Innovative Support Strategies for Sex Workers: A Look Beyond Illicit Substance Use

FACILI A !"S# $UI%& A'% (A'UAL

"AI'I'$

Lauren Casey and *ody +aterson %ana %eane- Lisa !sbitsc)- and Barbara S.it) )e Canadian 'ational Coalition of &xperiential Wo.en+&&"S /ictoria- and Crossroads reat.ent Centre Society

Aut)ors:

In Collaboration ,it):

)is pro0ect ,as gratefully funded by /ancouver Foundation- +olicy %evelop.ent Contribution +rogra.- +ublic Safety Canada- and Status of Wo.en Canada

/ancouver Foundation

ABL& !F C!' &' S:

12 Introduction 52 Sex Work in Canada: 326 42 Stages of C)ange 82 "ecruit.ent of +articipants 319 :2 "unning t)e (odel in a "esidential Setting 31; 92 "unning t)e (odel in an !utpatient Setting 354 62 Facilitators $uide 35; 324

rends in La, and "esearc)

327

;2

)e Curriculu.: 349

raining on t)e (odel

<

72 Working ,it) t)e Co..unity 381

1=2

A Final Word

386

Appendixes: A2 "eferences B2 !vervie, of t)e C'C&W 3 :8 3 :1

SWA

>Sex Workers Addressing

reat.ent?

A pilot program for sex workers only

This program is designed to address issues sex workers face when leaving the sex industry. The curriculum has been developed by Barbara Smith and Lauren Casey, in consultation with sex workers. special note! when delivering this program, always remember to acknowledge the traditional territory of the people whose land you are on. "e would like to acknowledge the #irst $ations people across Canada. The manual and accompanying curriculum are about women%s sex work issues only. "e cannot develop or speak to what we are not. There is no disrespect whatsoever.

Lauren Casey has a Masters Degree in

Sociology/Criminology, specializing in women, sex work and substance misuse issues She has worked with a number of organizations regionally and nationally that are committed to the ad!ancement of e"uality and human rights for sex workers, stri!ing to impro!e their li!ing and working conditions Ms Casey has deli!ered groundbreaking presentations at the national and international le!el, speaking on the necessity of bringing the experiential !oice into public policy, programs and ser!ices directly relating to substance misuse, access to health care and sex work

%ana %eane is a Masters #e!el Social $orker and

an internationally certified addictions counselor Deane is an excellent public speaker and facilitator with o!er thirteen years of experience She has designed and implemented se!eral outpatient addiction programs, and is currently a doctoral student at the %ni!ersity of &ritish Columbia 'kanagan Ms Deane has worked intensi!ely o!er the last thirteen years with both groups and

indi!idual women whom are struggling with addictions, !iolence, homelessness, po!erty, stigma, (ASD and sex work issues As a strong ad!ocate for many marginalized groups of women, Ms Deane feels moti!ated to assist sex workers in examining the o!erarching contexts of their li!es.

Barbara S.it) is a social worker and past director of

)rostitutes *mpowerment *ducation +esource Society ,)**+S- As a former sex worker, &arbara was a dri!ing force in the creation of a number of non.profit organizations and belie!es strongly in the experiential !oice She coordinated a three.year national pro/ect with 0ealth Canada focusing on awareness and support for those affected with (ASD ,(etal Alcohol Spectrum Disorderand those needing support throughout their pregnancies

Innovative Support Strategies for Sex Workers: A Look beyond Illicit Substance Use

raining (anual and Curriculu.

Introduction
$orking with indi!iduals who ha!e been in!ol!ed in the sex industry re"uires a skilled and non./udgmental approach that recognizes the distinct culture of sex work and the impact that has on the people who work in the industry 1his manual is intended to inform and support professionals who are interested in working with people in the sex industry who are addicted to illicit substances and alcohol 1here is no one path into the sex industry and no single experience that sums up what it means to ha!e been a sex worker (or the 23.43 per cent of workers who are on the streets, personal challenges may include mental illness, a history of abuse, addiction, post.traumatic stress disorder, li!ing with !iolence, (etal Alcohol Spectrum disorder, learning disability, homelessness and trauma (or indoor workers ,escort, massage, dancer, etc-, issues may be less ob!ious but still challenging 1hose who want to lea!e the sex trade also face the significant challenges of transitioning to mainstream culture 1his manual is designed for front.line workers working with people who ha!e been in!ol!ed in the sex industry and are also addicted to illicit 4

substances 5t pro!ides practical and realistic strategies for working with adults who ha!e been in!ol!ed in the sex industry and are seeking ways to reco!er from an addiction and transition out of sex work 1he group that has put this manual together, the Canadian 6ational Coalition of *xperiential $omen, is an organization of women with personal backgrounds in the sex industry $hile the members of the coalition each ha!e their own !iews on the industry due to their wide.ranging experiences while in it, they are in agreement that the people who are best.informed about the needs of those with sex.work backgrounds are the sex workers themsel!es 5t7s important to !alue the experiential !oice when working with sex workers, and recognize that sex workers are the experts in their own li!es $e extend our thanks and appreciation to the many past and current sex workers who contributed to the de!elopment of this manual and curriculum

W)at to &xpect Fro.

)is (anual

1his manual has been prepared by and for people with sex.work backgrounds, and includes a uni"ue sex.worker.de!eloped curriculum that goes beyond the issues of addiction to focus on topics that are particular to sex work 1his text will8
*xplain and introduce sex work as well as illicit drug use 'ffer useful ways to recruit participants for the model 9i!e hands.on tools for running the model in residential treatment settings as well as in a community.based, outpatient setting )ro!ide guidance and tips for facilitators who may not be familiar with this population 'ffer inno!ati!e ways to work with the community 0elp you recognize some of the beha!ioral traits commonly displayed by those who come from sex work backgrounds 0elp you support yourself as a worker or caregi!er with people who ha!e been in!ol!ed in sex work *xplain why traditional drug treatment programs seldom work for this population )ro!ide insight into the complexities of working in the sex industry 9uide you in taking a practical, hands.on approach that empowers women to face the issues that ha!e resulted from their work in the sex industry

)ro!ide a first.stage treatment tool for those seeking to transition out of the sex industry and needing inno!ati!e programming if they7re to be successful

1he manual includes information on the 1ranstheoretical Model of the Stages of Change, as well as tips on facilitating groups of women with sex. work backgrounds based on con!ersations with facilitators at )**+S :ictoria . a grassroots non.profit . and at Crossroads 1reatment Centre in ;elowna, & C , where the curriculum was piloted in the summer of 433< A special thanks to #isa 'sbitsch, who is currently facilitating S$A1 at )**+S :ictoria, and to Dana Deane, who facilitated these workshops at Crossroads 1reatment Centre during the summer of 433<

Background:
+esearch conducted on the impact on health status of sex work and illicit drug use has tended to focus almost exclusi!ely on sex.related illnesses, disease and !iolence ,)yett = $arr, 2>><? (arley, 2>><- 1he standard approach has been to focus on issues related only to substance use, and there is !ery little information that takes into account the many factors in a woman7s life that are directly related to her time in the sex industry 1raditional treatment programs ha!e thus been a poor fit with this population, as the risks of illicit substance use need to be !iewed in the context of other hardships ,such as po!erty- and in con/unction with issues particular to sex work if a course of treatment is to be maximally effecti!e 1his manual documents the effecti!eness of a 433< nationally funded pilot addictions treatment program for sex workers in a &ritish Columbia residential treatment facility, as well as ongoing use of the curriculum at the )rostitutes *mpowerment *ducation and +esource Society, a grassroots non.profit in :ictoria, & C 1his treatment model is uni"ue in Canada due to its taking into account the myriad issues sex workers face when lea!ing the sex industry $orking in the sex industry can be as addicti!e as drugs or alcohol for some people &y offering alternati!e treatment solutions, this groundbreaking model designed by and for sex workers pro!ides an effecti!e strategy for the complex issues of addiction and sex work

)e &xperiential /oice
1he importance of @experientialA knowledge as it relates to research, policy, programming and capacity.building among marginalized communities cannot be stressed enough when discussing strategies for dealing with illicit substance use treatment among people with a sex.work background An @experientialA person has first.hand, li!ed experience of illicit substance use and sex work in their past 1his manual comes from the point of !iew that past and current sex workers are the experts of their own li!es #i!ed experience produces uni"ue, pri!ileged knowledge that has been used to de!elop, design and deli!er this program 1his manual has been designed by women with direct experience in sex work and illicit substance use and has pro!en to be a successful reco!ery tool for this population $e strongly recommend that organizations wanting to optimize their success in working with people with backgrounds in sex work and illicit drug de!elop mentoring and employment opportunities that will support sex workers in becoming the 7

next generation of facilitators and staff of programs and ser!ices aimed at this population

C@A+ &"

W! rends in La, and "esearc)

Sex Work in Canada:

1he sale of sex between consenting adults is legal in Canada 1he long.standing laws against prostitution in Canada7s Criminal Code are primarily aimed at restricting any marketing or communication between customer and seller, particularly on the street, and at controlling exploiti!e aspects of the industry such as trafficking, pimping and the buying of sex from children ,under age 2B5n terms of criminal charges, all but fi!e or so per cent of prostitution. related charges laid in Canada in a typical year in!ol!e the buying and selling of sex on the street 5n the early 2>B3s, concern about the nuisance aspects of the street prostitution trade pro!ided the main stimulus for research funding $hen the federal go!ernment initiated research, public nuisance concerns shaped research "uestions Most of the sur!eys of the 2>B3s and early 2>>3s in!ol!ed street prostitutes? the li!ed experience of indoor sex workers has not been well.documented +esearch also began to emerge in that period specifically related to increasing concerns about 05:/A5DS, much of which presumed widespread infection among sex.industry workers 1hat is not actually the case, howe!er? the actual infection rate among sex workers is estimated to be !ery low, around fi!e per cent &y the mid.2>>3s, the bulk of sur!ey research was de!oted to youth, which later research characterized as academic work that ine!itably linked prostitution with !ictimization +ecently in Canada, there ha!e been discussions arising among politicians about decriminalizing most aspects of adult prostitution Much debate has ensued in the academic world about whether such actions are wise, with some arguing that legalizing or decriminalizing prostitution merely grants men @moral and social permissionA to buy sex 'thers argue that the research is incomplete, as little work has been done on the significant population of adult sex workers who choose to work in the industry and belie!e themsel!es to be neither !ictims nor exploited $hile researchers and police estimate that as much as B3 to >3 per cent of the sex industry operates indoors, the research continues to in!ol!e primarily outdoor workers, whose experiences cannot be assumed to be the 8

same as those who work indoors (ew studies ha!e included a wide di!ersity of backgrounds, identities and locations in their samples . and those that ha!e don7t often highlight these workplace !ariables as sources for understanding !ariations in experience 1his manual aims to go beyond the street sex trade in order to explore the relationship between drug use and sex work among a more di!erse group of sex workers 1he curriculum has been de!eloped by and for sex workers, including indoor and outdoor sex workers with a !ariety of personal experiences in the industry 1he training offered throughout this manual thus focuses on both indoor and outdoor sex workers who may ha!e worked in any number of sex.related aspects of the industry . prostitution, erotic massage, exotic dance, adult film, 2.>33 phone lines, and 5nternet 6o assumptions are made as to their personal li!ed experiences in the industry? the curriculum is specifically de!eloped to be able to allow people from di!erse backgrounds in the industry to find common ground 1his curriculum is intended to be used as a grassroots !ehicle for bringing together and empowering sex workers in your community $hen deli!ering the curriculum, please remember that all aspects of it are intended to be done in con/unction with sex workers, including facilitation of the workshops $e also anticipate that the curriculum will change o!er time and in !arious ways to suit the needs of sex workers in a particular community 1hat is how it should be under a grassroots model, as the most important consideration in deli!ering this curriculum is that it stays @realA for the participants as it supports them in finding their own !oice 1he o!erall goal of the curriculum is to empower past and current sex workers in li!ing healthier, happier li!es free of addiction

For me, this program created heightened selfawareness around triggers. I recognized my triggers and where they were coming from. Prior to SWA , I would react without !nowing why, and after ta!ing the SWA program I no longer reacted to my triggers. I would feel my triggers and then I would act differently. I highly recommend this program -- I learned so much a"out myself.# 9

)rogram )articipant, &ritish Columbia

10

C@A+ &"

@"&&

Stages of C)ange
1he work that researcher and clinician Cames )rochaska is doing these days might not appear to ha!e much to do with a training manual for those working with sex workers and addiction )rochaska is currently director of the Cancer )re!ention +esearch Centre and a professor of clinical psychology at the %ni!ersity of +hode 5sland &ut many years ago, he was simply the son of a depressed and addicted father, looking for ways to help his father stabilize his life $hat )rochaska obser!ed in that period, combined with what he learned later while working with a group of people trying to "uit smoking, became the basis for one of the most powerful models explaining how people bring about beha!ioural change in their li!es )rochaska and fellow researcher Carlo DiClemente came up with a fi!e.stage model of change to help professionals and ser!ice agencies understand their clients with addiction problems, and de!elop strategies for each of those stages that would support people in making change A sixth stage was added later 1he model is based on the researchers7 personal obser!ations of how people went about modifying !arious problem beha!iors . smoking, o!ereating and substance misuse, primarily, although the staged model of change can be applied to !irtually any beha!iour 1he six stages of the model are8

precontemplation contemplation determination action maintenance termination

%nderstanding the model and what stage of change people are at can help you tailor group work and e!en con!ersations in ways that make learning more rele!ant for people regardless of the stage they7re in 1he Stages of Change model is both practical and intuiti!e

11

0ere7s a poem from the late )ortia 6elson, which uses a metaphor of a walk down the street to illustrate )rochaska7s original fi!e stages of change $e7ll then take a deeper look at each of the stages of change

@&"&AS A @!L& I' (B SI%&WALC

Autobiograp)y in Five S)ort C)apters By +ortia 'elson

C)apter !ne 5 walk down the street 1here is a deep hole in the sidewalk 5 fall in 5 am lost 5 am helpless 5t isnDt my fault 5t takes fore!er to find a way out

C)apter ,o 5 walk down the street 1here is a deep hole in the sidewalk 5 pretend that 5 donDt see it 5 fall in again 5 canDt belie!e 5 am in this same place &ut, it isnDt my fault 5t still takes a long time to get out C)apter Four 5 walk down the same street 1here is a deep hole in the sidewalk 5 walk around it

