This action research project was developed in partnership with the National Society for the Prevention of Cruelty to Children (NSPCC) and Middlesex University. It focused on case studies of 55 young women at risk of, or experiencing, sexual exploitation and/or prostitution. The work drew on the young women's own stories about the choices and opportunities available to them in their transition to adulthood.

• All the young women, who were aged 13 to 18, had histories of truanting from school. Many had harmed themselves and/or attempted suicide, had histories of physical or sexual abuse, and/or regularly used heroin.
• The sample fell into three categories: those at risk of exploitation; those swapping sex for favours, and those self-defining as prostitutes.
• Early warning signs included running away from home, sexualised risk-taking and sexual health problems, truanting from school, and getting into unknown men's cars.
• Most of the young women had violent and abusive relationships with much older men, akin to domestic violence between adults. Many had been abducted, raped or violently attacked by these men.
• Services most often used by the young women were local community-based projects offering a range of legal, social and health services accompanied by outreach and drop-in provision. Many felt that a range of service providers were unable to offer them appropriate support.
• Despite having the most problems, those selling sex were the most alienated from statutory social services. They found outreach provision offering practical facilities to be the most helpful.
• Working with the young women was emotionally demanding and resource-intensive. Workers needed to continue to attempt to contact the young women, offering an 'open door' approach. To sustain this service, workers needed ongoing and regular support, training and supervision.
• The researchers conclude that interagency approaches that offer local outreach and drop-in support, protect young people from exploitation, and also collect evidence that could be used against abusers seem to be the most effective.

All the young women experienced problems with alcohol misuse, and 30 also used heroin at least once a week; 34 regularly self-harmed, 18 of whom had attempted suicide. Many felt that they were not worth protecting from harm. One said, "It's only possible to protect yourself if you think you're worth protecting". Another saw herself as a punch-bag:

"I'm just the one stuck in the middle, like a punch-bag to punch left, right and centre ... like I have no feelings".

Thirty-nine of the young women were in relationships with violent men considerably older than themselves; 40 had sexual health problems; nine had been pregnant, six of whom had had a baby. Sixteen of the young women had been abducted, 15 of them by men referred to as their boyfriends; 22 had been raped.

Despite this level of violence and abuse, few had confidence that their stories would be believed if reported:

"They think, 'Oh, she's making up stories', because I didn't have enough evidence and I was drugged at the time."

Many felt protective of their boyfriends:

"He was just taking it out on me because I was only 16 ... in a way I do forgive him because I love this boy."

Many failed to access sexual health clinics, doctors or advice centres because of depression: "I'm too depressed to go and the journey takes too long".

The case studies suggested that there was no one pre-determined progression from being 'at risk' to 'selling sex'. Instead, the young women's actions and behaviour depended on the most recent events in their lives.

However, it was the older of the young women (aged 16-18) who were in category three. This group experienced a larger number of problems at any one time. Some problems, such as homelessness, regular heroin use, being in trouble with the police and in violent relationships with abusive men were frequently noted for those who spoke of selling sex. This suggests that early intervention with 'at risk' young women in category one could support them away from exploitation, preventing an escalation of the number of problems faced at any one time.

Category one: At risk of sexual exploitation
Many of these young women's case studies illustrated attempts to work with teaching staff, family and care workers to improve their situations. This work identified early warning signs of sexual exploitation. 'Sexualised risk-taking' involved young women taking risks with their sexual behaviour, often suggesting that they were experiencing problems in their relationships with older, often abusive and manipulative men who were at the early stages of 'grooming' them for prostitution. One young woman noted that she:

"... shagged 26 blokes in seven months. I'm not worried about Aids, would return to this if I'm not allowed to go home to live with my Mum."

Invariably, this behaviour created conflicts at school, often pivoting on differing expectations of age-specific behaviour: "I don't want to be like a kid being told what to do". This tension, along with others such as over-dependence on mobile phones, can be common for all teenagers. However, these young women's disruptive or difficult behaviour at school involved tensions around their relationships with adults, often older boyfriends who were abusing them. For example, one 14-year-old began to truant and be bullied at school after being abducted and raped by two older men, one of whom she saw as her boyfriend at the time.

Vulnerability to abuse was also evident in the young women's descriptions of getting into men's cars. Eleven of the 19 in category one talked of doing this. They did it as a search for relief from depression:

"I get into cars with men I don't know, take drugs and do bad things because I am depressed."

Or for excitement and something to do:

"I used to get into anyone's car, but I never had sex with them or nothing like that. I just went for cruises or pictures."

Some young women's situations were alleviated where schools, pupil referral units and education social work/education welfare service had been able to identify and work with these early warning signs. However, the research suggests that more work is needed to help practitioners to respond to the issues.

Category two: Swapping sex for favours
Young women in category two spoke of exchanging sex for accommodation, money or drugs. They identified concerns about their management of risk when running away from home, their experience of abduction and rape, and of being in abusive relationships with older, violent men.

All 15 young women in category two had run away from home for differing periods of time. Their decision to run was invariably seen as a positive step to do something about seemingly impossible situations: "I thought, people are messing up my life, I've to hide from them". The young women often then found themselves in situations they were hesitant to talk about:

"Oh God, I can't talk about this ... this is just ugh. I used to eat food out of the garbage."

They were also at risk as they searched for accommodation. They often took up offers to stay with men, swapping sex for a bed for the night. One said: "I've slept in men's houses that I don't know"; another spoke of staying in a flat when 'on the run' with a man whom another young woman called a "sex dealer".

Seven of the 15 had been abducted, being held against their will for at least two nights. Six of these were abducted by men they called their boyfriends, and five had been raped. Invariably, the young women appeared to be stuck in situations similar to those described by adults experiencing domestic violence. They spoke of needing to stay with the abusive boyfriend, and identified confused feelings of love and hate: "I never loved anyone the way I loved you ... to make me hate you in the way I do now". This ambiguity reflected their position as children struggling in abusive relationships with exploitative, manipulative adults, suggesting that responses could helpfully draw on work practices developed to address domestic violence as well as child protection.

As the decision to run away was often seen as a positive step, so too was the decision to return home when a young woman felt the need to take some control of her circumstances: "OK, this is just about it, go home. You can't take no more".

Category three: Selling sex
The 21 young women (aged 16 to 18) in this category spoke of selling sex, self-defining as prostitutes. Nineteen were white, compared with seven of the 15 young women in category two, and 12 of the 19 in category one. This raised questions about the visibility of minority ethnic young women who may be selling sex, and points to the need for future research in this area.

Nine of the young women explained that they started selling sex for money to pay for drugs for their use; a further six were coerced into selling by a boyfriend who also needed money to support his drug habit. Three said that they started as a direct result of a traumatic event such as being raped, one saying it was a result of feeling bad about having had her third abortion.

Despite these various reasons for starting to sell sex, all the case studies identified a range of contributory problems. Nineteen of the 21 young women were regular heroin users, and 15 were homeless, either sleeping rough, with friends or in temporary accommodation. Sixteen were in relationships with violent men. All but one had no contact with any education or employment service. Thirteen had police records (three offences being related to prostitution), and three had been in prison. Twenty had experienced sexual health problems.

Despite these multiple problems, these young women were the most isolated from service providers. They relied in the main on local outreach and drop-in services. In talking of using a local drugs project, one young woman said: "... they help drug addicts ... we would eat there because there was a telly, snooker, and you could just go there...".