The Issue

Food insecurity is a major public health challenge associated with developmental and health risks for both children and adults. The connection between Adverse Childhood Experiences (ACEs) and household food insecurity is well established. ACEs have been linked directly to depressive symptoms associated with unemployment and underemployment, which can put people at greater risk for food insecurity.

Interventions that address food insecurity have largely ignored the social, physical, and mental health issues associated with it. Instead, they have focused solely on improving access to food. Our newest research, published in the Journal of Nutrition Education and Behavior titled “Trauma-Informed Financial Empowerment Programming Improves Food Security Among Families With Young Children“ (May 2020), tested the effectiveness of a trauma-informed intervention called the Building Wealth and Health Network in reducing household food insecurity.

Key Terms and Definitions

Food Insecurity

Lack of access to enough food for an active and healthy life because of limited economic resources

Adverse Childhood Experiences (ACEs)

Potentially traumatic events that occur before the age of 18 that have been linked to risky health behaviors, chronic health conditions, and early death. ACEs include the following:

Abuse and Neglect

• Emotional Abuse
• Physical Abuse
• Sexual Abuse
• Emotional Neglect
• Physical Neglect

Household Instability

• Parental Separation
• Parental Violence
• Mental Illness
• Substance Abuse
• Incarceration

Intervention: The Building Wealth and Health Network

The Building Wealth and Health Network (The Network) is a peer support financial empowerment program for parents of young children intended to improve health outcomes and economic security.

The Network uses the Sanctuary Model® as a frame work through which to provide a trauma-informed, healing-centered approach to financial education. It supports members in learning about normal responses to trauma, such as loss of trust and emotional control, sleep disturbance, and anxiety, following exposure to violence.

Peer group sessions promote personal and collective healing, recovery, and behavior change in addition to financial education. The Network curriculum does not focus on managing food purchases or nutrition education but instead on financial and mental wellness, with topics such as:

Personal Empowerment

• Managing relationships
• Managing emotions
• Providing self-care
• Giving and receiving support

Financial Education

• Understanding the banking system
• Improving credit scores
• Reducing debt
• Increasing income

Program curriculum emphasizes sharing of resources, ideas, and experience among the group rather than relying strictly on program facilitators (coaches) for support. The program also helps members set up bank accounts and matches their savings up to $20 per month for one year.

Methods

The study compared The Network’s effects on health and wellbeing in two participation groups:

• Full Participation: attended four or more educational sessions
• No/Low Participation: attended zero to three educational sessions

Members included in the study were parents of children under the age of six participating in public assistance programs in Philadelphia. Exposure to trauma was not part of eligibility criteria. METHODS Participants reported on their health and economic well-being via surveys before the program and during follow-ups over a one-year period. Surveys measured changes in the following categories:

• Household food insecurity
• Adverse Childhood Experiences
• Depressive symptoms
• Caregiver physical health
• Program satisfaction

Findings

Overall results show that participation in The Network dramatically reduced household food insecurity, independent of participation in public assistance programs and employment status. This impact was sustained well past the initial intervention and despite presence of depressive symptoms and ACEs. 

Program Participation

Members with full participation had 55% lower odds of reporting household food insecurity compared to those in low/no participation group after one year.  Full participation had a predicted probability of food insecurity of 25% versus 39% for low/no participation with a 95% confidence that it falls within the noted range.

Mental Health

Depressive symptoms were associated with increased odds of household food insecurity. Participation in The Network reduced depressive symptoms. The peer group format of The Network contributed to improved mental health by reducing isolation associated with both household food insecurity and a high number of ACEs.

Financial Education

The financial programming allowed members to minimize making trade-offs between bills, avoid alternative financial practices associated with lower food security, and build a practice of saving and long-term financial planning.

Conclusions

Participation in a trauma-informed educational program reduced the odds of household food insecurity for families with low or no income. Addressing the social, behavioral, and emotional issues associated with household food insecurity is a promising approach to improving economic security for the long term. This research contributes to the growing evidence that trauma-informed approaches promote health and wellbeing and shows they also improve economic security. It is time for US agencies that seek to provide economic and nutrition assistance adopt such approaches, as noted in our recommendations on the following page. The results would be transformative.

Context of COVID-19

This research was conducted well before before the COVID-19 pandemic. In this new context, with social distancing protocols in place, peer group experiences and social engagement could be continued through technology that allows for group engagement such as Zoom, in addition to those already utilized to stay connected with peers such as social media and phone technology. Therefore, social distancing requirements should not limit the formation of peer groups or implementation of trauma-informed financial education. Additionally, due to the trauma experienced related to COVID-19, more than ever, it is necessary to adopt trauma-informed approaches in all federal programs to counter this social isolation, grief, and loss.

Recommendations

Based on study results, states should continue to fund programs, such as SNAP and TANF, that are necessary to support those struggling with food insecurity. However, they can expand the impact of these programs by including the following recommendations.

1. Broaden goals of public assistance programs such as TANF and SNAP to include improvement in health and wellbeing.

   Decades of evidence suggest that trauma-informed approaches hold promise in improving health and wellbeing, yet government agencies have yet to include such approaches into public assistance programming.

2. Embrace peer support models in economic and food security programs.

   TANF intervention studies demonstrate that addressing mental health improves employment and economic outcomes, but such interventions rely on one-on-one interactions with trained mental health professionals. The peer group format is proven to reduce isolation associated with food insecurity and depression. Peer group learning is especially effective for people who have experienced trauma and adverse childhood experiences. During the COVID-19 pandemic, peer support programming can still occur during shelter in place through utilization of available technology.

3. Implement trauma-informed financial education with more people.

   Trauma-informed financial education can benefit a large variety of populations such as youths, adults without dependents, and formerly incarcerated individuals. Not only does it contribute to individual healing, the work done in the group setting also promotes collective healing. More programming and evaluation are needed to offer such initiatives in other types of communities.