Introduction

Food security and insecurity are terms used to describe whether an individual can access food in the quantity and of the quality they need to live an active and healthy life. Food insecurity is commonly considered a concern for developing nations in relation to poverty, agricultural capacity and sustainability. However, it is also an issue for developed nations like Australia where individuals, families and communities experience unequal levels of security in relation to food. While the contributing factors may differ across developed and developing nations, the range of experiences from secure to insecure are seen in both and result in differing manifestations of hunger, physical, social and emotional health implications and coping strategies.

Building on a CAFCA practice paper (Rosier, 2011), this practice guide and its companion practice paper offer insight into the experiences of food security and insecurity specifically in Australia. These resources were produced during a period spanning the 2019/20 bushfires and the COVID-19 pandemic. Natural disasters and pandemics can have significant social and economic impacts on affected individuals, families and communities, including their risk of food insecurity. At the time of writing, data are not available on the full impact of these events.

These resources are in two parts. In the practice paper Understanding food insecurity in Australia, it provides a review of the best available evidence on food security in Australia, and synthesises what is known about food insecurity by:

• defining food security and insecurity
• outlining some of the relevant contributing factors
• highlighting the populations within Australia more frequently affected by food insecurity
• describing different lived experiences.

In the practice guide Identifying and responding to food insecurity in Australia, it provides evidence-based and evidence-informed guidance on:

• screening for food insecurity
• supporting individuals and families
• reflecting on and adapting practice.

This practice guide and its companion practice paper are intended for practitioners working with families and households who may be affected by food insecurity to inform service responses.

Screening for food insecurity

Why screen for food insecurity?

Food insecurity negatively affects the physical, social, emotional and mental health of adults and children, and these consequences may be greater as the severity of food insecurity increases (Tarasuk et al., 2013). Seeking support for food insecurity is commonly accompanied by feelings of embarrassment and stigma, or a sense of shame and guilt that resources are being taken from others perceived to be in greater need (Loopstra, 2018). As a result, it is often not voluntarily disclosed, leaving it under reported and largely untreated.

Screening for food insecurity can be quick, discreet and built into existing intake or assessment processes. It also allows child, family and community welfare practitioners to identify potential specific food security requirements relative to other needs being screened or assessed; and to use this in providing or linking to appropriate supports.

Screening for risk

Internationally, there are a number of tools to measure the prevalence of food insecurity at the community or population level but not many designed to screen for it at the organisational level. In the US, Children's HealthWatch has developed the Hunger Vital Sign™, a two-item screening tool, derived from the US Household Food Security Survey Module. This screening tool is increasingly used to determine households' risk and experience of food insecurity. It has been validated for youth, adolescents and adults in the US. Emerging research on its use in Australia has shown that the tool phrased as questions rather than statements has potential for use in health care settings (Kerz et al., 2020).

Administration

Screening questions, such as the ones below which are based on the Hunger Vital Sign™ screening tool, can be included as part of regular service intake processes. Practitioners can use their discretion to determine the level of emphasis placed on food insecurity, relative to other questions. This sensitivity will reduce the risk of clients feeling stigmatised and increase their receptiveness to future discussions of support. Practitioners should ensure they frame for clients that the screening questions are part of regular intake processes and provide privacy during the screening (away from other clients, staff or children). Depending on literacy levels and other factors, practitioners should consider whether the questions should be asked via interview or self-completed by the client.

Below are two screening questions and a recommended introduction for inclusion in existing processes.

'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?'

Frequently asked questions by practitioners

My clients often get uncomfortable when I ask about running out of food. What should I do when that happens and who should I touch base with?

Food insecurity is a sensitive topic for clients. Reminding clients that the questions are designed to assist in providing the right assistance at the right time should help provide reassurance. Many clients will admit to being worried they will run out of food rather than actually running out of food; this is why it is important to ask both questions. Check in with your team leader, line manager or colleagues to see how others are approaching asking and responding to these questions.

My clients don't want to answer the questions or answer in a way that contradicts their non-verbal clues or other information they share. What should I do and how do I sensitively verify their answers?