C)apter )ree 5 walk down the same street 1here is a deep hole in the sidewalk 5 see it is there 5 still fall in itDs a habit but, my eyes are open 5 know where 5 am 5t is my fault 5 get out immediately

C)apter Five 5 walk down another street

12

First stage$ Precontemplation %&hapter 'ne( )eople in the precontemplation stage of change are not thinking about changing a problem, beha!iour, or e!en that it7s a problem 5f others point out the problem to them, they often think the person is exaggerating DiClemente talks of @the (our +sA that typify why somebody remains in this stage E reluctance, rebellion, resignation and rationalization8

+eluctant precontemplators are those who through lack of knowledge or inertia do not want to consider change 1he impact of the problem has not become fully conscious +ebellious precontemplators ha!e a hea!y in!estment in the beha!iour at hand, and in making their own decisions 1hey resist being told what to do +esigned precontemplators ha!e gi!en up hope about the possibility of change and seem o!erwhelmed by the problem Many in this category ha!e made repeated attempts to "uit or control their problem beha!iour +ationalizing precontemplators ha!e all the answers as to why their beha!iour is not a problem, or why it7s a problem for others but not for them wo(

Second stage$ &ontemplation %&hapter

5n this stage, people are willing to consider the possibility that they ha!e a problem, which offers hope for change 0owe!er, they may be extremely ambi!alent 1hey are on the fence Contemplation is not a commitment to change, but rather an opportunity for ser!ice pro!iders to gi!e people more information )eople at this stage are often "uite interested in learning more about their problem beha!iour and potential treatments for it 1hey know that they ha!e a problem, and often a mental list to go with it of all the reasons that a particular beha!iour is bad for them &ut e!en with all these negati!es, they still can7t make a decision to change 5n the contemplation stage and with the right support, people can make a risk.reward analysis 1hey will weigh the pros and cons of their beha!ior, and the pros and cons of change 1hey reflect on pre!ious attempts they ha!e made to stop the problem beha!iour . misusing drugs, for instance . and what caused them to fail 13

hird stage$ )etermination %&hapter

hree(

1his stage is marked by a commitment to action (or someone with an addiction, a decision to stop using is the hallmark of this stage of change 1he weighing of pros and cons and the risk.reward analysis has tipped the balance in fa!or of change 6ot all ambi!alence has been resol!ed, but ambi!alence no longer represents an insurmountable barrier to change Most people in this stage will make a serious attempt to stop their problem beha!iour in the near future 1he stage represents preparation as much as determination $hat the person will need to do next is de!elop a realistic plan Commitment to change without a framework of appropriate skills and acti!ities can create a fragile and incomplete action plan $ith the right support geared for the stage they are in, people will make a realistic assessment of the le!el of difficulty in!ol!ed in stopping their beha!iour 1hey will begin to anticipate problems and pitfalls, and de!elop concrete solutions as part of their ongoing treatment plan

Fourth stage$ Action %&hapter Four( 5n this stage of change, people put their plan into action 1his stage typically in!ol!es making some form of public commitment to stop the beha!iour in order to get external confirmation of the plan 5f they ha!e not done so already, people in this stage may enter counseling or some form of treatment, start to attend Alcoholics Anonymous or 6arcotics Anonymous meetings, or inform their family members and friends about their decision Sometimes the action plan in!ol!es all of the abo!e Making such public commitments not only helps people obtain the supports they need to reco!er from the beha!iour, but creates external monitors )eople can find it !ery helpful to know that others are watching and cheering them on And while there are others in their life who may "uietly be hoping for failure . one person7s success only highlights another7s inability to affect change in their own li!es, after all . one of the 14

many pleasures of changing problem beha!iour is the opportunity to dispro!e the negati!e predictions of others A person in this stage who is able to implement a good plan will benefit considerably when she sees it beginning to work o!er time $hate!er the problematic beha!iour has taken from the person will begin to be restored, as will hope, self.confidence and ongoing determination to maintain the change

Fifth stage$ *aintenance %&hapter Fi+e( 1he action stage will typically take three to six months to complete, and sometimes much longer Some people in reco!ery belie!e they will always be in this stage, and will need to work acti!ely for the rest of their li!es to maintain reco!ery Change re"uires building a new pattern of beha!ior o!er time 1he real test is long.term sustained change o!er many years 1his stage is called @maintenance A (or someone in this stage coming out of an addiction, a drug.free life is becoming firmly established, and the threat of a return to old patterns is growing less intense and less fre"uent &ecause addiction is a chronic disease, the possibility of relapse is always present 5ndi!iduals may experience a strong temptation to use, and not be able to cope with it successfully +elaxing their guard or @testingA themsel!es can begin a slide back (ortunately, people at this stage of change are armed with a !ariety of relapse pre!ention skills 1hey know where to get the supports they need )eople with addictions who relapse learn from the relapse 5t7s important to recognize that relapse is part of the reco!ery process 1he experience of relapsing and returning to sobriety often strengthens a person7s determination to stay sober Si,th stage$ ermination

1he ultimate stage in the change process is termination At this stage, the reco!ering addict no longer finds that drugs and alcohol present a temptation or threat She has complete confidence of being able to cope without fear of relapse 1his stage was added after the other fi!e were de!eloped, and remains contro!ersial among those who belie!e !igilance against relapse will be necessary for a lifetime for those with addiction 15

0ow would a full.ser!ice agency structure itself if it were trying to

pro!ide a continuum of ser!ices to take people through all the stagesF 5t might pro!ide8 'utreach, low.barrier group work and harm.reduction ser!ices to those in pre.contemplation *ducational, non./udgmental workshops and counselling for those in contemplation More intensi!e counselling, strategies for coping and the opportunity for treatment for those in the determination stage (or those in the action stage8 )ractical support to help people connect with a healthy community that they may not be familiar with? workshops focused on empowerment and personal de!elopment? recreational opportunities? help with de!eloping a @new lifeA that maintains healthy beha!iours 'ngoing support groups and social opportunities for those in the maintenance stage, including regular AA and 6A meetings ,or other 24.step groups suited to the problem beha!iour- for those who are following an abstinence.based strategy

Strategies for using t)e Stages of C)ange .odel

5n a group setting, you may be working with people who are all in different stages of change Consider which stage of change your workshop material is best suited for, and strategize for methods that would make it adaptable for people in different stages Ask people where they see themsel!es in the stages of change, and encourage discussion and thought around the pros and cons to indi!iduals in terms of both remaining at a particular stage, and progressing to the next one

0ere are some tips to help you get started8

16

&. Tailor the tactic to the stage. Don7t approach somebody in the first stage the same way you would approach somebody in Stage 1hree Determine where that person stands in the stages, and tailor your message to reach them where they7re at

1his approach will also keep you focused, and pre!ent you from /umping ahead before a person has shifted in their thinking Gour goal is to understand the stage people are at, and to support them in mo!ing to the next stage if that7s what they are indicating they want to do So if a particular person is at Stage 1wo, your ob/ecti!e is to mo!e them to Stage 1hree

'. (ove one stage at a time. Don7t expect to mo!e people from Stage 'ne to Stage (i!e in one fell swoop 'nce you ha!e established that change is wanted, the better goal is to work to influence an indi!idual through each of the stages, one stage at a time &uild bridges across stages . and help people see how they can maintain those bridges o!er time ). llow time

+ecognizing that stages can7t be skipped, it7s ob!ious that achie!ing the final stage might take a long time for somebody to achie!e $hile the ultimate goal is habit, it takes !arying amounts of time . years, in some cases . for people to mo!e through the stages &e patient and supporti!e, and guide people toward supports and ser!ices that are tailored to the particular stage they7re at

here-s no shame. he program is an enlightment. It allows women to not feel isolated. .ou
17

feel +alua"le. .ou can e,press pain. .ou don-t feel ashamed.#

SWA

progra. participant

18

C@A+ &" F!U" "ecruit.ent of +articipants

+ecruiting sex workers to participate in this program will primarily be accomplished through word of mouth or through the circulation of posters at key agencies, which are the most effecti!e means of reaching this population 5f your group or agency does not currently work with sex workers, you will first need to connect with other groups in your community that are 1hose already working with past and current sex workers struggling with addiction can begin by asking them if they would be interested in a treatment program specifically designed for sex workers, by sex workers 1he agencies most likely to be ser!ing outdoor sex workers will be those with a primary focus on street issues, help with housing, and support with mental health and addiction issues ,shelters, transition houses, needle exchange, street drop.in, etc-, although sex workers may ha!e chosen not to identify at these agencies so confirmation of that may need to be done at a later date Check for treatment facilities in your area that are already running the program 5f there are none and you are planning to run the program yourself, you will want to train facilitators to work with the specialized curriculum and ensure you ha!e sufficient networks and connections within the sex.work population to establish a group size of approximately fi!e to 24 participants 1he curriculum used in this training model was piloted simultaneously in the summer of 433< at the Crossroads treatment centre in ;elowna, & C , and at the )rostitutes *mpowerment *ducation and +esource Society ,)**+S- in :ictoria, & C At )**+S, the curriculum was incorporated into a larger six.month program designed to help people o!ercome their personal challenges and make a successful transition into mainstream work 1he program continues to be deli!ered at )**+S by experiential facilitators? at Crossroads, the non.experiential facilitator was trained by the experiential staff from )**+S Crossroads ran the pilot fi!e nights a week o!er a four. week period, and worked with 2H participants in total )**+S participants typically hear through friends and word of mouth about the ser!ices and programs offered by the grassroots non.profit Many initially come to )**+S because they ha!e heard through ac"uaintances that they can be fast.tracked onto income assistance Most sex workers in 19

& C would ha!e a difficult time "ualifying for assistance otherwise, due to a re"uirement that they be able to pro!e two years of pre!ious paid work experience 1hey are also drawn to )**+S because of the organization7s practice of hiring former sex workers whene!er possible to de!elop and run its programs and ser!ices @My friend said it7s a really cool place because of no /udgment,A noted one participant 'utreach can also be a useful tool for recruitment )**+S pro!ides late.night outreach on the outdoor prostitution stroll se!en nights a week, > p m to 2 a m 1he addiction rates are well o!er >3 per cent among the 233 or so outdoor sex workers ser!ed by the program and many are eager for additional support and ser!ices 1his is a challenging group to work with due to their many barriers, howe!er, and it is recommended that facilitators be well.!ersed in working with people with addictions and ideally, with sex workers @5n.reachA is an e"ually important strategy for reaching indoor workers, who constitute B3.>3 per cent of all sex workers 1his is a much harder group to reach due to the in!isibility of the indoor industry )**+S has had some luck accessing escort agencies by de!eloping working relationships with the owners and helping organize ser!ices to those workers . the pro!ision of free beauty treatments such as hairstyling and manicures, for instance, or organizing a !isit from the health nurse for !accinations &eing able to access indoor sex workers in your community will take time and patience, and will almost certainly re"uire experiential people to help make those connections 5deally, you will work on de!eloping a relationship o!er the long term with the indoor workers 1hey risk a great deal in coming forward as sex workers, so are not likely to identify unless they7!e de!eloped a trust and are sure it7s @safeA to do so &eyond recruitment, maintaining attendance can be a significant challenge in working with people with addictions, who are likely to be in !arious stages of change and in many cases dealing with ma/or personal issues )**+S has found that many sex.work participants respond well to @perksA for good attendance . a gift certificate at a local grocery store, for instance Such perks are particularly useful for outdoor workers, most of who are li!ing in po!erty 1he curriculum has been de!eloped in such a way that while all 43 components are related to each other and build on the pre!ious session7s lesson, they are also free.standing and can be taken in any order 1his feature is particularly important in non.residential settings, as you will need to ha!e a plan flexible enough to work around participants7 absences and 20

allow them to retake any classes they missed the next time the series is held 5ndoor workers are less moti!ated by gift certificates and will need solid programming, an experiential focus in program deli!ery, and con!enient hours if they are to stay engaged in a non.residential setting

C@A+ &" FI/&

"unning t)e (odel in a "esidential Setting
D/+ery single one of the women had clinically

significant issues - mental health, Post raumatic Stress Syndrome, personality disorder. Add to that their relationship conflicts that played out in the group, their trust issues, and drugs, and it "ecomes paramount to ha+e a facilitator who can manage through all that. .ou need someone who is a"le to wor! li!e a clinical therapist. hese are incredi"ly traumatized women who need a +ery s!illed negotiator who can help them na+igate the things that come up yet still get the information across. his wor! is not a wal! in the par!, or for the wea! at heart. 0ut it-s sacred wor!, and I en1oyed e+ery minute of it.#
%ana %eane- Crossroads facilitator

1he curriculum for the Sex $orkers Addressing 1reatment ,S$A1program was run three times o!er three months in the spring and summer of 433< at Crossroads 1reatment Centre in ;elowna, & C A total of 2H participants took the 43.workshop program in that period 1he le!el of enthusiasm among the women was heartening proof that people desperately want the opportunity to get into addiction.treatment programs designed with their life experience in mind

21

A great deal was learned through this pilot pro/ect, and we will attempt to highlight the key lessons in this chapter 1here were se!eral challenges on se!eral fronts, starting from the moment that a woman indicated her interest in taking the program Some of those challenges were directly related to ha!ing to transport people to a city se!eral hours away, but other challenges will be similar e!en if the treatment facility is in the city where the participant li!es

1he ma/ority of the participants throughout the pro/ect were clients of )**+S :ictoria 9etting them to ;elowna re"uired arranging for ferry, bus and taxi transportation there and back 1his might not be a particular challenge for a mainstream population, but there are many barriers for anyone still in their addiction, let alone those who are also street. entrenched and homeless Much ad!ance planning is re"uired, and the !arious personal issues of indi!idual participants need to be factored into the plan at e!ery stage $e strongly recommend that if there are support staff that will be working @long distanceA with women in a residential treatment facility, that those workers !isit the facility in ad!ance and get a full understanding of the facility7s policy and procedure, layout, and culture, all of which will impro!e the experience for e!eryone and smooth out the ine!itable crisis +reEtrip c)allenges: . Clients were excited but ner!ous at the prospect of lea!ing town for treatment, and needed considerable amount of support plus detailed information on the treatment centre and the program to help them make their decision 5n fact, they needed support throughout the entire process Assuring a reser!ation on the bus re"uired that a passenger show identification, which many didn7t ha!e )**+S has a special agreement in place with 9reyhound due to encountering this same problem in the past, but there were still se!eral problems due to few 9reyhound staffers being aware of the agreement ,See attached example special tariff agreement between 9reyhound and )**+S&us times needed to be carefully chosen to a!oid people @/umping shipA partway . addiction is a powerful force, and the risk was that people wouldn7t make it past :ancou!er $e chose e!ening departures that tra!elled o!ernight, although that brought up another challenge8

