Seeking Safety [Substance Abuse Treatment (Adolescent) and Trauma Treatment - Client-Level Interventions (Child & Adolescent)]

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Seeking Safety [Substance Abuse Treatment (Adolescent) and Trauma Treatment - Client-Level Interventions (Child & Adolescent)] has been rated by the CEBC in the areas of: Substance Abuse Treatment (Adolescent) and Trauma Treatment - Client-Level Interventions (Child & Adolescent).

Target Population: Adolescents with a history of trauma and/or substance abuse

For children/adolescents ages: 12 – 17

Brief Description

Seeking Safety is a present-focused, coping skills therapy to help people attain safety from trauma and/or substance abuse. The treatment is available as a book, providing both client handouts and clinician guidelines. The treatment may be conducted in group or individual format for adolescents (both females, and males) in various settings (e.g., outpatient, inpatient, residential, home care, and schools). Seeking Safety consists of 25 topics that can be conducted in any order and number. Examples of topics are Safety, Asking for Help, Setting Boundaries in Relationships, Healthy Relationships, Community Resources, Compassion, Creating Meaning, Discovery, Recovery Thinking, Taking Good Care of Yourself, Commitment, Coping with Triggers, Self-Nurturing, Red and Green Flags, and Life Choices. Seeking Safety has been also rated by the CEBC in the areas of Substance Abuse Treatment (Adult) and Trauma Treatment (Adult), click here to see that entry.

Program Goals:

The overall goals of Seeking Safety are:

  • Reduce trauma and/or substance abuse symptoms
  • Increase safe coping in relationships
  • Increase safe coping in thinking
  • Increase safe coping in behavior
  • Increase safe coping in emotions

Essential Components

The essential components of Seeking Safety include:

  • Group intervention (between 2 and 50 participants per group); is also available as an individual intervention
  • Five key principles:
    • Safety as the overarching goal (helping clients attain safety in their relationships, thinking, behavior, and emotions)
    • Integrated treatment (working on both trauma and substance abuse at the same time)
    • A focus on ideals to counteract the loss of ideals in both trauma and substance abuse
    • Four content areas: cognitive, behavioral, interpersonal, and case management
    • Attention to clinician processes (helping clinicians work on their emotional responses, self-care, and other issues)
  • 25 treatment topics, each with a clinician guide and client handouts:
    • Seven interpersonal topics:
      • Asking for Help
      • Honesty
      • Setting Boundaries in Relationships
      • Healthy Relationships
      • Community Resources
      • Healing from Anger
      • Getting Others to Support Your Recovery
    • Seven behavioral topics:
      • Detaching from Emotional Pain: Grounding
      • Taking Good Care of Yourself
      • Red and Green Flags
      • Commitment
      • Coping with Triggers
      • Respecting Your Time
      • Self-Nurturing
    • Seven cognitive topics:
      • PTSD: Taking Back Your Power
      • Compassion
      • When Substances Control You
      • Recovery Thinking
      • Integrating the Split Self
      • Creating Meaning
      • Discovery
    • Four combination topics:
      • Introduction to Treatment/Case Management
      • Safety
      • The Life Choices Game (Review)
      • Termination

Child/Adolescent Services

Seeking Safety [Substance Abuse Treatment (Adolescent) and Trauma Treatment - Client-Level Interventions (Child & Adolescent)] directly provides services to children/adolescents and addresses the following:

  • Trauma and/or substance abuse

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Hospital
  • Outpatient Clinic
  • Residential Care Facility
  • School

Homework

Seeking Safety [Substance Abuse Treatment (Adolescent) and Trauma Treatment - Client-Level Interventions (Child & Adolescent)] includes a homework component:

Clients are asked to make a "commitment" of one thing they'll do for their recovery prior to the next session (essentially homework); however, it is optional.

Languages

Seeking Safety [Substance Abuse Treatment (Adolescent) and Trauma Treatment - Client-Level Interventions (Child & Adolescent)] has materials available in languages other than English:

Chinese, Dutch, French, German, Greek, Polish, Portuguese, Spanish, Swedish, Vietnamese

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

There are no space/room/AV requirements. The only thing needed is copies of the program materials, which can be photocopied from the Seeking Safety book by the clinician for use with his/her clients. Additional implementation materials are available, but are optional (see later in this CEBC description).

