3-4 page paper needed APA style -Victim-Focused Programs in the Criminal Justice System
To prepare:
- Find 3 to 5 outside sources to use in your Assignment.
Research victim-focused programs for examples to use when proposing your new program or the implementation of an existing program.
Find cases, theories, or other research that you could use to support your proposal.
The Assignment:
Write a proposal for one of the following to be implemented in your community or in your current criminal justice practice:
- A new victim-focused program
- The implementation of an existing victim-focused program
Your proposal should include the following:
- A rationale for why the program will be effective in your community
- A rationale for how the program will help victims
- A rationale for how the program may also help offenders (if applicable)
- Your positions should be supported by examples and evidence from your references
References MUST come from two of the attached articles:
- Lessons Learned from the Boston Marathon Bombing Victim Services Program
- Victimization of the Homeless: Perceptions, Policies, and Implications for Social Work Practice
- And 2 other references of your choice
Journalof Social Work in the Global Community
2018, Volume 3, Issue 1, Pages 1–12
DOI: 10.5590/JSWGC.2018.03.1.01
Please address queries to: Simon P. Funge, Western Kentucky University. Email: simon.funge@wku.edu
Victimization of the Homeless: Perceptions, Policies, and
Implications for Social Work Practice
Marion M. Turner
Western Kentucky University
Simon P. Funge
Western Kentucky University
Wesley J. Gabbard
Western Kentucky University
Homeless individuals are particularly vulnerable to victimization, sometimes resulting in
fatalities. Theories of victimization prove useful to understanding the risks inherent in being
homeless as well as the public’s perception of the homeless population. Problematically,
public policy that criminalizes this population may exacerbate the victimization of this
group. Municipalities have turned to law enforcement and the criminal justice system to
respond to people living in public spaces. Programs that ensure adequate income, affordable
housing, and supportive services to prevent homelessness and address the needs of those
who are homeless are essential. In addition, increased law enforcement training and the
implementation of legislation to include homeless persons as a protected class in hate crime
statutes is needed. In effect, these interventions focus on reducing the risks associated with
being homelessness—in turn reducing the risk of their further victimization. Social workers
are both uniquely positioned and ethically obligated to support these efforts and contribute to
the social inclusion of people who are homeless or at risk of becoming homeless.
Keywords: homelessness, violence, social work practice, criminology, social policy
Introduction
On August 11, 2006, a homeless woman, Tara Cole, was pushed into the Cumberland River in
Nashville, Tennessee (Strobel, 2006). She was sleeping on the dock when two men pushed her into
the river, where she drowned. The men pled guilty and when asked about the incident; they reported
that they were drunk and pushed Ms. Cole into the river as a prank (“2 Plead Guilty,” 2007). On July
3, 2013, in Doylestown, Pennsylvania, George Mohr, a 71-year-old veteran, was found bleeding and
unconscious after being brutally assaulted (National Coalition for the Homeless [NCH], 2014).
Beaten and stabbed in the head, chest, arms, hands, and back, Mr. Mohr was taken to a hospital
where he remained in critical condition until he died several days later (NCH, 2014). These
seemingly random, senseless, and violent acts shocked the country; however, crimes like these as
well as nonfatal attacks and other forms of victimization have become far too common for those who
are experiencing homelessness.
The homeless are more exposed, have often been traumatized, and may experience ongoing health
and mental health problems but may have weak connections to people, places, and institutions that
could otherwise provide support and protection (Lee & Schreck, 2005; Muñoz, Crespo, & Pérez-
Santos, 2005). For these reasons, they are disproportionately victimized by violence and crime.
Turner, Funge, & Gabbard, 2018
Journal of Social Work in the Global Community 2
According to the NCH (2014), 1,437 acts of violence against the homeless were reported in the
United States in the 15 years preceding its report, and approximately one in six (16.5%) attacks
resulted in fatalities (NCH, 2014). Troublingly, between 1999 and 2013, the total number of
homeless individuals killed was nearly triple the number of individuals murdered from all other
protected classes combined during this period. These included individuals who were killed based on
the perpetrators’ biases against members of their race, color, nationality, ethnicity, religion, ability
status, or sexual orientation (NCH, 2014). These groups are those defined in federal law as
“protected classes” (Stoops, 2005). Individuals who experience homelessness are frequent victims of
nonfatal crimes as well, including burglary, petty larceny, motor vehicle theft, robbery, and physical
assaults, and have been the target of offensive speech, threats, and insults (Merrill, 2012; Wachholz,
2005). However, reports of victimization may be underreported. For instance, Novac, Hermer,
Paradis, and Kellen (2009) found that only one in five homeless youth and adults reported being a
victim of a crime including physical assaults, whereas only three in 10 of homeless women were
found to report being assaulted to authorities (Jasinski, Wesely, Wright, & Mustaine, 2010). This
underreporting may be a function of the harassment and brutality homeless individuals have
experienced (or fear experiencing) in their interactions with the police who may be overzealous in
their enforcement of quality-of-life issues (sometimes by municipal mandate) or undertrained in
their understanding of mental illness and other factors contributing to—and as a consequence of—
homelessness (Georgiades, 2015; Simpson, 2015).
In spite of these challenges—or possibly as a consequence of these challenges—the homeless have
been viewed as nonproductive members of society undeserving of more substantive efforts to address
their rights and needs (Belcher & DeForge, 2012). In contrast, with greater exposure to the homeless
the public have been more likely to acknowledge the structural causes of homelessness (versus the
personal failures of individuals experiencing homelessness; Agans et al., 2011; Lee, Farrell, & Link,
2004). Given these competing views, the public may simultaneously attribute homelessness to
individual factors while also advocating for more coercive measures such as the forcible removal of
homeless individuals from public spaces (Knecht & Martinez, 2009; Tompsett, Toro, Guzicki,
Manrique, & Zatakia, 2006).
As human service providers who often work with this population, professional social workers can and
should advocate for a more systemic understanding of homelessness that supports policies to address
and alleviate the victimization of this group. This effort can complement the American Academy of
Social Work and Social Welfare’s (Henwood et al., 2015) grand challenge to social work practitioners,
researchers, policymakers, and allied professions to play an instrumental role in ending
homelessness. However, as they work toward this goal, advocates may face limited support and/or
opposition as a result of the public’s negative perceptions about this population.
The goal of this article is to describe several theories of victimization as a means to frame these
perceptions and argue that more individualistic explanations of the causes and consequences of
homelessness (i.e., victim blaming) inform more punitive public policy responses that ultimately
reinforce the potential for this group to continue to be victimized. In contrast, it is argued that public
perceptions that acknowledge the causes and consequences of homelessness as largely outside of the
individual’s control can provide the justification for a more effective response to addressing the needs
of this group—thus diminishing the possibility of their further victimization. And because social
workers are called to challenge social injustice (National Association of Social Workers [NASW],
2015b), specific programmatic and policy recommendations are provided.
Turner, Funge, & Gabbard, 2018
Journal of Social Work in the Global Community 3
Review of the Literature
Explanations regarding the causes of victimization not only have value in terms of understanding
the variety of reasons why and how people who are homeless are particularly vulnerable, but also
how the public may perceive their victimization, and in turn, their views regarding appropriate
policy responses to homelessness. These theories range from those that conceptualize victimization
as a response to an individual’s behavior to those that focus on structural or systemic causes at the
community level.
Theories of Victimization
Victim Precipitation Theory
This theory frames victimization as precipitated by or provoked by the victim’s own behaviors (i.e.,
victims may either intentionally or inadvertently influence a perpetrator to victimize them; Wilcox,
2010). Active precipitation implies that the victim deliberately tries to provoke an attack. In
contrast, passive precipitation implies the victim unconsciously displays behaviors or characteristics
that may prompt the victimization. For the homeless, there may be circumstances where they
actively engage in verbal or physical altercations with others who, in turn, victimize them. In fact,
an association between substance use, violence, and victimization amongst homeless youth has been
found and homeless youth may use violence to resolve disputes only later to be similarly victimized
by their peers (Baron, Forde, & Kennedy, 2007; Heerde & Hemphill, 2014). The implication here is
that some victimization may be actively precipitated by the homeless themselves. However, it is
important to note that based upon crime data reported by NCH (2014), no perpetrators of the violent
crimes against the homeless they cite were acting in self-defense. Implied is the likelihood that the
victimization of the homeless described in the report was passively precipitated by the victim’s
unconscious behaviors or characteristics rather than as a result of their active engagement with
their victimizers.
Lifestyle Theory
Individuals may be victimized as a result of their lifestyle, which may expose them to situations
where victimization may be more likely (Wilcox, 2010). This may include their length of time in
public spaces (particularly at night), isolation from support networks, or heightened exposure to
potential offenders. Lee and Schreck (2009) hypothesized that homeless individuals’ vulnerability to
victimization is increased by their lifestyle, which is often a result of desperate choices. They may
engage in activities born out of a need to survive such as panhandling, sleeping outside, prostitution,
food scavenging, drug and alcohol distribution (and use), which may in turn contribute to the
likelihood of their victimization.
