Food-based Randomized trial for Enhancing Support of Hospitalized children and their families (FRESH) - PROJECT SUMMARY Nationally, 1 in 7 families with children are food insecure. Childhood hunger is associated with worse health and developmental outcomes; children in some families also experience more urgent healthcare utilization. During pediatric hospitalization, some parents/ caregivers (hereafter referred to as parents) experience hunger due to an inability to afford enough food in the hospital. This hunger may increase parent’s mental “fog” and reduce their ability to be present during the hospitalization. The hospitalization itself causes financial strain due to missed work and increased medical and non-medical expenses during the hospitalization. Pediatric hospitalization is an opportunity to intervene and support families that go hungry in the hospital and lessen the burden going home after hospitalization. At our institution, we instituted an in-hospital food support intervention on one inpatient unit to provide meal cards for our cafeteria for all parents of children insured by Medicaid or uninsured, which reduced parental hunger rates from 86% to 16%. Hospital leadership has asked our study team to spread it throughout the hospital. Additionally, we partnered with parents to design a post-discharge food support intervention that provides grocery gift cards and frozen meals to families who identified household food insecurity. We tested this intervention in the clinical system with high ratings of feasibility, acceptability, and appropriateness from a representative group of family participants. We will compare these interventions to usual care, as-needed social work referral. In our first aim, we will determine the effect of the in-hospital food support intervention on parent-reported and clinical outcomes, such as hunger, parent presence in the hospital, post-discharge urgent healthcare use, and time to return to normal routines after hospitalization. We will evaluate this intervention using a stepped-wedge randomized trial, where the unit of randomization is the clinical unit. Our second aim will determine the effect of the post-discharge food support intervention on parent-reported and clinical outcomes, including sooner return to work and school and urgent health care reutilization. This aim will be evaluated through a nested randomized control trial within the stepped wedge design. Our parent-centered and experienced study team is well-poised to complete the proposed project. Our three parent co-investigators bring different experiences to our study team, and our co-investigator team has worked together on many successful projects. Our Stakeholder Advisory Board is composed of both local and national stakeholders who are committed to this project and the dissemination of our findings.
