Vol.:(0123456789) 1 3 Maternal and Child Health Journal https://doi.org/10.1007/s10995-019-02785-6 Food Insecurity Screening in Pediatric Clinical Settings: A Caregivers’ Perspective Ellen Barnidge 1  · Kathryn Krupsky 1  · Gene LaBarge 2  · Joshua Arthur 2 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Objectives Food insecurity (FI) has serious academic, social, and physical health consequences for children. A recent clinical recommendation suggests FI screening during child well visits. While FI screening research has considered clinician feed- back, little is known about caregivers’ experience of disclosing FI to health care providers. Our paper explores caregivers’ barriers and facilitators to FI disclosure. Methods A survey on factors infuencing FI disclosure was completed in a pediatric clinic waiting room in St. Louis, MO. Among households with FI, 15 caregivers participated in a qualitative interview. Caregivers were asked about experiences discussing FI with health care providers. We calculated frequencies for survey responses and analyzed interview data using thematic content analysis. Results Caregivers highlighted stigma, fear of child being taken away, and shame as barriers to FI disclosure. Caregivers identifed strong interpersonal skills, open body language, and empathy as facilitators to disclosure at the interpersonal level. Provider initiated conversations, consideration of FI disclosure in the presence of a child, and normalization of FI discussions within the clinic were described as ways to encourage FI disclosure at the organizational level. In response to FI disclosure, caregivers would like providers to ofer resources including referrals to community-based resources extending beyond food. Conclusions for Practice Our study identifes considerations for FI screening in health care settings, spanning the social- ecological model, from the perspective of caregivers. To successfully screen and address FI, multifaceted health care inter- ventions should address barriers and promote facilitators across multiple levels and in consideration of multiple social needs. Keywords Food insecurity · Well child screening · Social needs · Family preferences · Qualitative Signifcance Statement This study gains perspective on caregivers’ experiences with disclosing food insecurity to providers during well child vis- its. Insights as to what promotes and discourages caregiver disclosure and practice recommendations for screening enhancement across social-ecological levels are ofered. Introduction Nearly 1 in 6 households with children experienced some level of food insecurity (FI) in the last 12 months (Cole- man-Jensen et al. 2016). A food insecure household is “uncertain of having, or unable to acquire, enough food to meet the needs of all their family members because they have insufcient money or other resources for food (Cole- man-Jensen et al. 2016).” Children living in food insecure * Ellen Barnidge ellen.barnidge@slu.edu Kathryn Krupsky krupsky.1@buckeyemail.osu.edu Gene LaBarge gene.labarge@health.slu.edu Joshua Arthur josh.arthur@health.slu.edu 1 College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104, USA 2 Department of Pediatrics, Saint Louis University School of Medicine at SSM Health Cardinal Glennon Children’s Hospital, 1465 South Grand Boulevard, St. Louis, MO 63104, USA