Identifying and Addressing Childhood Food Insecurity in Healthcare and Community Settings

Chapter 1. Epidemiology and pathophysiology of food insecurity This chapter will define key terms of relevance to FI. For example, particular focus will be paid to terms that include food security, FI, and hunger. The chapter will then extend to describe the prevalence of FI over the last 5 years and the various sociodemographic and clinical factors associated with FI. Finally, the chapter will review the deleterious effects that FI can have on children and their families with respect to short- and long-term health outcomes. 1. Definitions a. Hunger b. Food insecurity 2. Epidemiology a. National versus local b. Risk factors for higher prevalence c. Risk factors for FI 3. Pathology a. Health effects from birth to adulthood i. Life course and population health outcomes Chapter 2. Training providers to screen and provide resources to address food insecurity A starting point in action focused on FI relates to identifying the problem as being a relevant piece of clinical care. Indeed, providers must recognize the importance of addressing FI in order to properly address it. This chapter will focus on ways in which FI can be identified, specifically via screening techniques in the clinical setting. The chapter will also explore educational initiatives that have focused on increasing screening rates as well as identification rates. Principles of adult learning theory will be used to discuss different methods to train providers. 1. Screening methods for FI a. Evidence-based screeners i. 1 versus 2 versus 6 item screen b. Types of screeners i. Paper, EHR, tablet-based c. Who should screen i. Provider, nurse, MA, staff 2. Training methods aimed at increasing FI screening and identification rates a. Adult learning principles b. Review of specific methods employed, including pros and cons of each i. Didactic ii. Video/movie iii. Shadowing iv. others Chapter 3. Scope of interventions to address food insecurity. The next chapter will move from screening to intervention. Specifically, this chapter will examine the different types of responses that can occur when a patient or family has identified FI. The chapter will begin with a discussion of a response at the individual- or family-level, how a clinical provider responds to a positive FI screen. The chapter will then highlight how the larger community or practice can address FI in a broader way that has different approaches and actions - system-wide changes in practice that can occur to more effectively assess, identify, and manage FI across the clinical population. Finally, the chapter will address how providers can affect change by developing and supporting FI-relevant policies in their region or nationally. 1. Response to the FI patient/family 2. Clinic-wide integration of FI-relevant interventions 3. FI-relevant advocacy to effect policies a. Linking data to policy Chapter 4. Developing and evaluating community partnerships. Efforts by providers to implement programs with partners in their own community are likely to have an impact for individual patients and for populations. This chapter will review the critical components necessary and sustain community partnerships to address food insecurity. Quality improvement (QI) methods will be presented that can be used by readers to take a deeper dive into their data and increase the impact of their efforts to screen and address FI. This chapter will be fortified by case studies of interventions developed and sustained using such methods. 1. Community partnerships - food as a connector a. Resources needed for partnerships b. Key stakeholders c. Funding and sustainability d. Assessing impact of intervention using QI methods 2. Case studies a. KIND b. Hopple Pantry c. Child HeLP and public benefits Chapter 5. Developing an Action Plan to Fight Food Insecurity. Each institution has strengths and weaknesses that must be understood in order to create an action plan to address FI at their institution. Critical steps to develop successful programs will be discussed and barriers will be presented in order for readers to develop an action plan of their own to address FI at their home institution. 1. Strength and weaknesses of institution 2. Key stakeholders 3. Critical components 4. Next steps