. In terms of human development impact Sierra Leone has immense challenges. It's ranked to 181st out of a 188 countries in terms of human development which means social services, health education, social protection are very, very weak they don't have the systems for it and they don't have the infrastructure for it. So when the Ebola hit in-- I think it arrived in Sierra Leone in April of 2014 and steadily climbed up. Initially it covered the districts, if you that bordered with Guinea and Liberia and then it's spread. And once it spread to the capital Freetown then it just became an immense problem and it just climbed up and up as you know. So the havoc that it unleashed is on the population 14,000 people were infected and about 4000 death. I think just under that. It faired a little better than Guinea where, you know, the death rate was much higher, Guinea compared to the infection. On the health I just wanted you to give this fact it's a country that already had weak systems of 6 million people, a 188 specialized doctors and Ebola took 12 of them. To give you an anecdote with that did for the medical school, the only one medical school in Freetown is basically stopped it. The doctors were also lecturers so not only did you lose practitioners but now you're losing a generation of future practitioners. So on the economy, the GDP growth was cut by 50%. I won't bore you with that because it was obvious. Everything came to a halt. They were embarking on a huge economic strategy, iron ore was doing wells. So they had invested a lot in mining. They had already had diamond mining and the sector basically collapsed. Two of the three major companies packed up and went home so people were left without jobs and without any prospect for work. On school children, for health reasons schools were suppose to start in September of 2014 and they did not. And they remained closed for eight months. So children were left idle and as a sort of aside element of that teenage pregnancy skyrocketed. And this is something that we as partners didn't know either that a lot of young girls actually are in school and are de facto protected from all these social issues. It became an issue for these young women who were at home, no income, no sort of prospect of anything and things became really, really challenging. So I'll talk about why that became an issue after school reopened at the end of this. And then on physical infrastructure there just aren't roads. So it's really difficult to get out to people and to get the messages out to people about what needs to be done in order to sort of combat the EVD. So how the government responded? There was a national curfew that lasted for four months. You basically would not suppose to be out after 7 or 8 p.m. Restaurants were not supposed to be open unless you were a hotel and therefore you needed to feed your guest. Traditional burial practices were eventually outlawed and initially there were discouraged and then they basically said, "No, so anyone passed away you couldn't touch them. You had to call." And ambulances would come and they would just take the body. And it was regardless of how they passed away they fell of the roof. They-- You know, it didn't matter. And you would then wait for a call from someone to say this body is cleared and you can now bury it. Or oftentimes they would just bury it and give you a name and said we'll deal with it later. And that's what we're dealing with now is a lot of tribes have very unique burial traditions and they have to get the bodies back in order to rebury them essentially. So it's a matter or figuring out what needs to be done there. There was intense collaboration among partners and government. I think unique to the situation was that there weren't a lot of people in Sierra Leone to begin with. So there were only four of five donor partners that were already engaged. So we all kind of worked together. The funds that were provided funded medical supplies, that's obvious, food to quarantined communities, medical staff, and local health workers' salaries. Because UNICEF was on the ground, UNICEF took the lead in the implementation and the coordination and the World Bank and [inaudible] and others basically we work through them and with the government. So overcoming the crisis given the lack of literacy in the country, we used radios. We procured radios, used radio messages, used television messages. We hosted talk shows. Produced jingles anything that would get the message out. This-- Some of you may know this. But your cellphones in other countries, actually all other countries except the US has a radio transmitter. So we were able to get out to people with radio messages as long they had a cellphone. We also bought as donor partners about 80,000 radios for household that mostly for the rural areas. We also brought CAST lessons. And in those lessons it was the core subjects as well as psychosocial messages about Ebola, about five times a week. And these lessons ran sort of on the hour because the government wanted the kids to get as much education as they could during the closure. So they initially had said, "You will still be required for to complete the academic year." We also use image-based media campaigns. I think you've seen these on the internet. So instead of saying if you have symptoms of vomiting or diarrhea, we actually had cartoon images of someone vomiting and the diarrhea. And that was the most effective way to get the message out especially to those who couldn't read. We used the communities. There's a lot of social mobilizations. So basically it was the trickle down effect. We used the paramount chiefs. It's a country of 149 chiefdoms. So all of them came to town and these are the elected official so to speak but also traditional leaders. So they can read and write. They came to Freetown and there were workshops that they attended and then they would go back and carry up community mobilization. And so that when that seem to be only some what successful and it was in December I believe and the numbers were still climbing. The government took a drastic measure of doing this [foreign language]. It's basically House-to-House Ebola Talk. And there was a national quarantine where everyone was to stay home for three days unless you were one of the volunteers that were moving. We used a lot of youth and they went house-to-house with two objectives. One was to identify if you had sick people in the house and bring them to treatment centers. And two was to communicate the message about Ebola. And this I think was the most affective way to do it. It was a lot of manpower and it was drastic. But it seemed to then work because the numbers began to go down after that. There was diligent contact tracing. So as soon as someone was discovered to be ill a team of contact tracers would go out into the community. The community would have to be quarantine, so one of the major investments that the donor partners did was food for these communities. I think you heard a lot of-- and at least we heard a lot of anecdotal stories about people trying to escape simply because they had run out of food and they needed to get out. So, with these contact tracers, there's also a lot of messaging that was involved. And then there was a dedicated hotline that was involved. If you suspect someone of having Ebola or being sick or if someone dies there were hotlines. And the hotlines were well-funded and well sort of oiled to move very fast. So coming-- sorry. So coming out of the Ebola crisis because education is my background so I could speak to you about what we did to reopen schools. One of the major concerns was the safety of children. Given the infrastructure and the fact that children share everything in the classroom including seats and you have four to five seating to a seat and Ebola is transmitted by touch, all you needed was for one kid to transmit it to potentially an entire classroom. So, there were working groups established that focused on everything. There were protocols that were developed and received certification from WHO. And then we implemented a system of distributing wash buckets. I don't know if I have-- somewhere in here I have the photo of it. It's basically a plastic bucket with a little spigot at the bottom that's fused into another bucket and you put a little bleach and soap in it. And every child have to wash their hands coming into school. We also procured tons and tons of thermometers. Every school received at least two thermometers for 50 kid and then for every other 50 kids I think an addition of thermometer. And kids had to be tested every morning. Communities, not the schools, were tasked with recording that a school is ready to be opened. So we used social mobilization. And if a community felt that school was not cleaned it was not open, they would report it back to the ministry and then we would engage the-- so the Ministry of Health to make sure that it gets cleaned because the Ministry of Health took care of cleaning the schools. We also used the radio to inform parents that schools are safe to reopen that they are being sanitized the-- their children will be ensured safety that there are measures in place. And then we trained at least one teacher per school to understand how to deal with Ebola. The reason I wanted to put to say that we covered psychosocial and technical areas is we wanted to make sure that if a child is found to just have a fever that they are not stigmatize it's very likely they have just put out in the field in the sun until their parents came. So, we wanted to make it understood that there is a lot of compassion that was necessary given what was going on. OK. What we did not do. We did not evacuate our international staff and that helped significantly because we still have the manpower. On the bank side we did not require the staff travel there if they did not feel comfortable. But if they were able to, everyone was coming and going regularly. We did not establish isolation rooms in schools. And this was important because as we went to reopen schools the government received 4000 mattresses that they wanted to put in schools and the decision in the end was that you can't build mini treatment centers in these schools and you can't give the impression that this can be taken care of at the school levels. Someone who is expected of having Ebola needs to come off the premises as quickly as possible. We didn't open schools that have been used as holding centers prior to WHO certified sanitation this was obvious. So we need the Ministry of Health to clean it and then someone to say this is OK because there was a lot of-- there was a lot more diligence than just cleaning up of that school. We didn't taking unisexual approach and this is often what happens. So I can only think about education. In this case, we figured out that health needs to step in. Social protection, the Ministry of Youth needs to provide the manpower and education needs to come up with the plan and deliver information. We did not address the issue pregnant girls from the start. We knew that the pregnancies were rising and as schools were announce to be reopened on April 14th, the ministry announced that pregnant girls could not return to school and they could not take the exams. And the reasoning was that they would give the wrong lesson or there would be wrong role models for the other girls in schools. The donor partners and many felt that this was punishing the girls twice once for getting pregnant and once for now losing out on potentially education. There was a lot of back and forth and in the end what we now have is a program for the pregnant girls and those who gave birth in the last eight month to do alternative education. And once they have their child and they can catch up they can return to school assuming that they have not following too far behind. It's a reasonable kind of catch up effort. But I think if we had dealt with it early on this wouldn't have been a bigger issue now nine months down the road. And that's the extent of my presentation. I put in some pictures that you can see of the students and the wash buckets that were-- students having their temperature taken and the wash buckets. OK. So that was 15 minutes. [ Applause ] >> John Cole: Kali thank you very much. This is insightful and interesting and brings us kind of into a different part of the subjects and we appreciate it. We have to move on to try to keep up on our schedules so I'm going to have Jeff come up and bring his panel and we will get started. And give Mike our best as well. And our chair is Jeff Carter whom many of you know. Jeff is been deeply involve in all aspects of literacy but especially adult literacy and he is the Executive Director of the National Adult Education Professional Development Consortium and the National Council of State Directors of Adult Education. I know him best and he had another role of his and that is he is currently president of the National Coalition for Literacy, which is one of the Center for the Books' reading and literacy promotion partners. So we've come full circle and I'm turning it over to Jeff. >> Jeff Carter: Thank you John. Thank you John. And thank you everyone for coming out today. This has been an incredibly stimulating half-day so far. I'm looking forward to second half of the day. As John mentioned I have several titles. If you work-- I said this is to someone earlier. If you work in adult literacy you have usually have two or three jobs. You know maybe a couple to pay you and several volunteer jobs at the same time. I just want to sort of set this panel up. We're going to be talking about adult literacy and health during this panel. And I thought it might be helpful to just give you very briefly of-- some review of the landscape of adult literacy in this country right now. Many of you I hope everyone actually would find it shocking to know that according to the latest data that we have from an international survey conducted by OECD a few years ago, they estimate that approximately 36 million adults in the United States have low literacy or math skills. Our federal system of adult education talk a little bit what that looks like serves about 1.5 million people. And in that survey that OECD conducted, they ask people, "Would you like to attend an adult education class?" And they estimated as much as 3 million people would love to attend an adult education but cannot access one. There isn't one where they are. And that probably is just-- that's probably a very undercount of the actual demand for these services. So, that's the landscape that we work in. Let me tell you a little bit about the kinds of programs that work with adults and adult literacy. They range from community-based organizations, volunteer-based organizations, faith-based organizations, schools including charter schools and community colleges. So it's a system that a lot of people are not as familiar with just compared to K through 12 or higher education because it is so diverse and many of our students of course are-- they come for all kinds of different backgrounds and they're not as easily identifiable or as visible as in our other educational sectors. I want to talk briefly about why I think a discussion around adult literacy and health is so important in this-- in the context of our day-to-day. And I was thinking about this as I was listening to the speakers this morning. And one of the first statistics that was mentioned earlier was this issue that-- and, again, talking about another staggering number that 48% of our children are growing up in low-income households. So why are adults critical there? Well, educational attainment is directly correlated with earnings power. So when we educate our adults we effectively can address the issue of children growing in low-income situations because we empower those adults to earn more and raise their incomes. So that's one factor. Of course, the other one, parents are a critical influence on a child literacy development. And frankly, if we are going to make a significant impact in terms of health outcomes as we look at the connection between literacy and health, we can't ignore those. There're too many of them, as I mentioned 36 million adults. If we put all our energy just in the children we would disappointed by the outcomes because we would not be addressing the needs of those 36 million adults. And then lastly, and this has been touched on a little bit, I'm really glad to hear it. I think we have moral responsibility. One thing that's really important to remember about a lot of adults who find themselves in the situation is that that's related to factors that have-- that are related to issues about inequality and historical vestiges of discrimination. Robert Needleman mentioned this. This is a very strange coincidence I hadn't thought about. You mentioned how Reach Out and Read had to change their acronym because it was being used by an organization that was protesting in Boston during the Boston crisis, ROAR. I didn't thought about that in years, I grew up in Boston. And it mainly reflect the first time I got involve with adult literacy, I was this tutor. And I tutored a guy who was every bit as smart as I was. Everybody is engage and curious and hard working-- probably more hardworking than I was. The difference between me and him is that he grew in the city that was practicing systematic discrimination for people of color and he did not receive an adequate education. And that's why he ended up where he was. So I've mention because I think social justice and in equalities and important part of this discussion and I was glad to hear some people touch on it today and I think that's something to think about as we continue the discussion. That said, I like to introduce my panel, my esteemed panel. To my left Robert Logan is a member of the senior staff of the US National Library of Medicine and a professor emeritus at the University of Missouri Columbia School of Journalism. I'm always worried but-- when seniors staff I think that's-- I was weary of those title because it makes you sound old but you're not old, see. >> Robert Logan: I agree [inaudible]. >> Jeff Carter: Well. To Steve's left-- I'm sorry. To Robert's left is Steven Rush, the Director of the United Health Group-- Health Literacy Innovations Program an enterprise-wide program to help consumers understand and use health and wellness communications, and the former Director of Physician Engagement at UnitedHealthcare Health Service. To his left, Michele Erikson, is the Executive Director of Wisconsin Literacy which supports, develops, and advocate for literacy organizations across the state of Wisconsin. Her work with Wisconsin Literacy has focused on health literacy and ways to improve health outcome and reduce health care cause by educating both providers and patients on more effective ways to communicate. And we're going to start with Robert Logan. And we're sort of organized this is that Robert is going give us the 10,000 foot, look at this issue. And then we're going to have Steve give us the 1000 foot issue-- foot perspective. And then when we get to Michele, she's going to give us the perspective from the ground. So with that said take it away Robert. >> Robert Logan: Thank you Jeff. Thank you Jeff. And I appreciate the opportunity to be here. Our lawyers say we have to say in public. We speak for ourselves. We don't speak for the National Institute of Health. We don't speak for the National Library of Medicine. And I don't speak for the US Department of Health in Human Services either. Or I also don't speak for the National Academy in Medicine Health Literacy Roundtable that Steve and I are very active in. Steve I guess you could speak for it if you wanted to. I'm also the editor of the first book on comprehensive health literacy international research that I hope will be publish in about 18 months. And before I go on, thank you Dr. Sullivan for your leadership. The National Library of Medicine would not be what its today had you not been at the US Department of Health and Human Services at the time you were there. Very nice to see you as always. Let's-- This is the front entrance of the National Library of Medicine. Walk 9 miles that way and you'll get there. OK. It's part of the NIH campus. Look at our unambitious mission. That's a joke at the bottom in the page. NLM is PubMed. OK. It's all I have to say. I mean that's what we-- need more-- more I have to. If you don't need-- If you don't know what PubMed, quietly don't let Dr. Sullivan know that, OK. And that we're also the publisher of MedlinePlus. Something that Dr. Sullivan has been a long advocate of. MedlinePlus is it trying to provide health information down to the level of consumer. I'm not going to show that today. But nevertheless, that is-- if you're not familiar with that website all of you who are interested in those go there. Please don't tell me that there are not efforts to explain health and medicine in a broad comprehensive scale in American public. There are and they've been there for about 20 years. By the way, if you to MedlinePlus, you'll see a lots of links to Nemours. In many of MedlinePlus sites we link on various issues to websites that Nemours has. I'm going to talk briefly about one topic how health literacy-- adult health literacy differs from adult literacy and educational attainment. The second topic I would-- I've decided, for the purpose of time to discuss during the Q&A assuming that Jeff ask me the right question. On-- >> Jeff Carter: I might surprise you. >> Robert Logan: Who knows? >> Jeff Carter: They trusted me way too much. >> Robert Logan: On the screen is the Calgary charter definition of health literacy. As you read and I'm not going to read for you. As you read it, remember this, that every single word you see is the most expensive real estate imaginable, OK. People fought over every syllable on this for months before it was actually published in 2012. There are more than 50 definitions of health literacy. This is just one. But this is the only one I know that was done by interdisciplinary consensus of people from around the world, which is why I have it up in the screen. Here's my wonderful friend Ceci Doak who was the pioneer of health literacy. This was taken several months ago. Ceci and Len Doaks were health-- adult health educators in the 1970s. And they discovered there was surprisingly little research about how to best explain health and medicine to patients. So they decided to dedicate their career to professionalizing adult health literacy health education, research, and practice which they later named "health literacy." They coined the term. Here's some of the Doaks' discoveries in the 1970s. First, person with below 8th grade reading and other literacy skills rarely understood health and medical information. So low adult education attainment they believe was associated with low adult literacy. Low educational attainment and low adult literacy also were associated with less understanding of health materials and also health information seeking, which is just as important. The Doaks' other discoveries in the 1970s that medical and health information were not presented. So they could be read by low literate person. For example, the term "avoid" the term "prevention" alone were meaningless to most of the people that they used. If you'd put the word "PRE" that [inaudible] any word immediately they said they argued about two-thirds in the American republic have no idea what you're talking about. To stop-- just think about that right there, OK. Medical jargon was an obvious, very understanding. Here's just three examples. I'm sure we can come up with several hundred among us, OK. Routine medical jargon which was well-intended was significant barrier to understanding. And they argue that clinical materials need to better-matched to patient's skills, something that we still very much believe. And they began-- planned intervention to match materials with skills. In the 1980s after several years of many years of practice the Doaks hit an interesting confound that well-educated literate adults, I said well-educated literate adults and young person, often did not understand health and medical term either. Often they had as little interest in learning or discovering how to seek health information as low literate persons. They conclude the association among educational attainment literacy and understanding of an interest in health maybe one directional, which was the first time that was even postulated. Yes, low educational attainment was associated with low adult literacy and less understanding of health and interest in health information seeking. Yes, higher health education-- educational attainment was associated with higher literacy. However, and here's the key point, higher educational attainment and higher adult literacy were not consistently associated with more understanding in health and more interest in health informations seeking. And that was jarring to this day, OK, hypothesis. The confound. Why are the associations not bidirectional. This troubled the Doaks at first. For years they try to explain it. And then they began to notice that it helped explain that this information and this information about vaccines, for example. This is one example among very well-educated Americans. That's the only way you could possibly explain. Then they begin to-- say, the confound also provided insights such as why English is second language adult learners often are helped by using health materials. While other adult learners, people who speak English well are not helped by using health materials. Again, they couldn't explain that until they begin to realize that the-- what they assumed all along wasn't not necessarily the case. Soon, OK, the Doaks started to use the term health literacy to describe the underlying dynamics they were experiencing. In the 1990s, the Doaks argued as a dynamic of personal learning and constructive interventions. Adult health literacy might be independent of adult literacy. They began to argue for the first time that we need to assess health literacy on its own merits on its own terms as an independent research construct. And intervene with strategies to impact literacy as well as strategies to impact health literacy. Not to one or the other but to both. Twenty-first century research, which is now abundant, suggests strongly that the Doaks' observations are correct. Health literacy is apparently an independent dynamic, at least the evidence strongly suggests it, that should be assessed separately from educational attainment in adult literacy. Health literacy is an independent research construct that's separate from adult literacy and educational attainment. While health literacy and literacy are similar and are highly complementary, there are times when they diverged from each other and they can be different. The National Assessment of Adult Literacy and other findings confirmed about in 2003. It is important to respect some inconsistencies and think in terms of dual strategies. Work on both literacy and health literacy simultaneously. Here are some current health literacy research issues. There less about acknowledging the differences between literacy and health literacy. I think that era is basically over now. And most people instead focus on health literacy and health outcomes. Health literacy and the utilization of the health care delivery system. And briefly, here a few findings some of clinical benefits that have been link to health literacy interventions include reduce mortality, improved patient adherence to medical instruction and overall patient safety. The health literacy interventions can therapeutically assist patients with cancer, diabetes, asthma, and hypertension and at least 11 other diseases. The specific health administrative benefits link to health literacy interventions, again, these were all-- I'm just making it trying to-- a lot of research more than 60 papers in a few moments. Some of the health administrative benefits link to health literacy interventions include; improved diabetes patient self-management skills, much more use of preventive services, as well as a significant reduction in hospitalization and rehospitalization rates. As Dr. Sullivan knows well, the letter has a direct impact on the cost of health care. Here's a glimpse of why it is an absolutely fastening time to be in health literacy research or practice. Health literacy interests cover the waterfront. They include all the various stakeholders you've seen on the screen. The interests is well outside the United States. There's very active health literacy research now and several other countries here, four prominent ones on the screen. Michele and I will be on a conference call, I think, it's a week from Tuesday, where there'd be at least six or seven other people from around the world on and it's normal. Health literacy-- The roundtable of the National Academies actively takes a leadership role in this area and has for now for 11 years. Here is their website. Sorry. It's long. And I'm afraid-- I'm embarrass to tell you they're about to change it. >> Steven Rush: They changed it yesterday. >> Roger Logan: Thank you Steve. You