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Identifying Food Insecurity, Even in Pennsylvania's Wealthiest County

By Diana L. Walker and Lisa M. Huffman

Chester County is the wealthiest county among all 67 counties in Pennsylvania. The median household yearly income is more than $85,000. It has also been ranked the #1 healthiest county in the state, boasts highly rated schools, solid corporations, thriving small businesses, and desirable neighborhoods. And yet, more than 25,000 county residents received over $3 million in SNAP (food stamp) benefits because they do not have enough money to consistently put food – let alone healthy food – on the table each night.

In Chester County, 11,000+ children, 3,500+ seniors and 3,400+ disabled adults (age 18-59) are considered food insecure. Food insecurity, according to the U.S. Department of Agriculture, is "a household-level economic and social condition of limited or uncertain access to adequate food."

Awareness about the high percentage of food insecurity in Chester County has only recently appeared on Chester County Hospital’s radar as its Community Health and Wellness Services department completed the 2016 Community Health Needs Assessment.

The hospital learned that while 7.1 percent of individuals live in poverty county-wide, there are a half-dozen municipalities that experience poverty rates in excess of 15 percent.

“It was eye-opening,” said Julie Funk, MS, RD, CDE, LDN, director of Community Health and Wellness Services. “Our educators are out in the community working with people and organizations to talk about improving their lifestyle habits all year long. Having consistent access to healthy food is the first building block for a healthy life. But, food insecurity appears to be a silent issue for many people.”

Earlier this year, the Chester County Food Bank – a community health partner – reached out to Funk to talk about opportunities to address the hunger issue. The hospital has a long history with the Food Bank having organized many employee food drives over the years. Through community drives, the Food Bank distributed more than 2.5 million pounds of food to residents with limited or uncertain access to adequate food last year. It is aligned with about 40 food cupboards throughout Chester County.

This is also about the time that a Master of Public Health graduate student from West Chester University, Laura DelGuercio, joined Funk’s team as an intern. Eager to learn and create a solution, DelGuercio researched ways the hospital could assist with this county-wide concern.

As DelGuercio explored how other communities identified and reduced the percentage of hunger, she came across a food insecurity questionnaire that yielded positive results, and created a similar screening tool for Chester County Hospital.

The screening tool asked patients to rate how much they related to the following simple, yet pointed statements:

1. “We worried whether our food would run out before we got money to buy more.”

2. “The food we bought just didn’t last, and we didn’t have enough money to get more.”

3. “The Food Bank can call me.”

Funk and DelGuercio approached the Clinical Manager of the Ob/Gyn Clinic, Deb Mellon, CRNP, to talk about piloting this questionnaire with her patients. They felt the Clinic was a natural partner to test this screening tool, as it provides free or reduced-cost obstetric and gynecological health care services to the medically underserved women and Medicaid population –the same population affected most by food insecurity, according to nationwide studies.

“We are the only hospital-based prenatal clinic in Chester County. Last year alone, we provided care to 922 women and delivered 462 babies, which represents about 17 percent of all the babies born at the hospital,” Mellon said. “Knowing our moms-to-be as well as we do, we felt that identifying any food concerns could help ease their stress and create a healthier home situation so they could feed their growing families.”

To prepare, the Clinic staff attended a workshop so they were educated on the process. After training, they asked the three key questions to patients prior to their appointments, and shared a list of local food cupboards for the patients to take home.

Over the course of 28 business days this spring, the Clinic screened 201 patients. Of these women, 97 (48.3 percent) were identified as food insecure and 122 (60.77 percent) granted permission for the Food Bank to call them. DelGuercio's effort uncovered that an even higher amount of food assistance was needed than the Food Bank and Community Health department initially realized.

"What I found most surprising was that more than half of these individuals were looking for assistance, but didn't know where to go," she reflected. The hospital then shared the data with the Chester County Food Bank, who then contacted the women who requested a call to provide information on how to receive food assistance.

DelGuercio demonstrated that awareness of a patient’s food status and concerns can serve as a method for physicians and other allied health professionals to provide appropriate interventions, such as referrals to food sources.

“We care about our patients inside and outside the hospital,” Mellon said, adding, ”we want to do whatever we can to connect them to the services their families need so they have reliable access to healthy food.”

As a result of the Food Insecurity study, the Chester County Food Bank now pre-packages emergency food kits for the Ob/Gyn Clinic to have instantly available for their patients who acknowledge that they worry when their families will eat next. The boxes are nutritious and geared toward prenatal women.

There are discussions currently underway to expand the screening tool hospital-wide. Prior to the end of her internship, DelGuercio and Funk met with Case Management and Nutrition Services to discuss implementing the screening throughout the hospital. With more than 13,000 inpatients, 460,000 outpatients and 45,000 emergency patients receiving care annually, the opportunity to ask questions about food access is plentiful.

Michael McGarrigle, director of Case Management, explained, “Broadening the use of the Food Insecurity screening tool is something that my department and Nutrition Services are exploring for use with all hospital patients as part of their routine care. We want to identify any barriers to food access and increase the referrals to community resources.”

Helping patients – our community – gain access to adequate nutritious food will improve their overall health, which is what everyone at the hospital is working toward. Asking our neighbors if they have access to enough food to feed their family and then connecting them to the right resources is the most obvious first step.

Editor’s Note: Laura DelGuercio, MPH, successfully completed her Master’s in Public Health with a concentration on Community Health at West Chester University in May 2017. Her Capstone Project was titled “Implementation of a Food Insecurity Screening Tool in the Hospital Clinic.”

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