About

Aditi Vasan, MD, MSHP, is an Assistant Professor of Pediatrics (General Pediatrics) at the Children's Hospital of Philadelphia. She serves as an Attending Physician in the Division of General Pediatrics and is a Senior Fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania. Her clinical expertise focuses on pediatric hospital medicine, while her research interests include health equity, social determinants of health, administrative burden, access to benefits such as WIC, SNAP, and Medicaid. She has contributed to scholarly work on children's health insurance coverage, food insecurity, Medicaid, and health policy, with multiple publications addressing these topics. Her educational background includes a BA in Molecular Biology, Global Health and Health Policy from Princeton University, an MD from Johns Hopkins University School of Medicine, and an MSHP in Health Policy Research from the University of Pennsylvania.

Research topics

• Gerontology
• Medicine
• Family medicine
• Physical therapy
• Demography
• Environmental health
• Internal medicine
• Nursing
• Psychiatry
• Medical emergency

Selected publications

• Addressing Food Insecurity Through Hospital-Community Partnerships in a Changing Policy Landscape

  Hospital Pediatrics · 2026-01-12

  articleOpen accessSenior author

  Food insecurity (FI) rates are rising nationally, particularly among families with children. This is alarming because access to adequate and nutritious food is essential for children’s learning, growth, and development. In 2023, nearly 1 in 5 households with children reported experiencing FI.1 Unfortunately, FI rates are likely to worsen amid recent federal changes to government benefit programs. In particular, the 2025 Budget Reconciliation Act made changes to the Supplemental Nutrition Assistance Program (SNAP) that will (1) reduce federal funding and increase states’ cost-sharing requirements, (2) prevent future increases to SNAP benefit amounts in response to inflation, and (3) impose new work reporting requirements, including on caregivers of children aged 14 and older.2 The nonpartisan Congressional Budget Office estimates that in an average month, approximately 300 000 SNAP recipients, including 96 000 children, will have their benefits reduced or eliminated as a result of these changes.3Hospitals caring for children are uniquely positioned to respond to these policy changes. Hospitalization can magnify FI through lost wages and unexpected expenses related to food, parking, and childcare for siblings.4,5 Even previously food-secure families may face inpatient FI or acute food needs during their hospital stay. Thus, hospitalization represents both a period of vulnerability and an opportunity for meaningful intervention.6 In this issue of Hospital Pediatrics, Lopez and colleagues explore this opportunity through a pilot study assessing rates of household and inpatient FI among hospitalized children from March 2021 to March 2022 and testing an intervention bundle to address these needs.7Using an adapted version of the validated US Department of Agriculture 18-item Household Food Security Survey (HFSS), Lopez et al found that more than half of their study participants screened positive for FI, including 48% with household FI and 46% with inpatient FI. This household FI rate is substantially higher than national HFSS estimates among households with children, highlighting that hospitalized children are at increased risk for FI.8 These findings also exceed rates from other studies in the inpatient setting,9,10 which may be due to differences in patient populations across settings or trends over time. However, given this study’s intervention focused on food resource provision, there is likely some component of self-selection bias, as families experiencing FI may have been more likely to enroll, and expectation bias, as families may have responded affirmatively to screening to obtain resources. Regardless, their findings indicate a strong interest in food supports during hospitalization. Given national increases in FI in the years since this study,1 compounded by recent changes to SNAP, the demand for hospital-based food resources is likely even greater today.In their single-arm prospective trial, Lopez et al evaluated the feasibility, acceptability, and referral outcomes of an intervention bundle for FI. This intervention included complimentary meal trays during the hospitalization and active referral to a community-based organization (CBO) providing information on local food pantries, assistance in applying for government benefits, and referral to a partner program for support with other social needs. This bundle represents a multilayered approach to comprehensively addressing social needs6: complimentary meal supports address acute needs during hospitalization; guidance on community resources helps address subacute needs during the transition home after discharge; assistance with public benefit enrollment helps address more long-term needs; and finally, connection to a referral partner helps address other concomitant social needs.A notable strength of this study was its CBO partnership model. Building an effective partnership with a CBO requires time, mutual investment, and thoughtful coordination. The study team’s approach reflects many of the best practices highlighted in the Bidirectional Engagement and Equity Framework,11 which was informed by principles of community-based participatory research and designed to promote equitable, sustainable partnerships between academic and community interest holders. First, the hospital-based team selected a regional food bank already connected to their outpatient network, laying the groundwork for trust building and alignment across clinical and community settings. They then provided funding for their partner organization to expand capacity—demonstrating a commitment to