Letting the Future In Evidence, impact and evaluation

We've developed Letting the Future In to help the recovery of children and young people who've been sexually abused. In collaboration with the Universities of Bristol and Durham we've evaluated the service to see if a psychodynamic, attachment-based therapeutic approach helps sexually abused children and young people. 

This study is the largest multi-site randomized controlled trial (RCT) in the world for a sexual abuse intervention. Up to now, large-scale studies have focused on cognitive behavioural therapy (CBT) and were carried out largely in the USA.

How sexual abuse affects children

1 in 20 children in the UK have been sexually abused (Radford et al, 2011). But a high number of these cases go unreported, undetected, unprosecuted and untreated.

Sexual abuse can have many varied impacts on children and young people. The stress suffered by an abused child can have a significant impact on the child's health and development. It can impact on behaviour and relationships, including risky or harmful sexual behaviour, delinquency, crime and poor parenting. In the longer term, the consequences can limit future opportunities and lead to further problems later in life.

Dealing with the consequences of childhood sexual abuse also has a significant economic cost to the NHS, criminal justice system and children's social care services. We estimate that child sexual abuse costs the UK £3.2bn a year (Saied-Tessier, 2014).

Read more about child sexual abuse.

How we're evaluating this service

The study evaluated the delivery of Letting the Future In, in 18 NSPCC centres across the UK.

There are 3 components to the evaluation of Letting the Future In:

  • Impact evaluation
    A randomised controlled trial. There are 242 cases in the trial, which makes it the largest ever trial of a sexual abuse therapy anywhere in the world. The trial was conducted by allocating cases straight into the intervention or onto a waiting list for 6 months. Data was collected when cases were assessed, then again after 6 months (which would have been at the end of the waiting period for those cases on the waiting list and after 6 months of the intervention for those in the intervention) and then again after 12 months. The data is collected by practitioners delivering the therapy, though the second data collection at 6 months is collected by a different therapist to avoid any bias in the data.
  • Process evaluation
    Interviews with practitioners delivering the intervention about how they found implementing it, along with case studies of children and young people who received the intervention and a special study looking at the relationship between young people and their therapist.
  • Economic evaluation
    Comparing the cost and impact of Letting the Future In with the cost and impact of any help children and young people had while they were waiting for the intervention, which could be from doctors, social workers or other services.

The biggest challenges to the evaluation were carrying out the randomised controlled trial ethically and managing the waiting list.

The intervention is dealing with a very sensitive issue so it was important that the evaluation was conducted as ethically as possible and practitioners were comfortable with the approach. First we established that there was no existing evidence for the effectiveness of this kind of therapy, showing that ethically it was important that there was a robust trial. The study was then approved by the research ethics committee, who provided advice on carrying it out ethically, including providing clear information about the study and support for families assigned to the waiting list.

Managing the waiting list was difficult because managers had to ensure that the therapists were working on cases but that they would have space to start working with a new child or young person when they were due to come off the waiting list.

This service is being evaluated externally by the Bristol Univesity and Durham University. It uses the following tools:

  • Trauma Symptom Checklist for Children
  • Trauma Symptom Checklist for Young Children
  • Parental Stress Index
  • Therapeutic Alliance Scale for Children
  • Client Services Receipt Inventory

Find out more about the tools used to measure outcomes

Contact Matt Barnard for more information.

What we've learnt so far

  • Letting the Future In can work to help children who've been sexually abused
  • therapeutic work can be successfully delivered by social care professionals who receive additional training.

What we're doing next

We're looking at how we apply the learning from this evaluation to our Letting the Future In service. For example, we'll work to provide support to carers and parents to help them understand their children's experience and needs.

We'll work on a plan to scale up Letting the Future In to help children's services take it up. 

We'll deliver and evaluate new services based on Letting the Future In:

  • Hear and Now for children who have not yet spoken out about their experience of sexual abuse
  • Letting the Future In for children and young people with learning disabilities.

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References

  1. Radford, L. et al (2011) Child abuse and neglect in the UK today. London: NSPCC. 

  2. Saied-Tessier, A. (2014) Estimating the costs of child sexual abuse in the UK. London: NSPCC.