Els van Meijel

66 Chapter 4 | Results of a 2–4-year follow-up study questions and contains the subscales re-experiencing, avoidance and hyperarousal. Scoring is on a 5-point Likert scale. Items are rated according to the frequency of their occurrence during the past week (not at all=0, a little bit=1, moderately=2, quite a bit=3, extremely=4; range 0–88). The focus is on the child’s accident. A total score of 23 or above indicates the likely presence of PTSD (Mouthaan et al., 2014). The Dutch IES-R showed adequate similarity with the total score of the Clinician-administered PTSD scale (CAPS; r = 0.75; p < 0.001) (Hovens et al., 1994; Mouthaan et al., 2014; Weathers et al., 2001) and good reliability for the current sample; Cronbach’s alpha = 0.93. In the present study PTSS (posttraumatic stress symptoms at a clinically significant level) refers to self-reported posttraumatic stress symptoms at a score of 30 or above (CRIES) or 23 or above (IES-R). Health and mental health and new traumatic events The follow-up interviews were composed by EM, MRG and RL and are available on request from the first author. Parents and children were interviewed separately by telephone. Parents were interviewed about their child. The interview started with the following open-ended questions: “How are things going? What has happened since we last met?” The purpose of this initial part of the interviewwas to become informed about the interviewee’s perception of the course of posttraumatic stress reactions over time and about any other relevant health and mental-health related information. We explicitly asked whether the child still experienced physical impairment and/ or psychosocial consequences as a result of the accident. In our study, permanent physical impairment was defined as loss or abnormality of parts of the body, resulting in restrictions or inability to perform activities that were considered normal before the accident and are normal for children of that age. Examples of permanent physical impairment are chronic or frequent pain, walking with a limp and chronic fatigue. Besides physical impairment, details of psychosocial consequences of the accident (such as delay in school career, change of future plans, limitations in social life) were also assessed. A specific question was included regarding any new traumatic or life events: ‘Since the accident, have other stressful things happened to you?’ If necessary, we asked supplementary questions to assess whether an event was traumatic according to DSM-IV-TR criteria (APA, 2000). If a child experienced one or more new traumatic events, we asked the child if help in any formwas needed. If applicable, the choices regarding trauma-focused psychotherapy between T1 and T2 and its outcome were discussed.