'Letting the future in' a therapeutic intervention for child sexual abuse – Implementation in teams and methods of intervention

Letting the Future In (LTFI) is designed for children aged 4-17 who have experienced sexual abuse and for their carers. It is a guide to practice, rather than a treatment protocol. It is intended as a needs-led, flexible... [ view full abstract ]

Letting the Future In (LTFI) is designed for children aged 4-17 who have experienced sexual abuse and for their carers. It is a guide to practice, rather than a treatment protocol. It is intended as a needs-led, flexible approach, however this brings challenges to treatment fidelity and effective implementation across a service agency.
Objectives: To describe the LTFI intervention, including its theoretical basis, structure and approach, and to examine how it was implemented.
Method: Case studies based on interviews with practitioners (N = 12), managers (N = 6) and referrers (n=4) in eight teams over 2 years. Teams were sampled purposively to reflect diversity of service user groups, a range of team experience and a mix of urban and rural catchment areas.
An Intervention Checklist (ICL) which recorded the number of sessions, treatment content and the use of theory in individual sessions with children (N=2,394), carers (N=436) and joint sessions with carers and their children (N=311).
Findings:
Implementation: Most practitioners and managers welcomed the intervention components, but felt restricted by limits placed on work with carers. A strong therapeutic alliance was seen by practitioners as the most important factor in the success of their work.
Interventions: Creative therapies (23% of sessions), counselling (11%) and symbolic play (10%) were the three theoretical approaches used most commonly in sessions with all children. The use of both general CBT (3%) and trauma-focused CBT (1%) was low. Intra-familial victims were engaged in more symbolic play, whereas those abused outside the family were more likely to be offered solution focused interventions.
Conclusion: There are few studies of the implementation of therapeutic approaches. Implementing a flexible, guide-based (rather than protocol based) therapeutic approach to treat sexual abuse is possible in community-based settings, but requires sustained training and support.