Referral and resource utilization among food insecure families identified in a pediatric medical setting

Objective: Despite increased routine screening for food insecurity (FI) in pediatric medical settings, the uptake of offered food resources after FI identification is not well understood. We aimed to 1) describe utilization of referral and supplemental resources and 2) identify characteristics associated with utilization. Methods: We linked hospital screening and Electronic Medical Record data to Hunger Free Colorado (HFC) referral data for patients 0-18 years that were screened in the Emergency Department (ED), inpatient, or outpatient setting from January 2017 to December 2018. Among FI families, we compared patient demographic and clinical variables based on acceptance of HFC referral and connection to a food resource using Pearson's chi-square, Wilcoxon rank sum, and Poisson regression. Results: Of 1,952 patients with FI, 371 (19%) accepted a referral to HFC and of these 228 (61%) were connected to a food resource. In adjusted analyses, families screened in the ED (aRR 1.96, CI: 1.57-2.44) and inpatient (aRR 1.74, CI: 1.20-2.53) settings more often pursued referral to HFC than those screened in Child Health Clinic, while those screened in Special Care Clinic less often pursued referral (aRR 0.24, CI: 0.14-0.41). Families with 3 or more people in the home were more likely to be connected to resources (aRR 2.67, CI: 1.42-5.04). Conclusions: Only a small proportion of families with FI identified in a medical setting are ultimately connected to food resources. Higher rates of HFC referral among ED and inpatient families suggest that increased screening efforts in these settings may be warranted.