Residential care institutions, or orphanages, are becoming increasingly more common in Cambodia. These institutions are not closely monitored by the Cambodian government, causing many children to be raised in unsafe and inadequate environments. The vast majority of the children living in these orphanages have at least one living parent but are being sent to live in an institution because their parents cannot afford to provide for their material needs or their education. The donations of time and money from foreigners, as well as the relative ease of implementing institutions rather than alternative care, also contribute to the increasing number of inadequate residential care institutions. Children who are raised in these orphanages often experience physical and sexual abuse and exploitation; physical, psychological, or emotional health problems; and difficulty transitioning into adult life. Some practices that are being implemented to solve the issue of inadequate residential care and mitigate its negative effects include providing support to the original families, placing children in alternative care situations, and providing abuse-prevention resources.
Residential care institution (RCI) - A non-family based living center for children run by paid staff and often referred to as an orphanage. 1
Memorandum of understanding - A legal document that states the responsibilities of both parties involved in an agreement and summarizes the terms of agreement before an official contract is drafted. 2
Family care - A childcare situation in which children are raised within the home of their immediate, biological family.
Kinship care - An alternative childcare situation in which children are raised by extended family members such as grandparents, aunts, uncles, or other relatives. 3
Foster care - An alternative childcare situation in which children are temporarily placed in a household with a family that is oftentimes not biologically related to them. Foster care does not involve the permanent transfer of parental rights and responsibilities and, in Cambodia, often does not involve any legal agreement between parents, foster parents, local or central authorities, or an organization. 4
Ministry of Social Affairs, Veterans, and Youth Rehabilitation (MoSVY) - A Cambodian government organization in charge of RCIs in Cambodia. They monitor, inspect, approve, set standards for, and keep records for these RCIs. 5
Voluntourism - Travelers doing voluntary work in other countries as part of their vacations to help communities or the environment in the places they are visiting. 6 Also known as volunteer tourism.
Orphanage tourism - A type of voluntourism in which travelers visit and donate their time or money to residential care institutions, often as part of a tour or travel package. 7
Lower middle income country - A country with a per capita gross national income between $1,026 and $3,995. These nations are less economically stable than upper middle income countries but do not face many of the health and environmental risks of low income countries. 8
Millions of children around the world live in orphanages; as of 2017, UNICEF estimated that there were at least 2.7 million institutionalized children, but inaccurate record-keeping in many institutions suggests the number is likely much higher. 9 Some sources estimate that there are over 8 million children living in orphanages. 10 Orphanages are formally referred to as residential care institutions (RCIs), and the two terms will be used interchangeably throughout this brief. Although these types of facilities were widely used around the world historically, government-run RCIs have largely been phased out of many high income countries. 11 They are now much more common in lower income nations and, in these regions, have become the principal strategy for protecting and caring for children who cannot be raised in a traditional home. 12
Cambodia, a lower middle income country in Southeast Asia, has one of the fastest growing rates of RCIs in the world, with a 75% increase (from 154 to 269) in number of facilities and a 91% increase (from 6,254 to 11,945) in the number of institutionalized children from 2005 to 2010. 13 These numbers have continued to rise, and it is currently estimated that 16,579 children are living in 406 RCIs across Cambodia, with 9,608 children living in other residential facilities such as transit homes, temporary emergency accommodations, and faith-based care. 14 Nearly half of Cambodian RCIs are located in just two of the 25 provinces—Phnom Penh and Siem Reap—because they are the most populated. 15 Although Cambodia has a lower number of institutionalized children than other nearby countries (in 2007, Indonesia had over 200,000 16 and Sri Lanka had 21,000 17 ), the amount of residential care being implemented in Cambodia is rapidly increasing.
Due to the risks of raising children within RCIs, the United Nations and the Cambodian government have issued reports stating that residential facilities should be a last resort when caring for children and should only be used as a temporary solution. 18 However, the founders and donors of these RCIs are not adhering to these governmental guidelines. Seventy-two percent of RCIs in Cambodia are long-term care facilities where children stay for over six months, and residential care methods are much more common throughout the country than alternative forms of care. 19 Additionally, it is the responsibility of the Ministry of Social Affairs, Veterans, and Youth Rehabilitation (MoSVY) in Cambodia to monitor and inspect these facilities to ensure that they adhere to regulations, yet data implies the monitoring is not being conducted. 20 In a study from 2015, the MoSVY and UNICEF found that 38% of the RCIs in the country were newly identified, meaning there had been no previous inspection or oversight by the government to ensure quality of care. 21 In fact, 1 in 8 RCIs were not registered with any branch of government and 1 in 5 did not have a memorandum of understanding with the government. 22 As of 2014, only 29.5% of institutions were being inspected by the MoSVY. 23
The Cambodian children living in these facilities are mostly school-aged, with about 67% between 11 and 17 years of age and about 32% between 4 and 10 years of age. 24 Under 2% of the children are younger than 4, but all of the children who are under 4 are living in long-term facilities. 25 There is a slightly higher proportion of boys living in RCIs than girls: 53% are male and 47% are female. 26 The most pertinent statistic regarding these children, however, is that most of them are not even orphans. A 2015 study conducted by the MoSVY found that over 77% of children living in RCIs had at least one living parent. 27 In 2009, only 23% had no living parents, although many had other close living relatives. 28 The term orphan typically refers to children with no living parents, but in the context of institutionalized care, especially in Cambodia, children who have lost only one parent are still referred to as orphans. This is problematic because children with living parents are being institutionalized with orphanhood being cited as the primary contributing factor. 29 The parents of these children are normally the ones who make the decision to send the children to an orphanage because of a lack of resources to raise them at home. 30