can follow the field's progress, of course, in PubMed or Here are three resources to cover the field. The first is how you cover the PubMed with the special curated area that does nothing but provide articles-- excuse me-- referee journal publications about health literacy. Here's MedlinePlus' health literacy page, which for those of you who are not a health care practitioner, I encourage you to go. They'll make much more sense to you. And finally, there's an excellent resource which we have nothing to do with in Harvard University about resources. And the reason I put that one on the screen among many is that-- this particular one specializes in health literacy and adult education. I went through my references really fast, but that in-- that I certainly have them and I thank you for your touch. [ Applause ] Thank you. >> Steven Rush: Thanks. >> Robert Logan: Yup. >> Steven Rush: So, I'm Steve Rush and I'm the Director of the Health Literacy Innovations Program at UnitedHealth Group and you'd said, "Why is a health insurer interested in health literacy?" And in the next few minutes I'll let you know. I don't want to-- out of the bed. Let me just to ask a question. How many of you have been faced with decisions about buying insurance or using health care? How many of you know what your certificate of coverage says about getting a ride to the hospital in an ambulance. Nope. How many of you truly understand everything your physician has told you? Guess what? We all have low health literacy. Low health literacy we've talked about it and it is really interesting. People have talked about health literacy last night. Dr. Bailey talked about it. This morning we've talked about it. And I wanted to share with you that health literacy is not a trait. It's a state. It changes. And I'd like to thank the Library of Congress and Nemours for inviting me here today to talk a little about that. This morning Dr. Needleman talked about bookkeeping and basically talked about downstream costs. And I'll be addressing that in a minute. But what I wanted to tell you was that Health Literacy at UnitedHealth Group really began about seven years ago. And Dr. Migliori who's shown here is really a very big proponent of that at UnitedHealth Group. We have the "Just Plain Clear Communications" program where we're attempting to create health communications that are simple, accessible, understandable, and actionable. So, why is health literacy important? We've talked about it a little bit. We all know that health literacy is transient and people have difficulty understanding and using health care. And in today's health care environment more and more responsibility for utilization of health care is being put on the consumer, the patient. And it's difficult. It's really difficult to understand all the intricacies. We've talked a little bit about people with low health literacy having a greater risk of hospitalization. At the cost of the health care system using 2005, 2004 data was up to $238 billion a year. I think it's more upwards of $240 billion a year. And we do know and Rob just talked about it that health literacy is related to medication and treatment errors and medication adherence and ability to follow treatment recommendations. Health literacy by the numbers. It's a minimum of 77 million adults in the United States have-- don't have basic literacy skills. From a payer standpoint the average medical cost per year of a person with higher health literacy is about $3000, while the average cost per year of a person with lower health literacy is $13,000. That's a different of about 433%. We did some research and we found that taking the look at people utilizing health care within a low literacy community versus the higher health literacy community, the difference was amazing in terms of unavoidable admissions to the hospital, utilization of the emergency room, following treatment recommendations. The average reading level for a lot of health insurance documents is-- was at about 10th grade, 10th grade wow. We have states that are requiring health information to be written at the third grade level. Most state require people to have written communications about the sixth grade level. And realistically not choosing and using health care is really very difficult. The Patient Protection Affordable Care Act defined health literacy in the law and it's been talked about here. But people in the health literacy community talked about that definition is not being quite enough because-- just because you make a decision doesn't mean you're actually able to take that decision and then actually use it, take put it into action. I like the definition that Rima Rudd, one of our colleagues talks about and she says that "Health literacy happens when anyone on the receiving end of health communications and anyone on the giving end of health communications truly understand one another." There's no blame here. Early health literacy were blamed the person. You have low health literacy, you're dumb, you don't know what's you're doing. No; it's an equal bidirectional responsibility. So we-- and I did help fill that health communication should be simple, accessible, understandable, and actionable. So why is there a health focus on health literacy other than all the cost while the Patient Protection Affordable Care Act 2010 defined health literacy in the law for the 1st time. And then they're followed federal rules and guidelines and now accrediting organization and quality organization are demanding that health literacy be a component of the way people in the health community do business. State agencies are mandating that literacy level to be put into play. Customers, people who are paying for health insurance, CMS, and larger corporations even the employer-- other employers are saying you got-- give information to our employees that are simple, accessible, understandable, and actionable. And consumers remember this, say it too. And there's that gentleman in the lower right hand corner. And most of all providing information that's simple, accessible, understandable and actionable is the right thing to do. So why is there-- what's the linkage from health literacy to health outcomes? You'll notice that reading isn't there. But that's something that is-- that I point out because reading is in fact a very important segments but so as race and ethnicity, again, language, and age, vision, hearing, verbal ability, memory and reasoning. And one of the things that I did when I was talking to one of our leaders was to say, "Hey, look at this over here." And he said, "I didn't know that vision and hearing and verbal ability, reasoning was in there." "Oh, yeah, it is." But take a look at how health literacy impacts how people choosing to use health care, take a look at how health literacy is important for that provider, health care provider and patient interaction. And if people can't understand how is it that they're supposed to be able to take care of themselves? The many, many-- Today's health care environment really focuses to a greater extent than in the past on chronic care conditions, diabetes, heart, asthma, other pulmonary problems. The day-to-day care that needs to be done for that person is provide by that person or their personal caregivers, 95% of all chronic care on a daily basis is provided by that person or their personal caregiver, 95%. So Kathleen Sebelius at one point said, "If people can't understand, they can't decide, and they can't do." And that's-- that's what shown here. There are number of factors affecting health literacy, one is the general literacy level of the people, experience with the health care system, physical and psychological factors, culture and language, aging, complexity in information. And my God, I can tell you that health insurance information and health care information is so complex. I wish I could say that I had a full head of brown hair before I started working in the insurance company. But I can't do that. Learning style is really important and how information is communicated. So reading is really important so as listening and math, math is really becoming a very important factor, speaking, writhing, thinking, health care problem solving, health literacy, think health care problem solving and remembering. And if these skills doesn't need to be put into consideration to think about what member does, or a patient does and then the health care system. So here's some startling facts. $240 billion a year in medical cost are associated with low health literacy. Recent research showed that 4 in 10 uninsured don't know basic health insurance terms. Wow. Yet these people are going to be responsible for the medical spend and fewer than 4 in 10 understand complex coverage concepts. This is an amazing fact. Millennial may have-- maybe the best educated. But they have huge gaps in their care. And choosing and using health insurance creates cognitive burden. But the other piece to that is many people over estimate their knowledge of health insurance. Three out four people say, "Hey, I can do this. I know this stuff." But when push came to shove, only one in five really demonstrated the capability. So what does that mean in terms of literacy? So Jeff talked about PIAA that was the International Program the Assessment of Adult Literacy. Three components to it, understanding written communication, working with numbers, and then using computers for health problem solving. Take a look at where the US is relative to 24 or 20 countries. What does that mean for literacy? US is tied for 7th lowest of 24 countries. We're 3rd from the bottom in math skills and we're 3rd from the bottom in 20 countries when it come to using computers for problem solving, very interesting stuff. What's the implication? Health communications and learning style. We did some research and we found that in a general population of 18 to 49-- to 64 years old, 60% were visual learners-- 60% were visual learners, 15% were auditory learners, and 25% mixed. Take a look at what happens when people aged. It's really different. So that's-- I'd like you think about cognitive burden. Cognitive burden has two parts. One is the burden of illness. Boy there's a lot stuff that you have to remember when you're a diabetic. And it changes the way you live your life. And then there is the burden of treatment. When I wok with our telephonic pharmacist training them to communicate in simple understandable and actionable ways. I say, "To what extent are you adding to the burden of treatment when you use terms like"-- you-- there's a medic-- we have a medical class or a medication class called angio tension, beta blah, blah, blah, blah. And they go. I was just put on the medication and than I could barely say it. So health literacy another look, I really like this cognitive burden piece on the left hand side. Basically it says, "When you load my brain up with confusing choices, ambiguous phrases, unparasable sentences, you impose a cognitive burden. You make me think, and not about your subject. You are making me translate, transform, interpret what you say. And this distracts me from your point." And then there's always George Bernard Shaw with his statement about the illusion that communication has taken place. I want to share with you a resource that we've created. It's free. It's done as a social responsibility and that's the just plain clear English-Spanish glossary. No one will call up and say, "Hey, you use our glossary. You want to buy our insurance?" No-- That's not what it is. What we've done is taken over 3400 complex health insurance, healthcare terms and other terms, and put them more simpler, understandable language and we cross walk that with complex banish and complex and more understandable Spanish. And we're going through a redesign right now where we're going to hook up into images and to movies and PDFs. The just plain clear, we've use this with English as a second language with adult basic education programs and because it's on our responsive platform you can open it up. And when you're seeing the patient and you can't remember the English or Spanish term you can look it up and it really does work. Thank you. I appreciate your time. [ Applause ] >>Michele Erikson: So-- Good afternoon. My name is Michele Erikson. I have been involved in adult literacy for quite a while, longer than I'd like to admit. But about 30 years now. I started in adult literacy just of out of college. I got a call from the Boyd Public Library asking me for money. And I said I have two college loans. I have no money. But I probably could help someone. I've been in the library and saw advertisement to become a literacy tutor. I thought I might be able to do that. And so I went to the training and met my first student, Bill. Bill was a 39-year-old father of a 9-year-old. And Bill did not know that names of the letters or the sounds that they made. And he just got-- he just been laid off from his job as a welder. And we started-- We are going to meet at the public library and he told me we could sit outside in the bench but he would not go in the library. There are far too many books for him to feel comfortable in a library. So we sit outside in the bench and we talked awhile and started to meet at his kitchen table. Not long after we were meeting and some trust was built he shared with me a letter that he had in a drawer for about two and half years. It was from the DMV and the letter told him what he needed to do to get his drivers license back. It had been revoked. And neither he nor his wife could read the letter nor did they want anyone else to know they couldn't read the letters. So there it sat. I was thinking about that. I'm really glad it wasn't a letter from a doctor telling him what he needed to do to take care of his health or his family's health. So we started working toward getting Bill his driver's license and moved on from there. But that's how I got involved in this. And it just stuck with me ever since. I did not realize as a college student there were adults that didn't read and write. It just never ever occurred to me. So I find myself at Wisconsin Literacy. I started there in 2005 and been working a lot and health literacy. We're a coalition, a statewide coalition of 78 agencies that provide direct support for adult learners. And we-- what we do is provide the capacity building and training for those agencies, to help them train more volunteer tutors. We work also as an advocacy agency. We worked around workforce development. So we're helping our agencies prepare their adult learners for the workforce and job readiness skills. And then our biggest division is-- area we're working is called Wisconsin Health Literacy. It's a division of itself under our Wisconsin Literacy, Inc. umbrella and it has its own website and has really been working in this field since about 2003. A lot of growth since 2003. We have services that we provide. We do a summit every other year. We have one coming up in April 17. And these have become larger and more comprehensive. Now, there are national summits and we've had international guests as well. And it's a wonderful opportunity to bring health and education together under one roof and we spend about two and a half days and we learned a lot about the things that are going on in our country and in other countries as well around health literacy. We do a lot of awareness building. We started out just educating our state about what health literacy was and it's impacts and implications, we do a lot of community health projects where we go into community agencies. Primarily, we started with our literacy agencies. But now we've now we've branched out to a lot of social service agencies that are serving vulnerable populations and do community health projects. And then on the other side of this, we worked with providers and a lot of education and training, how to speak plain language. As you-- the definition that Rob provide in the Calgary charter talks about the communication piece of health literacy and it really is a two-way street. It's really important that when providers are communicating that they understand how to communicate in health literate ways. And so we work on training along those lines. So, again, you get to learn this over and over when-- it's a repetition this morning is one way to. So you've seen this but 90 million Americans trouble understanding and I think that is really important to remember. There's just so many areas in this field from insurance to, you know, taking your medicine at home that are impacted by health literacy. So I wanted to focus, just on one of our projects. We do many different projects out in the community. But the one I'm going to talk about today is called "Let's Talk about Medicines." It's actually-- We had one-- Before this we worked on called "Let's Talk about the Flu." So these are community projects that are funded by, this one, by Security Health Plan and Insurance Company in our northern part of the state. And we looked to agencies where we can go out and provide information in a health literate manner at a level that everyone can understand. These call-- or this project we started out working with seniors because seniors are utmost at risk for health literate behaviors that can have great consequences. They take more medicines and other things that are happening at that time affect this. So we've gone from seniors and I'll talk a little bit later. We're now working with refugees with the same project on medic-- Let's Talk about Medicine. So these are the goals of the project really understanding what a medication label looks like, the dosage, special instructions, feeling comfortable talking to your pharmacist, remembering how to take your medicine and where to store them. We usually do this in open hour workshops in different community settings. So we've been everywhere from, as I said, senior centers. We've-- We're in Salvation Army. We're in our literacy agencies. We're in neighborhood centers and providing this information. This particular project has a pill box incentives and this is a workbook that we developed for this project. There are some on back. There was the Let's Talk about Flu and Let's Talk about Medicines. But basically we developed this. It's written about a 4th grade reading level and it goes through the many project goals that I had just talked about previously, lots of pictures, easy to understand, writing, lots of white space. So this is the tool that we use similar one with the flu. But we started in 50 workshop locations across the state and deliver the workshop. We've had-- Every time we go they ask us when we can come back. We are on working developing other things with the workbook. So examples of what that looks like inside, types of medicines, prescription medicine and labels, and the medicine reminders. Each participant is-- gets incentivized with the pill box that they get to take home as well as we do other things like we do a preimposed test. So each participant comes in with a very simple pre-test and then this post-tested. So we can get some measurement on understanding and knowledge gain during the workshop. We develop some card games that they do during the workshop as well that give situations about medication use and safety. We've also worked on some videos that are posted on our website now. There's three of them. These two here, "When to Take Your Medicine" and "How to Store Your Medicine." They're just about a minute and a half, really short easy to understand videos. There's also one about talking with your pharmacist. And we promote these videos during the workshop. We've done online as well as a printed quiz, so that participants can take that home and use it with their family. And we're also now training the trainer on these workshops so that when the funding runs out that organizations are equipped to care on the workshops on their own with as many resources that we can make available for them with very limited cost. So here are some of the things we learned that there's a really big gap. And in this particular project with seniors what they really know and what they think they know as you had pointed out, everyone can thought, "Yeah, I can do this." And then all of a sudden when you're asked to demonstrate it, it becomes a little different. Medication storage is an issue. There was just something on Good Morning America Today about children accessing pill boxes and medications and how easy it is to had all this little kids opening up a child proof pill boxes and, you know, very easily like one kid had it done in nine seconds and-- >> Steven Rush: And these were child proof? >> Michele Erikson: These are child proof, yeah. So, yeah it was very really interesting story. So medication storage is a really big issue. The label instructions have often caused confusion. Those are the ones on the side to the special labels are often a source of confusions for many people. And remembering when to take them and how to take them and reluctance to ask pharmacist, we show a lot of-- we show this video a lot from the AMA where people talked about their own health literacy experience and, you know, knowing when to take your medicine is not something that's easily understood on the label. So take two tablets twice a day. That doesn't register with everybody and there's a little video clip of a woman saying I take, you know, I have 16 pills a day that I have to take and I don't want to forget and I'm not sure exactly when to take them, so I just take them all in the morning, so I make I've got them all in. And so, you know, this happens and it's very real. So these are the results where again trying to-- measuring health behavior outcomes and changing health behaviors, a very difficult thing. This is just the results from preimposed test, understanding or identifying the number of pills, like I said people think they get it but when they ask it like put the number of pills correctly-- the correct number of pills in their hand and it becomes a little bit different. So 72 were OK in the pre-test, 85% on the post test. I should also say that this similar study done in 2006 with intermediate both limited literacy intermediate and proficient literacy adults was done. And even the proficient literacy folks that were asked two tablets twice a day, there is consistently one or two mistakes out of that group that-- whereas the high literacy group. So people make mistakes as well. And then again as I mentioned the when to take medicine is a huge issue with understanding medication labels. So these are just a comment that some of the difference the program has made. Lot of people didn't understand about not storing your medication in the bath room. That's a really convenient place for most of us to store it but really not a good place at all for so many reasons. We had another story of participant who just happened to be going to the-- her doctor and the pharmacist the next day after her workshop and felt very empowered be able to ask questions and felt in a much better place in terms of understanding what she needed to know in order to correctly take her medicine. And then lastly one of the things about-- as I mentioned we spent a lot of time on just raising the awareness in our state about health literacy. A lot of small implementation projects like this. And these projects, have allowed us to expand. So we start out with these pilot projects. And this medication one in particular was-- we applied to Wisconsin Medical Society Foundation and they end up funding all the counties that the insurance company that funded the original project wasn't able to fund. They were outside of their service area and so we're able to do this project and get statewide coverage. The same medical society asks to apply again for more funding this year to continue it because they were very happy with the project and the impact that they were seeing. We got funding from our Department of Health Services then to expand this medication workshop to refugee populations, which is we're learning was just a whole another challenge in a different audience in terms of the language barrier, in terms of the cultural barriers and being so new in understanding our health care system. So we're-- in that project right now, it's a two-year project and we're about halfway through our first year and learning a lot with the refugee groups. And then Wisconsin Health Literacy is also, starting a second phase of a project where all this information on these medication workshops has helped us to develop a white paper. And I have some at the back of the room. I have another one here, if you haven't seen it. But we are trying to adapt an easy-to-read medication label in the State of Wisconsin. And the US Pharmacopeia in 2013 put out new standards for what a medication label should look like. Right now the biggest thing on that small little piece are real estate is the pharmacist logo. And so that's a bit of our problem as well how the wording for the label and for the direction is mentioned. So we're working on this project right now. And the second phase we have three pharmacy networks that are actually implementing a new prototype label we're designing and we're going to be able to measure how through health insurance network, how these patients do with the new label. So exciting work. I wanted to thank Nemours for having us here and for the Center for the Book, for John and Julian [assumed spelling] all your work, as well as pro-literacy for inviting me to speak. So thank you very much. [ Applause ] >> Jeff Carter: Thank you. That's a great panel. And I want to-- you know, John asked me to trying to keep us on time. We're little behind starting. I do want to give you all an opportunity to ask your question. I have a few I could ask. But I feel like this opportunity for you to get your question. And so in the few minutes that we have left, I throw it up into the floor, any questions for any member of our panel? Yes? >> I'm [inaudible] with pediatrician and medical editor at [inaudible]. And we produce thousands of articles [inaudible] instructions and, obviously, literacy, they need to focus for us because all over [inaudible] the adults. So I'm wondering how across the board of a large library to ensure consistency with literacy. A lot of the tools [inaudible] different literacy tools are not applicable to medical terminology and have some of the patient. So I was wondering how you manage that. >> Robert Logan: Not as well as it'd like. The-- By the way her question is very good one. The question was the diagnostics, OK, that you can use to help you assess, OK, the grade level, OK, of various types of efforts to try to explain health and medicine to the public. Most of the diagnostic tools are not designed with health and medicine in mind. So as soon as you have the word in there like pediatrics. Immediately-- you're at the college level, OK, and it completely skews of all those diagnostic tools as you know, OK. And we have never come up, OK, with a-- what I consider to be a good substitute, OK. There is a private firm in this area that does sell software that they allege, OK. It enables you to get a good reading that is not thrown off by medical terms. So I'm giving you technical answer because unfortunately we-- I don't have a good solution for you other than the private firm that sells software, the name of the company is called, Health Literacy Innovations. No, we do not use that in our own work for variety of reasons. On the other hand though-- and I'm going to give you a direct answer, OK. I distribute Strunk & White, "The Elements of Style" that everyone I worked with, OK. And I make sure that whenever I edit or whenever anybody else is in a senior editorial position, I make absolutely sure that "The Elements of Style" is foundational to what everybody does, OK. And I'm not going to go in detail. Those of you who never seen that book, that's still the best thing ever written about how to write in plain English. But still we got ways to go and I think-- I wish we had better diagnostic tools. >> Jeff Carter: Yeah Steve. >> Steve Rush: Yeah, that's really great question and it's something that we need to do for lots of reasons not only for patient education but there was a federal district court stipulation that came out of Louisiana that said, "If you're going to deny care to somebody, you have to do it in ways that people could understand it," which is really very good. One of the things that we have to do and we've been training our people to do is that if you're going to use a term like pediatrician. Maybe you put in parenthesis a doctor for children. And then you could use the term pediatrician again. And part of it is to in the communication is not only to make people aware of certain terms because they're going to have to become aware of it because it's common usage within the health care environment. So with taking pains to not only use the term or terms and define it but also to make sure that there's correct flow of information. And I'm seeing the, your kids and teen information website which I think is absolutely tremendous and gives the term, the definition and the usage of it. But it's very difficult particularly