strengthening community infrastructure and recognition that accepting new referrals from health systems may require substantial investment from often resource-limited nonprofits. Finally, they met periodically with CBO leadership during the study, fostering bidirectional communication to ensure responsiveness to evolving community needs.This study also used effective data sharing to track valuable metrics. For social care interventions, multiple process and outcome measures are important to track over time.12 One fundamental measure is family support of the intervention, which can be assessed through qualitative interviews or surveys evaluating the acceptability of an intervention, as performed in this study. Research teams should also track rates of referrals to ensure families in need of support are not missed. In addition, they should evaluate rates of resource connection, ideally through closed-loop referral systems, to assess intervention effectiveness.CBO partnerships can strengthen these closed loops. Social workers and community health workers, who are often responsible for addressing social needs in clinical settings, have shared that establishing closed-loop communication with CBOs is one of the most challenging parts of their role.13 In this study, only 23% of families had been successfully contacted by the partner CBO within 2 weeks of referral, likely due to both limited CBO capacity and families’ competing priorities after discharge. This emphasizes the value of longitudinal follow-up, ideally through ongoing CBO partnership, to ensure long-term connection to resources in the weeks to months following discharge.Finally, although out of this study’s scope, teams should ideally evaluate whether families’ social needs are improved or resolved after discharge. This helps determine whether interventions are sufficiently robust as implemented and whether additional supports are required to adequately meet families’ needs.For each of these steps, it is important to ensure interventions are implemented equitably by stratifying process and outcome measures by key demographic variables, such as preferred language, insurance status, and neighborhood characteristics. Even well-intentioned interventions can unintentionally widen disparities if they are not designed and iteratively improved with equity in mind.14When adapting this pilot for real-world applications, there are key limitations to consider. First, this study used the 18-item HFSS to evaluate household FI and did not include concurrent screening for other social needs. In practice, most hospitals use shorter FI screening instruments, often adapted from the 2-item Hunger Vital Sign (HVS) or the WE CARE screening tool.15 Studies have shown that when compared with the HFSS, the 2-item HVS has high sensitivity and specificity in detecting FI.16 This implies that hospitals can adequately detect families’ food resource needs using shorter, more streamlined screening instruments. This is particularly important when food insecurity screening is implemented in combination with screening for other health-related social needs.Second, scalability remains a challenge. In this study, of 2563 eligible patients, 1000 were ultimately screened, and 540 received the intervention bundle including CBO referral. Only 62% of those receiving the intervention had connected with the CBO by 1 year. The authors note that this attrition in CBO connection is likely in part due to limited CBO capacity to complete follow-ups. Scaling community referrals to accommodate universal inpatient social needs screening could place additional strain on CBO capacity, further limiting the effectiveness of referrals. Therefore, hospitals pursuing a community partnership model should commit to increased investment in these CBOs to help expand their capacity, potentially through allocations of nonprofit hospital community benefit spending. Moreover, as a single CBO is unlikely to have the resources or expertise to address all types of social needs, such as housing insecurity or childcare needs, hospitals and health systems may need to invest in multiple CBO partners.Finally, application across geographic regions is difficult. Local CBOs, particularly regional food banks like in this study, are often geographically limited in their influence. As pediatric hospital care regionalizes and catchment areas broaden,17 it becomes challenging to identify available and appropriate resources for families who may live hundreds of miles away from a hospital. Searchable electronic resource maps and referral platforms, such as those developed by organizations like FindHelp and Unite Us, may mitigate this problem by maintaining national community resource directories.18,19 However, adoption of such tools by hospital social workers is variable.13 Further, coordinating with these organizations to ensure local resources are up to date, align referral processes with existing staff workflows, and promote widespread use of these tools may require dedicated health system investment, including allocation of skilled hospital staff members to work with vendors to update and maintain resource directories.As FI continues to rise, amid shifting federal policy and constrained community resources, hospital-based interventions like that described by Lopez et al offer a promising model for responsive, equity-oriented care. Yet their success depends on our willingness to move beyond passive referral toward active partnership—to invest in the CBOs that make these interventions possible and to advocate for upstream policies that secure every family’s right to adequate nutrition. Children’s hospitals can and should lead in this space, not only by screening and referring but by cocreating solutions that bridge health care and community. In doing so, we can transform isolated acts of social care into a durable safety net.