The majority of the existing data on Cambodian orphanages comes from studies conducted by UNICEF and the MoSVY within the past decade. However, because the MoSVY has not adequately monitored the orphanages within the country, there may be inaccurate statistics or significant gaps in the data. 31 This is true for RCIs all around the world. 32 It is inherently difficult to gather data on the subjects that will be addressed in this brief, making it hard to create, find, and utilize reliable, causal data solely from the Cambodian RCI population. Therefore, data from orphanages in other countries will be used throughout this brief to supplement the topics that are lacking Cambodian data. Additionally, much of the government-collected research on the Cambodian population relies heavily on household surveys. 33 These surveys do not account for those living outside of traditional households—including those living in institutions—and thus overlook the most vulnerable populations and about a quarter of the most impoverished quintile. 34 Finally, it is important to acknowledge that, although public childcare facilities have severe negative effects on their young residents, it is occasionally necessary to provide short-term care facilities for vulnerable children awaiting a suitable long-term alternative. The organizations working to improve facility conditions acknowledge that the operators of these centers are often well-intentioned and that the issue resides in both the over-use and the misuse of this childcare method. 35
Tourists—frequently from the United States, Western European nations, Australia, and other higher income countries 36 —often come to Cambodia to enjoy the beautiful landscapes, unique culture, and tourist attractions. 37 In 2018, 6.2 million international tourists visited Cambodia. 38 Given the high levels of poverty within the country, these well-meaning tourists often feel they should do something to “give back” and help the local people while on their vacations; this is called voluntourism. 39 A popular and easy way for these foreigners to help is by donating their time and money at orphanages, which is a specific type of voluntourism referred to as orphanage tourism. In 2018, researchers found Cambodia to be among the top 10 orphanage tourism hot spots in the world. 40 Orphanage tourism is popular and diverse in Cambodia and consists of a range of activities involving the institutionalized children including tours, donations, cultural performances on site or in hotels, and volunteering. 41 In one orphanage located in Siem Reap, over 2 million tourists visit annually to watch the “charity show” performed by the orphans, and RCI visits often prompt donations amounting to anywhere from ten to several thousand dollars. 42 During volunteer activities, the children are expected (and sometimes even forced by the orphanage directors) to engage with the volunteers—hugging them, talking to them, asking to play with them, and so on—in order to encourage donations for the orphanage. 43
Although accurate records of the total number of tourists who participate in these activities across Cambodia have yet to be collected, research shows that as of 2013 there had been a 75% increase in the number of orphanages in Cambodia since 2005. In the same period of time, foreign tourists in the country had increased by 250%. 44 Additionally, in 2012, 88% of tour operators in the United States ran voluntourism trips, 45 and working with children was the most popular volunteer traveler activity reported. 46 Therefore, it can be reasonably concluded that large numbers of tourists are participating in orphanage tourism. These well-intentioned tourists are not trained in childcare; they are ordinary travelers with no specialized qualifications or experience. Organizations that are considered to have ethical volunteer programs—and that send volunteers to reputable institutions that fulfill MoSVY guidelines—require volunteers to have professional experience in childcare or a degree in psychology. 47 However, this is a very small portion of programs; most orphanages accept anyone who wishes to volunteer without performing background checks or confirming their qualifications. 48 49 Allowing inexperienced and unqualified tourists to interact so closely with the children contributes to the inadequacy of residential care.
In addition to volunteering their time, many foreign individuals and organizations wish to donate money to these RCIs in order to improve the conditions. Although the exact amount donated to Cambodian orphanages is unknown, a study among church attendees in Australia found that 51% regularly donated to institutional care overseas. 50 Additionally, about 245 Australian non-governmental organizations (NGOs) funded or sent volunteers to RCIs in 2017, and 565 Austrialian charities were involved with or operated RCIs overseas. 51 Donations are often used to create new centers as well as support existing centers. The issue with this is that the donors and charitable foundations are not experienced with childcare and do not understand the risks associated with placing children in institutional care. 52 The governments, donors, and NGOs that help to build and finance RCIs are not even aware of alternative care options. 53 This well-meaning but uninformed donation of time and money perpetuates the prevalence of RCIs in Cambodia and prevents alternative forms of care—that would be better for the development of the children—from gaining the financial support they need.
Orphanages have essentially become a lucrative business that drives the demand for the institutionalization of children. Some orphanage directors are corrupt and keep many of the donations for themselves or make money off of the children through child trafficking, 54 other RCIs receive government funding depending on the number of children in the institution, and still others are entirely dependent on volunteer donations to remain open. 55 All of these factors drive orphanage directors to coerce parents into sending their children to the institutions, occasionally offering money in return for placing their child in an RCI, 56 thus making the need for volunteers and donors seem more necessary than it is in reality.
