Families and food: Identifying and responding to food insecurity

Families and food: Identifying and responding to food insecurity

Sue Kleve, Sarah Pennell and Margaret Drivata
27 January 2021

This webinar explored and demonstrated ways to identify and support food-insecure families.

Happy little girl holds a bag of apples while volunteering with her family in a community food bank.

Audio transcript - Families and food: Identifying and responding to food insecurity

Audio transcript (edited)

MR BOWDEN: Hello, everyone, and welcome to today's webinar and our first webinar for 2021. So my name is Mitchell Bowden. I'm the manager of engagement and impact within the knowledge and translation impact team in the Australian Institute of Family Studies. I'd like to start by acknowledging the traditional custodians of the land on which we're meeting. In Melbourne, the traditional custodians are the Wurundjeri and the Bunurong people of the Kulin nation. I pay my respects to my elders past and present, and to the elders from other communities who may be participating today.

So today's webinar is going to be a little bit different, in that we're running our last webinar from 2020 again - Families and Food, Identifying and Responding to Food Insecurity. But we're adding in some roleplays to provide examples for practitioners working with families who may be experiencing food insecurity. The catch is that won't be having a live Q&A session today, but the upside is that all the questions from last year's webinar are incorporated into this broadcast, and the transcript and links to the recording are all available as well.

So, for a quick recap, in 2020, CFCA did a deep dive into food insecurity. We produced a research paper, looking at what the data tells us, some of the different experiences of food insecurity in Australia. A practice guide for professionals working with children, families and communities across a range of settings, and this guide gives strategies and tips on how you might identify people who are food insecure and then what support they might be linked in with. And then a short article on the experience of food insecurity for Australian women and children affected by domestic and family violence. All of these resources are now available on the CFCA website, and on the event page of this particular webinar.

The presentation you're about to watch contextualises food insecurity, first, as a public health concern, then through the experiences of on-the-ground professionals and services providing emergency food relief. And then, finally from the perspective of practitioners working with families experiencing food insecurity in other health and social services. What we've added to today's webinar are two examples - roleplay examples of how practitioners can include questions regarding food insecurity into a session with a client. Firstly, when a client may present with health or social needs, or when a client might present explicitly in need of emergency food relief.

So I'm now going to hand over to myself to continue introducing today's presenters. Today, we're joined by Dr Sue Kleve, a senior lecturer in public health and nutrition at Monash Uni, and she's also the convener of the Australian household food insecurity research collaboration. So, Sue's research focuses on the existence and experiences of food insecurity, strategies to prevent and pathways out of it. She's also an accredited practicing dietitian, with over 20 years' experience in health and community settings. And also Sue and a couple of her colleagues from the research collaboration worked with us on the paper in the practice guide that I mentioned earlier. So, welcome, Sue.

DR KLEVE: Thanks, Mitch.

MR BOWDEN: As the general manager at Foodbank Australia, our next presenter is Sarah Pennell, oversees Foodbank's research portfolio, which includes the annual publication of the Foodbank hunger report. For those who aren't familiar with these reports, the most recent addition has some really insightful findings on the impact of COVID-19 on food insecurity. I'm going to touch on these today, but you can also find the report on the CFCA report and Foodbank's website as well for later reference. So, hi, Sarah. And lastly, Margaret is part of the assessment and response team at Gippsland Lakes Community Health, focusing on child family - sorry, child first, family violence outreach and intake. She's a social worker with 15 years' experience in national and international settings, working with children and families, including working abroad in child protection services, in managing alcohol and drug prevention service and working with culturally and linguistically diverse communities and facilitating national prevention initiatives and workforce development. So, hi, Margaret. Welcome to you.

MS DRIVATA: Hi. Hi, everyone. Thank you.

MR BOWDEN: So now I'm going to hand over to Sue who is our first presenter, and she's going to set the scene for us with a bit of an overview of what we know about the link between food and financial hardship. So, over to you, Sue.

DR KLEVE: Thanks, Mitch. Hi, everyone. So, before I start, I'd like to acknowledge of the people Kulin nation, on who's land that we're all meeting today, and I wish to pay my respects to their elders past, present and emerging. So, in this very short space of time, I really want to go through kind of like a bit of what we know, what we need to know, and what do we need to do. But as a starting point, there's a couple of key points that I want to stress on, which is certainly available in the papers.

So one is around our definition or food and nutrition security. So, in essence, it's about regular, reliable, physical and social economic access to enough food that's nutritious and culturally relevant to meet dietary needs and food preferences. And because this is a basic fundamental human right, we also need to ensure that it's acquired in a socially acceptable way. So that's without resorting to emergency food supplies, scavenging, stealing and other coping strategies. So it's really important there's key elements to this definition that are around - that support, I guess, our direction of our responses.

The other point that I want to make is, when we hear statistics around food insecurity, that quite often we can't compare apples with apples. So it's really important that we consider, you know, how the data was gathered, who it's specifically looking, what was the tool that was measured. So we do know that from representative surveys by the ABS, so the Australian Bureau of Statistics, that approximately 4 per cent of our population are experiencing food insecurity. But for many of us, we know this is much higher. Other measures, again, of a representative sample are around 13 per cent. But we know that in some groups of the population it is significantly much higher than that.

So, with that point, it's also important - and this is some evidence that's come out of Canada, that it's also really important that we look at, I guess, you know, measures around or reports where, you know, statistics around usage of food relief that they don't become proxy measures of household food insecurity. Because what we do know, and I'll talk about in a moment, is that it really can underestimate the actual number of people experiencing food insecurity. Because it's really capturing those who are at that point of needing to source food relief. So we're essentially missing a large number of population who may be experiencing this issue. And this is really important that we - from our policy-based responses.

So the next thing that I really want to touch on and to draw your attention to is that food insecurity can have - or there are many faces of food insecurity and there are groups of our population who are at greater risk. But certainly what COVID and other, you know, experiences that we've had in Australia, including bushfires this year, et cetera, have really exposed more faces or more Australians to this experience. But also what is seen as really highlighted the inequities that do exist in our country. So what is the experience of food insecurity really look like?

Well, in short, it's kind of like this continuum of experience that, you know, is going along in a severity. So what we do know is that what is seen as perhaps the milder version is about stress, anxiety, and concern about putting food on the table. Consuming perhaps less or inexpensive less nutritious choices, making changes to the quantity and quality, skipping foods, skipping meals and then that severe experience of hunger, running out of food, unable to afford more, can't put food on the table and reliance then on social supports and/or emergency food relief. So people can actually slide across this continuum, so it may not necessarily be a steady experience and they may be showing more than one of these experiences.

The other thing to highlight is that this can be an episodic. So at different points in times for households and for individuals, it can be chronic, an ongoing entrenched experience that people may be, you know, caught in this cycle for many, many years. And then, there can be what we call the cyclical kind of experience, where it may be associated, say, perhaps, with a certain time or point in a particular month when pay comes in, but then there's also a range of bills, et cetera, that come in as well. So that it becomes this cyclical experience, whereas, episodic may be related to, say, for example, a bill shock, as an example. So this is well documented, this kind of range of spectrum of experience that can really happen. And certainly, this spectrum of experience, you know, I've certainly seen when I've talked to many people around this experience that, you know, certainly that stress and anxiety is core to this experience as well.

The next part, too, for us to consider, and I won't go into a lot of detail around this, apart from one element. And that's around the determinants of stressors of food insecurity. And in the paper on the website, it goes through what a kind of, like, the key dimensions of food insecurity and one of those being, - so those being around food availability, access and utilisation. But the stability over these of time, and I think what - with stability, that includes things like pandemics and natural disasters, which we are certainly experiencing at this point in time, and then natural disasters being things like bushfires and floods.

So, what I really want to focus on is what is the key driver of food insecurity? And that is certainly linked to financial resources and material hardships as well. So while there is this inverse relationship between food insecurity and income, using income alone as a potential marker is not necessarily sensitive. So it's really looking at things like, as I said, financial resources, asset to debt ratio. There's literature to describe that if households have savings up to a couple of months, that can be in their - can actually be enough as a temporary kind of protector against the experience. But things like, you know, income shocks, insecure employment, the casualization of employment, as I said, bill shocks, large household bills, something, you know, everything comes in at once, can certainly tip people into this experience.

Now, one of - so in Australia, I think probably Jeremy Temple from Melbourne University, he recently looked at some representative survey data by the ABS, and in particular, one around the general social survey. And what he really focused on in this analysis was looking at the stressors reported by food insecurity status. And what he highlighted within this, it's also things like health, so illness, mental health, but also things that impact on financial resources. So, around not able to get a job, loss of employment, but the other thing here, which I think is of interest and relevance to the paper that Mitch mentioned earlier is the experience of violence or witness to violence as also a key determinant.

And the other thing here is that quite often it's these determinants or these stressors that are stack together that significantly impact on food insecurity. So, with this, Jeremy Temple also looked at things like our social assistance payment. And it was really an interesting piece of work here, which he highlighted that, again, looking at something - data around the - called the household expenditure survey, highlighting that those who are on student benefits, so Austudy or ABSTUDY, disability support pensions and, at this point in time when this analysis was done, it was still called Newstart. So as we know now, it's called JobSeeker. Those people who are on this form of social welfare are significantly at a much higher risk of experiencing food insecurity than those that are on the age pension. So this was really important data for us here in Australia to hear about. So that's kind of - really wanted to set the scene is that these stressors around finance are significant tipping points for households.

