Els van Meijel

16 Chapter 1 | General introduction symptom of PTSD; it is likely that patients will not spontaneously report symptoms or seek help. Furthermore, injured children who are still undergoing medical treatment (or their parents) may judge treatment for physical problems as more important than treatment for psychological problems (NICE, 2005). Another important reason is that health care practitioners are often unaware of PTSD, so children and parents with posttraumatic stress symptoms remain unidentified. This means they are not given information about PTSD and are not referred for further diagnostics or treatment (National Center for PTSD, 2019). In response to large accidents or disasters, with dozens or hundreds of victims, psychological assistance is provided almost immediately. Victims are usually informed about normal psychological reactions and how to deal with them, and a monitoring system is set up to ensure 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. Some individual survivors of an accident do get psychological help, but only incidentally; whether this help is offered or not, depends on various circumstances. Screening for risk of PTSD Best practice recommendations after acute trauma include ‘watchful waiting’ and empirically sound screening to identify persons at risk for PTSD who can benefit from monitoring and intervention (Kassam-Adams et al., 2011; NICE, 2005). Watchful waiting includes a periodical professional check of the child and parent’s needs, rather than a formal intervention. Watchful waiting may also include web-based resources for children and parents that enable them to measure their own responses and recovery (Kassam-Adams et al., 2011). However, it is unclear who is supposed to do this professional check and monitoring. Currently, standard medical care following accidents does not include psychological care, screening for risk or active monitoring. After an accident, children and parents deal with various medical professionals (medical specialists, nurses, general practitioners) who generally lack knowledge of psychological aspects related to accidental or medical trauma. Identifying children and parents at risk of PTSD creates an opportunity to monitor them. A system of stepped care, including screening for risk and timely treatment if