Dynamic Diffusion Network: Advancing moral injury care and suicide prevention using an innovative model

Smigelsky, Melissa A.; Nieuwsma, Jason A.; Meador, Keith G.; Vega, Ryan; Henderson, Blake; Jackson, George L.

doi:10.1016/j.hjdsi.2020.100440

Cited by 12 publications

(9 citation statements)

References 36 publications

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“…Interventions that address both the psychological and spiritual dimensions of moral injury offer opportunities for collaborations between chaplains and mental health clinicians. As discussed, VA Integrative Mental Health offers training for chaplains in the integration of spiritual care with evidence-based psychosocial approaches to treat moral injury and other mental health issues through its education program, MHICS (Nieuwsma et al, 2013; Smigelsky et al, 2020). One of the interventions suggested by this program is the use of moral injury treatment groups cofacilitated by a chaplain and a psychologist, with an aim toward educating veterans about moral injury and exploring the spiritual dimensions of their military experience and personal lives.…”

Section: Roles and Functions Of Military Chaplainsmentioning

confidence: 99%

Military chaplains and mental health clinicians: Overlapping roles and collaborative opportunities.

Cooper¹,

Evans²,

Chari³

et al. 2023

Psychological Services

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Military chaplains and mental health clinicians have unique professional roles and functions within the Department of Defense. However, they also have intersecting roles in delivering care to service members with mental health issues. Although diagnosis and treatment of clinical disorders is the primary focus of mental health clinicians, military chaplains are often the first contact made by service members seeking help for mental health concerns, due in part to issues of greater accessibility, ensured confidentiality, and less stigma. There is growing recognition of the importance of spirituality in the well-being and readiness of service members, as many mental health issues have a spiritual dimension. As a result, chaplains and mental health clinicians often address many of the same issues, albeit with different approaches. This review examines overlap in the work of chaplains and mental health clinicians and contrasts their complementary treatment approaches. These overlapping issues and complementary approaches highlight the potential for greater collaboration between these two professional groups, which could be beneficial for the care of service members. Impact StatementThis article summarizes the complementary roles played by chaplains and mental health clinicians working in active duty military settings to address mental health concerns. Several examples of military programs that integrate both spiritual and psychological health constructs related to overall mental health are summarized, in an effort to promote greater integration of these services.

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Section: Roles and Functions Of Military Chaplainsmentioning

confidence: 99%

Military chaplains and mental health clinicians: Overlapping roles and collaborative opportunities.

Cooper¹,

Evans²,

Chari³

et al. 2023

Psychological Services

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“…Seven pairs of mental health providers and chaplains from sites across VHA were selected to participate in the DDN initiative based on approaches they developed to address moral injury (Smigelsky et al, 2020). These approaches were developed independently of one another at different times and in different locations.…”

Section: Participants and Proceduresmentioning

confidence: 99%

“…The novelty and readily apparent clinical relevance of moral injury has created a space for frontline VHA mental health and spiritual care providers to think creatively about how to apply their core professional skills and identities to moral injury—a form of distress that overlaps with and is also distinct from other concerns commonly addressed by frontline providers, such as PTSD and depression (Smigelsky et al, 2019). Some VHA providers have formed interdisciplinary collaborations that draw on the strengths of both mental health treatment paradigms and spiritual care traditions to intervene in the suffering of those with moral injury, and these providers comprised the moral injury arm of the inaugural Dynamic Diffusion Network (DDN; see Smigelsky et al, 2020 for a full program description). The DDN was formed in an effort to harness collective clinical knowledge and experience, with the hope of deepening understanding of moral injury and contributing to the development of evidence-based psychospiritual therapeutic practice.…”

mentioning

confidence: 99%

Core components of moral injury groups co-facilitated by mental health providers and chaplains.

