Letting the Future In

How Letting the Future In works

The programme begins with three or four weekly sessions for practitioners to assess the child’s needs and select appropriate therapeutic interventions.

Children and young people aged 4 to 17 are invited into safe therapeutic spaces to do things like messy play, writing, storytelling and art to help express feelings that they can’t put into words.

Practitioners delivering LTFI have access to an online resource hub, which contains a comprehensive set of materials based on what is known or believed to help children who have been sexually abused. It is used by practitioners to select appropriate interventions for the child and to ensure they are following a consistent approach.

Our work is child-centred and our timescales reflect this. We will work with children and young people for as long as needed, to help them recover from the impact of abuse, and strengthen supportive relationships with their siblings and carers.

Where it is safe and appropriate to do so, parents, carers and siblings may be offered some individual support and joint sessions with the child or young person.

The evidence base

Experiencing sexual abuse can have a long-lasting negative impact on a child’s wellbeing that can reach into adulthood.

> Find out more about the impact of child sexual abuse

NSPCC research found that there was a lack of therapeutic services for children who had been sexually abused (Allnock et al, 2009¹; Bunting el al, 2010²). The services that were identified tended to be generic mental-health services, as opposed to specialist post-sexual abuse services (Allnock et al, 2009)³.

A review of the literature found that abuse-specific interventions showed greater improvements than more general approaches, and highlighted the need for further research into the impact of specialist interventions (Allnock et al, 2012)⁴.

Who is Letting the Future In for?

The service is for children and young people who have experienced sexual abuse, are happy to be referred to the programme and are aged from 4 to 17 years, or up to 19 for children and young people with mild or moderate learning disabilities.

The child or young person should ideally also be:

• living with a carer who has been identified as safe, or
• not living with the alleged adult perpetrator, or
• in a foster home with no planned moves.

If they are living with another child or young person who has abused them, then a safety plan must be in place. This should include the views of the child who has been sexually abused.

If the child or young person has a learning disability there are additional criteria they must meet.

• The child or young person should be living with a carer who has been assessed as safe and not living with the alleged perpetrator who might be an adult or another child or young person.
• If the child or young person is in a placement, this has been assessed as stable, there are no planned moves and a significant carer is identified to work with the child.
• Consent of at least one parent or carer and the informed consent or assent of the child or young person is required.

The child or young person may have additional support needs such as autism or a physical disability. In exceptional circumstances, referrals for children with severe learning disabilities may be approved.

There must be an investigation into the allegations of sexual abuse, unless:

• the child is of sufficient age and understanding to withhold a formal statement to the police
• children’s social care are aware of the allegation
• protective action has been taken (such as the alleged abuser agreeing to leave the home or an agreement to move the child to a safer place).

At the point that the investigation begins and is known to children’s services, we are able to engage with the child or young person. In rare circumstances, this might happen post-conviction.

Making a referral

To see if LTFI is delivered in your area or to make a referral, email help@nspcc.org.uk.

Help us reach more children and young people

Are you interested in helping children or young people in your local area recover from sexual abuse? We are training and supporting organisations to adopt, implement and deliver the LTFI programme.

> Learn more about the opportunity

Evaluation of Letting the Future In

In collaboration with the Universities of Bristol and Durham, we evaluated Letting the Future In (LTFI) to see if a psychodynamic, attachment-based therapeutic approach helped sexually abused children and young people.

The evaluation included qualitative case studies and the largest multi-site randomised controlled trial (RCT) for a sexual-abuse intervention in the world.

What we learnt

Findings from the evaluation include:

• after six months of Letting the Future In, there was a significant reduction in the number of 8- to 17-year-olds with high levels of psychological and behavioural problems. There was no statistically significant change for the control group, suggesting that the intervention was responsible for improvements
• children under the age of 8 did not see a change in psychological and behavioural problems after six months of participating in LTFI. However, there was some evidence of improvement after 12 months. This suggests the service may take longer to have an impact on younger children
• children and carers both felt that LTFI had resulted in positive changes
• the mean cost of providing LTFI was estimated as £2,300 per case. This compares to an average cost of cases seen by a multidisciplinary Child and Adolescent Mental Health Service of almost £5,000 (Curtis, 2012)¹.

> Find out more about our evaluation of Letting the Future In

How we evaluated this service

There were three components to the evaluation of Letting the Future In.

Impact evaluation

We carried out a randomised controlled trial (RCT) including 242 cases – the largest ever RCT of a sexual-abuse therapy anywhere in the world.

Cases were allocated straight into LTFI or onto a waiting list for six months. Data were collected:

• when cases were first assessed
• after six months (which would have been at the end of the waiting period for those cases on the waiting list and after six months of the intervention for those in the intervention)
• after 12 months.

The data were collected by practitioners delivering the therapy, though the second data collection was collected by a different therapist to avoid any bias in the data.

Process evaluation

We carried out interviews with practitioners delivering LTFI to find out their experiences of implementing the programme. We analysed case studies of children and young people who received the intervention and carried out a special study looking at the relationship between young people and their therapist.

Economic evaluation

We compared the cost and impact of LTFI 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.

Evaluation tools

The evaluation used the following tools:

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

Evaluation of LTFI for children with learning disabilities

We asked the University of Bristol to carry out a formative evaluation of Letting the Future In for children with learning disabilities (LTFI-LD). They found that practitioners who already had experience of delivering LTFI were able to deliver LTFI-LD with appropriate training and support.

> Read about our evaluation of Letting the Future In for children with learning disabilities