Els van Meijel

24 Chapter 2 | Evaluation of the STEPP parents develop partial or full PTSD following pediatric injury (Kassam-Adams et al., 2009). Therefore, parents should also be monitored following their child’s accident. Identifying children and parents at risk of PTSD creates an opportunity to monitor them. A system of stepped care, offering timely treatment if needed, can contribute to the prevention of chronic trauma-related disorders. For this purpose, Winston and colleagues developed the Screening Tool for Early Predictors of PTSD (STEPP), see Figure 2.1 (Winston et al., 2003). The STEPP appeared to be effective in identifying those who are at risk of persistent posttraumatic stress – both children and their parents – following traffic-related injury to children. Since the purpose of the screening is to identify children and parents who are at risk of PTSD, a high sensitivity is required, while those who are unlikely to develop PTSD should be screened out with a high negative predictive value (Winston et al., 2003). STEPP sensitivity in predicting posttraumatic stress was 0.88 for children and 0.96 for parents, with negative predictive values of 0.95 for children and 0.99 for parents (Winston et al., 2003). For a further description of STEPP performance, see Measures . However, in an Australian mixed-trauma sample (all single-incident trauma), the STEPP was no better than chance at identifying positive PTSD status in children at either 3 months or 6 months posttrauma. At 3 months, sensitivity of the original STEPP in the Australian sample was 0.45, specificity was 0.68, with a positive predictive value of 0.17 and a negative predictive value of 0.89. An Australian version of the STEPP for children was then compiled from the 8 best performing items in the original itempool of Winston et al. (Winston et al., 2003). This Australian STEPP (STEPP-AUS) performed well at 3-months posttrauma: sensitivity was 0.73, specificity was 0.69, with a positive predictive value of 0.26 and a negative predictive value of 0.94. Best performance was at 6 months posttrauma: sensitivity was 0.89, specificity was 0.69, with a positive predictive value of 0.24 and a negative predictive value of 0.98 (Nixon, Ellis, Nehmy, & Ball, 2010). Until now, the STEPP has not been validated in other languages or other broader trauma samples. The purpose of this study was therefore to determine the reliability and predictive performance of the Dutch version of the STEPP in amixed-trauma sample. If sufficiently predictive, then screening for risk of PTSD would be an effective method to identify those who are at risk: children as well as their parents. In our study we expanded the