Introduction

The Residential Care (CIC) and Secure Care Services Sanctuary Framework, (the Framework), describes the overarching model and core elements that guide how the Department of Communities, (the Department), therapeutic residential care services operate. The Framework is based on the principles of the Sanctuary Model, and is informed by contemporary research and development from a range of disciplines and recognised international experts. It is the foundation of a coherent therapeutic approach to care and a trauma informed model that provides tools to address the impact of trauma at all levels of the organisation.

The Department provides Therapeutic Residential Care in 14 metropolitan homes that provide accommodation for up to 4 children aged between 10 and 17 years, 8 country Residential Care homes caring for up to 8 children with a range of ages and abilities and a Secure Care service for up to six children aged between 10 and 17 years deemed to be at extreme risk.   

The homes and the secure care facility are staffed by multidisciplinary teams including senior staff that are responsible for the operation of the facility and providing supervision and support.  Psychologists provide a therapeutic focus and support and oversee staff's therapeutic intervention with children and Education Officers provide assistance to staff and support children to access appropriate educational options.  The Aboriginal Practice Leader provides consultation support for therapeutic care planning  and assistance to staff in developing culturally safe practice. The Recreation Officer provides opportunities for young people to participate in tailored recreation programs, linkages to  community-based activities, as well as support to staff in the development of house activity planning.   The Senior Practice Development Officer provides programmatic support for policy development and staff practice advancement.  

All facilities operate within the principles of the Framework - a trauma-informed approach that supports the creation of a therapeutic environment for children, young people and staff.  The values and principles of Sanctuary are embedded into practice at all levels.  Care is provided in all these services by trained staff who undertake shifts using a rotating roster model.

The Residential Care Services leadership group which consists of the Director Residential Care, the Senior Consultant Psychologist, Assistant Directors, and the Business Manager manage the day-to-day operations as well as develop and contribute to policies and programs directly affecting the Directorate and the wider Department.  

The Context

Children and young people who have been neglected and/or abused may not function at their chronological age in terms of their physical, social, emotional or cognitive skills. It is therefore critical that caregivers are aware of the effects of maltreatment on the children and young people and that Residential and Secure Care staff are able to respond in considered and informed ways rather than react to the behaviours displayed by the children and young people. Many child protection interventions seeking to protect and support children and young people, such as removal from home and placement with strangers, as well as appearances in court, may  increase a child or young person's trauma. This is a common experience of many of the children and young people within Residential and Secure Care.

Healing from Trauma with the Sanctuary Model

The Sanctuary Model is a trauma informed model for creating an organisational culture that provides an environment within which healing from traumatic experiences can be addressed. The Sanctuary Model (originated in the USA in the 1980's it was created by Dr Sandra Bloom and her colleagues) is comprised of four pillars:

Pillar One - Trauma Theory:

Understanding Trauma theory begins with initial training for all staff. It includes; learning about the Impact of Trauma on children and youth; Introduction to the Sanctuary Model; and Therapeutic Crisis Intervention training which incorporates trauma theory in its practice model.

Each child's trauma history, including triggers and coping strategies are explored and documented to provide a shared understanding for all staff.   This is the foundation of practice that is based on awareness of what has happened to the child and being able to see escalations and reactivity as pain based behaviour. Trauma informed responses contribute to emotional healing.

Each child also has a safety plan based on their trauma and behavioural history. This creates a shared understanding of what triggers may lead to escalations and suggested responses to ensure safety for children and staff. The plans are regularly updated based on observations and information provided by the child and other significant people.

Pillar Two - The S.E.L.F Framework:

The Safety, Emotion, Loss and Future Framework (SELF) is incorporated into the spoken and written language in all residential care services.  Using SELF to organise the complex individual needs of each child helps staff to make trauma informed, therapeutic responses and interventions. Problem solving at all levels of the organisation is supported using SELF to ensure a holistic and considered outcome. The adoption of Sanctuary based shared language encourages trauma informed therapeutic discussions and guides and shapes policy development, care practice, and all interactions with internal and external stakeholders.

Pillar Three - The Seven Commitments:

Complementing the Departmental values of Integrity, Respect, Courage, Empathy Accountability, Trust and Empowerment; the Seven Sanctuary Commitments are integral to the creation and maintenance of a culture that supports healing from trauma.