Many of the children being raised in RCIs have at least one living parent or other living relatives, but these caretakers are unable to raise their children because they do not have enough money. An estimated 45% of all Cambodian children living in RCIs are there primarily because of the poverty of their families. 57 Seventy-five percent of children in Cambodian RCIs aged 13 to 17 reported that the primary reason they were there was “to escape from poverty” or “for educational opportunities.” 58 Although not all impoverished families send their children to RCIs, a UNICEF study in 2011 found that almost every family with a child in an RCI reported poverty as an influential factor in their decision to admit the child to an RCI. 59 Given that 12.9% of the Cambodian population lives below the national poverty line, a significant portion of Cambodian children are vulnerable to being sent to orphanages. 60 Parents often view RCIs as the best option for their children because they believe these institutions offer better standards of material care and education than the families can afford to provide. 61 Because so many parents have done this, other impoverished parents feel social pressure to do the same in order to do what is “best” for their children. This is a significant factor in sealing long-term institutionalisation and the loss of contact with the home environment. 62
There are not adequate social protection systems in place in Cambodia to help children and families living in poverty, leaving parents with no option but to place their children in institutions when they are unable to provide for basic needs and an education. 63 This is partially due to the rapid population growth, especially in urban areas, which puts pressure on families and social services. This pressure as well as the lack of social safety nets and community support services leaves parents needing a solution and means of social support for raising their children. 64 RCIs are filling this niche and providing a solution; they increase the number of spots in their institutions, and children from poor households are pushed out of their homes to fill those places. 65 Although many orphanage directors do this with good intentions to try to help impoverished communities, some exploit the issue and coerce or even pay parents to give their children away while the parents remain oblivious to the risks of sending their children to the institution. 66
Further research is needed to determine the number of Cambodian parents who send their children to RCIs due to poverty-related factors and to identify the income levels of the families who send their children to RCIs. However, statistics from nearby countries demonstrate that poverty is a primary contributing factor to sending children to RCIs. For example, in Sri Lanka, 92% of children in private institutions are there because their parents were unable to adequately provide for them. 67 Anecdotal evidence from orphanages all around the world and the self-reports from Cambodian children mentioned above allow one to reasonably conclude that poverty is one of the most prevalent reasons that children are sent to RCIs. 68 69
Although parents’ inability to afford an education for their children is closely tied to the factor of poverty, the parents’ reasoning in these two situations is different enough, and the number of parents that send their children to RCIs solely for education is large enough, that it also stands as its own significant contributor to the issue. Cambodian families place a great deal of value on the educational attainment of their children because they know it is important for their development and future success. 70 However, this often causes parents to undervalue the importance of children being raised within a household and to choose to send them to an institution in order to improve their chances of obtaining an adequate education. Many impoverished families cannot afford to pay for both the material needs of their children and the informal school fees and associated costs, forcing them to decide between one or the other. Given that material needs are more necessary for a child’s survival, parents recognize that they are sacrificing their children’s education in order to keep them in the home. 71
Because of significant social pressure to provide a proper education for one’s children, parents are driven to send their kids to orphanages, where they have a greater chance of being able to have their material and educational needs met. Indeed, nearly 96% of student-aged children living in RCIs in Cambodia do attend school every day and 86% are considered fully literate. 72 In comparison, about 90% of children in Cambodia as a whole were enrolled in primary school in 2018; the percentage of these children that attended school every day, however, is unknown. 73 Additionally, 55% of Cambodian adolescents have dropped out of school by the time they are 17 years old. 74 The prevalence of the societal pressure to send children to RCIs for the purpose of educational attainment is exemplified by the fact that 91.9% of family members in Cambodia stated that they agree that a poor family should send a child to an orphanage for education if the family cannot afford the educational fees. 75 As a result, approximately 37% of institutionalized children are there for educational opportunities. 76 These societal pressures even have an effect on children who really are orphans; many children are made to believe they are lucky and should be grateful to be orphans because it puts them in a better educational and financial situation than that of their peers. 77
Although educational attainment is extremely important for a child’s future career and income prospects, experts have stated that being raised in the home is more important to a child’s development and life outcomes. UNICEF released the following statement:
Education should not be viewed as a legitimate reason for child separation from their families. Whilst a child’s right to education is a fundamental right, the United Nations Convention on the Rights of the Child also clearly states that a child shall not be separated from his or her parents. Children’s rights in one arena should not be denied in favour of achieving rights in another. Parents and children should never be placed in the position of having to decide between education and family life together. 78
Cambodian parents are well-meaning in sending their children to live in RCIs in order to obtain an education but are unaware that it would be more beneficial to raise them in the home. They are unjustly forced to make the decision between the two.
The Cambodian government has limited resources and therefore many of the ministries and departments for child welfare are underfunded and understaffed. 79 Most of the funds these organizations do have at their disposal for providing childcare end up going to RCIs instead of providing financial assistance for children to remain in family care. 80 There are several reasons behind this. First, there is an underlying belief in many countries that removing children from impoverished circumstances (in their home) to higher standards of living (in an institution) will bring lasting benefits to society, despite the research on child development that shows otherwise. 81
There is also a lack of political commitment to explore or implement alternative methods of childcare because institutions are relatively easy to build and maintain and are a more visible, tangible, and contained “solution” to such a complex problem. 82 In contrast to many alternative methods, RCIs are clear locations for individuals to donate their time and money to. RCIs also present a straightforward way to show results by counting the number of children in the institutions, as opposed to the difficulty of quantifying the impact of family-based care. 83 Financing family care or alternative forms of care is seen as a process that is complex, difficult to communicate, and slow to generate results. 84 Therefore, governments and donors opt for institutionalized childcare instead.
