Els van Meijel

17 General introduction | Chapter 1 needed, can contribute to the prevention of PTSD. In the USA, the STEPP appeared to be effective in identifying children and parents at risk for PTSD after traffic related injury, and in screening out those who are unlikely to develop PTSD (Winston et al., 2003). Australian colleagues tested the STEPP in a mixed single-incident trauma sample but it was not shown to be effective (J. A. Kenardy, Spence, & Macleod, 2006). Prior to our study, the STEPP had not been evaluated in languages other than English. Research aims In accordance with the considerations above, the aims of this thesis are (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. This thesis describes research to provide scientific knowledge on the above mentioned aspects of posttraumatic stress after accidental injury in children and their parents in the Netherlands. Most of the studies concern children between 8 and 18 years of age — the age group for which reliable and valid psychological instruments are available. But an exploratory study directed at children below the age of 8 is also included. General outline In Chapter 2 we present the three-month prevalence of PTSD and PTSS in a sample of children and parents, and the results of an evaluation of the utility in the Netherlands of a screening instrument to identify children and parents at risk for PTSD. Besides factors included in the screening instrument, we examine the extent to which acute pain contributes to posttraumatic stress three months later. The results are reported in Chapter 3 . Chapter 4 describes the results of a 2–4-year follow-up study: the long- term impact of the accidental injury on children, specifically posttraumatic stress and including associated factors such as permanent physical impairment. The short-term and long-term parental posttraumatic stress and associated factors are presented in Chapter 5 . Due to the scarcity of knowledge on posttraumatic stress symptoms in younger children, we performed an exploratory study to examine algorithms for