Moral injury experienced by emerging adults with child welfare histories in developmental and sociocultural contexts: “I knew the system was broken.”

Haight, Wendy; Cho, Minhae; Soffer-Elnekave, Ruth; Nashandi, Ndilimeke J.C.; Suleiman, Johara

doi:10.1016/j.childyouth.2022.106537

Cited by 9 publications

(6 citation statements)

References 54 publications

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“…Most extant psychometric measures of MI to date focus on capturing either exposure to PMIEs or on outcomes of MI, and nearly all of these are tailored for military groups ( Currier et al, 2018; Currier, Holland, Drescher, & Foy, 2015; Koenig et al, 2018; Nash et al, 2013). Emerging research which does explore MI in civilian settings often uses these military-specific measures, modifying the wording of the scales on an ad hoc basis to make them appropriate for use in other settings (Brennan et al, 2022; Carter, 2021; Fani et al, 2021; Hagerty & Williams, 2022; Haight et al, 2022; Hines et al, 2021; Hoffman et al, 2018; Levi-Belz & Zerach, 2022; Sugrue, 2020; Williamson et al, 2022). This is necessary because researchers currently have few alternatives, given adaptations of existing scales validated for use by having their factor structure replicated and psychometrics examined in nonmilitary settings do not exist.…”

Section: Present Understanding Of MImentioning

confidence: 99%

“…The MIES is a nine-item scale with a three-factor structure (Bryan et al, 2015), that captures exposure to moral violations either perpetrated or witnessed by the individual, and betrayal experiences. It is a popular choice for modification for new nonmilitary research (Brennan et al, 2022;Carter, 2021;Fani et al, 2021;Hagerty & Williams, 2022;Haight et al, 2022;Hines et al, 2021;Hoffman et al, 2018;Levi-Belz & Zerach, 2022;Williamson et al, 2022) due to its brevity and simplicity of wording. Unfortunately, despite THOMAS, BIZUMIC, CRUWYS, AND WALSH frequent use in civilian research, the MIES has not yet been formally adapted and validated for use with a nonmilitary sample, which raises serious concerns for the validity of research utilizing the measure in this way.…”

Section: Rationale For Adapted Measuresmentioning

confidence: 99%

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Measuring civilian moral injury: Adaptation and validation of the Moral Injury Events Scale (Civilian) and Expressions of Moral Injury Scale (Civilian).

Thomas¹,

Bizumić²,

Cruwys³

et al. 2024

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective: Moral injury (MI) research has been expanded to populations beyond the military in recent years. A key barrier to further research into MI in civilian populations is the lack of valid, reliable measures of the construct appropriate for general civilian use. This article addresses this barrier by adapting two existing military measures and exploring their psychometrics in a general civilian sample: the Moral Injury Events Scale-Civilian (MIES-C) and Expressions of Moral Injury Scale-Military (EMIS-C). Method: A sample of civilian women (n = 192) and men (n = 88) completed the above measures, and additional scales designed to capture theoretically supported primary and secondary markers of MI (guilt, shame, anger; depression, posttraumatic stress symptoms, anxiety). Results: Confirmatory factor analyses found that the factor structure of the MIES-C and EMIS-C replicated well within our civilian sample. Discriminant validity was indicated through a significant negative correlation with well-being. Both measures correlated as predicted with each other and measures of MI markers at the total score level. Correlations of individual subscales with each of these measures were more varied. Conclusions: Results shed light on differential relationships between the type of MI event and clinical outcomes, suggesting some conceptual differences in how MI is experienced in general civilian populations. Results suggest that civilian populations are also susceptible to MI, but that existing measures may have problems capturing this effectively. While the MIES-C and EMIS-C are supported for civilian use, further scale construction efforts for this population are warranted. Clinical Impact StatementCurrent measures of moral injury (MI) are not validated for use outside the military, hindering further research efforts. This study adapted two commonly used military measures of MI for civilian use and tested their factor structure and validity in a civilian sample. Findings suggest that the Moral Injury Events Scale-Civilian and Expressions of Moral Injury Scale-Civilian are reliable and valid measurement tools of MI in civilian settings. These findings support the relevance of MI construct beyond the military and will facilitate further MI research in civilian settings.

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Section: Present Understanding Of MImentioning

confidence: 99%

Section: Rationale For Adapted Measuresmentioning

confidence: 99%

Measuring civilian moral injury: Adaptation and validation of the Moral Injury Events Scale (Civilian) and Expressions of Moral Injury Scale (Civilian).

