2015 FINDINGS REPORT Learning for Impact
Letter from Jimmy Dear Friends, Since our founding in 2009, we have served over 885 women via our Safehome, Outreach, and Economic Empowerment programs. For many of these women, access to our programs set them on a path to health, healing, and – ultimately – restoration. You are a co-laborer with us in this very important work and all of this – and so much more – has been made possible through the generous support of partners like you. Thank you. We are pleased to share with you our 2015 Findings Report: Learning for Impact. Last year, we released our inaugural Findings Report that shared learnings from our Outreach program. This year, we build on that report with updated data from our Outreach program and new early outcomes and learnings from our Safehome program and other initiatives. Why “Learning for Impact”? At Restore, we are laser-focused on impact. Our commitment to measuring the outcomes of our work allows us to continually improve our programs as we strive for excellence in all we do. We are especially excited to share the first set of outcomes for the women in our safehome, gathered as we tracked their progress along multiple dimensions every three months. What did we learn? Restoration is possible. As we grow and evolve as an organization, we will ultimately conduct a much more rigorous analysis of our impact but we consider these early learnings too important not to share with you in real-time. In addition: WE ARE COMMITTED TO TRANSPARENCY. By sharing our data and the learnings that result, we offer you a glimpse into our successes, our struggles, and our failures. We exist to help women find freedom and restoration and we desire to give them our very best as they begin the difficult work of healing. Data collection and analysis move us closer and closer to “the best” and allow us to maximize the impact of every dollar invested in our work while delivering programming that has been tested, refined, and proven to make a difference. WE ARE PART OF A BROADER COMMUNITY SEEKING TO END TRAFFICKING. Other organizations around the country - and around the world – are joining us in this difficult yet exceptionally important work. The anti-trafficking movement and approaches to survivor care are relatively new fields and we all have much to learn. When organizations share what works and what doesn’t – our programs become better and, as a result, more women can be restored. WE NEEP YOUR HELP. Data collection and analysis, when done properly, requires both significant time and skilled staff to execute. As part of our commitment to transparency, we believe this investment is worthwhile and will serve to advance our mission while maximizing the impact of our partners’ support. However, we cannot do this work without additional investment from those who share our commitment to serving survivors of sex trafficking. As you read the pages that follow, perhaps you will be inspired to invest in our impact assessment efforts so our programs can be refined, staff can be trained, and more women can be empowered to experience total restoration. Consider this report the start of a conversation between us, you, and the survivors we serve. It is not a “how to” manual or even a declaration of “what works.” Rather, we have many remaining questions, additional data to analyze, and we operate in an ever-changing environment that requires us to adapt and pivot on a regular basis. However, with your help, we will continue our commitment to delivering the most effective, most efficient programming to the hundreds of women we are honored to serve each year. We look forward to sharing our learnings as they unfold in the months and years ahead. Thank you for your continued friendship and partnership as, together, we continue to free women from commercial sexual exploitation and empower them as they seek total restoration. With gratitude, JIMMY LEE Executive Director, Restore NYC
About sex trafficking and Restoreâ€™s solution
Our approach to impact analysis
What we learned in 2015: 17
About the women we serve
From our outreach efforts
From our safehome
Executive Summary We are not in the business of “doing for the sake of doing” but rather are deeply committed to structuring our programs so that they work. For us, our programs “work” when survivors experience restoration and “rebuild the life intended”.
whAT DOES A RESTORED WOMAN LOOK LikE? She is recovering from the trauma of her trafficking experience. She is resilient and copes well with challenges that may come her way. She is looking forward to the future. She is economically empowered, working in a safe, life-giving job, and able to support her family. She is committed to and growing in her spirituality/faith and relies on it for comfort, guidance, and sustenance. Our mission is to end sex trafficking in New York City and to restore the well-being and independence of foreign national survivors. We envision this happening through a movement led by survivors who are physically, mentally, and economically thriving. Imagine when survivors encourage women trapped in the commercial sex industry to seek services; help law enforcement officials to identify traffickers and share their ever-changing tactics; empower other women who are at risk for trafficking to pursue other solutions; and educate practitioners and policy makers on how best to end trafficking and restore survivors. Together we believe this form of modern-day slavery can end. Since 2009, we have been working with survivors and developing programs towards this vision. Our current efforts to empower women in their restoration process are anchored around our safehome and Outreach programs. Impact assessment in these areas is in its infancy, but we have learned a tremendous amount in the past year and are already adjusting our work in response to these learnings. We are better as a result. We believe measuring our impact produces better results, for our organization and for the women we serve. It helps us to plan better, implement our programs more effectively, choose among competing scenarios, and successfully bring initiatives to scale. Impact assessment also keeps us accountable to those who invest in our work and it ensures we are making progress towards our mission: to end sex trafficking in New York City and restore the well-being and independence of foreign national survivors.
