It was, in many ways, a typical case on a typical day in the Children’s Wisconsin Emergency Department. A small boy came in after suffering a fall and needed an X-ray of his arm. Michael Levas, MD, a pediatric emergency medicine physician, was assigned to the case. After talking with the boy’s mother and gathering his standard medical history and details of the incident, he asked the mother two less-than-typical questions.
Within the last 12 months, have you worried that your food would run out before you got the money to buy more?
Within the last 12 months, did the food you bought not last and you didn’t have money to get more?
Tears immediately filled the mom’s eyes. She nodded her head and said “yes,” and then threw her arms around Dr. Levas.
“She thanked me for caring to ask,” Dr. Levas recalled.
The answers that mother gave to those two questions set off a chain of events that spread throughout the hospital, from the Emergency Department to the Daniel M. Soref Family Resource Center, that ultimately connected her with resources to help her and her family get their basic needs met.
This collaborative and cooperative effort, known as the Food Insecurity Program, was first conceived in 2016, after David Brousseau, MD, the section chief of pediatric emergency medicine at Children’s Wisconsin, did a study of the families coming to the Emergency Department. He discovered that about half of all the kids were facing food insecurities.
“A group of us in the Emergency Department decided we really needed to do something about that,” said Dr. Levas. “We started out small.”
The team noted that at that time, the Children’s Wisconsin cafeteria closes at 9 p.m., so families who came in after had no substantial food options. So, the team arranged for little box lunches to be made and given out to kids who were hungry while they waited for a test or evaluation. That was phase one.
“Dr. Levas was able to feed them before they left, and at least we met that initial step,” said Maggie Butterfield, executive director of Patient Amenities and Family Services at Children's Wisconsin. “But the problem was so much bigger. We started to attack the problem on a much larger scale and meet families in so many different ways.”
In December 2020, the program grew dramatically and expanded its scope. Now, if a family answers “yes” to the two questions — either asked verbally or on an iPad if the family wishes for more privacy — it’s added to the child’s health record and triggers an alert to the medical team. First, the family is given a $15 meal card for the Children’s Wisconsin cafeteria or one of its smaller cafes. They’re also given a handout of food resources in Milwaukee County. But the most important step takes place a couple days later when they get a call from an information and referral specialist at the Children’s Wisconsin Family Resource Center.
“That is the key,” said Dr. Levas. “The Family Resource Center reaches out and wraps the family in services they may need.”
“We understood what was happening through our Emergency Department with food insecurities and the social determinants of health,” said Maggie. “So what I challenged my team to do is if we had these families identified, could we have a referral into the Family Resource Center and could we use our very skilled staff to not only connect them to resources, but hold their hand through that process?”
To date, the Family Resource Center has received more than 1,360 referrals from the Children’s Wisconsin Emergency Department. Information and referral specialists were able to reach 80 percent of those families, and 70 percent reported positive outcomes, including being connected to at least one resource. Looking forward to 2022, the Family Resource Center expects to serve at least 1,800 families.
When most people think of health, they tend to think of medical care — getting sick and going to the doctor. But the truth is, direct medical care accounts for only a small percentage of a person’s overall health. Things like their environment, education, economic stability and access to nutritious food — what we call social determinants of health — are far more impactful to one’s wellbeing.
“If you look at the basic needs of an individual, it's hard for them to attain true health if basic needs aren’t fulfilled,” said Dr. Levas. “How can I expect a family to bring a child in for care, to make all the calls, schedule appointments and find insurance, when they’re hungry, when they’re worried about how to feed their child? I see a lot of families that have to make those choices and a lot of kids who suffer from those choices.”
Everything’s connected — hunger is health. A lack of food causes stress in a child and the lack of proper nutrition hinders development of the body and brain. As it snowballs, the child’s mental, physical and emotional health are negatively affected.
“Children’s Wisconsin has recently taken on a broader role in trying to promote health equity. And a lot of the work that Dr. Levas, Maggie and their teams have been working through is a big part of our health equity work,” said Jacqueline Whelan, RN, manager of health management operations at Children’s Wisconsin. “If you think about environments like the Emergency Department, it really is somewhat transactional. Families come to us in crisis and we treat them and send them home. And we do a great job of that. But we wanted to start addressing their social needs in that environment, too. This program is a critical launching point and it’s a great demonstration of where Children’s Wisconsin is headed in terms of taking a broader lens on health equity as part of our inclusion diversity and equity efforts.”
“This is a good example of our health care system thinking outside the box and being bold and really treating some root causes that lead to poor health,” added Dr. Levas, who is also an associate professor of pediatric emergency medicine at the Medical College of Wisconsin.
Even though food insecurity is the initial trigger, when a referral specialist from the Family Resource Center connects with the family, they often identify additional needs — such as employment, transportation or mental and behavioral health — and they’re able to connect them to other resources the family never knew existed.
“We have this opportunity to bring families up to a level of security and stability they didn't have before,” said Maggie. “That first conversation leads to another conversation, and we are able to refer them to resources throughout their community.”
Supporting the whole child and the whole family — not just treating the specific illness but encouraging wellness and prevention to achieve true health — was the entire idea behind the Daniel M. Soref Family Resource Center, which has supported families for more than two decades.
“It was built to be the one-stop shop for families. And it wasn't about clinical care. It was about support. This partnership with the Emergency Department has helped build out that supportive arena for our families,” said Maggie. “As we're making these phone calls, families are telling us how grateful they are that we reached out, made that phone call, lined up them with resources and called them back to make sure they had everything they needed. Families are amazed that we take that extra step.”
“Sadly, there is some stigma or shame associated with food insecurity. A lot of families are embarrassed, but they shouldn’t be,” said Dr. Levas. “I wish we could feed everybody, because I know if we fed every kid, I'd have less visits to my ED.”