  PublisherOA PDFDOI

• Patient Portal Enrollment, Use, and Care Utilization among Hospitalized Children

  medRxiv · 2026-01-11

  articleOpen accessSenior author

  Abstract Patient portals are designed to enhance patient and caregiver engagement by providing access to health information, communication with care teams, and telehealth services, yet their impact on health care utilization among hospitalized children is not well understood. In this cross-sectional study, we examined associations between patient portal enrollment and use and hospitalization outcomes among 40,377 children admitted to an urban quaternary or suburban tertiary pediatric hospital between 2022 and 2024. Portal activity was defined by enrollment and any use (login, messaging, or telehealth) within specified periods before or during hospitalization. Using multivariable regression models adjusted for sociodemographic factors, neighborhood opportunity, insurance type, language, medical complexity, hospital site, and year, we evaluated associations with critical care admission, hospital length of stay (LOS), and 30-day readmissions. Portal enrollment and use in the year prior to hospitalization were associated with significantly lower odds of critical care admission and shorter LOS, with average reductions of 1.56 days for enrollment and 1.21 days for use. Neither portal enrollment nor use was significantly associated with 30-day readmissions. Future research should explore any potential mechanisms facilitating lower acuity at admission and shorter hospitalizations for those engaged with digital health.

  PublisherOA PDFDOI

• Patterns in Patient Portal Enrollment and Use Among Hospitalized Children

  medRxiv · 2026-01-11

  articleOpen accessSenior author

  Background and Objectives Patient portals allow adolescents and caregivers of pediatric patients to better engage with health care, improving their medication adherence, health knowledge, self-efficacy, and receipt of preventive care. However, disparities in access to and comfort with using these portals persist. Hospitalization represents a promising opportunity to address these disparities among a high-risk population. Design/Methods We conducted a cross-sectional analysis to identify disparities in portal enrollment and use (logins, messaging, or telehealth use) among patients admitted to two pediatric hospitals within a single health system from 2022-2024. We calculated unadjusted rates of portal enrollment and use before, during, and after hospitalization, stratified by patient-level factors (age, race/ethnicity, insurance coverage, medical complexity), household-level factors (preferred language), and population-level factors (neighborhood opportunity). We then used multivariable logistic regression to identify associations between these factors and portal enrollment and use. Results Among 40,371 hospitalized patients, 93% had enrolled in our patient portal. Patients who identified as Non-Hispanic Black, were publicly insured, had a household language other than English, and lived in lower opportunity neighborhoods had significantly decreased odds of portal enrollment and use before, during, and after hospitalization. Conclusions Despite high overall rates of portal enrollment among our patient population, we observed persistent disparities in portal enrollment and use. Efforts to promote equitable portal usage among hospitalized children may be most effective when focused on families who are publicly insured, prefer languages other than English, or live in lower opportunity neighborhoods.

