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ences and inadequate role models; and (7) are likely to have experienced significant loss while lacking the emotional capacity to grieve, are likely to repeat the experiences that are a part of their past, and often lack any hope that the future will be any better than the past. In this way, children’s lives become “trauma-organized” as their attempts to cope with unmanageable conditions lead to maladaptive coping skills and the development of problematic habits. If we are to address the complex needs of these children, our goals must be aimed at resolving the difficulties that exposure to toxic stress creates. To accomplish this in a group setting, much is demanded of managers, therapists, caregivers , and educators. We must teach, role-model, and support the development of (1) safety skills and significant improvements in the capacity for interpersonal trust; (2) emotional management skills, including self-control, self-discipline, and the exercise of willpower; (3) cognitive skills, including identifying triggers and problematic patterns, while still being able to think in the presence of strong emotion; (4) communication skills that include rehearsals in what to say and how to say it; (5) participatory and leadership skills; (6) judgment skills, including socially acceptable and fair behavioral schemas; and (7) skills to manage grief and plan for the future. Trauma-Organized Staff Promoting healing in children who suffer from these kinds of interactive and complex challenges is not so much a technical problem as an adaptive one, meaning that every child is different and the moment-to-moment opportunities presented in the constant interactions between child and adult staff members offer chances for a ceaseless array of corrective emotional, cognitive, behavioral, and spiritual experiences (Bloom & Farragher, 2013). What characteristics best OUTLINING THE CHALLENGES Trauma-Organized Children The children who arrive for placement in a residential program or group home are there because each one has problems that are exceedingly complex, that cannot be managed in a less restrictive level of care, and that pose significant difficulties for the adults in their lives. When one hears the histories of the multiple adversities to which these children have been exposed, it may be relatively easy to explain how they could come to have such problems. More challenging, however, may be trying to explain how they have survived the terrors of their lives. The simultaneous realities of complex and interactive developmental problems that affect children’s bodies, minds, and spirits alongside the resilience of individual children and of childhood itself have implications for environments that set out to help heal those bodies, minds, and spirits. In brief, children who are admitted to group care environments (1) have difficulty with maintaining safety in interpersonal relationships, largely due to disrupted attachment experiences and the erosion of trust that accompanies such experiences; (2) have significant challenges in adequately managing distressful emotions in ways that are not self-destructive, including exercising the capacities for selfdiscipline , self-control, and willpower; (3) are beset by cognitive problems, particularly when stress occurs and the development of essential cortical functions has not gone as smoothly as it should; (4) frequently communicate through behavior, not directly, openly, or in words; (5) feel helpless and powerless in the face of a world that they perceive has been unjust and cruel and, as a result, may be repeatedly bullied or become bullies themselves; (6) frequently lack a clear sense of social responsibility, while moral development may have been affected by disrupted attachment experiThe Sanctuary Model Rebooting the Organizational Operating System in Group Care Settings SANDRA L. BLOOM, M.D. 11 110 Special Populations and Special Topics Trauma-Organized Organizations Actual rates of violence expose the problems with physical safety. But there are other safety issues as well that can be thought of as threats to psychological, social, and moral safety. Research in other industries has recorded the top workplace stressors, and although the area is insufficiently studied, anyone working in the health, education, social services, or mental health sectors can easily identify with these: too much to do in too little time; unnecessary, meaningless paperwork; random interruptions, such as telephone calls, walk-in visits, text messages, and emails; demands from supervisors; pervasive uncertainty as a result of organizational problems; unsatisfactorily explained and unannounced change; decreased funding; mistrust, unfairness, and vicious office politics; unclear policies and lack of organizational direction; career and job ambiguity resulting in feelings of helplessness and lack of control; lack of feedback , good or bad; absence of appreciation for work done; and lack...

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