Sanctuary Staff Training Manual
Indirect Care Staff Training Manual
Handouts
Module 1 Handouts
Module 1 Practice Handout – A Poem
Autobiography in Five Chapters
By Portia Nelson
I walk down the street
There is a deep hole in the sidewalk
I fall in
I am lost…I am helpless
It isn’t my fault
It takes forever to find a way out.
I walk down the same street,
There is a deep hole in the sidewalk
I pretend I don’t see it
I fall in again
I can’t believe I am in the same place
But it isn’t my fault
It still takes a long time to get out
I walk down the same street
There is a deep hole in the sidewalk
I see it is there
I still fall in…it’s a habit
My eyes are open
I know where I am
It is my fault
I get out immediately
I walk down the same street
There is a deep hole in the sidewalk
I walk around it
I walk down a different street.
Module 1 Discussion Handout – Exploring Organizational Values
1.
What are the current organizational values – formal and informal? (mission statement and policies vs.
arriving early and working late, having a degree)
2. How are indirect care providers viewed in the organization?
3. How are the values communicated formally and informally? (dress code standards, expectations for
timeliness of some things but not others)
4. What are some of the subtle ways that values are communicated? (who parks where, office size, etc.)
5. Do people tend to break into silos or work across departments? Which departments tend to be most
isolated?
6. How do people communicate with each other in your indirect care departments? Is e-mail the primary
way or do you have face to face opportunities?
7. What are these face to face opportunities like? Formal vs. informal?
Module 2 Handouts
Module 2 Toolkit Handout
Sanctuary Implementation Standards Specific to Indirect Care/Support Services
(Standards that are specific to direct care providers have been bracketed and shaded gray.)
Standard 1: Safety - Policies, procedures and practices protect physical, moral, emotional and social safety, including,
but not limited to respect for culture and diversity as well as diversity of belief and opinion.
Standard 2: Emotion Management - Policies, procedures and practices are sensitive and mindful of the effects of
overwhelming experiences, including trauma and chronic stress. In addition, the organization has clear expectations about
emotion management, is responsive to and has mechanisms for helping people cope with emotion.
Standard 3: Loss - Policies, procedures, and practices help the community identify, cope with and adapt to the tangible
and intangible losses experienced by those who are served by and those who provide services within an organization.
Standard 4:
Future - The organization is dedicated to co-creating change, embracing and reclaiming vision, planning
change, learning from struggle, and finding hope in an effort to maximize the potential of all members of its community.
Standard 5: Physical Safety - Policies, procedures and practices that actively promote the physical well-being of all
members of the community through health practices, facility structure and avoidance of physical injury or threat.
Standard 6: Psychological Safety - The organization strives to provide an environment in which all members of the
community have a sense of self-efficacy, self-confidence, self-esteem and self-determination.
Standard 7: Social Safety - The organization strives to provide an environment in which all members of the community
experience predictability in their routine, an appropriate level of trust in their caregivers and peers.
Standard 8: Moral Safety - The organization strives to provide an environment in which all members are expected to act
in an ethical way and in which unethical behavior is identified and addressed by the community.
Standard 9: Abuse of Power - Abuse of power is monitored and confronted when appropriate
Standard 10: Nonviolent Interventions - The organization supports the use of nonviolent interventions.
Standard 11: Leadership Accessibility - Leadership is accessible and receptive of critical feedback from every level of
the organization.
Standard 12: Regulating Affect - Staff are expected to regulate affect to avoid interpersonal or job stress from impacting
clients, and clients are expected to manage affect in appropriate ways.
Standard 13: Philosophy of Trauma as a Human Condition - A philosophy or perspective is promoted throughout the
organization that the sequelae of trauma is a universally human condition rather than pathology.
Standard 14: Use of Tools by Leadership - Leaders use the Sanctuary tools and processes to manage affect in the
organization and serve as role models in emotion management
Standard 15: Training in Sanctuary - There is institutional support for comprehensive and adequate training in the
Sanctuary Model available to all stakeholders.
