Trish O'Donnell Sexual Abuse Development Manager NSPCC

1. BASPCAN
EDINBURGH 2015
Letting the Future – a guided
therapeutic intervention for
children and young people who
have been sexually abused
TRISH O’DONNELL
SEXUAL ABUSE DEVELOPMENT MANAGER

2. About the presentation
• Why the service was developed and how
• What the service is and what we were seeking to
learn by commissioning the research
• Link to
'Letting the Future In' an intervention for child
sexual abuse: from practice model to RCT
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3. Gap between provision and need
2009 NSPCC study estimating need for therapeutic
services for children affected by CSA in the UK
Compared existing estimates of prevalence of CSA
with mapping of available services:
• estimate of need over 70,000
• 508 services identified across the UK: approx
16,000 children and young people in receipt of a
service in 2006/7
• NSPCC now commissioned an update of this
research
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4. The Rationale for Letting the Future In
• 1 in 20 children and young people under 18 report
contact abuse
• Sexual abuse can have devastating and long
lasting effects but recovery is possible
• Current research show that, for at least 30 years,
researchers have attempted to learn through
outcome studies whether therapeutic services help
children recover from sexual abuse
• No studies have yet been identified specifically in
relation the therapist/child alliance within the
context of child sexual abuse. There is varying
evidence which needs testing further.
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5. The Rationale for Letting the Future In
• Research suggesting that conventional mental
health responses that do not address child sexual
abuse may be less effective
• Use of the Trauma Symptom Checklist for Children
(TSCC) used in NSPCC therapeutic services
indicates that child centred, psychotherapeutic
services can be effective. What is not known is the
sustainability of such changes
• A home grown and organic service
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6. The Rationale for Letting the Future In
We need to know more about
• the experienced and skilled judgement of
practitioners
• how they establish effective working relationships
with children
• the relevance of the therapeutic relationship to the
outcomes of therapy for the child
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7. What has informed LTFI

8. What survivors told us
• Some children do not want to talk about the details
of abuse
• Some therapy does not suit the needs of children
and young people – differences in how they express
themselves
• Children have a range of needs, not only emotional;
but physical and social, that they want to be
addressed
• Children may have preferences about the gender of
their therapist or the activities that they do and
should be asked
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9. Practitioner wisdom
Integrative approach
• Regenerative model
• Range of needs may require different interventions/
approaches
• Continuum of interventions have been
recommended by some (e.g. Finkelhor & Berliner)
• Developmental stages of children may mean
different activities/ approaches may be required
• Supported by NSPCC practice
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10. Letting the Future In - Key characteristics
• trauma informed service
• from beginning, inspires hope and optimism, talks
about ending from the beginning
• delivered by mainly social workers, with additional
training
• Social care model of supervision, with peer
consultation
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11. Intended outcomes of LTFI
We will know know:
Children & young people experience the intervention as
effective
the effectiveness of the therapeutic intervention and approach
as in the guide
with which children and young people who have been sexually
abused the approach is most effective
how the Guide can be effectively used
more about the key relationship between the adult practitioner
and the child/young person in therapeutic work with child
sexual abuse
about delivering this service other than through mental health
settings,
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12. Letting the Future In – Structure
Module 1 – Introduction to the guide
Module 2 – Context to intervention for working with
sexually abused children and young people
Module 3 – Assessment – the work begins
Module 4 – Action – what happens in the room?
Module 5 – Resolution
Appendices
Ref: Creative Therapies with Traumatised Children Anne Bannister 2003 JKP
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13. Letting the Future In – Evaluation
• Bristol and Durham Universities
• A waiting list RCT design
• Gold standard
• Ethics
• Now the biggest RCT of its kind internationally
• Our largest service delivery
• 20 teams in England, Wales and Northern Ireland
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14. Research Design
Impact evaluation
Waiting list RCT
Process evaluation
Economic evaluation
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15. Outcome measure used
Trauma Symptoms Checklist for Children (TSCC and
TSCYC)
Juvenile Victimisation Questionnaire
(polyvictimisation)
Parenting Stress index
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16. Next Steps
Stopped randomising- October 2014, last few coming
off the waiting list –analysis to take place
Findings available this autumn- full publication by
Spring
Further presentation about detail and challenges of
the RCT presentation on Wednesday
P9 F52.3
'Letting the Future In' - An Intervention for Child
Sexual Abuse: From Practice Model to Randomised
Control Trial (RCT)
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17. References
Allnock, D. & Hynes, P. (2011) Therapeutic Services for Sexually Abused Children
and Young People: Scoping the Evidence Base. Summary report. NSPCC
Allnock, D., Bunting, L., Price, A., Morgan- Klein, N/. Ellis, J., Radford, L. & Stafford,
A. (2009) Sexual abuse and therapeutic services for children and young people.
NSPCC
Allnock, D., Radford, L., Bunting, L., Price, A., Morgan- Klein, N., Ellis, J. & Stafford,
A. (2012) In demand: Therapeutic Services for Children and Young People Who
Have Experienced Sexual Abuse. Child Abuse Review 21:318-334
Bannister, A. (2003) Creative Therapies with Traumatized Children. Jessica Kingsley
Publishers
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