What did we learn in 2015? ABOUT THE WOMEN WE SERVE: Women who were referred to us are from 30 different countries across five continents. Demographics of the women we serve continue to affirm vulnerabilities were similar to those we saw in 2014. More than 75% of women we served were mothers with an average age of 39. About half are not married, with a higher rate of divorce than women from their country of origin (23% divorced, which is over 5 times the divorce rate in China). The majorities are not college educated (89%), with the majority only finishing middle school (36%). Only 48% of the clients seen through our work with the courts have legal work authorization.
| 2015 Findings Report: Learning for Impact
Women were trafficked into multiple industries but primarily into illicit massage businesses and hotel/ motel services and brothels. 50% of referrals in 2015 were identified as trafficking survivors or exhibited signs of trafficking. Sex trafficking of foreign national women is a complex crime and the circumstances of their entrapment, along with their fear of deportation, debt bondage, shame, and financial dependency often prevents victims from coming forward or sharing their trafficking experience. Victim identification by service providers is needed to ensure women can access the services and benefits available to them.
FROM OUR OUTREACH EFFORTS: Demand for our programs continues to soar. In 2015, 456 women were referred to us from 65 unique sources. These referral sources spanned 10 states and all five New York City boroughs. Most of our referrals came from court systems, followed by law enforcement and human trafficking service provider organizations. This represents a 115% increase in referrals and 490% increase in referral sources from 2014. Of the women who came to Restore in 2015 on their own initiative, the majority (39%) first went to their family or community for help. Mental health professionals (26%) and attorneys (21%) were also cited as first points of contact. The most requested services were related to employment (31%). Victim identification is a specialized skill and with training, we can improve our identification rates by as much as 3x. Simply having language capabilities or even a background in social work or trauma-informed care is not enough to consistently and effectively identify victims. Utilizing culture- and trafficking industry-specific terminology can establish trust and encourage women to reveal their trafficking status. The use of a standardized health questionnaire can flag areas of concerns and more effectively guide counselors to help women.
from our safehome: Our findings reveal that restoration is possible. Early data indicates a stay of 15-18 months produces the best outcomes. 89% of women who enter the safehome have significant symptoms of depression. Nine months into our program, only 33% have depression and by 15 months, no women have depression. For foreign national survivors, faith and spirituality were cited as one of their top coping mechanisms. After six months, 80% of residents experienced an improvement in their spiritual well-being. After approximately 12 months, 100% of residents use positive coping strategies more often than negative ones to manage their stress. Upon graduation from our program, 83% of residents had secured a job offering higher pay than their prior work.
WHAT IS SEX TRAFFICKING? A form of modern-day slavery in which false promises, violence, or coercion are used to exploit a person’s vulnerabilities through work in the commercial sex industry. New York City is one of the largest destinations for trafficked women entering the United States. Trafficking does not require movement across borders or even physical force. In many instances, women are enslaved and their vulnerabilities taken advantage of through lies and threats.
HOW ARE FOREIGN NATIONAL WOMEN TRAFFICKED? Foreign national survivors of sex trafficking are often from poor countries and live a life of extreme poverty. Facing few options at home, vulnerable women are often persuaded to come to the United States by promises of work. Many are lured here while looking for work in the US. Others are sold into slavery by their husbands or parents or tricked by false marriage proposals or offers of an education. A typical survivor has her passport and papers taken and then is told she is in the country illegally and must pay off an excessive “debt” (often referred to as debt bondage) in order to be released. In other instances traffickers use violence or threats to entrap women. Regardless of the method used, trafficked women are scared, isolated, and dependent on their traffickers.
WHY IS IT SO HARD TO FIND & IDENTIFY FOREIGN NATIONAL VICTIMS OF SEX TRAFFICKING? Sex trafficking of foreign nationals is a complex crime and the circumstances of their entrapment, along with their fear of deportation, often prevents survivors from leaving this dangerous work and coming forward to receive care. For many women, their ability to trust others has all but disappeared, making it difficult for even trained professionals to establish the relationships required to help them escape. Women have been told that they will get arrested because of their undocumented status and involvement in the commercial sex industry so they do not trust law enforcement or service providers, even when told about the better life that might await them. For others, the level of trauma experienced in the hands of their traffickers is equivalent to that of victims of state-organized torture and the physical and psychological scars can be paralyzing.
HOW MANY VICTIMS ARE THERE? We don’t know. Figures range between 20 - 36 million globally but credible organizations do not agree on a specific number. In the U.S., too little data exists to form a more definitive estimate. What do we know? In New York City alone, there are 4x as many illicit massage businesses as Starbucks. Many are run by well-networked criminal operations that exploit women for labor and commercial sex.
| 2015 Findings Report: Learning for Impact
WHAT KIND OF WORK ARE VICTIMS FORCED INTO? In the media, street prostitution is the most visible form of commercial sexual exploitation. However, much of the industry operates underground via escort services, illicit massage businesses, brothels, or via online classifieds.
WHERE ARE OUR CLIENTS FROM? Most foreign national survivors we serve are from China, Latin America, or Korea. In total, Restore has worked with women from over 30 countries.
HOW BIG IS THE INDUSTRY? CHINA
$150 B I L L I O N MEXICO
KO R E A
The International Labor Organization estimates that forced labor and human trafficking is aÂ $150 billion industry worldwide.
