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Food Insecurity is the first of three Social Determinants of Health domains the Gravity Project will address during Phase 1 work.  

Community Homework


TaskInstructions and Due Dates

Review the Food Insecurity Master List and submit Consensus Votes.  Click here for instructions, downloads and vote submission form.

(Admin note:  the link above will be inactive until voting opens.)

  • Consensus voting will open at 5pm ET/2pm PT on November 21.
  • All votes should be submitted by 8pm ET/5pm PT on December 5.
  • Email questions or membership status change requests to gravityproject@emiadvisors.net


Click here for food-related terminology, definitions and source materials. These are the definitions and descriptions we will be using to guide community discussions around food insecurity data elements.

Working Draft Data Elements


This is where we will post data items that have been submitted and adjudicated.  These data elements will be the focus of our community discussions.  If there are data elements you are aware of that are not included here, please click here to submit them as soon as possible.

Food Insecurity Master List

Consensus Voting for the Food Insecurity Master List is now open November 21 through December 5.  Click here to download the document and vote on it.


Adjudicated Data Element Submission Statistics

Below is a list of how many of each food insecurity data element type has been adjudicated as of the date listed.

DateScreening Tool/Questions

Diagnosis/Needs

Goals

InterventionsTotal
17Oct1956 tools / 203 questions6013147220
12Sept1956 tools / 191 questions6012146218
29Aug1941 tools / 126 questions4411103158
15Aug1936 tools / 95 questions429100151
01Aug1928 tools / 71 questions38987134
18Jul199 tools / 34 questions

23

42890

Interventions Framework


This is an updated draft of the framework for intervention data element concepts. Thank you to everyone who submitted comments on the initial version!

Intervention Examples

  • Referral to:
    • Role (case manager, care navigator)
    • Organization (community action agency)
    • Program (senior congregate meal, SNAP)
  • Provision of: e.g., food, fresh fruit and vegetable voucher
  • Counseling: e.g., barriers to, readiness for, cognitive behavioral therapy
  • Education: e.g., nutrition related skills education
  • Assessment for/of: e.g., food insecurity, patient goals
  • Evaluation of eligibility for: e.g., WIC, home delivered meals
  • Assistance with application for: WIC, SNAP
  • Coordination of: e.g., care plan, care team

Screening Tools


Screening Tool

Description

Source(s)

AHC

The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) have made the Accountable Health Communities (AHC) Health-Related Social Needs (HRSN) Screening Tool to use in the AHC Model. This screening tool assesses 5 core domains:

  • Housing instability
  • Food insecurity
  • Transportation problems
  • Utility help needs
  • Interpersonal safety

https://innovation.cms.gov/Files/worksheets/ahcm-screeningtool.pdf

CommunityConnect

The CommunityConnect Social Needs Screening Tool was developed to capture social, medical, and behavioral health needs. The tool was designed to promote motivational interviewing, client engagement and rapport, allowing case managers from a range of disciplines to use the screening telephonically and in-field with patients.  The screening consists of 42 questions and crosses 10 domains including: housing instability, food security, transportation, interpersonal safety, vision & dental, behavioral and social support, medical, finances, education and employment, and legal needs.

FIES-SMThe Food Insecurity Experience Scale (FIES) Survey Module (FIES-SM) consists of eight questions regarding people's access to adequate food, and can be easily integrated into various types of population surveys.http://www.fao.org/3/a-bl404e.pdf
Health Information National Trends Survey (HINTS)HINTS collects data about the use of cancer-related information by the American public. These data provide opportunities to understand and improve health communication.https://hints.cancer.gov/data/survey-instruments.aspx
Health LeadsThe Health Leads Social Needs Screening Toolkit is a comprehensive blueprint for health systems seeking to identify and screen patients for adverse social determinants of health.

https://healthleadsusa.org/resources/the-health-leads-screening-toolkit/

HFIASHousehold Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide provides a simple and user-friendly approach for measuring the impacts of development food aid programs on the access component of household food insecurity. The guide includes a standardized questionnaire and data collection and analysis instructions. The HFIAS is composed of a set of nine questions that have been used in several countries and appear to distinguish food insecure from food secure households across different cultural contexts. The information generated by the HFIAS can be used to assess the prevalence of household food insecurity (access component) and to detect changes in the food insecurity situation of a population over time.https://www.fantaproject.org/sites/default/files/resources/HFIAS_ENG_v3_Aug07.pdf
Household Food Security Survey Module (HFSSM)

The HFSSM focuses on self-reports of uncertain, insufficient or inadequate food access, availability and utilization due to limited financial resources, and the compromised eating patterns and food consumption that may result.  The HFSSM contains 18 questions about the food security situation in the household over the previous 12 months. Each question specifies a lack of money or the ability to afford food as the reason for the condition or behaviour. The questions range in severity from worrying about running out of food, to children not eating for a whole day.

