Salient Quotes for Themes That Emerged From Interviews With Food Insecurity Screening Partnering Agencies
| Theme/Quote |
|---|
| Screening process |
| I think the two questions are a great tool to open discussion and to stimulate the thought with the parents, and to kind of de-mystify or destigmatize the idea of food insecurity, because a lot of our parents, you know, obviously don’t want to admit being food insecure, but when you bring it up in the form of a question, it gives validity to the issue, and lack of judgment, so I think it’s a perfect way to kind of set the table. (Agency 3, Participant 1) We were identifying all the determinants especially for food, and then we never knew what was happening. That’s when we realized we really needed to connect someone here with us, track it, follow up, see did they get food recourses, did they go, was that helpful to them—that’s how we discovered some of the food banks weren’t so helpful, others were too far. We’re looking to see what else we could do. (Agency 5) |
| Workforce |
| A [nutritionist or social worker] can be self-sustained through the billing process because they no longer have to see the provider for this…and the service would be a billable service. The clinic has such high needs for all kinds of things, but [food access and insecurity counseling] is not a billable service, so it is not sustainable. (Agency 1, Participant 1) There hasn’t been a whole lot of training. The staff that are actually involved in the food insecurity screening right now…haven’t done much training. It was more, “This is what we’re doing now. This is what we need you to do. Here are the questions.” And we gave them the information on food insecurity and really briefly sort of talked about why it’s important. (Agency 4) |
| Population-level barriers |
| I remember this one patient told me that, right now they’re gonna start getting housing, and once they get housing, they’ll be able to focus more on the food. (Agency 2, Participant 1) We’ll give the resource, we’ll give the people, we’ll do this, and then families are coming back and saying it’s not enough or they weren’t able to access, they forgot to call, or they lost the paper. (Agency 3, Participant 2)” |
| Organizational barriers |
| Taking patients from the PEDS clinic to the medical office, I don’t encourage that at all because not every patient will receive the same-day service. Because sometimes health education staff are busy in the classroom or clinic doing their presentation. What I will recommend is that the clinic staff keep a log of all of them, pass it to the social worker, and they make appointments or follow-up calls to them to make sure that they receive services that they need. (Agency 4) I think what’s needed now is the actual follow-through part, making sure we have enough social workers and staff in our family support programs and case management built up to be able to handle when those screens are positive. That’s the real crux of the sustainability. (Agency 3, Participant 2) |
| System-level barriers |
| Focus groups around CalFresh [SNAP] enrollment actually got a little ugly, because [patients] had poor experiences unfortunately. Our team had to contact a few attorneys just to figure out, okay, what is the language, what does this mean? Because some of the information is a little confusing to participants or there’s a lot of different information out there. (Agency 2, Participant 3) |
| Facilitators |
| The mission and the heart of the people that are running the program. And I would say that’s pretty much core to everything that we do. Everything we do is very mission driven for us. I think that part is probably the number one factor that has aided us in the success. It’s that willingness to do it because you recognize it’s important, you see it in the data, and you see your population suffering, and it’s the right thing to do. (Agency 3, Participant 2) |
| We had a presentation showing why we do this work and why it’s important to screen patients for food insecurity, and we’ve shared stories from our patients in the community and how we’ve helped them out. I think them hearing this coming from our own patients has really motivated them to see the big picture. Really, the support from the clinic administrators who are there with their staff and have really pushed them to be empathetic and make sure we’re screening the patients. A lot of staff and providers didn’t know what food insecurity was. Having a patient come in and share their story really impacted our staff and made them want to work with us. (Agency 2, Participant 3) |
| Impact |
| It’s an entirely different way of approaching primary care. It’s about a whole new model of forming relationships, really getting to know what’s going on in the lives of your patients and what are the true barriers to their health, and forming that pyramid of needs, and addressing them in the order of the highest priority. I’m not saying we’re there by the way, that sounds wonderful, it’s a vision. […] I don’t think that screening for food insecurity in isolation is how we’ve been successful. It’s the entire approach we’ve taken, and food insecurity is one domain in 7 or 8 that we look at for our patients. (Agency 5) We have families that have come in and thank us for caring and asking those questions because there’s embarrassment, there’s pride, and parents will not think first to come to a healthcare institution to report things like, “I’m hungry.” And it’s been a really neat thing that, for me, at least as a provider and a pediatrician, that families will come to me and talk to me about things that people may not ordinarily put in the healthcare bucket. And it’s a neat place that people are recognizing that it very much can be in the healthcare bucket because it very much impacts your health, your growth, and everything. So, that’s been, I think, a very big win for us. (Agency 3, Participant 2) |
| Sustainability |
| I think we’re constantly working on it and trying to see what points in the workflow need to be improved. So, I think sort of trying to figure out how to implement this, has been a really good example of how our departments can work together. And even though [another county agency] was in the building, we never really worked with them or knew what they do, or they didn’t know what we did, we didn’t know how they worked, they didn’t know how we worked. And, so, I think that sort of collaboration is helpful both for this and potentially for more projects in the future. (Agency 4) |