Piloting Signs of Safety: A Deaf-Accessible Therapy Toolkit for Alcohol Use Disorder and Trauma

项目摘要/摘要 美国聋人社区--一个由50多万美国人组成的群体，他们使用美国手语进行交流 语言(ASL)-经历终生问题饮酒率的近三倍，以及两倍于 与普通人群相比，创伤暴露的风险更大。尽管有有效的酒精治疗方法 在听力障碍(AUD)和创伤后应激障碍(PTSD)人群中，没有证据支持 针对任何行为健康状况的治疗，适用于聋人客户。目前的循证治疗失败了 以满足聋人客户独特的语言和文化需求。 为了解决这些障碍，PI领导了一个由聋人和听力研究人员、临床医生、电影制作人、演员、 艺术家和患有澳元的聋人将开发一个原型的“安全迹象”，这是一个聋人可以使用的工具包 与现有的、广为传播的澳大利亚/创伤寻求安全规程一起使用。安全的征兆 到目前为止，设计的工具包包括治疗师指南和特定人群的客户材料(例如，可视 讲义；ASL数字视频教学故事，介绍关键的学习要点)。它的设计目的是供 与ASL口译员一起工作的聋人、听障人士或听障非听障人士的临床医生。 拟议研究的目的是：(1)生成要使用的安全标志的最终专业版本 在未来的研究中，对三名研究临床医生进行安全征兆和寻求安全方面的培训；(2)进行两次 寻求安全标志的ARM飞行员随机对照试验(RCT)与未补充的安全工具包 寻求安全，收集关于可行性结果的数据(筛选、招聘、保留、满意度、忠诚度、 依从性、评估过程)和初步临床结果(即减少饮酒频率 和数量、酒精渴求、酒精相关问题、创伤后应激障碍症状的严重程度)；以及，(3)检查 潜在的结果调解人和调解人(例如，治疗动机、提供者文化能力、 应对技能、自我同情、对健康信息的理解)。 拟议的AIMS将提供支持NIAAA R01的可行性和初步疗效数据 全面的随机对照试验，以测试安全标志的有效性，以及实施参与式行动模式 聋人社区内的RCT。

PROJECT SUMMARY/ABSTRACT The U.S. Deaf community – a group of more than 500,000 Americans who communicate using American Sign Language (ASL) – experiences nearly three times the rate of lifetime problem drinking and twice the rate of trauma exposure compared to the general population. Although there are validated treatments for alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) in hearing populations, there are no evidence-based treatments for any behavioral health condition for use with Deaf clients. Current evidence-based treatments fail to meet Deaf clients’ unique linguistic and cultural needs. To address these barriers, the PI led a team of Deaf and hearing researchers, clinicians, filmmakers, actors, artists, and Deaf people with AUD to develop a prototype of “Signs of Safety,” a Deaf-accessible toolkit to be used with an existing, widely-disseminated protocol for AUD/trauma – Seeking Safety. The Signs of Safety toolkit, as designed thus far, includes a therapist guide and population-specific client materials (e.g., visual handouts; ASL teaching stories on digital video, which present key learning points). It is designed for use by clinicians who are Deaf themselves, hearing signers, or hearing non-signers working with ASL interpreters. The aims of the proposed study are: (1) to generate a final, professional version of Signs of Safety to be used in future research and train three study clinicians in Signs of Safety and Seeking Safety; (2) to conduct a two- arm pilot randomized controlled trial (RCT) of Seeking Safety + Signs of Safety toolkit versus unsupplemented Seeking Safety, collecting data on feasibility outcomes (screening, recruitment, retention, satisfaction, fidelity, adherence, assessment process) and preliminary clinical outcomes (i.e., reduction in alcohol use frequency and quantity, alcohol craving, alcohol-related problems, severity of PTSD symptoms); and, (3) to examine potential mediators and moderators of outcome (e.g., motivation for treatment, provider cultural competency, coping skills, self-compassion, understanding of health information). The proposed aims will provide feasibility and preliminary efficacy data necessary to support a NIAAA R01 for a full-scale RCT to test the efficacy of Signs of Safety, as well as a participatory action model for conducting RCTs within the Deaf community.