1. 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.

2. “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.

3. 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

4. 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

5. 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

6. 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 “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?

7. 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

8. “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?

9. 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”

10. 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.

11. 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

12. 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