591 - “We need to have something better than just handing them a piece of paper”: Resident Physician Perspectives on Food Insecurity Screening in Pediatric Primary Care

Poster Number: 591
Publication Number: 591.208

Jennifer O'Neil Lambert, Children's National Hospital, Washington, DC, United States; Kofi Essel, Children's National Health System, Washington, DC, United States; Emilia Kaslow-Zieve, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Samantha Crawley, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Olanrewaju O. Falusi, Children's National Hospital, Washington, DC, United States

Background: Food insecurity (FI) is known to have deleterious effects on child physical, behavioral, academic, and emotional health. In 2015, the American Academy of Pediatrics recommended pediatricians implement a highly-sensitive, two-item screen to assess for FI at well-child visits. The rate of FI found by this screening tool at a network of pediatric primary care clinics in Washington, DC in 2020 was approximately equal to the national average despite many risk factors for FI in this under-resourced population.

Objective: This qualitative study sought to understand the experiences of resident physicians administering FI screening in order to identify modifiable barriers to effective screening.

Design/Methods: Fourteen semi-structured interviews were conducted with pediatric senior resident physicians working among three continuity clinics serving primarily publicly insured families. Interviews sought to understand resident physician perspectives on the screening process and barriers to effective FI screening. Interviews were recorded, transcribed verbatim, and qualitatively coded. Thematic analysis was then used to identify salient themes.

Results: Two major themes emerged: (1) Most participants reported that FI screening in pediatric primary care was important and felt positively about the universal nature and process of FI screening at their clinic; (2) Most had received education about the importance of FI on child health but reported minimal training regarding how to perform FI screening. The most significant barriers to effective FI screening cited by participants were: (1) the stigma associated with discussing FI and (2) concerns about the quality of nutritional referrals for families who screen positive.Conclusion(s): While pediatric resident physicians recognize the importance of universal FI screening in pediatric primary care, the stigma associated with FI screening and concerns about the quality of resource referrals inhibit their ability to screen families effectively. Health systems should develop practical education on screening for FI in a way that minimizes stigma and should implement closed-loop referrals to most effectively connect families facing FI to comprehensive resources.
Jennifer O'Neil Lambert CVJOL CV.pdf