OBJECTIVES:

Food insecurity (FI) affects many United States families and negatively impacts the health of children. We assessed patterns of FI screening for United States children’s hospitals, characterized screening protocols, and assessed how hospitals addressed general and inpatient-specific caregiver FI, including provision of food or meals for caregivers of admitted children.

METHODS:

We conducted a cross-sectional, confidential survey of clinical team members at United States children’s hospitals. We evaluated FI screening practices and responses, including which team members conduct FI screening, the types of screeners used, and interventions including social work consultations, referrals to community resources, and provision of food or meals.

RESULTS:

Of the 76 children’s hospital representatives (40% response rate) who participated in the survey, 67.1% reported at least some screening, and 34.2% performed universal screening for FI. Screening was conducted most frequently on the inpatient units (58.8%), with social workers (35.5%) and nurses (34.2%) administering screeners most frequently. Responses to positive screens included social work consultation (51.3%), referral to community resources (47.4%), and offering food or meals (43.4%). Eighty-four percent of hospitals provided food or meals to at least some caregivers for admitted pediatric patients. Conditional qualifications for food/meals included need-based (31.6%) and presence of breastfeeding mothers (30.3%).

CONCLUSIONS:

Many United States children’s hospitals screen for FI, but most survey respondents reported that their hospital did not conduct universal screening. Screening protocols and interventions varied among institutions. Children’s hospitals could consider improving screening protocols and interventions to ensure that needs are identified and addressed.

Before the coronavirus disease 2019 (COVID-19) pandemic, 6.5% (2.4 million households) of United States households with children experienced food insecurity (FI).1  Food insecurity is defined by the US Department of Agriculture as either1  low food security: reduced quality, variety, or desirability of food, or2  very low food security: disruption or reduced intake of food.2  During the beginning of the COVID-19 pandemic, reported FI among households with children increased to 7.6% (2.9 million households).3 

Compared to those who are food secure, children who face FI have increased risk of chronic diseases, hospitalizations, nutritional deficiencies, educational issues, and emotional and behavioral challenges.49  Mothers in food insecure homes are at increased risk of anxiety and depression.10  When a child is hospitalized, caregivers may experience multiple stressors that affect health. Not only can they experience exacerbated household FI, but they can also have isolated inpatient FI (no household FI at baseline) as a result of the admission.1112  Caregivers may face financial hardship from lost wages and costs associated with food, lodging, child care, and transportation.1317  Despite these known stressors, a 2004 study found that only 14% of US and Canadian children’s hospitals routinely administered food to all caregivers and that 39% provided food to select caregivers on the basis of criteria such as demonstrated financial need or the presence of a breastfeeding mother.18 

The American Academy of Pediatrics and other experts recommend that pediatric clinical teams screen for FI and link families to needed resources.4,1921  There are multiple screeners such as the Hunger Vital Sign, Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education Survey Instrument (WE CARE), and Safe Environment for Every Kid (SEEK) which include questions solely regarding access to food or as a part of a more comprehensive assessment of social needs.2225  There are also screening programs with integrated community referral processes such as CommunityRX and NowPow that help health care teams identify and address FI via personalized resources lists and/or navigation programs.2629 

To our knowledge, the proportion of United States children’s hospitals which screen for FI in the inpatient setting has not been determined. In this study, we examined the patterns of United States children’s hospitals that screened for FI, characterized screening protocols, and described interventions to address positive screens, including hospital practices to address isolated inpatient caregiver FI.

We used the Children’s Hospital Association directory to compile a database of 190 United States children’s hospitals, excluding specialty hospitals and institutions which exclusively provided newborn care.28  We determined hospital size (bed number) by first assessing the Children’s Hospital Association directory. In cases where the bed number was not listed in the directory, it was determined via an internet search. We characterized hospital region based on United States census data and determined county-specific poverty rates using the County Health Rankings and Roadmaps.3031 

The survey was developed and refined by our research team and piloted with content experts with knowledge in survey methodology, epidemiology, and health services research who provided feedback. From the expert feedback, we modified the survey to include mostly multiple-choice (rather than free text) questions and to include specific items regarding FI screening procedures such as type of screener, when or where it is administered, and assessments of the types or qualifications for food provisions provided (Supplemental Table 4).

