P3.190: The Impact of Social Work on Food Insecurity Resolution in Pediatric Primary Care

Background: Food insecurity (FI) during childhood has well-documented long-term health consequences,
including nutritional deficiencies, developmental delay, and risk of chronic diseases. Early
intervention through screening is critical, especially in primary care settings. In 2023, Vanderbilt
Children’s Primary Care Clinic implemented social drivers of health (SDH) screening during
intake, with social work (SW) involvement as a key intervention. This study examines whether
the number of SW encounters is associated with FI resolution.

Methods: Data from May 2023 to November 2024 were abstracted from the electronic medical record
using Reporting Workbench, identifying patients under 2 years old with ≥2 well-child visits ≥6
months apart with positive FI at initial screening. Descriptive statistics were calculated, stratified
by FI status and SW encounters, and compared using chi-square tests. A logistic regression
model examined the association between SW encounters and FI resolution, controlling for
language and insurance. Secondary ordinal logistic regression analyzed the relationship between
SW encounters, FI severity, and total SDH burden.

Results: SW, language, and insurance were significantly associated with FI persistence. 3+ SW
encounters were linked to lower odds of FI resolution (OR 0.51–0.93). Spanish-speaking patients
had lower resolution odds (OR 0.01–0.62), while those with commercial insurance had higher
resolution odds (OR 1.03–6.79) compared to Medicaid. SW encounters were linked to relative
social needs at initial screening. Patients with 2 SDHs compared to FI alone (OR 1.35–3.43) and
those with more severe FI (OR 1.32–3.71) were more likely to have additional SW encounters.

Conclusion: More SW encounters (3+) were associated with less resolution of FI. However, higher SDH
burden and FI severity (i.e., greater social vulnerability) predicted more SW encounters. These
findings suggest that other factors may hinder resolution despite SW involvement. While
screening and SW interventions can help identify at-risk families, they may not be sufficient to
resolve FI alone. Additionally, Spanish-speaking families and those with Medicaid were less
likely to resolve FI. Therefore, families facing language barriers and greater socio-economic
challenges may require additional support, and broader systemic solutions may be necessary to
address structural barriers to food security.