Addressing Food Insecurity among Vulnerable Families of Youth with Diabetes in Routine Clinical Care

About This Grant

PROJECT SUMMARY/ABSTRACT Social determinants of health (SDOH) exert a powerful influence on the everyday management of type 1 diabetes (T1D) and short and long term outcomes of T1D. Experts agree that identifying and addressing negative SDOH may help accomplish numerous T1D care goals and promote health equity in treatment. However, fundamental research gaps in achieving these goals remain, including optimal screening and management processes for identification of negative SDOH, and how to develop robust partnerships with community-based organizations (CBOs) that address SDOH with high potential for sustainability and scalability. This project will generate new knowledge regarding how to implement a social work-led SDOH screening and referral program designed to aid families of youth with T1D who face several vulnerabilities, including food insecurity. We will implement a single arm, pragmatic clinical trial with contemporaneous, non- randomized controls; whereby all families with a child enrolled in the California Children’s Services (CCS) program (which provides specialized medical care for low-income families of youth with a qualifying chronic medical condition) will receive access to a novel social work-led SDOH screening and referral program. Outcomes will be compared against youth with T1D who are also seen in our Westwood Pediatric Endocrinology clinic but who are not enrolled in the CCS program and will not receive access to the SDOH intervention. We have partnered with several community-based organizations (CBOs) across Los Angeles County who provide social services, including food-related services, to receive referrals for CCS families who screen positive for having a social need. We will assess the feasibility and acceptability of this screening and referral protocol among families, CBOs, and providers (Aim 1) by measuring key implementation outcomes (comprehensive documentation of SDOH screening, result, and referral in the patients’ medical record) and acceptability outcomes (self-reported satisfaction with the program by families and barriers and facilitators by CBOs and providers). We will additionally estimate the effect of this intervention (Aim 2) by measuring changes (pre/post intervention) in families reported social needs, diabetes-related quality of life, and in the child’s glycemic control (measured by HbA1c). Results from this work can provide a roadmap for sustainable and scalable SDOH interventions with potential to improve outcomes for youth with T1D in an equity-informed manner.