  PublisherOA PDFDOI

• Preserving Continuous Access to Coverage and Care for Children in the United States: Lessons from Medicaid Unwinding

  Academic Pediatrics · 2026-03-07

  article1st authorCorresponding
  PublisherDOI

• Children’s Continuous Medicaid Eligibility During COVID-19 and Health Care Access, Use, and Barriers to Care

  JAMA Health Forum · 2025-06-13 · 6 citations

  articleOpen accessSenior author

  Importance: National continuous Medicaid eligibility under the Families First Coronavirus Response Act (FFCRA) may have differentially affected children's health care depending on whether states had preexisting 12-month continuous Medicaid eligibility for children. Objective: To estimate the association of states newly implementing continuous Medicaid eligibility under the FFCRA with children's health care access, health care use, and barriers to care. Design, Setting, and Participants: This survey study used a difference-in-differences research design comparing states before (2017-2019) and during (2020-2022) the FFCRA overall, by caregiver-reported race and ethnicity, and among publicly insured children. Analyses used data from the National Survey of Children's Health (NSCH), an annual household survey on the health and well-being of children 0 to 17 years old in the US. Data were analyzed from September 2024 to March 2025. Exposures: Whether states had pre-FFCRA 12-month continuous Medicaid eligibility for children. Main Outcomes and Measures: Insurance coverage, gaps in coverage, unmet health care needs, any health care visits, preventive visits, emergency department visits, hospitalizations, any time spent weekly arranging children's health care, and problems paying medical bills. Results: The sample included 215 884 children, with children in states with pre-FFCRA continuous eligibility being similar to children in states newly implementing continuous eligibility with respect to age (8.6 years old in both sets of states), gender (49.6% female compared to 48.5%), and nativity (66.7% third generation or longer with all parents born in the US vs 69.6%), with lower proportions who were non-Hispanic Black (11.9% compared to 13.8%) or non-Hispanic White (50.5% compared to 52.9%), and higher proportions who were Hispanic (25.5% compared to 23.9%). In adjusted difference-in-difference models, newly implementing continuous eligibility under the FFCRA was associated with a 0.7-percentage point (95% CI, -1.2 to -0.1 percentage point) reduction in children's unmet health care needs. There was no evidence of additional FFCRA-associated changes in outcomes overall. In subgroup analyses, there were reductions in coverage gaps, unmet health care needs, and time spent arranging care among Hispanic children and publicly insured children. Conclusions and Relevance: In this survey study, newly implementing continuous eligibility for children under the FFCRA was associated with reductions in unmet health care needs and no additional changes in health care outcomes overall, with additional benefits for Hispanic children and publicly insured children. This could reflect expected changes under mandatory, national 12-month continuous eligibility for children implemented in January 2024.

  PublisherOA PDFDOI

• Evaluation of Language Accessibility of Community Resources to Address Pediatric Social Needs in 2 Large US Cities

  Academic Pediatrics · 2025-10-28

  articleOpen access

  OBJECTIVE: To assess language accessibility of selected community-based programs serving families who speak Spanish, Somali, or Vietnamese in 2 large US cities. METHODS: We conducted a cross-sectional evaluation of selected community-based programs identified using online directories used by health systems seeking to address unmet social needs among pediatric patients. We reviewed program websites and telephone menus for language accessibility and surveyed program staff about language access for service delivery. RESULTS: Out of 179 community-based programs identified, 126 had unique websites (40% were available in languages other than English). One hundred and seventy-eight had working telephone numbers, of which 57% directed callers to a telephone menu. More than half (58%) of telephone menus had an option for language selection, almost exclusively Spanish. Of 136 programs that completed the telephone-based survey, 65% reported bilingual staff, and 46% reported working with interpreters for service delivery in Spanish. For service delivery in Somali, 9% reported bilingual staff, and 57% reported interpreters. For service delivery in Vietnamese, 16% reported bilingual staff, and 57% reported interpreters. A subset of programs reported no ability to support service delivery in Spanish (20%), Somali (32%), or Vietnamese (32%). CONCLUSIONS: Community-based programs may not have the language-related resources necessary to support families who speak Spanish, Somali, or Vietnamese. Health systems should consider confirming language access and/or providing language support when referring patients to community resources.

