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Reports on Children Exposed to Violence (CEV) and Department of Justice initiatives for Defending Childhood recognize that trauma and delinquency are related. From these perspectives, the emphasis on punishment and social control in child care and juvenile justice has shifted to a focus on the importance and effectiveness of prevention and treatment. The use of sanctuary and trauma-informed care represent emergent interventions that treat youthful offenders as victims of trauma. In this paper, the authors describe the organizational culture and youth responses to a trauma-focused approach at a residential facility that utilizes the Sanctuary Model to treat offenders with posttraumatic stress and mental health diagnoses. They also consider the challenges of treating acute trauma and posttraumatic stress in adolescent males in a residential setting.