22

)**+S staff then had to work late in order to ensure the woman got to the bus terminal on time . 1axi arrangements and fees ,from the ;elowna bus depot to the treatment centre, and back again- were challenging to figure out long. distance Clients coming from shelters had !irtually no possessions or money )**+S pro!ided a @treatment packA that included toiletries, clothing and pa/amas, but staff would need to accompany women to the store to buy those goods because cash in the hands of people in an ad!anced stage of addiction would almost certainly not end up being spent on clothes )**+S also had to pro!ide the I43 laundry fee re"uired by the treatment centre

)articipants needed to be on income assistance if the treatment centre fees were to be co!ered by go!ernment )**+S has a contract with the *mployment and 5ncome Assistance Ministry to @fast.trackA people onto income assistance if they7re coming out of the sex trade and into the )**+S.run six.month program *lements, but such contract pro!isions are uncommon and other agencies may ha!e to de!ote resources to helping clients get on income assistance ,Sex workers in particular face problems in &C, as the nature of their business doesn7t lea!e the necessary paper trail to pro!e two years of pre!ious work history (edicalFLegal Issues

Clients needed to ha!e tuberculosis tests done in ad!ance 9i!en the emergency nature of many of the referrals, this pro!ed challenging to make happen in a hurry 1he co.operation of a :ictoria street clinic was essential Clients7 prescriptions needed to be transferred to treatment centre, and a sufficient supply ensured to get them to the centre Crossroads accepts people on methadone, but many treatment centres do not? that would ha!e dis"ualified many of the )**+S referrals Some treatment centres also don7t allow smoking, which can be a ma/or barrier in con!incing people to go Some people turned out to ha!e charges pending and a date to appear in court, and would ha!e been in serious legal trouble if they had gone to ;elowna and missed a court appearance &e sure to en"uire about

23

this and either make arrangements to change the court date, or hold off referral until after the charges are dealt with C)allenges at t)e centre: . +elapses ine!itably happened, stranding women in a strange city when they were asked to lea!e treatment )**+S support workers kept a list of cheap motels and emergency shelters in the ;elowna area so clients who relapsed and ended up being asked to lea!e the centre could be "uickly referred to alternate accommodation )eople who relapse can be re"uired to lea!e for as long as a month before being allowed to return, so being prepared for this aspect is essential $omen needed at least a little spending money to use at the treatment centre canteen Consider setting up a I43 canteen account for each person at the facility

&ecause the S$A1 program was deli!ered in the e!enings as an @add onA to the rest of the treatment program, those taking the program were automatically identified as sex workers Due to the extreme stigma around the sex industry and the people who work in it, other clients and e!en some staff initially treated S$A1 participants with suspicion and /udgment ,'ne client was o!erheard talking about the S$A1 participants and saying, @$ell, at least 5 ne!er let things get 10A1 bad A- 1his issue was resol!ed through a meeting of e!eryone at the centre to discuss the problems, which dissipated "uickly once people understood S$A1 and the people taking the program Many of the S$A1 participants had ne!er done any kind of therapeutic work or counseling, and their emotions and cumulati!e li!ed experiences were !ery close to the surface Crossroads facilitator Dana Deane recommends that the groups be run by two well.trained, seasoned facilitators8 one to deli!er the workshop and the other to offer support to participants as needed as they respond to the sub/ect matter It is essential to t)e success of t)is curriculu. t)at one of t)ose facilitators )as a personal background in sex ,ork2 ,$e will discuss that point further in Chapter 23 1reatment centres typically feature a @psycho.educationalA curriculum, as opposed to doing therapeutic work 1he S$A1 program, howe!er, tended to create much more of a therapeutic en!ironment in the classroom due to the way participants reacted to the topics 1hat

24

presented challenges to the treatment facility in terms of offering additional support to people after a class ended, as those extra hours were not built into the plan Deane recommends building in an extra hour of support per client per week . 6ot all staff understood this population or the specialized curriculum $hile facilitators in particular need to be well.trained, all centre staff should get some training on the issues and challenges of this population before the residential program is launched (acilitators need to be prepared to @shareA themsel!es during group work $hile traditional facilitation places facilitators outside the experience, sex workers will be sharing intimate details of their li!es in the groups, in some cases for the first time 1hey will look to the facilitator to share something of herself as well, or otherwise are at risk of checking out of the process and not engaging due to a lack of trust @1he only thing they7!e experienced is /udgment, stigma and marginalization,A says Deane @1hey want to know who G'% are A

1raining and experience is essential for facilitators taking on this work, as these challenging participants will push the limits A three.day training session run by experiential trainers has been de!eloped to help people wanting to work with this curriculum and sex workers in general Contact #auren Casey at ,4H3- 43B.H2<J for more information (acilitator needs to be prepared to ad!ocate for the participants to other staff, who may be reluctant to accept the high needs of this population +ostEtreat.ent c)allenges:

'ngoing support is essential 1he group participants who were from ;elowna or who remained in ;elowna after completing the program ha!e continued to meet once a week under the guidance of Dana Deane She strongly recommends setting up a similar @after careA program 1his program will ideally run weekly for se!eral months after the course has finished, and could possibly become a permanent support group for sex workers to stay connected Clients who had been staying in a shelter when they went into treatment had no housing to return to after completing the program 1his was a recipe for an instant relapse and a rapid return to street life

25

5t7s !ital that at the !ery least, a month of housing be arranged for people who are returning from treatment, and that they be supported immediately upon their return in finding longer.term housing and connecting into programs that will help them maintain sobriety and continue their /ourney toward a happier, healthier life . 1o a!oid a return to their pre!ious lifestyle, participants will need to be supported to connect into new peer groups and new, drug.free acti!ities +unning the S$A1 program as part of a larger program is the most effecti!e way of ensuring that supports, counseling and acti!ities will continue to be a!ailable to participants after S$A1 has been completed

*+%m not alone. There are lots of organi,ations like $ or , but with S" T, it was nice to have a place to go to talk about your experiences with others in the sex trade.S$A1 participant

C@A+ &" SIG

"unning t)e (odel in an !utpatient Setting
)e +&&"S &xperience A four.week workshop !ersion of the curriculum that makes up the Sex $orkers Addressing 1reatment program has been running at the non. profit )rostitutes *mpowerment *ducation and +esource Society in :ictoria, & C , since May 433< )**+S was selected to pilot this pro/ect both because it has a well. de!eloped six.month program that is already ser!ing H3 to K3 past and current sex workers a year, and because it is a grassroots, experiential organization that is well.suited to deli!ering this type of program Aside from ha!ing backgrounds in the sex industry, the clientele at )**+S for the most part are also facing addiction problems

26

1he S$A1 curriculum is part of the )**+S *lements program, which has been designed to work effecti!ely with clients who are still in their addiction or newly in reco!ery and need support, therapeutic and educational workshops, and carefully managed coursework that suits each client7s @stage of change A 1o that end, Month 2 of the *lements program features /ust three afternoons a week of class work and has a primary focus on the earliest stages of reco!ery from addiction S$A1 is introduced in Month 4, when participants begin attending four days a week and are generally in a better state of mind for beginning more challenging coursework 1hey take a different S$A1 workshop four days a week for fi!e weeks 1he )**+S intake process for *lements in!ol!es the completion of a simple contract with the & C Ministry of *mployment and 5ncome Assistance establishing that contracted ser!ices will be pro!ided to a specific client o!er the next six months 1here is monthly intake into the program 5t7s up to go!ernment to confirm who will be accepted into the program, but most people who apply to come into the program are accepted 5f they are not on income assistance, there are @fast trackA measures to help people get on income assistance, which is a ma/or benefit to participants and often a prime reason for people wanting to attend the program

27

0ighlights from a client7s perspecti!e are the monthly intake . allowing the program to become a de facto @detoxA for those unable to access other ser!ices but needing daily support if they are going to maintain reco!ery . and a month.end @rewardA for those who keep up their attendance and !olunteer hours of between IH3 and I4J3 a month in department.store gift certificates 1he intake process takes no more than L3 minutes, although that time may be longer if the client needs to talk 'nce the go!ernment has indicated acceptance . a process that can take anywhere from a couple of days to two weeks . an appointment is made with a designated Ministry income.assistance worker 1he person is free to begin classes before that meeting, howe!er Clients attending the *lements program tend to be in the @contemplationA stage of change &ut some will still be in pre. contemplation, particularly those whose primary moti!e for getting into the program is to "ualify for income assistance 1hat means that facilitators in all modules must be prepared to work with people who are still in their addiction and facing myriad challenges . including homelessness, unstable housing, mental.health issues, and trauma, conflict with the child.welfare system o!er their children, unexpected pregnancy, and significant physical illness +ecognizing this, )**+S will typically hold off on formally enrolling someone in the *lements program until they can demonstrate the ability to attend regularly for two weeks 0owe!er, the agency works hard at keeping barriers to the program low, and pro!ides considerable after.class support for clients Among the ser!ices additional to the program that are a!ailable Monday through (riday at )**+S are an in.house counselor, immediate access as needed to a one.to.one support worker, a daily hot lunch, recreational opportunities, and a weekly @beauty dayA featuring haircuts and esthetics 1here is also an outreach nurse, a female doctor and a psychiatrist on hand at )**+S once a week '!erall, the introduction of the S$A1 curriculum has been extremely well.recei!ed at )**+S )articipants know and appreciate that the curriculum was written by and for sex workers, and that it7s constantly being changed, upgraded and ad/usted to suit their needs as feedback is recei!ed from people around making the program more effecti!e A ma/or benefit of running the curriculum in a non.residential setting is the ability to pro!ide a number of other complementary modules at the same time that shore up and enhance the personal work being done in S$A1 1he clients ha!e a wide !ariety of needs, and a community organization such as )**+S is well.placed to pro!ide a wide !ariety of 28

ser!ices and support networks that ensure a holistic approach to healing and reco!ery S$A1 and all modules of the *lements curriculum ha!e been de!eloped as stand.alone, related workshops So while there are 2K classes to complete in the S$A1 curriculum, one group might be taking the classes in order, 2.2K, while another starts with B.2K and then finishes up with 2.B in the next month 1his structure for all class modules is essential not only to make monthly intake possible, but to allow participants who relapse or ha!e to miss classes for other reasons . common in the early stages of reco!ery . to "uickly make up missed classes in the following month and continue on with the program

Feedback fro. +&&"S facilitators ,orking ,it) t)is population

$e inter!iewed experiential and non.experiential facilitators for this manual to get a sense of what it7s like to work with people with a background in the sex trade *!eryone agreed that there are some distinct challenges Sex workers are rarely the sullen, sulky type, and groups will typically be li!ely, with a !ariety of emotions on display Conflict is common, and strategies to deal with it need to be built into your facilitation plan )eople often arri!e late, and absenteeism is an ongoing problem, largely because of the chaos going on in participants7 personal li!es &ut the facilitators we talked to also agreed that working with this population is a powerful and transformati!e experience, and well worth the challenge $hat they stress as most important are an open mind, and a willingness on the part of the facilitator to be part of the group rather than an arms.length @instructor A A successful facilitator will also ha!e the ability to meet people for who they are without any /udgment or assumption )**+S has had significant success with both experiential and non. experiential facilitators, but for the S$A1 curriculum in particular, the organization feels strongly that the best facilitators will be those with a personal background in the sex industry and reco!ery from addiction Skilled, non.experiential facilitators are ob!iously a !aluable asset in mentoring experiential facilitators into this role, but S$A1 is a grassroots curriculum intended to be deli!ered by sex workers )ost.class support is also critical 1hat may be pro!ided by the facilitator if he or she has time to stay after class, or will need to be handed off to a different staff member familiar with the client ;nowing the procedure for such hand.offs is important to running a smooth group, as the 29

sub/ect matter of S$A1 can @triggerA some people and they may need immediate help in lea!ing the group for the day and talking to a support worker

0ere are some selected comments from )**+S facilitators that will gi!e you a few ideas around how to work with an experiential population who may still be in their addiction, many of whom may ha!e ne!er dealt with the deeper challenges, abuses and traumas of their li!es up to that point

@)eople here are hungry for optimism 5 focus on using optimism to create the life you want A . 2udith Attfield @(acilitators must be free of stereotypes as to who sex workers are Gou need to be an in!ited ally, as opposed to a Mhelper7 who sees people as !ictims A . *arcela *rn!a @&eing a male in a group dominated by females, 5 was eager to stretch myself but afraid of saying something wrong 1hat !ulnerability might keep some facilitators from saying what needs to be said $hat would be important in an orientation to work with this group is to make it clear that we all make mistakes, and what we want facilitators to understand is that they can come with their "uestions and learn A . *i!e Sheehan @1he women themsel!es are asserti!e for the most part 1hey7!e gone through the bullshit, and their faNade is gone 5f you come in with your Mfacilitator7 skin on . gentle, aloof . they7re eat you ali!e At no time are you not being tested to make sure you7re staying real Gour integrity is always on the line . if you wai!er, you7re in real trouble A . 2udith Attfield @5 want to be conscious of the culture 5 want to create in the room 5 want to set people up for success that day . can we work it out so the smoke breaks and bathroom breaks happen, but they don7t break the flowF Gou can also end up with an engaged group working hard, and all of a sudden two people walk in the door at that moment and you need to keep the group going while working these other two in So 30

while 5 ha!e an agenda for the day, 5 also ha!e six other things in my back pocket A . *i!e Sheehan

@1he inclusion is what works Sex workers ha!e been in a place where they didn7t ha!e a !oice, so now that they7re in the room and able to talk about who they are, transparency on the part of the facilitator becomes really important 5f the facilitator isn7t a sex worker or a reco!ering addict, then they need to talk about it so the group knows who they are A . racie Faw!es @Gou need courage, plus the self.confidence to hold the group together Gou need to be an experienced facilitator, but not a stuck one A person has to be completely flexible to that point that they7re ready to facilitate a group unlike any other, and will need to be energetic and real A . 2udith Attfield

*There were no barriers getting into S" T. + did not have to be on a waiting list. +%ve had a lot of support at .//0S.S$A1 participant

31

C@A+ &" S&/&'

