Reach Out and Read (ROR), a pediatric literacy intervention, is widely disseminated, yet there has been a paucity of research on training of intervention agents and no published research on the fidelity of intervention component delivery or identifying the amount of literacy counseling (LC) delivered during an intervention. In this evaluation study, data was collected for four resident physicians after three phases of training, by direct observation during 45 well-child exams. Data was examined to (a) evaluate the fidelity of implementation of the intervention components; and (b) report the frequency of occurrence of literacy counseling delivery by 10-second intervals during well-child exams. Other measures included an evaluation of resident knowledge and attitudes pre-training and post-study, and parent report post-intervention. Results demonstrated that: (a) during 93% of well child-visits at least 1 ten-second interval of LC was delivered and books were distributed during 91% of visits, (b) the amount of literacy counseling delivered during a ROR intervention was small; a mean of 49 seconds per well-child visit, (c) resident knowledge and attitudes remained constant pre-training and post-intervention, (d) parents may not have been aware of receiving LC; 7% reported receiving LC, and (e) 85% of parents did recall receiving a book. Future ROR research needs to address fidelity of ROR implementation, amount of literacy counseling delivered, and identify a threshold amount of literacy counseling needed to influence parents to deliver home literacy activities.