A Mobile App to Help Rape Survivors to Get Emergency Health Care

WASHINGTON DC, 16 March 2018 - The first mobile app to address the needs of rape survivors when they go to the emergency room was released today by Code Innovation and the Washington DC Rape Crisis Center, one of the first rape crisis centers to open in the world. Although approximately one in four people experiences the crime of sexual assault, most of us still have no idea how to cope with rape when it happens to us or someone close to us.

“Research shows that after sexual assault, going to the health center to get treatment dramatically improves long-term outcomes for the survivor, especially if an advocate accompanies them through the process,” says Elie Calhoun, a former rape crisis counselor in New York City and Principal at Code Innovation. "We digitized the training that an advocate receives into a free and open-source app. Now we want to make the app into a global public good that’s available in as many languages as possible so that anyone who needs it can access this necessary information.” 

Creating a digital resource for survivors of sexual violence is new territory and the Rape Crisis Counseling app was made possible through the expertise of partners at the DC Rape Crisis Center (DCRCC), whose Executive Director Indira Henard championed the app from the project’s early stages in 2015.

“The DC Rape Crisis Center is proud to partner with Code Innovation on this state of the art resource for global rape crisis advocates,” says Henard. “The Rape Crisis Counseling app is not only a game changer for the global community, but it raises the standard of trauma-informed care for survivors of sexual violence. The rollout of this app means that there will be uniformity in the way we treat sexual assault survivors at home and abroad.”

The app contains a Training for Volunteer Advocates and is a basic primer of the information that a US state-certified rape crisis counselor would receive as part of the 40-hour training that is generally required before a counselor can volunteer at hospitals. The original training material was developed by US rape crisis centers based on their experience with decades of emergency room advocacy work and has been adapted by a multicultural coalition of partners to be relevant for global use.

"As a global society, we're getting more comfortable talking about sexual harassment and sexual assault as real issues. But most of us still don't know how to respond when it happens. Now, anyone can use our app to help a survivor – or themselves – get necessary treatment after sexual assault," says Calhoun. “The Rape Crisis Counseling platform shows how easily and cheaply digital technologies can be leveraged to meet gaps in information and access that translate into real life outcomes and systems change.”

“We look forward to piloting the app with organizations working in women’s health and human rights around the world and already have pilots lined up in East Africa and the Middle East,” says Calhoun. “The plan is to get direct feedback during our pilot phase so we can develop and release a 2.0 version in other languages that we know will work all over the world to help rape survivors get adequate and appropriate care.”

The app is being released in English but Code Innovation has plans to scale it into more than a dozen languages with the next round of funding. The project has US non-profit status and a Bitcoin wallet address to help cryptocurrency investors donate some of their bitcoin or other cryptocurrency gains to helping survivors and their advocates in the immediate aftermath of sexual assault.

In the process of digitizing the rape crisis counseling material into a mobile learning platform, Code Innovation drew on the Digital Principles to co-design the app's content with a broad coalition of international stakeholders, including gender-based violence experts, women’s human rights advocates and US-based rape crisis centers.

The Training for Volunteer Advocates section of the app covers basic medical advocacy and includes a treatment overview and details about how to navigate the forensic exam, which is essential for evidence collection that can be used later in court. There are sections on safety planning and working with survivors of intimate partner violence, as well as special considerations, for example, materials for the LGBTQIA community and for survivors of drug-facilitated sexual assault.

Two additional user pathways, an In-Hand Resource for Survivors and an In-Hand Resource for Advocates, provide adapted information for use at health centers.

The community helping to build this resource is aware that many survivors enter health facilities that are not yet equipped to provide them with the appropriate treatments or facilities that cannot adequately collect forensic evidence. Our goal is for the Rape Crisis Counseling app to help generate awareness and demand for better quality services for sexual assault survivors around the world.

The Rape Crisis Counseling app is available on the Apple Store here.

The Rape Crisis Counseling app is available on the Google Play Store here.

