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Addressing food insecurity in the community

9 Essential Skills for a Food Insecurity Screening Program

The economic impact of the coronavirus pandemic is hitting millions of Americans. More people are out of work and dealing with higher medical bills. You’ve probably seen an uptick in your agency of people who are making decisions about paying bills or buying groceries, which is a direct route to food insecurity. These decisions aren’t likely to get easier any time soon.

Going to food banks and assistance programs like SNAP is a tough decision for some people, and it could be one they don’t know how to make. You can make it easier by creating a food insecurity screening program at your organization.

This kind of program can help you find people who both don’t have enough continuous food, but also enough nutritious food. People in food deserts have a harder time finding fresh nutritious food.

Adding food insecurity screening to your agency

Your agency might be like many of the healthcare systems that traditionally build programs to provide dietary counseling, but who neglect to include anything to address food insecurity.

This is a serious oversight, because it’s even more important than ever to eat nutritiously, because research shows that people with obesity and diet-related diseases who get COVID-19 have worse health outcomes.

If you’re ready to take steps to build a screening program at your agency so your staff can refer patients and clients to community food resources to support food security, make sure your staff is trained in these essential skills.

9 Essential Skills for a Food Insecurity Screening Program

  1. Food insecurity basics
  2. Nutrition
  3. Social determinants of health
  4. Food insecurity screening processes
  5. How to use screening tool kits
  6. Community needs and assessments
  7. Financial management
  8. COVID-19 resources
  9. Communication skills

1.      Food insecurity basics

Training individuals and teams on what food insecurity is and how to navigate food assistance since COVID-19 is imperative to reaching impacted communities. Feeding America provides useful reports since COVID-19.

2.      Nutrition

Provide nutrition education so that employees completing outreach can educate those at risk or suffering from food insecurity on the importance of healthy eating.

Make sure your team understands the basics of healthy eating and active living so they can promote healthy lifestyles to clients.

This includes knowing how to parse misinformation from scientific information and provide reliable resources.

“While there is general agreement that food has an impact on health,” Colin Hung says in the Healthcare Leadership Blog, “the specific foods and their impact on health is often contradictory and confusing. Carbs are good. Carbs are bad. Dairy is good, but not too much. Fruits are good for you, but too much sugar can be harmful…or is it just refined sugar?”

3.      Social determinants of health

Where a person walks around, earns and spends money, and lives close to all have a strong impact on their health. A full understanding of social determinants of health is vital for understanding how and where health inequities happen, and how these factors might affect food insecurity and overall health outcomes.

A good understanding of social determinants is also helpful to be able to recognize barriers to good health, which will also be barriers to healthy food.

4.      Food insecurity screening processes

It cannot be stressed enough that households that are already vulnerable to food insecurity pre-pandemic are mainly found in communities of color, inner city and rural areas, and low-income homes. These communities always face battles in health equity and deserve visibility when it relates to their health, especially now.

Some programs, such as the King County Healthcare and Food Insecurity Learning Network, offer in-depth training that show participants how to sensitively screen.

5.      How to use screening tool kits

Feeding America has a useful Food Insecurity Screening Toolkit for how healthcare and non-health care professionals might treat food insecurity in individuals. If you are a member of a clinic that is not screening for food insecurity, consider standardizing the Hunger Vital Sign tool.

6.      Community needs and assessments

Consider the barriers the populations you serve are facing. Are they elderly and in need of delivery services? Are they grade school children that rely on school lunches? Does the household have a personal device or stable internet to access a form they need to fill out?

7.      Financial management

Likewise, employees will benefit from being able to educate others, budgeting in particular, during a time of high unemployment.

8.      COVID-19 resources

Right now, the most powerful tool is learning what your community needs and what aid they are eligible to receive. Research and compile COVID-19 food assistance resources. Encourage your team to become knowledgeable about assistance on the federal and state levels since COVID-19. Many programs have become flexible allowing more to qualify for benefits; see a list below of a few resources you can begin to research.

