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Talking About Hunger with Patient Families in Suburban Primary Care Practices

Q+A with CHOP’s Deepak Palakshappa, MD

Deepak Palakshappa, MD, MSHP
Instructor, Children’s Hospital of Philadelphia

As part of his work at Children’s Hospital of Philadelphia (CHOP), Dr. Palakshappa has focused on understanding how health systems can most effectively screen and address food insecurity and other social determinants of health. Here, he reflects on his experience talking about hunger with patient families in suburban primary care practices.

Question:  What are the most compelling results you have seen from your work on food insecurity?

We conducted a mixed methods study evaluating the feasibility, acceptability, and impact of screening for food insecurity in suburban primary care practices. We found it was feasible and acceptable, for both clinicians and families, to screen and address food insecurity in suburban practices, but better approaches to connect families in need to local resources may be needed to maximize the effectiveness of screening programs in suburban settings.

Question:  Can you provide an anecdote or patient story that best exemplifies the difference you have made in the life of a child or family?

Several parents have told us about the shame, frustration, and embarrassment that they often feel about not being able to provide consistent access to food for their children. Discussing food insecurity with their trusted clinician though, can help alleviate some of these feelings of shame. As one mother said, “I love my pediatrician. He made me feel okay with it and said a lot of people are experiencing food insecurity.” Another mother said, “It was just good to find that someone cared.”

Question:  What types of resources are necessary to overcome challenges in this type of work?

It is important to understand what the greatest needs of your patient population are and how to provide those resources (whether it is emergency food or assistance with signing up for Supplemental Nutrition Assistance Program) at the initial point of care.

Question:  In your opinion, how does health care need to change in order to provide care that promotes healthy populations?

Health care systems need to understand how they can more effectively connect to community resources and public health agencies in order to address social determinants of health. In order to effectively address the social factors that affect patient’s health, health care systems need to create strong, sustainable clinical-community linkages.

Question:  What advice would you like to give to others interested in addressing social determinants that contribute to poor health?

There is often hesitancy from clinicians and providers that families will be embarrassed or uncomfortable discussing unmet social needs. What we have found is that while families are initially surprised by social-determinant-of-health screening, they ultimately feel comfortable discussing unmet social needs with their trusted clinician and welcome any assistance health care systems are able to provide.

For a very quick overview of how CHOP and seven other Philadelphia-area hospitals and health systems are collaborating to pilot approaches to food insecurity screening and intervention, review this infographic.

Deepak Palakshappa, MD, MSHP, is an instructor of general pediatrics and a faculty member at PolicyLab and the Center for Pediatric Clinical Effectiveness at CHOP. His work includes publications about screening for food insecurity, including perceptions of clinicians and families. For more information about this work, please contact PolicyLab.

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