The Modern Slavery Core Outcome Set

Author: Modern Slavery and Human Rights Policy and Evidence Center

Year Published: 2023

Link to Resource: Read More

Key findings

1. This consensus-driven participatory research project identified a set of seven core outcomes that should, as a minimum standard, be reported on in interventions for adult survivor recovery, healing, well-being and reintegration. This core outcome set provides a framework for research, policy and service design, development and evaluation. The outcomes are:

Secure and suitable housing
Safety from any trafficker or other abuser
Long-term, consistent support
Compassionate, trauma informed services
Finding purpose in life and self-actualisation
Access to medical treatment
Access to education.

2. Outcomes for people with lived experience of modern slavery must be considered in a way that is multi-level and holistic, encompassing outcomes across a variety of areas that have traditionally been viewed as separate in interventions.

3. Meaningful involvement of people with lived experience of modern slavery in the project led to a better-quality core outcome set and research process. Specific considerations need to be given to ensure that survivors engaging in the research process can do so through partnerships grounded in safety and a trauma-informed approach.

Background

There is widespread recognition that survivors of modern slavery experience serious and long-term health, social and economic consequences. However, there is a lack of evidence about which interventions are effective. Comparing the effectiveness of interventions requires the outcomes to be standardised and consistently reported on, yet systematic reviews have highlighted that there are a wide variety of outcomes and measures used in research to assess outcomes for survivors of modern slavery.

The purpose of the Modern Slavery Core Outcome Set (MSCOS) is to develop a minimum set of standard outcomes that should be used in the design and reporting of interventions. This core outcome set can be used to strengthen the development and assessment of interventions for the recovery, well-being, and integration of adult survivors of modern slavery and human trafficking.

Methodology

The MSCOS was developed through three rapid systematic literature reviews, 46 primary interviews with survivors of human trafficking and modern slavery, three stakeholder workshops, and a three-part international consensus building process through the E-Delphi method. Survivor inclusion was instrumental in creating a high-quality MSCOS, with outcomes that are meaningful for survivors and reflect their priorities. The majority of the workshop and E-Delphi participants were survivors, survivors’ responses were weighed more heavily than those of other participants, and the research team’s work was guided by a Research Advisory Board formed of experts by lived experience. The research team also worked with peer-researchers throughout the full life cycle of the MSCOS project.

Findings

1. This consensus-driven participatory research project identified seven core outcomes that should, as a minimum standard, be reported on in interventions for adult survivor recovery, healing, well-being and reintegration. This core outcome set provides a framework for research, policy and service design, development and evaluation.

Each of the outcomes are an important result and endpoint in the recovery and well-being of survivors: • Secure and suitable housing

Safety from any trafficker or other abuser
Long-term, consistent support
Compassionate, trauma informed services
Finding purpose in life and self-actualisation
Access to medical treatment
Access to education.

Each outcome includes a descriptor which has been developed with survivors, this included qualitative indicators with the potential for development of implementable standards. The purpose of these descriptors is to allow the core outcomes set to be used in practice. These are outlined in the MSCOS Toolkit, available on the Modern Slavery PEC website at modernslaverypec.org/resources/core-outcome-set and on the MSCOS website at mscos.co.uk. The core outcomes were developed via a consensus-led e-Delphi method, which was survivor-driven and informed by the opinions and experiences of several hundred participants including survivors, policymakers, service providers, regulators, professional health associations and politicians.

The core outcomes are not an exhaustive set and further outcomes should be used to recognise the specificities of survivor experience and tailor a service or policy to the people stakeholders are working with. The initial longlist of 38 outcomes, which can be found in the full report, can also be used in the design, development and evaluation of interventions. The project team has developed a Community of Practice that will offer practical training and guidance for the adoption of the core outcome set.

Outcomes were defined as, ‘the direct or indirect result of a planned action facilitated by an outside party or programme with the aim of supporting survivor recovery, well-being and integration post-trafficking’.

Many different types of interventions have been developed to aid the recovery of survivors, with some focussing on assisting survivors to address pragmatic issues post-trafficking, some on legal assistance, others on physical health, and others on mental health exclusively. Across these interventions, there are many mechanisms and outcomes that overlap and intersect. This suggests that an effective way to work with survivors is to combine effective components from a range of potential interventions into multi-level or multi-layered interventions that can address a variety of challenges faced by survivors in a holistic way.

