Earlier this  year Keri Duffy, Learning and Development Officer at Fife Violence Against Women Partnership used our CLiCK Bitesize resources to deliver awareness-raising training around commercial sexual exploitation (CSE) in Fife. In this blog she tells us what it was like to plan and deliver these sessions as well as her tips for anyone considering doing the same.

Why did you decide to deliver CLICK Bitesize sessions?
I wanted to raise awareness of the issues within Fife. We don’t know the extent of CSE in Fife and nationally it is the same. But we do know that it happens and that women are negatively impacted. I wanted to raise awareness with the workforce so that if anybody ever comes across a woman who was experiencing CSE, they would be able to confidently address it and have those open discussions with the women. I wouldn’t want people shutting down conversations when it’s the first time a woman’s been able to open up.

We are also hoping to work towards a policy of the licensing of Sexual Entertainment Venues within Fife and we would want to set that at zero. So really raising that awareness and bringing CSE to the forefront of people’s minds so that when we move to that next stage, people have a really good understanding of the issue and hopefully support us.

How has your knowledge around CSE changed after delivering CLiCK Bitesize sessions?
I definitely feel more confident. I was involved in delivering all of these sessions but I had to familiarize myself with the topics first, which meant going away and doing a bit of research. I went through all the CLiCK bitesize information and also teamed up with CSE Aware – who gave me a wee bit more resources to add to the training. Just the preparation work enhanced my knowledge, as well as being able to deliver the sessions alongside relevant partners.

It has definitely increased my knowledge of the impact that CSE can have on women and their daily lives. It also got us thinking about what supports are there in Fife specifically for women who are involved and recognising that there is a massive gap – there’s no specialized service in Fife.

What session gave you the most food for thought?
They were all really interesting. Obviously the overview led you into some of the issues that women have experienced. I liked that we ran all the sessions in succession and it’s something that we would plan to do annually now. The feedback was absolutely brilliant for each of the sessions, but we didn’t have the attendance that we had hoped for. I think even just reaching the number of people that we’ve reached and allowing other people to hear about CSE, I think each year we will probably increase the attendance once people start hearing about them.

Workers from different organisations attended the sessions – what were some of the themes that they found most surprising or interesting?
I think for attendees it was probably the session around legislation. We did a lot of engagement with the participants, it wasn’t just us talking to them – we did all sorts of exercises. We went through questions like ‘do you think that’s legal or illegal?’ and I think there was a lot of surprise about what was legal and what was illegal and the slight differences even between public and private spaces.

We had police delivering that session with us, so we were able to say, ‘we know that women aren’t always criminalised. They maybe have a look at what the circumstances are.’ For participants to hear that from someone in the police was really good. I think that actually the law does need to change and everybody is aware of that.

What would be your advice to those who want to deliver CLICK Bitesize sessions?
A few things. So like I said, that preparation, getting to know the materials and doing a bit of research so you’re ready for any questions that might come up. I also liked the partnering up. We are a violence against women partnership in Fife so I thought that it was great for participants to see our partners delivering with us – we went to those specialized in each subject. For legislation we went to police, for CSE and money we partnered up with social work justice services and it was someone who had a real interest in the subject and had previously supported service users who had been involved in CSE. For housing we had our housing colleagues. We had Laura of CSE Aware for the overview and for exiting, which I think worked really well. FRASAC – the rape and sexual assault centre in Fife –delivered the mental health one because they come across women who will be experiencing all the issues that we spoke about due to CSE.

And I think having engagement with your audience as well – the feedback that we got from the evaluations was that it was a really good mix. For each session we would cover the definition of CSE, the definition of gender-based violence and then went into the different topics and exercises. We would have breakout rooms, discussions in the whole room, we would do quizzes, videos, menti exercises, we even did a snakes and ladders game for one of them.

Running all the sessions was good advice as well. I know some people might pick and choose what they want to do, but I think running them as a series worked really well. Some people would come along to all of them, and others would choose to dip into what their interest was. I ran them quite close to each other – it was every 2 weeks until the holiday period when we had a wee break because we don’t get the same engagement in Fife during holiday periods, so I suppose it’s just looking at when you get your most engagement as well, and also publicising it widely.
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If you would like to deliver your own CLiCK Bitesize sessions in your organisation, download our free resources and materials here and get in touch if you have any questions.

In Scotland, My Body Back has been providing a unique sexual health service for survivors of sexual violence since 2018. Its trauma-informed approach has succeeded in removing common barriers for survivors of sexual violence who need to access smear tests and other sexual health support. In this interview, Dr Alyson Welsh, Joint Clinical Lead of MBB tells us about how this innovative project has addressed a gap for survivors.
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Can you tell us a bit about you?
I have worked as a Specialty Doctor in Sexual Health for NHS Lanarkshire for 13 years, having previously worked as a General Practitioner while serving in the Royal Army Medical Corps. My current role involves a mix of contraception and GU medicine clinics, alongside psychosexual counselling. I also work as a Sexual Offences Examiner for Archway, Glasgow, as well as my role within the My Body Back service.

What is the My Body Back project and why was it created?
My Body Back is a dedicated service offering cervical screening to those who have experienced sexual violence. Contraception and sexual health screening can also be accessed, but the primary reason for attendance is cervical screening. MBB Glasgow is inspired by the original MBB project in London.