For more information, visit rapecrisiscounseling.org

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About the DC Rape Crisis Center

The DC Rape Crisis Center (DCRCC) is a nonprofit organization dedicated to eliminating sexual violence and creating a violence-free world through conscience and action. Since its inception in 1972, the DC Rape Crisis Center has been making a significant contribution to the health, economic, social and cultural well-being of Washington, DC. As the oldest and first rape crisis center in the country. The DC Rape Crisis Center provides counseling and mental health services to the most marginalized sexual assault survivors in the District of Columbia; facilitates education to equip children and adults with the tools, and skills needed to establish and maintain healthy relationships. Our call to action obliges us to us to build the capacity of the Washington, DC community to respond to survivors of sexual assault with compassion, and dignity.

About Code Innovation

Code Innovation consults with the private and public sectors on systems strengthening, with a focus on equity. We leverage technology to bring field-proven interventions to scale and our developers span three continents (Africa, Europe and Asia). Code Innovation focuses on programs developed in and for vulnerable populations. We create and consult on free and open-source platforms, instructional design and social innovations that enable communities to lift themselves out of poverty. For more information about our work, visit http://www.codeinnovation.com.

Follow Rape Crisis Counseling on Twitter @crisisadvocacy

For more information, contact support@rapecrisiscounseling.org. For media enquiries, contact elie@codeinnovation.com.

Usability Testing the Self Help Group Digital Platform

 A woman in Kongwa District, Tanzania shares her experience of being in a Self Help Group. ( Photo by Rita Langley, CC-BY 4.0)

A woman in Kongwa District, Tanzania shares her experience of being in a Self Help Group. ( Photo by Rita Langley, CC-BY 4.0)

New Round of User Acceptance Testing

We decided to initiate another round of Self Help Group (SHG) Platform User Acceptance Testing (UAT) that was run in early 2017, with 9 facilitators in a workshop-style day in Kongwa, Tanzania.

All of the participants were involved in SHG programs run by Tearfund Tanzania partner Christian Churches of Tanzania (CCT), who have been using the app with a select number of their SHG facilitators since it was first piloted in 2015.

The 9 facilitators present ran 21 groups between them, involving 517 members. Time was allowed at the beginning of the workshop for non-guided usability testing of the new features, and assessment of issues found there preceded the UAT. As well as the UAT workshop day, we met with them and their groups in the field and heard stories of individual member’s success as well as group resilience.

Rather than assess the successfulness of SHGs overall, the SHG project’s UAT aims to assess the app’s ability to aid in that process by providing education and job support for facilitators.

Key feedback points from the UAT session:

We heard about the advantages of using the app over other facilitation methods. While the volume of information in the curriculum was an obvious advantage here, the facilitators were also appreciative of the ease of updates. Additionally, they talked about the amount of time they spend studying and preparing for meetings, which is considerable but necessary, and the benefits of having a powered device to do that on whenever they had the time, rather than needing a light on at night to read.

Challenges

The key hurdles to facilitating with technology continue to be access to charging facilities, and infrequent connection for those who have to travel to receive a cell signal. We've written more about this here.

Digital advantages and perception of technology

The facilitators were asked some additional questions focused on the way that their use of a tablet was perceived. Of the people in their groups, approx. 45% of people had their own mobile phone, but only a tiny number had access to a smart device.

For 5 of the facilitators, their facilitation tablet was the only smart device in their village. While group members were excited to have use of a tablet, there were some reports of envy from those not in the group. One facilitator mentioned he worries that certain groups of youths will see him carrying it and take it.

However, it was overall seen in a positive light, and the tablets were an aspirational asset for the facilitators who were proud of their access to and expertise with technology. All of the facilitators used the tablet’s other features (camera, phone, email capabilities) for personal and community use outside of its original intent.

Conclusion

We're training our Self Help Group coordinators to run User Acceptance Testing and User Acceptance testing protocols independently. In the future, we will be able to access a network of SHG coordinators to test when we want to explore how certain features are working or could be improved. We see UAT and UT as a key part of the Digital Principles 'Design with the User'.

Launching the Rape Crisis Counseling Website

We're proud to announce the launch of the website for our Rape Crisis Counseling platform. The project website will be the go-to place for media and advocacy materials, training resources and news about the global coalition partnership that is co-creating the app.

Currently more than a dozen organizations are working together to internationalize the US-focused training content, generously released into the Creative Commons by the following leading US advocacy organizations:

As we compile the community's feedback, we'll be working to align agreements around key themes.

