4.0 Programs and services
This section describes the different types of programs and services delivered to clients of MAPI organizations. The list of programs and services are as follows.
- Housing support: Emergency shelter, transitional housing and/or longer-term housing.
- Substance abuse treatment: Detox and substance abuse treatment.
- Mental health support: Counselling, trauma therapy, and crisis intervention and support.
- Healthcare services: Medical care, dental care, and specialized physicians.
- Social and economic programs: Education support, life skills programming, programs for developing social and communication skills, income assistance, financial and debt management support, and employment support.
- Family supports: Parental training, family support programs, and childcare.
- Indigenous support services: Elders, healing circles and Indigenous-designed support programs.
- Mentoring, advocacy and justice system participation: Mentoring and peer support, advocacy services, and support with the legal system (as accused or victim).
- Other programs and services: Food bank, clothing, safety planning, sexual assault and domestic violence support, and computer literacy courses.
The proportion of MAPI clients who accessed these programs and services are presented in Chart 4.1.
All of the representatives of MAPI organizations who participated in interviews stressed that their clients need access to significant supports regardless of whether they wish to remain in or exit the sex trade. Many of their clients do not have a safe place to live. Exiting the sex trade generally means losing their main source of income and they may not have access to transportation, identity documents, or a cell phone. They may have addictions that need treatment, as well as significant mental and physical health issues. As one interviewee explained,
“I would describe the exiting process as excruciating. It is excruciating. One survivor summed it up really well, she said ‘I went into exploitation and sex work with nothing and I left with even less.’ ”
Chart 4.1
Proportion of MAPI clients by the types of programs and services delivered to them by MAPI funded organizations, Canada, 2015-16 to 2019-20
Text version
This is a vertical bar graph with 18 categories representing the different types of programs and services delivered to MAPI clients by the MAPI organizations. The text on the side of the graph indicates that the data are presented as percentages and the total number of people in the study is 2,289.
The first category is for people who accessed housing support through a MAPI organization. The bar is dark blue and indicates 38.1%.
The second category is for people who accessed substance abuse treatment through a MAPI organization. The bar is dark blue and indicates 20.6%.
The third category is for people who accessed mental health support through a MAPI organization. The bar is dark blue and indicates 51.7%.
The fourth category is for people who accessed health care services through a MAPI organization. The bar is dark blue and indicates 17.6%.
The fifth category is for people who accessed education and life skills programs through a MAPI organization. The bar is dark blue and indicates 34.6%.
The sixth category is for people who accessed social and communication skills programs through a MAPI organization. The bar is dark blue and indicates 24.5%.
The seventh category is for people who accessed family, childcare and parenting support through a MAPI organization. The bar is dark blue and indicates 8.5%.
The eighth category is for people who accessed employment support through a MAPI organization. The bar is dark blue and indicates 8.6%.
The ninth category is for people who accessed income and financial management support through a MAPI organization. The bar is dark blue and indicates 14.4%.
The tenth category is for people who accessed mentoring services through a MAPI organization. The bar is dark blue and indicates 19.5%.
The eleventh category is for people who accessed advocacy services through a MAPI organization. The bar is dark blue and indicates 20.4%.
The twelfth category is for people who accessed Indigenous cultural services through a MAPI organization. The bar is dark blue and indicates 9.1%.
The thirteenth category is for people who accessed the justice system with support from a MAPI organization. The bar is dark blue and indicates 8.3%.
The fourteenth category is for people who accessed services for basic needs through a MAPI organization. The bar is dark blue and indicates 6.5%.
The fifteenth category is for people who accessed safety planning through a MAPI organization. The bar is dark blue and indicates 11.1%.
The sixteenth category is for people who accessed other programs and services through a MAPI organization that are not listed in this graph. The bar is dark blue and indicates 37.2%.
The seventeenth category is for people who did not access any programs or services through a MAPI organization. The bar is dark blue and indicates 0.7%.
The eighteenth category is for people whose access of programs and services through a MAPI organization is unknown. The bar is dark blue and indicates 10.8%.
Notes:
- Categories are not mutually exclusive as clients often use several programs and services, therefore percentages do not add to 100%.
- The "Unknown" category consists of responses of "Unknown" and "Not stated" (blanks).
Source: Justice Canada, Measures to Address Prostitution Initiative (MAPI), 2015-16 to 2019-20.