So, what has happened in the light of what we've experienced in 2020, and I think what has - certainly has - we've seen is that food insecurity has worsened within economical vulnerable populations under COVID, so a loss of income in already low-income households really puts them at much greater risk. But what we've also seen is households who were not previously seen as economically vulnerable and previously food secure now tipped into this experience because of income losses. And I think early on, we were seeing that households who had - who suddenly this heightened experience of economic vulnerability were then drawing on sort of finite unstable resources such as credit, so using credit cards and superannuation to help to support their household expenses. So this then also creates certain issues with that as well.

So, what do we know - I mean, is there any data? Well, there's on particular study during COVID that's happened in Australia that is currently in the literature, and that is by a team from University of Tasmania, led by Catherine Kent. And what this group were able to show is a representative survey across Tasmania and what they were able to show was this gradient of impact that was apparent for respondents who lost income as a result of COVID, where if an income loss of 25 per cent or more significantly increased the odds of food insecurity. And what they did find is that, independent of factors, including household income, a loss of more than 75 per cent of income was associated with around a seven-fold increase of risk of food insecurity. So what has happened in terms of response? And so I'm going to particular focus on the federal responses around the coronavirus supplement and the JobKeeper and the JobSeeker.

So what has this meant for households? Just as another example, there's been some work by Mandy Lee and Merin Lewis from University of Queensland. So, using a tool that actually measures the cost and affordability of food and you can actually look at it for a healthy diet. Now, previously, we know that anything that - across a standard basket of food, that affordability, anything around 30 per cent of income for is deemed as being unaffordable. And food stress at around 25 per cent of income. So, what they were able to show, using this basket and show the impact of some of the federal responses to the coronavirus, was that actually potentially made the access or the economic access to healthier food slightly more attainable by - and shifting people from that, you know, let's say that food stress and really having difficult to afford it, to potentially being able to afford it. And this was also supported by some recent work by Australian Council of Social Service.

So ACOSS prepared a report where they highlighted, across a number of factors, the impact around the coronavirus supplement across a number of people receiving social welfare. And what they were able to show was this measure really enabled people to purchase nutritious food. They were able to afford fresh food and vegetables. You know, prior to the supplement, 60 per cent of those surveys and we're looking just under 1,000 people - reported that they didn't eat fresh produce and were skipping meals. And so, it made significant - shown to make significant changes, particularly around people's access to food, in particular fresh fruit and vegetables as well.

So that's really just as a highlight of what we've seen as a measure and what has happened, and I think what we'll hear through the rest of this webinar is potentially around things that - what we can do and across working across this sector. But also, I think, it's for all of us - is our role as advocates around key things that are really going to make a real difference around not only the, you know, importantly, the prevention of food insecurity, but also in terms of bringing people out of this long-term - you know, potentially long-term experience. So that's it from me. So, thank you, Mitch. And I'll hand over to Sarah.

MS PENNELL: I'm going to corroborate a lot of what Sue had already said to you. I have been listening and a lot of what she has already highlighted has come through in our own research. I work for Foodbank. We're the largest food relief organisation in Australia, and for the past eight years, we have been producing a hunger report, basically taking a look at food insecurity in Australia. In 2020, that report is somewhat different to previously because obviously the year has been very much a year of two halves. And at the time of doing our research, the six months of COVID had really kind of thrown everything up in the air. And so, our research this year has just looked at the COVID experience, rather than being a general snapshot of the whole year.

So, what I can say is that food insecurity in the time of COVID has been very erratic and unpredictable. That said, overall, though, on average, demand for food relief has been up by about 47 per cent. But at different times, that figure osculated between up nearly 100 per cent to then down to below 30 per cent. And that's all been around what's happening with things like government support. So as soon as the coronavirus supplement and JobKeeper and JobSeeker kicked in and people had money in their pockets again, those people that had sought food relief for the first time when iso hit and people lost their jobs, they were able then to manage for themselves.

But that said, since September, when the first rollback of the support started, we have seen demand for food relief climb again, and, in fact, up a further 28 per cent since the end of September. And talking to charities, they believe that they're going to see double the number of people over Christmas than they did last Christmas. And they have even greater fears for post-January when there will be further rollback of the support - the government support packages. So, we at Foodbank believe that we actually haven't seen peak hunger in this COVID pandemic. We believe that the economic recovery phase is actually going to be far more of a concern when it comes to something like food security, but let's unpack the kind of people who have been experiencing food insecurity during COVID, and what we're seeing is that there's a number of things going on.

First of all, those people who were previously food insecure, so those who had been experiencing chronic food insecurity have suffered even more. And I think Sue mentioned this. What we've seen is that those Australians who were already seeking food relief before COVID are now actually seeking much more frequently than previously. And in 2019, it was about 15 per cent of those seeking food relief sought it more than once a week, and now we're seeing 30 per cent. The other group is a completely new group, or a completely new variety of groups. Three in 10 of those experiencing food insecurity during COVID had never experienced it before. And charities are seeing a significant number of two particular groups. One is casual employees and the other is international students. And I think we're familiar with that because there's been quite a bit of media about international students. And in the case of both groups, it's largely because they are ineligible for the government support.

Another point I wanted to make is that a higher proportion of people experiencing food insecurity for the first time during COVID are women. So about 60 per cent of all those people experiencing food insecurity for the first time are women. So, while the government assistance such as JobKeeper and JobSeeker have provided vital temporary relief, 62 per cent of food-insecure people say they are not receiving all the assistance they need. And a fifth, as I've said, are actually completely ineligible for the assistance. Another trend that's worth noting is that it's the young Australians who have been hardest hit during COVID. When it comes to, you know, experiencing hunger because of the pandemic, young Australians are the ones at the forefront. This is reflected in that 65 per cent of food-insecure 18 to 25-year-olds are going without food at least once a week. That is significantly more than any other age group. Amongst baby boomers, for instance, it's only 25 per cent.

The other thing I wanted to mention is there are grave fears for the future. We asked food-insecure people to look forward, and almost 35 per cent of them said they don't know whether they will cope or expect that they won't cope when the additional government support is withdrawn. Charities believe that demand will increase over Christmas, as I've already said, and then again when the assistance is rolled back. And they are telling us that they would need at least 50 per cent more food in order to be able to cope with the demand. Sue made the point that we shouldn't use numbers related to people seeking food relief as a proxy for food insecurity - household food insecurity. She's absolutely right.

What we've seen in our research is that 61 per cent of food-insecure people actually access food relief, which means about 40 per cent aren't. And when we unpack that, what we find is there's a variety of reasons why they don't, but quite often those reasons are - relate to embarrassment and shame, and this is the case under normal circumstances. But even during COVID, when we know that everybody is being affected equally, and, you know, genuinely people could not have predicted that they were going to lose their jobs in the way they did overnight as happened during the lockdowns. They still are not keen to reach out for help, but believe that, you know, it's embarrassing or it's their fault that they don't have the wherewithal to put food in their table.

So that's a big issue, and one that we really need to address. That's all I wanted to share today. I know we're going to have an opportunity a bit later to take questions, but I'm now going to hand over.

MS DRIVATA: Thank you, Sarah and Sue. I work in East Gippsland, which is in Regional Victoria in Gippsland Lakes Community Health. And what I will do during this time is focus a little bit about the clients we are seeing and the problems they are presenting to us in our practice. So, in Regional Victoria, we have experienced first the drought and then the national disaster of the fires - the bushfires that started the year, and then the pandemic. So the clients that are presenting to us are very much hit in the financial situation because of the pandemic, because of COVID-19, because of result of less income, lack of income, and also lost jobs. So if they maybe had part-time jobs that was giving them a little bit more income, stability in their lives or in their families, now they've lost even that. It could be a full-time job, but even those who are relying for that little bit extra income, many of them have lost that resource as well. So, what they present like are sometimes occasional clients, so sometimes they come because occasionally they're experiencing food insecurity and this might be because of an accident - an extra medical bill that they have because of something happening in their health, or else their car breaks down and it's an extra expense that they did not foresee. You know, and other situations like that which is not their usual pattern.

So they experience just a one-off situation where they're really struggling. And then they come to us and say, 'Look, I'm really struggling, can you help me?' And they might ask for food, which can be quite embarrassing for them, especially if they have been managing before. But we also have others who maybe have - are experiencing food insecurity because of other underlining issues. So sometimes it could be an addiction to substance abuse or even gambling that is leading them to mismanage their funds and putting maybe the funds in the wrong priority, and then they don’t have funds for the food. Or else, on the other way, they might be focusing on prioritising for the family or for themselves. But then, they are neglecting bills and then they end up having difficulties with paying their rent and sometimes they risk eviction. So, the problem of food insecurity is not part and parcel on its own. There's usually other complex issues around the food insecurity issue that they present.

Sometimes, there's family violence situations as well, and so the person that needs to leave the family-violence environment has to seek alternative accommodation, and that can be an added strain in the finances. Sometimes they cannot access their finances for a while as well, and they present to us, but that would be, again, an occasional situation. I think, as professionals, sometimes we are a bit reluctant in exploring the financial situations with clients. We might have - from a professional side, we might actually feel that we should not probe in that area because it's a private matter; however, we have noticed that when we have clients who have presented asking for food regularly, it has been very beneficial to sit down with them and actually explore a little bit what's happening in their finances.

