1. Kelly, Cheryl PhD
  2. Maytag, Allison MPH
  3. Allen, Marisa PhD
  4. Ross, Colleen MS, MPH


Context: Only 58% of eligible Coloradans are enrolled in the Supplemental Nutrition Assistance Program (SNAP). In recent years, more community-based organizations (CBOs) and health care clinics are incorporating screening for social needs into their workflows.


Program: Seven Colorado-based CBOs and 3 clinics received funding (2016-2018) to screen for food insecurity (FI) and provide SNAP application assistance to their clients and patients.


Implementation: Funded agencies were required to implement strategies focused on particular populations or settings based on Food Research and Action Center recommendations.


Evaluation: A 5-part care cascade from screening to SNAP enrollment was conceptualized to guide the evaluation. Funded CBOs and clinics were asked to submit de-identified individual-level data to the evaluation team (number and characteristics of individuals screened, screening results, interest in receiving assistance, submitted application, enrolled in SNAP). The purpose of the evaluation was to assess the proportion of individuals CBOs and clinics screen for FI and assist with completing a SNAP application and describe the characteristics of individuals who are not interested in receiving assistance to complete a SNAP application and the characteristics of individuals who enroll in SNAP.


Results: Thirty-five percent of individuals who reported FI participated in the care cascade and enrolled in SNAP. CBOs assisted a greater proportion of food-insecure individuals (55%) than clinics (22%) (P < .001). Males, adults 40 years or older, rural residents, and African Americans were more likely to be interested in receiving assistance, and adults 40 years or older, rural residents, and American Indians/Alaska Natives were more likely to enroll in SNAP.


Discussion: CBOs were more successful in assisting individuals along the care cascade than clinics. Certain subpopulations are more likely to be interested in receiving assistance and enrolling in SNAP. These findings can be used by public health practitioners to plan interventions to increase enrollment in SNAP.