Overview

Feed1st is a research and service program designed to alleviate food insecurity among patients

Organization Name

University of Chicago

Organization Type

• Academic Hospital
• Academic Medical Center

National/Policy Context

• Epidemiologic studies of U.S. adults, including informal caregivers, link food insecurity to mental health problems, including depression and anxiety, diet-sensitive chronic diseases, poor overall health, and impaired self-management.
• Among children, food insecurity has been associated with poor overall health as well as developmental problems, hospitalization, and emergency department utilization.
• Stigma is a fundamental cause of health disparities and commonly co-occurs with socioeconomic disadvantage and other forms of marginalization.

Local/Organizational Context

• According to Feeding America’s Map the Meal Gap Study, one in seven people in Cook County will experience food insecurity this year.
• In 2009, A Comer Children’s hospital chaplain brought it to the attention of the pediatrics physician leaders that patients’ parents were going hungry during their child’s hospital stay. A group of Pritzker medical students, Comer Children’s hospital staff, and University of Chicago faculty founded the program in 2010.

Patient Population Served and Payor Information

• Feed1st specifically serves the families of patients in the hospital. They found that many family members would go hungry while visiting their own family members in the hospital. Caregivers are:
  • 70% female
  • 45% non-Hispanic African American, 30% non-Hispanic white, 15% Hispanic
  • 90% English-speaking
• Communities served by Feed1st on the South Side of Chicago experience among the highest rates of food insecurity in the city.

Leadership

• Stacy Tessler Lindau, MD, MAPP – Project Principal Investigator
• Megan DePumpo, AM – Project Manager

Funding

• Feed1st receives funding from Comer Children’s Hospital and the Supportive Oncology Unit. They contribute to the operating cost to run the pantry.
• The University of Chicago Medicine provides the space for the pantries and accounts for this cost in its 501c3 community benefit reporting.
• Feed1st receives charitable donations, including monetary and food donations, from grateful patients and others through the University of Chicago, which is a 501c3 non-profit organization.
• Feed1st also has received funding from grants
  • In July 2018, Feed1st was awarded a $10,000 grant from the American Family Insurance Dreams Foundation.
  • In the past, they have been funded by a grant from an institutional philanthropic board and institutional research funds aimed at improving health and vitality in the region.
• Currently, research assistants and medical student volunteers provide assistance with research at reduced cost.
• Feed1st is applying for funding to study the effect of hunger on self-efficacy and healthcare utilization as well as hospital to home hunger mitigation.

Team Members Involved

• Administrative Assistant
• Volunteer

Workflow Steps

• Food pantries:
  • Food is purchased from the Greater Chicago Food Depository monthly.
  • All six pantries are self-serve and require no prescription, waivers or other credentials to receive food. They are open 24 hours a day, 7 days a week, 365 days per year to minimize stigma and barriers to entry.
  • Any member of the medical center community with access to the physical pantry locations, including employees, may use the pantries, no questions asked.

Budget

• $10K to $25K

Budget Details

• Food (12%):
  • The local food depository is a source of low-cost, non-perishable food. Increasingly, food pantries are working to optimize healthful and condition-specific nutrition options.
  • By partnering with the Greater Chicago Food Depository, they estimate $1 provides for about 3 meals. The amount of food required depends on pantry use and the hospital’s or clinic’s overall patient volume.
  • Perishable food is typically not viable for storage and self-service distribution in a hospital or medical center setting due to infection control concerns.
  • The medical center also operates a garden that yields produce in warmer weather and hosts a farmers market in the lobby area where food can be purchased.
• Space (13%):
  • Space for the pantry itself in the clinical area is both accessible to patients and does not disrupt the clinical workflow
  • Space and cost to store the food is dependent on square footage needed. This depends on where it is located, but it needs to be close to the pantry space and allow for large amounts of food to be stored.
  • Generally, it is more expensive per square foot to find space in an urban medical center than in suburban or rural settings.
• Staff (75%):
  • It takes about a 1.0 FTE of a college-educated person with local unit volunteers to keep shelves stocked to run all aspects of the operations of a single site, multi-pantry program.
  • Programs with multiple off-site pantries (pantries are distributed throughout a community) require more than 1.0 FTE and also have transportation/delivery costs.
  • They engage volunteers from their medical center volunteer program and medical school students from the University of Chicago Pritzker School of Medicine to stock the pantries day-to-day.

Where We Are

• The program is currently ongoing.
• As of September 2018, there are six Feed1st pantries: four on the inpatient floors of Comer Children’s Hospital, one in the emergency department of Comer Children’s Hospital and one in the Supportive Oncology Infusion Therapy suite of the Duchossois Center for Advanced Medicine at the University of Chicago Medicine.

Outcomes

• Research:
  • In 2011, Feed1st conducted a survey of a consecutive sample of 200 caregivers of hospitalized children at the University of Chicago Comer Children’s Hospital (Makelarski, AJPH, 2015). This study found that 44% of caregivers were food insecure in the 12 months prior to the hospitalization and an additional 11% became food insecure during the hospitalization. Overall, 39% of caregivers received SNAP benefits in the last 12 months. In the last year, a third of food insecure caregivers had used a community-based food assistance resource (35%) as had about one in ten food secure givers. Compared to white caregivers, African American caregivers were significantly more likely to be food insecure in the 12 months prior to the child’s hospitalization, adjusted for age, marital status and education.
  • In 2016, Feed1st conducted another study to test the diagnostic accuracy of the American Academy of Pediatrics (AAP) recommended food insecurity screener in their pediatric and adult emergency departments, where about 50% of hospital admissions are processed (Makelarski, AJPH, 2017). They found that, in an urban population with a high prevalence of food insecurity (46% vs 13% nationally), the 12-month and 30-day recall versions of the tool recommended by AAP lacked sensitivity, failing to detect more than a quarter of individuals with food insecurity.
• Food pantries:
  • As of August 2018, conservatively estimated, the organization has served more than 16,000 people.

Benefits

• The Feed1st pantries enable short-term hunger relief to patients in need of food during their time at the University of Chicago Medicine.
• The Feed1st pantries also offer community resource navigation support to users of the pantries. Posted signage directs pantry users to a navigator who can be reached by phone or email.
• Feed1st uses the NowPow community resource navigation tool which was originally developed by Feed1st researchers at the University of Chicago.
• The research conducted by Feed1st has proven that many people in the community served face hunger and there is significant need for increased access to food.

Unique Challenges

• This program enables short-term hunger relief to patients and families. The program is not yet able to alleviate food insecurity once the patient is discharged.
• Feed1st has had to spend a lot of time securing sustainable funding. With regard to expansion to other sites, Feed1st’s adaptability relies on each site determining the best funding/business models an working collaboratively with staff to understand best practice.