#399 - [Journal Club] - 📌 From Screening to Solution: Resolving Food Insecurity in Pediatrics

Ben and Daphna conclude Journal Club with a quality improvement study from Pediatrics titled "Improving Health-Related Social Needs Screening and Support Across a Pediatric Health Care System". The hosts discuss the successful implementation of universal social determinants of health (SDOH) screening across nine pediatric divisions at Levine Children's. They highlight the impressive results—screening compliance reaching 92%—and the practical impact of connecting families to resources like FindHelp.org, which led to a 56% resolution rate in food insecurity for positive screens. Daphna makes a personal commitment to improve resource accessibility in her own unit.

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Improving Health-Related Social Needs Screening and Support Across a Pediatric Health Care System. Laroia R, Minor W, Carr A, Buitrago Mogollon T, White BB, Mabus S, Stilwell L, Ahmed A, Mehta S, Obita T, Reed S, Senturias Y, Mittal S, Horstmann S, Demmer L, Dantuluri K, Chadha A, Noonan L, Courtlandt C.Pediatrics. 2026 Feb 5:e2024070035. doi: 10.1542/peds.2024-070035. Online ahead of print.PMID: 41638605

Transcript

[00:00.504] Ben Courchia MD Hello everybody, welcome back to the Incubator Podcast. We're back today for another episode of Journal Club. Daphna, good morning, how are you?

[00:07.95] Daphna Yasova Barbeau MD I'm doing well, I hope everybody else is doing well. In the last few weeks of Journal Club, we've had some really interesting articles, very... I feel like science-heavy articles. And I wanted to bring in something a little bit new. Not that I don't want people to come at me—not that QI is not science-heavy, I'm just saying. It's a different type of paper and we don't routinely do QI papers on the podcast because sometimes they're kind of hard to translate in audio format. Like you really need to see your change diagrams and looking at things over time. But this one really kind of stood out to me. This is in Pediatrics. It's called "Improving Health-Related Social Needs Screening and Support Across a Pediatric Health Care System". Lead author Rishi Laroia, senior author Cheryl Courtlandt. So this is coming to us from North Carolina. And the first thing you may notice is this is not a NICU specific paper, but I think that we can all learn a lot from this, especially as we're recognizing the importance of how social determinants of health impact medical care and outcomes, and that our NICU patients are potentially even at higher risk than the general population for having...

[01:48.066] Ben Courchia MD You don't need to sugarcoat this more than it needs to be. I think everybody agrees that like, come on, we're pediatricians at heart. I mean, at the end of the day, we are pediatricians.

[01:52.738] Daphna Yasova Barbeau MD I'm not sure everybody agrees. But I think to your point, so when we round, how often of us are we saying, "Okay, a poem, FEN, ID, access, family, SDOH"? We're not on every round, even though we know it's changing outcomes for the baby. So even though we buy in, we're not always putting our money where our mouths are. Myself included, I was feeling very ashamed reading this article. And I've made a commitment, which I'll tell people about at the end. Okay.

[02:32.59] Ben Courchia MD I mean, to my credit, I had this whole thing worked out, by the way. This is a funny story. It's not funny for our patients, but it's kind of funny because I wanted us to have social determinants of health... have an idea of social determinants of health. So I had coordinated with our social worker so that like once a week on Monday, we would run the list, we would create a list for us of each patient and their social determinants of health, whether food stamps, WIC forms, whatever that is. And we would get that paper every, at least Monday morning. It's not every day, but at least once a week when you round your own service, you get that paper. And maybe three weeks... maybe, no, I say three months, three months. Maybe two, three months after this is now well implemented and we're getting it consistently... she, our social worker, quit. So now, now I have, so now we have to start from scratch again, but...

[03:30.392] Daphna Yasova Barbeau MD Okay, I'll give you a little credit, okay? That was notated in our office right there. You don't let us hang many things in the office. We like to keep a clean desk space just so everybody knows, but that was hanging on the wall. And it really made you think about how you could support each family every day when you knew what they were struggling with.