Before the COVID-19 pandemic, in February 2020, we initially distributed the survey to 10 individuals from different children’s hospitals in the United States from multiple departments including social work, nutrition, patient relations, and nursing. We specifically spoke to these care team members, rather than physicians, nurse practitioners, and physician assistants, because of known inpatient clinical workflows. After the 10 surveys were administered, we found that social work team members demonstrated the most consistent expertise in answering survey questions and willingness to participate in the study. Additionally, other groups outside of social work would often defer to the social work team at their institution when asked to complete survey questions.

Because of the COVID-19 pandemic and clinical responsibilities, research activities were paused until February 2021. We then redistributed the survey, informed by the prepandemic responses, between February 2021 through July 2021 using the following workflow1 : We completed a Web site search for either a social work department phone number or the general phone number for the hospital.2  We then called and asked to connect with the inpatient social work department and to speak with either a social work manager or social worker. If neither was available, we left a message requesting a call-back. At least 2 attempts were made to reach each hospital.3  If we connected with someone from the social work department, we asked to speak with someone who had a global perspective of institutional FI screening and interventions such as a social work manager. If the social work team member shared that someone else at their institution could better answer questions regarding FI screening practices, we would attempt to connect with that individual even if they were from a different department.4  Once a person was identified and they agreed to participate in the study, respondents chose either E-mail or phone administration by member of the research team. E-mail respondents received 1 reminder E-mail if needed. We also redistributed the survey to the 10 institutions which completed survey before the survey modifications. There was no incentive for survey participation.

FIGURE 1

Survey assessing food provision and food insecurity screening for caregivers of admitted pediatric patients: workflow for connecting with a hospital contact and survey administration.

FIGURE 1

Survey assessing food provision and food insecurity screening for caregivers of admitted pediatric patients: workflow for connecting with a hospital contact and survey administration.

Close modal

After contacting all institutions, 40.0% (76 of 190) submitted at least 1 response and 9.2% (7 of 76) of those institutions submitted multiple responses (Fig 1). We consolidated multiple responses, and when there were discrepancies from the same institution, we included the affirmative responses (example: answered yes to screening for FI), recognizing that an individual may not always have a global perspective of protocols and services. Descriptive statistics were performed by using Stata 15 (StataCorp, College Station, Texas), and between-group differences were assessed by using χ2 test. This study was deemed exempt by the university institutional review board.

There was no significant difference in the hospital demographic characteristics for hospitals which had an individual complete the survey. Social work team members constituted the majority of participants in this study (79.0%). Most hospitals had between 100 to 300 staffed beds and were located in the Midwest or Southern regions of the United States. Most (68.4%) hospitals were located in a county with a child poverty rate between 10% to 20% (Table 1).

TABLE 1

Survey Assessing Food Provision and Food Insecurity Screening for Caregivers of Admitted Pediatric Patients: Hospital and Respondent Characteristics

