Moral injury among Child Protection Professionals: Implications for the ethical treatment and retention of workers

Haight, Wendy; Sugrue, Erin; Calhoun, Molly

doi:10.1016/j.childyouth.2017.08.030

Cited by 63 publications

(39 citation statements)

References 38 publications

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“…A considerable body of research has shown that exposure to PMIEs is associated with varied psychiatric symptoms among U.S. military personnel and veterans (Bryan, Bryan, Morrow, Etienne, & Ray‐Sannerud, ; Currier, Holland, Drescher et al., ; Currier, Holland, & Mallot, ; Currier, Smith et al., ; Dennis et al., ; Jordan, Eisen, Bolton, Nash, & Litz, ; Maguen et al., , ; Maguen, Vogt et al., ; Nash et al., ); Vietnamese veterans and civilians involved with the Vietnam War (Korinek, Loebach, & Teerawichitchainan, ); the Israeli Defense Force (Ritov & Barnetz, ); Portuguese Colonial War veterans (Ferrajão & Oliveira , , ); deployed healthcare providers (Gibbons, Shafer, Hickling, & Ramsey, ); professionals and parents involved with child protection services (Haight, Sugrue, & Calhoun, ; Haight, Sugrue, Calhoun, & Black, ); police officers (Komarovskaya et al., ); educators (Currier, Holland, Rojas‐Flores, Herrera, & Foy, ); and refugees (Nickerson et al., ). Furthermore, Wisco et al.…”

Section: Resultsmentioning

confidence: 99%

“…Although first conceptualized in reference to war zone trauma, moral injury can be applied beyond military contexts. To date, studies have examined moral injury in civilian populations, including healthcare providers (Campbell, Ulrich, & Grady, ; McAninich, ), educators (Currier, Holland, Rojas‐Flores, Herrera, & Foy, ; Levinson, ), law enforcement (Komarovskaya et al., ; Papazoglou & Chopko, ), parents and professionals involved with child protection services (Haight, Sugrue, & Calhoun, ; Haight et al, ), and refugees (Nickerson, 2015). Researchers may consider the potential relevance of other populations, including first responders, incarcerated adults and juveniles, birth parents following adoption of a child, women who are conflicted about terminating pregnancies, individuals in substance use recovery reconciling past behaviors, and perpetrators of interpersonal violence (e.g., domestic and sexual abuse) seeking rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

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Moral Injury: An Integrative Review

Griffin

Purcell

Burkman

et al. 2019

Journal of Traumatic Stress

484

576

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Individuals who are exposed to traumatic events that violate their moral values may experience severe distress and functional impairments known as “moral injuries.” Over the last decade, moral injury has captured the attention of mental health care providers, spiritual and faith communities, media outlets, and the general public. Research about moral injury, especially among military personnel and veterans, has also proliferated. For this article, we reviewed scientific research about moral injury. We identified 116 relevant epidemiological and clinical studies. Epidemiological studies described a wide range of biological, psychological/behavioral, social, and religious/spiritual sequelae associated with exposure to potentially morally injurious events. Although a dearth of empirical clinical literature exists, some authors debated how moral injury might and might not respond to evidence‐based treatments for posttraumatic stress disorder (PTSD) whereas others identified new treatment models to directly address moral repair. Limitations of the literature included variable definitions of potentially morally injurious events, the absence of a consensus definition and gold‐standard measure of moral injury as an outcome, scant study of moral injury outside of military‐related contexts, and clinical investigations limited by small sample sizes and unclear mechanisms of therapeutic effect. We conclude our review by summarizing lessons from the literature and offering recommendations for future research.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Moral Injury: An Integrative Review

Griffin

Purcell

Burkman

et al. 2019

Journal of Traumatic Stress

484

576

View full text Add to dashboard Cite

show abstract

“…2016), and the application of the concept with workers in the child protection field is most relevant to the current study (Haight et al . 2017). In particular, a study of professionals in the field of child protection found that 89% ‘described morally injurious events as occurring because insufficient resources within the system preclude effective intervention’ (Haight et al .…”

Section: Discussionmentioning

confidence: 99%

Workplace exposure to suicide among Australian mental health workers: A mixed‐methods study

