Data about childhood sexual abuse should be collected by Camhs so that national mapping of service need can take place. Picture: Alamy
Alison Domakin explores a study that highlights the gap in therapeutic provision for young people who have been sexually abused
Key words: young people ❙ sexual abuse ❙ therapeutic services
Authors: Debra Allnock with Lisa Bunting, Avril Price, Natalie Morgan-Klein, Jane Ellis, Lorraine Radford and Anne Stafford.
Title: Sexual Abuse and Therapeutic Services for Children and Young People: The gap between provision and need, NSPCC, 2009, 165 pages,
Aim: To explore the availability and range of current provision of therapeutic services for children and young people in the UK who have experienced sexual abuse.
Methodology: The location of agencies offering therapeutic services was geographically mapped. Views about service provision were gained from service managers, practitioners and commissioners from questionnaires and telephone interviews. Ten focus groups were held with young people.
Conclusion: More effective recording of the prevalence of sexual abuse is needed in order to accurately predict the service provision required. Estimates of need reveal that both an expansion and evaluation of resources is needed.
Previous research shows that survivors of childhood sexual abuse report severe reactions that can extend well into adulthood. However, historically, service provision in this area has been unco-ordinated, offered by a patchwork of agencies and has developed in the absence of national overview or planning.
The research began by mapping the geographical locations of agencies in order to identify where services are being offered. Services were identified as therapeutic if they reported spending a “substantial proportion” of time working with sexually abused young people. Defining “therapeutic service” was problematic because a range of provision is available from statutory, private and third sectors. Some agencies specialise in sexual abuse work but, more commonly, support is offered by agencies, such as child and adolescent mental health services (Camhs), which have a general focus on mental health issues.
Detailed information about what is provided as “therapy” was not sought in this research, the first step being to establish the level of specialist provision available.
Two major themes identified in the research are that young people may have to wait for a considerable time to access a service after referral and that flexible early intervention would be preferable.
Many of the agencies in the research manage resources by not taking self-referrals. This is in contrast with the views of the young people in the report who would prefer to self-refer and be able to access confidential advice and support before any therapeutic intervention.
The strongest message from the report is that budget constraints, not analysis of need, dictate service delivery. Many agencies identify major issues because of short-term and insecure funding. An expansion of services is called for, in addition to increasing the capacity of the workforce to offer support to children affected by sexual abuse. Developing clusters of regional provision is suggested as a means of ensuring more effective provision of services locally.
The report recommends strengthening the use of current sexual assault referral centres (see below).
Eleven recommendations are suggested at the end of the report clustered around the themes of service provision, funding and analysis of the outcomes of therapeutic intervention.
The authors call for strategic planning and funding of sexual abuse services to be considered at a national level. Distinct data about childhood sexual abuse should be collected by Camhs in order to inform local and national mapping of need. Further research is called for, to examine the effectiveness of a range of therapeutic interventions to address sexual abuse.
The need for joint guidance to inform policymakers and service commissioners is proposed alongside changes to ensure that accountability for commissioning services is determined locally.
Services should be funded for more than the current norm of one to three years due to the impact of short-term funding on service development.
This is a useful piece of research, most relevant to managers, commissioners and policymakers. The lack of standardised data collection about sexual abuse means that any attempt to assess the level of service provision is at best a guess. Measures to address this are urgently needed.
The lack of information and evaluation of therapeutic services that address sexual abuse is worrying. Sexual abuse of children is an emotive issue and there is a tendency within society to deny or ignore this problem. The NSPCC has commissioned a follow-up research programme, which will examine the efficacy of different therapeutic interventions for sexual abuse. The research will also develop tools to evaluate outcomes of therapy, providing policymakers and commissioners with a means of planning and funding therapeutic work. This will begin to address the paucity of evaluative research on therapeutic interventions.
The need for early intervention and support is frequently discussed. There is a common misconception that only skilled specialist workers can work on issues of sexual abuse. Given the financial climate, it may be useful to consider how the capacity of the workforce can be strengthened to support children who have been sexually abused, in addition to longer-term evaluation and planning of specialist interventions.
For policymakers and service commissioners
● More research is needed about the prevalence of sexual abuse and demand for therapeutic services including a national mapping of need using data from Camhs.
● Consideration should be given to increasing service provision, including using sexual assault referral centres and longer-term funding of services.
● Commissioners need more local and national guidance as to which kind of specialist interventions and support for sexual abuse are most effective.
● Evaluative tools to measure the effectiveness of different therapeutic approaches should be adopted.
● National or local services should be developed offering confidential advice and support about sexual abuse, directly accessed by young people. Early support may offset the need for specialist input later.
For commissioners, managers and frontline staff
● Not all young people will require specialist therapeutic intervention particularly if they can access support earlier post-disclosure. Trained social care staff may be best placed to help those affected understand how they have been groomed by the abuser and why they are not to blame for the abuse.
● Social care workers need to access training opportunities informing them about the key aspects of sexual abuse (for example, offender cognitive distortions, grooming and maternal alienation) and how children and families can best cope with the effects of sexual abuse in the short and long term.
● Offering short-term targeted support earlier may reduce waiting lists for specialist provision and strengthen the ability of families to cope.
What is a sexual assault referral centre?
The Cross Government Action Plan on Sexual Violence and Abuse (2007) aimed to stimulate development of services to people affected by sexual violence throughout their lives and provides guidance for commissioners in planning and providing services for them.
The main aim is to increase the number of sexual assault referral centres. Developed locally between the NHS, third sector and the police, they are open 24 hours a day providing a range of free services under one roof.
St Mary’s Centre in Manchester has been working with people who have been raped or sexually assaulted since 1986 and was the first service of its kind in the UK.
It is now recognised as a beacon of good practice and has provided one-stop services to more than 13,000 individuals, delivered through its inter-agency approach and work.
About the author: Alison Domakin is senior lecturer in social work at Manchester Metropolitan University
● Allnock, Bunting, Price, Morgan-Klein, Ellis, Radford, and Stafford (2009), Sexual Abuse and Therapeutic Services for Children and Young People – The gap between provision and need.
● Mariathasan (2009), Children Talking to Childline about Sexual Abuse, NSPCC.
● Nelson and Hampson (2008) Yes You Can! Working with Survivors of Childhood Sexual Abuse, Second Edition, the Scottish Government.
● NSPCC Research in Progress. Supporting Children and Young People Who Experienced Sexual Abuse: A research study.
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This article is published in the 14 April 2011 edition of Community Care under the headline “Mapping of sexual abuse is key to service expansion”