Pre-trial therapy is any form of therapy that is accessed while a criminal case about sexual violence is ongoing. Historically, legal processes have restricted access to pre-trial therapy, founded on the view that discussing details about the sexual assault could damage the quality of evidence and lead to a miscarriage of justice. Consequently, children and young people are often left without mental health support while their case awaits trial. On average, this wait is two and a half years; however, for some, it is much longer. We set out to understand the factors that are preventing children and young people from receiving the care that they require and investigate how to improve access to services. This policy report explores the barriers and facilitators to pre-trial therapy amongst children and young people who have experienced sexual abuse. We summarise the key findings from our research to make best practice and policy recommendations for the future delivery and commissioning of pre-trial therapy services across the UK.