

Skagit Weekend Food
Project Report !1
Outline INTRODUCTION
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LITERATURE REVIEW / BACKGROUND
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Review of programs in WA & nationwide
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Comparison to programs in Skagit County
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DESCRIPTION OF PROGRAM
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Formation of program
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WWU Community Health Program Partnership
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DISCUSSION
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APPENDIX
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SOURCES
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Skagit Weekend Food Delivery Project Report INTRODUCTION Backpack food programs in Skagit County are diverse in their funding sources and in their food procurement & delivery methods. Each program has unique strengths and weaknesses; however, all programs have common limitations that exist not only within the county, but in all Washington state and in the US. With the development of a new type of delivery system, several organizations in Skagit County hope to overcome those challenges to help provide more food to more Skagit County children than ever and model a new method for weekend food delivery.
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LITERATURE REVIEW / BACKGROUND Backpack food programs have been in existence since 1994, and are credited to a Little Rock, Arkansas school nurse who noticed students going hungry on the weekends and wanted to do something to help. She contacted the Arkansas Rice Depot, a local food bank, who provided food for these hungry children by starting the Food for Kids Program. Today, similar weekend food programs have spread to 40 states and even to Mexico (http:// arkansasfoodbank.org/programs/food-for-kids/). Nationwide backpack efforts include Blessings in a Backpack, which has participating schools in 47 states and served almost 68,000 K-12 students in 2014 (https://blessingsinabackpack.org/wp-content/uploads/2015/09/ WebvBIB_AnnualReport_2014_web.pdf). Possibly the largest sponsor of weekend food is Feeding America’s BackPack Program, which distributes weekend food bags to 450,000 students through 160 food banks in its network on a weekly basis (http://www.feedingamerica.org/about-us/helping-hungry-children/backpackprogram/). Food Lifeline, Feeding America’s western Washington state affiliate, does not directly support backpack programs in the state, though they support other programs for children like Kids Café and Target Meals for Minds. Feeding America’s other Washington affiliate, Spokane-based 2nd Harvest, has the “Bite2Go” program, and supplies food to children throughout eastern Washington. In Washington state, backpack programs have existed since as early as 2004, when the Seattle-based food bank, Northwest Harvest, started its program. It currently operates in 50 “high-need public schools” in nine school districts across six counties in both western and eastern Washington (King, Pierce, Yakima, Grays Harbor, Grant, and Spokane). There are other independent programs around the state, including in Clark, Pierce, Okanagan, Thurston, Whatcom, Snohomish, Kitsap, Kittitas, Cowlitz, and Skagit Counties, and in other locales (see appendix). However, distribution is often uneven throughout all these counties, and can miss children in rural areas. Typically, Washington state backpack food programs run exclusively during the school year. All programs are relatively similar in format, with minor differences: volunteers at a local food bank or church pack bags in the middle of the week, and the backpacks are then distributed to schools and taken home by students in need (who are identified by counselors and teachers) on Fridays. The programs are often dependent on the continued support of the aforementioned parents and volunteers. Some programs, such as those schools and school districts who partner with Northwest Harvest, are more systematic in their approach and have plans in place to ensure continuity and sustainability, such as annual counselor training sessions and district-mandated involvement of school principals in the program. They also limit the number of children that can receive backpacks in each school, so as to maintain their budget restrictions. This is not the case in most locales, however. This often means that sustainability is by no means guaranteed, including in Skagit County. Backpack programs exist throughout the US and in Washington state, but are they effective in achieving their purpose, to help kids who need food to develop in a healthy way? In order to establish their effectiveness, the effect of food insecurity on children must be recognized. Food insecurity poses major physical, psychological, behavioral, social, and academic risks to children. A 10-year study of Canadian children and youth from 1994-2005 by Kirkpatrick, McIntyre, & Potestio indicates that, “children who experience hunger are more likely to suffer from poorer health outcomes, even when baseline health and household markers of disadvantage such as low income and lack of home ownership are accounted for. Repeated exposure to to food insecurity appears to be particularly toxic.” Similarly, food insecurity has adverse !4
