One25-Theory-of-Change-3 (1)

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One25 Theory of Change
Evidencing the Core Assumptions
University of Bristol Social Innovation Programme
Report
March, 2015

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Table of Contents
Executive Summary.................................................................................................................................................... 3
Introduction.............................................................................................................................................................. 5
Methodology.............................................................................................................................................................. 6
Chapter One: Housing............................................................................................................................................... 7
Introduction......................................................................................................................................................................................................................7
Definitions.........................................................................................................................................................................................................................7
Context...............................................................................................................................................................................................................................7
Connections of Homelessness in the Research Literature...................................................................................................................................8
The ways in which the evidence supports or does not support the assumption...............................................................................................9
Tentative Recommendations from the Research......................................................................................................................................................10
Conclusions......................................................................................................................................................................................................................10
References for Housing...................................................................................................................................................................................................11
Chapter 2: Drug Treatment....................................................................................................................................... 12
Introduction.....................................................................................................................................................................................................................12
Definitions........................................................................................................................................................................................................................12
Context..............................................................................................................................................................................................................................12
The ways in which the evidence supports the assumption....................................................................................................................................15
The ways in which the evidence does not support the assumption....................................................................................................................15
Tentative Recommendations from the Research......................................................................................................................................................15
Conclusion....................................................................................................................................................................................................................... 16
References for Drug Treatment...................................................................................................................................................................................18
Chapter 3: Complex Trauma.....................................................................................................................................19
Introduction.....................................................................................................................................................................................................................19
Definitions........................................................................................................................................................................................................................19
Context..............................................................................................................................................................................................................................19
The ways in which the evidence supports or does not support the assumption.............................................................................................20
Tentative Recommendations from the Research.....................................................................................................................................................20
Conclusions.....................................................................................................................................................................................................................20
References for Complex Trauma................................................................................................................................................................................22
Chapter 4: Family and Parenting .............................................................................................................................. 23
Introduction....................................................................................................................................................................................................................23
Definitions.......................................................................................................................................................................................................................23
Context.............................................................................................................................................................................................................................23
The ways in which the evidence supports or does not support the assumption.............................................................................................23
Tentative Recommendations from the Research.....................................................................................................................................................24
Conclusions.....................................................................................................................................................................................................................24
References for Family and Parenting.........................................................................................................................................................................25
Conclusion .............................................................................................................................................................. 26
References............................................................................................................................................................... 27

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Evidencing the Assumptions
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Executive Summary
This report, created by a Social Innovation Programme student consultancy team, provides research evidence to support four of seven core assumptions that
inform One25’s Theory of Change. The main aim of the One25 Theory of Change is that women exit street based sex work, and this aim contains seven sub-
aims that work together to achieve the main aim. These sub-aims are embodied in seven core assumptions.
Due to time limitations, the student consultancy team has chosen to focus on
assumptions 1, 2, 6 and 7.
The following are the seven core assumptions that comprise the Theory of
Change, with the four assumptions selected for research evidence in italics:
This report has two aims:
1) To confirm the validity of the work of One25 by finding evidence to
support the core assumptions where possible.
2) To take a neutral, critical stance towards the assumptions,
challenging the assumptions or aspects therein as appropriate, based
on findings in the research.
The methods of analysis of this desk-based project include seeking relevant,
peer-reviewed published journal articles (our main sources), reports, case
studies from other charities and from select media articles. Research evidence
was drawn from the UK as well as other countries. Most research sources are
dated from 2005 onward to increase relevance.
The report finds that the four assumptions in question are generally well-
supported by the research. However, the consultancy team suggests minor
amendments as follows:
1. Housing
a. “Stable and secure housing is fundamental to making other
positive changes necessary to exit street sex work.” The
research tends to suggest that dependable housing may
support positive changes that may help in exiting street
sex work.
2. Drug Treatment
a. “When women are motivated to make change in relation
to their substance misuse or abuse…”. Some research
distinguishes abuse and misuse, both of which may have
their own effects.
b. Other suggestions?
3. Family and Parenting
a. Is there a suggestion here?
i. Possibly that “family” be broadly defined, to
include a possible development of non-blood-
relation sustained and positive relationships, such as other street sex working women? Or another positive, non-street sex
working, non-drug-using group?
In addition to the specific assumptions, this report offers the following possible suggestions:
1. Reconsideration of the order of the assumptions.
a. As the assumptions embody various sub-aims that contribute to the main aim of the One25 Theory of Change,
the report recommends that reconsideration to the order of assumptions be given to more clearly
acknowledge the relationships between the sub-aims. For example, the research tends to suggest that
Housing and Drug Treatment appear to be quite fundamental to making positive changes necessary to exit street sex work: the consultancy
team agrees that their position near the top of the list is well-considered. Perhaps Complex Trauma could be moved up in the list as well.
The consultancy team recommends further consideration to the order.
1. Housing
a. Secure housing is fundamental to making other
positive changes necessary to exit street sex work.
2. Drug Treatment
a. When women are motivated to make change in
relation to their substance misuse, they are less
likely to need to street sex work.
3. Criminal Justice
a. Taking women away from offending circles enable
them to make a change and denormalises their
behaviour/way of life.
b. Prison can have beneficial outcomes for women
and can be a catalyst for change.
4. Life Skills
a. Improved quality of life and new life skills improves
mental health, motivation and capacity to exit
street sex work and build new lives.
5. Health
a. Chronic trauma and neglect can result in women
normalising the absence of self-care.
6. Complex Trauma
a. Untreated and unresolved trauma can be a reason
for entering or maintaining street sex work.
7. Family and Parenting
a. Positive wider family relationships increase a
woman’s and child’s support. network providing
increase in emotional and practical support.

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2. A consideration to other possible assumptions or the introduction of an eighth assumption.
a. Some research makes suggestions for education (loosely defined, including non-formal and formal education, and including areas such as
sex education). While the report has not focused on the fourth assumption, “Life Skills,” the consultancy team suggests a consideration to
potentially broaden this assumption to include education in its various forms, or to create an eighth assumption, potentially titled
“Education.” Further research is suggested.

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Introduction
This research project was not undertaken lightly by the Social Innovation Programme team. Each of us have academic experience that contributed to our ability
to research around the four assumptions that we felt, firstly, we would be best equipped to tackle and, secondly, would be important foundational factors for the
other assumptions. Once we had narrowed these choices down we began the academic research that involved reading through reports, statistics and journals
that would give us not only a broad idea of how the current academia approaches the topic of street-based sex work (its motivations, its suggestions for helping
women to exit the profession) but an idea of whether we could support One25’s assumptions or not.
Overall, the main objective of this report is to have researched, analysed and collated relevant research to the assumptions that comprise One25’s Theory of
Change. We saw this project as an opportunity to challenge their assumptions to the best of our ability and within the time c onstrains and we believe that the
Theory of Change is a remarkable feat of social impact.
We hope that this report will provide academic research for One25 to use as supportive evidence for their Theory of Change. We hope to some degree the
analyses within this report will be useful. This report contains some tentative suggestions (gathered from academics, other charities and social workers
worldwide) that One25 might take inspiration from.

