Victim Advocate Serves the Community at Cleveland Clinic

Healthcare organizations are just beginning to appreciate the number and variety of violent interactions that can occur within their institutions and to the people they serve. Ashley Withrow, MSSA, LISW-S, is a member of the Cleveland Clinic’s police department and has served the community as a victim advocate; she offers a unique opportunity to help victims simultaneous to their medical treatment and employees within their work setting.

This article first appeared in PSQH Magazine.

Ashley Withrow, MSSA, LISW-S, is a member of the Cleveland Clinic’s police department and has served the community as a victim advocate since February 2014. In that role, Withrow, supports anyone connected to the Clinic who has experienced violence, providing information and referrals in addition to emotional support.

Healthcare organizations are just beginning to appreciate the number and variety of violent interactions that can occur within their institutions and to the people they serve. From gang-related shootings in the emergency department, to fights among family members, abusive interactions among clinicians and staff members, injuries to nurses caring for patients with dementia, patients or employees who report incidents of domestic violence, and children who have suffered abuse, violent behavior is common. Withrow responds to all of these incidents and more. Her position offers a unique opportunity to help victims simultaneous to their medical treatment and employees within their work setting. Susan Carr recently talked with Withrow to learn more about her work.

Carr: What is the scope of your role as victim advocate at Cleveland Clinic?

Withrow: My role is to provide emotional support and crisis intervention to victims of crime, including patients, visitors, and employees of the Cleveland Clinic. When someone becomes a crime victim, they may need to interact with many different individuals and systems—for example, reporting to law enforcement or seeking medical attention. If the victim chooses to pursue criminal charges, he or she may have to share their story with prosecutors, judges, or members of a jury. Many people find the process overwhelming and confusing. My role is to support them emotionally and help them engage effectively with the systems. I do this by offering education, resources, and referrals.

Carr: Are you primarily providing support services for people who are engaged in the criminal justice system?

Withrow: While my primary responsibility is to educate victims about their rights and make sure those rights are upheld within the criminal justice system, victims are typically impacted by the crime in a variety of other aspects of life. I tell them what to expect as they go through the criminal justice system and provide a realistic understanding of what that system might look like. Most people haven’t been through that before and don’t know what the process looks like. It’s definitely not like what they see on television and in the movies!

In order to meet the other varying needs that arise due to the victimization or trauma, I’m familiar with our community resources and counseling and support group options. Programs such as crime victim compensation or victim information and notification are available to crime victims. Connecting people with those kinds of programs or helping them apply to a compensation program is another part of my job.

Carr: Do you ever support victims of events that are more subtle—involving less physical violence than, say, an incident involving a weapon—but are very upsetting nonetheless? How do you determine the scope of events you’re responsible for?

Withrow: I respond to a wide range of incidents and individuals and work with people who have experienced many degrees and varieties of unfortunate events and injuries. Everyone reacts differently to a traumatic event, and my job is to address their needs rather than tell them how to react. Victims can access support of a victim advocate regardless of whether or not their case will be prosecuted.

Although I’m based in Cleveland Clinic’s police department, my job is fundamentally about offering help following an incident. For example, perhaps a nurse was struck by a patient suffering from dementia or coming out of anesthesia. There’s no criminal intent, but it is still my job to say to the nurse, “Hey, how are you doing? I’m sure that was very scary for you. Is there anything I can do to support you at this point?” or, “Are you feeling safe in your workplace, and if not, what can we do to increase your safety?” My job is very focused on the emotional needs of the victim, who in this case is the employee.

Carr: It sounds like you provide services across a wide spectrum of emotional circumstances.

Withrow: That’s true; there’s lots of variety. Another example of people I support are Cleveland Clinic employees who are experiencing domestic violence at home, and it’s impacting them in the workplace. Or I’m supporting employees who are experiencing workplace violence. Sometimes my clients are patients who have come in through our emergency department saying, “I’m here because I’m a crime victim.” Or patients might be here for an unrelated reason, but during the course of their treatment they disclose that they have experienced a crime—stalking, harassment, robbery, or something else. Certainly, the need is there. Our employee and patient populations reflect what’s going on in the larger community.

