Model of care
Sanctuary Model of Care
The Sanctuary Model is a whole of system, trauma informed model of care that strives to actively create and sustain non–violent, democratic, and therapeutic environments. The Sanctuary Model works to develop an environment in which the organisation, leaders, staff and clients are empowered as key decision-makers to build responsive, emotionally-intelligent communities that value growth and change (Bloom 1994, p. 4).
Trauma-informed organisational leadership
Organisational culture arises out of the people, history, memory, experiences and formal structures of the organisation. It is the foundation of the organisation’s identity (i.e. who it claims to be) and the health and wellbeing of its clients and staff (i.e. what the organisation claims to do). In their seminal work, Destroying Sanctuary (2011), Bloom and Farragher identify that the level of stress being experienced by organisations often mirrors the stress being experienced by traumatised service users. An organisation that exhibits the symptoms of stress and trauma will struggle to implement organisational culture change (pp. 189 – 190).
The Sanctuary Model offers an explanation for the lack of faith and trust within often chronically-stressed human service organisations that makes the introduction of any change difficult (Bloom, 1994). There are a number of factors that make implementing change challenging within human service organisations, such as funding reductions, staff turnover and workload pressures, and they need to be considered as part of the initial environmental workplace assessment to support implementation.
These challenges may be underestimated by leaders and key decision-makers. Uncertainty is a significant contributor to the perception of stress and there is nothing more uncertain in corporate life than organisational change (Bloom and Farragher 2011, p. 88).
For sustainable change to occur, the Sanctuary Model identifies the requirement for a whole of organisation approach, which means addressing the existing hierarchy, power relations, and conflicting values and priorities of the organisation. The use of a shared language, emotional intelligence, open communication and non-violence are necessary pre-conditions for sustainable change.
Theoretical underpinnings of the Sanctuary Model
The Sanctuary Model applies the key concepts of Trauma Theory, namely Traumatic Re-enactment, Parallel Process, Collective Disturbance and Vicarious Trauma.
The Seven Sanctuary Commitments
The Seven Sanctuary Commitments provide the guiding principles to support the development of a trauma-informed organisational environment that is safe at all levels for clients, staff and teams (Bloom, 2005).
||Being safe physically, emotionally, socially, culturally and morally
||Managing our feelings so we do not hurt ourselves or others
||Respecting and sharing the ideas of our teams
||Developing shared decision making and a flattened hierarchy across the team, organisation or community
||Saying what we mean and not being mean when we say it
||Together we accomplish more and everyone makes a contribution to the organisational culture
|Growth and Change
||Creating hope and a sense of future for our clients, staff and the organisation
The shared language of SELF
As human service organisations often employ people from a diverse range of specialisations and backgrounds, the Sanctuary Model encourages the use of a shared language that is simple and accessible to ensure practitioners focus on the most important aspects of helping people heal from trauma. In this regard, Sanctuary constructed the acronym S.E.L.F, which stands for safety, emotion management, loss and future, the four components of the organising framework for treatment planning, community conversations and collaborative decision making.
Sanctuary tools provide practical and concrete ways to operationalise the values of the Sanctuary Model and promote trauma-informed practice to clients, staff, teams and the wider organisation. Sanctuary tools include community meetings, care planning, safety plans, self care plans, team meetings, red flag meetings and psycho-educational group work. The Sanctuary Model recognises that the process of implementation will be unique for each organisation and therefore does not prescribe a manualised treatment approach.
Impact on clients
The diagram below shows the research evidence about the Sanctuary Model and its impacts on clients:
(Yanosy, S et. al. 2014, p. 27)
Bloom, S (1994) Creating Sanctuary: Toward the Evolution of Sane Societies. Routledge, New York and London.
Bloom, S. L. (2005). The Sanctuary Model of Organizational Change for Children’s Residential Treatment.
Therapeutic Community: The International Journal for Therapeutic and Supportive Organizations 26(1): 65-81.
Bloom, S and Farragher, B. (2011) Destroying Sanctuary: The Crisis in Human Service Delivery Systems. Oxford University Press, Oxford.
Bloom, S and Farragher, B. (2013) Restoring Sanctuary: A New Operating System for Trauma-Informed Systems of Care. Oxford University Press, New York.
Yanosy, S, Harrison, L and Bloom, S (2014) Sanctuary Implementation Workbook, Edition 1. Sanctuary Institute, Yonkers, New York.