Assessing the psychosocial needs of trafficked and sexually exploited girls using the Child Exploitation Psychosocial Assessment Tool (CEPAT)
Location: Phnom Penh, Cambodia
Name: Khun Channary
Email address: channary_khun(at)wvi.org
Date of profile: October 2011
Tool: Child Exploitation Psychosocial Assessment Tool (CEPAT)
Aim: To assess and monitor the psychosocial well-being of trafficked and sexually exploited girls and young women in residential care in Cambodia.
Background and context:
The CEPAT was developed to identify and monitor the needs of girls and young women residing in shelter-based care in Cambodia who had experienced sexual abuse, sexual exploitation and trafficking for the purposes of sexual exploitation. The development of the tool was part of a larger collaborative project between World Vision US, World Vision Cambodia, and Johns Hopkins University Applied Mental Health Research Group. The project aimed to conduct thorough staged assessments and develop locally validated tools for the purpose of piloting and evaluating interventions in a number country contexts. The project thereby aimed to contribute towards the identification of evidence based approaches in child protection.
Incorporating a number of psychometric instruments used with traumatised child populations internationally, the CEPAT was adapted drawing upon the qualitative assessment conducted in 2007 with formerly trafficked and sexually exploited girls in Cambodian shelters. The CEPAT was therefore adapted to reflect and encompass the range of problems that were identified by the girls in the 2007 study.
A pilot was undertaken in 2008 to test the interviewing procedures and assessment tool to ensure there were no problems for either the interviewer or the interviewees. In the initial pilot the ‘interviewees’ were counsellors working directly with girls in the shelters. This pilot led to further modifications and the tool was then tested with a sample of 206 girls and young women in six residential centres across Cambodia.
The study was led by John Hopkins University researchers. 20 students from the Royal University in Phnom Penh were trained to collect the data.
The pilot employed gold measure standards including test-retest reliability, internal consistency reliability and validity. In conclusion, the study found that the syndrome scales in the questionnaire was both reliable and valid, with a few exceptions. The scales developed to assess depression, post trauma and shame showed strong internal consistency, test-retest reliability and predictive validity. The hope and functional impairment scales were less consistent.
Since the pilot study, counsellors and social workers from a range of NGOs who support children affected by sexual abuse and exploitation in residential care have been trained to administer the CEPAT. Numerous organisations are now using the tool with young people as a way to assess their needs, plan their support and measure their progress.
What the assessment tool does:
The tool takes between 45 minutes to 90 minutes to administer. Scores are completed for each scale, and on completion it is possible to gain some insight into traumatic experiences encountered and the impact upon the individual’s psychosocial wellbeing.
The assessment can be used as a tool to gauge the needs of the individual in order to design an appropriate support package. The assessment can also be applied to measure the progress of individuals and may be used as part of broader evaluations of intervention effectiveness by using it as a base-line and end-line measure.
Training for social workers, counsellors and assessment staff in administering the CEPAT is being conducted nationally as part of World Vision’s Improving the Management of Programme and Aftercare for Children Trafficked and Sexually Exploited (IMPACTS) project. The training covers how to interview children and young people appropriately and sensitively, how to interpret the results of the assessment and analyse what that means for case planning and practice.
The training takes five days and there are approximately 12 participants in each training group. Most of those undertaking the training are from social work or counselling backgrounds. All training participants have previous experience in working with this population and certification to use the tool as a para professional is merit based.
- Since 2010, 54 people have been trained to use the tool, including counsellors, social workers, and shelter managers. 26 of the 54 are certified to administer the tool and 16 are in the process of coaching in order to become certified.
- Those administering the tool have shared their reflections on the usefulness of the tool in their work.
Non-discrimination and an individual response:
The tool has been validated for use with girls only, though some partners have modified the tool themselves to use with sexually abused boys. It must be remembered that in using the tool with boys that the validity of the CEPAT is untested with this population.
The tool allows for individual assessments based on the interview with the child and therefore helps determine the individual response for each and every child.
Children were initially consulted through the original 2007 qualitative study and their words and descriptions of problems were used to adapt assessment tools to their situations.
All children give their informed consent before being interviewed for the assessment and they are made aware that they can withdraw their consent at any time.
Due to the nature of the tool there is potential for an unintended negative impact as the child may become distressed when answering questions. In response to this risk, all practitioners wishing to use the tool must receive training and merit based certification; practitioners are also able to access refresher trainings.
Through the process of training, all trainees are instructed in measures intended to protect the wellbeing of children being consulted with the tool. Trainees are instructed to abstain from using clients names on forms, a coded system for recording client names is advocated, and to ensure that the forms are kept confidential and stored in a locked cabinet. When the CEPAT is administered, counselling staff must be on hand in case the child becomes upset or distressed.
Sustainability and replication:
The pilot and validation study was given ethical approval through the National Ethics Committee for Health Research, situated within the National Institute for Public Health, Ministry of Health. The tool was developed in partnership with the National Programme for Mental Health and has since been formally endorsed. It was planned in the design of the project to hand over the training responsibility to the National Mental Health Programme, unfortunately this has not been possible due to funding constraints. USAID through The Asia Foundation has been supportive of national trainings being conducted with social workers and counsellors.
It is planned that the background to the tools development will be included in the Royal University of Phnom Penh?s Social Work degree programme.
The project aims to train partners who are willing to use the tool, have the capacity to administer the tool safely and respond to the needs of the client.
The pilot study report and the tool is freely available and accessible for anyone who would like to adapt, pilot and validate the tool in other contexts.
- Not all those who participate in the training will complete the course or wish to go on to use the tool. For those who do not have a background in social work or psychosocial support, the tool may be viewed as too complex
- The tool is best used in an environment where there are counselling services available for the client
- Agreement and commitment is needed for each organisation to support their staff to implement the tool and monitor whether the tool is being administered correctly
- In order for the CEPAT to be used with confidence with other populations (such as boys), it should be re-tested or validated
- The CEPAT is presently efficious in terms of identifying needs and monitoring the wellbeing of the target group. Further testing related to criterion validity is required before the CEPAT could be considered a complete diagnostic instrument.
 See for example: Bass, J. Bearup, L., Bolton, P., Murray, L. and Skavenski, S., Implementing Trauma Focussed Cognitive Behavioural Therapy Among Formerly Trafficked Sexually Exploited and Sexually Abused Girls in Cambodia: A Feasibility Study; Johns Hopkins Bloomberg School of Public Health, World Vision International, Phnom Penh, 2011
 Bolton, P. Nadleman, S., Wallace, T. Qualitative Assessment of Trafficked Girls in Cambodia, Johns Hopkins Bloomberg School of Public Health, World Vision, Phnom Penh, 2008.
 See the full report on the development and testing of the tool: Bass, J., Bolton, P. and Bearup, L. (2010) Assessment of trafficked and abused girls living in shelters in Cambodia: Development and testing of a locally-adapted psychosocial assessment instrument. World Vision, Johns Hopkins Bloomberg School of Public Health: Phnom Penh