Note:  This is a Canadian survey adapted from the US Food Security Measurement Method.

https://www.canada.ca/en/health-canada/services/food-nutrition/food-nutrition-surveillance/health-nutrition-surveys/canadian-community-health-survey-cchs/canadian-community-health-survey-cycle-2-2-nutrition-2004-income-related-household-food-security-canada-health-canada-2007.html#appa
Hunger Vital SignThe Hunger Vital SignTM (HVS) is a validated 2-question food insecurity screening tool that allows clinicians to accurately identify households at risk of food insecurity and address patient needs appropriately.https://childrenshealthwatch.org/wp-content/uploads/CHW_HVS_whitepaper_FINAL.pdf
IHELPIHELP is a tool for collecting pediatric social histories. It includes both household needs (financial strain, insurance, hunger, domestic violence, housing stability and housing conditions) and several child-specific domains (child educational needs, child legal status, and power of attorney/guardianship).https://sirenetwork.ucsf.edu/sites/sirenetwork.ucsf.edu/files/IHELP_QUESTIONS.docx
Kaiser Permanente Your Current Life Situation (YCLS)Kaiser Permanente's Your Current Life Situation (YCLS) survey was developed to capture a range of social and economic needs, including living situation, housing, food, utilities, childcare, debts, medical needs, transportation, stress, and social isolation.https://sirenetwork.ucsf.edu/sites/sirenetwork.ucsf.edu/files/Your%20Current%20Life%20Situation%20Questionnaire%20v2-0%20%28Core%20and%20supplemental%29%20no%20highlights.pdf
KleinmanDr. Arthur Kleinman determined that a person's own opinions and viewpoints can affect their health.  This set of open-ended questions has been used to explore how and why individuals believe what they do about illnesses and treatments to support shared decision making.

https://www.ncbi.nlm.nih.gov/pubmed/17660098

http://files.professionalchaplains.org/conf/2018/workshops/handouts/SA2.04_2018_Conf_90M_Handout_2.pdf

NC Department of Health and Human Services (NCDHHS)DHHS, in partnership with a diverse set of stakeholders from across the state, developed a standardized set of SDOH screening questions.https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/screening-questions
NC Safe Environment for Every Kid (SEEK)SEEK is an evidence-based, practical model for improving primary healthcare for children and their families. SEEK helps primary healthcare professionals (PCPs) address common psychosocial problems, such as parental depression and substance use. The SEEK Parent Questionnaire-R (PQ-R) screens for the targeted psychosocial problems.

https://files.nc.gov/ncdhhs/documents/SDOH-Screening-Tool_Paper_FINAL_20180405.pdf

https://files.nc.gov/ncdhhs/documents/SDOH-Screening-Tool_Paper_FINAL_20180405.pdf

Medicare Total Health Assessment (THA)The Medicare Total Health Assessment (MTHA) is a survey used to assess several things, including food insecurity, in the elderly. The survey is offered to Medicare Advantage members in advance of Annual Wellness Visits that are a CMS-mandated benefit offering.https://sirenetwork.ucsf.edu/sites/sirenetwork.ucsf.edu/files/Medicare%20THA%20questionnaire%20v2%20%28rvd%2012-5-14%29%20with%20Sources.pdf
PRAPAREThe Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) is a national effort to help health centers and other providers collect the data needed to better understand and act on their patients’ social determinants of health.

http://www.nachc.org/wp-content/uploads/2018/05/PRAPARE_One_Pager_Sept_2016.pdf

http://www.nachc.org/wp-content/uploads/2015/06/WANTK.pdf

SWYCThe Survey of Well-being of Young Children (SWYC)™ is a freely-available, comprehensive screening instrument for children under 5 years of age.https://www.floatinghospital.org/The-Survey-of-Wellbeing-of-Young-Children/Age-Specific-Forms
US Household Food Security 6 ItemSix-Item Short Form of the Food Security Survey Module
For surveys that cannot implement the 18-item or 10-item measures, this "Short Form" 6-item scale provides a reasonably reliable substitute. It uses a subset of the standard 18 items. This is the same six-item questionnaire that is in the Guide.

