“The resources are so far, and you need them right here”: Perspectives on Emergency Care for Youth who Experience Violence

Abstract

Objective

In caring for youth who experience violence, variability in available emergency department (ED) resources and conditions that impact comprehensive care delivery (i.e., care coordination, connection to community resources) is not well understood. This study explored conditions that impact care delivery in pediatric and general EDs for youth who experience self-directed or interpersonal violence.

Methods

Semi-structured interviews with pediatric and general ED physicians and nurses were conducted to understand conditions that impact comprehensive care delivery in the ED for youth who experience violence. Participants were recruited from the National ED Inventory database from October 2023-May 2024. Recurring themes were identified using a constant comparative analytical approach.

Results

13 interviews were conducted (8 participants from pediatric EDs and 5 from general EDs). Five major themes were found: 1) imbalance of perceived needs and available resources; 2) consequences of this mismatch negatively affecting both patients and providers; 3) challenges to care provision from the legal system and sociopolitical environments; 4) negative impact of provider implicit biases on care provision; 5) lack of consensus among providers on the appropriate role of the ED in injury prevention efforts and post-discharge care coordination.

Conclusions

Pediatric and general EDs perceive many challenges when caring for youth who experience violence with particular emphasis on the mismatch between needs and resources and non-clinical influences on providers’ care provision. To improve comprehensive care for these youth, EDs may consider increasing pediatric-specific training, building awareness of clinical and community-based resources, and advocacy to expand specialized pediatric care in all settings.

Introduction

Firearm injuries and suicide are two of the leading preventable causes of injury and death among children and adolescents aged 0-18.^1,2 Beyond mortality, poor outcomes related to non-fatal firearm injuries and suicide attempts have devastating impacts on youth, their families, their communities, and the healthcare system.^3,4 When youth experience these forms of self-directed or interpersonal violence, the emergency department (ED) is often their entry point into healthcare⁵ with many of these youth discharged from the ED.^4,6 Following discharge, youth who experience self-directed or interpersonal violence often have ongoing medical and social needs which, if not addressed, could have profound impacts on their ability to recover.⁷

Comprehensive care delivery in the ED for youth who experience self-directed or interpersonal violence (hereafter called “youth who experience violence”) may include care coordination and connection with community-based resources addressing psychosocial and social needs.⁸ While these interventions improve outcomes including decreasing repeat injury, criminal justice involvement and violence-related risk factors,⁹ comprehensive care (i.e., care coordination, connection to community resources) is not consistently integrated into standard ED workflows.¹⁰ Currently, the conditions that impact comprehensive care delivery in the ED setting are not well understood. Additionally, within these factors, differences may exist between pediatric and general EDs based on providers’ experience in caring for pediatric patients and specific pediatric resources available.^11,12 Importantly, understanding modifiable opportunities to enhance the workforce and clinical environment will inform recommendations to optimize comprehensive ED care for youth who experience violence.

Thus, the primary objective of this study was to explore the conditions that impact comprehensive care delivery in pediatric and general EDs for youth who experience self-directed or interpersonal violence. Our secondary objective was to understand general and pediatric ED providers’ recommendations for improvement.

Methods

We conducted an exploratory qualitative study using semi-structured interviews of ED providers to understand the conditions that exist in providing comprehensive care for youth who experience violence (specifically suicide attempts of any mechanism and assault-related or unintentional firearm injuries) presenting to pediatric or general EDs. We followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for reporting qualitative research (Appendix). The Institutional Review Board of Ann & Robert H. Lurie Children’s Hospital of Chicago determined this study exempt from review.

Selection of Participants.

Participants were recruited through a purposive sampling approach using the National ED Inventory (NEDI-USA) database.¹³ The NEDI-USA database, created by the Emergency Medicine Network, contains data on all hospital-based EDs in the United States, including facility location and annual ED visit volume. NEDI-USA was used to create a randomly generated list of 56 pediatric and 75 general EDs across eight states with geographic and population diversity from a cohort of states defined by our study team’s prior work (Arkansas, Florida, Iowa, Maryland, Nebraska, New York, Vermont and Wisconsin).¹⁴ Prospective participants at selected ED sites were recruited via phone and email contacts. ED site leadership also assisted with identifying ED staff with interests in violence prevention. Recruitment started in October 2023 and occurred until thematic sufficiency was achieved in May 2024.