Facilitator#s $uide
W)o are t)e participantsH 1hese facilitation guidelines ha!e been designed to be easy to work with and customized to be effecti!e when working with people from the sex trade +emember that your most !aluable assets when facilitating are empathy, flexibility and an ability to act as a guide for the people you7re working with Gour participants7 expectations are ultimately determined by what they bring with them to your workshop 1ake time to understand where your participants come from, and what work, learning and life experiences they bring with them, and be an acti!e listener $hen working with a group of people with sex.work backgrounds, you may ha!e a mix of indoor and outdoor workers . two segments of the industry that can be "uite distinct from each other . as well as people who are dealing with a !ariety of problems in their li!es 1hey are the @expertsA in their own li!es, so be sure you ask about their experiences and engage them in understanding how their personal experiences gi!e them knowledge that can impro!e the group learning experience o!erall +ecognize and respect the di!erse backgrounds of the group ;now your participants well in order to accommodate their learning needs $hat if some people are "uite familiar with the topic and some are notF $hat if one person challenges the knowledge of another in the groupF Ask "uestions to gauge the basic understanding of the group

32

Consideration of different learning styles is another important factor Most of us learn using a combination of approaches Some of the more common learning styles are8
:isualizing O easier to learn information by drawing pictures ;inaesthetic O a Mhands.on7 learner +eading O easier to learn information by reading printed words #istening O easier to learn information that one hears Speaking O easier to learn when one can speak and express ideas

$riting O easier to learn when one can write the learning

Sensitivity and Self Care

Gou will almost certainly face some challenging situations facilitating groups for people with personal experience in sex work and addiction *xpect the unexpected Fetal Alco)ol Spectru. %isorder8 *stimates in Canada are that one per cent of the o!erall population has (ASD due to alcohol exposure before birth $hile there are no firm figures a!ailable for (ASD rates among people with addictions, a 433H.3K )**+S sur!ey of outdoor sex workers in :ictoria found that 2K per cent reported an (ASD diagnosis %nderstand the learning challenges that people with (ASD face, and de!elop your workshops to account for that 0ere are some tips for working with people with (ASD8 Stick to structure as much as possible %se !isual symbols Don7t assume e!eryone can read )repare for transitions? i e in H minutes we will ha!e a break 0a!e rules clearly posted 0a!e a no interrupting rule %se simple, concrete and direct language &reak steps down if gi!ing a task A!oid fluorescent lights and bright colors ;eep area neat and tidy, label items 0a!e a!ailable "uiet crafts, beading, coloring and fidget balls if someone can7t sit still or keep "uiet 33

Stage of C)ange$ )eople react !ery differently to information depending on which stage of change they are at +ead the chapter in this manual on the stages of change, and think about how you7ll present your information so that it can be @heardA in e!ery stage 1hink about the particular stages of change your participants are in, and how to adapt learning ob/ecti!es accordingly #et participants in the group set the pace of that day7s lessons 0a!e a lesson plan, but don7t try to hold onto it rigidly if it7s clear that participants are not ready to talk about a particular aspect of the day7s lesson Gou can anticipate that the participants in your group will all be at different stages in their reco!ery and in their ability to process the information you7re presenting

%on#t assu.e you kno, t)e lived experience of participants8 Some participants will ha!e abuse, !iolence, exploitation, trauma and neglect in their backgrounds 'thers will ha!e made clear.eyed choices as adults to work in the sex industry and will ha!e !ery different backgrounds to those with trauma and abuse in their personal history Create a safe en!ironment where participants are informed in ad!ance about the nature of the topic to be discussed, and in!ited to discuss any concerns (or instance, the concept of family mapping seems like a harmless group acti!ity, until you consider that some of the participants may still carry great trauma from their family relations and may be at genuine risk from ha!ing to go back and think about their childhood 5f somebody asks to lea!e the room due to the intensity of the con!ersation, ha!e a plan as to who will gi!e them support while you carry on the group 6e!er @open a doorA you will not be able to close by the end of the group +articipate personally in t)e group8 Sex workers respond well to being facilitated as @e"ualsA rather than in a teacher.student style 5f you7re comfortable doing so share rele!ant personal information about yourself during the group Sit among people rather than at the front of the room, or standing at a flip chart 1he experiential !oice seems particularly important when working with people with backgrounds of sex work and addiction? facilitators who can call on such backgrounds bring a particular strength to the curriculum in this manual Suspend 0udg.ent$ $hen talking with people about sex work and addiction, it is !ery important not to pro/ect an attitude of blame for any of 34

it, or to presume that participants were @!ictims A 5f you do not ha!e a background in sex work or addiction, don7t assume that you know what the group7s life experiences ha!e been . and e!en if you do ha!e a personal background in such issues, don7t presume that your experience is the experience of e!eryone &e open to learning from the participants !t)er tips: &e watchful for participants who look upset or who lea!e the room suddenly, and ha!e a plan in place for supporting them immediately )ro!ide fre"uent short breaks to accommodate participants who smoke +einforce respectful beha!iour among participants +ecognize the experience and wisdom of the group Stay behind at breaks and conclusion so participants can approach you $ork in pairs for sensiti!e topics, so one person can be watching the room while you are deli!ering the workshop 0a!e a plan for ongoing support for participants upset by the workshop

Set the room up in a circle rather than in rows or at forward. facing tables, and whene!er possible sit in the circle with participants 1his contributes to a sense of e"uality, fairness and respect for group members /ital: %nless a trained therapist, don7t offer ad!ice or pro!ide counseling

en ,ays to get a group DunstuckI

35 1ake a break to refocus energy Change seats to create a new !antage point &reak into pairs, mo!ing from group to smaller groups $rite down ideas to shift from discussion to writing or drawing

 focus the later rather

1urn out or dim the lighting to help distracted participants re. Change seats to create a new !antage point +oll participants around decision options, or take a "uick pulse of group Create a time deadline to stimulate action Mo!e onto something else and come back to the original sub/ect Assign or defer to a subgroup O let a small group tackle the task than ha!e the whole group stuck

Approac)es for creating dialogue

(ew things are more satisfying than a group that clicks into true dialogue with each other in engaged, empathetic communication 0ere7s how to help make that happen8 Suspension . )articipants ha!e temporarily let go of stereotypes, pre/udices and preconceptions to be able to enter the dialogue process with open mind intent on learning what others belie!e 3istening . )articipants know they are able to clarify what they don7t understand and that the en!ironment is one where indi!iduals trust they7re being heard in a compassionate and empathetic way )isco+ery . 1here7s an opportunity for breakthroughs by unco!ering hidden assumptions 0ere7s how you can help make dialogue happen8

&e open and suspend /udgment

;eep dialogue and decision.making separate . dialogue precedes decisions

Speak for yourself . don7t be a representati!e for others #isten with empathy
#ook for common ground Search for and disclose hidden assumptions, especially in yourself

en strategies for dealing ,it) c)allenging participants: 36

#isten acti!ely . let people be heard but then get things back on track "uickly *ncourage new !olunteers by posing "uestions to those who ha!e not yet spoken, or asking them what they think 5n!oke participation rules that curb inappropriate beha!iours %se good.natured humor to gently rib a problematic participant, taking care not to be sarcastic or patronizing Connect on a personal le!el and take time to get to know the person on a break %nderstanding can impro!e things Change the method of participation, shifting from group to indi!idual 5gnore mildly negati!e beha!ior in hopes they dissipate on their own Discuss !ery negati!e beha!ior pri!ately . take the person @offlineA to a!oid embarrassment Don7t take it personally . be ob/ecti!e in your reaction

)e Broader /ie,:

)e Skill of Facilitation

1he ideal facilitator stri!es to pro!ide a safe and comfortable learning en!ironment8 pro!ide a positi!e learning experience demonstrate empathy, respect and caring demonstrate respect for di!ersity keep the group work learner.centered teach with enthusiasm encourage acti!e participation be organized and well.informed on their sub/ect maintain a focus on the workshop material address sensiti!e issues and discomfort with respect and support stay flexible employ pacing and good time management in their workshops communicate clearly pro!ide debriefing opportunities for learners stay realP use feedback and personal reflection to impro!e their skills

37

)articipants also need to understand the rele!ance of information to ensure buy.in %se a !ariety of interacti!e, hands.on and other methods to get your message across and maintain a high le!el of engagement and participation

38

Learning &nviron.ent An ideal learning en!ironment creates a safe, emotionally comfortable atmosphere of trust, learning, empathy and support 0ere are some points to consider8 whoF 0ow will participants know they can speak freelyF 0ow will you create physically/emotionally comfortable en!ironmentF +)ysical environ.ent: time $B! 1ou will likely have many smokers in your group. Be sure to factor in smoke breaks2 +articipants# environ.ent: Checkpoints8 others needed 'utline responsibilities/ role as the facilitator 1ell group strategies be used to ensure empathy and respect for 5n!itation to the group to participate fully 'utline opportunities for debriefing and pri!ate discussion as (acilitator alert to body language, discomfort or uncertainty 1emperature of the room Air flow O should you open a windowF #ighting for o!erheads, con!ersation, etc )articipants briefed on finding refreshments, washrooms, break 0ow will you foster an atmosphere of respectF Are you prepared to debrief participants if necessaryF 5f not,

39

 thatA

(acilitator uses affirmation @5 was hoping someone would ask

1he most important characteristic of a good facilitator is to focus on the learning needs of the group Gou7ll need a basic understanding of facilitation styles, learning needs and workshop deli!ery techni"ues Style (acilitating workshops and seminars re"uires working effecti!ely with a group to help accomplish the ob/ecti!es of the day An effecti!e facilitator understands the importance of a physically and emotionally comfortable learning en!ironment? co!ered

ensure pacing is suitable for the group watch the time and ad/ust lesson so important elements are well encourage the acti!e participation of e!eryone in the room draw on the range of experience and knowledge in the group
constructi!ely address sensiti!e issues, discomfort and conflict enthusiastically encourage critical "uestions and problem.sol!ing

StrategiJe for a successful ,orks)op &e familiar with the room where you7ll be working, and arrange it to accommodate the number of participants and the types of acti!ities you ha!e planned Check your supplies of markers, flip chart paper, demonstration materials, lined paper and binders 0a!e spare pens or pencils on hand 0a!e your handouts ready well before the class begins, and arranged in the order they will be used Cey points: Stay #ocused

(ocus on the workshop topic as you begin #ea!e personal problems outside the room 40 Be .unctual

)articipants will en/oy being welcomed by you as they arri!e Start on time /stablish the .lan +e!iew ob/ecti!es and the o!erall agenda with the group #et the participants know if there will be any homework or assignments #et people know what they will be learning 'utline the acti!ities you ha!e planned 3ousekeeping #et the students know where the washrooms are, when breaks are scheduled, where the supplies are, and start and finish times Be #lexible *!ery group you work with will be different +emember that what works with one group of participants may not be successful with another 4se ppropriate Techni5ues

5f your "uestions are going nowhere, switch to a lecture or an exercise 5f participants missed a key point, paraphrase or re!iew *xperiment with different deli!ery methods Ask yourself @$hat techni"ue will best help achie!e the outcome 5 intendFA Close /ffectively

Choose your closing words carefully as the group wraps up ;now in ad!ance what you hope participants will take away from the session &riefly outline the next session7s group topic so that people ha!e time to start thinking about it (ake $otes

;eep track of what parts of your workshop went well, and those that didn7t 6ote specific changes that should be made to your presentation Make notes of the time it took to present the lesson 5deally, make these notes either during or immediately after the group

Co..on (isconceptions about Facilitation

$hen someone is speaking, others are listening

41

 saying

*!eryone in the group hears and understands what you7re )articipants are interested in the same things you are $hat people way is what they really mean 1he topic is e"ually important to all participants &ecause no "uestions are asked, e!eryone understands Gou are impartial Certain participants will always speak in a specific way

W)at participants need to )ear fro. you: 5 know my sub/ect, and 5 want to tell you about it 5 am well organized 5 will not waste your time 5 want to help you learn 0ere is my most important point 5 care 5 am finished

1here is no recipe for presenting a perfect workshop *ach is shaped by its participants and what they bring, and also by your particular style of presentation )lease explore the tips and guidelines presented here to find how they will work best for you

C@A+ &" &I$@

)e Curriculu.: raining on t)e (odel

42

1his curriculum has been de!eloped and designed by and for sex workers, and it is !ery important that training on the curriculum be done by facilitators who ha!e a personal background in the sex industry 5t is e"ually !ital that facilitation of the 43 S$A1 workshops be carried out by two skilled and experienced facilitators, one of whom has personal experience in sex work 1he skills of non.experiential facilitators are !alued under the S$A1 model, but it is a grassroots model that is intended to empower and support sex workers through a curriculum de!eloped by and for sex workers, which is in turn deli!ered in the community by people who ha!e personal experience in sex work 6on.experiential people wanting to get in!ol!ed in deli!ering S$A1 will be pro!iding important support and knowledge to the process, but will recognize that the power of the program is in its being de!eloped and led by sex workers themsel!es &ecause the curriculum has been carefully customized to speak to the issues that sex workers ha!e identified as essential to their transitions and growth, it is important that those wanting to deli!er this curriculum ha!e a complete understanding from an experiential point of !iew of the goals, rationale, and methods used to deli!er the workshops 1hat7s why a training component has been de!eloped as part and parcel of the deli!ery of this curriculum, which is the first of its kind in the world 1raining for your organization can be arranged in your community through #auren Casey and &arbara Smith, the experiential facilitators who designed the curriculum with feedback from sex workers Smith and Casey pro!ided extensi!e training on the curriculum in :ancou!er, 0alifax and 'ttawa during 433< and 433B as part of a funded initiati!e 1hat training finished in April 433B, but further training is a!ailable as needed $ith the exception of grassroots sex.worker organizations, there is a cost for the training

For training infor.ation: Barbara Smith barb6smith7shaw.ca Lauren Casey lauren.casey7shaw.ca

)eople with a background in sex work operate in a distinctly different culture than the mainstream 1heir li!ed experiences are not the same as 43

those who ha!e li!ed and worked inside mainstream culture 1o work successfully with this population and to be successful in the deli!ery of S$A1, it will be important to in!ol!e sex workers at all stages of de!elopment and deli!ery of the program, and also to suspend personal opinions and thoughts about what it might mean to be a sex worker #et the sex workers establish their needs and lead their own healing &y pro!iding specialized training on the curriculum, the experiential facilitators who de!eloped this model can help interested organizations learn how to reach out to a marginalized and misunderstood population 1hey can support your organization in implementing the curriculum as part of your own program, and work with your community to establish connections with past and current sex workers in your area Some are potential program participants /ust beginning their /ourney of reco!ery, while others can be supported in becoming facilitators of the S$A1 curriculum 0ere is the list of curriculum workshops, in the order that they are run A brief synopsis of the key themes of each workshop is included