The focus on our v1 is to create a training curriculum for women's rights organizations to give trainings to their staff and volunteers. We will also have the basic outline of a in-hand learning use case for survivors and their advocates.

Over time, the platform will seed networks of organizations that use the app to create in-depth trainings that empower advocates. As communities to holistically respond to gender-based violence, not just at the level of the health system, but also within the justice and law enforcement systems, we will create forward momentum towards gender equity everywhere (SDG 5). 

We want to thank all of our partners and supporters, including the Imago Dei Fund who continue to support our work on the crisis counseling platform this year. With their generosity, we were able to include the intimate partner violence response and safety planning modules in the v1 app, as well as the material around supporting during a forensic medical exam.

We hope you'll have a look at the new platform and let us know what you think about the site!

And we're actively looking for partners to engage with us to pilot the app with their staff and volunteer communities, so get in touch to learn more. 

Leveraging Women’s Self Help Groups with a New App

This article by Courtenay Cabot Venton originally appeared on the Imago Dei Fund's blog and is reposted with permission.

I met Meseret for the first time in Nazareth, a town south of Ethiopia’s capital, Addis Ababa. Meseret is a member and leader of a Self Help Group (SHG) approach that I had been asked to evaluate. We were sitting in a small room, rain falling on the tin roof, as she told me about her journey with her SHG. It is a story that will stay with me forever – and inspired me to develop tools that could help to share this approach with as many people as possible.

Self Help Groups (SHGs) are groups of 15-20 people – mostly women – who come together to save, invest in small businesses, and support each other and their communities. By saving together they are able to lend to each other for small business activities. But more importantly, by working collectively, the women feel empowered to create change in their communities. What’s more, the approach tends to go viral once seeded, with existing groups helping to set up new groups.

Determined to do something more, I pulled together a team and we collectively developed an app that would help facilitators to strengthen and spread the Self Help Group model. The app is designed for the facilitators of the groups, and digitizes the weekly content that they use to run a meeting; we could see the potential for an app to help to deepen and strengthen the spread of the approach.

At the time, I had no idea where this would lead, or if we would be successful. With seed funding from private donors, we started small and developed a prototype. That led to catalytic funding from the UK government. Three years in, we have funding from the Bill & Melinda Gates Foundation and a vision for a digital platform to help scale the Self Help Group approach globally.

The Inspiration: Meseret’s Story

Meseret came from a poor family, but they managed to get by. Her parents supported her and her four siblings to go to school, and Meseret had plans to go to university. That all changed when her father unexpectedly died when she was 14. Meseret had to work in the evenings after school to help support her family. Her mother wanted to marry her off to an older, wealthy man, but she resisted and married Belay, her childhood sweetheart, when she was 18.

The next year they had their first child – a daughter named Kalkidan – and moved to Nazareth to find work. They slept on the floor of a rented room. They had no money or food, and Meseret was struggling to nurse their baby. Belay would bring home the lunch that he received at work, and they would share that one meal.

Some of the local women invited Meseret to join their Self Help Group. They were meeting each week and working together to save, start small businesses, and create change in their community. Meseret was skeptical – she was very poor and didn’t see how she could change her life. Nonetheless, she began to save a small amount of money – as small as a few coffee beans a day – and quickly realized that by working together with the women in her group, she was growing in confidence.

When she applied for a local government job – and got it – her husband began to beat her. She was disrupting the traditional role for women, and he didn’t like it. He finally gave her an ultimatum – him or her work. She chose her work. She knew that she deserved to be independent, to honor the education given to her by her parents, and to provide for her children.

Her Self Help Group was her lifeline. Meseret’s savings and income grew, she was able to buy a small house, and send her daughter to school. But more importantly, the women had become her family. When I ask Meseret how long she thinks her Self Help Group will stay together, her first response is a confused expression. Then the smile creeps across her face, and she begins to laugh. “We will be together forever. We are sisters.”

Disrupting traditional approaches to aid

As an economist, I have been asked to evaluate many different types of projects – from water to health to education. And while there has been a lot of success, there has also been a lot of failure.

