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Seeking Safety (SS for Adolescents)


Delivery Approach:
  • Group
  • Individual
  • Group & Individual
  • Dyadic
Delivery Format:
  • In-person
  • Virtual
  • Hybrid
Provider Requirements:
  • No Provider Requirements
Type of Experience Addressed:
  • Domestic Violence
  • Child Abuse 
  • Sexual Abuse
  • Community Violence
  • Neglect 
  • Family Separation
  • Homicide/Familicide 
  • Substance Abusing Caregiver 
  • Natural Disasters 
  • Grief/Bereavement 
  • Criminal Victimization 
  • Refugee/Immigration
  • Reunification
  • Medical Trauma
  • Homelessness
  • Verbal/Emotional abuse
  • Mental Health Issues/Concerns
  • Mass shootings
  • Hate Crimes
  • Systemic/Interpersonal Racism
  • Historical trauma
  • Homophobia/Transphobia
  • Trafficking
Engagement Methods:
  • Talk-based
  • Experiential
  • Culturally Grounded
Level of Intervention:
  • Primary Prevention
  • Secondary Prevention
  • Tertiary Prevention
  • Intervention
  • Less than 6 weeks
  • Less than 12 weeks
  • Greater than 12 weeks
  • School
  • Home 
  • Hospital-based
  • Residential 
  • Domestic Violence Shelter
  • Correctional
  • Homeless Shelter
  • Day Care
  • Family service agencies
  • Health Services 
  • Foster Care 
  • Mental Health Setting
  • Community-based agency
Program Details:
Type of services:

Present-focused, coping skills therapy for adolescents that targets trauma and/or addiction (e.g., substance use disorder) and can be delivered as group or individual sessions.

Program setting:

Any setting including inpatient, outpatient, community mental health centers, residential settings, prisons, and home-based care.

Type of service provider:

Therapist/clinician/peer; has also been conducted by domestic violence advocates, case managers, and other types of service providers.

Length of program/number of sessions:

Highly flexible; there are 25 topics provided, but clinicians can choose to do as many as time allows, in whatever order they choose, with any session length and number of sessions per week

Type(s) of trauma addressed:

All trauma types; substance abuse

Additional Information:

Seeking Safety addresses cognitive, behavioral, and interpersonal domains. Each topic offers a “safe coping skill.” Topics include:

  • PTSD: Taking Back Your Power
  • Asking for Help
  • Healing from Anger
  • Creating Meaning
  • Setting Boundaries in Relationships
  • Recovery Thinking
  • Taking Good Care of Yourself
  • Honesty
  • Coping with Triggers
  • Compassion
  • Detaching from Emotional Pain (Grounding)

This intervention, originally developed for adults, has been both implemented and researched with adolescents in a wide range of settings.

Unique/Innovative Characteristics

Seeking Safety was the first psychotherapy for dual diagnosis of PTSD and substance abuse disorder with published outcome results and has been rated as Level 1 for PTSD/substance use disorder (effective) in the International Society for Traumatic Stress Studies guidelines.
At the time of the randomized trial with adolescent girls, there were no other published treatment studies using a manual designed for this population.
This intervention addresses the reality that substance abuse and PTSD are often connected (most adolescents in the randomized trial believed their PTSD and substance abuse were related). Both of these disorders are well-documented consequences of childhood exposure to domestic violence.

Information for this summary was abstracted from the NCTSN publication, Trauma-Informed Interventions: Clinical and Research Evidence and Culture-Specific Information Project and other publications.

Date Added/Updated:


Population Served

  • 13-17 (Adolescent)
  • 18-25 (Young Adult)
  • 25 & Up (Adult)
Population Language:
  • English
  • French
  • Spanish
  • Other Population Language
    • Arabic, Swedish, Dutch, German, Polish, Portuguese, Vietnamese, Chinese, and Others
Ethnic Racial Group:
  • Indigenous People – American Indian/Native American, Alaskan Native
  • Asian
  • Black or African American
  • Hispanic or Latino
  • Native Hawaiian or other Pacific Islander
  • White
  • Child and Non-abusive Parent/Caregiver
  • Family
  • Grandparents
  • Parent who uses Violence
  • Survivor parent
  • Community
  • Foster/Adoptive Parents
Population Adaptations:
Age range of children:


Parent/adult caregiver included in intervention:

Contact with parent(s) at the first session and brief updates with parents if the adolescent agrees to it.