9.      Communication skills

Again, many are new to experiencing food insecurity. They may feel ashamed, so it is appropriate to let them know that they are not alone. Normalize the need for assistance with communication skills.

Interested in more skills to develop your community oriented staff? Read about how they can advance their career.

Your Agency Needs Training for Food Insecurity

By Gabrielle Carrero

The coronavirus is emptying America’s cupboards. Growing food insecurity is making more people wonder where their next meal will come from.

Income disruption and limited access or availability of food at grocery stores are only a few reasons why families and individuals are experiencing it for the first time. Meanwhile, many that were already living with food insecurity are feeling added pressure.

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Agencies can help by understanding vulnerabilities in local communities, including where food deserts are.

It is also helpful to employ sensitive screening questionnaires to detect who might be food insecure and connect people experiencing food insecurity with sources of nutritious food.

Training your team to increase outreach efforts to connect those in need to food will ease the burden individuals and families are going through.

Using community outreach and engagement strategies for food insecurity might include talking to local groups, using local media and social media to promote food resources, or appearing at community events to do demonstrations and build linkages.

What Food Insecurity Is

Reviewing the background of food insecurity, causes, consequences, and responses prior to COVID-19 offers some insight into the complex environments people need to navigate to keep nutritious food on the table.

The United States Department of Agriculture (USDA) defines food insecurity as “a household-level economic and social condition of limited or uncertain access to adequate food.”

“Adequate food” here means safe and healthy food—not something like a candy bar for dinner.

Fewer than 1 in 10 US adults and adolescents eat enough fruits and vegetables. – CDC

The USDA reported that 37.2 million people were in food-insecure households in 2018. They also found that food insecurity happens in episodes averaging seven months to a year. That number is expected to rise hugely this year.

Source: Global Food Security Program, Center for Strategic & International Studies

People in food insecure households are more likely to suffer from hunger and the health issues associated with poor nutrition and diet like diabetes, cardiovascular disease, and obesity.

Children with a lack of food or poor nutrition harms their healthy growth, cognitive and social development, educational achievements, and mental health. Similarly, the health of the elderly can decline from little or unhealthy food.

“These groups are more at risk primarily because of a lack of money to buy food,” says Elizabeth Kimball, who manages the Healthy Eating, Active Living Program at Public Health – Seattle & King County. “It’s not because a person is disabled but because most likely they cannot work, have high medical bills, or live on a fixed income.”

Kimball is leading the King County Healthcare and Food Insecurity Learning Network, a Community of Practice whose goal is to eliminate food insecurity and improve health. The group is developing an online training to facilitate screening for food insecurity in communities.

“We don’t want to perpetuate stereotypes or prejudice by saying that people of color are more likely to be poor without saying how society contributed – otherwise people may assume that it is the fault of people of color for being poor,” she says.

Root Causes of Food Insecurity: Disparities and Discrimination

According to a 2014 Hunger Report by Research Triangle Institute (RIT), food insecurity doesn’t hit all sectors of society the same. People from low-socioeconomic status, racial or ethnic minority groups, single-parent households, and households that include persons with disabilities are more likely to be at risk.

The reason is pretty simple: lack of money. For example, if someone is disabled, it’s harder for them to find work or they might have high medical bills. Living on a fixed income means less money for everything, including food.

“You cannot take on poverty and hunger without taking on historical and contemporary discrimination,” Dr. Mariana Chilton, a professor of public health at Drexel University’s Center for Hunger-Free Communities, said in an article for The Nation.

This comes from a study that says it’s impossible to deal with food insecurity–like all health disparities–without taking on structural racism.

“How are racism and hunger related? Being mistreated at school, on the job, in health care and beyond, translates to lower wages and exclusion from society,” Sherita Mouzon, a community engagement specialist also at Drexel, said in an op-ed for the Philadelphia Inquirer.

