Intervening in Childhood Food Insecurity
Complicated by Pediatric Sensory Processing Disorders
Federal policy has been intervening in childhood hunger since 1964, when President Kennedy’s food stamp program was enacted into law as The Food Stamp Act under President Johnson (Almond, Hoynes & Schanzenbach, 2011). Now known as the Supplemental Nutrition Assistance Program, or SNAP, the USDA run program provides supplemental income for food, to families experiencing poverty (Almond, Hoynes & Schanzenbach, 2011). The FSA began a cascade of policy interventions in child hunger, as part of President Johnson’s “War on Poverty” movement (Almond, Hoynes & Schanzenbach, 2011). Shortly after the FSA was passed, the 1996 Child Nutrition Act was passed (Gundersen & Ziliak, 2014). This law expanded the National School Lunch Program (NSLP), created the School Breakfast Program (SBP) and Child and Adult Care Food Program (CACFP), and later added the Nutrition program for Women, Infants, and Children (WIC) (Gundersen & Ziliak, 2014). Despite attempts, the federal government’s policy-based interventions have not eradicated child hunger. In 2014 and 2015, an average 16.2% of children experienced food insecurity, even though they received SNAP and free or reduced-price school lunch (Ralston et. al, 2017).
Non-Governmental Interventions. In an effort to provide nutritional aide to the 6.5 million household that experience food insecurity annually in the United States, non-governmental organizations have introduced programs to mobilize the federal policies currently in place. Of these, Feeding America®— which is a network of community resource centers an food banks— has prevailed and supported some of the most significant community interventions (Montaquila & Weinfield, 2014). These interventions face challenging limitations, as the population they seek to serve are often ineligible for ethical client data collection (Montaquila & Weinfield, 2014). Therefore, the programs’ efficacy have to be determined by number of clients served and percentage of eligible people accessed (Montaquila & Weinfield, 2014). The exact population served by Feeding America®, are children from families who are 185% below the federal poverty line, come from a household that experiences food insecurity throughout the year, and/or are homeless (Montaquila & Weinfield, 2014). Feeding America® describes the significance of their work on their website, writing that in 2017 they “… served 10 million meals to more than 269,500 hungry children through the Summer Food Service Program”; the SFSP, as a whole, serves 3.76 million children free or reduced-price meals during the summer (“Summer Food Service Program”, 2018). Yet, contrasted to the 22 million children receiving these benefits during the school year through the NSLP, the SFSP has a 17% efficacy rate (“Summer Food Service Program”, 2018). Feeding America® sites the primary reasons this low efficacy occurs in the summer, are “…a lack of access to meal sites, insufficient program awareness, and limited resources when schools are closed.” (“Summer Food Service Program”, 2018). Throughout the Feeding America® network, food banks further attempt to resolve these barriers, through grant-funded School Pantry and Backpack Programs. School Pantry Programs intervene in afterschool and summer food insecurity by utilizing local public schools as epicenters for resources (Christner & Cotugna, 2014). Essentially, food pantries are set up within schools, so families at risk of being food insecure are allowed access to the free or reduced-price food and hygiene products (Christner & Cotugna, 2014). Backpack Programs intervene in afterschool and weekend hunger, by packing lunches and non-perishable food items in the children’s backpacks before they leave school (Hanson and Connor, 2018).
In a qualitative study, done by Christner and Cotugna in 2014, a convenience sample, surveys, and interviews were utilized to evaluate School Pantry Programs in northern Delaware. Of 10 in the region, 8 programs participated; only 5 of which were open throughout the summer months (2014). Of the 43 client’s surveyed, 88.4% identified as African-American and female; just under 75% of those surveyed reported the food they accessed was “Just enough food”, however all programs stated they handed out the maximum amount of food and hygiene products (30 pounds) to clients, and per month, the school pantry programs served between 0 and 12 families (Christner & Cotugna, 2014). When asked, the clients majorly cited four desired improvements for the program: an increased variety of food (specifically bread and milk), distribution of vouchers for free or reduced price on perishable items from stores or farmers markets, frequent delivery to the Pantry Programs, and increased advertisement about the program so more children could access the resource (Christner & Cotugna, 2014). Christner and Cotugna determined that increased varieties of foods and more aggressive advertising would benefit the School Pantry Programs evaluated (2014). They ultimately concluded that the School Pantry Programs surveyed failed to wholly fulfil the needs of the community they served (Christner & Cotugna, 2014). The study successfully included key perspectives—those of employees of the School Pantry Program and clients— in order to make a holistic evaluation of the program; however, the study met several limitations due to the small size and nature of the convenience sample (Christner & Cotugna, 2014). It can be noted, however, that based on Christner and Cotugna’s data, in the summer, the School Pantry Programs were 37.5% less accessible than during the school year (2014).
In a similar study, Hanson and Connor interviewed 22 parents of elementary school students from a rural Upstate New York town, nine of which had children involved in the school’s Backpack Program; a school based program that does not occur during summer months (2018). The majority of participants in the study were white females, and two-thirds of them had actively food insecure children; however, all households were at risk for food insecurity (Hanson and Connor, 2018). Hanson and Connor found that all parents reported their children eating breakfast and lunch on all school days, and most parents reported their children eating breakfast and lunch on non-school days and dinner on all days (2018). Additionally, while most parents stated that they “never” limited their child’s food intake, some did note placing restrictions on extra snacks or seconds (Hanson and Connor, 2018). The study collected numerous thoughts on the program from parents whose children were involved— one of the most frequent topics was food preference among children, which resulted in both increased sharing and consumption based on preference (Hanson and Connor, 2018). From the evaluation data collected, Hanson and Connor concluded that the Backpack program did not significantly affect the hunger of children participating more than those who did not but were at equal risk for food insecurity (2018). While the study was limited, and cannot accurately depict the effects of Backpack programs nationwide, it can offer some anecdotal insight into challenges and effectiveness of implemented Backpack programs, and questions the validity of their efficacy in ameliorating childhood hunger.