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Methodology
The assumptions chosen were: Housing, Drug Treatment, Complex Trauma and Family and Parenting. Housing was undertaken on our first research week and
we chose a topic that we believed would have available a significant amount of research online and in the library. This was a topic that had been widely reported
on and we had to keep our focus to street-based sex workers as there was a large portion of papers devoted entirely to homelessness itself and little to its
relationship with sex work. Drug Treatment was chosen for our second week as it tied in neatly with the Housing topic; we now realise in hindsight that Drug
Treatment is a topic that has an influence on every assumptions to some degree. Drug Treatment gave us a good platform to begin researching Complex
Trauma. In our research, it became clear just how important and influential Complex Trauma was as a motivation for women to enter street-based sex work.
Finally, we researched Family and Parenting in our final week and discovered further connections; particularly with Housing and Complex Trauma. Positive
relationships are invaluable in motivating a woman to exit street sex work, but due to decreased, sometimes negative home experiences, such positive
relationships are sometimes difficult to achieve.
The report acknowledges limitations in its analysis. Some limitations include:
i. A slightly confined list of sources from which support and suggestions were drawn. This is due to the relatively short timeframe of the
project, and efforts were made to include a minimum of ten, peer-reviewed published sources per assumption that were the focus of this
report. The team believes that ten quality sources may be sufficient to support, generally, each assumption and make tentative
suggestions for amendments. However, for increased robustness and more finely tuned suggestions for change, further research is
recommended.
ii. The relative inexperience of our student consultancy team in the area of street sex work may have led to some potential
misinterpretations in our analysis. We attempted to decrease such potential misinterpretation by regular consultation with the CEO of
One25, but recommend maintaining a critical eye towards the analysis of the research.
iii. The consultancy team focused on one assumption each, so potentially there may be some inconsistencies in the report, although we have
reviewed our report as a whole in an attempt to eliminate such potential inconsistencies.
The research is drawn from contexts outside the UK, as well as within the UK. Therefore some research findings may not be as applicable to the context of
Bristol. In the reference section of each chapter, a note on the context for each reference has been made.

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Chapter One: Housing
Assumption: Secure housing is fundamental to making other positive changes necessary to exit street sex work.
Introduction
There is evidence in the research literature to support this assumption.
The research indicates that the interrelationships between homelessness, sex work and substance misuse and abuse are complex. In part due to these complex
interactions, the state and condition of housing may contribute to entering, maintaining and exiting street sex work.
In the research, there is a suggestion that stable, as well as secure, housing is fundamental to making positive changes in t he lives of women who engage in
street sex work. The report makes a recommendation to amend the wording of the statement of the Housing assumption to the following: “Secure and stable
housing is fundamental to making other positive changes necessary to exit street sex work.”
Definitions
As Lazarus et al. (2011) illustrate, homelessness is often defined as a continuum and is extended to include substandard housing. Besides sleeping on the streets,
precarious housing situations such as ‘couch surfing’ are accompanied by their own series of challenges: in the case of couch surfing, increased expenses and
financial exploitation has been reported in one study conducted in Canada (Lazarus, 2011). “For women involved in street sex work, homelessness often occurs
over time. According to CRESR, “Exploring each woman’s trajectory from trauma to homelessness reveals that homelessness in these circumstances is a
transition rather than an abrupt ‘event’ and that the transition from ‘housed’ to ‘homeless’ can be gradual, and multi-factorial” (2009, pp. 25-26).
Women who engage in street sex work often form part of the ‘hidden homeless,’ where “homeless women are on the streets as sex workers, less visible, and less
catered for” (Shelter, 2004, p. 4). Goodman writes in the context of the United States: “Women and children… may stay on friends’, neighbors’, and family
members’ couches night after night (‘couch surfing’) or return to their abusers when emergency shelters are full, (sleep) in rural areas where no shelters are
available, and… trade sex for a place to sleep” (2006, p. 1). Women who engage in sex work at night and ‘crash out’ during the day often miss out on engaging in
programmes that assist street homeless people (Shelter, 2004).
Secure housing can be defined as accommodation that is free from danger or harm.
Stable housing can be defined as accommodation that is able or likely to be long-term. Research suggests that stable, as well as secure, housing is fundamental
to women making positive changes.
Context
There is a high prevalence of homelessness in women who engage in street sex work; Duff et al. decry its “staggering prevalence” (2011, p. 3).
Research in Glasgow… found that 44 per cent of working women surveyed had slept rough. A 1999 study
found that 86 per cent of women interviewed had experienced some type of housing difficulty and that, for
most, this meant recurring or continual housing problems. Other studies have shown that prostitutes are
likely to be sleeping in crack houses, on the streets, in cars, in parks, in building stairwells, and on friends’
floors.
(Shelter, 4004, p. 7)
In research carried out in Stoke-on-Trent in 2009 (CRESC, 2009), researchers of a small quantitative study (n=28) found that participants reported their highest
unmet need as “finding a home” (50%) above the unmet need of “someone to talk to” (43%), while “settling into a new home” was also reported (21%) (see
Table 1).
Table 1. (Source: CRESC, 2009)

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Unmet Needs %
Finding a home 50
Someone to talk to 43
Drug use 36
Counselling 25
Relationship Difficulties 25
Claiming benefits 25
Mental Health 25
Settling into a new home 21
Budgeting 21
Contacting children 18
There is robust research evidence that shows that sex work, substance abuse and housing are closely connected and interact in complex ways (Shelter, 2004;
Duff et al., 2011; Lazarus et al., 2011). Further, sleeping on the street was associated independently with: younger age, violence of non-commercial partner,
servicing clients in public spaces, daily and intensive crack use and servicing a higher number of clients (Duff et al., 2011).
Homelessness often leads women to enter street sex work: “Homelessness can make women (particularly young women) vulnerable to entering
street sex work” (CRESR, 2009, p. 6). As Lazarus et al. (2011, p. 1600) note, there is strong research evidence that:
Homelessness and unstable housing have been associated with increased risk of HIV infection (Aidala &
Sumartojo, 2007; Corneil et al., 2006; Shannon, Ishida, Lai, & Tyndall, 2006), reduced personal safety, higher
rates of morbidity and mortality (Riley, Gandhi, Hare, Cohen, & Hwang, 2007) and increased barriers to
accessing health care (Lewis, Andersen, & Gelberg, 2003).
With consideration to the complex interactions between these issues, research around homelessness and women who engage in street sex work appears to focus
particularly on these three connections:
a. Homelessness and drug abuse
b. Homelessness and gender-based violence
c. Homelessness and health issues
The three connections will be discussed in turn.
Connections of Homelessness in the Research Literature
a. Homelessness and drug abuse
There is a poignant link between homelessness and drug abuse, and drug use is often found to be an antecedent for homelessness and having sex for survival
(CRESR, 2009; Duff et al., 2011). Drug abuse appears to be present for many women at multiples stages: transitioning into sex work, remaining in street sex
work, and exiting (or not exiting) street sex work (CRESR, 2009). In particular, drug use may often play a strong role in entering street sex work. As Shelter
notes, “Women often turn to prostitution at a young age, when they fail to find a route out of their housing problems or homelessness, and when their drug
addiction becomes more problematic” (p. 30, 2004).

