Sanctuary has been practiced most extensively in residential settings. Although it was created in an inpatient hospital unit, most of the implementation process, training materials and manuals were created as it was adapted for use with youth in residential programs. This is also the setting that has been most widely researched with regard to the implementation and outcomes of Sanctuary. The 24 hour nature of residential treatment also offers a unique setting in which to examine organizational dynamics and interventions. Because residential programs provide a multidisciplinary staff to provide services and a relatively long course of treatment, they are great settings for Sanctuary’s integration. Residential programs offer the experience of community, which is the primary vehicle for healing in Sanctuary. Residential programs often have the benefit of family involvement, so are able to do work with families as children begin their transitions home.
Residential settings also present some unique challenges to the integration of Sanctuary. The need for constant supervision of the children can create challenges for release time, training time and opportunities for direct care workers to participate. In addition, the children’s constant exposure to each other creates a crucible effect that can sometimes result in explosive or deleterious interactions. On the flip side, the constant exposure to therapeutic staff and a community of safety over the course of months or years can create long-lasting changes in brain structure, thinking and behavior.