Deviant Place Theory
Similar to lifestyle theory, deviant place theory posits that exposure to dangerous places makes an
individual more likely to become the victim of a crime (Gaetz, 2009). Unlike victim precipitation
theory, victims do not actively or passively instigate crimes against them; rather, they are victimized
because they are in an environment that increases their exposure to risks. Different from lifestyle
theory, which suggests that victims choose the lifestyle that contributes to their vulnerability,
victims may inadvertently find themselves in an unsafe environment with little to no opportunity to
move to a different place to protect themselves. This is likely to be the case for homeless persons who
frequently find themselves in unsafe places where they are exposed (Gaetz, 2009). This can include
living in unsafe, abandoned buildings, areas of cities where there are higher crime rates, and less
fortified structures such as tents and cars.
Turner, Funge, & Gabbard, 2018
Journal of Social Work in the Global Community 4
Social Exclusion Theory
Restricted access to the social, economic, political, and cultural systems of a community may inhibit
individuals’ ability to integrate into their community (Gaetz, 2004). As a result, they may be become
disconnected from the very resources that would otherwise protect them from victimization. In the
case of the homeless, having limited access to adequate housing, employment opportunities, social
supports and a healthy lifestyle renders them more vulnerable. Social exclusion could be a factor
long before an individual becomes homeless, but may be intensified when they are no longer housed.
Due to their compromised safety, health, and opportunity, it is difficult for them to escape social
exclusion.
Whether precipitated by the victim, their location, their lifestyle, or as a consequence of social
exclusion, people who are homeless are disproportionately victimized. Further, although coverage of
homelessness has steadily increased over time, both newspapers and the professional literature have
increasingly focused on individual rather than structural factors associated with the causes and
effects of homelessness (Buck, Toro, & Ramos, 2004). As a result, the public holds disparate views
regarding the nature, causes, and consequences of homelessness (Agans et al., 2011; Buck et al.,
2004).
Blaming the Victim
Particularly in the United States, where dominant cultural values include independence, personal
responsibility, and the concomitant belief that personal circumstances are a function of the choices
people make, Savani, Stephens, and Markus (2011) found that this orientation tends to reduce
empathy for those in need, increase the likelihood of blaming the victim for negative outcomes an
individual may experience, and may diminish support for public policies that may seek to address
the needs of marginalized individuals. Essentially, the process of victim blaming stems from the
individual’s belief that society is fundamentally just and that the negative outcomes experienced by
another as a product of the victim’s choices rather than as a result of systemic problems in the social
environment. As a result, the individual may be more likely to dismiss or minimize the relevance
and impact of the social context as it may have contributed to another’s victimization. Consequently,
the individual is less likely to support changes to the social context that may promote the public
good.
Victim precipitation and lifestyle theories largely undergird public views of homelessness that
effectively blame the victim. From these explanations, the individual would be less likely to be
homeless and victimized should they choose different behaviors or a different lifestyle. These
explanations reflect a more individualistic view of the causes and consequences of homelessness
which may lead those who hold them to support (or be less likely to oppose) policies that effectively
police the behaviors of people who are homeless. In contrast, deviant place and social exclusion
theories provide explanations that identify factors largely outside of the control of the individual. A
public that holds these views is more likely to recognize the role of structure in the cause and
consequences of homelessness, and may be more likely to support (or less likely to oppose) changes
that are systemic in nature. However, as implied above, the public may simultaneously express both
individualistic and structural views in their explanations for the causes and consequences of
homelessness. Nevertheless, more individualistic views have proven more influential in public policy
responses to homelessness.
Criminalizing the Homeless
Cities across the country have turned to law enforcement and the criminal justice system to respond
to quality of life issues such as people living in public spaces. Municipal codes against sleeping,
Turner, Funge, & Gabbard, 2018
Journal of Social Work in the Global Community 5
standing, and eating in public have more than doubled since 1990, and antibegging, antisoliciting,
antipeddling, vagrancy, loitering, and curfew laws effectively criminalize homelessness (Fisher,
Miller, Walter, & Selbin, 2015; NCH & National Law Center on Homelessness and Poverty
[NLCHP], 2006; NLCHP, 2016; Stuart, 2014; Weisberg, 2005). Though they are more likely to be
arrested for order maintenance and property offenses (i.e., misdemeanors) than for felonies,
homeless arrestees have been incarcerated for low-level, nonviolent crimes (Fitzpatrick & Myrstol,
2011).
Concerns about general public health, crime and safety, the economic impact of homelessness on
business interests, and aesthetic and general quality-of-life concerns have largely driven these
efforts (Foscarinis, Cunningham-Bowers, & Brown, 1999). Tourism remains among the primary
motivators as local shop owners, chambers of commerce, tourism officials, and other business
advocates have been frustrated by the presence of homeless individuals in their commercial districts
perceiving their presence as a threat to their business interests (Culhane, 2010). However, when
these city ordinances are not coupled with a sufficient number of shelter beds and services, they
effectively increase costs for the homeless and costs to public safety, are a misallocation of police
resources, and ultimately fail to achieve the goal of removing the homeless from the streets
(Saelinger, 2006).
In reality, these laws effectively control the poor living on the streets and are a way for
municipalities to avoid confronting the root of the problem (Gerry, 2007; Mitchell, 2012). Thus, they
reinforce negative perceptions about the homeless and lead the public’s to support more punitive
policies. As a consequence, the homeless population are further excluded and forced into increasingly
deviant places where they are more susceptible to
being victimized.
Protecting and Empowering the Homeless
More productive policy responses better address the structural issues that contribute to
homelessness. They also provide a countervailing force against the negative public perceptions that
are at the root of and emerge from more punitive policies and can go some way to reducing the
likelihood of further victimization either by addressing the vulnerabilities associated with being
homeless or ending homelessness altogether.
Programs and Services
The National Alliance to End Homelessness (NAEH; 2016) has highlighted a range of program and
services to address the needs of those who may be temporarily homeless to those who are chronically
homeless. Essentially, the group advocates that communities pursue public policies that ensure
adequate income, affordable housing, and supportive services to prevent homelessness and address
the needs of those who are homeless. For those who are at risk of homelessness, rapid rehousing
programs provide temporary financial assistance and case management services to support
individuals and families who are at risk of losing their housing or are temporarily without housing to
return to permanent, stable housing as quickly as possible. Housing-first programs focus on moving
homeless individuals and families into safe housing in an expedient manner and then blanketing
them with short-term and long-term critical services as needed (NAEH, 2016; Padgett, Henwood, &
Tsemberis, 2015). These services may be intensive—particularly for those returning to the
community after military service, hospitalization for physical or mental health needs, incarceration,
or substance abuse treatment programs (NAEH, 2016). The integration of harm reduction supports
and services (e.g., needle exchanges) with housing-first programs is also recommended so that an
individual who is homeless and using drugs or alcohol still has access to supportive services (Pauly,
Reist, Belle-Isle, & Schactman, 2013). For homeless youth, family reunification may be a priority.
Turner, Funge, & Gabbard, 2018
Journal of Social Work in the Global Community 6
But in other cases, long-term housing and supportive services including those former foster youth
require to successfully transition into adulthood (e.g., life skills training, education and job training,
and needs-based case management) may be needed.
In another critical area, although there have been cases in which excessive force and brutality have
been used by officers against homeless individuals (NCH, 2012), law enforcement agencies in some
municipalities can collaborate with social service providers and proactively train their officers to
more effectively work with the homeless (U.S. Interagency Council on Homelessness, 2012). This
process also reinforces to police the civil liberties of homeless individuals and families, as well as the
fact that many have made (and will make) meaningful contributions to society given the right
support systems.
In effect, programs and services should target a range of systems that foster and support the
wellbeing of individuals who are experiencing or at risk of homelessness. These should be
multisystemic, affecting every level of a homeless person’s individual needs, care, family,
employment, food, shelter, and overall wellbeing as a functioning member of their community. The
desired outcome is to build the capacity of a community to support its residents such that the factors
that may otherwise cause homelessness are reduced or eliminated and protective factors are
enhanced (Banyard, 1995; Kilmer, Cook, Crusto, Strater, & Haber, 2012; Novac, Serge, Eberle, &
Brown, 2002).
With each of these programs and services, the fundamental goal is to promote safety and/or
contribute to the social inclusion of people who are homeless (or at risk of homelessness). In effect,
these interventions focus on reducing the risks associated with being homelessness—in turn,
reducing the risk of their further victimization.
Hate crimes legislation. A policy intervention not widely explored in the literature is the inclusion of
people who are homeless as a protected class in hate crimes legislation. As previously noted, when
compared with the number of homicides classified as hate crimes against individuals from other
protected classes, the number of reported fatal attacks on the homeless has been disproportionately
higher. In 2006, for example, three racially motivated attacks against individuals were fatal,
whereas attacks against 20 homeless individuals resulted in deaths. And in 2012, 10 people in the
United States were murdered based on their race, religion, or sexual orientation, whereas 18
homeless individuals were reported killed in the same year (NCH, 2014).
