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Developing the Expanded Food Security Screener and Pilot Testing It for Prioritization of Applicants to the Home-Delivered Meal Program

Food insecurity is multidimensional and may be an outcome not only of economic need but also of inability to prepare meals and shop for food, especially in older adults. As the prevalence of waiting lists for the Older Americans Act home-delivered meal program is increasing, we expanded the 6-item US Department of Agriculture Household Food Security Survey Module, named it the Expanded Food Security Screener, and used it to develop a 5-level prioritization system to assess need for a meal based on economic access and ability to shop and cook, with or without help. We pilot-tested the tool and its prioritization system on older adults who applied for the program. The tool effectively distributes applicants into 5 different levels of need. The priority levels were generally appropriate (75%), based on follow-up assessment by programs. The tool is useful to set priorities for a waiting list and/or to identify need in the community.