Needs Assessment

            Food insecurity is defined by the U.S. Department of Agriculture [USDA] as a "lack of consistent access to enough food for an active, healthy life" (Feeding America, n.d.-b). This term is often used to describe situations where individuals or families feel stress or anxiety over where their next meal will come from or how they will manage to feed every member of a family. This issue has been present for many years and continues to worsen despite the efforts of governmental programs and charitable organizations such as food pantries or soup kitchens. In fact, Feeding America reports that in 2016, 1 in 8 Americans or 42 million Americans in total, dealt with some degree of food insecurity (Feeding America, n.d.-b). More specifically, the rate of food insecurity in South Carolina is 15.3% of the population, which equates to 746,810 people total (Feeding America, 2018). Locally in Richland County, the food insecurity rate is 17.7% of the county's population, which accounts for 70,420 people (Feeding America, 2018). Not only does food insecurity have a wide impact on the national and local populations, it also impacts a wide array of demographic groups. In terms of age, the majority of clients seeking help at Feeding America food banks are between the age of 18-59 years old, although children under 17 and adults over 60 also account for a nearly half of this population (Weinfield et al., 2014). The majority of clients served nationally by Feeding America programs identify as white (43%), while black (26%) and Latino (20%) groups make up the rest of the client base (Weinfield et al., 2014). These demographics are slightly different at the local food bank, Harvest Hope, since 64.9% of its clients identify as black or African American and 28.5% identify as white (Mills et al., 2014). There is also a large difference in the amount of people who identify as Hispanic since this group only composes 3.8% of the clients served by Harvest Hope (Mills et al., 2014). Although poverty and food insecurity is often associated with unemployment, more than half (54%) of the households served at food banks were employed in the past year (Weinfield et al., 2014). Despite this fact, the majority (72%) of these individuals and families live at or below the federal poverty line, while the average monthly income for all households is $927 and the average annual income is a mere $9,175 (Weinfield et al., 2014).

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            Considering the intense level of poverty that many people who are often food insecure also face, it is no surprise that this group has significantly higher rates for certain diseases and health conditions. Many of the diseases that clients develop are those that have a strong link to nutrition and stress, such as diabetes and high blood pressure (Feeding America, n.d.-a). The link between these diseases and food insecurity can be understood through the Multicausation disease model that was discussed in Key Insight #1. This model explains the connections between food insecurity, stress, and the eventual formation of disease. In order to understand the impact that food insecurity and poverty has on the clients of food banks, it is necessary to consider the current data that we have on this issue. The data from the Hunger in America study that was conducted by Feeding America in 2014 is summarized by national and local data below. There is also a video from Feeding America that summarizes health data (Feeding America, 2017).

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Nationally (Weinfield et al., 2014):

• 47% of clients report having poor or fair health 

• 58% have at least one family member with high blood pressure

• 33% have at least one family member with diabetes 

• 29% of client households lack health insurance of any kind (including Medicaid)

• 55% of families have unpaid medical bills 

• 66% of clients report choosing between food and medicine or medical care in 

the past year 

​Locally (Mills et al., 2014):

• 50% of clients report having poor or fair health 

• 44% have at least one family member with diabetes 

• 75% have at least one family member with high blood pressure

• 24% of client households lack health insurance of any kind (including Medicaid)

• 74% of families have unpaid medical bills  ​

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            Due to the high prevalence of disease within this group, we can better understand exactly how hunger and food insecurity impacts this group of people. The high occurrence of disease eventually leads to health problems that are poorly managed, which culminates in the need for immediate or continuous medical care (Feeding America, n.d.-a). The advance of disease that is due to poor diet and lifestyle habits, along with the lack of access to medical care eventually leaves many clients seeking care at local emergency departments.  In fact, the frequency of emergency department use increases with increasing levels of poverty, and also increases with insurance coverage (U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2010). Those who have Medicaid are the most likely to utilize the emergency department for care, while the uninsured population are slightly more likely to utilize this than privately insured patients (U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2017). The increased risk for diseases that require long-term management and the lack of access to proper healthcare resources leads to the emergency department of local hospitals becoming a primary source of care for many patients that find themselves struggling with poverty and food insecurity. It is due to this overlap in food insecurity and healthcare that an intervention that targets this population within an emergency medical setting would be ideal and could function to identify individuals that would benefit from the services of a food bank.

