Harassment of women Veterans in VA settings is unfortunately common and has negative effects, but a team of VISN 5 MIRECC researchers, led by Dr. Amy Drapalski, have begun to develop a bystander intervention training for use by Veterans and staff to stop harassment when they see it. Dr. Drapalski’s work was informed by a recent national survey of women Veterans receiving VHA primary care services in 12 VA Medical Centers (VAMCs) across 4 VISNs. Results showed that 25% of women Veterans reported experiencing harassment at VA in the past year.^1-2  A separate anonymous survey of women Veterans at 26 different VAMCs nationwide found similar rates.³ These unwelcome behaviors involved both sexual harassment, e.g. catcalls, being stared at or watched, propositioned, or targeted with sexual or derogatory comments, and sexist harassment, e.g. questioning or denigrating a woman’s identity as a Veteran or right to VA care.¹ Most importantly, these behaviors were consistently associated with women feeling unwelcome and unsafe at the VA^1,3 and with delays in seeking care or missed appointments, particularly among women Veterans who had experienced prior trauma.¹

Dr. Amy Drapalski, along with colleagues Drs. Alicia Lucksted, Amanda Peeples, and Samantha Hack, received funding from VA Health Services Research and Development (HSR&D) to work with Veterans and VA staff to develop a bystander intervention to help people learn ways to stop harassment when they see it. Bystander education interventions aim to supply members of a community, in this case the VA community, with the skills to recognize harassment when it occurs and feel more comfortable and capable of responding to it.  By doing so, organizations can reduce harassment and ensure that everyone feels safe and welcome throughout VA spaces.

An exciting element of the bystander intervention being developed is the use of photovoice to produce photo-narratives that illustrate women Veterans’ harassment experiences and their impact. Photovoice is a technique where people take pictures and then create captions for the pictures which help the viewer understand the meaning and feeling behind the photograph. It has been used throughout the world to help people identify social problems and solutions in communities. To produce the photo-narratives for this project, women veterans will take photographs, with either literal or metaphorical images, and caption the photographs with their stories in order to help viewers better understand how experiencing harassment at the VA makes women Veterans feel.

These photo narratives will be combined with bystander education materials on the 5 D’s developed with input from Veterans and VAMHCS staff. Developed by Hollaback!, a global organization working to end harassment in all its forms, the 5 D’s highlight different ways a person could respond to harassment which include:  Distract (taking an indirect approach to de-escalate the situation); Delegate (getting help from someone else); Document, (noting details of the harasser and situation can help if the victim wants to file a complaint); Delay, (checking in after the incident with the person who was harassed); and Direct (speaking up firmly and clearly about the harassment you are witnessing). These materials will be used to help Veterans and staff learn how to use each of the 5 D’s to address harassment if they see it in ways that they are comfortable with and are safe for everyone involved. Once the intervention has been created, it will be pilot tested with Veterans and VAMHCS staff in order to get feedback and make additional improvements.

For more information about the project please contact Amy Drapalski at 443-421-6273 or at VHABALGBH@va.gov.

References:

1. Klap, R., Darling, J.E., Hamilton, A.B., Rose, D.E., et al. (2019). Prevalence of stranger harassment of women Veterans at VA medical centers and impacts on delayed and missed care. Women’s Health Issues, 29(2), 107-115.
2. Klap, R., Yano, E.M. (2017, September). Prevalence, implications, and efforts to address stranger harassment on VA grounds. VA HSR&D Cyberseminar: Spotlight on Women’s Health.
3. Klap, R., Golden, R. (April, 2017). Preliminary findings from Wave 1 of the WH-PBRN stranger harassment card study. PBRN Community Call.