December 21, 2021 by
A grassroots effort led by Larner College of Medicine alum and Associate Professor of Pediatrics Keith Robinson, M.D.’07, and key partners across the academic medical center and state, has established an invaluable resource to ensure pediatric patients and their families receive the quality and amount of food they need.
Robinson, who is a pediatric pulmonologist and vice chair for quality improvement and population health for the University of Vermont Children’s Hospital, says the seeds of the initiative were planted around 2016. A longtime proponent for food security, he joined nurses, social workers, nutritionists, and other UVM pediatricians who had been screening patients for food insecurity on the inpatient pediatric unit. In reviewing the findings, he discovered that 24 percent of pediatric patients admitted for cystic fibrosis (CF) were food insecure. That realization prompted the establishment of an informal food bank at the Children’s Specialty Center for CF families led by Christine Prior, L.I.C.S.W., Carlie Geer, M.S., R.D. (now retired), Maryann Ludlow, R.D., and Diane Imrie, R.D., M.B.A., director of nutrition services.
John Sayles, J.D., Vermont Foodbank CEO, learned about the UVM Children’s group’s efforts from Sarah DeSilvey, D.N.P., F.N.P., a UVM clinical instructor in pediatrics and family medicine nurse practitioner at Northwestern Medical Center with deep experience in addressing the social determinants of health in clinical practice.
“Sarah and I had been having conversations for a while about trying to do some kind of medically-tailored meals or food is medicine project,” recalls Sayles. She mentioned the Children’s Hospital and pediatric practice and particularly, kids with CF – who are very nutrition-dependent – and connected him with Robinson.
Sayles found out from Robinson that the clinic already had a small, informal food pantry that staff were contributing to and thought, “Wow – we can do better than that,” says Sayles. He visited the clinic, spoke with staff, and discussed how to safely store the food, designating a cabinet within the Specialty Center for the purpose.
“Because there wasn’t any funding at that time, the Foodbank set them up as a network partner,” and more specifically, as a co-op customer, Sayles says. “We purchase a lot of food and partners can order what they need,” he explains.
Because the Children’s Hospital food pantry did not have a budget, the Foodbank put $1000 on their account, adding additional funding the following year. This allowed Robinson and his colleagues to get deliveries and scale up gradually, ensuring they would be able to get the food that would meet the CF families’ needs, says Sayles.
Over time, access to the food pantry expanded to families in the pediatric inpatient unit and other specialty clinics, and finally, to the pediatric outpatient clinics, where Stanley Weinberger, M.D., Elizabeth McDonald, N.P, and Cathleen Kelley, M.S.W., spearheaded the effort.
Just months before the onset of the pandemic, in November 2019, Robinson and a Children’s Hospital leadership group – including Assistant Professor of Pediatrics Caroline Hesko, M.D., Senior Pediatric Outreach Coordinator Kristin Fontaine, M.P.H., Senior Quality Improvement Partner Kathleen Browne, LICSW, and Professor Emeritus of Pediatrics Richard Colletti, M.D. – formed the Vermont Pediatric Population Health Coalition. They joined with the UVM Health Network, OneCare Vermont, Vermont Department of Health, and the Vermont Child Health Improvement Program to prioritize and address population health issues impacting children and families.
“We collectively decided to improve food insecurity screening in key clinical areas and establish reliable interventions for patients and families,” says Robinson, who invited Sayles to make a presentation on the Foodbank, the work they were doing, and the possibilities for the food pantry at one of the group meetings.
“The more places where we can have an intervention immediately, that’s really key,” says Sayles. “Having people be able to order food right on the spot or take food home – that’s really what we want.”
The coalition’s work sparked the attention of a Vermont couple whose generous philanthropic support has helped both upgrade the food pantry to a “food pharmacy” and provided a critical learning opportunity for coalition members through the internationally recognized Institute for Healthcare Improvement (IHI). For a full year, team members worked with national leaders in population health, presented on the food security initiative’s progress in a collaborative manner, and attended a forum this past fall. As a bonus, Robinson was able to build more capacity to do population health work.
In addition, the couple’s philanthropy has helped garner greater awareness about and appreciation for the important link between food access and health among Children’s Hospital team members and helped the initiative become successful and sustainable.
