DRAFT SOW UNC HPDP Qual FY25 - DS markup 20250715.pdf

Department of Veterans Affairs (VA) Mid-Atlantic Veterans Integrated Service Network (VISN 6)

Mental Illness Research, Education and Clinical Center (MIRECC)

DRAFT PERFORMANCE WORK STATEMENT

(07/15/2025)

Office of Mental Health Services and Suicide Prevention

Integrative Mental Health Department of Veterans Affairs, Mid-Atlantic VISN 6, MIRECC

1.0 Scope & Objectives

1.1 Scope:

Moral injury is a problem among Veterans that is connected to myriad mental health struggles, including suicidality, though it has only recently received research and clinical attention and merits substantial additional investigation. In House Resolution (H.R.) 6411 Section 506a, congress instructs that VA “shall conduct suicide prevention and mental health care improvement research on how moral injury relates to the mental health needs of veterans who served in the Armed Forces after September 11, 2001, and best practices for mental health treatment for such veterans.” In accordance with this instruction and the focus on improvement and intervention research, the present project will address H.R.

6411 Section 506a via a mixed methods project that has two arms: quantitative and qualitative. This SOW covers the qualitative arm.

H.R. 6411 506a is being administered by VA Integrative Mental Health (IMH), a national program funded out of the Office of Mental Health and Suicide Prevention (OMHSP) and administratively supported by the VISN 6 MIRECC.

IMH has for over a decade devoted substantial focus to research, education, interventions, and clinical systems pertaining to moral injury care in VA. IMH has examined mental health and chaplain co-led moral injury care practices that have developed across VA by pulling together innovators and early adopters in a manner that promotes cross-pollination of ideas, iterative refinement of practices, incorporation of measurement, and commitments to cross-disciplinary collaboration and evidence-based principles – all with an understanding that much remains to be learned about moral injury, moral injury care, and how to optimally facilitate such care for Veterans across a diversity of contexts in VA.

In keeping with the instruction provided in H.R. 6411 Section 506a, the present project will expand understandings of moral injury and possibilities for moral injury care alongside maintaining and bolstering critical engagement from the clinical care providers and systems where moral injury is encountered and addressed in VA. Specifically, the qualitative work for this project will support

DRAFT PERFORMANCE WORK STATEMENT (07/15/2025)

the Section 506a aim to better understand moral injury from the perspective of Veterans and personnel operating in related systems of care.

1.2 Objectives:

This contract is requested to support VA IMH in completing work in service to H.R. 6411 506a. Specifically, the contractor shall conduct qualitative work to determine the existing state of moral injury care and opportunities for improvement. In close collaboration with IMH staff, the objectives are to:

1) Develop a comprehensive qualitative study strategy that will integrate with quantitative data collection as part of a mixed methods approach in support of H.R. 6411 506a.

2) Complete a qualitative study that illuminates Veteran perspectives on moral injury as well as areas for improvement within related systems of care.

3) Analyze and interpret qualitative data and report results in a format appropriate for professional presentation and manuscript(s) for professional journals.

1.3 Target Audience

VA leadership and eventually congress are the immediate target audiences for this work. Relatedly, VA healthcare providers and administrators are audiences insofar as information from this project will be used to enhance care provision and structure. Ultimately, the primary purpose of this work is to benefit the lives of Veterans through care they receive at VA.

1.4 Features & Functionality

The contractor must have:

1) the select level of expertise and qualifications sufficient to facilitate qualitative study design and development, as well as to coordinate the conduct of various types of qualitative examinations;

2) demonstrated readiness to immediately execute the contract with minimal modifications;

3) demonstrated experience and expertise in conducting high-quality qualitative projects in an efficient and expedient fashion, facilitating the delivery of a coherent and coordinated final product to VA;

4) demonstrated experience and expertise in qualitative methodologies;

5) quality control at all stages of contract execution, ensuring continuity and reliable quality of support.