So, we do ask those probing, uncomfortable questions of when is your Centrelink due? How much income do you actually get? What has happened during these last two weeks? Where has your money gone? But of course, in a very sensitive manner so that the client does not feel intimidated or, you know, or close us off to give us that information. But by asking those questions, if we ask it in a sensitive way in and a caring manner, the client might actually be in a position to open up about other issues that they need help. They might be able to be linked into counselling, they might be able to be linked into specialised services for addiction, for their addiction issues. There might be family violence that comes out through that conversation or other abuse situations that is occurring that is leading to the financial instability and need for food and security. So, it's really good to have that question and do it in a very sensitive way.

So, we sometimes focus on assessing the big problems, so let's say if we work in child first, we want to work with parents and we wanted to address parenting skills and the other issues around the parenting. However, if a parent is struggling to put food on the table, sometimes if we manage to actually address that need before we address the other bigger problems, the client might be more inclined to open up and receive our suggestions because the first - I mean, if you are a mum, for example, and you cannot provide food for your children, that is the biggest problem that you need to be tackling before you are tackling anything else. So, clients seem to appreciate when we actually address financial instability and food insecurity as one of our assessment - things that we assess. So they really appreciate that and sometimes open up to want to receive other things as well, other services and other supports. I think it's very important as well for organisations and for social workers to be aware of non-government organisations around their agency that provides food. So if you're working within an agency where you do not have food bags to give to clients, you can actually have resources around you that you can link clients to or liaise with.

For example, we do that in our work. We have a non-government organisation that provides us with food bags for clients, and we make sure that they are food which is specifically for the need of the client. So whether it's a homeless person or whether it's a family, the needs for food might be different. If somebody doesn't have a house on their head, they might actually still need food, but they won't be able to cook that food. So we need also to be aware of our clients' needs. And we can only be aware if we do those conversations with the clients. If a client comes and we just give a food bag and not dwell further, we might be missing out opportunities to be able to reach to those clients.

So, it's very important that we tackle that issue, maybe to think about also sensitively including it - including food insecurity as part of our assessments with clients and also to be aware of clients that present to your agency and the different situations that they come from and how that might be leading to the food insecurity. So, that's all from my part, and I hand over back to Mitch.

MR BOWDEN: Thank you. Thanks, Margaret. And equally, thank you to Sue and Sarah so far. And that's a really segue actually into the next part of this webinar, where we are actually going to look at this idea of screening or incorporating some sensitive screening questions into your existing intake or assessment forms, or even if you're not working a client-centered way, even just in some discussions, some discussions that you might be having with communities or individuals or families. So, we are going to look at some of those things. And first, I might just ask Sue to come back on and she's going to, I guess, just give us a quick overview of what screening questions are available to us, and these are available in the practice guide that I mentioned earlier that's on the website and also available in the hand-out section. But don't worry if you don't have it in front of you because Sue's going to just quickly introduce those to you and tell us why they're important and how they can help you help your clients.

DR KLEVE: Great. Thanks, Mitch. So I think, you know, the first question, I think, Margaret, you know, the segue has been fantastic because why screen - it is really important because one of the things that we haven't touched in, but it's really well-described within the practice papers is food insecurity - ultimately has impacts for both adults and children in the short term and the long term around physical, social and mental health as well. So it is really important that we do actually screen for it and have those discussions.

So, what can we use? So, in the practice paper, we actually have, I guess, a tool that has been relatively newly validated and it's built on a tool from the US from the US Children's Health Watch, and it's called hunger vital signs. And it's a two-item screener. So, a team from Queensland University of Technology, so Danielle Gallegos and a team have actually taken this tool and done some preliminary validation of this with some modifications in an Australian context. And so they've done this within a paediatric health care context, and as well as in a regional context in-and-out patients kind of setting while people were waiting for appointments. And what this tool really does - I think, you know, you get the picture that through across our presentations, this experience, as we've talked about is not just about that end stage of experience, about running out of food, not having enough money for food, but it's also centered around that worry, concerns, stress around will I run out of food before - that we're able to buy more.

So these are essentially the two screening questions, and these can actually be built into your assessment that you're doing with clients or as people as you see them. So they can actually be threaded through the conversation. And yes, there is stigma and I think that's something that we have all alluded to around. Food is something that, you know, we all, you know, I guess what I'm trying to say is that, you know, people - you know, particularly parents and particularly mothers, there's that stigma and that shame of I don't want to say that I can't feed my children or, you know, we're really struggling with food. But the question can actually be asked particularly as a starting point, is have you ever been worried about that?

And so, in terms of this screener, we've got those two questions there, and they're - and in responses, it's been phrased as something that's never true, sometimes true, or often true. So if we get people who respond never true to both of those questions, then they are on the continuum, is what we would describe, as they're food secure. But I guess the thing is also to highlight that these are screening questions and an assessment of whether the people are at risk or potentially are experiencing. For those that may then response sometimes true to either one of those questions, then certainly they may be at that - if we think back to that spectrum, perhaps on that the early stage or some of the earlier kind of experiences where people may not be progressing further up to that continuum. But certainly is serious, you know, potentially at risk of progressing further. And then there's often true where people are responding to both of those questions. So they would be described as - certainly if they've said, responded to that they've run out of it, and both of these highlights of these questions, then they are certainly deemed to be experiencing food insecurity and on that continuum of more that severe sort of spectrum.

So, I think the thing is there's - both these questions can be threaded through the conversation as - when we're facing clients that - and as Margaret sort of mentioned that, you know, food insecurity is really potentially a marker of a range of multiple stressors that are going - people are experiencing in their day-to-day lives. So, I think now we're going to go back to Mitch and then we'll talk about those in more detail.

MR BOWDEN: Thank you, Sue. So before we head back to the panel, this is where we're going to show you our two roleplay examples. And again, these are of practitioners incorporating screening questions into discussions with clients, either as clients presenting with emergency food relief needs or with other health and social needs.  

Roleplay scenario #1

CLINICIAN: Hi, thank you for coming in today for the appointment. I called you to come in today because I wanted to talk to you about a referral from Child First that we have received suggesting that you might need support.

CLIENT: I don't understand why I'm here.

CLINICIAN: Okay. And I understand you can be a bit confused because you wouldn't know who has done this referring, is that what worries you? So basically, we've received a referral saying that you have two children, is that right?

CLIENT: Yes.

CLINICIAN: And that you have mental health issues and you might be struggling a little bit about that?

CLIENT: Can I ask you who the referrer was?

CLINICIAN: It was an anonymous referral, but they said that they - you have kids and you have mental health and that you might be struggling a little bit, and some parenting support might help you.

CLIENT: I'm really uncomfortable with that because, you know, normally people get involved and it causes problems, and I don't want anybody to take my children away from me.

CLINICIAN: Can you tell me a little bit more of what you mean by it causes problems and your children will be taken away from me?

CLIENT: I don't really want to share my personal life with anybody.

CLINICIAN: Okay. Has Child Protection ever been involved with you?

CLIENT: No.

CLINICIAN: And what do you mean by you are afraid that your children would be taken from you?

CLIENT: Well, when people start asking questions and they get involved in your life, accidents can happen, things can go wrong, people can make bad decisions.

CLINICIAN: I understand your fear, but what I can reassure you about is Child First job is different than that. So Child First is aimed at trying to give you support as a parent to actually care for your children. We don't have the authority to remove your children. That is something Child Protection can do. We do, yes, feedback information to Child Protection if we feel there is the need. But if we do that, usually we discuss that with you and we explain that we are concerned. So, our aim is not to actually contact Child Protection and say how bad a parent you are, but actually, it's to try to empower you as a mum in whatever struggles you have at the moment for your kids. That's it. Does that mean anything to you?

CLIENT: Are these people parents themselves?

CLINICIAN: Well - - -

CLIENT: I mean, I think I'm doing a pretty good job. I'm trying to do a really good job, just under really difficult circumstances.

CLINICIAN: Yep. Whether the professionals that work with us are parents or not, it's not important because they give the same support to any parent. So, they can - they won't do decisions for you as a parent. We also understand that you as a parent are the best person who can take decisions for your family. So it's not about whether they're parents or not. I believe they can still try to understand you if you allow us to give you support, but it's something that is voluntary. This is not something you are forced to engage with. It's something that can be an additional support for you if you wanted.

CLIENT: I'm not sure.

CLINICIAN: Okay. So let me give you a bit of an understanding of some of the services that we have here. So, there's a lot of services like counselling, parenting support, family violence, outreach supports, services for the children and young persons. So there's a variety of services that we offer as an agency. But I'm actually going to ask you something that some families that we encounter struggle quite regularly with, which might be something that you might also consider. Do you worry about your food? Do you have food?

CLIENT: Always, always.

CLINICIAN: So you feel that financially you struggle?

CLIENT: M'mm.

CLINICIAN: Okay, okay. And that's okay to discuss even things like that because they're day-to-day struggles that you might have as a parent. So even basic things like that we can discuss. So, you're saying that you worry sometimes about food. What's your situation like this week for you?

CLIENT: Really difficult. I don't have a lot of money. I'm not working. And with the two children with the baby, and my five-year-old, I have to choose and make choices on a weekly basis between do I buy a formula and nappies for the baby or do I feed my five-year-old and I don't eat, myself. I don't - - -

CLINICIAN: And it's really concerning that you're not eating because you need to take care of yourself, as well as taking care of your children, and I believe that can be quite stressful for you.

