Q&A: Assessing food insecurity

Q: What are the best tools for case management to use to assess food insecurity?

A: Food insecurity is among the easiest SDoH to address although among the toughest to assess. It can be difficult to know when clients are hungry, unless they tell us. For my case management colleagues who work in hospitals, this becomes an especially challenging mission. Dealing with clients who are ill and facing physical or behavioral health challenges is not synonymous with their having an appetite. It is also a daunting effort for any professional to deal with clients only by phone. Case managers may struggle with knowing the best way to ask a client suitable questions about their diet or food intake. Does the question come across in a biased fashion that embarrasses the client or family? Will the client even respond honestly? How do we know that clients aren’t simply telling us what they think we want to hear versus the truth? Because everything in life is relative, it stands to reason that clients may not even realize they are hungry. Perhaps your client is so used to budgeting dollars that eating less is the norm. As a result, the thought of eating three or even two real meals each day is from another time long ago and far away, if at all.

A team of clinicians completed a nationwide study of more than 30,000 caregivers of children from seven urban medical centers. Twenty-three percent of the respondents were found to be food-insecure. The research group identified how children younger than age three who lived in food-insecure homes had (Hager et al., 2010):

• 90% greater adjusted odds of being in fair/poor health versus good/excellent
• 31% greater adjusted odds of being hospitalized since birth
• 76% greater adjusted odds of being at increased developmental risk compared with food-secure families

In response, two questions were developed that could get to the root of whether clients were food-insecure: the Hunger Vital SignsTM. The questions remain among of the most widely used tools for the industry to assess household food insecurity.

For more information see The Social Determinants of Health: Case Management's Next Frontier.