2.0 Background

Interest in moral injury among Veterans has been increasing rapidly since 2009. Moral injury can affect those who have been exposed to traumatic events wherein there is a perceived violation of deeply held moral beliefs or values. The consequences of such a violation can affect the whole person – body, mind, relationships, spirit – and can interfere with functioning. The defining characteristic of moral injury is that it involves a betrayal or violation of what a person believes to be right and good. The violation could be of one’s social trust in others (such as betrayal by leadership in a high-stakes situation), of oneself for perpetrating suffering or cruelty, or as a bystander, unable or unwilling to stop the suffering or cruelty of others.

Among military personnel, the killing of civilians or enemy combatants is frequently cited as an example of a potentially morally injurious experience, though the range of phenomena that could be experienced as morally injurious is quite broad and includes acts of perceived betrayal by leadership and military sexual trauma. Moral injury is a subjective experience that is shaped by an individual’s life experiences prior to, during, and after military service. Despite widespread interest in moral injury, there continues to be a lack of definitional clarity around what moral injury 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 moral challenges, moral stress, or various forms of psychopathology.

Moral injury is not a psychiatric disorder and thus does not have diagnostic criteria or “symptoms.” Research with Veterans has consistently found higher levels of moral injury to be related to greater psychiatric symptomatology on measures of PTSD, depression, alcohol and substance abuse, and suicidality.

Mental health professionals, chaplains, and others who care for Veterans have responded to the emerging research on moral injury and recognition of it in their clinical practice by developing interventions and other care practices. Examples include Adaptive Disclosure, ACT for Moral Injury, Reclaiming Experiences After Loss, Building Spiritual Strengths, Impact of Killing, Acceptance and Forgiveness Therapy, and adaptations of existing interventions (e.g., CPT). Interventions include individual and group-based approaches, variations on the integration of psychological and spiritual care practices, and a mixture of care provider approaches (e.g., individual clinician, mental health-chaplain co-led groups). Multiple books have been published on different moral injury interventions and approaches for addressing moral injury in clinical contexts.

Recognizing the expanding interest devoted to moral injury in research and clinical contexts, Congress explicitly devoted attention to moral injury as part of the STRONG Veterans Act of 2022 (H.R. 6411). The STRONG Veterans Act aims to effect “certain improvements in mental health care provided by the Department of Veterans Affairs,” which are delineated in 5 titles and 29 sections of the bill. Title 5, which focuses on research, contains 9 total sections, including Section 506: “Expansion of suicide prevention and mental health research.” Part A of Section 506, “Research on Moral Injury,” reads as follows:

The Secretary of Veterans Affairs, acting through the Office of Research and Development of the Department of Veterans Affairs, shall conduct suicide prevention and mental health care improvement research on how moral injury relates to the mental health needs of veterans who served in the Armed Forces after September 11, 2001, and best practices for mental health treatment for such veterans.

VA Integrative Mental Health (IMH) was selected to lead work on this Section 506a (i.e., above). IMH is a national program funded out of the Office of Mental Health and Suicide Prevention (OMHSP) and administratively supported by the VISN 6 MIRECC. IMH has for over a decade devoted substantial focus to research, education, interventions, and clinical systems pertaining to moral injury care in VA.

Consistent with the aims of the STRONG Veterans Act Section 506, IMH is devoting attention to examining the intersections between moral injury and mental health problems in Veterans, with specific focus on potential linkages between moral injury and suicidality. Further, this work is being conducted with an understanding that the intention is to focus on tangible mental health care improvements and promising practices for the treatment of Veterans affected by moral injury. Finally, special consideration is being given to post-9/11 Veterans, with the understanding that moral injury affects all eras of Veterans and that care improvement practices stand to benefit the entire VA patient population.

The present contract is in support of the above-described work on moral injury, with a focus on completing a qualitative inquiry that will shed light on Veterans’ understandings of moral injury and areas for improvement within related systems of care.

3.0 Contracting Officer’s Technical Representative (COR) & Project Manager (PM)

Contact information for the COR and PM to be provided upon award of contract.

(1) Under the authority in Veterans Affairs Acquisition Regulation (VAAR) 801.603-70, Brian Gordon is hereby designated as Contracting Officer's Technical Representative (COR) for this contract action.