“When employers discriminate, people of color make lower wages than white people. When health-care providers discriminate, people cannot get the health care they need, and when the courts and the police are biased, they are more likely to put our family members behind bars, which damages their prospects for economic security.”

Eating well is imperative to health, and COVID-19 has forced households to make hard decisions when it comes to food.


COVID-19 and Food Insecurity

The coronavirus has created many substantial barriers for people to access food, for example:

  • Food supply system disruptions have limited the availability of food in grocery stores
  • Food pantries and food banks have high demand and long wait lines
  • Some individuals are not healthy enough to leave home to get food
  • Some people are especially cautious leaving home because they have immunocompromised family members at home

And, of course, many more people can’t afford food.

The Department of Labor reports that millions of Americans are filing for unemployment benefits. Record unemployment rates have destabilized food budgets and left many uninsured without an employee-sponsored health plan.

With drastic changes in economic and physical circumstances since the virus, it is no wonder that so many are experiencing food insecurity for the first time.

A recent survey shares the impact COVID-19 has on children and the elderly, two of the same groups at risk or enduring food insecurity before the virus.

According to The Survey of Mothers with Young Children, “40.9 percent of mothers with children ages 12 and under reported household food insecurity since the onset of the COVID-19 pandemic.”

Comparatively, 15.1 percent of mothers with children of the same age reported food insecurity in the Food Security Supplement (FSS) 2018 survey.

A survey from December 2019 by the University of Michigan National Poll on Healthy Aging found that 1 in 7 older adults experienced food hunger in that past year. Because the elderly have been advised to isolate to safeguard health, food assistance programs like Meals on Wheels are seeing an increased demand of aid.


Source:
Meals on Wheels America

The pandemic is exacerbating the pre-existing issue of food insecurity. Without dedicated education and intervention for healthcare staff and non-clinical workers such as community health workers, the potential for long-lasting impacts on community members increases. Until now, food insecurity is a real and lived experience for many, and since COVID-19, it is also new and unfamiliar.

5 Ways Your Team Can Address Food Insecurity

Here are some ideas of how healthcare teams can help with food insecurity:

  1. Training individuals and teams on what food insecurity is and how to navigate food assistance since COVID-19 is imperative to reaching impacted communities.
  2. Make sure your team understands the basics of healthy eating and active living so they can promote healthy lifestyles to clients.
  3. Educate your agency team about where food insecurity happens. It cannot be stressed enough that households that are already vulnerable to food insecurity pre-pandemic are mainly found in communities of color, inner city and rural areas, and low-income homes. These communities always face battles in health equity and deserve visibility when it relates to their health, especially now.
  4. Train your team in food insecurity screening. Some programs, such as the King County Healthcare and Food Insecurity Learning Network, offer in-depth training that show participants how to sensitively screen.
  5. Use screening tool kits. Feeding America has a useful Food Insecurity Screening Toolkit for how healthcare and non-health care professionals might treat food insecurity in individuals.

A regular source of nutritious food can make a tremendous difference in the lives of Americans, and it’s more important now than ever for agencies to build the infrastructure to help them.

Gabrielle Carrero is a Latina educator and writer from Brooklyn, NY that now lives in Durham, NC. She teaches First Year Writing at NC State University.

What’s New for Navigating Health Insurance

By Monique Cuvelier

Health insurance is—if possible—even more important for Americans now than ever before. Everyone’s healthcare needs have been turned upside down, thanks to the coronavirus.

Some people are sicker, some are withholding their preventative care checkups, such as breast cancer screenings, until they feel comfortable visiting doctors, and others still have shifts—or gaps—in their coverage as their jobs change and as President Trump limits and threatens to overturn the Affordable Care Act (ACA).

→ Free Resource Guide: 10 Things To Fix in Women’s Health [Access Now]

It’s been more than 10 years since the ACA passed—and seven years after CHWTraining released the Navigating Health Insurance course–more Americans are insured. However, more people are under-insured. Plus, government funded education about the ACA has been either reduced or eliminated, which leaves many more people confused about coverage.

