Richmond Area Multi-Services

IntroductionAbout 20% of police calls involve a person experiencing a behavioral health crisis. To better address these community member’s needs and reduce risk of harm, jurisdictions are developing programs that shift calls for crises related to homelessness, addiction, and mental health to non-law enforcement alternatives. In responding to these calls, first responders working in these alternative response programs are exposed to a different set of moral dilemmas and pressures, increasing their risk of developing moral injury.MethodsThe Alternative Response Program Moral Injury and Burnout Model highlights causes of exposure to potentially morally injurious events and the interplay between moral distress, moral injury, and burnout among first responders working in alternative response programs. The conceptual model was developed through a multi-year participatory action research (PAR) study with members of a large urban alternative response program. The article draws on a highly diverse set of data sources that contributed to the development and refinement of the model, including focus group discussions, analysis of call logs, assessment of moral injury, and reflective conversations with members and leaders of the alternative response program. Through our collaboration, we identified contributory factors that can produce moral injury and opportunities for interventions to mitigate moral injury. We piloted several interventions collaboratively developed with team members and hypothesized to reduce moral distress and injury based on this model.ResultsOur model explains sources of moral dilemmas and how these can lead to moral distress, moral injury, and burnout. The model also points to intervention pathways to reduce or prevent these outcomes. We provide illustrations of how moral injury arises, using data from the program members, describe six pathways, and share examples for how moral injury may be mitigated.DiscussionDespite scarce research in first responders, moral injury and burnout are growing concerns in alternative response programs. Our goal was to amplify participants’ voices to highlight both their struggles as well as proposed interventions fostering resilience. Through close collaboration, we developed a moral injury model that resonates for these first responders and can guide a better understanding of issues and pathways for interventions among high-risk occupational groups.

This study examined the outcome effects of cognitive match between Asian and White outpatient clients and their therapists. Many clinicians believe that one hindrance to the treatment of ethnic minority clients is that therapists and clients may not share common assumptions and attitudes about therapy and about the problems that are presented in treatment. The study investigated client–therapist similarity in their perceptions of the presenting problem, coping orientation, and expectations about treatment goals. This study constituted a more rigorous test of the cognitive match hypotheses in that it was prospective in nature, used separate and independent sources for the cognitive predictors, employed multiple outcome measures, and focused on specific attitudes and perceptions that are quite salient and relevant to treatment. Cognitive match on treatment goals was predictive of session impact. Moreover, cognitive matches in avoidant coping orientation and in perceived distress associated with interpersonal problems were predictive of certain treatment outcomes. The findings may help explain why clients matched on ethnicity with their therapists tend to stay longer in treatment and do better in psychotherapy. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 569–585, 2005.