MBB was created by Pavan Amara who drew on her own difficulties in accessing healthcare after experiencing sexual violence, particularly surrounding being invited for a smear.​ It started life as a website and discussion forum which highlighted many people experiencing similar difficulties. A specialist clinic was established and opened in 2015, ​to provide women with “cervical screening, STI testing and contraceptive care in an environment tailored to their comfort and empowerment”.

MBB Glasgow was launched in 2018 and is staffed by doctors, nurses and counsellors employed by NHS GGC, Lanarkshire, Ayrshire and Arran, and Dumfries and Galloway. Although the project is housed in Sandyford in Glasgow, it is open to anyone in Scotland who has experienced sexual violence and who has been invited for, or is overdue for cervical screening.

Why did you become involved with the project?
I have been involved in the project since its inception in 2018 when staff working in sexual health were invited to apply, if interested. I was aware of the difficulties some people face surrounding intimate examination, and cervical screening in particular, and felt this was a very worthwhile and much needed service. Having worked in General Practice, as well as sexual health, I was also aware of the limitations in these settings in terms of the time and support that can be offered.

What are some of the barriers that survivors of sexual violence face when accessing sexual health services?
MBB is primarily a cervical screening service but contraception and sexual health testing can be accessed if required. The barriers to accessing sexual health services and cervical screening are very similar. Some are related to the process of making and attending appointments and some to the procedure itself. For a lot of people, they are unsure how they will feel and react to having an intimate examination after sexual violence, and may not feel like their GP practice or local clinic has the privacy, time or space to accommodate this. For others, they may not wish to disclose previous sexual violence to their GP practice or local service. In terms of the procedure itself, people report pain, being reminded of the previous assault, not feeling safe or in control, previous negative experience of smear, embarrassment and dislike of being touched.

How does My Body Back address those barriers?
As a dedicated clinic for those who have experienced sexual violence, there is no need for explicit disclosure. While people may be asked in a clinic to identify any triggers they may have, or modifications required to make the process more comfortable for them, they need not disclose any details of any previous violence. Each appointment is an hour long and begins with discussion with a counsellor and ends with further discussion with a counsellor if required. We have a dedicated space at Sandyford and, as the clinic is on a Saturday, often have sole use of the premises meaning a quiet, private space which includes the waiting area. An initial questionnaire is completed with the counsellor to identify any potential triggers and then discussed with the clinician. Clinicians are experienced, trauma-informed practitioners who are able to adapt and accommodate the individual’s requirements.
At MBB you take a trauma-informed approach to sexual health support, what does that look like in practice?
There are five key principles of trauma informed practice as outlined by the Scottish Government:

Safety
Efforts are made by an organisation to ensure the physical and emotional safety of clients and staff. This includes reasonable freedom from threat or harm, and attempts to prevent further re-traumatisation. ​
Trustworthiness ​
Transparency exists in an organisation's policies and procedures, with the objective of building trust among staff, clients and the wider community. ​
Choice ​
Clients and staff have meaningful choice and a voice in the decision-making process of the organisation and its services. ​
Collaboration ​
The organisation recognises the value of staff and clients' experience in overcoming challenges and improving the system as a whole. This is often operationalised through the formal or informal use of peer support and mutual self-help. ​
Empowerment ​
Efforts are made by the organisation to share power and give clients and staff a strong voice in decision-making, at both individual and organisational levels. ​
 
In practice, this means ensuring these principles are incorporated throughout the person’s journey through the service. Safety, trustworthiness and empowerment are at the core of how the clinic is set up and also in its aims. From the quiet, designated space, to the time spent in discussion and collaboration both before and during the clinic visit, these principles are adhered to. Questionnaires are completed at the beginning and end of each consultation in order to allow clients to have a voice in decision making and service improvement.

Ultimately, the whole journey is taken at the pace of the client. There is no pressure to proceed with a smear on the day of attendance and an examination can be stopped at any point in the process.
 
How was this trauma-informed approach developed and embedded at MBB?
In 2016, NHS Education Scotland was asked by the Scottish Government to develop resources to promote trauma informed practice, and the Scottish trauma informed practice toolkit was published in March 2021. As MBB began in 2018, the service has operated in a time where resources and understanding of what being trauma informed looks like in practice has now been formalised. This training has been adopted by the service and all staff have completed the formal training package from NES.  A lot of what we were doing instinctively, now has a framework in which to operate and that can be used to evaluate our practice.
 
What are some of the benefits of having a service like My Body Back for survivors?
There are benefits of the service for both clients and staff. As a practitioner, lessons learned from my sessions working in MBB have helped shape my approach to dealing with patients in all of my other roles, and I know this is the case for many of my colleagues. For some of those using the service it really can be about being able to achieve what they once considered unachievable.
 
What would you tell workers in any type of service who are developing their trauma-informed practice?
In my experience as a practitioner, the things that can make a huge difference to people can be small and easy to implement. Time, patience, understanding, listening and being able to adapt to each person’s unique needs can all make a huge impact. At a service level, an appreciation of the prevalence of trauma allows an understanding of how important this issue is. As I mentioned previously, there is now a government toolkit that can be used as a starting point.
 
How would you see MBB’s approach being expanding across Scotland?
Ideally, local provision of a service based on the MBB format would be better for clients. We have had people travel from all over Scotland but recognise that this creates a logistical and financial barrier to some. Ultimately, a truly trauma informed workforce and organisation would mean that dedicated clinics may not be necessary but, until then, I hope the MBB project continues to grow, flourish and share its approach with others. 

