Let’s Get “REAL”: A Collaborative Group Therapy for Moral Injury

Smigelsky, Melissa A.; Malott, Jesse; Parker, Ryan; Check, Carter; Rappaport, Brad; Ward, Steffanie

doi:10.1080/08854726.2022.2032978

Cited by 10 publications

(2 citation statements)

References 31 publications

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“…Third, while DDN teams have anecdotally shared clinical outcomes collected as part of measurement-based care, we did not obtain Institutional Review Board approval to consolidate or report on those outcomes here. However, individual teams have published group-specific findings (e.g., Cenkner et al, 2021;Pernicano et al, 2022;Smigelsky et al, 2022), which contribute to the evidence base for this work. Finally, while CCA is a developmentally appropriate methodology at this stage of moral injury intervention research, future efforts should employ a diverse range of approaches to contribute to the evidence-base for group-based moral injury interventions.…”

Section: Discussionmentioning

confidence: 90%

“…Data can be quantitative or qualitative. Qualitative data may be captured from verbal (e.g., written narratives, as in the REAL group; see Smigelsky et al, 2022) or visual means, such as the cracked bowl drawings used by the San Antonio team (see Pernicano et al, 2022 for more information). Data can be captured once or at multiple time points, depending on how it is to be used.…”

Section: Systematic Measurementmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 90%

Section: Systematic Measurementmentioning

confidence: 99%