Learning from the food brigade: pivoting pediatric care to meet basic food security needs during COVID

Summary

The goal of this project is to better understand how food systems and traditional health care services can work together to support the needs of food-insecure (defined as uncertain of having, or unable to acquire, enough food to meet the needs of all household members because of insufficient money or other resources for food) families, and to share these lessons learned with relevant UW, Seattle-area, and WA state stakeholders. The Odessa Brown Children’s Clinic (OBCC) is a community health clinic located in the Central District of Seattle that provides low-income and predominately BIPOC families with free or low-cost medical, dental, mental health, and nutrition services for children from prenatal care-21 years. Addressing fundamental causes of ill health is a major focus of this clinic, and as a result they often partner with non-profit and governmental organizations to address basic needs such as food security and stable housing. At the beginning of the COVID-19 pandemic when everything shut down, OBCC staff recognized that many of their already low-income families would be unable to work or lose their jobs. Many families already struggled to navigate government programs pre-pandemic, and OBCC also serves undocumented families who are further limited in their ability to access government relief programs. In order to respond to this crisis, OBCC staff stopped seeing children for standard wellness visits (besides vaccinations) and pivoted almost entirely to basic needs services, the primary of which was food security. Staff working on this, or the “Food Brigade”, did this through a variety of approaches – e.g. partnering with other food systems stakeholders to gather food for home delivery, and linking families to community-based organizations also providing food for families in need. Because of the current Black Lives Matter movement and increased awareness around systemic racism as the fundamental driver of negative health outcomes, we expect (and hope) to see more health care systems focus on addressing social needs (e.g., food security, housing) of patients as part of the basic standard of care. OBCC has been at the forefront of this movement – the clinic was founded in 1970 by Odessa Brown, a Black community organizer who saw a need for culturally-relevant and high-quality health care in her Central District community. We are requesting funding in order to conduct interviews with 1) OBCC clinic staff and 2) food-insecure families about their experiences during the COVID-19 pandemic and meeting basic food security needs. Interviews with families will be conducted in both English and Spanish, with a particular focus on families with undocumented household members. We plan to share the successes and lessons learned with other community stakeholders (e.g. health care systems, other hunger and food systems-focused organizations, policymakers) to start a dialogue around increasing coordination to meet the needs of food-insecure families. With 20% of UW students across all three campuses reporting that they ran out of food and didn’t have the money to buy more prior to the pandemic, the results of this work will directly impact the health and well-being of UW students.

Background

While definitions of food insecurity include the traditional concept of hunger, food insecurity also includes needing to skip or reducing the size of meals, purposely compromising nutrition by purchasing lower quality foods, and seeking food from emergency food sources. Approximately 15.8 million households in the United States experience food insecurity each year; communities of color are both at higher risk for food insecurity overall and are disproportionately affected by the negative health outcomes that result. Chronic food insecurity is associated with a number of chronic diseases in both adults and children including obesity, diabetes, hypertension, hyperlipidemia, and asthma. Prior to the pandemic, 36.8% percent of low-income households at or below 130% of the federal poverty line were food insecure at some point in the last year. At the start of the pandemic, in Washington state the number of individuals experiencing food insecurity nearly doubled from 85,000 to 1.6 million, one-quarter of whom were children. As the pandemic continues and we head into another economic crisis, taking the time to better understand, share, and address integrating food security initiatives in health care settings is critical to ensuring the most vulnerable families in our community are reached and served. We want to share stories of this from OBCC because they represent an excellent example how to provide culturally relevant, high quality care and develop trusting relationships with families marginalized by and excluded from traditional health care systems.

Impact measured

These interviews are the first part of a multi-step project meant to increase dialogue around food justice and integrating food systems-focused organizations with health care settings. Many of our intended impacts are long-term and would require policy changes, which we are unlikely to be able to assess during the project timeframe. However, we do have a few shorter-term measures that will indicate we are on the way to reaching those long-term goals: 1. Number of completed interviews with clinic staff (n=~9) and heads of household (n=~16). 2. All transcripts coded and analyzed using traditional qualitative methods (all interviews will be audio recorded). 3. For student mentorship, whether the student is able to and feels comfortable conducting interviews on their own by the end of the project. Additionally, if the student is interested, their ability contribute to coding and analysis of transcripts will also be an indicator success. 4. Published report and policy brief of findings vetted by OBCC staff and families disseminated to relevant stakeholders. Additional communication materials may be developed in partnership with OBCC staff and families. 5. Our ability to use these findings to hold further conversations with other stakeholders, namely other health care organizations/systems, food systems-focused organizations, and policymakers. The number of stakeholders reached and number of meetings/conversations held is how we anticipate measuring this. In particular, we are hoping to present our results to the City of Seattle sugar-sweetened beverage tax working group. 6. To the degree we are able, any actions taken or changes made as a result of these conversations. In particular, based on initial conversations with OBCC staff, we hope to see more strategic alignment and coordination between COVID food security initiatives. The result of this would be more individuals able to access food assistance resources. We plan to complete these tasks by the end of October 2020. Additionally, back in the fall, we received a small grant to work with BIPOC food-insecure families to find out what food justice would look like to them and identify priorities for policy advocacy work. The plan was to use Photovoice, which is a community based participatory qualitative approach in which participants take photographs to visually represent, communicate, and critically examine a given topic. Participants bring these photos with them to small group discussions where they lead the discussion, develop the findings together and share the photos and results with community stakeholders (typically a public community forum) to identify further action. Due to COVID, this project was put on hold. However, our secondary goal with these interviews is to identify how we can adapt this original project for an online/digital format due to COVID and the need for social distancing. Our ability to successfully adapt this Photovoice project based on families’ needs and preferences is an additional secondary goal of this project. Depending on COVID-19, we would also like to host a community forum with the families and their photos that would likely be held at Othello Commons and be promoted to the entire UW community.

Budget

1. $1,100; Funding for graduate or undergraduate student assistant; 55 hours* $20/hour rate
2. $1,900; Funding for postdoc (me); 70 hours*$27/hour rate

Matching funds

We have a $5,000 grant from the UW Center for Communication, Difference, and Equity for the original Photovoice project. Since the project has shifted due to COVID, we plan to use most of that funding for incentives to distribute to OBCC staff and families following the interviews and for the Photovoice sessions down the line. This funding can also be used to support a student (which we plan to tap into if the funding from this is not enough). It cannot be used to support my time.

Additional details

This project is not part of my current postdoctoral work and I do not receive any funding/salary support for this work at the moment, I volunteer my time. I did my PhD in Health Services at UW (graduated in December 2019), and have volunteered with Odessa Brown on food security projects with BIPOC families since 2016. I am working towards getting funding to support my work/time, but do not have any yet. National Institutes of Health postdoc salaries are not cost-of-living adjusted, so I have to take on side jobs support myself. Essentially getting even some funding for this project allows me to commit time outside of my postdoc appointment to this project instead of other jobs. Additionally, my career goal is to be a professor at a university, and as a multiracial POC who is part of a Black family, I am also deeply committed to mentoring BIPOC students as part of my job. Finally, I just wanted to say thank you for being open to supporting my own and a student’s time for this project! I do a lot of community-based work/research, and even though folxs’ time, including my own, is always the largest expense I have on these projects, it is also the hardest get support for.