Measuring Survivor Restoration With the Assessment of Survivor Outcomes Tool
International Justice Mission (IJM) is a non-governmental organization with operations in 11 countries that provides legal and social services to victims of violent abuse. It also collaborates with local justice officials to hold perpetrators accountable.
As part of its mission to support victims, IJM has developed a tool to measure progress towards healing, recovery and reintegration—in a word, restoration—of victims of violent abuse, including forced child labour, bonded labour, commercial sexual exploitation of children and online commercial sexual exploitation of children. The Assessment of Survivor Outcomes (ASO) is the first comprehensive assessment tool that covers all relevant domains, including safety, legal protection, mental well-being, economic empowerment, education, social support and physical well-being.
How the ASO is used
By using the ASO, practitioners can gain insights into essential information about individual survivors’ areas of strength as well as vulnerabilities, informing the development of treatment plan goals, progress towards restoration and case closure. It also illuminates the effectiveness of services provided by government and NGOs.
Each domain of the ASO is divided into several sub-domains. For example, the safety domain includes three sub-domains, each of which is scored in the ASO: freedom from abuse or neglect; freedom from threats from suspects or others who intend to revictimize; and ability to identify and manage unsafe situations. Assessors score a survivor’s well-being in each sub-domain using a vulnerability scale of 1-4, with one as the highest level of vulnerability and four as the lowest level of vulnerability. The overall domain score is calculated by averaging the sub-domain scores.
The ASO tool has been a helpful guide to understand my own self in the process of restoration.
For example, Foli was 17 when he was rescued from many years of forced labour on Lake Volta, in Ghana. On his IJM intake form, Foli scored one, or highly vulnerable, on the domains of Safety and Legal Protection. Foli had limited awareness that the situation he was in was one of abuse, and that he had had protection under the law. He was also not able to identify any means of support in his home community. Because of this, IJM staff designed his treatment plan to focus on educating him about the laws in place for his protection as well as the identification of individuals and systems of support.
On the domain of mental health and wellbeing, Foli scored a three, indicating that he was stable. He had occasional nightmares due to his experience, but this did not impair his daily activities. IJM insured that he had a social worker at the home that he could talk to. And IJM made it a priority to find a key contact or support person for Foli before his reintegration into society.
How the ASO was developed
The ASO was developed by IJM’s aftercare team in Chennai, India, which supports survivors of bonded labour. IJM had previously evaluated its survivor-support programmes by capturing information on the provision of services and care for individual clients, which informed individual needs assessments and treatment plan goals. The Chennai team saw the need to go further than existing standards, a standardized assessment instrument that would measure restoration centred on outcomes reflected in survivors’ own lives. IJM developed the instrument in consultation with survivors themselves, and staff have been using it in field offices in Asia, Africa and Latin America since 2012.
In 2015 IJM undertook an internal validation process to improve the tool by conducting three mixed method validation exercises in 16 IJM field offices across nine countries. All 16 field offices reviewed a global case study, and 12 field offices orally presented 4-8 cases and subsequently conducted in-person interviews with 4-8 survivors. The analysis methods for these exercises included five types of quantitative, statistical testing:
- internal consistency of the tool itself;
- intra-rater reliability among case managers;
- inter-rater reliability between case managers;
- inter-rater reliability between case managers and a subject matter expert; and
- inter-office reliability between field offices combatting the same type of violence or exploitation and one qualitative method involving each exercise’s guided discussion.
The following year, IJM undertook an external validation process that involved a review and feedback process of the tool and supporting materials from 25 subject matter experts. Additionally, 15 third-party organizations in eight countries field-tested the tool with their clients and held focus groups and in-depth interviews with survivors to understand their perspective on the key components of restoration. The study identified key areas for needed adjustments and further recommendations for assessment of survivor outcomes. In response to feedback from subject matter experts and organizational field testers, IJM made the following critical changes to the ASO tool:
- Several domains from the original ASO tool were renamed for clarity;
- The housing domain was re-organized into other domains;
- A sub-domain was added within the social support domain referencing access to community resources; and
- A legal protection domain was added with three sub-domains.
The results of both the internal and external validation determined that the ASO tool is precise and reliable and can be used to measure progress of survivors rehabilitating from various forms of violence and exploitation. After this review process, the ASO is now available for wider use.
Ghana police and IJM staff approach child labourers on Lake Volta. Copyright IJM
Working to sustain survivor restoration
IJM’s social workers employ the ASO with their clients at least twice throughout the course of treatment: when survivors enter IJM’s aftercare programme and again when their cases are closed. In the period 2014-2017 the average rate of survivor restoration, which is based on an ASO score three or higher, was 84 per cent, or 4,859 individuals restored.
IJM also endeavours to contact survivors one year after exiting IJM’s aftercare programmes and was able to do so in approximately 30 per cent of its cases in this period. The average rate of sustained restoration for those individuals was 92 per cent.
Survivors reported the value and importance of the self-assessment, which was conducted as part of the feedback from organizational field testers, as a helpful tool for reflection. Furthermore, survivors noted that the ASO tool allowed the case managers to better assist them in their recovery and did not express any concerns about being rated by their case manager.
Vanessa Bautista notes:
Personally, as a survivor, the ASO tool has been a helpful guide to understand my own self in the process of restoration. It helps us survivors identify what mental, physical and psychological states we are in throughout the journey of healing. It also motivates us to identify areas we need to be mindful of in order to sustain personal growth and healing from the trauma we have experienced. Also, seeing my results from the ASO tool helped me to see how much change has been made possible through the healing process.
The Validation studies and the ASO tool itself are available at www.ijm.org/aso The tool and accompanying material are available free of charge, but IJM requires that users sign a simple licensing agreement, which is also available at the website. IJM offers in-person and web-based trainings in its use, as well. Inquiries should be made to email@example.com.
Vanessa Bautista is a survivor, a social worker and a fellow at International Justice Mission
Holly Burkhalter is Senior Advisor at International Justice Mission.