In Minnesota, one in 10 households struggle with food insecurity, lacking the means to buy enough food for all members of the household. For children in particular, going hungry can have lasting effects. Young people facing hunger are more likely to repeat a grade in elementary school, experience impairments in language or motor skills, and have social or behavioral problems.
Caitlin Caspi, Ph.D., part of the U’s family medicine and community health faculty, and Gretchen Cutler, Ph.D., a scientific investigator with the Children’s Minnesota Research Institute, believe we can and must do better. With Masonic support, they’ve found a new way to fight food insecurity. And it starts in the pediatric emergency department.
Finding food insecure families, a novel approach
In Minnesota, it is not uncommon for households to experience food insecurity. But sometimes it can be challenging to navigate and access services that help alleviate it. It can also be hard to identify households that could benefit from these services, since people can be reluctant to talk about food insecurity.
Through a Masons-funded study, called Project FEED, Caspi and Cutler are using a novel approach to find and help households whose members lack adequate nutrition.
Their study is screening families who visit the Minneapolis and St. Paul emergency departments of Children’s Minnesota for food insecurity and testing two different approaches for connecting them with community food resources.
“People are tackling food insecurity in adult clinics a little more every year,” says Caspi. “But our work is somewhat novel because it’s being done in pediatric and emergency department settings, and it’s using screening questions to capture food insecurity directly in the patient’s electronic medical record. It’s also being rigorously evaluated.”
Screen time, well spent
Caspi and Cutler have enrolled more than 200 food insecure families in their study. All participants have completed an 18-item questionnaire to gauge their level of food security before and after the study. And all have received a print handout with information about local food resources.
But Caspi and Cutler have been especially interested in—and surprised by—some of the results they are seeing.
“When we first started looking for food insecurity, we were surprised by how low the rate was for the families we screened,” says Caspi. “We thought we were going to see really high rates due to socioeconomic factors, but initially only four percent were identifying as food insecure, compared to the overall rate of 10 percent among Minnesota households.”
When Cutler and Caspi dug into this, their biggest takeaway was that screening method matters.
“When we first started the study, our nursing staff asked parents of emergency department patients in-person questions to identify families struggling with food insecurity,” says Cutler. “But it became pretty clear that this was not an easy thing for families to talk about, especially with children in the room, as there’s a stigma associated with it.”
So Cutler and Caspi changed course halfway through the study, switching to an iPad questionnaire rather than an in-person interview to screen for food insecurity. The results? Four times as many families—16 percent—identified as food insecure through iPad screening.
Texting to fight hunger
Another tactic that Caspi and Cutler are evaluating is the use of text messaging to connect families with food resources.
Working with a company called NowPow, which links people with community health resources, they sent multiple text messages at different points in the study to a subgroup of participants. The texts shared community food resources specific to the family’s neighborhood.
“Our texts included detailed information on food shelves, places you could go to sign up for food assistance programs, congregant dining settings, and more,” explains Caspi. “It’s all in a database and if you put your address in it will populate a map.”
“There were links to different food resources, and their phone numbers, websites, maps, hours they were open, languages spoken, whether they were free or at a cost—all that information was in the click,” adds Cutler. “It was a unique way to send people information.”
Shaping the field
Today, Caspi and Cutler are analyzing results from their study to see if there’s been a reduction in food insecurity among the 200-plus participants. They hope to have final numbers soon.
In the meantime, they’ve been connecting with health care providers and researchers locally and nationally who are interested in similar methods of addressing food insecurity.
Cutler will be sharing results with leaders at Children’s Minnesota as they work to implement screening for social determinants of health in multiple hospitals and clinics. She will also be connecting with national experts who are working to increase food insecurity screening in health care settings, while Caspi will be presenting their results at a national conference in Washington D.C.
“Lately, there’s been a lot of focus on screening for social determinants of health, including food insecurity, in clinical settings,” Cutler explains.
“The issue is that there’s not a lot of evidence on the right way to do it. That’s where I think our findings will be really useful and important. Ultimately, this is about helping emergency departments and clinics figure out the best way to screen and provide resources to patients.”
Bringing clinic and community together
In Minnesota, addressing food insecurity in the clinic is just one piece of the puzzle in the broader fight against hunger. The state is well ahead of the curve, say Caspi and Cutler, due in large part to local governments and grassroots organizations stepping up.
Many school districts across the state now offer free breakfast to students. And transforming the nutritional quality of foods offered at local food shelves has “caught fire,” says Caspi. “Local food shelves have taken it upon themselves to become welcoming places for people to access healthy foods.”
In the end, the intersection between clinic and community will play an important role in the fight against hunger. And that’s where Masonic support has been so valuable.
Funds from Minnesota Masonic Charities supported the Child Health Collaborative grant that is funding Caspi and Cutler’s study. The grant, offered by the U’s Clinical and Translational Science Institute, is reserved exclusively for research led jointly by the U’s Department of Pediatrics and Children’s Minnesota. It’s a unique—and much-needed—resource that moves research discoveries quickly and effectively to patients.
“As the momentum to address food insecurity grows, grants like this are tremendously helpful,” says Caspi. “We’re really excited about the intersection between the clinical work and the community resource work. These things are happening somewhat independently, but they only help each other as they grow stronger.”