Course Teaches How to Screen for Hunger

Jane Doe is in for her 3-year-old well visit. Her physical exam is unremarkable. She's growing at a healthy rate, appears to be meeting all the developmental milestones and is given a clean bill of health.

What Jane's pediatrician didn't pick up on during this routine visit is that Jane and her family are hungry, but not in the way people suffer in Third World countries. The hunger Jane's family experiences is perhaps driven by a recent job loss and is mostly felt at the end of the month, when the utilities and mortgage have been paid and what's left in the budget is spent on food that is cheaper and often not very nutritious.

Jane's family are among the estimated 50.2 million Americans who lack consistent access to enough nutritious food. And because Jane does not appear skinny or emaciated, her type of hunger – called food insecurity – often remains hidden.

But there is a solution. Hunger Free Vermont, a Burlington, VT-based non-profit, has developed a free, online tutorial that gives pediatricians and other clinicians the information and tools to screen, identify and help families whose young children are at risk of developing health problems caused by food insecurity.

Childhood Hunger in Vermont: The Hidden Impacts on Health, Development & Wellbeing is a one-hour accredited course for CME and CNE training that teaches:

• What factors put families at risk for food insecurity

• The consequences of food insecurity – malnutrition, behavioral and developmental issues, poor health

• The clinician's role in asking questions, screening, monitoring and making referrals

• What nutrition resources are available to children and families (tailored for Vermont clinicians)

More on the program will be presented at this year's PCC Users' Conference in Orlando, Fla.

“You're probably not walking down the street and seeing with your eyes that one in five kids is hungry,” Hunger Free Vermont's Sarah Weisman says, referring to Vermont's hunger statistics. “It's hidden. You can't tell by looking.”

Hunger issues cross all socio-economic lines, and it's the hidden and sensitive nature of food insecurity, in particular, that often makes it difficult for clinicians to broach the subject with parents. Before embarking on the project, Hunger Free Vermont surveyed a group of Vermont health care professionals on whether they discussed food insecurity with their patients. The results showed that while clinicians recognized the importance of the issue, they don't have the resources or the language to talk about it. The course was designed with this in mind and prepares health care professionals to ask the tough questions.

“This creates a neutral and compassionate way for physicians to be able to talk to patients without creating unnecessary tension in the doctor-patient relationship,” Weisman said.

Physicians who take the course will learn to look for clinical red flags that might otherwise be attributed to something else, such as being overweight/underweight, having dental decay, a delayed acceptance of foods/textures and anemia.

If food insecurity is within the family is suspected, the physician would then ask the parent if the following two statements apply to him or her:

“Within the last 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 did not last and we did not have money to get more.”

The statements, which are included as part of a larger federal survey on food insecurity, have been sanctioned by the American Academy of Pediatrics as appropriate to ask in a clinical setting. A positive answer to both statements has been determined to accurately identify most families affected by hunger.

Locally, the statements are already incorporated into intake forms for visits at the Community Health Center of Burlington and for emergency room visits at Fletcher Allen Health Care, Vermont's largest hospital. Weisman encourages practitioners who take the course to follow suit. “If the best they can do is put the questions on an intake form, that's better than not screening parents at all,” says Weisman.

So far, some 70 people have taken the course, said Weisman. Next fall, health care professionals who have completed the course will be interviewed to determine what outcomes the course may have had on their food-insecure patients.

Hunger Free Vermont's online tutorial has been endorsed by Deborah Frank, founder and director of Children's HealthWatch, and Dr. Lewis First, Chief of Pediatrics at Fletcher Allen Health Care, Vermont's largest hospital.

“Working through this tutorial will teach all health care providers about the seriousness of hunger issues here in Vermont, how to inquire tactfully about food insecurity in the families we care for, and then how to take the right steps to treating this critical problem that is far more prevalent than you might have suspected,” Dr. First says of the program.