CLIENT: It is very stressful. I've got some other issues myself recently and not eating makes it worse.

CLINICIAN: Can you tell me a little bit more about this other issues?

CLIENT: I have post-natal depression, which I struggle with, and I'm diagnosed but I'm not taking medication because I can't afford to pay for the medication.

CLINICIAN: I understand. So, this financial situation is affecting you in many different areas in your life, both in your parenting, it seems, and also in your mental health. Would providing you with some food today and some food vouchers to buy some formula for baby help a little for this week?

CLIENT: I'm not Australian-born, and in my family, a mother who can't feed her children isn't worth much - - -

CLINICIAN: I understand.

CLIENT: - - - and I can't talk to my family about that for that reason.

CLINICIAN: I'm sorry about that you don't have support from your family. What I can tell you, although I'm not from your same culture and I wouldn't pretend to be an expert as well because you know your culture well. But what I can assure you from our side is that we offer you privacy and confidentiality and your family or relatives do not need to know that we've provided you with food - - -

CLIENT: You need to make sure of that. That's really important to me. They can't know that I - because, as a mum, you know, I feed my children, I feed my family, I take care of them. If I can't do that, they'll look down on me.

CLINICIAN: Yeah. And you're not the only mum that struggles with providing food for your kids. We are meeting a lot of families who are struggling at the moment with providing food. So it's not because you're a bad parent, it's a reality of the kind of situation and I really actually appreciate that you've voiced your concerns with me because at least we can do something about it. Going back to what you told me about your family, I can reassure you that they cannot phone and know what services we're giving you and also you don't need to tell them where you bought your food from or that we've given you food vouchers, because I understand it can be sensitive for you and we respect you for that and we respect that you've been able to share it with us. And if you will allow us, we'd like to help you with that.

CLIENT: Okay, thank you.

CLINICIAN: Would you accept food bags and food vouchers from us today? Would you want that?

CLIENT: Yes, that would be good, thank you.

CLINICIAN: We can also look a little bit on the long term to see how we can avoid this worry being something that is repetitive, of not having food for yourself and your kids. And maybe look at how that is affecting your mental health if you allow us to offer you support with Child First?

CLIENT: Okay.

CLINICIAN: Is that okay? Do you feel a little bit better than how we started this appointment?

CLIENT: I've never reached out for help before, but I'm glad that I came today because it sounds like you might be able to help me.

CLINICIAN: Okay. I will be calling you again, and would it be okay if I come visit you at home? Is that something more easier for you?

CLIENT: Yes, if we can arrange a time when they'll be nobody else around, - - -

CLINICIAN: Definitely.

CLIENT: I'll appreciate that.

CLINICIAN: Yes, okay. Thank you for being so honest with me, and we can assure that we'll be very sensitive in how we provide you support.

CLIENT: Thank you.

CLINICIAN: Thank you. 

Roleplay scenario #2 

CLINICIAN: Hi. How are you today? How can we help you?

CLIENT: I'm good, thank you. I've just come in today because I'm hoping that you might be able to assist me with some food because we don't have any of that.

CLINICIAN: Okay. So, how many people are in the home?

CLIENT: There's myself and my partner and our two children.

CLINICIAN: Okay. How old are your children?

CLIENT: One's two, one's five.

CLINICIAN: That's good. And you were saying that you were finding yourself, this week, having no food?

CLIENT: Yes.

CLINICIAN: When is your next payment? Do you have a job? Do you have - - -

CLIENT: No, I lost my job. I work in catering and we received Centrelink payments, but it's been - I think we were paid last week. We've got another week to go, and it's really difficult to try to keep on top of everything and I'm just hoping that I might be able to get some food.

CLINICIAN: Yeah, we can help today. We do have food bags and food vouchers that we can help you with. It's just, I'm trying to understand whether this is something that occurs often and whether you actually find yourself worrying about not having food for yourself and for the family regularly.

CLIENT: I do, but there's nothing much that I can do about it, because, you know, having lost my job, it's very difficult to pay the bills and the rent and sort of keep everything going. I have to prioritise and choose which one to do.

CLINICIAN: And does your partner work or is he also on - - -

CLIENT: No, he's also on JobSeeker as well. He doesn't work.

CLINICIAN: Okay. And how does it go, like do you have other expenses that you were finding yourself struggling financially with?

CLIENT: Well, we've got the real estate agents on our back at the moment because we're behind. We're getting into the arrears. We're about three weeks in arrears, and they've already threatened us that they're going to evict us.

CLINICIAN: And that would be quite stressful to - - -

CLIENT: Oh, it's very stressful, very stressful.

CLINICIAN: So you're three weeks behind in rent, and when is your next Centrelink payment?

CLIENT: Next week.

CLINICIAN: Okay. And did you plan to try - do you have a plan on paying back the rent somehow with the agents, or have you - - -

CLIENT: Well, it's very hard to have a plan when you, you know, you don't know where your next dollar is coming from.

CLINICIAN: Of course, I understand that. It's like you're juggling you every week, is it?

CLIENT: Yeah, all the time.

CLINICIAN: Okay, okay. We do have food bags and food vouchers that I can provide you with today. I'm just concerned about this - that you called straight about eviction, which is very concerning as well. Would it help you if I tried to see if we've got some funding to try to help you with the rent that you've got in the arrears? Maybe you can find your feet a bit financially.

CLIENT: I'm really worried about my husband finding out that I've actually come here because I think he might be a bit too proud to accept that kind of help and assistance.

CLINICIAN: Okay.

CLIENT: That's something I - you know, if it's something you can do, then I would probably talk to him about it, but I wouldn't talk to him first.

CLINICIAN: Yes, definitely. You can talk to him about it, and let me know whether we can help you with rent in arrears. Look, we have a lot of support and services here. Do you think there's something that we can provide you and your partner with that can help you maybe understand what the problem is that is leading to this financial struggle, apart from you not having a job?

CLIENT: Well, when I get another job in catering, it won't be as hard as it is now because obviously I have a wage coming in. And we're not spending a lot of money on things that we shouldn't spend money on. We're spending money on rent and food and things like that, but my husband has a bit of a drinking problem. He's - you know, he buys a lot of alcohol and that money goes towards the alcohol, rather than food for the kids because we've tried to keep up with the rent, then we pay the rent first. But still, three weeks in arrears, but you know, he's drinking - I mean, he doesn't help much with the kids, either, so that makes it even more difficult.

CLINICIAN: And I see that you're expressing quite a bit of pain as well about that because you seem to be concerned about your children and maybe you feel that he's not seeing the same priorities the same as you?

CLIENT: No, he doesn't.

CLINICIAN: So, I'd like to give you an appointment, because I'm aware that today you dropped in and asked for the food, but would you be able to come and have a bit of a more chat with us so that we can see whether we can offer you supports like you've said and maybe also your partner, you know, if he wants support with his alcohol issue, eventually. We can give him support as well if he agrees.

CLIENT: I don't know that he would agree, but I - you know, I would appreciate being able to come back and see what you can do for us.

CLINICIAN: Yes. Maybe giving you a bit of support and these struggles and also trying to understand, you know, what's causing it because I see that you're a bit in pain. Maybe we can understand what happens when your husband drinks and whether there are other issues that we can give you support with.

CLIENT: Okay.

CLINICIAN: Thank you. 

MR BOWDEN: Great. Thanks, Kim and Margaret. So now we're going to head back to the panel discussion and the Q&A session with all of our presenters. I might ask Sarah and Margaret to join us again. And really, one of the things that has been touched on throughout this presentation but I think is worth exploring a little bit more as a panel is - is this idea of stigma and shame. And so, in the practice guide, people will find that there's a series of FAQs, or frequently asked questions, that we've attempted to respond to to try and overcome of these.

And one of them I'm keen to discuss as a panel, and that's, you know, as a practitioner, if I was to, you know - to not feel sure about asking these questions because, you know, I know my clients get uncomfortable and I worry that they might feel judged or embarrassed. You know, do I really need to include this in my intake and what should I do if I do notice that either in their verbal responses or in their non-verbal ques if I notice that they're starting to feel uncomfortable or that they're indicating in their body language something that might indicate that they are feeling - that they are food insecure, but their verbal response is saying no, I'm fine. So, Margaret, maybe could we get your perspective on that first, being that this is something that you're familiar with in your practice?

MS DRIVATA: Yeah, so I think we need to be sensitive. And of course, although we want to probe to actually help clients, I think fundamentally, it has to also portray care. And that as an organisation we can identify the specific needs so that we can offer the support. So, that message needs to be highlighted. So we cannot just do like a tick-box kind of questionnaire with the clients to find out whether they have food insecurity. Because it is an embarrassing topic, and it's not a topic that clients will just gladly admit to, unless they are willingly coming to us for food in their first response. So we need to be sensitive, probe, but also work with the client. And if they don't feel comfortable, then we need to be able to stop and just see whether there are other resources that we can offer instead that might actually release some funds for them to be able to then tap into food resources for themselves.