Smigelsky¹,

Trimm²,

Meador³

et al. 2022

Spirituality in Clinical Practice

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Despite increasing interest in moral injury, there is not yet consensus around what it is (and is not), who can have it and under what circumstances, or the degree and form of distress necessary to distinguish moral injury from other psychological and spiritual difficulties. The novelty of moral injury has created space for frontline Veterans Health Administration (VHA) mental health and spiritual care providers to creatively apply their core professional skills and identities to moral injury. This article presents findings of a core components analysis (CCA) derived from seven co-led chaplain-mental health moral injury group facilitation teams that were involved in a 16-month quality improvement endeavor of the Dynamic Diffusion Network (DDN). The DDN initiative engages providers in collaborative and iterative refinement of practices to promote rapid improvements in care for complex problems that lack a codified evidence base. Using CCA, we identified 10 core components of co-facilitated moral injury group care. Components include a clear conceptualization of moral injury, an inclusive approach to spirituality, and exploration of forgiveness, among others. This article offers guidance that can be widely applied and readily adapted as our collective understanding of moral injury continues to expand and clarify. The core components are articulated here as principles for ongoing review and revision in response to future moral injury advances in the DDN and elsewhere.Melissa A. Smigelsky https://orcid.org/0000-0002-9753-4492The views expressed in this article are those of the authors and do not reflect the position or policy of the Department of Veterans Affairs, United States Government, or other organizations with which authors are affiliated. We would like to thank the individuals who comprised the Dynamic Diffusion Network (DDN) moral injury teams:

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“…There are presently no best practices for treating moral injury, there are many promising treatments, including acceptance and commitment therapy adapted for moral injury, adaptive disclosure, Impact of Killing intervention, and coordinated efforts between military chaplain and mental health care providers (Currier et al, 2021;Farnsworth et al, 2017;Gray et al, 2012;Maguen et al, 2017;Smigelsky et al, 2020). As research continues to differentiate self-from other-directed moral injury, treatment efforts must be tailored accordingly.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

Moral Injury as a Mediator of the Associations Between Sexual Harassment and Mental Health Symptoms and Substance Use Among Women Veterans

Hamrick

Ehlke²,

Davies

et al. 2021

J Interpers Violence

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Moral injury is an array of symptoms theorized to develop in response to morally injurious events, defined as events that challenge one’s core moral beliefs and expectations about the self, others, and world. Recent measures of moral injury have distinguished self-directed moral injury (e.g., moral injury symptoms that emerge following the perpetration of morally injurious events) from other-directed moral injury, the symptoms of which are believed to stem from one’s response to actions that others have committed (e.g., within-rank violence, failures of leadership, and acts of betrayal committed by trusted others or institutions). Using a convenience sample of 154 primarily former military women, the present study examined if other-directed moral injury symptoms (e.g., anger, betrayal, and mistrust) associated with military experience would mediate the association between military sexual harassment and mental health and substance abuse symptoms. Results demonstrated that 85.8% ( n = 127) of the of this sample of women veterans reported experiencing sexual harassment during their military service. Using a single mediation model, we further demonstrated that other-directed moral injury mediated the association between sexual harassment experience and mental health symptoms. Given the percentage of women veterans who reported sexual harassment, these results suggest that additional training for military members, and particularly, military leaders, is necessary to begin to reduce sexual harassment. In addition, mental health providers who work with current and former military members should consider how other-directed moral injury may be associated with mental health symptoms among women veterans who have experienced sexual harassment while in the military.

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Dynamic Diffusion Network: Advancing moral injury care and suicide prevention using an innovative model

Cited by 12 publications

References 36 publications

Military chaplains and mental health clinicians: Overlapping roles and collaborative opportunities.

Military chaplains and mental health clinicians: Overlapping roles and collaborative opportunities.

Core components of moral injury groups co-facilitated by mental health providers and chaplains.

Moral Injury as a Mediator of the Associations Between Sexual Harassment and Mental Health Symptoms and Substance Use Among Women Veterans

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