Sanctuary in a residential treatment center: creating a therapeutic community of hope countering violence
Authors: Kramer Michael George 
Published: May 2016

Purpose
– The purpose of this paper is to present insights into how and why the Sanctuary and SELF models are effective in decreasing trauma symptoms with a population of court-committed male adolescents in a residential treatment program. The Sanctuary model is a trauma-focussed, trauma-sensitive, organizational change model, and treatment protocol approach to working with clients who have experienced trauma, loss, and toxic stress to the degree that they interfere with social and personal functioning. The SELF model within Sanctuary is a treatment protocol that is an acronym for the organizing categories of safety, emotion management, loss, and the future. In essence, Sanctuary’s purpose is to create therapeutic community.

Design/methodology/approach
– Qualitative research methods of observation of groups and meetings, content analysis of existing quantitative data and agency documents, focus groups with staff and residents, and individual interviews with staff were utilized.

Findings
– Data show that the Sanctuary model ameliorates the symptoms of complex trauma. The substantive theory that emerges is that relational and neurological integration and recovery occur in the lives of residents as shaped first by the therapeutic community that supports the level of interpersonal relationships experienced with staff within a therapeutic milieu, along with shaping the organizational culture.

Research limitations/implications
– As a complex intervention, it is evident that reducing the Sanctuary model into its component parts cannot capture fully the essence of the intervention. A complex system can never be understood fully by observing it at single points in time.

Practical implications
– It is suggested that future research and programmatic planning within this therapeutic community need to demonstrate how to continue enhancing staff-resident relational integration vis-à-vis staff training and vehicles that offer residents more of a representative voice while in placement.

Social implications
– It is suggested that future research and programmatic planning within this agency need to demonstrate how to continue enhancing staff-resident trauma-informed therapeutic milieus and relational integration vis-à-vis staff training and vehicles that offer residents more of a representative voice while in placement.

Originality/value
– This is a unique study in that it employs qualitative methods to explore how and why the Sanctuary model contributes to its working in a residential treatment facility. The Sanctuary model is the only trauma-informed organizational intervention of its kind, with limited published evaluations in the current literature (Esaki et al., 2013). This study used focus groups with residents and staff that allowed them to influence the research and its processes. The residents expressed their views about the experience of being placed outside of their homes and of living in a therapeutic community within the Sanctuary Network. Staff spoke of aspects of working in a trauma-informed milieu and its effect on clients, colleagues, and the organization as a whole.