In this blog, Robyn Moffat-Wall and Jitka Perinova write about their Glasgow-based project for women experiencing economic abuse.

What is Financially Included
We are a project developed by GEMAP Scotland and the Glasgow Violence Against Women Partnership, funded by the Scottish Government Delivering Equally Safe Fund in order to address a gap identified between women’s support services and advice services in addressing both economic abuse, and the financial impacts of gender-based violence. We identified that women who had experienced economic and financial abuse felt their needs were not being appropriately addressed by either sector. We work to bring these sectors together, raise awareness and educate on economic abuse and how best to support survivors.

We are the only project in Scotland solely dedicated to responding to economic abuse. Our small team aims to improve the response to economic abuse in Glasgow, by providing specialist services and delivering training to money advisers. Our one-to-one support helps women who have experienced gender-based violence on their journey towards financial freedom. We provide expert benefits and money advice to maximise women’s income.

Some experiences of economic abuse
Some clients need help to transfer from joint benefit claims to single benefit claims, some need guidance throughout the claiming process as they lack English language skills, knowledge of the UK benefits system, basic computer skills, or because they suffer from mental health difficulties and require extra support.

There are many forms economic abuse can take, some clients have never had control of their own finances in their lives, some were only allowed ‘pocket money’. We’ve supported women who were coerced into fraudulent benefit claims by an abuser, forcing them into statutory debt and risking criminal consequences.

Lots of our clients have sizeable debts such as utility, council tax or rent arrears and store or credit cards opened fraudulently or were coerced by abusers. We have successfully supported women in security debt write-offs or accessing grant payments. 

Some contact us for advice before they escape abuse, to assess their options and begin safety planning their escape route. We support women to make informed choices based on their circumstances and entitlements.

Barriers to survivors’ economic independence
Some barriers to financial independence our clients face include technicalities around entitlement to benefits, often involving complex immigration rules. Other barriers take the form of post-separation abuse – economic abuse, unlike some other abuse tactics, can extend beyond a successful separation for years. Abusers take advantage of court processes, dragging out expensive legal battles, they withhold child maintenance payments among other tactics.
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What can frontline services do
The best thing frontline workers can do to sustainably support survivors of economic abuse is to learn more about this issue, it is complex – and as a society we shy away from talking openly about finances. We can help with that – please get in touch with us at financiallyincluded@gemap.co.uk to discuss how we can bring our training to you and link you in with a trained money advice service!

During the pandemic, the Encompass Network administered a crisis fund for women involved in selling or exchanging sex. In this blog, Linda Thompson, who coordinates the network, shares how the fund worked, how women benefited, the learnings from this experience and the vision for a longer-term financial solution for women.

How did the Encompass Network identify money as a key priority for women involved in selling or exchanging sex during the pandemic?
Right from the beginning of March 2020 we flagged up that women selling or exchanging sex were starting to be in financial difficulty. On a weekly basis I had contact with all the Encompass Network services and heard what was happening on the ground for women and took that to the Scottish Government.

At the end of March we also completed a needs assessment, which involved speaking to Encompass workers and collating the issues that women were facing, and the number one issue was money. Given that a lot of women involved are not investing or saving, have no masses of resources to draw upon, we knew that if their money supplies stopped they didn't have anything, so we started work on this very early, kind of pre-empting and looking at what was happening elsewhere in the world as lockdown restrictions started to appear in different countries.

What were some of women’s specific financial issues that you identified?
It’s really important to note that the women are not a homogeneous group, so not everyone was affected in the same way – it depended on their own context and background. But what we saw in other countries and which we knew was coming our way was that there wasn't going to be the same amount of punters given the restrictions that started to be put in place. Lockdown was going to have a huge impact on women and their opportunities to sell sex were going to be reduced with the temporary closure of saunas, brothels and lap dancing clubs – no demand equals no money. For women involved in direct contact, this was cataclysmic – they had no money coming in, no financial reserves to draw upon, very often no family support and many hadn’t disclosed that their income stream was through selling sex.

The government launched some financial support programmes like furlough. Were women able to access these supports?
No, because women selling sex didn’t fit the criteria. They weren't employees, they didn't have payroll numbers, they weren't able to evidence income, they had no wage slips. There wasn't a pot of money women could easily apply for, but there were some crisis funds available, for example for single parents and we were able to support women to access them.

We tried to identify other means of ensuring that the women had the basic needs met, like food banks, while also lobbying the Scottish Government for a bigger pot of funding that could be available for women as a crisis fund.

After much lobbying and pressure from us, the Scottish Government identified women involved as a high risk non-shielding group. Also COSLA’s community health and wellbeing board noted the women as a priority group because of their vulnerabilities. And because women were granted that priority status, we said – well, what are you going to do about that? You need to put a measure in place. And that became the Encompass fund.

Once you got the grant, how did you decide how to administer and make it available for women?
I'm going to be honest, at the start, the Encompass Network were very apprehensive about this fund because we are not fund administrators. We are a group of frontline services with support workers and so we had huge concerns about the management and administration of this money. But we wanted to make it as accessible as possible for women with a quick turnaround, giving women a decision within 48 hours.

In the first instance, the government identified £30,000, which were to be administered by Encompass member organisations. The reason behind this was around accountability. As this was public money, we wanted to ensure due diligence, but also be able to better understand women's needs – what were they coming forward for? How much was for food? What was being used for other needs?

