This project is part of the Bridge QUERI Program
which improves health outcomes by expanding access to prevention, treatment, and support services for Veterans.
Spirituality is one of eight health domains within the Whole Health approach, a national VA priority for delivering healthcare. The “Spirit and Soul” health domain conceives of spirituality as a way to find meaning or purpose in something larger than oneself, varying in definition and experience across individuals, and including but not being wholly defined by organized religion.
Despite VA’s focus on Whole Health, there exists no real evaluation of spiritual needs among Veterans re-entering civilian life from incarceration (re-entry Veterans), nor are there modes of delivery for meeting such needs. Considering that spirituality as a coping mechanism can be protective against repeat offenses1 and substance use2 for individuals who have experienced incarceration and substance abuse3,4 – and thus support the success of community re-entry - this evaluation gap within VA is important to address.
Thus, the quality improvement Bridge QUERI program’s Post-Incarceration Engagement project (PIE) evaluated the need for a spiritual intervention for re-entry Veterans. Project investigators also explored the potential for delivering such an intervention through a VA-based mobile phone application, though findings related to this second goal are not included in this brief report.
Co-Lead Investigator Jennifer Palmer, MS, PhD, conducted individual telephone conversations with six Veterans and six VA staff. Recently but formerly incarcerated Veterans were invited to participate during a social hour for re-entry Veterans held at a VA Medical Center (VAMC). Staff known to the project team were invited to participate via email; these staff included peer support specialists and social workers within Health Care for Re-entry Veterans (HCRV) and/or Veterans Justice Outreach (VJO) programs.
Conversational questions inquired about personal definitions of spirituality, presence/absence of spiritual needs in re-entry Veterans, suggestions for VA-based spiritual interventions for re-entry Veterans, and perceived implementation facilitators and barriers to such interventions. Project investigators used rapid qualitative analytic techniques to identify common and unique themes across the 12 transcribed conversations.
Veterans and staff indicated respect for spirituality as a highly individualized experience.
"I mean I respect people who, you know, if you wanna have religion and you wanna praise God… you know, that's what America's all about… You do you." - Veteran #1
“I appreciate…spirituality meaning different things to different people…for the Veterans that we serve, their vantage point of spirituality is very inclusive and means many different things.” – Staff Member #5
Veterans and staff described numerous positive impacts related to re-entry Veterans’ spirituality. These included personal growth, transformation and healing, a sense of peace, security, gratitude, or hope, motivation to be a better person, and social connection. Of note, no instances of negative impacts were mentioned.
“…I've grabbed a hold of this and I'm never gonna let go of it…I was a career criminal for 40 years. I spent 32 years locked up. …this is the only thing that ever seemed to work for me… it's just a beautiful thing.” - Veteran #2
“…All of their friends… are still incarcerated… (H)aving a spiritual base could help them to… create this new level of community that they didn’t have before.” - Staff Member #3
Tensions around primacy
Veteran and staff perspectives reflected tensions around the extent to which spiritual needs are primary to Veterans during re-entry.
Some viewed “basic needs” (e.g., housing, food security) as primary over spiritual needs:
“…I don’t know if it’s spiritually, it’s – what they need is housing often, they need money, they need food, they may need mental health treatment.” - Staff Member #2
Some viewed spiritual needs as essential, however:
“…you need it in your life like you need water and food.” - Veteran #3
Some viewed basic needs and spiritual needs as interactive with one another:
- “Someone might pray fervently to say God, please help me find a place to live, please…help me put my life back together.” - Staff Member #2
Tensions around the primacy of one set of needs over another can lead to lost opportunities in fully meeting re-entry Veterans’ needs:
“I don't think we give them the opportunity to [find spiritual meaning] sometimes…we're really [focused on] seeing them housed…” - Staff Member #5
Existing supports, their limitations, and suggested improvements
- Participants discussed a number of VA programs providing spiritual resources for re-entry Veterans:
- Whole Health newsletter’s links to spiritual resources.
- The availability of spiritual groups, meditation groups, and links to AA/NA groups.
- Special programming, like recreational outings and equine therapy.
- Limitations to spiritually-oriented programming included:
- Some Veterans and staff did not know what programming exists.
- The presence of programming may depend on adequate staffing or on the initiative of individual staff members.
- Suggested improvements included:
- Maintaining programs in yoga and meditation and offering them consistently when not done so.
- Offering outings to foster community and to bolster Veteran-staff therapeutic relationships.
- Hold spiritually-oriented Veteran study groups.
- Current program staff involvement included:
- Screening for basic spiritual needs
- Offering warm hand-offs to other providers
- Researching community resources to make introductions as needed
- Encouraging use of NA/AA programs as a resource
- Limitations to current program staff involvement included:
- Not all staff are providing such services.
- Staff do not typically follow up on spiritual needs on an ongoing basis
- Suggested improvements included:
- Training program staff in basic spiritual needs screening and spiritual need content (for example, theory on the stages of grief)
- Asking consistently and “proactively” about spiritual needs as part of initial intake conducted at re-entry and during ongoing check-ins
- Doing warm hand-offs to VA spiritually-focused providers (e.g., chaplains) on a consistent basis for Veterans who wish it
- Connecting Veterans with external supports (e.g., faith-based organizations, AA groups) on a consistent basis for Veterans who wish it
- Spread the word broadly to Veterans and multi-disciplinary staff about: 1) VA’s patient-centered approach to spirituality, and 2) VA’s spiritual programming.
- Affirm the vision of all Veterans’ needs (including spiritual needs) as overlapping and interactive – regardless of the subpopulation.
- Assess VA Justice Program staff members’ perceptions of training needs around re-entry Veterans’ spiritual needs (e.g., training in conducting basic spiritual screening, in making referrals for spiritual support that is outside of their professional scope).
- Strengthen collaboration across VA Justice Program staff and VA chaplains.
The contents of this report do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.
- Janssen PA, Korchinski M, Desmarais SL, et al. Factors that support successful transition to the community among women leaving prison in British Columbia: a prospective cohort study using participatory action research. CMAJ Open. 2017;5(3):E717-E723.
- Bakken NW, DeCamp W, Visher CA. Spirituality and desistance from substance use among re-entering offenders. Int J Offender Ther Comp Criminol. 2014;58(11):1321-1339.
- Banfield LE. Fostering spiritual resilience and vitality in formerly incarcerated persons of African American descent. J Pastoral Care Counsel. 2019;73(4):222-231.
- Mowen TJ, Stansfield R, Boman JH. During, after, or both? Isolating the effect of religious support on recidivism during re-entry. J Quant Criminol. 2018;34(4):1079-1101.