1. About this presentation These slides present interim findings from a review of the evidence undertaken in workshop conditions at Evidence Base Camp 2013/14. The findings from the review are not exhaustive. Due to time constraints not all available bibliographic databases have been searched, and books and longer reports were excluded from our synthesis sessions. The findings have not been peer reviewed or quality assured in the same way as a formal research publication. The College of Policing Research Analysis and Information Unit (RAI) plans to turn this review of the evidence into a full Rapid Evidence Assessment Report in due course.

2. What interventions have been shown to be effective in responding to prostitution? Delegates: Naomi Eales – NCA Dani Matthews – College Syed Hussain – ACPO TAM Ian Henderson – College Debbie Edon-Hayhurst – College Michael Black – Nottinghamshire Nicky Davey - Wiltshire Emma Rees – Sussex Delegates: Jenny Hyams – Derbyshire Nary Lou – Met Melanie Morrison – South Yorkshire College of Policing: Nicky Miller - Research Jo Wilkinson - Research Lynn O’Mahony – National Police Library

3. How did we answer the question? Using a Rapid Evidence Assessment (REA) REAs follow a systematic process to identify and appraise evidence… …but make compromises given available time and resources Pragmatic and transparent approach Ensure best possible coverage of literature in the time available

4. The process (in a nutshell) 1.Draft search terms 2.Draft sift criteria 3.Sift received abstracts 4.Request relevant papers 5.Read and ‘grade’ papers 6.Write it up (‘synthesis’)

5. Developing search terms What interventions have been shown to be effective in responding to prostitution? TierAreaSynonyms include… 1ProstitutionProstitution; hooker; hustler; sex worker; rent boy; kerb crawling; call girl; pimp; sex tourism; stripper; brothel; sex tourism 2InterventionResponse; stop; reduce; decrease; prevent; tackle; control; deter; cut 3What WorksSystematic review; rapid evidence assessment; trial; RCT; experiment; evaluation; effective; assessment; “What works”; impact; success.

6. Search outcomes Prostitution What WorksIntervention Our search identifies studies that mention all three of our areas: Prostitution, Intervention and ‘What Works’… 979 potentially relevant studies identified.

7. Searches find all potentially relevant studies… Abstract: Attack! It's often said in sports that the best offense is a good defense. That's true when it comes to clean skin, too. Having the right skin care routine is really the only effective treatment for breakouts. "By the time you see blackheads or whiteheads, the damage is done and there isn't much you can do," says Dr. Larry Green, assistant professor of dermatology, George Washington University School of Medicine. "The key is stopping pimples before they start." Take that! Say you follow this regimen and still have whiteheads, blackheads, pustules or papules. The key to getting rid of them is using the right treatment product. Pick the wrong one and things'll get worse. Dr. Green advises, "Use salicylic acid on blackheads and whiteheads and benzoyl peroxide on pustules and papules." Peroxide does nothing for blackheads or whiteheads because it primarily attacks swelling. And salicylic acid only makes redness and inflammation of pustules and papules worse. Again, start with the gentlest formulas and work your way up. The big cover up. While everyone breaks out at some point, there's no need to walk around advertising. "Redness is a tough problem for regular makeup to handle," says Michael Criscuolo, celebrity makeup artist and on-line beauty advisor for www.pimpleportal.com. "Look for `corrective' makeup (typically in a light green or yellow shade) that takes redness out of your skin." Sifting our abstracts identifies the truly relevant literature. Sift criteria is used so that we are consistent and transparent in our sifting. Returned by the prostitution search… Anonymous Learn the secrets to solving the clear skin riddle, GIRLS' LIFE, Apr, 2000, at64.

