Seeking Safety

Seeking Safety is a coping skills intervention to help adults or adolescents attain safety from trauma and/or addiction. The intervention can be delivered individually or in groups. Seeking Safety offers up to 25 treatment topics that address cognitive, behavioral, interpersonal, and case management domains. The model is highly flexible and can be delivered by peers as well as professionals. Providers can choose how many topics to cover with clients and for how long. It can also be delivered in any setting and level of care. Seeking Safety offers various training and certification opportunities to providers, but formal training is not required (except for research studies).

Seeking Safety is rated as does not currently meet criteria to receive a rating because no studies of the program that achieved a rating of moderate or high on design and execution demonstrated a favorable effect on a target outcome.

Date Research Evidence Last Reviewed: Mar 2020

Sources

The program or service description, target population, and program or service delivery and implementation information was informed by the following sources: The California Evidence-based Clearinghouse for Child Welfare, the program or service developer’s website, and the studies reviewed.

Program/Service Description Updated: Week of August 24, 2020

This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the download the Handbook of Standards and Procedures, Version 1.0

Target Population

Seeking Safety is designed for a broad range of adults and adolescents. The model is highly flexible and can be conducted with individuals who have a history of trauma and/or substance abuse.

Program or Service Delivery and Implementation

Dosage

Seeking Safety does not specify frequency or duration requirements. Providers have the flexibility to choose which of the 25 topics they cover and how much time to dedicate to each.

Location/Delivery Setting

Recommended Locations/Delivery Settings

Providers can deliver Seeking Safety in any setting (e.g., community-based settings, treatment facilities, criminal justice settings, military settings, schools, medical offices) as well as any level of care (e.g., outpatient, residential, inpatient).

Education, Certifications and Training

Seeking Safety offers various training and certification opportunities to providers. Training is available via multiple modalities, including on-site training, webinars, DVDs, online courses, teaching guides, and phone consultation. Seeking Safety offers three levels of certification, including certification in (1) Conducting Seeking Safety, (2) Fidelity Rating for Seeking Safety, and (3) Seeking Safety Supervision. Training and certification is recommended for all providers but only required if a formal publishable clinical trial is being conducted for research purposes. Providers are not required to have specific experience or degrees.

Program or Service Documentation

Book/Manual/Available documentation used for review

Najavits, L. M. (2002). Seeking Safety—A treatment manual for PTSD and substance abuse. Guilford Press.

Available languages

Materials are available in various languages, including: English, Spanish, French, German, Dutch, Arabic, Swedish, Greek, Chinese, Japanese, Korean, Vietnamese, Polish, Portuguese, and Italian. There is also an audio version for the blind.

Other supporting materials

Seeking Safety Overview

Seeking Safety Training Fact Sheet

Seeking Safety Adherence Scale

Seeking Safety Adherence Scale – Brief Version

For More Information

Website: http://www.seekingsafety.org/

Phone: (617) 299-1610

Email: info@seekingsafety.org

Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.

Extent of Evidence

Results of Search and Review	Number of Studies Identified and Reviewed for Seeking Safety
Identified in Search	17
Eligible for Review	11
Rated High	0
Rated Moderate	1
Rated Low	10
Reviewed Only for Risk of Harm	0

Summary of Findings

Outcome	Effect Size and Implied Percentile Effect	N of Studies (Findings)	N of Participants	Summary of Findings
Adult well-being: Parent/caregiver mental or emotional health	-0.08 -3	1 (2)	49	Favorable: 0 No Effect: 2 Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group.

Individual Study Findings

Outcome	Effect Size and Implied Percentile Effect	N of Studies (Findings)	N of Participants	Summary of Findings	Months after treatment when outcome measured
Adult well-being: Parent/caregiver mental or emotional health	-0.08 -3	1 (2)	49	Favorable: 0 No Effect: 2 Unfavorable: 0	-
Study 10730 - Seeking Safety (SS) vs. Treatment-As-Usual (TAU) Control (Zlotnick, 2009)
Brief Symptoms Inventory: Positive Symptoms Score	-0.45 -17	-	49	-	0
Clinician-Administered Posttraumatic Stress Disorder Scale: PTSD Diagnosis	0.30 11	-	49	-	0

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

Study Participant Characteristics

The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtglobal.com.

The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.

For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.

Characteristics of the Participants in the Studies with Moderate or High Ratings
Study Location	Study Year	Age or Grade-level	Race, Ethnicity, Nationality	Gender	Populations of Interest*	Household Socioeconomic Status
Study 10730 - Seeking Safety (SS) vs. Treatment-As-Usual (TAU) Control
Characteristics of the Adults, Parents, or Caregivers
Providence, RI, USA	--	Average age: 35	47% Caucasian 33% African-American 14% Hispanic 6% Other Races/Ethnicities	100% Female	100% Substance Use Disorder (SUD); 100% Repeated trauma, 94% Sexual abuse, 90% Physical abuse; 84% Full Posttraumatic Stress Disorder (PTSD), 17% Subthreshold PTSD; Met criteria for dependence: 94% Cocaine, 88% Alcohol, 76% Cannabis, 59% Heroin/other opioids; Met criteria for dependence: 39% Sedatives/hypnotics/anxiolytics, 31% Hallucinogens/PCP, 27% Stimulants; 4% Met criteria for lifetime alcohol abuse	--

“--” indicates information not reported in the study.

* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings. The Clearinghouse is currently seeking consultation from experts, including those with lived experience, and input from the public to enhance and improve the display.

Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.

Studies Reviewed

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers. To receive a rating of supported or well-supported, the favorable evidence for a program or service must have been obtained from research conducted in a usual care or practice setting.

Studies Rated Moderate

Study 10730

Zlotnick, C., Johnson, J., & Najavits, L. M. (2009). Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD. Behavior Therapy, 40(4), 325-336. doi:10.1016/j.beth.2008.09.004

This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)

Studies Rated Low

Study 10718

Boden, M. T., Kimerling, R., Jacobs‐Lentz, J., Bowman, D., Weaver, C., Carney, D., . . . Trafton, J. A. (2012). Seeking Safety treatment for male veterans with a substance use disorder and post‐traumatic stress disorder symptomatology. Addiction, 107(3), 578-586. doi:10.1111/j.1360-0443.2011.03658.x

Boden, M. T., Kimerling, R., Kulkarni, M., Bonn-Miller, M. O., Weaver, C., & Trafton, J. (2014). Coping among military veterans with PTSD in substance use disorder treatment. Journal of Substance Abuse Treatment, 47(2), 160-167. doi:10.1016/j.jsat.2014.03.006

This study received a low rating because it did not meet design confound standards.
Study 10726

Schäfer, I., Lotzin, A., Hiller, P., Sehner, S., Driessen, M., Hillemacher, T., . . . Grundmann, J. (2019). A multisite randomized controlled trial of Seeking Safety vs. Relapse Prevention Training for women with co-occurring posttraumatic stress disorder and substance use disorders. European Journal Of Psychotraumatology, 10(1), 1577092-1577092. doi:10.1080/20008198.2019.1577092

This study received a low rating because the standards for addressing missing data were not met.
Study 10727

Tripodi, S. J., Mennicke, A. M., McCarter, S. A., & Ropes, K. (2019). Evaluating Seeking Safety for women in prison: A randomized controlled trial. Research on Social Work Practice, 29(3), 281-290. doi:10.1177/1049731517706550

This study received a low rating because it did not meet design confound standards.
Study 10728

Upshur, C. C., Wenz-Gross, M., Weinreb, L., & Moffitt, J. J. A. (2016). Using prenatal advocates to implement a psychosocial education intervention for posttraumatic stress disorder during pregnancy: Feasibility, care engagement, and predelivery behavioral outcomes. Women's Health Issues, 26(5), 537-545. doi:10.1016/j.whi.2016.06.003

Weinreb, L., Wenz-Gross, M., & Upshur, C. (2017). Postpartum outcomes of a pilot prenatal care-based psychosocial intervention for PTSD during pregnancy. Archives of Women's Mental Health. doi:10.1007/s00737-017-0794-x

This study received a low rating because it did not meet design confound standards.
Study 10734

Lynch, S. M., Heath, N. M., Mathews, K. C., & Cepeda, G. J. (2012). Seeking Safety: An intervention for trauma-exposed incarcerated women? Journal of Trauma & Dissociation, 13(1), 88-101. doi:10.1080/15299732.2011.608780

This study received a low rating because it did not meet design confound standards.
Study 10729

Wolff, N., Huening, J., Shi, J., Frueh, B. C., Hoover, D. R., & McHugo, G. (2015). Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men. Journal of Anxiety Disorders, 30, 66-80. doi:10.1016/j.janxdis.2014.10.009

This study received a low rating because baseline equivalence of the intervention and comparison groups was necessary and not demonstrated.
Study 10723

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. doi:10.1007/s11414-006-9034-2

This study received a low rating because baseline equivalence of the intervention and comparison groups was necessary and not demonstrated.
Study 10737

Hein, D. A., Cohen, L. R., Miele, G. M., Litt, L. C., & Capstick, C. (2004). Promising treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry, 161, 1426-1432.

Cohen, L. R., & Hein, D. A. (2006). Treatment outcomes for women with substance abuse and PTSD who have experienced complex trauma. Psychiatric Services, 57, 100-106.

This study received a low rating because the standards for addressing missing data were not met.
Study 10722

Desai, R. A., Harpaz-Rotem, I., Najavits, L. M., & Rosenheck, R. A. (2008). Impact of the Seeking Safety program on clinical outcomes among homeless female veterans with psychiatric disorders. Psychiatric Services, 59(9), 996-1003. doi:10.1176/ps.2008.59.9.996

Desai, R. A., Harpaz-Rotem, I., Najavits, L. M., & Rosenheck, R. A. (2009). Seeking Safety therapy: Clarification of results. Psychiatric Services, 60(1), 125-125. doi:10.1176/appi.ps.60.1.125

This study received a low rating because it did not meet design confound standards.
Study 10732

Gatz, M., Brown, V., Hennigan, K., Rechberger, E., O'Keefe, M., Rose, T., & Bjelajac, P. (2007). Effectiveness of an integrated, trauma-informed approach to treating women with co-occurring disorders and histories of trauma: The Los Angeles site experience. Journal of Community Psychology, 35(7), 863-878. doi:10.1002/jcop.20186

This study received a low rating because it did not meet design confound standards.