mental, emotional, and behavioral effects. Jyoti, Frongillo, & Jones (2005) found that increased food insecurity in kindergarten-aged children “predicted impaired academic performance in reading and mathematics for girls and boys, a greater decline in social skills for boys, and greater weight and BMI gains for girls. Food insecurity thus serves as an important marker for identifying children with delayed trajectories of development.” Furthermore, chronic food insecurity from kindergarten through third grade adversely affected reading ability, especially among girls. Food insecurity also impaired social skills, but those effects were mitigated when households moved from food insecurity to food security, especially among girls. These adverse effects most likely have various causes, including a lack of adequate nutrition and food insecurity-induced stress that affects parent and child behavior. Finally, Weinreb, Wehler, et al. (2002) have found that food insecurity can have severely damaging psychological consequences. At its worst, it is associated with “higher rates of chronic illness and psychiatric distress… In addition, families that experience multiple signs of child hunger are more likely to be homeless, experience more stressful life events, and live in families in which mothers have a lifetime diagnosis of posttraumatic stress disorder or a substance abuse problem.” While backpack programs will not completely erase these pressing issues, they have been shown to have a positive effect in providing food for children who need them. A study of backpack programs in Montana by Shanks & Harden (2010) evaluated a statewide program using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) approach and found that backpack programs aimed at providing weekend food assistance (1) are successful at reaching a proportion of representative children (reach), (2) are effective at providing food bags of modest dietary quality based on HEI- 2010 (effectiveness), (3) have large community adoption and support, with a pragmatic level of expertise required to deliver the program (adoption), (4) have protocol fidelity that is relatively easy to follow (implementation), and (5) have had adaptations (e.g. food donations), that increase the potential program sustainability across Montana (maintenance). The backpack programs Shanks & Harden evaluated are similar to most existing programs in Skagit County. Currently, 5 of the 8 school districts within the county have some kind of backpack program. While each has its own unique characteristics, they all operate in a similar way, with the same goal – providing kids with food over the weekends by sending them home with a bag of mostly non-perishable food. For all programs, the school is the handoff point between the food supplier and the child, and the entire operation depends on the help of school staff to identify students, store food, and distribute it to each student. Currently, 600-700 children in Skagit County rely on this system to obtain sufficient food on the weekends. This represents about 10% of the more than 6,000 kids who experience food insecurity in Skagit County, and only 7% of the roughly 9,600 students enrolled in free & reduced lunch programs at schools. The need for weekend food assistance is high, and though the backpack programs already reach a significant number of children, there are many more who are in need. However, to get a sense of the need for a more comprehensive delivery system, it is necessary to examine the current state and structure of these programs.
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Anacortes School District Anacortes is located in the far West of Skagit County, on Fidalgo Island. It is a wealthy community relative to the rest of Skagit County. As a result, it has an abundance of community outreach and involvement, and its schools’ free/reduced lunch rates are relatively low for Skagit County (27.6%, 2015-16). This community atmosphere and ready availability of cash gave rise to the program known as “Food2Go Anacortes,” its version of the backpack program. This is funded by community members and by Westminster Presbyterian Church in Anacortes, which also houses the weekly packing and distribution of the backpacks from its basement. The program procures most of its food from an Amazon delivery subscription; volunteers pack the bags in the middle of the week at the church and then deliver them to each school. Due to the town’s small size and tightlyknit connections, Food2Go has the full support of the superintendent of Anacortes School District, who helps the volunteers access the schools for delivery. The program does not continue over the summer or during breaks, which is an unavoidable frustration to some volunteers who want to help kids year-round. Despite this, the program has strong momentum going into its third year of operation. However, if its volunteers or funding were to dry up, the program would collapse.
Burlington-Edison School District Burlington-Edison School District is located in central Skagit County, separated from Mount Vernon to the south by the Skagit River. Its schools are both in Burlington proper and in the rural outskirts between Burlington and the small town of Edison to the northwest. Its free/reduced lunch rates vary widely; some schools have extremely high rates of students on free/reduced lunch (80.8% at Allen Elementary, 2015-16), while others resemble Anacortes’ overall (low) rate (26.8% at Edison Elementary, 2015-16). Burlington-Edison’s backpack program has the most labor-intensive approach of any program. The program, which involves about 5 schools, is funded by the Burlington AM Rotary Club, which purchases food procured by the Skagit Food Distribution Center. Every week, a group of students from Burlington-Edison High School pack the backpacks of food and delivers them to each school, reaching about 150 other students. The program was started under the direction of a 21st Century Community grant, which lasts 3 years. The program will enter its third year next year (2017-18). Though the program is going strong currently, it may face sustainability concerns once the grant runs its course, when the high schoolers involved graduate, or if the Rotary Club decides to discontinue funding. It also has some logistical issues. The backpacks provided are substantially larger than most of the other programs’ bags, and this makes it difficult for many younger students to carry the bags, and bus drivers often complain about the size of the backpacks as well, since the bags pile up on the buses and slow down drop-offs.