(2) Subject to the limitations stated elsewhere in this delegation of authority, he is authorized in connection with this contract to perform or cause to be performed the duties of the Contracting Officer enumerated below:

(i) Provide technical clarification or technical direction to the Contractor without changing the requirements of the contract action.

(ii) Monitor the Contractor's performance to assure compliance with technical requirements of the contract, and keep the Contracting Officer fully informed.

(iii) Review and approve progress reports, technical reports, and other items required for approval.

(iv) Review all invoices received from the Contractor and recommend for payment. In the event suspensions are recommended, supporting information should accompany your request for suspension.

(v) Assure that changes in work under the contract are not implemented before written authorization or a contract modification is issued by the Contracting Officer.

(vi) Recommend in writing to the Contracting Officer changes desired in the contract with justification for the proposed change. Recommendations shall be accompanied by a complete work statement describing the services to be performed, timeframes for completion, acceptance/inspection criteria, all other pertinent information, and an independent Government estimate.

(vii) Advise the Contracting Officer of performance issues and provide recommendations for remedial actions when needed.

(viii) Conduct inspections or testing of all services or supplies received under this contract, and recommend acceptance or rejection to the Contracting Officer.

(ix) Perform other tasks, as specifically requested by the Contracting Officer, deemed necessary to ensure successful contract performance and to protect the interest of the Department of Veterans Affairs.

(3) This delegation does not authorize the COR to take any other actions, including, at a minimum the following, all of which remain the responsibility of the Contracting Officer:

(i) Make any commitments or changes that will affect the price, quantity, quality, or delivery terms of the contract.

(ii) Require additional supplies or services, or supplies or services beyond the scope of the contract.

(iii) Extend the completion time established in the contract.

(iv) Terminate the contract in whole or in part.

(v) Give instructions that may constitute an assignment of additional work inside or outside the general scope of the contract.

(vi) Change any of the expressed terms, conditions, or specifications of the contract.

(4) Upon expiration of the contract, under no circumstances is the COR to assume that the contract has been extended or otherwise renewed unless he/she is informed to that effect by the Contracting Officer.

(5) Written monthly status reports shall be forwarded to the Contracting Officer.

Reports shall include the current status of the contract, discuss pending issues including actions being taken to resolve, and make recommendations for contractual actions as appropriate. Copies of all correspondence or other documentation to or from the Contractor that has not previously been copied to the Contracting Officer, reports, and record of meetings, shall be attached.

Interim reports, requests for assistance and information regarding contractor performance shall be submitted at any time deemed necessary or appropriate.

(6) Any act on his part that is not within the scope of this delegation may lead to his personal pecuniary liability to the contractor.

(7) He/she is responsible for conducting herself in a professional manner in accordance with the Principles of Ethical Conduct for Government Officers and Employees. If guidance is needed please feel free to contact the Contracting Officer at any time.

(8) This delegation may not be re-delegated. It is effective immediately and shall expire when the contract is completed or when rescinded in writing by the undersigned Contracting Officer or successor.

(9) By acceptance of this contract the Contractor acknowledges the entire delegation of authority.

(End Delegation)

1. The COR will work in collaboration with the contractor, VISN 6 MIRECC and the VA Integrative Mental Health Office to establish time and location for initial planning, weekly project management team and workgroup meetings within one week of contract award.

2. The COR shall provide:

a. VHA Handbook, 1605.1, Privacy and Release of Information Handbook

b. Information on Federal Regulations governing VA research

4.0 Specific Tasks and Deliverables

Task 4.1: Contract Kick-off Meeting

• The Contractor shall have a contract kick-off meeting with the VISN 6 MIRECC and the VA Office of Mental Health’s national Integrative Mental Health (IMH) office staff within 10 business days after the award of the contract. The Contactor is responsible for recording minutes for the kick-off meeting. At the discretion of the VA Project Manager, the meeting will be conducted in person if possible or via videoconferencing if needed. During the kick-off meeting, the VA team will:

1. Review the Statement of Work (SOW) and discuss the detailed requirements of all deliverables.

2. Overview the specific goals and objectives of the project.

3. Define the role(s) and responsibilities of each project team member, including national experts and contractor.

4. Review and discuss technical details.

Deliverable 4.1: Kick-off Meeting, meeting minutes and dissemination of minutes to VISN 6 MIRECC / National Integrative Mental Health Office Team.