Responding Hospitals
(N = 76)
Nonresponding Hospitals
(N = 114)
Pb
n(%)n(%)
Number of staffed beds     .41 
 < 100 13 (17.1) 27 (23.7)  
 101–200 35 (46.1) 44 (38.6)  
 201–300 13 (17.1) 21 (18.4)  
 >300 10 (13.2) (7.9)  
 Could not determine (6.6) 13 (11.4)  
Region     .17 
 Northeast 14 (18.4) 27 (22.8)  
 South 26 (34.2) 40 (35.1)  
 Midwest 27 (35.5) 24 (21.1)  
 West (10.5) 22 (19.3)  
 Pacific (1.3) (0.90)  
Child poverty rate by county, %    .17 
 <10 12 (15.8) 20 (17.5)  
 11–20 52 (68.4) 64 (56.1)  
 >20 12 (15.8) 30 (26.3)  
Participant department     — 
 Social work 60 (79.0) — —  
 Nursing (7.9) — —  
 Other 10 (13.2) — —  
Responding Hospitals
(N = 76)
Nonresponding Hospitals
(N = 114)
Pb
n(%)n(%)
Number of staffed beds     .41 
 < 100 13 (17.1) 27 (23.7)  
 101–200 35 (46.1) 44 (38.6)  
 201–300 13 (17.1) 21 (18.4)  
 >300 10 (13.2) (7.9)  
 Could not determine (6.6) 13 (11.4)  
Region     .17 
 Northeast 14 (18.4) 27 (22.8)  
 South 26 (34.2) 40 (35.1)  
 Midwest 27 (35.5) 24 (21.1)  
 West (10.5) 22 (19.3)  
 Pacific (1.3) (0.90)  
Child poverty rate by county, %    .17 
 <10 12 (15.8) 20 (17.5)  
 11–20 52 (68.4) 64 (56.1)  
 >20 12 (15.8) 30 (26.3)  
Participant department     — 
 Social work 60 (79.0) — —  
 Nursing (7.9) — —  
 Other 10 (13.2) — —  

—, not applicable. a Other included: nutrition and administration.

b

P values were calculated using χ2.

The majority (67.1%) of hospitals screened at least some individuals for FI. About one-third of institutions universally screened for FI on admission. The most frequently reported locations where FI screeners where administered included the inpatient unit (58.8%), multiple settings (33.3%), and the emergency department (13.7%). Individuals administering screeners included social workers (35.5%), nurses (34.2%), and physicians (4.0%). The most frequently reported method used to administer the screener was via oral interview (38.2%), followed by paper (10.5%), and electronic device (7.9%). Screener type included institution-specific (30.3%), “other” (15.8%), and the Hunger Vital Sign (2.6%). Interventions and responses to address identified FI included placing a social work consultation (51.3%), providing connections to community resources (47.4%), and/or offering food or meals (43.4%) (Table 2).

TABLE 2

Survey Assessing Food Provision and Food Insecurity Screening for Caregivers of Admitted Pediatric Patients: Screening Administration and Follow-up (N = 76)

n(%)
Screens for food insecuritya   
 Yes 51 (67.1) 
 No 20 (26.3) 
Screened personb   
 Everyone admitted to the hospital 26 (34.2) 
Conditional   
 Per medical team discretion 14 (18.4) 
 Unit-based 12 (15.8) 
Location of screeningc   
 Inpatient unit 30 (58.8) 
 In multiple settings 17 (33.3) 
 In the emergency department (13.7) 
 Other (13.7) 
Survey administrator or screenerd   
 Social worker 27 (35.5) 
 Nurse 26 (34.2) 
 Medical assistant or similar (11.8) 
 Physician (4.0) 
 Food services (4.0) 
Method of screener administratione   
 Oral interview 29 (38.2) 
 Electronic medical record 21 (27.6) 
 On paper (10.5) 
 On electronic device (7.9) 
 Food insecurity screener usedf   
Own institutional screener 23 (30.3) 
Other 12 (15.8) 
Not sure 10 (13.2) 
Hunger Vital Sign22  (2.6) 
Result of positive screeng   
 Social work consult placed 39 (51.3) 
 Community resources given 36 (47.4) 
 Food or meals offered 33 (43.4) 
 Food insecurity added to problem list 17 (22.8) 
n(%)
Screens for food insecuritya   
 Yes 51 (67.1) 
 No 20 (26.3) 
Screened personb   
 Everyone admitted to the hospital 26 (34.2) 
Conditional   
 Per medical team discretion 14 (18.4) 
 Unit-based 12 (15.8) 
Location of screeningc   
 Inpatient unit 30 (58.8) 
 In multiple settings 17 (33.3) 
 In the emergency department (13.7) 
 Other (13.7) 
Survey administrator or screenerd   
 Social worker 27 (35.5) 
 Nurse 26 (34.2) 
 Medical assistant or similar (11.8) 
 Physician (4.0) 
 Food services (4.0) 
Method of screener administratione   
 Oral interview 29 (38.2) 
 Electronic medical record 21 (27.6) 
 On paper (10.5) 
 On electronic device (7.9) 
 Food insecurity screener usedf   
Own institutional screener 23 (30.3) 
Other 12 (15.8) 
Not sure 10 (13.2) 
Hunger Vital Sign22  (2.6) 
Result of positive screeng   
 Social work consult placed 39 (51.3) 
 Community resources given 36 (47.4) 
 Food or meals offered 33 (43.4) 
 Food insecurity added to problem list 17 (22.8) 
a

