Lessons learned: MUSC's trauma response after tragedy

On the evening of June 17, 2015, a sacred space was shattered. During a quiet Wednesday night Bible study, as 12 worshipers bowed their heads in prayer inside Mother Emanuel AME Church – one of the nation’s oldest and most historically significant Black congregations – a 21-year-old racial extremist opened fire. In a matter of minutes, nine lives were stolen in an act of unimaginable violence. The massacre shook Charleston and the nation to its core, piercing the heart of a city known for its grace and hospitality. 

In the immediate aftermath, amid the grief, confusion and horror, the community faced an overwhelming question: how to begin healing from such an unthinkable wound. Fortunately, Charleston had resources not every city would – and among them, the Medical University of South Carolina. Through its expertise in mass casualty response and experience supporting victims of crime and trauma, MUSC was able to step in immediately to provide critical care, solace, coordination and support for those affected – the families of those lost, their fellow congregants and the broader Charleston community. But the trauma also struck close to home, as MUSC employees were also suffering – some were lifelong members and leaders at Mother Emanuel, some lost dear friends – and others had planned to attend the Bible study that night, until their plans changed. All would need what MUSC had long prepared to give: a path forward.

Much of MUSC’s ability to respond so swiftly and compassionately in the wake of the tragedy was rooted in years of groundwork already in place. In the decades prior, Dean Kilpatrick, Ph.D., and his team at the National Crime Victims Research and Treatment Center (NCVRTC), housed within MUSC, hosted week-long victim assistance trainings as a part of the National Victim Assistance Academy and the SC Victim Assistance Academy, sponsored by the United States Department of Justice Office for Victims of Crime. The trainings were offered to victim advocates, law enforcement and mental health professionals to help them to assist victims of crime more fully. Kilpatrick said these trainings turned out to be extremely helpful after the tragedy at Mother Emanuel AME Church. 

“We had already worked with a lot of these agencies and people,” Kilpatrick said. “When the mass shooting at Mother Emanuel AME Church happened, we were able to contribute to an effective, collaborative response that would have been harder if we all hadn’t already known each other.” 

Kilpatrick said it also gave the center’s faculty a more natural introduction to the church members and surrounding community. “We did not carry the burden a lot of other academic entities do – being asked, ‘Why are you here?’ and ‘Why should we trust you? You’re just a bunch of academics.’”

The relationships the NCVRTC shared with local governments and organizations allowed partnering community agencies to quickly respond in the aftermath. The team collaborated with Charleston Dorchester Mental Health Center (CDMHC), Berkeley County Mental Health Center (BCMHC), City of Charleston Police Department, Charleston County Coroner’s Office, Charleston County Sheriff’s Office, Ninth Judicial Circuit Solicitor’s Office, FBI Office of Victim Assistance, SC State Office for Victim Assistance and the U.S. Attorney’s Office for the District of South Carolina to work closely as part of the response and recovery efforts invited by leadership from Mother Emanuel AME Church. 

Alyssa Rheingold, Ph.D., credits these partnerships with the effective response to the incident. “One of the lessons learned from the Mother Emanuel AME Church shooting is that even though we didn’t have a mass violence response plan in the community from the perspective of victim and mental/behavioral health services, we did have important partnerships already established,” Rheingold said. “So, when this happened, we were able to effectively respond because of those partnerships. If we didn’t have such existing collaboration in our community, it would not have gone as well.”

In the immediate aftermath, several partnering agencies coordinated to take several steps to assist the families of the victims and the community at large. The team attended each funeral and memorial service, provided support for parishioners at the Sunday Church services, staffed a Family Assistance Center in the community for five weeks and provided individual assessments and care for family and church members. As time went on, the team continued to provide evidence-based trauma and grief counseling, offered support at various church functions and held a support group for family and church members at the local library.

Nearly a year later, a federal grant from the DOJ’s Office for Victims of Crime’s Antiterrorism and Emergency Assistance Program (AEAP) funded the Mother Emanuel Empowerment Center (MEEC). The center provided in-person and virtual resources for victims, families, church members and anyone else in the local community who was directly affected by the attack at the church. In addition to in-person support services, the center offered website resources and a self-help app for those navigating the traumatic event.

The response and recovery partnering team also learned firsthand how to serve a hurting community. “We had some lessons learned,” Rheingold said. “We acknowledge we didn’t always do everything well, as there were no written or consistent best practices at the time. However, we did know the impact of trauma and traumatic loss and trauma recovery among individuals and communities. But each community is unique, and context is important to consider. We were figuring it out as we went along.” 

The team worked together to assess what was needed in the aftermath of tragedy and how to work in concert with local agencies to understand the work that needs to be done more fully. 

“I do think some of the things that we learned and some ideas we had about what the field may need did inform some of the initial work of the National Mass Violence Center, in addition to learning from other communities and other professionals in the field,” Rheingold said. 

In the 10 years since the tragedy at Mother Emanuel, many of the faculty and staff at the NCVRTC have applied their experience to the NMVC. The center provides guidance and best practices for those responding to mass violence incidents. The lessons that were learned from applying for the AEAP grant, establishing relationships with and working alongside local partners, helping victims through the court process and setting up a resiliency center informed what are now considered to be recommended best practices by the NMVC. “Building local partnerships before a mass violence occurs matters, and they are really important,” Rheingold said. “You should not be sharing your business cards for the first time with other agencies at a family assistance center.”  

“At the time of the Mother Emanuel AME Church shooting, there were few best practices for setting up a resiliency center,” Rheingold said. “There weren’t guidelines. We started by reaching out to resiliency centers in Aurora, Boston and Sandy Hook to learn about what they did and determine how to best adapt something that was relevant to victims, survivors and church members impacted by the mass violence event at Mother Emanuel AME Church. Since then, over 20 resiliency centers have been established.”

As part of their training and preparedness efforts, the NMVC emphasizes the importance of these local partnerships to others. “When we’re working with communities, our role isn’t to come in and do,” Rheingold said. “Our role is to come in and help other communities strengthen those connections and partnerships and use them to shape what their response and recovery efforts look like.”

“The tragedy at Mother Emanuel served as an example of how a community and a country could come together to support the families of those that were lost,” said Kristina Rose, a senior research associate at the NCVRTC, who worked for the DOJ at the time of the incident. “Because of the preparedness work that the NMVC has been doing, I do think more and more communities are in a place to be able to respond in a smoother way because those relationships have already been established, and they have preparedness and response protocols in place.”