The Experience of Moral Injury Among Emerging Adults with Child Welfare Histories

Background

Moral injury is the psychological, social and spiritual harm caused by events in high stakes situations that transgress deeply held, core moral beliefs and expectations (see Litz et al., 2009; Shay, 1994). Events such as wartime atrocities and child abuse can lead to intense and persistent feelings of guilt, shame, rage, depression, loss of trust, sense of betrayal, and anomie. Indeed, injury to our morality might be among the most painful of human experiences. Recent research found high levels of moral injury in child welfare involved parents and professionals (Haight et al. 2017a; 2017b; & 2016). Moral injury also is reported by some emerging adults in college (Chaplo, Kerig, & Wainryb, 2019). The current study examines moral injury in emerging adults those with histories of foster care.

We asked: 1) Do emerging adults with foster care histories describe moral injury? 2) If so, what events do they identify as morally injurious? 3) What do they describe as the immediate and longer-term consequences?

Methods

This study used a mixed-method design (Creswell, 2015). The sites of the study were three Midwestern states. Participants were 27 emerging adults aged 18-24 with foster care histories. Eight were Black, 8 were Indigenous, 6 were Hispanic, and 5 were white.

Participants completed an 8-item, revised moral injury events scale (MIES, Nash et al., 2013). Then, they elaborated their responses to the MIES during a semi-structured, audio recorded interview lasting from 30-90-minutes in a private location.

Interviews were transcribed verbatim. Emic codes were induced through repeated readings of each transcript (Schwandt, 2014) and applied to the transcripts by two independent coders. Disagreements were resolved through discussion. Peer de-briefing enhanced the credibility of our interpretations (Lincoln & Guba, 1985).

Results

Participants reported high levels of moral injury on the MIES. During individual interviews, 22 youth described others’ moral transgressions. These included transgressions by biological parents (e.g., physical abuse of a younger sibling; abandonment), foster/adoptive parents (e.g., sexual abuse) and professionals (e.g., not being listened to or believed). Nine youth also reported transgressing their own moral values. These transgressions included abusing a younger child (e.g., acting out the sexual abuse they had experienced) and physical harm to the self.

Participants described that the morally injurious events they experienced made them feel profoundly vulnerable as children. They felt betrayed, isolated, exploited, forgotten, and rejected. Some reported a deep and abiding sense of deficiency. They felt “not normal,” “like garbage,” like “throwaway” children. Longer term, developmental consequences articulated by participants included continued problems with attachment, suicidality, feeling “haunted,” or persisting existential challenges, “Why was I brought into a world where I wasn’t wanted?”

Conclusion

Individuals who have grown up in foster care are among our most vulnerable emerging adults. Many expressed ongoing suffering from repeated violations of their fundamental sense of right and wrong, just and unjust. This moral injury, unaddressed by existing trauma-informed interventions, is a burden they carry with them into adulthood. Research is needed to design, implement and evaluate interventions for moral injury in this population.