The establishment of a “Seeking Safety” Group in The National Drug Treatment Centre. Dr.Siobhan Rooney, Consultant Psychiatrist in Addictions HSE, Keltoi Ruth Ann Buckley, Counsellor, HSE, Keltoi.

“Seeking Safety” Seeking Safety is the first evidence based integrated treatment for PTSD/Trauma and substance abuse. Developed 2002 by Lisa Najavatis CBT + Psychoeducational Model. Core Goal: gaining “Safety” + learning to manage addiction behaviours, emotions, impulses and past traumas Focusing on the present and “Ideals” and problem solution orientated, Based 25 Topics/Coping Skills Applied in a group or on a 1:1 basis. Significant improvement in Substance Misuse Reduction in trauma related symptoms Reduced suicidal risk + suicidal thoughts Improvement in depression Improved social adjustment Improved family functioning Improved problem solving abilities Improved knowledge of treatment 1.) Safety: prioritises safety as the most urgent clinical need 2.) Integrated treatment for PTSD and Substance abuse 3.) Focus on Ideals: Aim is to support the restoration of Ideals that have been lost. 4.) 4 content areas: Cognitive, Behavioural, Interpersonal and Case Management.

Prior to Commencement of Treatment 2 day Training arranged August 2015 : Keltoi and HSE Social Inclusion: Dr.Martha Schmitz Training Manual : “Seeking Safety”, a treatment manual for PTSD and Substance Abuse An Information Leaflet + poster developed and placed on Patient notice boards in the NDTC Weekly Copies of the handouts were made for clients from the Seeking Safety Manual Review the therapist’ s objectives for the session/topic Develop a list of National and Community resources **Weekly Tea and Coffee arranged

Core Concepts of Treatment Safety Respect yourself Use Coping- Not Substances Make the present and future better than the past Learn to trust Take Good care of your body Get help from safe people To heal fully from PTSD become substance free If one method does not work, try something else Never, never, never, never, never, never give up

25 Topics May need more than 1 week to complete each topic Introduction to Treatment/ Case Management Safety PTSD/Taking back your power Detaching from emotional pain (Grounding) When Substances control you Asking for help Taking Good care of yourself Compassion Red + Green Flags Honesty Recovery Thinking Integrating the Split self Commitment Creating Meaning Community Resources Setting boundaries in relationships Discovery Getting others to support your recovery Coping with triggers Respecting your time Healthy relationships Self-nurturing Healing from Anger The Life Choices game Termination May need more than 1 week to complete each topic

Format of each session Check-In: 5 minutes per patient How are you feeling?, What good coping have you done? Any substance use or unsafe behaviour?, Did you complete your commitment? Did you utilise your community resource? Quotation + Handout 1.“It’s never too late to be what you might have been”. 2. “Although the world is full of suffering, it is full also of overcoming of it.” 3. “You are not responsible for being down, but you are responsible for getting up” The objective is to engage patients emotionally and provide a brief point of inspiration. Go through Handout/Topic and relate to client’s lives Discussion, Role play, rehearse a new skill, Safe Coping Sheet, Q+A, Grounding techniques, Commitment, make a tape, replay an event. Objective: Safety, reduction of Substance Use and PTSD Symptoms Check-Out: Name 1 thing you got out of the session? What is your new commitment? What Community Resource will you use? N Name 1 thing you got out of the session What is your new commitment? Suggestions are also made at the end of each topic. i.e. stay clean for the week, attend next week, complete written work, try new coping skill from the current topic What Community Resource will you use?

Results 10 women participated in the programme Dec.2016 – June 2017 All had suffered trauma and substance abuse 4 Women provided feedback at the last session. Average of 2-4 participants per session and a maximum of 8 participants on 1 occasion Certificate of attendances given at the end of 6 months

“Seeking Safety” Feedback Questionnaire How helpful was Treatment overall for: PTSD and Substance Misuse? PTSD alone and Substance Misuse alone? How helpful were each of the topics (each coping skill)? How helpful were parts of the treatment? Responses were based on a Likert Scale with -3 being greatly unhelpful +3 being greatly helpful Participants rated each part of the treatment as + 3, “Greatly Helpful” 70-100% stated that they will use what they have learned in the treatment in the future 100% stated that they would recommend this treatment to others. i.e. Safety as a priority, integration of treatment for PTSD and Substance misuse, focus on abstinence, learning new skills, interpersonal, cognitive + behavioural skills, core concepts of treatment, specific structure of each session?

Individual Feedback Positive feedback was received from each participitant: “The Seeking Safety Programme was described “ as a brilliant course, empowering, enlightening, respectful.” Learning about “red flags” helped to put on the brakes on a relapse” Helped another in improving her self – esteem, confidence, assertiveness and learning to say “NO.” She had “hated” herself but found that she accepted herself and had a better relationship with her daughter Another client realised the power of becoming “honest” with herself and feeling not alone , more positive and to “make things that matter to me more important”

The group was facilitated well and felt safe in the group. All enjoyed the format of the programme and did not feel overwhelmed with the material. “All the sections were very interesting and helpful, also easy to do your own work on. The frequency is good, as once a week is a perfect time, not too much or too little. The group was facilitated well and felt safe in the group. The programme was described as being “practical and straight forward.” Participitants felt the group was: “Perfect for people who have been isolating for long periods of time due to PTSD and/ or drug use. They can gain confidence back and overcome anxiety”. “Perfect for someone willing to change but maybe have not been in an environment of learning or working with handouts. “People who are really honestly trying to get/stay clean and are struggling would be perfect for this course. No modifications to the programme were recommended.

Unique Features Commitment and honesty of participants Dynamics of the group: respectful, helpful, non judgmental No exclusion criteria for anyone attending Missing sessions did not prevent learning or participation at the next group Focus on the “here and now” and the focus on developing “Safety” in their lives Can be lead/facilitated by any discipline

Progress A second “Seeking Safety” Group commenced in November 2017 and completed 2018 with 1 nurse as co-facilitator Third group currently recruiting in the NDTC and is now led by 2 nurses Support and encouragement given to other services to establish Seeking Safety Groups Finalist for Irish Healthcare Awards March 2018: Patient Psycho-educational, and Mental Health Initiative