Five had no response.

b

Eight had no response, participants could select >1 answer.

c

Six had no response, participants could select >1 answer.

d

Six had no response, participants could select >1 answer.

e

Nine had no response, participants could select >1 answer.

f

Six had no response, participants could select >1 answer.

g

Seven had no response, participants could select >1 answer.

Most respondents (84.2%) reported administering food/meals to some caregivers. Conditional qualifications for food or meals included need-based determination (31.6%) and presence of a breastfeeding mother (30.3%) (Table 3, Fig 2). Need-based was further defined by participant free-text responses and included food insecurity (25.0%), medical team assessment (18.4%), and being out of town (11.8%).

FIGURE 2

The types of conditional food provisions provided to the caregivers of admitted pediatric patients. a Each column represents a different hospital.

FIGURE 2

The types of conditional food provisions provided to the caregivers of admitted pediatric patients. a Each column represents a different hospital.

Close modal
TABLE 3

Survey Assessing Food Provision and Food Insecurity Screening for Caregivers of Admitted Pediatric Patients: Qualifications, Type of Food, and Funding Sources (N = 76)

n%
Provides free or subsidized food or meals   
 Yes 64 (84.2) 
 No 12 (15.8) 
Qualifications for mealsa   
 All caregivers 21 (27.6) 
Conditional   
 Need-based 24 (31.6) 
 Breastfeeding mothers 23 (30.3) 
 1 caregiver 19 (25.0) 
 COVID-19 positive patient (2.6) 
 2 caregivers (2.6) 
 Out of town (2.6) 
Definitions for need-basedb   
 Financial insecurity 19 (25.0) 
 Health care team assessment 14 (18.4) 
 Out of town (11.8) 
 Caregiver request or self-identified (6.6) 
 Uses Medicaid (4.0) 
 Other (4.0) 
 Lack of resources (2.6) 
 Food insecurity (2.6) 
Types of meals or food offeredc   
 Food voucher 30 (39.5) 
 Common area with snacks 28 (36.8) 
 3 meals per day 25 (32.9) 
 Food pantry 24 (31.6) 
 1 meal per day 14 (18.4) 
 Gift card or debit card 10 (13.2) 
 Ronald McDonald House meals (10.5) 
 Bagged meal (7.9) 
 Other (4.0) 
 2 meals per day (1.3) 
Funding for meals or foodd   
 Hospital funding 28 (36.8) 
 Hospital cafeteria or food services 27 (35.5) 
 Monetary donations 20 (26.3) 
 Community organization 14 (18.4) 
 Other (6.6) 
 State funding (5.3) 
n%
Provides free or subsidized food or meals   
 Yes 64 (84.2) 
 No 12 (15.8) 
Qualifications for mealsa   
 All caregivers 21 (27.6) 
Conditional   
 Need-based 24 (31.6) 
 Breastfeeding mothers 23 (30.3) 
 1 caregiver 19 (25.0) 
 COVID-19 positive patient (2.6) 
 2 caregivers (2.6) 
 Out of town (2.6) 
Definitions for need-basedb   
 Financial insecurity 19 (25.0) 
 Health care team assessment 14 (18.4) 
 Out of town (11.8) 
 Caregiver request or self-identified (6.6) 
 Uses Medicaid (4.0) 
 Other (4.0) 
 Lack of resources (2.6) 
 Food insecurity (2.6) 
Types of meals or food offeredc   
 Food voucher 30 (39.5) 
 Common area with snacks 28 (36.8) 
 3 meals per day 25 (32.9) 
 Food pantry 24 (31.6) 
 1 meal per day 14 (18.4) 
 Gift card or debit card 10 (13.2) 
 Ronald McDonald House meals (10.5) 
 Bagged meal (7.9) 
 Other (4.0) 
 2 meals per day (1.3) 
Funding for meals or foodd   
 Hospital funding 28 (36.8) 
 Hospital cafeteria or food services 27 (35.5) 
 Monetary donations 20 (26.3) 
 Community organization 14 (18.4) 
 Other (6.6) 
 State funding (5.3) 
a

