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Therapeutic intervention for children with learning disabilities affected by sexual abuse

Formative evaluation of a developing service

Authors: Tricia Jessiman and John Carpenter

Children and young people in England with moderate to severe learning disabilities are around six times more likely to have been affected by sexual abuse than the general population of children and young people (Spencer et al, 2005). There are a number of reasons why this may be so. These children may be particularly vulnerable because they need intimate personal care, which may be provided by multiple carers, outside as well as within their family. They may be cared for away from the family home, in residential care or with foster carers. They may have limited sexual knowledge and lack the ability to interpret social situations, which makes them vulnerable to targeting by sexual predators for grooming and abuse. They may have communication difficulties, low self-esteem and little confidence, making it more difficult to disclose their abuse.

Even if the sexual abuse of children with learning disabilities comes to light, there is evidence from the Children’s Commissioner for England (Horvath et al, 2014) that they may receive a poorer response from professionals than their non-disabled peers. Furthermore, there is little empirical understanding of the effects of sexual abuse on children with learning disabilities and there are no published trials of therapeutic interventions to help these children recover.

A review of clinical studies has suggested that psychodynamicbased interventions that emphasise the value of a close therapeutic relationship and employ creative methods, such as play and painting, may be especially helpful (Allington-Smith et al, 2002). The recent evaluation of a psychodynamic intervention developed by the NSPCC called ‘Letting the Future In’ (Carpenter et al, 2016) showed that this approach can be effective, but it specifically excluded children with learning disabilities. The NSPCC has since adapted it to be suitable for these children and it has now been piloted in four NSPCC service centres. The NSPCC commissioned the University of Bristol to undertake a formative evaluation of the pilot of this adapted version of Letting the Future In (LTFI-LD) to inform the development of the intervention and future roll-out.

This paper begins by describing Letting the Future In (LTFI) and the adapted version for children and young people with learning disabilities (LTFI-LD). It outlines the aims and methods of the study and reports the findings of a scoping review of the literature on the prevalence of sexual abuse and its effects on children with learning

disabilities and the effectiveness of existing therapeutic approaches.

The formative process evaluation that follows used interviews and feedback questionnaires to explore the perspectives of NSPCC practitioners and ‘safe’ parents/carers on LTFI-LD. With a view to further summative evaluation, the paper reviews potential outcome measures. It concludes with some recommendations for the roll-out of LTFI-LD.