Risk Screening:
[There is a more recent version of the Food Insecurity Screening information - linked here]
The Vermont Food Access and Health Care Consortium worked with Children’s HealthWatch and Hunger Free Vermont to produce a detailed explainer kit for Hunger Vital Sign, the most common screening tool for food insecurity. Just here for the highlights? Those are below.
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.A screen is positive when often or sometimes is answered for either of the questions.
A few key points to keep in mind:
Risk screening tools are only meant to be a first step; positive screens always lead to more detailed review of next steps. If your process doesn’t go from risk screen to second step, ask why the screen is in there in the first place. The graphic linked here shows an example of different paths a positive “Hunger Vital Sign” might lead to.
Risk screening tools are different from diagnostic tools - they do not provide details on a condition. The graphic linked above includes examples of diagnostics in the referral pathways.
For example, if you are trying to measure changes in food insecurity over the course of a food program, the shortest tool that will show you that is the 6-question version of the USDA Household Food Security Survey (HFSS).
The Hunger Vital Sign is validated against the USDA Household Food Security Survey (HFSS) for the following things:
Likelihood that someone is experiencing food insecurity (ie a positive screen is in the “food insecure” range on HFSS)
Likelihood that someone is not experiencing food insecurity (ie a negative screen is negative)
Food security definitions include a range of levels of security. Individuals and households may move through this range over the course of a lifetime. Saying that someone is food secure / insecure from a Hunger Vital Sign screen is a form of shorthand meant to indicate whether a follow up conversation is warranted - see the first bullet point.
Another place where we often see HVS screening is in aggregated results to suggest trends in community level food security ahead of the USDA reports. Major disasters / pandemics are one example of where you might want a quick snapshot in time to inform the emergency response. If the system works well, there’s a signal of a spike in food insecurity, the region responds quickly to bring that down, and the USDA official research later shows that the trend stabilized.
The Hunger Vital Sign is also validated against a range of negative health outcomes established through other research as being connected to food insecurity. In other words, it’s not only accurate in predicting risk of food insecurity, it also predicts risk of poor health.
This correlation was especially relevant in the original research that focused on children, because poor health outcomes could take years to appear and by then prevention would be too late.
As part of developing screening tools, researchers test how brief they can be while still remaining within acceptable parameters for validity. Changing the Hunger Vital Sign introduces a large margin of error.
Two common changes are: only asking one question or changing the response to yes / no. Both of those changes lead to significant under-reporting of food insecurity.
Health care practices assist their patients with many health-related social needs - food access, transportation, housing, affording medications, and other concerns. Sometimes the Hunger Vital Sign appears in a screening tool that covers a range of these factors, the CMMI Accountable Health Communities project provides more details on developing these broader screens.