 

Recommendations for Action

​​            Considering the intersections between food insecurity and health, the recommendation would be for the food bank to work together with the local hospital system to offer emergency food resources and counseling to individuals that were screened to be food insecure upon admission to the emergency department. This would also incorporate a reference for these individuals to the food bank for future attainment of resources. Although this program will utilize skills from each key insight, the basis of the program has a strong link to addressing the cause of disease as discussed in Key Insight #1.

 

Program Plan and Implementation Strategy

 

Social Ecological Model

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             (Centers for Disease Control and Prevention, 2015)

             

           The focus of this program will be to serve as a prevention measure for identifying individuals who are food insecure and prevent the diseases that are associated with food insecurity or aid in the management of that disease through providing nutritious food. The development and implementation of this program will use the Social Ecological model as a framework, since this focuses on how a community or organization can impact the health behaviors of individuals. It is of vital importance that this program functions to utilize and encourage a community where health is promoted, as discussed in Key Insight #2. In order for this program to function properly, it will require that at least two local organizations (a food bank and a hospital) work together in order to carry out the goals of this program. For the purpose of this program, I will be using Harvest Hope food bank and Palmetto Health hospitals as reference points since I have worked with both of these organizations. Harvest Hope will be a useful reference group to provide details about the complexities of food insecurity and healthcare, while also providing expertise on how to provide food resources and references to new clients. Palmetto Health would provide information about access to healthcare and how this program could be implemented into their care routine. They could also provide the necessary details about how this process could be used most efficiently and the implementation that could reduce overall cost to the hospital system. Listed below are the steps necessary to carry out this program from development through evaluation and maintenance.

 

Implementation Strategy

 

Step 1.

            In order to begin the development of this program, the formation of focus groups and a inter-organizational committee will be necessary. A group from Harvest Hope food bank and a group from the Palmetto Health Emergency Departments will be necessary in order to understand how both of these organizations would contribute to this program and how they both view the issues at hand. These two groups would meet, formulate their suggestions or concerns about the implementation of the program, and then members from these groups would be selected to be members of the permanent inter-organizational committee that would run the program from beginning to end. It would be important that this committee represents both organizations equally, while also representing the clients/patients who would be benefitting from the program. This method of program development would be geared towards these two organizations helping each other by using their organization's values. Through working with each other and observing how each of these two groups approach this issue, a more comprehensive plan will be put in place that utilizes observational skills as discussed in Key Insight #3.

 

Step 2.

            The first priority of these groups would be to determine the roles and responsibilities that each organization would have within this program. This would include determining the financial or physical resources that each organization would offer to this program, along with the specific goals that each organization will accomplish for the success of the program.

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Step 3.

             This step would be the most important to the program since this is the point where the delivery of the program would be decided upon. This would involve participation from both organizations within the inter-organizational committee on how to carry out the program. Some important questions to answer during this step of the process are: How should patients be screened for food insecurity? Are we going to use a chart system where they verbally answer the questions to a staff member or a paper survey? Who moves forward with the counseling after they have been identified as food insecure? Is there a position specifically for this or will this be something that all staff are trained on? What format do we reference the people to the food bank with and how do we ensure follow up? 

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Step 4.

           In order to prepare for the pilot launch, staff training for a limited number of staff at the hospital would be mandatory to participate in. This training would focus on different positions within the staff and would discuss how to utilize the screening and reference systems. A part of the training would also help the staff to understand the purpose of this program by focusing on the factors that lead to disease as mentioned in Key Insight #1, and understanding the importance of a community in changing health as shown in Key Insight #2. 

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Step 5.

              Launch the pilot program in order to better understand how the program functions in the hospital setting, while also gathering useful data on how to improve the program for a later launch of the final program. 

 

Step 6.

