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Currents - Sept. 2011 - Disaster Preparedness Article - Sandy Chaiken
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Worst Bus Accident in City's History

Social Work's Expanding Role in a Post 9/11 World

Sandy Chaiken, LCSW-R, NYC Health & Hospital Corporation, North Bronx Health Care Network Director Of Social Work, Jacobi Medical Center/North Central Bronx Hospital



Sandy Chaiken

Editor's Note: Recently, NASW-NYC staff became aware of the inspiring work of the Bronx-wide Social Work Disaster Response Team (SWDRT) after hearing Sandy Chaiken speak at an event celebrating Social Work Month. She sha red the critical role that social workers played in the March 12th Chinatown Bus Accident, and described how Social Work is now recognized as a key component of Emergency Preparedness and Disaster Response in the Bronx, with social workers taking the lead to address the psychosocial and mental health needs of victims of disaster. Planning a special focus on the tenth anniversary commemorating 9/11, Currents staff invited Ms. Chaiken to share how more than a decade of coalition building, competency-based training, and on-the-ground experience led to the formation of the SWDRT. Collaborating on this article with Ms. Chaiken were her colleagues at the NYC Health and Hospital Corporation's North Bronx Health Care Network: Bill Lane, LCSW-R and Regina Riolo, LCSW-R. Mr. Lane is the Deputy Director of Social Work at Jacobi Medical Center/North Central Bronx Hospital and Ms. Riolo is the Social Work Supervisor for the Emergency Department Social Work Unit at Jacobi Medical Center.

When my pager went off early in the morning of Saturday March 12, 2011, I saw the number, and immediately knew something was wrong. I was informed there was a Chinatown Bus Accident on Interstate 95 which resulted in multiple casualties. This was later written about in New York Magazine as “the worst bus accident in the city’s history… 15 of its victims were brought to one hospital, 14 lived.”

The hospital’s Emergency Response Plan was activated and Social Work was mobilized. I immediately thought who would I need? Were there children involved? Who could get to the hospital after a week of flooding and road closures? Would we need social workers who spoke Mandarin or other dialects? Would we need to activate the Bronx wide Social Work Disaster Response Team?

The first person I called was Regina Riolo, LCSW-R, Supervisor for the Emergency Department, quickly followed by each Social Work Supervisor in the Department. Once it was clear we were activating our disaster plan, we mobilized 10 social workers who practice in the Emergency Department, Medical and Surgical Critical Care, Medicine, Palliative Care and Pediatrics. We arrived at the hospital prepared to respond to the emergency, with minimal information about the victims and their families, not unlike the situations social workers often encounter. However, having been trained in disaster response, we were clear on our roles and confident in being able to effectively work together as a team to meet the needs of the individuals, family members and community. This readiness is the result of a professional social work infrastructure and integration into the hospital emergency response structure that has been developed over many years.

Social Work’s Integrative Role in Emergency Response
Review of the professional literature and experiences of first responders internationally reveals that health care facility disaster planning has focused on the provision of medical care, despite the considerable evidence that health care facilities are often called upon to meet non-medical psychosocial needs of victims of the disaster, and their families, patients and staff. We believe in a best practice model to respond to disaster, the integration of the medical, psychosocial support and mental health treatment systems is essential.

Core Skills Translate to Emergency and Disaster Competencies
Social workers have core crisis intervention skills utilized daily in diverse settings that directly translate to intervention with disasters. Masters level workers are trained in crisis intervention, mental health assessment and counseling, and are familiar with both facilitating and accessing community resources. Social workers in healthcare and other settings address personal emergencies, traumatic loss, bereavement and crisis issues with individuals and family members daily. These crisis competencies reflect “everyday” social work practice, which typically occurs on a smaller scale with a client, family or group. We take the perspective that Emergency and Disaster Response competencies are a core part of Social Work’s scope of practice, similar to our scope of practice and role in Child Abuse and Neglect.

Prior to the events of September 11, 2001 the Emergency Department Social Workers at Jacobi Medical Center had taken steps to be part of the Emergency Operations Plan. They became Red Cross Disaster Mental Health Volunteers and, along with their medical colleagues, attended workshops in Emergency Management. They actively established the Social Work role of psychosocial and mental health disaster response into the facility’s Emergency Operations Plans. By 2000 Social Work at North Bronx Healthcare Network (Jacobi and North Central Bronx Hospital) was seen as a critical component of disaster response.