when states are saying you got to have a certain reading grade level but it doesn't do anything for comprehension. >> Robert Logan: It just occurred to me that there's a part of and answer that I didn't give that we should acknowledge, OK. I'm so impressed by how improved natural language processing is, OK. I mean we may be talking about a none issue in several years, OK. >> Jeff Carter: Interesting. >> Robert Logan: Because natural language processing is-- becomes so sophisticated that it may very well take care of this issue by itself, OK. I certainly hope so that would be a nice solution but I can't guarantee that. >> Jeff Carter: Let's have one more question or two really fast questions. Who else has a question? Don't be intimidated because I said the two fast questions. Just anybody, any other questions? Yes. >> Here at library we are tackling health and literacy here. Because Dr. Charles's office heath services, we started a forum here that is on health and wellness. And so we've been doing this for about a year and a half and the surprising amount of staff that actually doesn't know but now knows much more of because of the programs that we've been having here to actually to conquer that situation about health literacy. >> Jeff Carter: Well, I want to close. I'm going to just take the moderator's privilege here to close with this one thought, which is that I'm really glad that we have this panel talking about both health literacy and how adult literacy impacts health. The reason I think that's important because it's a-- I think it's a good reminder that, you know, we're all learners to one level or another and I think to the extent that we can identify with each other as we learn about our own health care. You know instead of start of thinking about our-- the folks we serve in adult literacy as being these other group over there. I think it kind of brings us all together as learners so I think that's kind of how the spirit I'd like to close out this panel with. And I'd like to thank the panel. And I'd like to thank you for your attention and Center for the Book and everyone who organize this thing. Thank you very much for having me. It's been a great privilege to be able to work with this group here and I look forward to the rest of discussion. [ Applause ] >> John Cole: Well, I'd like to thank, thank the panel tonight. We're going to move right into the next panel discussion of that as I said the restrooms are outside. You can come in. But we're going to keep moving because our panel members are here just for limited period of time. I must say I'm very pleased that the Library of Congress health services has come into this and is joining us. It's terrific. And I had with one thing that I've kind of hope for but had followed up on. It was great to see you. Our next panel is going to be on-- we call it after some discussion, Business Perspectives on Literacy and Health. And our moderator Nancy Fishman is going to bring her panel up right now and introduce them. This is a unique panel with some people that we are very pleased have taken the time to join us. I'm going to let Nancy Fishman introduced them or get them started. Nancy is the deputy director of ReadyNation. And I'm also going to have Nancy tell you about ReadyNation and it's importance to what we are doing here. Let's give Nancy a hand to get everything started. [ Applause ] There you go. >> Nancy Fishman: Thank you very much and thank you so much for having us. ReadyNation is an organization of business people across the world who support investments in quality early care and education programs as a way of building their workforce in the economy. And we partner with other business group and organizations across the country. And yes, I said across the world earlier. We are doing some work internationally. And ReadyNation is very honored to have had an opportunity to help put together this panel today to talk about business perspectives in this topic area. Very honored to have with us this morning, Mike Edwards, the retired state supervisor of banking from Washington State, that is, who flew across the country to join us today. We have Karen Baker, the Director of Community Affairs from Scholastic. Next to Karen, we have Dominic Robinson with CenterState CEO. Vice President of Economic Inclusion, Director of Work Train and the director of Northside Urban Partnership. And on the end here we have Dana Conners the President of the Main Chamber of Commerce. So we are from all over the country today. We are thrilled to be here. ReadyNation is part of Council for Strong America. That's our umbrella organization that in addition to bringing the business perspective to this issue, we have a sibling organization Fight Crime: Invest in Kids that brings a law enforcement perspective. Their members are district attorneys and sheriffs and police chiefs. We have Mission Readiness. A group of 600 retired admirals and generals who find this issue important in military readiness perspective. Shepherding the Next Generation, group of the Angelical pastors who bring families together to support these efforts. And we have champs, elite athletes, and coaches to talk about nutrition and physical activity and teamwork as part of these efforts. We know that high quality early childhood programs can lead to a host of better health outcomes. It's for that reason that we're here today to share with you some examples. Since we know that reading proficiency is a predictor of overall health. We'd like to talk to you how the business community has gotten involved in this subject area. We're going to make ours a little bit more of a panel. We're going to address certain questions to certain panelist, give them an opportunity. Since we're crowded up here they may choose to stay seated to answer the questions and we'll leave a few minutes at end for some questions from all of you. So we're going to start at the very beginning. Mr. Connors, when we spoke earlier, you mentioned that you had an "aha moment" that came when you first learned about early brain development. We know that the foundation of many critical workplace skills is established in the earliest years but what's really happening then and how does that relate to success in school? >> Dana Connors: You're asking me to explain that? >> Nancy Fishman: I am. I'm asking you as a Chamber of President to-- how about why it matters to you in your role at a Chamber. >> Dana Connors: I didn't tell you I have to leave the airport about five minutes ago just before you ask that question. My "aha moment" was not around explaining brain to you. But I can tell you exactly what it was. It was 2007. It was a September day it was about this time in the afternoon and the-- oh, that would help huh? And the speaker was a professor from Harvard who's name was Dr. Yoshikawa. And I had-- Well, first of all let me go back to set it up. The governor at that time, Governor Baldacci, asked me to come to the Blaine House with probably a dozen other people to talk about a conference that he was going to hold at one of our prime location in the state along the coast. So I tended because I had great respect for him, we had a great relationship so I went. The subject was early childhood development. And I confess. You've heard these words and it's happened to me more than once, you don't know what you don't know. Well, I really didn't know what early childhood development was and I probably should not admit that in front of this group, but in truth before that moment in 2007 I really didn't know. I thought it was more like daycare and medley there's an aspect to that but it was much. My understanding was far, far immature and not really aware of its value. So he asked me. I went there I listed to discussion. I really could reasonably follow it but wasn't too tuned in. Until he said to me, "Dana, I want you to be the final wrap up speaker on Friday," to which my million thought was, "What the devil am I going to say," because I really don't know the subject matter but I respect to the governor I went. I'll make the story short because I could move-- I could make it last forever. So I go and it's not my habit to attend conferences that last three or four days. But in this one I figured I better go to learn the subject matter so I can wrap up the session. So this Thursday afternoon it started Tuesday night I'm speaking at Friday noon so far it hadn't click. My "aha moment" hadn't come and I wasn't so sure that it was going to come, but it did. It happened I was sitting in the conference room, the professor was speaking and when he approach the subject of the early childhood development and spoke in terms of the formation, the architecture, the brain development, 85% occurs in the first three years, 90% by the fifth year. And then he went on both in science in terms of the number of neurons that a young person at birth has a hundred million, a Milky Way as many stars in the Milky Way, I can't remember that term. And then he went on to explain the synopsis and how important that was, those connectivities and you reach the peak of those synopsis about time of your 85% brain is formed. He went into more detail because he knew a heck of a lot more about the issue than I just expressed to you as you could obviously tell. But I was so struck by it because he went on to explain that those three years much like a house when you build is that you start with the foundation, you frame in the house, you do your electrical system, the circuit is really what he was talking about. He went on to explain it becomes the foundation for your intellectual, your moral, your emotional, your physical, your health, your psychological. And I remember saying, out loud, to the person next to me heard, oh my God, I get it. I know exactly what I needed to say. And the guy next to who was a Maine senator, not a US senator but represent us the ledger said to me, "What'd you say that for?" So I explained his name was Richard, "I said Richard, didn't you just get that?" And I went on explaining why I felt that way and he said, "Dana, you're so wrong. That's parent's responsibility." At that moment I realize part of the debate and as time has gone on it's-- I've come to really realize as I've heard the speaker sand may I say, very inspirational day today. I'm grateful that I had the opportunity to get here early because it was very heart warming but also informative. I've come to know that it's not about one or the other. It's clearly about both of us. It's a community concept but we ignore it. We have ignored it for so long that we start with K to 12 and then expect by the fourth grade we're going to be at the national standard on reading and Math and you really investing too little at the early stages and expecting too much in such a short time. So to me it became almost everything that I do and work for whether it's growing the economy whether it's dealing with skill in the workplace, whether it's productivity, whether it's helping a kid, a young person achieve through aspirations, through educational attainment that lowers crime, it lowers remedial education, special ed. Productivity is up, oh my God. That became the "Aha moment". And to me it was so significant. I can-- and later on if I'm asked the question and even if I'm not I may go there just as I did on this one is that to share with you what happened since. Because I'm really-- it's a race that has no finish line but I'm very encouraged by what the state is doing and what the business community has stepped up to do since 2007. My final comment in this, that afternoon when I stood up I didn't tell you this or it wasn't mentioned, there's no reason to. But previous in the President State Chamber which I've been for 20 years I was Commissioner of Transportation. Yeah I know I'm only 30 but I-- I was Commissioner for 11 years of Transportation. And I used to always say, you know, the foundation of our economy is our transportation system moving products, people safely and efficiently. And it cost a lot to build and maintain a good transportation but it cost a lot more not to. You've got to maintain it, you've got to invest in it or it's going to cost you more when you try to fix it. Well that afternoon that was my message but it wasn't transportation, it was early childhood quality care and education. It does cost money to do it, but it cost you a lot more if you don't invest in it. That was my message then, that's my message now. That's my "aha moment". >> Nancy Fishman: Thank you. Mr. Robinson, you've just heard about how the community can benefit when we get kids off to a good start in life. We know that your work involves community and economic development. Can you tell us how you think businesses can get more involved? For example, are you just-- are we just talking about businesses making donations to worthy programs or is it more? >> Dominic Robinson: Sure. Well thank you for the opportunity to speak here today. Just a little bit of context for my position up here, I'm a Vice President for a Regional Economic Development Agency and Chamber of Commerce in Central Upstate New York based at SYRACUSE. And for many years the organization I represent has operated like a traditional chamber of commerce representing the interest of its members and promoting what was kind of conventionally thought to be what was in the best interest of the regional economy. We have kind of headed evolution and leadership overtime which is also included my coming on board which is really been about thinking more broadly around what economic development means. And in the case of my role, very specifically trying to connect the dots between economic development and community development and community investment, and what I really think about our work is that we're actually trying to break apart of a false dichotomy in our public narrative which is that the interest of business or economic interest are at odds with the community interest. And I think, you know, much like what Dana was saying that there's profound business case to be made for investing in communities, investing in children, investing in education. And I think that we need to do a better job as a business community of articulating that. And so it's the work we do is both kind of advocacy-based and programming-based but ultimately is about leveraging the self-interest of our businesses and our region and is also interest of those we're trying to drive the regional economy in order to make smarter, more effective investments in our community. The work we do ranges from programmatically we do workforce development, we put together workforce development programs and initiatives that connect the needs of our employers to the un- and under employed and distant franchise, members of our community. We foster entrepreneurship in low income neighborhoods, we help spur neighborhood revitalization and we ultimately are looking for ways to advocate and echo policies that we think align our community's business and economic interest with community impact. And so, when we think about the role of business in all of that there's really a lot of different ways that that can happen. But I think what we're ultimately talking about is a shift away from what many of us might be all too familiar with which is kind of the corporate sponsorship model. You carve out a little piece of your budget and you send some of your employees every year to some, you know, really bad convention center dinner. You get, you know, your company's name in a program and you may be even go and send some of your employees to go clean up a neighborhood for a day. I think what we can all believe in this room is that those things are fundamentally paternalistic. They actually disassociate the business owner and the workers and the business with the community and with the problem. It creates an otherness. And I think what we're really trying to do is create a space where business owners and business leaders can come together and own some of the challenges in our community. So that really ranges. One of the things we're doing around workforce development is simply saying to our employer in our region, you have hiring challenges. You have high rates of turnover. We have the 23rd poor city in America and some of the highest concentrations of poverty among minority populations in the United States. There's a supply and demand challenge here that we can knit together. Let's figure out how we meet your workforce needs and better prepare and equip a pipeline of workers who need it. And, you know, we've had great success piloting programs with this philosophy in mind for the last several years and I think fundamentally what we're able to do is get our businesses to understand that they can act in their self-interest and yet contribute to solving the community's challenges. So, you know, when we think about things like early childhood or we think about literacy in general, we are doing all kinds of stuff. One big effort on behalf of my organization was contributing to a campaign among our local businesses to invest in something called the SYRACUSE College Promise which is a program that allows for any city of SYRACUSE school district student who graduates whose parents make less than $75,000 a year to attend college for free. So we've been able to help raise that money, it's not been-- it's not our program it's not our effort we have been able to be an organizing force for our local businesses to get them to invest in that. We also are starting to jump on board to advocacy efforts around early childhood education investment expanding the facilitated enrollment program in New York State for middle and low income workers. And what's really powerful about that is when we get our businesses to stand up for that and we get-- and we use our voice for that. It's a voice that people aren't expecting. So our, you know, our Republican State politicians suddenly pay attention. We're also thinking about how do we get our employers to think about their workforce and some of the challenges that they're facing at a family level. So right now we're actually just yesterday we partnered on a grant application to the federal Department of Labor with out local workforce development board for something called the Strengthening Working Families Initiative in which we would, you know, be able to have access to underwrite workforce development efforts here in our community the kind of building I said we already did but specifically to underwrite the workforce training efforts for parents and children under the age of 13 who are low income. And specifically to address some of the child care and early childhood education needs of those individuals. One thing that we have written into the grant would be that we would actually be able to place and ombudsman of sorts or navigator in some of our major employers, you know, who could go in and actually consult with lower wage workers about their child care options and opportunities to better facilitate child care enrollment or utilization of the child care system especially if they are trying to embark upon ongoing training and education in order to move their way up a clear ladder. So, you know, to do that thought it requires willing participation from our employer partners, we were talking to our employers asking if this is something that we could do as part of our an incumbent worker advancement strategy that, you know, we've been working out with them and they were open to it, receptive to it. And so I think it's really getting employers at the end of the day to become part of the conversation and see themselves as part of the solution beyond the obligatory check writing and the superficial, you know kind of engagement. >> Nancy Fishman: Thank you very much. Mr. Edwards, you have an amazing history with the banking community so would you talk to us about some numbers. What can you tell us about return on investments made in young children and how that might impact our economy? >> Michael Edwards: Thank you Nancy. The amazing history is out there you read about it everyday in the banking world. I retired me for most of that came around, I'll have you know. I am one the-- In fact, I am the only legally declared, governor declared, SOB in the United States today. Each state has one, but in my state it was a supervisor of banking. Everywhere else it's bank commissioner or whatever and I was appointed by two governors, two of the said I was an SOB. I also found out today that I'm also learned that I'm a health care practitioner. I didn't fully realize that but listening to the speakers this morning on the earlier panel I find with having six grand kids I find that I'm-- you know, often in a health care provider position. It also gives me the perspective on what these growing kids need. The youngest I have is 3 and the oldest is 13, adorable children of course. But I find too that in the course of working with them and caring with them I find that I'm also-- well, I'm having some literacy problems because in the course of things my little 5 year old at breakfast one morning was just-- we were just finishing up and I said-- she said, "Well Papa I'll savor you-- save this for later." And I said, "Well, you don't have to save it honey." I said, you know, "There's plenty there. I'll have more for dinner tonight." And she says, "No Papa I am savoring my food." That's a 5 year old. They're in preschools and I now watch them very carefully but it is amazing what they have, you know, versus the banking industry that I came out of. The literacy there is, my gosh, you have to be a Philadelphia lawyer to have open a checking account nowadays. And then it doesn't do too much good and usually it come out on the short end. But anyway, I will share a few things. I was drafted a couple times in my life. Well, I avoided the first draft, I signed up for the military rather than getting drafted. But this program here I was drafted into after I had-- mostly I had actively retired. And it was for the advocacy of these younger kids that we're talking about. Anyway, I was brought in by the law enforcement people. My brother was the elected chair for 20 years in our county and through the fight crime program for the law and justice folk that have gone out with early learning messages they-- we-- in our state we evolve in a business community having sprung off of that same concept. So we now have three-pronged approach, we have the retired military that Nancy talked about earlier, and we have the business community and then we have the law enforcement including the prosecuting attorneys. All three have already taken off and done extremely well and the messages that are able to deliver have been very well received everywhere we go as you can imagine. The problem is most of our-- well, a lot of our parents aren't aware of the fact that they need the pre-K education quality and they have-- that's the first problem. So we have a message to deliver to the parents as well as elsewhere in the legislators. And it's often the case that our investments go to the way say side because we're not in early enough on our own. If you don't get these kids early into the program you're missing a terrific opportunity because of that, as I learned as well about early brain growth is something you can't reverse and come back on. So it's really important to get them. When I'm in the legislative body asking for some funding for our state programs we have a state program called e-cap program, early education and assistance program. And until last year where it was not very well funded, our state is having a difficulty as you can imagine as a lot of states are on the K through 12 programs. In fact, we just had a State Supreme Court Decisions come down that said there was an inequality and funding in our state because the state was not meeting its basic obligation across the board and a lot of the dependency for education was following on local levies. And so that would take disadvantaged communities, lower income communities they were-- they can't just spring forward and, you know, do the levy action to bring it up to speed. So, a long story short we're still in the legislative sessions trying to resolve that issue which is about a $1.2 billion additional burden for that education program to bring it up correctly where it needs to be. So you can well imagine is a business community I and others we brought in to the program as we go before the legislator. You know, we're very well received. I've been in the legislative bodies for a long time and not always well received and I was an SOB for a good reason on many of those occasions. But when I appear up there with a message for the legislators on the need to fund this pre-K and the state program, I can tell you I'm-- It's a fun thing to do. You get up there and the legislators are actually anxious to hear from you, they're anxious to hear the message. It's a bipartisan acceptance and-- not this year's session but the years before for biannual period. We were actually in our state able to get $160 million to the program that we hadn't really had before. So that was a major step up on the part of the legislator. I'm having a hard time this year getting them to follow with that good record but sooner or later if we don't get it this year we'll get it next. And that's one of the things that we find too is you have to be steady in your course. You have to be steady in your message and now fortunately we have some 130 business people throughout our state that are carrying forth the message not only in the communities that they're in but into the legislature when we call on them. So it's me and these other folks, community leaders that are going before the legislator and face it. You know, their business, their known, they get there, these people are in office because somebody supported them usually it's the ones that we have in the cavalry of our group. And so we do get a real good hearing and get a good reaction. But I can tell you that it's very severe and I know it is in other states as well is to get the funding for these programs. And it's just desperate. But early learning as you've heard earlier starts at a very early age. We get a return on investment when we start them off and that in our state we've got a pretty well plan down to 4 to 1 ratio that we get $4 back for every dollar that we've invested. And it keeps from repetitive needs for going into additional years of education. We actually had about 2000 people-- 2000 of our little people that had to go back and to remediation back in from the kindergarten. So the kindergarten program is impacted in our state to have tune of about 5700 student-- per student or 10 million in reeducating and retaking those people through the-- young people through the course for another year is a $10 million issue. So we use that kind of example. You know, it pay us now, or it pay us greater amount later. And so really when I was in asking for $10 million, you know, the message I was giving to the legislators was, you know, this really isn't new money. I mean, if we don't come up with the 10 million you're going to spend it on remediation the next year. And we know that about 44% of our little youngsters come in that haven't had the advantage of early education aren't really up to speed by any means to go on into the K through 12 and they fall behind and the result are poor. And I guess we could go on with the stats for that forever but we've only got a short time today but I will tell you that it's known through studies so it's valid, it's there and we bring the message, the legislators listen. So we get-- when I come in and ask for the $10 million even though I didn't get it this year, we'll get it next year. It's really money that it's going to be spent anyway and it's a lot smarter way to spend the money. And it's just been fun. It's been a neat experience now as I've retired from my banking career to come into this endeavor especially being the grandfather of six growing smart kids. Thank you. >> Nancy Fishman: Thank you very much. Ms. Baicker, Scholastic is interested in innovative educational partnerships with the focus on corporate social responsibility. Can you explain how your community partnerships promote literacy and health? >> Karen Baicker: Yes, thank you Nancy. It's a pleasure to be here today at this symposium and on this panel, so I want to thank the Library of Congress, the Center for the Book and ReadyNation for bringing together this group of partners. I arrived yesterday and I didn't know anybody and thanks to the, you know, good will and relationship of Scholastic with great partners like Reach Out and Read and ReadyNation I piggybacked on that god will and I've met a lot of great people and I've learned a lot. And a lot of what I've learned in the past day and a bit is stuff that I think most of us already had a pretty good idea about-- I think that very few of us in the room who didn't know that literacy has a great impact on outcomes on health, on economics, and we could-- we might argue and research about whether it's a direct causal relationship or a marker or, you know, how those relationships work. But what seems new in what I'm hearing today one