Moral Injury in the Context of Child Protection

Background & Purpose

Moral injury refers to the lasting psycho-social and spiritual impact of perpetrating, witnessing, or experiencing acts that transgress deeply held moral beliefs or expectations (Litz et al., 2009; Shay, 1994). Empirical research on moral injury has primarily focused on military veterans, but a handful of studies have begun to examine its existence among other groups, such as refugees, teachers, and those with substance abuse disorders (Haight, Sugrue, Calhoun, & Black, in progress). In this paper, we describe the experiences of moral injury from the perspectives of clients and professionals involved in the child protection system.  The research questions are: 1) To what extent do clients and professionals involved in child protection experience moral injury? 2) What are the morally injurious events and contexts they experience? 3) How do these clients and professionals describe responding to moral injury?

Methods:

Using an exploratory qualitative design, we conducted individual discussions with parents who had an open child protection case within the last three years (n = 10); staff at a university-based child protection legal clinic, (n=14); prosecuting attorneys (n = 4); and child protection social workers (n = 4).  A modified version of the Moral Injury Events Scale (Nash et al., 2013) was used to help participants identify potentially morally injurious events and responses that they then elaborated on in a semi-structured interview.  Next, participants responded to two vignettes portraying morally injurious events and responses in a child protection client and worker.  Finally, they completed a personal history questionnaire.  Using analytic induction techniques (see Schwandt, 2007), researchers interpreted participants’ responses through repeated readings of transcripts.  Following the development of an emic coding system, two independent coders coded all transcripts, resolving disagreements through discussions.  Credibility of analyses was further strengthened through member checking, peer debriefing, and negative case analysis.

Results:

Preliminary results suggest that moral injury is experienced by clients involved with child protection.  Injurious events include contact with professionals and services perceived to be fundamentally punitive, unfair, and resulting in feelings of betrayal, anger and hopelessness. Other morally injurious events include participants’ perpetration of child abuse and neglect and resulting feelings of guilt and shame.  Fewer professionals described moral injury related to child protection. They were more likely to describe moral distress (Jameton, 1987) and vicarious trauma (Schuaben & Frazier, 1995).

Conclusions & Implications:  

The results of this study highlight the on-going moral issues that permeate the child protection system and raise important questions for social work.  On an individual level, failure to address issues of moral injury can have significant consequences for families and professionals.  Parents can be left struggling with issues of guilt, shame, hopelessness, and moral confusion, that may persist for years and create obstacles to positive change.  Professionals may experience “burn out” and high staff turn-over. Perhaps more significantly, these results suggest that clients and professionals view the child protection system, a core practice arena in social work, as a significant moral transgressor.  Specific recommendations for policy and practice reform will be discussed.