Letting the Future In

Last updated: 12 Jul 2019
Introduction

Helping children who have been sexually abused

Letting the Future In helps children who’ve been sexually abused to rebuild their lives.

Letting the Future In is recommended by the National Institute for Health and Care Excellence (NICE) (NICE, 2017) and showcased as an example of commissioning practice in the Home Office’s commissioning framework for support services for victims and survivors of child sexual abuse in England (Home Office, 2019).

How it works

How Letting the Future In works

Children aged 4 to 17 are invited into special play-therapy rooms. They do things like messy play, writing, storytelling and art to help express feelings that they can’t put into words.

The programme begins with three or four weekly sessions for practitioners to assess the child’s needs and select appropriate interventions from a practice guide. The guide provides a comprehensive set of materials based on what is known or believed to help children who have been sexually abused. It allows practitioners to tailor the intervention to the child, while following a consistent approach.

We work with each child for about a year. We support them to recover from the impact of the abuse and work on strengthening the important supportive relationship between the child and their carers.

Parents and carers are offered some individual support and joint sessions with the child.

Evidence base

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, 2009; Bunting el al, 2010). The services that were identified tended to be generic mental-health services, as opposed to specialist post-sexual abuse services (Allnock et al, 2009).

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).

Who it is for

Who is Letting the Future In for?

Letting the Future In (LTFI) is for children aged 4 to 17 who have been sexually abused and:

  • are able to communicate without an intermediary
  • are happy to be referred.

The child should 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’re living with a brother or sister who has abused them, then a safety plan must be in place. This should include the views of the child who’s been sexually abused.

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 and it’s believed
  • 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).

Making a referral

To make a referral to LTFI, get in touch with one of the service centres offering this service, as listed under the Locations tab.

Delivering Letting the Future In

We’re also supporting organisations to adopt, implement and deliver LTFI themselves.

> Find out more about delivering our services

LTFI for children with learning disabilities

We have also developed an adapted version of Letting the Future In for children and young people aged 4 to 19 with mild or moderate learning disabilities who have been sexually abused. In exceptional circumstances, we will allow referrals for children with severe learning disabilities. In addition:

  • the child or young person should be living with a carer who has been assessed as safe and is not living with the alleged perpetrator
  • 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
  • the child or young person may have additional support needs such as autism or a physical disability
  • the consent of at least one parent or carer and the informed consent or assent of the child or young person will be required.

Service centres offering the adapted version of this service for children with learning disabilities are indicated with an asterisk under the Locations tab.

Locations

Letting the Future In locations

Where the NSPCC is delivering Letting the Future In:

(Locations with an asterisk (*) are also running an adapted version of this service for children with learning disabilities aged 4 to 19.)

  • Camden*
  • Carlisle
  • Craigavon*
  • Croydon
  • Foyle, NI
  • Gillingham*
  • Jersey
  • Newcastle Upon Tyne*
  • Peterborough*
  • Plymouth
  • Prestatyn
  • Sheffield*
  • Southampton
  • Stoke on Trent
  • Swansea
  • Swindon*
  • Warrington*
  • York*

* We’re also running an adapted version of this service for children with learning disabilities aged 4 to 19 in Camden, Craigavon, Gillingham, Newcastle, Peterborough, Sheffield, Swindon, Warrington and York.

> Find contact details for all our service centres on the NSPCC website

Delivering NSPCC services

If Letting the Future In is not available in your area, find out how we can support you to implement and deliver this service locally.

> Find out more about delivering our services

Evaluation

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).

> 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

References and resources

References and resources

Evaluation reports

Carpenter, J. et al (2016) Letting the Future In: a therapeutic intervention for children affected by sexual abuse and their carers: an evaluation of impact and implementation. London: NSPCC.

Jessiman, T. and Carpenter, J. (2018) Therapeutic intervention for children with learning disabilities affected by sexual abuse: formative evaluation of a developing service. London: NSPCC.

Evidence base

Allnock, D. et al (2009) Sexual abuse and therapeutic services for children and young people: the gap between provision and need: full report. London: NSPCC.

Bunting, L., Anderson, P. and Allnock, D. (2010) Sexual abuse and therapeutic services for children and young people in Northern Ireland: the gap between provision and need: executive summary. London: NSPCC.

Curtis, L. (2012) Unit costs of health and social care 2012. Canterbury: Personal Social Services Research Unit, University of Kent.

Home Office (2019) Commissioning framework for child sexual abuse support (PDF). London: Home Office.

National Institute for Health and Care Excellence (NICE) (2017) Child abuse and neglect: NICE guidance (PDF). London: National Institute for Health and Care Excellence (NICE).