We sent out flyers to other organisations, peer support groups like Umbrella Lane, Scot-PEP, the GMB, escort agencies. We tried to ensure via the commercial avenues that women were informed about what supports were available. Again, it was trying to broaden that net out through the violence against women partnerships, so whenever they were compiling information for local services, ensuring that the Encompass fund was included in that.

We decided to have a light touch application that would be assessed by workers. We also had a checking mechanism in place, so if there was a larger sum of money or a larger item needed or something specific, that would go for a decision with service managers of the Encompass Network. We had applications coming in from addictions workers, from counsellors and mental health workers, but we also had a high number of applications from peer support groups.

What was the process for women to tap into this fund?
As I said, this was a light touch application keeping her and her context at the core, with the intention of seeing what we could do to support her. We worked on the assumption of believing women and the needs, issues and priorities they came with.

Our starting point was: if anybody had issues around food, we would get a supermarket e-voucher out to them within a matter of hours. We wanted to ensure that women and their children had food in their bellies that night whilst we were assessing an application.

Then it was looking at her application and saying, well actually there's the Aberlour fund that is also available to you. Okay, you're living in this area and there is a food sharing scheme. Let's get you signed up for that so from this point onwards you get a weekly delivery of food. OK, what other issues are there? You're struggling with your data – let’s get you a data stick with enough data for six months. Each application would be assessed on an individual basis according to her location, what was her housing like, her utilities, was she in arrears. It was an exploration with the woman about the issues she was facing.

Now, there were other funds available for women at the same time, for example, Umbrella Lane had a crisis fund. So we were very clear that we weren't the only ones. And if women came forward to us and there was something they asked for that we weren't able to provide them, we would ensure that they knew about other funds.

It seems that the Encompass fund almost fulfilled two purposes. One was to get women hardship money to address that crisis situation, but also the opportunity to assess her wider needs.
Absolutely. And it wasn’t a condition of this fund to commit to ongoing support and engagement. The other thing that we spent a lot of time considering, reflecting on and monitoring was that we were very conscious of the power that you have if somebody's in desperation and needs money and you've got it. The very nature of selling and exchanging sex is that you do something for somebody to get money or goods. We didn't want to mirror that dynamic in the administration of this fund. So we agreed that this would be a short-term intervention, and that we did not want to manage this fund in the long term.
What are some examples of how the women benefited from the Encompass Fund?
Supermarket vouchers were the largest proportion of what was given out. And that would cover things like food, cleaning materials, but also kids’ clothes. The fund was used to support housing for women who had issues with their accommodation or rent. I will give one example that it's quite tangible: there was a woman whose fridge broke down. She had no fridge and no money. For her to avail of the food bank and food share, she had nowhere to store some of it. Giving her a fridge meant that she was able to access other supports on a longer term basis and not just the Encompass fund. And it gave her a degree of stability and breathing space to start to thinking about dynamics and issues and relationships in her life.

So absolutely the focus was getting practicalities, priority issues, needs, whatever the woman needed. But the other benefit for women was the onward impact. As we know, a lot of women involved don't disclose to services, they don't have support workers, they don't engage with services. For some of the women, this was the first time they tapped into support and received a positive response. They were able to open up and start talking about other issues in their life – their mental health, what was happening with their kids, previous experiences, issues around domestic abuse. In many ways it opened the door for the women to feel safe to talk to somebody who didn’t judge them.

Right now are there any similar funds that women can access to get through the Cost of Living crisis?
Not to my knowledge. At this stage there is no specific fund, but the Encompass workers are trying to find relevant funds that women can avail of. Being involved in selling or exchanging sex is only one part of women's lives, so Encompass workers are supporting women if there's funding available for energy and utility support, for example. We have also revisited the Victim’s Fund, now known as the Emergency Assistance Fund, and done training with staff and with Victim Support in that this money is still crisis money.

In your view, what were the key learnings of running this fund?
One is the challenges of administering a crisis fund. How do we get applications? How do we get criteria? How do we process it? What are the timeframes? But I think one of the key learnings was that there is a need for women to have a crisis fund, not just during COVID. There is a long term need for women to be able to access funding, which should not lie with organisations that are providing support to women. We made the recommendation that there should be a fund that Encompass would support, but that we shouldn't administer. That was when the Scottish Government put an additional ringfenced £60,000 into the Victim’s Fund for women involved in selling or exchanging sex, which is still available and open.

But my big question is, where is the learning from COVID about the vulnerabilities and the precarious financial situation for women? COVID clearly showed that there is a need for women to access light touch crisis support in the short term, but what are we doing in the long term? Because a crisis fund is absolutely needed, but that is not the solution to women's gendered poverty, and to those who will exploit financial poverty and fragile situations. We have to take the learnings from these crises and ensure that as part of the framework for Scotland there is a longer term support that considers the goals of women involved and support them to get to where they want to be.

We are very grateful to Anna Forrest whose invaluable research and documentation of the Lock Hospital’s history made the writing of this article possible.

Walking in the Rottenrow area in central Glasgow, you can easily get a sense of the history of this city, with its red sandstone buildings and the remains of what was the old maternity hospital. However, there is a piece of history in here that has remained hidden and almost completely forgotten if it wasn’t for a group of researchers who have unearthed this chapter in Scottish history: the Lock Hospital and the women who were ‘treated’ there.

In 19th century Glasgow, hundreds of women were incarcerated in the Lock Hospital to ‘prevent’ the spread of sexually transmitted infections. Yet, rather than being looked after, the women endured inhumane treatment and a complete exclusion from society. In this blog we trace back some of this history and remember the lives of the women that found themselves locked at the Lock.