Six had no response, participants could select >1 answer.

b

Twenty-six had no response.

c

Seven had no response, participants could select >1 answer.

d

Twelve had no response, participants could select >1 answer.

In this cross-sectional survey of representatives of United States children’s hospitals, we found that, although many hospitals screened for FI, the majority did not conduct universal screening. Screening practices and interventions for identified FI varied among institutions. Most hospitals provided some food or meals to the caregivers of admitted pediatric patients, but there were often conditional qualifications.

Although the majority of institutions performed some FI screening, universal screening was conducted at one-third of institutions. In hospitals that did not perform universal screening, conditional qualifications for screening included admission to certain units and/or medical team discretion. These results are consistent with the previous study of 4 large United States children’s hospitals, in which it was found that universal screening was less common than screening for FI when deemed clinically relevant.32  As one-fourth of recently hospitalized children experience household FI and around 40% of pediatric caregivers experienced inpatient FI, transitioning from a conditional to a universal screening approach may present an opportunity for practice change to address unmet needs.11,33 

We found that FI screening was conducted in multiple clinical settings, with the majority completed on inpatient units. Other studies have similarly found that screening for social stressors occurs in multiple clinical settings such as inpatient units, emergency departments, and primary care clinics.32,3436  Within these various clinical settings, we found that social workers and nurses accounted for the majority of individuals who administered screeners, whereas physicians made up a minority of screening. In 1 analysis of 4 large academic United States children’s hospitals, it was found that nurses were the most common providers to screen for social stressors, although hospitalists also conducted many of the screens.32  This variation in findings of physician-administration of screeners may be related to survey methodology (our respondents did not include physicians), the breadth of institutions included, and/or the type of screeners administered.

Respondents identified that an oral interview was the most common screening method used, whereas few reported administering screeners with paper or electronic devices. Most hospitals used their own institutional screener, with only a small proportion using the Hunger Vital Sign, a validated tool.37  Screened individuals have been found to be more likely to disclose health related social needs when using electronic tablets or written questionnaires, compared to oral interview.3840  Hospitals could consider refining screening practices by selecting validated, standardized screening tools and implementing evidence-based modalities of administration.

When there was a positive screen for FI, study participants shared that some hospitals provided caregivers with food or meals. Other hospitals provided food or meals to caregivers without specific FI screening but had conditional qualifications such as need-base and/or presence of a breastfeeding mother. These findings are similar to a 2007 study of United States and Canadian children’s hospitals that found that 39% of institutions provided some caregivers with food or meals and 14% provided provisions without conditional qualifications.18  These collective findings indicate that hospitals may meet the needs of some caregivers experiencing inpatient FI, but, because of conditional qualifications, others may be missed. Past research has shown that the caregivers of admitted pediatric patients may not only experience exacerbations of household FI, but also encounter isolated inpatient FI.1112  Our results present a potential opportunity for institutions to target food or meal provisions to those who are in need but may be missed currently, allowing caregivers to fully engage in their child’s care.

