Food insecurity as a pediatric health concern

Date
2019
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University of Delaware
Abstract
Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to implement food insecurity (FI) screening and community resource referral during non-acute pediatric emergency room visits. Background and Review of Literature: FI is defined as inadequate access to nutritious food due to financial or other constraints. In 2016, over 15 million American children lived in food insecure households. Pediatric FI sequelae include neurocognitive, developmental and physical impairments. Effective FI screening and referral protocols may promote earlier identification and enrollment with services. Systematic literature review of FI screening in Cochrane, Medline, PubMed, and Scopus databases produced 1,775 peer-reviewed articles published since 2013. Of these, 28 studies met inclusion criteria of English language and pediatric ambulatory environments. Methods: A FI screening protocol was established in a pediatric tertiary hospital emergency department. A two-item validated tool was integrated into the electronic health record (EHR) and staff performed screening of clinically stable children and families. A diagnosis of FI was added to the EHR to promote monitoring across health disciplines and social work consulted for urgent unmet needs. An English and Spanish regional food resource brochure was distributed. Eighty families were contacted retrospectively 30 days post discharge to ascertain perceptions of the screening process and to determine their connection rate to food services. Results: Over eight weeks, ED staff conducted 6151 FI screens, of which 117 were positive (1.9%). Telephone follow-up was completed with 80 families. Of these, 96.25 % had accessed one FI resource, 72.7% had accessed two or more services. Conclusions: Professional staff in a pediatric ED successfully developed and deployed a FI screening measure during an eight-week trial. Follow-up of those screened positive showed that they used the resources provided. Limitations included face to face social determinant screening methodologies, and truncated time period allocated for project. Still, the protocol holds promise for providing early intervention for FI, enabling children and their families to restore nutritional health. Insufficient literature existed to determine the ideal methods of successfully connecting patients to services. ☐ Keywords: Combinations with Boolean operators ’food’, ‘security’, insecurity’, ‘intervention’, ‘hunger’, ‘screening’, ‘pediatric’, ‘children’, ‘adolescent’, ambulatory
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