Standard 16: Culture of Inquiry - The community promotes a culture of inquiry, where members recognize that
behavior has meaning.
Standard 17: Training and Education vs. Discipline and Punishment - There are policies and practices that address
mistakes with training and education before discipline and punishment.
Standard 18: Confronting Others and Questioning Authority - The organization encourages discussions about safety
and risk-taking in confronting others or questioning decisions made by those in authority.
Standard 19: Participatory Leadership - Leadership is participatory and collaborative; decision-making and problem
solving are done collaboratively.
Standard 20: Involvement in Decisions - Efforts are made to involve all stakeholders in decisions that impact the wider
organizational community.
Standard 21: Collaboration in Performance Improvement - Performance evaluation/improvement processes for
individuals and the organization as a whole are done on a collaborative basis.
Standard 22: Shared Information - Managerial information and issues that affect the community as shared with the
whole community when legally possible.
Standard 23: Discussion of Difficult Topics - Difficult subjects can be and are discussed (i.e. problematic interpersonal
relationships, gender differences, prejudices, racial biases, etc.) among staff and with clients during meetings.
[Standard 24: Client Care Information - Client care information is shared among key participants in treatment.]
Standard 25: Staff/Client Access to Leadership - Staff and clients/students/families have the opportunity to interface
with agency leadership.
Standard 26: Transparency and Clarity - The agency strives for transparency and clarity of information whenever
legally appropriate.
Standard 27: Forums for Information Sharing - There are regular forums for all staff and clients to share information.
Standard 28: Conflict Resolution - Conflicts are resolved by members at the level of impact.
Standard 29: Maintenance of the Physical Environment - Stakeholders at all levels commit to maintaining the physical
environment.
Standard 30: Supervision – All staff have regular supervision which includes discussion of SELF in relation to the work.
Standard 31: Community and Group Meetings - Community issues are dealt with in group meetings.
Standard 32: Sanctuary Outside of Direct Service - The organization strives to incorporate the Sanctuary Model
beyond the services it provides and into all areas of business.
Standard 33: Sanctuary Work Plan - Leadership has a work plan for ongoing adaptation and sustaining the Sanctuary
model in the organization.
Standard 34: Annual Reviews - Programs conduct annual reviews of goals, challenges and successes.
Standard 35: Resistance to Change - Factors that contribute to resistance to change (ie: learned helplessness,
homeostasis of systems) are identified and resolved within the context of the Sanctuary principles.
[Standard 36: Active Role of Clients in Treatment - Clients/students are active participants in their treatment and take
responsibility for their care]
Module 3 Handouts
Module 3 Practice Handout
Bob and June Scenario
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Have you ever experienced being perceived as Bob or June?
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What was that like?
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What is the stress in the workplace for you? How do you find yourself “reacting” (fight, flight or
freeze)?
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How do we build safety nets with each other?
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What helps you in those moments? Consider the following:
o Staying calm
o Acting differently than what you would normally do (fight, flight or freeze!)
o Using your own safety plan
o BANC: Breathe, Accept, Notice and Choose
o What helps you? What can you change?
Module 4 Handouts
Module 4 Discussion Handout
Reenactment
Looking at Your Own Vulnerability
1.
Which role in the reenactment triangle do you think you are most likely to fall into at work?
2. What are some of the qualities you have that make you vulnerable to falling into this role?
3. What behaviors in other staff members are most likely to trigger you or push you into one of these roles?
4. How might a co-worker best intervene with you if you if he/she feels that you are engaged in a
reenactment?
Module 5 Handouts
Module 5 Practice Handout
Talking About Power
1) At your agency, how can you tell who has the power? How do people in different positions show the
power they have/ How do people recognize and respond to shows of Power?
For example, they have the nice, big offices. They sit behind a desk when they talk to you. Staff “yes” the
leaders and don’t challenge any abuses of power.
2) What are some of the leadership styles you see in your organization? How would you describe your
leadership style? How might others describe your leadership style? How do these different ways of
leading influence perceptions about power?