“We want to be able to have an impact that's more meaningful for people around us,” say the donors. They want regional community members in need to know that “somebody will be there for you … there are many people [who] are willing to be there and to be supportive when they understand there's a need.”
An IHI Improving Population Health Action Community project team was also created, with a multidisciplinary group of professionals – including social workers/case managers, nurses, community outreach workers, public health specialists, and representatives from not only the Vermont Foodbank, but other community programs, including Hunger Free Vermont, Feeding Chittenden, Everyone Eats, Vermont 2-1-1, and others.
“The pandemic brought us together with more urgency to address food insecurity – it united us,” Robinsons admits. The IHI action community group has stepped up efforts to further leverage their partnerships and collective programs to improve and determine which strategies work best to achieve food security.
Hunger Free Vermont’s Katy Davis is “our essential partner” in the effort, says Robinson. She helps Children’s Hospital care teams understand more about food insecurity and how it impacts patients and families and explains the systems that are currently in place to address food insecurity. In addition, he says, she “really challenges us to engage, to find solutions to address food insecurity as a health care organization."
Davis appreciates the heavy load the nursing staff, LNAs and social workers are managing, so views her role as “making a little space to think about how [food insecurity] might play out in people’s lives outside of the hospital, and what it means to be asking these questions.”
Food insecurity is rooted in a lack of access to financial resources and systemic inequities, says Davis, who serves as community health initiatives director for the education and advocacy organization. When people have monthly rent, power, and other bills to cover, food is the first thing to get compromised when it comes to meeting basic needs, she says.
Davis is a fan of the approach that Robinson and the Children’s Hospital team use in designing the interventions to be as low-barrier as possible. Sometimes, she notes, people might not be comfortable signing up for services, so initially, it can be enough for them to respond to food insecurity screening questions. Later, they may register for one of the federal nutrition programs around the state, like 3SquaresVT, or connect with other services.
“There’s real value in getting help to meet your basic needs being associated with your doctor’s office as the access point,” says Davis. “If you’re told that they can help you with this and it is important to you and your family’s health, that’s in many ways an endorsement – hearing it from a trusted source can make a difference,” she explains. Equally as critical, she notes, is for these folks to feel heard – “it is a really important emotional support for folks.”
The Children’s Hospital’s population health work was challenged by the COVID-19 pandemic, a significant change to the electronic health record, and the cyberattack that disabled all information technology services, says Robinson. But despite these challenges, “Our team persevered and was able to support the screening process and continue to build community connections, including strengthening a partnership with Vermont 211.”
More recently, Children’s Specialty Center team members Leah Pence, M.S.W., and Maureen Leopold, practice supervisor, have been applying for and securing grant funding to improve sustainability of the food pharmacy.
The core goal, says Robinson, is still to “feed hungry families that are in clinic.” He credits Sayles and the Vermont Foodbank with allowing the Children’s Hospital to get the ball rolling with food orders so they could do that.
“The goal was that we would become financially independent and self-sustaining, and we have, through donations," he notes.
The coalition has developed a sustainable framework to improve outcomes for these families, not only connecting them to healthy food, but to all the resources available to support them.
“As an academic medical center, this is what we do,” Robinson exclaims. “We try to have the highest academic rigor and most comprehensive methodology in order to address the most important issues facing our patients and families."
While there’s more to be done, and the coalition’s efforts continue to move forward, it’s apt, during the giving season, to take a moment to reflect on the accomplishments they have achieved.
Sayles, who continues to interact with Robinson on regular basis, says, “Given where the healthcare system is now with COVID, the fact that people have continued to pursue and grow this project shows the Children’s Hospital’s commitment to improving the health of the community and not just treating disease.”
To donate to this initiative, visit the UVM Medical Center’s philanthropy page, select “Other” and write in "Children's Food Security Fund."
Photo (left to right): Katy Davis, Hunger Free Vermont; Kristin Fontaine, M.P.H., senior pediatric outreach coordinator, UVM Medical Center; Caroline Hesko, M.D., assistant professor of pediatrics; Dr. Robinson; Ceili Quigley, M.S.W., social worker case manager, UVM Medical Center; Laura Dattilio, R.N., assistant nurse manager, UVM Children’s Hospital. (Photo: Ed Neuert)