The experiences of people who sell or exchange sex and their interaction with support services: lived experience engagement

7 Conclusions

Research Aim 1: To map the current provision of services in Scotland for people who sell sex, and to identify any gaps in provision.

The mapping survey identified significant gaps geographically in provision. Whilst these areas are covered by the availability of limited online support, limited eligibility criteria prohibit access for many. Participant experiences identified that it is essential that in-person support is also made available in order to improve access for all. Ensuring good practice in partnership working, and improved consistency through the increased availability of uptake and training for those in mainstream services was firmly indicated as a way of improving support provision.

Research Aim 2: To understand how people who sell sex or exchange experience engaging with mainstream and specialist support services in Scotland including identifying barriers to access

Across all of the barriers and challenges shared in the research, there was existing evidence of good practice and reported instances where the same engagement had been achieved successfully, leaving the participant feeling supported and able to achieve positive outcomes. The strong conclusion to be drawn from this is that good practice already exists and is happening across Scotland. The main challenge therefore is not in creating a new style of good practice, but rather addressing the lack of consistency in understanding and response to people selling and exchanging sex, the lack of clarity and certainty around legality, and commonly expressed stigmatised and judgemental views. Central to any service design is ensuring that it is well advertised, clearly outlines what support it will and will not provide, and that it is individually tailored to meet the needs of the person seeking support. Flexibility in approach is central, both in anticipating that some people may disengage and re-engage with support multiple times before they are able to engage reliably, and in understanding that the range of experiences of selling or exchanging sex is substantial, and support needs will vary significantly within this.

Research Aim 3: To gather views from those with lived and living experience on future service design.

A core element in designing future services must be consideration of partnership and joined up working. All the evidence points to the value in clear referral routes and assistance with disclosure to allow people to access the large number of services they may require with ease, and without having to keep revisiting trauma experiences in telling their stories. Relationships with individuals within services are important, and adequate secure funding to allow consistency of provision is vital to any service success. Areas particularly highlighted for improvements are support with addictions and housing, as well as a system of benefits which fosters a sense of stability and security.

Detailed conclusions spanning all three research aims are summarised in Table 8.

Table 8: Detailed Conclusions.

Knowledge

Improved knowledge in mainstream services

Widely accessible training for professionals offering:

• Consistent guidance
• Improved awareness of the depth of the impact that experiences selling or exchanging sex can have
• Understanding that individual presentation does not always reflect support needs, especially that the ability to present well does not mean an individual does not require support.
• Nuanced understandings of the interplay between addiction and selling or exchanging sex

Reduced judgement and stigma through improved understanding. Suggestions for this include:

• More workers with lived experiences
• Specialist workers within mainstream services

Partnership Working

Improved partnership working

• Streamlined referrals
• Incentives to adopt clear position statements

Considerations of the impact of siloed working, and acknowledgement that many people who sell or exchange sex will need to access multiple support services

Practicalities

Services should be long-term, with no limit on appointments

• No penalties for missed appointments or disengaging
• Attempts should be made to maintain contact with individuals when they disengage
• Opening hours to include evenings and weekends
• Options for appointments and drop-in
• No long waiting lists
• Accessibility built into service design including translation, and accessible buildings
• In an easy to access location, ideally on public transport routes
• Services should ensure access is away from crowds, particularly away from men, and consider offering staggered appointments to facilitate this
• Provision of mobile phone, tablet etc. where support access requires it

Options to access support via technology should be provided, but there must be elements of in-person support retained. Options should include:

• Telephone support
• Text Messaging
• Email
• Instant Messaging
• Video Calling

Service Provision

Services should be available to cover the range of experiences and support needs which people who sell or exchange sex may present with. These are likely to include

• exiting services
• support for people who do not wish to exit
• long-term support post-exit
• proactive outreach

There must be services offering:

• Women-only support (including female staff being available as requested)
• Support for men, with clear advertising of services where they are welcomed
• Support considering intersectionality and people navigating multiple stigmatised identities

Support offer should be a combination of practical and emotional support

• Practical support must be trauma-informed
• Emotional support must feel directional and as if there are tangible benefits
• Wider projects aimed at social change must also offer benefits to the individual

Support should be holistic, tailored, and led by the individual

• Must include time to form genuine relationships
• Non-judgemental
• Appropriate time given for participants to tell their story and feel heard
• Believe participants account of their experiences and factor this in to support planning
• Designed around the goals of the individual

Trauma-informed

• Must ensure participants are safe before leaving support appointments
• Only pursue disclosures where safe

Communication

Services must be clear on what they can or will offer, and consistently deliver on this

• What is and is not offered
• Eligibility for support

Services must offer clear routes in, including:

• Referral pathways from other services
• Self-referral options (clearly advertised)
• Drop-ins
• Proactive outreach (both on-street and in other venues

Service information to be available at a central location such as a website, or app. Participant suggestions include:

• Function as a central reference point for individuals and professionals
• Be regularly updated as services and support provision evolve
• Provide information which is official and trusted

Inclusion of questions about selling or exchanging sex on initial assessments or referrals into services There is likely benefit in more services asking directly whether people have sold or exchanged sex including normalising discussions and providing full support. However:

• There must be a clear benefit to disclosure e.g., onwards referral or additional testing
• Must only ask what is necessary not delve into trauma unless there are suitable safety measures in place
• Be aware of concerns around the impact on other support, and address these directly. Particular considerations include:
  • Clarity on the response from social services to selling sex
  • Reassurances around arrest and legality, especially to allow people to report crimes against them and access justice and associated support as a victim of crime
  • Clear information on the impact of selling and exchanging sex on benefit entitlements
  • Reassurances around confidentiality and information sharing

Future Research

Further research is suggested on:

• the experiences of men, and trans people.
• the potential for group work.

Scoping studies are recommended to get a clear picture of the landscape of selling and exchanging sex across Scotland including in urban and rural areas, and smaller communities.