Partnering With Hunger Free Vermont

Find all supporting materials at the Hunger Vital Sign explainer series website.

This episode features an interview with Katy Davis, Community Health Initiatives Director at Hunger Free Vermont.

Part One of this series featured Children's HealthWatch - find their Hunger Vital Sign materials and background research here.

Audio Editing and Post-Production Provided By Evergreen Audio

Transcript

LABUN:

Welcome to episode number seven in our series of short explainers for the Hunger Vital Sign tool. I’m your host, Helen Labun. We’ve been speaking with Richard Sheward, the Director of Innovative Partnerships at Children’s HealthWatch about the origins of the Hunger Vital Sign.

A quick reminder here of how the project began:

SHEWARD:

Children’s HealthWatch was founded in 1998, initially as a research project to understand how economic and household hardships, namely food insecurity, impact the health and development of very young children and their caregivers. Over the years, children's health watch developed a research base, demonstrating that food insecurity in households with young children resulted in a myriad of negative health outcomes. And that there is a really important opportunity for, in this case, pediatricians, to identify families with young children who are at risk for food insecurity.

LABUN:

The starting point was understanding what shapes the health of young children and their caregivers, including non-clinical factors. Researchers realized that food insecurity was having a significant impact, and they wanted a way to make that visible, and actionable, to health care providers. 

In this next section of episodes, we’ll begin from a slightly different starting point – an organization with a mission to end hunger, which expanded its work to include health care organizations as partners in that mission.  

DAVIS:

My name is Katy Davis and I am the community health initiatives director at Hunger Free Vermont. Hunger free Vermont is a mission driven organization with the goal of ending the injustice of hunger and malnutrition for all Vermonters.

LABUN:

Hunger Free Vermont is one of many Vermont-based groups focused on food access. And health care practices partner with these organizations in many ways, not necessarily ways that involve implementing the Hunger Vital Sign. Hunger Free Vermont itself has many different programs, many of which are outside of the health sector. But this is a Hunger Vital Sign explainer, so we’re going to quickly bring the focus in on that element. 

We’ll begin with Hunger Free Vermont’s connection to federal nutrition programs. 

DAVIS:

Hunger Free Vermont's work is really at the systems level, trying to expand and increase access to food and our main vehicle for that is really trying to encourage use of the federal nutrition programs. So, things like Three Squares Vermont, or what we call nationally SNAP. Meals in school. Meals in childcare. Really trying to provide technical assistance on how to best run those programs and how to increase participation . . . . working with service providers who are connecting folks to those programs, working with our state agency who administers those programs, as well as working with the legislature and the federal delegation to make sure that those programs are as expansive as possible.

LABUN:

If you want to expand Vermont’s participation in federal nutrition programs, and make these programs as universally available as possible, then the health sector is a great point of connection. Comparatively speaking, Vermonters are highly engaged in primary care. Our uninsured rates are quite low, consistently 3% or less - in calendar year 2022 it was a record low of 1%. While underinsurance can also reduce doctor visits, we have a high rate of primary and preventive care use - 86% of Vermonters have an established primary care provider relationship and annual office visits are equally high. Visits are even more frequent in households with young children. Telehealth offers even more points of contact. If you want to find a screening location where a lot of people from all walks of life pass through in a given year - health care providers are a good start 

DAVIS:

. . .  The state of Vermont has really done a good job of making sure that our folks with, you know, the lowest socioeconomic status have really had access to healthcare.

I think that some of it is, how are you able to be connected to resources? And that “over time” piece of really seeing your or medical provider as a trusted resource can go a really long way to really starting to build the notion that that food is related to your health. And really seeing that as a place where you, as an individual, have some autonomy and can make some decisions and you actually have the resources to be able to make those decisions.

LABUN:

We also mentioned starting with the nationwide nutrition programs in our episodes with Richard. Health care providers won’t want to screen patients for food insecurity if they don’t have an immediate next step for addressing a positive screen. 