Our solution How do we find and restore? Thanks to you, Restore has moved to the forefront of the anti-trafficking movement in the United States. Our work with survivors is pioneering and increasingly looked to as a model for providing best-in-class care to foreign national survivors.
One of the biggest challenges in our work is simply identifying a woman as trafficked as many women hesitate to come forward due to cultural norms, physical and emotional trauma, threats from their captors, and fear of law enforcement officials and the possibility of deportation. As a result, we often encounter women, in law enforcement raids or otherwise, who are trafficked but do not disclose their trafficking experiences and are unable to access the critical resources available to trafficking survivors. Unless a woman declares her trafficking status, many critical resources remain unavailable to her.
For many survivors, safe, affordable shelter is nearly impossible to find, especially after a raid or escape. Prior to Restoreâ€™s founding, foreign national survivors were referred to homeless shelters or domestic violence programs that were ill-equipped for the trauma and cultural/linguistic competencies needed to effectively serve this population. Furthermore, most stays were limited to 3-6 months, too short a time for survivors to regain health, establish healthy coping strategies, , secure a job, and find a home.
Through our Outreach Program, we find and identify more foreign-national victims of sex trafficking so women can access the health, legal, and economic resources they so desperately need. We do this through partnerships with law enforcement, the court system, and community-based organizations. Our partnership with the Human Trafficking Intervention Courts (HTIC) is especially key to our outreach efforts and has allowed us to more easily meet and identify victims, many of whom would not have come forward otherwise. This specialized court was established originally in 2004 and renamed in 2013 to connect individuals arrested on prostitution-related charges to counseling and social services in lieu of jail time. Our counselors work to educate women about their rights and about sex trafficking, help them begin to process their often-traumatic experiences within the commercial sex industry, while empowering them to access the comprehensive resources available in the community.
Through our safehome, 12-15 women a year can access transitional housing and holistic care for up to 18 months, during the months immediately following their escape from trafficking when their trauma is severe and their needs are numerous.. Our safehome was the first of its kind in the northeast to offer this kind of care and now serves as a model for serving foreign national women. Our programming empowers residents to move towards greater independence and well-being as their immediate, long-term, and on-going needs are met. We focus on empowering residents to improve physical and mental health, job skills training and placement, and spiritual exploration and growth.
ECONOMIC EMPOWERMENT As a result of our interactions with safehome residents, we became aware of clientsâ€™ acute need for safe, well- paying employment. Many women cannot provide financially for their families back home and are susceptible to finding further exploitive work on their own. In fact, many of the women we serve are more interested in finding a job to support themselves and their families than they are in accessing other services. In early 2016, we launched a pilot version of our Economic Empowerment Program. This initiative includes job and life skills training, access to a community of peers and mentors, and a staffing agency anchored in a workers coop. This new social enterprise will place survivors in carefully screened, safe, jobs at for- and non-profit organizations to set them on a path towards financial independence. We will share initial learnings from this pilot in 2017.
| 2015 Findings Report: Learning for Impact
Our Approach and Definitions Throughout this document, we will reference the following terminology as it illustrates the values that are foundational to our approach:
TRAUMA-INFORMED An approach to care that accounts for the impact of trauma in all aspects of service delivery; recognizes trauma’s effects on clients and service providers; responds by integrating this knowledge into program and policy design; and prevents re-traumatization at all levels of the organization.
CULTURALLY-SENSITIVE SERVICES Culturally-sensitive services stem from an understanding of and respect for the existence of cultural differences and similarities and their impact on the values and behavior of both clients and service providers.
LINGUISTICALLY-SENSITIVE SERVICES Linguistically-sensitive services provide care that caters to the native languages of clients via verbal and document translation and access to staff of diverse linguistic backgrounds.
SURVIVOR-CENTERED An organizational culture which prioritizes the rights, needs and wellbeing of the survivor above all else. Survivors’ perspectives are welcomed and valued in the development, delivery, and evaluation of services.
STRENGTH-BASED This empowering perspective focuses on a client’s strengths more than her weaknesses; emphasizes her resources instead of her deficits; recognizes her skills and abilities instead of what she does not know; and leads with a focus on her capacity to grow and heal.
SURVIVOR vs. victim: Why it matters Throughout this report, we reference the women we serve as ‘survivors’. The women we serve have survived unimaginable challenges and made the often difficult choice to rebuild their lives. They are, in every sense of the word, survivors. When we use the term ‘victim’, we are referring to women who are still being trafficked or exploited and who have not yet been identified as trafficked.
