Creating Change

Adults ages 18 and above who have experienced trauma and/or addiction

Creating Change is a past-focused model for trauma and addiction for a very broad range of clients. It can be conducted in individual or group format by any provider. The program is designed to be highly accessible, flexible, and engaging from a public health standpoint. Each treatment topic helps clients face their past by addressing a theme, for example:

• Honor Your Survival
• Break the Silence
• Emotions and Healing
• Relationship Patterns
• Influences: Family, Community, Culture
• Power Dynamics
• Why Addiction?
• Darkness and Light
• Listen to Your Body
• What You Want People to Understand
• Deepen Your Story

Creating Change has the same format and compassionate tone as Seeking Safety (a present-focused model for trauma and/or addiction) and can be used with that model if desired.

Jamie Miller

• Agency/Affiliation: Treatment Innovations
• Website: https://www.treatment-innovations.org/creating-change.html
• Email: coordinator@treatment-innovations.org
• Phone: (617) 299-1610

The goals of Creating Change are:

• Reduce trauma symptoms.
• Reduce substance use or other addictive behavior.
• Reduce other mental health symptoms, such as depression and anxiety.
• Increase functioning (e.g., work, social).
• Increase self-compassion.

The essential components of Creating Change include:

• Individual or group intervention
• Flexible delivery:
  • Topics can be done in any order and, if the goal is to mirror the clinical trial method, clients should be offered all topics.
  • Session length and pacing can vary based on the setting.
• Integrated treatment: Addresses trauma and addiction at the same time
• Seven key principles:
  • A goal of lasting change—by facing the past, clients can achieve sustained recovery .
    • Public health relevance—
      • Flexible
      • Low cost
      • Designed for a broad range of clients who have experienced trauma and addiction
      • Designed for a broad range of facilitators
    • Skill development—Teaching clients how to process painful life events so they can continue to do so on their own
    • Inspiration—The use of quotations and poignant language to help build hope and convey the message that clients can succeed
    • Balancing positive and negative life experiences—Encouraging clients to integrate the full range of their experiences, both what was difficult and what allowed them to survive
    • Safeguards—Emphasis on best practices when working with trauma and/or addiction:
      • Explicit strategies to ensure safety
      • Letting clients set the pace in what they share
    • Convergence with Seeking Safety—Has the same format and compassionate tone as Seeking Safety and can be used with that model if desired. Seeking Safety (www.seekingsafety.org) is a present-focused model for trauma and/or addiction.
  • Numerous treatment topics, each with a facilitator guide and client handouts. The full list of topics is here.

Adult Services

Creating Change directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

• Trauma symptoms and/or substance use disorder (or other addiction) symptoms

Recommended Intensity

Session length and pacing are flexible to adapt to the setting. An individual session might be 50-60 minutes and a group 60-90 minutes or whatever length is typically done. Sessions can be weekly, twice-weekly, or any other pacing.

Recommended Duration

Duration is flexible; the CEBC rating is based on a randomized clinical trial in which all 23 session topics were offered.

Delivery Settings

This program is typically conducted in a(n):

• Community Daily Living Setting
• Group or Residential Care
• Hospital
• Justice Setting (Juvenile Detention, Jail, Prison, Courtroom, etc.)
• Outpatient Clinic
• School Setting (Including: Day Care, Day Treatment Programs, etc.)
• Shelter (Domestic Violence, Homeless, etc.)
• Virtual (Online, Smartphone, Zoom, Telephone, Video, etc.)

Homework

This program does include a homework component.

There is optional homework that is chosen by the recipient.

Languages

Creating Change has materials available in the following languages other than English:

• Danish

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:

No special equipment needed.

Prerequisite/Minimum Provider Qualifications

Any facilitator can conduct Creating Change and/or obtain training on it, regardless of degree, licensure, experience, etc.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

• Najavits, L. M. (2024). Creating Change: A past-focused treatment for trauma and addiction. Guilford Press. https://www.guilford.com/books/Creating-Change/Lisa-Najavits/9781462554621

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

Training occurs in whatever form is best for the interested person or agency and can include webinars, onsite, phone consultation, or a combination. Training is optional unless a research study is being conducted.

Number of days/hours:

The typical training is 1 day for facilitators. For fidelity and supervisor training, this is typically done via phone consultation and varies in length as it is a structured plan using work samples or role-plays for the staff person to demonstrate competence.

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Creating Change.