Studies Not Eligible for Review

Study 10719

Brown, S. H., Gilman, S. G., Goodman, E. G., Adler-Tapia, R., & Freng, S. (2015). Integrated trauma treatment in drug court: Combining EMDR therapy and seeking safety. Journal of EMDR Practice and Research, 9(3), 123-136. doi:10.1891/1933-3196.9.3.123

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 10720

Anderson, M. L., & Najavits, L. M. (2014). Does seeking safety reduce PTSD symptoms in women receiving physical disability compensation? Rehabilitation Psychology, 59(3), 349-353. doi:10.1037/a0036869

Cohen, L. R., Field, C., Campbell, A. N. C., & Hien, D. A. (2013). Intimate partner violence outcomes in women with PTSD and substance use: A secondary analysis of NIDA Clinical Trials Network 'Women and Trauma' Multi-site Study. Addictive Behaviors, 38(7), 2325-2332. doi:10.1016/j.addbeh.2013.03.006

Hien, D. A., Wells, E. A., Jiang, H., Suarez-Morales, L., Campbell, A. N. C., Cohen, L. R., . . . Nunes, E. V. (2009). Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders. Journal of Consulting and Clinical Psychology, 77(4), 607-619. doi:10.1037/a0016227

Hien, D. A., Campbell, A. N. C., Killeen, T., Hu, M.-C., Hansen, C., Jiang, H., . . . Nunes, E. V. (2010). The impact of trauma-focused group therapy upon HIV sexual risk behaviors in the NIDA clinical trials network 'Women and trauma' multi-site study. AIDS and Behavior, 14(2), 421-430. doi:10.1007/s10461-009-9573-7

Hien, D. A., Campbell, A. N. C., Ruglass, L. M., Hu, M.-C., & Killeen, T. (2010). The role of alcohol misuse in PTSD outcomes for women in community treatment: A secondary analysis of NIDA's Women and Trauma Study. Drug and Alcohol Dependence, 111(1-2), 114-119. doi:10.1016/j.drugalcdep.2010.04.011

Hien, D. A., Morgan-Lopez, A. A., Campbell, A. N. C., Saavedra, L. M., Wu, E., Cohen, L., . . . Nunes, E. V. (2012). Attendance and substance use outcomes for the Seeking Safety program: Sometimes less is more. Journal of Consulting and Clinical Psychology, 80(1), 29-42. doi:10.1037/a0026361

Killeen, T., Hien, D., Campbell, A., Brown, C., Hansen, C., Jiang, H., . . . Nunes, E. (2008). Adverse events in an integrated trauma-focused intervention for women in community substance abuse treatment. Journal of Substance Abuse Treatment, 35(3), 304-311. doi:10.1016/j.jsat.2007.12.001

Morgan-Lopez, A. A., Saavedra, L. M., Hien, D. A., Campbell, A. N., Wu, E., & Ruglass, L. (2013). Synergy between Seeking Safety and twelve-step affiliation on substance use outcomes for women. Journal of Substance Abuse Treatment, 45(2), 179-189. doi:10.1016/j.jsat.2013.01.015

Morgan‐Lopez, A. A., Saavedra, L. M., Hien, D. A., Campbell, A. N., Wu, E., Ruglass, L., . . . Bainter, S. C. (2014). Indirect effects of 12‐session Seeking Safety on substance use outcomes: Overall and attendance class‐specific effects. The American Journal on Addictions, 23(3), 218-225. doi:10.1111/j.1521-0391.2014.12100.x

Myers, U. S., Browne, K. C., & Norman, S. B. (2015). Treatment engagement: Female survivors of intimate partner violence in treatment for PTSD and alcohol use disorder. Journal of Dual Diagnosis, 11(3-4), 238-247. doi:10.1080/15504263.2015.1113762

Ruglass, L. M., Miele, G. M., Hien, D. A., Campbell, A. N. C., Hu, M., Caldeira, N., . . . Nunes, E. V. (2012). Helping alliance, retention, and treatment outcomes: A secondary analysis from the NIDA clinical trials network Women and Trauma Study. Substance Use & Misuse, 47(6), 695-707. doi:10.3109/10826084.2012.659789

Ruglass, L. M., Hien, D. A., Hu, M., & Campbell, A. N. C. (2014). Associations between post‐traumatic stress symptoms, stimulant use, and treatment outcomes: A secondary analysis of NIDA's Women and Trauma Study. The American Journal on Addictions, 23(1), 90-95. doi:10.1111/j.1521-0391.2013.12068.x