Children living in RCIs have an increased risk of experiencing physical and sexual abuse because of the isolated nature of the institutions and the powerlessness of the children to defend themselves. 85 The staff and volunteers are not required to undergo background checks and are rarely trained in childcare, exposing the children to more dangerous situations and greater possibility of being abused. 86 For example, exposé reporters visiting a Cambodian orphanage in 2012 asked the orphanage director if they could take the children out to sightsee with them. Without asking for any sort of identification or proof of who they were, the director said yes. 87 These reporters could have been dangerous or had abusive intentions toward the children, but were allowed to take them out of the orphanage with relatively little explanation or purpose. This negligence and lack of careful monitoring is common in orphanages throughout Cambodia and suggests there is little security or protection of privacy for the children within RCIs. 88
In addition to lack of protection from strangers, Cambodian RCI staff members often fail to protect children from other children or other staff members. Anecdotal evidence suggests that kids of all ages often sleep in the same room and staff members sometimes share a bed with the children, increasing the likelihood of sexual abuse. 89 Because of a shortage of staff and the high quantity of children, instances of bullying and violence between the children also often go unnoticed. 90
The scale and nature of violence within institutional care is difficult to measure because of how hidden it is and how little it is reported. 91 There is no system in place for the children to report abuse, 92 and anecdotal evidence suggests that children who are abused in institutions have greater difficulty escaping the situation or getting support from outsiders. 93 Additionally, because children are so dependent on the institution, the abuse often continues for extended periods of time. 94 Although quantitative research on orphanage violence and abuse within Cambodia is sparse, studies on RCIs in other countries present evidence of the extent to which institutionalized children are abused and suggest abuse is widespread for both boys and girls. 95 A 2002 study in Kazakhstan found that 63% of children living in children’s homes had been subjected to some form of violence. 96 Over 56% percent of institutionalized children in India were subjected to physical abuse by staff members in 2007. 97 In North America in 2002, children in group home care were 27% more likely to experience sexual abuse than children in foster care or kinship care. 98 Half of Romanian orphanage residents in 2000 had been beaten as a routine punishment, and more than a third knew of children who had been forced to have sex. 99 This evidence from countries of diverse geographic locations and economic levels indicates this is a problem in RCIs all around the world, suggesting that similar results would also be found in Cambodian institutions.
Due to funding problems or the embezzlement of funds by the directors of some RCIs, children within certain orphanages often suffer abuse in the form of neglect. 100 Despite the opportunity for greater material care being an important factor for parents sending their children to these institutions, some children are not receiving adequate amounts of food or are not experiencing acceptable living conditions. 101 Exposé reporters found that many of the orphanages they visited made no effort to comply with government standards. They found open sewage in the courtyard of one of the orphanages and no roof or other weather-protecting structure in the boys’ room. The director even admitted to being unable to feed the children properly. 102 Children may also suffer physical and emotional neglect from the staff because of low staff-to-child ratios. 103
Children also suffer abuse in the form of exploitation and are often forced into child labor by the directors. 104 Fishing or planting rice to acquire food for the orphanage residents, performing song and dance shows for tourists to raise funds, and playing with groups of volunteer tourists when they visit are all common activities forced upon the orphanage residents. 105 106 107 Nearly one third of Cambodian children in RCIs reported being involved in performances or other fundraising activities for the institution, and girls were more likely to be forced to participate than boys. 108 Children in institutions are also more vulnerable to exploitation in the form of sex trafficking and prostitution. 109 These conditions—combined with the high rates of physical abuse, sexual abuse, and neglect—indicate that children living in these facilities are not better off than if they had stayed in their impoverished households.
When children grow up in overcrowded, impersonal environments such as those in orphanages, they are more likely to experience social, physical, and emotional developmental harm. They may experience higher exposure to diseases, delays in physical growth, clinical personality disorders, and emotional insecurity. 110 Children with physical or learning disabilities, health or behavior problems, past trauma, or history of abuse are also more likely to be sent to RCIs by their parents or relatives because they often take more resources to care for, thereby increasing the concentration of institutionalized children who need specialized care. 111 However, the RCI staff often do not receive the resources or training necessary to be able to give specialized care and attention to these children, further exacerbating their conditions and causing lifelong harm. 112
Children living in RCIs are more likely to contract diseases because of their close proximity to other children during day and night. 113 In a study of orphaned and abandoned children in six different countries (including Cambodia), researchers found that, in the two weeks prior, 19% of children had experienced a fever and 18% had experienced a cough. Fifty-five percent had experienced illnesses within the six months prior. 114 Moreover, institutionalized children who are not consuming adequate amounts of food, who have experienced traumatic events, or who experience low caregiver involvement are more susceptible to malnutrition and other poor health outcomes. 115 Although a quantitative study on the broad health effects of institutionalized care has yet to be performed in Cambodia, such a study of children in Romania from 2009 provides us with valuable information on the possible health consequences of living in an RCI. The study found that, compared to non-institutionalized foster children, kids in large-scale institutions were more physically stunted. On average, for every 2.6 months a child had spent in an orphanage, he or she fell back one month of normal growth. 116 This stunted growth is due to poor nutrition, illnesses, poor hygiene, and lack of access to medical care. These same children were also found to have reduced motor and language abilities because of the lack of toys, play facilities, and developmental education within the RCI. 117
Child development specialists have demonstrated that, beyond adequate physical care, children need love, attention, and an attachment figure in order to fully and healthily develop. 118 Research conducted by UNICEF has demonstrated that a strong bonding attachment to a caregiving figure, established at birth and continuing throughout the child’s life, is necessary for children to develop normally. 119 Cambodian RCIs have consistently failed to meet these needs. With a median of 21 children per institution and an average staff-to-child ratio of 1 to 6.46, children are not receiving the individualized care they need. 120 Because of the high staff turnover and low number of staff, children have reduced potential to form secure, long-lasting attachments. 121 The large number of volunteers that come to the orphanage and stay for only a few weeks can also cause institutionalized children to form attachment disorders. 122
Even if an institution is well-run and employs trained, careful staff, there can still be negative developmental effects on children. For example, lasting behavioral and psychological problems have been associated with the distress of a child’s separation from parents and siblings. The reduced or eliminated possibility of maintaining contact with family members and friends causes increased emotional stress for these children. 123
The aforementioned 2009 study in Romania found that children in large-scale institutions, as compared to non-institutionalized foster children, had more social and behavioral abnormalities, aggressive behavior problems, and inattention and hyperactive behaviors. If these children entered the institution at a younger age, they were even more likely to have significantly lower IQs and decreased levels of brain activity. 124 A meta-analysis of studies from 19 different countries revealed that children raised in orphanages had IQs 20 points lower, on average, than children raised in foster care. 125 Similar psychological and emotional issues would likely be seen in Cambodian RCI residents.
