Addressing Food Insecurity Through Hospital-Community Partnerships in a Changing Policy Landscape

Food insecurity (FI) rates are rising nationally, particularly among families with children. This is alarming because access to adequate and nutritious food is essential for children’s learning, growth, and development. In 2023, nearly 1 in 5 households with children reported experiencing FI.1 Unfortunately, FI rates are likely to worsen amid recent federal changes to government benefit programs. In particular, the 2025 Budget Reconciliation Act made changes to the Supplemental Nutrition Assistance Program (SNAP) that will (1) reduce federal funding and increase states’ cost-sharing requirements, (2) prevent future increases to SNAP benefit amounts in response to inflation, and (3) impose new work reporting requirements, including on caregivers of children aged 14 and older.2 The nonpartisan Congressional Budget Office estimates that in an average month, approximately 300 000 SNAP recipients, including 96 000 children, will have their benefits reduced or eliminated as a result of these changes.3Hospitals caring for children are uniquely positioned to respond to these policy changes. Hospitalization can magnify FI through lost wages and unexpected expenses related to food, parking, and childcare for siblings.4,5 Even previously food-secure families may face inpatient FI or acute food needs during their hospital stay. Thus, hospitalization represents both a period of vulnerability and an opportunity for meaningful intervention.6 In this issue of Hospital Pediatrics, Lopez and colleagues explore this opportunity through a pilot study assessing rates of household and inpatient FI among hospitalized children from March 2021 to March 2022 and testing an intervention bundle to address these needs.7Using an adapted version of the validated US Department of Agriculture 18-item Household Food Security Survey (HFSS), Lopez et al found that more than half of their study participants screened positive for FI, including 48% with household FI and 46% with inpatient FI. This household FI rate is substantially higher than national HFSS estimates among households with children, highlighting that hospitalized children are at increased risk for FI.8 These findings also exceed rates from other studies in the inpatient setting,9,10 which may be due to differences in patient populations across settings or trends over time. However, given this study’s intervention focused on food resource provision, there is likely some component of self-selection bias, as families experiencing FI may have been more likely to enroll, and expectation bias, as families may have responded affirmatively to screening to obtain resources. Regardless, their findings indicate a strong interest in food supports during hospitalization. Given national increases in FI in the years since this study,1 compounded by recent changes to SNAP, the demand for hospital-based food resources is likely even greater today.In their single-arm prospective trial, Lopez et al evaluated the feasibility, acceptability, and referral outcomes of an intervention bundle for FI. This intervention included complimentary meal trays during the hospitalization and active referral to a community-based organization (CBO) providing information on local food pantries, assistance in applying for government benefits, and referral to a partner program for support with other social needs. This bundle represents a multilayered approach to comprehensively addressing social needs6: complimentary meal supports address acute needs during hospitalization; guidance on community resources helps address subacute needs during the transition home after discharge; assistance with public benefit enrollment helps address more long-term needs; and finally, connection to a referral partner helps address other concomitant social needs.A notable strength of this study was its CBO partnership model. Building an effective partnership with a CBO requires time, mutual investment, and thoughtful coordination. The study team’s approach reflects many of the best practices highlighted in the Bidirectional Engagement and Equity Framework,11 which was informed by principles of community-based participatory research and designed to promote equitable, sustainable partnerships between academic and community interest holders. First, the hospital-based team selected a regional food bank already connected to their outpatient network, laying the groundwork for trust building and alignment across clinical and community settings. They then provided funding for their partner organization to expand capacity—demonstrating a commitment to strengthening community infrastructure and recognition that accepting new referrals from health systems may require substantial investment from often resource-limited nonprofits. Finally, they met periodically with CBO leadership during the study, fostering bidirectional communication to ensure responsiveness to evolving community needs.This study also used effective data sharing to track valuable metrics. For social care interventions, multiple process and outcome measures are important to track over time.12 One fundamental measure is family support of the intervention, which can be assessed through