Sanford

Hawker

Wayland

et al. 2020

Int J Mental Health Nurs

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Workplace exposure to suicide attempts and deaths has been widely recognized as an occupational hazard for mental health and social care workers, including mental health nurses. Research consistently demonstrates the adverse impact on professionals. This paper explores the results of an online survey examining suicide exposure and impact. Of the 3010 Australian adult participants who identified exposure to suicide attempts and/or deaths in a larger study, 130 indicated that the most impactful suicide attempt and/or death exposure was that of a client or service user. While distress levels were relatively low among participants with workplace exposure, the qualitative content from 53 participants provides illumination into this experience. Themes that emerged in the qualitative responses include impact on the professional, organization response, and lack of adequate resources and supports to prevent suicide. Previous research has examined the impact of suicide exposure among professionals specifically, but this is the first known study of participants in a community sample who identified the most impactful suicide attempt or death exposure they had experienced was that of a client in a mental health setting. Workplace exposure among mental health workers is common and can have both deleterious and positive effects. Bereavement focused outcomes, where the loss of an attachment relationship is the focus, does not capture the full range of experiences in workplace exposure. Systemic issues in mental health care contribute to further distress among exposed workers, and this requires additional investigation and response.

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“…Although civilian environments that are guarded by civilian laws and policing may produce limited prevalence of self‐related perpetration–type PMIEs (e.g., murder, rapes), betrayal‐related types of PMIEs are highly prevalent in civilian societies and should be further studied in order to expand the scope of MI research and its clinical applications. As summarized in this issue by Griffin and colleagues (), several studies have begun to explore MI in civilian contexts, including in relation to health care providers (Campbell, Ulrich, & Grady, ; McAninich, ), education (Currier, Holland, Rojas‐Flores, Herrera, & Foy, ; Levinson, ), law enforcement (Komarovskaya et al., ; Papazoglou & Chopko, ), parenting (Haight, Sugrue, & Calhoun, ), and refugees (Nickerson et al., ). Additionally, although not explicitly studied as PMIEs, the association between civilian interpersonal traumas that would fall under the rubric of PMIEs (e.g., childhood abuse, intimate partner violence) are being studied with respect to MI‐related constructs, such as betrayal (Platt & Freyd, ), shame (Dodson & Beck, ; Kim, Talbot, & Cicchetti, ), guilt (Beck et al., ), and self‐blame (Reich et al., ), which may advance our conceptualization of MI in civilian populations.…”

Section: Gaps In Knowledge and Future Directionsmentioning

confidence: 99%

Commentary on the Special Issue on Moral Injury: Advances, Gaps in Literature, and Future Directions

Neria

Pickover

2019

Journal of Traumatic Stress

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We contextualize and provide commentary on articles in the current issue that address the nature, measurement, and consequences of exposure to potentially morally injurious events (PMIEs) and moral injury (MI). PMIEs involve acts of commission or omission of oneself and others and can include perpetration of, and failure to prevent, harm; MI includes “the lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations” (Litz et al., 2009). New and informative research aims to characterize types of PMIEs among military service members and veterans, including in multinational samples. There are also ongoing efforts to devise outcome scales that reliably capture broad MI outcome themes. Further, several new measures of MI assess emotional, cognitive, and behavioral responses of wrong‐doing; the nature of distress following PMIEs in civilians, servicemembers, and veterans; and interpersonal consequences in youth. These are promising efforts toward ecologically valid definitions of a potential MI phenotype. Notably, PMIEs may or may not meet DSM PTSD Criterion A, yet early longitudinal data reveal predictive and reciprocal effects of MI and PTSD on one another. Further, a growing literature on MI outcomes beyond PTSD is identifying ways in which MI is linked to alcohol misuse and self‐injurious behaviors. The sum of these efforts has led experts to consider the utility and shortcomings of extant PTSD interventions for individuals with MI. We address clinical implications of this emerging research domain, gaps in the literature, and future directions for research.

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Moral injury among Child Protection Professionals: Implications for the ethical treatment and retention of workers

Cited by 63 publications

References 38 publications

Moral Injury: An Integrative Review

Moral Injury: An Integrative Review

Workplace exposure to suicide among Australian mental health workers: A mixed‐methods study

Commentary on the Special Issue on Moral Injury: Advances, Gaps in Literature, and Future Directions

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