Avoiding Chronic Conditions

The simplest first step for anyone in navigating health insurance is to avoid the need for care. Preventive care, such as immunizations and cervical cancer screenings, can help individuals and their families stay healthy and reduce the risk of developing a chronic disease.

Lifestyle choices—exercising and eating healthfully—also contribute hugely to a person’s health and finances.

“1 in 3 US adults has pre-diabetes,” says Eric Hannah, the Chief Catalyst at Mode Health in East Lansing, MI. “That is an impending tsunami on the healthcare and insurance system.

“One point I preach is that health literacy needs to include how the insurance plan works, but also how [people can] care for themselves, for example avoid lifestyle-related chronic conditions, and navigate the healthcare system–when to go to the ER.”

Hannah refers to “food as medicine,” a technique of choosing the right foods to reduce or even avoid medication for conditions such as diabetes.

The impact of making smart lifestyle choices can save a great deal of money. Diabetes, for one, is expensive. The journal Diabetes Care revealed the cost for one single person with diabetes to be more than $13,000.

The average economic cost per person was projected to be $13,240 for diagnosed diabetes, $4,250 for undiagnosed diabetes, $500 for prediabetes, and $5,800 for gestational diabetes mellitus (GDM). –Diabetes Care, September 2019.

“When we empower people to be good health citizens and healthcare consumers, it can transform how and how much we pay for healthcare,” Hannah says.

CHWs and Health Insurance

Without the proper education about health insurance, patient populations will only decline if trends in insurance cover continue on the path they’re on.

This is why community health workers, promotores and other health promoters are so important in helping people become insured and also understand the basics of health insurance. CHWs can connect clients to professionals who can help them sign up for insurance, make payments and file claims.

That’s why we created Navigating Health Insurance and included it as part of our core competencies for CHWs learning track. As part of our latest updates to the course, we took a careful look at how things have changed in the last six years. The data reveal that confusion about health coverage in the U.S. has a strong impact on people’s overall health and well-being.

Trends in Navigating Health Insurance

According to the Commonwealth Fund, which conducts surveys of health insurance, today compared to 2010:

  • More people have insurance
  • More people are underinsured
  • People who are underinsured or uninsured have trouble getting care because of cost and paying medical bills

Here are some important highlights about health insurance we learned during our recent updates:

Low Health Insurance Literacy Stops People from Seeking Care

People who don’t understand how health insurance works are more likely to avoid care. People will skip treatment due to cost. This is a powerful case for health insurance literacy as well as general health literacy.

Noncitizens Are More Likely Than Citizens To Be Uninsured

Nearly a quarter of lawfully present immigrants and more than four in ten (45%) undocumented immigrants are uninsured compared to less than one in ten (9%) citizens.

 

The U.S. Spends More on Health Than Anywhere Else

On average, the U.S. spends twice as much as other wealthy countries per person on health., according to a KFF analysis of OECD and National Health Expenditure (NHE).

 

Many People Think They Don’t Need Travel Health Insurance

Serious problems when traveling in other countries are rare, many people do get hurt. People with chronic illnesses can also be at risk of a medical emergency. This decision can be an expensive mistake if they become sick or hurt while in other countries, and their main insurance doesn’t work. Request a copy of the Travel Health Insurance Toolkit to use with clients.   

 

Millions of People are Uninsured and Even More Are Underinsured

Around 25 million people don’t have health insurance at all, and for those who do, premiums on family policies have increased 54% in the last decade.

 

Not understanding health insurance is bad for people in the U.S. Government debates about ACA and Medicaid aren’t helping people know how their health is affected by coverage. Community health workers are more important than ever when it comes to navigating health insurance.

If you’re not including training about navigating health insurance in your CHW workforce, start now. If you’re interested in building a diabetes education program for your team with these or other courses, contact us to learn how to add certified training to your program. Our team will be in touch ASAP to schedule a time to chat.

