Exit Doors Here: Helping Sex Workers Leave Prostitution

Brief Description

The Exit Doors Here: Helping Sex Workers Leave Prostitution program, implemented by Elizabeth Fry Toronto, aims to help women wanting to exit prostitution by providing them a time-based service intervention. Using a Critical Time Intervention (CTI) model of change, the program offers an individually-adapted, multi-disciplinary approach to supporting participants out of a life of prostitution using customized wraparound services.

The program is centered on counselling and social work; cognitive behavioral therapy; service referral; skills training; support groups; and psycho-education.

Goals

The main goals of the Exit Doors Here program are to:

• Support women wanting to exit prostitution;
• Provide women leaving prostitution with the services to meet their needs; and
• Build capacity and opportunities for the participants.

Clientele

The appropriate clientele for the Exit Doors Here program are women (16 years and older) seeking to exit the sex trade. This group includes street based sex workers (including transgendered women), trafficked sex workers (both Canadian and migrant), and private/non-self-identified sex workers.

Referrals from the program come from the host organization; outreach workers meeting clients in the street; and legal, social justice, and anti-human trafficking networks.

Core Components

The Exit Doors Here program consists of the following phases:

• Pre-phase – Making the connection on-going: This phase encourages sex workers to take the first step in accessing services toward their plans to exit. Activities in this stage include outreach campaigns (online/print), in-reach to potential clients, providing informational material about the service, and providing clients with non-judgmental reception;
• Phase 1 – Client Intake and Assessment: The intake process is the foundational step in which information about the client (including risk factors, program eligibility, presenting issues, etc) is gathered. This information is used to indicate the level of readiness of the client, which will assure that the correct service planning approach is taken for each client;
• Phase 2 – Service Implementation and behaviour change: At this phase, a service plan for the client is developed, and an agreement as to what supports are needed by the client are decided by the client and case manager. Interventions are offered to the client at this stage, including individual counselling, psycho-education/group counselling, and peer supports. It is also at this stage that clients are referred to the appropriate outside services for other issues; and
• Phase 3 – Adopting a non-prostitution identity: At this stage of the intervention, the case manager works with the client to set in motion long term goals identified in the client service plan. Meetings are still made to review progress made, and ensure that the client can function independently.

Implementation Information

Some of the critical elements for the implementation of this program or initiative include the following:

• Organizational requirements: The organization aiming to implement the Exit Doors Here program must have extensive knowledge of the prostitution issue in their community, and must have the resources and knowledge to appropriately care for clients attempting to leave prostitution.
• Partnerships: Important partnerships for the successful implementation of the program include counselling centres; employment centres; health, mental health, and substance abuse centres; and any other community agency that can help intervene with the clientele’s issues.
• Training and technical assistance: Limited information on this topic.
• Risk assessment tools: Limited information on this topic.
• Materials & resources: As the program uses the Critical Time Intervention (CTI) model of change, the progress scales and other measurement tools associated with the model are necessary for the program.

International Endorsements

The most recognized classification systems of evidence-based crime prevention programs have classified this program or initiative as follows:

• Blueprints for Healthy Youth Development: Not applicable.
• Crime Solutions/OJJDP Model Program Guide: Not applicable.
• SAMHSA's National Registry of Evidence-based Programs and Practices: Not applicable.
• Coalition for Evidence-Based Policy: Not applicable.

Gathering Canadian Knowledge

Canadian Implementation Sites

Public Safety Canada’s National Crime Prevention Strategy provided funding to the Elizabeth Fry Society to implement the Exit Doors Here: Helping Sex Workers Leave Prostitution program from 2017-2022 in Toronto, Ontario.

Main Findings from Canadian Outcome Evaluation Studies

As part of Public Safety Canada’s funding, an outcome evaluation study of Exit Doors Here was carried out between December 2017 and February 2022 by MAP Centre for Urban Health Solutions at St. Michael’s Hospital. The evaluation methodology included a mixed-methods design, including qualitative (e.g., interviews) and quantitative (e.g., pre- and post-testing) measures. The evaluation used contribution analysis, which is a theory-based approach that allows for the inference of causality to understand the contribution a program makes to observed results, in the absence of a control group.

Results from this evaluation showed the following:

• The program was successful at reaching the target clients with 95% (n = 52) involved in sex work and 4% (n = 2) at risk of returning to sex work at recruitment. Of the 30 women with follow-up data, 63% (n = 19) reported they were not involved at all in sex work while 37% (n = 11) reported they were rarely involved one month after graduating the program.
• The focus areas for which the most women progressed were “support networks” with 63% of women (n = 19) reporting progression, followed by “accommodation” (60%, n = 18), “money” (50%, n = 17) and “work and learning” (50%, n = 16).
• All partner agencies surveyed (n = 22) reported a positive working relationship with the Exit Doors Here program and saw great benefit to their shared work efforts. 

Cost Information

A cost analysis was conducted for Years 2 to 5 (2018-2022) of the Exit Doors Here program.  The findings from this analysis have shown the following:

• In Years 2 to 5 of the program, between 30 and 40 participants were enrolled in the program each cycle, with the cost per participant ranging between $15,292.42 and $19,549.97.
• The total program operating costs (not including evaluation costs) ranged from $586,449.10 to $623,385.78 per cycle of the program.

References

MAP Centre for Urban Health Solutions. (2022). Elizabeth Fry Toronto Exit Doors Here program. Final year evaluation report [Unpublished final evaluation report]. Submitted to Public Safety Canada.

For more information on this program, contact:

Elizabeth Fry Toronto
215, Wellesley Street East
Toronto, Ontario M4X 1G1
Telephone: (416) 924-3708
E-mail: info@efrytoronto.org
Website: http://www.efrytoronto.org/