PROTECT-II- Promoting Recovery of Trafficked People
Human trafficking is defined as the “recruitment, transportation, transfer, harbouring or receipt of persons by means of threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power, or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation” (1). It is estimated to affect 136,000 women, men, and children in the United Kingdom (2). Survivors of trafficking report a range of health problems, especially psychological distress. Research with women survivors of trafficking who had returned to Moldova found that 54% met diagnostic criteria for DSM-IV mental disorder using the Structured Clinical Interview for DSM-IV (SCID) (3). Failure to provide effective mental health support for trafficked people increases the risk of persisting mental ill health and, in consequence, poor social outcomes, which carry costs for both individuals and society. Yet, evidence on what helps people’s recovery is absent.
In the UK, survivors of trafficking are entitled to government-funded support that aims to help them recover from abuse and rebuild their lives. Support is provided by a network of 12 non-governmental organisation (NGOs) that provide specialist post-trafficking support. Support follows an “advocacy” model, although the specific service model and the intensity of support varies between organisations. Advocacy interventions are defined as strengths-based, survivor-centred services based on empowerment models, in which caseworkers help service users to make sense of their situations, achieve self-identified goals, link them to community services, and provide ongoing support and informal counselling. The effectiveness of advocacy interventions in reducing psychological distress among survivors of trafficking remains unknown: outcomes have not been evaluated for this population either in the UK or elsewhere. The evaluation of advocacy-based interventions is therefore a priority need in informing the design of future services and to guide commissioning and investment. Additionally, there are no data examining how service level variations of or specific components of care appear most beneficial for which trafficked people.
The aim of this study is to evaluate the effectiveness of community-based advocacy interventions in improving mental health among people following their referral into the U.K. National Referral Mechanism (the framework by which trafficked people are identified and provided with government funded support in the U.K.) who have consented to receive NGO support.
Additional objectives of this study are: to evaluate whether aspects of the advocacy intervention experience thought to improve outcomes modify the effect of the advocacy intervention on mental health and well-being, to assess the service use and costs associated with advocacy interventions for trafficked people who have been referred into NGO services; and to explore service user and staff perspectives on how advocacy interventions improve outcomes, for whom, and under which circumstances.
In order to fulfill the study’s aims and objectives, this study is comprised by two linked studies.
Study 1 – Cohort Study
This study will assess whether mental health among survivors of trafficking improve over the period during which advocacy support is provided, with measures taken at baseline (T1), at 3 months follow up (T2), and at after a further 6 months follow up (T3). To support the interpretation of any detected change as a causal intervention effect in the absence of a control group dose-response relationships between change over time and factors describing the intervention experience will be assessed. Such factors are the “dose of support” which will quantify by frequency and duration of support and “intervention characteristics”. Participant characteristics that predict outcomes will also be identified and dose-response analyses will be adjusted for their potential confounding effect.
Study 2 – Qualitative Study
The aim is to understand how and why advocacy support does or doesn’t make a difference to people’s mental health. Data will be collected using qualitative semi-structured interviews with survivors and NGO staff. Professional interpretation will be provided as required.
Exploratory prospective uncontrolled cohort study and realist evaluation with assessments at baseline (T1), at 3 months follow up (T2) and at 6-months follow-up (T3). The primary outcome is reduced psychological distress (measured using the CORE-OM) at 3 months follow up (T2) compared with baseline (T1).
It is not feasible to recruit a control group for the following reasons: (1) All trafficked people who enter the National Referral Mechanism (NRM) are entitled to government-funded NGO support. Support is provided by a national network of NGOs; there is enough capacity, so NGOs do not operate waiting lists that could serve as a source of controls; (2) Trafficked people who enter the NRM but elect not to receive NGO support are extremely difficult to identify for recruitment. The PI’s previous research showed that it is not feasible to recruit from settings such as the NHS and Local Authorities (3). (while all NGOs provide advocacy-based support, the structural characteristics of services and the relative emphasis placed on components of support provided vary - reports of the National Audit Office and Public Accounts Committee, and conversations with NGOs, indicate considerable variability between services (4, 5) ).
This research will be among the first rigorous intervention evaluation studies to assess the effectiveness of a post-trafficking intervention and will contribute to public mental health initiatives by providing evidence for an understudied group at high risk of mental health problems (4). The near-absence of previous intervention evidence and the urgent need for robust evidence to inform: 1) interventions to promote recovery and reduce psychological distress among trafficked people, 2) UK budget allocation, and efficient use of health and other support services resources; 3) development of future monitoring and evaluation methods and tools for post-trafficking interventions; and 4) research capacity-building for interventions addressing modern slavery. By conducting a multi-site study with organisations using different service models, findings will be generalisable to survivor support services across the UK. We anticipate that the findings will inform future support to trafficked people and could be extrapolated to inform interventions for the UK’s asylum seekers and refugees.
Key beneficiaries of the research are:
- Trafficked people, who will benefit from refinement and improved targeting of interventions. Recent estimates suggest there are 136,000 trafficked people in the UK.
- Asylum seekers and refugees, many of whom have experienced interpersonal violence and have support needs similar to those of trafficked people.
- NGO service providers, who will benefit from evidence on the effectiveness of interventions; the development of programme theory and an articulated model for uptake/replication; and increased research capacity and improved data collection systems, supporting internal impact evaluation and external research collaboration;
- Policymakers, commissioners, and funders, who will benefit from evidence to inform resource investment and how to meet legal requirements to address survivor needs. The UK has international legal requirement to support the recovery of trafficked people and spends over £20m per year on the provision of support services for this group. To date there has been no evaluation of whether and how this support is effective in supporting the recovery of trafficked people, and no evidence to inform the refinement or improved targeting of support to promote recovery.
- Academics and researchers, who will benefit from improved methods to evaluate complex interventions among vulnerable populations, and from increased research capacity and improved data collection systems among NGOs working in this area.
Funding Body: National Institute for Health Research (NIHR)
Period: November 2019 - October 2022
Dr Sian Oram, Ph.D
Head of the Section of Women’s Mental Health
H3.02 David Goldberg Center, KCL