Our approach to impact
LEARN AND REFINE
Our field serving survivors of sex trafficking in the US lags behind others in the non-profit sector in measuring holistic impact. We are committed to changing this. It is difficult to assess how a life has been changed as this process is often multi-faceted and complex. This assessment also takes resources, time, imagination, and creativity. However, we treasure the women we serve and they deserve access to proven methods of care that will make a meaningful difference in their lives and futures. To us, the cost of meaningful assessment is worth it. We believe measuring our impact produces better results, for our organization and for the women we serve. It helps us to plan better, implement our programs more effectively, choose among competing scenarios, and successfully bring initiatives to scale. Impact assessment also keeps us accountable – to our donors and to the women we serve. By measuring outputs, outcomes, and impact, we are better able to understand how and why we have succeeded or failed. Measuring impact involves much more than simply collecting data or even analyzing outcomes. This work requires an intentional approach and involves establishing control or comparison groups, conducting longitudinal studies to evaluate our impact over time, and gathering qualitative perspectives to inform the data we collect. Accordingly, our organization’s focus is evolving from one
SERVE CLIENTS BETTER
focused not just on outputs – how many women served, for example – but on true indicators of a life transformed. Each day we are confronted with a fundamental question: How do we best use the talents of our staff and our financial resources for maximum impact? It is through this filter that we wrestle with questions like: What is the most effective way to find more victims? Which partnerships are the most effective and why? How are traffickers luring women? What newspaper classifieds, businesses, and recruiting tactics should potential victims be aware of? Do we build another safehome? If so what kind – emergency or long-term apartment style? What type of programming and staffing structure should it have? We believe responsible stewardship and leadership require us to analyze which of the many paths before us will have the greatest impact on our mission: to end sex trafficking in New York City. In addition, if our experience and analysis can identify best practices (and, frankly, subpar ones, too), we have an opportunity to share our learnings with peer organizations so they, too, can maximize their own impact.
How did we approach impact assessment in 2015? LEARNED FROM OTHERS We explored how our peer organizations and others in related fields are attempting to measure the impact of their programs. We also reviewed research on best-practices in our space and for work with other high trauma populations (e.g. survivors of domestic violence, veterans, etc.) to develop guiding principles and leverage existing measurement tools. All this led us to conclude that our field lags behind other non-profit sectors in impact assessment and affirmed our desire to establish a framework for our own work and perhaps for our peers as well.
ASKED CLIENTS We surveyed current and former clients to better understand how they view their successes and challenges and what components of their work with Restore were most critical to their restoration.
Both efforts affirmed the need to develop our own framework to measure the impact of our work, even as we identified existing tools that could be valuable. This ultimately led us to partner with the University of North Carolina to identify metrics suitable for assessing the current state and future progress of foreign-national women who are survivors of sex trafficking.
How do we measure our impact? Based on client feedback, we’ve identified three key areas of a woman’s journey to restoration and we want to better understand how our programs can drive each of them, individually and collectively. These areas are: Physical and mental well-being
We began collecting outcomes-related data in our safehome in early 2015. We interview and gather data from all women upon arrival (“in take”) and subsequently at three-month intervals up to and including month 15. Using seven surveying tools (“measures”), this process provides a glimpse into survivors’ physical and mental well-being, economic status, and spiritual growth. We used a combination of surveys commonly used by social service practitioners and those uniquely designed for our programs to measure the following over time:
To assess physical and menTal well-being SF-12 Health Survey: This “short-form” survey is the gold standard for measuring physical and mental well-being. Because more than 1,800 published articles have documented its use in randomized control trials and it has been translated into 110 languages, it is normalized across various populations and allows us to track a survivor’s progress according to a widely-accepted standard.
To assess sTress level Perceived Stress Scale (PSS): This survey asks a series of questions about one’s feelings and thoughts in the past month and measures the degree to which a survivor views these situations as stressful.
To assess posT-TraumaTic sTress PTSD Checklist (PCL-5): This checklist measures a survivor’s symptoms of post-traumatic stress disorder within the past month, which includes flashbacks, sleep disturbance, and hyper vigilance.
| 2015 Findings Report: Learning for Impact
To assess abiliTy To manage sTress Brief COPE: This questionnaire measures how a survivor copes with stress and problems in her life. Possible responses range from “gave up trying to deal with it” to “getting comfort and understanding from someone”.
To measure incidence of depression Center for Epidemiologic Studies - Depression (CES-D): This tool measures symptoms of depression and asks a survivor to indicate how often she had a poor appetite, felt lonely, had trouble keeping her mind on a task at hand, etc., in the past week.
To measure resilience and growTh Post Traumatic Growth Inventory (PTGI): This survey aims to capture the extent to which a survivor’s life has changed for the better during her trauma recovery by asking if she’s experienced new interests, a greater degree of self-reliance, a greater sense of closeness with others, etc.
To moniTor spiriTual growTh Faith Maturity Scale (FMS): This tool measures the strength of a survivor’s spirituality, how it influences her life, and her commitment to transforming her life through faith.
IMPACT INDICATORS FOR SAFEHOME PROGRAM: Physical and Mental Well-being
Client and Staff Report: Has not re-entered trafficking, is employed, income above poverty threshold (NY State 2015), and pays rent of less than 50% of income
To understand the effectiveness of our Outreach program, we focus on three key metrics, particularly for women we see through the Human Trafficking Intervention Courts (HTIC). Through the HTIC, we meet with women for five sessions over a period of 1-2 months. In many cases, not all referrals from law enforcement raids or partner organizations are trafficking victims and therefore some do not fit our service population. Impact indicators for the Outreach Program were developed and refined in the latter part of 2015. We will share our complete results in 2017 as we gather more data.
