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，道德伤害被认为是一些退伍军人的心理健康发病率的来源 人群和概念上与现有的心理健康诊断不同。它代表了一个星座 负面影响，主要是内gui，羞耻，愤怒和厌恶。道德伤害与多种 负面健康结果，包括自杀风险。它也被认为会影响精选的康复 结果。在VA设施中，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并未常规评估或解决道德伤害。 VA牧师 作为对道德伤害影响的一些退伍军人的支持来源。例如，初步发现 建议VA牧师服务使用者报告了可能有害的道德上有害事件的强度。作为 日常练习问题，牧师管理铅笔和纸调查，称为精神评估， 旨在告知牧师服务。该项目旨在创建标准化的精神评估 工具，由经验验证的工具组成，该工具将同时用作专注的工具 辅助数据收集。该项目的直接目标是开发和管理新的 VA牧师服务中的标准化SA工具的目标是快速识别MI和/或 有问题的康复成果（例如自杀风险）以及需要服务来解决MI的人。目标1 这项研究是为了定性地检查发展和 在VA牧师设置中应用标准化的SA工具。这项研究的目标2是设计标准化的SA （a）满足牧师和（b）的工具可以用来收集有关道德伤害和的数据 个人退伍军人的康复结果。由8个牧师和4名退伍军人进行的焦点小组将 用于检查（a）他们如何确定道德伤害的问题，（b）将道德伤害评估的评估与 精神评估的其他方面，（c）使用标准化精神的可行性和后勤性 牧师的典型工作环境中的评估工具，（d）从 评估以支持道德伤害，以及（e）从评估转向支持道德伤害。我们将 使用焦点小组评估让VA牧师使用标准化精神评估工具的可行性， 告知（a）道德伤害工具的选择最适合纳入 标准化的精神评估工具和（b）最适合检查结果的工具 与牧师环境中的社会功能，社区重返社会和自杀风险有关。这 标准化的精神评估工具将与VA国家牧师中心合作开发 监督所有V​​A设施中的牧师服务。一旦批准使用，标准化的精神 评估工具将对来自精神卫生保健的25个牧师服务用户的样本进行管理 在亚特兰大弗吉尼亚州医疗中心线。该项目代表着开发可行的至关重要的机会 系统评估道德伤害的途径，并告知人们对道德伤害的理解 影响老兵人口的健康和康复结果。其他实际含义包括信号 对于牧师来说，服务用户可能面临不良后果的风险（例如自杀）。可以 强调需要向正式VA医疗保健提供者转介临床治疗支持 还告知牧师与临床医生之间的跨学科合作，以支持受影响的退伍军人 通过道德伤害。

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