I have lost count of the number of times that I have been in poor communities around the world, and witnessed perfectly constructed schools, standing out amidst a horizon of mud huts, but with no teachers or teaching materials…

Hospitals with no medical supplies…

Water pumps that are no longer delivering clean water…

The Self Help Group approach instantly caught my attention. It was the first time, ever, that I sat in a village, speaking with a group of people affected by poverty, and not a single person asked me for assistance. Quite the opposite, they were talking over each other, overflowing with examples of the ways that they were creating change in their communities, bursting with ideas for how to do more.

The approach disrupts the ways that we typically provide aid to poor communities. First, it believes in the power of the poor as change agents themselves. It breaks the cycles of dependency that are so rife in many developing countries. Change is truly grassroots, led from the bottom up, as opposed to activities being driven by external agents. And it’s scalable – once seeded, Self Help Groups can become viral, with rapid replication, often growing organically as SHG members from one group seed a new group.

Self Help Groups unleash transformative change. At the heart of the model is a focus on empowerment. Women have worked collectively to stop female genital mutilation, and have run campaigns to ensure that people with HIV/Aids are taking their anti-retrovirals. They have stopped child marriages from taking place, opened preschools, and advocated with local governments. They are driving change in their communities that we could never hope to do from the outside. They are transforming poverty from the inside out.

Building an SHG Digital Platform

When I returned from that first trip to Nazareth, I knew that I wanted to do something to help to bring this approach to more people. I started by talking to as many people as I could about the Self Help Groups, and a partnership started to emerge. Tearfund, the relief and development agency that was implementing the SHG model in Ethiopia, understood how the process worked. One Hen, a US non-profit that works with youth around starting their own businesses, offered to incubate a pilot. Code Innovation, a company that develops technology solutions in developing countries, saw the potential to build an app that would help to strengthen the SHG approach.

I was incredibly lucky that the concept resonated with a couple of private donors – friends of mine who don’t even work in the international development space but could see the potential and had a heart for seeing women empowered.

And so we embarked on building our first iteration. The app focuses on content – it provides a facilitator with the materials that they might need each week as they meet with the Self Help Groups. It gives them games and resources, at their fingertips. While mobile phone use is growing rapidly in developing countries, the cost and availability of data can be a blockage, so the app works entirely offline, making it accessible even in very poor and rural locations.

The first version of the app was enough to catch the attention of the UK Department for International Development (DFID), who gave us catalytic funding to scale our pilot by 1,000%, expanding to Tanzania and adding a new implementing partner. The process is heavily driven by user feedback, and we were able to start to respond to some of the facilitators’ requests by adding in significant amounts of content and functionality.

Last year, the project secured funding from the Bill & Melinda Gates Foundation. We just held a co-creation workshop in Nairobi with 18 implementing partners across Africa and as far afield as Haiti. We have over 200 groups in India who are using the app – despite the fact that we have never seeded nor sensitized any Indian partners.

The journey has been intense. I am so grateful to friends who provided the seed funding at the early stages when I was trying to develop the concept. But it was daunting to accept their funds, knowing that even the best projects can fail. I knew that the project would be far better served by bringing together a group of partner organizations who collectively delivered the expertise that would make this fly. But institutional donors were reluctant, wanting to fund a single dedicated organization – we were lucky to have partners like the Imago Dei Fund who valued our collaborative approach. And navigating the team’s different ideas and ways of working stretched our boundaries repeatedly. The team worked tirelessly, well outside the bounds of our funding, to get this project to each next step.

I am still pinching myself. It is amazing to see a concept grow into something that can help to bring the SHG approach to more and more women, and hopefully strengthen and deepen that process. Every step has felt like a leap of faith – and every step has been worth it.

Sankofa mHealth Innovation Brings PTSD Support to War-Impacted Communities

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Monrovia. 3 May 2017 – Second Chance Africa and Code Innovation announce our partnership on the Sankofa project to create a mobile application of an innovative clinical curriculum that helps people recover from trauma in war-impacted communities.

The mHealth curriculum pioneered by Second Chance Africa will be used by the organization’s cohort of mental health facilitators, half of whom are graduates of the program. Since 2008, they have reached more than 7,000 war-impacted Africans on a shoestring, crowdfunded budget. Participants in one of their clinical outreach projects report a 65% reduction in the debilitating symptoms of trauma like intrusive memories, hyper-arousal, and avoidant behavior, a difference that allows them to return to a more stable life in their families and communities.

