Letting the Future In (LTFI)

What is LTFI

Helping children and young people recover from sexual abuse

Letting the Future In (LTFI) is designed to help children and young people who have experienced sexual abuse rebuild their lives.

We support children and young people aged between 4-to 17-years-old so that they can recover from the impact abuse has had on their lives. Referrals can also be made for children or young people with learning disabilities up until the age of 19.

Parents and carers are critical to the child or young person’s recovery, so we work with them to help them support their child throughout the therapeutic process. Siblings who require support may also be provided with a service.

This service is recommended by the National Institute for Health and Care Excellence (NICE) (NICE, 2017) and was 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 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 are invited into safe therapeutic spaces where they can meet with a trained practitioner and engage in activities like messy play, writing, storytelling and art. This aims to help them express feelings that they can’t put into words. Some children and young people may be able to talk about the impact of abuse and work with the practitioner to resolve any ongoing issues.

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 children and young people are given the time and space to help them recover from the impact of abuse, and strengthen supportive relationships with their siblings and carers.

Evidence and evaluation

Evidence and evalution

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).

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

Make a referral or deliver LTFI

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.

We usually accept referrals for work with children and young people after an investigation into the allegations of sexual abuse has occurred. Sometimes we we work with children and young people where an investigation hasn’t been completed, for example when:

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).

The child or young person 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 are living with another child or young person who has abused them, then a robust 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.

Making a referral

To see if LTFI is delivered in your area see our list of regional and national hubs on the NSPCC website. If you want to discuss the possibility of making a referral please contact your nearest hub. You can also contact help@nspcc.org.uk.

Deliver LTFI in your area

We are training and supporting organisations to adopt, implement and deliver the LTFI programme in their local area.

Our training and implementation support package includes:

a licence to deliver the service in accordance with the model but with the flexibility to meet local needs and practice
pre-training workshop for senior managers to work with you to identify how you can make the most of the service and establish methods for ongoing evaluation and outcomes
a bespoke, individual needs-assessed training programme
ongoing implementation support.

> Find out more about the implementation support we offer

Email lettingthefuturein@nspcc.org.uk for more information about delivering this service.

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).