Restoring Sanctuary: A New Operating System for Trauma-Informed Systems of Care PDF
Preview Restoring Sanctuary: A New Operating System for Trauma-Informed Systems of Care
RESTORING SANCTUARY This page intentionally left blank Restoring Sanctuary A New Operating System for Trauma-Informed Systems of Care Sandra L. Bloom , M.D. Brian Farragher , M.S.W., M.B.A. 1 3 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offi ces in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Th ailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016 © Oxford University Press 2013 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging-in-Publication Data Bloom, Sandra L., 1948- Restoring sanctuary : a new operating system for trauma-informed systems of care / Sandra L. Bloom, Brian Farragher. p. ; cm. Includes bibliographical references. ISBN 978–0–19–979636–6 (hardback : alk. paper) — ISBN 978–0–19–979649–6 (updf) — ISBN 978–0–19–997667–6 (epub) I. Farragher, Brian J. II. Title. [DNLM: 1. Mental Health Services—organization & administration. 2. Delivery of Health Care—organization & administration. 3. Models, Organizational. 4. Organizational Innovation. 5. Stress Disorders, Post-Traumatic—therapy. WM 30.1] LC Classifi cation not assigned 362.2068′5—dc23 2012029880 9 8 7 6 5 4 3 2 1 Printed in the United States of America on acid-free paper My heart is moved by all I cannot save: so much has been destroyed I have to cast my lot with those who age aft er age, perversely, with no extraordinary power, reconstitute the world. Adrienne Rich, 1977 From “Natural Resources” [1] This page intentionally left blank Contents List of Figures and Tables x v Prologue x vii 1. It Starts with a Dream 1 Creating Sanctuary 3 Trauma-Organized Individuals 3 A Humbling Experience 4 Trauma Th eory 5 Attachment and the Loss of Integrated Experience 6 Neither Sick Nor Bad, But Injured 7 A Stress Continuum 9 Healing = Integration 1 0 Broad Defi nition of Safety 1 1 Grappling with Complexity and Democracy 12 Destroying Sanctuary 1 3 Living Systems 1 3 Systems Under Siege 1 4 Workplace Stress, Bad Habits, and Parallel Process 1 4 Organizational Hyperarousal 1 5 Loss of Emotional Management 1 6 Organizational Learning Disabilities and Organizational Amnesia 17 Miscommunication, Confl ict, and Organizational Alexithymia 1 7 Th e Uses and Abuses of Power 17 Punishment, Revenge, and Organizational Injustice 1 8 Unresolved Grief, Reenactment, and Decline 1 8 Trauma-Organized Systems 19 Sanctuary Trauma 2 0 Restoring Sanctuary: Focusing on Organizational Culture 22 Can Computers Be a Useful Metaphor? 2 2 Hardware, Soft ware, and Operating Systems 23 Th e Human Operating System: Healthy Attachment 2 4 Th e Bad News: Trauma Is the “Virus” Th at Disrupts Attachment 24 vii viii Contents Organizational Culture: Th e Organizational Operating System 25 Changing Operating Systems: Developmentally Grounded and Trauma-Informed 26 Th e Impossibility of Engineering Human Service Delivery Change 2 6 Why Sanctuary? Why Now?: A Public Health Approach 2 7 Nobody’s Coming 2 7 Shift ing to Developmentally Grounded, Trauma-Informed Systems 2 8 Th e Good News: Most Human Dysfunction Is Preventable 2 8 Th e Sanctuary Model: A Parallel Process of Recovery 2 9 Chapter Summaries 3 1 2. Turning Imagination into Reality: A Vision of Health 33 “Healthy” and “Normal” 3 3 Th e Inevitability of Change 34 Healthy People Adapt to Changing Conditions 3 4 Healthy Organizations Have a Purpose and Can Adapt 3 5 Commitment to Growth and Change (Chapter 3) 3 6 Managing Power 36 Healthy People Value Diversity and Participation 3 6 Healthy Organizations Are Democratic 3 7 Commitment to Democracy (Chapter 4) 3 8 Envisioning Safety 3 8 Healthy People Are Safe and Secure 3 8 Healthy Organizations Are Safe 3 9 Commitment to Nonviolence (Chapter 5) 3 9 Emotional Intelligence 4 1 Healthy People Can Manage Th eir Emotions 41 Healthy Organizations Are Emotionally Well Regulated 4 1 Commitment to Emotional Intelligence (Chapter 6) 42 Learning All the Time 4 2 Healthy People Love Learning and Are Able to Adapt to Changing Conditions 4 2 Healthy Organizations Are Real-World Classrooms 4 3 Commitment to Social Learning (Chapter 7) 4 3 Th e Constancy of Communication 4 4 Healthy Human Beings Communicate Constantly, Verbally and Nonverbally 4 4 Healthy Organizations Encourage Conversation and Feedback 4 4 Commitment to Open Communication (Chapter 8) 4 5 Justice and the Common Good 4 5 Healthy People Are Socially Responsible and Care about Social Justice 4 5 Healthy Organizations Encourage Individual and Social Responsibility 4 6 Commitment to Social Responsibility (Chapter 9) 4 6 Contents ix Th e Sanctuary Model: Transforming Vision into Reality 4 7 Trauma Th eory 4 8 Th e Sanctuary Commitments 4 8 Leadership Commitment 5 1 S.E.L.F.: A Compass for the Recovery Process 5 3 Sanctuary Education and Training 5 5 Sanctuary Implementation 5 6 Th e Sanctuary Toolkit 5 7 Sanctuary Certifi cation 5 7 Sanctuary Network 58 Results of the Sanctuary Process 5 8 3. Growth and Change: Isn’t Th is the Whole Point? 6 3 A Vision of Growth and Change 6 3 What Do We Mean by Growth and Change? 64 A Boy Named Peter 6 4 Starting with the Future 66 Hope and Saying Goodbye to the Past 6 7 It All Starts with Being a Baby: Attachment and Development 69 Before We Have Words 6 9 Habits 7 0 Change, Attachment, and Loss 7 2 Sending Out Signals 7 3 Th e Commitment to Growth and Change and Trauma-Informed Practice 7 4 Traumatic Reenactment 74 Disrupted Attachment 7 5 Fear Conditioning 7 6 State-Dependent Learning 7 6 Th e Addictive Potential of Arousal 7 6 Loss of Language—Speechless Terror 7 7 Failed Enactment 7 7 Self-Fulfi lling Prophecies 7 8 Foreshortened Sense of Future 78 Putting It All Together in Peter’s Story 7 8 Organizational Commitment to Growth and Change 81 Recognizing Reenactment 8 3 Rescripting Reenactment 84 Implications for Growth and Change Leadership 8 6 Be the Change You Want to See 87 Leadership and the Emerging Future in Complex Organizations 8 8 Adaptive Versus Technical Problems 89 Sanctuary Toolkit for Growth and Change 91 Th e Reenactment Triangle 9 1 Red Flag and Green Flag Reviews 9 2
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