Eligible study participants were any ED staff member that provides or manages clinical care for youth in the ED, such as medical directors, nursing directors, physicians, and nurses. There could be multiple participants from the same ED site. There were no specified exclusions. Consistent with prior work by research team members,¹⁴ a pediatric-resourced ED (hereafter called a “pediatric ED”) was defined as an ED located in (1) a freestanding children’s hospital or (2) a hospital that admits children and has a pediatric intensive care unit. All other EDs were considered general EDs.

Procedures.

The interview guide (Appendix) was informed by the study objectives and relevant literature to explore the experiences of study participants in caring for youth who experience violence. The guide was developed by the primary and senior investigators, who have expertise in qualitative methods, emergency medicine and youth violence prevention. Feedback was solicited from all study investigators and the guide was pilot tested with research assistants at the primary investigator’s study site. Interviews were conducted by trained facilitators (including DM). Interviews were audio recorded on Zoom and professionally transcribed; no additional field notes were utilized, and participants did not review transcriptions. Zoom sessions were password-protected with the waiting room feature enabled to ensure confidentiality. Interviews were conducted in English and only included the participant and interviewer. No prior relationships existed between the interviewers and interviewees. Interviews ranged from 14 to 49 minutes. Participants were compensated with a $50 gift card.

Analysis.

Thematic analysis occurred iteratively alongside data collection using combined inductive and deductive coding to identify recurring themes. Investigators had diverse expertise including emergency medicine (SK, JAH, ERA, MSK), qualitative methodology (SL, DM, MSK), and pediatric injury prevention (SK, JAH, ERA). The primary investigator and two research team members read and annotated the first completed interview transcripts to develop the initial codebook. The study team met to refine codes and identify additional concepts that were not captured by preliminary codes developed using deductive coding. Any coding discrepancies were discussed by the study team until consensus was achieved. The remaining interviews were coded independently by one research team member and then reviewed for accuracy by the primary investigator. The codebook was iteratively refined throughout. Codes were then organized into major themes. Ongoing transcript review and analysis continued until thematic sufficiency was achieved and no new themes were identified. Dedoose (Version 9.2.12) was used to manage coding, data linking, conceptual development, and qualitative analysis.

Results

Characteristics of Study Subjects.

We conducted 13 interviews, including 8 from providers in pediatric EDs and 5 from providers in general EDs. Our sample included participants from 11 distinct EDs (6 pediatric, 5 general); of the 131 EDs included in the sampling frame, 13 declined participation (5 pediatric, 8 general) and 107 could not be reached during the enrollment period (45 pediatric, 63 general). Interview participants predominantly identified as female (76.9%, N=10) and non-Hispanic White (84.6%, N=11) (Table 1). Participant ages ranged from 33 to 67 years old. Participants represented EDs in 6 states: Florida, Iowa, Maryland, New York, Wisconsin and Vermont. Participant roles included medical director, nursing director or manager, director of emergency medical services, hospital operations coordinator and attending physician.

Table 1.

Characteristics of study participants.

	N (%) N = 13
Age category, in years
20-34	1 (7.7%)
35-44	8 (61.5%)
45-54	3 (23.1%)
65+	1 (7.7%)
Gender
Female	10 (76.9%)
Male	3 (23.1%)
Race and Ethnicity
Hispanic	1 (7.7%)
Non-Hispanic White	12 (92.3%)
Role in ED
Attending Physician	3 (23.1%)
Director of Emergency Services	1 (7.7%)
Hospital Operations Coordinator	1 (7.7%)
Medical Director	4 (30.8%)
Nursing Director or Manager	4 (30.8%)
State
Florida	4 (30.8%)
Iowa	1 (7.7%)
Maryland	2 (15.4%)
New York	1 (7.7%)
Vermont	1 (7.7%)
Wisconsin	4 (30.8%)
ED Type
General	5 (38.5%)
Pediatric	8 (61.5%)

ED = Emergency Department

Major themes.

During interviews, participants reflected on factors affecting the comprehensive care of youth who present to the ED after experiencing self-directed or interpersonal violence. Five major themes arose (Table 2): 1) the imbalance of perceived needs and available resources, 2) consequences of this mismatch between needs and resources negatively affecting both patients and providers, 3) challenges to care provision from the legal system and sociopolitical environment, 4) the negative impact of provider implicit biases on care provision, 5) the lack of consensus among ED providers on the role of the ED in injury prevention efforts and post-discharge care coordination. Quotes identified as “Gen” represent a general ED participant while “Ped” represents a pediatric ED participant.