  PublisherDOI

• Social Worker and Community Health Worker Collaboration in Addressing Social Needs

  PEDIATRICS · 2025-08-04 · 1 citations

  articleOpen accessSenior author

  BACKGROUND AND OBJECTIVES: Recent regulations require that hospitals screen families for health-related social needs (HRSNs), but many hospitals lack the resources and infrastructure to address these needs. Social workers (SWs) and community health workers (CHWs) play a critical role in filling this gap. We aimed to understand SW and CHW perspectives regarding effective strategies for addressing HRSNs during and after inpatient pediatric hospitalizations. METHODS: We conducted semi-structured interviews with inpatient SWs and CHWs at 3 academic children's hospitals exploring participants' experiences connecting families with resources, communicating with medical teams, and facilitating continued support for families after hospital discharge. Interviews were recorded, transcribed, and coded; themes were derived using thematic analysis. RESULTS: We interviewed 28 participants (19 SWs, 9 CHWs). We then identified 4 themes (and 5 subthemes): (1) engagement with caregivers (SWs and CHWs aim to balance providing resources and promoting families' self-sufficiency), (2) approach to addressing needs (SWs and CHWs have complementary skillsets, and they find maintaining updated resource repositories a significant challenge), (3) engagement with medical teams (communication with providers focuses on needs impacting medical care or discharge planning), and (4) approach to follow-up (ensuring families have continued support following hospital discharge is a challenge, particularly for select populations). CONCLUSIONS: SWs and CHWs offer synergistic and complementary expertise to support families experiencing HRSNs. Participants highlighted opportunities to optimize processes for updating resource repositories and improve longitudinal support for families following hospital discharge.

  PublisherOA PDFDOI

• Children’s Medicaid Enrollment Increased During First Year Of Consolidated Appropriations Act

  Health Affairs · 2025-11-01 · 1 citations

  articleOpen accessSenior author

  Under the Consolidated Appropriations Act, 2023, which required the provision of national twelve-month continuous Medicaid eligibility for children up to age nineteen, children's Medicaid enrollment increased. After implementation of the act, states without prior twelve-month continuous eligibility showed larger gains in children's enrollment than states with prior continuous eligibility. These gains occurred during the unwinding of COVID-19 pandemic-era protections.

  PublisherOA PDFDOI

• Expanded Child Tax Credit Payments During Pregnancy Were Associated With Decreased Odds Of Adverse Birth Outcomes

  Health Affairs · 2025-10-01 · 2 citations

  article1st authorCorresponding

  The 2021 expanded Child Tax Credit (ECTC) provided families with six monthly cash transfer payments disbursed between July and December 2021, with the goal of alleviating financial strain during the COVID-19 pandemic. These payments reduced child poverty and food insufficiency and may have had beneficial effects on child health. Using 2019-22 Pennsylvania birth certificate data, we examined the association between parental receipt of monthly ECTC payments during pregnancy and infant birth outcomes, exploiting quasi-random variation in ECTC payment amounts based on date of birth and number of siblings. For every $1,000 in ECTC payments received during pregnancy, we observed decreased odds of preterm birth, low birthweight, and very low birthweight among infants of Medicaid-insured pregnant people. Nondirected cash transfer programs such as the ECTC and other income support programs and policies targeting pregnancy may lead to improved birth outcomes.

