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

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.