These guiding commitments, (Democracy, Open Communication, Social Learning, Emotional Intelligence, Nonviolence, Social Responsibility and Growth and Change) provide a structure for staff to commit to, which in turn promotes the concept of practice community Residential Care (CIC) Services and Secure Care Services.  Working in a way that honours each of these commitments is viewed as a continual challenge, only possible through regular reflective practice and accountability for all members.  This occurs through team meetings, supervision, and informal reflection and discussion.

Pillar Four - Sanctuary Tools:

Using a range of practical interventions and tools, staff and children in the organisation are supported to use and reflect on the core Sanctuary principles and maintain fidelity and consistency in all areas. 

Community Meetings: Held daily or more often if opportunities present, staff and children have the opportunity to identify and share emotions and goals as well as identify others within their community who can provide support. 

Team meetings: Structured to allow staff to reflect on the work, discuss team functioning, share ideas and challenges and reflect on therapeutic care practice.

Red flag reviews: Are used in response to any issues or critical incidents.  The meetings follow a clear protocol and focus on solutions rather than problems.

Self-care plans: All staff and children create and carry with them their own individual plan to support appropriate and safe management of stress or negative emotions.  Health and wellbeing self-care plans: All staff and children are supported to create a broad range of strategies, activities and resources that support physical, social, psychological and moral safety both at work and at home.

S.E.L.F reviews: Documentation and planning documents reflect the SELF framework as a way of organising complex challenges for children, staff and the organisation

BEST SELF Sanctuary Psychoeducation: Children residing in Residential and Secure Care services participate in fun, interactive and meaningful activities that explore the impact of trauma on their lives.  Focusing on all four pillars of the Sanctuary Model psychoeducation sessions provide opportunities for reflective learning.

Supervision: Individual, group, formal and informal opportunities for supervision are provided to staff, allowing a great deal of flexibility and responsiveness.  Supervisors raise awareness of vicarious trauma prevention and self-care as well as areas of therapeutic care practice

Training: All new staff are provided with comprehensive training prior to commencing work in Residential Care or Secure Care.  All staff are provided ongoing opportunities for learning both formal and informal. 

Core Team: A range of staff from all levels of the organisation meet monthly to ensure the ongoing maintenance of the Sanctuary framework in practice.  All staff are able to contribute via smaller groups that feed into the Core Team.

Staff Therapeutic Behaviours with the Children and Young People

Some of the key behaviours that staff can employ with young people that will make a difference to their sense of safety, healing and day to day behaviour include the following:

• Listening and responding with respect to young people helps them to develop a sense of dignity, a sense of being valued as persons, a sense of self-worth.
• Communicating a framework for understanding with young people helps them to develop a sense of meaning and a sense of the rationality within daily life.
• Building rapport and relationships with young people helps them develop a sense of belonging and connectedness with others. 
• Establishing structure, routine and expectations with young people assists them to develop a sense of order and predictability in the world, as well as a sense of trust in the reliability of others.
• Inspiring commitment in young people encourages them to develop a sense of value, loyalty and continuity.
• Offering young people emotional and developmental support helps them to develop a sense of caring and mastery.
• Challenging the thinking and actions of young people helps them to develop a sense of potential and capability.
• Sharing power and decision-making with young people encourages them to develop a sense of personal power and discernment.
• Respecting the personal space and time of young people helps them to develop a sense of independence.
• Discovering and uncovering the potential of young people helps them to develop a sense of hope and opportunity.
• Providing resources to young people helps them to develop a sense of gratitude and generosity.
  

Measurable and observable indicators of success:

• Reduction in violence (physical, verbal, emotional).
• A system understanding of the impact of trauma.
• Reduction in victim blaming: reduced punitive and judgemental responses.
• Clearer, more consistent boundaries and higher expectations (linked to rights and responsibilities).
• Earlier identification of, and strategies to deal with, perpetrator behaviour.
• Better ability to state clear goals, create strategies for change, justify need for a holistic approach.
• Understanding of repeat behaviour and resistance to change.
• More democratic environment at all levels.
• Improved outcomes for children, staff and the organisation.

Reference:

Sandra L Bloom (2005), The Sanctuary Model of Organisational Change for Children's Residential Treatment, Therapeutic Community: The International Journal for Therapeutic and Supportive Organisations

Dr James Anglin (2004) School of Child and Youth Care, University of Victoria Canada.