There were several limitations to this study. Most hospitals (91%) had 1 representative respondent who may not have had a complete knowledge of all screening protocols and interventions. Our study workflow did attempt to identify the key stakeholder with knowledge about food insecurity screening and interventions at each institution. Of note, the most frequent response provided to identified FI was “social work consult.” Social workers, who made up the majority of survey respondents, thus may represent a key stakeholder group to evaluate institutional screening and food provision practices. Respondents may have been affected by social desirability bias, although an online survey platform offered an opportunity for confidential responses that may have helped to mitigate bias. We had a 40% response rate; thus, the reported results may reflect a response bias with participants being more likely to respond if their institutions had practices for screening for FI and providing food. It is also possible that institutions with fewer resources, specifically without dedicated social workers, may have been more represented in the nonrespondents, and thus, we may be underrepresenting available services especially in areas with limited resources. We were not able to connect with an initial contact at 30% of hospitals; thus, our results may not represent all institutional practices. Although components of the survey were not validated, we field tested and refined the instrument with content and survey experts. Despite the discussed limitations, our results still highlight areas where many hospitals can make improvements to FI screening practices and interventions to identified needs.

In this survey of inpatient United States children’s hospital representative, we found that the majority of respondents reported at least some institutional inpatient screening for FI. A lack of universal screening may lead to missed opportunities to address needs. Institutions had variable screening practices and interventions to address both inpatient and household FI, and there are opportunities to improve screening protocols and interventions to ensure that families in need receive support, especially during and around hospital admission.

We thank Drs Eugene Shapiro, Magna Dias, Mona Sharifi, Adam Berkwitt, Melissa Langhan, and Marc Auerbach and for their feedback on our survey. We would like to thank Drs Kristin Reese and Nishant Pandya for help with data collection. We would like to thank Denine Baxter MHA, BSN, RN, CNML and Drs Jaspreet Loyal and Magna Dias for working to improve food provisions for families admitted to our children’s hospital. Finally, we would like to thank the parents and caregivers who inspired this work.

COMPANION PAPER: A companion to this article can be found online at https://doi/10.1542/hpeds.2022-006871.

Drs Markowitz, Rosenberg, and Tiyyagura conceptualized and designed the study, designed the data collection instruments, coordinated and supervised data collection, collected data, carried out analyses, drafted the initial manuscript, and reviewed and revised the manuscript; Dr Quallen collected data and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