Originally defined in 1968 by the U.S. Congress, a hate crime is a crime in which a defendant
intentionally selects a victim because of that individual’s race, color, or national origin. It is an
“illegal act motivated by the wish to harm groups or individuals whose affiliations, values, or actions
are intolerable to the perpetrator” (Barker, 2003, p. 191). Over time, the definition of a hate crime
has broadened to include additional protected identities such as ethnicity, religion, ability status,
and sexual orientation (Stoops, 2005). Additionally, subsequent amendments to the original act have
mandated that the U.S. Justice Department begin collecting data from law enforcement agencies
about crimes motivated by prejudice (the 1990 Hate Crime Statistics Act) and increased penalties for
perpetrators (the Violent Crime and Law Enforcement of 1994; Anti-Defamation League, 2012).
Although hate crimes legislation strives to protect those within a society who are deemed more
vulnerable based on a particular trait (O’Keefe, 2010), the homeless are not currently recognized as a
protected class despite the documented persistence of their victimization. However, several
prominent homeless organizations have advocated that the homeless be included as a protected
class. NCH (2014), NLCHP (2016), and the Anti-Defamation League (2012) have all endorsed the
inclusion of homeless individuals in hate crimes legislation.
Turner, Funge, & Gabbard, 2018
Journal of Social Work in the Global Community 7
However, because bias motivated crimes against the homeless are not currently recognized in federal
hate crimes statutes, some states have moved forward to include the homeless as a protected class
under state-level hate crimes statutes. In 2009, Maryland became the first state to add homeless
persons to its list of protected categories under the state’s existing hate crimes, opening the doors for
other states to do the same (Associated Press, 2009).
In 2014, there were seven states and three cities that recognized violence against the homeless as a
hate crime (Cain, 2014). Most recently, Representative Eddie Bernice Johnson (Democrat–Texas)
introduced H.R. 1136, the Violence Against the Homeless Accountability Act of 2013. This act
proposed to include homeless people as a protected class under the Hate Crimes Statistics Act (Cain,
2014). If implemented, it would have increased policymakers, advocates, and researchers’ knowledge
regarding the nature and extent of victimization, and plausibly serve to reduce victimization of the
homeless; however, H.R.1136 was not enacted in the 113th Congress. No subsequent bill had been
introduced at the time of this writing.
Implications for Social Work Practice
Social workers seek to promote social justice for vulnerable populations (NASW, 2015a). As
professionals who provide services to people who are homeless, they are therefore ethically obligated
to support changes that accomplish this. They are also uniquely motivated, qualified, and positioned
to challenge negative perceptions about people who are homeless—particularly those who work
directly with homeless populations (Weng & Clark, 2018). This can be accomplished in part by
advocating for best practices and policies that alleviate and address the victimization of people who
are homeless (i.e., decriminalizing and protecting the homeless; Aykanian & Lee, 2016). This
includes educating the public about the extent to which the homeless population is victimized and
disrupting views that attribute the causes of victimization to individual behaviors and focus instead
on the consequences of social exclusion. In this way, social workers can be instrumental in shifting
public perceptions away from those that effectively blame the victim for the causes and consequences
of their homelessness which may then bolster support for more constructive approaches to reducing
their victimization (Aykanian & Lee, 2016). It also promotes the perception of the homeless as
individuals with feelings, stories, and aspirations, rather than a crude stereotype in 21st-century
society.
Moreover, NASW (2015) has advocated for broader access to affordable housing and a living wage,
more targeted and coordinated services aimed at prevention and intervention, and political action on
behalf of the homeless population. Existing organizations like NCH, NAEH, NLCHP, and Homeless
Advocates Group advocate for, educate, and broker services for people who are homeless and need
additional resources and support to successfully exit shelters and the streets.
People who are homeless need safety and protection to allow them to pursue opportunities that
address their needs, not oppressive measures that criminalize them for quality-of-life issues (NCH &
NLCHP, 2006; NCH 2012). Social workers should advocate against the criminalization of the
homeless and be in favor of productive approaches to addressing homelessness (Aykanian & Lee,
2016). These include housing and supportive services programs such as Rapid Re-Housing and
Housing First and harm-reduction initiatives as well as collaborative efforts with municipal law
enforcement to train officers to better understand and more effectively respond to the needs of this
population. In addition, because few states recognize crimes against the homeless as a hate crime,
social workers should support federal and state legislative efforts to include homeless persons as a
protected class in hate crime statutes. This advocacy can be part of broader overall efforts to shift the
public’s perceptions in a manner that simultaneously acknowledges the social exclusion of this
Turner, Funge, & Gabbard, 2018
Journal of Social Work in the Global Community 8
population while building support for interventions that provide them with greater protections from
being victimized.
Conclusion
Homeless individuals like Tara Cole and George Mohr were the victims of senseless cruelty.
Unfortunately, stories such as theirs are not uncommon in 21st-century America. Although most
victimization is nonfatal, it has significantly hurts a group of individuals who are already
precariously housed and consistently marginalized on a daily basis. Thus, it is critical that social
workers understand the reasons behind and manner in which the homeless are victimized (Weng &
Clark, 2018). Being cognizant of these factors allows them to better design interventions that counter
oppressive practices and promote the safety and self-determination of folks living on the streets and
in shelters. Further, social workers must understand how public perceptions inform and are
informed by this victimization and advocate for interventions that protect those like Ms. Cole and
Mr. Mohr, who remain vulnerable on the streets. Finally, they can support housing-first programs
that focus on moving homeless individuals and families into places of safety before blanketing them
with effective supportive services (NAEH, 2016; Padgett et al., 2015). These are all ways to help
social workers rise to the grand challenges of ending the victimization of the homeless as well as
ending homelessness altogether.
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Vol.:(0123456789)
1 3
Clin Soc Work J (2017) 45:111–123
DOI 10.1007/s10615-017-0624-7
ORIGINAL PAPER
Lessons Learned from the Boston Marathon Bombing Victim
Services Program
April Naturale1 · Liam T. Lowney2 · Corina Solè Brito1
Published online: 27 April 2017
© Springer Science+Business Media New York 2017
mass violence events. This article shares what we currently
know about traumatic stress reactions related to human
caused mass violence events and provides program details,
lessons learned and recommendations from the Marathon
Bombing Victim Assistance program.
Keywords Boston marathon bombing · Mass violence ·
Disasters · Terrorist attacks · Victims of crime · Traumatic
stress
The Boston Marathon Bombing
The Boston Marathon bombing event began on April 15,
2013, at 2:49 pm when pressure cooker bombs were deto-
nated within seconds of each other near the finish line (at
Copley Square, a prominent historic site). Nearly 27,000
participants were registered in the 2013 race and this mara-
thon traditionally attracts about half a million spectators.
Three people died at the scene and more than 200 others
required medical attention. Many survivors received serious
injuries including head injuries, hearing loss, and severed
limbs as a direct result of the blasts; 14 survivors required
amputations post examination (FBI, 2013; US DOJ 2014;
Kotz 2013). Every year, the Boston Marathon is a highly
publicized event that draws runners, their supporters, and
spectators from all parts of the globe (including Bostoni-
ans) and receives local, national, and international news
attention. Reports and videos of the bombing—including
graphic images of severely injured runners and specta-
tors—were immediately televised and shared online, then
via print media. This exposure continued for weeks thereaf-
ter, then increasingly again around each anniversary time-
frame. This intentional, human-caused mass violence at an
event attended by hundreds of thousands and accompanied
Abstract The Boston Marathon bombing of April 15,
2013 involved the detonation of pressure cooker bombs
near the finish line of the Boston Marathon. Three people
died at the scene and more than 200 others required medical
attention. Many survivors received serious injuries includ-
ing head injuries, hearing loss and severed limbs as a direct
result of the blasts and 14 survivors required amputations.
The media reports included graphic images of severely
injured runners and spectators that were shown repeatedly
and continuously for months thereafter. This intentional,
human caused mass violence at an event attended by hun-
dreds of thousands and accompanied by graphic, gruesome,
and extensive media exposure exacerbated the behavioral
health risks in the affected community as well as those who
observed the events in the media. The Massachusetts Office
for Victim Assistance provided an immediate response
and continues to provide victim assistance, behavioral
health counseling and other supports through a Depart-
ment of Justice/Office for Victims of Crime Antiterrorism
Emergency Assistance Program grant to help those most
affected. Many lessons were learned about the need for
preparation, close working relationships and an understand-
ing of the powerful psychological impact of terrorist and
* April Naturale
April.Naturale@icfi.com
Liam T. Lowney
Liam.lowney@state.ma.us
Corina Solè Brito
Corina.SoleBrito@icf.com
1 ICF International, 9300 Lee Highway, Fairfax, VA 22031,
USA
2 Massachusetts Office for Victim Assistance, 1 Ashburton
Place, Suite 1101, Boston, MA 02108, USA
http://crossmark.crossref.org/dialog/?doi=10.1007/s10615-017-0624-7&domain=pdf
112 Clin Soc Work J (2017) 45:111–123
1 3
by graphic, gruesome, and extensive media exposure exac-
erbated the behavioral health risks and concerns for those
both directly and indirectly involved, from survivors to the
general public (Marshall 2006).
