Interventions- Promising Models

While we believe that each model can be an effective way of supporting food security for students and families, we recognize that each model requires varying levels of capacity and models should align with community needs and center priorities. We encourage sites to approach this as a long-term change process to always assess your community’s needs and assets and determine the best method(s) for connecting families to existing resources or filling in gaps (see section 3 Readiness).

“The program has created a robust resource for families. With multiple and varied components (financial assistance, produce boxes, hot meals, classes, etc.) we have been able to offer every family at least one, and usually many, options that fit with their preferences and needs.” 

What is it? 
  • Not just completing screenings for screening’s sake, connecting to referrals and offering appropriate resources is the important follow-up 
  • Low cost option, but requires staff resources/capacity and training.  Engaging community or school partners can be critical to ensuring families get connected and enrolled in programs they are eligible for. 
  • Dr. Essel presentation: Dr .Essel Recording.mp4 
How does it work?  
  1. Integrate a food insecurity screening tool into standard screening questionnaires for students and their families, these can be added to registration packets, or completed at routine well child visits. 
         – Toolkit note: paper survey was better, shorter survey was better 
  2. Some EHR systems already have food insecurity screening questions integrated into the system. This allows for ease of integration into workflows in the Center.   
  3. More global SDoH screeners may also include questions about food security.  A common screening tool used by SBHC’s is RAPS.   
  4. Examples from the network:  Port Chester  or Metro Health  
Resources 
What is it?  
 
  • Referrals to federal nutrition programs can have one of the lowest barriers to entry of any method for addressing food insecurity for your patients.  Whether or not your center is conducting screening for food insecurity, you can very easily incorporate messaging, information and/or warm handoff referrals regarding federal nutrition program which families may be eligible for.   
  • What Federal Nutrition Programs might families be eligible for?  
         i) SNAP: The Supplemental Nutrition Assistance Program (SNAP – formerly known as food stamps) provides monthly food assistance to eligible families and individuals. It provides direct aid through monthly payments on an Electronic Benefits Card (EBT) that is used to purchase food at stores and farmers markets. 
         ii) WIC: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a public health nutrition program that provides nutrition education, nutritious foods, breastfeeding support, and healthcare referrals for income-eligible women who are pregnant or postpartum, infants, and children up to age 5. 
         iii) National School Lunch Program (NSLP) & School Breakfast Program (SBP) are two federally assisted meal programs generally operated by public and non-profit private schools. Participating schools must serve meals meeting federal nutrition requirements and offer free or reduced-price meals to eligible students in exchange for cash subsidies from the United States Department of Agriculture (USDA). 
         iv) The Summer Food Service Program (SFSP) is a federally-funded, state-administered, and locally-sponsored program of the USDA that allows children to access nutritious meals free of charge when school is out. 
How does it work? (include how it can integrate with the clinic workflow) 
 
  • Promote 
    i) Inform families of programs and the health and academic benefits of participation.  Food program information can be mailed with registration materials, distributed at visits, sent with other clinic communications, or linked on center website.  Providers or other clinic staff can also follow up with these resources for families that screen positive for food insecurity.  
         – Health-based messaging “SNAP has helped my patients afford the nutritious foods needed to prevent diabetes”    
         – Build Program Knowledge:  The school’s summer recreation, learning and meal programs will help your child be ready for the next school year”
    ii) Understand the barriers that families may experience in accessing benefits.  Educate staff at the clinic to be able to provide accurate information and capitalize on status as a trusted messenger.   
         – Ex. Public Charge rule roll back and communications to mixed status families  
  • Ask 
    i) Ask all Medicaid Beneficiaries if they are enrolled in SNAP. As an alternative to food insecurity screening, which can be perceived as stigmatizing, instead ask all Medicaid patients about their participation in SNAP.  There are overlapping qualifiers for both programs and families are often eligible for both, though more families are likely to enroll in Medicaid then SNAP.  
         – Lead with Resources “Are you enrolled in SNAP?  Are you aware of the summer meal program?” 
         – Normalize Participation:  So many of my patients have benefitted from SNAP and the Summer Meal Program” 
  • Assist
    i) Facilitate enrollment in SNAP and other federal food programs through offering application assistance.  This may be offered onsite through your center (I.e. a social worker or CHW), but can also be a warm handoff to a community partner or patient advocate outside of your center.   
         – The advantages include accessible and supportive enrollment assistance for all that need it and higher likelihood of families following through on enrollment.  
          – Identify and utilize key opportunities to support families to enroll.  This could include pairing SNAP enrollment assistance with assistance for Medicaid enrollment, or offering assistance at health visits for Medicaid beneficiaries. 
    ii) There are many organizations that offer enrollment assistance including state human services, community organizations like local food banks,  211 or other call centers.  Identify partners that you may work with in your community to support families to enroll in benefits.  
  • LACK OF HEALTHCARE STAFF KNOWLEDGE IS A BARRIER TO SNAP ENROLLMENT (Mesa County Interviews by Andrea Nederveld) Interviews revealed that the healthcare staff lacked knowledge of: 
    i) SNAP program and its health benefits 
    ii) The extent of stigma people experiencing food insecurity felt 
    iii) Their patients sometimes perceived screening as judgement 
  • Examples from the network  referrals to federal nutrition programs
    i)
    Using CHW’s (Rush – Chicago) 
    ii) Referring to resource navigators within larger FQHC/health system (Sara H – NY)  (also ask for example workflow and/or staff training materials for screening and referral process) 
Other Resources for outreaching families about federal nutrition programs  
  1. SNAP Outreach in Schools Toolkit (adobe.com) 
  2. Summer Meals Outreach Toolkit  
  3. SNAP application assistance is often available through community organizations and/or local food banks.  https://www.feedingamerica.org/our-work/hunger-relief-programs/snap; https://www.fns.usda.gov/snap/state-directory   
  4. FRAC 2017 The Role of the Federal Child Nutrition Programs in Improving Health and Well-Being 
  5. https://bipartisanpolicy.org/event/strengthening-the-child-nutrition-programs/   
What is it?  (Food Pantry on site, Snack program, afterschool/sporting event meals, garden)  
 
