Hunger Hurts

05/04/2017
Pictured (Left to Right): Lisa Brukilacchio, Director of CHA’s Somerville Community Health Agenda, Amy Smith, MD, MPH, and Nawang Tsomo, Medical Assistant.
By: Amy Smith, MD, MPH

For my daughter’s fourth birthday we decided to celebrate her growing capacity to be of service to others by organizing a food drive with her summer camp friends instead of receiving gifts. I made arrangements to drop off several bags of generously donated fresh and canned food to a local food pantry, but when we arrived it was closed. I searched on my smartphone and ended up driving around for 30 minutes to various locations until I found a place that was still open and could accept the bags of food. It made me think about how a family experiencing food insecurity would find resources without a car, a phone, with multiple children on rainy, hot, or snowy days. It made me think of my patients, and the complex systems they potentially have to navigate in their efforts to feed their children. 

Food insecurity impacts 21 percent of children nationwide, almost 18 million households according to the Academy of Pediatrics. I decided to apply to the Kraft Practitioner Program, a two-year program that supports community health practitioners to take on leadership roles within their organizations. I was accepted into the 2015-2017 program and am using the support they provide to implement a food insecurity screening at Cambridge Health Alliance, a major health provider for underserved populations.

Children are especially hard hit by hunger.  They are more likely to be homeless, have low birth weights, higher chronic illness and have more stressful life events compared to children who are not hungry. In fact, hunger is a significant predictor of chronic illness but it’s often invisible.  

Every child touches a healthcare clinic at some point in their lives, and the recommendation is that each child at a minimum has annual well child exams. There are a rich array of wonderful organizations in the region that work hard to address food insecurity; are my patients being connected to them? Are we as healthcare providers routinely screening for food insecurity? And once we do, how will we keep up with the list of available resources? What if a resource on my list has closed and a patient has to run around like I did above? I started researching evidence-based methods to identify families and discovered that the USDA has an 18-item method, far too time-consuming for the 20 minutes usually allotted to a primary care visit. I soon discovered the Hunger Vital Signs screening tool, Hager et al’s two questions derived from the USDA questions, that are proven to be 97% sensitive and 83% specific for identifying families at risk.  

It wasn’t enough to identify which of our patients is food insecure – I wanted to make sure they got connected to available resources.  And it had to be a workflow that would be easily built into the clinical visit and allow us to collaborate with community organizations with expertise in addressing food insecurity. 

Cambridge Health Alliance’s long-standing commitment to the community health improvement offered me the internal framework for the next step to set up the screening and referral system. I contacted Lisa Brukilacchio, Director of CHA’s Somerville Community Health Agenda, who helped initiate a meeting with Boston’s Project Bread to set up a referral system, and connected me with other partners such as Greater Boston Food Bank’s public health initiative.  “Such connections illustrate our community health efforts,” said Lisa. “It’s not just about providing healthcare, it’s about the whole person and the many factors that impact health.”

It’s a simple process that was implemented first at the CHA Broadway Care Center.  Nawang Tsomo, CHA Medical Assistant, helps patients answer these questions. “I love doing this because it’s really helping families who are struggling to put food on the table,” explained Nawang. “Because most people have never been asked these questions before, I have to explain what we’re doing and how the program works.  Once they understand, they always fill out the forms.” 

Patients are asked to answer the two questions during their intake and if screened positive, are asked if they would like to be connected to hunger relief services. They complete a second questionnaire that allows them to be contacted by Project Bread, which enrolls those who are eligible in appropriate food support programs like SNAP (Supplemental Nutrition Assistance Program) and gives them information on resources in their location and neighborhoods.

So far, the referral outcomes are higher than national averages. It varies by month, but between 21 and 24 percent of the families seen in December and January screened positive. The pilot program is running at the CHA Broadway Care Center and it expanded to the CHA Revere Care Center in early April.

The health center referral is completed with a follow-up call to the family from Project Bread.  Project Bread provides an over-the-phone eligibility screening for SNAP, assists with enrollment into the program and ensures people know about additional food resources in the community. "We have had great success in connecting food-insecure families with critically needed food resources through the Hunger Prevention Partnership with CHA,” said Noreen Kelly, Director of Programs at Project Bread. “Since the partnerships began we successfully reached 177 patient households and assisted 37 households to access the SNAP program.  We expect this help will result in nearly $100,000 in SNAP benefits over the course of the coming year and will enable these families to purchase fresh produce they otherwise weren't able to afford on their strained food budget."  

Together we can ensure families and children at risk for hunger will get the food they need to stay healthy.
Cambridge Health Alliance

Contributed By: Cambridge Health Alliance

Cambridge Health Alliance is an academic community health care system committed to serving all members of our communities. We have expertise in primary care, mental health and substance abuse, and caring for diverse and complex populations. CHA patients receive high quality care in convenient neighborhood locations, and have seamless access to advanced care through CHA’s affiliation with Beth Israel Deaconess Medical Center. With over 140,000 patients in Cambridge, Somerville Everett and Boston’s Metro North, CHA is working hard to offer the integrated services its communities need now, and in the future.