AOAV: all our reportsImprovised Explosive Devices2013 Boston Marathon Bombings report

Blood on the Streets of Boston: the Provision of Services

This report is part of AOAV’s research on the bombing at the Boston Marathon in 2013. The full report, ‘Blood on the Streets of Boston’, can be read here. The main findings and summary can be seen here. The report considered the mental health support offered to survivors and witnesses, for more on this see here. As part of the report it AOAV also researched the medical care and financial support provided to survivors – this report can be read here – and the health impacts the bombing had – here. It was also important to consider the ‘Victims’ Voices’, from those who survived the attack. To read these please go here, here, and here.

The Provision of Services

Overall the services available to survivors and 
the wider community can be applauded. While few new services were established specifically in response to the bombings, existing services were utilised largely successfully to provide support to survivors, their families and the wider community.

Immediate Support

Federal and State organisations came together to provide support for the families of those who had been killed and injured in the attacks. Immediate support needs included reunification with family members, emergency financial assistance, mental health support, and being made aware of existing services which were available.

AOAV spoke to the Boston Public Health Commission (BPHC), Office of Public Health Preparedness, which is funded through federal grants to the State. The BPHC, through its Medical Intelligence Center (MIC), coordinated the immediate response from the American Red Cross, the Boston Athletic Association, the Massachusetts Departments of Mental Health and Public Health, as well as federal departments and other services.

Atyia Martin, Director of the Office of Public Health Preparedness, told AOAV that a family reception center was set up by 7pm on the day of the bombing to serve as a ‘one-stop-shop’ for the families of those who had been physically injured. A multitude of Federal and State departments, as well as victim support organisations, based them- selves there in the days following the bombings.34

Family Assistance Center

It was decided by the Office of Public Health Pre- paredness that a longer term Family Assistance Center was needed in order to support those who had been injured and their families. At this Center, which was established in the days after the bombing, Federal, State and City representatives were all under one roof, including the Red Cross, the Salvation Army, the BPHC, Attorney General’s Office, the FBI, the Police Department, the Massachusetts Office for Victim Assistance (MOVA), and mental health workers.

The Center was intended to assist only those physically injured and the family members of those in hospital. It was a confidential center, the location of which was kept secret from the public and the media. Family members could talk to the FBI, find out about mental health services, and receive emergency vouchers for things like transportation and food from the Red Cross. Other problems were identified and dealt with at the Family Assistance Center, such as tax deferment and housing needs.

Immediate financial assistance was available at the Center, as was information about longer-term financial support. The Red Cross provided financial grants to 41 families to cover costs such as clothing, food, hotel stays, travel and health co- pays. Lisa Solecki, from the AGO told AOAV that they were instantly aware that the Office would play a role in providing such assistance to survivors and their families through the VCF. The AGO was present at the Family Assistance Center, both to assist family members with filling out victim compensation forms, and to identify the scale of assistance that would likely be required.

It was quickly recognized that those who had been physically injured and their family members would likely face mental health and psychological issues. Mental health workers were present at 
the Family Assistance Center, as were resources to help family members identify mental health services they could utilise. The US Department of Health and Services sent 24 mental health workers who were specially trained in mental health counselling for disasters and incidents such as the Newton mass shootings. The BPHC ensured that individuals were assigned a mental health worker to walk them through the process at the Center so that they had constant support.

The Family Assistance Center was open for 10 days, and during that time helped 80 families.

Donna Ruscavage, Director of the Family Assistance Center as of June 2013, put together a Resource and Recovery Guide that consolidated all the information survivors would need about the services to which they could be connected through the BPHC.

Karen Brassard, who was injured alongside six family members and friends, talked to AOAV about her experience with the services provided. She said that the Center made her aware of all of the available services. “From the beginning,” victims knew that any lawyers, doctors and nurses they might need were available at no cost. Healthcare, mental health and trade professionals were at the Center, and they had a process whereby survivors had access to all the information needed in one place. Karen was “incredibly pleased” with what was made available; “I don’t know how much more they can do…everything that the State has been doing,
I see it as a gift, something that they didn’t have to do.” She told AOAV that she feels very supported by the State, and that if she needs anything she can just pick up the phone. “I really feel like they are there. If I need anything, they’re there.”

The Boston Survivor Accessibility Alliance

Some survivors, such as those with single or double amputations, were going to have a huge amount of difficulty living in their own homes. Thomas G. Gatzunis, Commissioner of the Massachusetts Department of Public Safety, had the idea of bringing together architects, engineers, contractors and trade organisations to help the survivors. The architectural community in Boston had the same idea and reached out to the Department. Together they created the Boston Survivors Accessibility Alliance, an alliance which provides voluntary home improvement services to survivors.

Commissioner Gatzunis told AOAV that the Alliance was given $250,000 funding through the legislature, but those carrying out the work have provided all other services voluntarily. There was also a single one off private donation of $100,000. The Alliance offers services to any survivor who was physically injured in the attacks, whose injury necessitates a modification to their home. Once an application form is filled out an architect is assigned to the project and ultimately it becomes a construction project based on the needs of the survivor. The Alliance was able to get the various building permit fees waived for these home modifications. As well as those involved in the construction industry, members of the Boston Bar Association have donated their time and services to assist with services such as drawing up contracts.

The work that the BSAA can do ranges from installing visual smoke detectors for those who are hearing impaired, to complete remodels for those who suffered amputations. The Alliance has worked on homes that survivors will only be staying in temporarily while they look for permanent, more accessible, accommodation. One survivor was unable to access her second floor bedroom, leading her dining room to be converted to a substitute bedroom. Her husband had to carry her on his back when she needed to go upstairs. The Alliance installed a stairlift in her house, so that her family could return to some kind of normalcy while they waited to move into their new house. Ten of the 17 who suffered amputations have been directly helped by the Alliance. While help is avail- able to those who have suffered from less severe injuries, only amputees have so far requested assistance from the BSAA.