KEY METRICS FOR OUR OUTREACH PROGRAM Self-identification as a victim of trafficking (Restore designed assessment & TVIT – Trafficking Victim Identification Tool by the Vera Institute). Increase in physical and mental well-being (SF-12). # of resources coordinated, as requested by clients.
What we learned in 2015
Overview 2015 was a pivotal year for us as we began the transition from a focus on outputs to a focus on outcomes. Our preliminary findings reflect both outputs and outcomes based on 2015 program data and, with additional resources, we hope to expand our ability to effectively measure the outcomes and long-term impact of our work.
About the women we serve What countries are women who seek our services from?
What are the demographics of our clients? The demographics of the women we serve are similar to prior years and paint a picture of financial and emotional vulnerability. Our clients are typically middle-aged, less educated, on their own, and unable to work in the US.
Age *average age: 39
We tracked data across all programs and learned that the average age varied by program.
Education level We only tracked education for clients we saw through our HTIC program. As in prior years, the majority of clients (89%) were not college educated and 45% never graduated from high school.
family situation The family status of HTIC clients was mixed. Half are married and approximately half are single or divorced. Interestingly, the majority of clients we work with are from China and have a significantly higher divorce rate (23%) when compared to the average divorce rate in China (4%).
ABLE TO WORK IN THE US Only 48% of the clients seen through the HTIC have work authorization. We suspect that those who left the answer blank were likely undocumented and did not reveal this information. Many have expired tourist or student visas. Those who have work authorization received it through their asylum application.
| 2015 Findings Report: Learning for Impact
What industries were women “working” in when they were trafficked? Foreign national women can be trafficked into a variety of industries. Our peer organization Polaris identified 25 industries or “manifestations” of trafficking in the U.S. In 2015, women from 12 different industries were referred to us and the majority of women had been trafficked into the massage parlor industry, illustrating the high rate of foreign- national women (especially Chinese) being exploited in illicit massage businesses.
Top three trafficking industries:
massage parlors 304, 66.7% Why is it so hard to find and identify foreign national survivors of sex trafficking? Not all women referred to us are confirmed trafficking survivors. We estimate approximately 50% of the women referred to us have been trafficked. Sex trafficking of foreign nationals is a complex crime and the circumstances of their entrapment, along with their fear of deportation, often prevents victims from coming forward to receive care. Debt bondage, shame, and financial dependency often prevent women from leaving their dangerous work. For many victims, their ability to trust others has all but disappeared, making it difficult to establish the relationships required to help women escape. Women have been told that they will get arrested because of their undocumented status and involvement in the commercial sex industry - or both - so they do not trust law enforcement or service providers, even when told about the better life that might await them. For others, the level of trauma experienced in the hands of their traffickers is equivalent to that of victims of state-organized torture and the physical and psychological scars can be paralyzing. One of the primary goals of our Outreach Program is to find and identify victims of sex trafficking. In 2015, 456 women were referred to us and we independently assessed and identified 49 to be trafficking survivors. When we include women who were identified by other service providers (law enforcement or attorneys) and women whose stories and circumstances indicate a high likelihood of experience with trafficking, this number rises to 227 (50%).
From our outreach efforts Who do trafficking survivors first turn to for help? Of the 456 referrals received in 2015, we obtained data on 38 referrals who escaped their trafficking situation on their own. It takes great strength and courage for women to escape and we see that this is the method by which more and more women leave their trafficking situation (vs. trafficker-led or law enforcement raid). Of these 38 women, we asked “who did they first turn to for help?” 39% went to family or community members while 10 women (26%) first approached a mental health professional (counselor, case manager). Eight women (21%) went to an attorney (e.g. public defender, immigration attorney, or family lawyer), while five (13%) went directly to law enforcement (e.g. local, federal, or district attorney). The rates of identification varied significantly depending on who a woman first approached for help. Although law enforcement and attorneys are among the least-pursued sources of help (due to fear of deportation, trauma, language barriers, etc.), our data indicate that law enforcement and attorneys are among the best sources of referrals for trafficking victims. Though this sample is small, it provides a window into the circles of influence in a victim’s life. Any outreach efforts should focus on community members as trafficked individuals often go directly to those closest to them (either physically or emotionally) for help. We also want to recognize the critical role law enforcement and attorneys play in serving survivors.
n = 38
How are women referred to Restore? In 2015, 456 women were referred to us from 65 unique referral sources across nine categories. These referral sources spanned 10 states and all five New York City boroughs. Most of our referrals come from court systems followed by law enforcement and human trafficking service provider organizations. This represents a 115% increase in referrals and 490% increase in referral sources from 2014.
65 REFERRAL SOURCES
AND ALL 5 NYC BOROUGHS
ACROSS 10 STATES
| 2015 Findings Report: Learning for Impact
What services do clients most frequently request? The most requested services in 2015 were related to employment (31%). Of note: 37% of women referred to our outreach (crisis) program were in need of emergency housing but we were only able to accommodate 3% of referrals due to a lack of capacity. This problem has eased thanks to partners who are providing clients with free hotel accommodations for 3-4 nights but accommodating all whose safety depends on emergency housing remains a major challenge.
n = 456
What are we learning about finding and identifying victims? Victim identification is a specialized skill and with training, identification can improve by as much as 3x.
