Food Insecurity Screening: SNAP-Ed Learning Collaboritive AAP Hot Topics, May 12, 2017 Rachel Téllez, MD MS FAAP Park Nicollet Health Services

Goals Review experiences and lessons learned from clinics involved in SNAP-Ed Learning Collaborative Assist additional clinics in preparing to screen for food insecurity Provide options for collaborating with SNAP-Ed and other community resources

AAP Policy Statement on Food Insecurity AAP Council on Community Pediatrics, Committee on Nutrition: “Promoting Food Security for All Children” December 2015. 2013: 21% of all children were in a food insecure household Food insecurity goes beyond poverty: 60% of all food-insecure households had incomes below 185% of the federal poverty thresholds 30% of all food-insecure household are above the poverty threshold Are there Minnesota numbers?

Screening Questions for Food Insecurity “Hunger Vital Sign” Within the past 12 months, we worried whether our food would run out before we got money to buy more Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more Answering affirmatively (“often true” or “sometimes true” versus “never true”) to both questions increases the likelihood that the family is food insecure The two screening questions have a sensitivity of 97% and a specificity of 83% 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). Available at: http://pediatrics.aappublications.org/content/early/2015/10/20/peds.2015-3301 Check on AAP Policy Statement for wording: Diana pointed out that the study was based on “affirmative” answers as noted in this slide but AAP turned into yes or no? “A sensitivity of 97% indicates that only 3% of families who experienced FI were likely to be misclassified”

Grantees Park Nicollet Clinic – St. Louis Park Team lead: Melanie Lind-Ayres, MD Creekside Clinic – St. Louis Park, Methodist Hospital Family Medicine Residency/Park Nicollet Team lead: Alice Macdonald, MBChB, Judy Boylan, MD, Ashley Estrem, MD Partners in Pediatrics – Brooklyn Park and Maple Grove Team Lead: Rebecca Doege, MD Hennepin County Medical Center – Minneapolis Team lead: Diana Cutts, MD

Grantee Approaches to Screening Park Nicollet- St. Louis Park Screening process: paper; physician asking screening questions changed to support staff handing out the screening questions Frequency: all well visits Rate of food insecurity: 3-4% Collaboration/resources developed: Cooking Matters class with SNAP-Ed Developed a food resource manual for patients

Partners in Pediatrics-Maple Grove Screening process: Added to existing paper well child questionnaire already in use Frequency: all well visits Rate of food insecurity: 1% Collaboration/resources developed: Cooking Matters class with SNAP-Ed Identified additional community resources for food and other needs of those screening positive

Creekside Clinic Park Nicollet/Family Practice Screening process: paper at front desk check in Increased positive responses when more “anonymous” at front desk versus with clinician Frequency: all sick/well children and adults at high-yield times: summer and holiday season Rate of food insecurity: 13-14% Collaboration/resources developed: Cooking Matters class with SNAP-Ed video for families explaining food insecurity began using Matterboxes at the clinic for emergency groceries

Hennepin County Medical Center Screening process: Embedded screening questions into well visit template, asked by clinicians Frequency: all well visits Rate of food insecurity: 30% Collaboration/resources developed: 2 Cooking Matters classes in Spanish with SNAP-Ed Electronic referral to Cooking Class and Second Harvest who contacted families to screen Food shelf on site

Lessons learned More than one way to implement screening. Integrating into established workflow may be easier Staff administered vs. patient administered screening can lead to different results Role of the person administering questionnaire may influence results Consider use of support staff versus clinician to improve accuracy of responses and referral rates Physicians are willing to participate but need to have something “to do” if screen is positive Be prepared with resources that may be needed for families screening positive that may go beyond food-related needs

SNAP-Ed https://snaped.fns.usda.gov/ https://snaped.fns.usda.gov/state-snap-ed-contacts/minnesota https://snaped.fns.usda.gov/materials/cooking-matters-national

Questions? rachel.tellez@parknicollet.com