Annex A

Routes Out of Prostitution Intervention Team Good Practice Guidelines

Introduction

The Routes Our Partnership is a part of Glasgow Community Planning Limited, which is the company arm of Glasgow Community Planning Partnership. The Routes Out Intervention Team is the service delivery arm of the Partnership, with Glasgow City Council undertaking line management on behalf of the Routes Out Partnership Board. The Routes Out of Prostitution Intervention Team aims to support women to leave prostitution and has one core objective, which is to develop and implement an effective, integrated model of service delivery that helps women to exit and supports them through the transition to an alternative lifestyle.

The team was set up in 2000, initially as a demonstration project to identify What Works in relation to supporting women to not just leave but exit prostitution. The learning over this period of time by working directly with women is that women's motivation to stop their involvement in prostitution is not a problem. Women want to leave. However the hardest challenges for women trying to exit are working through the trauma caused by their involvement in prostitution and finding viable long-term alternatives. For most women, dealing with the trauma of their life experiences to date, and confronting the underlying issues that led to their involvement in prostitution, is an extremely difficult process.

The Routes Out of Prostitution Intervention Team offer long term, intensive, structured work to support women looking to leave prostitution. The work if fully informed by research that suggests that the approaches and services offered are the most effective and are proven to be "What Works" when supporting women to leave prostitution. The model that the team works to mirrors the work of Judith Herman, an American psychologist and involves 3 broad stages in the process of supporting women, which are outlined below.

Initial Stage: Engaging with Women

Engaging with women and developing trust is key in the initial stages. We have learned that what is said in the first meetings is a crucial factor in engaging with a woman. If the worker displays certain characteristics, i.e. if the worker appears strong and confident in their role and knowledgeable, understanding and empathetic when talking about issues of prostitution; clearly explains the process of intervention; and if they "sell" the idea that change is possible, then the chance of the woman returning to the project increases. Also if the woman is left in no doubt that she has a huge part to play in her own exiting process, it is easier for the worker to gauge her real motivation and commitment to exiting.

At this initial stage and through all subsequent stages the pace and nature of the work has to be directed by the women. For many women their experiences of disempowerment and disconnection are overwhelming. Therefore no intervention should take power away from the women. Instead the success of exiting from prostitution lies within a framework of empowerment and workers have to be aware of and demonstrate this as part of their core values when working with women in prostitution. It is also paramount that workers are upfront and that women are left in no doubt that part of the work with her will involve exploring issues around her involvement in prostitution, her experiences, how the harm of involvement in prostitution has impacted on her, how she can move on and the potential barriers she may face from moving on.

In our experiences women have responded very positively to this approach. In fact we suggest that for many women, there is a sense of relief in knowing that there is somewhere available to them where the subject of prostitution can be raised within a safe, secure environment, where workers are non judgemental and empathetic and where women will receive support to leave prostitution without fear of stigma and fear of her past/present lifestyle being used against her.

Within this stage, workers carry out an assessment over several meetings. The assessment is conducted to enable the worker, along with the woman, not only to determine whether or not she is ready/able to work through the process of exiting at that time, but to identify unmet need and establish a care plan /safety plan with her to meet her basic needs. During the process of assessment it can provide the worker with huge opportunity to really engage with women and build a trusting relationship. It further provides huge opportunities for exploring women's experiences of their involvement around: how she felt; what she thought; how she coped; what led to her involvement; and how she feels now, etc. thus enhancing the therapeutic process for women.

In addition as part of the relationship building stage workers will offer practical and emotional support until the woman is ready to discuss the issues surrounding her involvement in prostitution and allow her to work through the process of exiting.

When working with women to support them to exit prostitution the approach has to be flexible and accommodating to women's circumstances. Quality time has to be invested in meetings with women to agree their personal/safety plans and goals and to work through difficult issues when they arise. Women who use our service told us " we really value that you don't clock watch". No one agency will enable a woman to exit prostitution, so partnership working with other agencies is crucial in the first stage. As women present with an average six issues (ranging from, for example, drug dependency, criminal justice involvement, housing, mental health to childcare) workers need to have knowledge of local resources that will be able to address and deal with these issues.

