Assessing Moral Injury in Veterans as part of a Chaplain-Delivered Spiritual Assessment: Implications for Social and Community Rehabilitation

作为牧师精神评估的一部分来评估退伍军人的道德伤害：对社会和社区康复的影响

• 批准号: 10392842
• 负责人: Jeanette Irene Harris
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10392842
• 关键词: Address; Affect; Anger; Assessment tool; Behavior; Belief; Clinical; Clinical Services; Collaborations; Collection; Communities; Community Integration; Data; Data Collection; Development; Diagnosis; Distress; Documentation; Emotional; Ensure; Ethics; Event; Feeling; Feeling hopeless; Focus Groups; Goals; Grief reaction; Guilt; Health; Health Personnel; Healthcare; Individual; Injury; Intake; Link; Literature; Logistics; Major Depressive Disorder; Measurement; Measures; Medical center; Mental Health; Morals; Morbidity - disease rate; Outcome; Paper; Patient Self-Report; Persons; Post-Traumatic Stress Disorders; Procedures; Psychometrics; Rehabilitation Outcome; Rehabilitation therapy; Reporting; Research; Risk; Role; Sampling; Self Care; Services; Shame; Signal Transduction; Social Functioning; Social isolation; Source; Standardization; Suicide; Surveys; Testing; Therapeutic; Veterans; Work; Workplace; acceptability and feasibility; adverse outcome; base; clinical Diagnosis; community reintegration; design; experience; follow-up; functional outcomes; handicapping condition; health care settings; innovation; instrument; interdisciplinary collaboration; military service; military veteran; negative affect; psychologic; routine practice; social; social implication; sound; suicidal risk; tool

In recent years, moral injury has been recognized as a source of mental health morbidity in some Veteran populations and conceptually distinct from existing mental health diagnoses. It represents a constellation of negative affect, chiefly guilt, shame, anger, and disgust. Moral injury has been associated with a variety of negative health outcomes, including suicide risk. It has also been theorized to impact select rehabilitation outcomes. In VA facilities, mental health care providers are the chief source of support for affected Veterans. Still, moral injury is not routinely assessed or addressed in formal clinical-therapeutic settings. VA chaplains serve as a source of support for some Veterans affected by moral injury. For example, preliminary findings suggest that VA chaplaincy service users report a high intensity of potentially morally injurious events. As a matter of routine practice, chaplains administer pencil-and-paper surveys, called spiritual assessments, intended to inform chaplaincy services. This project is designed to create a standardized spiritual assessment tool, comprised of empirically validated instruments, which would simultaneously serve as a vehicle for focused secondary data collection. The immediate goals of this project are to develop and administer a new standardized SA tool in VA chaplaincy service with the goal of rapidly identifying individuals with MI and/or problematic rehabilitation outcomes (e.g., suicide risk) and who are in need of services to address MI. Aim 1 of this study is to qualitatively examine the feasibility, logistics, and practical implications of developing and applying a standardized SA tool in VA chaplaincy settings. Aim 2 of this study is to design a standardized SA tool that (a) meets the stated needs of chaplains and (b) can be used to collect data about moral injury and rehabilitation outcomes in individual veterans. Focus groups conducted with 8 chaplains and 4 Veterans will be used to examine (a) how they identify moral injury concerns, (b) incorporating assessment of moral injury with other aspects of a spiritual assessment, (c) feasibility and logistics of using a standardized spiritual assessment tool in the chaplains' typical work setting, (d) documentation and procedures to move from assessment to support for moral injury, and (e) moving from assessment to support for moral injury. We will use focus groups to assess the feasibility of having VA chaplains use a standardized spiritual assessment tool, informing the choice of which (a) moral injury instrument(s) is/are most appropriate for inclusion in a standardized spiritual assessment tool and (b) instruments are most appropriate for examining outcomes relevant to social functioning, community reintegration, and suicide risk in chaplaincy settings. The standardized spiritual assessment tool will be developed in collaboration with the VA National Chaplain Center, which oversees chaplaincy services across all VA facilities. Once approved for use, the standardized spiritual assessment tool will be administered to a sample of 25 chaplaincy service users from the mental health care line at the Atlanta VA Medical Center. This project represents a critical opportunity both for developing a viable avenue for systematically assessing for moral injury as well as informing understandings of how moral injury affects health and rehabilitation outcomes in Veteran populations. Other practical implications include signaling to the chaplain that a service user may be at increased risk of adverse outcomes (e.g., suicide). This could highlight a need for a referral for clinical-therapeutic support from a formal VA health care provider, thereby also informing interdisciplinary collaboration between chaplains and clinicians in support of Veterans affected by moral injury.

