Table 2

Qualitative quotes

Theme/subthemeQuotes
Recruitment and retention
 Acceptability(Face-to-face recruitment)worked well, it wasn’t intrusive, you weren’t pushy, you know you blended in within the drop-in setting. So I think the women felt that if they did wanna buy into it they would, there was no pressure there. So I think that was done really sensitively. Service provider 6
It [recruitment] was very sort of like confidential and actually it was quite nice ‘cause, yeah no one really knew what I was doing when I was doing summut, you know what I mean, which is – like it don’t usually happen like that. Everyone knows what I’m doing all the time. Participant 7
 ImprovementsI think from a clinical point of view if you remove that criteria (sex work at least once a week in the last calendar month) and then of course there’s more chance of getting people through to the finish line to be able to be ready for treatment at the end. Service provider 4
Actively drug using? Yes, that makes sense (…). If they’ve been able to bring that down themselves maybe another service would be better. Like, what this offered, it’s specialistic in this. So if you was able to manage to a level yourself, maybe you don’t need [the intervention]… I’m not sure, I think that would be an interesting conversation because if they could bring it down themselves, they’d probably be a lot more stable and a lot more reliable to actually get to the EMDR . Service provider 7
So I think if you were to extend the period of time and say ‘Oh actually do you know if you’ve used within the last three months you can participate in the study and then someone who’s three months abstinent or reducing from their street heroin use or their crack use is then exposed to somebody who’s going no no no man I’m using up like a party every night’. There’d be that ethical thing within it but it would be nice to see the study opened up to a wider cohort. Service provider 2
Facilitators to attendance
 Encouragement and support to attendI would say that I’ve been quite integral in regards to developing relationships with the women, contacting them for both their individual one to ones and stabilisation groups and also their Thursday DUSSK groups as well. So just keeping that contact going if they were coming in, in our drop-in service I would see them and then sort of give them reminders, did they want little welfare calls, that type of thing. Service provider 6
 TransportIt was more of a focus thing where you know she(service provider 6)sort of like coached us as we went down, like you know keeping us like sort of aware of what we’ve got to be thinking of doing and making sure that, you know, there’s nothing wrong. Participant 7
 Food provisionI was turning up and I was like sort of god like hanging out for (…) that lunch. It was like, not the reason I was turning up but the main reason why I could (…). There is light at the end of the tunnel, you know you’re gonna be nourished and fed.’ You’re gonna be able to concentrate as well. Participant 7
Barriers to attendance
 Unstable lifestylesMy mental problems, my drug use, everything, just my life, it gets in the way [of attendance]. Participant 1
 Mental healthThey’re so low resourced, they just don’t have the distress tolerance to be able to cope with any more distress, they’re already facing so much. Even things like their housing and threats of eviction. Service provider 8
My home life was getting a bit chaotic. My depression was getting really bad as well. So, yeah, and I was waiting for my antidepressants to work but they took a while. Yeah, it was just my depression, that’s all. My anxiety. Participant 6
 Sex workIf I’ve been working the night before there’s no way I could have attended because I’m too tired, because you work all night. Participant 4
 Delays between treatment stagesIt took a little bit of a while and also for them to access their stabilisation groups then their one to ones. I think we may have lost some of the interest. Service provider 6
Experience and acceptability of the intervention
 Initial impressionsThere aren’t many services out there, which will offer individual, tailorised counselling and support to the women who have got dual diagnosis and you know mental health, drug misuse. So this study was unique and I think that’s what we were all so passionate and so behind it because it was giving the women an opportunity. Service provider 6
 Reason for participatingI just felt so alone and afraid and stuck and just needed to see if there was some way that I might be able to gain something so—really, if I’m willing to put myself out on the street and sell myself to a complete stranger, knowing that I might die, whatever, so it kind of … I felt I needed to understand why I needed to do this… So it’s about me owning my power, and about not letting myself feel as shit about myself as I have done. Participant 5
The post-traumatic stress [treatment] is—is a way of like sort of detoxing your brain. So, you know finding a reason why you do these drugs (…) to like sort of be the reason for me to like say ‘Well, I’ve got to stop now.’ You know and get off it. Participant 7
 Service providers views on the interventionI guess that people thought they weren’t going to talk about their traumas [in the drug groups] but if somebody’s been raped last night, they’re going to need to talk about it, so we were here dealing with that stuff on the spot and then we didn’t have no-one to go away and talk about it. Service provider 10
It’s very hard to do trauma processing when women to some degree are being traumatised and then having to self-medicate against all of that and then you’re trying to work on quite deep attachment developmental trauma stuff from a long time ago. (…) I’d say that trauma processing would be more successful with women who have maybe made a very strong commitment to stop [sex] working. Service provider 8
I would offer it [EMDR] as part of a—as a range of things that are offered…we’d say ‘You can have EMDR, trauma focus CBT [Cognitive Behavioural Therapy] or narrative exposure therapy and you’d kind of match the person to what you thought they might be more suited to. Service provider 8
I think they had huge admiration for the workers at [SSW charity], and found them friendly and supportive, but…there wasn’t a specific, I don’t know, once a month structured ‘let’s talk about the women and how they’ve been in the month. Service provider 9
 Participants views of the interventionI enjoyed going down there. (…) We had a good laugh and learned something while we were doing it. Participant 6
With it being all woman and not mixed going to (mainstream drug treatment service provider) and doing groups where men are involved is like, I didn’t really want to do it but here because it’s all women and I know most of the women that come here, we’ve all been through it, hence why we all come here. So one way or another we’ve all been through something that we can all relate to. Participant 3
 Intervention characteristicsIt’s [SSW charity] familiar and it’s comfortable and it’s safe. Service provider 5
The groups weren’t too big, so you sort of—I knew the people that were coming to the groups which was better, so we’d sort of you know built up a rapport. Participant 4
 Impacts of the interventionI’m just going to stop [drug use], I’m ready and I’m kind of already preparing for that, so it’s kind of brought me to a close, and I mean that as well. Personally it’s like, I’m ready, bring it on, I’m like do you know what I’ve been raped, I’ve been beaten I’ve stuck needles in myself(…) I’m done, I’m not playing this game anymore, I deserve better. Participant 5
It’s just made (…) me realise I’m not just a, like, drug addict, sex worker. I’m a real person and I’ve got feelings and, you know, I’ve got potential. You know, yeah, they [service providers] build me up a lot. Participant 6
When she(participant 6)started with [name of intervention] study and she was coming to her Thursday [drug] groups, she didn’t want to be associated with street sex working. So she said ‘Can you call me (own name rather than working name)?’ I could have cried (…). She was owning her own name and taking back ownership of who she is rather than somebody who was street sex working. Service provider 6
Their chaoticness. (…) To manage that in a [mainstream drug service] group setting would be difficult and I’m not sure how they would manage that. I just know how much regularly how they’ve turned up [to the intervention drug treatment groups) chaotic and they’ve turned up leaking out trauma. … I’m far from confident that they would be able to sit under them [mainstream drug service] rules enough to be a part of what it is for here[research study], due to the level of flexibility here and that they would be able to talk about what their problem is without mentioning what they do and that might make them vulnerable Service provider 7
 FidelityI guess we were kind of thinking of it in a really linear sense, that the women would engage in the drug groups and then reduce their drug use to then move on to the next group and I’m not sure that that actually happened in reality.
Service provider 5
In the beginning we went in doing the same sort of work that we would do here [mainstream drug services], and it’s getting them to look at their behaviour, and the consequences of it and stuff, and it didn’t work with these women, it’s too much, too direct. Service provider 10