P3.D072: On Paper or In-Person: Optimizing screening for food insecurity

Background: Food insecurity impacts children and families across the country. The U.S. Department of Agriculture defines food insecurity as an economic and social condition of limited or uncertain access to adequate food and reports 7.3 million children lived in food-insecure households. In Texas, 4,057,910 people are struggling with hunger - and of them 1,348,600 are children. Food insecurity is associated with poor health status, developmental risk, mental health problems and poor educational outcomes. We aimed to optimize screening for food insecurity by a) reporting to the PCP (in-person) or b) privately (on paper.)

Project Description: Universal screening was implemented during Well Child exams using the Hunger Vital Signs™ to identify families who were food insecure. Families were randomly assigned to complete this screen in-person vs on paper. The children ranged in ages from 2 weeks to 18 years. Families with a positive screen were given information on Federal Nutrition Programs including Special Supplemental Nutrition Program (SNAP), Women, Infants and Children (WIC), child care meals, school meals, and were also connected with social workers available in clinic to assist with local food resources. Posters were displayed in both English and Spanish in clinic with information on food resources.

Discussion: Of the total families screened (N = 108), responses were obtained via paper forms (N = 60) and or in-person by the PCP (N = 48). Responses on paper screening disclosed a 31% positive food insecurity rate. In this population, Hispanic families were more likely to report food insecurity (44%) vs Caucasian families (22%), African American families (22%) or non-Hispanic families (11%.) (Chart 1) In-person results showed only 16% reported food insecurity. In this cohort, Hispanic families were also more likely to report food insecurity (36%) vs Caucasian (20%), African American families (28%) and non-Hispanic families (16%). (Chart 1)

Conclusion: Food insecurity is a critical health issue and can affect any family. Significantly more families reported food insecurity when queried on paper. Screening can be delivered in several ways; however, the ability to give answers in a private manner appears to improve affirmative responses. This may allow families to respond without disclosing sensitive information in front of their children. Families may feel stigmatized asking for assistance. By screening all patients in private, information about food programs can be readily delivered. We will continue to offer private screening via paper during our intake process. Food insecurity poses serious threats to children potentially impacting healthy growth and development and should be addressed routinely with families.