  PublisherDOI

• An Antiracist Approach to Firearm Injury Prevention Screening and Safety Counseling

  PEDIATRICS · 2025-09-09

  articleSenior author

  Since 2019, firearms have been the leading cause of death for children and adolescents aged 1 to 19 years.1 In response, some clinicians and health systems have recognized that providing families with counseling on secure firearm storage and firearm injury prevention falls within their scope of practice.2 Storing firearms unloaded, locked in a safe, and separate from ammunition is an evidence-based practice to reduce firearm injury.2Stark disparities in firearm injury rates among racial and ethnic minority groups,3–5 including Black, Hispanic, and American Indian/Alaska Native (AI/AN) populations, alongside rising firearm ownership rates among these groups, highlight the need to recognize and address the effects of racism on firearm ownership and firearm injury prevention.6,7 This commentary presents an antiracist framework for firearm injury prevention screening and safety counseling in clinical settings.An antiracist approach recognizes that policies and practices can either perpetuate or disrupt racism and seeks to intentionally design systems that advance racial equity.8 In the context of firearm safety counseling, this approach involves identifying and anticipating inequities that could result from existing counseling strategies and proposing alternative interventions that actively counteract or mitigate the effects of racism. Specifically, this framework addresses racism at structural, institutional, and interpersonal levels and offers strategies for intervention development, safety risk assessment, documentation, resource distribution, and family- and community-centered support (Figure 1).9,10 Applying an antiracism framework to firearm safety counseling could improve equitable access to resources that reduce firearm injury risk.Most existing literature on firearm ownership among racial and ethnic minority communities focuses on Black or African American individuals. Structural racism likely also shapes firearm ownership practices for Hispanic, Asian American, and AI/AN families, yet there remains a notable gap in research on firearm access, ownership, and storage practices in these communities. We offer strategies that could apply broadly across racial and ethnic minority populations.Disparities in firearm victimization are caused by policies and practices rooted in racism. Discriminatory policies, such as redlining, have contributed to increased firearm violence within Black communities in the United States. Redlining and associated financial disinvestment by banking and real-estate institutions reshaped the built environment in these communities, creating segregated areas of concentrated poverty, limited employment and educational opportunities, and decreased access to health care.11–14 This concentration of poverty and limited economic resources and opportunities increases the likelihood of firearm violence.15 Consequently, children from racial and ethnic minority groups are disproportionately impacted by firearm violence.4Black, AI/AN, and Hispanic adolescents are more likely to be victims of firearm homicides than their white counterparts.4 Between 2019 and 2020, firearm suicide rates increased for AI/AN males aged 10 to 44 years, and in 2022, the rate of firearm suicide among Black youth aged 10 to 19 years in the United States outpaced the rate among white youth for the first time.5,16 Additionally, from 2019 to 2023, the crude death rate from unintentional firearm injuries among Black children has remained 5 times higher than that of white children.17Simultaneously, firearm ownership rates among racial and ethnic minority adults have increased from 2015 to 2021, with surges in purchasing during the COVID-19 pandemic.6,7 In a survey study conducted from January 2019 to April 2021, 21% of new firearm owners identified as non-Hispanic Black adults, compared with 9% prior to 2019.6,7 Additionally, 20% of new firearm owners during this period self-identified as Hispanic.6 In a nationally representative 2022 survey of 527 individuals self-identifying as AI/AN, 45.5% reported access to a firearm.18Although motivations behind this trend are an active area of research, historical contexts may provide some insights. During the Jim Crow era, laws rooted in white supremacy barred racial and ethnic minority individuals from legally owning or purchasing firearms.19,20 These laws were founded on racist beliefs that Black individuals were inherently dangerous and intentionally disarmed and disempowered Black communities to reinforce social hierarchies and suppress resistance.20 For example, the 1967 Mulford Act in California, which prohibited public carrying of loaded firearms, was crafted in response to the Black Panther Party’s armed patrols against police brutality.21Similarly, firearms were used as a tool of oppression, colonization, genocide, and forced removal of AI/AN individuals from their ancestral land.22 Despite this history, firearm ownership has remained high among AI/AN individuals, partly due to the critical role of firearms in subsistence hunting and other AI/AN cultural practices.22 Understanding this history is