              This stage of the program would involve analyzing data from the pilot program and discussing how that data may change the program. Some questions that would be answered during this stage include: What is working for the program? What is not working? How can the efficiency of the program be improved? Does the staff understand the implementation of the program? Are we seeing benefit from the program? These questions would ideally lead the inter-organizational committee to make better decisions in the execution of the program. 

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Step 7.           

              For this step, the final program would be launched after utilizing the data from the pilot launch to refine the program.

 

Step 8.

             The last step of this program would involve continuous monitoring of results and the decision on whether or not to continue the program based on the data gathered. This decision would be based on the definition of success as defined by the inter-organizational committee. The program would be reassessed for continuation at every 3 month period in order to manage for cost to the food bank and the hospital system. 

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Evaluation

​              In order to properly evaluate this program and better understand if it is accomplishing its goals, it is necessary to have a thorough evaluation process in place that continuously monitors the program and provides data from every party involved. For this program, the following evaluations will be used: 

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1. Follow up surveys for staff and patients

   • These surveys will be used to assess how the delivery system for the program is viewed by both the patients and the staff. This will help the planning committee to understand how to make the system more efficient and if the program is communicating the right purpose to the patients. 

2. Gathering data from the food bank to understand program utilization 

   • By using the food bank data, the program will be able to understand how well the reference system is working in accomplishing its goal after the initial emergency room visit. This will allow the program to change the reference system if necessary to increase food bank utilization. 

3. Tracking follow up or recurrent visits to the emergency room and the reason for utilization 

   • This data will provide insight into the overall effectiveness of the program since it assesses a measure of program success by reducing the amount of visits through nutrition assistance. The utilization of this data during quarterly program checks will allow the planning committee to decide if the program is achieving its purpose and how to move forward. 

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References 

Centers for Disease Control and Prevention. (2015, October 27).  Social ecological model [Online Image]. Retrieved April 3, 2018                                 from https://www.cdc.gov /cancer/crccp/sem.htm

Feeding America. (2018). Food insecurity in South Carolina. Retrieved from http:// map.feedingamerica.org/county/2015/overall/south-                    carolina

[Feeding America]. (2017, January 27). Illuminating intersections: Hunger and health [Video File]. Retrieved from https://www.youtube.                       com/watch?time_continue=3&v=QkGdGLNj0HM

Feeding America. (n.d.-a). What are the connections between food insecurity and health? Retrieved from https://hungerandhealth.                             feedingamerica.org/understand-food-insecurity/hunger-health-101/

Feeding America. (n.d.-b). What is food insecurity? Retrieved from https://hungerand health.feedingamerica.org/understand-food-                           insecurity/

Mills, G., Weinfield, N.S., Borger, C., Gearing, M., Macaluso, T., Mendonca, S....Zedlewski, S. (2014). Hunger in America 2014: State report                 for South Carolina. Retrieved from http://help.feedingamerica.org/HungerInAmerica/SC_report.pdfs_src=W184DIRCT&s_                           subsrc=http %3A%2F%2Fwww.feedingamerica.org%2Fresearch%2Fhunger-in-america%2F&_ga=2.218952153.111015827                             4.1522785488-445597535 .1495131385

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. (2017).                 Health, United States, 2016. pp. 27. Retrieved from https://www.cdc.gov/nchs/data/ hus/hus16.pdf#074

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. (2010).                 Emergency department visitors and visits: Who used the emergency room in 2007? NCHS Data Brief, 38. Retrieved from   https:                 //www.cdc.gov/nchs/data/ databriefs/db38.pdf

Weinfield, N. S., Mills, G., Borger, C., Gearing, M., Macaluso, T., Montaquila, J., & Zedlewski, S. (2014). Hunger in America 2014: National                  report. Retrieved from http://help.feedingamerica.org/HungerInAmerica/hunger-in-america-2014-full-report.pdf?s_src=W184                      DIRCT&s_subsrc=http%3A%2F%2Fwww.feedingamerica.org%2Fresearch%2Fhunger-in-america%2F&_ga=2.176495973.111015                  8274.1522785488-445597535.1495131385

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