Dealing with any of these issues, in particular drug misuse, is by no means a straightforward, easy process. Many women they find this too difficult and may relapse, miss appointments, change their minds about accessing supports or not turn up for meetings. They may also be dealing with major issues such as rape, violence, murder, bereavement, etc which impact on their readiness to address their illicit drug use and involvement in prostitution. Individual work with women is therefore paramount and can take years to bring women to the point of being safe and stable enough to address their issues. It is understandable that recent research has found that it can take on average seven years for some women to fully exit from prostitution.

Undoubtedly during this stage and moving into the next stage it can be extremely difficult for workers to hear the life histories of women. For the women that we work with, their entry into prostitution is not a choice but a desperate act of survival and workers listen daily to accounts of horrendous physical and sexual abuse, powerlessness, oppression, and strength and courage from women with current or prior involvement in prostitution. Therefore workers need strong support systems, debriefing sessions and peer support in order to continue to provide effective services. If support is missing, workers will become de-motivated, feel deskilled and their confidence will decrease and this will ultimately affect the quality of services provided and result in vulnerable women not accessing much needed support services.

In summary: women will not open up and reveal intimate details of their lives without feeling a degree of trust with the worker. Therefore in stage 1, a worker will have to be able to build trusting relationships with women, they need good communication skills and experience of partnership working with other agencies. Some workers in reviewing successful engagements with women have revealed that one of the reasons for women moving on to the second stage of exiting was the worker consistently assisted the women to meet their basic needs. Thus workers will also have to demonstrate strong assessment skills, knowledge of appropriate resources, confidence and the use of different theoretical approaches, i.e. task centred casework.

Undertaking assessments with women can allow workers to establish trusting relationships and allow them opportunities to discuss their involvement in prostitution. It further provides a structure for prioritising and planning how to meet women's identified needs in partnership with the women and other agencies. Workers require an understanding of the general issues for all women and an in depth understanding of the issues for women in prostitution. They have to work from a perspective that takes into account the effects of poverty and marginalisation on the women, gender inequality, and social exclusion. The workers core value base has to be embedded within anti oppressive, anti discriminatory practice and should display the following characteristics as described by Smale (2000):

  • Empathic,
  • Respectful,
  • Warm and friendly,
  • Authentic,
  • Rewarding and encouraging,
  • Confident, and
  • Interested.

Middle Stage: Access to Services and Personal Development

This is probably the most difficult stage for women in the exiting process as it is about women becoming more stable and tackling experiences of previous trauma and violence. When women have accessed services such as safe accommodation, substitute prescribing, whatever they need to make them safe they tend to reduce or cease their involvement in prostitution. When women achieve this point they can begin to confront the trauma of prostitution and the issues that led to their involvement.

During this stage, women will tell their story of their traumas in depth and in detail. The idea is that by using reconstruction this will actually allow the women to transform the traumatic memories so that she can begin to integrate it into her life and take control. The basic principle of empowerment is even more relevant during this time as it has to be the woman's choice, she has to feel ready, to confront the horrors of her past. As you may be aware this requires great courage from the woman and the worker. It also requires that both are very clear on the purpose of the work and feel secure in their working relationship.

As the woman begins to talk about her memories, the need to preserve safety must be balanced against facing her outstanding issues of her past. Decisions regarding pacing and timing need to be meticulous and frequently reviewed by both the worker and women. However it has to be the women who is in control of the work, it has to be her choice how deep she wants to go. Women should never feel pushed into looking at issues that they are not ready to do so, but equally workers should not avoid them either because they may be uncomfortable. To do that is to deny the women's history and all her traumas and the harm caused to her by her involvement in prostitution continues to be invisible.

If the reconstruction of past memories is too traumatic for the woman, workers need to be confident and have the skills to shut women down safely and ground them back in the present. This is paramount as the last thing that a worker should be doing is opening up issues for women if they are not skilled at supporting women to close down. If this is the case, workers should refer women on to more appropriate and trained workers who are able to support the women effectively through this stage.

In reconstruction work the trauma story should begin with a review of the women's life prior to the trauma and the circumstances that led up to the event. The purpose of this is to put the trauma into a context. The use of life story work is a very useful tool at this stage.