Carr: Do you work alone? How do you handle what sounds like an overwhelming workload?

Withrow: Well, I’m just one person, and I definitely can’t do it all. I work collaboratively with many partners here at the Cleveland Clinic, such as committees that focus on issues related to my work. The Cleveland Clinic has committees for domestic violence, elder abuse, workplace violence, and a child protection team. I work closely with other departments, such as employee assistance, case management, human resources, and nursing to support victims. It is also critical that I maintain partnerships in our community as well. I’m active, for example, in the county sexual assault response team. I frequently refer victims to community agencies, such as the Domestic Violence and Child Advocacy Center or Cleveland Rape Crisis Center. If a survivor comes to me as the victim advocate, and they are in crisis, I have to do the best I can to help them, but I can’t do everything. For example, I do not provide shelter. So if I’m helping someone who has safety concerns at home, I will connect that victim with the local domestic violence shelter and support her through the process—hopefully—of getting into the shelter. Then the victim transitions to that provider, who can welcome them to the shelter and support them during their stay.

Individuals travel from all over the country and world to seek medical treatment at the Cleveland Clinic, so I sometimes help navigate referrals and situations at a distance, even outside of Ohio, and refer them to their local law enforcement jurisdiction.

Carr: Do you collect data about the incidents you respond to?

Withrow: I do track data on the number of victims served, as well as type of victimization and other demographics as required by my funding source, the Victims of Crime Act (VOCA). We have seen growth in numbers over the last 2.5 years since I started in this position, which indicates to me that the need continues to be present for this type of service.

Carr:How do victims find their way to you?

Withrow: The bulk of my referrals come from police officers who are out in the hospitals and on the main campus in downtown Cleveland on a daily basis. We also have officers in our regional hospitals throughout northeast Ohio. Our Cleveland Clinic police officers staff those facilities 24 hours a day. Most of my referrals come from officers responding to calls and requests for service. They might refer someone to me who is filing a police report or someone involved in an event to which the Cleveland Clinic’s crisis intervention team has responded.

However, I have seen an increase in the number of referrals coming from other sources, such as nurses, physicians, case managers, employee assistance, medical assistants, or even individuals referring themselves who have heard about the program over the last couple of years.

We hope we are creating awareness and a more victim-centered environment at the Cleveland Clinic. For example, we want to make sure our caregivers have the tools and resources they need to effectively screen patients for domestic violence. We also want caregivers to understand what workplace violence really is, and then know what to do should they feel they’ve experienced it. That’s another piece of what I do.

Carr: Given that it is unusual for a health system to provide this kind of support, are you aware of special commitment to this effort from leaders at Cleveland Clinic? How did this start, and where does the funding come from?

Withrow: In 2013, David Easthon, the chief of the Cleveland Clinic Police Department, became aware of funding through the Ohio Attorney General’s Office VOCA grant. Under his leadership, the Cleveland Clinic applied for and was granted funds for a full-time victim advocate position. VOCA funds were established in 1984 as a federal grant that takes fines and fees from convicted federal offenders and distributes the money to victim service providers across the country. We apply for continued grant funding each year.

Leadership has been important to my advocacy work as well as to our efforts to prevent workplace violence. In the case of employees who are victims of violence, the organization needs to provide support to the person who directly experienced the violence, as well as the entire department and unit where the incident occurred. The effects of violence can ripple across the team, and we must acknowledge and support each individual’s experience. Witnessing violence can cause psychological trauma, just like experiencing it directly. The message from leadership and managers following a violent incident must be clear and concise: “This was not your fault. This is not acceptable behavior. How can we help you feel safe?” I have seen many leaders come together to form a collaborative effort to address issues of workplace violence and other victim concerns in our healthcare system.

By helping patients, visitors, and employees of the Cleveland Clinic feel safe and supported through victim advocacy, we strive to improve the quality of services as a healthcare system and quality of life for those providing world-class healthcare.