Table 2.

Major themes and additional representative quotes by pediatric and general emergency department (ED) providers¹

Major Theme	Description of Theme	Exemplary Quotes: General ED participants	Exemplary Quotes: Pediatric ED participants
The imbalance between perceived needs and available resources	This theme focuses on the mismatch between the resource need and actual availability in EDs. This mismatch manifested in multiple ways, including knowledge gaps and ability to access tangible resources to care for patients and families both while in the hospital and within the community upon discharge.	“I wish that there was more available hospitals that would take peds. They are few and far between and we have boarded them in the emergency department for close to a week at a time.” (Gen 2) “Because we see such a small number of pediatric patients in general, some of our providers are not comfortable working with children and they're not aware of… age differences or milestones that they should be at or they're really not aware of signs to look for… that somebody that's worked in pediatrics would catch onto much faster.” (Gen 1) “But in our state, if you are in involuntary commitment, then the police officer or law enforcement are the people that make the determination whether the person will be admitted or where they'll be admitted.” (Gen 4)	“I think a lot of these kids, honestly, they need ongoing therapy and then that's something that most places don't have access to. It doesn't even have to be in-person therapy. It could be telehealth. There's lots of ways to do it, creative ways, but we don't have that those kind of resources.” (Ped 6)
The negative impact of this mismatch between needs and resources on both patients and providers	This theme expands on how the mismatch between needs and resources have a negative impact on patient outcomes (i.e., boarding) and provider well-being (i.e., moral distress, burnout).	“All of us feel badly for the children that while they’re here, they’re not getting therapy. We're not a treatment center, we’re just really a holding spot.” (Gen 3)	“Anytime a pediatric patient comes in, in either medical or trauma distress, it really raises the stress levels, because… we really don't see that many truly unwell kids through our emergency department, even with the volumes that we see…and that's kind of the biggest challenge right there is trying to keep the medical team calm in a high-stress situation.” (Ped 8) “I wish our facility did a little bit better at debriefing and kind of we have multiple support options available, but I wish that we made them a little bit more at the forefront. And just kind of did them every time we had an event, not at the request of a staff member or something.” (Ped 8)
Challenges to care provision from the legal system and sociopolitical environment	This theme describes how the legal system and local sociopolitical environment create challenges for providers including balancing differing priorities of state agencies and families.	“Because we live in a rural community, there is a lot of focus on like hunting and things like that. So, some of that's good, because kids get hunter safety and they get gun safety and so they actually have a fairly good respect for weapons and understand how to use them and how to keep them safe and things like that. It also increases the number of weapons that are available in our community.” (Gen 4)	“Whether it be gang violence, whether it be the kind of open carry in our state where it's much more normalized that weapons are out in the open… maybe not seen as anything that needs to be regulated or have stricter laws… So, I think that all adds to that component of… the accessibility and visibility of firearms within our state.” (Ped 1)
The negative impact of provider implicit biases on care provision	This theme describes how the personal beliefs of providers, including conscious and unconscious biases, often negatively affect their attitudes, behaviors and perceptions while providing care for youth and families who experience violence.	“And just family dynamics too, right? Anytime you have a child with a traumatic injury, I don't care if it's a UTV accident, a gunshot, a fall off the swing set, there's always, this was your fault, there's a lot of blaming, there's guilt that goes with that.” (Gen 4)	“A little bit of I think victim blaming… I've heard people say… the families need to be responsible… And I think sometimes it's unrealistic… I don't think we as a medical system really are listening to the families who are asking for help… And I think there's a little bit of that attitude that's a barrier too.” (Ped 4) “I guess there are some staff that have some fears that maybe a lot of these are gang related injuries. So, I think some people have fears that the violence will continue into the ED, so a lot of people, a lot of times we like staff police officers outside or things like that. But a lot of staff worry about these kids having other guns or weapons on them or retaliation by someone coming in.” (Ped 3)
The lack of consensus among ED providers on the appropriate role of the ED in injury prevention efforts and post-discharge care coordination	This theme demonstrates the wide spectrum of beliefs participants have on the role of the ED in the care continuum for youth who experience violence, including injury prevention and intervention efforts and post-discharge care coordination.	“We do not have social services or child life or any of those luxuries in our ER, so really nursing does most of that… it is really difficult for nurses to take care of acutely ill patients, manage those injuries and illnesses, and then also try to plan… things outside of this visit.” (Gen 4)	“Because once we get kind of the acute medical pieces done, that's sometimes where the care stops, but it needs to continue.” (Ped 8) “We're working on a subset of questions to understand a kind of a risk for patients in the future, whether it's just assessing risky behavior and having some countermeasures in terms of education and/or discharge teaching… those questions would tie to really a more strategic discharge plan.” (Ped 1) “We're good at setting up services within our four walls. It's outside of the four walls where we struggle.” (Ped 4)

