KidsPeace and the Sanctuary® Model: Helping Families Find Peace
By Leslie Tenbroeck, LCSW

Raheem Khawaja* was a troubled boy who came to KidsPeace in the fall of 2009. Raheem’s family had emigrated from Pakistan shortly after his birth; he had no conscious memories of living in Pakistan and was grounded in American culture… skateboarding, cartoons and McDonald’s. Raheem had done very well at his local elementary school, which was located within walking distance from his new home. His father walked him to school in the morning, and his mother was waiting at home for him when he returned afterwards. Raheem did well academically and had many friends. It seemed like middle school would be a smooth transition. However, problems started almost immediately in the fall of his sixth grade year. Raheem was suspended twice for fighting on the bus. His grades dropped, and he became moody and unhappy. His parents grew concerned. What was wrong with their son? When they asked him, he had no answers. His pediatrician assured them that the onset of puberty often produced such changes in behavior… this reassured them, for a time. Then, following another bus incident, Raheem was suspended for bringing a knife to school. The guidance counselor insisted that the parents take their son to the emergency room to obtain a psychiatric evaluation. It was then that Raheem was admitted to the KidsPeace Hospital for treatment.

Raheem was pleasant and cooperative during his stay. He followed the rules and did not exhibit any behavior problems. The Treatment Team had a difficult time understanding why this cheerful boy was having such a difficult time at school. The therapist gathered a comprehensive history of Raheem’s experiences, and everything she was told appeared to support the story of a developmentally normal, healthy boy. Then she asked Raheem’s parents about their own lives. Suddenly, the picture began to change. Mr. Khawaja’s face grew troubled; his wife looked down at her hands entwined in her lap. In halting English, Mr. Khawaja began to talk about living in Pakistan during war. “We lost our home,” he explained, “As many did. Raheem was born in the basement of a building that had been bombed. There was nowhere safe to go, and my wife couldn’t travel in her condition. The neighbors helped us.” The clinician asked gently, “Did you lose many people who you cared about?” Mrs. Khawaja began to cry. Her husband merely responded, “It was very bad. Ever since we were young. We came here and were very happy to be in the United States.”
As the days went on, the clinician worked closely with the Khawaja family, and significant issues emerged. Living in a war zone where they feared for their lives, and the lives of their loved ones, every day had emotionally traumatized Raheem’s parents. Their experiences of terror, loss and catastrophe had shaped the way they responded to the world. They thought that all of these problems would disappear when they came to America, and what they found was that the fear and panic that they’d learned to live with came to America with them. Raheem’s parents lived every day in fear and he, living with them, did as well.

The events that this family experienced create a tragically familiar story to many of the professionals who work in mental health treatment. A traumatic event is defined as a single experience, or an enduring series of events, that completely overwhelm the individual’s ability to cope¹. Traumatic events include some of the experiences that we least like to think about: Violent crime, natural disasters, accidents, wars, community violence, child physical and sexual abuse, bullying and domestic violence. While there are many different situations that can be considered traumatic, these events have one thing in common: They are events that cause overwhelming feelings of fear, helplessness and/or horror.² Think of the victims of concentration camps; the earthquake survivors in Japan; Viet Nam veterans.

We are only beginning to understand the role that traumatic events play in the development of mental health problems, substance abuse and disruptive and dangerous behaviors. Severe and chronic trauma may lead to physical changes inside the brain and to the brain’s chemistry, which damage the person’s ability to adequately cope with stress. This is particularly problematic for children. Children who have witnessed or have been victims of interpersonal and community violence, have been neglected or have suffered terrible losses often present with a wide range of emotional and behavioral problems ³.

Children, like Raheem, can also suffer from secondary or “vicarious” trauma. This form of traumatization impacts people who are in a close relationship with traumatized individuals. Raheem’s parents’ experience of terror and loss had resulted in changes in their entire approach to life. Mrs. Khawaja in particular was afraid to leave the house. Moreover, she was terrified to let her child out of her sight and would panic when she put him on the bus in the morning. Mr. Khawaja was working two jobs and feared that he could at any time lose his jobs, and his family would again be homeless. Raheem told the clinician that he wished he didn’t have to go to school; he believed that he was safer at home, with his parents, and that they needed his help.

What is significant about Raheem’s situation is that the clinician asked this family about their history of trauma. In many cases, such information is overlooked as frustrated parents, overworked professionals and harried teachers focus on more immediate approaches to behavior. Often, the child is punished by suspensions or expulsions; various medications are tried without a thorough understanding of the problem; or the behavior is minimized or ignored until it becomes a significant threat to the safety of the community.

At KidsPeace, we recognize the role of trauma in the lives of the children and families who come to us for help, and we treat the entire family. The Sanctuary® Model, which is being implemented as the model of care at KidsPeace, provides the tools and the theory to help us to create a culture of safety, empowerment and positive change. This model teaches that, in order to recover from trauma, people need to live in a community of supportive people who are committed to their growth and healing. While KidsPeace strives to provide that for our children, we recognize that the best place for a troubled child to heal is in a safe, supportive family; and the best place for a troubled family to heal is within a safe, supportive community. KidsPeace is committed to using the Sanctuary Model, its theories and its tools to help our community become one where children and families, like the Khawajas, find peace.

For more information on the Sanctuary Model, visit the site or contact the author at 800-25PEACE.

¹Van Der Kolk, B.; McFarlane, A.; Weisaeth, L., Eds. (1996). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. New York: Guilford Press.
²Bloom, S. L. (1997) Creating Sanctuary: Toward the Evolution of Sane Societies. (1997). New York: Routledge.
³Farragher, B. and Yanosy, S. (2005). Creating A Trauma-Sensitive Culture In Residential Treatment. Therapeutic Community: The International Journal for Therapeutic and Supportive Organizations 26(1): 97-113.

Leslie Tenbroeck, LCSW, Sanctuary® Coordinator and Clinical Instructor at KidsPeace, has over 20 years experience working in the mental health field with a broad range of direct-care experience with children and families. Ms. Tenbroeck has extensive experience in crisis management; she has taught courses in Handle with Care and Professional Crisis Management and is currently a certified instructor for Life Space Crisis Intervention. She has taught courses in conjunction with the American Health institute, the Penn State Cooperative Extension and Norwich University. She is affiliated with the Sanctuary Institute and is an advocate for trauma-informed care. For the past nine years, she has been teaching and assisting in developing curriculum for direct care staff in multiple areas of instruction related to children’s developmental and behavioral health, including the treatment of self-injurious behavior, therapeutic relationships, group therapy and trauma treatment. She is currently the designated coordinator for the implementation of the Sanctuary Model at KidsPeace. Ms. Tenbroeck lives in Allentown, PA, with her husband and two sons.