Post-traumatic stress disorder (PTSD), complex trauma and extreme stress are common outcomes of war and debilitate a person’s ability to function in society. In West Africa, the recent Ebola outbreak worsened existing war-related PTSD, compounding long-lasting community mental health issues that remain unattended. In post-conflict areas, trauma often becomes a silent epidemic and while some people get better with time, many do not.

In some areas, rates of PTSD diagnosis are close to 100% based on the nature and severity of events, and trauma symptoms have been documented in refugee groups decades after traumatic exposure. PTSD may heighten the risk for poverty, aggravating the consequences of war and conflict.

“Approximately 17.6 million people are currently impacted by war and conflict across East, West and Central Africa,” says Second Chance Africa founder and Executive Director Jana V. Pinto. “Yet despite the clear need, trauma relief is not yet a humanitarian priority, as current efforts are expensive and there is no evidence base available to guide treatment choice. We urgently need more scientific research to develop best practices around trauma relief interventions in war-impacted communities.”

“While it may seem secondary to investments in maternal health or child survival, research has shown that communities with a high prevalence of trauma struggle to progress economically,” says Elie Calhoun, Director of Code Innovation. “Trauma becomes a piece of the poverty trap and needs to be addressed before war-impacted communities can make lasting social and economic progress.”

“The Sankofa mHealth app is designed as a tool for civilians and community health workers to lead local trauma relief groups independently and without prior training or experience,” says Calhoun “The 10-hour protocol directly addresses major PTSD symptoms without one-on-one psychotherapy or drug interventions. Digitizing this model on a free mobile app makes the approach accessible to health systems and organizations all over the world. It is a truly game-changing model.”

“Although feature phone handsets still significantly outnumber smart phones in Africa, we expect to see a gradual shift to smartphones as they become increasingly available and affordable. Because the Sankofa mobile app is designed to be used by one facilitator working with many groups over time, the program model leverages what is still a relatively rare technology to harness its impact.”

Field testing of the digital tool will begin in June in Northern Uganda with South Sudanese refugees fleeing current conflict, and in Monrovia, Liberia with a core team of Second Chance Africa facilitators who have been with the organization since its inception in the Buduburam Refugee Camp in Ghana in 2008. As early recipients of the intervention, the facilitators are a testament to the transformative potential of the Second Chance Africa model and have dedicated themselves to ensuring that others in their country receive the same life-changing services.

The Sankofa digital tool will help them and other heroes in the battle against trauma to reach more people and help more people impacted by war regain their lives.

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Sankofa is crowdfunding to cover its program costs: https://www.razoo.com/story/Sankofa2017

For more information about the Sankofa project, visit http://secondchanceafrica.org/sankofa

Second Chance Africa After six years delivering hands-on clinical services, Second Chance Africa’s team of scientists and health workers now focus on rigorous research and development of innovative, scalable and culturally-adapted intervention tools to advance trauma relief for African communities impacted by war. For more information, visit http://www.secondchanceafrica.org.

Code Innovation’s team of ICT4D experts specialize in helping high-impact development solutions go to scale. Our projects have been supported by UNICEF, the UK Department for International Development and major philanthropic foundations. For more information, visit http://www.codeinnovation.com.

For more information, contact:

Jana V. Pinto, Executive Director, Second Chance Africa, jana@secondchanceafrica.org

Elie Calhoun, Director of Operations, Code Innovation, elie@codeinnovation.com

Version 1.0 of Curriculum for our Digital Resource for Rape Crisis Counselors

A year ago at Code Innovation, we started a crowdfunding journey to create a digital resource for sexual assault survivors who seek medical care and the volunteer advocates who support them. With the support of rape crisis centers across the United States and the US Department of Justice, we have created a concise, four-part curriculum to guide volunteer advocates through a training primer in how to advocate for rape survivors in health centers in different contexts and communities around the world.

This digital intervention guides volunteer advocates on how to offer psychosocial support and medical advocacy, which empowers a rape survivor with the agency to make their own health decisions on the road to healing.

Research shows that rape survivors who have an advocate in the emergency room are significantly less likely to experience post-traumatic stress, anxiety and depression.

 

We also share this video to thank all of our crowdfunding supporters and also the Imago Dei Fund for creating the seed investment for this global digital resource.

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