[03:50.444] Ben Courchia MD Yeah. Because the concept of dignity, which is something that I was taught at a very young age in school... It's like, it's not always the family that appears disheveled and whatever that has the higher need.

[04:07.736] Daphna Yasova Barbeau MD Yep. That's true. There were a lot of surprising facts on that sign out.

[04:12.532] Ben Courchia MD Exactly, right? It's the family who appears to be very well put together, who's trying to really get themselves out of potentially the difficulties that they are. And then you see the social determinants of health sheet and you're like, "I would have never realized". And all the assumptions that this might lead to can be quite nauseous.

[04:33.09] Daphna Yasova Barbeau MD Yeah, I think it led us to identify patients we might have missed if we weren't doing universal screening for sure. And especially... I mean, these patients are doing the best they can. They're putting their best face forward. They want us to think... we've heard that from parents time and time again. "I wanted the medical team to think that like I had it all together, that I would be able to safely take care of my baby. I wasn't going to ask for help because what if they didn't let me take home my baby or they didn't think I could care for my baby?" So I mean, they're really doing everything they can to put their best face forward.

[05:08.75] Ben Courchia MD Was that Lauri Sullivan who said that at Delphi this year? We have lots of parents at Delphi. Parents play a central role. We're very inspired by the work that Jen Canvasser has done at the NEC Symposium. So we always thought families should be involved. And that was one of the things that Lauri Sullivan, who was a parent, who was saying they brought the wheelchair. And she was like, "I would just stand just to show the medical team that I was good".

[05:19.418] Daphna Yasova Barbeau MD Yeah, I think so. Pressure. Yeah. Yeah. And that's not even social determinants of health, right? Just like two days post-op saying like, "I can walk. I'm fine. I can walk." Okay. Now we've digressed and nobody remembers what the paper is anymore. Okay. So this is why we struggle with QI papers. Like, do I go through the PDSA cycles? What do I tell you? So I figured out what I'm going to tell you.

[05:35.042] Ben Courchia MD Yeah, yeah, that was quite powerful. All right, I'm sorry, we digressed, I'm sorry. Okay, you will start again, that's okay.

[05:59.802] Daphna Yasova Barbeau MD I think this is an incredible thing at Levine Children's. So they basically in 2021 made a division-wide, department-wide commitment to universal screening for social determinants of health. So they looked at nine of their divisions. They looked at hospital medicine, which again, obviously admitted patients. They looked at the newborn nurseries, the child protection team, the outpatient developmental behavioral pediatrics, outpatient ID, pulmonology, sleep medicine, genetics—all outpatient—and the heme-onc service, which included inpatient and outpatient patients.

[05:59.802] Daphna Yasova Barbeau MD And some of those divisions picked specific domains that they felt were a threat to their patients. So I'm going to highlight the newborn nursery. They really wanted to look at food security or food insecurity and housing insecurity. And the screening method they used... they picked a universal screener, but I mean, it was literally the pediatrician interviewing these families and putting it into the EHR. So when we say we don't have the time and we say it can't be done, they did it. It was done. But not only did they really want to optimize their screening of social determinants of health, what they really wanted to do was offer resources, which is not revolutionary, but what is the purpose of screening if we can't offer concrete solutions to families?

[07:42.522] Daphna Yasova Barbeau MD And so in general, they had a number of PDSA cycles, the first of which of course was education, showing them how to document it in their EHR, showing the basic flow process, then knowing, recognizing that different units had different needs and the outpatient had different needs than the inpatient. So making different pathways for each of those people. They used their EMR to their strong suits. They used ICD-10 codes to help document some of these disparities. And then they moved forward with determining resources. And that's actually really what I want to spend some time on. Because they recognized that depending on what was flagged, different people needed different resources and potentially their different units needed different resources. So like the sleep medicine team adopted this open source national information on "Move Your Way 60 Day"—how do you get 60 minutes of daily physical activity to improve your sleep?

