Residential Family Assessment Centres - A Call for Psychological Reform

By Ella Ucer, Family Support Worker 

Dr Marianne Trent talks to Ella Ucer

When I started working at a Residential Family Assessment Centre (RFAC) six months ago, the question that kept running through my mind was, “Where are all the psychologists?” Although my understanding of the aims and structure of the children’s social care system has since developed, I find myself continuing to ask the same question.

In this blog, I hope to offer an overview of the current RFAC model, highlighting some of its inherent tensions and challenges, and invite my psychologically inclined colleagues to reflect on how a more equitable and effective system might function.

What are RFACs?

To provide some background, RFACs are establishments where vulnerable families are offered accommodation for a limited time – typically 12 weeks – during which their capacity to parent safely and effectively is assessed. The assessment outcome is then provided to family courts, where life-changing decisions are made as to whether families will be allowed to remain together.

Despite most families entering RFACs having endured significant trauma and disadvantage throughout their lives, the House of Lords have expressly directed that the prevailing goal of these centres is assessment, not therapy (source). This means that in practice, RFACs take a critical stance towards families who are already in fight-or-flight mode and create environments where the support offered is not held to the same rigorous standards as they would be in a mental health setting.

Because offering support is not the aim, no clear, standardised guidelines – like NICE – exist to guide parenting interventions. In practice, this means that teaching is often provided on an ad-hoc basis by staff without specialist training, including detailed sessions addressing domestic violence, childhood trauma, and substance abuse.

A baby rolling on its back

Parents’ experiences of RFACs

A significant issue in its own right is that very little research currently exists as to the effectiveness of RFACs. 

Mothers have spoken about feeling criminalised by the 24-hour CCTV used in some centres, including while breastfeeding and bathing children (source, p.119).

Furthermore, although Ofsted regulates the provision of RFACs, inspections generally take place only once every three years and are announced in advance. This means that in practice few checks and balances exist to ascertain a reliable standard of care.

The routine collection of outcome measures is not a requirement, meaning that little is known as to whether RFACs help families, or, even more alarmingly, whether or not they could harm them.

 

The tension between assessment and support

Working at an RFAC, I have seen the incredible pressure staff are under to both mitigate potential risks to children and simultaneously support parents during what might be the most difficult time of their lives. Any trusting relationship we attempt to build with them, however, is inherently undermined by the fact that we are the same people passing judgment on their capacity to care for their children.

In psychotherapy, it is understood that a strong therapeutic alliance is necessary for change, characterised by collaboration, empathy, responsiveness, and positive regard for clients (source). In the highly pressurised context of parenting assessments, nearly all of these components are compromised. The nature of an assessment means that staff must prioritise the identification of risks over understanding and empathising with parents’ internal experiences, and our obligation to “put the child first” renders their personal struggles secondary, if not irrelevant.

One jarring illustration of this tension is in the case of trauma interviews, typically required to satisfy court instructions. Because staff are primarily assessors, the aim during these sessions is to obtain as much "evidence" as possible about how parents' histories impact their current functioning. However, from a psychologist's perspective, neglecting emotional safety and the prevention of re-traumatisation is a significant ethical breach. Without establishing these foundations for positive change, parents who would most stand to benefit from therapeutic, intensive, long-term support are often the ones least likely to progress under assessment.

Baby's Feet

The cost of RFACs

Meanwhile, parenting assessments are not cheap. While data is limited, Freedom of Information requests have revealed that the average cost paid to RFACs by some Local Authorities range around £4,092 per week (source). Down the line, if no kinship, adoption or foster placements are found, councils pay an average of £318,000 per year for each child placed in children’s homes (source). Much more importantly, there is the human cost.

Extensive research documents that looked-after children and care leavers have significantly poorer outcomes across key domains of mental health, education, employment, and housing (source).

While it is difficult to parse whether these outcomes relate to children’s experiences prior to entering care, as opposed to their experiences in care, they illustrate a clear need for intervention against family breakdown. I believe that RFACs could offer this, but only if redesigned in accordance with trauma-informed, evidence-based principles and robust oversight.

An alternative model of support

The UK Government has prioritised Children’s Social Care reform in recent years (source, source), and Ofsted’s National Director for Social Care, Yvette Stanley, has highlighted concerns around the lack of research into RFACs (source). While the number of RFACs in the UK is growing (source), there is little evidence that they currently offer the best possible chance to families, nor that assessment outcomes correctly predict children’s experiences in the community. 

I believe that psychologists have significant contributions to make in shaping the path forward. Most critically, we could help develop an evidence-based framework guiding what support should be offered at RFACs and how. Although I agree that assessment is necessary to ensure children’s safety, without an equal emphasis on support, it is difficult to see how meaningful change can be facilitated for families at breaking point.

Additionally, rigorous oversight mechanisms are needed to ensure a consistent quality of care. In my opinion, once-every-three-years, announced-in-advance inspections by Ofsted are not good enough. The dramatic variation across centres in how therapy and assessment are balanced (source) is not good enough. The lack of research into RFACs and parents’ and children’s experiences, whilst they continue to operate and drive life-changing decisions, is a scandal.

Young child plays with wooden blocks

Although these are my views following six months on the job, I recognise that there is much more to explore, and that colleagues across disciplines will be able to advance these ideas further. My hope is that together, we can move forward from asking, “Where are all the psychologists?”, to the next logical question: “Where can we begin?”

Thanks for reading, I look forward to your input and collaboration! Ella

Reflections by Dr Marianne Trent, Clinical Psychologist

Ella, thanks for this thoughtful and compassionate article. I can tell from your words how much you care for the children and families in RFACs. The words which arose for me as I read were dignity, safety and teamwork. It sounds like parents can’t necessarily feel safe to explore and develop and to optimise their parenting in an environment which lacks robust processes and therapeutic skill. I think if I was a parent in this situation I would feel like it was very Us VS Them and that wouldn’t be a situation in which I could thrive as a parent. It sounds like during this incredibly vulnerable and important time period in people’s lives there would be a golden opportunity for some attunement and attachment work. If I could have a hand in the services, I think that the following approaches would do wonders:

·         The Solihull approach,

·         Video Interaction Guidance (VIG)

·         Systemic family therapy alongside

·         Individualised trauma therapy for parents

Ella, thank YOU for caring and for raising these important issues.

Marianne

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