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

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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.