The creation of Lock Hospital
In the 1800s, there was great concern for the health of men, particularly soldiers and sailors. It was also a time when cases of sexually transmitted infections were growing in cities like Glasgow, and so did concerns about those infections reaching men. Thus, the authorities decided to act.

As the Victorians held the widespread belief that women were to blame for the transmission of STIs  - especially working class women and those living in a context of poverty and scarcity -, it was decided that women should be locked away for their own and for men’s protection.

In 1805, Glasgow opened its own Lock Hospital for “Unfortunate Females with Venereal Disease” with 11 beds to ‘treat’ women and girls with infections such as syphilis and gonorrhoea. The Lock only took women - men infected were treated at royal hospitals or in separate purpose-built clinics.

The Lock was located in what was considered Glasgow’s ‘red light’ district and was designed to look just like the neighbouring buildings, with nothing to indicate it was a hospital. This reflected the idea that the women needed to be hidden away.

In fact Anna Forrest, historian and researcher of the Lock, was able to find only a single photograph of the building taken before its demolition in the 1950s. The place (as seen below), looks inconspicuous, like any other tenement building, which contributed to its hidden nature and that of the women kept within its walls.

The Women’s Support Project has linked with Public Health Scotland for an exciting new pilot focusing on improving how sexual health service respond to women involved in selling or exchanging sex. 

We know that sexual health and wellbeing is a key issue for women who sell sex and that staff in clinics and services can be pivotal in ensuring that women have their needs met.  
In recent years, the nature and context of selling sex have changed, with increasing ease of entry especially via online platforms. It is hard to truly ascertain the numbers of women involved, but rough estimates published in 2016 suggest there are over 72,800 people working in the ‘sex industry’ in the UK, and approximately 80% of them are women. There is little published research in the UK that explores the sexual health needs of the full spectrum of those in the ‘sex industry.’ Within England, sexual health surveillance data shows that in 2019 only 6,531 people attending sexual health services identified as a sex worker. 

Women can find it challenging to disclose that they are selling sex for a number of reasons, as highlighted in recent research commissioned by the Scottish Government. These can include concerns around confidentiality, feeling judged or stigmatised, losing control of their information, and the impacts of immigration, police and social work involvement. 

The underreporting of involvement in selling sex means there is limited understanding of the complexities of women's health and wellbeing needs. It also means there are clear opportunities to develop and improve the health responses provided to women. 
We want to better understand the current health service responses to women involved in the selling and exchanging of sex and find examples of good practice to learn from, build upon and share.  

We undertook a short survey with sexual health staff in Grampian, Greater Glasgow, Lothian and Highlands helped to identify staff’s information and training needs, with initial results showing limited awareness of the Scottish policy position on prostitution and its implications for practice. There were also varying levels of discomfort in asking enquiry questions on selling sex and commercial sexual exploitation, as well as varying levels of confidence in supporting women. 
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Following the survey, the Women’s Support Project will support existing workforce development opportunities and test new approaches in four NHS Board areas. This includes developing and delivering new training using the findings from the scoping and surveys, along with the lived experiences of women as reported in the Scottish Government’s commissioned research. The training will be delivered both online and in person throughout 2023 and learnings will be shared early in 2024. ​

Last December, the Minister for Justice launched the new principles that will underpin a new framework for prostitution.
 
These principles were developed as a result of the Scottish Government consultation on commercial sexual exploitation held in 2020, which highlighted strong divides around legislation and approaches, as well as areas of consensus around the harms of CSE, that women needed other choices and alternatives and that wider socio economic factors were key drivers into exploitation.
 
These principles set out the need for:
 

• A national approach
• Acknowledging those involved as victims of exploitation, not criminals
• Promoting social inclusion and addressing stigma
• A preventative approach
• Supporting recovery and sustainable exit
• Learning from lived experience

 
You can read more about the principles here. In this blog, the Scottish Government writes about their vision for the principles and next steps to develop a framework around prostitution.
 
The Scottish Government has a Programme for Government commitment to challenge men’s demand for prostitution. This is being progressed through the development of a Framework to challenge men’s demand for prostitution and support those with experience of it.
 
The developing Framework recognises that prostitution cannot be considered in isolation and therefore its development has relevance to other forms of CSE, recognising the links to wider forms of violence against women and girls, and forms part of a series of policy actions that are being taken to tackle misogynistic behaviours in society.
 
Work is progressing well, and principles developed with stakeholders, to underpin the Framework were published in December and have been adopted across the Scottish Government. Going forward we will look to have them incorporated within the planned Equally Safe Refresh.
 
The principles highlight that in addition to the crucial aim of challenging and deterring men’s demand, it is it is equally important that we develop a collective approach to tackling the structural inequalities that can lead to women and girls becoming at risk of sexual exploitation. The principles need the engagement of the full range of interests across Scottish life and it is therefore expected that the principles will inform relevant policy and practice across government, the wider public and third sector – in turn supporting Scotland’s collective approach to tackling CSE. It is only by working together we will successfully challenge men’s demand and tackle the attitudes and factors which drive this, whilst supporting those affected.
 
The principles were also informed by lived experience engagement, carried out by an independent researcher, which highlighted the need for a joined-up multi-agency approach to supporting those with experience of selling/exchanging sex – illustrated by the fact that those taking part in the research had on average 7 different support needs, often with individuals having to retell their story on multiple occasions when interacting with mainstream services.
 
