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.
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:
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.
Transparency exists in an organisation's policies and procedures, with the objective of building trust among staff, clients and the wider community.
Clients and staff have meaningful choice and a voice in the decision-making process of the organisation and its services.
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.
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.
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 firstname.lastname@example.org to discuss how we can bring our training to you and link you in with a trained money advice service!
"There is a need for women who sell or exchange sex to have a crisis fund, not just during COVID" – Encompass Network
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.