1
Coleman-Jensen
A
,
Rabbitt
MP
,
Gregory
CA
,
Sing
A
.
Household food security in the United States in 2019
.
Available at
: https://www.ers.usda.gov/publications/pub-details/?pubid=99281.
Accessed November 13, 2021
2
Economic Research Service, US Department of Agriculture. Definitions of food security
. Available at: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security.aspx. Accessed November 13, 2021
3
Coleman-Jensen
A
,
Rabbitt
MP
,
Gregory
CA
,
Singh
A
.
Economic Research Service UsS
. Available at: Available at: https://www.ers.usda.gov/webdocs/publications/102076/err-298_summary.pdf?v=5234.3. Accessed January 28, 2022
4
Council on Community Pediatrics
;
Committee on Nutrition
.
Promoting food security for all children
.
Pediatrics
.
2015
;
136
(
5
):
e1431
8
5
Cook
JT
,
Black
M
,
Chilton
M
, et al
Are food insecurity’s health impacts underestimated in the U.S. population? Marginal food security also predicts adverse health outcomes in young U.S. children and mothers
.
Adv Nutr
.
2013
;
4
(
1
):
51
61
6
Kirkpatrick
SI
,
McIntyre
L
,
Potestio
ML
.
Child hunger and long-term adverse consequences for health
.
Arch Pediatr Adolesc Med
.
2010
;
164
(
8
):
754
762
7
Skalicky
A
,
Meyers
AF
,
Adams
WG
,
Yang
Z
,
Cook
JT
,
Frank
DA
.
Child food insecurity and iron deficiency anemia in low-income infants and toddlers in the United States
.
Matern Child Health J
.
2006
;
10
(
2
):
177
185
8
Jyoti
DF
,
Frongillo
EA
,
Jones
SJ
.
Food insecurity affects school children’s academic performance, weight gain, and social skills
.
J Nutr
.
2005
;
135
(
12
):
2831
2839
9
Melchior
M
,
Chastang
J-F
,
Falissard
B
, et al
Food insecurity and children’s mental health: a prospective birth cohort study
.
PLoS One
.
2012
;
7
(
12
):
e52615
10
Whitaker
RC
,
Phillips
SM
,
Orzol
SM
.
Food insecurity and the risks of depression and anxiety in mothers and behavior problems in their preschool-aged children
.
Pediatrics
.
2006
;
118
(
3
):
e859
e868
11
Lee
AM
,
Lopez
MA
,
Haq
H
, et al
Inpatient food insecurity in caregivers of hospitalized pediatric patients: A mixed methods study
.
Acad Pediatr
.
2021
;
21
(
8
):
1404
1413
12
Makelarski
JA
,
Thorngren
D
,
Lindau
ST
.
Feed first, ask questions later: alleviating and understanding caregiver food insecurity in an urban children’s hospital
.
Am J Public Health
.
2015
;
105
(
8
):
e98
e104
13
Vessey
JA
,
DiFazio
RL
,
Strout
TD
,
Snyder
BD
.
Impact of non-medical out-of-pocket expenses on families of children with cerebral palsy following orthopaedic surgery
.
J Pediatr Nurs
.
2017
;
37
:
101
107
14
Shields
L
,
Tanner
A
.
Costs of meals and parking for parents of hospitalised children in Australia
.
Paediatr Nurs
.
2004
;
16
(
6
):
14
18
15
Callery
P
.
Paying to participate: financial, social and personal costs to parents of involvement in their children’s care in hospital
.
J Adv Nurs
.
1997
;
25
(
4
):
746
752
16
Mumford
V
,
Baysari
MT
,
Kalinin
D
, et al
Measuring the financial and productivity burden of paediatric hospitalisation on the wider family network
.
J Paediatr Child Health
.
2018
;
54
(
9
):
987
996
17
Chang
LV
,
Shah
AN
,
Hoefgen
ER
, et al
;
H2O Study Group
.
Lost earnings and nonmedical expenses of pediatric hospitalizations
.
Pediatrics
.
2018
;
142
(
3
):
e20180195
18
Stremler
R
,
Wong
L
,
Parshuram
C
.
Practices and provisions for parents sleeping overnight with a hospitalized child
. Available at: https://academic.oup.com/jpepsy/article/33/3/292/902703. Published September 28, 2007. Accessed February 12, 2021
19
Ashbrook
A
,
Essel
K
,
Montez
K
,
Bennett-Tejes
D
.
Screen and intervene: a toolkit for pediatricians to address food insecurity
. Available at: https://frac.org/aaptoolkit. Published March 2021. Accessed January 2021
20
Garg
A
,
Boynton-Jarrett
R
,
Dworkin
PH
.