For 4 days, law enforcement searched for suspects
throughout the area, culminating in Watertown, approxi-
mately seven miles west of the city of Boston. The man-
hunt for the perpetrators was highly televised and posted
throughout internet news and social media outlets. The
effects of these activities in the days leading up to the cap-
ture of the alleged perpetrators were profound. Commu-
nity members experienced an extensive lock down period
and shooting events by both uniformed and plain clothed
law enforcement. Public transportation, public institu-
tions, and many businesses in the Watertown area were
shut down, first in response to a request from authorities to
stay indoors, and then to comply with a “shelter in place”
advisory. These circumstances were highly unusual and
while protective, also had the effect of increasing residents’
fear, especially school-aged children in the area (Gortych,
personal communication, January 2015; Dupuis, personal
communication, October 2015). The alleged bombers’
subsequent murder of a Massachusetts Institute of Tech-
nology police officer and the shooting of a Massachusetts
Bay Transit Authority police officer, further exacerbated
the fear and anger that the bombing had imposed upon the
affected community (DART, 2014). The manhunt finally
ended with one alleged bomber dead, and his brother, the
second alleged bomber, in custody.
The reality of the killings, the horrific and widespread
nature of the physical injuries of so many victims,1 and the
emotional aftermath experienced by these communities
were just beginning to be recognized when the Massachu-
setts Office for Victim Assistance (MOVA) began imple-
menting their disaster response program. Some survivors
reported experiencing intensifying emotional distress, find-
ing it difficult to function with the challenges that each day
brought, especially the continuous news coverage of the
bombing which often included gruesome images and
details of legal procedures surrounding the surviving
alleged bomber, while other survivors experienced a delay
in emotional responses (US DOJ 2004; SAMHSA 2014;
Norris 2002).
This information was obtained from a needs assessment
conducted by the MOVA, the state agency that would even-
tually apply for and obtain a U.S. Department of Justice/
Office for Victims of Crime (DOJ/OVC) Antiterrorism
1 MOVA is aware that many people who have experienced a trauma
prefer to use the term ‘survivor’ rather than ‘victim’ in referring to
themselves, thus we interchange the terms as ‘victim’ remains in the
language of our federal and state scope of services.
Emergency Assistance Program (AEAP) grant to provide
post-disaster services to those affected by the Marathon
bombing. MOVA and their funded partners worked directly
with survivors, responders, and their family members
through the fourth anniversary timeframe of the event.
The authors of this article were tasked with implement-
ing the victim services response to the event and will focus
on the lessons learned from the implementation of this dis-
aster response program. Our respect and gratitude are to the
family members, survivors and responders who allowed us
the privilege of working with them and who showed great
courage in sharing their stories so that others might feel
understood and cared for.
What We Know About the Effects of Human
Caused Mass Violence and Terrorist Events
The literature shows that exposure to a disaster is the single
most important predictor of adverse emotional outcomes
and is compounded by a combination of the disaster type,
size and scope of the incident, and other risk variables
(Norris et al. 2002). The psychological effects of a disas-
ter are second only to death and injury, yet in most survi-
vors, intense emotional distress is experienced for a limited
amount of time (CMHS 2001; Myers and Wee 2005). After
a natural disaster, about 90% of those affected will eventu-
ally return to their pre-disaster level of functioning or make
the necessary adaptations that will allow them to continue
their routine activities without developing a mental dis-
order (Norris et al. 2002). In larger scope or scale events,
human-caused incidents (particularly with intent to harm),
the percentages of those with diagnosable conditions may
increase to as high as 20% in the general population (Neria
et al. 2012). Posttraumatic stress symptoms are generally
highest in the first year and lessen over time (Galea et al.
2002) while depression, anxiety, and traumatic bereave-
ment can last for longer periods (Norris and Rosen 2009;
CDC 2006; Hobfall et al. 2007). Incidents of mass vio-
lence may lead to additional responses such as humiliation,
a sense of responsibility for other’s deaths, survivor guilt,
self-blame, and a sense of being unworthy of assistance.
The inability to make sense of the randomness of victimi-
zation may increase difficulty with recovery in survivors
and can even cause family or friends to distance themselves
from any association with the incident or those involved
as a means of avoiding confrontation with this reality (US
DOJ 2014; CMHS 2004).
Populations considered at higher risk for the develop-
ment of mental health problems include those experiencing
bereavement, those who sustained injury, have an injured
family member, or witnessed injury to others, those whose
lives were threatened, and those who experienced panic,
113Clin Soc Work J (2017) 45:111–123
1 3
horror or feared for their lives (Boscarino et al. 2002; Nor-
ris et al. 2002). These exposure types are the most predic-
tive of posttraumatic stress disorder (PTSD) although over-
all numbers of people who develop a diagnosable mental
disorder such as depression, PTSD, and other anxiety dis-
orders are in the minority (Morganstein et al. 2016; Neria
et al. 2012; Norris et al. 2002; Galea et al. 2002). Regard-
less of the numbers, the development of a mental illness in
anyone is of concern and should be addressed as soon as
identified.
Some additional factors that contribute to negative emo-
tional effects post-disaster include the following:
Neighborhood/Community‑Level Exposure
In the case of the Boston Marathon bombing, neighbor-
hood exposure is exemplified by the experience of Water-
town and nearby communities. A community-wide lock-
down accompanied by hovering helicopters, many shooting
episodes, and public messaging that a manhunt for the per-
petrator “at large” was active had longstanding negative
psychological effects on many, especially school-aged chil-
dren (Gortych, personal communications, January, 2015;
Dupuis, personal communications, October 2015).
Age, Gender, and Ethnicity
Middle-aged adults are more adversely affected by disasters
than other adult age groups (Norris et al. 2002). Children
can be more negatively affected than adults depending on
the level of exposure to the event along with their devel-
opmental level and ability to understand what is happening
around them (NCTSN 2016). They are sensitive to familial
disaster distress and conflict and research shows that paren-
tal responses are the best predictor of children’s responses,
especially in younger children (Gurwitch et al. 2002).
Women and girls in general are more adversely affected
by disasters than men or boys (Norris et al. 2002). Moth-
ers are particularly at risk for substantial distress (Chemtob
et al. 2011). Minorities are at greater risk if more severely
exposed and/or if beliefs impede help-seeking behavior
(Norris et al. 2001). Establishing causation around eth-
nicity itself is difficult, as certain groups are traditionally
underserved, possibly due to language barriers, lack of trust
in authority, or lack of outreach (Naturale 2006).
Psychological Resources
People with higher pre-disaster psychological symptoms
can be strongly negatively affected by disasters (Norris et al.
2002). A lack of access to and use of psychological resources
such as social supports can contribute to negative coping such
as substance misuse, domestic violence and eating disorders
(Hobfall et al. 2007; Norris and Kaniasty 1996; Kaniasty and
Norris 1995).
Resource Deterioration
Lower socioeconomic status and perceived resource loss
have been associated with greater post-disaster distress (Nor-
ris et al. 2002). What survivors determine as “resources” can
affect their psychological state. For example, anecdotally, we
often hear victims say that they are grateful to come away
from a trauma event with their lives and that their physical
possessions can be replaced. Still, the stress of needing medi-
cal care, rebuilding one’s home and replacing everyday items
needed to survive and/or losing local community supports
such as schools and businesses that provide goods necessary
for daily living (e.g., food and gasoline) can add to a survi-
vor’s psychological stress.
Environmental Factors
The ecological perspective which looks at how individu-
als act and accommodate within their environment empha-
sizes that every aspect of a survivor’s life (familial, social,
economic, cultural, educational, physical, intellectual,
geographic, spiritual) has the potential to a have a strong
impact on whether a person will develop a mental disor-
der after a traumatic experience (Germain and Gitterman
1995). Two strong predictive factors for negative psycho-
logical effects are previous life stress and social support
from others (Dunmore et al. 2001; Filipas and Ullman
2001; Zoellner et al. 1999). Recent research done with sur-
vivors of individual trauma (e.g., assault, motor vehicle
accidents) has consistently shown that the absence of social
support impedes recovery (Zoellner et al. 2011). Further,
negative support reactions such as critical comments about
the length of time taken for recovery, from family members
in particular, seem to stand in the way of recovery among
trauma victims in treatment for PTSD. In disaster studies,
the size, vitality, and closeness of the survivor’s social net-
work is also related strongly and consistently to positive
mental health outcomes (Zoellner et al. 2011; Norris and
Kaniasty 1996; Kaniasty and Norris 1995). Disaster survi-
vors who believe that they are cared for by others and that
help will be available if needed fare better psychologically
than disaster survivors who believe they are unloved and
alone (Zoellner et al. 2011).