Concrete School District Concrete is the most rural, remote school district in Skagit County. It lies far to the east, in the Cascades Mountains, and its boundaries reach south into Snohomish County as well. It is also one of the most impoverished school districts in Skagit County, with a 64.4% free/reduced lunch rate district-wide (2015-16). Its backpacks are particularly helpful (and crucial) because Concrete is in the middle of a major food desert in the eastern part of the county. The backpacks are packed and delivered by the Skagit Food Distribution Center, with occasional assistance from Helping Hands Food Bank in Sedro-Woolley. It is a relatively successful program because a relatively small !6
number of backpacks reaches a larger proportion of the student population than most of the other programs in the county. The 58 backpacks counted in the Fall quarter of 2016 represented almost 17% of the student population that qualified for free/reduced lunch at school. In contrast, the ~150 backpacks distributed by the Mount Vernon School District reached just 3.5% of the qualifying student population. Also, since the Skagit Food Distribution Center is a stable entity, its sustainability is relatively certain for the foreseeable future.
Mount Vernon School District Mount Vernon School District is the largest school district in Skagit County, with over 6,600 students, 63% of whom qualify for free/reduced lunch. The need for weekend food here is very high. Located in central Skagit County, it is very ethnically diverse, with a significant Latino population. Neighbors in Need Food Bank in Mount Vernon is the entity that oversees this district’s backpack program, weekly distributing 150 backpacks to students at 5 schools, along with a collection of snacks that are delivered to Mount Vernon High School for students to take as needed during the week. One elementary school’s program operates year-round, with boxes of food being delivered directly to families even during breaks. For the rest of the schools, the food bank packs all 150 bags, and counselors or volunteers from the schools pick them up and distribute them. This food bank’s backpack program is the longest-running in Skagit County; it has operated for at least 5 years and has consistent, if limited, financial support. Therefore, its sustainability is assured for the foreseeable future. Its only limitation is space and funding; the food bank operates out of a small building and therefore cannot expand its storage facilities to accommodate for more backpack food supplies.
Sedro-Woolley School District Sedro-Woolley School District is located in east-central Skagit County; it is similar to Burlington-Edison School District in that it contains both “in-town” schools and rural schools. Of the 10 schools in the district, 9 have a backpack program (the 10th voluntarily declined); all are provided by Helping Hands Food Bank in SedroWoolley. The food bank provides between 120-130 backpacks across these schools, and also supplies a pantry at Sedro-Woolley High School, where teens face a higher stigma for receiving a weekend food bag. The food bank employs special needs students from a transitional school in Mount Vernon to pack the bags on Tuesdays, and food bank volunteers distribute the bags to the various schools every Friday. This system is among the most stable and sustainable in Skagit County, along with Concrete School District’s program and Mount Vernon’s program; it has strong leadership, consistent funding, and robust district support and appreciation (a school district staff member sits on the board of the food bank). Helping Hands Food Bank also is the only backpack-providing entity in Skagit County to employ a nutrition policy; the policy was written in concert with WSU Extension Skagit County and the 1095 Skagit Coalition. It emphasizes increasing the procurement of healthy whole grains, fruits, vegetables, and proteins as appropriate for backpacks. It is also the only food bank currently involved with CHOW, an innovative new backpack delivery pilot, described below.