Wor!shops$ Sex work issues

$orking through the issues of money, power and admiration that can make sex work itself addicti!e

Secrets
#etting go of the secrets and lies that mark a life in the sex industry

(illing the :oid

(inding different alternati!es to filling the !oid that sex work, drugs/alcohol and money ha!e filled up until now

#oss of 5dentity
Someone working in the industry has likely been @actingA for many years, playing the roles her clients want her to fill $ho are youF

5ndependence
1here7s loneliness and isolation hiding behind that mask of fierce independence, and work to do before people can learn to let go

44

5solation
6egati!e self.image and shame can make it tempting to shut yourself away from the world, especially emotionally

5ntimacy
Sex workers shut down feelings of intimacy when they7re on the /ob, and can find it difficult to let that go

0ealthy +elationships 'utside of Sex $ork

(inding friends, and redefining men as more than /ust customers

Addiction to (ast Money

#earning how to li!e on less and get beyond the fast money of the sex trade

Media )ortrayals of Sex $ork

%nderstanding the impact of negati!e media portrayals for people with sex.work backgrounds 5ncludes tips for commenting to the media and writing letters to the editor, as well as public speaking and ad!ocacy

Sex $ork and the #aw

(amiliarizes sex workers with the many Canadian laws around prostitution, and raises awareness of their ci!il and human rights

*ntitlement
)oor self.image combined with the ego rewards of the sex industry can often manifest as a misplaced sense of entitlement 9etting beyond the @meA factor

&etter not be &oringP

(inding ways for firecracker personalities to find peace and contentment in a ,slightly- "uieter lifestyle

(inding Meaning
#ooking beyond the day to day to find purpose and spirituality

45

Sex Sizzle Silence

*xamining inner belief systems to redefine a new way of thinking

Self.Awareness
#earning to lo!e oursel!es, and letting go of the many roles foisted upon us

:isioning
Disco!ering what we want out of life and what strategies will get us there

#eadership/Acti!ism
$hat defines a leaderF #earning about participation, acti!ism and mentoring

#ike any meaningful grassroots initiati!e, this curriculum will take on a slightly different shape . and e!en change shapes within that shape . depending on the women who are attending the workshops $e strongly ad!ise being open and welcoming to suggestions from participants for changes that will enhance the curriculum A program that remains true to grassroots principles needs to check back in with participants at all times to ensure the information being presented reflects participants7 li!ed experiences and learning goals 1his curriculum has undergone many changes since it was first piloted at )**+S :ictoria Some of those ha!e in!ol!ed changing an entire segment of the workshop that wasn7t working? others ha!e been more minor changes that brought the curriculum more into sync with the needs of the participants (or instance, the curriculum didn7t initially include homework, but that7s now an option that grew out of feedback from participants who wanted to keep working on their own time A participant workbook is currently underway that can be used in con/unction with the curriculum 5n another instance, one group decided to de!elop personal @mission statementsA as part of the work they were doing together 5n another, participants began to take note of miracles ,or positi!e e!ents- happening in their li!es and to record them &ut at other times, the changes that will be needed may in!ol!e group dynamics, material being taught, facilitation style, or any number of other possibilities 1hat7s what would be expected 46

of a healthy grassroots approach, and we encourage you to @go with the flowA and let the group guide you

)ersonal affirmation and empowerment for participants are !ery important principles throughout the series of workshops )ersonal challenges that take people beyond their comfort le!el are also important, albeit keeping in mind that participants must be allowed to take things at their own pace )articipants could be asked to do something e!ery day that they7re a little scared of each day, perhaps, and report back to the group at the next session Angel cards, fairy cards, and animal medicine cards and such are excellent ways to begin a group %se them as icebreakers or to wrap up a workshop, which accords unity to the group

*Being validated and being heard. This was a new experience for me. 8The facilitator9 wasn%t afraid of being truthful.S" T participant

47

48

C@A+ &" 'I'&

Working ,it) t)e Co..unity
Some communities implementing the S$A1 curriculum will be working specifically with sex workers for the first time A strong community action plan will be important to ensure the implementation and success of the program, as sex workers will come to S$A1 with a !ariety of needs that will be beyond the scope of a single program . or ser!ice pro!ider . to meet A community action plan will help de!elop capacity, and allow attention to be paid to the many issues that will come up as a result of programs focused on the issues for sex workers What is a &ommunity Action Plan4 A community action plan is de!eloped to increase capacity for addressing a specific issue Capacity depends on the resources a!ailable in the community . in other words, e!erything must be in place that you need in order to get the /ob done Capacity includes the people, their skills and knowledge, and their moti!ation 5t also refers to the physical resources and the money a!ailable #eadership is also important, as are the policies and processes that permit goals to be reached *!ery community has capacity, but it may need to be disco!ered and de!eloped 1his is particularly true in the case of sex workers, as their needs can be significantly different from women o!erall 'utside of larger cities, sex.worker.specific ser!ices are rare, and the grassroots approach that is so effecti!e for sex workers is rarer still 5n de!eloping your community plan, you will need to take a lack of such ser!ices into account 1his action plan pro!ides a framework for making decisions and taking action 5t includes specific goals, a plan for necessary steps to reach the goals and some measurable ob/ecti!es Community action plans ha!e as their main goal to increase the knowledge and skills of service providers for sex workers who are addicted to illicit substances. 5deally, the process for de!eloping a Community Action )lan will be8 49 *asy to understand 5nclusi!e +ealistic and practical +esults.focused, and Community.based

Why )e+elop a &ommunity Action Plan4 Community capacity can be de!eloped without going through the formal planning process, and many community initiati!es around sex work ha!e come to be as a result of the issues becoming apparent 5n :ictoria, & C , the )rostitutes *mpowerment *ducation and +esource Society was launched in 2>>H by former sex workers and community supporters who identified a need and pushed their plan forward, in the absence of a formal capacity.building process 0owe!er, planning impro!es the chances of success and makes the process easier in the long run, and ultimately engages more of the community in the issue at hand 1here are many benefits to ha!ing a community plan 1he plan will8 Create guidelines for making decisions *nsure that the approach is holistic and comprehensi!e and integrates the perspecti!es of !arious community members 5dentify goals, ob/ecti!es and acti!ities that can be measured and e!aluated )ro!ide a way to communicate goals and actions in the community and to others outside the community? and )erhaps make it easier to apply for funding to support a community initiati!e

)e+eloping a &ommunity Action Plan and Strategy 1o de!elop the plan you will need to go through a series of steps8 Create a !ision $hat are you trying to doF $ho are you trying to helpF $hat needs are you trying to addressF Assess the current situation $hat ser!ices already existF 5s there a lack of ser!ices, or merely a lack of co. ordinationF $hat groups/agencies are the sex workers in your community currently recei!ing help fromF De!elop the details of the plan $ho will make it happenF 0ow will it happenF

50

$here will funding come fromF $here will ser!ices/programs be locatedF Decide how it will be e!aluated 0ow will you know that you ha!e achie!ed successF

'nce de!eloped, your community action plan should contain the following information8 $here you want to get to ,a !ision for the future$here you are now ,the current situation0ow you are going to get from where you are now to where you want to be, and what resources you will need to do so ,the tasks and resources to accomplish the plan-? and 0ow you will know when you are there ,e!aluation tools to measure the impact of the plan in the community-

SA(+L& C!((U'I B AC I!' +LA' A'% S "A &$B Step 5 6 Where do we want to get to4 Create a vision K &xa.ple: Ser!ice pro!iders in the community will ha!e knowledge about illicit substance use and sex work and the skills to work with affected clients Step 7 6 Where are we now4 Assess t)e current situation K &xa.ple: Most of the ser!ice pro!iders ha!e some knowledge about illicit substance use and sex work, but they feel that they need more skills Step 8 6 9ow are we going to get from here to there4 (ake a plan K &xa.ple: $hat8 skill.building workshops? $ho8 trained facilitators deli!er to ser!ice pro!iders? 0ow8 'ne.day workshops for groups of 43? $hen8 'ne workshop a month o!er the next four months Step : 6 9ow will you !now when you are there4 &valuate K 51

&xa.ple$ Questionnaires will assess the knowledge and skill le!el of ser!ice pro!iders before and after the workshops, and six months later

52

What will ma!e your planning process successful4 &uilding community capacity takes time and effort 5t re"uires bringing together people in the community who ha!e a shared !ision, as well as others who are willing and able to get the ball rolling, including around funding 1hose initial !isionaries must, howe!er, be able to draw on the ideas and talents of others and share the action plan as the community takes ownership of the pro/ect Community action plans re"uire teamwork and collaboration, and may need people to step beyond their le!el of comfort when inno!ati!e approaches are incorporated 1his is particularly true if you are building an @experientialA model that incorporates people with li!ed experience into the work plan not /ust as participants, but as leaders, facilitators, staff, and planners )eople may need to be educated around the idea of such grassroots approaches, including the success of initiati!es elsewhere that followed a similar path 1eam members will need to be flexible, open to new ideas, sensiti!e and inclusi!e 5t won7t always be easy &ut working as a team to de!elop capacity and arri!e at your shared !ision is !ery rewarding &e sure to draw on mentors and other supports both within your community and beyond it (or example, you may be able to connect with others in your communities who ha!e experience with action plans and new initiati!es 5dentify @mo!ers and shakersA who are known for getting things done, and others who share your passion for addressing the issues at hand 5t may be helpful to identify key leaders in the community to help you get your plan off the ground 1hese leaders may be in a recognized leadership position in the community ,for example, the mayor- or in a more informal position of influence ,the C*' of a ma/or employer, a church leader, someone in the media who @getsA the issues- (or the S$A1 program, it will be essential to find leaders from within the sex work community as well De!eloping effecti!e programs for sex workers re"uires finding people with li!ed experience to work alongside on a pro/ect, as sex work is a different culture 5t7s !ery difficult for someone who has ne!er been in the industry to understand the issues clearly as they pertain to the sex workers themsel!es Sustaina"ility$ ;eeping your Plan Ali+e 5t is not enough to simply implement your plan and trust that the plan will sustain itself 5n other words, you may plan to deli!er the sex work workshop to se!eral groups of ser!ice pro!iders in your community o!er the next few months &ut then whatF 0ow will you ensure that ser!ice 53

pro!iders in your community continue to increase their knowledge about illicit substance use and sex work and their skills in working with affected indi!idualsF As part of the planning process you will need to address the long.term sustainability of the capacity you ha!e started to de!elop 'ne of the best ways to ensure that the capacity building process keeps its momentum is to put together a team of people that share your community !ision $ork as a team to put together a long.term plan 1ry to ensure that there are enough team members to spread the work around the pre!ent anyone from burning out ;eep in mind that other communities are going through the same process Gou may want to establish collaborati!e connections with other communities to share ideas and pro!ide support to each other #ook for ser!ice agencies and allies who are already doing similar work and get them in!ol!ed? for instance, capacity.building for impro!ed ser!ices to sex workers might include housing pro!iders, addiction ser!ices, human rights organizations, police, child and family support groups, women7s groups, transition houses and unions, as sex workers may be experiencing challenges on all those fronts (orming partnerships with organizations outside the community may also be a means of increasing the impact and sustainability of your plan )artners to consider are programs and organizations funded by8 Status of $omen Canada Department of Custice Canada )ublic Safety Canada )ro!incial )ublic 0ealth departments %nited $ay )ri!ate foundations with an interest in social /ustice or women7s issues 5ndi!idual donors

(inding sources of ongoing funding will be crucial to long.term sustainability (unding to pro!ide education and training pertinent to sex work and illicit substance use may be a!ailable from !arious go!ernment programs beyond the ones listed abo!e ,federal, pro!incial and municipalas well as pri!ate foundations and industry $omen7s ser!ice organizations such as Ronta 5nternational may also be supporti!e 5deally, one of your team members will ha!e skill and interest in proposal writing *stablishing partnerships with other groups or communities may also increase the chances of securing funding +emember that you will be competing with many other groups and communities trying to secure funding for their own 54

pro/ects, and will need to @sellA funders on why your plan is needed and will be effecti!e (inally, don7t forget to recognize your most !aluable resource8 the people in!ol!ed *nsure that anyone who is in!ol!ed in the planning process is recognized in some way for their contributions 1he acknowledgement can range from a simple thank you card to formal recognition in the newspaper or radio +ecognition is especially important for businesses or go!ernment agencies that ha!e made a contribution, so be sure to include logos on promotional materials )eople also like to know if their ideas or contributions were worthwhile 5f you use someone else7s ideas, let them know how it went 1his will encourage buy.in and participation from committee members because they can see the fruits of their labours /+aluation$ 9ow do you !now if you ha+e "een successful4 Systematic e!aluation of the impact of your plan in your community is !ery important 5t will tell you what is working ,finding this out can be !ery rewarding- as well as what needs to be approached in a different way *!aluation doesn7t need to be complicated or difficult 5t is often a re"uirement of funders before money is appro!ed for such pro/ects *!aluations are designed to pro!ide the answers to a few basic "uestions8 $hat worked ,and how well did it work-F $hy did it workF $hat didn7t work ,and why not-F 0ow should things be done differently in the futureF

*!aluation can take the form of "uestionnaires or a more informal recording of anecdotal information 5t is important that the responses be as unbiased and accurate as possible 1his usually re"uires that the responses be anonymous and the respondent be fully informed as to how responses will be used An open mind will be !ital to this process 5f it7s clear that some aspects of your plan were not successful, they will need to be re!isited and refitted . no matter how badly your team had hoped a particular strategy would work A community plan is ultimately not about bringing to fruition the dreams of the team . it7s about being effecti!e 5f you find that aspects of your plan don7t align with the needs of the population you7re trying to impro!e ser!ices to, you will need to be willing to start all o!er again &ut it

55

will be worth it when you end up with a strategy that truly does work for the population for whom it7s intended 1he good news is that people with a background in the sex industry don7t tend to be @shrinking !ioletsA and will let you know "uickly if a specific program or strategy isn7t going to work for them 'b!iously, these kinds of problems will be alle!iated to a large extent by in!ol!ing sex workers from the start in the de!elopment of all aspects of the process, as those with li!ed experience know what does and doesn7t work based on their own li!es 1hey7re the experts in terms of knowing what it means to ha!e worked in the sex industry and how that has shaped their personal experiences, but they will benefit greatly from your team7s expertise around mentoring, de!eloping curriculum or ser!ices, finding funding, and securing community support 9ood luck with your community action planP

