Andrus, a New York-based social services organization, has developed a concept based on the Sanctuary Model that delivers treatment to children and families with trauma histories, training to staff and organizations, and a healing approach that focuses on positives rather than negatives. Reimbursed mainly by Medicaid, school districts, and state contracts, Andrus is many things: a treatment provider, child-care provider, corporate trainer, and partner with schools.
The trauma-sensitive care promulgated by Andrus is based on the sanctuary-oriented framework of S.E.L.F. – Safety, Emotion, Loss, and Future. Not only is this framework the underpinning of its approach to treating patients, but it is also used in staff and family training (see Figure 1).
This fall, the New York State Office of Children and Family Services funded a partnership that linked Andrus and the Mount Vernon City School District, with a mission of building a safe and healing community in the classroom.
The one-year project, called “Creating Sanctuary in Mount Vernon Schools,” is designed to improve classroom management, decrease student suspensions, decrease unfounded calls to Child Protective Services, and reduce the number of children in special education classes. Through a $100,000 grant awarded to Andrus, which is based in Yonkers, and the nearby Mount Vernon School District, problematic behavior in elementary and middle school students will be addressed in a positive, healing way, say Andrus officials.
Andrus will provide professional development services in mental health and behavioral strategies to teachers, administrators, and support staff in the schools, helping them be more aware of the impact of trauma and adverse experiences on student behavior and academic performance. Using Sanctuary tools, they will learn to recognize and help students with traumatic histories while building a more cohesive and connected school culture.
Founded in 1928, Andrus is a family-centered organization that provides a range of social services to families and children. There are 14 locations in Westchester County, as well as the Andrus Center for Learning and Innovation and the Sanctuary Institute, which provides training and consultation to organizations on trauma-sensitive treatment models.
Since 2001, Andrus has been using the sanctuary model to “successfully transform the culture of an organization to create a trauma-informed culture,” said Lorelei Vargas, VP and Chief Strategy Officer (see Figure 2). The model involves a great amount of transparency in communications, she told Behavioral Healthcare. “We share things that a lot of organizations might think twice about sharing, with all staff.”
For example, community meetings are held throughout the organization, with questions such as “How are you feeling today? What is your goal for the day? Who will you ask for help?” asked frequently. “We ask those questions because we know about people who are experiencing stress become disconnected with how they are feeling,” said Vargas. That “disconnection” is contagious in an organization, she added.
‘Toxic stress’ equates to trauma
When Andrus officials talk about trauma, they consider the terms “toxic stress” and “adversity” interchangeable. There are children in the residential facility who have experienced trauma: chronic abuse, neglect, and “toxic household dysfunction,” said Vargas. But other children in “normative” populations, such as public schools, are also living with toxic stress, and nobody knows about it, she said. “Part of the work we’re trying to do involves getting better at screening children for toxic stress, and helping them to develop protective factors.”
It’s not just children and clients who are experiencing toxic stress, but staff and systems in general, said Vargas. In particular, the child welfare system, a system meant to intervene and help children, can be stressful and traumatic in itself, said Kerron Norman, Andrus’ vice president of Community Based Programs. Parents and children are threatened with being separated – what can be more traumatic to a child and family than that? Norman ran the Department of Social Services in Yonkers, and has seen how system-related stresses can impact children, she told Behavioral Healthcare.
In fact, Andrus has a contract with the Office for Children and Family Services to train and work with the Department of Social Services in Westchester County (where Yonkers and Mount Vernon are based) and Nassau County. “The goal is to try to create trauma-informed cultures in those offices,” said Norman. By helping child welfare organizations learn to tap into open communication that is needed to weather a crisis, Andrus can help staffers and clients alike. “We know that organizations that experience trauma mimic the people they are trying to help,” said Norman.
“We have to stop asking what’s ‘wrong’ with people,” said Norman – clearly disliking the “wrong” as an unfair term. “You look at a child who’s acting out in school, and the automatic response based on our cultural understanding would be, ‘What’s wrong with that child?’” But the question should be, “What has happened to that child?” Finding out about adverse childhood experiences will clarify how professionals can move forward.
Much of the work at Andrus is informed by the Adverse Childhood Experiences (ACE) study (see Figure 3), an ongoing collaboration between the federal Centers for Disease Control and Prevention and Kaiser Permanente. A brief summary of the ACE study and its implications is contained in a December 2012 article.
Range of services
Andrus has a residential treatment program with 73 beds for boys and girls ages 5 to 16. There are five cottages on the 107-acre campus. After treatment, which consists of intensive emotional, psychiatric, and/or behavioral care, the patients rejoin their families and home communities. The campus has a therapeutic motorbike program, a ropes course, gardens, farm animals, and therapy dogs as well as an indoor pool, movie theater, wooded hills, and a pond. The treatment team includes a psychiatrist, milieu therapists, a clinical social worker, a recreational therapist, and a program manager.
Special treatments to help autistic children, as well as children who have been traumatized, are focused on the Sanctuary Model, which promotes feelings of safety. Instead of restraints, treatment is based on family participation in the structure of the program. Using Therapeutic Crisis Intervention (TCI), an approach that avoids crisis and de-escalates difficult situations, the team aims to provide a stable structure.
Andrus operates three mental health clinics in Westchester County, where it offers individual, group, and family therapy. Trauma-informed care, cognitive behavioral therapy, and dialectical behavior therapy are among the tools used to help children and families.
Andrus has discovered that the children coming to the residential facility – who have been referred through special education committees, and whose treatment and schooling is paid for by public schools districts – can no longer be educated in public schools, said Vargas. Some can’t even live at home. About 80 are bussed in and live at home at night, and 70 live on campus seven days a week. “They’re diagnosed as severely emotionally disturbed – their families can’t manage their behaviors.”
What will help these children, so they can return to their families and schools, is to succeed, said Vargas. “A lot of these kids have never had the opportunity to experience success,” she said. For most of these children, success won’t happen in the classroom, so Andrus has developed other avenues, via greenhouses, farm animals, and gardens. By harvesting honey, caring for animals, and growing fruits and vegetables, the children can succeed and heal.
“There’s a growing body of research that is telling us that when bad things happen to children, it changes the architecture of their brain, and it alters their social and cognitive development,” said Vargas. School districts working with Andrus “get it – that you can’t have academic outcomes unless you have social and emotional wellness.”