4.1 Housing support
Close to 40% of MAPI clients accessed housing support services (Chart 4.1). Almost a third (32%) of all clients received housing support such as transitional housing and support finding affordable and longer term housing, and 16% of all clients used emergency housing supports such as shelters and crisis beds (data not shown).
According to a few of the interviews with MAPI organization representatives, when shelters are full, some cities will pay for people to stay in motels and hotels, which is very dangerous for clients as there are generally traffickers and exploiters working in motels and hotels. This compromises clients’ safety and puts them at a higher risk of being recruited or lured back into the sex trade.
4.2 Substance abuse treatment
Over two-thirds (68%) of MAPI clients had a substance abuse issue, whereas 19% reported not having any addiction issues (Table 4.1). More specifically, about a third (34%) of MAPI clients reported an addiction to drugs, 6% reported an addiction to alcohol, and 16% reported addictions to both drugs and alcohol.
Overall, 21% of MAPI clients attended some form of substance abuse treatment, which was either delivered by a MAPI organization or was a referral to another service delivery agency (Table 4.1). During interviews with MAPI organization representatives, the majority reported that their clients having an addiction to drugs and/or alcohol is one of the main reasons they struggle with leaving the sex trade.
One interviewee explained that sometimes third parties and purchasers will provide drugs, openly or covertly, to people selling their sexual services which is often the start of a dependence.
Table 4.1
Proportion of MAPI clients by type of addiction issues, Canada, 2015-16 to 2019-20
| Type of addiction issues | Percentage N = 2,289 |
|---|---|
Total addictions |
68.0 |
Addiction to drugs |
34.0 |
Addiction to alcohol |
5.5 |
Addictions to both drugs and alcohol |
15.5 |
Addiction(s) but not specified |
12.9 |
No addiction issues |
18.5 |
Unknown |
13.4 |
Total |
100.0 |
Note: The “Unknown” category consists of responses of “Unknown” and “Not stated” (blanks).
Source: Justice Canada, Measures to Address Prostitution Initiative (MAPI), 2015-16 to 2019-20.
4.3 Mental health support
Just over half (52%) of clients in the MAPI dataset received mental health support such as counselling, trauma therapy, and crisis intervention and support (Chart 4.1). Other examples of mental health supports included in this category are grief counselling and anger management.10
During interviews with MAPI organization representatives, all interviewees identified that most of their clients, not only those in the MAPI-funded programs, have mental health issues resulting from their involvement in the sex trade. Mental health support was the most frequently used program/service among the clients of MAPI-funded organizations from 2015-16 to 2019-20 (Chart 4.1).
In one interview it was explained how providing sexual services in the sex trade has an intense impact on people psychologically and emotionally:
You don’t totally know how you’re going to respond to certain circumstances, certain requests for sex acts or fetishes or all the rest. And I can tell you from hearing the nightmares for years and the screaming in their sleep that this affects people in a profound way.
It’s not about morality; it’s about understanding psychologically that sex is an act that for some people has a much more intimate engagement with who they are. You can do your best to shut it down, but it’s so physical, it’s so engaged with the person and it’s a stranger that very often doesn’t respect you and a stranger where there is an inherent power imbalance because of the services rendered and financial component.
The interviewees from the MAPI organizations generally referred to the trauma that results from involvement in the sex trade as complex trauma, which involves being repeatedly exposed to multiple traumatic events. All MAPI organizations either referred their clients to counselling or provided counselling services directly.
In several MAPI interviews, the representatives of the organizations indicated that many of their clients exhibit symptoms of post-traumatic stress disorder (PTSD) such as flashbacks, nightmares and night terrors, or have an official diagnosis for PTSD. Additionally, in a few of the interviews, interviewees noted that a mental health issue they commonly see among their clients is dissociation. Dissociation occurs when a person experiences a feeling of detachment from their body and loss of memory (American Psychiatric Association 2018). It can be a result of involvement in the sex trade, as people providing sexual services often have to split or change their personality in order to conduct themselves in certain ways that appease the requests of different sex purchasers.
In one interview, a MAPI organization representative described how many of their clients engage in self-harm as a direct result of trauma they experienced from involvement in the sex trade, as well as suicidal ideation. Staff at all the MAPI organizations have witnessed some very serious self-harm and suicide attempts by their clients, and some clients did complete suicide during the MAPI program (data not shown).
