Participants
A retrospective case record review was conducted of 54 adult foreign-born survivors of torture who received an initial assessment, case management services, and a 6-month assessment through ASSIST, between June 2012 and November 2013. This represents 72 % of the total number of clients who were referred to ASSIST for case management; the remaining 28 % either did not elect to receive case management or received case management but lost contact with ASSIST staff and, as a result, did not receive a 6-month assessment. The average age of participants was 35 years old, and 51.9 % identified as women, 44.4 % as men, and 3.7 % as transgender. They came from a wide variety of countries: the Gambia (6), Ethiopia (5), Kenya (4), Mexico (4), Democratic Republic of the Congo (3), El Salvador (2), Honduras (2), Nepal (2), Russia (2), Uganda (2), Albania (1), Angola (1), Bangladesh (1), Bosnia, Herzegovina (1), Brazil (1), Chad (1), Djibouti (1), Egypt (1), Fiji (1), Ghana (1), Kosovo (1), Mali (1), Mauritania (1), Nigeria (1), Peru (1), Rwanda (1), Sierra Leone (1), Sri Lanka (1), Sudan (1), Togo (1), Trinidad and Tobago (1), and Zimbabwe (1). Twenty-two participants lived in New York State, and the remainder lived in Washington State (19), Colorado (7), California (2), New Jersey (2) Connecticut (1), and Maine (1).
Procedures
All study participants received at least one pro bono medical, gynecological, or psychological evaluation from an HRC-trained volunteer clinician to document the sequelae of torture and abuse they suffered. After the evaluation, the clinician conducted a brief needs assessment and offered the participant the opportunity to request case management from ASSIST. Clients who wished to do so then signed a consent form, and information about the services they requested was sent to the ASSIST social worker, who screened requests and shared them with the case manager. The case manager then contacted the client by phone to conduct an initial assessment of client needs. Based on the services the client requested, the case manager made referrals to medical, mental health, and social service providers in the client’s community. In total, participants were referred for 575 services during their initial 6 months in the ASSIST program, an average of around 10 services per participant.
Provider organizations ranged from more specialized torture treatment centers to community-based organizations such as food pantries and shelters. The case manager maintained contact with the clients after making referrals, troubleshooting, or making additional referrals as needed. Six months after the initial assessment, the case manager contacted the client for a follow-up assessment applying the same procedure as employed in the first assessment.
Measures
The Survivor of Torture Outcomes Matrix (SOT Matrix) was utilized for each initial (T1) and 6 months (T2) assessment. The SOT Matrix, created by ASSIST staff, is an adaptation of the Self-Sufficiency Matrix, designed for use with individuals moving out of poverty by the Self-Sufficiency Task Force of Snohomish County and based on the federal outcomes standard Results-Oriented Management and Accountability (Snohomish County Self-Sufficiency Task Force 2004). The Self-Sufficiency Matrix demonstrates good reliability, with internal reliability of client dysfunction = 0.79, independent life skills = 0.78, and overall self-sufficiency = 0.81 (Culhane et al. 2007). It has already been adapted for youth aging out of foster care and survivors of trafficking (Senteio et al. 2009; Coalition to Abolish Slavery and Trafficking 2002). ASSIST staff made adjustments to the tool to more accurately capture the circumstances that foreign-born survivors of torture face in the USA. A program evaluation consultant was funded by a national capacity building project grant for torture treatment service providers, assisted with the instrument adaptation process.
The SOT Matrix serves a dual function as a case management tool, guiding the case manager’s assessment of the client, and as a program evaluation tool used for monitoring and evaluating service provision. It is comprised 14 different indicators: medical/physical symptoms, medical services access, mental health symptoms, mental health care access, medical insurance, food, clothing, housing, close relations, employment, income, English ability and literacy skills, community involvement, and legal needs. During the initial phone interview, the case manager conducts a semi-structured interview utilizing the SOT Matrix. Based on the responses, the case manager ranks the client on a Likert scale from 1 (very poor) to 4 (very good) for each indicator. The four possible scores per indicator are explained in further detail on the SOT Matrix; for instance, in the medical/physical symptoms category, 1 indicates “symptoms are disabling” and 4 indicates “symptoms not present.” SOT Matrix scores then become a part of the client’s case record and contribute to an overall program evaluation database.