U.S. flag

An official website of the United States government

Talk to the Veterans Crisis Line now
Skip to main content

Last updated

Collaborative Moral Injury Groups (Mental Health & Chaplaincy)

Share Print

Collaborative Moral Injury Groups provide an opportunity for frontline mental health providers and chaplains to adopt a moral injury group approach that is best suited to their context and invites them to join an ongoing community of others engaged in moral injury care. These diverse collaborative approaches to moral injury care have been developed across time and geographic location, yet they share common elements that help illuminate what is at the heart of the experience of moral injury and how it can be addressed by diverse helping professionals. At the same time, these interventions are distinctive in ways that shed light on which aspects of moral injury intervention may be approached flexibly.

This innovation is replicating across multiple facilities as its impact continues to be validated. See more replicating innovations.

Origin:

June 2019, VA Integrative Mental Health

Adoptions:

29 successful, 1 unsuccessful

Partners:

Health Services Research & Development, Quality Enhancement Research Initiative

Tags:

Chaplain Care Mental Health Suicide Prevention Whole Health
Contact Team

Overview

Problem

Moral injury is an emerging construct that involves a perceived betrayal of what's "right" and is associated with psychosocial and spiritual distress. The integration of mental health and spiritual care can be beneficial, if not essential, for some Veterans who experience this distinctive form of distress.

Solution

Collaborative moral injury groups are therapeutic groups co-facilitated by a mental health provider and chaplain. These groups combine evidence-based psychological principles and practices with spiritual care traditions and paradigms to help Veterans process their morally injurious experiences while also cultivating a life filled with connection and meaning.

Videos

Hear from Veterans who participated in a collaborative moral injury group

Results

Veterans report that these groups offer something different than other trauma-focused therapies. Group members typically experience reductions in mental health symptomatology, including suicidal ideation and other depressive symptoms, from pre- to post-group. Furthermore, group members report re-engaging in important relationships and activities that were pr ... See more

Metrics

  • Facilitators utilize the BHL platform to conduct measurement-based care. Moral injury is assessed using the Moral Injury Outcome Scale (MIOS), mental health symptoms and suicidality (PHQ-9, PCL-5) and well-being (SWEMWBS).

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

Statuses

AL: Tuscaloosa VA Medical Center (Tuscaloosa) AR: John L. McClellan Memorial Veterans' Hospital (Little Rock, Arkansas) CA: San Diego VA Domiciliary (San Diego Domiciliary) CO: Fort Collins VA Clinic (Fort Collins) FL: Lake City VA Medical Center (Lake City, Florida) FL: West Palm Beach VA Medical Center (West Palm Beach) MI: Lieutenant Colonel Charles S. Kettles VA Medical Center (Ann Arbor) MO: Cape Girardeau VA Clinic (Cape Girardeau) MS: G.V. (Sonny) Montgomery Department of Veterans Affairs Medical Center (Jackson, Mississippi) MT: Helena VA Clinic (Helena, Montana) NC: Charles George Department of Veterans Affairs Medical Center (Asheville) NC: Durham VA Medical Center (Durham) NY: Buffalo VA Clinic (Buffalo Main Street) OH: Louis Stokes Cleveland Department of Veterans Affairs Medical Center (Cleveland, Ohio) OK: Tulsa Eleventh Street VA Clinic (Tulsa Eleventh Street) OR: Portland VA Medical Center (Portland, Oregon) OR: Salem VA Clinic (Salem, Oregon) PA: Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center (Philadelphia, Pennsylvania) RI: Providence VA Medical Center (Providence) SD: Royal C. Johnson Veterans' Memorial Hospital (Sioux Falls) TN: James H. Quillen Department of Veterans Affairs Medical Center (Mountain Home, Tennessee) TN: Nashville VA Medical Center (Nashville) TX: Audie L. Murphy Memorial Veterans' Hospital (San Antonio, Texas) TX: Temple VA Clinic (Temple South General Bruce Drive) WA: Mann-Grandstaff Department of Veterans Affairs Medical Center (Spokane, Washington) WA: Vancouver VA Medical Center (Vancouver) WI: Tomah VA Medical Center (Tomah) WI: William S. Middleton Memorial Veterans' Hospital (Madison) WY: Cheyenne VA Medical Center (Cheyenne)

There are no in-progress adoptions for this innovation.

VA: Hampton VA Medical Center (Hampton)
  • Unable to attain necessary staff

Implementation

Timeline

  • Month 1
    Assess capacity for collaboration at your facility.
    Identify group co-facilitators.
    Select a collaborative moral injury group approach.
  • Month 2-3
    Participate in training in collaborative moral injury group approach.
    Develop preliminary screening and referral plans.
    Become familiar with BHL platform and outcome measures.
    Begin recruitment.
  • Month 4
    Begin first group.
  • Ongoing
    Continuously refine and improve screening and referral processes.
    Monitor Veteran clinical outcomes.
    Participate in continuing education opportunities related to moral injury.
    Pursue consultation as needed.

Departments

  • Mental health care
  • Chaplaincy

Core Resources

Resource type Resource description
PEOPLE
  • Mental Health Provider - ongoing group co-facilitation
  • Chaplain - ongoing group co-facilitation
TOOLS
  • Mental Health Checkup or BHL Touch for measurement-based care

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

Email

Email with questions about this innovation.

About

Origin story

In 2017, VA’s Integrative Mental Health program (formerly Mental Health and Chaplaincy) assessed the status of collaborative moral injury care in the field by putting out a request for moral injury group materials. Over a dozen submissions of protocols, curriculums, and guides were received. Six different group curriculums were selected for inclusion in the ... In 2017, VA’s Integrative Mental Health program (formerly Mental Health and Chaplaincy) assessed the status of collaborative moral injury care in the field by putting out a request for moral injury group materials. Over a dozen submissions of protocols, curriculums, and guides were received. Six different group curriculums were selected for inclusion in the Dynamic Diffusion Network (DDN) from June 2019 to September 2020. The DDN is an innovative approach to intervention development and dissemination. Care practices are delivered and continuously evaluated under real-world conditions as part of a structured network experience that promotes cross-pollination of ideas and shared learning to generate relatively rapid improvements in care.

Original team

Integrative Mental Health (formerly Mental Health and Chaplaincy)

DDN Development & Facilitation

Chaplain-Mental Health Teams

Moral Injury Group Co-Facilitators

Search tags

Chaplain Care Mental Health Suicide Prevention Whole Health