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Youth (defined by Miller et al. as females under 18) appear to be particularly vulnerable: “Increased likelihood of frequent heroine injection of youth in this study
was most likely fueled by the more precarious state of the housing condition and limited access to methadone” (Miller et al., 2011, p. 39).
Duff et al. (2011, p. 3) note that homelessness is significantly associated with “intensive, daily crack smoking” and that “the pressures of living on the street may
contribute to heightened levels of crack use among homeless street-based (female sex workers)” (p. 5).
Stable housing is cited as an important factor that may support a woman in exiting street sex work. As Shelter notes, “Women w ho are taking their first steps
towards exiting prostitution have often spent a period of time off drugs and away from sex work; usually while in prison, in a drug programme, or in hospital.
Unfortunately, they are likely to relapse and return to sex work unless they find suitable, stable accommodation” (2004, p. 21).
b. Homelessness and gender-based violence
There is a notable correlation between homelessness and gender-based violence among women who engage in street sex work.
Shannon et al. (2009) found that homelessness, along with many other factors, was independently correlated with gender-based violence, even after adjustment
for individual and interpersonal risk practices. Goodman et al. (2006, p. 5) found that although previous sexual abuse and partner violence may precede
homelessness, “the condition of homelessness itself dramatically increases women’s risk of being sexually assaulted.” El Bassel et al. (2001, cited in Goodman,
2006, p. 5) found that “homeless prostituted women are at much greater risk for sexual assault than their non-homeless counterparts.”
In light of such findings, secure housing, broadly defined as being free from danger or violence, is a foundational requisite to modify the risks of violence for
women who engage in street sex work.
c. Homelessness and health issues
Research has found many connections between homelessness and health issues, both mental and physical, in women who engage in sex work.
As CRESC (2009, p. 7) reports, “the women interviewed… reported significant physical damage and sexual health issues... Extreme violence, including rape, was
routinely experienced.” The same study found that 67% of participants had experienced domestic violence and 57% had experienc ed ‘other’ forms of abuse, while
44% reported mental health issues. In another study, researchers found that “persons who are homeless or unstably housed have been found to have HIV rates
that are up to nine-fold higher than those who are stably housed” (Duff et al., 2011, p. 2). Miller et al. (2010) report that research has shown a relationship
between inconsistent condom use and multiple sex partners in connection with homelessness.
Regarding mental health, Browne and Bassuk (1997, cited in Goodman, p. 2), in their study of homeless women who had been vict imized, found that “most
participants reported mental health problems ranging from suicide attempts (45%) and depression (47%) to alcohol or drug dependence (45%) and
posttraumatic stress disorder (39%).” For more on mental health, specifically complex trauma, see Chapter 3 of this report.
“Homeless FSWs were younger, experienced higher exposure to violence by non-commercial partners, serviced a higher number of clients and were more likely
to engage in sex work in public spaces as compared to their housed counterparts. Taken together, these findings support the need for safer environment
interventions to modify the social and physical contexts of risk faced by homeless FSWs and increase access to safe, secure housing options for vulnerable
women” (Duff et al, 2011, p. 6).
The ways in which the evidence supports or does not support the assumption
The evidence supports the assumption.
In regards to secure housing being fundamental to making other positive changes, UCL Institute of Health Equity for Inclusion Health (2014, p. 5) found that
“homelessness and drug addiction have been identified as the two most significant factors when prompt engagement in on-street sex work and two of the main
barriers to stabilising the lives of sex workers.”
In regards to secure housing being fundamental to making positive changes, Lazarus et al. (2011, p. 1604) note: “The physical, structural and social environments
of low-income and transitional housing worked to significantly limit women’s ability to secure safe and stable housing, exert agency and negotiate safety in terms
of reducing sexual risks and violence.”
This report makes the recommendation that the assumption include “secure and stable housing,” to reflect recommendations in the research. A connection
between health and homelessness among women who engage in street sex work is clear, and research recommendations include “safer environment interventions
aimed at improving access and availability of safe, stable low-income housing for women in street-based sex work” (Duff et al., 2011, p. 5). Shelter (2004, p. 4)
recommends “providing stable environments where women can access intensive and comprehensive support to gain a home, address their drug use, and move
towards leaving prostitution.”

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Tentative Recommendations from the Research
 Findings indicate a need for “safer environment interventions that mitigate homelessness and associated risks” (Duff et al., 2011, p. 5) where women
can access accommodation that is safe, with intensive and flexible support available (Shelter, 2004).
 Research shows that “social networks are important to the exiting process overall (Ebaugh, 1988), and among prostitutes who leave the trad e
(Månsson and Hedin 1999)” (Oselin, 2010, p. 544).
 Women-only shelters are helpful, but their temporary nature may be problematic. “A secure sense of home has been found to lead to increased
agency and resistance to risky behaviours (Aidala & Sumartojo, 2007; Dickson-Gomez et al., 2009)… At the same time, the temporary nature of many
of these shelters and continued policy restrictions and curfews regulating women’s work and private lives meant that many of the gendered risk
environments persisted.”
 The research literature recommends a consideration to housing in combination with drug treatment options. “Initiatives aimed at reducing crime and
antisocial behaviour associated with street based prostitution must offer drug treatment in conjunction with appropriate housing” (Shelter, 2004, p.
6).
Conclusions
Stable housing is regarded as a key factor in enabling women to complete drug treatment and/or exit
prostitution successfully.
(Shelter, 2004, p. 5)
Research indicates the fundamental role of housing in supporting a woman’s exit from street sex work. As CRESR (2009, p. 47) identifies, “without adequate
housing it can prove impossible to address other problems such as drug addiction and family breakdown.”
Secure and stable housing is critical to providing a foundation on which positive changes may be made to exit street sex work.

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References for Housing
CRESR (2009) The Housing Needs and Experiences of Homeless Women Involved in Street Sex Work in Stoke-on-Trent. Available at:
http://www.shu.ac.uk/research/cresr/sites/shu.ac.uk/files/housing-needs-exp-women-sex-work-stoke.pdf (Accessed: 2 March 2015). (Based in United Kingdom)
Duff, P. et al. (2011) "Homelessness among a cohort of women in street-based sex work: the need for safer environment interventions." BMC public health 11(1), p.
643. (Based in Canada)
Fletcher, J. et al. (2014) "Housing Status and HIV Risk Behaviors Among Transgender Women in Los Angeles", Archives of Sexual Behaviour, 43(8), pp. 1651-1661.
(Based in United States)
Goodman, L. et al. (2006) ‘No Safe Place: Sexual Assault in the Lives of Homeless Women’, VAWNet: Applied Research Forum. Available at:
http://www.vawnet.org/Assoc_Files_VAWnet/AR_SAHomelessness.pdf (Accessed: 2 March 2015). (Based in United States)
Lazarus, L. et al. (2011) “Risky health environments: Women sex workers' struggles to find safe, secure and non-exploitative housing in Canada's poorest postal
code”, Social Science and Medicine, 73(11), pp. 1600-1607. (Based in Canada)
Miller, C. et al. (2011) "Individual and structural vulnerability among female youth who exchange sex for survival", Journal of Adolescent Health, 49(1), pp. 36-41.
(Based in Canada)
Oselin, S. (2010) "Weighing the consequences of a deviant career: Factors leading to an exit from prostitution." Sociological Perspectives 53(4), pp. 527-549.
(Based in United States)
Shannon, K. et al. (2009) "Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers." Bmj, p. 339. (Based
in Canada)
Shelter (2004) Off the streets: Tackling homelessness among female street-based sex workers. Available at:
http://england.shelter.org.uk/__data/assets/pdf_file/0016/49030/Off_the_Streets.pdf (Accessed: 2 March 2015). (Based in United Kingdom)
UCL Institute of Health Equity for Inclusion Health (2014) A Review of the Literature on Sex Workers and Social Exclusion. Available at:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/303927/A_Review_of_the_Literature_on_sex_workers_and_social_exclusion.pdf
(Accessed: 2 March 2015). (Based in United Kingdom)

