Publication: https://modernslaverypec.org/assets/downloads/MSCOS-Report-Final.pdf
Background: The Global Slavery Index (2022) estimated that there are over 49.6 million people in modern slavery across the world. Modern slavery is the 'severe exploitation of other people for personal or commercial gain' and can include human trafficking, forced labour and debt bondage (Anti-Slavery International 2021). Yet currently, there is no consensus on the definition and measurement of healing and recovery for survivors. We developed the Modern Slavery Core Outcome Set (MSCOS) to address this gap. The MSCOS aims to provide an accepted list of meaningful outcomes that should be measured and reported as a standard in service/intervention monitoring and evaluation.
Method: We began by creating a longlist of outcomes to narrow down into a core outcome set. We extracted outcomes from three literature reviews (qualitative, quantitative, and grey) summarising 46 papers and reports; the analysis of 36 fully anonymised pre-existing interview transcripts with survivors of modern slavery; interviews with 7 survivors from underrepresented groups, and two exploratory stakeholder workshops (a total of 84 attendees including policymakers, researchers, survivors, and service providers). This longlist was narrowed down by removing duplicates and merging similar outcomes.
The refined longlist was presented to stakeholders as part of a three stage E-Delphi survey (53 respondents in Round 0, 64 is Round 1, 74 in Round 2). In the surveys, stakeholders were asked to comment on and rank outcomes. Outcomes were removed and merged based on comments, their position in overall stakeholder rankings, and their position in survivor participant rankings. The E-Delphi produced a shortlist of outcomes that were debated and ranked in a final half-day consensus workshop. The top results in overall participant and survivor participant rankings produced the MSCOS.
We developed our MSCOS in close collaboration with survivors, practitioners, academics and policymakers. Our work was supervised and guided by our survivor research advisory board. We also used participatory methods throughout the study, training and working with three peer researchers with lived experience of human trafficking and modern slavery. In every workshop and survey, the vast majority of stakeholders were survivors.
Results: The literature reviews, survivor interviews and exploratory workshops produced 1,313 individual outcomes. This was narrowed down into a longlist of 74 outcomes spanning 10 different domains (e.g., ‘health and wellbeing’, ‘creating change’, ‘employment’) for use in the E-Delphi. In Round 0 of the E-Delphi, comments were used to merge, reduce, and change the outcomes, reducing the number to 72 in total. In Round 1 and 2, the least popular outcomes we removed, leaving 34 and then a 14-outcome shortlist. The final consensus workshop left seven core outcomes for the MSCOS. These outcomes were: ‘long-term consistent support’, ‘secure and suitable housing’, ‘safety from any trafficker or other abuser’, ‘access to medical treatment’, ‘finding purpose in life and self-actualisation', ‘access to education’, and ‘compassionate, trauma-informed services’.
Conclusion: We produced a survivor-driven MSCOS to encourage quality, meaningful, comparable evidence in the field of modern slavery and human trafficking. The MSCOS will support the recovery and healing of survivors of modern slavery and human trafficking.
To develop the Modern Slavery Core Outcome Set (MSCOS) to reach consensus on the definition and measurement of healing and recovery for survivors. In terms of the scope of the COS:
Nature/type of intervention - Specialist therapeutic support; Caseworker support with accommodation, employment, access to services etc.; Structured Mentoring; Clinician and Service Provider training.
Population within the health area - Survivors of modern slavery and human trafficking (both recent migrants and British nationals).
Setting for intended use - Research and Service Delivery
Principal Investigator: Sharli Paphitis (King's College London)
Principal Researcher: Sohail Jannesari (King's College London)
Co-Researchers: Bee Damara (Survivor Alliance), Jeanet Joseph (Survivor Alliance)
Co-Investigator: Rachel Witkin (Independent Consultant)
Co-Investigator: Minh Dang (Survivor Alliance)
Co-Investigator: Cornelius Katona (the Helen Bamber Foundation)
Co-Investigator: Nicola Wright (University of Nottingham)
Co-Investigator: Emma Howarth (University of East London)
Community of Practice Fellow: Queenie Sit (Helen Bamber Foundation)
BSC Student: Olivia Triantafillou (King's College London)
Core Outcome Set Consultant: Claire Powell (University College London)
Grant Award Chief Investigator: Sian Oram (King's College London)
Disease Category: Mental health
Disease Name: Generalized anxiety disorder, Major depressive disorder (MDD), Post-traumatic stress disorder (PTSD)
Age Range: 18
Sex: Either
Nature of Intervention: Other
- Charities
- Clinical experts
- Consumers (patients)
- Patient/ support group representatives
- Policy makers
- Regulatory agency representatives
- Researchers
- Service commissioners
- Service providers
- Service users
- COS (Other)
- Consensus meeting
- Delphi process
- Interview
- Literature review
- Semi structured discussion
We began by creating a longlist of outcomes to narrow down into a core outcome set. We extracted outcomes from three literature reviews (qualitative, quantitative, and grey) summarising 46 papers and reports; the analysis of 36 fully anonymised pre-existing interview transcripts with survivors of modern slavery; interviews with 7 survivors from underrepresented groups, and two exploratory stakeholder workshops (a total of 84 attendees including policymakers, researchers, survivors, and service providers). This longlist was narrowed down by removing duplicates and merging similar outcomes.
The refined longlist was presented to stakeholders as part of a three stage E-Delphi survey (53 respondents in Round 0, 64 is Round 1, 74 in Round 2). In the surveys, stakeholders were asked to comment on and rank outcomes. Outcomes were removed and merged based on comments, their position in overall stakeholder rankings, and their position in survivor participant rankings. The E-Delphi produced a shortlist of outcomes that were debated and ranked in a final half-day consensus workshop. The top results in overall participant and survivor participant rankings produced the MSCOS.
We developed our MSCOS in close collaboration with survivors, practitioners, academics and policymakers. Our work was supervised and guided by our survivor research advisory board. We also used participatory methods throughout the study, training and working with three peer researchers with lived experience of human trafficking and modern slavery. In every workshop and survey, the vast majority of stakeholders were survivors.