In 2019, members of the Department of General Internal Medicine (DGIM) started a Food Pharmacy for general medicine patients with food insecurity. Pediatric residents from the General Pediatric Practice (GPP) at Mt. Zion heard about this program in 2021. They conducted a survey of 150 of their patients and found that nearly 20% rate had food insecurity. In March 2021, pediatric resident Priya Pathak contacted Dr. Moreno-John about starting a food program for their patients. DGIM Food Pharmacy members and the pediatric residents began a collaboration and the first DGIM+Peds Food Pharmacy was conducted on 7/12/21. Currently, only patients of pediatric residents are being referred to the DGIM+Peds Food Pharmacy although there are many patients with food insecurity at the GPP.

This grant would support a Food Pharmacy at the GPP for all food-insecure pediatric patients. Our program would use the infrastructure that DGIM created and will be adapted to our patients’ needs. Our program will include a Food Pharmacy at the GPP site twice a month. We will distribute bags of fresh produce, a grain, and a protein, as well as take-away meals. We will also distribute a smaller bag of healthy non-perishables to families at the time of positive screening so they have an immediate take-home product. We will provide literature on healthy eating and recipes to utilize the contents of the grocery bags in the dominant languages of patients' at the practice. During windows when children are returning to school, we will include school supplies to help address other sources of financial strain on families.

List of Goals

• Identify patients and families who are either experiencing or at risk of experiencing food insecurity at the GPP through medical screenings conducted during medical visits
• Provide referrals to patients and families to a GPP food pharmacy where they are able to acquire fresh produce and groceries on a bi-weekly basis
• Provide home delivery of groceries to patients who are experiencing food insecurity and have limited transportation/ambulation
• Reduce food insecurity among the pediatric patients
• Quantify and track participation and outcomes
• Train and educate staff and faculty on food insecurity and federal nutrition programs and the local resources available to patients
• Provide assistance and support in connecting eligible patients to federal nutrition programs
• Incorporate efforts in addressing food insecurity in clinic/institutional workflow

Summary of healthcare-related needs being addressed

This GPP Food Pharmacy will be treating the medical and social consequences of food insecurity in our patient population because children experience an increased rate of developmental risk, poor academic performance, school absenteeism, asthma and less access to routine and urgent care (20). They also have higher rates of obesity, mental health diagnoses, an increased risk of all-cause mortality, and health-risking behaviors such as meal rationing and avoiding medical care (5,6,7).

We are addressing health and social inequalities for African American, Latinx, and Indigenous populations, single-parent families, patients with low English proficiency and Medi-Cal patients, as these groups have higher rates of food insecurity than others (The Department of Health and Human Services). 4 million children (1 in 6) in the U.S. will likely experience food insecurity (14).

Roles of UCSF and Community Partner(s)

Arcadio’s Produce (produce and other foods), Farming Hope (take-away meals), The Family as Medicine Collaborative of the SF Department of Public Health (funding, support), the SF Marin Food Bank (pantry at home, delivery of food to house-bound patients)

Name, title, division of individuals who will lead the project, with brief background information relevant to ability to accomplish the project activities:

• Joslyn Nolasco, MD, Associate Clinical Professor, Pediatrics. Joslyn has maintained the pediatric component of the food pharmacy alliance for multiple years as well and has expanded site buy-in and provided mentorship to multiple residents throughout grant writing and organizational processes.
• Consultant - Gina Moreno-John, MD, MPH, Director of Diversity, Equity, and Inclusion, Department of General Internal Medicine. Gina has been involved in the existing food pharmacy for multiple years from the adult medicine side and has maintained community relationships that have thus far helped keep the project alive.

MZHF values the project embodies

• Service (Avodah): MZHF supports organizations and projects that serve society by addressing community health needs.
• Social Justice (Tikkun Olam): MZHF supports organizations and projects that seek to correct imbalances, inequities, and injustices in health and healthcare.
• Community Building (Kehilah): MZHF supports organizations and projects that build community on the UCSF Mount Zion Campus and across San Francisco.
• Innovation (Hidush): MZHF supports pioneering clinical, research, and educational programs that advance new standards of prevention, screening, diagnosis, and treatment of illness as well as the promotion of health and wellbeing.