¹Participant interview ID is indicated in parenthesis next to quotes; “Gen” indicates general ED participant; “Ped” indicates pediatric ED participant

The imbalance between perceived needs and available resources.

A common theme among participants was the mismatch between desired and available resources to provide comprehensive care for youth who experience violence. In particular, participants noted how greater physical distance from needed resources outside of their institution amplified these barriers. As one general ED participant noted, “it's the feeling of you're never going to get there fast enough. And just the resources are so far, and you need them right here.” (Gen 1) While many participants highlighted the value of access to specialists outside of the ED (i.e., telepsychiatry, social work), some general ED participants expressed how lack of personnel that are often available in pediatric EDs (i.e., child life specialists, pediatric subspecialists) meant they were more isolated in the responsibility of providing comprehensive care. A final sentiment unique to general ED providers was how infrequent exposure to pediatric patients leads to challenges and discomfort with care provision for this population.

Consequences of this mismatch between needs and resources negatively affecting both patients and providers.

Many participants described how the mismatch between needs and resources could negatively impact patient outcomes. For example, participants described prolonged ED length of stay (i.e., boarding) for patients with suicide attempts due to limited availability of inpatient psychiatric beds and community mental health services. Participants also reflected on psychological consequences for providers including moral injury from caring for youth who experience violence: “the mental toll that it takes on the nerves just because they are young… the anxiousness and hopefulness that you did the best that you could while you had the patient in your care.” (Gen 2) Many participants reflected on how psychological distress is exacerbated by a paucity of hospital and community-level resources. A pediatric ED participant shared particular concern around “being able to feel like we're doing something to help with prevention and not just patching kids up and sending them out.” (Ped 5) Multiple participants desired more accessible hospital-led support systems for provider emotional support.

Challenges to care provision from the legal system and sociopolitical environment.

Many participants described tension in providing care to victims of violence when other agencies, such as law enforcement or child services, are involved and have their own priorities. As one pediatric ED participant shared, “It makes the care harder, sometimes it feels like law enforcement is there to adjudicate crime and safety. My job is health and well-being, and I don't think that they're antithetical to each other. I just think sometimes there's differences in approach and priorities.” (Ped 4) Participants noted that certain state-mandated policies dictating the role of these agencies in care delivery posed additional challenges for healthcare providers. For example, participants in one state shared that law enforcement, not medical providers, determine whether a child who attempted suicide is an imminent risk to themselves and requires hospitalization. Lastly, participants noted how societal and cultural norms pose barriers to implementing certain injury prevention strategies given concerns about family perceptions. For instance, one general ED participant stated, “If we try to even do gun safety or gun lock programs, I think people see that as infringing on their Second Amendment rights… and that's really, certainly not our intent, it's more for educating and safety. But I do feel, especially in the political culture that we live in right now, there's no middle ground, right?" (Gen 4)

The negative impact of provider implicit biases on care provision.

Another theme was how personal beliefs of providers influenced attitudes and behaviors that may negatively affect their provision of care for youth who experience violence. Some participants described how the child’s age and injury circumstances can lead to conscious or unconscious biases that influence care delivery. As one pediatric ED participant stated, “I say there's definitely a difference in our management when they're perceived to be out doing gang related activities versus the seven-year-old who got shot… So, there is a little bit of a dichotomy there.” (Ped 7)

The lack of consensus among ED providers on the appropriate role of the ED in injury prevention efforts and post-discharge care coordination.