I'm excited about is the increased urgency across a wide range of specters-- sectors in collaborating and integrating our efforts and approaching it in new and innovative ways. So that's what I'm excited about and what I'd like to tell you a little bit about is a little bit of background about Scholastic and our business model what we're looking to do and how we're looking to try to break this cycle that we've all been describing. Some of the shifts in our model and then also a couple promising pilots that we've been doing, so thank you. It's interesting and unusual for me to be on a business panel because I don't associate Scholastic very closely with the business. And-- Yes. >> Michael Edwards: Probably a good decision. >> Karen Baicker: Yes, well I think that we get reminded that it is at work. But the fact is we are very, very mission driven business and that mission is literacy. So there is a high correlation between the work that we all want to do here and our business model. So, you'd like to ask me at lunch whether we were for profit or not for profit and I-- it's sort of a nonprofit and I have been to be the Director of Community Affairs which has like privilege of corporate social responsibility without the burden of directly like revenue bearing. But-- So that's-- I'll get a little bit more into my role in community affairs. But we are business and a successful business and this is a great time to be in the literacy business because of the imperative that I've just been describing. Because we have new tools through data, new research neuroscience, we have all sorts of new mechanisms to look at and education itself is right for a change and the educational publishing business again needs to be part of it. So I'm glad to be here on some business panel. A little bit of background about Scholastic, is everyone here pretty familiar with Scholastic? OK. So I won't say much but, you know, Clifford, The Magic School Bus, Harry Potter and we also create educational curriculum material, professional training and other forms of outreach. But we're the largest children's book publisher which Robie spoke to earlier. So, the mission of Scholastic-- Scholastic has had, I don't know if you know this, they've had only two owners, Maurice Robinson and his son Dick Robinson have been the only two owners in the 90, 95 year history of Scholastic. So, that's unusual sort of family business perspective right there. And it's been the entire time based on emission of teaching all children based on equity teaching all children to learn to read and to love to read. It's heavily focused on independent reading, the joy of reading, the choice in reading. So we are not so much in the educational publishing space the same that a BASO program is, but. We are in schools and in fact we have an enormous reach wherein 95% of the schools nationwide in one form or another. So that might be our book fairs that everyone has and certainly nostalgic memories of, or the magazines or books. So having that kind of reach into the school is also as I see it an opportunity and obligation to do something. You know, we're there in the ground in a lot of struggling regions. And we have the opportunity to try to do something more than just for books in the hands of kids. So that's the other thing I want to speak about briefly Scholastics reach in terms of access to books. So we've long known that this is critical there're sort of studies about the number of books in the home and the correlation to literacy and we've done an amazing job at that from the corporate social responsibility. Point of view we've donated more than 40 million books since 2000 and we have a family and community engagement department just focused on getting books into homes and our partnership with Reach Out and Read. So that something for Scholastic and me [inaudible] pretty feel really good about. We have a lot of knowledge about how children best learn to read and that changes a lot and we've swung with the pendulum from whole language to phonics to, you know, and just we keep amassing a body of knowledge and communicating it better and better. And I think we do a pretty good job in the schools of teaching kids to read and helping teachers teach kids to read. Nonetheless we still have this interacted problem that we've all been describing. We have not seen reading scores improved. We haven't seen the achievement gap close, despite not just Scholastic but the whole world of education and education publishing and all the efforts. We haven't moved the needle much. And so the question is with like the power of our trusted brand of Scholastic and Clifford and the platform that we have and all of the schools whether we're going to do about it, you know what's our contribution, that's part of what I seeing. You talked a little bit about not just writing a check and I feel that way also about donating books, like I'm very pleased that we donate books. I want us to continue to do that but it's has to be beyond that. So in a minute that's going to bring me to role in community affairs and how I'm hoping to help drive that to be. But, first, I just want to mention a few of the shifts. Am I OK, 10 min? >> Nancy Fishman: You can have 30 more seconds. >> Karen Baicker: OK. OK. All right. Well, the shifts I'm seeing in the education space at Scholastic and in publishing are towards more towards early childhood and by early we mean, early, we mean from birth and the importance of talking too and singing too and playing with your child [inaudible]. The importance of out to reach outside the school kids. A school age kid is only in school 20% of the hours that he or she is awake over the course of the year. And so what are we doing in these other channels and times toward personalized towards personalized instruction instead of, you know, someone made the analogy that if we treated kids-- or we're treating kids if someone came to the hospital or a doctor and we treated all of those patients by saying, "OK, you're all getting this treatment and you're going to-- it's going to go on for this amount of time and then we're going to discharge you. That's kind of what we're doing in the education system. We're giving everybody the same. So there needs to be a trend towards customization of individuals. So I'll stop with the-- >> Nancy Fishman: Sorry. >> Karen Baicker: I'll stop with the trends. You can ask me more about translator if you'd like to. And I'll just really quickly just describe the pilots and that we have going. So I guess I'll just talk about our most exciting pilot to me which is called Discover Together. And it's a partnership we started in conjunction with Linda Mayes, Dr. Linda Mayes of the Yale Child Study Center to test the hypothesis that we can use literature and literacy to build resilience in struggling communities. So we joined forces in rural Appalachia and piloted a program that we've been doing for the last several years that I think has very exciting potential. And what we are doing there is we're pairing literature with very place-based experiences. Field trips to sources of local pride like a worm farm or bakery or the railroad or a nature trail. Pairing those with literature and field trips and activities and helping the community come together to celebrate their own stories around the idea of literacy and the power of narrative and what we notice in Grande County is that that wasn't the only thing that they wanted. It was helpful. But we just began a long process of listening to the community. And so now that program consist of a family coop, early childhood coop from zero to five where we bring pants and use the same of curriculum in model reading and work with the multigenerational approach and it just keeps expanding. And so that's the other trend I would highlight is customizing to the communities we're serving. >> Nancy Fishman: Thank you. I apologies for rushing you. I wish we had about three more hours up here. Now I'm going to address one question to all of you. Particularly just tell us how businesses, business leaders, and business groups can more actively collaborate to help more young people have access to the programs that we're talking about. And Dana, I know your flight is first this afternoon. So why don't you start? You each have about two minutes and we'll just work our way down the line here. >> Dana Connors: Just about it gives me time to get to the plane at 4:30. So I appreciate. I'm very grateful and please forgive for having to rush of the platform here. That's why they put me to the side. Hopefully I just push me off here. The business communities like I mentioned it earlier, I mean I have found in my 20 years to get the business community involved particularly in something that begins as a social issue which most business see this as. Is you build awareness as to what it does or why it relates then in the economy. You got to give them some action. We can't just talk it to death, which is characteristic of a lot of issues. And thirdly, there has to be accountability. And when I can put those three things together, I've got a secret formula. And once they started to become aware and how we became aware is that we're very involve in ReadyNation. ReadyNation is a tremendous resource. A lot of our business signed up, our law enforcement investing kids, fight crime, mission readiness for our military people, they're all very engaged. That in itself is a community because there are so many of them and we have a very passionate person that represents all three in Maine. So she's fantastic. We have a group of business leaders that took upon themselves-- we did this research project right here. It's called Make a Name Work: Critical Investments for the Main Economy. A partnership to the research empathy very well respected research entity. We put this together it tells-- it's all about early childhood the facts, the facts drive the solution in instance because it's more than emotion. It's more than feel good as much as it is. The facts help drive this success. That helped bring the awareness to the forefront. This group a business leaders call themselves main early learning investment group mainly have raise over $10 million. That's the check book that's putting money there. But it's not sponsorships. They take that and they've worked with EduCare which most of you are familiar with. We have one in our state. They designate a community. They are committing, I think, it's $4 million to address a number of kids with the community with family. The boots are on the ground. They're very involved. I can't ask for more than that on any issue. And here's an issue that at first blush they saw as social and not economic. Now they see as economic more than social. Our challenge is what Mike said is that we don't have enough money for K to 12 and higher ed, and we've got some to the state government but it's a race that has on finish line. It is sunk. You got to be constantly persistent about and you got to stay on message. That's my story and I'm sticking to it and I appreciate it. And if sneak out it's only because I have to make a plane because I have to speak at a funeral tomorrow morning and I can't afford to miss it. So thank you very much and thank you. >> Dominic Robinson: Thank you. [ Applause ] >> Karen Baiker: It's OK. >> Dominic Robinson: Well, I think my job got a little easier because he stole half the things I'm about to say, which is great. So I guess I would echo a lot of that. I think that one thing I like to reinforce, repetition, is I think for business owners in particular business leaders, engagement in a partnership that kind of takes them outside of their kind of core mission or core focus. In an ideal scenario you ground that in some form of self-interest for them. But I don't think that that is ultimately critical. What I do think is critical is that whatever it is that they are being asked to do is able to result in an outcome. I think business leaders are much more prone to be thinking about kind of I do this and this happens. They want to see you know kind of cause and effect. And I think that too often in the world of nonprofit in policy and in the worlds that most of us probably operate in, we do perhaps get a little bit too comfortable in the conceptual, in the ethereal. And I think business leaders they want to see something. There's an instant gratification that they're seeking. The other thing that I would just kind of bring up and I think it's really important and it certainly speaks to the work that I'm doing with my team is playing the role of broker. I think that you-- in order to build unconventional partnerships that are advancing mission around outcomes relative to early childhood or health or literacy and you're trying to bring these desperate partners together. You have to recognize the very different languages that a community college will speak compared to a business compared to a social service agency compared to a governmental organization. They have different outcomes. They have, in some cases, very different motivations. And they by all means use different terminology. And it's very difficult to put them in a room and expect them to kind of make magic happen. So whether that's through some form of formal facilitation or it's just identifying people in coalition who have that kind of translator capacity or capability. I think it's really insuring that there is kind of that brokerage rule embedded in those types of partnership. So I think that that's really important because too often you bring those different types of partners in a room and they're conceptually on board but they really don't have any way of finding a common language or create in commons base. >> Nancy Fishman: OK. Go ahead. >> Karen Baicker: OK. I think in terms of getting businesses more involved in the issues of literacy and health, one of the first things that we need to do is listen to needs of a particular community, look at the data. And before we ask a business to get involve to know exactly what will be most helpful because they agree with you that they are not necessarily looking at ROI in the traditional way. They do want to be helpful and we need to use-- show them that we're going to use their resources most effectively. I've found in the work that I'm doing for the research and development lab that the combination of having a research institution like and academic or university, a business, and schools, and CBOs all involve together is the most powerful way to have a common purpose and affect change. >> Michael Edwards: I just add to that. Thank you. That, you know, really we're in-- I know this is an energy in the room because you brought me into more literacy, hopefully, in your program and in your talks earlier today. But, you know, health is an important thing and we view at ReadyNation with our activities of how important it is. And we include that in our programs, we make sure the kids get the meals the parents understand the importance of, and they can't learn if they're hungry and they can't if they don't get that early development. You'll lose them in the succeeding years as they into their K through 12. So health is a definite play in this and I think you could be and I'd like to solicit your support going forward and keeping in your mind the benefits of what we hopefully help shed on with light the for you today is the benefits of bringing those kids early on, getting the parents to understand. If you think-- If-- You know, if they're in your office and they're in for a medical reason and they're in discussing-- just if you can get any kind of direct or indirect message to them. The importance of those kids getting in to an early education program, I'll bet you many of our states I haven't research that have an early education program. And if they don't you have many community members that do have an education program. And often the church or a paternal organization or somebody that's recognized it in your community. If you can get together with them and cause us an energy between you to go forward for better health and for early education. You know, our research shows that this is going to be one of the-- [inaudible]. One on the first generations lived shorter lives than their parent. Well, these ones are coming up. And a lot of it has to do with health and a lot of the ability to reach good health care which is very expensive depends on good business and early education of these kids and putting them in the workforce. We in the business side are looking for growing our future employees. We have a lot of problems. I've noticed this in the industry we have people that can't basically count back cash. They can't convey in a comprehensive way their ideas bringing forward. You may have people that are quite bright and do what they do but they can't convey their ideas and their smartness, if you will, on because they can't converse and they're not-- they're literacy is lacking. Starts with education and good health. So being Nancy is up here going to be evil eye on me pretty soon. I'm going to seal it off at that. But I would like to recruit each of you in your own communities, in your own way to impose on the parents and your community how early this early education program business is. Thanks pretty much. >>Nancy Fishman: Thank you. I love being the bouncer. So a couple ways that you can get involved and get some of these information go to our website, Sign up to get our resources and information. There's no cost, we won't sell your name. We're not going to have you come to meetings. There's no obligation. One of the resources that we have available on our website is a brief that we did for businesses talking to them about how they can talk to their employees and support their employees in high quality really education opportunities. That brief along with lots of other information and resources are available there or just seek Kali-- Kali are yo here? Kali or I after the event today and we can connect you with this valuable resources. We wanted to leave a minute and half for questions. So if a couple of you have a quick question about the rules? Two fast questions I believe are allowed. >> It's a challenge. >> Nancy Fishman: It is a challenge. In the back. >> For the first time you just mentioned quality and I think that was missing from the discussion earlier. And I would argue or want you to give thought to how it's not-- you talk about how parents want what best for their children, but the data shows that parents want accessible, affordable quality-- not quality-- accessible and affordable care for their children and so then it's, I think, our job to bring in the quality and make sure that that's a part of everything that's available [inaudible]. >>Nancy Fishman: And you're right. And much of our research does cite the quality. They are familiar with the quality aspect of what has to be. And we did not highlight that today. It's an important distinction. Different states define quality different ways. Some states don't even define quality. All the research shows that the benefits are greatest for those who participate in equality or high quality program. And it's those high quality programs where parent engagement is an inherent part of the program that we also have an opportunity to affect two different generations. Thank you so much. We should have called that earlier. I appreciate bringing that to our attention. And do you have a quick question, sir? >> Well, I try to make it quick. First of all, excellent panel, I agree. I appreciate this every encouraging. One of the things that I found in trying to work to support various educational programs at least dealing with governmental bodies. The state legislators are concerned that if they invest in education. They say that we don't know that these young people will be here 10 years from now. Why should we be training young people who will end up in California or in New Jersey et cetera? So my question is have you come in contact with that kind of sentiment and how do you counter it and part of my question also is with the Chamber of Commerce do you interact with the National Chamber of Commerce so they could really help get that message to our members of congress as well? >> Michael Edwards: Now let me just share with you quickly the message that I try to give to our legislators. If we don't educate the kids and start them off early, we're going to be lacking in our workforce. And we're already lacking in our workforce. Seattle as you know is a high tech community. We got Microsoft, Amazon, Expedia, you name it. But the fastest answer to that question when I get to ask is if we don't educate them and give them an early opportunity we will continue to import people from outside of the United States to fill those critical positions. And it isn't only the real high tech community. It's other things of manufacturing just like we had the solar power became an issue in our state where-- in our nation where we need to have an increased. And a lot of our linemen, and power people that are out there in our infrastructure getting the retirement age, we can't even find people that are trained well enough, for school well enough coming out of our school system to put those people into those programs to make it happen. So, if you want to retain your intellectual power and your brain powers and your resources start them early. It's like growing a garden. You put the seed in the ground and you culture it and take care of it all the way. And if you don't some-- yeah, in some ways it's a long range program that you're looking at. But if you don't do it, you'll end up short and you'll have to import them. >> Nancy Fishman: You want to close us out here Dominic? >> Dominic Robinson: Sure just one quick into that and then I also put the chamber. I would say that the other argument relative to, you know, why would we invest in these folks when we don't know we're going to able retain them. Statistically speaking, you know, yes, there's always kind of churn in the population. But the majority of the population is raised in a geography does in fact stay there. So I think you can also just point to the statistics that in fact more often than not that's a good bet. And I would agree with everything you else-- you said that, I think that your question around, for example, our relationship to the US Chamber of Commerce or other national chamber type organizations. It's an important question because we often associate chamber voice, especially nationally, with a voice that isn't always hospitable to these types of conversations. I think that it's a slowly changing dynamic. But I do think that there's at least a greater awareness that these things cannot be disconnected forever. I was invited to, but was not able to attend an event here in DC. I think in the fall that was a co-sponsored event between the US chamber and NAACP, I believed, kind of talking about where their organizational interest might align. And I thought that was a really encouraging sign. So I think that the reality is that we often feel like outliers within a broader kind of chamber conversation that only underscores our need to kind of continue to kind of use our platform as best we can. >> Nancy Fishman: Thank you all so much for having us. We appreciate your interest. >> Karen Baicker: Thank you. >> Michael Edwards: Thank you. [ Applause ] >> John Cole: Well, that was a wonderful different kind of insight for all of us. And I want to thank ReadyNation and thank our panel so much. Our final panel is also going to be different and interesting, Technology and Other Innovative Solutions. As Tony brings his panel members up, let's take a brief three or four minute break as they get settled up here and we will conclude with Technology and Other Innovative Solutions. Thank you again. It's my pleasure to-- one of the ways that we put this together is through partnerships that already exist and through new partnerships and I want to thank Laura Nemours for getting the last panel helping us so much which I think will be a new partnership for the Center for the Book. But we also are making use of some of our own board members, Laura is one and Tony Bloome who is chairing this panel on technology and literacy is also part of our literacy advisory board. He works for aids and has a wonderful project that is going to be described as part of the program. I'll turn it over to Tony. Tony? Let's give him a little applause to get him going. >> Anthony Bloome: All right. I haven't really done anything yet but I appreciate it, so. All right. So it's the last panel of the day and so you guys have been faithful to sit through a bunch of interesting conversations. But there's probably somebody in the room that you don't know. So I'd like to use five minute of our presentation time for you to introduce you somebody in the room that you don't know and tell them about a favorite book that read recently. You have five minutes please begin. So great. I wanted to start with that because obviously being able to meet somebody new be able to share your experiences about the book that you've read and how important obviously the theme of today is about literacy and how important it is that we can extend the opportunities for individuals around the world to have acces to literacy. I'm excited to have the three representatives of the organizations that will be speaking with us today to talk about various uses of technology that we can make access to health and the general literacy available to a variety of learners and using some creative technology options as well. So typical with the other format. We'll start with a few comments from our individual panelists. But then I would really like to open it up into a dialogue for organizations here to be able to share their own experiences around a specific concept of how can we use technology cost effective and sustainably to reach this audience to promote and accelerate literacy. And so can learn as much from you about the work you're doing as you can from us. So I'm delighted to welcome to my immediate left, Judy Dixon who's a Consumer Relations Officer right here at the Library of Congress. Judith did I see you that you've been working here for 35 years? That's enormously exciting. Who you can't see is her friend Potter who's I guess on the other-- oh, you can see that. So we're going to have you invent a story about what the tale came from, but you can-- so. And Judith will be talking to us about the services that her office provides including for braille and talking books. And then has brought some toys, some devices that she'll show us as well. So Judith in just a moment welcome you to walk us through that. And then next to Judith is Linda Harris who's Director of Health Communications and eHealth, the Office of Disease Prevention and Health Promotion at the US Department of Health and Human Services. And Linda I know you'll be talking about designing access to information for individuals with limited literacy, in particular in terms of health literacy. And then finally to my far left is a good friend and colleague of mine, Rebecca Leege who's the project director of an initiative called the All Children Reading Grand Challenge for development4, which specifically is looking at the use of technology to advance early grade reading in developing countries around the world. And Rebecca I know you've been at organizations like World Vision but also World Relief in a variety of capacities, exploring how to bring education to marginalized populations around the world. So without further ado, Judith can I turn it over to you just to walkthrough, tell us about some of the toys that you have. >> Judith Dixon: Down here? >> Linda Harris: It's-- you got it on the front-- yes. >> Judith Dixon: Oh, there, OK. Thank you very much. Good afternoon everyone. I am from the National Library Service as Tony indicated, at a National Service for the Blind and Physically Handicapped. We're part of the Library of Congress. We've been in existence since 1931. And our role is to create talking books and braille books. What we do is select them and produce them and then we give them out to libraries around the country who actually circulate them to individuals. So the idea here is people who don't read print either because of a visual or a physical disability are literate, yes, no. We have this debate all the time in my office. If somebody doesn't read print but they access information by listening, are they literate? I would say yes. There are people who actually would say no. But literacy is a challenge because the world is designed for print readers. So this is health literacy in a different way. It's not just people who can't communicate, most blind people can communicate just fine. It's a matter of not being access-- able to access print. So we do braille and talking books. And we do have books about health. As a matter of fact, I did a search this morning. And in our national collection we have 1168 audio books and 381 braille books specifically the topic of health. We have player, our talking books are-- I'm going to hold this up and they are recorded on a cartridge which that actually is just a USB flash drive. Most of