Identifying trafficking victims is a fundamental component of helping women find freedom and restoration. For example, the U.S. Government grants a specific visa (T-Visa) to victims of trafficking that is not available unless a woman selfidentifies as a survivor and describes the force, fraud, or coercion that led to her commercial sexual exploitation. Selfidentification is often extremely difficult for a woman who has experienced significant trauma and many times remaining in the shadows seems easier, making it all the more critical for our staff to be skilled at identifying and working with victims. We believe a background in social work or training in general trauma-informed services is not sufficient when working with foreign national victims of sex trafficking. Even professionals who see victims on a regular basis â€“ including defense and immigration attorneys - struggle to identify victims.
In July-September 2015, new staff and a new class of interns joined our counseling team. We expected these new team members to experience a sharp learning curve particularly in their work to screen for trafficking status but we had never measured the impact of new staff on identification rates. We used this opportunity to track victim identification rates and observed a sharp decline in trafficking identification in July (5%) and August (11%). We then began intensive training at both the individual level (in supervision) and at the group level (in our team meetings) and our identification rates grew by 3x. In fact, October - November identification rates were higher than any other time before. Improving skills in this area is leading to higher numbers of identification overall.
Note: We stopped receiving referrals during the month of April and early May due to capacity constraints.
What are we learning about finding and identifying victims? USING A HEALTH SURVEY AS A WAY TO IDENTIFY AREAS OF CONCERN The SF-12 is a survey that evaluates physical and mental well-being. In the fall of 2015, we began using this survey to evaluate the women referred to us via the Human Trafficking Intervention Courts (HTIC) in an effort to understand if and how their physical and emotional health improved as a result of their time in our program. It can be challenging for clients to speak about their trafficking history due to numerous cultural and trauma-related factors and we saw that this standardized questionnaire could give us another tool for identifying red flags in addition to tracking well-being. Using data from 43 women from intake through program completion, clients who self-identified as trafficked had a mental health score approximately 10 points lower than those who did not identify as such. In addition, women who self-identified as trafficked had a difference of six points between their physical and mental well-being scores versus a onepoint difference for their non-trafficked peers. Unemployed trafficked women scored the lowest of all, supporting our emphasis on economic empowerment to best serve this group. Our preliminary findings affirm the use of this tool as a way to identify red flags so that counseling resources can be directed at those who need them most, namely women who receive low SF-12 scores, exhibit a difference in physical and mental health, and who are also unemployed.
USING CULTURAL AND TRAFFICKING INDUSTRY SPECIFIC TERMINOLOGY Many professionals struggle to identify trafficking victims. In some instances, a victim is seen by multiple attorneys and domestic violence organizations, all of whom failed to identify her trafficking status. Our 2015 assessment affirmed for us the key role industry-specific language can play in creating an environment that is most-likely to encourage a woman to self-identify. The same is true for using culturally-appropriate terminology.
| 2015 Findings Report: Learning for Impact
For example, when speaking to Chinese women working in illicit massage businesses, talking about cultural dynamics early on in a conversation (e.g., openly discussing differences in age and education and its impact on the client/counselor relationship) and using specific Mandarin slang like in our questions helps counselors to build trust with clients and encourages women to self-disclose. For example, terms like “pimping” (拉皮条), an idiom that refers to something that is “not illegal but not legal” (擦边 球), and “yellow”, a term that refers to prostitution (黄色) seem to set a conversational tone that encourages disclosure.
THE NEED FOR SERVICES CONTINUES TO GROW AS WE SPEARHEAD NEW OUTREACH EFFORTS In 2015, we hired an outreach manager who is now dedicated to helping Restore find and identify more survivors of trafficking while also working to develop new strategies to bring women out of the shadows. Referrals in 2015 grew by 115% to 456 women. We were only able to serve 292 due to capacity constraints.
EMIâ€™S* STORY Emi was brought to the US from China by her parents when she was 13 years old. Her parents were busy working to support her family so they did not notice that her neighbors were sexually abusing her. She dropped out of high school and decided to run away. She tried to support herself through odd jobs at various restaurants and retail stores but eventually began working in a brothel. She did not want to do so but felt she had no choice. After some time, the NYPD raided the brothel and she was arrested for prostitution. It was at this point that we first met her. During Emiâ€™s session with one of our counselors, she began to open up as she finally felt safe enough to share her story. She completed her court-mandated sessions with Restore and the prostitution charges against her were dismissed. Emi asked to continue meeting with our counselor even after the mandatory sessions were finished and, through Restore, she was introduced to internships and various ESL programs to help her get back on her feet. When Emi called about one possible internship, she realized she needed identification documents that she didnâ€™t have and missed her interview. Her parents had her green card and were refusing to give it. Upon discovering her reason for not showing up, her counselor connected her to her defense attorney and immigration attorney to help Emi replace her green card. Today, Emi is part of our pilot Economic Empowerment program. Working with our team, she built a resume and practiced her interview skills. She is now working with one of our business partners in her first safe, legal job since she arrived in the U.S.
