Food insecurity in households with children remains a concerning problem. While trends had been decreasing in all households with children, the COVID-19 pandemic disrupted this decade-long declining trend, resulting in the first increase since 2011 (13.6% in 2019 vs. 14.8% in 2020).1 Further, food insecurity during the pandemic disproportionately impacted Black (13%) and Hispanic (12.2%) households with children as compared to White (4.2%) children, likely due to longstanding structural racism.2
The American Academy of Pediatrics (AAP) recommends screening all families at health supervision visits using the 2-question, validated Hunger Vital Sign tool,3 but has yet to recommend screening in other clinical settings. Food insecurity is often transitory, it negatively impacts health, and many families may not be accessing care regularly due to other social risk factors; therefore, screening families for food insecurity at all points of contact with the health care system may uncover an opportunity to intervene.4 How can subspecialty clinics, for example, go about screening and intervening on food insecurity?
This week in Pediatrics, we are early releasing a quality report, “Identifying Food Insecurity in Cardiology Clinic and Connecting Families to Resources” (10.1542/peds.2020-011718). Dr. Allison K. Black at the University of Louisville School of Medicine and her colleagues conducted a quality improvement project aimed at implementing food insecurity screening in cardiology clinic and connecting families that screen positive with resources. This article describes the process by which one cardiology clinic implemented a screening and social work referral for families who screen positive for food insecurity.
At the conclusion of the testing period, the authors screened 85% of families and found positive food insecurity screens averaged 6%; among children with severe congenital heart disease, the risk was significantly higher. Acceptance of screening among cardiologists, the balancing measure, was 100% among survey respondents, and 70% strongly agreed that screening was a benefit to all patients. The authors reported that adding screening questions to an automatic intake form increased screening rates. In-person meetings with a social worker and a resource sheet improved ability to offer families individualized resources. A follow-up phone call by social work and community partnerships reduced loss to follow up for those who screened positive.
Primary care clinics are increasingly screening and intervening on food insecurity as recommended by the AAP. However, if you work in a subspecialty practice and are not already screening and intervening on food insecurity, this study can provide ideas for how to get started.
- Economic Research Service. (2021, September). Key Statistics & Graphics. United States Department of Agriculture. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/key-statistics-graphics.aspx. Accessed April 14, 2022.
- Economic Research Service. (2021, September). Interactive Charts and Highlights. United States Department of Agriculture. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/interactive-charts-and-highlights. Accessed April 14, 2022.
- Council on Community Pediatrics, Committee on Nutrition. Promoting Food Security for All Children. Pediatrics. 2015;136(5):e1431-e1438.
- Ashbrook A, Essel K, Montez K, Bennett-Tejes D. Screen and Intervene: A Toolkit for Pediatricians to Address Food Insecurity. (2021, January). American Academy of Pediatrics/Food Research & Action Coalition. https://frac.org/wp-content/uploads/FRAC_AAP_Toolkit_2021.pdf. Accessed April 14, 2022.