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Yet there are <jats:italic>no<\/jats:italic> evidence\u2010based treatments for <jats:italic>any<\/jats:italic> behavioural health condition that have been evaluated for use with Deaf people. The driving aim of our work, therefore, has been to develop and formally evaluate a Deaf\u2010accessible trauma\/SUD counselling approach. Here we describe our initial intervention development work and a single\u2010arm pilot that evaluated the feasibility, acceptability, and preliminary clinical efficacy of <jats:italic>Signs of Safety<\/jats:italic>\u2014a Deaf\u2010accessible toolkit to be used with an existing, widely adopted protocol for trauma and addiction (<jats:italic>Seeking Safety<\/jats:italic>). Preliminary efficacy results indicated clinically significant reductions in PTSD symptoms and frequency of alcohol use for the <jats:italic>Seeking Safety\/Signs of Safety<\/jats:italic> model. Frequency of drug use did not change significantly\u2014likely attributable to the mid\u2010study legalization of recreational marijuana in our state. Next steps include the redesign and refilming of <jats:italic>Signs of Safety<\/jats:italic> based on pilot participant feedback, again using a Deaf\u2010engaged development and production process. This new toolkit will be tested via a pilot randomized controlled trial designed based on present methodological lessons learned.<\/jats:p>","DOI":"10.1002\/cpp.2596","type":"journal-article","created":{"date-parts":[[2021,4,13]],"date-time":"2021-04-13T23:49:28Z","timestamp":1618357768000},"page":"1562-1573","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Developing <i>Signs of Safety<\/i>: A Deaf\u2010accessible counselling toolkit for trauma and addiction"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6141-5013","authenticated-orcid":false,"given":"Melissa L.","family":"Anderson","sequence":"first","affiliation":[{"name":"University of Massachusetts Medical School (UMMS) Implementation Science and Practice Advances Research Center (iSPARC)  Shrewsbury MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil S.","family":"Glickman","sequence":"additional","affiliation":[{"name":"University of Massachusetts Medical School (UMMS) Implementation Science and Practice Advances Research Center (iSPARC)  Shrewsbury MA USA"},{"name":"Advocates  Framingham MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly S.","family":"Wolf Craig","sequence":"additional","affiliation":[{"name":"University of Massachusetts Medical School (UMMS) Implementation Science and Practice Advances Research Center (iSPARC)  Shrewsbury MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda K.","family":"Sortwell Crane","sequence":"additional","affiliation":[{"name":"National Deaf Therapy  Evergreen CO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander M.","family":"Wilkins","sequence":"additional","affiliation":[{"name":"University of Massachusetts Medical School (UMMS) Implementation Science and Practice Advances Research Center (iSPARC)  Shrewsbury MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Najavits","sequence":"additional","affiliation":[{"name":"University of Massachusetts Medical School (UMMS) Implementation Science and Practice Advances Research Center (iSPARC)  Shrewsbury MA USA"},{"name":"Treatment Innovations  Newton Centre MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,24]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.5935\/0946-5448.20170004"},{"issue":"1","key":"e_1_2_8_3_1","first-page":"133","article-title":"Nature and treatment of comorbid alcohol problems and post traumatic stress disorder among American military personnel and veterans","volume":"38","author":"Allen J. 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