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Chapter 2: Drug Treatment
Assumption: When women are motivated to make a change in relation to their substance misuse and abuse, they are less
likely to need street sex-work.
Introduction
Drug use can be considered one of the most dangerous problems faced by women currently engaged in street sex work, and seen to be greatly intertwined with
numerous, multiplying, self-reinforcing vulnerabilities. Chapter Two collates and synthesizes evidence around these specific vulnerabilities that strengthen the
link between drug use and street sex, tweaks the assumption’s wording, and observes pathways into and out of street sex as they correlate to drug use. The
collected evidence is then tied down to the assumption itself.
Definitions
Drug abuse: excessive and irresponsible consumption of a drug, often leading to addiction and dependency.
Drug misuse: incorrect consumption of a drug, e.g. using a dirty or used needle.
Context
Morozini’s (2011, paragraph 7 ) findings claim that substance use and street sex-work are thoroughly and mostly intertwined, but she more importantly brings
attention to the “premeses and backgrounds that generate, enforce and perpetuate” this strong link, which is greatly affected by the specific d rugs used, their
frequency and the context. Other articles delve into this with greater precision, e.g. Nuttbrock illuminates how previous detoxification increases likelihood to
leave street sex completely.
The most prominent document in this research is Cusick et al.’s “Home Office Research Study 268” (2003). I shall directly refer to this piece of literature,
reinforcing it with other literature which talks about similar themes in novel angles, and finally discuss points Cusick et al . overlook or fail to make. Cusick et al.
predict a plethora of psychological, situational and emotional reasons for entry into street sex, tying each of them indirectly to drug abuse as well:
Psychological factors include low self-interest, emotional disturbance, damaged self-esteem, sex-role confusion etc. Dixon (2014) talks about complex childhood
traumas in her article. Situational factors include a broken home, a deprived socio-economic background, parental promiscuity, etc. Emotional factors range from
a strong desire to lead life independently, gain acceptance and attention from adults, which is what Shaw and colleagues (1996) call “a mix of coercion and
comfort.” (page 2 of Cusick et al.’s report.)
Participants found to be ‘untrapped,’ i.e exempt from vulnerabilities, displayed that freedom from problematic drug use is freedom from multiplying,
strengthening vulnerabilities. BY WHO? These sentences should not be their own paragraphs.
However, there is strong debate amongst researchers about the directness of drug abuse to street sex work however.
Hannington et al (2008) talks about several stages workers go through when attempting to leave street sex, in a holistic, in-depth model that is applicable to
most addictive behavior (in this scenario – drug abuse):
Diagram 1. (Source: Hannington et al. 2008)

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Cusick et al.’s (2003) research suggests tentatively that sex workers with experience of drug use will have used a wider range of drugs, and will have used drugs
more frequently than the general population abusing drugs. A range of vulnerabilities heighten culpability to abuse drugs: of the drug-abusing sample, being
quite young was prevalent when the first experience of ‘hard drug’ use or selling sex had occurred. A minority of the sample had committed offending behavior,
mostly possessing illegal drugs. A strong minority had been ‘looked after,’ and a smaller minority was in unstable or no housing when they first sold sex.
Daddow et al. (2013) further highlight additional problems such as poor physical health, risk of sexually-transmitted diseases and HIV infection. Daddow’s (2013)
research tackles the political barrier that exists, and he discusses the failure of national policy to address these problems in a complementary fashion. Balfour and
Allen discuss poor education as impeding on financial security and driving entry into sex work.
Cusick et al. (2003) then go deeper into the reasons for the links existing, by discussing the existence of a ‘shared environment’ and the order of involvement.
Homeless street sex workers often find themselves sharing a space with drug-abusers and street-sex workers, where they make abusive, predatory contacts that
bind and strengthen their vulnerabilities. A relative majority in various studies was found to have used ‘hard drugs’ before entering street sex, which points to
the need to create a source of income to fund drug abuse habits, while others exchanged sex directly for drugs, as said by Ditmore (2013). Nuttbrock et al. and
other studies also discuss drugs to be a natural coping mechanism for street sex-work. This data can be summarized by the Venn diagram:
Diagram 2. (Source: Ditmore 2013)

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Cusick et al. (2003) consider variations in drug use due to tradition, and as mentioned, the availability of drugs for sale in the ‘shared environment.’ Religion,
culture and fear of disrepute dissuaded drug use strongly in a minority of the sample. Another small minority was found to have been selling sex without
abusing drugs: this group described drug abuse as a ‘binge’ they recovered from. An even smaller minority prone to said vulnerabilities refrained from both drug
abuse and sex work, and this very small minority is crucial as it displayed an instantaneous shattering of the links that bind drug abuse and street sex work. This
had occurred prominently by successful drug use treatment when sex work funded drug use. Mentoring and accommodation also served to shatter links
completely for the observed sample.
Cusick et al. (2011) looked further into the exact pathways adopted by street sex-workers when they do make the changes that Hannington et al.’s (2008) model
touches upon. The following table displays the exiting strategies used by the interviewed sample in Cusick et al.’s study:
Tables 3 & 4. (Source: Cusick et al. 2011)
This paragraph considers the phrase used in the assumption, “motivated to make a change.” Cusick et al. (2011) discuss intervention which helped a larger
population in the interviewed sample than self-motivated exit. Next, they looked at ‘opportunistic exiters.’ Studying them pointed to multiple circumstances that
allowed these street-sex workers to make important life-decisions: the discovery made was that they reverted to drug use and sex-work based on their fluctuating
needs, e.g. need for more money, than as the result of a chaotic, addictive lifestyle. Thirdly, Cusick et al (2011) talks about ‘gradual exiters,’ whose maturity,
altering socio-personal relationships, and seizing of increasing opportunities had allowed them to wean themselves slowly off both drug abuse and sex work
completely. It finally discusses ‘strategic exit,’ where exit is defined by determination, willpower, and conscious, cautious measures to change one’s life, a process
unobserved amongst Cusick’s (2011) sample data for street sex-workers. Oselin’s study suggests that for just some, sobriety and its resultant mental clarity was a
pivotal component in formulating reasons for change, i.e. moving from ‘Pre-Contemplation’ to ‘Decision’ in Hannington et al.’s (2008) model. Oselin further
refers to physical incapability to sell sex, altered sexual orientation during the course of selling sex on the streets, and the urge to reclaim custody of children as
turning points for many street sex-workers.
Even with the problems discovered and positive action taken to provide necessary services, there exist barriers to accessing them, that Daddow et al. (2013)
discuss. These include personal barriers such as low motivation from hurt esteem or a fear of losing one’s social support network, but these barriers may well be
organizational. These can include conflicting schedules, lengthy delays in accessing prescriptions or other services, inflexibility of service provision, being located
too far, a stigmatizing staff attitude and so on. Ditmore (2013) provides her own list of barriers as well.

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Rodger’s (2012) article in an online magazine highlights a critical nomenclature in the assumption itself, i.e. the distinction between ‘abuse’ and ‘misuse’ of
substances. ‘Abuse’ is characterized by addiction and excessive usage of a drug to the extent where it damages the mind and body. ‘Misuse’ is characterized by
improper usage of a drug, e.g. injecting ill-made heroin using a grimy needle. Rodger refers to research by Nick Davies that concluded that a large proportion of
illness experienced by blackmarket heroin users is caused by wound infection, septaecemia, etc. via unhygienic injection, and refers to well-functioning heroin
addicts. Rodger further discourages the heroin substitute methadone as it is relatively harmful and approximately eight times cheaper.
The ways in which the evidence supports the assumption
Evidence suggests that for the majority, street sex-work and drug abuse and/or misuse are tightly intertwined. Those selling sex on the street abused drugs in
general, as studies have repeatedly validated. The majority of street sex workers abuse class-A drugs, e.g. heroin, methadone, or cocaine, which can create a more
dangerous and chaotic lifestyle of dependence than other intoxicants, e.g. alcohol, which was shown to hold far less statistical significance as shown by Cusick et
al.’s (2003) research. This research also shows that street sex-workers abuse a greater range of drugs and with far greater frequency than those who abuse drugs
but don’t sell sex. THAN WHO?.
Cusick et al.’s (2003) psychological, emotional and situational vulnerabilities can be tied down to the assumption as they reinforce both street-sex work and drug
use, e.g. broken self-esteem that drugs can help cope with, parental promiscuity that leads children into accepting street sex as relatively acceptable, or even a
strong desire to be independent.
Drug abuse is a result of various vulnerabilities that lead women to greater weaknesses that are also mutually associated with street sex work and drug abuse,
e.g. homelessness. Thus they further constrain a woman’s ability to exit, proving that drug abuse is often indicative of other trapping factors, some of which it
may or may not directly fuel. At the same time, evidence suggests that drug abuse, by trapping women into selling sex, disables remedy of the original
vulnerabilities themselves.
Hannington et al’s (2008) model gives further insight into the difficulty of transitioning, highlighting it as a difficult ‘process’ than a singular ‘event’ with strong
ease of relapse.
Observing the order of involvement in Cusick et al.’s research (2003) yields the interpretation that drug abuse is the leading factor that drives women into street
sex work. The relative minority gets involved in street sex work first and then becomes intertwined with drug abuse due to shared spaces etc. WHO SAYS THIS?
Cusick et al (2011)’s discussion of modes of exiting sheds light on the fact that motivation in itself can serve as route to exit, and this may vary depending on the
individual. Opportunistic, gradual and strategic exiters were all self-motivated and successfully left street sex and drug abuse.
The ways in which the evidence does not support the assumption
An observation in Cusick et al.’s research (2003) was made for women who viewed street sex as vital to their livelihood but discontinued drug abuse because of
tradition, religion, fear of disrepute or a negative profile FROM WHO?. Nuttbrock’s study shows that no previous exposure to drug treatment facilities, or the
task of undergoing the process of exit for the first time means that it is more difficult. Cusick et al. (2011) suggest that drug use and street sex are offsprings of
various vulnerabilities and often, when these are not resolved, chances of relapse increase even with successful drug treatment. Hannington et al.’s (2008) model
displays that relapse is always possible, and it is during the process of ‘maintenance’ that the vulnerabilities are in a bet ter place to be swept clean. If they are
not, the process could re-start.
There was also a minority of women who suffered similar vulnerabilities but did not fall victim to drug abuse or street sex in Cusick et al.’s (2003) study, due to
successful drug treatment policies, mentoring etc. which served to shatter the link between drug use and street sex.
Cusick (2011) suggests that besides self-motivated exit, intervention has play a prominent role in encouraging women to change their lives.
Finally, Daddow (2013) and Ditmore (2013) talk about how even with self-motivation, personal barriers e.g. fear of stigmatization, or organizational barriers, e.g.
inflexible timing, could prevent a street sex worker from seeking help.
 While street-sex work and drug use are thoroughly intertwined, they are not unbreakable links, and when the problems don’t self-reinforce, dealing
with them can become simpler.
 Hannington et al.’s (2008) model is especially useful as it is allows service providers to implement holistic practices tailored to the particular stage a
street-sex worker is at, e.g. continued support at ‘Maintenance’ to eradicate vulnerabilities e.g. by providing greater education is essential in preventing

