Validating the Measure of Moral Distress for Child Welfare (MMD-CW): A bifactor exploratory structural equation modeling approach.

BACKGROUND: Moral distress occurs when professionals know the ethically appropriate action to take but are unable to do so due to constraints. U.S. child welfare workers, who operate under multiple constraints, are at high risk for moral distress. However, current measures do not sufficiently capture sources of moral distress specific to this profession. OBJECTIVE: This study evaluated the factorial validity, reliability, and measurement invariance of the Measure of Moral Distress for Child Welfare (MMD-CW; 13 items). PARTICIPANTS AND SETTING: The study used survey data from 1452 child welfare workers (48% Black or African American; 45% White). METHODS: Bifactor exploratory structural equation modeling was conducted to determine the factor structure of the MMD-CW. Measurement invariance across racial groups was tested sequentially. RESULTS: The MMD-CW includes a general moral distress factor (12 items) and two distinct yet related sources of moral distress at the organization (7 items) and team (5 items) levels. The MMD-CW demonstrated good reliability for the general and two specific factors and showed the dimensional uniqueness of moral distress. Partial residual measurement invariance was achieved across racial groups. Workers of color reported higher team-level distress but lower organization-level distress than White workers. CONCLUSIONS: Findings support the use of the MMD-CW as a valid and reliable tool for assessing the complexity of moral distress among child welfare workers and for informing research and practice aimed at addressing moral distress in child welfare.