Statement of purpose Black and Latinx youth bear an unequal burden of adversity and trauma with an overrepresentation in violent injury and gunshot wound hospital admissions. To address the long- reaching developmental impacts on health and wellbeing, hospital-based violence intervention programs (HVIPs) have emerged to provide case management services after discharge. Recruitment and engagement of youth are primary barriers to program success, yet little research exists on best practices. By convening a sample of representatives from established HVIPs, this study illuminates barriers and facilitators to successful recruitment and engagement of youth.

Methods/Approach Drawing from four HVIPs based in Midwest and Northeast cities of similar demographics in the United States, a purposive sample of representatives (n = 7) participated in a focus group (90 minutes). Content analysis was conducted in three phases. First, two researchers separately completed open and focused coding resulting in preliminary categories. Second, a researcher reviewed these codes for accuracy, and revisions were made after consensus was reached. Third, preliminary themes were vetted and finalized by the full research team using consensus. A code book was created documenting all changes.

Results Two themes emerged related to barriers and facilitators: ‘Individual/Relational’ with categories such as Patient and Parent-Specific Characteristics, Building Rapport, Enhancing the Teachable Moment, and Building Relational Health; and ‘Structural/Systemic’ with categories including Hospital Investment, Structural Racism, Workflow, Training and Preparedness of Staff, and Trauma Informed Procedures.

Conclusions The findings illuminate barriers and facilitators relevant to structural, programmatic, familial, and youth-focused aspects of HVIPs. Strategies to address these barriers are discussed.

Significance This is the first study to examine facilitators and barriers to recruitment and engagement of clients in HVIPs. As the emerging standard of care for violent injury in hospitals, studies advancing the practices of HVIPs are critical to ending the cycle of violence experienced by youth of color.