qualitative interviews or surveys evaluating the acceptability of an intervention, as performed in this study. Research teams should also track rates of referrals to ensure families in need of support are not missed. In addition, they should evaluate rates of resource connection, ideally through closed-loop referral systems, to assess intervention effectiveness.CBO partnerships can strengthen these closed loops. Social workers and community health workers, who are often responsible for addressing social needs in clinical settings, have shared that establishing closed-loop communication with CBOs is one of the most challenging parts of their role.13 In this study, only 23% of families had been successfully contacted by the partner CBO within 2 weeks of referral, likely due to both limited CBO capacity and families’ competing priorities after discharge. This emphasizes the value of longitudinal follow-up, ideally through ongoing CBO partnership, to ensure long-term connection to resources in the weeks to months following discharge.Finally, although out of this study’s scope, teams should ideally evaluate whether families’ social needs are improved or resolved after discharge. This helps determine whether interventions are sufficiently robust as implemented and whether additional supports are required to adequately meet families’ needs.For each of these steps, it is important to ensure interventions are implemented equitably by stratifying process and outcome measures by key demographic variables, such as preferred language, insurance status, and neighborhood characteristics. Even well-intentioned interventions can unintentionally widen disparities if they are not designed and iteratively improved with equity in mind.14When adapting this pilot for real-world applications, there are key limitations to consider. First, this study used the 18-item HFSS to evaluate household FI and did not include concurrent screening for other social needs. In practice, most hospitals use shorter FI screening instruments, often adapted from the 2-item Hunger Vital Sign (HVS) or the WE CARE screening tool.15 Studies have shown that when compared with the HFSS, the 2-item HVS has high sensitivity and specificity in detecting FI.16 This implies that hospitals can adequately detect families’ food resource needs using shorter, more streamlined screening instruments. This is particularly important when food insecurity screening is implemented in combination with screening for other health-related social needs.Second, scalability remains a challenge. In this study, of 2563 eligible patients, 1000 were ultimately screened, and 540 received the intervention bundle including CBO referral. Only 62% of those receiving the intervention had connected with the CBO by 1 year. The authors note that this attrition in CBO connection is likely in part due to limited CBO capacity to complete follow-ups. Scaling community referrals to accommodate universal inpatient social needs screening could place additional strain on CBO capacity, further limiting the effectiveness of referrals. Therefore, hospitals pursuing a community partnership model should commit to increased investment in these CBOs to help expand their capacity, potentially through allocations of nonprofit hospital community benefit spending. Moreover, as a single CBO is unlikely to have the resources or expertise to address all types of social needs, such as housing insecurity or childcare needs, hospitals and health systems may need to invest in multiple CBO partners.Finally, application across geographic regions is difficult. Local CBOs, particularly regional food banks like in this study, are often geographically limited in their influence. As pediatric hospital care regionalizes and catchment areas broaden,17 it becomes challenging to identify available and appropriate resources for families who may live hundreds of miles away from a hospital. Searchable electronic resource maps and referral platforms, such as those developed by organizations like FindHelp and Unite Us, may mitigate this problem by maintaining national community resource directories.18,19 However, adoption of such tools by hospital social workers is variable.13 Further, coordinating with these organizations to ensure local resources are up to date, align referral processes with existing staff workflows, and promote widespread use of these tools may require dedicated health system investment, including allocation of skilled hospital staff members to work with vendors to update and maintain resource directories.As FI continues to rise, amid shifting federal policy and constrained community resources, hospital-based interventions like that described by Lopez et al offer a promising model for responsive, equity-oriented care. Yet their success depends on our willingness to move beyond passive referral toward active partnership—to invest in the CBOs that make these interventions possible and to advocate for upstream policies that secure every family’s right to adequate nutrition. Children’s hospitals can and should lead in this space, not only by screening and referring but by cocreating solutions that bridge health care and community. In doing so, we can transform isolated acts of social care into a durable safety net.