Bright Spot: Seeking Safety for Adolescents

Photo by Daria Tumanova on Unsplash

This bright spot was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.


Detailed Description

Seeking Safety for Adolescents was originally designed for adults. It is a present-focused, coping skills therapy to help people attain safety from trauma and/or substance abuse. The treatment may be conducted in individual or group format for adolescents in various settings.

Key principles are:

1. Safety as the overarching goal (helping clients attain safety in their relationships, thinking, behavior, and emotions)

2. Integrated treatment (working on both PTSD and substance abuse at the same time)

3. A focus on ideals to counteract the loss of ideals in both PTSD and substance abuse

4. Four content areas (cognitive, behavioral, interpersonal, and case management

5. And attention to clinician processes (helping clinicians work on counter transference, self-care, and other issues).

Expected Outcomes

The overall program goal is to help clients attain safety in their relationships, thinking, behavior and emotions.


Emerging bright spot (emerging evidence)

Cost Details

As of June 2014, the cost of this intervention is as follows:

  • $46 for manuals (required)
  • $16 for poster of safe coping skills (not required)
  • $16 for card deck of safe coping skills (not required)
  • $250 per set of training videos (not required)
  • $1600 per day plus travel expenses for on site training (not required)
  • $115 per hour for telephone consultation (not required)

Key Steps for Implementation

  • Client selection - describe the treatment and then give clients a choice in whether to join
  • Be as inclusive as possible - invite anyone who has an interest and only remove someone who presents a danger to others or is likewise unable to participate
  • Encourage clients to apply coping skills broadly. Use the case management component of Seeking Safety to engage clients in additional treatments
  • Tell clients to ignore the term "PTSD" or "substance abuse" in the handouts if these do not apply
  • Allow clients to try the treatment before committing to it
  • Clients can be at any stage of recovery
  • Clients do not need to be stabilized first. Seeking Safety for Adolescents includes a homework component where clients are asked to make a commitment of one thing they'll do for their recovery prior to the next session, although this is optional.
  • Clinician selection: Any clinician can conduct Seeking Safety Several clinician characteristics are helpful
  • All clinicians need to recognize their limits
  • Consider a try-out using the manual. Seeking Safety sessions are structured to emphasize good use of time, appropriate containment, and setting goals and sticking to them. Sessions are conducted with the following four parts:
    • Check-in: brief questions to find out how clients are doing
    • Quotation: A quotation is read aloud to emotionally engage clients in the session
    • Handouts: handouts are used to explore a new coping skill
    • Check-out: brief questions to reinforce clients' progress and close the session on a positive note There is a training coordinator who can discuss agency needs and develop a training plan that includes fidelity and supervisory training.

Special Infrastructure

There are no space, room, AV requirements. The only things needed are copies of the program materials, which can be photocopied from the book by the clinician for use with their client. The program is typically conducted in a community agency, hospital, outpatient clinic, residential care facility, or school.


Training is not required but can be helpful to teach staff how to implement the model.

  • Training videos are available that provide an overview of the model (4 videos in the series, totalling 4.5 hours)
  • Training videos can be combined with online training
  • Training videos can also be combined with the training facilitation guide

Additional materials:

  • Adolescent-relevant optional materials are available and include a card deck, magnet, key chain, and poster of the Safe Coping Skills from Seeking Safety Onsite training is common; and there is no limit on the number of attendees. Some programs set up a training and invite others from the region to attend. Training associates are available throughout the country Phone consultation is also possible
  • A typical training day can be 1, 1.5, or 2 days, but any length is possible
  • Training Contact - Treatment Innovations 

Types of Staff

No specific degree or experience is required. Any clinician can conduct the program. It has been done by social workers, psychologists, nurses, case managers, emergency workers, domestic violence advocates, paraprofessionals, mental health counselors, substance abuse counselors, and even has been done in peer-led version.

Outcome Measures

  • Client completion of treatment
  • Decrease in substance use
  • Improvement in trauma-related symptoms
  • Improvements in psychopathology
  • Treatment retention

Process Measures

  • Number of clients who attend the sessions
  • Completion of the Seeking Safety structure (following the 4 component session)
  • Use of Seeking Safety content|Use of strong, general clinical skills (e.g., empathy, warmth, etc.)


Website of Seeking Safety
Seeking Safety
Resource - Website/webpage
Brought to you by Treatment Innovations

 Related Topics

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Adverse Childhood Experiences

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Young and Emerging Adults

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Substance Use

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Mental and Behavioral Health

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Children and Youth