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DESCRIPTION OF CHOW Formation of Program The formation of a new kind of weekend food program began in 2016, when the Executive Director of United Way of Skagit County, Debra Lancaster, approached Heather Hernandez, the publisher of Skagit Publishing, a local publication and distribution company, regarding the possibility of distributing weekend food bags through the firm's ubiquitous delivery network. Ms. Lancaster and Ms. Hernandez sat on the idea for several months until February 2017, when the 1095 Skagit Coalition (with which Ms. Lancaster is involved), picked up on the idea. The 1095 Skagit Coalition is comprised of local organizations dedicated to ensuring that the children and families of Skagit County have access to 3 meals a day, 365 days a year. The AmeriCorps VISTA member assigned to the Coalition, Drew Gilliland, took up the mantle of driving the project forward. The partners gathered are as follows (in alphabetical order by organization): • • • • • • • •
Rebecca Schlaht, Executive Director, Helping Hands Food Bank (Sedro-Woolley) Cole Bitzenburg, Community Food Access Manager, Skagit Food Distribution Center Heather Hernandez, Publisher, Skagit Publishing Manuel Nevarez, Circulation Director, Skagit Publishing Jim Henderson, Circulation Manager, Skagit Publishing Debra Lancaster, Executive Director, United Way of Skagit County Diane Smith, Faculty, Food Access Specialist, WSU Extension Skagit County Drew Gilliland, AmeriCorps VISTA, 1095 Skagit Coalition/WSU Extension Skagit County
(At the onset, the group also had a board member from the food bank in Mount Vernon, the largest town in Skagit County. However, due to internal differences, the food bank withdrew from this pilot.) The group was well aware of the challenges described in the above section. The most significant issues to address, however, were: 1) the chronic inability to consistently and accurately identify which children needed weekend food assistance; 2) the inability to provide enough children with weekend food assistance; and 3) the lack of food assistance available over school breaks. The capacity of weekend food programs to shore up a lack of weekend food is generally greatly hindered by the limitations inherent in the school system. The group observed that these limitations could be mitigated by bypassing the school as the primary food distribution point (not as a valued community partner).
Methods The first meetings in February and March were productive; the group discussed delivery methods, potential funding sources, and how to begin a pilot program. Geographically, where would the program start? Who would be involved? How would the public be informed? It became clear that the process of starting would be tedious and labor-intensive. Assessments for drop-off costs, times, and fundraising were needed. The development a viable business model to present to funders and to the public was necessary. At first, answering these questions seemed relatively simple, especially with the involvement of the food bank in Mount Vernon. There were multiple viable neighborhoods in Mount Vernon to target with a single delivery route. However, when Neighbors in Need Food Bank in Mount Vernon withdrew, it presented new challenges. Due to local food bank “politics,” the group decided that operating in Mount Vernon and in Burlington, both of which had their own weekend food programs operating in schools, was not feasible. Sedro-Woolley became the !8
clear choice to begin the pilot, despite its lower population density and smaller size, because its weekend food program sponsor, Helping Hands Food Bank, was fully invested in this delivery pilot. The next step in planning the pilot’s launch was to determine a route in a route in Sedro-Woolley with a relatively high concentration of households with children. This is where the involvement of Skagit Publishing was crucial. Because the company delivers newspapers on nearly every road in the county, it has extensive household data on Sedro-Woolley’s neighborhoods. Due to its database, identifying a specific neighborhood in southern SedroWoolley in which to promote the pilot was relatively simple. Strategy sessions regarding information distribution and program enrollment methods followed.
The enrollment system for the delivery pilot had two meet two criteria: 1) it had to be efficient for both the food bank and Skagit Publishing, the distributor; and 2) it had to be minimize risk of harm to the people receiving the bags. To meet these criteria, Skagit Publishing created a single-page website in which only an address and the number of children in the house (to determine the number of bags to deliver) would be required. In order to ensure anonymity, the inclusion of the enrollee’s name was deemed not necessary on the enrollment form, and any proof-of-need requirement was also waived, because verifying need would be labor-intensive and could jeopardize enrollment. “Fraud” risks seemed insignificant to both the food bank and Skagit Publishing. A phone number was provided for potential “clients” to call in case they could not access the internet. The anonymity of potential program clients was of utmost importance. Due to the current political climate, local food relief leaders have anecdotally reported a decrease in the number of Latino community members accessing food bank resources. This presented a major hurdle; from a community member’s perspective, a free food delivery program could seem suspicious. In order to circumvent this, the decision was made to advertise by going !9
door-to-door in the target neighborhood. This had to be hyper-targeted because the pilot program had to be along a single delivery route in order to determine cost-effectiveness. In June and July, 2017, Helping Hands Food Bank oversaw three door-to-door canvassing sessions with a member of the Latino community in an effort to bolster trust in the program. A WSU Extension staff member who lives in the neighborhood also aided in this effort. WSU Extension and the 1095 Skagit Coalition provided the canvassers half-page cards in English and Spanish so that people could have the information to sign up at a later time if they wished. This phase led to a two-month stall. Because of the small staff size of Helping Hands Food Bank, it has limited capacity to go door-to-door, and does not have a dedicated volunteer manager. There was also another major building project underway for the food bank, which limited its capacity to participate further. As a result, there was little success in getting people to enroll for about two months. The original enrollment threshold for starting the pilot was 20 households; by the end of July, only 11 households, representing 25 children, had signed up for the program (Helping Hands weekly delivered those 25 bags itself while waiting for enrollment expansion). At the end of July, in an effort to jumpstart the pilot effort again, Skagit Publishing decided to move ahead with delivery to those 11 homes to determine cost-per-drop and to trial the distribution system. It was a successful experience for the driver, who reported positive reactions from recipients; as a result, Skagit Publishing greenlighted opening up distribution to the rest of Sedro-Woolley proper in early August. This development made advertising and outreach much easier and more effective. On August 3, 2017, the 1095 Skagit Coalition sent a representative to the distribution day of Helping Hands Food Bank to recruit clients to enroll in the program. By the end of the day on August 16, 2017, 25 households representing 90 children had enrolled in the program. Further strategies and outreach to increase enrollment are in development.