The key focus throughout 2023 will be to use the principles to define the components parts of a Framework that will provide a sustainable pathway to enable women to move away from prostitution and at the same time challenge men’s demand. As with the development of the principles, we will continue to work with stakeholders as that work progresses.
 
The Scottish Government funds a range of services which support those with experience of CSE, which includes projects with a specific focus on supporting those with CSE and raising awareness of it, through the Delivering Equally Safe (DES) Fund.
 
These DES funded projects (which include CSE Aware) are helping to ensure the principles’ aims are realised. A progress report on the CSE focussed DES projects was published this month and offers further information about the projects – which during the reporting period delivered support to 283 people, and helped to raise awareness amongst over 900 staff across the public and third sector.
 
The DES funded work that Sacro delivers, working with Fedcap, regarding employability support is helping to realise the principle’s aim to ensure that all adults with experience of prostitution can access emotional and practical trauma informed support, at any stage, and that there’s consistent support when ready and preparing to exit. The Minister for Community Safety’s recent visit to hear more about the project, made clear that ensuring lived experience is at the heart of the developing Framework is key. 

Each year, in the days between 25 November and 10 December, organisations around the world organise events, demonstrations, workshops, online campaigns and other activities to mark the UN’s global campaign of 16 Days of Activism against Gender-Based Violence.

Scotland is no stranger to this campaign, and in 2022 the CSE Aware team had the opportunity to attend some of the event organised by local and national organisations. In this blog, we review some of them:

Laura – Intimate image abuse
One of the events I most this year was a session delivered by the Revenge Porn Helpline and organised by the West Lothian Health and Social Care Partnership. The Revenge Porn Helpline was established in 2015 following the legislation which made it an offence to share intimate images without consent.

Intimate image abuse entails a wide range of forms and perpetrators. In addition to taking, sharing or threating to take or share nude or sexual images or videos without consent, it can include voyeurism, upskirting, sextortion, collector culture, doxxing and deepfakes. Perpetrators are not limited to partners – it can be anyone. It is, however, a gendered phenomenon: the Helpline statistics revealed that 12.5 images were reported for females, with 0.2 for males.

The session made me reflect on the links between covered forms of abuse and commercial sexual exploitation. As we have highlighted in the Safety bulletin, doxxing is a threat that women who sell or exchange sex face. The research conducted by the Avery Centre evidenced non-consensual uploading of content on PornHub. Social media platforms – including OnlyFans – are mediums through which sex trafficking can be facilitated.

Intimate image abuse is a reminder that gender-based violence is about power, coercion and control. Its impact on victims cannot be underestimated: it can lead to pervasive fear, shame and isolation. Yet, the recognition of its manifestations and justice responses is lagging.

Natalia – Forced migration and sexual violence
During 16 days I was lucky to attend a range of the events highlighting progress and challenges in tackling GBV in local areas and spotlighting specific forms of abuse. One event that left an impression was the presentation of the SEREDA project’s findings. This project has been researching sexual and gender-based violence against forced migrants in Europe.
 
Forced migration – whether it is due to wars and climate change or to poverty, gender discrimination and state violence – continues to be a crisis for many. Despite that, I’ve always felt that there is a knowledge gap in terms of how forced migrants can and o experience sexualised violence. It is something so pertinent and vital for organisations and services to know, because only then can we fully understand the complex layers of trauma that refugees and asylum seekers carry.

I was glad to hear of this research project and to learn that it has done research specifically with survivors in Scotland. So on an early morning in December, I travelled to Edinburgh to hear from principal researcher Professor Jenny Phillimore. The SEREDA team interviewed eight survivors in Scotland, and looked at Scottish service provision and the Scottish Policy context. Unsurprisingly, we found out that the majority of forced migrant affected by sexual and gender-based violence are women and children.

Among my key takeaways was learning that survivors experience abuse at multiple points in their journey: it can happen before leaving their country, while in transit and once they arrive in Scotland. The likelihood of repeated incidents throughout their displacement means that women’s trauma is compounded, and it can worsen if women cannot access support due to lacking information, language barriers, distrust of interpreters, stigma and shame, and not recognising what happened as violence.

It was interesting to find out that the abuse women experienced often featured sexual exploitation and forced prostitution. It made me consider how, for women, the journey to find refuge is paved with vulnerability to sexualised violence, and the vital importance of services working with migrant women to be aware of and proactive about women’s experiences of abuse, including commercial sexual exploitation.
You can read a very handy briefing of the SEREDA findings here. 

​For the latest issue of our CSE Aware bulletin focusing on substance misuse and women who sell or exchange sex, we wanted to reflect on the impact of vicarious trauma and frontline workers’ coping strategies. For this reason, we decided to ask members of the research project Women working to support women in the welfare sphere to share some of the findings and learnings. Below is our interview with researchers Michele Burman, Loraine Gelsthorpe and Joana Ferreira:

1. Could you tell us more about the projects you’ve been involved with on vicarious trauma?
Our current research project ­aims to identify and explore the challenges faced in the post-Covid pandemic period by women in third sector organisations across the UK who work closely with marginalised girls and women. The research is documenting the cumulative effects of intensified client need, arduous work conditions, job security concerns, and additional domestic caring responsibilities, on the psychosocial wellbeing and personal welfare of women workers, many of whom come from the same communities and share the same experiences as their clients. We have recently published a report on the preliminary findings of our first round of interviews.

