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Success Story: Screening for Food Insecurity with Two Questions Results in Sixteen-Fold Increase in Food Resource Referrals

Learn how Hayward Wellness Center (HWC) consulted with experts to better identify patients at risk of food insecurity and improve referrals for food resources.

What Was the Problem?

The HWC clinic is a vital part of the community, providing health care services to a largely underinsured and low-income population. The health of the community is deeply impacted by a number of social determinants of health (SDOH), such as housing, transportation, and education. These factors play a role in the health status of the clinic's patients, and chief among these health-related social needs (HRSNs) is food insecurity.

HWC began working to train all clinicians and care team members on how to use diet and nutrition to address chronic medical conditions like hypertension, diabetes, and obesity. The clinic developed “produce prescriptions”, identified community resources, formed partnerships with a local urban farm to develop an on-site “food farmacy,” developed cooking group medical visits, and assisted patients in obtaining food stamps. The HWC clinic's model relied on clinical judgment to trigger the cascade of interventions to help. Screening for food insecurity at the patient level was inconsistent and sparse, resulting in low numbers of referrals for food resources to community partners.

Developing the Intervention

HWC decided to partner with HealthBegins to put together an Upstream Quality Improvement (QI) campaign that could improve the efficiency and quality of their clinical-community partnerships, and care for their food-insecure patients.1,2 HealthBegins helped HWC align their food insecurity efforts with their health system's specific Medicaid-driven strategic priorities. Together, they refined their food insecurity screening practices using the Hunger Vital Sign™, revised workflows, and defined care team roles.3,4 Additionally, HealthBegins introduced the concept of Community Health Detailing™ to accelerate the clinic's Upstream Quality Improvement campaign and increase the adoption of new HRSN-related behaviors and workflows among clinicians and care teams.

Community Health Detailing™ is adapted from traditional Academic Detailing, in which educators (“detailers”) deliver key messages that are tailored to a clinician's learning needs through a series of brief, semi-structured, on-site visits.5 Unlike traditional detailing methods that rely on professionals with technical health care expertise to serve as educators, the educators in the Community Health Detailing™ model are team members from medical and non-medical community-based organizations and/or community residents with lived experience dealing with HRSNs. These efforts culminated in the Community Health Detailing™ Campaign.


Once the team launched their Community Health Detailing™ Campaign to improve care for food-insecure patients, HWC quickly saw impressive results. In just over 3 months, HWC screened more than 3800 patients for food insecurity (a 94% screening rate). When screened with the Hunger Vital Sign™ tool, 1 in 5 patients were found to be at risk for food insecurity. Not only were patients in need identified, but referrals for community support increased as well. In the year prior, HWC sent 35 referrals for patients needing food support or resources. After the Community Health Detailing™ Campaign launched, HWC clinicians and care teams generated 550 food resource referrals in just over 3 months, a nearly 16-fold increase.

This early success, accomplished in such a short period of time, has inspired HWC leadership, clinicians, and care teams to look for other opportunities to better address the HRSNs of their community through the Upstream Quality Improvement campaign. HealthBegins actively supports health care systems across the country to deploy Upstream Quality Improvement strategies, campaigns, and tools to make meaningful, rapid progress toward addressing SDOH and improving patient care.

About the Organization

Situated across the bay from San Francisco in Alameda County is Hayward Wellness Center (HWC), an outpatient clinic that serves a diverse community as a Federally Qualified Health Center (FQHC) within the county health system.

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Article Information

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

 Introduction to upstream quality improvement. American Hospital Association YouTube page.  February 15, 2019. Accessed March 27, 2020. https://www.youtube.com/watch?v=C3YQp0HIWuU
 HealthBegins.  Accessed March 27, 2020. https://www.healthbegins.org
 The Hunger Vital Sign™. Children's HealthWatch.  Accessed March 27, 2020. https://childrenshealthwatch.org/public-policy/hunger-vital-sign
Hager  ER, Quigg  AM, Black  MM,  et al.  Development and validity of a 2-item screen to identify families at risk for food insecurity.  Pediatrics. 2010;126(1):e26–32. doi:10.1542/peds.2009-3146Google Scholar
 Community Health Detailing™.  Accessed March 27, 2020. http://www.communityhealthdetailing.org/home.html

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