The MA Office for Victim Assistance (MOVA)
Marathon Bombing Response Program Goals
The goals of MOVA’s Marathon Bombing Response Pro-
gram were informed by several resources, previous events
114 Clin Soc Work J (2017) 45:111–123
1 3
that the DOJ/OVC and MOVA had experienced, a needs
assessment conducted to obtain input from the victim and
provider communities, and a review of the empirical litera-
ture. Overall, the program sought to provide timely relief
through immediate and ongoing assistance services offered
to the survivors and their families through liaisons, referred
to as”victim navigators.” The navigator’s role was essen-
tially that of case management/advocacy, helping the sur-
vivors to identify their needs and access all of the services
that were made available to them. Services included crisis
response, consequence management, crime victim compen-
sation, criminal justice support (e.g., victim participation
in criminal justice proceedings), crisis counseling, emer-
gency transportation and travel, compensation for medical
and mental health costs, compensation for lost wages and
funeral expenses, temporary housing, emergency food and
clothing, repatriation of remains, outreach and education,
victim notification and vocational rehabilitation.
The program’s long-term goals were to help steer indi-
viduals and the community onto a recovery path, increase
opportunities to support and build community resilience,
and increase the capacity of the community to continue to
address these concerns after the program ended. MOVA
wanted to enable the local victim services and other pro-
vider agencies who participated in the response to: (1)
increase their awareness of the need to work with each
other prior to and in response to disaster situations, and (2)
offer provider agencies the opportunity to participate with
other emergency management staff in planning and training
for the provision of future disaster response services.
There are limits to reaching every single affected survi-
vor based on lack of self-identification, stigma around help
seeking and the recognition that the majority of people will
return to their pre-disaster level of functioning or make
positive adaptations especially with the use of good coping
skill and social supports. With this understanding, the over-
all goals of the program were met in terms of the delivery
of stated services and successful efforts at education and
outreach to survivors, family members and the community
at large.
Needs Assessment Data
Needs assessment data informed service delivery plan-
ning and incorporated feedback from survivor and family
forums, provider reports, community activities related to
the disaster, and direct case studies. Survivors were ini-
tially more focused on receiving victim compensation
(e.g., lost wages from injury or attending to an injured
family member, concerns over continued medical care/
surgery, and invisible injuries including mental health
concerns, traumatic brain injury and hearing loss). The
majority of survivors requested assistance with mental
health concerns—both for themselves and their family
members. Many victims lived outside of the Boston area
and requested centralized information and other commu-
nications via internet (e.g. email, websites, and telecon-
ferences, etc.). An update to the Needs Assessment was
informed by outreach efforts (telephone contact) with
approximately 500 survivors by the MOVA program staff
just after the second anniversary timeframe.
Summary of Services
The response program was tasked with attempting to reach
all identified victims/survivors throughout the Common-
wealth of Massachusetts and, wherever possible, through-
out the U.S. The service delivery design focused on meet-
ing those with high-risk needs that were identified based
on the literature. Members of this group included survivors
with injuries such as amputations and disfigurement, burns,
traumatic brain injuries, deafness and partial loss of hear-
ing, tinnitus, and loss of vision; family members and other
loved ones and close friends and coworkers of those killed
and those injured; survivors who were direct witnesses of
the event or were present at the event; and school-aged chil-
dren exposed to the bombing struggling with school partic-
ipation, emotional distress, and fear responses around loud
noises similar to gunshots and helicopters as experienced
in the disaster (Gortych, personal communications, Janu-
ary 2015; CMHS 2001; Norris et al. 2002). An outreach
strategy was developed to reach additional groups at risk
such as first responders (e.g., those exposed to the scene’s
fear and chaos and/or treated patients with gruesome inju-
ries) and their family members; survivors with prior trauma
experiences and/or mental illness; and survivors with medi-
cal problems, limited mobility, or other functional and
access needs. A large scale media/communications plan
was designed to provide outreach, information, and educa-
tion to the entire community. A behavioral health response
plan that included training to approximately 70 mental
health clinicians and delivery of disaster specific interven-
tions was made available to all affected survivors free of
charge to help mitigate the development of and address the
negative psychological outcomes resulting from the disas-
ter and its’ aftermath.
Phased Activities Post Incident
In the first year of the response, crisis intervention ser-
vices were provided at the same time providers navigated
the victim compensation structure and helped survivors
with their “core daily needs of recovery.” This included
115Clin Soc Work J (2017) 45:111–123
1 3
assistance with government, financial, legal, and employ-
ment benefits and school advocacy. Groups were organ-
ized groups that brought survivors together to share their
experiences and support each other. These services contin-
ued throughout the duration of the program. By the second
anniversary, the staff developed opportunities for survivors
and their families to come together in various ways meant
to support recovery and build resiliency. Forums were held
with speakers who shared information and resources. Peer
support groups were introduced and recreational peer to
peer activities were organized routinely. Staff conducted
outreach to reach those affected in the Watertown Schools,
Watertown Police Department, and the MA Institute of
Technology Police. During year 2, the Behavioral Health
Response program was launched offering evidence-based
short-term methods of reducing trauma-related symptoms.
As part of the behavioral health response, every victim that
had authorized MOVA to access their contact information
was notified of the free interventions and expanded victim
compensation services.
The public memorials recognizing the anniversary time-
frame of the bombing provided staff and partner agencies
an opportunity to attend and offer a compassionate presence
and support. Informational materials highlighting what to
expect leading up to the anniversary and helpful coping
activities were distributed directly to survivors, parents,
staff, and children within the most highly affected schools
and to the general public in the affected communities.
The Boston Marathon has historically received annual
local, national, and international news coverage. Due to
the unprecedented nature of this incident, it received exten-
sive media air time, and videos of the actual bombing, full
of graphic images of severely injured runners, spectators,
and rescue and recovery staff, were repeatedly televised
and shared on social media continuously for weeks. Much
of this news coverage violated social rules of privacy and
even many journalists’ own recommendations for coverage
of traumatic events (DART Center for Journalism, 2014).
This intense and extensive exposure exacerbated the behav-
ioral health risks and concerns for those both directly and
indirectly involved in the disaster (Hopwood and Schutte
2016). In response, MOVA subsequently created a media
campaign to provide messages of support, hope, recov-
ery, and resiliency and to raise awareness of the long term
impacts of violence on families, first responders, and chil-
dren. For many, learning that some of their symptoms are
expected and common in a post-disaster environment and
the reassurance that the symptoms will likely decrease
over time can be a supportive behavioral health response
(Draper 2006). The media campaign was launched prior
to the third anniversary and included television and radio
commercials delivered via mainstream networks, featur-
ing actual survivors sharing their own stories about the
incident, their reactions, and what helped them cope. Lis-
teners were guided to the Marathon bombing hotline and
website as sources of educational information and for vic-
tims/survivors to find services and resources. Related social
media ads were developed and posted on Facebook and
Twitter. The media messaging provided psychoeducation
around trauma-related symptoms in a non-pathologizing
way, normalizing common reactions.
By the third year of the program, services reached into
the Boston Public School (BPS) system. The funding
allowed the BPS to identify and support students, fami-
lies, and staff members most effected by the trauma of the
bombing and other characteristics that created high risk cir-
cumstances. This work helped BPD to launch their trauma-
informed schools initiative and develop a sustainability
plan for long term services. Watertown Schools received
their own funding as their community was exposed to the
incident in a greater degree during the hunt for the alleged
bomber and the resulting shoot out which destroyed to a
large degree, the sense of safety in that community. In addi-
tion to their direct exposure to swarms of heavily protected
and armed law enforcement personnel, multiple shooting
incidents, and hovering helicopters, these school-aged chil-
dren experienced the anxiety of their parents, caregivers,
and other adults around them. This was considered by some
to be a second, separate but related traumatizing aspect of
the Marathon bombing.
The Boston Police Department (BPD) received mara-
thon bombing response funding and worked closely with
MOVA to support affected responders and their families
with stress management, wellness, and peer support activi-
ties. They were also provided with disaster-specific behav-
ioral health interventions as needed. These services were
aimed at reducing the symptoms associated with mass vio-
lence response efforts. Fortunately, the BPD had an existing
peer support structure with staff already trained and was
receptive to integrating the marathon-related services. They
were able to expand their current structure and increase the
number of staff qualified to administer these peer support
activities.
Lessons Learned
Disaster Response Relationships
MOVA is an independent state agency established to serve
all victims of crime in the Commonwealth through fund
administration, training, policy implementation, and some
limited direct referral services. Each of these components
made the agency an especially important provider to estab-
lish services for victims of the marathon bombing and the
events that followed. Yet, MOVA was not an established
116 Clin Soc Work J (2017) 45:111–123
1 3
partner in any of the emergency response protocols that
existed. In one call to an official in a partner state agency to
determine how MOVA could assist, they were asked, “Why
would MOVA work on this response?” The lack of recogni-
tion and, more importantly, understanding of the agency’s
role would present a continuous challenge in the days and
months to follow.