For children in all cultures and countries, growing up in a safe and healthy environment is vital to a successful transition into adulthood and being able to handle the responsibilities of adult life, such as holding a job, raising and providing for a family, and creating healthy relationships with others. 126 Anecdotal evidence demonstrates that children who grow up in RCIs often experience dependency issues or a sense of abandonment, hindering their ability to form and maintain successful relationships later in life. 127 Given that close, supportive relationships are necessary for well-being, this will go on to negatively affect all aspects of their lives. 128 For example, the lack of positive, consistent adult interaction while growing up limits the kids’ development of personal confidence and key social skills, which are necessary for positive parenting. These children then often go on to become inadequate parents. 129 Although a study regarding the intergenerational effects of institutionalization has yet to be conducted in Cambodia, a longitudinal study in Ireland revealed that the memories of fear and abuse from orphanages tended to follow individuals into their adult lives. 130 Many of the subjects reported parenting difficulties, including repeating harmful behaviors with their own children. About half of the participants attended counseling, and many described their lives as marked by poverty, aggressive behavior, alcoholism, social isolation, and difficulty in forming stable, secure relationships in adult life. 131
Beyond the social effects of being raised in an orphanage, these children often face discrimination within their communities and limited job prospects. This may occur because others in the community are aware of some of the social, emotional, and personality disorders or delays that these children are likely to develop, creating a stigma around them. 132 This stigma makes it difficult for individuals to reintegrate into society after leaving the orphanage. 133 Although statistics from Cambodia on this subject are lacking, a survey in Russia found that 1 in 3 children become homeless after leaving an RCI, 1 in 5 develop a criminal record, and as many as 1 in 10 commit suicide. 134
The decreased amount of job prospects may also be influenced by the lack of a social network once the children leave the institution, having been separated from family and friends. 135 This is often true for children from RCIs that are not well-planned or well-supported, and can result in homelessness or exploitative domestic labor even after the child grows too old for the institution. 136 The lack of adequate resources to assist ex-“orphans” in finding housing and employment, developing relationships, and accessing services leads to a lack of preparation for future life and a myriad of future problems. 137
Since many of the children living in RCIs have at least one living parent, and the main factor preventing these parents from raising their children is the inability to financially provide for them, providing financial and social support resources for parents allows many of these children to return home to be raised by their families. These resources aid parents in acquiring the money necessary to pay for the material needs and education of their children. This allows children to be raised within the home and community, leading to better health and life outcomes. Organizations implementing this practice hope to prevent children from being placed in institutions in the first place as well as help to integrate children that were living in RCIs back into the home.
One organization that employs this intervention is Cambodian Children’s Trust (CCT), a nonprofit organization based in the province of Battambang. 138 CCT implements a Village Hive model which “facilitate[s] holistic interventions in children’s lives, taking families from a place of vulnerability to empowerment.” 139 This model helps to build a network of support around the families, including the extended family, community members, and social workers. The money donated to the organization is used to support these long-term networks, ensuring that children can remain in the home. The social workers employed by the organization help the family to create empowerment plans to ensure that they have the resources necessary to connect with services such as free health and education services and social insurance. 140 141
CCT has implemented this model in 36 villages across Battambang and is currently working with more than 600 children and their families. They employ a team of over 150 Cambodians to support and provide resources for families. 142 According to their 2019 Impact Report, CCT prevented 2,244 children from being separated from their families and provided about 110,000 people access to strengthening support and services. 143 Additionally, 179 new vulnerable families were identified and referred to CCT’s social workers and 538 case plans were created with the families. CCT was also able to ensure that these children living with their parents could obtain an education: 144 children were newly enrolled in public school, 143 children advanced to the next grade in public school, and 163 vulnerable children stayed enrolled in public school. 144 Finally, 31 children from orphanages were reintegrated into their families and 39 families attained full independence from CCT’s support. 145 These statistics, although demonstrating positive outputs and outcomes, do not prove the impact that the organization itself had on the lives of these children since no randomized controlled trial (RCT) was conducted to compare those who participated in CCT services and those who did not.
Because this organization does not report any impact statistics, it is difficult to know how effective this organization has been at helping children to reintegrate into their home life and enabling parents to provide financially for their children. Moreover, because CCT only operates in one province in Cambodia, it is limited in the impact that it can have on children across the country.