Task 4.2: Project Plan Document (PPD).

The contractor shall deliver a Project Plan Document (PPD) to the VISN 6 MIRECC, National Integrative Mental Health Office Team that details processes, schedules, and milestones for this contract’s deliverables.

• The PPD must contain the following elements:

• Executive Summary: Include an outline of your proposal to conduct this project, and the necessary time and cost to complete the work. Specifically address how you plan to implement and achieve the stated goals and objectives. (Maximum of two pages)

• Understanding of the Scope: Provide a concise description of the challenge you believe VISN 6 MIRECC / National Integrative Mental Health Office is facing in regards to this project.

• Project Management and Schedule: Describe your approach. Include a work plan outlining resources (yours and ours), phases, timelines, and deliverables.

• Regular contractor project meetings: The Contractor’s project management team shall attend regular meetings (recommend quarterly, in addition to any as needed extra communications) with the VISN 6 MIRECC/National Integrative Mental Health office team to discuss operational details, based on the schedule of deliverables and reporting of activities.

• The Project Plan Document must be delivered as an attached Microsoft Word or

Adobe PDF document via e-mail to the COR. Be advised that copies of the Project Plan document will be made for internal distribution to VISN 6 MIRECC/ National Integrative Mental Health office team members. Note: E-mail message delivery limitation. E-mail messages with a file size, including attachment(s), over 5 MB cannot be received by the COR.

Deliverable 4.2: The Project Plan Document (PPD) completed from Task 4.2.

Task 4.3: Coordinate with core Integrative Mental Health program faculty and staff to develop a comprehensive qualitative study strategy that will integrate with quantitative data collection as part of a mixed methods approach in support of H.R. 6411 506a.

• Provide expertise to guide and develop the qualitative methodology (e.g., interview questions, length of interview, sample size, saturation).

• Develop the qualitative approach in collaboration with IMH, who will provide

VA expertise, access, and connections to relevant stakeholders and expertise.

• Build from existing qualitative work among subject matter experts to advance understandings of moral injury in Veterans.

• Participate in regular project planning and oversight meetings.

Deliverable 4.3: All elements defined in Task 4.3 are completed within the project period.

Task 4.4: Complete a qualitative examination of the systems of care that aim to serve

Veterans with moral injury.

• Provide expertise to guide and develop the qualitative methodology (e.g., method(s) of inquiry, key data sources).

• Develop the qualitative approach in collaboration with IMH, who will provide

VA expertise, access, and connections to relevant stakeholders and expertise.

• Oversee and manage the full qualitative study to ensure timely completion of the project and achievement of other relevant timeline milestones.

Deliverable 4.4: All elements defined in Task 4.4 are completed within the

Task 4.5: Analyze and interpret qualitative data and report results in a format appropriate for professional presentation and manuscript(s) for professional journals.

• Consistent with the study design (developed in 4.3), employ advanced qualitative analysis techniques to code qualitative data and interpret findings.

• Report study results in a format appropriate for professional outlets, including presentations and professional journals.

• Collaborate with IMH in interpretation of findings and development of professional products.

• IMH reserves sole proprietary rights of all products from the project.

Authorship on professional products will be shared appropriately with the contractor and other personnel involved in manuscripts and other products.

Deliverable 4.5: All elements defined in Task 4.5 are completed within the

5.0 Period of Performance / Delivery Schedule

• The project should begin no later than 2 weeks from contract agreement by both parties.

• All deliverables are to be completed on or before the milestone deadlines set forth in this SOW or are superseded by the VISN 6 MIRECC, Integrative Mental Health Office and Contractor mutually agreed upon milestones/dates as stated in the final approved Project Plan Document (Task 4.2).

