Developing Signs of Safety: A Deaf-accessible counselling toolkit for trauma and addiction

UMMS Affiliation

Implementation Science and Practice Advances Research Center (iSPARC); Department of Psychiatry

Publication Date


Document Type



Clinical Psychology | Communication Sciences and Disorders | Psychiatry and Psychology | Substance Abuse and Addiction | Translational Medical Research


The U.S. Deaf community-more than half a million Americans who communicate using American Sign Language (ASL)-experiences higher rates of trauma exposure and substance use disorder (SUD) than the general population. Yet there are no evidence-based treatments for any behavioural health condition that have been evaluated for use with Deaf people. The driving aim of our work, therefore, has been to develop and formally evaluate a Deaf-accessible trauma/SUD counselling approach. Here we describe our initial intervention development work and a single-arm pilot that evaluated the feasibility, acceptability, and preliminary clinical efficacy of Signs of Safety-a Deaf-accessible toolkit to be used with an existing, widely adopted protocol for trauma and addiction (Seeking Safety). Preliminary efficacy results indicated clinically significant reductions in PTSD symptoms and frequency of alcohol use for the Seeking Safety/Signs of Safety model. Frequency of drug use did not change significantly-likely attributable to the mid-study legalization of recreational marijuana in our state. Next steps include the redesign and refilming of Signs of Safety based on pilot participant feedback, again using a Deaf-engaged development and production process. This new toolkit will be tested via a pilot randomized controlled trial designed based on present methodological lessons learned.


deaf, trauma exposure, substance use disorder, counseling, UMCCTS funding

DOI of Published Version



Anderson ML, Glickman NS, Wolf Craig KS, Sortwell Crane AK, Wilkins AM, Najavits LM. Developing Signs of Safety: A Deaf-accessible counselling toolkit for trauma and addiction. Clin Psychol Psychother. 2021 Nov;28(6):1562-1573. doi: 10.1002/cpp.2596. Epub 2021 Apr 24. PMID: 33847426; PMCID: PMC8511355. Link to article on publisher's site

Journal/Book/Conference Title

Clinical psychology and psychotherapy

Related Resources

Link to Article in PubMed

PubMed ID