Minimum Provider Qualifications

No specific degree or experience is required. Any clinician can conduct the program. It has been done by social workers, psychologists, nurses, case managers, emergency workers, domestic violence advocates, paraprofessionals, mental health counselors, substance abuse counselors, and even has been done in peer-led version.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Note: For clinical implementation, training is not required, but can be very helpful to teach staff how to conduct the model. For research studies on Seeking Safety, training and fidelity assessment are required by someone certified to provide these (per the Seeking Safety website).

The following training resources are also available on the program's website (http://www.treatment-innovations.org/seeking-safety.html) in the Store section:

  • Training Videos: The Seeking Safety training videos were designed to provide an overview of the model, an example of a session conducted with real clients, and related implementation material. The series has 4 videos. They total 4.5 hours and were developed with a grant from the National Institute on Drug Abuse.
  • Training Online: The training videos (above) and/or Seeking Safety book can be combined with online learning, which can be done with continuing education credits or without.
  • Training Facilitation Guide: The training videos (above) can be combined with an online training facilitation guide so that someone in an agency can facilitate helping people become familiar with the model.
  • Phone consultation: Phone consultation is available either on its own or combined with some other training format (e.g., after an onsite training). Calls provide an opportunity to discuss Seeking Safety implementation and allow for open discussion as well as themes that we provide to help guide discussion (how to get started with Seeking Safety, challenging clinical scenarios, etc.)
  • Fidelity rater training: Agency staff can be trained how to conduct fidelity ratings and within a few sessions obtain certification so they can rate other agency staff.
  • Supervisor training: Agency staff can be trained how to supervise on Seeking Safety.
  • Additional materials: Adolescent-relevant optional materials include a card deck, magnet, key chain, and poster of the Safe Coping Skills from Seeking Safety.
Number of days/hours:

Flexible; a typical training is either 1 day, 1.5 days, or 2 days, but any length is possible

Implementation Information

Since Seeking Safety [Substance Abuse Treatment (Adolescent) and Trauma Treatment - Client-Level Interventions (Child & Adolescent)] is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Seeking Safety [Substance Abuse Treatment (Adolescent) and Trauma Treatment - Client-Level Interventions (Child & Adolescent)].

Formal Support for Implementation

There is formal support available for implementation of Seeking Safety [Substance Abuse Treatment (Adolescent) and Trauma Treatment - Client-Level Interventions (Child & Adolescent)] as listed below:

There is a training coordinator who can discuss agency needs and develop a training plan that includes fidelity and supervisory training.

Fidelity Measures

There are fidelity measures for Seeking Safety [Substance Abuse Treatment (Adolescent) and Trauma Treatment - Client-Level Interventions (Child & Adolescent)] as listed below:

The following are fidelity measures:

  • Seeking Safety Adherence Scale is used to evaluate a clinician's use of the treatment based on listening to or watching a tape of a session (audio or video), or sitting in on the session. It is used for outcome research and for general clinical supervision purposes.
  • The Adherence Scale Score Sheet is a form that the supervisor or rater fills out for use with the Adherence Scale.
  • The Brief Adherence Form can be used for clinical purposes (but not for research).
  • The Session Format Checklist is an additional form that can be useful to verify the elements of the session (but if using the Adherence Scale, it is not needed).

All are available at http://www.treatment-innovations.org/assessment.html.

Implementation Guides or Manuals

There are implementation guides or manuals for Seeking Safety [Substance Abuse Treatment (Adolescent) and Trauma Treatment - Client-Level Interventions (Child & Adolescent)] as listed below:

These and several other articles on implementation of Seeking Safety are available at http://www.treatment-innovations.org/articles-ss-implementation.html:

Najavits, L. M. (2009). Seeking Safety: An implementation guide. In A. Rubin & DW Springer (Eds). The clinician's guide to evidence-based practice. Hoboken, NJ: John Wiley.