Formal Support for Implementation

There is formal support available for implementation of Creating Change as listed below:

Treatment Innovations provides implementation assistance for Creating Change in the form of:

• Fidelity monitoring and training of implementing agency personnel to conduct fidelity monitoring
• Implementation phone consultation to help an agency with support and coaching for conducting Creating Change
• Program evaluation (e.g., design and consultation services for studies of Creating Change at all levels, including randomized controlled trials, pilot studies, quality assurance, etc.)
• Supervisor development to help supervisors provide feedback to their staff who are implementing Creating Change

The format for the consultations above is typically by phone (but can be onsite or via webinar). It is available ongoing for as long as an agency would like. For the fidelity and supervisor components listed above, there is a structured plan using work samples or role-plays for the staff person to demonstrate competence to receive a certificate.

Fidelity Measures

There are fidelity measures for Creating Change as listed below:

The Creating Change Fidelity Scale can be completed by an observer or used as a self-assessment. Training on it is optional, unless a research study is being conducted on Creating Change, in which case training on the scale and use of it during the research gathering timeframe is required (contact the training contact above for more information on that). The measure is publicly available at: https://www.treatment-innovations.org/uploads/2/5/5/5/25555853/creating_chg_adher_scale_10-21-2010_adherence_scale_for_creating_change-copy_11-24-just_added_cite.pdf

Implementation Guides or Manuals

There are no implementation guides or manuals for Creating Change.

Implementation Cost

There are no studies of the costs of Creating Change.

Research on How to Implement the Program

Research has not been conducted on how to implement Creating Change.

Child Welfare Outcome: Child/Family Well-Being

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

• Najavits, L. M., Krinsley, K., Waring, M. E., Gallagher, M. W., & Skidmore, C. (2018). A randomized controlled trial for veterans with PTSD and substance use disorder: Creating Change versus Seeking Safety. Substance Use and Misuse, 53(11), 1788–1800. https://doi.org/10.1080/10826084.2018.1432653

  Type of Study: Randomized controlled trial

  Participants: 52

  Sample / Population:

  • Age — Mean=48.75 years
  • Race/Ethnicity — 60% Caucasian/Non-Hispanic, 30% African American, 4% Hispanic, 4% Mixed Race, and 2% Pacific Islander
  • Gender — 73% Male
  • Status —

    Participants were veterans with posttraumatic stress disorder (PTSD) and substance use disorders (SUD).

  Location/Institution: Not specified

  Summary:

  The purpose of the study was to compare a new past-focused treatment, Creating Change to a present-focused treatment for PTSD/SUD, Seeking Safety on symptoms of both disorders. Participants were randomized to either Creating Change or Seeking Safety. Measures utilized include the Mini Neuropsychiatric Interview, the Addiction Severity Index-Lite (ASI), the Beliefs about Substance Use, a Nicotine Screen, the Trauma Related Guilt Inventory, the World Assumptions Scale, the Coping Self-Efficacy Scale, the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form, the General Self-Efficacy Scale, the Global Severity Index of the Brief Symptom Inventory, the Clinical Global Impressions Scale-Patient version, the Structured Clinical Interview for DSM-IV Personality Disorders, the Suicidal Behaviors Questionnaire, the Client Satisfaction Questionnaire, and the Helping Alliance Scale. Results indicate that both conditions improved over time, with no difference between conditions, on PTSD, alcohol use, and drug use (the primary outcomes) as well as mental health symptoms, quality of life, self-efficacy, and SUD cognitions. Effect sizes were medium except for alcohol use, which was large. Change over time reflected improvement from baseline to end-of-treatment, with gains sustained at follow-up, although alcohol use showed continued improvement from end-of-treatment to follow-up. Both treatments evidenced a strong safety profile; and attendance, alliance, and treatment satisfaction were also very strong. Effect sizes were consistently large, including for both alcohol and drug problems. No adverse events were reported. Limitations include the small sample size, lack of a non-treatment control group, and the length of follow-up.

  Length of controlled postintervention follow-up: 3 months.

• Najavits, L. M. (2014). Creating Change: A new past-focused model for PTSD and substance abuse. In P. Ouimette & J. P. Read (Eds.), Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders (pp. 281–303). American Psychological Association Press. https://doi.org/10.1037/14273-014 and https://www.treatment-innovations.org/uploads/2/5/5/5/25555853/2013_creating_change_in_ouimette_book.pdf