Table 1.

Action steps and resources for food insecurity screening and referral programs

Steps	Resources
Engage clinicians and staff	■ CME: http://seniorhealthandhunger.org/ ■ Clinical algorithms: https://nopren.org/ ■ Resources: https://sirenetwork.ucsf.edu/; www.rootcausecoalition.org/; www.childrenshealthwatch.org/
Screen for food insecurity	■ The Hunger Vital Sign: https://goo.gl/neMVit ■ Motivational interviewing, trauma-informed care ■ EHR processes for screening
Refer to federal or community-based food support programs	■ Outreach referral with HIPAA protection: www.rootcausecoalition.org/hipaa-webinar/ ■ Community specialist teams to facilitate referral and follow-up ■ Secure referral platforms in EHR to government enrollment sites or community organizations
Connect to food resources	■ Support community organization capacity to enroll in SNAP, WIC, and community-based food resources ■ Patient education about health benefits of SNAP/WIC
Document in chart and analyze screening and referral data	■ Capture screening and referral data in chart fields, which are extractable ■ Consistent charting and coding of food insecurity: http://childrenshealthwatch.org/foodinsecuritycoding/ ■ Data-sharing agreements with government and community partners ■ Clinical outreach to referred patients to assess outcomes
Perform collaborative quality improvement	■ Business associate agreements for clinical and community partners to formalize responsibilities ■ Establish incentives for successful connection to food resources ■ Build quality-improvement structure and expertise
Improve outcomes	■ Standardized metrics to measure changes in satisfaction, diet quality, food security, health outcomes, and utilization of food resources

CME = continuing medical education; EHR = electronic health record; HIPAA = Health Insurance Portability and Accountability Act; SNAP = Supplemental Nutrition Assistance Program; WIC = Special Supplemental Nutrition Program for Women, Infants, and Children.