them have labels. This one isn't because I created it this morning. >> Player on. Health and Nutrition Newsletters. February 2016. Current position, jogging and health, easier than you may think. Jogging and health, easier than you may think. >> Judith Dixon: Now, we can actually-- >> Reading time six minutes. >> Judith Dixon: We can skip through. >> Second opinion. Special report, supplement to Mayo Clinic health letter. Vision. Article jump. I health section. Jump. Phrase. Bookmark. Jump. Unit. Jump. As-- End of book. Within. Mayo Clinic health letter. Scientific American health after 50. >> Judith Dixon: So what this is is a monthly compilation of health newsletters. One of the reasons we don't have more health books than we do is because health topics come and go. And our library and they're very concerned about the books being up-to-date and accurate and current. So magazines and current health newsletter type items are a good way to do that to give people up to date information. So that's one way that a blind person can access print. Another way-- There are many other ways. There are actually lots of ways. And it's a matter of what is this information available in. So people can use computers to access material that's online. Smartphones, we actually have an app for our talking books called BARD mobile. And people can download our books also through a service called BARD. And I normally make this presentation in about two hours. So I'm trying to summarize that I can tell you so much more about anyone of these things. But I did bring some handouts. There are fact sheets about our program, application for service and things like that back on your handout table. So the program, there's lots of ways that have blind person can access information. Now, what you may not know is this is an iPhone, a regular old iPhone that you get at the Apple store. And every single iPhone has on it a screen reader called VoiceOver. And every iPhone can talk. >> Messages, contacts. >> Judy Dixon: Fortunately I hope I don't-- >> Double tap to open, messages, double tap to open, app switcher, blind fold solid, messages, act digitize, mail, active, igloo, WebMD, active. >> Judy Dixon: So-- >> Medicine button, WebMD, icon nav, button. >> Judy Dixon: I know you can't see the screen of this iPhone so you can just listen. This is probably a little fast. Actually let me-- >> Language. >> Judy Dixon: I can even scroll it down. >> Headings, audio ducking, volume, speech rate, words, speech 51-- 46%. >> Judy Dixon: There. That might-- >> Icon nav, button search WebM-- symptoms checker, button, medication reminders, button, conditions, button, medicine, button, refill and transfer prescriptions by-- first aid information, button. >> Judy Dixon: So this is WebMD, a regulator mainstream off the shelf app. >> ETN back arrow. >> Judy Dixon: I can double tap on it. >> First aid, button, search first aid, table index, adjust abdominal pain in adults, abdominal pain in children, acetaminophen, Tylenol, poisoning, alcohol intoxication, allergic reaction, amputation, accidental. >> Judy Dixon: I was reading this this morning and said amputation, accidental, oh my. That's sounds rather major, you know. >> ETN back arrow. >> Judy Dixon: I'm going to go to my iPhone if I'm accidentally amputated something. You know. So-- >> 41%. Walk-- have the injured person lie down. If possible don't reposition the person if you suspect the head, neck, back or leg injury. >> Judy Dixon: If I haven't fallen down. Yes. So-- But that's an incredible tool for accessibility of information. Finding-- It can do tons of other things, too. But just a mainstream app like WebMD that has good health information. Hush now, you're done. So that's another. Accessing printed material is one thing. But another major issue for people who don't see is identification of things, labels all this print, its-- everything is labeled in print. One way to identify kind of mainstream items. This-- [ Music and Machine Talking ] This is a barcode reader. But it's special barcode reader. So I have this box. What is this box? Who knows? I just damn no idea it's just a box. And so I can-- I'll try to do this. [ Machine Talking ] I should be able to hear what it says. [ Machine Talking ] Now that speech might be slightly off putting for people who don't listen to synthetic speech all the time. But for someone who does it's actually pretty understandable. There's a lot of information in a barcode. [ Machine Talking ] So it tells you how to take it, how often all the things about it. And this-- you're done, too. These things don't know when to shut up. There are barcodes on tons of things. I mean, I actually take this a little device to the grocery store and use it on items and just regular items in the grocery store. And there's also apps on my iPhone that can do the same thing. They're a little bit more difficult to use because they're little bit more difficult to find the barcode. But the process is the same. So now we have-- this is device called the ScriptTalk. Coincidentally made by the same company that the barcode reader was made by En-Vision America but this is a device for reading the labels on prescription bottles. It has to be created every Rite Aid Pharmacy in the United States can now provide this to their subscribers or customers. And the way this works is with RFID tags. >> ScripTalk Station ready. >> Judith Dixon: Right. So all I have to do is put the bottle on the device. >> Patient, John Jay Smith medication. Amoxicillin 250 milligram capsule. Instructions; take one capsule three times daily-- >> Judith Dixon: And again you can skip through. >> Prescription date. Use by March first 2017. Refills remaining, prescriber, ScriptAbility pharmacy. To reorder this prescription, prescription number, warning, important, finish of this medication. >> Judith Dixon: So they also have other kinds of pill bottles with large print. This bottle has a large print and a brand label. Brand label only says the name of the person. I hope they actually put more on it than that because the person probably knows who they are. It's the name of the medication that would be useful. But these Rite Aids now can do either large print brand labels or use-- provide the person with a ScriptTalk. And the last items-- there are lots of talking devices these days. There are talking glucose monitors. There are talking thermometers, talking scales, talking everything under the sun. This happens to be-- >> Low. >> Judith Dixon: -- talking. >> Your body temperature is 98.1 degrees Fahrenheit. >> Judith Dixon: It's close enough. Again, the speech-- where the speaker in this foolish thing. Looks like I'm going to do it again. Come on you can do it. >> Your body temperature is 90 degrees Fahrenheit. But if you use it right it probably will work. So this is just-- again there is talking blood pressure monitors and talking, you name it, there's talking almost everything. A lot of this stuff-- one of the challenges is for people who are deaf-blind because there is a bazillion things that talk. But it's a lot harder for people who also don't hear. So there are devices like that have-- that are-- this is refreshable braille display. And the pins raise and lower depending on what's on the screen. And the downside of these they are very, very expensive. But it is device that's really useful and can be paired via Bluetooth with a smartphone or with some of these other devices. Not our talking book machine the best example of the things I have here is that it can be paired with smartphone and anything that's displayed on the smart phone or anything that's displayed on a computer screen can also be read in braille. So this is a way that people who are deaf-blind have of accessing information that's typically in print. OK. >> Anthony Boome: Great. Well, thank you so much Judith for brining a bunch of toys to share with us important. And I wonder if you ever in your office do they start having an exchange with each other? >> Judith Dixon: No but they do at home. >> Anthony Bloome: You have to tell them to all be quite. And so we will have an opportunity for questions and answers afterwards. So with a hope that you would have some specific for Judy I know I have several as well. Judy thanks for kicking us off with really important discussion about range of technologies that can make a literacy materials more accessible by variety of learners. Linda, can I turn it over to you? I know you have some slides as well to talk to us about access to health literacy and other resources. >> Linda Harris: Yeah, I think I can-- I will see if I can see the screen. Is that the title of my presentation? OK, good. I'm going to talk about what we can learn from people with limited literacy about designing the interface for the technologies that we use to access health information. And it turns out we can learn a lot. I'm the Office of Disease Prevention and Health Promotion. And so the consumer is really an important part of being able to prevent disease and promote their own health. So that's why we pay a lot of attention to the consumer. And so what I'm going to talk with you about real quickly is that some of the research that we've done on people with limited literacy and limited health literacy, so the first thing I thought I would just kind of share with you is the difference. You'll see that-- You've probably heard that half the population struggle with reading. But-- oops. I'm sorry I can't see what I'm showing you. [ Inaudible Discussion ] Can you -- hold on. OK. So this is the slide-- oh, great thank you. Yeah. So this is half the population struggles with reading. But 90% of the population struggles with health literacy that is that only about 90% of us. 90% of us struggle at sometime, 10%-- about 10 to 12% of us are always proficient and understanding the complexity of health information. And so we have a lot to work with because of this challenge that almost all of us have. Health information is a little bit different from other kinds of information is that it's inherently complex. It comes from the medical kind of language. And it's also inherently stressful. So when we're trying to understand health information we-- even if we have-- those of us who have advance degrees and we think that we're really very literate when the time comes to get that diagnosis and it's really personal and eventful for us then our ability to process information kind of goes up the window. So we designed for everybody and what I'm going to talk about with you about is how we-- how our understanding of people with limited literacy and limited health literacy is helping us create that sort of that cyber curve cut for all of us. I'm going to show just a couple of screen shots. This is in our research, our usability research. And this is a picture, a graph of what it looks like when you're tracking-- doing eye tracking of just a regular person who's fully literate. So you can see how they're moving their eyes along the page. And now I'm going to show you eye tracking of somebody who is challenged with reading. So you see how inefficient they are, how they're struggling to try to find the point. And so this is accompanied with usually with limited memory. And so what am I reading and how am I to understand this information and then once I think I've got it how do I remember what I've read. This is a question that lots of people with limited literacy and limited health literacy are asking themselves all the time. So, we know that we have an enormous challenge to work with people with limited to provide meaningful access to health information among those who are limited in their reading and limited in their health literacy. But we've learned some really interesting things about those folks because we've really started paying a lot of attention to them. We have been interviewing and working one to one with over 800 folks most of them have either limited health literacy or limited literacy. And so here are some a few things that we've learned. People with limited literacy are willing to use the web and it's important to them to use the web for health information. They're able to accomplished tasks when the websites are design well and this is really key. We can make this accessible to people if we really make the effort. And then the third thing that I'm drill down on a little bit is that people with literacy seem to prefer mobile. So I'm going to just go into that a little bit more and I tell little bit why we think that's true. People with limited literacy usually prefer mobile. It seems that the reading is easier for them. We think that may be because the sentences are short. And there is some evidence that the tactile experience also helps process that information when you're using a mobile app or a phone. So I'm going to quickly share with you what we think is the definition of health literacy once-- now that I've kind of told you what we are learning about people with limited literacy and limited health literacy. We do not think that it is all that useful to defined health literacy as a deficit that those of us who are struggling have with reading or with health information. We prefer, we at HHSS, and that includes Rob and Logan and those of us who are in the Department of Health and Human Services. We prefer to think of health literacy as defined as that match between what the health organization or the publisher, or the source of health information provides and the way they provide it and our ability to find, understand, and use that information. So, what's that means for us is that the responsibly is really on those of us who published information to design it well. And that's why we have started with people with limited literacy and limited health literacy to define-- to develop a guide we call it Health Literacy Online: A Guide for Simplifying the User Experience. And that's where we brought these 800 folks together-- not together-- but individually these are not surveys. These are actually working with people watching them use the technology and the interfaces for websites. And this guide is-- was just published in October the second version of it. And it offers those folks who are developing any interface whether it's a web or a mobile app ways that we can design that interface in ways that almost everybody who can read, who can understand, who can process information at a simple level can find meaningful access to the information on that technology. So, it we-- it comes with a checklist that I have-- I brought the checklist with so want to take a look at it. I'm not going to go into that right now. But you'll see that's it's base-- it's an evidence-based guide based not only on the folks that we've been telling you-- that I've been telling about. But also on the literature that we've been referred to people with limited literacy, people with disabilities, and people with limited health literacy. So I'm going to just finally close with giving you an example of the kind of interface that we're working and Judy we should talk because we'd love to have this at the Library of Congress. Our-- As I mentioned to you we're in the Office of Disease Prevention Health Promotion. One of the websites we have for the public is called And so we've used these guides, these criteria to develop health literacy of That website is really the department faced to the public for the preventive services that we all need are covered by ACA. So, it's really important that we get that right and so that everybody needs to have the preventive services and because they're free. It's really important for us to make it so easy to use that anyone who can use the web or can use an app will find this very easy to access. So as I will close by saying, there's a lot more work to do, we would love to work with the disability community as well, work with the children who are actually helping us understand about design. Because what we really believe is that if you design with-- forget about grade level, you really design by engaging people who have-- who are challenged with reading and with health literacy, ask them to help you design the interface. That's really the most important thing you can do. So all of those of you who are working with people with limited literacy, with limited health literacy, and with disabilities, we hope that you'll encourage them to be a part of the design process and the information or health information that's important to them. >> Anthony Bloome: Thank you Linda. And then a really nice segue from talking about devices that can make information accessible that Judy was talking about to those who are creating the content, Linda, to make sure that it's also accessible. So obviously the connection as you've mentioned in terms of the types of audiences. So Rebecca, let's just-- let's go overseas and talk about sort of some of the challenges we face as part of the All Children Reading Grand Challenge and our literacy efforts that are involving technology for all the grade learners. >> Rebecca Chandler Leege: Great. I'm going to take a pulse check, who has worked in an office overseas in the room? One person? Great. Have anybody visited programs overseas that work on literacy projects? OK. Thank you. So as Tony mentioned, I'm Rebecca Leege, worked with World Vision. For those that may not be familiar with World Vision, we are an international relief and development organization and focused on multi-sectors, education being a key component of ours. We join the All Children Reading Grand Challenge five years ago at the partnership between USAID, World Vision and the Australian government. And it was really premised on the notion of, can we use science and technology to offer and breakthrough for early grade reading in developing countries? We as three agencies with very similar strategies weren't cracking the code. There were still 250 million children as we know without reading. There are one in-- or 80% of children with disabilities are in developing countries, 3% of those have access to school. So many opportunities for trying to make break through advancements in that space. So as I just mentioned, we've been around for five years and we have started to see some very interesting application of technologies in various sectors and I just though I highlight three of those. The three areas that we wanted to focus on to help improve because we know as listening even to the business panel and apologize that I cannot be here all day. But it is about parent and community engagement. It's about having the right quality materials and it's also ensuring that we have inclusion of all children in that process that no one is excluded. And we all know it's our human right to have literacy. We also know it unlocks our potential. And listening to the business, we're constantly trained to make that case overseas as well to those companies in developing countries that say we don't have the workforce talent and we say to ministries but you're also not investing in the education system to build that next generation. So these are three focus areas. For those of you who have grown up in the states, we've quite familiar with Sesame Street, right? And they have done a great job in helping educate many children in this country. They have taken their model in many countries but primarily in India where they have developed recognizing one their population need to improve reading in that country, they have taken and developed and contextualized the whole Sesame Street messaging called Galli Galli Sim Sim. It rolls off the tongue very nicely, too. They have done everything from creating e-reader, I mean e-publish books for e-readers to just simple games. We had asked for their high tech version of a phone, one of those [inaudible] and they sent us PVC piping. And I thought, oh, this was not what I was expecting to see. But how clever, something that is very low tech, affordable that can be sourced in the community so that children can start to hear themselves, practice their reading. They're currently working on a mobile app which is designed to be utilized at the home, they're working self-help groups primarily women that are focused on health issues or livelihood issues and introducing it their engagement in the reading process with their child and then giving them tools through an application on a very low-end smart phone to begin practice their reading. We're really excited to see how that will roll out. With any of these projects, one thing that is lacking at least in the developing countries is research. Research to say, does this app really make any difference or is it-- I mean we know it's great, the kids like to play on games and that has value. But can it demonstrate any improvement in their reading outcomes. And so we are tagging all of our grant programing to some robust research on that. And we hope the findings are positive. But, you know, it's a good thing to at least start to define what that process is, the contextualization of the assessment process, and so forth. The second one I wanted to highlight is related to our children with disabilities. This is a group IDRT, Institute for Disabilities Research and Training. They're based out of in Wheaton, Maryland. It's women owned business that has worked with the National Science Foundation and others. But they have partnered with a group in Morocco. And they feel very passionate that there's software application that was really trying to articulate a way to document sign language of a language to be utilized to create materials for deaf and low hearing in various countries. So they're partnering with the Institute of Morocco. The next slide kind of shows you what it will be. So you get an idea of just defining what it is, how it can be used in the market place and then they actually have a video of someone signing it. And then their training teachers and the deaf associations on how to create their own stories and began to allow material for deaf. It's also a way for them to teach many parents sign language because many of them don't actually know sign and even how to teach their children, right. So it serves multiple purposes. USAID Morocco is highly engaged in this in funding and it's been really supported by the Ministry of Education there as they're seeing it as a potential model to roll out throughout the whole country. We also see it as an opportunity to replicate because it's also based off of modern standard Arabic which is used throughout the whole North Africa and Middle East World. My last example is really on how to use source a new technology and I really appreciate Linda's focus and attention on user experience and simplifying tools for those that have low literacy levels. We put a challenge out 18 months ago, almost two years ago to say, can someone source an authoring tool that could be used in developing countries by individuals with 20 hours of training but embedded in that technology is the decoding and leveling framework of books. There are lot of authoring tools out there, some are very fancy, but when you're in the middle of South Sudan working with an elementary school teacher, it's unlikely that she's going to navigate a device that requires connectivity as well as something that is highly-- I'm going to say fancy, right, it has all the bells and whistles and it's almost overwhelming. So we put this challenge out. We had nine different teams around the globe that competed. And we ended up-- we have a demonstration to hand. Thank you. We'll do that in a second. We awarded it to a group called SILV. For those that may be familiar with SILV are a linguist organization that's been around over 60 years. They're probably are the ones that have documented the most languages. They have also worked at that very grassroots level to know what could be achievable in a software system. And so what we do like about it, though it looks kind of low tech in some ways is that it is easy to adopt-- I mean it's easy to learn. We run our first training on it in Ethiopia at the end of January and we did a usability study and assessment process. And it scored quite high because they said it's simple, we can master it, we understand what we're supposed to do and it already identifies the decoding and leveled elements for us. So we're not questioning, is this book appropriate for grade one or grade three, it's defined in that space. So we're very excited about this tool for beginning to roll out process. We think it has multiple usages, one even here in DC. We know that there's like-- if we look at Diaspora here in DC we can envision engaged in the Ethiopian community to contribute back reading materials. Basically, as we look at the vast materials and I don't Scholastic still in the room but great to hear it from Nancy that I know they do a lot of work overseas and partner with many of us as organizations. But even with large publishing firms, there are no resources and enough or little resources in local languages are we need to ensure that children actually have something that they can hold and read and practice in a language that they understand. I think that's it. Tony has a thumb drive here and we've been passing these out and I didn't think to bring, so if anybody wants it. The software is free. If anybody wants to-- online let me see if I put it in here. I didn't put it in here, sorry, bloom-- I can give it to you but it's, you know, if you're interested in downloading it it's very simple to open and start to create your own book. It might be kind of fun to do with any children that you might have or some youth that you want to give them a task to write a book for a child. Thank you. >> Anthony Bloome: Thank you Rebecca and maybe just a round of applause for the three presenters. [ Applause ] So I'm going to put the honors on you guys. We've heard about some really interesting examples of assistive technologies, designing content that it could be accessible particularly for a low literacy audiences and international projects that are looking at the use of technology to accelerate early grade reading. Do you have any questions for our panelist in regards to what you've just heard? >> Yes. >> Anthony Bloome: And if you could please introduce yourself and your organization again for our benefit that'd be terrific. >> Thank you those were all really, really informative and great. I'm Laura Bailey I direct in a Morse BrightStar program. I'm also on the Literacy Awards with Tony and, you know, the winner of the Rubinstein Prize in our second year was Room to Read. And I don't know if your organization works with Room to Read and all that I know one component of their program is they train-- they work in Third World Countries, mainly Southeast Asia I think, and they train local people to write children's books in the mother tongue, it seems like there might-- and they're pretty tech shabby too, so I didn't-- that's just a connection point so I don't know if you guys are working together-- >> Rebecca Chandler Leege: We do connect with them and we do greatly value their expertise in what they're producing, yes. >> Oh, good. That's great to hear. >> Rebecca Chandler Leege: They'll be working with us on a writer's workshop this summer in Cambodia. >> And then I just had a question that it's kind of been percolating through several of the sessions the woman who spoke about the response to the Ebola crisis earlier today and maybe some of you may not have been here for that, but she talked about the importance of public messaging through radio. And, you know, that audio for people with visual impairment or low literacy. Audio I think is such a great and readily available way to message to large numbers of people but I don't know that we're using that in the US very much anymore, it seems like everything has gone to texting and visual on devices so I don't know if anyone in the audience has a perspective on the value of audio for public health kinds of things or other international examples of that. >> Anthony Bloome: Boy that's terrific and just noting relations and partners the importance and then maybe Judy a question for you in regards to audio as well as others in the audience. Let's take a few questions and then ask the panelist it looked like there is somebody else who had-- if you could introduce yourself that'd be terrific. >> Sure. Actually it was a comment and invitation. I'm Dr. Sandra Charles, physician here at the Library of Congress running the occupation and health services office and that we each may have a wellness fair in which we invite a number of different organizations, vendors to partner with us and have an exposition where they off-show their services. And I'm thinking also disease prevention would be an excellent partner in helping people and spreading the word about what's available for people to use in terms of literacy and health literacy in particular because that's one of our main for us wellness and health promotion and we are constantly promoting health literacy. And in fact in addition to that wellness fair in August with your family health and wellness day where we ask employees to bring in their family members to also be exposed to the different things available in terms of health and I think