Running out of food is a common outcome of low income, financial stress and housing insecurity. The food budget is often the only flexible outgoing expenditure that can be adjusted. When clients don't want to answer the question or answer in a way that contradicts other information, normalising the issue and framing any adaptive behaviours as a coping strategy may alleviate their discomfort. For example, if a client admits to needing assistance to pay rent or a utility bill you may follow up with a similar response to: 'For many of my clients, when they need this sort of help, they have used up all of the money they would use for food. Are you having any trouble putting food on the table as well?'

I'm not sure about asking these questions, as I know my clients might feel judged or embarrassed. Do I need to include this in my intake?

Not being able to feed your family feels like a big failure and is a significant source of embarrassment. Not asking these questions means clients and their families will continue to struggle alone, worrying about and actually putting food on their table. The embarrassment of having to go to an emergency food relief provider may be even greater for them. Asking these questions sensitively, and in the context of providing overall assistance within the remit of their contact with your service, will go some way to alleviate the discomfort. Asking these questions gives you an opportunity to have a discussion that debunks some myths or misconceptions they might have about accessing emergency relief, which may then reduce their embarrassment and reluctance to access it. This is not a failure of the individual but the result of a combination of factors that are largely outside of their control. By asking the questions, your service may be able to develop a systems-level approach that will provide ongoing support to your community.

My clients can be from Aboriginal and Torres Strait Islander communities and/or from a range of overseas backgrounds. When I'm asking these questions of clients from cultures I'm not familiar with, is there anything I should be aware of?

For many cultural groups, food, especially traditional dishes, are a central part of life and coming together as a community. Given its importance, you may notice some uncomfortableness when asking these questions. In some communities, sensitive topics are only discussed with someone of the same sex or without eye contact. While you do not need to be from a particular background or an expert in culture to be able to understand and support someone, you do need to be open to learning and non-judgemental. If you feel uncomfortable asking clients directly what would make them more comfortable to discuss sensitive topics with you, contact your nearest Aboriginal community-controlled organisation and/or migrant resource centre for some cultural sensitivity training.

Scoring and next steps

Table 1 provides guidance on interpreting responses and mapping clients on the food security continuum, in order to determine an appropriate response. A positive screen is a sometimes true or often true response to at least one question.

A positive screen does not necessarily indicate desire for assistance, and clients have the autonomy to decide what (if any) assistance is best for them. Organisations and practitioners should review sections 'Supporting food insecure households' and 'Planning your response' when considering how best to respond to clients at different stages of the food security continuum.

Case study 1: Individual screening

Kai is a youth worker who has started screening for food insecurity when meeting with clients for the first time at a community neighbourhood house. Kai has an initial chat with Ruby - a 17 year old living at home with her mum and younger brother in a private rental. Her mum works casually after recently losing her full-time job and Ruby is applying for TAFE as she can't find regular work. In their chat, Kai asks Ruby whether they worry about running out of food at home and she answers that her mum is often anxious about this.

As he builds rapport, Kai comes back to food insecurity and asks if anyone is skipping meals or if the food they can afford has changed? Ruby says her mum suggested the two of them go without lunch this week, so her brother could take lunch to school. She is worried if he has no lunch at school, he may be taken away from them.

Reflecting on Ruby's responses, Kai determines her family is at severe risk of food insecurity. He discusses some options with Ruby:

• a voucher for a local supermarket to address immediate needs
• accessing the breakfast program at her brother's school
• a referral and an access card to a social café for cheaper meals
• reviewing her eligibility for various payments and applying for youth allowance
• contacting the TAFE equity office to request support for her application
• discussing with Ruby and her mum the option of applying for community housing.

Case study 2: Organisational planning

Tahlea manages a family support service that works across a few local government areas. For six months, they have collected intake data on food insecurity using the screening questions. By analysing this data, Tahlea can see that for families in their area:

• over two-thirds are worried about feeding their family
• around one-third have experienced running out of food.