Although reintegrating children back into family life is considered the best practice for this issue, it could pose some problems if the original family is abusive towards the child or if the organization is unable to locate the child’s family. Additionally, because no organization has implemented this practice for a prolonged amount of time, it is difficult to know how sustainable it is. It is unknown how long most families will require financial support from the organization, and CCT does not currently have the funds to sustain the families of all institutionalized children. 146
The data demonstrates that it is very difficult to successfully raise a healthily functioning child within a public institution, but some of the children that live in these RCIs truly are orphans or cannot be raised by their relatives for various reasons. In these cases, some form of childcare needs to be provided by organizations, the government, or the community. Foster homes, adoption services, and short-term emergency care centers can fill this need in a way that is much healthier for the children. Few resources are currently being allocated to finding good community-based care alternatives because most government and donor funds go straight to institutions. 147 However, institutions take up to 12 times more money to operate than community-based alternatives, demonstrating that alternative forms of care would not only be better for the children but would be more cost-effective as well. 148
SOS Children’s Villages International is an NGO that provides alternative care services for children around the world, including in Cambodia, that cannot be raised by their biological families. 149 They provide or arrange several different types of alternative care, including family-like care, kinship care, foster care, and emergency shelters. Family-like care involves children being raised in small groups resembling a family (called SOS Children’s Villages) where four to ten children live together with a certified SOS “parent.” In kinship care, children live with an extended family member; SOS Children’s Villages International assists in finding willing and able relatives and arranging the care situation. When arranging foster care situations, the organization ensures that the foster parents are eligible to receive financial support from the state and trains and counsels the parents. Finally, they build emergency shelters as a temporary living situation when there has been emergency family separation and then help the family reunite afterwards. 150 The organization works in 136 countries around the world 151 and has supported 4 million children through alternative care and family strengthening programs. 152 They currently have 6 active programs running in different provinces in Cambodia. 153
SOS Children’s Villages International does not report any data from their services in Cambodia specifically. However, over 559 Children’s Villages have been established across the world. 154 Within Asia, there are currently 164 Children’s Villages. The number of children placed in foster care, kinship care, or emergency shelters is unknown. 155
The organization conducted a study that found that, of the children who have participated in their programs (which can also include youth programs and educational or vocational training), 90% generally have adequate accommodations, food security, and health. 156 Additionally, outcome data reveals that 90% of former SOS participants have been found to give good care to their own children, 60% have received education and job skills and are earning a decent living, and 80% are experiencing social and emotional well-being. Of the participants that were placed in family-like care situations, 87% now have a stable housing situation. 157 SOS Children's Villages International has not conducted any RCTs, so they do not report any impact statistics.
Although SOS Children’s Villages has reported that they are currently implementing 6 different programs in Cambodia, there is no information on what kinds of programs these are or how many children they are helping. 158 Additionally, many of the reported statistics are only outputs and do not demonstrate how the lives of the children have been impacted. The study that looked at the current conditions of former SOS participants produced outcome data and provides evidence that the lives of these children were improved, but the lack of impact data means there is no evidence that this improvement was a result of SOS Children’s Villages International’s intervention or that they are living in better conditions than children who grew up in RCIs. Even with the presence of this data, it would still be unclear how the children in Cambodia specifically are being helped.
SOS Children’s Villages International acknowledges this lack of data and does not claim to be the sole source of the increase in the children’s well-being. 159 They reported that the lack of impact data is due to their inability to “find a sufficient sample of people who shared the same characteristics, risk profile, and who had not received any care services or who had received similar care services.” 160 As a result, they were forced to compare their data against similar external data, which does not prove the impact of their practices but does give an idea of the helpfulness of the services they are providing. 161
Although raising children in a home environment is the best solution to this issue, there are cases when no other form of childcare is available and public facilities are necessary, even just for a temporary period. In these cases, organizations can train RCI staff members to better care for and protect the youth and give children the resources they need to report cases of abuse. This ensures that, when children need to be placed in public care or until they are able to return to their homes, they can still avoid some of the negative consequences by being in a safe and protected environment instead of abused, neglected, or exploited by the staff or strangers.
Friends-International, a Skoll Foundation 162 and Schwab Foundation 163 awardee, is an NGO that provides various services for marginalized children and families in Cambodia, Thailand, Laos, Indonesia, and Switzerland. 164 Their ChildSafe program provides a 24/7 emergency hotline that responds to calls about children in danger and then provides social workers to take immediate action to rescue and protect the children. The program also provides child protection training and certification for various organizations, businesses, and community members to give them tools to protect children and youth. Finally, they run behavior-change campaigns for citizens, travelers, and donors to raise awareness of the harm of orphanage tourism and inform volunteers of the most effective ways to protect and support children. 165
Friends-International does not report any impact statistics on its ChildSafe program specifically, but it does report output data. The organization is currently implementing the ChildSafe program in two provinces in Cambodia: Phnom Penh and Siem Reap. 166 In Phnom Penh, 600 ChildSafe Agents (the community and organization members certified under the child protection training) undertook 9,000 child protection actions in 2018. In the same year in Siem Reap, 281 ChildSafe Agents in the community and 56 businesses in the tourism industry were trained in child protection, and 632 children were protected through the emergency hotline and agent interventions. 167
Unfortunately, the reported data about Friends-International’s aid in abuse prevention is merely output data and does not communicate how effective the practices have been at improving the conditions for children in RCIs. There may not be any impact data because the ChildSafe program in Cambodia is run through two subdivisions of the Friends-International organization that perhaps do not currently receive the funding or otherwise do not have the ability to measure impact. Additionally, the reported statistics are not specific to orphanages and could be referring mostly to children living in other circumstances. 168 Finally, although this practice can help to make RCIs more of an adequate setting for raising children, it does little to mitigate the other negative effects of growing up in an RCI or to return non-orphans to their families. Therefore, it is a downstream approach that addresses a consequence of the issue rather than the issue itself.