SHEWARD: 

I think there are real concerns that clinicians face in identifying a need, working with a patient to try to address that need. And there's the risk of not being able to address that need and then you know, losing trust and, and degrading the relationship between the patient and the provider. But that being said, there are a number of response options that are available.

LABUN:

This aligns well with the Hunger Free Vermont mission of making federal nutrition programs more accessible - checking for eligibility, then enrollment, would follow the screening. We also know it’s not the only answer. Other resources will be needed. Hunger Free Vermont makes it easier for health care providers to both connect patients with national nutrition safety nets and connect them to local resources. 

DAVIS:

Medical providers are used to having to do it all. And there's certainly a lift in terms of all the data pieces and implementing the screen. But I think in terms of the referral and response there's a lot of people in communities across the state and across the country who have been dedicated to making sure folks can get connected to social services of all kinds. And that includes food access too. And so it’s an opportunity to elevate their skills and  to open the doors a little bit wider and have it be more of a community medical response as well.

LABUN:

Katy was part of a food resource series for care coordinators held in 2020, which we will link in the show notes. 

Now, Children’s HealthWatch is far from the only organization to be looking at the close connection between health-related social factors, like food insecurity, and health outcomes. That interest has spread broadly into our approach to health care. There are different ways these factors come into play. A common route is through upstream prevention, or addressing these non-clinical risk factors before they become serious health conditions. Hunger Vital Sign makes one of these risks visible at the time a patient visits a health care provider. Added together across all patients, Hunger Vital Sign results can also give an idea of food insecurity’s presence within the community. In this way, it supports investing in community level prevention, too.

There are other frameworks that health care practices use to look at community-wide health concerns. Hunger Free Vermont started with Community Health Needs Assessments, a process that non-profit hospitals and community health centers go through every three years. The process requires both assessment and the implementation of plans to improve community health. Participating in that process led to Katy’s first major health care practice partnership around food insecurity screening. 

DAVIS

I've had the pleasure of being able to be a part of the food security action team up at UVM children's hospital for a number of years now. And you know, all that work really started as a result of the community health needs assessment. It was really the community health needs assessment that pushed and was the impetus for really digging into the work around implementing the hunger vital sign at the children's hospital. And it's been a wonderful experience as a community partner to be a full member at the table.

There's so many different angles that you're wanting to hone and to assess, from what is actually working for the folks who are asking these questions, you know, are they asking them in the appropriate way? So in the case of a children's hospital, are they providing a paper screen tool to be able to fill out, then what happens to that piece of paper? How does it get into the actual electronic medical record? How does that information then get. . if it's inpatient, how does it end up getting communicated back to the patient's primary care provider? So really trying to think through what was working, taking best practices, and trying them out and evolving and assessing along the way and looking at data over time for that.

LABUN:

Okay, so Hunger Free Vermont was looking for health care partnerships in addressing hunger, the Community Health Needs process led them to a hospital partnership, which then led to being able to dig into the details of food insecurity screening, using the Hunger Vital Sign. But how do these details help an organization with an overall mission to drive systems change?

I personally do not need convincing - I’m the one making an explainer series on the details of Hunger Vital Sign. But Katy had a larger board to answer to. There are several goals that this tool helped reach. One was data related. 

DAVIS:

We've always been really interested in the data -- looking at and trying to understand what food insecurity really looks like. And so it's another opportunity outside of the USDA census survey to really get a handle on that. Being able to have that kind of data at the state level seemed like a really great opportunity, both for understanding what's happening and also really understanding what's not working for folks too. And, you know, are there places where the federal programs could be expanded or are there places where the federal programs are just not gonna meet this need that we're able to identify too?

LABUN:

To be clear, official research on food security levels is done with the USDA household food security survey, using established research protocols like sample size and demographic weighting. But sometimes that isn’t the data you want. Sometimes, you want to represent a small section of the population - like patients at a health care practice or within a rural community. Or you want insight into a sudden change, trying to grasp what’s happening on the ground right now - in which case you don’t want a stable trend like what USDA tracks, you want a snapshot. And two attributes of Hunger Vital Sign were that it could be used quickly for all patients passing through a clinic, catching that smaller population, and that it was highly responsive to changing situations. 