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the 6th
stage of ‘Relapse.’ Studies also suggest increased need for greater social inclusion as a means to increase self-motivation to leave, similar to
findings suggested in Chapter One on Housing.
Diagram 5. (Source: Hannington et al. 2008)
 Instead of general, standardized interventions, if intervention is thought necessary, it should tailor itself to the individual’s specific needs and
problems. Interventions in this manner, as well as mentoring and counseling should thus target factors not limited to, but including: separation of
private and commercial sex (as stressed by Cusick et al., 2003) to eliminate informal, opportunistic selling of sex; moreover, not having drug abuse as
a coping mechanism or using drug abuse as a motive to sell sex, inhibiting vulnerabilities that entrap one further e.g. having a child, and refusing to
take drugs with, or offered by clients.
 Motivation to seek continued help may increase through trust and consistency of keyworker, reduced stigmatization by staff, shorter, flexible waiting-
lists, ease of access, and so on as emphasized by Ditmore’s (2013) and Nuttbrock’s (2003) research.. (SAYS WHO?)
 Finally, drug misuse issues can be rectified with greater ease as suggested by Rodger (2012) through the provision of information. One of the studies
Rodger mentions discusses provision of clean, safe heroin to street-sex workers, which disabled them from misusing the heroin e.g. by incorrect
injection, and simultaneously not needing to sell sex for income to buy heroin.
Conclusion
To summarize, Chapter Two generally supports the assumption on Drug Treatment believing that street-sex work and drug abuse and misuse are closely inter-
connected, and concludes that drug treatment is a powerful liberating mechanism. It also takes into consideration various situational and psychological
exceptions that may be present, such as the individual’s motivations or the space within which sex is being sold. The chapter also links drug use with other
assumptions that formulate the report, believing them to be inter-connected as well. There is also a belief that the efficiency of drug treatment services impacts
motivation to seek help. The chapter finally concludes by offering tentative advice on treating drug abuse and misuse, such as the need to tackle the problem
holistically and individually in interventions.

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LONGER CONCLUSION

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References for Drug Treatment
Balfour, R. and Allen, J. (2014) ‘A Review of the Literature on Sex Workers and Social Exclusion’, The UCL institute of health equity. Available at:
(Accessed: 2 March 2015). (Based in the UK.)
Cusick, L. et al. (2011) ‘ “Exiting” drug-use and sex-work: Career-paths, interventions and government strategy-targets’, Drugs: Education, Prevention and Policy
18:2 pp. 145-156. (Based in the UK.)
Cusick, L. et al. (2003) ‘Vulnerability and involvement in drug use and sex work’, PsycEXTRA Dataset. Available at:
http://www.popcenter.org/problems/street_prostitution/pdfs/cusick_etal_2003.pdf (Accessed: 2 March 2015). (Based in London, UK.)
Daddow, R. et al. (2013) ‘The Challenge of Change: Improving services for women involved in prostitution and substance use’, DrugScope and AVA. Available at:
http://www.drugscope.org.uk/Resources/Drugscope/Documents/PDF/Policy/Challenge%20of%20change_policy%20briefing.pdf (Accessed: March 2 2015). (Based in
Vancouver, Canada.)
Deering , K. N. et al. (2011) ‘The street cost of drugs and drug use patterns: relationships with sex work income in an urban Canadian setting.’ Drug and alcohol
dependence 118.2: 430-436. (Based in the UK.)
Ditmore, M. H. (2013) ‘When sex work and drug use overlap Considerations for advocacy and practice’, Harm Reduction International. Available at:
http://www.ihra.net/files/2014/08/06/Sex_work_report_%C6%924_WEB.pdf (Accessed: March 2 2015). (Based in the UK.)
Dixon, L. (2014) ‘Prostitution and drug misuse: breaking the vicious circle’, OpenDemocracy. Available at: https://www.opendemocracy.net/5050/lucy-
dixon/prostitution-and-drug-misuse-breaking-vicious-circle (Accessed: March 2 2015).
Hannington, T. et al. (2008) ‘Working with Sex Workers: Exiting’, UKNSWP. (Based in the UK.)
Morozini, S. (2011) ‘The real link between drug use and sex work’, Talking Drugs. Available at: http://www.talkingdrugs.org/drug-use-and-sex-work-what-is-the-
real-link-between-them (Accessed: March 2 2015).
Hiller, S. et al. (2013) ‘Social support and recovery among Mexican female sex workers who inject drugs.’ Journal of substance abuse treatment 45.1: 44-54.
(Based in Tijuana, Mexico.)
Nuttbrock, L. et al. (2004) "Linking female sex workers with substance abuse treatment." Journal of Substance Abuse Treatment 27.3: 233-239. (Based in New
York.)
Oselin, S. (2010) "Weighing the consequences of a deviant career: Factors leading to an exit from prostitution." Sociological Perspectives 53.4: 527-549. (Based in
the United States of America.)
Rodger, S. (2012) ‘The one sure way to reduce prostitution: heroin prescription’, OpenDemocracy. Available at: https://www.opendemocracy.net/stuart-
rodger/one-sure-way-to-reduce-prostitution-heroin-prescription (Accessed: March 2 2015).
Patton, R. et al. (2011) "Rethinking substance abuse treatment with sex workers: How does the capability approach inform prac tice?." Journal of substance abuse
treatment 45.2: 196-205.