So either we could - if they present, for example, with an issue I don't have fuel or I don't have a gas cylinder, et cetera, we can offer them food to release finances from their food expenses, so that they can use that funds to use it for the other presenting issues that they've presented, and that sometimes leads to a more comfortable conversation of, oh, wow, thank you. Sometimes, I have had these challenges. Or else if they present wanting the food specifically, then it's more comfortable to have that conversation of understanding more about the income and what's happening, if it's a repeated pattern. So, we need to always show care in our approach, of course.

MR BOWDEN: Yeah, yep. Well, maybe, Sarah, we'll go to you first. Did you want to add anything to that?

MS PENNELL: I would just add from - another potential approach is to just ask them about their shopping habits and how well their kids are eating, you know, what kind of meals do they do at home, what do they give their kids to take to school. So you start asking from that positive perspective, and then, you know, where they're experiencing difficulty or challenges and having enough food, it'll start to come out, but you don't start with that. You just talk about, you know, having to cater for a, you know, a growing family and how challenging that can be and work towards it - towards that greater understanding.

MR BOWDEN: Yeah, great one. And what about you, Sue? Anything to add?

DR KLEVE: Yeah, I think - I mean, it certainly is tricky, but I think it's also to, as we've sort of said, it's having that respect and coming with that care and that empathy. But also, I think in how we approach the question. So it may not be - we can sort of perhaps frame it of, you know, I come across - lots of my clients who talk about, you know, this is an experience and, you know, really struggling at times to put food on the table and, you know, provide school lunches or, you know - as an example. That can - you know, is this something that, you know, you're experiencing or you've experienced in the past? So it's taking away from that specific also focus on that individual and also saying, look, hey, you know, I've come across this scene, you know, with lots of people that I speak with and I work with, too.

MR BOWDEN: Yeah.

MS PENNELL: Yeah, you're not alone.

MR BOWDEN: Yeah.

DR KLEVE: Yeah, you're not alone. Because I think that is a really good point. There is that sense of, I'm a failure, this is what I'm - you know, my experience in speaking with people in terms around their experience of food insecurity, particularly women, there is that sense of failure. Because, I think, like as an example, one woman, I clearly remember she said, 'This is my job. I'm meant to be able to feed my kids, and I can't do it.'

MR BOWDEN: Yeah, wow.

MS PENNELL: Another response that we get quite frequently from our surveys is people saying, yes, I am struggling, but I'm sure there's other people who need it more than I do.

MR BOWDEN: Yeah.

DR KLEVE: Yeah, I agree, Sarah. And I think that's that sense of that people will hold on and struggle and perhaps, you know, as you've sort of said, there's a whole group of people that are not - you know, may not seek support.

MR BOWDEN: Yeah.

DR KLEVE: Or even support from family and friends.

MR BOWDEN: Yeah. So what I'm hearing is definitely this importance of the rapport building and having a good relationship with your clients. And that - and, you know, that may be difficult if you're not always working with the same client, but I think it's probably, as a service organisation, worth considering. You know, there's these questions, yes, they've been validated and yes, we know that they can lead to good conversations, but it's worth thinking about where in the process with people that fits, whether it's at the point of intake or whether it's maybe a little bit later on and in various discussions or through enquiry it comes up.

MS DRIVATA: I think also they might actually be thankful if we ask the question. They might not have actually thought that they could ask that question. Maybe they're not aware that there's that resource or that possibility of asking us that question. So they come to us for something else, maybe. For counselling or other things, and they might not identify that they can actually speak about food insecurity as well, unless we ask. So they might actually be very thankful that we have actually put that forward.

MR BOWDEN: Yep.

DR KLEVE: And it's so powerful if you do because not having the stress or concern about food in the household can free up time and energy and hope for addressing the other more fundamental issues, you know, that have brought them to that circumstance.

MR BOWDEN: Yeah.

DR KLEVE: So the charities that we supplied food to are always telling us that the food relief that they do provide is just so critical in building trust and giving people the capacity to address their other issues.

MR BOWDEN: We've got one other one that we might get to in a little bit, but I do want to go one of the questions that's come through the audience, which I think is a really interesting one. And so it's, 'As a local government or community development worker or public health, health promotion type of a role, how can we best support stakeholders to deliver food security initiatives and build capacity of individuals and groups in the community to increase their access to healthy and nutritious food through gardening, Foodbanks and seed sharing and things like that. So I think it's really around, again, that notion of not working in a client-focused service, but how can we work as a system. So, Sue, maybe did you have some perspectives on that firstly?

DR KLEVE: Yeah, I think it's - well, I think what they're, you know, implying and leading to is that systems thinking. So really applying, within that local system, that local government context, that broader system of food access. So looking at it quite broadly, so inclusive of perhaps food relief, but beyond that. So what are other things that within that local government and within all the, you know, the myriad of organisations that sit within local governments and community-based organisations and the connections, I think that's really important. That to provide a very much joined-up, but a very varied response to actually support access to food. And, you know, even within a local government context like the power that they potentially have in terms of even looking at, well, what are the - you know, the access points for people in terms of food? So what are the fresh food outlets? Where are they? Do we have adequate public transport? Do we need transport, you know, transportation systems to help, you know, if that's food physical kind of access kind of point that we're doing as well. Yeah, so it's really looking at that system.

MR BOWDEN: Yeah.

MS PENNELL: And I think, Sue, the big issue is that while food insecurity touches on so many areas of policy and, you know, welfare response, be it social welfare, health, education, employment, you know, it touches on all these areas. But it doesn't sit in one area, and so it falls between the cracks. And I think one way of being able to get a better, more systematic approach, as Sue said, is to have - be at the local government level, or right up to commonwealth government level, have a food security strategy, so actually look at food security in totality as it spans across all the other portfolios.

MR BOWDEN: M'mm.

DR KLEVE: I think that's a good point.

MR BOWDEN: It's actually - it's interesting, this touches on the point that, Margaret, you made earlier around, you know, if you're not in a position in your organisation to be providing food vouchers or food hampers or even running community meals or lunches or things like that. You know, doing a little bit of that mapping of who else in your local system is doing what in relation to food or like Sarah said, it may not be that they're working in food at all, but they're working in employment services or, you know, education. So that actually links to this next question that we've got, which is, 'Given that the main drivers of food insecurity are related to financial resources and material hardship, for those professionals and organisations that are responding to food insecurity, this might be our emergency relief or charity organisations, who should they be working with?' If they're starting from scratch, who can they be reaching out to identify and work with? So, Margaret, did you want to maybe give your thoughts on that first?

MS DRIVATA: Yeah, so we have actually linked with a local church in the community that wanted their initiative to be providing food. So, they don't actually meet the client. They just do meetings with us and organise food bags for us, which is great. So they provide that through their finding, and they're reaching out to the community through that. And of course, that provides us with resources to give to the clients. So I think it's very important to just keep, you know, a really wide perspective about where actually resources can come from because we might be focusing only on a few organisations that we know, but there might be other voluntary organisations also that would be willing to work with us to (indistinct) clients.

MR BOWDEN: Yeah, yep. Sarah, did you want to add any of those? So you're nodding avidly.

MS PENNELL: Yes, I mean, Margaret's absolutely right that help can come from all sorts of sources and COVID was an amazing example of that for us at Foodbank. Because when we first - when COVID first hit, a lot of charities, the normal regular charities that we were supplying closed because they had - all the volunteers who needed to isolate themselves or they found it too difficult to adapt to the COVID-safe protocols. You know, changing perhaps from cooking hot meals to providing hampers was too difficult for them. So we had to reach out to others to help. And the response was overwhelming. We had everything from local footy clubs actually delivering hampers for us, you know, commercial companies whose reps were off the road. They actually offered the services of those reps and their vehicles to help us, you know, deliver food to new places. People who were in lockdown and therefore couldn't come and get the food. Rotary service groups all dived in. It's amazing, once you have a plan, how many people will step up and say I will help you with that plan.

MR BOWDEN: Yeah.

MS DRIVATA: And I think also building networks with other professionals and other organisations. For example, last week, we had a local hospital social worker working within a local hospital who contacted us because they knew that one of the services that we provided was actually food for clients, and they had a client who was being discharged and he was homeless, so they wanted to provide food vouchers and food bags for them. So they've linked - it wasn't our client, but we could work to get it like that, to provide the resource for that service to provide to the client. So I think we need to be really aware of the networks that we can build with other professionals as well.

MR BOWDEN: Yeah, yep. We're probably going to have to wrap up soon, but I also wanted to just add, neighbourhood houses and community centres are great pick-up drop off point. And there's also the Ask Izzy website, which you can actually go to and visit and search for a range of these different things. And that's on the web page for this webinar. All right, so we might jump back into the practice guide now and look at one of the other FAQs that we tried to respond to, and this is really around, I guess, working with people from different cultural backgrounds. So, 'My clients can be from Aboriginal and Torres Strait Islander communities and/or from a range of overseas backgrounds, including people seeking asylum and refugees. So when I'm asking these screening questions of them, is there anything I should be aware of? Do I need to use any particular language? And is there anything else to consider?' So, Margaret, I know you've done some work in culturally and linguistically diverse background communities, so did you want to answer that one first and then we'll see what Sarah and Sue want to add?

MS DRIVATA: Yeah. So, although food, of course, is a universal need, so everybody needs food regardless of their background; however, there are some backgrounds and different cultures that for them food is not just a food intake every day because their body needs it, but it's also around bringing the family together and having a social event and inviting extended family over and providing quite an abundance amount of food. And they feel that there is that expectation that they need to meet as well, so sometimes they might feel more embarrassed as well to say to their extended family that they do not have that food provision to provide because it's not just about the daily needs but it's also meeting that social expectation and the social event that is part of also the culture.

