Els van Meijel

35 Evaluation of the STEPP | Chapter 2 (Winston et al., 2003). In the latter study, the CAPS-CA was used for the assessment of PTSD, while in our study we used the ADIS-C/P. Winston and colleagues administered the STEPP within one month of the accident, and assessment of PTSD was 3 to 13 months after the accident (Winston et al., 2003). In our study we administered the STEPP within one week of the accident and assessment of PTSD was 3 months after the accident. As a consequence, children and parents with delayed onset of PTSD were not included in our study. Furthermore, the STEPP was originally developed in a sample of children who were injured in traffic accidents. In our study we included children who were injured in all types of accidents; it is possible that the various types of accidents have a different impact on the children and parents. The results of our study are in line with the results of the study of Nixon et al. (2010) who compared the effectiveness of various screening instruments following accidental injury in an Australian mixed-trauma sample. As in our study, the STEPP did not accurately predict PTSD in the Australian sample using the original cut-off scores. Because the Australian colleagues at the same time wished to reduce the screening time and effort by not using items fromhospital files, they developed a new, alternative screening instrument for children, the STEPP-AUS (Nixon et al., 2010). Although the results of our study are promising, there is still a challenge for improvement and future research. It would be interesting to investigate the possibilities and benefits of alternative methods to administer the STEPP, for instance by telephone or online. This might be interesting particularly if children are discharged from the hospital immediately after treatment at the Emergency Department. There are also a few limitations of our study to mention. First, the performance of the STEPP with adjusted cut-off scores requires replication in a larger and independent sample to improve the generalizability. Second, an inherent limitation of STEPP is its lack of specificity combined with high sensitivity. If used in practice, too many children and parents will therefore need monitoring. This is a potential disadvantage in terms of healthcare costs and may negatively influence the possibilities of implementing the instrument. In a future stepped care model this disadvantage can be addressed by using a brief questionnaire like CRIES or IES-R to determine if children or parents probably have developed PTSD. Only in case of a positive screen would they be referred to further screening and diagnostics. False positive screenings increase