*Name has been changed to protect client's identity
| 2015 Findings Report: Learning for Impact
From our safehome RESTORATION IS POSSIBLE CASE STUDY: A WINDOW INTO THE RESULTS OF THE SAFEHOME PROGRAM Our safehome accommodates just 11 women at a time. To date, weâ€™ve collected 38 data points in total across 15 residents and have multiple data points over time for 8 residents. As a result, our sample size is inherently small and our findings should be viewed as entirely preliminary. Note: Each of the tools used to assess safehome residents has a different scale. To better facilitate a global view of our data, we have transformed all scores to percentiles. The benchmarks for depression are 27%, stress are 50%, PTSD are 48% and physical and mental well-being are 50%. For post-traumatic growth, the benchmark is 61%. That is, if a survivor scores above 50%, she is considered above average in physical and mental well-being and if she scores over 61%, she is experiencing healthy post-traumatic growth. There are no benchmarks for the coping and faith maturity measures.
Positive Well-being and Growth Indicators Across Time
Negative Well-being Indicators Across Time
NOTEWORTHY FINDINGS: When entering the safehome, 89% of women presented with serious depression symptoms. Nine months into our program, only 33% had depression, and by 15 months, 0%. After 6 months, 80% of residents experienced improvements in their spiritual well-being. Most use faith/ spirituality as one of their top coping mechanisms. 100% of residents use positive coping strategies more often than negative coping strategies to manage stress by months 12 and 15. Upon graduation from our program, 83% of safehome residents had secured a job offering higher pay than their prior work.
THE MOST MEANINGFUL OUTCOMES FOR SAFEHOME RESIDENTS ARE ACHIEVED AT MONTH 3 AND 15 Our preliminary findings indicate residents of the safehome experience two â€œcritical restoration periodsâ€?, one at 3 months post-intake and one at 15 months post-intake. That is, three months after intake, most clients experienced a significant reduction in their stress level, a reduction in PTSD, and improvements in physical and mental well-being. Likewise, safehome residents experienced a second, equally meaningful increase in their overall wellbeing at 15 months post-intake. Positive Well-Being and Growth Indicators Across Time
Negative Well-Being Indicators Across Time
| 2015 Findings Report: Learning for Impact
THIS HAS LED US TO RE-EVALUATE RESIDENTS’ LENGTH OF STAY IN THE SAFEHOME Historically, residents could stay in our safehome for up to 12 months. We now offer a standard stay of 12 months with two 3-month extensions, bringing the total possible stay to 18 months. Early data indicate a stay of 15-18 months produces better outcomes for survivors.
WITH TRAUMA EDUCATION, POST-TRAUMATIC STRESS CAN BE REDUCED BY 65% In mid-2015, we piloted a new wellness group for safehome residents with an emphasis on trauma education. We’ve long known that providing education on trauma, trauma-related symptoms, and healthy coping skills is integral to the healing process for survivors. We also believe that providing this education in a group setting helps to foster a sense of community that enhances the recovery process. The new residents who chose to participate in this group saw their measures of PTSD scores drop significantly during the course of the pilot, especially when compared to residents who did not participate. In fact, those who did not participate experienced (on average) a slight increase in their PTSD score. Although this effort is in its infancy, early results are promising. Based on these initial results, we now invite all residents to participate in this group curriculum and have worked to minimize any barriers to a meaningful experience (e.g., time of group sessions, language, etc.). We have also begun screening new arrivals to assess their ability to discuss trauma in a group setting and, if they are not best-served by this approach, we have increased our capacity to work through the curriculum on a 1:1 basis.
PSTD Scores Improve by 65% with Training
PSTD Scores Increase by 10% for Those Not Participating
FOR FOREIGN NATIONAL SURVIVORS, FAITH AND SPIRITUALITY ARE KEY COMPONENTS TO THEIR IDENTITY AND OF THE RESTORATION PROCESS Our impact assessment continues to affirm how critical a woman’s faith/spirituality is to her restoration. At our safehome, we approach all residents from a culturally-sensitive and trauma-informed perspective. This includes a commitment to encouraging residents to pursue a religious tradition of their choice. Residents may also decide to decline. Our data indicate that when women first move in the safehome, they report that traumatic experiences often lead to a strengthening in their faith as measured by the Post-Traumatic Growth Inventory which reveals a religion subscale score that is higher than other components. Likewise, relying on faith is the third most used coping style (of 14 measured by the Brief Cope) for 7/15 residents as reported at their first assessment, behind “active coping” and “acceptance”.
SASHA’S* STORY Sasha entered the safehome and, like many before her, was shy and reserved. For the first two months, she stayed in her room and only came out for meals and appointments arranged by her case manager. During meals or other meetings, it was clear she couldn’t focus and had very little desire to engage in group activities. At other moments, she would suddenly erupt in a rage over minor incidents. She also struggled with climbing up the stairs and standing for long periods of time given how much trauma her body had experienced. Veteran members of the safehome continued to welcome and befriend Sasha while the staff made sure to care for her needs. Eventually, she participated in more “family” gatherings at the home, met more regularly with her counselor, and participated in the home’s classes on PTSD, yoga, and nutrition. It was clear her confidence was rising, helping her to better cope with her trauma triggers. After one year in the safehome, Sasha found a part-time job at a hospital and found a house of worship in her own language. Recently, as she was preparing to testify against her trafficker in court, other safehome residents expressed how encouraged they were by her resilience and strength.