8. Sifting – inclusion criteria QuestionAnswerAction Q1.Is the paper directly related to: Prostitution? NoExclude YesGo to Q2 UnclearExclude Q2.Does the paper focus on: Interventions/responses to tackle prostitution? NoExclude YesGo to Q3 UnclearExclude Q3.Does the paper include: Empirical data/ methods? NoExclude YesInclude UnclearCan’t exclude

9. Sifting – flow of papers Searches of two online databases (Proquest and EBSCO) N=979 Papers sifted out: N=892 Reasons for exclusion: Did not meet sift criteria. Papers excluded: Total N= 40/87 Reasons for exclusion: Language (not English) n= 2 Other exclusions: Publication not available n= 25 Duplicatesn= 2 Too long for EBCn = 11 Reports meeting inclusion criteria & mapped N= 47 Abstrac t and title screene d N=979 Full text screene d N=87 Our initial search identified 979 papers, but only 87 (9%) were actually relevant to our research question. Our findings are drawn from xx studies that we have reviewed over the last two days. We searched two of the main databases available to the National Police Library Due to time restrictions, we have not included books and reports in our synthesis Some longer studies could not be included due to time restrictions.

10. Synthesis – Mapping the evidence

14. What does ‘good’ or ‘robust’ evidence look like? Systematic Reviews (Based on level 3-5 studies) 5 Randomised controlled trials 4 Before/after measures Multiple site comparisons 3 Before/after measures Two site comparisons 2 Before/after measures No comparison site 1 One-off measure No comparison site Study designs increasingly rule out potential alternative causes Statements about ‘what works’ Statements about ‘what’s promising’ Study designs cannot rule out potential alternative causes Statements about possible impact

15. Synthesis – Quality of evidence

16. Synthesis What Works There is no clear evidence to show ‘what works’ in responding to prostitution What’s Promising There is promising evidence from one study conducted in Thailand that criminalisation of the users and controllers of prostitution, together with the provision of education and training for arrested prostitutes, did have an impact on arrest rates but this varied regionally and was not statistically significant. This was not accompanied by any change in police tactics. Evidence, from one UK study, suggests a short-term impact on displacement of street prostitution away from residential areas with the introduction of a road management schemes; the longer term impact of this intervention was not known.

17. Synthesis What’s Unknown There is some evidence to suggest that: criminal justice diversion programmes (4) targeted at ‘Johns’ will result in changed attitudes towards prostitution but there are mixed results, using recidivism rates, that this attitude change translates into behavioural change. Youth (13 – 19 yrs) involvement in ‘street schools’ (1) has a positive impact on self esteem, school sentiment and reduced involvement in child prostitution activities, as well as reducing depression in this group. Legalisation of prostitution (1) increases the demand for human trafficking Criminalisation of prostitution in Canada (1) did not impact on rates of prostitution but did facilitate prosecution; this was not applied equally. Therapeutic intervention programme (well being) aimed at prostitutes in prison and community resulted in positive impact; long term impact not known. What Doesn’t Work There was no evidence available. What’s Harmful There was no evidence available.

18. Key messages Most studies were published in the last 10-15 years and were undertaken in North America with only one UK study The overall quality of evidence is low The main focus of impact intervention studies has been on diversion (5) and criminalisation (3). The two most robust research studies (Level 4) related to criminalisation of users and controllers of prostitutes, together with an education and training programme for prostitutes (Thailand) and the impact of a road traffic management scheme on displacement of street prostitutes (UK study). There are a number of policing operations that target prostitution, as well as multi agency initiatives for which funding is sought; it was surprising that the number of impact studies was so low. Opportunities exist for more testing of such interventions. What interventions have been shown to be effective in responding to prostitution?

19. Key messages Issues to consider: More research is needed both overall and in relation to adapting to technological development (e.g. you could focus on the role of the internet in facilitating prostitution and inhibiting the law enforcement response). Lack of research evidence on how to manage and reduce demand Need to map out exactly what is going on with prostitution across the UK to get a better idea of the issues involved so as to inform design of more targeted interventions What is the outcome measure for an ‘effective’ response to prostitution? Who is the intervention best aimed at – the client, the prostitute, the community? Conducting research in this area with ‘sensitive’ populations will always be challenging. Who conducts the research may have an impact on the accuracy/value of the research outcomes (research ethics); different agencies have different objectives (e.g. sex worker well being Vs law enforcement) which impacts on what they are looking for from research. Opportunities exist for collaborative, multi agency research. What interventions have been shown to be effective in responding to prostitution?