There have been rising concerns in the UK about the levels of serious violence between young people, especially serious physical violence and knife crime. Interactions with young people in the emergency department (ED) at the time of injury provide an opportunity for screening and intervention in order to reduce the risk of repeat attendances. However, paediatricians and other healthcare workers can feel unsure about the best way to intervene. Embedding youth workers in EDs has started in some UK hospitals, making use of a potential ‘teachable moment’ in the immediate aftermath of an event to help change behaviour. Based on a rapid review of the literature, we summarise the evidence for these types of interventions and present two practice examples. Finally, we discuss how EDs could approach the embedding of youth workers within their department and considerations required for this.

A large proportion of consultant time is spent in outpatient practice. This setting provides an excellent learning environment for different levels of a trainee if well organised. This article describes an evidence-based teaching approach and its evaluation by trainees, patients and carers in a typical district general hospital setting which it is hoped others might find helpful.

Opinion statementTo truly understand the challenges and solutions of the safety of children in our community, we should be willing to embrace its complexity. Child safety itself goes further than some might conceive, encompassing the prevention of all types of injury: physical, emotional and psychological as well as interventions to promote resilience to harm. We believe child safety is a 'call to action' to paediatricians, government and society in general to advocate for children who remain vulnerable and often voiceless. We have chosen to take a narrative approach examining one particular case and have identified different preventable safety issues that occurred throughout her childhood. Acknowledging that early events have an impact later in the life course, we emphasise the importance of prompt early intervention and reflect on 'missed' opportunities for action. In particular, we have tried to use a holistic lens to view the case, exploring issues in the system around the child, in their family, school and the wider environment. In exploring the solutions to these issues, we look at three key areas (the 3 R approach): firstly, effective communication between professionals (relationships) and how this might be practically facilitated at ground level; secondly, how to best ensure protocols Patient Safety (P Lachman, Section Editor) (roadmaps) are followed wisely within an organisational and human behaviours framework; and finally, by putting the child at the centre (recognition), we can address the multiple issues affecting them and identify factors that build his/her own resilience. Child safety is a complex far reaching public health priority, which requires holistic ways of identifying safety issues, as well as practical solutions that support professionals and empower children and their families.

Figure 2 The Index of Multiple Deprivation Deciles for new patients in clinic compared to local averages Conclusion Our results show the clinic has been seeing a wide range of young people with physical symptoms, and many Abstracts

declined by specialist tertiary centers where the age cut-off under Paediatric Subspecialties is 16 years and some local adult medicine specialties have an age cut-off of 18 years. Given the increasing medical needs of the 16-18yr age group, there is an urgent need to jointly develop local care pathways to ensure that they receive age appropriate care and adequate resources need to be allocated to ensure a smooth transition into adult services. 1 2