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This paper describes methods being used to implement and assess the effects of a trauma-focused intervention in residential treatment programs for youths with emotional and behavioral problems, and histories of maltreatment and exposure to family or community violence. Preliminary baseline profiles of the therapeutic environments and youths are also presented. The intervention, referred to as the Sanctuary Model (Bloom, 1997), is based in social psychiatry, trauma theories, therapeutic community philosophy, and cognitive-behavioral approaches. Within the context of safe, supportive, stable, and socially responsible therapeutic communities, a trauma recovery treatment framework is used to teach youths effective adaptation and coping skills to replace nonadaptive cognitive, social, and behavioral strategies that may have emerged earlier as means of coping with traumatic life experiences.

This article describes the experience of five change agents from a diverse group of settings: two residential treatment programs for children and adolescents, a group home for disturbed adolescents, a residential substance abuse program for urban women, and an acute care psychiatric inpatient unit. What all of these innovators share is a willingness to engage in the challenging and complex process of changing their systems to better address the needs of the traumatized children, adolescents, and adults who populate their various programs. Using the Sanctuary Model as originally applied to a specialty inpatient psychiatric program for adult survivors of childhood abuse as their guide, the leaders of each of these organizations discuss the process of change that they are directing.