Delaware pediatricians now screen for hunger

Delaware pediatric health care practices believe the answer to ending food insecurity in Delaware is asking the right questions.

Along with general inquiries about vaccines and other medical issues designed to pick up areas of medial concern, many family doctors and pediatricians now screen for a far simpler, more direct question: Do you have enough to eat?

“Studies have shown that children that grow up with food insecurities have worse long-term outcomes,” said Dr. Justin P. Eldridge, a pediatrician and internist with Christiana Care Health System.

Kids without enough food don’t grow as well, their brains don’t develop as well and they don’t do as well in school or life. All that leads to stress, anxiety and even depression for children and adults. And yet, many families are unaware of the sources for help with food or they may be reluctant to seek or take that help.

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“Most people don’t know where a food pantry is,” said Hiran J. Ratnayake, a Christiana Care Health System spokesman.  “Some don’t think they qualify for food assistance."

“Food Insecure” is a term that the U.S. Department of Agriculture uses to describe families who go without food or consume a limited amount of food over a period of time because of low income or other factors.

The Delaware doctors are following the lead of the American Academy of Pediatrics, which in October 2015 recommended that all children be screened for food insecurity with primary practices asking families to answer specific questions to determine if they have access to adequate food and nutrition:

• 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.

Patients who answer “often true” or “sometimes true,” to one or both, test positive for food insecurity.

For Christiana patients, that means connecting the families with social workers who help by steering families to food banks and pantries, as well as applying for help with state and federal programs to feed women and children, including school lunch and breakfast programs. At Beebe Hospital, the Delaware Food Bank has partnered with Delaware Pediatrics and Beebe Medical Center in Lewes for a produce “prescription” program for families with food insecurity as well as a small food pantry at Beebe itself.

The programs are part of health care company efforts to reach into the community to try to help people adopt healthier lifestyles, stop illnesses or catch illnesses and make them more manageable and less of an impact on a patient's quality of life and everybody's wallet. Some of that is a result of demands by insurance companies and government agencies for more accountability and better outcomes for the health care dollars they oversee, but also a result of health providers wrestling with the exploding costs of health care and shrinking payments.

No matter the economic status and other social circumstances in their life, the purpose of the screening and food assistance is to ensure families are in the best health possible, says Bettina Tweardy Riveros, Christiana’s chief health equity officer. Health equity is a commitment to understanding and addressing disparities in health while working to achieve health equality for all, she says.

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Those disparities affect length and quality of life, the rate of disease, disabilities and death, Riveros says.

“Being proactive is part of the solution,” says Linda Brittingham, director of social work at Christiana Care added, “Being proactive is part of the solution.”

The need to make food available is larger than many may realize.

The pediatrics academy says about one in six children in the United States live in a food-insecure household, which means about 16 million U.S. children are struggling with hunger. A 2016 USDA household food security report estimated 12.7 percent of U.S. households are food insecure at certain times during the year. Five percent of households were considered very low food security.

In Delaware, food insecurity remains prevalent within the city of Wilmington because of the number of low-income households, said Jill Fredel, a Delaware Department of Health and Social Services spokeswoman.

Why, when there are so many resources?

Some federal nutrition programs – such as the supplemental nutrition assistance program (SNAP) and special supplement nutrition program for women, infants and children (WIC) – are pivotal in the fight against food hunger, says Christiana’s Ratnayake. Yet they go unused by many patients prior to their entry into the Wilmington Hospital’s food program, he says.

The stigma of food banks makes the topic a tough subject to talk about with patients, Eldridge said.

“People may not know that we care about them and can connect them to resources,” he said. “I think the other reason is that for many people asking for help is difficult.”

Sandra Tineo, a social worker at Christiana Care, is tasked with helping patients open up about food issues once they test positive for food insecurities. In some instances, the patients are guarded, suffocating from self-imposed shame and fearing consequences for answering truthfully.

That makes building trust with families paramount, Tineo believes, through asking the right questions to help alleviate the stress of not having enough food.

“The hope is that if patients know someone is offering help, there’s some trust there,” Tineo says. “If we can get that out of their head and help them understand we’re not here to judge them, I think that means we’ve accomplished a great deal.”

Kim Turner, spokeswoman for Food Bank of Delaware, sees the stigma against seeking help from a food bank, but she’s encouraged by the organization’s increased partnership with state healthcare facilities in the state.

In May 2016, the Food Bank partnered with Delaware Pediatrics to create a  “prescription” program that allows families who are identified as 'food insecure" to have access to fresh fruit and vegetables at Beebe Medical Center in Lewes.

“It’s similar to Christiana Care,” Turner said of the hospital’s referral process. “While patients are visiting with their physician, the doctor has a questionnaire that he or she uses to see if people might be at risk for food insecurity.”

If families are found to be food insecure, doctors write a “prescription” that would enable the family to visit a Food Bank of Delaware mobile food pantry when the van comes to the pediatric clinic once a month and receive 20 to 25 pounds of fresh produce, she said.

In addition, patients leaving the hospital are asked questions similar to what the AAP recommends. If they answer yes, staff right then will offer emergency food supplies kept on hand as well as food bank resources for the future.

To date, Beebe Healthcare’s program has helped about 30 people, says Catherine Murphy, Beebe’s community health outreach coordinator.

“The big push that Beebe is trying to do is we want everybody to be healthy,” Murphy said.

Eldridge agrees. As a physician, he shares the responsibility for the mental, physical and emotional development of adolescents. During each wellness visit, a food security screening will become routine, he said.

Assessment starts with families who have children who are as young as six months old.

“Some families may get offended with us asking, but we make this the standard because we want to make sure (families) are doing well,” Eldridge said. “It’s become generally well received.”

Contact Alonzo Small at (302) 324-2856 or asmall@delawareonline.com. Follow him on Twitter @P_AlonzoSmall.