Participants shared their perspectives on what injury prevention efforts could and should take place in the ED setting. Lack of personnel and time pressure were identified as barriers in both pediatric and general ED settings. Nevertheless, some participants felt that more preventive interventions were needed in the ED, including universal education rather than targeting youth with specific risk factors. For example, one general ED participant suggested, “Why are we picking and choosing who we give this information to?… Maybe they're here with belly pain and their issue is really a mental health issue and we didn't recognize that, they didn't share it. But if we give them the information, it still puts them a step ahead." (Gen 3)

Most participants agreed the role of the ED was to connect patients and families with appropriate follow-up resources, but they differed on the extent to which they felt the ED could or should facilitate follow-up. Participants acknowledged challenges of stretching ED resources to manage both acute care needs and post-discharge care coordination. As one pediatric ED participant stated, “We’re super busy… I don't think the providers have the resources to do it, but I think a lot of these kids aren't seeking general pediatric care in their communities, right? So, if this is the only touch point that they have, it's kind of our only option.” (Ped 3)

Goals and recommendations for the future.

Participants provided perspectives and recommendations on resources to enhance comprehensive care provision for youth who experience violence. Both pediatric and general ED providers commonly expressed insufficient knowledge about available community resources for post-discharge care. Participants described potential solutions, including creating curated lists of community-based resources and improving direct communication and coordination with community organizations. As one general ED provider proposed, “there needs to be some bridge that allows for the health care providers and the community to come together and know about these resources and become better educated on it.” (Gen 1) Participants also noted that even after referral, families face barriers to accessing resources (e.g., long wait times, transportation). Participants desired increased availability and accessibility of community resources to optimize post-discharge care.

Discussion

In this qualitative study exploring factors that impact providers’ and health systems’ ability to provide comprehensive ED care for youth who experience self-directed or interpersonal violence, we identified a mismatch between desired and available resources for comprehensive care provision among both pediatric and general ED providers. Challenges that were more specific to general ED participants included limited access to pediatric-specific personnel within their institution and decreased proximity to specialized pediatric resources outside their institution. Both pediatric and general ED participants reflected on the consequences of the mismatch between needs and resources, resulting in reduced quality of care for patients and increased moral distress among providers. We also identified how implicit biases, the legal system and the local sociopolitical environment affected provider attitudes, behaviors and perceptions of care for youth who experience violence. Lastly, there was a lack of consensus on the role of the ED in injury prevention efforts and post-discharge care coordination for youth who experience violence, highlighting limited staff capacity and challenges in coordinating with entities outside the hospital across both pediatric and general ED settings. Together, these themes demonstrate the collective impact and downstream negative consequences of a widespread mismatch between needs and resources and conflicting individual-, systems- and societal-level priorities on comprehensive care delivery in the ED for youth who experience violence.

These findings build upon prior work exploring barriers and facilitators to ED-based care for youth who experience violence. First, prior studies have consistently demonstrated that insufficient hospital resources and competing demands are perceived by ED providers to negatively impact patient care,^15-17 which was strongly echoed by our participants. In particular, our work resonates with prior studies demonstrating high provider distress and frustration in caring for youth with mental health conditions, amplified by limited psychiatric resources and pediatric-specific knowledge.^18,19 Studies have also shown that individual provider biases and societal biases about specific patient populations (i.e., patients who are incarcerated, those with psychiatric conditions and/or substance use disorders) may negatively impact the care provided to those patients in the ED,^20-22 which was reiterated by our participants as they reflected on their care of youth who experience violence.

While similar themes emerged in our work compared to the available literature, our study uniquely focused on the highly specialized needs of youth who have experienced self-directed or interpersonal violence, both during and after ED visits. We highlight novel findings related to the role of the ED in comprehensive care delivery, including care coordination and connection with community-based resources. While our participants universally recognized comprehensive care as an important component of youth’s recovery following a violent event, they differed on the degree of involvement they felt the ED should have in injury prevention and care coordination efforts. Evidence-based practices for care coordination include initiatives such as hospital-based violence intervention programs (HVIPs), which often provide several months of trauma-informed, wraparound care to patients injured from interpersonal violence. These programs may include case management services, peer mentoring, behavioral health therapies and referrals, and direct linkage to community-based resources addressing social needs and positive youth development.⁹ Importantly, as our participants articulated, not every ED or hospital will be capable of implementing these resource-intensive initiatives. Therefore, the breadth and depth of ED-based care provision must account for availability of internal resources and connection to community-based resources.

