Designing veteran-centered strategies to reduce and prevent food insecurity: A veteran and community-partnered approach

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Background: Food insecurity is defined as limited or uncertain access to food due to household economic restrictions and affects 1 in 4 post-9/11 Veterans. Food insecure Veterans have increased risk for mental health conditions like depression and suicidal ideation. Current methods to reduce food insecurity focus on immediate food access but do little to address underlying contributors such as such as unemployment, poor access to healthcare, and social isolation. Fortunately, the VA has services that address these underlying contributors. Unfortunately, more than half of post-9/11 Veterans have yet to enroll in, or use, VA programs because they lack awareness of, and/or access to, services. Community-based VSOs are critical entry points for Veterans with unmet social needs who have yet to connect with VA services. However, we know little about their screening practices. Like in healthcare settings, robust screening and referral processes in community settings are imperative; otherwise, a large portion of Veterans may continue to go without food. Significance: The proposed CDA directly responds to the VHA HSR&D’s call for research to mitigate unmet social needs of Veterans. Mounting evidence indicates that food provision alone does not improve food security. We need a comprehensive approach that considers underlying contributors to food insecurity. Many of the 53% of post- 9/11 Veterans not enrolled in VA services separated with low enlistment ranks and/or are women. These characteristics place them at increased risk for food insecurity. Thus, we also need to integrate robust screening processes to identify Veterans who are food insecure where they are—in the community; otherwise, a significant portion of Veterans may continue to go with unmet social needs. Innovation: The need to partner with community-based organizations, VHA, and VBA to design an intervention that will address underlying contributors through peer-support to reduce isolation and navigate existing resources is the basis for the research proposed in this CDA. Our study will also, to my knowledge, be the first attempt to examine how VSOs are screening for food insecurity and other health-related social needs. Specific Aims: My long-term career goal is to be a VA-based independent investigator recognized for implementing innovative, community- engaged solutions that tackle food insecurity and other social determinants of health. With guidance from my mentorship team, I aim to increase proficiency with participatory research, expand knowledge on intervention design and evaluation, and build implementation skills to translate evidence to practice. To support these career objectives, during the CDA I propose to: Aim 1. Design a stakeholder-informed, wrap-around intervention to help post-9/11 Veterans who are food insecure. Aim 2. Conduct a feasibility trial of a stakeholder-informed, wrap-around intervention designed to provide Veterans who are food insecure with peer support and connect to existing services that address underlying contributors to food insecurity. Aim 3. Examine community-based screening practices for food insecurity and other health-related social needs in Veterans. Methodology: We will use the human-centered design framework to design a wrap-around intervention with key stakeholders (e.g., Veterans, community partner, VHA social work, and VBA outreach specialists). We will then conduct a 12-week feasibility and acceptability trial of the intervention. In Year 4 and 5, we will conduct a landscape survey of screening practices among VSOs in Texas and 1:1 in-depth interviews with select VSOs to further explore factors that facilitate and prevent screening in VSOs. Findings will include stakeholder-informed process maps for screening. Next steps: The research generated from this CDA will support an IIR submission to conduct a hybrid type 1 study of the stakeholder-informed, wrap-around intervention and a proposal to initiate and/or expand screening of social needs in community settings. As a VA- based nurse scientist, I will use the skills, mentorship, and experience gained from my CDA to generate research that will inform practice and policy to address complex social needs affecting Veterans.