The majority of MAPI organization representatives emphasized in interviews that their clients tend to suffer from very low self-esteem and self-worth for various reasons, such as the stigma of being in the sex trade, guilt from things they have done while in the sex trade,11 and pre-existing lack of self-esteem. These feelings of worthlessness are often tied to past trauma and to trauma from sustained physical and sexual assault in the sex trade, to the point that many of their clients accept violence and abuse, including because they feel they deserve it. MAPI organizations reported that low self-efficacy can be a huge barrier to a successful exit from the sex trade, which is why all the MAPI organizations provide programs that focus specifically on building self-esteem. Self-efficacy is about how well a person is able to cope with a given situation based on their experiences and skills.
4.4 Healthcare services
Close to 20% of clients accessed healthcare services through a MAPI organization (Chart 4.1). Some examples of referrals to healthcare services are family medicine clinics, dental clinics, hospitals, specialized physicians, pharmacies, diagnosis and treatment for sexually transmitted infections (STIs), dietitians, pre-natal care and occupational therapy (this last example represents a very small portion of healthcare services). This category does not include mental health support services, which was measured as a separate category.
4.5 Social and economic programs
Among clients of MAPI organizations, 35% accessed supports for education and life skills programs (Chart 4.1). Examples of education supports include support with accessing and completing formal education such as high school or equivalency, as well as vocational training and college or university programs. Life skill programs focus on teaching MAPI clients how to cook and eat healthily, how to access public transportation, how to obtain identity documents,12 as well as other general life skills and information on different social programs.
MAPI organizations have noted that many of their clients have not had much exposure to different social processes and structures due to the isolating nature of the sex trade, and many of their clients lack basic knowledge and skills.
A quarter (25%) of MAPI clients attended a program that assists with development of social and communication skills. One organization noted in their interview that the sex trade is very isolating; their clients usually work alone and they work irregular hours any time during the day and night. They often have not had the time to develop relationships and social networks outside of the sex trade and lack basic social skills. MAPI organization staff have observed that their clients often struggle to work in teams in mainstream employment when they do attempt to exit the sex trade.
Many MAPI organizations have noted that as a result of a general lack of social, life and communication skills, their clients find navigating through mainstream society challenging, which makes exiting the sex trade even more difficult. Many clients view their time in the sex trade as lost time, as described in one of the MAPI interviews:
Another challenge is that it is not cross-transferable; most clients will say it’s completely lost time. Any time they are in sex work, nothing else in their life was able to develop or grow, everything actually started to die in their life.
In the MAPI client dataset, 9% accessed employment supports such as help finding employment, career coaching, job shadowing, paid work experience programs, and support for starting a small business (Chart 4.1). About 14% of clients accessed financial management programs such as income support and debt management, including learning how to open a bank account.
4.6 Family supports
About 9% of MAPI clients received some form of family support through a MAPI-funded organization, most of which were related to parenting and children (Chart 4.1). MAPI organizations offered three types of family programs and services to their clients: family support, parental training and childcare. For some of these programs and services, clients were referred to other service delivery agencies.
Among MAPI clients, 6% accessed family support programs such as support for working with child welfare services, family preservation units and early childhood intervention programs13 (data not shown). About 4% of MAPI clients attended parental training programs, and 2% accessed childcare services such as day care, early childhood learning programs and summer camps.
4.7 Indigenous support services
MAPI organizations were asked to report on the number of clients they referred to arts and cultural programs. In the MAPI dataset, just under 10% of clients were referred to at least one of these programs (Chart 4.1). The majority of these programs are Indigenous support services such as access to Elders, healing circles, Indigenous arts programs, Indigenous cultural teachings and Indigenous court support workers.
4.8 Mentoring, advocacy and justice system participation
About 20% of clients received mentoring and peer support from MAPI organizations, and 20% used advocacy services available through the organization (Chart 4.1). During interviews with MAPI organizations, a few explained that their clients often encounter discrimination and stigma when trying to access mainstream services such as healthcare and the justice system and that, due to their lack of knowledge of societal structures and organizations, many clients struggle with navigating these systems. MAPI organizations provide advocacy services to support their clients and ensure they are able to access the services they need.
Around 8% of MAPI clients received some form of support when dealing with legal systems in Canada, as offenders and/or victims (Chart 4.1). These include support with accessing Legal Aid, dealing with criminal records,14 accessing victim compensation, accessing transportation and the per diem for food when the day is spent at court, working with police, statements to police and court appearances, and Indigenous court support programs.15 In interviews, MAPI organizations noted that their clients find the criminal justice system very difficult to navigate, especially when the matter concerns charges against a third party who has financially benefitted from their sexual services as this process is often re-traumatizing and substantial support is required, including outside of court hours.