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Chapter 3: Complex Trauma
Assumption: Untreated and unresolved trauma can be a reason for entering or maintaining street sex work.
Introduction
Regarding this assumption, research suggests that trauma itself can be a motivation to begin working in street-based sex work. This assumption shares
similarities with the ‘family and parenting’ assumption (see Chapter Four): a majority of the research corroborated that child sexual and emotional abuse can
lead to deep psychological scars that affect the behavior patterns and lifestyles of the victims.
Definitions
Complex trauma is defined by psychologist and trauma expert Dr. Christine Courtois (2004, p. 412) as “a type of trauma that occurs repeatedly and
cumulatively, usually over a period of time and within specific relationships and contexts.” This definition is important to emphasise as it is the concept of a
repeated trauma that occurs frequently throughout the life of the victim that allows a diagnosis of complex trauma. With regard to street-based sex workers,
their working environment could potentially trigger them on a daily basis. This cycle of violence is discussed more thoroughly below.
The definition for complex trauma is often confused with other psychological conditions such as post-traumatic stress disorder (PTSD) which complicated the
search for a true definition of the psychological condition. This report looked at complex trauma as its own separate condition that is accompanied with a very
specific set of symptoms. It is similar to PTSD and other post-traumatic conditions but a separate condition nonetheless. Some interesting research was found
regarding the relationship between PTSD and/or general mental health problems (such as depression, suicidal thoughts, etc.). Street-based prostitution will be
included in this section of the report but it will be made clear when the report is not explicitly discussing the effects of complex trauma.
Context
In regards to the contributing factors and causes of complex trauma that motivates women into street-based sex work there were three major factors that was
found from the research for this project:
1) Childhood sexual abuse
2) Childhood emotional abuse
3) Childhood physical abuse
Childhood emotional abuse had been somewhat neglected in academic circles for some decades but recently its lasting and complex effects are being more
thoroughly considered. It is especially hard to diagnose largely due to the fact that it can come in a variety of forms and often the victims themselves do not
consider it abuse in the same way they can categorise sexual/physical abuse. Emotional abuse is purely psychological and can impact on decision making, social
skills and self-esteem which combined with an environment such as an unstable home results in a woman who sees her only option that will allow her to survive
and make a living is through street-based sex work.
Stoltz et al. (2007, p. 1219) argue in their article for the importance of an association between emotional abuse and complex trauma which can act as a
motivation towards street-based sex work, “attention also need to be paid to experiences of emotional abuse as a potential determinant of high-risk
behaviour…Emotional abuse can be more difficult to assess than sexual or physical abuse of physical neglect… Enhanced social support and reduced social
isolation are important protective mechanisms against past emotional abuse.” Emotional abuse therefore requires a more thorough diagnosis as it is not as well
researched as other areas of childhood abuse despite the fact that the psychological effects of emotional abuse establish patterns of behaviour and thought that
are consistent with those vulnerable to entering street sex work. Social networks and knowledge of a supportive group of people around the w oman is important
as a first step towards allowing the emotional abuse trauma to be uncovered and resolved.
Roe-Sepowitz (2012, p. 563) argues that “survival sex experiences were more often reported by study participants who had experienced living on the street, had
witnessed drug abuse in their families, reported a history of victimisation, had participated in criminal behaviour, and had a history of attempted suicide, family
abuse, substance abuse, and friends who sold sex.” It is implied that experiences of childhood and adulthood abuse are yet untreated and so are being dealt with
through the use of substance abuse/common tactic of running away. These are coping mechanisms that allow the street sex worker to numb herself in order to
continue living and working on the streets. This study provides us with evidence that unresolved trauma is a common factor in not only motivating a woman to
run-away from her home but is likely to be a factor in her entering into street sex work in order to provide for herself.
This is also confirmed by Simons and Whitbeck (1991, p. ?) who purport that “sexual abuse leads a girl to run-away from her offender and her unsafe home; she
then becomes involved in street life and associated social networks and develops criminal skills, including prostitution to support herself.” Sexual abuse is

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commonly reported by many of the articles analysed as a major factor in motivating a victim to run-away from her home, often with the belief that the only
opportunity they have to make money and survive is through street-based sex work. There is a clear connection with the unresolved mental injuries of being the
victim of sexual abuse that include low self-esteem, emotional distancing from sex, difficulties establishing social ties and trust issues. These all contribute to
creating a personality that is more susceptible to predation on the streets.
Stoltz et al. (2007, p. 1218) also establish an explanation of how child sexual abuse victims are vulnerable to turning to street-based sex work: “…Children who are
sexually victimised develop psychologically and emotionally in ways that make them vulnerable to continuing sexual predation… These psychological effects may
combine to create a vicious circle for many youth, wherein poor coping skills and resources are not adequate for the high-risk situations in which they find
themselves, thereby increasing their dependence on strategies such as trading sex for survival. This in turn would compound risks for which they are poorly
equipped, perpetuating a downward spiral from which it is difficult to break free without external intervention.” This idea of a downward spiral is particularly
convincing as it accurately mirrors the concept in the definitions section where repetitive circumstances lead to complex trauma; as the woman continues to
work within street-based sex work she will experience further trauma from their clients, intimate partners and even witnessing violence which in turn pushes
her further into the downwards spiral. Through this spiral it becomes ever more difficult to extract the woman from her cycle of violence and allow her to
escape street-based sex work.
Through the research shown above there appears to be academic consensus that the One25 assumption is correct. There is statistical and psychological research
that evidences that complex trauma is a contributing factor to motivating and maintaining a woman in street-based sex work.
When trying to establish motivations for entering street-based sex work there are often different paths that lead women to enter sex work to survive so it is
important not to over-generalise; street-based sex workers are not a homogenized group. However, there are patterns of motivation that do emerge from women
suffering from childhood sexual/emotional/physical trauma from an early age, and the research appears to agree that the untreated and unresolved nature of
complex trauma is an important factor in the motivation of women to enter and maintain sex work due to the psychological downwards spiral and cycle of
violence within which complex trauma traps its victims.
 The research recommends an increased awareness of issues that are central for this group, particularly child sex abuse and ongoing sexual assault
which often engenders a lack of trust and difficultly with disclosure of their experiences (Roxburgh, et al.). Eliminating stigma within services (not just
charities but for GPs, police, local mental health centres) is crucial for woman to begin to resolve their complex trauma and take a step towards
leaving street-based sex work.
 Much research on successful PTSD intervention recommends removing clients from the potential of exposure to further trauma and establishing a
safe environment, which may mean leaving the sex industry. However, sex work was the main source of income for vast majority of women,
suggesting they have limited employment alternatives. Therefore, behaviourally focused strategies have been recommended:
o Harm reduction strategies
o Relaxation techniques
o Increased awareness of mental health crisis telephone lines/services
o Mental health outreach services (Roxburgh, et al.)
 Psychological interventions for sex workers should be specifically tailored for their needs and they should be flexible as many of these women have
little stability in their lives. (Roxburgh, et al.)
 More targeted intervention programs and more integrated models of care need to be developed given the high comorbidity of mental health and
substance abuse (and the interplay between the two). (Roxburgh, et al.)
 Like in Chapters One and Two, increased social support is recommended. “Studies have shown that enhanced social support and reduced social
isolation are important protective mechanisms against past emotional abuse” (Doyle, 2001, p. 2119)
-Conclusions
The psychological effects from childhood sexual and emotional abuse are long term and ultimately destructive if left untreated. Some women may enter into
survival sex when they run away from abusive homes so at that stage is part of a desperate search for money. Others may enter into street sex work because of
childhood sexual abuse they suffered at home. Once they are within the vicious circle of street sex work, however, the unresolved complex trauma not only
exacerbates low self-esteem and depression that make them believe there is no other option, but they may also have become vulnerable to predation that may
involve getting the woman addicted to drugs.

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The relationship between complex trauma and drug abuse is interdependent and seen clearly through the perspective of a coping mechanism also known as
‘numbing’. Without psychological treatment for their unresolved trauma the women are vulnerable to remaining on the streets and following the downwards
spiral their complex trauma has constructed.

