Pilot RCT of Seeking Safety for Incarcerated Women

Background and Purpose:Seeking Safety (SS) is a cognitive-behavioral intervention that addresses trauma and substance abuse. The goal of the intervention is to promote trauma recovery, increase coping strategies, reduce drug and alcohol use, and address mental health issues. A large portion of women in prison have a history of substance use and severe victimization histories, but their needs often go untreated. Preliminary evidence indicates that SS has positive impacts for incarcerated women, but investigations are limited by their use of quasi- or pre-experimental designs. This study pilot tested the feasibility of implementing an RCT to evaluate the effectiveness of SS among incarcerated women to reduce PTSD, depression, and substance cravings. 

Methods:Participants were recruited from a medium-maximum security prison in North Carolina. Forty women who had a history of trauma and past substance use were randomly selected to participate and randomly assigned to treatment or control groups. The intervention was delivered by a certified SS facilitator and occurred in 25 90-minute sessions over 12 weeks. Control group members received treatment as usual. Outcomes were PTSD, depression, and substance cravings as measured by the PTSD Checklist – Civilian, the Center for Epidemiology Studies Depression Scale, and the Brief Substance Cravings Scale, respectively. Additionally, client satisfaction for the intervention group was measured using the Client Satisfaction Questionnaire and participants were asked several open–ended questions about their experiences. Pretest data was collected at the time of the screening, post–test data was collected when the treatment was over, and follow–up data collection occurred 4 months later.

Results:During the study, seven women dropped out due to non-intervention factors. Due to the small sample size, there were pretest differences in the PTSD symptoms, depression, and cravings between the two groups, which were controlled for during analyses. ANCOVA analyses indicated that SS was effective in reducing PTSD (p=.029) and Depression (p=.027) symptoms for this sample of incarcerated women, but not substance cravings. PTSD scores decreased by 18.5 units from pretest to posttest for the treatment group, while decreasing 14.2 units for the control group. Depression scores decreased by 10.1 units from pretest to posttest for the treatment group and decreased by 6.6 units for the control group. Women in the treatment group were extremely satisfied with the intervention, expressing that they learned coping skills and enjoyed making connections with others who had similar experiences.

Implications: As women’s presence in prisons is exponentially growing, often for crimes related to their survival strategies as a result of their severe polyvictimization, it is imperative to find effective ways to treat their growing needs. SS is a designed to promote trauma recovery, which was associated with decreased PTSD and depression symptoms for participants in this sample. This type of intervention may equip women with the tools needed to begin a journey toward recovery from their trauma, which could prevent reincarceration or recidivism for offenses previously utilized as coping skills (i.e., substance abuse).