Els van Meijel

119 General discussion | Chapter 7 traumatic stress and psychosocial care (Alisic et al., 2011; Alisic et al., 2016). The extent to which aspects of trauma-informed care are currently being used in medical care in the Netherlands is unknown. However, at least two hospitals in the Netherlands (OLVG in Amsterdam and Maastricht UMC), actively promote and implement a trauma- informed approach for children. With this approach, the initiators are aiming to reduce stress, fear and pain, and to improve confidence. They have started to disseminate their approach by training colleagues. The results of our research project support their vision and will hopefully help them in continuing the development of their approach. Screening, monitoring and intervention Trauma-informed care can facilitate a hospital monitoring systemafter injury, including screening for risk, monitoring and timely interventions if needed. Our research project has yielded the STEPP screening tool to identify children and parents at risk for PTSD after accidental injury. The STEPP can serve as a first step in systematic monitoring of accidentally injured children and their parents. It is advisable to screen all children and their parents, regardless of injury severity, hospitalization or other presumed decisive factors. Since posttraumatic stress symptoms can also develop or worsen later on, long-termmonitoring is appropriate, which is in accordance with best practice guidelines following acute trauma (NICE, 2005). The emergency department is the only department where the personal data of all accidentally injured persons are available. Consequently, it is the logical starting point for screening and psychological care following accidents. In a pilot project involving six Dutch hospitals, we tested the possibilities for implementing screening for risk of PTSD. Despite very positive reactions, implementation was successful in only one of these hospitals. Evaluation of the project revealed the following main reasons and points of interest. First, extra work such as screening for risk requires re-allocation of financial resources and staff (or deploying additional staff). Second, not all hospital boards, departmental managers or staff feel responsible for preventing mental health problems in their patients. Many of them support the idea of screening, monitoring and prevention. However, when it comes to practical implementation, they suggest that this should be done by others, for example by the general practitioner. Third, partly as a consequence of the preceding points, the emergency department has no infrastructure for psychological or mental health issues, except for patients in an acute psychiatric crisis. At the only hospital where we were able to implement the STEPP, the procedure was integrated into the existing care system following sexual abuse. Fourth, as we stated in our introduction,