The Sanctuary Model as Organizational Operating System
Although the roots of the Sanctuary Model go back to Moral Treatment and Quaker philosophy of the 18th century, the Sanctuary Model was originally developed in a 
short-term, acute inpatient psychiatric setting for adults who were traumatized as children and functioned from 1980 - 2001 [1-4]. The Model is currently being adapted by a number of programs around the country and in several international sites. Programs for serving children and adults in psychiatric, substance abuse, and shelter settings have begun to recognize that a high proportion of their clients are trauma survivors and that sending staff to learn various treatment techniques or creating specialized projects was not going to be enough to create a trauma-informed culture.
In 2000, we began the implementation process at the Andrus Children’s Center creating a multidisciplinary Sanctuary Facilitation Team representing every level of the organization, which then took on the responsibility of training the entire staff in the Sanctuary Model [6]. Although the implementation processes in the two organizations varied, the assumptions, goals and practices that describe the Sanctuary Model are the same. Although these programs focused on children’s treatment, we have found that the organizational dynamics are similar regardless of the population the organization is designed to serve.
Embedded in the history of residential treatment settings for children – and of virtually all human service delivery systems - are many debates about how treatment should be delivered and what constitutes treatment [7]. It was clear from the initiation of our current projects that these debates continue to surface in a number of ways: lack of a clear, consistent, comprehensive and coherent model for delivering care that could be shared by staff, children, and families; lack of communication and feedback between and among component parts of the system; conflicts between various levels of staff as to what defines therapy; hierarchical management structures that encourage obedience to authority but do not encourage initiative, innovative problem-solving, or direct conflict resolution; a relative inability to sufficiently address the enormity of trauma-based problems in the people’s lives; only partially effective methods for dealing with aggressive acting out; and unclear ideas about what constitutes success in these programs.
It became clear that three essential tasks need to be accomplished: 1) the development of a model of intervention that could be broadly applied across the population, could be shared between staff, children and families; would be consistent with established good practice, and would allow for the uniqueness of each setting; 2) practically integrating the system by developing better communication networks, feedback loops, shared decision making, and conflict resolution practices; and 3) using the developed infrastructure to synthesize a variety of treatment approaches and techniques into a progressive map of recovery for each child. The Sanctuary Model as applied to adults had evolved throughout twenty-two years of experience and had previously only been replicated in a state hospital unit for adults and a longer-term program for adults in Canada and although the process of system change had been described it had not been previously systematized [2, 8-10]. What has emerged from our experience to date is a plan, process, and method for creating trauma-sensitive, democratic, nonviolent cultures that are far better equipped to engage in the innovative treatment planning and implementation that is necessary to adequately respond to the extremely complex and deeply embedded injuries that our clients have sustained.
The Sanctuary Model as Organizational Operating System
The Sanctuary Model is an operating system for a trauma-informed organization. It is designed to get a number of people, from diverse backgrounds, with a wide variety of experience, on the same page, speaking the same language, living the same values, sharing a consistent, coherent and practical theoretical framework. It functions underneath all the other things that go on in a treatment program – all the approaches, kinds of therapy, techniques – as long as those are compatible with the Sanctuary operating system.
In the Sanctuary Model, we believe that organizations, like individuals, are alive. We use an everyday analogy to mediate between two conceptual frameworks – the computer. Computers are machines and yet scientists are on the verge of integrating these machines components into human bodies and are using living systems as models to improve machines, a field known as bionics. Until recently androids, synthetic organisms designed to look and act like human beings, and cyborgs, beings that are partly organic and partly mechanical, have been relegated to the world of science fiction. But there is now global competition to produce robots that are increasingly like living beings, modeled on the way living systems work.
Brains Have Things In Common: A Computer Metaphor
References
- Bloom, S.L., The Sanctuary Model: Developing Generic Inpatient Programs for the Treatment of Psychological Trauma, in Handbook of Post-Traumatic Therapy, A Practical Guide to Intervention, Treatment, and Research, M.B. Williams and J.F. Sommer, Editors. 1994, Greenwood Publishing. p. 474-49.
- Bloom, S.L., Creating Sanctuary: Toward the Evolution of Sane Societies. 1997, New York: Routledge.
- Bloom, S.L., Creating Sanctuary: Healing from systematic abuses of power. Therapeutic Communities: The International Journal for Therapeutic and Supportive Organizations, 2000. 21(2): p. 67-91.
- Bloom, S.L., Creating Sanctuary: The Active Development of Nonviolent Environments. www.pointtopointlearning.com, 2003.
- Rivard, J.C., et al., Assessing the Implementation and Effects of a Trauma-Focused Intervention for Youths in Residential Treatment. Psychiatric Quarterly, 2003. 74(2): p. 137-154.
- Bloom, S.L., et al., Multiple opportunities for creating sanctuary. Psychiatric Quarterly, 2003. 74(2): p. 173-190.
- Abramovitz, R. and S.L. Bloom, Creating Sanctuary in a residential treatment setting for troubled children and adolescents. Psychiatric Quarterly, 2003. 74(2): p. 119-135.
- Bills, L. and S. Bloom, Trying out Sanctuary the hard way. Therapeutic Communities: The International Journal for Therapeutic and Supportive Organizations, 2000. 21(2 (Special issue)): p. 119-134.
- Bills, L.J. and S.L. Bloom, From Chaos to Sanctuary: Trauma-Based Treatment for Women in a State Hospital Systems, in Women's Health Services: A Public Health Perspective, B.L. Levin, A.K. Blanch, and A. Jennings, Editors. 1998, Sage Publications: Thousand Oaks, CA.
- Wright, D.C. and W.L. Woo, Treating Post-Traumatic Stress Disorder in a Therapeutic Community: The Experience of a Canadian Psychiatric Hospital. Therapeutic Communities: The International Journal for Therapeutic and Supportive Organizations, 2000. 21(2): p. 105-118.