With this work, we are hoping to contribute to response and recovery efforts tailored to support women in this sector, by identifying innovative practices and providing insights to inform policies and models of working to support resilience and wellbeing.

This research builds upon earlier work conducted by members of the research team, including a study of vicarious trauma in those working with young women in criminal justice settings.

2. How would you describe vicarious trauma? How prevalent was it among research participants?
Vicarious traumatisation (VT) refers to a set of symptoms that are developed through indirect exposure to trauma, particularly in the context of supportive and therapeutic relationships.  As a result of the cumulative effects of exposure to information about traumatic events and experiences, VT can potentially lead to distress, dissatisfaction, hopelessness, serious mental and physical health problems and collapsed belief systems (Robinson, 2015). In our study, we consider VT as a phenomenon that occurs as a result of interactions with services users who have experienced trauma. These are not always direct interactions – VT can be experienced by those in managerial and research or policy positions, as we have found in our research; although most of our participants had some experience of recent frontline work.

The process of VT can disrupt an individual’s sense of safety, resulting in increased fearfulness, terror, and perception of vulnerability to harm, and is shown to erode trust, safety, and empowerment. It can lead to physical and mental ill health and results in staff absence and a loss of efficacy in the delivery of the work. These are impacts which we have recurrently heard during interviews with our research participants, who spoke of the impacts of this work on their mental, emotional, social, and physical wellbeing.

This research is not specifically looking at prevalence – and it is not something we asked directly in interviews or in our survey – however, it can be conceptualized as a ‘normal’ response to working in trauma-saturated environments. It is something that most respondents are aware of, and many could recount instances of experiencing VT either themselves or by their colleagues. 

3. Is the concept of vicarious trauma helpful in understanding the impact of working alongside traumatised populations?
The term VT is often used interchangeably with other terms such as ‘burnout’ and ‘secondary traumatic stress’, but it is not the same. Unlike burnout – which is a fairly common experience and can be understood as an overwhelming state of physical and emotional exhaustion caused by excessive work-related stress, and secondary traumatic stress which may be acquired by a single incident of disclosure/exposure to another’s experiences, resulting in post-traumatic stress disorder –  VT is a cumulative process of psychological and somatic symptoms of acute and post-traumatic stress that can result from the close and constant work of service providers with traumatised individuals. The term captures the impacts of this constant ‘exposure’ to trauma – it highlights the ‘build-up’ process that often occurs for those working in these environments.

As mentioned above, most of our participants were aware and familiar with the term ‘vicarious traumatisation,’ and we heard many accounts of workers experiencing this.  Our preliminary findings highlight the impacts of VT on workers, including changes in psychological wellbeing, mental and physical exhaustion, and internalisation of trauma (particularly when boundaries between personal and professional become blurred). Identifying this phenomenon allows for the consideration and development of strategies to address it.

4. Practitioners use a number of so-called positive and negative coping strategies to manage the impact of their work. However, negative coping mechanisms are less talked about, both in practice and in the literature. Would you agree? What ‘’negative’’ coping strategies have you identified among research participants?    Yes, there is more in the research literature about positive coping strategies, but some studies have focused on negative strategies (i.e., drinking excessively as a response to the traumatizing nature of the work). These are perhaps not best thought of as strategies, but rather as things people do when work becomes very tough and traumatizing and they start to feel out of control or hopeless.

5. What effects of negative coping strategies have you observed? How did the workers manage them? 
We heard about a range of reactions  to the challenges of the work, including heightened anxiety, safety concerns, the difficulty of maintaining professional boundaries,  sickness, and  staff absences.  Many  participants spoke of ‘positive’ strategies that they have developed in order to cope with the work and its heavy impact. For instance, exercise (e.g., yoga, pilates, running), creative activities and hobbies (e.g., arts and crafts, knitting), and social activities with family and friends. Other strategies involved self-awareness, reflection, and mindfulness. Interestingly, for some participants, the need to attend to their other ‘responsibilities’ outside of their jobs (e.g., looking after family, caring for a pet, roles within the community) provided an ‘escape mechanism’ from work and its impacts.
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These strategies were crucial for participants to deal with the emotional toll of their work and the potential for VT. It is important to emphasise, however, that embedded policies and mechanisms within organisations are needed to ensure the health and wellbeing of service providers. This was recognised by our participants who highlighted the fundamental role of organisational-led initiatives in responding and minimising the effects of VT. These include, for example, adequate supervision (including externally provided clinical supervision) and support, opportunities for reflective practice, and regular debriefs, among others. It is key that worker-facing trauma-informed practices are implemented and we aim to provide insights into developing adequate support policies and processes, as well as resources for organisations and for their staff to assist in the identification and mitigation of vicarious trauma.

When looking at media articles, TV shows, films or any media that depicts women involved in prostitution, webcamming, escorting, stripping, etc more often than not we tend to get the same stereotypical stock images. No matter what the issue or key story is, the same images are used over and over again with little variation or alternatives.

Women are usually portrayed as either oversexualised or completely disenfranchised, they appear uniformly in fishnets and high heels, they are standing in a dark street under a spotlight, they are leaning into cars or exchanging money with anonymous men.  Very often, women are shown just as body parts – legs in stockings, feet in high heels, arms, the back of the head or just a dark shadow.   They are not shown as whole beings but reduced to objects, bodies sexualised in their entirety or a sum of sexy parts.
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You only need to see these examples taken from local mainstream media articles (Daily Record and BBC News respectively): 

But what’s missing from the picture is the fact that women selling or exchanging sex lead rich and complex lives just like anyone. They have been reduced to tropes, indicators and stereotypes which reinforce the message that this is about sex instead of women very often faced with difficult and complex choices and different pressures and coercion.
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These images do not recognise women as individuals with qualities, personalities, experiences and skills, “othering” them instead.  They can feed into stigma and judgements and hide the realities of vulnerabilities that put women into situations where selling sex is needed to bring money into households. There is no one-size-fit-all standard of a woman who becomes involved in this industry.