C@A+ &"

&'

A Final Word
1he S$A1 curriculum is generating considerable interest in communities coast to coast C6C*$ trainers #auren Casey and &arbara Smith ha!e de!eloped ad!isory groups and done training on the curriculum in :ancou!er, 'ttawa and 0alifax, and know from the o!erwhelming positi!e response to the S$A1 model in each of those communities that this is a program that sex workers are welcoming and many agencies are eager to launch 1hat is an excellent de!elopment S$A1 was concei!ed as a curriculum that could e!entually be brought into any community to help past and current sex workers heal and de!elop that important feeling of empowerment that comes from working with your peers to empower each other 0owe!er, there are some !ital points to consider before launching S$A1 in your community 1his chapter is based on feedback we heard in the six training sessions held in late 433< and early 433B in :ancou!er, 'ttawa and 0alifax, in particular from participants who had personal backgrounds in the sex industry As noted throughout this manual, S$A1 is a healing, empowering curriculum de!eloped by and for sex workers 1he workshop topics were chosen based on feedback from past and current sex workers who went 56

through the pilot programs ,and in the case of )**+S :ictoria, continue to do so- 1he program is intended to be facilitated by sex workers as well, as the model re"uires first.hand knowledge by at least one of the two facilitators to ensure the course material is brought to life through the sharing of real experiences during the workshops Some of the most powerful feedback that trainers Smith and Casey heard was the difference made by their own personal backgrounds in the sex industry $hat sets S$A1 apart from other programs intended to help sex workers is that S$A1 speaks directly to the uni"ue experiences of sex workers by ha!ing experiential in!ol!ement at all le!els of deli!ery of the model, including curriculum design and the facilitation of the 43 workshops

Sex.worker participants who took part in the S$A1 training in :ancou!er, 'ttawa and 0alifax in 433<.433B are rightly fearful that the S$A1 curriculum could end up being taken o!er by well.meaning but non. experiential mainstream professionals who ha!e no personal knowledge of working in the sex industry 1hat is not what the !ision is for this model $e ask that non. experiential people wanting to work with the S$A1 model undertake that work with the understanding that the intent is for sex workers to be guiding the process e!ery step of the way (or S$A1 to be effecti!e, communities wanting to do this work will ha!e to commit to in!ol!ing local sex workers in all aspects of the de!elopment and realization of the program 1his includes a commitment to hiring and training people who ha!e sex.work backgrounds to share in facilitation duties We reco..end )aving t,o facilitators to run t)e ,orks)ops- at least one of ,)o. is experiential2 5t also re"uires a commitment to regular focus groups . at least three times a year . with participants to ensure that the curriculum and presentation continue to be effecti!e in meeting the needs of sex workers in that particular community @)eople need to go get themsel!es an education around the sex industry when they7re taking this on, and the experiences of sex workers,A says &arbara Smith

57

1hat may seem like a tall order for communities that ha!e little or no connection with their sex.worker population, and may not e!en know how to find people (ortunately, the ad!isory.group de!elopment model that Smith and Casey use for the S$A1 community training brings together experiential and non.experiential people to work with each other Communities that ha!e taken the S$A1 training thus are able to forge a connection with past and current sex workers in their area Communities that ha!e no sex.worker.specific support organizations . which is to say, most Canadian communities . may not be able to find an experiential person who is also ready to be a facilitator 5n such cases, we ask that non.experiential people doing similar work in a particular community step forward to mentor and train the experiential person so that she/he is able to co.facilitate the S$A1 workshops @A personal understanding of sex work is essential to getting the most out of the S$A1 curriculum as a facilitator,A say Smith and Casey @1his model is about building capacity and getting sex workers in!ol!ed,A says Smith @5t7s about gi!ing them that tiny seed of hope A Smith "uotes from one participant7s written feedback upon completing S$A18 @$hen 5 heard what was being talked about in S$A1, my body started to !ibrate 5t was about hope 5 floated out of there A

58

1he message of hope starts with ha!ing an experiential facilitator in the room, which also ensures credibility with participants As is e!ident by the S$A1 curriculum topics, these workshops are designed to be deli!ered by someone who has personal and intimate knowledge of the sub/ect matter . knowledge that comes only from ha!ing worked in the sex industry As noted in the chapter on facilitation, S$A1 is best facilitated by those who are comfortable being part of the group discussion . someone who sits with the group on e"ual terms 1his is not to suggest that the facilitator will be relin"uishing control or responsibility for the group, but simply that the most effecti!e S$A1 @styleA is to gi!e something of yourself to the group in exchange for what you are asking them to gi!e you #et your life experiences and theirs find common ground . particularly important for non.experiential facilitators, who may not ha!e had a career in common with sex workers but will still ha!e many other shared life experiences to draw on for story.telling and group work @1he big difference with S$A1 is that it7s not so much leader.led,A says Smith @1here7s a curriculum, but each workshop on any gi!en day might be a bit different Gou need to let the group determine where the group goes A 'ne participant taking the training to de!elop a S$A1 program in her community put it this way8 @,1he training- was reinforcement for me to take my clues from the clients, and to keep checking with them what they need A $e are excited about the success of the S$A1 model and hope that it will one day be in communities across the country $e recognize the importance of ha!ing the support and skill.sharing of the mainstream community in the expansion of the model, and look forward to the links that community groups will be forging with sex workers in their regions as a result 1hank you for your commitment to a grassroots initiati!e that brings sex workers to the table as e"uals to work on the issues facing tens of thousands of Canadians employed in the industry and exploited on its margins

59

Appendi, A

<eferences
Source8 Adapted from (rank, ( = Smith, A ,2>>>- The Community :evelopment 3andbook! Tool to Build Community Capacity Minister of )ublic $orks and 9o!ernment Ser!ices Canada &enoit, C , Millar, A ,4332- :ispelling (yths and 4nderstanding 0ealities! "orking Conditions, 3ealth and Status and /xiting /xperiences of Sex "orkers. &ritish Columbia8 )**+S&erry, C ,433L- /asing the .ath! 5ualitative study on the service needs of women who have experienced an addiction and are exiting the sex trade in (anitoba Status of $omen Canada &rannigan, A ,2>B>- Street .rostitution! Law, Calgary, 0egina, "innipeg. 'ttawa ssessing the +mpact of the

&rannigan, A ,2>>K- ;ictimi,ation of .rostitutes in Calgary and "innipeg 1echnical +eport 6o 1+2>>K.2He 'ttawa Department of Custice Canada &rock, D + ,2>B>- @1he 5mpact of &ill C.J> on Street )rostitution8 A SummaryA The $ational ction Committee on the Status of "omen &rock, D + ,2>B>- @)rostitutes are Scapegoats in the A5DS )anicA 0esources for #eminist 0esearch, 2B8482L.2< &rock, D + ,2>>B- (aking "ork, (aking Trouble! .rostitution as a Social .roblem. 1oronto8 %ni!ersity of 1oronto )ress Centre for #eadership and Community #earning, Custice 5nstitute of &C College of 6ew Caledonia, # S: facilitation manual Communication 5nitiati!e 6etwork, Stages of Change, www.comminit.com 60

Deane, Dana, contracted facilitator, S" T treatment program, Crossroads Treatment Centre, <elowna, B.C.

*akin, # ,4332- "omen, Crack Cocaine ddiction and the Sex Trade +ndustry! standpoint analysis. Department of Sociology, %ni!ersity of Manitoba *1+ Associates, www.etr=associates.org (leischman, C ,2>>K- ;iolence against Street .rostitutes in 3alifax 1echnical +eport 6o 1+2>>K.2Ke 'ttawa8 Department of Custice Canada, 2>>K9ibbs :an &runschot, * ,2>>4- @Albertans7 'pinions on Street )rostitutionA Canadian Social Trends8 Summer *dition8 Calgary 0odgson, C ( ,2>><- >ames .imps .lay! .imps, .layers and "ives=+n= Law 1oronto8 Canadian Scholars7 )ress Cessome, ) Somebody%s :aughters! +nside the Toronto?3alifax .imping 0ing 0alifax #owman, C ,2>BH.BK- @)rostitution in CanadaA 0esources for #eminist 0esearch. 2J8J8LH.L< #owman, C ,2>BK- @Street )rostitution in :ancou!er8 6otes on the 9enesis of a Social )roblemA Canadian @ournal of Criminology, 4B8282.2K#owman, C ,2>BB- @Street )rostitutionA pp HJ.23J in : Sacco, :eviance! Conformity and Control in Canadian Society. :ancou!er8 )rentice 0all #owman, C ,2>>2- @Street )rostitutes in Canada8 An *!aluation of the &rannigan.(leischman 'pportunity Model A Canadian @ournal of Law and Society K82L<.2KJ Maticka.1yndale, * , #ewis, C ,2>>>- /scort Services in a Border Town! Transmission :ynamics of Sexually Transmitted :iseases "ithin and Between Communities. 'ttawa8 0ealth Canada May, 1 , 0arocopos, A , 0ough, M ,4333- @(or #o!e or Money8 )imps and the Management of Sex workA .olice 0esearch Series .aper &)A pp K.B 61

6elson, )ortia ThereBs a 3ole in (y Sidewalk! The 0omance of Self= :iscovery. Beyond "ords .ublishing Company, &CCA. +SB$! DCA&E)&EFG )**+S :ictoria, interviews with clients, staff and facilitators, 'DDF )yett, ) , $arr, D ,2>><- @:ulnerability on the Streets8 (emale Sex $orkers and 05: +iskA +:S Care >8H8HL>.J< Shackleton, & ,2>><- @)rotecting )rostitutesA .olicing Today HSeptemberI )F=AD $eisburg, D ,2>BH- Children of the $ight! .rostitution. 1oronto8 #exington, Mass Study of dolescent

$olf, #, 9eissel, D ,2>>J- @Street )rostitution in CanadaA Canadian Social Trends Gouth Ser!ices &ureau ,2>>2- Jttawa 1outh .rostitutes! 'ttawa8 Gouth Ser!ices &ureau Survey.

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Appendix B:
An o+er+iew of the &anadian =ational &oalition of /,periential Women$ <esearch conducted in response to gaps in literature
1wo ma/or research pro/ects were carried out nationally in response to key issues de!eloped by the Canadian 6ational Coalition of *xperiential $omen 1hese reports were carried out in 433K and are working documents that ha!e lead to the de!elopment of this training manual

=ation Wide Focus >roups 'n ?iolence and Addictions in the Se, Industry
Final "eport- co.pleted *uly 5==9

63

a"le of &ontents 5. A"out &=&/W 7. Focus >roups =ational '+er+iew 8. *ethodology :. <ecommendations

64

Solutions *@S address all 9<// pro"lems in order to succeed at eliminating '=/ pro"lem.

*.rostitution doesn%t start on the street, it starts in our homes.80egina9

65

12 About t)e Canadian 'ational Coalition of &xperiential Wo.en >C'C&W? !ur /ision: 1he C6C*$ is a consortium of women committed to the ad!ancement of e"uality and human rights of sex workers 1he C6C*$ is committed to the impro!ement of the li!ing and working conditions of women in and from sex work 1he C6C*$ supports di!ersity and inclusion of dialogue that does not promote harm to those acti!e in and from sex work 1he C6C*$ opposes models of enforcement or rehabilitation that promote the continued criminalization or harm of women in and from sex work

1he C6C*$ is designed to be a national mechanism for women form across Canada to gi!e !oice to issues of !iolence, criminalization, trafficking, exploitation, working conditions, discriminations, health safety and other concerns related to sex workers and sex work A first in Canada, and one of !ery few in the world +ositions: 2- 1he C6C*$ takes the position of the immediate decriminalization of laws specifically regarding communicating and bawdy houses with respect to prostitution 4- 1he C6C*$ recognizes decriminalization as a priority in addressing intolerable conditions of risk and harm to women howe!er, commits to the continued ad!ancement of law reform and human rights for women L- 1he C6C*$ re"uires the participation of an experiential group like C6C*$ in the de!elopment, implementation or ongoing go!ernance of any and all laws or regulations relating to sex work J- 1he C6C*$ re"uires and see oursel!es as a mechanism for the representation and ad!ancement of human rights for women in/from sex work within the decriminalization declaration that no other administrati!e of criminal regulation or law, at any le!el of go!ernment, is put into place to regulate the sex industry 1he C6C*$ has identified these areas as priorities for immediate action8 #aw +eform, )ublic Awareness, 0ealth and Safety, Social Custice, and Children and Gouth 1he C6C*$ has prepared statements identifying key issues and recommendations for action 66

Cey Concerns: 1he C6C*$ formed as a direct response to the alarming rates of !iolence targeted towards sex workers in cities across Canada As well, we ha!e identified issues such as discrimination, criminalization, stigma, media representation, trafficking, in!ol!ement of children and youth and the working and health conditions of sex work as key areas of concern $oals: 1o combat conditions of !iolence, abuse, exploitation, sla!ery, and coercion relati!e to sex work 1o pro!ide opportunities for women to communicate their ideas directly to legislators, policy makers and public towards the impro!ement of li!ing and working conditions of women in and form sex work 1o facilitate the in!ol!ement of women in and form sex work on issues of direct impact

52 Focus $roups 'ational !vervie,: 1he ob/ecti!e of the focus groups was to obtain input from experiential women in key pro!inces and municipalities on strategic issues regarding8 /iolence and Addictions 1he idea was to get sex workers perspecti!es on the current situation and recommendations for impro!ement in these three areas $hat would they want to see changed on these L issuesF 42 (et)odology 1he cities chosen for focus groups were identified in the original work plan 1he pro/ect was coordinated and the materials for the focus group were de!eloped by the research assistant, a C6C*$ member C6C*$ members in each city were contacted to facilitate the focus group 1here were a total of > focus groups held across Canada 1hree were held for each of the key topics8 :iolence? Social Ser!ice &arriers? and Addictions 1he total number of participants was <> 1he groups ran from 4 hour to K hours All the focus groups were facilitated by experiential woman, K facilitators are C6C*$ members $hen possible, experiential women were contracted to take the notes from each focus group held as well