She shares her analysis with her team and manager. Her team shares their reflections on these intake discussions, and the challenges they experience in supporting food insecure clients. In response, Tahlea works with her manager and another colleague to:

• run a series of focus groups with affected families to understand more about their experiences of food insecurity and identify the underlying causes
• map local options for accessing emergency relief, community gardens and kitchens and low-cost groceries, as well as housing support services
• review referral pathways
• establish community partnerships with government and non-government organisations and families to co-design locally relevant, long-term solutions.

Supporting food insecure households

This section aims to identify best-practice strategies that child, family and community welfare practitioners can use when supporting food insecure households. The focus of the strategies identified below are smaller-scale, food-based initiatives that aim to address food insecurity at the individual, interpersonal and organisational levels (see the CFCA practice paper Understanding food insecurity in Australia for more detail about these levels). (Box 1 provides more information on population-based interventions, which are not explored at length in this practice guide.) Interventions at the individual, interpersonal and organisational levels are often delivered locally (e.g. by child, family and community welfare organisations and practitioners), and are likely to always be required to ensure the needs of vulnerable cohorts are still addressed in locally, socially and culturally appropriate ways.

The evidence to support strategies that address food insecurity is mixed and understandings of where different strategies may produce the most impact are still developing. This section describes three broad strategies aimed at addressing food insecurity, which should be considered within local contexts:

1. Partnering to deliver local solutions
2. Alleviating hunger through food relief
3. Enhancing food and nutrition literacy.

This section also provides an overview of various programs and initiatives that seek/have sought to promote food security in Australia. These initiatives have been selected as they focus on addressing individual, interpersonal and organisational level contributors to food insecurity - those deemed most relevant to practitioners and services. Some examples of interventions that seek to address community and public policy factors contributing to food insecurity are also included.

1. Partnering to deliver local solutions

Each state, territory, region and locality is likely to experience a unique combination of challenges that renders some community members food insecure. These can include high levels of disadvantage, remoteness, the presence of food deserts and poor transport infrastructure. Emerging evidence suggests local place-based initiatives may be successful in addressing this (NSW Council of Social Service, 2018). A collective of agencies or community groups commonly plan and deliver these initiatives, working together to address local issues.

Partnering with a range of community services can enhance a service's ability to help connect households with food and nutrition resources (American Academy of Pediatrics and the Food Research and Action Centre [AAPFRAC], 2017). Similarly, Ward and colleagues (2013) promote an interdisciplinary approach, where organisations from a range of sectors work together in a coalition model. This has a greater impact on the behaviour of government, non-government organisations and the community, enabling food insecurity to be addressed across the whole food system (Crawford, Yamaziki, Franke, Amanatidis, & Ravulo, 2015; Rogers et al., 2018; Ward et al., 2013). This way of working allows coalitions to produce better outcomes that would not be possible working individually (Ward et al., 2013).

Table 2 provides an overview of an Australian initiative delivered by eight councils in partnership with other local organisations and groups. It explores how the initiative was implemented and some of the results.

2. Alleviating hunger through emergency food relief

Households can face a number of barriers relating to the access and appropriate use of food. These include but are not limited to:

• financial - low income
• logistical - lack of private or public transport
• material - lack of cooking facilities, refrigeration and storage, preparation space (Herault & Ribar, 2016).

These barriers are often linked and can compound each other, meaning attempts to address just one set of barriers may not in fact improve food security. For example, bulk purchasing may address financial barriers; however, a lack of access to transport or limited refrigeration may prevent households from opting to purchase in this way. Low-income households may also lack the initial funds to outlay for such large quantities.

One of the most common service responses outlined in the research to address these barriers are emergency food relief initiatives (Loopstra, 2018). These include: pantry-style services; food trucks; pop-up and mobile markets; community meals; soup kitchens; emergency relief hampers; and meals at homeless shelters or women's refuges (Asylum Seeker Resource Centre, 2018; Fareshare, 2018; Foodbank, 2018a; Foodbank, 2018c; Salvation Army, 2017; Secondbite, 2018). As emergency food relief is commonly perceived as a strategy of last resort, accessing it can be associated with significant stigma and shame (Loopstra, 2018).