WWU Community Health Program Partnership While the program itself was developing, WSU Extension Skagit County made a connection with Western Washington University’s Community Health Program, led by Dr. Senna Towner. The senior cohort completes an annual project where students help various community agencies develop a social marketing program in order to bolster awareness, enrollment, or funding. Drew Gilliland, WSU Extension’s AmeriCorps VISTA member, worked with a group of four students (Nicole Durham, Jeevan Noel, Maddie Lind, and Shelby Marber) to develop the weekend food delivery’s name and various marketing materials. The group coined the name of the program “CHOW” – Cutting Hunger On Weekends – and developed a logo (right) and several flyers, radio ads, a bus banner, and a press release for identified target audiences: parents, elementary school students, and middle- and high-school students. When the program has a larger scale, these materials will be key in expanding its reach and normalizing the program for all eligible children and teens.
Discussion CHOW, a new and innovative weekend food distribution program, has emerged as an encouraging and exciting new force on the Skagit food access front, even though it began just 6 months ago. The program’s partners have developed a viable plan to reach up to 12,000 children who qualify (or would qualify, if they were of school age) for free/reduced lunch with weekend food. However, we have faced several major challenges in reaching our goal. The largest barrier is a lack of capacity for recruitment for the program. It has been difficult to get people to enroll in CHOW. Once a critical mass is reached, it is expected that word about the program will spread and help more people to enroll in the program. As the distribution area expands, a sufficient number of families is !10
expected to enroll, enabling accurate cost analysis and further program expansion, so that we reach even the most remote areas of the county. So far, with our expansion into Sedro-Woolley, this has proven to be the case.. However, we believe that the infrastructure exists to make this program succeed. It just needs to have a critical mass to effectively get off the ground. CHOW is not a long-term solution to hunger, and the group understands this. Deeper structural issues must be addressed in order to ensure more complete food security and to provide long-term solutions to food access. However, the weekend is a specific time where children and teens are vulnerable, and this program aims to help children have consistent access to food so that they have a greater opportunity to succeed in school and in their development as well-rounded, healthy human beings.