From direct work with women, we know they can be mothers, students, office workers, service workers.  They may struggle to find work and they may have attended college or university; they may enjoy dancing, cycling, music or cooking; they may speak one or several languages. Of course, despite how the media portrays them, they are not one dimensional. Women involved may be close to us and we may not know of their involvement. This diversity and richness of experiences away from narrow stereotypes is what we wanted to represent in our CSE Aware illustrations.

Learning from previous work with women through Inside Outside and more recently the CLiCK magazine, there is a need to break these stereotypes and challenge the norms within how women are presented and shown.

To bring our project to life, we decided to commission a series of illustrations that will be feature in our website and resources. In order to foreground the reality that women from all walks of life may be involved in selling or exchanging sex, we created five characters: Alice, Alina, Paula, Precious and Sinead.

These characters are fictional woman based on the collective experiences of different women who have told us their stories through projects like Encompass Network, CLiCK, Inside Outside and through other research. Each character is shown in two different day-to-day setting: spending time with her kid, attending a clinic, going shopping, relaxing, etc. The idea is to move away from the typical trope of women shown only in situations where they are selling or exchanging sex.

The result are ten illustrations in total which will be launching on our website very soon. These images will also appear in our events and other resources and social media materials. We hope that they bring reflection on the stereotypes we hold of women involved and that they inspire new and more positive representations that attest to the complexity and variety of experiences that exist in this area.

Here is a sneak-peak of our illustrations:

​Recently our colleague Heather conducted a survey of women’s aid groups and rape crisis centres in Scotland to find out whether women selling or exchanging sex access their services, the specific experiences of selling and exchanging sex women bring and the needs they have. Here she describes her initial findings:
 
Over a week in November 2021 the Encompass network gathered information about the women they supported which showed that 83% of women had disclosed experience of domestic abuse and 36% childhood sexual abuse.
 
Following on from this over March 2022 we collected information from workers in Women’s Aid and Rape Crisis groups about their experiences of supporting women involved in CSE.
 
Workers who completed the survey had come into contact with women involved in various aspects of the ‘sex industry’ including women who had been involved in escorting and web camming, but the majority had supported women who had been coerced into selling sex by a partner or who exchanged sex for drugs.
 
Workers told us that in their experience that the support women required was often similar to that of women who hadn’t been involved in selling or exchanging sex, this included requiring support in relation to housing, around safety and finances. Workers identified  differences in support needed around sexual health and the level of emotional support needed due to higher levels of trauma experienced.
           
‘The support women needed was almost exactly the same except we have purchased pregnancy tests and supported women to sexual health clinics where selling or exchanging sex was involved. Similar financial struggles and issues of housing and requiring refuge were needed but the emotional support differed for the women who had been involved in selling or exchanging sex, they needed more in-depth support for the emotional trauma specifically relating to this issue. I required more support also to enable me to better support women with these particular set of issues due my own lack of knowledge, especially at first.’

In March 2022 the Encompass Network held an event for workers to showcase the range of resources available to improve practice and increase their understanding of the needs of women who sell or exchange sexual activity in Scotland.

Around 150 workers attended from areas such as social work, sexual health, housing services, criminal justice, prison, women’s aid, rape crisis, fire and rescue service, money advice, to name just a few. The diversity of workers present reflects the range of services that women who sell or exchange sex regularly access for support and highlights why it is so vital that workers across all areas understand the spectrum of women’s needs.

During the event we had the opportunity to ask attendees about their views on supporting women in this context and below are some of their responses:

How many have supported women who sell/exchange sexual activity?
In a quick poll, workers attending were asked to share whether they have supported women involved in selling or exchanging sexual activity in their service or organisation, and 66% of attendees said they have:

Reflections from workers
At the end of the event, the workers shared some of their key learnings from the event. Some of their takeaways and comments included:

• Knowing there is a range of support, advice and information available 
• Awareness of the agencies that can offer specialist support 
• A better sense of the challenges women face and how multi-faceted their needs are 
• Knowing that services across different sectors encounter the same issues when engaging and supporting women who sell or exchange sex and that there is a need for services to work together to support women meaningfully. 

 
Upcoming training
If you would like to find out more about the needs of women who sell or exchange sex in specific areas like housing, safety, mental health, problematic substance use among others, visit our events page to sign up to our upcoming training and sign up to our bulletin to receive resources and details of our events straight to your inbox.

Last month we launched the CSE Aware website, a place where workers can find resources, information, research, the voices of women with lived experience and more to inform their practice. 
We have big plans for the website and one of our main ideas is to make it easy to navigate different topics affecting women who sell or exchange sex, such as housing, problematic substance use, abuse and violence, immigration. But we are not there yet...
Our website is a work in progress and our Resource Worker is working behind the scenes to unveil the next phase after May. In the meantime, we want to hear your feedback: is there anything you would like to see there? Would you be interested in sharing your own ideas and practice experiences? Please get in touch, we really want workers to help us shape this website.