For example, someone who is more democratic may be perceived as abdicating his or her power while
and autocratic leader may be viewed as powerful.
3) How do relatively “powerless” people exercise power at your agency?
For example, relatively “powerless” people form sub-groups of peers to form their own shared values
and practices.
4) What are some ways power is abused at your agency? How do people recognize abuses of power, and
respond to them?
For example, administrative decisions about budget are only shared with supervisors. Abuses of power
are recognized by relatively “powerless” staff because they are good detectors of unfairness. They may
respond by feeling demoralized which gets played out in their interactions with clients.
Module 5 Discussion Handout
Dog Whisperer Video Clip: Emily
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What sorts of assumptions do we make about people who come to work here or who come here for
help?
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Do we ever ask what has happened to them – what their last working environments were like? What
their experiences may have been before joining our teams?
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Do you see people falling into old patterns like Emily did when her owners came to visit?
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How would you describe the ways that your department’s community helps new people when they
come in?
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What kinds of leadership styles work best for you?
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What kind of leadership style do you have?
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Are there leadership styles that you find anxiety producing or difficult to manage?
Module 6 Handouts
Module 6 Practice Handout
Collective Disturbance Worksheet - Handout 1
Group
Behavior
Leaders
Staff
Clients
Two staff members are
reported to have stolen
money from the petty
cash box used for
recreation trips.
Emotions
Module 6 Discussion Handout
Collective Disturbance Worksheet - Handout 2
Group
Leaders
Staff
Clients
Behavior
Emotions
Module 7 Handouts
Module 7 Toolkit Handout
My Personal Self-Care Plan
Personal Physical
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Engage in self-care behaviors
Physical activity – exercise, dance, strenuous manual labor
Reconnecting with one’s body – massage, yoga
Take care of oneself physically; use physical means to find adrenalin highs
Maintain a high-energy level through proper diet, sleep, exercise
List the Personal Physical components of your self-care plan:
__________________________________________________________________________________________
__________________________________________________________________________________________
Personal Psychological
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Identify those triggers which may cause one to experience vicarious traumatization
Get therapy if personal issues and past traumas get in the way
Use one’s own self-soothing capacities in a positive manner
Know one’s own limitations
Keep the boundaries one sets for self and others
Maintain an ability to see gray
Know one’s own level of tolerance
Engage in healing activities that renew meaning of life both in therapy and out of therapy settings.
Listen to music
Spend time in nature
Take a vacation
Read for pleasure
Balance work, play, and rest
Engage in practices that renew a cherished sense of identity or extend one’s identity beyond that of
someone who works with trauma
Engage in activities that allow one to feel particularly like a man/woman or that allow one to be in a
dependent or receiving role
Engage in creative endeavors
Play and laugh
Develop personal rituals to ensure safety and empowerment
Dream
Journal
Modify one’s own work schedule to fit one’s life
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Consider joining a creative therapy group
List the Personal Psychological components of your self-care plan:
__________________________________________________________________________________________
__________________________________________________________________________________________
Personal Social
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Identify one’s own personal and social resources and supports and then plan strategies for their use.
Engage in social activities outside of work
Garner emotional support from colleagues
Garner emotional support from family and friends
Spend time with children, pets
List the Personal Social components of your self-care plan:
__________________________________________________________________________________________
__________________________________________________________________________________________
Personal Moral
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Adopt a philosophical or religious outlook and remind oneself that he/she cannot take responsibility for
the client’s healing but rather must act as a midwife, guide, coach, mentor
Clarify one’s own sense of meaning and purpose in life
Develop one’s spiritual side as a grounding tool
Connect with the larger sociopolitical framework and develop social activism skills
List the Personal Moral components of your self-care plan:
__________________________________________________________________________________________
__________________________________________________________________________________________
Professional
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Become knowledgeable about the effects of trauma on self and others
Attend workshop/conference
Attempt to monitor or diversify case load
Seek consultation on difficult cases
Get supervision from someone who understands the dynamics and treatment of PTSD
Join supervision/study group
Use – don’t ignore - case consultation and supervision that you get
Read relevant professional literature
Take breaks during workday
Have hope in the ability of people to change, heal, grow
Admit it when one does not know an answer or makes a mistake
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Develop strategies to stay present during therapy sessions, even when hearing or seeing the horrors
others have experienced
If one feels overwhelmed in a therapy-related matter, break the task(s) down into manageable
components; apply case management strategies
Diversify interests to include balance, including materials read or workshops attended and between
personal and professional lives.