1 UNICEF, Mapping of Residential Care Facilities in the Capital and 24 Provinces of the Kingdom of Cambodia (February 2017), 6, https://www.unicef.org/cambodia/media/1331/file/Residential%20care %20facilities%20in%20Cambodia%20Report%20English.pdf.
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5 UNICEF, A Statistical Profile of Child Protection in Cambodia, (2018), 7, https://www.unicef.org/cambodia/media/711/file/Cambodia_Report_Final_web_ready_HIGH.pdf%20.pdf.
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12 Save the Children, A Last Resort: The Growing Concern About Children in Residential Care (September 2010), 15, https://resourcecentre.savethechildren.net/node/2644/pdf/2644.pdf.
13 UNICEF, A Statistical Profile of Child Protection in Cambodia (2018), 8, https://www.unicef.org/cambodia/media/711/file/Cambodia_Report_Final_web_ready_HIGH.pdf%20.pdf.
16 International Save the Children Alliance, “Someone that Matters”: The Quality of Care in Childcare Institutions in Indonesia (2007), 19, https://resourcecentre.savethechildren.net/node/2988/pdf/2988.pdf.
17 UNICEF, Out of Sight, Out of Mind: Report on Voluntary Residential Institutions for Children in Sri Lanka: Statistical Analysis (2007), 17, https://bettercarenetwork.org/sites/default/files/Out%20of%20Sight%20Out%20of%20Mind%20%20Report%20on%20Voluntary%20Residential%20Institutions%20for%20Children%20in%20Sri%20Lanka.pdf.
18 UNICEF, Mapping of Residential Care Facilities in the Capital and 24 Provinces of the Kingdom of Cambodia (February 2017), 44, https://www.unicef.org/cambodia/media/1331/file/Residential%20care %20facilities%20in%20Cambodia%20Report%20English.pdf.
19 Ibid., 10–11.
20 UNICEF, A Statistical Profile of Child Protection in Cambodia (2018), 7, https://www.unicef.org/cambodia/media/711/file/Cambodia_Report_Final_web_ready_HIGH.pdf%20.pdf.
22 Ibid., 8.
23 Lindsay Stark, Beth L. Rubenstein, Kimchoeun Park, and Sok Kosal, “National Estimation of Children in Residential Care Institutions in Cambodia: A Modelling Study,” BMJ Open (2017): 4, https://doi.org/10.1136/bmjopen-2016013888.
24 UNICEF, Mapping of Residential Care Facilities in the Capital and 24 Provinces of the Kingdom of Cambodia (February 2017), 8, https://www.unicef.org/cambodia/media/1331/file/Residential%20care%20facilities%20in%20Cambodia%20Report%20English.pdf.
25 UNICEF, A Statistical Profile of Child Protection in Cambodia (2018), 8, https://www.unicef.org/cambodia/media/711/file/Cambodia_Report_Final_web_ready_HIGH.pdf%20.pdf.
26 Ibid., 7.
27 Ibid., 8.
28 UNICEF, Residential Care in Cambodia, http://dpaabwfttl39p.cloudfront.net/wp-content/uploads/ 2013/03/Fact-sheet-residential-care-Cambodia.pdf.
29 UNICEF, A Statistical Profile of Child Protection in Cambodia (2018), 7, https://www.unicef.org/cambodia/media/711/file/Cambodia_Report_Final_web_ready_HIGH.pdf%20.pdf.
30 UNICEF, With the Best Intentions: A Study of Attitudes Towards Residential Care in Cambodia (2011), 9, http://www.thinkchildsafe.org/thinkbeforedonating/wp-content/uploads/With-The-Best-Intentions-UNICEF-and-Ministry-Of-Social-Affairs-Of-Cambodia.pdf.
31 UNICEF, A Statistical Profile of Child Protection in Cambodia (2018), 7, https://www.unicef.org/cambodia/media/711/file/Cambodia_Report_Final_web_ready_HIGH.pdf%20.pdf.
32 Save the Children, A Last Resort: The Growing Concern About Children in Residential Care (September 2010), 12, https://resourcecentre.savethechildren.net/node/2644/pdf/2644.pdf.
33 Beth L. Rubenstein and Lindsay Stark, “A Forgotten Population: Estimating the Number of Children Outside of Households in Cambodia,” Global Social Welfare, Research, Policy, and Practice 3, (2016): 119–124, https://doi.org/10.1007/s40609-016-0051-7.
34 Roy Carr-Hill, “Missing Millions and Measuring Development Progress,” World Development 46, (2013): 30–44, https://dx.doi.org/10.1016/j.worlddev.2012.12.017.
35 Better Care Network, Families, Not Orphanages (September 2010), 3, https://bettercarenetwork.org/sites/default/files/Families%20Not%20Orphanages_0.pdf.
36 Ministry of Tourism, Tourism Statistics Report: Year 2018 (2018), 3, https://www.tourismcambodia.com/img/resources/cambodia_tourism_statistics_2018.pdf
37 “Tour Packages,” Tourism of Cambodia, accessed June 15, 2020, https://www.tourismcambodia.com/tours/.
38 UNWTO, International Tourism Highlights (August 28, 2019), 19, https://www-e-unwto-org.erl.lib.byu.edu/doi/pdf/10.18111/9789284421152.
39 Tess Guiney and Mary Mostafanezhad, “The Political Economy of Orphanage Tourism in Cambodia,” Tourist Studies 15, no. 2 (2015): 133, https://doi.org/10.1177/1468797614 563387.