Originally published Dec 15, 2019, updated July 24, 2020.

What’s New for Diabetes and Prediabetes

CHWTraining launched its Diabetes and Prediabetes more than six years ago, and it remains our top requested course. It’s not hard to understand why, as diabetes continues to grow in the U.S. and trigger a host of other chronic diseases.

Adults in the U.S. need diabetes support, especially now when the coronavirus brings new threats to communities and people who already have the disease. Without the proper education about diabetes, patient populations will only decline if trends continue on the path they’re on.

CHWs, Diabetes and Prediabetes

Community health workers, community care coordinators, health promoters and others are more important than ever in helping people understand their diabetes or prediabetes diagnoses and control it.

CHWs can advise on what diabetes is, how to interpret blood sugar levels, share healthy eating ideas and recipes, and give ideas for physical activity. They can also connect clients to professionals who can provide more support beyond a physical, such as dental workers and dietitians. They can also help vulnerable and minority communities who have statistically worse health outcomes from diabetes.

That’s why we created Diabetes and Prediabetes (and the Spanish language Diabetes y prediabetes) included it as part of our chronic illness learning track. As part of our latest updates to the course, we took a careful look at how things have changed with diabetes.

[Related: Add Chronic Illness training to any Learning Track]

Diabetes is on the Rise

The number of people with diabetes in the US is up. In the United States, an estimated 34.2 million people of all ages have diabetes. That number continues to rise. In 2018, about 1.5 million adults in the United States were newly diagnosed with diabetes, according to the CDC’s National Diabetes Statistics Report 2020.

[Source: CDC]

Diabetes is the seventh leading cause of death in the United States.

African Americans, Hispanic/Latino Americans, and Native Americans are at a higher risk for both type 2 diabetes and gestational diabetes. These health disparities gain an alarming momentum when you see that more African-American and Hispanic people are testing positive for COVID-19 and are being hospitalized at higher rates than whites.

Diabetes and COVID-19

Scientists and officials have revealed that most cases of the disease are mild. Most serious cases are in patients with underlying health conditions, such as hypertension, obesity, and diabetes.

This is a serious consideration in the US, because the CDC reports that 60 percent of U.S. adults have a chronic condition. More people in the ICU for COVID-19 had diabetes than any other condition.

Diabetes makes outcomes worse by weakening the immune system, especially if the infected person’s diabetes is not well managed.  This means that their bodies have to work even harder to fight off the infection.

Stress can cause another problem with immune defense systems and blood sugar levels. It can cause both to grow out of control. This can make diabetes even worse. The American Diabetes Association has more information on How COVID-19 Impacts People with Diabetes.

This is an opportunity for community-focused health workers to step in and help. By helping patients understand how to interpret their blood sugar readings and helping them eat nutritiously, they can both help them manage diabetes and boost their overall immune system.

Diabetes and Oral Health

The relationship between oral health and diabetes is more pronounced than many people realize. Good dental hygiene is associated with a lower diabetes risk, according to a study. On the other hand, people with a dental disease, such as periodontal (gum) disease, are at a higher risk of developing it. One surprising statistic says “In individuals missing 15 or more teeth, this risk increases to 21%.”

CHWs can help by educating clients and caregivers on good oral health habits, including frequent brushing, daily flossing, and avoiding sugary snacks. Many people are not seeing dental workers because of cancellations and coronavirus risks, which means they need to be extra vigilant with their oral hygiene to avoid the need of seeing a professional.

More information on oral health and its relationship with other chronic disease is in the course Oral Health Disparities.

Diabetes is bad for people in the U.S. more than ever before. Community health workers are more important than ever when it comes to avoiding and managing diabetes and prediabetes.

If you’re not including training about diabetes in your CHW workforce, start now. If you’re interested in building a diabetes education program for your team with these or other courses, contact us to learn how to add certified training to your program. Our team will be in touch ASAP to schedule a time to chat.

Image by Myriam Zilles from Pixabay