Core components of moral injury groups co- facilitated by mental health providers and chaplains
Open accessAbstract
Despite increasing interest in moral injury, there is not yet consensus around what it is (and is not), who can have it and under what circumstances, or the degree and form of distress necessary to distinguish moral injury from other psychological and spiritual difficulties. The novelty of moral injury has created space for frontline Veterans Health Administration mental health and spiritual care providers to creatively apply their core professional skills and identities to moral injury. This paper presents findings of a core components analysis (CCA) derived from seven co-led chaplain-mental health moral injury group facilitation teams that were involved in a 16-month quality improvement endeavor of the Dynamic Diffusion Network (DDN). The DDN initiative engages providers in collaborative and iterative refinement of practices to promote rapid improvements in care for complex problems that lack a codified evidence base. Using CCA, we identified 10 core components of co-facilitated moral injury group care. Components include a clear conceptualization of moral injury, an inclusive approach to spirituality, and exploration of forgiveness, among others. This paper offers guidance that can be widely applied and readily adapted as our collective understanding of moral injury continues to expand and clarify. The core components are articulated here as principles for ongoing review and revision in response to future moral injury advances in the DDN and elsewhere.
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Chaplain-psychologist co-facilitated groups have been identified as a particularly helpful clinical format in qualitative work examining core components of moral injury groups.
“Chaplain–psychologist co-facilitated groups have been identified as a particularly helpful clinical format in qualitative work examining core components of MI groups (114).”
From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [114]
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- Authors
- Smigelsky, M. A., Trimm, V., Meador, K. G., Jackson, G. L., Wortmann, J. H., & Nieuwsma, J. A.
- Affiliations
- United States Department of Veterans Affairs (US)
- Duke University (US)
- Venue
- Spirituality in Clinical Practice
- Published
- 2022-09
- Volume
- 9
- Issue
- 3
- Pages
- 159-174
- ISSN
- 2326-4500 (ISSN-L)
- 2326-4519
- PMC
- PMC10288643
- OpenAlex
- W4281684156
- Cited by
- 18
- References
- 40
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 3 · 2023: 3 · 2022: 1
- FWCI
- 2.30
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Spirituality in Clinical Practice (publishedVersion, other-oa)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- US Department of Veterans Affairs (CIN 13-410, QUE 20-012)
- Topics
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Social Psychology › Forgiveness and Related Behaviors
- Keywords
- moral injury, chaplaincy, mental health professionals, veterans, spirituality, forgiveness, quality improvement, group facilitation
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