both of those would be excellent for expounding in health literacy and improving it. And we certainly would like to have Judy bring over so the rest of the Library because we know she exist. We go out there to the National Library but I really think the rest of the Library ought to be aware of those things too, so thank you. >> Anthony Bloome: Thank you Dr. Charles. Great. >> Rob Logan, National Library of Medicine. I think this one is more for Linda but anybody can answer it. One of the challenges that I think that we have when we do MedlinePlus and I think it's similar to what challenge you have in Healthfinder is it would be a much better website if we knew the role in which people were using it were in. Are you here as a caregiver for example, OK? Are you here as a patient, OK? Are you here as a parent, OK? And I believe if we could provide a totally different website with different orientation based on the role and the reason why people were there in the first place, OK? I believe our materials would even be better utilized than they are now. I think that's beyond our techno capacity at the time but it occurs to me that I still haven't seen anyone, you know, take advantage of the fact that our needs with health information or requirements differed depending on the role that we're in when we're seeking. >> Anthony Bloome: Thank you Rob. OK, so I heard a few-- first of all a great recommendations in and suggestions. Thank you. So I heard three questions maybe I'll address to each of the panelist. Linda, clearly in terms of the role of the audience that's coming to the websites, Judy if you wanted to elaborate on perhaps some other radio or audio laced related technologies. I heard you mentioned was it BARD Mobile, so that'd be interesting maybe to mention a little bit more about. And then Rebecca just on the subject of partnerships, we heard an example of a partner but what role partnerships have in regards to the activity of all children reading. So maybe let's start with Judy. >> Judy Dixon: Yes thank you. Audio is certainly an important way to communicate to everyone including people with visual impairment. You're right in that radio as certainly in commercial radio is not used as much as it once was. I don't think people listen to radio as much as they once did. But there is also a network of radio reading services throughout the United States that is used to communicate various things to the visual impaired audience but these are primarily people who are long time well-established visually impaired people not so much reaching people who just have a little difficulty seeing. That's the population that's very difficult to reach and that's a population that really needs that kind of information. >> Anthony Bloome: I would also give you-- >> Judy Dixon: Oh, BARD Mobile, yes. It's a mobile app and I'm wondering I had a question for Linda as far as mobile apps. There are mobile apps that are not possible for me to use on my iPhone so I'm hoping that when you provide advice about developing mobile apps you also make sure to point out that they need to be made accessible with voiceover because not all apps are. So that's an important thing. But we have an app for playing our talking books and real books on smartphones and all of our audio books and real books can be played on that so that's possible. We have the iOS version of that it's been out for about two years and we just released an Android version. >> Anthony Bloome: Thank you Judy. Linda? >> Linda M. Harris: Yeah I would just-- to Judy's point, you know, we are really committed to complying with the 508 kind of regulations and rules and so that is a part of everything that we design and recommend. And I only wish that everybody was willing to step up to those kinds of standards. To Rob, to your question, actually Rob and I together I guess represent two of the library sources, sources of information to the public. Our Healthfinder is really about prevention and of course the MedlinePlus at the Library of Medicine is for kind of managing chronic conditions and understanding how the rest of the health span. So, we are often in conversations about how do we do better at understanding our audience. And I think what we've kind of come to the conclusion we and our part of the department is that that is you really want to have a trusting relationship between the source and the audience. And that's probably not the best role for the government to try to fulfill. And so as a result we have really been focusing on partnering with others who have websites and we have content-- we've indicated our content so that other websites can take it into their websites. They are the ones who are on the ground. They are the ones who have customers, constituents who already trust them. And so I'm, you know, we're kind of thinking If you can-- we, the government with the, you know, the NIH of the department who have the science backing that information can make it available and it's indicated to those folks who have the personal relationship with those folks then that smart interface could really be useful so that you get to know the people that you're talking with. We do that in partnership with CVS for example if you go to the MinuteClinic you'll see my Healthfinder on the MinuteClinic you will, you know, it'll be easy to use there as it is here. So I appreciate your question Rob, I think it's a really important path to go down but we've chosen to take that partnership path rather than trying to do the whole-- create those trusting relationships between the federal government and the individual. >> Rebecca Chandler Leege: And partnership, partnership is key and it's kind of the premise of a grand challenge is that we much work together collaboratively we must seek new problem solvers. We've used prize competitions really because it attracts the private sector, attracts entrepreneurs, attracts those not typically in the space to help us create a solution and I really appreciate recommendations that's part of our goal as an entity as an initiative is really just to start creating the voice and starting to understand where we can be at a catalyst for new partnerships in collaboration as well as start to replicate and adopt promising practices here in the US or in other places that can be replicated in developing countries. >> Anthony Bloome: Thank you Rebecca. So I wanted to ask a question of each of the panelist as well. We're in this center of knowledge, the Library of Congress. We've just created a Library of Congress Magic Wand, right, John, just being a question of another prize. So what would you like to see as a breakthrough activity or innovation in your respective areas that could help you accelerate your own initiatives? I know I had asked them this every time and it'd be interesting what they come up with. But what would you like to see just as something-- >> Rebecca Chandler Leege: If I do let's start. >> Anthony Bloome: -- yeah, something transformative maybe it's a technology, maybe it's a user Linda or-- and Rebecca maybe it's a new partner just what is an example of something you'd like to see once we've made wave the Magic Wand for Library of Congress. Linda you got something? >> Judy Dixon: I'll go first. >> Anthony Bloome: Judy. >> Judy Dixon: I think-- Just we were just talking about accessibility and Linda mentions that they use 508 but the current 508 guidelines were developed in 1998 and they have been working on a refresh for the last 18 years and they're supposedly close but who knows. Accessibility is a very complex is very complex and very thorny issue and extremely frustrating. It's frequent that I can go to websites that I can't use. It's frequent that I can download a mobile app that I can't use. So, if I was going to wave a Magic Wand I would just get rid of all the accessibility barriers, get rid of Flash and get rid of Java and all these other technological barriers that are used to make websites always banging, pretty and exciting and fun and our-- for the most part barriers to blind people. >> Anthony Bloome: Great, thank you Judy. Linda? >> Linda M. Harris: Well I think that the reach of the Library of Congress is just remarkable and I've been trying to think about how could we better make our information available through the Library of Congress? I mean, we have the websites and the sources of health information in the department, is really precious I think. It's updated constantly. It's the best of the science that we have translating that into understandable and actionable information is what we try to do. But our real limitation is really reaching people who are, you know, where they live. And if I had a Magic Wand I would distribute the Library of Congress' reach, I mean, facilities and capabilities for making that information more accessible to people where they are in their homes not just here or not just in their library but in their homes. >> Anthony Bloome: Great, thank you Linda. >> Rebecca Chandler Leege: Maybe a little bit on that line of accessibility just for your say Linda is I think I would love for there to be some approach or breakthrough for urgencies creating that urgency that we need to be educating our next generation in a way. And I struggle with trying to articulate that message we know reading is a long process it doesn't happen, you know, take a pill and we all read. I wish it were that simple. But really creating that sense of urgency for our future because of the trend is that we have more and more countries with children that cannot read our world is not going to become a more stable place and we need to figure out ways fast in which we can make that breakthrough and really start to change generations that are good to move forward and be our leaders. >> Is it OK to have an audience member to answer that question? >> Anthony Bloome: Oh yeah. >> OK. Because I got a totally [inaudible], right, medicine, totally different answer, OK, and I think there is something that could be done that would be I think transformative. One of the most impressive health care organizations in the US in my opinion is the Southcentral Foundation in Anchorage, Alaska. And I won't go into detail to why they are impressive but one of the things that they do is they serve a medically underserved population mostly Native Alaskans and what they gone out to do in order to improve health care there is to first give the people who live there a sense of pride in who they are and their own heritage, their own background. They have begun to realize that a sense of pride in who you are, a sense of your own history, a sense of your own community, a sense of what their challenges are and I'm not going to go more detail about it. It's fundamental to giving people interest in their own health, taking care of themselves, taking care of their families. You can't put the cart before the horse is what they've argued for years. Now translate that into something that the Library of Congress could uniquely do. Why should you be proud if you're from a low income area in Philadelphia? Why should you be proud if you're in to it? Why should you be proud if you're this providing a place where people could go? The story of various different demographic wake grounds and groups people in this country, something they could look at and really develop some pride, some ownership in, some interest, tell people how to-- where they can go from there to learn more. I'm not going to go in more detail about it but I don't know what resource like anywhere. I don't know any organization in this country or frankly for the Ed Med or any country that has the kind of resources that this place had that could do something like that. >> Anthony Bloome: Well thank you Rob. So John, all these people are waving their Magic Wands. Our session is done but I would say in this period of partnership, you know, we found particularly with the [inaudible] grand challenge model. If you have a problem there's good will and there's people out there that are probably have some ideas to help you achieve a solution. So I want to thank once again and ask you to please join me in a round of applause for our three panelists. [ Applause ] And invite John to come back up. Thank you. >> John Cole: Well first a couple of thank yous to everybody for sticking it out with us. Gosh, we've had quite a day. It's been a wonderful day. I am going to respond but first I'd like Dr. Sullivan said he has been with us all day and I'm looking around and I wanted to ask him if he's willing to make some comments on what he's heard and maybe present another challenge for the Library of Congress to which I will attempt to respond. Would you mind? Would you like-- Yes, let's get a microphone. >> Well, let me say again for me this has been a very exciting, very rewarding day and I think I've learned a lot from all of the presenters here. I was thinking it was back in 1979 that Joyous Richmond when he was surgeon general and assistant secretary of health issued a report called Healthy People. That was a prescription for indeed people taking responsibility for their own health in setting goals for them and it's been my pleasure and opportunity as secretary to issue an update Healthy People 2000 which we issues in September of 1990. It had grown then. We had some 298 objectives for people really taking responsibility for their health and showing people the power that they had to indeed protect their health and project their health forward. That has really now it its current iteration is now Healthy People 2020. So this has been a growing effort. It has become much-- The public has become much more aware of this, individual citizens, companies promoting health behavior in their employees and the recognition of the business community that a healthy work for us is a positive for them. I was pleased to see the business representation here today. So, I think that with the growing interest and focus on this as well as the fact that with the Affordable Care Act we've now provided added resources for this. This is a great opportunity so I think we have a lot yet to do, a lot of challenges but I think the environment is much more positive. Twenty or 30 years ago much of what today's discussion was about, people would have interpreted as well kind of feel good activity, something that makes you feel better but we don't really know whether it works. But then now have been enough studies showing that physical activity reduces death rates, reduces heart disease, diabetes make slow the progression of development of Alzheimer's. So, I think we have enough now that the kinds of activities that have been described today really should go forward and as we heard from our business colleagues return on investment is now very much documented. So I think this for me has been a very enlightening day, a very encouraging day and I certainly think the Library of Congress is a great place to really help get this movement further around the country so those are my comments, thank you. >> John Cole: Well, thank you very much. And thank you for joining us today it's really been a joy and you've made a major contribution. I see a couple of other people before I present we're not going on much longer it's been a wonderful day but Laura Bailey has been with me for this. We have done the planning with help from many others for this. I'm wondering if you might want to say a few things about today and Robi would you like to say a few things in a minute and then I'll try to rewind this up and get us out of here with promises for the future that I hope we can follow up on? >> Well, I would also to thank John and all of his helpers at Library of Congress. I was kind of saying to John and others at a meeting in February here that I don't think you always realize the power of your brand and the Library of Congress is a brand like no other. And I think when you put your name behind the cause really great things can happen and I so appreciate everyone who's been here all day, all the speakers, all the planning that went in to your comments and I hope it was a good for everyone. I certainly learned a lot. I do think that the theme of urgency came up a couple of times Jeff and I talked about that at lunch and then Rebecca mentioned the urgency is her Magic Wand, how do we keep this issue present and have that sense of urgency. We really do know enough to certainly make things much better than they are. And so, where do we find that urgency and will to work together in some new ways to get this done, so thank you and I'll pass it to Robbie. >> John Cole: Thank you very much. >> Robbie Harris: It's a privilege right now to say a few words, just a few, at the end to be here. I'm just sitting thinking about the fact that as authors and illustrators as I mentioned this morning we're on our own room working a way and then with our publishers and editors and wonderful people. But we're not out there doing the work that all of you are doing so what I hope and what I learned from today is that I want to go back to my friends and colleagues and everybody in the field of children's books and all even apps, people are creating apps what's going online and say, you know, there's something about health out there that all of those can do and continue to do if we really, really care deeply about the children in out family and certainly, thank you all who've talked about our most vulnerable families and ways that hopefully one can help those families move out of poverty. And I think this is certainly that's the record-- that struck a chord in me, so many people talked about it so thank you for all that all of you do. >> John Cole: And finally-- Jeff would you like to say something at the end today and this will be the last person call-- >> Oh that's pressure John. >> John Cole: No, no. I'm putting the pressure on myself Jeff. I just want you folks to get a chance to say something. >> Well I just want to thank again everybody for participating today and as I've said to several people during the day. This is really one of the few opportunities, unfortunately one of the few opportunities we have for so many people who look at this problem from so many different place whether it's working with adults as I do, whether it's working with government, private sector, business, children's literacy and in health and it doesn't happen often enough and I think, you know, when we saw the connections being made and the recommendations that you're talking about Tony, you can see how much value these kind of discussions have. And I guess I would just end with, you know, I hope we live with that spirit that this is a collective issue. There's a lot of energy and it's incredibly important, we talked a lot about early childhood and how crucial that is. But it goes beyond. It goes also to older children, teenagers and of course adults and we've got to look at this problem from all those perspectives I think for us to make significant progress. So again thank you to everyone who put this day together it was wonderful and thank you John and I look forward to your closing remarks. >> John Cole: I'm going to promise things right that, who knows. Also however Tony thank you, I mean we've-- it's been a wonderful experience inside the library to do this and I'll just share that with you a little. First we have three or four board members from the literacy board which is I'm going to say a little bit about the literacy project and how we might with literacy awards program and how we might carry forward. But even within the Library of Congress today and I was so pleased that we had our own, Dr. Charles was here, the people from health services I learned a lot about what the Library of Congress. We are a big organization, 3800 people spread all over this area and in other places. And I was so pleased in their interest in this and I learned and that's another example of, you know, we need to get to talk more and learn about our own organizations and see which way they're headed. Now the library of congress has-- is an exciting part of our history right now because the new Librarian of Congress has been nominated. We are hoping that there will be hearings soon and I was so pleased that the department of education had a hearing on a new leader and nobody stop that and it sailed through and we are hoping for new leadership. It also has to be confirmed by the senate which is I'm pausing a little bit here but we have great hopes. So here are some of the opportunities and I appreciate what people said. I see them through my job, my two fold job for which I'm paid and my other job for which I'm not paid which is as a historian of the Library of Congress. I can see an opportunity coming historically for this institution with new leadership because a lot has happened in terms of outreach and those of you who were able to join us last night met the person who introduced Dr. Bailey, Jane who is the new director of national and international outreach. And this is the new department comes out of a larger department but it indicates a new interest in outreach for the Library of Congress that is above board, it's the name of the organization is outreach. And the Library of Congress has had a lot of outreach going on but it's been segmented and it's not really been up front in the way that it needs to be now because as an institution as we've developed we had 5200 employees in the Library of Congress in 1992. We now have 3800. We have not given up a single function. We still have strong prestige. We still have dedicated people who were working on each of these areas. One of the reasons that numbers gone down is a good reason it's cataloging it's been centralized they are-- automation has helped us but we're also doing a lot of outsourcing. So we haven't lost any functions and in the mean time outreach has grown. And part of it is our presence on the website. When we first develop the national digital library of and then eventually the worldwide web came along, the Library of Congress did some testing for the digitalization that we've been doing and had struck a bargain with congress about funding yet another new office and the bargain that was struck was if we paid with private money with a Madison council group that supports us to get started with the national digital library and then did some testing about who is using our digitize product which turned to be American history American memory would congress go along and help fund the development of this national digital library? Well, we succeeded in that but guess what the new survey did after two years. It showed us we had a whole new class of users, students and teachers were using American memory and some of our digitized products. And one of the results was the creation of something called educational outreach. So for the first time we have a major outreach function funded by congress to reach out to teachers and students. And they bring students here to learn how to use online resources. I'm going towards this idea of reaching out internationally because our international role has grown since World War II the same time the worldwide web and this new educational outreach has started. And our new emphasis has got to be and I'm sure the new librarian will recognize this on the education side and in the areas-- so this is actually impart why the center for the book was created with Dr. Boorstin [assumed spelling] where he looking ahead we were reaching out to promote books in reading. And one of the answer actually when I'm thinking of Rob in a way is that we have established centers every state, we don't pay for them, they are partnership organizations that have the job of promoting locally books, reading, literacy and libraries in that area and that's closely associated with state pride. And each state wants to have and keep a state center but they have to do something and they have to really reevaluate after every three years. And as the installation of the pride in the state and put it together in our country but it's the state pride issue which we also are capitalizing on in such a way that we have in Alaska center for the book. They tell you what work they do, they promote reading and literacy in Alaska but they use it with the state library and they do data basis about Alaska writers each state. And we have helped develop through our national book festival a whole system of state and regional book festivals. We don't run them they're locally done. But it's a long this idea of rebirth at the state level of activities that are related to education, books, reading, literacy and libraries. And I think that if I have, you know, I have much to say about it and I'm working hard at it is the area with this where we are headed. David Rubenstein has helped us immensely. He the benefactor I talked about earlier today by doing the funding for the national book festival, I mean, for the Library of Congress to have a national book festival free that celebrates readers and writers and now has moved to the conventions center. And last year the convention center put out a news release, we moved from the mall on to the convention center. It said that one day crowd was the largest crowd in the history of the Washington Convention Center. They estimated 125 to 150,000 people came to that program which now Mr. Rubenstein with the development of the program part of today also is helping with the literacy corner at the book festival and with the outreach that we are doing with the literacy awards program is being tied in institutionally in ways that I think give me hope for just some of the suggestions that were here. I didn't mention Judy is still here but I mention-- should have answered with having NLS as part of this along with health services the center for the book. We are able to pull the library together in this area of reading and literacy promotion in ways that we've not done. Now, this isn't a complete answer but it is an answer I think to the hopefulness of carrying on with some of the ideas that we've talked about today because Mr. Rubinstein is quite interested in helping support this kind of activity and with the help from our partners and our advisory board members who are here today, we continue to stretch literacy and the Library of Congress in new ways. Last year's symposium was literacy in poetry, this year it's poetry, it's literacy and health and we've made new friends and new partners. There'll be another one next year, two people and are meeting on, the day before yesterday, they say it's got to be on literacy and technology and we'll have another board member who really thinks it should be on literacy and indigenous cultures which would bring us into a whole another range of partners plus we have picked up partners along the way, Reach Out and Read was here today and, you know, the fact that it not only, you know, was-- it isn't here because it was a winner of the Rubinstein Award, it's here because its work is so important to what we're doing. And so we're going to be using the literacy awards program also funded by Mr. Rubinstein as part of this outreach effort. . And I explained, I-- well, other some of people weren't here and I'll slow down in a second, but we're expanding the number of awards that are organizations that are recognized through their work in literacy in this program, I talked about that a little bit last night. And we would be able to expand and to include the range of organizations that are here. And we also want to look back to past winners, if you are part of the network now and even though Reach Out and Read has always been a reading and literacy promotion partner to help with this new outreach. So I end up, I'm sorry I'm going on a bit but I'm optimistic and this kind of meeting has teach me optimistic because I can see partners and interest and I also as a historian of the Library of the Congress know its potential in terms of international outreach. I know its potential in terms of technology and part of this is-- and I also know the potential of having new leadership in an organization like this. Library of Congress was created in 1800, we've had 13 librarians of congress, it's a long term of offices especially who one of them only lasted a year and a half, he died in office. So you're talking about, now there's a limitation which I think is a good thing on the term of the library and of the congress to a total of 20 years with 10 year and a 10 year renewal. But it is a period historically that is will be a revitalization for the library and your presence in the planning that's been done in bringing us all together, I consider to be an important part of it and I would challenge myself and I challenge the rest of you to keep us on the track that you've helped us step on today and move ahead. So I'm going to end, thank you all for participating especially to Laura and board members, the NEMOURS was we couldn't have done this without NEMOURS and we're just very pleased with everything that's going on and I think we have a number of our participants here and let's give them a hand and thank you very much for being with us. We'll be back in touch but let's-- [ Applause ] >> This has been a presentation of the Library of Congress. Visit us at