Formation of the Bronx Emergency Preparedness Coalition (BEPC)
Following September 11, 2001, 13 Bronx Healthcare facilities formed the Bronx Emergency Preparedness Coalition (BEPC) whose purpose was to provide mutual aid in the event of a community wide disaster. This included municipal, voluntary, state and federal hospitals, as well as skilled nursing facilities. As part of the BEPC, Social Work leaders from the facilities formed a Social Work subcommittee. Based on our work, what became apparent was how divergent the Social Work role was in each facility during a disaster. Specifically, many social workers were deployed to be part of the general “labor pool” (i.e. feeding, transporting, etc.), rather than being utilized as social workers with expertise in crisis intervention and mental health.

As a result of the coalition’s work, in 2006 BEPC applied for and was awarded a grant through the NYC Department of Health and Mental Hygiene Healthcare Emergency Preparedness Program to develop two projects to address county wide disasters: 1). To establish the BEPC Surge Capacity and 2). To develop a Social Work Disaster Response Team. This was a 3 phase, multi-year grant from 2006-2009. By 2009 Social Work’s role leading the psychosocial and mental health response was incorporated into all 13 of the BEPC Bronx health care facilities’ Emergency Response Plans.

Competency-Based Training Increases Social Workers' Readiness for Disaster
In partnership with the Workplace Center at the Columbia University School of Social Work and NYC Department of Health and Mental Hygiene Healthcare Emergency Preparedness Program, social work leadership developed an inter-agency Social Work Disaster Response Team (SWDRT). The project created and implemented standardized policies and procedures delineating social workers’ roles in a disaster. This included standardized assessment tools, job descriptions, plans for social work deployment to other facilities and plans for a family support center. The competency based education and training curriculum in disaster response that was articulated in the project has been the conduit that brings staff together.

In addition to teaching specific disaster skills, this training helps staff integrate disaster response as a core component of their practice. The 6 hour, 3 sessions training, developed by the Workplace Center, has been conducted in groups of 20-25 with trainers and staff from the 13 facilities attending together in one setting to parallel the process of deployment. The 3 sessions include: 1) Social Work’s Role in Disaster Preparedness, 2) Understanding and Responding to Secondary Trauma, and 3) Psychological First Aid.

To date, approximately 200 social workers have been trained and training is on-going. Despite everyone’s busy schedule and competing agendas, the training sessions continue to be well attended. Self reports from staff’s post training evaluations indicate a greater sense of being confident to respond to disaster. After a recent June school bus accident in Westchester County, the Social Work manager from the responding hospital reported that staff who participated in the SWDRT training were in the forefront of the disaster response and that the staff shared they were better prepared for the situation they had to face.

Expanding View of Hospital's Overall Emergency Response Plans
In a best practice model, SWDRT provides emergency response competencies to meet the needs of patients and families in a disaster. Advocacy and education with facility leadership resulted in administration recognizing that Social Work is a critical component of the Hospital Incident Command Structure. Thus, SWDRT has resulted in patients and staff viewing Social Work’s role in addressing traumatic incidents in a more expansive way.

The project’s success is the result of the partnership of social work practitioners in healthcare, social work academic researchers at the Workplace Center at Columbia University School of Social Work and public health researchers at the New York City Department of Health and Mental Hygiene – each brought the strengths of their skills and experiences.

Like the development of a good disaster plan, the implementation of that plan is dependent on the individuals that work as a team. We wish to acknowledge our team: BEPC facilities Emergency Managers; BEPC Social Work leadership; Lauren Gates, PhD and Virginia Oran-Sabia, LMSW at the Workplace Center; Marni Confino, LCSW-R, Project Administrator; Regina Riolo, LCSW-R and Bill Lane, LCSW-R Deputy Director of Social Work, North Bronx Healthcare Network.

I am grateful for the partnership and collaboration with the BEPC social work leadership. We continue to meet together regularly, brainstorming how to be more effective in preparing for disaster, as well as address the complex clinical and systems issues impacting our practice today. 


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