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Specialist social work training can improve outcomes for abused children

Evaluation of study finds reduced depression, anxiety and anger in young people

Providing social workers with specialist training to deliver therapeutic interventions can help young people who have been sexually abused to move on from their past experiences, an evaluation of a study has found.

Children who had participated in the Letting the Future in study also reported improved mood, better confidence, reduction in guilt and self-blame, reduced depression, anxiety and anger, improved sleep patterns and a better understanding of appropriate sexual behaviour, the evaluation from the University of Bristol and Durham University found.

Letting the Future In is a service designed by the NSPCC for children aged 4 to 17 years who have been sexually abused. Letting the Future In helps children come to understand and move on from their past experiences through activities such as play, drawing and painting and storytelling. Parents and carers are also offered support to move on from the impact of finding out about the sexual abuse and to help their children feel safe.

“Letting the Future In was highly valued by the children and their carers who were interviewed,” said the evaluation of the service. “They were unanimous in thinking that the intervention had resulted in positive changes. They identified improved mood, confidence, and being less withdrawn, a reduction in guilt and self-blame, reduced depression, anxiety and anger, improved sleep patterns and better understanding of appropriate sexual behaviour.”

In a trial, 242 children aged 6–16 years took part and most had experienced contact sexual abuse. On initial assessment, over half of young people and children over eight reported ‘clinical’ level scores on a standardised measure of psychological and behavioural symptoms, rising to 70% when one or more ‘significant difficulties’ were included.

Parents and carers reported ‘clinical’ or ‘significant difficulty’ level scores for 92% of younger children under eight years old.

The intervention was, in the main, delivered consistently across teams. Interventions used with younger children included symbolic play, creative therapies and awareness and management of feelings. Older children and young people received more interventions concerned with the awareness and management of feelings and identity and self-esteem, in addition to creative therapies.

At six months, the proportion of older children and young people in the intervention group with clinical plus significant difficulty scores remaining in the study had reduced from 73% to 46%. For younger children, there was no change at six months. However, there was some evidence of a reduction in the intervention group at the 12 month follow-up, suggesting that improvements may take longer to achieve.

The study found:

  • Almost three-quarters (73%) of children aged 8 and over who completed 6 months of Letting the Future In had severe emotional difficulties at the start. After 6 months this dropped to less than half (46%).
  • When taking into account the children who didn't engage or dropped out of the service early the number of children experiencing severe trauma dropped from 68% to 51%.
  • There was no comparable change for children in the control group (a 6 month waiting list). This indicates that the positive outcomes were a result of receiving the service.

John Carpenter, lead author of the University of Bristol and Durham University written report, added: “Evidence-based therapeutic approaches are vital to help all children deal with the effects of sexual abuse. It is crucial that commissioners know what interventions work in ‘every day’ community based services to improve outcomes for children, in a cost-effective way.”

The evaluation found that the majority (86%) of practitioners delivering Letting the Future In were social workers, many with additional training in therapeutic work. Most also had at least six years’ experience of direct work with children affected by sexual abuse and were skilled in developing strong therapeutic relationships with children and young people.

Social workers delivering Letting the Future In reported that they:

  • understood their role
  • were confident about being able to deliver Letting the Future In
  • felt the Letting the Future In guide had added value to their work with children.

Jon Brown, NSPCC head of development and impact, said: “I think what this study is showing is that potentially there is a much wider range of professionals both within health and within social care who could deliver help for children, with the appropriate training and using a model like this.”

In an exclusive interview with Children First last month, CSE expert Craig Barlow warned that the whole approach to tackling Child Sexual Exploitation needs to be transformed in order to protect children and tackle offending behaviour from perpetrators.

Barlow stated that social workers often feel under-confident when dealing with issues of CSE and were crying out for more social work training. However, there is no mandatory training for CSE and often budget restraints prevent local authorities from commissioning the courses they would like to put on for social workers.

However, the evaluation found that the mean cost of providing Letting the Future In, including meetings with external professionals, management costs, staff training and supervision was estimated as £2,300 per case. This compares to an average cost of cases with a range of mental health problems seen by a multidisciplinary Child and Adolescent Mental Health Service of almost £5,000 (PSSRU, University of Kent 2012).

The study concluded that Letting the Future In can and should be developed further, particularly in its use with younger children.

The evaluation is available here.

The interview with CSE expert Craig Barlow is available here.

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