The garden at Children’s Hospital Colorado was overflowing with chard, which is how Brenda Flores ended up taking some of the dark-green leaves home and sauteing them for her two kids for the first time.
“It was like a weird vegetable,” Flores said, taking a minute to recall the word chard, or acelgas in Spanish. But they liked it.
Flores first found out there was a food pantry full of fresh produce, chicken and fish, lentils and potatoes at Children’s Hospital after bringing her 3-year-old son to an appointment for his auditory and sensory issues. When the health specialist heard the family was struggling to buy enough to eat, Flores was directed to another floor in the hospital’s child health pavilion — to a program called Resource Connect.
The program that began in 2019 has become a model for the country, hosting about 50 health officials from other hospitals last week. Every time a child has a checkup or sees the dentist or eye doctor at the Aurora hospital’s pavilion, their parent fills out a screening form that includes questions about food insecurity, housing and mental health.
“In the last 12 months, did you ever feel stressed about making ends meet?” it asks, telling parents to circle anything that applies — rent, mortgage, formula, diapers.
“Did you ever worry that your food would run out before you had money to buy more?”
When parents answer yes to any question, the doctor sends in a navigator from Resource Connect. And from there, families can pick up fresh food, talk to a benefits expert to sign up for Medicaid or food stamps, or get introduced to a nonprofit that provides diapers and wipes and backpacks filled with school supplies.
Many hospitals, if they have any program at all, just hand struggling families boxes of food.
The point is to address the factors outside the doctor’s office that affect children’s health, which is impacted about 80% by their ZIP code, home environment and social and economic situation. Doctor visits represent only about 20%, according to research from the American Journal of Public Health and the University of Wisconsin.
“It’s all about what’s going on in their families, their schools and their neighborhoods,” said Dr. Lisa DeCamp, a primary care physician in the hospital’s child health clinic. “There’s little that I can do to impact their health trajectory. They can get their vaccines. I can make sure they get their antibiotics for an ear infection. The more we can do to support and help families access the resources that are available in the community, that is what’s really contributing to the health of the child.”
In the three years since it opened, Resource Connect has helped 4,235 patients get social services. The most-used resource is the in-house Healthy Roots Food Clinic, where bananas and squash fill the shelves, and refrigerators are neatly organized with packages of meat, milk and eggs. Hundreds of families have gotten help paying their electric or water bills, been linked with housing assistance, signed up for food stamps and registered for preschool programs.
The operation takes holistic medicine to a new level. There’s a strong correlation between childhood obesity and food insecurity, for example, but doctors don’t have time to give families much coaching on healthy eating. The food clinic, though, gives recipes, advice on shopping and tips on how to get kids to eat vegetables. Families can take food home six times each year, but they also get information on other food pantries to visit in the area, including partner pantries at nearby Aurora Central High School and Crawford Elementary.
“It’s a whole different world to have personalized education in a non-hurried environment,” DeCamp said.
Normalizing questions about food, housing
It helps to know if a child who is in the clinic for an asthma flare-up is living in a house with mold. But it’s another level of care to direct the family to a social needs navigator who can help them get rent assistance so they can move or offer advice on talking to a landlord.
Sometimes the hard part is getting families to talk about economic or social needs at the doctor’s office because “they may not realize they can have these conversations with their medical provider,” said Sandimar Timberman, supervisor of community health navigation for the program. The clinic staff wants questions about housing and food to feel as normal as “How long have you had a cold?” or “What are your concerns about your child’s speech?”
“They may get a little shy,” Timberman said. “For some families, asking these questions is very private. They might be used to keeping things within their community, but I feel as we’ve built that trust with a lot of our families, they sort of accepted us as part of that community.”
Many of the clinic’s patients are immigrants, working to navigate life and health care in an unfamiliar language. Staff speak Spanish and Arabic, and the hospital has interpreters who speak Nepali, Vietnamese, Somali and several other African languages common in the neighborhoods around the hospital, home to many refugees.
The diversity is reflected on the food clinic’s shelves, which contain tortillas, peppers and quinoa. And there are no cans of Spaghettios or chili or boxes of macaroni and cheese like you might find at a typical food bank — this is the hospital version, filled with nutrition-dense foods and even some straight from the hospital garden.
Before the COVID pandemic, when the Resource Center first opened, health navigators would visit families in their homes. The home visits revealed why some families had complained the milk and eggs they were receiving through WIC, the Women, Infants and Children food assistance program, were spoiling. It was because they were leaving them on the counter instead of keeping them in the refrigerator, as they would have done in their home countries where milk and eggs come fresh from the farm.
“Food is such a huge part of culture,” Timberman said. “They were always cooking something good. That was the beauty of going out to visit the families.”
The nine-person navigation team, intentionally, includes people who grew up in the same kind of bilingual and immigrant neighborhoods where many patients live.
Health navigators often learn more about a family’s situation in one conversation than doctors know after seeing them for seven years, Timberman said. “It’s like, now I see why they weren’t following through with picking up their asthma medicine or bringing in healthy fruits and vegetables.”
Some needs are easier to solve, such as when families say they can’t afford warm clothes for the winter or the school supplies requested by their child’s teacher. Others are trickier — like helping immigrant parents who aren’t eligible for Medicaid navigate the system to enroll their Colorado-born children, for example.
The hospital partners with Denver Human Services, which provides a benefits technician to help families apply for insurance and food assistance. The program also offers job referrals and resume assistance from Adams County Workforce & Business Center, and legal assistance for matters that affect child health from the Medical Legal Partnership.
If a screening form indicates a parent is depressed, anxious, suicidal or using drugs or alcohol, staff refers them to the hospital’s mental health and social work team.
Health insurance doesn’t count food as medicine
Medical clinics have been working for years to integrate mental health care into their practices. Resource Connect takes that further by incorporating something broader: social wellness. The hospital is making plans to expand the program, teaching its network of pediatric clinics around the state to use health navigators.
One barrier, though, is funding.
While the hospital can bill Medicaid for doctor’s visits, it cannot get reimbursed for providing food or talking to a patient about how to get mortgage assistance. “You cannot currently bill Medicaid for anything we do in this space,” said Susan Goldenstein, the hospital’s interim director of community health.
Resource Network began as a pilot project funded by a couple of grants. Now, it’s paid for through a patchwork of funding that includes operational funds from the hospital and philanthropy. The hospital’s government affairs team is hoping to persuade state officials within the next few years to allow health providers to bill for social needs navigation.
“And then the pie in the sky would be billing for our ‘food is medicine’ work,” Goldenstein said. “That’s much further away.”
The goal is that someday all pediatric offices would connect children to other resources that impact their overall health. While it’s unrealistic for every clinic to have a team of navigators and a pantry, small clinics could team up to share one resource center, Goldenstein said.
Flores, who works for a cleaning company and lives in Commerce City with her two children and her mom, said the help she’s received from Resource Connect is closely linked to her son’s medical care. The preschooler, who was born with hearing loss, has sensory issues and won’t eat foods with certain textures. He won’t eat meat, so the food clinic’s outreach coordinator, Jessica Rivera, is helping Flores use vegetables to help him tolerate different types of textures.
Also, they’re all eating healthier, including her 11-year-old daughter.
“My family has changed our diet,” Flores said. “My son loves vegetables. My daughter is kinda picky, but I try to make her eat it.”