PECARN STELAR Podcast – Episode 2: Food Insecurity

The emDOCs.net team is very happy to collaborate with PECARN STELAR (Seattle, Dallas/Texas, and Los Angeles) Node and the Emergency Medical Services for Children Innovation and Improvement Center (EIIC) in presenting high-yield pediatric topics that highlight evidence based medicine with solid research.

Today on we have our two renowned experts, Dr. Ilene Claudius and Dr. Danica Liberman, discussing the case for food insecurity and how it impacts the health of our children.

Social Emergency Medicine:

• Making the case for screening and referral for social needs in the pediatric emergency department

Show notes by: Mohsen Saidinejad, MD, MS, MBA, on behalf of the PECARN STELAR Node

1. The problem: poverty and health related social needs in the US
   • As of 2022, approximately 16% of all children in the US living in poverty
     • Worse in Los Angeles, approximately ¼ of kids live in poverty

• • Similar statistics for food insecurity, approximately 17% of households with children are food insecure
    • 40% of households with children in Los Angeles
  • With the end of many pandemic related interventions, such as child tax credit, continuous Medicaid enrollment, statistics have worsened since 2021.

2. What can we do about this in the pediatric ED?

• • If we don’t, it’s possible no one will.
  • The emergency department takes care of some of the highest risk patients with the worst access to health care and social services
  • Over the past 20 years, many researchers have created and validated social needs screeners
    • Some examples: iHELP, WE CARE, SEEK, USDA 2-item food insecurity questionnaire

3. Does screening make a difference?

• • We know that toxic stress, poverty, untreated social needs lead to worse health in adults (ACES study from the 1990s)
  • Research shows that screening and referring families to social services has social benefit
  • We’re beginning to study and prove that screening and referral to services also has health benefit
  • Hierarchy of screening:
    • Screening without referral many consider unethical
    • Screening with passive resource handouts is helpful and may be quite effective for some
    • Screening with resource navigation and follow-up is likely the most successful
    • Screening for social needs is now evolving with an understanding that need does not always translate to want. More screeners are now asking for wants, allowing families to choose their own priorities and what they want help with, and if they want help today with anything at all

4. What models exist?

• • Online search engines like: 2-1-1, Findhelp.org
  • Most pediatric screening to date is in the outpatient setting—primary care clinics
    • Health Leads is a model that’s existed now for over 20 years, reproduced in multiple health care settings across the US
  • CHLA pediatric ED Help Desk, similar model to Health Leads
  • Electronic screeners with resource maps

5. Are there larger policies to address health related social needs?

• • Insurance companies paying more attention to addressing social needs
    • Medicaid: 1115 Demonstration Waivers, CalAIM in California
    • ICD-10 code modifiers to acknowledge – and compensate—for the added complexity of social needs

Additional resources/further reading:

1. Liberman DB, Pham PK, Semple-Hess JE. Social Emergency Medicine: Capitalizing on the Pediatric Emergency Department Visit to Screen and Connect Patients and Families to Community Resources. Acad Pediatr. 2022 Aug;22(6):1049-1056. doi: 10.1016/j.acap.2021.12.028. Epub 2022 Jan 5. PMID: 34995821.
2. Semple-Hess JE, Pham PK, Cohen SA, Liberman DB. Community Resource Needs Assessment Among Families Presenting to a Pediatric Emergency Department. Acad Pediatr. 2019 May-Jun;19(4):378-385. doi: 10.1016/j.acap.2018.11.009. Epub 2018 Nov 22. PMID: 30471361.
3. Kanak MM, Fleegler EW, Chang L, Curt AM, Burdick KJ, Monuteaux MC, Deane M, Warrington P, Stewart AM. Mobile Social Screening and Referral Intervention in a Pediatric Emergency Department. Acad Pediatr. 2023 Jan-Feb;23(1):93-101. doi: 10.1016/j.acap.2022.08.011. Epub 2022 Sep 6. PMID: 36075518.
4. Cullen D, Wilson-Hall L, McPeak K, Fein J. Pediatric Social Risk Screening: Leveraging Research to Ensure Equity. Acad Pediatr. 2022 Mar;22(2):190-192. doi: 10.1016/j.acap.2021.09.013. Epub 2021 Sep 24. PMID: 34571253; PMCID: PMC8479442.
5. Gottlieb LM, Hessler D, Long D, Laves E, Burns AR, Amaya A, Sweeney P, Schudel C, Adler NE. Effects of Social Needs Screening and In-Person Service Navigation on Child Health: A Randomized Clinical Trial. JAMA Pediatr. 2016 Nov 7;170(11):e162521. doi: 10.1001/jamapediatrics.2016.2521. Epub 2016 Nov 7. PMID: 27599265.
6. Garg A, Toy S, Tripodis Y, Silverstein M, Freeman E. Addressing social determinants of health at well child care visits: a cluster RCT. Pediatrics. 2015 Feb;135(2):e296-304. doi: 10.1542/peds.2014-2888. Epub 2015 Jan 5. PMID: 25560448; PMCID: PMC4306802.
7. Beck AF, Cohen AJ, Colvin JD, Fichtenberg CM, Fleegler EW, Garg A, Gottlieb LM, Pantell MS, Sandel MT, Schickedanz A, Kahn RS. Perspectives from the Society for Pediatric Research: interventions targeting social needs in pediatric clinical care. Pediatr Res. 2018 Jul;84(1):10-21. doi: 10.1038/s41390-018-0012-1. Epub 2018 May 23. PMID: 29795202.
8. Medicaid. Coverage of Health-Related Social Needs (HRSN) Services in Medicaid and the Children’s Health Insurance Program (CHIP) November 2023. https://www.medicaid.gov/health-related-social-needs/downloads/hrsn-coverage-table.pdf
9. Hinton E, Diana A. Medicaid Authorities and Options to Address Social Determinants of Health. Published January 29, 2024. https://www.kff.org/medicaid/issue-brief/medicaid-authorities-and-options-to-address-social-determinants-of-health-sdoh/
10. Dubowitz H, Feigelman S, Lane W, Kim J. Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) Model. Pediatrics. 2009 Mar;123(3):858-64. doi: 10.1542/peds.2008-1376. PMID: 19255014.
11. Colvin JD, Bettenhausen JL, Anderson-Carpenter KD, Collie-Akers V, Plencner L, Krager M, Nelson B, Donnelly S, Simmons J, Higinio V, Chung PJ. Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals. Acad Pediatr. 2016 Mar;16(2):168-74. doi: 10.1016/j.acap.2015.06.001. Epub 2015 Jul 14. PMID: 26183003; PMCID: PMC4712125.