Abstract

Background: Moral injury symptoms include guilt, shame, and self-isolation. Moral injury is also associated with increased suicide risk. Moral injury symptoms are common in Veterans being treated for posttraumatic stress disorder (PTSD) or substance use disorder (SUD) and current treatments do not always improve these symptoms. The Mental Health Clinician / Chaplain Collaboration (MC3) intervention is delivered by VA chaplains who facilitate forgiveness and community reintegration. MC3 is a collaboration between resources in the mental health clinic, chaplain service, and community to support moral injury symptom recovery. Significance: MC3 addresses the VA HSR&D research priority of mental health including PTSD because moral injury symptoms are often comorbid with PTSD. MC3 also addresses the HSR&D cross-cutting principle of coordinating and integrating care, in this case between mental health, chaplain, and community resources. The MC3 intervention is also consistent with the following VHA goals: the National Strategy for Preventing Veteran Suicide 2018-2028 (i.e., clinical and community prevention), integrating VA and community resources (i.e., MISSION Act), and learning healthcare system priorities (i.e., multidisciplinary research methods). Innovation & Impact: The new directions associated with MC3 are utilizing VA chaplains to facilitate forgiveness and community reintegration. If MC3 is successful, then Veterans will have an intervention that does not stop at the doors of the VA facility but takes advantage of community resources that already exist to facilitate long-term recovery in a community of the Veteran’s choosing. The explicit focus on community reintegration is what sets MC3 apart from other moral injury interventions. Specific Aims: 1. Pre-implementation: Adapt the intervention that was originally delivered by community clergy for delivery by VA chaplains. Stakeholders in this process will include VA chaplains and mental health clinicians at the Little Rock and Pittsburgh VAMCs. 2. Conduct a single arm pilot study (total N = 20 across 2 sites) of the MC3 intervention to assess feasibility, acceptability, and fidelity (primary outcomes). 3. Post-implementation: Conduct a formative evaluation with stakeholders of the recruitment methods, MC3 intervention, and outcome measures. This information will be used to refine the MC3 intervention and study procedures for a subsequent RCT. Methodology: The study design is a two site one arm trial. The population is Veterans being treated in specialty mental health who have symptoms of moral injury. MC3 will be delivered by VA chaplains who will facilitate forgiveness and community reintegration. The primary outcomes are feasibility and acceptability. Quantitative and qualitative data will be collected at baseline and 6-months (end of intervention). Evidence-based quality improvement methods will be used to implement MC3 at the Little Rock and Pittsburgh VAMCs. Next Steps/Implementation: Results from this study will inform a future randomized controlled trial of MC3 versus Present Centered Therapy (PCT). PCT was chosen because other moral injury interventions use PCT as a time and attention control condition and this will facilitate comparison across studies. MC3 is sustainable because VA chaplains deliver the intervention, and they are already integrated with VA mental health care and community resources.

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DRA: Mental, Cognitive and Behavioral Disorders

DRE: Treatment - Observational, TRL - Applied/Translational

Keywords: None at this time.

MeSH Terms: None at this time.