Ethnic/racial and other groups served:

The randomized, controlled trial described in the evaluation section had a small study population of which 21.2% of the participants were minority youth. The manual for Seeking Safety was found to be helpful without modification in this outcome study.

Languages available:

The Seeking Safety book/manual is available in 14 languages including Spanish, French, German, Chinese, Dutch, Polish, Arabic, Vietnamese, and Swedish. Various optional materials (e.g., therapeutic card deck, wallet cards, and poster of the Seeking Safety safe coping skills are available in English, Spanish and/or French).


Theoretical basis:

Seeking Safety is a cognitive behavioral model that focuses on current problems/issues to help people attain safety from trauma and/or addiction (e.g., substance use disorder, problem gambling).

Evaluation Studies:

There have been over 60 publications of studies of Seeking Safety, including pilots, randomized controlled trials, and multisite trials. One with adolescent girls and another with Canadian adolescents are summarized below. For all other studies, see section Outcomes.

Adolescent girls

A randomized, controlled trial was conducted with 33 outpatient adolescent girls (average age=16 years old) who met current DSM-IV criteria for both PTSD and substance use disorder. Girls who received Seeking Safety plus treatment-as-usual were compared to girls who received treatment-as-usual alone. The most common trauma history was sexual abuse (87.9%); many had multiple trauma and the average age when the first trauma occurred was 8.75 years. The average attendance was 11.78 sessions.

Published results:

At the end of the intervention, girls who participated in Seeking Safety had significantly better outcomes compared to girls who received just treatment-as-usual. The findings included:

  • Positive outcomes for self-reported substance abuse and associated problems
  • Improved cognitions related to substance abuse and PTSD
  • Reduction of some trauma-related symptoms
  • Improvements in various psychopathology including some problems not targeted in the treatment (e.g., anorexia, somatization)

Effect sizes were generally in the moderate to high range. Some gains were sustained at 3-month follow-up.

“Najavits LM, Gallop RJ, Weiss R. Seeking Safety therapy for adolescent girls with PTSD and substance use disorder: A randomized, controlled trial. Journal of Behavioral Health Services and Research. 2006;33(4):453-463.

Canadian adolescents

Preliminary data were collected from French Canadian youth (18-25 years) who received motivational interviewing sessions combined with SS offered in group (n=6 ) or in individual sessions (n=3). The results show that the French version of the SS program appears to be effective in a group context as significant improvements were noted in the PCL-S, the MAST-22 and also according to the axis 5 of the DSM-IV-TR (large effect sizes). However, no significant improvement was noted for individual care and the DAST-20 in group context; although these measures appear to have evolved in the direction of wellness. This study suggests that the French version of the SS program is promising in the treatment of PTSD-SUD for French-Canadian youth in a clinical context.

Other evaluation studies:

A comprehensive literature review of all published evaluation studies, including randomized controlled trials, can be found at, section Evidence

Other publications about the program:

An extensive list of publications about the Seeking Safety model is also available at

Rated/Reviewed by Evidence Based Registries:

SAMHSA’s National Evidence Based Practice Resource Center  (For Adults)
California Evidence-Based Clearinghouse for Child Welfare
Evidence-Based Practices for Children Exposed to Violence: A Selection from Federal Databases (For Adolescents)

Training & Resources

Training Language:
  • English
  • Spanish
  • French
Training Available:
  • Yes
Training Details:
Training manuals/protocols:

Najavits LM. 2002. Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. New York: Guilford Press.

Articles on implementation are available at:

Languages other than English:

The Seeking Safety book/manual is available in 14 languages including Spanish, French, German, Chinese, Dutch, Polish, Arabic, Vietnamese, and Swedish. Various optional materials (e.g., therapeutic card deck, wallet cards, and poster of the Seeking Safety safe coping skills are available in English, Spanish and/or French).

Training Contact:

Chris Jones
Treatment Innovations
28 Westbourne Road
Newton Centre, MA 02459

Program Contact

Jamie Miller
Treatment Innovations
28 Westbourne Road
Newton Centre, MA 02459
617-299-1620 /