Thomas¹,

Bizumić²,

Cruwys³

et al. 2024

Psychological Trauma: Theory, Research, Practice, and Policy

View full text Add to dashboard Cite

show abstract

“…Child protection services are morally framed, and parents, especially those within marginalized groups, have less power than social workers to determine which parenting practices are 'good' or 'bad'; they also have less power to shape and enforce the child welfare system (McGrath et al, 2023). Parents might experience morally injurious events, especially in connection to child removal (Haight et al, 2020;Haight et al, 2022). Parents from ethnic minority groups and other parents with less power might be more likely to experience moral injury.…”

Section: Moral Injury and Related Conceptsmentioning

confidence: 99%

Exploring moral injury among parents with children in out‐of‐home care

Wissö,

Melke,

Josephson

2024

Child & Family Social Work

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This article brings together the experiences of parents whose children are placed in out‐of‐home care (OHC) with the theoretical concept of moral injury. The findings are based on empirical data from a research and development project conducted in seven Swedish municipalities with the aim of developing support for such parents. This article draws on a data set of qualitative interviews with 40 parents, 30 mothers and 10 fathers, with children in OHC. The interview transcripts were analysed thematically, with an abductive approach to theories and the empirical data. The findings illustrate how parents of children in OHC experience moral injury in relation to seven aspects: professionals' morally problematic and distressing behaviour, problematic services, an adversarial system, systemic bias, parent's actions, children's withdrawal and feeling excluded. The injuries are related to events in several periods—prior to the child's removal, during the execution of removal and during OHC—and tend to last for many years. These findings stress that the social services must be aware of the injuries parents experience and must minimize the possible harm and moral injury. We also suggest that parents of children in OHC should have an appointed social worker as a means of support.

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“…Although empirical research on moral injury in children and adolescents is only just emerging, a handful of recent studies have demonstrated the occurrence and impact of PMIEs and moral injury in vulnerable youth populations including former child soldiers, refugee youth, and youth involved in the child welfare system (Haight et al, 2022;McEwen et al, 2022McEwen et al, , 2023Wong, 2022). For example, Wong (2022) found that, among former child soldiers in Liberia, committing violent acts was associated with symptoms of avoidance and anxiety.…”

Section: Moral Injury In Adolescencementioning

confidence: 99%

“…The psychiatric and child welfare systems have deeply rooted histories of racism and violence (e.g., Edwards, 2019;Hill, 2004;Shim, 2021) and often utilize police contact and other punitive elements that youth may perceive as severe moral violations (Haight et al, 2017;Jones et al, 2021). Recent studies have confirmed that youth involved in the child welfare system frequently report PMIEs such as betrayal by system officials and abuse by foster parents (Haight et al, 2022) and that youth psychiatric patients often experience fear, loss of autonomy, and damaged trust following involuntary hospitalizations (Jones et al, 2021).…”

Section: Moral Injury In Justice-involved Youthmentioning

confidence: 99%

Moral Injury as a Transdiagnostic Risk Factor for Mental Health Problems in Detained Youth

Alexander,

Mendez,

Kerig

2023

Criminal Justice and Behavior

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Youth who become involved in the juvenile justice system are at highly elevated risk for many emotional and behavioral problems. Past research has often focused on trauma exposure as a transdiagnostic risk factor in this population. However, distress resulting from perpetrating or witnessing acts that conflict with one’s deeply held moral beliefs, termed moral injury, may also play a role in predisposing these youth toward negative mental health outcomes. This study utilized a sample of 96 youth housed in secure detention centers and tested associations between exposure to potentially morally injurious events (PMIEs) and mental health outcomes, including anxiety, depression, posttraumatic stress, and nonsuicidal self-injury (NSSI). After controlling for trauma exposure and demographic variables, PMIEs were significantly and positively associated with symptoms of depression and anxiety, as well as engagement in NSSI. Implications for research and clinical practice are discussed.

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Moral injury experienced by emerging adults with child welfare histories in developmental and sociocultural contexts: “I knew the system was broken.”

Cited by 9 publications

References 54 publications

Measuring civilian moral injury: Adaptation and validation of the Moral Injury Events Scale (Civilian) and Expressions of Moral Injury Scale (Civilian).

Measuring civilian moral injury: Adaptation and validation of the Moral Injury Events Scale (Civilian) and Expressions of Moral Injury Scale (Civilian).

Exploring moral injury among parents with children in out‐of‐home care

Moral Injury as a Transdiagnostic Risk Factor for Mental Health Problems in Detained Youth

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