Els van Meijel

127 Summary | Chapter 8 on long-term posttraumatic stress and associated factors is scarce. Regarding long- term PTSD, potentially important factors include permanent physical impairment and choices regarding psychotherapy. Trauma-Focused Cognitive Behavior Therapy (TF- CBT) and Eye Movement Desensitization and Reprocessing (EMDR) are recommended in national guidelines in the Netherlands and other countries. In the Netherlands, hospital care and aftercare with regard to physical consequences of accidental injury is integral to hospital policy and the financial compensation structures of health insurers. This is different for the psychological consequences of accidents. Despite the availability of evidence-based trauma-focused interventions, many children or parents do not receive any form of psychological treatment. An obvious reason is that avoidance is a frequent symptomof PTSD; it is likely that patients will not seek help. Another important reason is that health care practitioners don’t recognize symptoms and therefore don’t take action. Whether children and parents are offered help or not depends on the circumstances. In response to large accidents or disasters, psychological assistance is provided to many victims almost immediately. Victims are usually informed about normal psychological reactions and how to deal with them, and they are offered screening and adequate short-term and long-term care. For individual accidents, however, such systematic care is absent, even though the total of all victims of accidents, is the equivalent of a yearly disaster. Best practice recommendations include ‘watchful waiting’, including screening to identify persons at risk for PTSD and monitoring those who are at risk. Screening for risk can be performed with instruments such as the Screening Tool for Early Predictors of PTSD (STEPP). The STEPP was developed in the USA and appeared to be effective in identifying children and parents at risk for PTSD. If the STEPP was also shown to be effective in the Netherlands, it could contribute to systematic psychological care for children and their parents after an accident. The aims of this thesis were (1) to evaluate the utility – in the Netherlands – of the STEPP, a screening instrument to identify children and parents at risk for PTSD following child accidental injury, and (2) to examine short and long-term posttraumatic stress in children and parents following child accidental injury, including possibly associated factors such as acute pain, permanent physical impairment and choices regarding trauma-focused psychotherapy. The focus of this thesis is on children between 8 years