How does it work? (include how it can integrate with the clinic workflow, ie. Identifying students in the clinic and sending them to the pantry)  
  • While providing direct food access to students and families can require more resources (funds, space, food, staff coordination, etc.), this can be an essential strategy to address acute food insecurity and fill identified gaps in resources available in your community.  Some SBHCs involved in this project identified the need to establish a food pantry on-site at their clinic or school, where students or families could discretely access food to take home.  These pantries could range in size and capacity, some offering pre-boxed shelf-stable items, while others included produce and refrigerated items.  In some rural communities, having emergency food available onsite at the school was critical to address transportation challenges related to food insecurity.  Other centers developed a food or produce prescription-type model where students and families were provided vouchers or gift cards that could be redeemed at local farmers’ markets or other food retailers.  Still, others created unique food programs to fill specific needs, like healthy snacks or meals available to students and families outside of school hours, gardens to improve access to fresh produce and nutrition education, or mobile food or meal programs.   
  • Example case studies here 
    i) pantry, meals, garden:  Alanson, MI;  Little Rock, AK  
    ii) It Could be a great place for video tours, photos, etc. 
         – There are food bank tours on YouTube we could link here 
         – Food Pharmacy Program – YouTubeOther resources (establishing a pantry, videos from sessions, produce Rx toolkit)  
Resources 
What is it? (I.e. produce rx, offsite pantry, mobile meals, mailing food)  
How does it work? (include how it can integrate with center workflow)  
  • Examples from the network – Choptank (Produce Rx), EW Haase (mailing food boxes)  

Resources 
What is it?  
  1. Nutrition education can be a key component of food access interventions.  Education offered should be linked to community needs assessment and feedback, as well as supportive of food access efforts.  For example recipes or cooking classes utilizing foods available in your food pantry.   
How does it look?  
  1. Integration education or healthy eating messaging with food pantry and supporting the use of local produce or a produce prescription: recipe of the month, connect with health education instructors to create nutrition curriculum, create meal kits, helpful hint/tip/instruction cards next to ingredients, SWAP “Stoplight Nutrition Ranking System” healthy-pantry-initiative.pdf (feedingamerica.org), Hands-on cooking/nutrition classes, cooking videos and recipe demonstrations posted on school website, YouTube channel, or social media platforms 
  2. Find local partners offering nutrition education in your community.  SNAP-Ed https://snaped.fns.usda.gov/state-snap-ed-programs  
  3. Work with your school’s food service department – do they participate in farm to school programs or other nutrition promotion programs?  Can your center be a place for mutually reinforcing messaging about healthy eating?   
  4. Example/case study from the network: Basecamp Velda Keeney: “We are doing a recipe of the month.  We are posting the recipe on our social media site and on our SBHC website.  We also are printing the recipes on recipe cards and they get the recipe card that includes the recipe and a nutrition fact as well when they access the pantry.  The recipes coordinate with the pantry supplies for that month. During the school year we have been fortunate to have a partnership with a large medical facility that provides us with links to nutrition and physical exercise lessons each week that we make available on the same platforms mentioned above.” 
  5. Successful cooking programming with youth – Michigan or Colorado? 
Other resources (CM website, SNAP ed etc.)  
  1. Opportunities for Nutrition Education in US Schools (cdc.gov) 
  2. Cooking Matters 
  3. Cooking Matters – SNAP-Ed Toolkit (snapedtoolkit.org) 
  4. Whyville Snack Shack Games | FDA 
  5. Science and Our Food Supply | FDA 
  6. Read the Label Youth Outreach Materials | FDA 
  7. Health Educator’s Nutrition Toolkit: Setting the Table for Healthy Eating | FDA 
  8. Printable Materials and Handouts | Nutrition.gov