Judicial Assistance

Those in the legal profession recognized that those who were physically injured, and those otherwise impacted by the bombings, were potentially going to need help with legal matters. Both the Boston Bar Association (BBA) and the Massachusetts Bar Association (MBA) reached out to attorneys in their Associations, asking for volunteers to work on specific issues such as property damage and privacy issues. Around 70 lawyers volunteered with the MBA and a similar number volunteered with the BBA. The services they provided to survivors and those impacted by the bombings were provided voluntarily, at no cost to the survivors. Lawyers were matched with clients on the basis of their knowledge and expertise.

Initially, it was anticipated that survivors might need assistance due to unemployment, problems with debt, housing problems, property damage issues and personal injuries. The BBA began by focusing on the businesses in the vicinity of the bombing which were damaged, resulting in a loss of business or damaged property, although they ultimately represented individuals as well as businesses.

AOAV spoke to Chris Strang, a lawyer who volunteered through the BBA and assisted five different survivors who wanted advice about privacy issues. Due to the attorney-client privileged relationship he was limited in what he could discuss, but he told AOAV that some survivors were very uneasy about the extent of publicity they were inadvertently faced with. The bombings gained a huge amount of media attention. Survivors’ photos, names, and personal details were splashed across front pages worldwide, potentially elevating traumatic response risks. They were put in all sorts of publications, sometimes with information including their addresses. Chris said that they were nervous about so much personal information being available online, primarily due to security concerns. He gave them advice regarding preventing their further distribution.

The BBA provided other means of legal assistance. Lawyers helped people with employment issues, such as businesses that were physically or economically damaged by the blasts, and people being unable to work due to their injuries. Some people needed help with applying for and receiving disability benefits, with insurance claims, and with filling out applications to the One Fund.

Members of the MBA also assisted those impacted by the bombings. They helped victims in similar situations to the assistance provided by the BBA, as well as playing a key role in assisting victims who suffered from TBI with their claims for support from the One Fund.

AEAP Grant

The US Department of Justice, Office for Victims
of Crime (OVC), administers an Antiterrorism Emergency Assistance Program Grant (AEAP). This Grant was established by Congress after the Oklahoma City bombing in 1995, and can provide $50 million annually to assist victims in extraordinary circumstances. State departments can apply to this grant to cover costs for organisations providing crisis intervention, trauma-informed counselling, physical and vocational rehabilitation services, services for the deaf and hard of hearing, and other services essential to victim recovery and healing.

MOVA was given a grant of $8,355,648 to “sup- port direct services and supports for victims, witnesses, first responders, and others impacted by the Boston Marathon bombings.” These funds will not be given to victims as cash payments, but will be spent on services such as crisis response, web-based services portals, resiliency forums, behavioural health support services, hearing sup- port and Traumatic Brain Injury support services will be funded through this grant.

The services provided by this grant will be avail- able for those who were not physically injured
by the bombings, such as witnesses and first responders. Much of the services to be provided will focus on mental health, and Attorney General Martha Coakley has said that the grant “will help ensure that effort reaches all victims suffering from physical or emotional trauma.” The specifics of many of the services to be funded by this grant have not yet been announced, but no-one AOAV spoke with was unhappy with this.

The One Fund

The One Fund, while initially set up to provide cash payments directly to those who had been injured by the bombings, and the families of those who were killed, will also now fund the provision of services. Any money donated to the One Fund since the Second Distribution in September 2014, and any future donations, will be used to provide services. These services will not only be available to the ‘One Fund community,’ but to the wider community of those impacted by the Boston bombing.

This decision was largely made due to the realization that more support should have been provided to those with mental health and psychological issues, and those who are suffering from TBIs. The One Fund, in their second distribution, funded a $1.5 million medication collaborative with Massachusetts Eye and Massachusetts General Hospital. They will fund research into hearing problems such as tinnitus41, which will affect a much wider population than even those who were impacted by the bombings, as it is hoped that this will help people who suffer from tinnitus from other causes.

The One Fund is funding a tablet based research study, which is “essentially a video game that will help re-train your brain.” Microsoft donated tablets and Bose donated headphones for this research. The idea is that tinnitus is caused by a brain problem, so the hope is that this therapy will help people tune out the noises that they don’t want to hear from the ones that they do. If this therapy works, it is something that could positively impact a much wider community.

Resiliency Center

In July 2014 it was announced that a Resiliency Center would be opened to provide support for anyone affected by the bombings. The Center was approved by the Attorney General’s Office and will be overseen by the Massachusetts Office of Victim Assistance (MOVA). It will be managed by Boston Medical Center, and funded with up to $1.9million of federal grant money administered by the US Department of Justice’s Office for Victims of Crime. This money comes from the AEAP Grant, which was secured by the Massachusetts Office of Victim Assistance.

It will be a centralized resource center, which can connect victims with any services they might need, including trauma, mental health and rehabilitation support. It will also be a gathering place for survivors, and others who were affected by the bombings and their aftermath, and will use online forums and things such as video links so that survivors who are physically distant from Boston can access support services.

Many of the people who have previously provided support to survivors, such as the One Fund and the Boston Public Health Commission, told AOAV that they have now transitioned, or will be transitioning their services to the Resiliency Center. It will therefore be a ‘one-stop-shop’ for all services and support. Those creating the Resiliency Center were careful to ensure that the views of survivors were taken into account in its establishment. The needs and opinions of the survivors have consistently been at the forefront of all services provided for their support.

To read the whole report, please click here.