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

> **NIH NIH R34** · UNIV OF MASSACHUSETTS MED SCH WORCESTER · 2020 · $419,343

## Abstract

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.

## Key facts

- **NIH application ID:** 9976408
- **Project number:** 5R34AA026929-03
- **Recipient organization:** UNIV OF MASSACHUSETTS MED SCH WORCESTER
- **Principal Investigator:** Melissa Lee Anderson
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $419,343
- **Award type:** 5
- **Project period:** 2018-08-10 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9976408

## Citation

> US National Institutes of Health, RePORTER application 9976408, Piloting Signs of Safety: A Deaf-Accessible Therapy Toolkit for Alcohol Use Disorder and Trauma (5R34AA026929-03). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/9976408. Licensed CC0.

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