Clinicians and Parents’ Perspectives of Screening for Food Insecurity in Suburban Pediatric Practices

by Deepak Palakshappa, MD, MSHP Assistant Professor, Wake Forest School of Medicine

Because of the detrimental effects of food insecurity on individuals’ health, many national medical organizations are recommending that all healthcare providers screen and address food insecurity in order to improve patient care and population health. Increasingly, clinics and hospitals are testing strategies to identify food insecure patients and connect them to resources. Most of these clinics, though, have been located in urban communities, and little is known about how to implement food insecurity screening in other health care settings.

Over the last decade, poverty and hunger have significantly increased in suburban communities. Also, more than half of pediatricians in the U.S. practice in suburban communities, which provides an opportunity to help families who may otherwise struggle with food insecurity in silence. We therefore conducted a study to evaluate the feasibility, acceptability and impact of screening for food insecurity in suburban pediatric practices.

What did we do: We implemented a 2-item food insecurity screener (the Hunger Vital SignTM) in 6 pediatric practices located in the suburbs of Philadelphia. Screeners were built into the electronic medical record and clinicians (doctors, nurses, and nurse practitioners) were prompted to ask parents whose children were coming in for a routine visit. Families who were identified as being food insecure were eligible to be referred to our community partner, who helped families apply for SNAP. We also did interviews with the parents who were identified as food insecure, and focus groups with the clinicians to understand their perspectives about screening and how to improve the process.

What did we find: In 9 months, over 4,000 families were screened for household food insecurity, and we identified 122 families who were food insecure. Clinicians felt the screening was quick and easy to do, and that it showed families that the practice cared about the broader social issues affecting families. Parents reported being initially surprised by the screening questions, but ultimately felt comfortable talking to their trusted pediatrician about the lack of food in the home. Parents even discussed how talking to their clinician helped alleviate some of the feelings of shame and helplessness that accompanies food insecurity. Clinicians and parents agreed that having better connections to local food resources were needed to assist food insecure families in the suburbs, as many families were ineligible for SNAP and were unaware of local food resources.

What we can take away: We learned that integrating food insecurity screening into suburban pediatric practices was both a feasible and an effective way to identify families who were struggling with having enough food at home. Parents ultimately feel comfortable discussing unmet food needs with their pediatricians, and talking to their pediatrician helped alleviate some of the shame that accompanies food insecurity. What both clinicians and parents in suburban practices wanted and needed were better connections to local food resources, either through off-site referrals to community organizations or resources provided at the visit, to help address families unmet food needs.

Additional Resources:
Health Care Provider Training
Screening and Interventions for Food Insecurity in Health Care Settings

Deepak Palakshappa is an Assistant Professor at Wake Forest School of Medicine. His research focuses on improving the health outcomes of low-income and vulnerable populations. Deepak completed his internship and residency at Massachusetts General Hospital after receiving his MD from the University of Alabama School of Medicine and a BS in biology and psychology from Birmingham-Southern College. He received a Master’s of Science in Health Policy Research from the University of Pennsylvania.