The Sanctuary Model ® represents a trauma-informed and trauma-responsive method for creating or changing an organizational culture in order to more effectively provide a cohesive context within which healing from psychological and socially derived forms of traumatic experience can be addressed. The Sanctuary Model was originally developed in a short-term, acute inpatient psychiatric setting for adults who were traumatized as children The Model has since been adapted by residential treatment settings for children, shelters, group homes, outpatient settings, substance abuse programs, parenting support programs and has been used in other settings as a method of organizational change.
The Sanctuary Model is not a trauma-specific intervention but a way of reorganizing whole organizational cultures. We believe that is what a “trauma-informed and trauma-responsive” culture has to be – it requires a shift in the very foundations of the way we think, what we feel, how we communicate, and how we practice. The challenge for everyone in the mental health field is to consider how we unwittingly – and often in the name of science – erect barriers to recovery that prevent self-organization in the individual life of the children in our care and in our organizational lives as well. Our diagnostic categories shame children from the moment they enter care. Our rigid hierarchies prevent participation and innovation, when we need staff members to exercise almost constant creativity in order not to be drawn into traumatic replays of previous negative life experiences in the lives of the children and adults we serve. From chaos theory we are learning that “an organization – even one as small as a child – will spontaneously know how to reorganize in the face of a challenge, if the obstacles hindering its capacity to self-organize are removed.
These are some of the critical questions we address in the Sanctuary Model: How do we create treatment cultures that promote and support positive change in adults, families and ourselves?; How do we maximize each other’s strengths and minimize each other’s weaknesses?; How do we create workplace cultures that buffer us from the impact of repetitive stress so that we can be effective in helping our clients to recover? These tasks are too large to approach from an individual position. We have to make greater efforts to shape our organizational cultures to achieve more. Organizational culture matters because cultural elements determine strategy, goals, and modes of operating.
Deliberately creating specific kinds of cultures requires attending more to norms than to rules. Rules are directives for conduct that are imposed by the institution and enforced by the staff through a system of penalties. For people raised in unhealthy environments, status may be achieved by breaking the rules, not following them. Children and adults socialized in subcultures that place a high value on conning, challenging authority figures, aggression and disobedience are likely to use rule-based cultures as ways of proving that they can get around the rules, that they can successfully defy authority, that they can achieve power by breaking the rules. In such climates, the staff spend most of their time trying to enforce rules and applying sanctions.
In contrast, although norms also deal with standards of conduct, they do so through the group pressure that is exerted on individual members. Violation of norms leads to a loss of status not a gain. It is behavior that a group expects of its members. Creating and sustaining a normative culture requires a large up-front investment of time, energy and resources but in the long-term produces compound interest in the investment. To do so the desired culture must be explicit, consciously and deliberately planned to promote the objectives of the organization. It must be continually monitored both directly and indirectly, while any evidence of a weakening of the culture must produce an immediate, coordinated response by the entire organization. There must be a mechanism to regularly familiarize all members with the norms and it will probably be necessary to manipulate member pressures to insure that high status in the organization is closely associated with conformity to positive prosocial norms.
Creating Sanctuary” refers to the shared experience of creating and maintaining physical, psychological, social and moral safety within a social environment - any social environment - and thus reducing systemic violence. The seven commitments of Sanctuary are tied directly to trauma-informed treatment goals.
The philosophy of a therapeutic community is central to the Sanctuary Model . The Sanctuary Model challenges organizations to reexamine their basic assumptions concerning the extent to which social service environments promote safety and nonviolence across physical, psychological, social, and moral domains. As such, the intervention is aimed both at strengthening the therapeutic community environment and at empowering people to influence their own lives and communities in positive ways. The core values of a therapeutic community are: the community itself is the most influential factor on treatment; clients are responsible for much of their own treatment; the operation and management of the community should be more democratic than authoritarian; and clients can facilitate each others’ treatment.
The Sanctuary Model adds to these values an emphasis on creating a ‘‘living-learning environment’’ which is physically, psychologically, socially, and morally safe for both clients and staff. Establishing and maintaining a therapeutic community in the Sanctuary Model requires an active process of breaking down institutional, societal, professional, and communication barriers that isolate administrators, staff and clients. Simultaneously, the re-building process involves consciously learning new ways to relate as interdependent community members, creating and modeling healthy and supportive relationships between individuals, and developing an atmosphere of hope and non-violence.
A fundamental aim of the Sanctuary Model is to assist all kinds of organizations in the process of becoming trauma-responsive. A trauma-responsive environment deliberately sets about to minimize the risk of making things worse for the individuals or families who have experienced trauma and maximize the possibility of improvement while helping to guarantee safety and even recovery, for the workforce involved in providing services. Leadership training and development, skills for teamwork, cross-collaboration, and system integration all require time and sufficient freedom from immediate stress for the brains and minds of participants to engage in innovative and strategic change. Some of the greatest challenges to organizational change are the ethical problems and moral dilemmas that are rarely addressed in social service and health care environments when demands for productivity clash with patient care, even though those dilemmas powerfully impact the people delivering services as well as the clients receiving services (Bloom & Farragher, 2010; Pope, 2015). Some examples of where the allocation of resources that enables successful culture change includes all child welfare organizations including those involved with foster care; school settings where we know already there are likely to be high levels of ACEs among the children; hospital-based violence intervention programs, substance abuse programs, mental health delivery organizations, and juvenile and adult justice settings of all kinds. It is not sufficient for such organizations and systems to be trauma-informed. They need the resource allocation and leadership that enables them to become trauma-responsive.
Additionally, a trauma-responsive environment would create a dense network of connection with community resources who could provide actual trauma-specific treatment so that true recovery from traumatic experience is possible.
Bloom, S. L. (2016). "Advancing a national cradle-to-grave-to-cradle public health agenda." Journal of Trauma & Dissociation 17(4): 383-396.
Bloom, S. L. and B. Farragher (2010). Destroying sanctuary: The crisis in human service delivery systems. New York, Oxford University Press.
Pope, K. S. (2015). "Steps to strengthen ethics in organizations: Research findings, ethics placebos and what works." Journal of Trauma & Dissociation 16(null): 139-152.