Modify one’s own work schedule to fit one’s life
Develop strategies to stay present during therapy sessions, even when hearing or seeing the horrors
others have experienced
Know one’s own level of tolerance
Recognize emotional, cognitive, and physical signs of incipient stress reactions in self and in colleagues
and respond appropriately
Do not limit clinical practice to only PTSD clients – balance victim and nonvictims case loads
Limit overall case loads.
Recognize you are not alone in facing the stress of working with traumatized clients – normalize your
reactions.
Remind oneself of the health in the person’s story
Use a team for support
Where indicated, use debriefing
Consider time-limited group approach with clinicians who have a history of trauma.
Become knowledgeable about PTSD – seek professional training
Join a network of others who work with PTSD population
Maintain collegial on the job support thus limiting the sense of isolation
Understand dynamics of traumatic reenactment
List the Professional components of your self-care plan:
__________________________________________________________________________________________
__________________________________________________________________________________________
Organizational / Work Setting
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Accept stressors as real and legitimate, impacting individuals and group-as-a-whole
Work in a team
Create a culture to counteract the effects of trauma
Consider developing Assaulted Staff Action Program
Alter physical setting to be more secure, safe, and soothing
Establish a clear value system within your organization
Develop clarity about job tasks and personnel guidelines
Obtain supervisory/management support
Maximize collegiality
Encourage democratic processes in decision-making and conflict resolution
Emphasize a leveled hierarchy
View problem as a problem for the entire group, not just an individual problem
The general approach to the problem is to seek solutions, not assign blame
Expect high level of tolerance for individual disturbance
Express support clearly, directly and abundantly and through tangible behavioral response like providing
resources – helping with paperwork, making phone calls, providing back-up
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Communicate openly and effectively
Expect a high degree of cohesion
Expect considerable flexibility of roles
Join with others to deal with organizational bullies
Eliminate any subculture of violence and abuse
Create a culture of nonviolence
List the Organizational components of your self-care plan:
__________________________________________________________________________________________
__________________________________________________________________________________________
Societal
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General public and professional education about PTSD and secondary traumatic stress
Find a mission – become politically and socially engaged
Encourage local, state, and national organizational to education professionals and nonprofessionals
about trauma
Community involvement
Coalition building
Legislative reform
Social action
Rescuing efforts directed at any oppressed or traumatized group
Bearing witness and seek justice.
Share and transform suffering through the use of the arts
Political action
List the Social/political components of your self-care plan:
__________________________________________________________________________________________
[i]
Riley S. An art psychotherapy stress reduction group: for therapists dealing with a severely abused client population. Arts in
Psychotherap, 1997, 23:407-415
[ii]
Flannery, R. B. Becoming Stress-Resistant: Through the Project SMART Program. New York: Continuum, 1990; Flannery, R. B.,
P. Fulton, J. Tausch, A.Y. DeLoffi. A program to help staff cope with psychological sequelae of assaults by patients. Hospital and
Community Psychiatry, 1991,. 42(9): 935-938; Flannery, R. B. Violence in the Workplace. New York: Crossroad, 1995; Flannery, R.
B. The Assaulted Staff Action Program: Coping With The Psychological Aftermath Of Violence. Ellicott City, MD: Chevron
Publishing Co, 1998.
[iii]
Bloom, SL. Practicing Sanctuary: Creating and Maintaining Safe Environments. Unpublished manuscript.