Sanctuary Institute: The Sanctuary Model

"A traumatic experience impacts the entire person – the way we think, the way we learn, the way we remember things, the way we feel about ourselves, the way we feel about other people, and the way we make sense of the world..."

- Sandra Bloom, M.D.

The Sanctuary® Model is a blueprint for clinical and organizational change which, at its core, promotes safety and recovery from adversity through the active creation of a trauma-informed community. A recognition that trauma is pervasive in the experience of human beings forms the basis for the Sanctuary Model's focus not only on the people who seek treatment, but equally on the people and systems who provide that treatment.

The Sanctuary Model originated in the Philadelphia area in the early 1980s, created by a team of clinicians working in a small inpatient adult hospital unit. This team, led by Dr. Sandra Bloom, combined their clinical knowledge with their own experiences to create a trauma-informed program they called Sanctuary.

Today, after over twenty years of adaptation built on its original design, the Sanctuary Model has reached across the human services system. In an effort to create safe and healing environments for children, families and adults who have experienced chronic stress and adversity, the Sanctuary Model is being used across a wide range of settings, including: residential treatment, juvenile justice, drug and alcohol treatment, school and community-based programs, partial hospitals, domestic violence and homeless shelters.

Creating Sanctuary in an organization is not a textbook or manualized protocol, but an organic process that happens over the course of time to move an organization toward creating a trauma-informed culture. A trauma-informed organization is one that recognizes the inherent vulnerability of all human beings to the effects of trauma and organizes system-wide interventions aimed at mitigating the negative effects of adversity and stress that are manifested in the clients served and the organization itself.

Simply explained, the Sanctuary Model is comprised of three primary components:

1. Theoretical philosophies which form the underpinnings of the model

2. The trauma-informed shared language represented by the acronym SELF

3. A set of practical tools, known as the Sanctuary Tool Kit

1. Theoretical Underpinnings

The three theoretical foundations of the Sanctuary Model are drawn from of trauma theory, business theory, systems theory and perspectives from the work of Therapeutic Communities in the UK. The Sanctuary Model uses concepts from these sources to focus on the effects of trauma exposure, parallel process and the Seven Sanctuary Commitments as the basic tenets of the model.

The Effects of Trauma Exposure: The Sanctuary Model identifies the experience of trauma along a wide continuum that includes both discrete events and ongoing, cumulative and perhaps intangible experiences like racism and poverty. Trauma is defined as an experience in which a person's internal resources are not adequate to cope with external stressors. Trauma theory suggests that many of the behavioral symptoms that we see in individuals are a direct result of coping with adverse experiences. What we identify as maladaptive behaviors are really misapplied survival skills. For example, when we see aggression in a client toward others in circumstances in which aggression is not warranted, trauma theory proposes that during a traumatic experience, a person may rely on aggression in order to survive. Changes in brain chemistry that result from the trauma can cause that person to perceive threat when it does not exist and apply the survival skill of aggression in other stressful situations. An example might be a child who has been physically abused who responds to teasing by a classmate with physical aggression - a "fight or flight" response to stress. In order to intervene effectively, we must move from a position of blame to one of questioning; Sanctuary recommends changing the central question we ask about clients from "What's wrong with you?" to "What's happened to you?" as the first step in recognizing the influence of the past on current behaviors and functioning.

Parallel Process: The Sanctuary Model recognizes that just as human beings are susceptible to the misapplication of survival skills, organizations themselves are equally vulnerable. This understanding is reflected in the recognition that there is a parallel between the traumatic symptoms we see in clients and those that we see in an organization. Just as we see individuals who have experienced trauma responding with isolative behavior and withdrawal from the community, we also see organizations facing financial or political stressors respond with isolationism, rigidity and hierarchical decision-making. Intervening in this parallel process requires shifting behaviors and thinking to align with a specific set of values.

The Seven Sanctuary Commitments: The set of values that Sanctuary outlines as a way to lead individuals and organizations away from trauma-reactive behaviors are the Seven Sanctuary Commitments. These commitments, adapted from work done in the UK by Therapeutic Communities, are defined as follows:

Commitment to Nonviolence: building and modeling safety skills

Commitment to Emotional Intelligence: teaching and modeling affect management skills

Commitment to Inquiry & Social Learning: building and modeling cognitive skills

Commitment to Democracy: creating and modeling civic skills of self-control, self-discipline, and administration of healthy authority

Commitment to Open Communication: overcoming barriers to healthy communication, reduce acting-out, enhance self-protective and self-correcting skills, teach healthy boundaries

Commitment to Social Responsibility: rebuilding social connection skills, establish healthy attachment relationships

Commitment to Growth and Change: restoring hope, meaning, purpose

2. The Shared Language of SELF

Human service organizations often employ professionals from a wide range of specialized backgrounds and orientations. Sometimes these varied professionals speak in terms that are not clear to each other or to the people they serve. The Sanctuary Model has constructed an acronym, SELF, which stands for safety, emotion management, loss and future. These four components are the organizing framework for treatment planning, community conversations and collaborative decision-making, and allow providers to focus on the most important aspects of helping people heal from trauma in a simple and accessible way.

3. Tool Kit

The Sanctuary Tool Kit is a set of practical and simple interventions that reinforce the language and philosophical underpinnings of the Sanctuary Model. These tools, community meetings, safety plans, SELF treatment planning conferencing, team meetings, self-care planning, SELF psycho-education are the daily practices for both staff and clients that support an organization's creation of a trauma-informed culture.

When an organization makes the commitment to implement Sanctuary, trains its staff in the philosophical underpinnings, embraces the language of SELF, and uses the Sanctuary tools, its members can expect to see improved outcomes for clients, improved staff retention and satisfaction, and decreased violence. While many models address the individual and group treatment needs of vulnerable clients, Sanctuary is unique in that it instructs leaders and community members not only in the treatment of clients, but also in creating safer, better-functioning organizations.