Els van Meijel

23 Evaluation of the STEPP | Chapter 2 Background Despite the fact that accidents are widespread, systematic attention for the psychological consequences of accidents is still not common practice. Children who have been injured due to accidental trauma and their parents are at risk of posttraumatic stress disorder (PTSD) (Kazak et al., 2006; Winston et al., 2003). PTSD can cause many symptoms that can be grouped into three clusters: 1) re-experiencing symptoms such as flashbacks or nightmares, 2) avoidance symptoms such as avoiding locations, events or other reminders of the experience, 3) hyperarousal symptoms such as sleep or concentration problems or defiant behavior (APA, 2000; National Institute of Mental Health NIMH, 2014). These symptoms disappear spontaneously in the majority of the children, but up to 37.5% develop full or partial PTSD following motor vehicle accidents or unintentional injury (Alisic et al., 2014; Kahana et al., 2006). PTSD is a debilitating psychiatric disorder, often involving the development of co-morbid disorders (Stallard et al., 2004). If left untreated, PTSD negatively affects children’s functioning and physical recovery from injury (Kahana et al., 2006). In the Netherlands, 240,000 children per year are injured in an accident and are subsequently treated in the Emergency Department of a hospital (VeiligheidNL, 2014). Medical aftercare following accidents is well organized, but until now no systematic monitoring of the psychological well-being of these children has been available during hospitalization or after discharge. Post-trauma psychological problems of parents are thought to play a role in the prediction and development of child PTSD (Kazak et al., 2006; Kolaitis et al., 2011; Saxe et al., 2005; Trickey, Siddaway, Meiser-Stedman, Serpell, & Field, 2012). Parental symptoms can impact child symptoms in various ways. For effective coping assistance, accurate parental judgment is necessary, but the parents’ own symptoms may influence how they judge their child’s needs (Kassam-Adams, Garcia-Espana, Miller, & Winston, 2006). Parents with posttraumatic stress symptoms may be less able to support their child (Saxe et al., 2005; Sturms et al., 2005). Moreover, parents’ symptoms have been found to increase the risk of their child developing PTSD (Kolaitis et al., 2011). Following injury to their child, parents are at risk for developing substantial posttraumatic stress symptoms (Le Brocque et al., 2010); approximately 15% of the