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Impact of the Seeking Safety Program on Clinical Outcomes Among Homeless Female Veterans With Psychiatric Disorders

Dr. Desai, Dr. Harpaz-Rotem, and Dr. Rosenheck are with the Department of Psychiatry, Yale University, New Haven, Connecticut. Dr. Desai and Dr. Rosenheck are also with the Northeast Program Evaluation Center, Department of Veterans Affairs Connecticut Healthcare System, West Haven. Dr. Najavits is with the Department of Psychiatry, Boston University School of Medicine, and with the National Center for PTSD, Veterans Affairs Boston Healthcare System. Send correspondence to Dr. Desai at the Northeast Program Evaluation Center, Department of Veterans Affairs Connecticut Healthcare System (182), 950 Campbell Ave., West Haven, CT 06516 (e-mail: desai{at}yale.edu).

OBJECTIVE: Seeking Safety is a manualized cognitive-behavioral therapy intervention that is designed to treat clients with comorbid substance abuse and trauma histories. This study examined its effectiveness when used with homeless women veterans with psychiatric or substance abuse problems at 11 Department of Veterans Affairs medical centers that had Homeless Women Veterans Programs. METHODS: The intervention consists of 25 sessions that cover topics to help build safety in clients' lives and is present-focused, offering psychoeducation and coping skills. A cohort of homeless women veterans (N=359) was recruited before Seeking Safety was implemented (phase I). After clinicians were trained and certified in Seeking Safety, a postimplementation cohort was recruited and offered Seeking Safety treatment (phase II, N=91). Phase I lasted from January 2000 to June 2003. Phase II lasted from June 2003 to December 2005. The intervention lasted for six months. All participants were interviewed every three months for one year and received intensive case management and other services during the study. Mixed models were used to compare one-year clinical outcomes across phases. RESULTS: There were few differences across groups at baseline. All women entering the Homeless Women Veterans Programs showed significant improvement on most clinical outcome measures over one year. The Seeking Safety cohort reported significantly better outcomes over one year in employment, social support, general symptoms of psychiatric distress, and symptoms of posttraumatic stress disorder, particularly in the avoidance and arousal clusters. However, the Seeking Safety cohort was significantly more likely to have used drugs in the past 30 days. CONCLUSIONS: Seeking Safety appears to have had a moderately beneficial impact on several clinical outcomes. Although the nonequivalent comparison groups and low follow-up rates limit the internal validity of these results, availability of Seeking Safety may be of benefit for homeless female veterans. It is noteworthy that it could be delivered and implemented by case managers with little or no prior counseling experience.

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				R. A. Desai, I. Harpaz-Rotem, L. M. Najavits, and R. A. Rosenheck Seeking Safety Therapy: Clarification of Results Psychiatr Serv, January 1, 2009; 60(1): 125 - 125. [Full Text] [PDF]

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