This assessment measures reflections in journals or blogs using five categories of data: culture shock, communication challenge, cultural appreciation, cross-cultural comparison, and (self-reported) adaptive behavior.  If you find that your learners' reflections don't yield much evidence of empathy, self-awareness or openness; this is a good rubric to use for amassing evidence of intercultural learning. (It's also a possible indication that you need to change your reflection prompts.)