Avoiding the unintended consequences of screening for social determinants of health
.
JAMA
.
2016
;
316
(
8
):
813
814
21
Finkelhor
D
.
Screening for adverse childhood experiences (ACEs): Cautions and suggestions
.
Child Abuse Negl
.
2018
;
85
:
174
179
22
Hager
ER
,
Quigg
AM
,
Black
MM
, et al
Development and validity of a 2-item screen to identify families at risk for food insecurity
.
Pediatrics
.
2010
;
126
(
1
):
e26
e32
23
Garg
A
,
Butz
AM
,
Dworkin
PH
,
Lewis
RA
,
Thompson
RE
,
Serwint
JR
.
Improving the management of family psychosocial problems at low-income children’s well-child care visits: the WE CARE Project
.
Pediatrics
.
2007
;
120
(
3
):
547
558
24
Dubowitz
H
,
Feigelman
S
,
Lane
W
,
Kim
J
.
Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) Model
.
Pediatrics
.
2009
;
123
(
3
):
858
864
25
Sokol
R
,
Austin
A
,
Chandler
C
, et al
Screening children for social determinants of health: A systematic review
.
Pediatrics
.
2019
;
144
(
4
):
e20191622
26
Lindau
ST
,
Makelarski
JA
,
Abramsohn
EM
, et al
CommunityRx: A real-world controlled clinical trial of a scalable, low-intensity community resource referral intervention
.
Am J Public Health
.
2019
;
109
(
4
):
600
606
27
Berry
C
,
Paul
M
,
Massar
R
,
Marcello
RK
,
Krauskopf
M
.
Social needs screening and referral program at a large US public hospital system, 2017
.
Am J Public Health
.
2020
;
110
(
S2
):
S211
S214
28
Gottlieb
LM
,
Hessler
D
,
Long
D
, et al
Effects of social needs screening and in-person service navigation on Child health
.
JAMA Pediatr
.
2016
;
170
(
11
):
e162521
29
The Children’s Hospital Association
. Available at: https://www.childrenshospitals.org. Accessed November 15, 2021
30
United States Census Bureau
.
Census regions and divisions of the United States
. Available at: https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf. Accessed November 13, 2021
32
Schwartz
B
,
Herrmann
LE
,
Librizzi
J
, et al
Screening for social determinants of health in hospitalized children
.
Hosp Pediatr
.
2020
;
10
(
1
):
29
36
33
Banach
LP
.
Hospitalization: Are we missing an opportunity to identify food insecurity in children?
Acad Pediatr
.
2016
;
16
(
5
):
438
445
34
Fraze
TK
,
Brewster
AL
,
Lewis
VA
,
Beidler
LB
,
Murray
GF
,
Colla
CH
.
Prevalence of screening for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence by US physician practices and hospitals
.
JAMA Netw Open
.
2019
;
2
(
9
):
e1911514
35
Gonzalez
JV
,
Hartford
EA
,
Moore
J
,
Brown
JC
.
Food insecurity in a pediatric emergency department and the feasibility of Universal screening
.
West J Emerg Med
.
2021
;
22
(
6
):
1295
1300
36
Meyer
D
,
Lerner
E
,
Phillips
A
,
Zumwalt
K
.
Universal screening of social determinants of health at a large US academic medical center, 2018
.
Am J Public Health
.
2020
;
110
(
S2
):
S219
S221
37
Makelarski
JA
,
Abramsohn
E
,
Benjamin
JH
,
Du
S
,
Lindau
ST
.
Diagnostic accuracy of two food insecurity screeners recommended for use in health care settings
.
Am J Public Health
.
2017
;
107
(
11
):
1812
1817
38
Palakshappa
D
,
Goodpasture
M
,
Albertini
L
,
Brown
CL
,
Montez
K
,
Skelton
JA
.
Written versus verbal food insecurity screening in one primary care clinic
.
Acad Pediatr
.
2020
;
20
(
2
):
203
207
39
Knowles
M
,
Khan
S
,
Palakshappa
D
, et al
Successes, challenges, and considerations for integrating referral into food insecurity screening in pediatric settings
.
J Health Care Poor Underserved
.
2018
;
29
(
1
):
181
191
40
Cullen
D
,
Woodford
A
,
Fein
J
.
Food for thought: A randomized trial of food insecurity screening in the emergency department
.
Acad Pediatr
.
2019
;
19
(
6
):
646
651

Competing Interests

CONFLICT OF INTEREST DISLOSURES: The authors have no conflicts of interest relevant to this article to disclose.

Supplementary data