Intervention Proposal
The programs described above have attempted to intervene in communities during times where child hunger is a greater risk—after school or during summer break— but haven’t been able to implement programs sans access barriers. Federal policies, like SNAP, have attempted to solve the overarching issue of child hunger in the nationwide community, yet haven’t modified the programs for inequitably affected geographical and sociodemographic communities. Resultantly, 22-33% of children experienced food insecurity in the majority of counties or parishes in 18 States (Ralston et. al, 2017). Additionally, according to data collected in the 2016 National Survey of Children’s Health (NSCH) children with complex special healthcare needs were twice as likely to experience food insecurity than children with singular special healthcare needs or none at all (Balistreri, 2019). Some of the most common neurodevelopmental conditions that children with complex special healthcare needs are diagnosed with— such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD)— include symptoms of sensory processing differences (Balistreri, 2019; Ghanizadeh, 2011; Little, Dean, Tomcheck, & Dunn, 2017). These can have numerous implications— one of which is food selectivity (Kral. Et, al. 2013). As found in a recent study, food selectivity is positively correlated with sensory sensitivity in children; and in children with ASD, food selectivity leads to an increased risk of nutritional deficiencies (Coulthard & Farrow, 2012; Kral. Et, al. 2013). Combined with food selectivity, food insecurity could lead to an even higher risk of nutritional deficiencies, which could more severely affect the health of the estimated 1 million children within this population (Balistreri, 2019; Kral. Et, al. 2013). Children with sensory processing differences who also experience food selectivity are greatly affected by food perception (Kral. Et, al. 2013). Selectivity is different from food preference, because it is not based on if the child likes the food, but rather, the perceived edibility of the food to the child; this is often significantly influenced by perceived texture of the food (Kral. Et, al. 2013). Yet, a primary issue of the Backpack Program and School Pantry Program— as reported by clients of both— was the limited range of food offered (Christner & Cotugna, 2014; Hanson and Connor, 2018). When already combined with the limited edible foods, the implications for children with sensory processing difference experiencing food selectivity could be detrimental. To intervene with this specified population, all supplemental programs have to be modified. This would ideally be done through creation of a multi-faceted, interdisciplinary database, accessible and useful for both child hunger interventions and clients: the Nutrition Accommodation Database (NAD).
Prior to implantation, to test the efficacy of the NAD, an experimental model would be set up in a specific community, with both a pre-existing Backpack Program and School Pantry Program, that had applied to participate. After the NAD was developed, it would be introduced to a number of volunteer guardian participants who were already clients of the other programs. Pre-trained community-based program specialists would act as consultants and the participants would receive an electronic and paper form of communication inviting them to either sign up with a consultant or download the app. Some of the population would have children with sensory processing disorders, the rest would not. All clients in the program (including those not in the trial) would be sent an optional survey after the trial about their perception of their child’s hunger within the past month. If effective, the database could be broadened and specified for other communities, and integrated into the professionals already present within the local organizations. Potential limitations of the NAD include stigma against food selectivity (potentially perceived as pickiness an poor behavior). Additionally, in the present model there are not any specific modifications of rhetoric or programming for cultural differences; both of these would limit the efficacy of the database and the percentage of target population accessing the resource.
The NAD’s specific goal is to intervene with children experiencing, or at risk for, food insecurity, by providing access to perceived edible food, and to decrease the public health risks associated with child hunger. The NAD’s overarching goal is to become an autonomous resource any community can access to decrease the rates of food insecurity, and manage the health of their children. Once enacted, the NAD would achieve these goals by utilizing public schools as points of access— as done in the School Pantry Program— for consultations and data entry. Guardians who wanted sensory food accommodations for their children could set this up with support staff at the School Pantry Program, and input food preferences for their child under their personal profile. If data protection was a concern, there would be a general sensory food preference— which would include commonly safe-textured foods— that the guardian could opt for. If the guardian could not easily access the school to set up a consultation appointment, the NAD would also be accessible through a smart phone app, through which they could create and modify their child’s profile and food preferences. If the guardian chose, this information could be anonymously disseminated to other services within the NAD: such as the Backpack Program, NSLP, SBP, CACF, and SNAP; however, information would otherwise be encrypted to protect the data on the vulnerable population. The information disseminated through the NAD would be crowdsourced and analyzed so trends in food selection could guide the general sensory food preference within the database itself, the food stocked within the School Pantry, the food served in the NSLP and the SBP, as well as the food deemed appropriate to purchase through the SNAP program.
An added facet of the NAD would be to mitigate potential nutritional deficits that children might procure as a result of food selectivity. This would be mediated by the databases’ analysis of which of the foods could be switched with their fortified alternatives to have the greatest impact. For instance, if 85% of children with a sensory processing disorder find rice edible, all of the supplemental nutrition programs above would receive a recommendation from the database to replace rice in meals with fortified rice. Or, if the majority of children with sensory processing disorders preferred to eat carrots over red bell peppers, the programs would receive the recommendation to switch the similar vegetables or increase the amount of one. The NAD would ideally act as a resource itself, because it would inform the guardian of all of the potential resources available to their child, their geographic proximity, and the months open. This would be accessible to all families (regardless of children’s diagnosis or lack thereof) and thus help resolve some the barriers that Feeding America®’s programs were unable to— like lack of advertising and program awareness. While limited in its initial proposal, and primarily focused on children with sensory processing differences, the NAD would be frequently modified by the communities accessing it, and thus become a dynamic accommodation tool for present child hunger interventions and initiatives.
References
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