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MNAAP Newsletter

Food Insecurity Screening and Referrals

NeilBratneyNeil Bratney, MD, FAAP

Nearly 1 in 10 Minnesotans are food insecure; that’s a half-a-million Minnesotans who don’t always know where their next meal is coming from. While poverty is a common contributing factor, transportation and geographic factors may also affect families without cars or without a grocery store nearby. Many families are just above the threshold for qualifying for assistance programs and still cannot afford the nutritious food important for their families.

Screening for food insecurity can be easy, but may require small changes to your office workflow. Screening should be completed at every well child exam, and whenever concerns exist. Screening can be accomplished using a standard, validated, two-question screening tool, known as the 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.

A patient or caregiver can respond “Often true,” “Sometimes true,” “Never true,” or “Don’t know / Refused.” An “Often true” or “Sometimes true” response is considered a positive screen and should prompt advice and referral.

The screening may be administered as part of the routine rooming questions asked by your nurse or medical assistant, or it may be completed on a written questionnaire. We feel written screening allows parents to be more honest about their situation, and more discreet about their needs in front of their children.

Either screening method requires education and understanding from nursing staff about the importance of screening for food insecurity and the effects of hunger on children. We also have teenagers who come in alone for well child exams complete the questionnaire. You may chart, notate, or track the child’s food insecurity within your electronic medical record as you see appropriate.

Connecting children with community resources

After a family has been identified as food insecure, just like any other risk factor, the pediatrician must identify interventions to improve the child’s health. Many choices exist to assist families in need, and the process can be simple or more involved.

SNAP Rx: Experts at Hunger Solutions Minnesota are available to direct families statewide to local resources. When a family is identified as food insecure, after signing a release of information form, their basic information may be faxed to Hunger Solutions. Hunger Solutions will then reach out to the family and connect them with all of the food resources available to them, including SNAP, Fare for All, farmers markets,and discount grocery programs. Providers can also give Hunger Solutions’ Minnesota Food HelpLine number directly to families, although follow-up is less assured. Hunger Solutions will also assist a family in navigating a Bridge to Benefits screen (see below).

Bridge to Benefits: Families who are identified as food insecure may benefit from the Children’s Defense Fund’s (CDF) Bridge to Benefit (B2B) web app. Users can anonymously enter income data and be screened for various government assistance programs that they may not yet receive, and receive links to applications for programs for which they might qualify. Patients can be given B2B’s website, or patients may be assisted on completing the questionnaire by clinic staff before leaving. Clinics may set up their own accounts with B2B to track their own referrals, and CDF will provide free training to staff in using their application. Minnesota pediatricians may watch an archived webinar at the Chapter’s website about the Bridge to Benefits program and how it can be integrated into your clinic. Bridge to Benefits does not identify non-governmental local agencies that may help with access to food.

Work with community partners: Connect with local food shelves, religious leaders, tribal leaders, community development organizations and know what your neighborhood’s resources are. My clinic in rural central Minnesota has cooperated with local farmers and is providing a CSA share (Community Supported Agriculture) of fresh fruits and vegetables twice monthly to food insecure families.
Helping a family with food insecurity is an opportunity to help a child succeed. Connecting a family to resources that can help will help a child achieve their fullest potential.

2015 AAP policy statement “Promoting Food Security for All Children”:

Food Research Access Center’s Food Insecurity Toolkit for Pediatricians:

Hunger Solutions Minnesota:

Bridge to Benefits:

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