1. Implementing Seeking Safety Presented at the NIDA CTN Pre-Steering Committee Dissemination Workshop, Bethesda, MD, October, 2009 Supported by the California-Arizona Node of the NIDA Clinical Trials Network (U10 DA105815)

2. Pat Penn, PhD Amy Tilley, PsyD Wendy Layne, MA La Frontera Center, Inc. Tucson, AZ www.lafrontera.org ppenn@lafrontera.org www.lafrontera.org ppenn@lafrontera.org

4. La Frontera Center, Inc.  One of the original CMHCs, 1968  Largest community behavioral health organization in Arizona; top 15% in US  Over $50 million annual budget  21 sites and 15,000+ clients served in FY 08/09  Capitated funding predominant

5. Co-occurring Conditions: Now What?

6. Why We Initially Choose Seeking Safety  Client need  Demonstrated efficacy  Treatment for a wide range of clientele  Treatment is relatively brief  Focus on strengths and building positive coping skills rather than on reprocessing the trauma  Appeared to be user friendly  Flexibility possible

7. First Steps  Site – Casa de Vida - residential  Staff – psychology interns  Train – books, website  Clients – mixed gender groups  Assessments – LASC, client satisfaction, qualitative

8. Next Steps  Tried adaptations: –Open enrollment –Clients choose topics –Vary order of topics –Extend/repeat some topics  Supervision  Looked at data  Talked with Dr. Najavits

10. Our Results Thus Far Residential Setting Clients with co-occurring conditions Rotating psychology intern facilitators

11. Repeated Measures Analysis PTSD Scores – Combined Data 2007-09 Significant Decrease for Total (N=17)

12. PTSD Scores - Female Facilitators Combined Data 2007 - 09

13. PTSD Scores - Male Facilitators Combined Data 2007 - 09

14. PTSD Scores By Year

16. Satisfaction Data Combined Facilitators 2009

17. Observations from Facilitators  Many clients seem to feel relaxed in the emotionally “managed” atmosphere  Most clients leave group in a positive, upbeat mood  Clients refer to the tools they are learning when outside of group

18. What Clients Have Said:  Noted improvements in overall self- esteem  Greater confidence coping with PTSD and SA triggers  Said they felt “safe” in group  Topics and handouts were very useful

19. Client quotes include:  “This is my favorite group”  “I have learned a lot of tools”  “I have used a lot of the tools outside of group”  “I would like to go through the series again as a refresher”

20. Our Data Suggest  The method can be successfully used with mixed gender groups  Adaptations are feasible (and may increase client engagement)  Clients and facilitators like it  Closer supervision may be needed, esp. re gender considerations

21. Further Dissemination  Presentations – LFC staff, regional meetings  Interns - Post-docs take to other sites  Other LFC staff start using it

22. Lessons Learned  Choose what to implement wisely  Start small – 1 willing person (interns!)  Start at a group friendly site  Experiment with adaptations

23. Lessons Learned, cont.  Collect data over time  Assign one person to manage data  Supervise more closely  Communicate with author  Give presentations

24. “Although the world is full of suffering, it is full also of the overcoming of it” - Helen Keller (quote used in the manual)