https://www.ers.usda.gov/media/8281/short2012.doc

https://www.ers.usda.gov/media/8282/short2012.pdf

US Household Food Security 10 ItemU.S. Adult Food Security Survey Module
(10 items) Three-stage design with screeners. Screening keeps respondent burden to the minimum needed to get reliable data. Most households in a general population survey are asked only three questions. The questionnaire has been modified very slightly from that specified for households without children in the Guide.

https://www.ers.usda.gov/media/8280/ad2012.doc

https://www.ers.usda.gov/media/8279/ad2012.pdf

US Household Food Security 18 ItemU.S. Household Food Security Survey Module
(18-items) Three-stage design with screeners. Screening keeps respondent burden to the minimum needed to get reliable data. Most households in a general population survey are asked only three questions (five if there are children in the household). The questionnaire has been modified slightly from that in the Guide, and the questions have been re-ordered to group the child-referenced questions after the adult-referenced questions.

https://www.ers.usda.gov/media/8278/hh2012.doc

https://www.ers.usda.gov/media/8279/ad2012.pdf

We CareWE CARE (Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education) is a clinic-based screening and referral system developed for pediatric settings. The 12-question WE CARE screening tool assesses needs in 6 domains: parental educational attainment, employment, child care, risk of homelessness, food security, and household heat and electricity.http://sirenetwork.ucsf.edu/sites/sirenetwork.ucsf.edu/files/HL%20BMC%20Screening%20Tool%20final%20%28English%29.pdf

Terminology, Definitions and Resources


Term

Definition or Description

Source(s)

Food access

There are many ways to measure food store access for individuals and for neighborhoods, and many ways to define which areas are food deserts—neighborhoods that lack healthy food sources. Most measures and definitions take into account at least some of the following indicators of access:

  • Accessibility to sources of healthy food, as measured by distance to a store or by the number of stores in an area.
  • Individual-level resources that may affect accessibility, such as family income or vehicle availability.
  • Neighborhood-level indicators of resources, such as the average income of the neighborhood and the availability of public transportation.

https://www.ers.usda.gov/data-products/food-access-research-atlas/documentation/#definitions

https://www.ers.usda.gov/publications/pub-details/?pubid=82100

Food desert

The Food Access Research Atlas maps census tracts that are both low income (li) and low access (la), as measured by the different distance demarcations. This tool provides researchers and other users multiple ways to understand the characteristics that can contribute to food deserts, including income level, distance to supermarkets, and vehicle access.

https://www.ers.usda.gov/data-products/food-access-research-atlas/documentation/#definitions

https://www.ers.usda.gov/publications/pub-details/?pubid=82100

Food security

Access by all people at all times to enough food for an active, healthy life. 

https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/
Food security range:  high food securityNo reported indications of food-access problems or limitations.https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security/#ranges
Food security range:  marginal food securityOne or two reported indications—typically of anxiety over food sufficiency or shortage of food in the house. Little or no indication of changes in diets or food intake.https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security/#ranges
Food insecurityLimited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.

Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide To Measuring Household Food Security, Revised 2000. Alexandria, VA: US Department of Agriculture, Food and Nutrition Service; 2000.

https://www.fns.usda.gov/guide-measuring-household-food-security-revised-2000

Food insecurity range: low food security

Reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake.

https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security/#ranges
Food insecurity range:  very low food securityReports of multiple indications of disrupted eating patterns and reduced food intake.https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security/#ranges
HungerTerm should refer to a potential consequence of food insecurity that, because of prolonged, involuntary lack of food, results in discomfort, illness, weakness, or pain that goes beyond the usual uneasy sensation.https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security/#CNSTAT


Data Element Concept Leads



Role

Name

Organization

Value Set Subject Matter Expert

Linda Hyde

EMI Advisors, LLC
Value Set Subject Matter ExpertLisa NelsonEMI Advisors, LLC
Food Insecurity Subject Matter ExpertSarah DeSilveyLarner College of Medicine at the University of Vermont
Food Insecurity Subject Matter Expert

Donna Partel

Academy of Nutrition and Dietetics
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1 Comment

  1. Unknown User (wmswan)

    Definitions for Intervention Framework need to clarify what goes in the blanks or are blanks needed at all. Otherwise seems like a good start


    Bill Swan