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References for Complex Trauma
Choi, K. et al. (2009) ‘Posttraumatic Stress Disorder (PTSD) and Disorders of Extreme Stress (DESNOS) Symptoms Following Prostitution and Childhood
Abuse’, Violence Against Women, 15(8), pp. 933–951. (Based in Korea)
Courtois, C. (2004) ‘Complex trauma, complex reactions: Assessment and treatment.’, Psychotherapy: Theory, Research, Practice, Training, 41(4), pp. 412–425.
(Based in North America)
Farley, M. et al. (2004) ‘Prostitution and Trafficking in Nine Countries’, Journal of Trauma Practice, 2(3-4), pp. 33–74. (Based in Canada, Germany, Mexico,
South Africa, Thailand, Turkey, United States and Zambia)
Herman, J. L. (1992) ‘Complex PTSD: A syndrome in survivors of prolonged and repeated trauma’, Journal of Traumatic Stress. Springer, 5(3), pp. 377–391.
Ozbay, F., et al. (2008) ‘Social support and resilience to stress across the life span: A neurobiologic framework’, Current Psychiatry Reports. Springer, 10(4), pp.
304–310.
Roe-Sepowitz, D. (2012) ‘Juvenile Entry Into Prostitution: The Role of Emotional Abuse’, Violence Against Women, 18(5), pp. 562–579. (Based in North America)
Roxburgh, A., et al. (2008) ‘Drug Dependence and Associated Risks Among Female Street-Based Sex Workers in the Greater Sydney Area, Australia’, Substance
Use & Misuse, 43(8-9), pp. 1202–1217. (Based in Australia)
Simons, R. and Whitbeck, L. (1991) ‘Sexual Abuse as a Precursor to Prostitution and Victimization Among Adolescent and Adult Homeless Women’, Journal of
Family Issues, 12(3), pp. 361–379. (Based in North America)
Stoltz, J.-A. M., et al. (2007) ‘Associations between childhood maltreatment and sex work in a cohort of drug-using youth’, Social Science & Medicine, 65(6), pp.
1214–1221. (Based in Canada)
Tyler, K., Hoyt, D. and Whitbeck, L. (2000) ‘The Effects of Early Sexual Abuse on Later Sexual Victimization Among Female Homeless and Runaway
Adolescents’, Journal of Interpersonal Violence, 15(3), pp. 235–250. (Based in United States)
Vaddiparti, K. et al. (2006) ‘The Effects of Childhood Trauma on Sex Trading in Substance Using Women’, Archives of Sexual Behavior. Springer, 35(4), pp. 451–
459. (Based in United States)
Villano, C. et al. (2004) ‘Psychometric Utility of the Childhood Trauma Questionnaire with Female Street-Based Sex Workers’, Journal of Trauma & Dissociation,
5(3), pp. 33–41. (Based in North America)

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Chapter 4: Family and Parenting
Assumption: Positive wider family relationships increase a woman’s and child’s support network providing increase in
emotional and practical support
Introduction
Dalla argues that ‘social bonds are considered essential for healthy functioning; isolated people, or those lacking social bonds are presumed vulnerable to
emotional, physical and social problems because they lack something essential and only available through social transactions.’ (2001, p. 1078) Dalla goes further in
their article to argue that interpersonal experiences play a crucial role in determining how, when and even if a woman will (or will be able to) leave the streets.
This interpersonal connection to street-based sex work is equally as strong when it comes to analysing some women’s entrances to sex work.
Therefore we can safely assume that positive family and social ties are important for a woman to gain the confidence and support network necessary to escape
street-based sex work. Without these ties it is unlikely that the woman will have a solid network of support to rely on and help her on her road to exiting street-
based sex work. She will be unlikely to perceive positive evaluations that will contribute to a more positive personal understanding of herself, therefore leading to
the confidence needed to exit street-based sex work. She is also unlikely to ever feel a sense of security in her life therefore leading to a lifestyle that is primarily
chaotic and erratic. From our research it is largely established that a stable and reliable financial and emotional lifestyle is what is required as a foundation
before a woman can begin exiting street-based sex work and from our research it seems to confirm that it is easier to construct a stable lifestyle if surrounded
by a familial or close social network.
Definitions
Family: includes biological, foster, adoptive, chosen relationships.
Context
A majority of the evidence that has been collected was traced down to Sloss and Harper (2003.)
Qualitative methods, including interviews and cross-questioning were used to assess emotional frame of mind in street sex workers for Harper and Sloss (2003),
proving that low self-esteem, increased anxiety for the family’s and one’s own well-being. A particular finding in these interviews, was that even with positive
family networks, inaccessibility to them was a barrier that prevented street sex-workers from reaping the emotional support they could, and increased separation
often led to more free-time to spend in increased drug use, which thrust them into a spiral where street-sex work became a problem.
Many of the assumptions in One25’s Theory of Change are causes of mothering and parental barriers, e.g. homelessness and drug abuse, reinforcing the fact
that the two aren’t compatible. For those who worked during pregnancy, or were mothers, most of them lived double-lives, as opposed to willingly or unwillingly
explaining their lives to their children, or waiting till the children found them out. This created a lot of stress and caused complex trauma and other problems.
Conversely, many mothers who were cut-off from their children also faced much stress due to little or no contact with their children. Very few mothers found
that their lives as sex-workers meant that they could positively raise their children about the world’s harsh realities. Given this exception observed by Harper and
Sloss (2003), mostly negative effects observed, e.g. unmet resources, deceiving children about job, expecting highly of elder children, hence alienating them.
In many cases, mothers involved children in negative experiences e.g. drugs and violence as well.
A study in Canada conducted with 99 street-sex workers defined ‘family’ rather broadly, and it proved that a wider, positive family network enabled
participation in leadership roles that benefitted their network of support, e.g. caring for those around them, asserting own truths in media and law, keeping the
family together. It discussed mothering specifically and stated how stigma and disrupted self-identification as a mother were strong motivational factors for
leaving street-sex. It also talked about other family relationships, and how for many street-sex workers, abuse, rejection, ‘grey areas’ between acceptance and
rejection which acted to bother psychologically, played a vital role, often determining motivation for transitioning.
Sloss, Harper and Budd conclude by saying that the incompatibility of the dual roles of being a mother and a street-sex worker is not inevitable, and can be
reduced by two major things: firstly, reduced stress. Secondly: improved working conditions, which form various other assumptions in the Theory of Change, e.g.
homes, less drug dependency, more life-skills, and reduced stress which can be put into place if women are made aware of and given greater choice of the dual
lives they may lead, e.g. women may choose to be especially cautious regarding contraception to avoid earlier pregnancies.
- Sloss et al suggests various approaches that could be used to address some of the difficulties faced by female street-based sex workers who are also
mothers: ‘One form of intervention would be to provide services to help sex workers permanently or temporarily discontinue working the street once
they are pregnant or parenting, should that be their desire. Such programs could help them access structural, financial, and employment resources”
(2004, p. 339)

