Hunger Vital Sign

About:

The Hunger Vital Sign is a screening tool for identifying households at risk of food insecurity and poor health outcomes linked to food insecurity. The creation of this tool offers valuable insights into how we can make health-related social needs visible, start conversations with patients, and build community networks to address a range of factors that impact health. 

This Explainer Series was created by the Vermont Food Access and Health Care consortium (FAHC) as part of a strategic planning grant for integrating food access into rural health care systems. It followed a 2020-2022 review of systems currently in place in Vermont health care practices, results are available here. This Explainer Series responds to two recommendations:

  1. Develop a common set of materials from which trainers and quality improvement specialists can develop practice-specific approaches to social risk screening, which can both minimize duplication of effort and ensure that health care practices & their staff receive consistent information.

  2. Ensure Vermont’s approach to integrating food access and health care is aligned with national strategies and prepares health care practices for future federal policymaking, including use of SDOH data in designing alternative payment models.

We have structured this series to offer a national framework for background that should apply to any region. At a state level, we include an example of bringing Hunger Vital to Vermont. We also provide specific examples of putting HVS into practice and how the national dialogue connects to Vermont in our “HVS In Practice” modules. 

These materials were developed to be used in trainings. Any interested organization can adapt the content to meet their specific informational needs. For example, this version of the series focuses on the work of the HVS National Community of Practice, while these sample e-mails highlight single pieces of the HVS explainer. Please credit Bi-State Primary Care Association as the original producer and copyright holder when using or adapting Hunger Vital Sign Explainer Series materials.

Bi-State Primary Care Association is not the creator of the Hunger Vital Sign itself. These materials profile the work of other organizations. The correct citation for the Hunger Vital Sign is:

Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers A. F., Frank, D. A. (2010). Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics, 126(1), 26-32. doi:10.1542/peds.2009-3146.

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Hunger Vital Sign Questions:

“Within the past 12 months we worried whether our food would run out before we got money to buy more.” Often / Sometimes / Never True.


“ Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.” Often / Sometimes / Never True.

Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers A. F., Frank, D. A. (2010). Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics, 126(1), 26-32. doi:10.1542/peds.2009-3146.

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Implementing Food Insecurity Screening:

See also the tools at the UCSF Social Interventions Research & Evaluation Network (SIREN) resource library and report State of the Science on Social Screening in Health Care Settings (2022)

Hunger Vital Sign Explainer Series:

The following sections offer short audio conversations, transcripts, and reference materials to walk through different aspects of Hunger Vital Sign and answer common questions. Review the series in order, or pick and choose the sections of most relevance. A summary of key points is included.

 

Part 1: Creation of the Hunger Vital Sign Tool - Richard Sheward, Children’s HealthWatch

See all featured Hunger Vital Sign resources collected by Children’s HealthWatch here.

3: Creating a Valid Tool

Audio & Transcript | Summary of Key Points

Related Materials:

Part 2: Partnering on Hunger Vital Sign in Vermont - Katy Davis, Hunger Free Vermont

See more information on Hunger Free Vermont’s programs for health professionals here.

 

7: Partnering with Hunger Free Vermont

Audio & Transcript | Summary of Key Points

8: Conversations About Food Insecurity

Audio & Transcript | Summary of Key Points

9: The Bigger Picture

Audio & Transcript | Summary of Key Points

Previous Podcast Episodes with Katy Davis:

For more information about Hunger Free Vermont: hungerfreevt.org

 

Related Materials:

Outreach Systems (VT) - Information to guide referrals to food programs.

Community Food Security (VT):

School Meals Resource Hub (VT)

Example of Work on 3SquaresVT / SNAP Federal Nutrition Assistance (VT):

Landscape of Nutrition Services (VT, 2022)

Conversations about food insecurity


Using Community-Level Food Insecurity Data in Policy Work:

Building from Federal Food Access Programs to Eliminate Hunger:

Part 3: Accountable Health Communities Model - Katherine Verlander, CMS Innovation Center

 

Federal Policy & Social Risk Screening - Hunger Vital Sign National Community of Practice

Co-convened by Children’s HealthWatch and the Food Research & Action Center (FRAC), the NCoP works to facilitate conversations and collective action among a wide-range of stakeholders interested in addressing food insecurity through a health care lens. The overarching goal and purpose of the NCoP is to rapidly share leading best practices and data on food insecurity screening/intervention activities and strategies to scale what works. These notes are from the fall, 2022, quarterly meeting.