The MSCOS adopts this multi-level and holistic approach encompassing outcomes across a variety of domains that have traditionally been segregated in interventions. The MSCOS outcomes also span individual, organisational, governmental, and societal levels. As such, the MSCOS intentionally moves away from a model where the expectation for achieving recovery and outcomes is placed mostly on survivors and moves towards a framework that emphasises the important role of institutions and systems. Inter-agency collaboration and integration should be an important focus in the development of any programme for the recovery of survivors of modern slavery.

Additionally, the holistic approach of the MSCOS indicates that outcomes should be considered consistently across time. While there may be a temptation to measure outcomes in the short, medium and long term, the research found that all outcomes are relevant at different stages of someone’s journey, and that these are not linear paths. As such, all MSCOS outcomes should be measured at consistent, regular timepoints, regardless of someone’s circumstances or years since their experience of modern slavery.

3. Meaningful survivor involvement in the project led to a better-quality core outcome set and research process. Specific considerations need to be given to ensure that survivors engaging in the research process can do so in partnership in a safe and trauma-informed way.

Survivors were engaged in the development of MSCOS through participation in the consensus workshops, employed as peer-researchers and through a survivor research advisory board. This engagement was instrumental in providing insights that could not have been obtained without survivor expertise. For example, peerresearchers’ lived experience meant they picked up on outcomes in the literature reviews that were overlooked by non-survivor researchers and all outcomes were rephrased to give a positive framing. Survivor-conducted interviews utilised survivors’ knowledge of how to frame questions sensitively and appropriately.

The benefits of this involvement were felt both by the researchers with lived experience of modern slavery and the wider research team. Benefits identified by peer researchers included improved confidence and ability to share ideas, improved teamwork, and greater understanding and respect of people’s opinions. Some reported that it helped in getting jobs and setting goals by giving them confidence to apply for work and study opportunities. Overall, most survivors viewed their engagement as transformative.

The benefits of reciprocal learning to the wider project team included openness in interactions with co-researchers and equipping them with improved skills to support contributions to central aspects of the project, such as literature reviews, participant interviews and academic outputs.

Considerations need to be given to the needs of survivors participating in research. This includes transparency over project funds, guidance for leaving the project and a recognition that materials used in literature reviews, workshops or interviews might trigger past and present traumatic experiences. External pressures relating to the asylum process and physical or mental health needs may lead to researchers needing to take time out or to remove themselves from projects. External supervision with a trauma-informed specialist would be beneficial, as would longer induction periods and 1:1 introductory meetings, to allow for a greater dialogue around each individual’s needs and strengths, and to fully explain safety and confidentiality procedures.

Recommendations

The full research report identifies a comprehensive set of recommendations that address the issues identified by the evidence. In particular, we highlight the following recommendations which address the findings outlined in this Research Summary:

For the UK Government, service providers and researchers

1. The MSCOS should be referred to as the minimum standard set of outcomes to be used in research, service and intervention design, evaluation and development, and policymaking.

2. Researchers, policymakers and service providers should use the MSCOS to think about interventions holistically. This means considering all MSCOS outcomes in intervention development and evaluation. If an intervention for survivors doesn’t cover all the MSCOS outcomes, policymakers, researchers and service providers should either consider amending it or partnering with services or interventions that do. This will necessitate cross-departmental working in government and collaborations across NGOs.

3. Researchers and service providers should use the MSCOS to think about interventions on many different levels, including the individual, organisational, governmental and societal levels. Service providers, researchers and policymakers should consider the importance of structural factors in intervention evaluations.

4. Survivors need to be provided with secure and appropriate safe accommodation to support their recovery, wellbeing and reintegration. Government providers should consider supporting the creation of survivor-managed safe houses.

5. Professionals working with survivors should understand the key principles of relational ethics (mutual respect, engagement, embodied knowledge, environment and uncertainty) and use these to help build more meaningful, trusting relationships.

6. Service providers and policymakers should acknowledge that access to medical treatment and education are structural issues. They should design interventions that address the structural biases based on race, ethnicity, gender and other characteristics, as well as financial deprivation that many survivors endure.

7. Service providers, policymakers and researchers should avoid thinking about survivor outcomes based on a linear short-term, medium-term and long-term progression. Rather, stakeholders should accept that needs and support can fade out and come back into relevance over many decades. Services should, therefore, be accessible at any time during a survivor’s life.

8. Projects, services, evaluations, interventions and policymaking on human trafficking and modern slavery should involve survivors in their design and implementation, as early in the process as possible. 9. Survivors should be appropriately compensated for participation in research, policy or NGO work, and all financial information relating to any project with survivor involvement should be transparent.