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o ‘…Practical help such as welfare, parent training, healthcare, therapy, education and childcare… Mothers who are street sex workers may
need extensive services such as case management to improve their financial and living situations.’ (2004)
o ‘Parenting services, including prenatal and postnatal care, parent training, family therapy, parent support and mentoring. These women
may benefit from improved social support or the opportunity to ‘get together as mothers, as single mothers taking care of their
kids.’(2004)
o When mothers are separated from their children they are most at risk for returning to drug abuse or the re-emergence of emotional
problems which is an obstacle to their exiting street sex work: “These women could benefit from therapy to deal with their loss, as well as
assistance in attaining reunification if possible.’ (2004, p. 339)
o ‘They would also benefit from drug treatment” This drug treatment would be useful to ensure that women do not return to drug use in
this important period after her child has been taken away; extra efforts must be made to ensure that constructive progress is made, rather
than a return to drug abuse. (2004, p. 339)
o Many academics (including Sloss et al) reference the importance of services help addressing feelings of shame when it comes t o being a
mother and unsure of whether to hide profession (and therefore over compensate) or to be open about it to their children: ‘They
experienced considerable shame about being mothers and sex workers and often chose not to disclose their involvement in the sex industry
to their children and families.’ (2004, p. 330)
- Duff et al addressed the concern that many services will have obstacles for women who are street-based sex workers and more can be done to
overcome these issues in order to make pregnancy and child rearing a less stressful and 24stigmatized experience: ‘Our results demonstrate that many
sex workers experience at least one barrier to health/social supports and services while pregnant or parenting. Participants reported a wide range of
social and structural barriers, with social (i.e., stigma, lack of social support, homelessness, education) and structural factors (i.e., poverty, child
protection services, policing, lack of support services) topping the list of barriers. Participant’s history of injection drug use further compounded these
risks.’ (2014, p. 8, 10)
o ‘These services need to consider challenges faced by parenting sex workers, including homelessness/housing instability, addictions,
criminalization, fear of child protection services, violence, stigma, and a lack of social and financial resources.’ (2004, p. 13) An
understanding of the variety of issues, the interplay between the issues themselves and the consequences of these issues will likely allow the
services to help the women in a more effective way and will work towards tackling stigma in services within which women desperately
need to be open and honest (such as GPs, local health clinics and the police)
o “Given that we found that lower levels of education were associated with experiencing barriers, we suggest there is an urgent need for
services to better address the health literacy needs of women with lower education, together with improved income and educational policy
and programming supports” (2014, p. 10) – More about Education in our suggestions about additional assumptions.
o ‘…A shortage of accessible and appropriate drug treatment services and supports for sex workers who are mothers and a child protection
program [falls] short of adequately protecting children or supporting the integrity of families ” (2014, p. 11)
 As has been mentioned by Sloss (2014), interventions may include options for street-sex workers to permanently or temporarily discontinue work
while pregnant or parenting, should that be what they want. To this end, resources should be made available.
 Specific parenting services will help street-sex workers manage street-sex and mothering simultaneously. This includes increased healthcare, education,
childcare etc..
 Drug abuse and misuse are closely linked to parenting barriers, and drug treatment may help street-sex workers be become parents,
 It is especially important to target psychological catalysts that instigate drug abuse and misuse in the case of a street-sex worker who’s pregnant or a
parent. In this case: shame, sadness and guilt. Therapy should aim to resolve these factors.
 Therapy should aim to deal with the complements of parenting barriers, and the ways in which homelessness, trauma, drug abuse , etc. are linked so
as to better resolve them.
Conclusions
Family and Parenting is a largely subjective topic as the evidence has shown as every woman has their own individual backstory. However, many women have a
similar past of abuse (whether it be sexual, emotional or physical) within family settings and so it is important that we emphasise how important it is for all
relevant services to be aware of Complex Trauma and the behaviour and lifestyles that typically follow with such a diagnosis.
When a positive family and social support network is constructed it is likely that is will be simpler to exit street sex work, rather than if only supported by
negative or no support networks at all.

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References for Family and Parenting
Bucardo, J. et al. (2004) ‘A Qualitative Exploration of Female Sex Work in Tijuana, Mexico’, Archives of Sexual Behavior, 33(4), pp. 343–351.
Castañeda, X. et al. (1996) ‘Sex masks: The double life of female commercial sex workers in Mexico City’, Culture, Medicine and Psychiatry. Springer, 20(2), pp.
229–247.
Dalla, R. L. (2001) ‘Et Tu Brute?: A Qualitative Analysis of Streetwalking Prostitutes’ Interpersonal Support Networks’, Journal of Family Issues, 22(8), pp. 1066–
1085.
Dodsworth, J. (2012) ‘Sex worker and mother: managing dual and threatened identities’, Child & Family Social Work, 19(1), pp. 99–108.
Duff, P. et al. (2014) ‘Sex Work and Motherhood: Social and Structural Barriers to Health and Social Services for Pregnant and Parenting Street and Off-Street
Sex Workers’, Health Care for Women International, pp. 1–17.
Kalil, A. et al. (2003) ‘Domestic Violence and Children’s Behavior in Low-Income Families’, Journal of Emotional Abuse, 3(1-2), pp. 75–101.
Larios, S. E. et al. (2009) ‘An exploration of contextual factors that influence HIV risk in female sex workers in Mexico: The Social Ecological Model applied to
HIV risk behaviors’, AIDS Care, 21(10), pp. 1335–1342.
McClelland, G. T. and Newell, R. (2008) ‘A qualitative study of the experiences of mothers involved in street-based prostitution and problematic substance
use’, Journal of Research in Nursing, 13(5), pp. 437–447.
Read, K. W. (2013) ‘Sex work: constructing “families” with community of practice theory’, Community, Work & Family, 17(1), pp. 60–78.
Sloss, C. M. and Harper, G. W. (2004) ‘When Street Sex Workers Are Mothers’, Archives of Sexual Behavior, 33(4), pp. 329–341.

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Conclusion
In summary, it is sufficient to say that the majority of research conducted by the Social Innovation Programme team validates and supports the assumptions.
Relevant qualitative and quantitative data supports the assumptions, laying a robust foundation for the Theory of Change by One25. This research spans many
geographic areas, rather than focusing solely on Bristol, uses a variety of techniques regarding data collection, but it should be noted that it is privy to bias by
the researchers and the Social Innovation Programme team itself. Therefore, suggestions should not be considered absolutely conclusive, and should be open to
criticism and modification as future research emerges, in order to keep the Theory of Change in-line with modern advancements in society. In this respect, the
Social Innovation Programme team welcomes further research.
Housing is observed as a basic need, and significantly worsens other chaotic, entrapping factors, e.g. increasing the probability of complex trauma. It needs to be
stable, unlike bunking on a friend’s couch, and secure, unlike living with ‘pimps’ who may abuse the worker, to make a tangible, long-term impact, and can lead
to other strong changes that may stabilize a street-sex worker’s life and finally encourage exit.
Drug treatment should focus on both the improper usage of a drug, i.e. ‘misuse’ and addictive consumption, i.e. ‘abuse’ of a drug. Drugs are a strong motivating
factor which drive women into street-sex work, and are closely tied to the environment in which they work as well, making street-sex work and drug use
intertwined; nevertheless, individual and situational factors e.g. religion may impact drug usage.
Complex trauma is a very broad term, including PTSD, depression, suicidal tendencies, etc. and can develop through numerous childhood incidents, be they
physical, emotional or mental, and create a psychology that could demotivate exit and make other entrapping factors more severe.
A strong, healthy social support network can be found from any-one, not simply blood-relatives, and such a family network may encourage leadership,
motivation to exit street-sex work, stress-reduction and so on; nevertheless, parenting while working in the streets is often complicated and incompatible,and
services should be tailored to address parenting barriers.
A common theme seen in the chapters has been to target each street-sex worker individually, be it through intervention or be it through encouraging self-
motivated exit. The four assumptions are not isolated, but parts of a complex, difficult process involving exit, which may take a very long time. As a result, it is
essential to understand that these four factors are inter-linked and complementary and should be treated as such. It is also relevant to understand what needs to
happen when, e.g. initiating a process to resolve complex trauma might make a street-sex worker more enthusiastic to seek other areas of support. This
statement also illustrates interlinks between the factors researched; furthermore, no specific area of support, e.g. providing a secure, stable residence, will be
enough unless other areas of support are provided.
In the end, it may suffice to say that we hope the conclusions and findings we have derived serve to inform and educate, shed light on the complex daily lives of
street sex workers, as well as the organisations endeavouring to offer them a brighter future. Moreover, by offering comprehensive facts, the team hopes that
those reading this report develop a better-informed perspective on street-sex workers in Bristol and in other parts of the world, and the lives they lead.
, summarise again the few points that don’t support the assumptions. The conclusion should be a general summary of everything the reader has
just read. Something that could be added would be if there are any general critiques or recommendations about their theory of change or their
method of research and collecting evidence that you guys would like to add, on top of the more assumption-specific suggestions you’ve made?

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