Els van Meijel

15 General introduction | Chapter 1 the treatment are often unknown (whether this is trauma-focused treatment, and if so, which recommended treatment was used). A model on the consequences of accidental injury and medical stress In 2006, the model of Pediatric Medical Traumatic Stress (PMTS) was introduced. PMTS is defined as ‘a set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences’, often including posttraumatic stress reactions (Kazak et al., 2006). The model was evaluated and adjusted to the Integrative Trajectory Model of Pediatric Medical Traumatic Stress in 2016 (Price et al., 2016). The model describes three consecutive phases, each of which may include potentially traumatic events. Phase I (peritrauma) includes the accident and related events such as transport to hospital, the first medical procedures and communication of the diagnosis of the injury. Phase II includes acute medical care. Phase III (ongoing care or discharge from care) refers to longer-term PMTS and to the potential for traumatic responses to continue for months or years. This phase reflects the need for monitoring changes in PMTS over time. All three phases have implications for assessment and intervention. Screening for risk is appropriate in phase I and phase II. Prevention of traumatic stress and treatment of significant symptoms is also indicated in phase II. Phase III includes screening for traumatic stress and treatment of significant stress. The model may help explain the role of the individual factors in studies on posttraumatic stress following accidents. Furthermore, the model offers a framework for assessment and for specifying treatment needs (Price et al., 2016). Awareness of psychological consequences of accidental injury: the state of affairs in the Netherlands 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. However, systematic care for the psychological consequences of accidents is still not common practice. Evidence based trauma- focused interventions have been shown to be effective, but many children with PTSD or significant symptoms do not receive any form of psychological treatment (Smith, Dalgleish, & Meiser-Stedman, 2018). An obvious reason is that avoidance is a frequent