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MNAAP Newsletter

Searching for The Holy Grail: A Perfect Screen for Social Determinants of Health

DianaCuttsDiana Cutts, MD, FAAP, Hennepin County Medical Center; and Rich Sheward, deputy director of innovative partnerships at Children’s HealthWatch

Why screen for social determinants of health?
In the United States, we spend increasingly more money per capita on medical services compared to other industrialized nations, while we spend increasingly less on social services. Thus, despite medical advances and increased health care spending, underinvestment in addressing patients’ socioeconomic needs inhibits progress in achieving improvements in our nation’s health.

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Pediatricians’ Voices on Equity Needed Outside the Clinic

By Nate Chomilo, MD, Minnesota Doctors for Health Equity

Nate ChomiloHere’s a statistic that may be hard to hear: Only 10 to 20 percent of health outcomes are attributable to health care.

For all our education, training and expertise, there is only so much we as physicians can do if we choose to only work within our clinics or hospitals.

We can highlight the ongoing health disparities (health differences that arise from economic, social or environmental disadvantages) that are worse in Minnesota than almost every other state, but putting a spotlight on the problem alone is not a solution. These disparities also arise from implicit bias, explicit bias and the structural racism intrinsic to many parts of our society, our healthcare system being no different.

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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.

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Nurse-Family Partnership in Minnesota

By Stacy Walters, MD, Park Nicollet Pediatrics

Nurse-Family Partnership (NFP) is an evidence-based community health program with over 38 years of randomized, controlled trials demonstrating multi-generational outcomes for first-time mothers and their children living in poverty.

Positive Outcomes for Clients Served by Minnesota’s Nurse-Family Partnership

  • 93% of all children received all recommended immunizations by 24 months
  • 91% of babies were born full term and 90% were born at a healthy weight
  • 85% of mothers initiated breastfeeding
  • 49% of mothers who entered the program without a diploma/GED have since earned one, and another 27% are working toward one

Cummulative data as of Sept. 30, 2015. This data does not include outcomes from the Tribal communities.

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MN Clinics Screening for Food Insecurity

CookingMatters CookingMatters2

Above: Families participate in the Cooking Matters class at HCMC. (Photos courtesy of HCMC.)

Shortly after AAP released its policy statement titled “Promoting Food Security for All Children,” the Minnesota Academy of Pediatrics Foundation (MAPF) received a grant from the University of Minnesota to help pediatricians implement it and partner with SNAP (formerly called Food Stamps) educators.

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