critical to engaging patients in culturally responsive safety counseling.An antiracist approach to firearm safety intervention development requires recognizing racism as a root cause of disparities in firearm injury, acknowledging the diversity of firearm owners and reasons for firearm ownership, and challenging racial stereotypes related to ownership.23–25 Regarding the latter, one study found that white individuals with anti-Black bias were more likely to associate firearm rights with white Americans and were less supportive of extending those rights to Black Americans.24 In reality, some Black Americans and first-generation immigrants may see firearm ownership as an exercise of their rights and a strategy for self-protection against racism.17,18 For example, during the COVID-19 pandemic, firearm ownership among Asian Americans increased, motivated in part by experiences of interpersonal racism.25Firearm injury prevention interventions should therefore center on safety and avoid questioning families’ motivations for firearm ownership. Although evidence demonstrates that the safest home is one without firearms, we recognize that removing firearms from the home may not be a feasible or desirable first step for some individuals.2,26–29 Pediatricians should adopt strengths-based, family-centered approaches to collaboratively develop firearm safety practices that honor families’ values while reducing the risk of intentional or unintentional injury.For instance, a caregiver may choose to keep a loaded firearm in her car while driving through an unsafe neighborhood to take her son to school. This decision might reflect her concern for her family’s safety and commitment to her child’s education. These priorities should be recognized and affirmed as strengths. Rather than focusing on risk alone, a clinician might ask: “How can we work together to find a way for you to feel safe, get your child to school, and also reduce the chances that your child or someone else could gain access to your firearm, leading to an injury?” This reframing could create space for shared problem-solving that aligns evidence-based recommendations with the caregiver’s lived experience and values, grounding firearm safety counseling in empathy, trust, and collaboration. Positive individual-level interactions between providers and patients around firearm injury prevention have the potential to mitigate disparities and enhance trust.Health systems should aim to implement trauma-informed and targeted universal approaches to firearm safety counseling.30 All health care providers should be trained in performing firearm safety counseling in a trauma-informed manner, as this has been noted as a critical barrier to implementation.2 A trauma-informed approach recognizes that many racial and ethnic minority families experience trauma related to community and racialized violence, discriminatory policing, and systemic inequities. For some families, firearm acquisition may represent a rational response to lived experiences of danger and the absence of reliable institutional protections. Trauma-informed counseling seeks to understand families within this social and historical context and to partner with them to promote safety in a respectful, nonjudgmental way. Examples of trauma-informed techniques for addressing safety risks could include encouraging incremental steps toward safety, such as the purchase of a lockbox or safe, and identifying local spaces where children and families can gather safely and feel supported.31Recent evidence suggests that patients from racial and ethnic minority groups are less likely to be screened for firearm access.32 However, a recent national survey found that unsecure firearm storage is most prevalent among Black firearm owners, suggesting that individuals from this community might be most likely to benefit from safe storage interventions.33 Although universal screening and counseling may help mitigate stigma and maximize the reach of firearm safety interventions, targeted universalism goes a step further by refining strategies to assess and address safety risk within specific subpopulations, improving outreach and intervention effectiveness and preventing unintended consequences, such as erosion of trust. This approach reflects an antiracist commitment to equity rather than equality, addressing community-specific barriers and engaging local partners to co-design outreach and assessment tools that achieve a common goal across all populations.For example, Da El Siguiente Paso, a national public education campaign on secure firearm storage featuring 2 Hispanic fathers and firearm owners, was created by the Ad Council to maximize the cultural relevance of safe storage messaging for Hispanic firearm owners.34 In another example, a pilot intervention in 2 predominantly Alaska Native villages in Bristol Bay, Alaska, partnered with local village public safety officers, firearm owners, and medical, mental health, and law enforcement professionals to co-develop a firearm safe and trigger lock distribution program. At a 3-month follow-up, 86% of the safes distributed were in use with firearms stored inside, demonstrating both feasibility and cultural acceptability.35Health systems should ideally track