In culture and the diverse and the linguistically diverse communities, there's also the sensitivity of ensuring that the communication is actually not misleading and that they're actually understanding your point of where you're coming from, where you're asking about food, because it can be, you know - in different cultures, it's different. So they might feel that that's something that they should not open up to you. They might feel more comfortable to address it with a person of more - that is more aware of their cultural backgrounds.

So we might need to, maybe, if we are working with somebody and we're not aware how our questions might impact or how we're going to address food insecurity because they're presenting it. I think it's very important for us to seek knowledge from expertise who work with CALD communities or with Aboriginal communities who can give us tips on what the client is presenting and what their actually need is. And how best to address it. So we might need to maybe address the clients to a specialised service or it's just receive enough information for ourselves to understand the presenting problem and the surrounding issues as well in regards to the culture.

MR BOWDEN: Yep. And I think also, I guess, I would also just always encourage the use of interpreters and not always using - and where possible and not using family members, yep, because we can't necessarily always guarantee the quality of the translation that's being done or whether there's - they're answering truthfully because of the stigma that's attached with this kind of an issue. Sue or Sarah, did you want to add anything to that one?

MS PENNELL: I could just add that our 2019 research, we did some analysis around Indigenous communities and found that, not surprisingly, very high levels of food insecurity, much higher than obviously the general Australian population and higher levels of psychological distress around that food insecurity than is the case elsewhere. But one thing that is note-worthy is that a higher proportion of Indigenous people do seek food relief, not to say that they're successful in getting it, but they're more likely to actually seek help than people in the cities - other areas. So just some observations.

MR BOWDEN: Yep. And, Sue, anything lastly to add?

DR KLEVE: No, I think I really concur with Margaret's point in terms of, you know, how they approach and, you know, that understanding of the role that food has, and that pressure of, you know, certainly in perhaps family celebrations situations, it's not like bringing a plate, it's potentially the expectation for that household to provide everything and the pressure that that does put particular people under. And I think also in cultures of - that notion of within family of that sharing and what is mine is yours and what is yours is mine as well is important to note, too.

MR BOWDEN: Yeah.

MS DRIVATA: I think it's important also to note that if we're working with CALD communities, we need to also be aware of their religious backgrounds and not offer foods which might actually be disrespectful to their practice. So, we need to also be sensitive and do a little bit of research about what we actually offering them, not to actually disrespect their practices.

DR KLEVE: Yeah, that's a great point, Margaret, and comes back to that whole definition and consideration of how we respond in this situation that it is culturally-appropriate foods that are being provided, yep.

MR BOWDEN: Yeah. And I guess I would just summarise that conversation by saying that, you know, by reminding people that are listening that we're not expecting - no one's expected to be, you know, a cultural expert or to be, you know, an Aboriginal liaison worker in order to this work well, and I think it's probably just - there's probably some cultural competence building that can be done quite easily by liaising with your local Aboriginal controlled - community-controlled organisation or working with a migrant resource centres that are nearby. Or even reaching out more broadly beyond your local area, just to get a sense of what are the key things I need to know so that I can be confident to ask these questions sensitively. I think the other question that's come through from the audience is just around - on a similar note, the idea of food insecurity in regions versus major cities, and I think Sarah touched on that before, but I was wondering, Sue, whether there's any research around, you know, rural and remote areas and the experience of food insecurity?

DR KLEVE: Yeah, I think - in answer to your question, yes, there is, Mitch. And certainly what - there's that ABS statistics highlight that those that live in regional and remote Australia may be experiencing food insecurity more, perhaps, than those in, you know, larger cities. The reasoning may - certainly can be the same, but, you know, there are some differences. So if we think about Australia where we're a big quite, you know, quiet country. You know, there's aspects where there's - you may live in one town that may not have a store where you can access food and you need to drive two hours or more to the nearest food store to access food.

So there's that physical access to food and it's whether people actually have - physically they have a car, they, you know, can afford to put petrol in the car, you know, that sort of thing as well. But then, also we know the cost of food as well in regional and remote parts of the country is significantly greater as well. So there's also that physical access, the cost, as well as statistically, you know, the median income is potentially lower in regional parts and remote parts of the country than, say, living in, you know, major cities as well. So there's similarities, but there's also some clear differences as well that add to this complexity as well, and then certainly the response, too.

MR BOWDEN: Yeah, yep. Yeah, Sarah anything to add from the Foodbank hunger report work that you've done?

MS PENNELL: Yeah, so another aspect of this is - Sue's absolutely right. Our research also shows that there's a higher level of food insecurity in the country areas, not surprising with - you know, recently with things like drought and then the black summer, just to add on top. The other thing is, people in the country experiencing food insecurity are more likely to experience stress, depression and shame. You know, kind of, there's a pride there that when they're unable to support themselves, you know, really knocks them for six. And it does mean that it hits them psychologically harder than perhaps, you know, their fellow Australians in the city areas.

MR BOWDEN: Yeah, yep. Okay. And this is sort of the last question and a closing question, and it's really around - I mean, I guess touching on the fact that this is quite a layered, complex issue and we've talked about financial hardship as the key driver, but not the only driver, and that's important to note. So I guess - so I might start with you and then hear what Margaret and Sarah have to say as well, but I guess the question in closing is, what does the solution look like? What's the answer to this really, really tricky problem to solve?

DR KLEVE: Yep. Well, there's probably a reason why it's called a wicked problem or a complex public health problem. And because there is no one simple solution. There's not one response that is, you know, one size fits all, okay, as firstly. And that is really, as we've sort of highlighted, through all of this, there is - while financial resources is one of the primary determinants, we've got a whole range of other factors coming into play as well that provides that stress. So what we actually need is multi-strategy responses that range from a population kind of level that has cross-sectors.

So by cross-sectors, I mean that it's bringing in, you know, health, education, employment, social assistance. So we're looking at that really kind of cross-sector kind of policy-based response, okay, that is going to have that population level impact. Then we can - if we then go down to the other end of the spectrum, is then what we've perhaps been touching on today is more of that individualised focus. But the reality with the individualised focus, while yes, it is really important that that is not going to lift people out of the long-term experience of food insecurity, I think. You know, it's like - and I think, Sarah, you've mentioned it's like a Band-Aid, and I've heard - I've got a colleague in the UK and she talks about, it's like putting the sticking plaster on the wound. You take it off and it's still there. So you've kind of addressed it to a point but you haven't completely solved the issue. And then we've got that gamut in between, you know, across communities that we can have a range of responses at a community-based level with, you know - that's really again multiple community partners across sectors that really then, you know, address at that level.

But we need - it's not a one size fits all. And what might fit in one community may be very different in another community, as well as what we've said, you know, what might fit in regional Australia may be very different to what fits within, you know, your larger cities. So I think that's the message there. It's about multiple responses that we need. And with that, to really try and help. To drive that, we need to have a much better understanding of the scope and the magnitude of this as an issue, and that comes down to having really, really clear measurement and not only clear measurement, but one that's on a regular basis. So you look at, you know, countries like the US where it's measured on an annual basis. Canada, every two years. UK is now starting to do every year as well. And we are stuck with, like, a three to four kind of - - -

MR BOWDEN: Yeah, yep, yep, yep, yeah. Margaret or Sarah, anything to add to that?

MS PENNELL: I just agree with everything that Sue has said, and we do understand that, you know, at Foodbank and other food-relief organisations, we're just treating the symptoms and what we need to do is, you know, take a more preventative health kind of approach where people don't get the issue in the first place.

MS DRIVATA: Yeah, on a practice level, when we're meeting clients, rather than just putting the bandage on as we're saying, but rather just exploring if they're coming with food insecurity, exploring the issue behind that presenting problem. What is causing the financial instability and the food insecurity. And because there might be things that we can actually provide solutions for them, might be mismanagement of funds, there might be mental health issues, there might be addictions, there might be other things that we can help the clients tap into maybe, linking to a job provider if they would like to, maybe, find a job if they are struggling to find a job. You know, trying to understand a bit the - what is causing the food insecurity and trying with the resources that we have supporting the clients to actually come to a better place.

MR BOWDEN: Yeah, yep. And I would guess I would just say on my own reflection that - I don’t want to devalue the importance of the Band-Aid, I guess, and that, you know, and that based on what we've heard today from you all, the most resourceful people can still be - can still encounter an unforeseen shock and that kind of episodic food insecurity could hit any one of us at any point in time, so we could have the best systems in the world and the best population health approaches and public policy approaches, but we will always need people like Margaret at Gippsland Lakes Complete Health and we will always need the Foodbanks of the world to be there for people when they fall on hard times. Yeah.

DR KLEVE: And I think it's - sorry, Mitch. I was just going to jump in as kind of a last point. I think it's really also important that we recognise that - to really approach this from a strengths kind of based approach is that recognising that lots of people I talk to have these amazing levels of resilience, as well as, you know, skills and assets and, you know, very creative in trying to make ends meet. And as we've sort of all been saying, it takes that kind of really ongoing kind of point or that one point that really puts that stress on - you know, for that individual as well, too.