Delivery Schedule:

Delivery Schedule:

Project “kick-off” meeting (Task 4.1) .5 month after award of contract Delivery of Project Plan (Task 4.2) 1 month after award Coordinate with core Integrative Mental Health program faculty and staff to develop a comprehensive qualitative study strategy that will integrate with quantitative data collection as part of a mixed methods approach in support of H.R. 6411 506a. (Task 4.3)

3 months after award

Complete a qualitative examination of the systems of care that aim to serve Veterans with moral injury. (4.4)

9 months after award

Analyze and interpret qualitative data and report results in a format appropriate for professional presentation and manuscript(s) for professional journals. (4.5)

12 months after award

6.0 Performance Standards and Incentives

TASK (S)/

SUBTASK (S)

QUALITY

STANDARDS

ACCEPTABLE

QUALITY LEVEL

MEANS OF

MEASUREMENT

PENALITIES/

INCENTIVES

4.1. Contract Kick-off

Meeting

Timeliness: Contractor meets with VISN 6 MIRECC, Integrative Mental Health Project Team within the time described in the Delivery Schedule above.

Quality:

The meeting minutes shall accurately reflect the discussions during the kick-off meeting.

The action and product required, as described in the task, shall meet the COR’s approval

The COR will review all components of the TASK requirements and provide written feedback and/or approval to the Contractor.

The VISN 6 MIRECC COR may receive assistance from other

VISN 6 MIRECC,

Integrative Mental Health project team members.

a) Any additional expense caused by contractor delay is borne by the contractor.

b) Delays not approved by the COR will be noted in performance evaluations.

c) Delays not approved by the COR will cause the issue to be referred to the CO for possible cure notice action and or termination of the task order.

Incentives: Favorable contactor performance evaluation

4.2 Project Plan Document

(PPD)

Timeliness: Contractor completes Project Plan Document (PPD) as described in the Delivery Schedule section of this SOW.

Quality:

The PPD provides all of the requested information in the format specified by this

SOW.

the task, shall meet the COR’s approval.

The COR will review all components of the TASK requirements and provide written feedback and/or approval to the Contractor.

The VISN 6 MIRECC COR may receive assistance from other

VISN 6 MIRECC,

project team members.

a. Any additional expense caused by contractor delay is borne by the contractor.

b. Delays not approved by the COR will be noted in performance evaluations.

c. Delays not approved by the COR will cause the issue to be referred to the CO for possible cure notice action and or

4.3 Develop mixed

methods plan

Timeliness: Task completed as described in the Delivery Schedule section of this

SOW.

Quality:

The contractor develops a comprehensive qualitative study strategy that will integrate with quantitative data collection in support of H.R. 6411 506a.

the task, shall meet the COR’s approval.

The COR will review all components of the TASK requirements and provide written feedback and/or approval to the Contractor.

The VISN 6 MIRECC COR may receive assistance from other

VISN 6 MIRECC,

Integrative Mental Health project team members.

a. Any additional expense caused by contractor delay is borne by the contractor.

b. Delays not approved by the COR will be noted in performance evaluations.

c. Delays not approved by the COR will cause the issue to be referred to the CO for possible cure notice action and or

4.4 Examine care system(s) Timeliness: Contractor shall

deliver this as described in the Delivery Schedule section of this SOW.

Quality:

The contractor shall complete a qualitative examination of the care systems that exist to

The action and product required, as described in requirements and provide written feedback and/or approval to the Contractor.

The VISN 6 MIRECC COR may receive assistance from other

VISN 6 MIRECC,

a. Any additional expense caused by contractor delay is borne by the contractor.

b. Delays not approved by the COR will be noted in performance evaluations.

c. Delays not approved by the COR will cause the serve Veterans with moral injury.

project team members.

issue to be referred to the CO for possible cure notice action and or

4.5 Data analysis Timeliness: Contractor shall

deliver this as described in the Delivery Schedule section of this SOW.

Quality:

The contractor shall analyze and interpret qualitative date and report results in a format acceptable for professional publication and dissemination.

requirements and provide written feedback and/or approval to the Contractor.

The VISN 6 MIRECC COR may receive assistance from other

VISN 6 MIRECC,

Integrative Mental Health project team members.

a. Any additional expense caused by contractor delay is borne by the contractor.

b. Delays not approved by the COR will be noted in performance evaluations.

c. Delays not approved by the COR will cause the issue to be referred to the CO for possible cure notice action and or