Project start date and duration (earliest start date is January 1, 2023): January 1, 2023

Estimate of total budget required and the amount requested from MZHF: $150,000

Applicant name, division

• Joslyn Nolasco, MD, Pediatrics;
• Traci Barnes, MD, Pediatrics;
• Reed Hausser, MD, Pediatrics

Contact info

• joslyn.nolasco@ucsf.edu
• traci.barnes@ucsf.edu
• reed.hausser@ucsf.edu

Pediatric Food Pharmacy, Phase 2 proposal

Joslyn Nolasco, MD, Reed Hausser, MD, Traci Barnes, MD

1. Specific aims:

• Identify patients and families who are either experiencing or at risk of experiencing food insecurity at the General Pediatric Practice (GPP) through medical screenings conducted during medical visits
• Provide referrals to patients and families to a GPP food pharmacy where they are able to acquire fresh produce and groceries on a bi-weekly basis
• Provide home delivery of groceries to patients who are experiencing food insecurity and have limited transportation/ambulation
• Reduce food insecurity among the pediatric patients
• Quantify and track participation and outcomes
• Train and educate staff and faculty on food insecurity and federal nutrition programs and the local resources available to patients
• Provide assistance and support in connecting eligible patients to federal nutrition programs
• Incorporate efforts in addressing food insecurity in clinic/institutional workflow
• Anticipated benefit for underserved or vulnerable communities in San Francisco

1. Anticipated benefit for underserved or vulnerable communities in San Francisco

Targeted screening would directly identify, support, and refer on an immediate timeline, those most economically and socially vulnerable. The Pediatric Food Pharmacy would then establish continued support and provisions to ensure sustained benefit, thus supporting these children’s ongoing health and development. This could have immense impact on their general mental and physical health throughout their life. In addition to promoting the long-term wellbeing of the most vulnerable children, we will be able to uplift their families and communities, freeing up resources for continued quality of life improvements. Once these patients are identified, the Pediatric Food Pharmacy can also identify and meet other needs these families may have. The resources provided would compliment the various other social safety nets, which are falling short for these patients.

3. How the project addresses UCSF Mount Zion priorities and compelling San Francisco healthcare needs

This Gen Peds Food Pharmacy will be treating the medical and social consequences of food insecurity in our patient population because children experience an increased rate of developmental risk, poor academic performance, school absenteeism, asthma and less access to routine and urgent care (20). They also have higher rates of obesity, mental health diagnoses, an increased risk of all-cause mortality, and health-risking behaviors such as meal rationing and avoiding medical care (5,6,7).

We are addressing health and social inequalities for African American, Latinx, and Indigenous populations, single-parent families, patients with low English proficiency and Medi-Cal patients, as these groups have higher rates of food insecurity than others (The Department of Health and Human Services). 4 million children (1 in 6) in the U.S. will likely experience food insecurity (14).

4. Type and duration of campus-community partnership, if applicable.

Through our partnership with the Department of General Internal Medicine (DGIM) Food Pharmacy, we have worked with Food as Medicine Collaborative, who is supported by the Public Health Initiative. We have also worked with Farming Hope through this joint program. We joined the GDIM Food Pharmacy in 2021, and both programs have been working with the DGIM Food Pharmacy since 2019. We will continue to work with both

5. How the community partner's experience and expertise was integrated into proposal development

Farming Hope works with formerly incarcerated or formerly homeless adults to create meals for food insecure people in San Francisco. They offer job training and source “cosmetically imperfect” (read: funny-looking) produce.  Farming Hope has given us a list of their typical meals to make sure that they are healthy and acceptable to our clients. They offer vegetarian meals when requested. This collaboration is particularly meaningful as many of the staff and leadership have a deep empathy for and experience with food insecurity.

6. For each community partner (if applicable):

1)Food as Medicine Collaborative: The Food as Medicine Collaborative is a fiscally sponsored project of the nonprofit San Francisco Public Health Foundation and is based within the San Francisco Department of Public Health. They have agreed to supply food for first 6 months through our partnership with DGIM Food Pharmacy.

2)Farming Hope: See the attached IRS exemption letter verifying 501(c)(3) status for Farming Hope.

Farming Hope Board of Directors:

• Lyndsey Boucherle
• Shelley Dyer
• Michael Fu
• Lucia Gaia Pohlman
• Xochitl Hernandez
• Sheena Jain
• Ilana Lipsett
• Savannah Schoelen
• Salim Zymet 

7. Total proposed project budget with justification: $146,394/year for 3 years

• Requested grant period: 3 years
• See attached Line-item breakdown of revenue and expenses, including individual project team members' percent effort