MR BOWDEN: Yeah, yep. I think that's all we've got time for today, so I might wrap it up there, and thank you all once again for, yeah, your participation and sharing your incredible wisdom and knowledge. So thank you, all.

DR KLEVE: Thank you very much.

MR BOWDEN: You're very welcome.

MS PENNELL: Yeah, same to you.

MR BOWDEN: Well, thanks, all.

MS DRIVATA: I've learnt a lot as well, so thank you, Sue and Sarah as well because I really learnt about strong research and stuff, so thank you.

WEBINAR CONCLUDED

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Slide outline: Families and food: Identifying and responding to food insecurity

Slide outline

1. Household Food Insecurity in Australia:
What do we know?
What do we need to know?
What do we need to do?

Dr Sue Kleve APD
Dept of Nutrition, Dietetics and Food, Monash University

2. Acknowledgements

I wish to acknowledge the people of the Kulin Nations, on whose land we are gathered today. I pay my respects to their Elders, past and present.

3. What does food security mean?

‘Food and nutrition security’
… exists when all people at all times have physical, social and economic access to food, which is safe and consumed in sufficient quantity and quality to meet their dietary needs and food preferences, and is supported by an environment of adequate sanitation, health services and care, allowing for a healthy and active life’ (2012, Committee on World Food Security, FAO)

Food is a fundamental human right, sourced in ways that are socially acceptable and maintain human dignity. Food secure families and individuals can use regular marketplace sources and do not have to resort to emergency food relief and/or begging, stealing or scavenging.

4. Food Security Monitoring & Prevalence in Australia

Australian Bureau of Statistics nationally representative survey using a 1 and 2 part measure show the population prevalence of food insecurity around 4% of whom 1.5% had gone without food (ABS 2015) → Over 1 million Australians → BUT: Using a more sensitive measure to the experience of food insecurity this may be higher across the population 10-12%

Aboriginal & Torres Strait Islander households 22% of whom 7% went without food 31% in remote areas of whom 21% went without food

But the risk of food insecurity is not evenly spread and food insecurity has different faces AND the impacts of COVID19 has exposed many more Australians to the experience of food insecurity

5. Social & Economic Determinants

  • Employment
  • Income
  • Education
  • Housing
  • Area of Residence
  • Social connection

Food Security and Stability

  • Availability
    • Food Outlet Location
    • Quality & Variety
    • Availability in food outlets
    • Promotion
    • Price
  • Access
    • Financial resources
    • Transport to shops
    • Social support
    • Mobility
  • Utilisation
    • Knowledge
    • Skills
    • Preferences
    • Storage & cooking facilities
    • Time Available

6. The reality of the food insecurity experience for Australians

The juggle and stress to make ends meet was too much I deferred (Uni) for a year and tried to get work so I could get by …

I'll just wear the stress of it. I think that plays a huge part of me physically and emotionally

I ration the food ... I make sure they (partner & 2 young children) get everything first and whatever is left over, then I get it.

The juggle, what and how much the bill is, can I negotiate payment with the company, then I know I've got more for food.

Last week our solar panels went, gas hot water service went, heater went, and our car. So, this week's a tight week I’m just not sure we will have enough money for food.

depends on robbing Peter to pay Paul with the food budget . . . it goes down to the last $10 by the end of the week... what level of food we get for the week

7. Food security continuum, severity of household food insecurity

Marginal food secure (Mild)

  • Anxiety or stress associated with trying to meet daily food needs
  • Poor food consumption patterns such as relying on inexpensive non-nutritious foods

Intermediate

  • Food insufficiency (quality and quantity)
  • Restricting intake or skipping meals

Very low food security (Severe)

  • Experiences of hunger
  • Running out of food and not being able to afford more
  • Reliance on social supports and/or emergency relief

The experience may be: Episodic, chronic or cyclical

8. Pre-COVID: Stressors/stressful events and food insecurity

  • Temple (2018) examined 2014 General Social Survey using the question “In the last 12 months, have any of these happened because you were short of money?” Respondents who indicated that they went without meals due to a shortage of money = food insecure.
  • Exposure to stressors significantly increased the likelihood of experiencing food insecurity.
  • Stressors related to employment and health approximately doubled the odds of experiencing food insecurity.

9. Stressors Reported by Food Insecurity Status

Table 1: Stressors reported by Food Insecurity Status, Weighted (%), 2014.
Type of Stressor 2 Food Insecure % Food Secure (%) n 1
Divorce or Separation 17.6 11.3 ***
Death of Family Member/Close Friend 35.1 21.4 ***
Serious Illness 33.3 22.3 ***
Serious Accident 7.7 4.5 **
Alcohol or Drug Related Problems 20.7 6.8 ***
Mental Illness 34.9 13.0 ***
Serious Disability 13.1 6.0 ***
Not Able to Get a Job 40.5 16.8 ***
Involuntary Job
Loss
Witness to Violence
16.5 7.0 ***
15.8 2.2 ***
Abuse or Violent Crime 12.6 2.5 ***
Trouble with the Police 14.2 2.8 ***
Gambling Problem 6.6 2.6 ***
Discrimination-Ethnic or Cultural Background 5.5 2.1 ***
Discrimination-Other Reason 7.6 1.6 ***
Bullying and/or Harassment 20.6 6.4 ***
Removal of Children 4.8 < 1% ***
Other < 1% < 1%  

Temple, J.B. The Association between Stressful Events and Food Insecurity: Cross-Sectional Evidence from Australia. Int. J. Environ. Res. Public Health 2018, 15, 2333. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6266169/

10. Stressors Associated with Food Insecurity

Table 2: Prevalence of food insecurity by stressor type, 2014.
Type of Stressor 3 Odds Ratio (UOR) 1 Odds Ratio (AOR) 2  
Stressor Type Models 3      
Divorce or Separation 1.68 1.53 *
Death of Family Member/Close Friend 1.99 2.01 ***
Serious Illness 1.74 1.81 **
Serious Accident 1.78 1.55  
Alcohol or Drug Related Problems 3.58 2.35 ***
Mental Illness 3.59 2.87 ***
Serious Disability 2.36 2.30 **
Not Able to Get a Job 3.35 2.49 ***
Involuntary Job Loss
Witness to Violence
2.62 2.59 ***
8.27 4.40 ***
Abuse or Violent Crime 5.67 3.26 ***
Trouble with the Police 5.75 3.70 ***
Gambling Problem 2.69 2.53 *
Discrimination- Ethnic or Cultural Background 2.76 2.17 *
Discrimination-Other Reason 5.04 3.75 ***
Bullying and/or Harassment 3.79 2.82 ***
Removal of Children 6.79 4.58 **
Other 1.00 0.66  

Temple, J.B. The Association between Stressful Events and Food Insecurity: Cross-Sectional Evidence from Australia. Int. J. Environ. Res. Public Health 2018, 15, 2333.

11. Food Insecurity by Payment Type

(Food Depletion with Inadequate Intake)

  • Age pension - 1
  • Disability Pension (DVA) - 1
  • Carer Allowance - 5
  • Family Tax Benefits - 5.5
  • Carer Supplement - 5.9
  • Parenting Payment - 9
  • Carer Payment - 10.9
  • Newstart Allowance - 11
  • Disability Support Pension - 12.4
  • Austudy/Abstudy - 13.8

12. Financial Stress Indicators and Food Insecurity

Food insecure, Social Assistance Payments

  • Sought assistance from welfare/community organisation - 42.7
  • Pawned or sold something - 34.7
  • Sought financial help from friends or family - 59.7
  • Unable to heat home - 30.4
  • Could not pay gas/electricity/telephone - 59.3
  • Could not pay registration/insurance on time - 31.6

Food secure, No Social Assistance Payments

  • Sought assistance from welfare/community organisation - 1
  • Pawned or sold something - 1
  • Sought financial help from friends or family - 3.9
  • Unable to heat home - 1
  • Could not pay gas/electricity/telephone - 5.6
  • Could not pay registration/insurance on time - 2.3

Temple, J.B.; Booth, S.; Pollard, C.M. Social Assistance Payments and Food Insecurity in Australia: Evidence from the Household Expenditure Survey. Int. J. Environ. Res. Public Health 2019, 16, 455.

13. Social & Economic Determinants

Employment
Income
Education
Housing
Area of Residence
Social connection.

Pandemic (COVID-19) & Natural disasters (Bushfires, Droughts and Floods)

Availability

  • Food Outlet Location
  • Quality & Variety
  • Availability in food outlets
  • Promotion
  • Price

Access

  • Financial resources
  • Transport to shops
  • Social support
  • Mobility 

Utilisation

  • Knowledge
  • Skills
  • Preferences
  • Storage & cooking facilities
  • Time Available

14. The challenge to maintain household and individual food security in the face of drought, bushfires and pandemics in crisis:

What have been some of the responses?

  • The food response: The Charitable Food Sector and beyond
  • Federal government financial support initiatives
  • Retail response to COVID-19 panic buying

15. Impact of Coronavirus supplement and food affordability

Healthy Diets Australian Standardised Affordability and Pricing (HD-ASAP) protocol measures cost & affordability

Figure showing the Affordability of healthy diets for unemployed households. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC7675258/

  • When diet costs more than 25% of disposable income, households are considered to be in ‘food stress’; when more than 30%, healthy diets are considered ‘unaffordable'
  • In 2019, healthy diets for two-parent households where both adults were unemployed would have been unaffordable, costing 36% of household income
  • In 2020, healthy diets for two-parents households that were eligible for COVID‐19 economic support were potentially attainable at 20% of household income
  • In 2019, unemployed single‐parent households (one adult, two children aged 14 and 8) were unaffordable, costing 33% of household income
  • In 2020, healthy diets for single-parent households that were eligible for COVID-19 economic support became attainable at 22% of household income.

