Seeking Safety (Adolescent version)

Adolescents with a history of trauma and/or substance abuse

For children/adolescents ages: 12 - 18

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.

Jamie Miller
Treatment Innovations

• http://www.seekingsafety.org/
• Email: info@seekingsafety.org
• Phone: (617) 299-1610

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

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 (Adolescent version) directly provides services to children and addresses the following:

• Trauma and/or substance abuse

Recommended Intensity

The length and pacing of sessions are flexible: some programs conduct 1 hour once per week, others 1.5 hours twice a week, etc. The goal is to provide whatever is feasible in the setting.

Recommended Duration

The model was designed for a high level of flexibility for different settings, clients, and clinicians. The model can be conducted as long or short as time allows. For example, if it's conducted twice per week it will take about three months. If all of the topics are done once per week, it would take about six months.

Delivery Settings

This program is typically conducted in a(n):

• Community-based Agency / Organization / Provider
• Group or Residential Care
• Hospital
• Outpatient Clinic
• School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

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 (Adolescent version) has materials available in the following languages other than English:

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

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed in 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).

Prerequisite/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.

Manual Information

There is not a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

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

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Seeking Safety (Adolescent version).

Formal Support for Implementation

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

Fidelity Measures

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.

Established Psychometrics

There are no established psychometrics for Seeking Safety (Adolescent version).

Fidelity Measures Required

No fidelity measures are required for Seeking Safety (Adolescent version).

Implementation Guides or Manuals

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.

Implementation Cost

There are no studies of the costs of Seeking Safety (Adolescent version).

Research on How to Implement the Program

Research has not been conducted on how to implement Seeking Safety (Adolescent version).

Child Welfare Outcome: Child/Family Well-Being

"What is included in the Relevant Published, Peer-Reviewed Research section?"

• 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(4), 453–463. https://doi.org/10.1007/s11414-006-9034-2

  Type of Study: Randomized controlled trial

  Number of participants: 33

  Population:

  • Age — Average=16.06 years
  • Race/Ethnicity — 79% Caucasian, 12% Asian/Pacific Islander, 3% African American, 3% Hispanic, and 3% Multiracial
  • Gender — 100% Female
  • Status —

    Participants were adolescent girls with PTSD and substance abuse dependence who were recruited from clinical and community settings.

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

  Summary:

  The purpose of the study was to evaluate the efficacy of Seeking Safety (SS) in a sample of adolescent girls with PTSD and substance abuse dependence. Participants were randomly assigned to a SS intervention group plus treatment as usual (TAU) or to a TAU control group. Measures utilized include the Clinician Administered PTSD Scale-Child and Adolescent Version (CAPS), Personal Experiences Scale, Adolescent Psychopathology Scale, Trauma Symptom Checklist for Children, Reasons for Using Scale, and the World Assumptions Scale. Results indicate that SS+TAU group evidenced significantly better outcomes than the TAU control group in a variety of domains at posttreatment, including substance use and associated problems, some trauma-related symptoms, cognitions related to SUD and PTSD, and several areas of pathology not targeted in the treatment (e.g., anorexia, somatization). Some gains were sustained at 3-month follow-up. Limitations include the small sample size, greater level of psychopathology at intake on some variables, and the female-only sample.

  Length of controlled postintervention follow-up: 3 months.

• 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.