Women going through this stage need intensive, active and verbal support. It is not enough for workers to be non-judgemental and non-directive. Workers must verbally affirm the woman, i.e. that she was not to blame for the harm caused to her or the abuse that she experienced. Workers must also remember that many women also feel guilty and blame themselves if, for example they have been raped, physically and./or sexually assaulted whilst prostituting, if they no longer have the care of their children, have lost contact with family members, caused worry and anxiety to people who care about them. Although during this stage women may understand the she was coerced, pressured and even tricked into becoming involved, this in itself will not make her feel any better. Women must be given the space and time to mourn the loss of; relationships, time, self, health, morality etc and most importantly to forgive herself. She will need to put things into perspective and move on. This perspective has to be verbalised by the worker and continually reinforced.

The use of cognitive behavioural techniques is very appropriate at this stage as they can enable women to change the negative ways of thinking that influences her behaviour. As women often find it difficult to verbalise their feelings and thoughts non verbal tools can be used, i.e. worksheets, life story books, letter writing to significant people without necessarily posting it, visiting places of significance with women, keeping journals to chart progress, etc.

In summary: During this stage at all times the women's safety is paramount. The pace, time and review of work needs meticulous attention. Women must be in control of the work and not pressured by workers to disclose issues to early or be allowed to avoid them altogether either. Workers must be aware that for the woman they do not only have to deal with the events but how they have affected her emotionally and what coping strategies she has adopted in order to survive. For some women this may have involved disassociation/splitting (disconnecting the body and mind), which at the time may have serviced her well. However if she continues to use this when she no longer needs to it may prevent her from integrating self as well as preventing her having healthy, intimate relations with others in the future. Women must be supported to integrate their experiences, reframe them and take control of their lives. Workers therefore need to be confident, strong, affirming, available, flexible, knowledgeable, patient and supportive. They also have to be able to deal with shocking accounts of violence, abuse, sexual assaults and sometimes multiple rapes. In addition, workers need knowledge of loss, change and grief theories, to be familiar with approaches such as cognitive behavioural interventions, and have the confidence to challenge the negative self-destructive image women often have of themselves.

Moving on Stage: Alternatives to Prostitution

By the time women have reached this stage, if they have worked through the stages, they will have worked through and overcome many difficult personal issues. At this point it is possible for a woman to realistically contemplate a future that is not associated with prostitution and to consider alternative long-term options.

Women should feel appropriate trust, have secure boundaries, and be able to distinguish what is safe and not safe for her. It is also a time for the worker and the woman to go back to basics and check on basic safety issues. For example the difference between safety in the first stage and the third stage is that women in the first stage are looking for safety as a means of survival. The third stage is about thriving, making choices and taking control of their own lives. It is the difference between existing and living.

All women at this stage have exited prostitution and changed their lives dramatically. The indicators that we measure for success are: levels of increased motivation, external supports, stabilised, safe housing, ending of relationships with abusive partners (where appropriate), being illicit drug free, reconcilement with family, etc. This has allowed us to demonstrate that through planned, structured interventions, at the woman's pace exiting from prostitution is possible.

The workers role in this stage really is to facilitate access to appropriate opportunities that the women may require, continue to offer emotional and practical supports and reinforcement of the women's achievements. As the work by this stage coming to an natural end the emphasis for both worker and woman is to disengage with the service safe in the knowledge that the women can come back at any point for any reason. Women are encouraged to keep in contact with the service and provide updates on what they are doing

Conclusions

It is evident that supporting women to exit prostitution is extremely complex, challenging and time-consuming process not just for women but also for workers. Moving through the stages is not a linear process; some women move through the stages many times. Some women may only want to stop their involvement in prostitution without addressing deeper issues. Whilst we know that not completing all 3 stages increases the risk of relapse, it is still very much the women's choice to go as far into the journey as she wants at that time. Workers will also require ongoing support and debriefing sessions to allow them to work effectively with women who are looking to exit from prostitution.

To support women to fully exit prostitution from a strategic level, organisations have to base their work around the realities of women's lives. It must encompass solutions which respond to the complex issues experienced by women and it needs to tackle the range of barriers that exist within services that make it difficult for women to exit and move on. Recognition has to be made of the importance of multi agency working as although we recognise that women involved in prostitution need services to support them in exiting, no one service can do this alone. Thus a comprehensive approach that includes crisis, short term and longer term interventions aimed at supporting women whilst they are in and when they are exiting prostitution is essential. This will involve a variety of different agencies who work together to support women in the exiting process .

Routes Out Intervention Team