Even though Massachusetts had been involved in the
response to families impacted by the 9/11 attacks in 2001,
the relationships that were established between with
responding agency personnel, were not formalized with
any Memorandums of Understanding or contracts in a sys-
temic manner. The result is that as personnel left, so did
the established relationships with the many emergency
response partner agencies and a mutual understanding of
agency roles. It was necessary to reintroduce these response
agencies to each other in the midst of the marathon tragedy,
an effort which was exceedingly more difficult at that time.
One strategy initiated was bringing together over 30
agencies that interacted with survivors to serve as a “Con-
tinuum of Care Working Group.” Participants included
state and city responders, federal law enforcement, Victims
of Crime Act (VOCA) funded community providers, the
American Red Cross, and members of the private sector.
The meeting gave participants opportunity to learn about
each other, including individual roles and missions, and
real-time activities related to the incident. Shared informa-
tion also ensured participants were aware of the messages
being delivered to survivors, enabling timely, accurate,
and consistent communication, which in turn served vic-
tims well by decreasing anxiety and establishing a sense
of trust and legitimacy in the agencies. The Continuum of
Care Working Group allowed participants to be engaged
on equal footing and talk openly about law enforcement,
advocacy, behavioral health needs, special populations, and
the very basic unique needs of survivors. The group identi-
fied service gaps and made recommendations about how to
address them.
Planning and Program Implementation
Victim services response should be immediate and sys-
temic, starting with notification when an event occurs and
clear protocols for where their programmatic role begins
and ends to help meet victims’ immediate and long term
needs. To effectively address the needs of crime victims,
victim services should be: (a) ongoing and unique to the
group impacted; (b) adjusted as needs change and become
longer term; and (c) informative and instructional, allow-
ing local providers to tailor and sustain services as long
as needed. This allows service providers to build relation-
ships with survivors, effectively assess needs, and inform
responses through a victim services lens. It is the local,
city, and statewide victim service providers who remain
in the community and can continue to be a source of sup-
port, resources and referrals long after the time limited
disaster resources end.
Thus it follows that disaster and emergency prepar-
edness activities need to be regular and ongoing. State
and local government, law enforcement, and emergency
management leadership structures must be trained and
informed about what victim service agencies can offer
in the wake of a tragedy. In order for this to happen, all
disaster response and victim services agencies must be
represented at the state, city, and local community emer-
gency management planning committees pre and post
incidents. It is essential that agencies spend time learning
about each other before an incident occurs to ensure the
most effective and efficient response possible.
Even with good planning, there are inherent chal-
lenges to administering funding for human services in the
midst of a crisis. It is complex to contract with providers
to deliver necessary services for those impacted. MOVA
reached out to the behavioral health provider agencies
with existing contracts and asked them to provide crisis
intervention and behavioral health supports in the imme-
diate aftermath of the bombing. These agencies then had
the opportunity to extend their contracts and expand their
service delivery through the next several years. Working
with existing contracted agencies not only provided them
with the time to identify their scope of work and appro-
priate budgets, it also proved quicker program implemen-
tation and less burdensome than contracting from scratch.
The challenge with some of these agencies was to ensure
they were providing evidence-based interventions that
helped address the specific needs of those affected by
the bombing, people experiencing a traumatic stress
response, rather than quickly diagnosing for serious men-
tal illness, using psychopharmacology before allowing a
natural return to pre-disaster functioning or reverting to
offering general psychodynamic psychotherapy which
may provide support, but often does not address the
trauma symptoms directly.
To help address this concern individual clinicians were
invited to participate in disaster behavioral health specific
training events that the marathon bombing program was
offering and allowed them to apply as contractors through
a Master Services Agreement. The contracting proved
to be very time consuming as many private practitioners
were unfamiliar and overwhelmed with the application
process even with online accessibility. Preparing these
contracts ahead of a disaster or executing them as soon as
possible post incident would have increased the availabil-
ity of these clinicians early on in the response.
117Clin Soc Work J (2017) 45:111–123
1 3
Staff Capacity
MOVA was established to serve all victims of crimes,
not one specific population or event. This reality created
several challenges for the agency and all of the providers
funded by the federal grant to deliver Marathon Bomb-
ing related services. Staff and tasks associated with the
incident could not supplant existing daily responsibilities
to clients that any of the agencies were already serving
through a large number of existing contracts.
Most of the victim services agencies in the state were
in the midst of planning and participating in National
Crime Victims’ Rights Week. In the acute and immediate
phases of the marathon bombing event response, atten-
tion to the disaster response was the priority, but agencies
also had to continue to care for existing providers and
consumers. Victims of other crimes were still in need.
The large influx of urgent tasks required extensive repri-
oritization and planning. Mostly it created internal con-
flict and much stress for many agency staff.
The AEAP grant application allowed MOVA to hire
direct services and grants management staff as necessary
to fulfill the goals of the program. Writing job descrip-
tions, posting positions, and hiring candidates all take
significant time and in the case of grants management,
MOVA waited until after applying for the grant to post
the openings. In retrospect the need for staff dedicated to
the marathon bombing incident were immediate.
In the case of a future tragedy, and knowing now the
scope of work associated with similar incidents, MOVA
would make the call to post for the new positions imme-
diately upon deciding to apply for the AEAP grant, even
if the hires would be made on a temporary basis. Just
managing the needs assessment and grant application
processes takes work away from staff who are expected to
maintain their traditional workload. New hires or consult-
ant assistance could ease this burden.
Another concern around staff is that many community-
wide disasters create a shared trauma event, or an event
where the response staff have experienced the same expo-
sure to the trauma as those they are helping (Tosone et al.
2011). In addition, many staff bring their own history
of traumatic experiences to the present situation. While
MOVA was aware of the importance of promoting self-
care for employees, it was difficult to create activities that
were not already part of the structure of current opera-
tions. Additionally, staff were resistant to taking time for
their own self-care as they measured, and in most cases,
invalidated their needs against the needs of the bomb-
ing victims. Creating more opportunities for staff to dis-
cuss and address their own experiences would likely have
reduced some of their concerns and distress. It is highly
recommended to create, early on, formal and informal
opportunities to help staff talk through these issues
(Salston and Figley 2003).
The Issue of Inequity
One Fund Boston was established within hours of the trag-
edy on April 15th and served as a central donation point to
support victims of the Boston Marathon bombing. It was
seeded by corporate donations, but swiftly began attract-
ing individual donations, and events were organized to feed
it. Amazingly, the fund raised $61 million in private dona-
tions for those with physical injuries resulting from the
bombing. Separate, incredibly generous offers of help were
made from around the world and over time, some survi-
vors would be provided everything from medical supports
to trips and vacations. However, this generous community
response was starkly different than what more traditional
crime victims (e.g., survivors of somewhat stigmatized sex-
ual assault, domestic violence, and community violence)
would receive (Filipas and Ullman 2001). The inequity was
disturbing to many crime victims who were not marathon
bombing survivors and to staff who had to negotiate the
system to provide services to all victims in need.
Eventually MOVA would receive an $8.3 million AEAP
grant to specifically serve marathon victims. This was
more money than the agency had administered statewide
for all crime victims in 2012. Staff struggled with how
to ensure an effective and appropriate response to survi-
vors of the incident, while not neglecting others they were
charged to support. To address this issue, it was decided
that—when building services for marathon survivors—the
new infrastructure and capacity would eventually be able
to support services for everyone served. Some examples
include: training efforts that were offered to agencies and
individual providers across the state who might be work-
ing with bombing survivors even though they were not part
of our program; a media campaign that provided messages
directly to marathon bombing survivors but also normal-
ized distress reactions for all victims of crime in an effort to
destigmatize help seeking; the development of a navigator
system that provided an identified liaison for each survivor
/ family affected that will remain part of our structure; and
trauma services within the Watertown and Boston Public
schools that serve marathon victims and those exposed to
other traumatic events.
A significant learning from the bombing was that victim
definition is extremely important and powerful. The strat-
egy employed to address potential inequity was to create
a broad, inclusive definition of victims that would allow
support of current survivors, those triggered from previ-
ous events such as 9/11 families, veterans, and other vic-
tims of crime and survivors who had not yet come forward.
Leadership worked to message within the community their
118 Clin Soc Work J (2017) 45:111–123
1 3
intent to build infrastructure to serve all victims and advo-
cates provided information regarding services available
under both the AEAP funding and the Victims of Violent
Crime Compensation (MA AGO 2016).
Future programs should carefully explore how the defi-
nition of victims used will inform the needs assessment and
affect the fund and service distribution process.