近年来，精神伤害已经被认为是一些退伍军人精神健康疾病的一个来源 在概念上与现有的精神健康诊断截然不同。它代表一个星座 消极情绪，主要是内疚、羞愧、愤怒和厌恶。精神上的伤害与各种 消极的健康后果，包括自杀风险。它也被理论化地影响选择的康复 结果。在退伍军人管理局，精神卫生保健提供者是受影响退伍军人的主要支持来源。 尽管如此，在正式的临床治疗环境中，精神伤害并不是常规的评估或处理。退伍军人协会牧师 为一些受精神创伤影响的退伍军人提供支持。例如，初步调查结果 建议退伍军人事务部牧师服务用户报告高强度的潜在道德损害事件。作为一名 在日常实践中，牧师们会进行纸笔调查，称为精神评估， 意在通知牧师服务机构。此项目旨在创建标准化的灵性评估 工具，由经经验验证的工具组成，这些工具将同时作为一种工具 二次数据收集。该项目的近期目标是开发和管理一个新的 退伍军人事务部牧师服务中的标准化SA工具，目标是快速识别患有MI和/或 有问题的康复结果(例如自杀风险)和需要解决心肌梗塞的服务的人。目标1 这项研究将定性地检查开发和开发 在退伍军人事务部设置中应用标准化SA工具。本研究的目标2是设计一个标准化的SA (A)满足牧师规定的需要和(B)可用于收集有关精神伤害的数据和 个别退伍军人的康复结果。由8名牧师和4名退伍军人组成的焦点小组将 用于审查(A)它们如何确定精神损害问题，(B)将精神损害评估与 灵性评估的其他方面，(C)使用标准化灵性评估的可行性和后勤 牧师典型工作环境中的评估工具，(D)文件和程序 从评估转向支持精神伤害；(E)从评估转向支持精神伤害。我们会 利用焦点小组评估让退伍军人教士使用标准化的精神评估工具的可行性， 告知选择哪个(A)精神损害赔偿文书(S)最适合列入 标准化精神评估工具和(B)最适合检查结果 与牧师环境中的社会功能、重新融入社区和自杀风险相关。这个 将与退伍军人事务部国家牧师中心合作开发标准化的精神评估工具， 负责监督退伍军人管理局所有设施的牧师服务。一旦被批准使用，标准化的灵性 评估工具将用于从精神卫生保健中心抽样调查25名牧师服务使用者 在亚特兰大退伍军人医疗中心排队。这个项目代表着一个关键的机会，对于开发一个可行的 系统评估精神损害以及告知对精神损害如何理解的途径 影响退伍军人的健康和康复结果。其他实际影响包括发出信号 对于牧师来说，服务使用者可能面临更大的不良后果风险(例如自杀)。这可能会 强调需要由正规退伍军人保健提供者转介以获得临床治疗支持，从而 还通知牧师和临床医生之间的跨学科合作，以支持受影响的退伍军人 受到精神上的伤害。

项目成果

Understanding Moral Injury Morbidity: A Qualitative Study Examining Chaplain's Perspectives.

• DOI: 10.1007/s10943-021-01414-3
• 发表时间: 2021-10
• 期刊: Journal of religion and health
• 影响因子: 2.8
• 作者: Boska RL;Dunlap S;Kopacz M;Bishop TM;Harris JI
• 通讯作者: Harris JI

Feasibility of using moral injury screening instruments in VA chaplaincy spiritual assessments.

在退伍军人管理局牧师精神评估中使用道德伤害筛查工具的可行性。

• DOI: 10.1080/08854726.2022.2032980
• 发表时间: 2022
• 期刊: Journal of health care chaplaincy
• 影响因子: 1.9
• 作者: Kopacz,Marek;Bishop,ToddM;Ayre,Amanda;Boska,RachelL;Goldstrom,David;Tomberlin,Drew;Baxter,Sheila;Dunlap,Shawn;Harris,JIrene
• 通讯作者: Harris,JIrene

Chaplains' perspectives on standardizing spiritual assessments.

牧师对标准化精神评估的看法。

• DOI: 10.1037/ser0000726
• 发表时间: 2023
• 期刊: Psychological services
• 影响因子: 2.3
• 作者: Boska,RachelL;Dunlap,Shawn;Bishop,ToddM;Goldstrom,David;Tomberlin,Drew;Baxter,Sheila;Kopacz,Marek;Quigley,KarenS;Harris,JIrene
• 通讯作者: Harris,JIrene