The U.S. Department of Justice found fault with the congressional, senatorial and Assembly districts in Manhattan and Brooklyn under the apportionment of 1971, and ordered a revision to safeguard the rights of minorities.[1] The Legislature enacted an amendment to the 1971 apportionment, remapping the legislative districts in Manhattan and Brooklyn, during a special session on May 29 and 30, 1974.[2] On July 1, the U.S. Department of Justice accepted the revised districts as passed by the Legislature.[3]

Thus, under the provisions of the New York Constitution of 1938 and the U.S. Supreme Court decision to follow the One man, one vote rule, re-apportioned in 1971, and amended in 1974, by the Legislature, 60 Senators and 150 assemblymen were elected in single-seat districts for two-year terms. Senate and Assembly districts consisted of approximately the same number of inhabitants, the area being apportioned without restrictions regarding county boundaries.

At this time there were two major political parties: the Republican Party and the Democratic Party. The Conservative Party, the Liberal Party, the Courage Party, the Free Libertarian Party, the Socialist Workers Party, the Communist Party, the Socialist Labor Party and the Labor Party also nominated tickets.


The New York state election, 1974, was held on November 5. Congressman Hugh Carey and State Senator Mary Anne Krupsak were elected Governor and Lieutenant Governor, both Democrats. Carey defeated the incumbent Governor Malcolm Wilson. The elections to the other five statewide elective offices resulted in a Republican Attorney General with Liberal endorsement; a Democratic State Comptroller with Liberal endorsement; a Republican U.S. Senator with Liberal endorsement; and two Democratic judges of the Court of Appeals, one of them with Liberal endorsement. The approximate party strength at this election, as expressed by the vote for Governor, was: Democrats/Liberals 3,029,000; Republicans/Conservatives 2,220,000; Courage 12,500; Free Libertarians 10,500; Socialist Workers 9,000; Communists 5,000; Socialist Labor 4,500; and Labor 3,000. Gathering from the results for the other offices, the strength of the Liberals was about 400,000 votes, and the Conservatives about 250,000. However, Conservative Barbara A. Keating polled more than 800,000 votes for U.S. Senator.