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APPENDIX Current Skagit County Backpack Programs Anacortes School District (Food2Go Anacortes) District Enrollment
% Free/Reduced Lunch
Backpack Program? Y/N
Number of Students Served
% of Free/Reduced Students Reached
2,787
27.6%
Yes
147
19%
Burlington-Edison School District (Food Distribution Center, Burlington AM Rotary) District/School Enrollment
% Free/Reduced Lunch
Backpack Program? Y/N
Number of Students Served
% of Free/Reduced Students Reached
3,664
48.6%
Yes
150
8.4%
Westview Elementary – 426
72%
Yes
TBD
TBD
Lucille Umbarger Elementary – 684
64.2%
No
0
0%
Edison Elementary – 473
26.8%
No
0
0%
Bay View Elementary – 537
32.6%
No; would like one
0
0%
Allen Elementary – 433
80.8%
Yes
TBD
TBD
Burlington-Edison High – 1,131
39.8%
No
0
0%
Burlington-Edison North High – 57
51.9%
No; would like one
0
0%
Concrete School District (Food Distribution Center, Helping Hands FB) District Enrollment
% Free/Reduced Lunch
Backpack Program? Y/N
Number of Students Served
% of Free/Reduced Students Reached
545
64.4%
Yes (Elementary school)
58
16.5%
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La Conner School District District Enrollment
% Free/Reduced Lunch
Backpack Program? Y/N
Number of Students Served
% of Free/Reduced Students Reached
631
52.5%
Starting
TBD
TBD
Mount Vernon School District (Neighbors in Need FB) District/School Enrollment
% Free/Reduced Lunch
Backpack Program? Y/N
Number of Students Served
% of Free/Reduced Students Reached
6,624
62.9%
NA
~150
3.5%
Centennial Elementary – 560
78.2%
No
0
0%
Jefferson Elementary – 462
64.1%
No
0
0%
Lincoln Elementary – 373
73.2%
No
0
0%
Little Mountain Elementary – 635
61.1%
Yes
28
7.2%
Madison Elementary – 525
66.3%
No
0
0%
Washington Elementary – 443
77.2%
Yes
20
5.8%
La Venture Middle – 632
76.1%
Yes
TBD
TBD
Mount Baker Middle – 675
61.3%
Yes
4
0.09%
Mount Vernon High – 1,865
56.3%
Yes
TBD
TBD
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Sedro-Woolley School District (Helping Hands FB – Capacity for 250-300 students) District/School Enrollment
% Free/Reduced Lunch
Backpack Program? Y/N
Number of Students Served
% of Free/Reduced Students Reached
4,314
50.7%
NA
~120
TBD
Big Lake Elementary – 349
18.1%
No (Does not want one)
0
0
Central Elementary – 423
63.4%
Yes
22
8.2%
Clear Lake Elementary – 267
47.6%
Yes
10
7.8%
Evergreen Elementary – 524
63.5%
Yes
12; capacity for 25
3.6%
Lyman Elementary – 175
52%
Yes
25
27.4%
Mary Purcell Elementary – 394
72.1%
Yes
11
3.9%
Samish Elementary – 184
46.2%
Yes
10
11.8%
Cascade Middle – 600
52.5%
Yes
20
6.3%
Sedro-Woolley Senior High – 1,146
41.4%
Yes
2
0.4%
State Street High – 171
60.8%
Yes
10
9.6%
Good Beginnings Center – 81
54.3%
No
0
0%
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Current Non-Skagit Washington State Backpack Programs Program/County
More Information
Northwest Harvest Three Squares – King, Pierce, Yakima, Grays Harbor, Grant, Spokane Counties
https://goo.gl/uNV7HX
Clark County
https://goo.gl/4dkcer
Pierce County
https://goo.gl/QEXMPZ ; https://goo.gl/KDX3tQ
Okanagan County
https://goo.gl/1pffgg
Thurston County
https://goo.gl/My4tou
Whatcom County
https://goo.gl/DVbY6e
Snohomish County
https://goo.gl/QAnGhs ; http://www.meptsa.org
Kitsap County
http://www.standupforkids.org/bremerton/
Clallam County
https://goo.gl/j4x22A
Kittitas County
https://goo.gl/B3Vfgd
Cowlitz County
https://goo.gl/U8u5kK
Klickitat County
https://www.backpacks4kids.org
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Reference List Jyoti, Diana F, Edward A Frongillo, and Sonya J Jones. 2005. "Food insecurity affects school children's academic performance, weight gain, and social skills." The Journal Of Nutrition 135, no. 12: 2831-2839. MEDLINE with Full Text, EBSCOhost (accessed August 16, 2017). Kirkpatrick, Sharon I, Lynn McIntyre, and Melissa L Potestio. 2010. "Child hunger and long-term adverse consequences for health." Archives Of Pediatrics & Adolescent Medicine 164, no. 8: 754-762. MEDLINE with Full Text, EBSCOhost(accessed August 16, 2017). Weinreb, Linda, Cheryl Wehler, Jennifer Perloff, Richard Scott, David Hosmer, Linda Sagor, and Craig Gundersen. 2002. "Hunger: its impact on children's health and mental health." Pediatrics 110, no. 4: e41. MEDLINE with Full Text, EBSCOhost (accessed August 16, 2017).
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