Food insecurity screening and intervention strategies in pediatric primary care practices: A mixed methods study

OBJECTIVE: Pediatric clinics identify and address food insecurity (FI), but processes vary nationwide. State and federal policies increasingly require FI screening in healthcare settings and as a quality metric in payment models. A better understanding of existing practices and opportunities for efficient and effective clinical integration is needed. 

METHODS: A multiple-choice survey was first completed with 27 clinics nationwide. Semi-structured interviews informed by the Consolidated Framework for Implementation Research were then conducted with clinics (n=25) to explore current FI practices and understand how policies and payment models could support FI processes. Descriptive analysis was used for survey results. Rapid qualitative analysis was used to identify themes. 

RESULTS: Pediatric practices were predominately in the South (44%) and in urban (70%) locations. Most used the Hunger Vital Sign to screen (89%); interventions included resource list distribution (89%), referral to federal nutrition programs (78%) and/or community-based organizations (78%). Few practices coded (37%) or billed (7%) for FI. Three overarching themes were identified: (1) FI screening, intervention, and documentation processes varied across primary care clinics; (2) Multi-level barriers hindered efforts to address FI; and (3) Policy and payment reforms are needed to support the integration of FI screening and intervention in health systems and effectively assist families experiencing FI. 

CONCLUSIONS: While clinics have integrated FI screening and interventions, streamlined documentation and billing remains limited. As FI screening becomes increasingly incentivized, designing performance metrics that include healthcare provider input and address existing barriers should be a priority.