Hunger Free Vermont had seen the utility of this kind of community level data in their work on other projects.  

DAVIS:

I think a very current example is a bill that is currently in the Vermont legislature to make school meals universally free for all students. And we have really been well, we won't be the first state to implement cuz we got beat by a few other states. We were really instrumental in helping to devise how you cost out what meals would actually cost for states to be able to implement that change. That was hugely data driven and you know, used a variety of different data sources to kind of pull that information together and try to make our best guess as to what an estimate could be for what that would actually cost us.  

LABUN:

Since we recorded this interview, the Universal School meals bill did pass the Vermont legislature.

Another element of Hunger Vital Sign is that it’s designed to be able to be used by every health care practice. Patients see the same tool, wherever they’re seeking care. We talked about this with Richard earlier as part of standardization:

SHEWARD:

So one way that standardization happens is when you have a previously validated test or tool -- in this case, the Hunger Vital Sign --  that is continually administered in the same manner and shows consistently reliable results again and again.

LABUN:

Hunger Free Vermont had an interest in standardizing the tool for reasons beyond data validity - they wanted to reduce the stigma around food insecurity, and seeking help with food access. If Hunger Vital Sign screening became a standard part of everyone’s conversations with their health care providers, as normal as discussing the annual flu shot, then that could go a long way towards making these conversations more frequent and comfortable. 

DAVIS:

When we talk about universal programs certainly it's destigmatizing if everyone has access to things . I also think there's a piece of it where the tools that we use to put folks into different categories, those categories aren't sufficient. So to say that you're only struggling with food access if you're 185% above the federal poverty line is just not true and is not representative of the experience that folks are having. So I think part of it is a recognition that there's a lot of structural things happening across our society, both economic and non-economic, that make it harder for some people to get food than other people to get food. 

LABUN:

This issue of categories came up before when we discussed the fact that Hunger Vital Sign is only meant to be an initial step - it’s identifying patients who likely would see a health benefit from assistance with accessing food. It doesn’t perform additional sorting. Knowing a patient’s precise needs and eligibility for different services, including clinical services, requires a follow up conversation. 

DAVIS:

Ideally there would continue to be more and more of a recognition that food access is really an issue for a broader swath of the population than we wanna admit or than feels comfortable talking about.

LABUN:

Now, we should acknowledge that while health care offers an opportunity for Vermont to advance towards being “Hunger Free” -- reaching that goal is a pretty darn big ask. Health professionals are busy doing a lot of valuable, lifesaving things that don’t happen to be solving hunger. And last I checked, health care did not control the budget of the department of agriculture. We mentioned this at the beginning of the episode, Katy and Hunger Free Vermont have been pursuing food insecurity screening systems in the spirit of collaboration, not shifting all the responsibility onto health care. And I’ll restate that here. We’ll go deeper into this topic soon.

Next episode, though, will dive into another aspect of what Katy has been describing, which is how a validated food insecurity screening tool helps shift the cultural context of talking about food access in a health care setting. 

To recap a few key points from this episode - 

• Community organizations working on hunger issues can benefit from partnering with health professionals not only because food insecurity impacts the health of their patients, but also because providers see so many different people over the course of a year - it’s a natural hub to reach many community members. 
• Some of the benefits that groups like Hunger Free Vermont find in the Hunger Vital Sign include how it offers insights into food insecurity at a community level in real time, the fact that it’s a general enough tool to offer an entrypoint for a range of possible food access programs, and the potential for making conversations about food and food access a standard part of everyone’s health care experience as a way to reduce stigma. 
• Implementing Hunger Vital Sign screening and referral systems offers a concrete way to start a partnership between community organizations and health care practices.  

Check the resource page linked in the show notes for more details and materials on the topics we’ve discussed.