Other initiatives that seek to address these barriers include:

• school breakfast club programs, which provide meals to food-insecure students and occasionally broader school community members (Bowditch, 2013; Edith Cowan University & Telethon Kids Institute, 2018; Gooey et al., 2017; MacDonald, 2019)
• café/restaurant meal voucher programs, which offer people an alternative to emergency food relief services (Allen et al., 2014; Hollander Analytical Services, 2013; Huxtable & Whelan, 2016)
• community gardens, which provide a cost-effective and socially supported way for households to acquire fresh food (Lovell, Husk, Bethel, & Garside, 2014).

These services provide a safety net that seeks to alleviate hunger and other impacts of poverty, and are often delivered by non-government or charitable organisations such as Foodbank, Secondbite, Oz Harvest and Fareshare. In 2017, Foodbank provided an estimated 67 million meals and SecondBite provided an estimated 22 million meals (Foodbank, 2018a; Secondbite, 2018).

Table 3 provides two examples of Australian initiatives that aimed to alleviate hunger through the provision of free or low-cost meals. It explores how each of the initiatives was administered and some of the results.

Note: ^a Several studies support the use of school-based programs to address food insecurity among primary and secondary school students (Bowditch, 2013; Edith Cowan University & Telethon Kids Institute, 2018; Gooey et al., 2017; MacDonald, 2019). These programs are generally delivered by school staff or a local non-government organisation and aim to address the risk of decreased educational capacity as a result of hunger (e.g. diminished energy and reduce concentration).

3. Enhancing food and nutrition literacy

Australians have mixed levels of knowledge and skill in relation to diet and dietary planning. A study by Rhodes (2017) of nearly 2,000 Australian parents found over half (57%) of the respondents reported challenges in understanding which foods are healthy. These challenges can be more pronounced in households experiencing socio-economic disadvantage (Venn, Dixon, Banwell, & Strazdins, 2017), and may result in an imbalance between the quantity of food available and the food's nutritional quality.

Begley, Paynter, Butcher, and Dhaliwal (2019) highlight that the level of knowledge and skill required to plan and manage food shopping, preparation and cooking (food and nutrition literacy) are associated with food security. As such, nutrition education programs, particularly those that incorporate the development of these skills, have been identified as a way to improve nutrition literacy and, as a result, food security (Schembri et al., 2016; Sorbello & Martin, 2012). Schembri and colleagues' (2016) systematic review of nutrition education initiatives in Aboriginal and Torres Strait Islander communities adds that programs with the support of the community they are delivered to have greater capacity for success.

Skills commonly taught in these programs include: getting value for money, balancing food groups, budgeting, storage and preparation skills (Aliakbari, Latimore, Polson, Ross-Kelly, & Hannan-Jones, 2013; Australian Red Cross, 2018; Schembri et al., 2016; Yeatman et al., 2013).

Table 4 provides three examples of Australian programs that focused on nutrition literacy. It details what each program aimed to achieve, how they were delivered and some of the results.

Note: ^a Several studies support the use of school-based programs to address food insecurity among primary and secondary school students (Bowditch, 2013; Edith Cowan University & Telethon Kids Institute, 2018; Gooey, Browne, Thorpe, & Barbour, 2017; MacDonald, 2019). These programs are generally delivered by school staff or a local non-government organisation and aim to address the risk of decreased educational capacity as a result of hunger (e.g. diminished energy and reduce concentration).

Planning your response

The section 'Supporting food insecure households' identified best-practice strategies that child, family and community welfare practitioners and their organisations can use when supporting food insecure families and individuals. Because of this focus, the examples primarily sought to address individual, interpersonal and organisational level contributors, which form only part of the overall picture. It is also important for organisations to support practitioners in carefully considering the other factors (e.g. community and public policy) contributing to their clients' food insecurity, and in determining which strategies might be most effective.

The following reflective questions have been compiled for practitioners and organisations to jointly consider when planning a response.

Your organisation

Identifying where clients sit on the food security continuum and how your organisation can support them is useful for organisations addressing food insecurity. The following questions have been compiled to support practitioners and organisations in considering their internal approach.