4.9 Other programs and services
Among the MAPI clients, 7% accessed supports for meeting basic needs such as the food bank and for clothing (Chart 4.1). Around 11% worked on safety planning with the MAPI organization, and almost 40% participated in other programs. The category for other programs contains a wide variety of programs and services that did not fit under the other categories, such as (but not limited to) sexual assault and domestic violence support, after hours support, transportation (e.g., a low income bus pass), computer literacy courses, and pet care.
4.10 Program participation and completion
When assessing the level and extent of their clients’ participation in MAPI programming, organizations were more likely to report that their clients are meeting program goals (31%) than exceeding them (8%) (Chart 4.2). The proportion of clients who were assessed as not meeting program goals, below and far below goals, is 17% (data not shown). About 10% of clients were not participating in MAPI programming, such as those who were discharged from the program or who stopped contact with program staff. The proportion of cases for which information was missing (not stated) is notably high at almost 30% (Chart 4.2).
Chart 4.2
Proportion of MAPI clients by extent of program participation, Canada, 2015-16 to 2019-20
Text version
This is a vertical bar graph with seven categories representing the extent that MAPI clients participated in the MAPI program. The text on the side of the graph indicates that the data are presented as percentages and the total number of people in the study is 2,289.
The first category is for people who exceeded their goals while participating in the MAPI program. The bar is dark blue and indicates 7.6%.
The second category is for people who met their goals while participating in the MAPI program. The bar is dark blue and indicates 30.7%.
The third category is for people who were below their goals while participating in the MAPI program. The bar is dark blue and indicates 14.5%.
The fourth category is for people who were far below their goals while participating in the MAPI program. The bar is dark blue and indicates 2.4%.
The fifth category is for people who did not actively participate in the MAPI program. The bar is dark blue and indicates 9.9%.
The sixth category is for people for whom participation in the MAPI program was not applicable. The bar is dark blue and indicates 5.8%.
The seventh category is for people who did not state the extent of their participation in the MAPI program. The bar is dark blue and indicates 28.7%.
Note: In some cases, information from an open-ended variable was used to identify clients who were discharged from the program or who stopped contact with program staff. These counts were added to the existing category of "Not participating".
Source: Justice Canada, Measures to Address Prostitution Initiative (MAPI), 2015-16 to 2019-20.
About 16% of MAPI clients completed all of their organization’s program(s) or exited the sex trade; the largest share of MAPI clients had partially completed their programs or completed some of their programs (40%) (Chart 4.3). Almost one fifth (18%) did not complete any program, and 4% were referred to another program.
Chart 4.3
Proportion of MAPI clients by program completion status, Canada, 2015-16 to 2019-20
Text version
This is a vertical bar graph with five categories representing program completion status among MAPI clients. The text on the side of the graph indicates that the data are presented as percentages and the total number of people in the study is 2,289.
The first category is for people who completed all programs and/or exited the sex trade. The bar is dark blue and indicates 15.7%.
The second category is for people who completed some programs. The bar is dark blue and indicates 40.3%.
The third category is for people who were referred to another program. The bar is dark blue and indicates 3.7%.
The fourth category is for people who did not complete the program. The bar is dark blue and indicates 17.9%.
The fifth category is for people whose completion of the program is unknown. The bar is dark blue and indicates 21.0%.
Notes:
- The category "Completed all programs" includes "Exited prostitution" when that was the only response submitted by the MAPI organization.
- The “Unknown” category consists of responses of “Not applicable” and “Not stated” (blanks).
Source: Justice Canada, Measures to Address Prostitution Initiative (MAPI), 2015-16 to 2019-20.
Footnotes
10 These numbers are not publishable on their own due to small sample sizes.
11 During interviews with MAPI organization representatives, the main reasons provided for their clients’ guilt include degrading acts they have had to perform for sex purchasers, as well as violence and crimes they have committed and guilt from luring/grooming others to enter the sex trade.
12 These numbers/percentages include clients who used I.D. clinics to obtain their identity documents, as some clients have had their I.D. withheld from them by traffickers and exploiters.
13 In this study, early childhood intervention programs were coded separately from early childhood learning programs to differentiate the use of targeted and extra supports from standardized early learning and play programs such as the Head Start program.
14 Includes bail, incarceration, and parole.
15 Clients who accessed the Aboriginal Court Worker Program were counted in both categories of “Indigenous support services” and “Justice system participation” (Chart 4.1).
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