Els van Meijel

132 Chapter 8 | Summary are outlined. We evaluated the utility of the STEPP with adjusted cut-off scores and recommended how to use this instrument to address possible negative side-effects. We discussed our findings in the light of the model of Pediatric Medical Traumatic Stress (PMTS) to support understanding of individual risk factors and the importance of screening and monitoring, also in the long-term. The implications of the introduction of DSM-5 criteria for PTSD were discussed in the light of the utility of the STEPP and the prevalence of PTSD. Clinical implications of our findings were discussed regarding two important themes: Challenges for improvement in medical care and Screening, monitoring and intervention. In the first section we described the benefits of identifying potentially modifiable factors such as acute pain and anxiety. Recognizing these factors provide the opportunity to intervene and address them, thus contributing to prevention of adverse psychological consequences. We discussed the introduction of Trauma- Informed Care (TIC) as a way to target medical care-related risk factors for PTSD. TIC is a multidisciplinary approach to reduce the risk of persisting posttraumatic stress and PTSD after injury. It uses psychotrauma-related knowledge in medical practice. In the second section we discussed the barriers and facilitators of introducing and implementing screening for risk and subsequent care in hospital settings. We argued that prevention of PTSD can save considerable costs for society. Limitations of the studies were discussed and recommendations for future research were made. In the final conclusions we recommended implementing a stepped care approach including screening for risk and trauma-informed care. Ongoing efforts are needed to increase awareness for psychological consequences of accidents in all those concerned. Increased awareness and knowledge of psychological consequences of PTSD are preconditions for successful implementation of screening for risk and trauma-informed care and changes in hospital policies and protocols.