Helping children to recover from sexual abuse: A therapeutic service that works

There is a significant gap in the provision of therapeutic services for children and young people who have experienced sexual abuse in all its forms, including online abuse and child sexual exploitation. This is in part due to the fragmented commissioning landscape for support services in which multiple agencies, such as local authorities, Police and the NHS, are responsible for commissioning different elements of our response to child sexual abuse. As a result, some children will not be able to get the support they may need at a time when they most need it.

Every child who has experienced sexual abuse is affected differently – for some the impact is short term, but for others it has a long term and damaging impact. It can derail a child’s development, ruin their childhood and lead to problems lasting into adulthood. This can result in an increased reliance on public services, which inevitably places pressure on ever diminishing resources.

To help address this, the NSPCC has developed a therapeutic service that can be adopted by a wide range of organisations in the public and third sector, to provide the support those children need to recover.

Letting the Future In

Letting the Future In is an evidence-informed, child-centred therapeutic intervention for children aged four to seventeen who have experienced sexual abuse. The service helps children to move on from their past experiences through activities such as play, drawing, painting and storytelling; and offers parents and carers support to deal with the impact of finding out about the sexual abuse and to help their children feel safe.

Between 2011 and 2016 the Universities of Bristol and Durham evaluated the effectiveness of Letting the Future In through a randomised controlled trial, in which the outcomes for two groups were compared: one group that received Letting the Future In and one that didn’t. This evaluation showed that the service can significantly reduce the highest levels of trauma experienced by children aged eight and over who have been sexually abused, and demonstrated promising findings for younger children. As a result, Letting the Future In has been recommended in the National Institute for Health and Care Excellence’s guideline on child abuse and neglect (NICE, 2017).

We continue to deliver Letting the Future In in some of our service centres, but we want more children and young people to be able to benefit from the service than just those we work with. As a result, we have recently begun working alongside the Durham Constabulary and the Durham Child Advocacy Centre, to help them adopt the model to deliver themselves.

Supported by Home Office innovation funding, Durham is working to improve processes and support for victims of child sexual abuse aligned to the Child Advocacy Models introduced in the USA and Canada.  Key to this work has been an integrated partnership approach with oversight and advice provided by a child clinical psychologist working within the local Sexual Assault Referral Centre. Upskilling of key staff across social services; education; youth offending and police has been a priority and this is ongoing to ensure they have the skills and capacity to meet the current needs of the children and future demands on their combined services. The roll out of Letting the Future In will broaden the capacity within the local area to provide appropriate interventions for young people and carers.

Using implementation support to help organisations embed the service

The Durham Child Advocacy Centre and its partners in the Local Authority and Child and Adolescent Mental Health Services are part of a group of organisations that NSPCC has been working with. Through this work we have come to recognise that implementing a new service and ensuring sustained delivery of that service is often difficult to achieve, particularly considering the needs of local teams and the individual challenges they can face.

To support organisations to overcome these challenges we provide the materials, training and guidance they need to successfully implement and deliver Letting the Future In themselves. Training is tailored to practitioners’ individual therapeutic skills and experience and the NSPCC provides implementation support to help their partners plan for and adapt the model to meet their own needs, while ensuring they can be confident the service achieves its stated outcomes for the children and young people

The benefits of Letting the Future In for our partners

There are some really clear benefits of implementing Letting the Future In, beyond its ability to help children recover after experiencing sexual abuse. Letting the Future In:

• gives commissioners and providers confidence that they are delivering a robust, evidence-based service, recommended by NICE;
• is a cost-effective solution, with an average cost of £2,300 per case compared to an average case for Child and Adolescent Mental Health Teams of almost £5,000;
• can be delivered by social workers who receive additional training, as well as more traditional therapeutic professions, allowing children and young people to receive the support they need without having to be escalated to services at a higher threshold.

Helping more children at a time when resources are diminishing is a challenge for all organisations. We believe many more children can achieve better outcomes if we work together and use the evidence we have to inform what we do.