[07:42.522] Daphna Yasova Barbeau MD One of the teams really, really was targeting food insecurity. So food gaps, how are they gonna get families to food pantries? And to be clear, they had social workers. So the social workers were available like they are in most hospitals. But they really needed a system that would allow for universal screening and then universal distribution of resources. What they wanted to study was just were they better at doing screening? And I'll give you the short answer is yes, but I'll tell you how well they did. And then were they able to provide resources for families? And the short answer is also yes. And then when they re-evaluated some of these families, did some of those social determinants of health disappear? And the answer is also yes, which is what we would want for every single family.

[10:03.225] Daphna Yasova Barbeau MD I want to really highlight these resources that they used because I looked at a bunch of different states, a bunch of different zip codes, of course, including our own. And they were using this website. It's called Find Help. I have it pulled up here again. It's called findhelp.org. And you basically can put in your zip code and what you're looking for. Is it food? Is it housing? Is it legal help? Is it educational resources? Is it connecting people to work, transportation? I mean, admittedly, they have resources on here in our local community that I had no idea about. And at a bare minimum, this is my statement of commitment to our listeners is I'm going to make a sheet for each of these things in our unit. And I know our social worker had created those things to hand out to families, but we know social workers change jobs. And just like you said, like this should be available for every family in our waiting rooms, in our check-in spaces so that they don't have to even disclose if they don't want to, but they should have access to these resources. So it's beautiful. It's absolutely beautiful.

[11:19.201] Ben Courchia MD It's a very nice website. I'm checking it out right now. This is findhelp.org. Yeah, that's...

[11:25.977] Daphna Yasova Barbeau MD So I really wanted to highlight that because I think that any team could do this, even if you're not... you know, we're saying, "Well, now we have to screen families to offer resources". Well, maybe we can at least offer resources, even if you're not a unit that is yet totally doing universal screening. Very easy. So basically what they did is exactly that. They found the resources, they put them on handouts and brochures, and they started giving them to families who screened for some of those social determinants of health.

[11:55.866] Daphna Yasova Barbeau MD So I'll get just to the results. I mean, and they're beautiful control charts. They're beautiful. They're extraordinary. Looking at percent compliance over time, where you can just see, obviously they have these ups and downs. I mean, not a lot of downs, mostly just ups, plateaus, ups, plateaus, ups, plateaus for their different PDSA cycles. And then they looked at by service line, but I'm not going to get into that because I think the overarching goals were completed for them. So they wanted to look at performance for appropriate screening and intervention. So this increased to a mean of 92% across nine pediatric divisions. And then they followed it for almost a year and for seven consistent months at the end of the project, they showed again a mean of 92% universal screening across those nine pediatric divisions.

[11:55.866] Daphna Yasova Barbeau MD They looked at inpatient versus outpatient and they were able to show that the inpatient team did 93%, the outpatient team did 88%, and both groups showed improvement from initial performance: a 17% improvement in the inpatient and a 13% in the outpatient. And like I said, they both showed, both inpatient and outpatient showed resilience in their process, especially once they added some of the screening directly to their EMR. Final division performances ranged from 85% to 98% with all of them showing increases. For example, hospital medicine increasing from 78% to 90% and pulmonology from 58% to 93%. And these are extraordinary increases for sure.

[14:16.217] Daphna Yasova Barbeau MD And then they wanted to see if the screening interventions decreased specifically food insecurity, because in their local community, it's a major problem, a major social determinant of health. So they wanted to look at food insecurity. And it was the most screened domain and they had the most robust interventions to target it. So from April 2022 to October 2023, 24,251 patients were screened for food insecurity. Of those patients, 10,000 of them—50% of them—had at least one follow-up screening so that way they could look at the difference. Now, nearly 20% of the patients who had both screeners—so of the 10,000 patients—screened positive for food insecurity on their initial screening. So I'll say this is higher than the national data, but comparable to their North Carolina data. But it's a reminder of how many patients we see on a day-to-day basis have food insecurity. And I mean, we have the data that that's even higher in the NICU community.

