1. Facilitators to Successful Implementation
 Straightforward & efficient EMR screen
 Privacy of self-administered paper screen
 Clear communication & thorough explanations
 Nonjudgmental attitudes reduce stigma
Moving Forward
 More private screening methods
 Further assistance for caregivers with limited English
proficiency and/or literacy
 Provide more community-based resources
 Offer caregiver networking opportunities
 Emphasize support, not family deficits
 Ensure buy-in from all clinic staff
 The lack of access to enough food for an
active and healthy life1
 Associated with poor child health, increased
pediatric hospitalizations & risk for
developmental delay2,3
 19.9% of U.S. households with children under
age 6 were food insecure in 20141
Importance of Food Insecurity
Screening and Referral
 Pediatricians ideally positioned to identify &
refer food insecure families
 Positive screen for food insecurity: indicator for
other financial hardships & poor child health
Validated Two-Item Food Insecurity
Screener
 High sensitivity & high specificity4
 Recommended by American Academy of
Pediatrics to be used in all pediatric clinics5
 Two-item screener being used at Children’s
Hospital of Philadelphia (CHOP)
 Two screeners: paper form & from within
Electronic Medical Record (EMR)
 Screening in both English & Spanish
Positive Screen for Food Insecurity
 Refer food insecure families to resources &
benefits enrollment assistance at time of visit
and/or refer families to partnering organizations
Resource Referral at CHOP
 Offered referral to Benefits Data Trust (BDT),
known as “BenePhilly” in Philadelphia
 Connected by BDT to public benefits, community
resources, & financial counseling depending on
eligibility
 Offered financial counseling through Clarifi
Evaluation Methods
Selected Evaluation ThemesScreening and
Referral Process
Role of Pediatric Clinics
Please see references handout for complete list of references.
Food Insecurity
1. Within the past 12 months, we worried
whether our food would run out before we
got money to buy more. (Often true,
sometimes true, never true).
2. Within the past 12 months, the food we
bought just didn’t last and we didn’t have
money to get more. (Often true, sometimes
true, never true).
Evaluation Objective
To qualitatively evaluate the efficacy
of a food insecurity screening and
resource referral implemented in
three CHOP pediatric clinics
through focus groups and
key informant interviews.
“We are the people that’s taking care of the kids.
And we need just as much help as these babies
do. And I’ll be honest, we need nurturing.
We still need [the doctor’s] advice.”
- Mother reporting food insecurity
Clinic Food Insecurity Screening
Referral to Resources
Community Resources Recommended by Caregivers
Thank you to Children’s Hospital of Philadelphia, Benefits Data
Trust, Clarifi, & participants for your support with this evaluation.
Conclusions
Recommendations
Food
Assistance
Emergency food
banks, food
pantries
Non-food
Assistance
Child care,
counseling,
transportation,
housing, utilities
Resources for
Children
Free activities,
clothing/shoes,
diapers, uniforms
Employment &
Education
Living-wage
employment,
education
opportunities
References
Evaluation of a Pediatric Clinic-Based Food Insecurity Screening and Referral Program
Brittany Koch,1 Molly Knowles, MPH,2 Mariana Chilton, PhD, MPH2
1Drexel School of Public Health, 2Center for Hunger-Free Communities
Acknowledgements
CHOP
Food
Insecurity
Screening
EMR
Screen
Paper
Screen
Promoting Food and Financial Security
CHOP
Outreach
Staff
BenePhilly
Eligibility
screening
Community
Resources
Public
Benefits
Clarifi
Practice Level
 Consider context of setting & communities
being served during program development
 Emphasize private screening methods
 Increase provider & staff education
 Ensure communication is clear & culturally
relevant
 Provide immediate, updated resources list
 Emphasize follow-up with families
Policy Level
 Require routine food insecurity screening at all
pediatric clinics in U.S.
 Pediatricians should advocate for prioritization
of public policy concerning child food
insecurity/poverty
 The Surgeon General should issue a call to
action on food insecurity in U.S.
 Strengthen federal nutrition assistance
programs & increase program benefits
Successes
Caregivers Providers
1. Clear screening questions/multiple screen methods 1. Ease of EMR
2. CHOP & BenePhilly staff helpful 2. Scripting for staff
3. Interest in financial counseling 3. Self-administered paper screening
4. BenePhilly helps parents avoid county assistance offices 4. Trust of clinic staff
Challenges
Caregivers Providers
1. Stigma, shame & disrespect 1. Administrative burden of screening
Caregivers and Providers
1. Families already enrolled in/not eligible for public benefits
2. Lack of community resources from CHOP & BenePhilly
3. Privacy & confidentiality concerns
Recommendations
Caregivers Providers
1. Destigmatize screening questions 1. Continue EMR screening
2. Multiple forms of outreach 2. Provide screening on tablets
3. Improve communication & staff education 3. Improve communication
4. Social support groups 4. Improve follow-up with families
Caregivers and Providers
1. Provide more community resources at time of visit & through outreach organization
Impacts
Caregivers Providers
1. Minimal financial impacts 1. Few reported impacts on families
2. No reported health impacts 2. Increased attention to food
insecurity among patients
“[BenePhilly staff are] very courteous and they respect you as a human being when
you talk to them. Even though you are not seeing them, you can see the smile through
the phone.” – Mother reporting food insecurity
“It was a slight difference [with receiving SNAP benefits] as opposed to trying to do it
just off of working alone…Now the last week is the hardest…It would have been, like,
two or three weeks where it was hard without [benefits].”
– Mother reporting food insecurity
“Benefits don’t make it possible for people to get by. And it’s just the situation. The
world we live in, the society we live in. Where is the actual food that families can get
their hands on? That’s the most valuable information for me.” – Social Worker
 3 focus groups with total of 18 caregivers who
participated in CHOP screening
 11 key informant interviews with CHOP staff
members involved in screening & referral
 Audio-recorded, transcribed, & entered into
qualitative research software ATLAS.ti
 Used ATLAS.ti to identify & organize themes
 Categorized themes into success, challenges,
impacts, & recommendations from provider &
caregiver perspectives
Background
Data Analysis
Participating Caregivers (N=18)
and Providers (N=11)
Caregivers CHOP Staff Members
Data Collection
“I was skeptical of the program…You can be topnotch mother of the year, but you made
one error and they quickly snatch your child. Y’all want to make it better for us? But
y’all not making it better for us because when we tell you that we need help, they’re all
taking our kids and making it a stressor.”
– Mother reporting food insecurity