67

1he focus groups were held at not.for.profit sex worker organizations, G$CA7s or other suitable locations Dinner was pro!ided along with bus tickets and an honorarium for the women7s participation was gi!en 1he information collected from the focus groups was collected thought the notes from the focus groups, the data from the flip chat sheets, summaries from both the facilitator and the note.taker and e!aluations completed by the participants at the end of the focus group 1he information collected was compiled, analyzed and the recommendations are based directly from the information pro!ided by all the participants 1he facilitators located a suitable location, contracted a note.taker, recruited participants and organized the supplies and practical needs for the focus groups in each city *ach participant was explained their rights under the consent form and was gi!en an honorarium for their participation 1he data was collected !ia notes, summaries from the facilitator and the note.taker, flip chart data and e!aluations completed by the participants 1he research assistant input all data, coded the data and analyzed for any emerging themes that were repetiti!e or any other rele!ant data 1he recommendations were based on the themes that emerged 1he data collected from the > focus groups included 2HK pages of data, including <3 e!aluations from the women after completion of the focus groups and JH documents from the focus groups themsel!es

68

69

Addictions Analysis ;ey issues identified were during the addiction focus group includes8 housing? higher risk for !iolence? health? stigma, /ustice system? peer supports and social ser!ices *(akes you more or less likely to do dates, depending on how wired you are. +f you%re wired and sick, you%re more likely to go with a bad date. Take dates you otherwise would not go with, because of your addiction. +t would be great to have safe house to have your dates. 1ou need the money, be able to take customer to safe house, he pays for the room, doesn%t know it%s a safe house, place you can call on for help.- 8;ictoria9 +riorities related to )ousing issues: #andlords take ad!antage of sex worker 1hey will charge more $ill not rent to addicts Almost impossible to get clean if other women are using around 0ard to work on anything without a home

you

*+t%s too bad we couldn%t get housing in the different stages of recovery K + know for myself that + 5uit using, + think a safe house would be good. +%d be scared that the rest of the girls, who are using, would be dangerous.- S:ictoriaT "eco..endations related to )ousing issues: 2 4 L J H K a b < B > Safe house to take dates to 1ax incenti!es for landlords who rent to working girls Subsidized housing O working girls Safe housing with bouncers &awdy house with mother hen 0ousing in different stages of reco!ery $et housing Dry housing 6eed appropriate sex work housing Cap on housing costs so not to be taken ad!antage of )ercentage of money from housing rent to go back to women

* bawdy house with a madam, done in a way that is peaceful, safe, professional, so you don%t have to go out into the street. + also like the different stages of recovery K can%t go to wet house to get clean.- S:ictoriaT

70

*@ust thinking if we%ve actually a bunch of girls have talked about this K often we all take that date that will be trouble Hviolence, too drunkI we need the money, we take the date anyways, and in the back of our minds we know better. +f there was a house we could go to and rent room there, would be great. >uys that + don%t know + take to my brother%s boarding house and + feel safe, bouncer there, a bunch of people. Better to have a place that the money%s going back to something like a sex worker agency, you want out kind of literature, spare essential rooms you could rent for the hour. LAD=LMD.DD per hour for the room alone.- S:ictoriaT *Jne simple 5uestion K why is there only one place to go K it was a nightmare K + was staying at a wet house, + was in line to get a bed by a group of girls dumping needles, and + was clean at the time, they pair you up. >uys have a salvation army, etc. for guys but there%s none of that for women. 1ou have to be escaping an abusive relationship or have childrenK Try escaping an abusive relationship and being an ex prostitute. They won%t even let you in the house where there are children.- S:ictoriaT *3aving a tax incentive, having suite in house, get a decrease, subsidi,ed in a home. They would get money off their taxes to do it, like a charity. 0enting a safe house. >et income tax break from their mortgage.S:ictoriaT +riorities related to )ig)er risk of violence issues: 2 4 L J More likely to take a bad date O poor /udgment 9uys prey on addicts *asier to be pimped )olice don7t take sex workers seriously

"eco..endations related to )ig)er risk of violence issues: 2 4 L J H K < B 71 Self defense training Street smart workshops a 0ow to get out of a bad date b $hat to look for when getting in a car 5mmediate bad date information ,not housed at police stationa &ad date hotline b Message board for sex workers 5nstant cameras to be pro!ided to sex workers :olunteer spotters Safe area to work with cameras installed a +ound about b )ri!ate parking stalls Safe in/ection site More detox beds that are attached to a seamless continuum

*+n >ermany they have a mini highly way regulated, girls are in safe area, working paring areas, girls have their bus stops, cameras at bus stop, driver drives down the street, and girls have shelter, still on street, but can pick and choose. nd it%s a highway all on camera. The guys don%t leave with the girls K- S:ictoriaT +riorities related to )ealt) issues: 2 4 L J H Detox not a!ailable to cocaine/crystal meth users 6ot enough detox beds Skin bad, teeth bad Different rules for sex workers Stigma and /udgment from medical profession

"eco..endations related to )ealt) issues: 2 4 L J H K < B > 23 22 24 2L 1reatment specific to sex workers U we ha!e different issues 1raining for medical profession Medical and dental benefits 5n.house education on S1D7s, 05:, 0ep C Street nurses handing out medication from street !an Access to therapy O before, during, after 1reatment centres that accommodate women and their children 1reatment centres that are accepting of transgender women on all le!els And not /ust in to programs but on all le!els *xperiential staff working in treatment centres 1he glamour is hard to deal with U we need treatment that is specific to sex workers Detox and +ehab waiting list to long, (ollow.up care, 'piates beds, no continuum $aiting list for Methadone V doctors access 6eedle *xchange

+riorities related to stig.a issues: 2 4 L #anguage O crack whore, needle poking ho )olice records 1reat Cohn7s as if they are not safe O not the other way around

*#eel really ashamed because they call you drug ho, needle poking ho, drug addicted working girl- S:ictoriaT *(ine Hpolice recordI says approach with caution, armed and dangerous and wait for backup- S:ictoriaT 72

"eco..endations related to stig.a issues: 2 4 L J H )rofessionalize sex work Counseling for girls to present better %nion for sex workers +egulate O guidelines, etc Specific place for sex workers to worship ,spirituality-

*.eople say prostitution has no value in society, what about societies where it%s really shunned uponN (ore violence, more rapes. They say testosterone need release, what about places for men to take out their frustrationsN "here prostitution is more accepted, must be less rape, violence, etc. against womenN That must have some bearing on society.S:ictoriaT "eco..endations related to t)e 0ustice syste.: 2 4 L J H K < B > 23 22 24 Mmore leniency7 Mmore understanding7 M5 am not Myeah.prostitution7 5 am anti.oppression7 M$hen 5 was charged 5 had to prostitute more to pay the bills 5 don7t know how to get out7 M5 am against the oppression of women7 Mcriminal charges lea!e women more stuck7 Meducation as opposed to intimidation7 MA girl has a nursing degree but can7t get a /ob as a nurse because of a prostitution charge She has to explain why she was a prostitute7 M5t shouldn7t be as big of a deal as it is Gou ha!e to do what you ha!e to do Gou ha!e to eat and feed the kids7 Myou need education and resources to get them out7 Munderage girls get confused and caught up, they need education and resources7 M1he most important thing is someone speaking the same language 1here needs to be an interpreter that understands, 5 am talking about a street interpreter, who goes in to the court and sees what the system can do and can7t do )eople get sucked in and played Gou sign the paper that the pimp will go to /ail for L years, so he will come back and kill you in 4 years 7

73

"eco..endations related to peers support syste.s: 2 4 L J H K < B > Mbesides the /ustice system, you need someone to speak your own language and your dialect7 M5f you want to speak to someone, speak in your dialect 5f you talk to an *gyptian, someone from *gypt should speak to them7 Mnot someone who /ust speaks it, someone that7s been there7 M5 am a !et $e need to take the !ets in the social ser!ice system $e are working on degrees and can access the community7 Mwe speak to people who know what we are talking about7 Mtell me how to go from making I2333 a day to pay rent, feed my kids, when the only way 5 know how to do that is from the streets7 Mif you can7t !isualize it, you can7t get there7 M5f someone hadn7t done it before me, 5 wouldn7t ha!e thought it possible7 M$e ha!e li!ed through more shit than anyone else Gou go to war, that7s nothing, 5 ha!e bullet.holes and scars and tattoos to remember the scars $hy did 5 li!e through itF 5n the end of it we are going to tell someone how to get out7 M(or my inspiration it was ,name- and ,name- 5 seen ,name- get out and was kind of like Myou can do it too7 1hey were pushing me and pushing me, a great and steady support for me, no matter what drama they ha!e pulled me out from7 Msome of the most beautiful people in the world, and some of the baddest women of time help me grow up7 M5 was one of the youngest bitches on track 5 learned all my good skills 1hese people taught me how to sur!i!e on the streets All these women taught me how to adapt in this life And when 5 s"uared up, 5 saw ,name- who was s"uared up 5 thought if ,name- could s"uare up that nice, 5 can do it 1hat was so much hope for me7

23

22 24

"eco..endations related to social services: 2 4 L J Mwe can7t be pimped by the system when we are trying to get out7 Mwhat7s the difference between this and immigration7 Mwe need to know where to go and how to get there, who will support me7 M$e are the !ictimsF 6ot on the whole 5 pimped a bitch Maybe 5 am not the !ictim 5t7s the only thing 5 know since the age of 2L 5 am a J3 year old who ne!er accessed welfare or mothers allowance7

74

H K < B > 23 22

24 2L 2J 2H 2K 2< 2B 2> 43 42 44 4L 4J

M1hey say if we lea!e the streets they are gonna help us8 where is itF Gou are not going to take the oppressed and gi!e them access to resources7 Mwhen you ask for help, they say @you are nothing but a hoA7 Myou try to call >22, but then you ha!e drug charges7 Mtalk about in/ustice7 M5 didn7t grow up thinking 5 was going to stab, rob 5 came from that to this, tell me it7s not society $hat didn7t 5 ha!e, or what did 5 ha!e that7s different7 M5 always ha!e my own place on the streets 5 am going back to school from Streetlight, 5 would ha!e been still there7 Gou need moral support, people telling you Myou can do it7 Gou need confidence, you ha!e known so many people talking down to you Gou are smart, intelligent, beautiful and strong Gou can look in the mirror 7 M$omen with children are penalized for child tax $hy is that penalizedF 5 can barely afford food 7 M$e are accessing food banks and clothing.that7s my stupidity Society told me if 5 straighten myself out and don7t stand on Church Street they would help me out.where is the helpF7 Male counselors where hitting on women they are supposed to be supporting $ith hold ser!ices if unless 5 sleep with counselor Some had positi!e experience 6eeded addiction support at women7s shelter O was told to worry about domestic !iolence O not addictions #ose my home and child in order to get addictions ser!ices O */A won7t pay rent when in treatment 6o where to access treatment = ha!e kids looked after %ncomfortable being in reco!ery meetings run into Cohns 0it on by other people in reco!ery because they were know sex workers 1reatment facilities O food substandard O not healthy #et detox because of men hitting on me 1reatment O need excuse/reason O was accused by counselors of working/made to feel bad about thisP

!t)er priorities related to addictions t)at ,ere identified include: 2 4 L J H 75 $hen we go to treatment centres the focus is on addiction only, and 5 think that is not enough U you can7t take care of /ust one area Coping with trauma 0olistic care Seeking help and assistance Confidence

K < B > 23 22 24

1he trade off, finding something to replace addiction My own personal path U 5 gotta feel the shame until it7s not healthy anymore 1he role addiction plays in keeping people trapped in the sex trade in order to feed their habit 1he cyclical nature of addictions, both inter.generationally and within the indi!idual 1he impact of addictions which often leads to poor coping mechanisms, including poor /udgment which increases the risk of !iolence from @/ohnsA and others 1hese issues are compounded by a lack of ade"uate detoxification and treatment programs @1he problem with drugs is its fun at first but it progresses into many problems on many different le!els A

!t)er reco..endations related to addictions t)at ,ere identified include: 2 4 L J H K < B > 23 22 24 2L 2J 6ew #aws, infrastructure for addicted sex workers, Continuum of after care for addicted sex workers, $elfare needs to ha!e more realistic approach, more sensiti!e to reality, not looking at them like people, )olice trained on info and reality, what is a!ailable to offer sex workers, laws in relations to housing, long waits to see a doctor, as well as lack of doctors, no forms will be filled out to access ser!ices, methadone, more low rental with single persons accepted not /ust families, addition ser!ices, close the gap in the time restraints, and wait time, 0ep C drugs more a!ailable, die while waiting, Soup kitchen only open on the week day, only lunch and super, parents help to fill out forms *ducation on needle use 6eedle exchange more accessible 4J hour open house/centre for women ,prostitutes6eed more long term detox = treatment centres ,4B days O not enough1reatment center for sex workers More family treatment centres 5nclusi!e healing programs = supports for indi!iduals affected by sex trade

1he main issues identified were housing, higher risk of !iolence, health and stigma 5t was clear that many of these issues could be easily addressed in a cost efficient way with decriminalization of section 42L Safe housing where women could work safely, recei!e health information and medication 76

and pay into a medical and dental plan would alle!iate many of the issues that were raised $hile some women want to get clean from their addictions, there are those who do not 0ousing that takes this into consideration would pro!e to be more successful as women who do not use drugs could ha!e safe houses and for those who continue to use could ha!e safe houses that include a safe in/ection site, detox, or other harm reduction methods 0ealth issues such as bad skin and teeth could be addressed by ha!ing a medical and dental plan a!ailable 1he medical profession could ha!e sensiti!ity training in regards to sex workers and these safe houses could offer practicum placements for nurses and doctors who are interested in working with this population 1here was a lot of discussion about de!eloping transferable skills, life skills for sex workers 0a!ing a peers.like model has been !ery successful and supporti!e for many of the women attending the focus group 1he main recommendation is for sex worker specific programs8 There%s a lot of discomfort by being in a meeting and you%re sitting across from someone you%ve sucked off. "ould run into 6ohns K at 8treatment centre9 a lot of girls were hit on a lot by other people in recovery meetings. Because we are known sex workers Final Luote: *.rostitution and addictions go hand in hand.- 80egina9 Final "eco..endations 12 (andatory Works)ops K &ducation

(andatory workshop where we are trained to design and deliver K workshops for policy makers% government officials, and service providers that are designed, delivered and run by experiential women. Then they have to tell us what they are going to do. 1he best way to de!elop or impro!e ser!ices for a population is to ask that population what they need *xperiential women need to be a part of the process, we need to teach go!ernment and ser!ice pro!iders how to treat us O with e"uality, dignity and respect 77

52

$et rid of discri.inatory policies K We )ave to look at policy .akers too E because c)ange is a big t)ing2