Victim Services Navigators and Outreach
Prior to the Boston Marathon bombing, MOVA’s role deliv-
ering “direct services” to victims consisted of providing
resources and referral assistance to survivors working with
the many different funded programs or partners. In the early
days after the bombing it was readily apparent that MOVA
required “all hands on deck” to meet the varied needs of
those impacted. Any MOVA or Attorney General Victim
Service personnel who had ever provided direct services to
crime victims was assigned to staff the Family Assistance
Center (FAC) which the City of Boston established. Navi-
gators worked collaboratively with the numerous FBI Vic-
tim Specialists brought in from around the country to meet
with survivors and their families. It became very clear that
the affected population was large and very diverse in their
cultural and socioeconomic backgrounds as well as their
injuries and needs. A significant number of the injured had
families who were struggling financially and emotionally to
provide the support their loved ones needed. Many families
travelled from out of town, were staying at hotels, taking
time off work, and incurring significant costs. The injured
and their families needed to deal with the shock of their
experience while simultaneously making medical deci-
sions, filling out victim compensation, One Fund and other
applications/paperwork, understanding the role of various
agencies and representatives, and speaking to law enforce-
ment. Survivors incurred stacks of mail that included
important and less important offers and opportunities, all of
which required their attention just to be sorted.
MOVA determined it was necessary to have a position
based upon best practices in the field of victim advocates.
As a result, the agency developed a job for “Navigators”
who assisted individual victims of the bombing, and the
related events in Watertown and Cambridge. These Navi-
gators were charged with providing significantly more ser-
vices directly to victims than had been done previously.
They helped victims to understand their own needs, pro-
vided crisis counseling and psychoeducation, assisted with
applications for federal and state benefits, sought access
to behavioral health services, and provided information
about various additional resources. Over time, the Naviga-
tors would build relationships with the victims they were
serving and provide assistance and mental health support
at survivor-led activities, anniversaries, and the trial of the
offender. These Navigators provided a much needed, con-
sistent presence to the survivors they assisted, gaining trust
and legitimacy. They obtained feedback, hearing from vic-
tims directly about whether they liked or didn’t like the ser-
vices and if the felt their needs were met.
One of the lessons around navigation was the need to
conduct outreach to those beyond the direct victim com-
munity. The limits in reaching some survivors in the com-
munity was partly due to the focus on the MA Resiliency
Center, where the expectation was that victims and other
affected community members would come to a designated
site for services. As with many other disaster response pro-
grams, this was not as successful as anticipated. Once a
FAC closes down, having staff go out into the community is
the most successful mode of reaching those affected (Natu-
rale 2006). Alternately, outreach from the response staff
often got lost in the early days because of the multitude
of organizations trying to contact survivors. An outreach
plan included as part of the continuing Navigators’ services
or the addition of designated outreach workers may have
helped reach unidentified victims. Combining geomap-
ping and needs assessment data could have provided details
about the geographic areas reached and untapped sectors
informing program response staff to revise their outreach
strategies and adjust their efforts to reach any newly iden-
tified populations or those for whom original efforts were
unsuccessful.
External Challenges of Overwhelming Information,
Offers and Routes to Accessing Resources
Survivors received an overwhelming amount of informa-
tion from multiple sources. Navigators and victim special-
ists met with survivors in the wake of the tragedy to help
them sort their stacks of regular mail. They received, in
many cases, well intentioned direct and electronic informa-
tion about services, how to plan and apply for financial sup-
ports, and how to receive further information from munici-
pal, state, and federal authorities. Communities made offers
of vacations, trips, prosthetics, medical equipment, and oth-
ers offered survivor’s professional services at no, limited,
or full cost.
The timing of this influx of information was during the
same period that most survivors and their families were
addressing many of their medical needs and suffering
from the negative effects of trauma. This is of real con-
cern as one of the domains that trauma can impact sig-
nificantly is cognition, with a potential to impair memory,
highly influence decision making, impulsivity/reactivity,
judgement and thinking in general (SAMHSA 2014; Nor-
ris et al. 2002). The extent of a traumatic event’s effect
can be seen in the other domains of emotional, behavio-
ral, physical and spiritual responses, but even without the
119Clin Soc Work J (2017) 45:111–123
1 3
impact of the trauma, the volume of information alone
would have been overwhelming.
Navigators often spent significant amounts of time
with survivors and families assisting them in wading
through piles of communications to determine the most
pertinent and valid offers of assistance and information.
While advocates worked to provide information about
resources’ with individual victims, other important infor-
mation was often missed. This is one area in which vic-
tims of terrorism are at a distinct disadvantage caused
largely by the high numbers of victims and the high pro-
file nature of the event. Media distributes information
often without considering how survivors will interpret
it. The focus is often about the offender(s), the scale of
the event, and whether the public is still in danger. The
right to information is at the core of U.S. federal and
state victim rights laws (U.S. DOJ 2016). Crime victims
have rights to information about the criminal proceeding
involving them, their role in it, case updates, the results
of the proceeding, and other information about the case
and the offender before and after the proceedings. There
is usually also some basic language about the right to
be informed of available resources but not about how to
access these supports. Information is power and in the
case of traumatic events, it can reduce anxiety (Hamblen
et al. 2009). It would be helpful if community agencies
responding to a mass tragedy event could, during their
planning process, identify one trusted information source
and create a comprehensive list of resources to share with
the survivor community. This designated point agency
could coordinate communications to the survivors in an
effort to reduce duplication, eliminate advertisements,
screen media and other self-interest requests, and stream-
line resource and referral details.
A Family Assistance Center (FAC) where families could
gain access to all available information and services was
established early on in the response. In an attempt to main-
tain privacy, the FAC was placed in an out of the way loca-
tion and the details were not disclosed in public or shared
with the media. Thus, some family members experienced
difficulty accessing the FAC. It is recommended that in
future events, planners consider placing a FAC near hos-
pitals or other settings where survivors are being attended
to, be more open about the location, and increase security
to restrict the media from invading the privacy of victims
and their families. A related issue involved the Health
Insurance Portability and Accountability Act (HIPAA)
(U.S. H.H.S. 1996) which restricts sharing of health care
information without informed consent of the patient. While
this legislation is designed to protect people in routine situ-
ations, it inhibits necessary information sharing in an emer-
gency. There is a need for legislation that is designed for
emergency situations to address how to inform families if
and where a victim is receiving treatment in the aftermath
of a disaster.
Victims and their families need to know how to access
emergency shelter, financial assistance, food, and other
immediate, basic resources. The bombing did not discrimi-
nate between those that had a lot of money and those who
did not. Many survivors and their families experienced
serious financial hardships. There were at least 20 family
members who traveled to Boston solely to support their
injured family member. As a result, these family members
were unable to continue working and used vacation time or
unpaid time to care for their loved one. Some were staying
in hotels and/or paying Boston’s expensive parking rates.
The financial toll was a huge burden for many of them
until they were given information about available resources
and eventually, their expenditures were covered by Victim
Compensation.
A large number of survivors needed to know how to rap-
idly replace identification, financial documents, and credit
cards that were left behind in what had been labeled a
crime scene. Many were temporarily unable to perform the
basic activities of daily living like buying groceries, obtain-
ing money from the bank, and picking up their kids from
school, because so much depends on our ability to identify
ourselves and access money.
Victims needed to know how to access Victim Com-
pensation and Assistance and other government supported
financial assistance. Survivors who sustained permanent
disabilities were eligible to apply for disability benefits but
there are specific rules about when and how to access both
short term, private disability funds and longer term, gov-
ernment benefits. The applicable rules are complex and can
be quite confusing to survivors who are already trying to
cope with extensive medical concerns, emotional reactions,
and life changes.
A major learning regarding bomb blasts is that many
with hearing loss and traumatic brain injury resulting
from these kinds of injuries (often referred to as “invisible
injuries”) do not initially realize they are injured. Ring-
ing in the ear or sustained loss of focus was overlooked by
many marathon bombing survivors who went home feel-
ing “lucky” to be able to walk away from the disaster in
comparison to others. Later, they would realize they had
significant problems functioning and needed to seek medi-
cal treatment. Many survivors who were suffering hearing
loss and tinnitus felt isolated and required assistance being
screened, understanding assistive technology, and receiving
modifications to their homes. The Massachusetts Commis-
sion on the Deaf and Hard of Hearing was brought in as a
contracted partner, establishing services that included peer
support to address the concerns related to these injuries and
help survivors’ families learn to support their loved ones.
If staff had been able to identify and communicate with the
120 Clin Soc Work J (2017) 45:111–123
1 3
population of those within the blast zone, providing mes-
saging regarding this critical information could have been
prioritized. Recommendations to see a physician as soon as
possible may have gone a long way to help these survivors
feel less isolated in their experience and influenced their
availing themselves of services at the optimal time. It may
have at least allowed them to make an initial connection to
medical services and behavioral health care.
There were other significant physical injuries from the
blasts that are similar to those you see in veterans of wars.
