Poverty, food insecurity and social prescribing — formative SAQs

SAQ 1 — Screening, the Hunger Vital Sign and the social-prescribing response (10 marks)

A four-year-old girl is brought to your clinic for routine immunisation. Her mother, recently made redundant, asks quietly whether you know anywhere that gives food. The child's weight has fallen across centiles since her last visit. ^{[2] [3]}

Questions

1. Describe how you would screen this family for food insecurity and broader material hardship, including the validated tool you would use and how you would frame the questions. (4 marks) ^{[3] [5]}
2. Outline the five-step social-prescribing pathway you would follow for this family. (3 marks) ^[6]
3. Explain the clinical significance of the mother's question and the child's centile crossing, including the organic workup you would perform. (3 marks) ^{[2] [4]}

Model answer

Screening and framing (4). I would screen routinely and destigmatisingly, framing the questions as universal — "we ask all families these questions because they matter for children's health" — to reduce shame and improve disclosure. For food insecurity I would use the validated two-item Hunger Vital Sign: whether in the past 12 months the family worried food would run out before they had money to buy more, and whether the food bought did not last and there was no money to get more. A "sometimes true" or "often true" to either item is a positive screen. For broader material hardship I would add a validated multi-domain social-needs instrument (such as WE CARE or PRAPARE) covering housing, income, utilities, transport and safety. A systematic review confirms that such screening is feasible and acceptable and identifies need that would otherwise be missed. ^{[3] [5]}

The five-step pathway (3). The social-prescribing pathway is screen, assess, co-design, connect and follow up. Screen identifies the hardship; assess clarifies the severity, drivers and any organic or safeguarding concern; co-design asks the family what they need and will accept, respecting autonomy; connect delivers an active referral to food programs, income maximisation, welfare rights and community support, ideally through a link worker; and follow up checks the referral worked, measures whether the hardship resolved, and advocates at the policy level for the structural causes. ^[6]

Clinical significance and workup (3). The mother's question is a direct disclosure of food insecurity, and the child's centile crossing is faltering growth that may be driven by inadequate nutrition — but each has an organic differential that I must exclude rather than assume the cause is purely social. I would measure and plot growth, take a full feeding and dietary history, check a full blood count and iron studies for anaemia, arrange a developmental screen, and review dental and immunisation status. I would investigate and treat the organic cause while simultaneously activating the food-security and income support response, because the two plans reinforce each other. ^{[2] [4]}