)olicies than discriminate, marginalize, or further exacerbate problem for experiential women, specifically around addiction and !iolence need to be changed *xperiential women need to be a part of this process as well 1wo recommendations include remo!al of section 423 = 42L of the criminal code and basic human right of sex workers should be co!ered under human rights legislation 1hese two approaches can address almost all of the recommendation made by the <> women who participated &lanket wide sensiti!ity training across Canada7s ser!ice pro!iders will reduce experience of discrimination of sex workers Changes in all policies should shift from criminalization to human rights and e"uality for sex worker when accessing ser!ices in Canada

Addiction Ser+ices <esearch <eport

78

.repared by! Barbara Smith September 'DDG

79

a"le of contents
Introduction......................................................... 3iterature <e+iew................................................. *ethodology........................................................ Analysis of data.................................................... &onclusion........................................................... <ecommendations

80

Introduction Substance misuse among sex workers is a complex issue often related to many other issues, such as sexual abuse, emotional abuse, low self.esteem, !iolence in relationships and health status ,$omen7s Addiction (oundation, 4334- 5n :ancou!er there has been a substantial increase in the number of sex workers dying of drug o!erdoses ,:)D 5nformation on Deaths of persons known to ha!e prostituted, 2>>L- Sex workers who are addicted to drugs are more at risk for contacting 05:, experiencing !iolence and exploited than non.addicted sex workers 1he pre!alence of addiction to alcohol and other drugs is excessi!ely high among street prostitutes ,&oritch, 2>><, p KLMany belie!e that prostitution and drug addiction go hand in hand, and while this may not be the complete picture there is certainly a specific section of the industry in which this is the case $omen are often encouraged to identify the drug problem as the cause and root of their in!ol!ement in sex work, but homelessness, unemployment and !arious other problems such as (etal Alcohol Spectrum Disorder, bi.polar and so on are often present and contribute to the womenDs decision to work in prostitution 1hese other problems are, howe!er, not as fashionable to speak about as heroin addiction W1he moral code which identifies prostitute women as Wbad womenW encourages many women to say that they would not work as prostitutes were it not for drug addiction 5n some sense prostitution is more acceptable or forgi!able when accompanied by drug addiction W "uote from submission made by the )rostitutesD Collecti!e to the +n5uiry into .rostitution, ;ictoria! #inal 0eport ,4 !olumes- ,Melbourne8 9o!ernment )rinter, 2>BHSome authors ha!e addressed drug use as a beha!ioural strategy ,e g , Goung, &oyd, = umbel, 4333- who asserted that drug using prostitutes, more so than other drug users, use drugs to increase confidence, control, and closeness to others, and to decrease feelings of guilt and sexual distress 1he purpose of this report is to document the situations experienced by sex workers and propose ser!ice strategies that will assist them in accessing addiction treatment Literature "evie, 1here is little research in Canada regarding addictions as it relates to sex workers, particularly regarding inter!ention and successful models for reco!ery 05:/A5DS dominates the research done in Canada, citing sex work as a ma/or contributor to the spreading of 05:/A5DS as well as the spreading of Sexually 1ransmitted Diseases ,Spittal, et al , 433L- 1his study compared drug using sex workers and non drug using sex workers and their 81

rate of 05: pre!alence $hile this study is important, it ignores the addictions treatment component and focuses only on patterns of sexual and non sexual risk Sex trade work is not uni"ue to drug users, but it is a common way for female drug users to support their habit $hen crack began dominating the street market in the 2>B37s, many women began engaging in sex work to earn enough money to support their drug habits ,5n"uired, 2>BK- $omen7s need to support themsel!es through sex work created an insidious cycle $omen remained in sex work because they had few, if any, other ways to make a li!ing ,cited in *akin, 6o! 4332Sex workers were unable to separate themsel!es from the drug world, which in turn was what kept them tied to prostitution ,5nciardi, 2>BK1here ha!e been se!eral studies carried out that illustrate the use of drug for sex exchanges and women turning to prostitution to support their drug habits ,5nciardi, #ockwood = )ottieger, 2>>2? Maham, 2>>K- As their addiction progresses, women find they can no longer hold legitimate /obs 5n order to support their drug habit, they turn to sex work to obtain enough money for their next drug 1herefore, their li!es become enmeshed in the drug world and sex work ,Sterk, 2>>>5n summary, addiction and sex work appear to be Mintertwined 7 $omen perform sex work as a means to support their e!ery increasing appetite and need for more drugs, particularly so once they become addicted to the drug As such, many of these women7s li!es become enmeshed with degradation, stigmatization and low self.worth $omen who participate in sex work may become !ulnerable to the dangers associated with this lifestyle, such as !iolence abuse or rape Despite media attention and public anxiety, there remains little academic research on addiction among women who ha!e engaged in sex work As 0elen $ard ,2>><- notes8 @Drug using female prostitutes appear to be a Mhard to reach7 group #ittle is known about these women7s perception of their health needs and their knowledge, responses and access to appropriate ser!icesA ,$ard, 2>>>- 6ot only do we need to know more about drug addiction, sex trade work and the connections between the two, we need to know more about this population in Canada as the o!erwhelming ma/ority of the research has been carried out in the %nited States ,&rock, 2>>B8 #owman, 2>>4(et)odology 1his research was conducted nationally with sex worker specific organizations in three pro!inces across Canada? namely, &ritish Columbia, 'ntario and 6ew &runswick A non.standardized "uestionnaire, consisting of 82

22 "uestions relating to barriers in accessing addictions ser!ices ,see Appendix A-, was designed (i!e sur!eys were distributed to sex worker. specific agencies across Canada (ifty sur!eys were a!ailable for their clients 'f the H3, L4 sex workers responded 5n addition to the sur!eys, a focus group with sex workers was held at )**+S :ictoria on September 24th, 433H %pon completion of returned "uestionnaires, the results were tabulated and outcomes were produced Analysis of %ata %sing a flip chart, a list of issues were discussed by the women regarding access or lack thereof to treatment and addiction ser!ices Some of these barriers include8 #ack of appropriate ser!ices? long waiting lists, unrealistic expectations to enter treatment, shame, stigma and lack of childcare Additionally, it became e!ident that society7s interpretation of what addiction is and their marginalized !iews on prostitution were a ma/or barrier to accessing ser!ices Sex workers sur!eys indicated that many began using drugs at an early age, some as young as nine years old Ages ranged from 4L years old to HJ years old 'f the L4 sur!eys 4L were no longer in!ol!ed in sex work (i!e were in the process of exiting while still working 1he most pre!alent ser!ice accessed while exiting the sex trade was sex worker specific agencies such as )**+S and Streetlights 'f the drugs identified in the sur!ey, cocaine was by far the most common, followed by alcohol A !ery small number of the women had been to detox or accessed treatment, howe!er, many stated that they had attended twel!e step programs Shame, fear and extremely long waitlists for detox and treatment pre!ented them from recei!ing the support they needed An o!erwhelming response to what is lacking in addiction ser!ices was the unrealistically short duration of a treatment program and no follow up aftercare *+ was able to clean up and get out of crisis, however + felt little support afterwards and was passed over many times because + was not in crisis, there was no treatment program that my son could come with me O and +%ve had many slips and + believe its because the in=depth work needed to be done was not done.A lack of understanding towards sex workers issues was also brought up Sex workers would like to see sex worker specific ser!ices combined with addiction ser!ices pro!ided to those seeking treatment A combination of support for sex workers issues and their addiction issues was mentioned as an important element in reco!ery 83

@+ feel meeting with both support and drug counselors together is most effective. The tag team effect really puts the view in a better light for the person who needs support K.1he importance of experiential support was mentioned many times *the peers program in ;ictoria + believe to be one of a kind here. (yself it has helped me to get clean, get off the street, and support with learning in a positive place O (on to #ri otherwise O where would + go to unlearn this behaviour, and put positive things in its place.5mmediate safe housing was echoed throughout the agency sur!eys Mental health was also an issue for many of the agencies who responded (ASD, &i.polar, depression and other disabilities affected the agencies ability to pro!ide ade"uate ser!ices Addiction and sex work affect women emotionally, sexually, physically, psychologically and socially ,*akin, 4332- All of the women in the focus group had experienced some form of !ictimization and/or complete loss of control at certain stages in their drug addiction and sex work All of the women in the focus group expressed a desire to stop using and working in the sex trade 0owe!er, all of the women struggled and felt they could not stop, until they were so caught up in the web and so desperate to get help, they became willing to do anything and it is in that moment that immediate housing is re"uired A large disco!ery as a result of this research pro/ect was the amount of women in sex work who are affected with (etal Alcohol Spectrum Disorder Many of these women ha!e the capacity of a six year old yet li!ing in the body of a 4H year old Many of these women ha!e had children while still working and using 5n fact, according to current research through the & C 0ealth +esearch (oundation on the working conditions of sex trade workers, 2JH out of 2K3 women inter!iewed ha!e been pregnant anywhere from 2 O 22 times #ess than 4HX of these women ha!e their children with them Most of these children are in care Sex work and addictions ha!e a powerful connection and many sex trade workers are addicted to alcohol and drugs Some pregnant sex trade workers, particularly youth do not ha!e the knowledge about the se!ere impact alcohol has on the fetus ,C &enoit, A Millar, Dispelling the Myths, 4333-

84

Age of Participants

35

30

Over 30 Under 30

25 # of participants

20

15

10

Source: Sex Work and Addictions, 2005

85

Age started using

20 18 16 14 # of participants 12 10 8 6 4 2 0
Source Sex work and addictions, 2005

14 & under 16 18 20 & over

Services Accessed

14

12

10 # of participants !etox "esidentia# treat$ent AA%&A addictions da' (rou) addictions indiv ot*er +

Source Sex work and addictions, 2005

86

Barriers

14

12

10 s*a$e, $'se#, Wait#ists c*i#dcare $enta# *ea#t* )i$)s, ,a$i#' no )*one address

# of participants

Source Sex work and addictions, 2005

Services Lacking

16

14

12 !etox, residentia# -x)erientia# .ractica# su))ort /enta# *ea#t*

# of participants

10

2
Source Sex work and addictions, 2005

87

Suggestions

18 16 14 12 # of participants 10 8 6 4 2 0
Source Sex work and addictions, 2005

residentia# treat$ent -x)erientia# exitin(

Conclusion Addiction is a complex issue Are women addicted to drugs before they become in!ol!ed in sex work O or do they become addicted afterF Sex workers who are homeless, under housed or socially isolated are at high risk of de!eloping addictions Some ha!e been in and out of L3 day treatment programs, only to go right back into the lifestyle $ithout longer term treatment and follow up, the system becomes a re!ol!ing door that is neither helpful nor cost effecti!e Some li!e li!es that are too chaotic for them to focus on their addictions 'ften traditional treatment programs are not accessible because these women do not meet rigid admission criteria 1heir relapse rate is high, in part because the ser!ices they recei!ed were not appropriate +eco!ery from addiction and sex work is a long process Drug addiction and physical health needs must be addressed first through residential detox and safe, staffed housing +eco!ery from sex work is a process on its own and must be dealt with through gender specific, peer support #ack of immediate ser!ices, particularly detox and safe housing were echoed as one of the biggest barriers $aitlists, unrealistic expectations on clean time before entering treatment was also a barrier 6ext came 88

childcare and lack of family inclusion Many women were afraid their children would be apprehended if they sought help for their addiction 1hose affected with (etal Alcohol Spectrum Disorder ha!e a difficult time, not only accessing ser!ices but also in completing programs &ecause those with (ASD ha!e such high needs many addiction ser!ices are not e"uipped with the education and/or understanding of how to support those with this disability 'ften they are asked to lea!e because of their high needs, being mistaken as non.compliant and a nuisance 1his population re"uires a long term reco!ery process that focuses on the addiction first, then the trauma associated with sex work Many sex workers are in different stages of their reco!ery and therefore re"uire different ser!ices along the continuum "eco..endations $omen7s needs are multidimensional 1he a!ailability of a wide range of health and treatment ser!ices is crucial Many sex workers are often ambi!alent about accessing ser!ices or afraid of puniti!e conse"uences 'pportunity must be taken when it arises otherwise the opportunity can be lost if treatment is not immediately a!ailable or readily accessible A prere"uisite to ha!ing L3 days clean can seem impossible without a super!ised pre treatment facility Accessibility of ser!ice remains the most important factor in determining treatment recei!ed (ollow.up and aftercare is the most important factor in sustaining their sobriety Waitlists 2 5ncrease supporti!e reco!ery beds for women while they wait for treatment 1his includes detox beds, stabilization, AA/6A reco!ery models, healthy, super!ised acti!ities that focus on issues that sex workers face )ractical case management in remo!ing barriers to accessing treatment Direct referral agents to work with case managers to reduce intake procedures, particularly when transferring clients out of town Connect experiential agencies across Canada to transfer women out of town to similar models of reco!ery (unding for emergency transportation, practical needs

4 L J

+rogra.s and follo, up 2 #onger term residential treatment through a three step continuum 5ndi!iduals can access whiche!er stage they are at

89

4 L J H K C)ild Care 2 4 L @ousing 2 a b c d 4

Case management and follow up with women before they lea!e treatment Ser!ices must be client.centered, demonstrating respect for where the sex worker is at and not where the ser!ice is at Ser!ices must be flexible, easy to access, and pro!ide options and choices for sex workers who are addicted to substances *xperiential must play an integral role in the de!elopment of ser!ices that affect them )rograms that deal with both sex work and addictions

De!elop safe child care with no fear of apprehension while the woman attends treatment *nsure there are treatment centres who accept children *ducate addictions specialists about sex work and co.current disorders such as (etal Alcohol Spectrum Disorder

L J

L stage housing continuum attached to experiential agencies (irst stage immediate structured, staffed, supporti!e safe housing for those wanting to Mget out of the life7, includes detox component, ten days while waiting for residential treatment Second stage residential treatment that includes children as part of the reco!ery process 1hird stage post treatment O longer term stabilizing housing for families 5ndi!idual plan and follow up includes life skills, employment training, etc 0ousing focused on stages, harm reduction model with the abstinence model has not pro!en to be successful, according to the sur!eys $omen focused on abstinence cannot share groups and rooms with those still using $et housing for those who need a place to crash and are not interested in reco!ery Consistent funding for operating staff

90

Appendi, )$ <esources used in this manual

College of 6ew Caledonia facilitation manual Centre for #eadership and Community #earning, Custice 5nstitute of &ritish Columbia )**+S :ictoria, whose facilitators work daily with sex workers in !arious stages of reco!ery Crossroads 1reatment Centre Society, whose generous contributions made the program a success in a residential setting

91