Meeting Topics:

During this virtual meeting, The Hunger Vital Sign National Community of Practice discussed recent rulemaking by CMS, and the publication of preliminary lessons from the CMS Innovation Center's Accountable Health Communities (AHC) Model, marking a new phase of bringing food insecurity screening to scale nationally.

This conversation covered the recent Hospital Inpatient Quality Reporting guidance from CMS for SDOH screening, Global Malnutrition Composite Score, and CMS' request for information to support future changes. We also introduced a new resource profiling the research behind food insecurity within the AHC Model. This model was cited by CMS in its recent decisions, and a recent explainer series attempts to deepen understanding of social risk screening tools at the healthcare practice level while also gathering feedback on specific practice questions around implementation.

Presentations:

Vermont Implementation:

Vermont hospital preparedness for implementing SDOH screening per the CMS IPPS guidance was one topic addressed in our 2022 Food Insecurity Screening Systems review.

We did not directly review Registered Dietitian protocols as part of inpatient services. However, we did conduct a general review of nutrition service access, available here.

The 2022 Bi-State Primary Care Association comments on the CMS proposed rule for social risk screening are available linked from this update; notes on options to help practices gauge system maturity are found in this HVS Implementation Benchmarks brief.

Measuring Impact of Food Interventions - Hunger Vital Sign Research Update

The Friedman School of Nutrition Science and Policy hosted a virtual conference on food security measurement to recognize 25 years of household food security measurement. The conference featured presentations on research supported by the U.S. Department of Agriculture, in cooperation with Tufts University and the University of Missouri.

Abbreviated Scale for Measuring Food Security:

The Friedman School of Nutrition Science and Policy hosted a virtual conference on food security measurement to recognize 25 years of household food security measurement. The conference featured presentations on research supported by the U.S. Department of Agriculture, in cooperation with Tufts University and the University of Missouri. Papers will appear in a special issue of the Journal of the Academy of Nutrition & Dietetics (JAND).

Interview with Dr. Ana Poblacion & Richard Sheward - On the research into an Abbreviated Child and Adult Food Security Scale, presented as part of the April 4th conference. Audio & Transcript

See all research presentations online:

Testing Impact of Food Interventions:

The research discussed in this podcast highlights the difference between HVS (a risk screening tool) and a food security scale. HVS returns a binary yes/no on whether a patient is at risk for food insecurity. To know whether an intervention had an impact on food security requires measuring food security levels before and after, such as with the abbreviated scale discussed by Dr. Poblacion.

The Nutrition Incentive Hub provides details on using abbreviated food security scales for evaluating the impact of food & health interventions. Learn more about of the USDA food security measures & their applications at the USDA Survey Tools site.

The FAHC Project Evaluation resource pages provide examples of this and other structures to evaluate impact of food interventions on participants health / health risks.

Vermont Implementation:

Strategic planning by the FAHC reviewed common evidence-based models for integrating food into health care, with analysis provided on our homepage VTFoodInHealth.net.

Our work included reviewing key data feedback loops needed for assessing the impact of food-based interventions on the intended health outcomes. We did not limit our analysis to food interventions that address USDA-defined food insecurity. We also considered more complicated dietary needs & temporary barriers to food (such as limited mobility following a hospital stay), along with access to clinical nutrition services and chronic condition management services. We also included evaluations used to track implementation. See, for example, this broad overview.

At the time of completing FAHC strategic planning we were still working on risk screening and closed loop referrals to resources and had not progressed to adding food security evaluations.

Using this Resource

We encourage other organizations and states to use this series as a starting point for developing their own resources on implementing social risk screening tools. For this reason we have adopted a Creative Commons license allowing distribution, remixing, and adaptation of the work. We ask that the original work be recognized as produced by Bi-State Primary Care Association. Please contact Bi-State Primary Care Association (bistatepca.org) for more information.

Podcast Script and Narration 

Interviews, script, and narration by Helen Labun (helen.labun@gmail.com) as part of the Policy in Plainer English podcast series.

Audio Editing and Post-Production Provided By Evergreen Audio

Audio editing and post-production by Evergreen Audio. Evergreen Audio is an independent production company that provides a full range of podcast production services. Find out more at their website.

Funding Source

The Hunger Vital Sign toolkit is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,040,000 and as part of another award totaling $189,892; 0% is financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

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