Sanctuary for Youth 

By Pat Sullivan

The Sanctuary Model® is a residential intervention philosophy that forms the basis of treatment and community within the organization to focus on addressing the traumas in clients’ lives that have led them into residential treatment.

Developed 20 years ago for traumatized adults in psychiatric settings, Sanctuary has been modified to help youth who are suffering from trauma-based issues. According to Jeanne Rivard et al., children who are neglected, abused and exposed to violence are at greater risk of mental health issues, developmental delays and aggressiveness.

Essential to Sanctuary is forming a safe, nonviolent environment for clients and assisting them in forming healthy relationships with staff, who are role models for caring and safety. These tenets are taught to clients’ families as well to ensure that children return to nonviolent homes and caring family units. Sanctuary teaches kids to cope effectively with stress and trauma and heal their mental and behavioral health issues. It also teaches residential treatment facilities to form communities that are safe and caring and maintain a culture that reflects these qualities at every level within the organization.

Sanctuary teaches an understanding of trauma and its effects on clients and the entire organization. It also assumes that most children who are in treatment have experienced trauma, which, in turn, has caused or exacerbated their mental or behavioral issues. First, staff must understand that traumatized children act differently from other children in many ways including: They are likely to not avoid danger, may hurt themselves, do not learn from experience and are often unable to remember the worst things that have happened to them. According to Sanctuary, it is the responsibility of caretakers to change their approaches to treatment of traumatized children from viewing them as ill to viewing them as hurt.

Thus, instead of asking, “What is wrong with you?” clinicians ask, “What happened to you?” This removes the feeling the child may have that he is broken or sick and instead asks him to identify the external circumstances that brought him to treatment. This, in turn, prompts caretakers to begin the relationship with compassion and understanding.

In essence, Sanctuary brings a unifying model to staff and clients that makes them more aware of the impact of trauma on all aspects of their lives and treatment. Clients meet twice a day to talk about their feelings, which improves their ability to communicate and teaches them to identify maladaptive feelings throughout the day and discuss how these feelings affect their behaviors and relationships.

7 Commitments
The Sanctuary Model also contains seven commitments that serve as goals for resolving trauma-based issues:
1. Nonviolence
2. Emotional Intelligence
3. Social Learning
4. Social Responsibility
5. Shared Governance
6. Open Communication
7. Growth and Change.

Trauma-induced mental and behavioral issues are treated using a framework called S.E.L.F., which is applicable to all clients, their families and treatment staff. The clients and staff form a community in their unit, house or group and have two daily community meetings to discuss how the group is doing. S.E.L.F. is defined as follows:
• Safety • Emotions • Loss • Future.

These components chart the journey clients take to heal and change their behaviors and choices in order to keep themselves safe. The operative word is change, which should be positive and measurable. The premise is to develop treatment to address what happened in the child’s life rather than the child’s current behavior issues. Sanctuary-trained staff are expected to be role models for healthy relationships among clients and treatment providers and to make safety and non-violence major priorities across the milieu.

Safety Plans
Developing safety plans for clients and staff members is a core component of the Sanctuary Model. These plans are constantly evolving and basically outline what triggers anger in an individual and contain internal de-escalation techniques for clients to use until they can get help from staff. On a daily basis, the safety plan that the client carries in his pocket reminds him of what his triggers are and lists relaxation techniques to help calm him down and keep him safe. These techniques distract clients from focusing on what is upsetting them and helps them internalize de-escalation techniques that keep them safe during potentially dangerous situations. As clients proceed through treatment, these triggers change, sometimes on a daily basis, and so do the techniques they use to address their triggers.

By training all levels of staff in the Sanctuary Model, the ultimate outcome is a safer facility with fewer client restraints and a less stressful environment for clients and staff. The Treatment Planning Conference includes staff, clients and families gathering to discuss past interventions, the goals of current treatment and the elements of S.E.L.F.

Red Flag Reviews are meetings called to allow the team to discuss a “critical incident” that has occurred or is about to occur in a client’s life. Everyone who deals with the client professionally is present, and, when appropriate, the client and family attend as well. A critical incident may include trying to run away from the treatment facility, failure to return from a home visit, escalated aggression, self-harm or knowledge of upcoming bad news that may adversely affect the child’s progress. Team members discuss how to deal with the incident and receive assignments on which they report back after completion.

Psychoeducation Groups meet 12 times to teach clients about the Sanctuary Model and how stress and trauma affect how they act, feel, think and behave toward others. The groups stress safety, recovery, coping strategies, personal boundaries and dealing with grief and loss. These sessions provide youth with decision-making and problem-solving skills; enhance their social, emotional and moral intelligence; help them build self-esteem; prepare them for traumatic experiences; improve their abilities to change their behaviors, participate, negotiate and resolve conflicts; and to give them hope for the future.

A vital element of the model is the “Community Meeting,” which takes place twice daily in each house and involves input from all clients and staff members regarding personal and group goals and is structured to make all participants feel safe and unthreatened. These meetings serve to reinforce the sense of community and form stronger bonds among participants. During the meetings, each client is asked three questions: “How are you feeling?” “What is your goal for today?” “Who will you ask for help?” These meetings foster the ability in clients to communicate their feelings and to identify maladaptive feelings throughout the day. Each client sets daily goals and tracks his or her own progress toward those goals throughout the day.

Sanctuary in Practice
The Sanctuary Model was implemented at the KidsPeace Broadway Campus in Pennsylvania during the summer of 2008 and will be introduced at additional campuses and programs in 2009. The model fits very well with the existing KidsPeace Positive Youth Environment (PYE), which stresses a proactive approach to promoting a healthy and positive living environment and a sense of community responsibility and cohesiveness. It also complements the KidsPeace Treatment Stages component that stresses goal attainment and rewards progress toward treatment goals.

Although it has only been used for a short time, KidsPeace is collecting data on the affects of Sanctuary to analyze with an empirically supported tool over the next year. This will give KidsPeace a sense of how well the model is working to reduce incidents by heightening awareness and understanding the role that trauma plays in clients’ lives.

In real world terms, the Sanctuary Model builds upon and supports the KidsPeace clinical mission to provide quality evidence-based treatment to children and adolescents. It helps staff conceptualize clients’ psychological and behavioral functioning in a common language and from a common perspective.

Andrus Children’s Center/Community Works. (2007). Sanctuary Leadership Development Institute Implementation Guide.
Rivard, Jeanne C., Ph.D., Bloom, Sandra L., M.D., Abramovitz, Robert, M.D., Pasquale, Lina E., M.A., Duncan, Mariama, M.S.W., McCorkle, David, M.S.W., and Gelman, Andrew, Ph.D. (Summer 2003). Assessing the Implementation and Effects of a Trauma-Focused Intervention for Youths in Residential Treatment. Psychiatric Quarterly, Vol. 74, No 2 (137–154)

Rivard, Jeanne C., Ph.D., McCorkle, David, M.S.W., Duncan, Mariama E., M.S.W., Pasquale, Lina E., M.A., Bloom, Sandra L., M.D., and Abramovitz, Robert, M.D. (October 2004). Implementing a Trauma Recovery Framework for Youths in Residential Treatment. Child and Adolescent Social Work Journal, Vol. 21, No. 5 (529-550).