*Name has been changed to protect client's identity
| 2015 Findings Report: Learning for Impact
What’s next Our initial efforts to measure the impact of our programs have been humbling and instructive. For some of our programs, we have learned more about the women we serve, their strengths and needs, and how our programs are – and aren’t – helping them move towards physical, mental, economic and spiritual restoration. For others, we were unable to capture sufficient, accurate data to draw reliable conclusions and we are now exploring how to more successfully measure our impact in the year ahead. We aspire to make outcome measurement an essential component of our day-to-day operations and to build a rigorous process for ensuring the efficiency and effectiveness of our programs – but this requires an additional investment in staffing and other resources to evolve into a full impact assessment.
OVER TIME, WE COULD EXPAND OUR ASSESSMENT WORK TO INCLUDE: Control or comparison groups to help us to better understand the concrete outcomes of our programs and, more specifically, which components of each program have the most significant impact. More qualitative perspectives to inform our data via interviews with survivors and staff to better understand their opinions on the primary drivers of restoration. More intelligence on sex trafficking including a deeper knowledge of tactics, trends, and networks that could Through assessments like this one and others to come in the future, we are working to answer the following questions:
programming: Which of our programs are the most effective at making the biggest difference in the lives of survivors of sex trafficking? How do outcomes differ between the women we serve and those who receive no assistance? How can we determine if a victim is best served by our Safehome, Outreach, or Economic Empowerment program? What aspects of these programs are driving our results? What is the ideal length of a client’s engagement with our programs? Are there new programs we should consider to help women experience greater restoration?
Supporting the field How can our impact assessment work help the many organizations who are working to end sex trafficking? How can we better educate law enforcement, the legal profession, and other service providers to best serve survivors?
Partnerships What are there strategic partnerships we should explore? Who can help us learn more? Our existing partnership with the University of North Carolina – Chapel Hill has been invaluable - how can we best leverage this and other relationships to implement data-driven, proven approaches to our work?
Tools, technology, and skills What tools and technologies would enable our data collection and analyses to be more efficient and cost effective? What type of skills does our team need to have? What kind of staffing structure do we need to measure our impact? Are there tools others are using that might be suitable for us?
learning from survivors How can we most effectively engage survivors to teach us how to better serve future clients? What do survivors feel was most helpful in their restoration process? How can we be more culturally-sensitive and trauma-informed? What services do survivors need that we currently do not offer?
managing growth Demand for our programs is soaring. How do we continue to provide high-quality care for survivors as we grow? How do we attract and retain high quality talent? How do we provide a healthy work environment for them?
| 2015 Findings Report: Learning for Impact
We believe that survivors deserve the highest quality care and we are committed to maximizing our impact through on-going, rigorous assessment of our work. We look forward to learning with you as, together, we work to end sex trafficking in New York City.
| 2015 Findings Report: Learning for Impact
References Tools and Resources for Assessing Social Impact, Foundation Center McKinsey Social Sector office. How does Social Impact Assessment Work?. http://mckinseyonsociety.com/social- impactassessment/how-does-social-impact-assessment-work/ Fay Twersky, Jodi Nelson, Amy Ratcliffe (2010). A Guide to Actionable Measurement. Bill & Melinda Gates Foundation McKinsey Social Sector office (2014). Learning Driven Assessment Workbook: Dana Rotz, Nan Maxwell, Adam Dunn(2015). Economic self-sufficiency and life stability one year after starting a social enterprise job. Mathematica Policy Research Sasha Dichter, Tom Adams, & Alnoor Ebrahim (2016).The Power of Lean Data. Stanford Social Innovation Review Chief Judge Jonathan Lippman (2013). Announcement of New York’s Human Trafficking Intervention Initiative. Center for Court Innovation SF-12 Ware, J., Jr., Kosinski, M., & Keller, S. D. (1996). A 12-Item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233. CES-D Radloff, L.S. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401. PSS Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385-396. PCL-5 Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28, 489–498. doi: 10.1002/ jts.22059 Brief COPE Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the Brief COPE. International Journal of Behavioral Medicine, 4, 92-100. PTGI Tedeschi, R.G., & Calhoun, L.G. (1996). The posttraumatic growth inventory: measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455-71. Faith Maturity Scale Benson, P. L., Donahue, M. J., & Erickson, J. A. (1993). The Faith Maturity Scale: Conceptualization, measurement, and empirical validation. Research in the Social Scientific Study of Religion, 5, 1-26. Trauma-Informed Care http://www.samhsa.gov/nctic/trauma-interventions Culturally-sensitive Services (Stafford, J.R., Bowman, R., Ewing, T., Hanna, J., & Lopez-De Fede, A. (1997). Building Culture Bridges. Bloomington, IN: National Educational Service.) Survivor-centered http://www.endvawnow.org/en/articles/652-survivor-centred-approach.html