'Letting the future in' a therapeutic intervention for child sexual abuse - Outcomes of a pragmatic multi-site RCT

The outcomes of Letting the Future In (LTFI) were evaluated using the most rigorous possible methodology, a pragmatic randomised controlled trial. Unlike in an efficacy trial of two or more interventions, the aim here was to... [ view full abstract ]

The outcomes of Letting the Future In (LTFI) were evaluated using the most rigorous possible methodology, a pragmatic randomised controlled trial. Unlike in an efficacy trial of two or more interventions, the aim here was to test the effectiveness of the intervention in a ‘real world’ setting of community-based services.
Methods: 281 children (age 4-17) with established CSA referred to 18 agency teams were assessed and then randomised to immediate intervention or a six-month waiting-list control group. 242 families (86%) consented to participate in the evaluation. Follow-up was at six and twelve months. Outcome measures were standardised multi-dimensional scales assessing depression, PTSD, anxiety and behavioural problems (the self-report TSCC for older children and the proxy parent-report TSCYC for young children, Briere 1996/2002). The primary outcome was the proportion of children in intervention and control groups at baseline and follow-up with a ‘clinical-level problem’ or ‘serious difficulty’ on at least one sub-scale. ‘Intention-to-treat’ (ITT) and ‘completers’ analyses were employed.
Results: Completers: 73% of 56 older children and young people scored above the clinical/difficulty level at baseline, reducing to 46% at the six month follow-up of 172 children (p=.001) vs. control (no change, p=.581). ITT analysis (N = 162): Intervention 68% vs. 51% p=.016 vs control NS. For younger children, both completers (N=57) and ITT (N=82) analyses showed no change in either intervention or control groups at six months, but evidence of a reduction in the intervention group at twelve months.
Conclusion: This ‘real world’, multi-site trial shows that rigorous methods of evaluation can be employed effectively; this is the largest RCT yet. Its strengths and weakness will be noted. Results demonstrated the short-term effectiveness of LTFI for older, but not younger children. Recommendations are made for improving effectiveness included enhancing the engagement of parent/carers, especially for younger children.