[14:16.217] Daphna Yasova Barbeau MD So they were able to follow these 10,000 patients—again, 18% of which screened positive for food insecurity on their initial screening—and then they looked at the follow-up. 56% of the people who screened positive initially, after they got the intervention, subsequently recorded no concerns of food insecurity on their most recent screen. 38% showed no change and sadly 6% changed from negative to positive. But this really stuck with me that there are things we can do on an individual basis. Yeah, we got to tackle these big systemic problems, but on an individual basis, to just connect people to resources. And for some families, I mean, being in the medical system is our opportunity to connect them to medical resources. And for our little babies, where nutrition and medical care is just paramount to the long-term outcomes, I thought this was really valuable.

[16:36.045] Daphna Yasova Barbeau MD Chetal Shah's advocacy talk at Delphi really reminded me that, you know, we do all this work in the NICU and then we send these babies home to a world that is like not optimized to optimize their outcomes, you know? So I think in these little ways, like we're obligated, I feel like, to try to connect these families to resources before they go home and not on the day of discharge, not the week of discharge. Like this is something we can be working on while babies are in our unit. So that's my commitment. I said it here so you people have to hold me to it. Did I make our resource pages?

[17:20.4] Ben Courchia MD Yeah, we will check in with you in a few weeks and find out how that project is going. But I mean, it is sadly elementary. Like you're looking at it and you're like, "It's that easy?". Because it's like when you say it, it's like, "Oh my god, I got to screen, then I got to find the resources, and I got to plug our unit with these resources, and then I have to do..." No, it's there. But thank you for highlighting this paper.

[17:32.257] Daphna Yasova Barbeau MD Yeah. Duh.

[17:50.543] Ben Courchia MD It's very valuable. And findhelp.org, we have absolutely no affiliation with this website. It's just... well, granted, I just started browsing this website while you were talking, so I haven't really reached out to any of the things that are listed, but some of them I do recognize, and so, that's quite good. It's quite good.

[18:18.765] Daphna Yasova Barbeau MD Well, I'm glad you like that, buddy.

[18:20.78] Ben Courchia MD No, this is good. This is good. I always wonder if, you know, like some other people are doing good pediatrics podcasts, but I'm like, "Could we do a version of the Incubator for general peds?". And I'm like, it would definitely would not be done by us. Like we don't do enough gen peds and we're not plugged in, but look, maybe...

[18:44.053] Daphna Yasova Barbeau MD You're saying we could just take those podcasts over. I think we got enough on our hands here, you know? And we do have some great Gen Peds colleagues doing great podcasts already.

[18:47.088] Ben Courchia MD We have plenty on our hands, but look at us. No, could still represent. But that's not what I'm saying. I said, look, we are able to represent the general pediatrics team on the Incubator. Like, I don't want to do more podcasting. I am saturated. I definitely do not want to do that.

[19:05.059] Daphna Yasova Barbeau MD Well, it's a reminder how much of our neonatology job is still general pediatrics, I think, especially today.

[19:10.116] Ben Courchia MD The parents sometimes remind you of that. You come and they're like, "Who are you?" And you're like, "I'm the neonatal physician." And they're like, "You're a pediatrician." It's like, "Yeah, I'm a pediatrician." It sounds OK.

[19:18.307] Daphna Yasova Barbeau MD Yeah, that's right. Now, still, even in 2026, one of the most trusted resources for families, so we just have to remember that. We still hold that badge for now.

[19:34.297] Ben Courchia MD Yeah, yeah, because as a field we're quite poor and I think that this is the biggest mark of trust we can hold. So I think that that's a big reason, but we do care about babies so I'm happy to hear that this translates. All right, enough chit chatting. I'll see you tomorrow for new news. Thank you, Daphna. Talk to you later.

[19:57.508] Daphna Yasova Barbeau MD Bye everyone.