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

Executive Summary

Background

LKJ research was commissioned by the Scottish Government's Violence Against Women and Girls Justice Unit, on behalf of the Scottish Ministers, to conduct lived experience research with people who sell or exchange sex. The project was planned in order to inform work related to the Scottish Government Programme for Government commitment to develop a model for Scotland which effectively tackles and challenges men's demand for prostitution. This model will also aim to reduce stigma and criminalisation experienced by women and encourage better access to services and support.

Within the suite of research designed to inform the model for Scotland, the remit of this research was to focus on support service provision. To this aim, the research looked to map current service provision in Scotland with a view to understanding the current service landscape and identifying any gaps in provision. Lived experience input was sought across three areas: accessing service provision, experiences and impact of support and ideas for future service design. The research took place over a period of 6 months from December 2021 to May 2022.

The Mapping Survey

The first strand of research was a mapping study aimed at understanding current specialist service provision for people who sell or exchange sex, across Scotland, as well as exploring the perceived levels of understanding around the support needs of this population in mainstream services. This research was completed using two surveys, one for professionals with suitable oversight at a local authority level, and one for completion by identified specialist services. The survey questions involved identifying specialist services, information about the specific support they provide including routes in and eligibility, and ratings of the levels of expertise in mainstream services, including brief discussion of the positive practices and challenges that have informed this rating. Of the 32 local authority areas in Scotland, representatives from 31 completed the initial mapping survey. From this, 16 specialist services were identified.

Findings:

• The mapping of specialist services revealed substantial gaps in provision of in-person support for people who sell or exchange sex.
• Whilst some remote support, or assistance with relocation was available, this was only for those who met strict eligibility criteria; including women who have been trafficked, and those who have already exited from involvement in selling or exchanging sex. In many areas, individuals seeking support around selling or exchanging sex would need to rely on mainstream service provision, or to travel to a service at their own expense.
• An interactive map was compiled with locations of each service, details of the support they provide, and eligibility criteria.
• A final map was compiled based on professional ratings of the expertise in mainstream services around the needs of people who sell or exchange sex, in their area. The majority of areas were rated as having a basic understanding (n=24), with smaller numbers rated very good (n=4), or poor (n=3).
• Key practices the professional respondents rated as helpful for improving understanding were joined-up and partnership working, clear position statements and the availability of training.
• Identified challenges were inconsistent approaches, a lack of joined up and partnership working, stigmatised views, lack of training options and 'it doesn't happen here' attitudes.

Lived Experience Engagement

In the second strand of research, the lived experience engagements were conducted either through an individual online interview with one of the research team, or through a facilitated survey conducted at a support service. Both the survey and the interview included three sections of open-ended questions focussed around accessing services, experiences and impact, and future service design. Interview participants also completed a short online survey as part of the service mapping element. The interviews were semi-structured, allowing participants space and time to share anything they felt might be particularly relevant.

The facilitated survey in particular was designed to maximise engagement from a population understood to have strong concerns around confidentiality. Through services recruiting and collecting data, participants were able to take part without the research team ever knowing any identifiable information about them. Participants either completed the survey online with the support of a worker at the service, completed it online independently, or completed it on a paper copy which was then inputted into the online survey website. Where required a translator assisted with survey completion. This method had substantial advantages, meaning that for many, their concerns about confidentiality were addressed, that participant information was shared by a trusted worker, and that there was support available immediately should they feel uncomfortable at any point during the survey.

The disadvantages however are that completing the survey in a service, and often with the worker typing their answers for them, may have impacted on the information that they shared, especially on positive reflections on their experience with that service. The research attempted to address this through training given to facilitating services, as well as through ensuring the research asked about experiences at previous services as well as the service they were currently engaged with. There were more negative experiences than positive reported in these engagements which can be considered indicative that these measures were successful. It is the opinion of the researchers that as the project was conducted on a tight timescale and remotely due to restrictions of the Covid-19 pandemic, without the facilitated survey option the majority who took part this way would otherwise not have taken part at all. The facilitated surveys were therefore utilised, with the potential limitations flagged within the report.

A total of 71 participants took part in the lived experience engagements. 9 through an interview and 62 using facilitated surveys. Of these, 65 were female, 3 male and 3 non-binary. Included in this sample were participants from the four largest cities in Scotland, as well as from smaller cities, towns and rural areas.

Findings:

• Participants were frequently accessing a number of mainstream services, with support being sought for an average of 7 different needs (such as addictions, housing or mental health).
• When accessing specialist services, participants valued being able to use a range of remote methods including telephone support, video calling, text messages and instant messaging, however face to face contact remained vital for a large number of participants who do not have access to technology, or do not feel comfortable engaging in this way.
• Referrals from other services, proactive outreach, provision of drop-in support and the option of self-referral were all utilised regularly as routes into services.
• Key barriers to engagement with support services identified included fear or judgement and stigma, not knowing services existed or that they were eligible, difficulties trusting, and challenges presented by peers or others in their lives who may either be accessing the services too or exerting control over their movements.
• Additionally, there were a number of identified practical barriers including the need for services to be open at evenings or weekends, waiting lists, difficulties getting appointments and services not being easily accessible by public transport.
• Participants further expressed concerns about the impact of accessing specialist support around selling or exchanging sex on their other support such as benefits, or eligibility for supported housing.
• Participants shared that where there was a clear service offer with tangible benefits including a combination of practical and emotional elements, support had the potential to be life changing.
• The main facilitators of engagement were individual worker approaches, especially being knowledgeable, consistent, non-judgemental, working in a person-led way and ensuring those engaged with the service feel they are 'treated like a human'.
• Barriers included feeling workers were not knowledgeable, not feeling heard, and being judged.

Conclusions

The report draws together a number of detailed conclusions and suggestions for future service design. Conclusions focus on the need for improved knowledge across mainstream services, especially in reducing stigma and judgement and increasing consistency of approach, the value of joined up and partnership working, the importance of support in this area being practical, holistic and tailored to individual needs and the importance of clear communication to ensure individuals know exactly where services are, who is eligible and what they offer.