1. Can your organisation sensitively incorporate food insecurity screening into its everyday practices so it is sustainable? 
   Adding a screening tool into existing intake and assessment processes that are applied to all clients can help to discreetly identify those that may be experiencing food insecurity (AAPFRAC, 2017). Collating and analysing these data across your organisation's client base can give an indication of what service responses are required by your community at a population level.  
   Next steps: See 'Screening for food insecurity'.
2. If your organisation provides information or education resources to clients, have you considered the language and literacy skills of your community? 
   Translated, plain English or accessible resources are likely to be necessary for some of the groups discussed in the CFCA practice paper Understanding food insecurity in Australia (e.g. CALD, older people).  
   Next steps: Examples of these resources can be found on the Health Translations Directory, and information on how to produce accessible material within your organisation can be found on the Centre for Culture Ethnicity and Health's Resource Hub.
3. If your organisation provides food or meals directly to clients, do staff have good food and nutrition literacy? 
   Professional development and training on public health recommendations (e.g. the Australian Guide to Healthy Eating) can assist staff to plan and prepare appropriately balanced meals, and to have better informed conversations with clients about food insecurity.   
   Next steps: Contact your state Nutrition Australia division, or enquire with your local community health service whether a dietitian could help build staff food and nutrition literacy. Information and training resources can also be found on the Dietitians Australia and Nutrition Australia websites.

Your local community

Identifying where clients sit on the food security continuum (see 'Screening for food insecurity') and how your organisation can support them is a useful starting point. However, there are likely to be a range of other local programs or services that may benefit clients, depending on their needs. These may be directly related to food, or might target the underlying determinants of food insecurity such as financial hardship (e.g. debt management, rental assistance or financial counselling initiatives). The following questions have been compiled to support practitioners and organisations in scanning their local community for appropriate supports.

1. Is it possible for your organisation to lead or be a part of a coalition or working group of local organisations focused on addressing food security? 
   This might be something comprehensive that addresses multiple aspects of your clients' food insecurity (e.g. hosting a community partner who can provide on-site assistance or emergency food relief to your clients); or it might be something simpler that addresses one aspect (e.g. providing information in accessible formats about, or referrals to, community kitchens and gardens, breakfast clubs or other programs in your area).  
   Next steps: See the example of WA's statewide approach to bringing government, community and commercial/corporate partners together to address food insecurity at multiple levels.
2. Is your organisation able to assist with transporting food to clients or vice versa, or are there local organisations or supermarkets that are? 
   This might include arrangements such as subsidising home delivery of groceries, transporting clients to and from emergency food relief organisations or linking clients with community transport options.
3. Are there any organisations in your community that provide people with advice or education around food budgeting and/or food purchasing and preparation? 
   In some areas, community kitchens, neighbourhood houses and community centres provide these types of skill-building activities, along with facilities to communally prepare and share meals.  
   Next steps: Many of these services, as well as emergency relief providers, are listed by postcode on websites such as Ask Izzy or are available from your local council.
4. Are there other referrals or supports that you can arrange to reduce the impact of food insecurity on individuals or families you work with? 
   Some clients may be eligible for: dietetic services; vouchers, loans and case management support through Centrelink; debt management or housing support, and/or additional concessions at emergency relief programs and meal pantries (Lindberg, Lawrence, Gold, Friel, & Pegram, 2015). An appropriate referral for these supports may be generated either directly or by working with the clients' general practitioner. Guidelines, checklists and templates for making appropriate referrals can be found in the Australian Council of Social Service's (2011)

Although there are many not-for-profit organisations and non-government organisations providing emergency food relief services, the three organisations funded by the Commonwealth to deliver food relief in Australia are Secondbite, Foodbank Australia and OzHarvest. Practitioners looking to partner with, or refer clients to emergency food relief providers, can find more information and a directory of providers across Australia on the Department of Social Services' website.

Conclusion

For child and family welfare service practitioners, strategies responding to food insecurity typically focus on: building food and nutrition literacy through education; alleviating hunger through emerging food relief; and/or partnering to deliver local solutions. Child and family welfare practitioners and services can support food insecure households through sound screening and identification processes, and referrals to appropriate supports.

References

For a full list of references see the CFCA practice paper Understanding food insecurity in Australia.