Addressing Food Insecurity at the Doctor’s Office

cambridge health allianceFrom left to right: Amy Smith, founder of the program; Nawang Tsomo, medical assistant; and Lisa Brukilacchio, director of CHA’s Somerville Community Health Agenda. Photo by Jess Benjamin.

A revolutionary new collaboration between the Cambridge Health Alliance and Project Bread could help ensure that families are fed.

Strolling through the aisles at Whole Foods or watching an ever-growing number of restaurants pop up throughout the city, it can be easy to forget (or ignore) how many people for whom hunger is still a very real concern. In 2015, the most recent year for which there’s data, the United States Department of Agriculture Economic Research Service reported that 42.2 million people lived in food-insecure homes, meaning that their households were “uncertain of having, or unable to acquire, enough food to meet the needs of all their members because they had insufficient money or other resources for food.” That year, 6.4 million children lived in food insecure households nationwide. The same study found that households with children are more likely to be food insecure than those without. And yet, only an estimated 28 percent of food insecure families used food pantries in 2015.

That could be because the barriers to access aren’t just of a financial nature—something Cambridge resident Amy Smith saw firsthand when she decided to do something a little different for her daughter’s birthday. Smith, who has two young children, wants them to develop a sense of service to the community, so she decided to organize a food drive. Rather than bringing the latest have-to-have-it Hasbro toy, birthday gifts from her daughter’s friends were fruits and veggies.

Smith called around to a bunch of pantries and scheduled the donation delivery, but when she got there, the office was closed. She ended up driving around for another 30 minutes to find a place that would accept the food, trying to keep it from going bad.

“It made me think, ‘Wow, imagine a family with multiple kids, in the snow or the rain, trekking around looking for an open pantry,’” she says. “How do people who have the most need find out about these resources—and is there something that we’re doing to help?”

By “we,” Smith—a Cambridge Health Alliance physician—is referring to her fellow doctors and clinicians. The experience got her considering the needs of her own patients, many of whom could use those resources.

The food insecurity issue can be largely invisible, but the myriad problems it leads to are not. Food insecurity is a cause of anxiety and stress, and it hits kids particularly hard. It’s been linked to chronic illnesses and lack of academic achievement.

“It’s also a social justice issue,” Smith adds. “In this country—and in this area, where there is so much wealth—there should not be families who worry that they’re not going to have enough money to provide food for their families. It’s unjust.”

Smith wanted to do something about it. Unlike a seemingly insurmountable, systemic problem like housing, this was something where she could potentially move the needle—small-scale, high-impact. Coming at it as a clinician rather than from a public health perspective, she considered what existing medical infrastructure could help—what could be fixed in one clinic visit to be as effective as possible? “All kids touch a health clinic at some point,” she explains. She envisioned those centers taking a proactive approach to addressing childhood hunger, acting as a node that could connect at-risk populations with programs that met their need.

Instituting some kind of screening process made sense—asking the questions that identify food insecurity, then linking patients with a specialist who could help. Smith likens it to referring those who have heart problems to a cardiologist; hunger is a similarly foundational health need. So from there, she started to identify groups that were already working successfully to address the issue.

Dozens of conversations later, Lisa Brukilacchio, director of the CHA’s Somerville Community Health Agenda, introduced Smith to Noreen Kelly at Project Bread. Her Boston-based organization did accept referrals, but only 11 percent of them came from health centers. Project Bread’s hotline can connect callers with food pantries and other programs, but Smith understands that low figure: “I hand a lot of papers to my patient at the end of a visit—to go to a lab for a referral, for this, for that— and someone who’s overwhelmed, who has kids … there’s so much going on, chances are they’re not going to call to a hotline number.”

Smith wanted to take it one step further, getting a specialist to reach out to patients rather than the other way around. She took her cues from QuitWorks, a program that finds smokers filling out referral forms during doctor visits if they want to be contacted with resources on kicking a tobacco habit. From there, QuitWorks will send patches, set up phone calls and support them in efforts to stop smoking moving forward.

The pilot program launched in the pediatric clinic of the CHA Broadway Care Center in Somerville, where the results have been eye-opening, to say the least. At Broadway, Smith reports that about 24 percent of the families they’ve screened are positive for food insecurity, a figure much higher than the national average. And the numbers are even more staggering at the CHA Revere Family Health Center, where, in a collaboration with the Greater Boston Food Bank, the results were 50 percent positive. At least one doctor who had been with the Somerville clinic for decades said he never knew that a family of five he’d been caring for experienced food insecurity until he asked.

“I think being able to ask that question in a clinical setting, where already you’re talking about a lot of things that are really personal, I think people may be more comfortable discussing it,” Smith affirms.
The program is still in its early stages, a skeleton around which the CHA will build more robust, in-clinic services after the referral process is systemized. After launching the pilot screenings on Broadway and in Revere, clinicians are in conversations to introduce them in Union Square, Porter Square and Malden. Brukilacchio is applying for grants to have dry goods and frozen meals available right in clinics, too, so that those who are positive for food insecurity can get some assistance even before they walk out the door. Eventually, Smith would like to build the program or something like it into the electronic medical records system at CHA.

“Clearly, there’s a great need,” she says. “And I think this idea of really collaborating with our public health partners and developing workflows within a clinical system to address these needs is really important.”

This story originally appeared in the September/October issue of Scout Cambridge, which is available for free at more than 200 locations throughout the city or by subscription.

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