Najavits L. M. (2004). Implementing Seeking Safety therapy for PTSD and substance abuse: Clinical guidelines. Alcoholism Treatment Quarterly, 22, 43-62.

Najavits L. M. (2000). Training clinicians to conduct the Seeking Safety treatment for PTSD and substance abuse. Alcoholism Treatment Quarterly, 18, 83-98.

Research on How to Implement the Program

Research has not been conducted on how to implement Seeking Safety [Substance Abuse Treatment (Adolescent) and Trauma Treatment - Client-Level Interventions (Child & Adolescent)].

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Najavits, L. M., Gallop, R. J., & Weiss, R. D. (2006). Seeking Safety therapy for adolescent girls with PTSD and substance use disorder: A randomized controlled trial. The Journal of Behavioral Health Services & Research, 33, 453-463.

Type of Study: Randomized controlled trial
Number of Participants: 33

Population:

  • Age — Mean=16.06 years
  • Race/Ethnicity — 26 Caucasian, 4 Asian/Pacific Islander, 1 African American, 1 Hispanic, and 1 Multiethnic
  • Gender — 100% Female
  • Status — Participants were obtained through posted flyers (e.g., at local bus stops, laundromats, and bookstores), and active recruitment from local clinics, hospitals, schools, and clinicians. All met current DSM-IV criteria for both PTSD and SUD, with most (n = 31, 93.9%) having substance dependence.

Location/Institution: McLean Hospital/Harvard Medical School, Belmont, MA

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Thirty-three outpatient adolescent girls were randomized to either Seeking Safety plus treatment as usual (TAU) (n = 18), or TAU alone (n = 15). The treatment manual had 25 topics representing cognitive, behavioral, and interpersonal domains. Each topic offered a “safe coping skill” relevant to both disorders, such as Asking for Help, Compassion, Setting Boundaries in Relationships, and Honesty. Major assessments were conducted at intake, end-of-treatment, and 3 months follow-up. Unless otherwise indicated, all measures were self-report, administered at major assessments, and scaled such that higher scores indicated greater impairment. Positive outcomes favoring the Seeking Safety condition were found in various domains including substance use and associated problems (on the Personal Experiences Scale and the Adolescent Psychopathology Scale), some trauma-related symptoms (on the Trauma Symptom Checklist for Children), cognitions related to SUD and PTSD (the Reasons for Using Scale and the World Assumptions Scale), and various psychopathology (on the Adolescent Psychopathology Scale). It is notable that on the latter scale, improvements were seen even on problems that were not targeted in the treatment (e.g., anorexia, somatization). Effect sizes were generally in the moderate to high range. Some gains were sustained at follow-up. Seeking Safety appears a promising treatment for this population, but needs further study and perhaps additional clinical modification. Limitations included small sample sizes, greater level of psychopathology at intake on some variables, and female-only samples.

Length of postintervention follow-up: 3 months.

References

Najavits, L. M. (2007). Seeking Safety: An evidence-based model for substance abuse and trauma/PTSD. In K. A. Witkiewitz & G. A. Marlatt (Eds.), Therapist's guide to evidence-based relapse prevention: Practical resources for the mental health professional (pp. 141-167). San Diego: Elsevier Press.

Najavits, L. M. (2009). Seeking Safety: An implementation guide, in A. Rubin & D. W. Springer, (Eds.), Substance Abuse Treatment for Youth and Adults: Clinician's Guide to Evidence-Based Practice (pp. 311-348). John Wiley: Hoboken, NJ.

Najavits, L. M. (2002). Seeking Safety: A treatment manual for PTSD and substance abuse. New York, NY: Guilford.

Contact Information

Name: Lisa M. Najavits, PhD
Agency/Affiliation: Treatment Innovations
Website: www.seekingsafety.org
Email:
Phone: (617) 299-1610
Fax: (617) 701-1295

Date Research Evidence Last Reviewed by CEBC: December 2015

Date Program Content Last Reviewed by Program Staff: March 2016

Date Program Originally Loaded onto CEBC: September 2010