rates of screening and resource provision across demographic groups to identify and address inequities as they arise. One strategy to achieve this could involve a quality improvement analyst regularly tracking rates of firearm safety screening and resource provision, disaggregated by race, ethnicity, preferred language, and insurance status. Additionally, health systems should ideally provide multilingual educational materials on safe storage to improve access for families who prefer a language other than English.Health systems adopting firearm injury prevention screening should ensure they have the resources to support families effectively. Rather than just documenting families’ firearm storage practices, health systems should provide tangible, concrete resources like educational information about secure storage practices, locking devices, and temporary storage maps.Health systems should also ensure their own practices reflect antiracist principles, for example, through thoughtful and nonjudgmental documentation of firearm safety discussions in electronic health records. Documentation that avoids stigmatizing phrases, such as “family refused [firearm safety counseling],” may help preserve patient-provider trust, especially given that patients and families can access their medical records. Instead, providers could use phrasing that emphasizes families’ strengths and priorities, such as “family expressed a strong commitment to protecting their child from community violence. Educational materials on firearm safety were provided, and they were open to discussing this further at future visits.”Biases in documentation of firearm practices could also lead to unintended consequences if used inappropriately to, for example, support child neglect reporting.36,37 For example, a caregiver may be documented as engaging in unsecure storage despite never receiving education on how to store their firearm safely. This documentation could then be misinterpreted as neglect, despite the issue stemming from a lack of awareness and access to safe storage resources.38,39 Documentation of firearm storage practices should only be linked to child neglect cases if these practices directly result in injury or are adjudicated separately under child access prevention laws. Standardized documentation templates that minimize bias may help mitigate these risks.Clinicians should guide patients along a spectrum of storage practices toward the safest standards, identifying opportunities for education, shared decision-making, and support, and building on shared values like family safety and well-being.Successful implementation of an antiracist approach to screening and counseling also requires authentic, longitudinal partnerships with community-based organizations (CBOs) engaged in firearm injury prevention. External partnerships should avoid exacerbating existing inequities and eroding trust. For example, referring families to law enforcement agencies to obtain locking devices may have unintended consequences, as protection from law enforcement has been cited as a reason for firearm purchasing among racial and ethnic minority individuals.18,23,40 Although law enforcement agencies can be important partners in firearm safety promotion, health systems should, when possible, invest in community-based device distribution as an additional approach. For example, Youth Empowerment for Advancement Hangout (YEAH Philly) is a CBO that serves the community near our hospital and primary care sites and that promotes violence prevention among Black adolescents and young adults through peer mediation, conflict resolution, and community-based distribution of firearm locks.41Family and community involvement is critical to promoting culturally responsive firearm safety strategies. Gathering ongoing feedback from families from minoritized racial and ethnic backgrounds can help ensure strategies are responsive to community needs.Structural, institutional, and interpersonal racism may influence clinicians’ ability to provide effective firearm safety counseling to patients and families from racial and ethnic minority groups. Health systems engaging in firearm safety counseling should aim to mitigate individual and institutional biases, use data to identify and address disparities, and prioritize community partnerships. By embedding antiracist principles into aspects of firearm injury prevention, health systems can better serve diverse communities and advance health equity.

  PublisherDOI

Frequent coauthors

• Chén C. Kenyon

  Children's Hospital of Philadelphia

  57 shared

• Zoe Bouchelle

  Denver Health Medical Center

  34 shared

• Alexander G. Fiks

  Children's Hospital of Philadelphia

  25 shared

• B. G. Beatty

  University of Pennsylvania

  22 shared

• Philip V. Scribano

  Children's Hospital of Philadelphia

  16 shared

• Joel A. Fein

  University of Pennsylvania

  15 shared

• Saba Khan

  Jamia Hamdard

  14 shared

• Chris Feudtner

  Children's Hospital of Philadelphia

  11 shared

Education

• B.A., Molecular Biology, Global Health and Health Policy

  Princeton University

  2010

• M.D.

  Johns Hopkins University School of Medicine

  2015

• Other, Health Policy Research

  University of Pennsylvania

  2021