Of the seven women members of the previous legislature, State Senator Mary Anne Krupsak (Dem.), a lawyer of Amsterdam, was elected Lieutenant Governor of New York, and became ex officio President of the State Senate; and five of the other six—State Senators Karen Burstein, a lawyer of Lawrence, and Carol Bellamy, a lawyer of Brooklyn; and Assemblywomen Elizabeth Connelly (Dem.), of Staten Island; Estella B. Diggs, of the Bronx; and Rosemary R. Gunning (Cons.), a lawyer of Ridgewood, Queens—were re-elected. Linda Winikow, of Spring Valley, was also elected to the State Senate. Jean Amatucci (Dem.), a registered nurse of White Lake; Mary B. Goodhue (Rep.), a lawyer of Mount Kisco; and Marie M. Runyon (Dem.), of Manhattan, were also elected to the Assembly.

The New York state election, 1975, was held on November 4. No statewide elective offices were up for election. One vacancy was filled in the Legislature: Jeannette Gadson, of Brooklyn, was elected to the Assembly.

On February 10, 1976, Gerdi E. Lipschutz (Dem.), of Queens, was elected to fill a vacancy in the Assembly, making her the eleventh woman member of the Legislature of 1976, surpassing the previous record of eight in the 166th New York State Legislature (1947–1948).


The Legislature met for the first regular session (the 198th) at the State Capitol in Albany on January 8, 1975; and adjourned sine die in the morning of July 12.[4]

Stanley Steingut (Dem.) was elected Speaker.

Warren M. Anderson (Rep.) was re-elected Temporary President of the State Senate.

The Legislature met for a special session at the State Capitol in Albany on September 4, 1975;[5] and adjourned sine die in the early morning of September 9.[6] This session was called to take measures concerning the financial crisis of New York City.

The Legislature met for another special session at the State Capitol in Albany on November 13, 1975.[7] On November 25, a help package worth $200 million was enacted to avert the financial breakdown of New York City.[8] They adjourned sine die on December 20, after enacting an increase of $600 million in state taxes.[9]

The Legislature met for the second regular session (the 199th) at the State Capitol in Albany on January 7, 1976;[10] and adjourned sine die in the morning of June 30.[11]

The Legislature met for yet another special session at the State Capitol in Albany on August 4, 1976;[12] and adjourned sine die on the next day.[13] This session was called to consider Governor Carey's proposed court reform.[14]

State Senate


The asterisk (*) denotes members of the previous Legislature who continued in office as members of this Legislature. Franz S. Leichter changed from the Assembly to the Senate at the beginning of the session. Assemblyman Anthony V. Gazzara was elected to fill a vacancy in the Senate.

Note: For brevity, the chairmanships omit the words "...the Committee on (the)..."

District Senator Party Notes
1st Leon E. Giuffreda* Republican
2nd Bernard C. Smith* Republican
3rd Caesar Trunzo* Republican
4th Owen H. Johnson* Republican
5th Ralph J. Marino* Republican
6th John R. Dunne* Republican
7th John D. Caemmerer* Republican
8th Norman J. Levy* Republican
9th Karen Burstein* Democrat
10th John J. Santucci* Democrat on December 30, 1976, appointed as D.A. of Queens County[15]
11th Frank Padavan* Republican
12th Jack E. Bronston* Democrat
13th Emanuel R. Gold* Democrat
14th John J. Moore* Democrat died on January 18, 1976
Anthony V. Gazzara* Democrat on March 2, 1976, elected to fill vacancy[16]
15th Martin J. Knorr* Republican
16th A. Frederick Meyerson* Democrat in March 1976, appointed to the New York City Criminal Court
Howard E. Babbush Democrat on April 27, 1976, elected to fill vacancy
17th Major Owens Democrat
18th Chester J. Straub* Democrat resigned in December 1975
Thomas J. Bartosiewicz Democrat on February 10, 1976, elected to fill vacancy[17]
19th Jeremiah B. Bloom* Democrat
20th Donald Halperin* Democrat
21st William T. Conklin* Republican Deputy Majority Leader
22nd Albert B. Lewis* Democrat
23rd Vander L. Beatty* Democrat
24th John J. Marchi* Republican Chairman of Finance
25th Carol Bellamy* Democrat
26th Roy M. Goodman* Republican
27th Manfred Ohrenstein* Democrat Minority Leader
28th Carl McCall Democrat
29th Franz S. Leichter* Democrat
30th Robert García* Democrat
31st Israel Ruiz, Jr. Democrat
32nd Joseph L. Galiber* Democrat
33rd Abraham Bernstein* Democrat
34th John D. Calandra* Republican
35th John E. Flynn* Republican
36th Joseph R. Pisani* Republican
37th Bernard G. Gordon* Republican
38th Linda Winikow Democrat
39th Jay P. Rolison, Jr.* Republican
40th Richard E. Schermerhorn* Republican
41st Douglas Hudson* Republican
42nd Howard C. Nolan, Jr. Democrat
43rd Ronald B. Stafford* Republican
44th Fred Isabella Democrat
45th Hugh Douglas Barclay* Republican
46th James H. Donovan* Republican
47th Warren M. Anderson* Republican re-elected Temporary President
48th Edwyn E. Mason* Republican
49th Martin S. Auer* Republican
50th Tarky Lombardi, Jr.* Republican
51st William T. Smith* Republican
52nd Frederick L. Warder* Republican
53rd John D. Perry Democrat
54th Fred J. Eckert* Republican
55th Joseph A. Tauriello* Democrat
56th James D. Griffin* Democrat
57th Jess J. Present* Republican
58th vacant Senator-elect Thomas F. McGowan (R) was appointed to the New York Supreme Court
Dale M. Volker Republican on February 4, 1975, elected to fill vacancy[18]
59th James T. McFarland* Republican
60th Lloyd H. Paterson* Republican


  • Secretary: Albert J. Abrams, resigned 1976
    • Roger C. Thompson, in 1976

State Assembly


The asterisk (*) denotes members of the previous Legislature who continued in office as members of this Legislature.

Note: For brevity, the chairmanships omit the words "...the Committee on (the)..."

District Assemblymen Party Notes
1st Perry B. Duryea, Jr.* Republican Minority Leader
2nd George J. Hochbrueckner Democrat
3rd Icilio W. Bianchi, Jr.* Democrat
4th Robert C. Wertz* Republican
5th Paul E. Harenberg Democrat
6th John C. Cochrane* Republican
7th John J. Flanagan* Republican
8th Regis B. O'Neil, Jr. Republican
9th William L. Burns* Republican
10th Lewis J. Yevoli Democrat
11th Philip B. Healey* Republican
12th George A. Murphy* Republican
13th Milton Jonas* Republican
14th Joseph M. Reilly* Republican
15th Angelo F. Orazio Democrat
16th Irwin J. Landes* Democrat
17th Joseph M. Margiotta* Republican
18th Armand P. D'Amato* Republican
19th John S. Thorp, Jr.* Democrat
20th Arthur J. Kremer* Democrat
21st Henry W. Dwyer Republican
22nd Herbert A. Posner* Democrat on November 4, 1975, elected to the New York City Civil Court
Gerdi E. Lipschutz Democrat on February 10, 1976, elected to fill vacancy
23rd John A. Esposito* Republican
24th Saul Weprin* Democrat
25th Vincent F. Nicolosi* Democrat
26th Leonard P. Stavisky* Democrat
27th Arthur J. Cooperman* Democrat
28th Alan G. Hevesi* Democrat
29th Guy R. Brewer* Democrat
30th Herbert J. Miller* Democrat
31st Alfred A. DelliBovi* Republican
32nd Edward Abramson* Democrat
33rd John T. Flack* Republican
34th Joseph F. Lisa* Democrat
35th John G. Lopresto* Republican
36th Anthony V. Gazzara* Democrat on March 2, 1976, elected to the State Senate
Denis J. Butler Democrat on April 27, 1976, elected to fill vacancy[19]
37th Rosemary R. Gunning* Cons./Rep.
38th Frederick D. Schmidt Democrat
39th Stanley Fink* Democrat
40th Edward Griffith* Democrat
41st Stanley Steingut* Democrat elected Speaker
42nd Brian Sharoff* Democrat
43rd George A. Cincotta* Democrat
44th Mel Miller* Democrat
45th Chuck Schumer Democrat
46th Howard L. Lasher* Democrat
47th Frank J. Barbaro* Democrat
48th Leonard Silverman* Democrat
49th Dominick L. DiCarlo* Republican
50th Christopher J. Mega* Republican
51st Joseph Ferris Democrat
52nd Michael L. Pesce* Democrat
53rd Woodrow Lewis* Democrat
54th Charles T. Hamilton* Democrat resigned
Jeannette Gadson Democrat on November 4, 1975, elected to fill vacancy
55th Thomas R. Fortune* Democrat
56th Albert Vann Democrat
57th Harvey L. Strelzin* Democrat
58th Joseph R. Lentol* Democrat
59th Peter G. Mirto* Democrat
60th Guy Molinari Republican
61st Elizabeth Connelly* Democrat
62nd Louis DeSalvio* Democrat
63rd Anthony G. DiFalco* Democrat
64th William F. Passannante* Democrat
65th Andrew J. Stein* Democrat
66th Mark Alan Siegel Democrat
67th Richard N. Gottfried* Democrat
68th Alexander B. Grannis Democrat
69th Albert H. Blumenthal* Democrat Majority Leader
70th Marie M. Runyon Democrat
71st George W. Miller* Democrat
72nd Angelo Del Toro Democrat
73rd Edward H. Lehner* Democrat
74th Herman D. Farrell, Jr. Democrat
75th José E. Serrano Democrat
76th Seymour Posner* Democrat
77th Armando Montano* Democrat
78th Estella B. Diggs* Democrat
79th Louis Niñé* Democrat
80th Guy J. Velella* Republican
81st Alan Hochberg* Democrat
82nd Thomas J. Culhane* Democrat
83rd Burton Hecht* Democrat Chairman of Ways and Means;
on November 2, 1976, elected to the New York City Civil Court
84th G. Oliver Koppell* Democrat
85th John C. Dearie* Democrat
86th Vincent A. Marchiselli Democrat
87th Bruce F. Caputo* Republican on November 2, 1976, elected to the 95th U.S. Congress
88th Richard C. Ross* Republican
89th Alvin M. Suchin* Republican
90th Gordon W. Burrows* Republican
91st Richard E. Mannix* Republican
92nd Peter M. Sullivan Republican
93rd Mary B. Goodhue Republican
94th Willis H. Stephens* Republican
95th Eugene Levy* Republican
96th Robert J. Connor Democrat
97th Lawrence Herbst* Republican
98th Jean Amatucci Democrat
99th Emeel S. Betros* Republican
100th Benjamin P. Roosa, Jr.* Republican
101st Maurice D. Hinchey Democrat
102nd Clarence D. Lane* Republican
103rd Fred G. Field, Jr.* Republican
104th Thomas W. Brown* Democrat
105th Charles D. Cook* Republican
106th Neil W. Kelleher* Republican
107th Clark C. Wemple* Republican
108th Robert A. D'Andrea Republican
109th Glenn H. Harris* Republican
110th Gerald B. H. Solomon* Republican
111th Andrew W. Ryan, Jr.* Republican
112th K. Daniel Haley* Democrat
113th Peter S. Dokuchitz* Republican
114th Donald L. Taylor* Republican
115th William R. Sears* Republican
116th Nicholas J. Calogero* Republican
117th John R. Zagame Republican
118th Ronald A. Stott Democrat
119th Hyman M. Miller* Republican
120th Melvin N. Zimmer Dem./Cons.
121st Thomas J. Murphy* Republican
122nd Clarence D. Rappleyea, Jr.* Republican
123rd James W. McCabe Democrat
124th James R. Tallon, Jr. Democrat
125th Lloyd Stephen Riford, Jr.* Republican
126th L. Richard Marshall* Republican
127th Charles D. Henderson* Republican
128th Gary A. Lee Republican
129th James F. Hurley* Republican
130th Thomas A. Hanna* Republican
131st Raymond J. Lill* Democrat
132nd Thomas R. Frey* Democrat
133rd Andrew D. Virgilio Democrat
134th Roger J. Robach Democrat
135th Don W. Cook* Republican
136th James L. Emery* Republican
137th R. Stephen Hawley* Republican
138th John B. Daly* Republican
139th Matthew J. Murphy, Jr. Democrat
140th Harold H. Izard Democrat
141st G. James Fremming Democrat
142nd Stephen R. Greco* Democrat
143rd Arthur O. Eve* Democrat
144th William B. Hoyt Democrat
145th Francis J. Griffin* Democrat
146th Dennis T. Gorski Democrat
147th Ronald H. Tills* Republican
148th Vincent J. Graber, Sr. Democrat
149th Daniel B. Walsh Democrat
150th Rolland E. Kidder Democrat



  1. ^ Legislative Expert Sees Hurdle to Redistricting in the New York Times on April 3, 1974 (subscription required)
  2. ^ Redistricting Has Usual Result in the New York Times on June 2, 1974 (subscription required)
  3. ^ U.S. ACCEPTS PLAN ON DISTRICTS HERE in the New York Times on July 2, 1974 (subscription required)
  4. ^ Longest Session Since 1911 Is Ended in the New York Times on July 13, 1975 (subscription required)
  5. ^ Legislators Reluctantly Go to Albany For Special Session on Fiscal Crisis in the New York Times on September 5, 1975 (subscription required)
  6. ^ CAREY PLAN TO HELP CITY VOTED BY ASSEMBLY, 80–70 in the New York Times on September 9, 1975 (subscription required)
  7. ^ Indicted Speaker of Assembly Given Ovation by Colleagues in the New York Times on November 14, 1975 (subscription required)
  8. ^ COMPROMISE WON; Minority Caucus Gets Concessions to Back Fiscal Package in the New York Times on November 26, 1975 (subscription required)
  9. ^ ALBANY APPROVES $600 MILLION TAX BY A CLOSE MARGIN in the New York Times on December 21, 1975 (subscription required)
  10. ^ For the Legislature, End Marks Beginning in the New York Times on January 8, 1976 (subscription required)
  11. ^ A 19-Hour Windup Closes '76 New York Legislature in the New York Times on July 1, 1976 (subscription required)
  12. ^ Albany Ready to Approve Court Reorganization Plan in the New York Times on August 5, 1976 (subscription required)
  13. ^ STATE TAKEOVER OF COURT COSTS VOTED IN ALBANY in the New York Times on August 6, 1976 (subscription required)
  14. ^ CAREY RECALLING THE LEGISLATURE in the New York Times on July 30, 1976 (subscription required)
  15. ^ Carey Appoints Santucci as Queens District Attorney in the New York Times on December 31, 1976 (subscription required)
  16. ^ Gazzara Wins Special Vote For State Senate in Queens in the New York Times on March 3, 1976 (subscription required)
  17. ^ DEMOCRATS WIN SPECIAL ELECTIONS in the New York Times on February 11, 1976 (subscription required)
  18. ^ GOP Calls Election Rebuff for Carey in the Watertown Daily Times, of Watertown, on February 6, 1975
  19. ^ Butler Defeats Romandino In Queens Assembly Vote in the New York Times on April 28, 1976 (subscription required)


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