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Being Outside: CONSTRUCTING A RESPONSE TO STREET PROSTITUTION
Chapter Ten: EXITING
10.1 There are a number of key components in the process of exiting street prostitution. The combination of tasks being undertaken at any time, the order in which the various tasks are prioritised, and indeed whether or not the full range of tasks is applicable in all cases will depend entirely on the circumstances and needs of the particular woman. It is more than likely, however, that a woman with a history of prolonged or intensive involvement in street prostitution will have a complex range of needs, which require multiple service responses, with sustained support and advocacy. Above all there needs to be a clear 'care plan' worked out with, and centred on, the woman, indicating what needs to be tackled, in what order and with what service assistance. The complexity of cases can be such that the normally accepted sequence of care interventions may not be appropriate or useful. Flexibility of care-sequencing is therefore key to successful outcomes. Continued involvement of a key worker or 'care manager' will normally be necessary to ensure that the full range of required services is in place, that the care plan evolves as the woman responds, and that problems such as relapse or loss of service contact are dealt with promptly and appropriately. The key objectives must be to sustain an appropriate level of service until the goal of independent living is achieved, and not allow problems or lapse to lead to service disengagement. If lapse occurs it should simply lead to a change of service focus or intensity rather than disengagement.
Prominent among the tasks to be undertaken will be the following:
- Where there is a concurrent drug problem it needs to be controlled either by prescribed substitution or by becoming drug free.
- Stable, long term housing needs to be made available, with help and support as required to live independently and manage a home.
- Development of personal skills is important, including the development of an understanding as to how the past came about, and how it is being progressed from, undertaking the development of responsibility for oneself, managing money, taking responsibility for children or using access to children to best effect, structuring time appropriately and making purposeful use of free time.
- Developing constructive personal relationships is also essential, breaking negative associations and finding positive personal support networks.
- Having access to relapse prevention help is a prerequisite to good practice. Given that drug use may often have arisen as a way of helping women to deal with difficult intra- and inter-personal issues, it will be no surprise that both internal and external pressures to use drugs will at times be high. It is essential that the woman has the capacity to recognise these risks and has the support and help she needs when such an occurrence of relapse threatens.
- An alternative way of life needs to be developed, including, as necessary, remedying educational deficits.
- Training should be provided in employable skills, and assistance provided in finding and sustaining employment.
10.2 Service inputs which can help these processes may include counselling, support, advocacy, education and training along with mutual support and self-help activity among women with similar background or experience.
10.3 A Coherent Process
The four elements in the total process of tackling the needs of the individual caught up in prostitution (prevention, early intervention, harm reduction and exiting) are distinct activities, which should be self-standing (although prevention and early intervention can link closely together). The reason for this is that it avoids mixing women at different stages of the process - mixing continuing chaotic drug users, for example, with those who are trying hard to move on. If it is sensible to locate harm reduction services within the main areas of need, then to base exiting services there also would continuously draw women who are seeking to move on, back to the locality associated with drug use and prostitution.
Nevertheless, it is important that services work together in a co-operative and co-ordinated way and that the person designated as keyworker (for previously discussed reasons) remains so during the transition through all these phases. This will maximise their effectiveness and ensure relevant information is shared, access can be progressed in the best way and, in the event of relapse, the woman does not fall out of service contact but reverts to a previous form of service involvement.
For this to work effectively there needs to be not only the key worker case management approach described above, there also needs to be a clear and agreed strategic basis underpinning the work of the various service components, so that they complement and support one another. The strategy will also ensure that those other participants in the comprehensive local planned approach - such as police, planners, prisons and criminal justice services, work with statutory and voluntary sector health, social care and housing providers in a co-ordinated approach.
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