Informed by the reflections of study participants, we offer the following recommendations to optimize comprehensive care in the ED for youth who experience violence. First, general ED providers requested pediatric-specific education to increase confidence in caring for youth who experience violence. One role that may help facilitate these efforts in EDs is a pediatric emergency care coordinator (PECC),²³ which is a designated nurse or physician focused on coordinating quality improvement and education to enhance pediatric readiness in all EDs. While PECCs are associated with improved pediatric outcomes, implementation of the PECC role across EDs has been limited and heterogenous.^24,25 For EDs without PECCs, alternative educational strategies may include utilization of online pediatric resource toolkits,²⁶ and increased partnerships wherein children’s hospitals offer education to providers in general EDs.²⁷

Next, it is well-recognized that “burnout” (i.e., a state of physical, mental and emotional exhaustion caused by chronic workplace stress) is common among emergency medicine providers and may be associated with decreased quality of care for patients.^28-30 Our participants articulated high levels of moral distress while caring for youth who experience violence due to inadequate resources and/or pediatric-specific knowledge, which may contribute to provider burnout. Hospital systems must implement strategies to adequately support staff coping with these emotionally challenging encounters.³¹ In particular, participants desired increased accessibility of support options for ED staff, including debriefing and wellness programs.

Furthermore, participants requested the development, dissemination and continuous revision of a centralized list of local community-based resources relevant to youth who experience violence to aid in care coordination. This resource would require critical investments in building and maintaining strong relationships with community-based organizations. For example, mentorship-based intervention models (e.g., Big Brothers Big Sisters) are a specific type of hospital and community-based partnership with demonstrated success in improving outcomes for youth victims of interpersonal violence.³² Hospitals may also consider expanding telehealth support for families of youth who experience violence to help navigate community resources that address social needs, including housing and food insecurity, legal assistance, and school and vocational support.

Lastly, a larger systems-level concern shared among participants was limited access to specialized pediatric care in their communities. This sentiment is supported by data demonstrating widespread mental health professional shortages disproportionately impacting youth and non-urban communities.³³ To address this, individual providers and hospital systems may contact their respective local, state and federal policymakers to advocate for equitable access to mental health resources, such as through behavioral health workforce development, expansion of pediatric tele-mental health services, increased local crisis support services and improved funding for pediatric readiness initiatives.³⁴ Advocacy is also needed for more robust injury prevention initiatives, such as HVIPs and other community-based violence prevention programs,^9,35 which may particularly help serve youth seen in general EDs with more limited pediatric-specific resources.¹⁴

There were several limitations to our study. First, our study’s purposive sampling strategy may have led to selection bias as individuals interested in this topic may have been more likely to participate. Additionally, due to a high representation of participants in administrative roles compared to those actively providing clinical care, there may be a component of recall bias. We addressed this by discussing global perceptions of care rather than specific patient care experiences. Given that participants reported their own attitudes, beliefs and behaviors, social desirability bias may have also influenced findings. We attempted to mitigate this by avoiding leading questions and assuring confidentiality to encourage honest responses. Lastly, our findings are limited by the identities and perspectives of our sampled population. Importantly, our sample had a high proportion of participants who identified as Non-Hispanic White, one participant who identified as Hispanic, and no participants who identified as Black or any other racial identity. As such, our findings may not be reflective of providers with different identities or those caring for youth in other geographic regions. They also do not represent the perspectives of impacted youth and caregivers which will be important to explore in future work.

In summary, pediatric and general ED providers face many challenges when providing comprehensive care to youth who experience self-directed and interpersonal violence. Our findings demonstrate a particular emphasis on the mismatch between needs and resources, especially in general ED settings, as well as the impact of implicit biases, legal systems and local sociopolitical environment on ED care delivery, and a range of perspectives on the role of the ED in injury prevention efforts and post-discharge care coordination for youth who experience violence. EDs and hospitals seeking to improve comprehensive care for youth who experience violence may consider increasing pediatric-specific personnel and trainings, implementing or expanding collaborations with community-based organizations, and advocating for policy and systems-level changes to increase access to specialized pediatric care and community-based resources.

What’s New.

This study highlights key modifiable opportunities to enhance the emergency department (ED) workforce and clinical environment to optimize comprehensive care delivery in the ED (i.e., care coordination, connection to community resources) for youth who experience self-directed and interpersonal violence.