Many have pieces of metal or shrapnel embedded in their
bodies that cannot be removed causing chronic pain, and
emotional injuries as well, leaving some survivors unable
to do their jobs. Another effect of this intentional, human
caused violence was that a number of survivors expressed
that they experienced a change in their life view and felt
that they needed a career change that had “meaning” or
was a means to give back and express gratitude. In order to
ensure survivors could be empowered to work and support
themselves, the University of Massachusetts Institute for
Community Inclusion (ICI) provided vocational rehabili-
tation services. ICI staff work with any survivor in under-
standing their professional / employment goals and helping
them to achieve them.
The Need for Disaster Trained and Trauma Informed
Clinicians
While it might seem self-explanatory, most people who
have never accessed mental health services before will not
likely see themselves as having this need, even after a trau-
matic event (Wang et al. 2007; CMHS 2001). But research
shows that everyone who witnesses a disaster is affected
by it in some way to some degree, though the expression
of responses can be different—even among people with
the same level of exposure (Meyers and Wee 2005; Hob-
fall et al. 2007). Social supports and crisis intervention
are immediate and ongoing needs which may show up
after people have taken care of their basic survival needs
and attempt to move towards a recovery path. Survivors
may first start to realize they are having negative behav-
ioral health responses weeks or months after an incident.
It can take time for survivors to realize that these distress
responses are disaster related and may be interfering with
their work, relationships, and their ability to function on a
day-to-day basis.
A significant finding too, was that in the midst of
Boston, where there are a high number of subject mat-
ter experts and trauma focused mental health treatment
organizations, there was still a lack of individual clinicians
skilled and experienced in disaster specific evidence based
treatment, especially in communities outside of Boston
proper. Many clinicians offered traditional psychodynamic
psychotherapy services which was supportive, but did not
reduce the trauma associated symptoms, and survivors
were suffering. Thus, specialized training on post disaster
distress was offered through the experts at the National
Center for Posttraumatic Stress Disorder to qualified prac-
titioners. These clinicians were then able to offer treatment
to referred Marathon bombing survivors, family members
and responders with costs covered by the antiterrorism
grant funds. Clinicians also expressed the need for ongoing
supervision and case conferencing. These supports helped
clinicians learn from peers about the broad impacts of this
disaster from each different case. They also learned to keep
the work focused on addressing bombing related trauma
symptoms and understand how these issues infiltrated vari-
ous aspects of their clients’ daily living and emotional and
relational mental health.
Communications and Public Messaging
The “Boston Strong” slogan adopted after the marathon
bombing served the greater community, putting forth a
message that supported a sense of unity, strength, and
empowerment. MOVA staff remained concerned that the
use of the terminology, especially so early on after the
disaster, would set many survivors up for a “fall” later
on when they did not feel “Boston Strong” and the real-
ity of their “new normal” set in. Indeed, many survivors
expressed to Navigators and other staff that they didn’t
feel “strong.” Many reporting wondering if something was
wrong with them as they interpreted the messaging to mean
their recovery timeline was lagging behind others. Some
reported feeling they had a responsibility to respond at an
“accepted” level. The response program’s media campaign
ran during service delivery and was designed to be a broad-
reaching informational and educational intervention geared
towards both the general population from the affected com-
munities and specific victims. The information helped to
normalize distress responses to traumatic events with the
intent to decrease anxiety through a better understanding
of common and “normal” responses to an abnormal event
(Hamblen et al. 2009).
As part of the media campaign, the “AskMOVA.org”
website was created to establish one place all crime vic-
tims in Massachusetts could visit to gain accurate and
streamlined information and created sustainable, reusable
resources which addressed the current need and will help in
the next crisis. This was a lesson learned from Project Lib-
erty, New York’s 9/11 mental health response, which used
a “one stop shop” approach at the New York City piers and
the mental health hotline “Lifenet” for all disaster-related
crisis calls and referrals (Draper et al. 2006; Norris et al.
2006).
121Clin Soc Work J (2017) 45:111–123
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Through the media campaign and direct outreach to vic-
tims, information and support was offered surrounding the
time of the incident’s anniversary and during other times
when victims could be “triggered” or have strong remind-
ers of the horrible aftermath of the bombing (e.g., when
recreations of the event were frequently aired on commer-
cial previews of the Hollywood movie based on the inci-
dent). Many survivors responded with comments about
how helpful it was to have information about coping strat-
egies and recommendations for planning ahead for these
triggers. They also noted how comforting is was to see
the victim advocates at the anniversary events and movie
screenings knowing they could reach out for support when
they needed it.
In general, there continues to be a need for increased
awareness of the negative physical, social, emotional,
spiritual and financial impact of the trauma experienced
by disaster survivors and victims of terrorism. While the
level of public support for Boston marathon survivors was
unusual, how families and communities cope is universal,
not unique (Neria et al. 2012). It is important to normal-
ize distress reactions to trauma and violence for survivors
by providing psychoeducational information about the
known impacts of these traumatic events (e.g., “If you can’t
sleep or are afraid to go to busy places, that is normal and
help is available”) and reduce stigma around help seeking
by allowing individuals to identify themselves as victims/
survivors. MOVA provided this information during family
forum sessions months after the bombing, and a year later
in the media campaign. Dissemination of this information
to survivors and the broader community should be a prior-
ity in the aftermath of these events.
Conclusion
While every disaster is different, the human responses
are the same, even though different cultures vary in their
means of expression (CMHS 2001). Humans are horrified
by incidents of mass violence and terrorism and often have
difficulty making meaning of such incidents when perpe-
trated intentionally by our fellow human beings (NCPTSD
2016). The Boston Marathon bombing was unique in many
ways, stemming from the race’s hometown feel (even with
international participants and observers), to the extraordi-
nary immediate medical care available in the field and the
nearby hospitals that saved lives, to the self-sufficiency
with which the city picked itself up and continued its regu-
lar activities, to the rapid construction of the memorial to
the fallen MIT officer and more.
Still, many of the experiences noted here and by the
victims’ families, survivors, responders, and response pro-
gram directors have been echoed by those in prior terrorist
incidents in the U.S., including the Oklahoma City bomb-
ing, the September 11, 2001 terrorist attacks, and mass
violence events such as the Virginia Tech shootings, the
Aurora killings, and the massacre in Newtown. This article
is an attempt to share experiences, lessons learned and rec-
ommendations in the hope that we as a nation can continue
to identify best practices and learn from each other. No
template will serve every event response perfectly. People
and communities vary widely even in small towns across
America—many with their own rituals and traditions—due
to the mix of races and ethnicities that make us a cultur-
ally integrated country. Thus, every disaster response pro-
gram needs to be tailored to the population that it is serv-
ing, attending not only to the type, size and scope of the
incident itself, but also to the demographics of the affected
areas (CMHS 2001).
This article also shares programmatic details that
might inform those who will help in the aftermath of the
next event, so that they do not feel they have to start from
nothing. Our strength lies in our ability to reach out to
each other and know that we are not alone; we are all in
this together. The evidence of this lies in the actions that
we continue to see in victims who help each other, in our
emergency and disaster responders, our medical and behav-
ioral health professionals, our victim services providers,
our government workers and among friends, neighbors, and
even strangers every time an event occurs.
Acknowledgements The MA Office for Victim Assistance Mara-
thon bombing response program services are offered for free and
are (partially) supported by the MA Office for Victims Assistance
through an Antiterrorism Emergency Assistance Program cooperative
agreement number 2014-RF-GX-K002 from the Office for Victims of
Crime, Office of Justice Programs, U.S. Department of Justice (OVC/
OJP/DOJ). The article reflects the opinions of the authors and does
not reflect the opinion of the OVC/OJP/DOJ. This project was (par-
tially) supported by the Massachusetts Office for Victim Assistance
through and Antiterrorism Emergency Assistance Program (AEAP)
cooperative agreement number 2014-RF-GX-K002 from the Office
for Victims of Crime, Office of Justice Programs, U.S. Department
of Justice. The opinions, findings, conclusions and recommendations
expressed in this article are those of the authors and do not neces-
sarily reflect the views of the State of Massachusetts or the Office of
Justice Programs.
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Clinical Social Work Journal is a copyright of Springer, 2017. All Rights Reserved.
- Lessons Learned from the Boston Marathon Bombing Victim Services Program
Abstract
The Boston Marathon Bombing
What We Know About the Effects of Human Caused Mass Violence and Terrorist Events
NeighborhoodCommunity-Level Exposure
Age, Gender, and Ethnicity
Psychological Resources
Resource Deterioration
Environmental Factors
The MA Office for Victim Assistance (MOVA) Marathon Bombing Response Program Goals
Needs Assessment Data
Summary of Services
Phased Activities Post Incident
Lessons Learned
Disaster Response Relationships
Planning and Program Implementation
Staff Capacity
The Issue of Inequity
Victim Services Navigators and Outreach
External Challenges of Overwhelming Information, Offers and Routes to Accessing Resources
The Need for Disaster Trained and Trauma Informed Clinicians
Communications and Public Messaging
Conclusion
Acknowledgements
References