Source: Quintiles 1-5 from the Australian Bureau of Statistics 2016 census, welfare incomes calculated from www.servicesaustralia.gov.au

16. Impact of JobSeeker, Youth Allowance or other social security payments & Coronavirus Supplement

Australian Council of Social Service (ACOSS) n = 955 receiving

Key food security related findings:

  • Before the Coronavirus supplement 60% did not eat fresh produce.
  • People’s ability to purchase nutritious food
  • 93% said they were now able to afford fresh fruit and vegetables.
  • 83% reported eating healthier and more regularly.
  • Prior to the supplement, 75% of respondents skipped meals. Of those who skipped meals, 28% skipped 1 meal a day or more.
  • The number of people skipping meals because of a lack of funds had dropped by over half, to 33%.
  • 59% could save for major h/hold items fridges and freezers.

17. What do we need moving forward

Responding with food and food based solutions with a focus on individual responsibility is not a long term issue but these responses should be dignified, nutritious, sustainable and equitable

Advocate for multi-strategy solutions that move beyond this:

  • Adequate income
  • Poverty alleviation
  • Monitoring and Surveillance
  • Affordability of food, housing and utilities
  • Strengthening of welfare safety net
  • Access to equipment to store and prepare food

18. Screening for risk of Food Insecurity

19. Screening Questions for Practice

  • ‘The next two questions are about your food situation. We know that going without food happens to lots of Australian families now and again.
  • These questions will let us know about your food situation and help us understand what support you might need to get through these times.
  • For each question, can you tell me whether this is often true, sometimes true, or never true for your household in the last 12 months:
  1. Have you ever worried that food will run out before you are able to buy more?
  2. Have you run out of food and not had enough money to buy more?’

20. Table 1: Mapping clients on the food security continuum

Screenshot of Table 1: Mapping clients on the food security continuum retrieved from the CFCA Practice Guide Identifying and responding to food insecurity in Australia. Available on https://aifs.gov.au/cfca/sites/default/files/publication-documents/2009_cfca_identifying_food_insecurity_in_australia.pdf#page=7

21. Thank You

Sue Kleve
suzanne.kleve@monash.edu
@ SueKleve

22. Foodbank: Fighting hunger in Australia

Foodbank Hunger Report 2020
Sarah Pennell | General manager

23. Method

  • Online survey of 1,001 Australians 18 years and older who have experienced food insecurity in the last 12 months between 25 June and 15 July ie 3 months into COVID-19
  • Five pulse surveys amongst charities registered with Foodbank averaging 500 respondents per survey conducted between April and September.
  • Nine interviews with Australians experiencing food insecurity and representatives from Foodbank Charities conducted on 20-21 August.

24. Charities are seeing demand for food relief become erratic and unpredictable, but overall numbers are up by an average of 47%

25. COVID-19 has increased the demand for food relief in Australia

  • Food insecure Australians are seeking assistance from charities more frequently. Those seeking food relief at least once a week have doubled:
    • 2019 – 15%
    • 2020 – 31%.
  • Those Australians who were struggling for food before COVID-19 are going hungry even more often now. 43% are going a whole day a week without eating.

26. Food insecure groups

Three in ten Australians now experiencing food insecurity had not gone hungry before the pandemic. 

Charities have seen two new food insecure groups emerging as a result of the pandemic.

27. Young people are being hardest hit by the impact of COVID-19

Proportion of food insecure Australians in each generation that are unable to afford enough food at least once a week.

  • Gen Z (aged18–25): 65%;
  • Gen Y (aged 26–40): 57%;
  • Gen X (aged 41–54): 46%;
  • Baby Boomers (aged 55–74): 25%;
  • Builders (aged 75+): 25%.

28. Food relief is even more crucial in times of crisis.

61% of Food Insecure Australians have accessed food relief since COVID-19 was declared a global pandemic.

  • Top 3 Benefits of receiving food relief –
  1. 1. 40% feeling less hungry
  2. 2. 27% improvements in mental health
  3. 3. 26% improvements in physical health.
  • Top 3 Barriers to seeking food relief from a charity
    1. 1.33% there might be people who need assistance more than me
    2. 2. 33% embarrassment (afraid of what people around me will think)
    3. 2.3. Shame (afraid of feeling inadequate and dependent on charity).

    29. Government assistance is providing temporary relief

    Of those who are in need of government assistance:

    • 38% suggest government assistance has helped their situation
    • 62% are not receiving the assistance they need (37% needed additional assistance, 21% were ineligible, 4% found it too difficult.

    30. Thank you - Committed to ending hunger

    • Instagram - @FoodbankAus
    • Twitter - @FoodbankAus
    • Facebook - @FoodbankAus
    • LinkedIn - Foodbank Australia

    SARAH PENNELL
    General Manager
    Foodbank Australia
    sarah@foodbank.org.au
    www.foodbank.org.au 

    Client scenarios

    Families and food: Identifying and responding to food insecurity. Client scenarios.

    This webinar was held on Wednesday, 27 January 2021.

    To effectively address food insecurity, both small-scale practice responses that provide real time support and large-scale structural solutions that target root causes are needed. Child, family and community welfare organisations play an important role in both but particularly in identifying families that may be food insecure and linking them with supports.

    This webinar explored common causes of food insecurity and what works when identifying and responding to it. Building on a recent CFCA practice guide, it:

    • Explored research evidence on the link between financial hardship and food insecurity
    • Shared insights on the impact of COVID-19 on socio-economic status and food security
    • Considered what works in responding to food insecurity, particularly in a COVID-19 context
    • Identified practical strategies such as the use of screening questions for identifying food insecure families.
    This event is of interest to professionals working in child and family support, health, emergency relief and material aid, social services, local government and rural and remote settings.

    Questions answered during presenter Q&A

    To view the presenter Q&A, go to 57:15 in the recording

    • What can we do if clients get uncomfortable when asked about food, or their responses indicate that they feel judged or embarrassed?
    • How can workers (e.g. community development, public health) at a local government level support stakeholders to deliver food security initiatives that increase community access to health and nutritious food?
    • How can services that are providing emergency food relief work with others in their local area? Who are the key organisations to partner with?
    • How can practitioners be culturally sensitive when discussing food and asking food security questions of clients from Aboriginal and Torres Strait Islander and/or Culturally and Linguistically Diverse backgrounds?
    • How do experiences of food insecurity differ between metropolitan/urban areas and rural/remote areas?
    • What does a solution to food insecurity look like?

    Related resources

    • Identifying and responding to food insecurity in Australia
      This CFCA practice guide is for anyone working with families who may be experiencing food insecurity. It includes a guide to screening for food insecurity, reflective questions to help identify support options and case study examples. 
    • Understanding food insecurity in Australia
      This CFCA paper explores common experiences of food insecurity and looks at which population groups are most likely to be food insecure.  
    • Foodbank Hunger Report 2020
      This report, prepared by Foodbank, combines qualitative and quantitative insights on how COVID-19 has affected the ability of people to have food for themselves and their families.  
    • Ask Izzy
      Ask Izzy is a mobile website that connects people in need with housing, a meal, money help, health and wellbeing services, family violence support, counselling and much more. 

    Featured image: © GettyImages/SDI Productions

    About the presenters

    Sue Kleve

    Dr Sue Kleve is a Senior Lecturer (Public Health Nutrition) in the Nutrition Science and Dietetic programs  in the Dept of Nutrition, Dietetics and Food at Monash University. She is an Accredited Practising Dietitian who came to Monash with over 20 years experience working as a public health and community nutritionist. It was through this experience that she developed her interest in community and household food insecurity and led her to her PhD exploring the existence and experience of food insecurity in low-to middle income Melbourne households. Sue’s research focus continues in the area of the existence and experiences of food insecurity  and responses to prevent and pathways out of food insecurity.  She is the convenor of the Australian Household Food Security Research Collaboration, a member of Dietitians Australia and the Public Health Association of Australia.

    Sarah Pennell

    Sarah joined Foodbank, the largest food relief organisation in Australia, in 2010 and since then has fulfilled a variety of roles as the organisation has evolved and grown. As well as now being responsible for business, finance and  governance, she oversees the research portfolio which includes the annual publication of the Foodbank Hunger Report. Sarah came to Foodbank from a long career in the food industry supporting and promoting farmers and their products, particularly dairy and horticulture. She started her working life as a newspaper reporter before moving to corporate communications. 

    Margaret Drivata

    Margaret is part of the Assessment and Response Team at Gippsland Lakes Complete Health focusing on Child First, Family Violence Outreach, and Intake. She is a social worker with post-graduate certification in Family Therapy and has 15 years’ experience in working with children and families, including working abroad in Child Protection Services and in managing an AOD prevention service, facilitating national prevention initiatives and annual professional development conferences. She has also worked within Family Services in Australia, providing parenting support in CALD communities.

    Comments

    Thank you for providing an informative webinar it was interesting and useful.
    debra madley