As part of her own rehabilitation, Hotaling earned a bachelor's degree in health education from San Francisco State University.
"[2] Toward the end of her work in the sex industry, Hotaling was kidnapped, driven to a cemetery in Colma, outside of San Francisco, brutally beaten and sexually assaulted.
She was left for dead, and the resulting physical injuries required her to have a metal plate installed inside her skull.
In an oral history interview, a SAGE employee under the pseudonym "Angela" said "Treatment as we know it today exists because of people like Norma.
Because intravenous drug usage is common among those involved in prostitution, the danger of Hep-C or HIV transmission is high.
SAGE's harm- reduction approach to public health was used to prevent risky behavior, for instance, by offering condoms and bleach (for cleaning needles) to those at risk.
She was able to communicate well with the whole spectrum of society, from inmates and prostitutes, to the most politically successful of local, national, and international circles.
On one occasion she visited the White House and spoke with President George W. Bush about the conditions of trafficked women.
[4][6] Hotaling believed that education and training were key factors in the rehabilitation process and undertook the task of replacing prostitution with financially viable, self-affirming employment.
Hotaling worked with groups in France, India, South Korea and other countries who requested her help in established their own rehabilitation programs.
Most of the treatment programs at SAGE involved therapy so that survivors could work on past emotional trauma with a person who was not afraid of listening to stories of pain and abuse.
It was the first to use a holistic approach to rehabilitate its clients, and most importantly, Hotaling insisted that “survivors of the sex industry are going to be the leaders.” By establishing the "John" school in San Francisco, SAGE was also one of the first organizations to seriously address the way in which men fuel demand within the sex trade, and to point out that if the demand side for prostitution could be made to decrease, the supply side would decrease as well.
Nobody knew how to talk about the men.”[2] The work environment at SAGE was conducive to recovery, as Hotaling believed that employee participation in self-care was crucial for healing the many different types of trauma which clients and staff may have experienced.
It was more than a place to work, especially to those who were in recovery, which included just about everybody in the building ... What began as 90% survivor-run program became a 60/40 ratio of peer/survivor counselors to professional counselors.”[4] Honors, decorations, awards and distinctions In 1998, SAGE's First Offender Prostitution Program/John school won the Innovations in American Government Award from the John F. Kennedy School of Government at Harvard University.
In 2000, SAGE's Peer Educator Training Program won the Peter F. Drucker Award for Non-Profit Innovation through the Ford Foundation.