Bronx Health REACH and the Institute for Family Health Urban Horizons Family Health Center Help Address Food Insecurity amongst Patients

This post was written by Mickelder Kercy, Evaluation Assistant for Bronx Health REACH.

Bronx Health REACH and the Institute for Family Health’s Urban Horizons Family Health Center (IFH) are implementing an innovative program that aims to bridge the gap between a health center and community-based organizations (CBOs) to improve patients’ health behaviors and health outcomes.

This CDC-funded program will have two main components: a screening phase and a referral phase. At the IFH Urban Horizons Family Health Center, all patients who are 18 years and older will be screened to determine if they are food insecure.

Patients who identify as food insecure will meet with a physician who will then refer them to a case manager. The case manager will connect the patient with resources in the community using “Aunt Bertha,” an online platform that lists up-to-date information about community-based organizations, as well as tracks the referrals to ensure that the needs of the patient are met. Bronx Health REACH is developing partnerships with food pantries and soup kitchens near Urban Horizons Family Health Center to ensure that these organizations have the ability to serve our patients.

We are ideally looking for food pantries and soup kitchens that accept a wide range of clients, serve/provide healthy foods, and offer additional support services. The goal of this intervention is to provide patients who lack sufficient food at home to have access to, and consume, nutritionally healthy foods. This is important, as many of our patients suffer from diabetes, hypertension and obesity. One patient has told us, “I just accept what they (the food pantry) offer. There’s not a lot of really fresh food, only one fruit.” Another patient added, “They have old food and it is not healthy. We need to help people with illnesses to prevent chronic conditions.”

The Food Insecurity Screening and Referral Program will be monitored and evaluated by our evaluation team to measure the impact of the program. We will report on the number of patients screened positively for food insecurity at Urban Horizons Family Health Center and referred to CBOs in their neighborhood. Data will also be collected on the number of patients identified as food insecure who have a diagnosis of diabetes, hypertension or obesity.

When analyzing the data, our evaluation team will estimate the percentage of patients screened for food insecurity who are no longer food insecure after one year of receiving supplemental foods at the CBOs, as a means of measuring program impact. Additionally, we will evaluate the potential impact of the program on patient blood sugar level, blood pressure level and/or weight.

To ensure that patients are satisfied with the Food Insecurity Screening and Referral Program, a sample of patients who were part of the program will be interviewed during the first 6 months of the intervention. We will also solicit feedback from participating staff at the health center and CBOs.

Bronx Health REACH plans to share key findings from this innovative program. If the program is successful, the ultimate goal will be to scale up and implement the Food Insecurity Screening and Referral Program at all Institute for Family Health centers to help mitigate food insecurity amongst our patients and by doing so, improve their health status.