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

近年来，精神伤害已被认为是一些退伍军人心理健康发病的来源 在概念上与现有的心理健康诊断不同。它代表了一个星座， 消极的情感，主要是内疚、羞耻、愤怒和厌恶。精神伤害与各种各样的 负面的健康结果，包括自杀风险。它也被理论上影响选择康复 结果。在退伍军人管理局的设施，精神卫生保健提供者是支持受影响的退伍军人的主要来源。 尽管如此，精神伤害并没有在正式的临床治疗环境中进行常规评估或解决。退伍军人事务部牧师 作为一个来源，支持一些退伍军人受到精神伤害。例如，初步调查结果 表明VA牧师服务用户报告了高强度的潜在道德伤害事件。作为 作为一种常规做法，牧师们管理着纸和纸的调查，称为精神评估， 旨在告知牧师服务。这个项目的目的是建立一个标准化的精神评估 工具，由经验验证的工具组成，同时作为重点工具， 二次数据收集。该项目的近期目标是开发和管理一个新的 VA牧师服务中的标准化SA工具，目标是快速识别MI和/或 有问题的康复结果（例如，自杀风险）和需要解决MI的服务的人。目标1 这项研究是定性研究的可行性，后勤，和实际影响的发展， 在VA牧师设置中应用标准化SA工具。本研究的目的二是设计一个标准化的SA 一种工具，（a）满足牧师的既定需求，（B）可用于收集有关精神伤害的数据， 退伍军人个人的康复结果。由8名牧师和4名退伍军人组成的焦点小组将 用于检查（a）他们如何识别精神伤害问题，（B）将精神伤害评估与 精神评估的其他方面，（c）使用标准化精神评估的可行性和后勤 牧师典型工作环境中的评估工具，（d）文档和迁移程序 评估，以支持精神伤害，（e）从评估到支持精神伤害。我们将 使用焦点小组来评估退伍军人事务部牧师使用标准化精神评估工具的可行性， 告知选择哪些（a）精神伤害文书最适合纳入 标准化的灵性评估工具和（B）工具最适合检查结果 与社会功能，社区重新融合和牧师环境中的自杀风险有关。的 标准化的精神评估工具将与VA国家牧师中心合作开发， 负责监管退伍军人事务部所有机构的牧师服务一旦批准使用，标准化的精神 评估工具将管理的样本25牧师服务用户从精神卫生保健 亚特兰大VA医疗中心的电话。这个项目是一个关键的机会，既发展一个可行的 系统评估精神伤害的途径，以及了解精神伤害如何 影响退伍军人群体的健康和康复结果。其他实际影响包括信号 服务用户可能处于不利结果的增加的风险中（例如，自杀）。这可能 强调需要从正式的VA卫生保健提供者那里转诊获得临床治疗支持，从而 还为牧师和临床医生之间的跨学科合作提供信息，以支持受影响的退伍军人 道德伤害。

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.