40 Michael Howe-Ely as cited in “Facts and Figures About Orphanage Tourism,” ReThink Orphanages, accessed April 6, 2020, https://rethinkorphanages.org/problem-orphanages/facts-and-figures-about-orphanage-tourism.
41 Tess Guiney, “‘Hug-an-orphan Vacations’: ‘Love’ and Emotion in Orphanage Tourism,” The Geographic Journal 184, no. 2 (June 2017): 125–137, https://doi.org/10.1111/geoj.12218.
42 Denise Hruby, “In Cambodia, Fake Orphanages Soak Up Donations by Duping Tourists,” PRI, last modified July 21, 2014, https://www.pri.org/stories/2014-07-21/cambodia-fake-orphanages-soak-donations-duping-tourists.
43 Tess Guiney, “‘Hug-an-orphan Vacations’: ‘Love’ and Emotion in Orphanage Tourism,” The Geographic Journal 184, no. 2 (June 2017): 125, https://doi.org/10.1111/geoj.12218.
44 Morgan Hartley and Chris Walker, “Cambodia’s Booming New Industry: Orphanage Tourism,” Forbes, May 24, 2013, https://www.forbes.com/sites/morganhartley/2013/05/24/cambodias-booming-new-industry-orphanage-tourism/#535af38e794a.
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49 Juliana Ruhfus, “Cambodia’s Orphan Business,” Aljazeera, last modified June 27, 2012, https://www.aljazeera.com/programmes/peopleandpower/2012/05/201252243030438171.html.
50 Christopher Knaus, “The Race to Rescue Cambodian Children from Orphanages Exploiting Them for Profit,” The Guardian, August 18, 2017, https://www.theguardian.com/world/2017/aug/19/the-race-to-rescue-cambodian-children-from-orphanages-exploiting-them-for-profit.
52 Save the Children, A Last Resort: The Growing Concern About Children in Residential Care (September 2010), 5, https://resourcecentre.savethechildren.net/node/2644/pdf/2644.pdf.
53 UNICEF, Mapping of Residential Care Facilities in the Capital and 24 Provinces of the Kingdom of Cambodia (February 2017), 16, 20, https://www.unicef.org/cambodia/media/1331/file/Residential%20care%20facilities%20in%20Cambodia%20Report%20English.pdf.
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55 International Save the Children Alliance, “Someone that Matters”: The Quality of Care in Childcare Institutions in Indonesia (2007), 28, https://resourcecentre.savethechildren.net/node/2988/pdf/2988.pdf.
56 Kathryn E. van Doore, “Paper Orphans: Exploring Child Trafficking for the Purpose of Orphanages,” International Journal of Children’s Rights 24 (2016): 378–407, https://doi.org/10.1163/15718182-02402006.
57 UNICEF, With the Best Intentions: A Study of Attitudes Towards Residential Care in Cambodia (2011), 9, http://www.thinkchildsafe.org/thinkbeforedonating/wp-content/uploads/With-The-Best-Intentions-UNICEF-and-Ministry-Of-Social-Affairs-Of-Cambodia.pdf.
58 UNICEF, A Statistical Profile of Child Protection in Cambodia (2018), 8, https://www.unicef.org/cambodia/media/711/file/Cambodia_Report_Final_web_ready_HIGH.pdf%20.pdf.
59 UNICEF, With the Best Intentions: A Study of Attitudes Towards Residential Care in Cambodia (2011), 42, http://www.thinkchildsafe.org/thinkbeforedonating/wp-content/uploads/With-The-Best-Intentions-UNICEF-and-Ministry-Of-Social-Affairs-Of-Cambodia.pdf.
60 “Poverty Data: Cambodia,” Asian Development Bank, accessed July 20, 2020, https://www.adb.org/countries/cambodia/poverty.
61 Save the Children, A Last Resort: The Growing Concern About Children in Residential Care (September 2010), 12, https://resourcecentre.savethechildren.net/node/2644/pdf/2644.pdf.
63 Ibid., 1.
64 Ibid., 16.
65 Better Care Network, Families, Not Orphanages (September 2010), 8, https://bettercarenetwork.org/sites/default/files/Families%20Not%20Orphanages_0.pdf.
66 Save the Children, Keeping Children Out of Harmful Institutions: Why We Should be Investing in Family-Based Care (2009), 5, https://resourcecentre.savethechildren.net/node/1398/pdf/1398.pdf.
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71 UNICEF, Residential Care in Cambodia (2013), 1, http://dpaabwfttl39p.cloudfront.net/wp-content/uploads/2013/03/Fact-sheet-residential-care-Cambodia.pdf.
72 Lindsay Stark, Beth L. Rubenstein, Kimchoeun Park, and Sok Kosal, “National Estimation of Children in Residential Care Institutions in Cambodia: A Modelling Study,” BMJ Open (2017): 6, https://doi.org/10.1136/bmjopen-2016013888.
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74 UNICEF, “Education,” accessed April 6, 2020, https://www.unicef.org/cambodia/education.
75 UNICEF, Residential Care in Cambodia (2013), 1, http://dpaabwfttl39p.cloudfront.net/wp-content/uploads/2013/03/Fact-sheet-residential-care-Cambodia.pdf.
76 Lindsay Stark, Beth L. Rubenstein, Kimchoeun Park, and Sok Kosal, “National Estimation of Children in Residential Care Institutions in Cambodia: A Modelling Study,” BMJ Open (2017): 6, https://doi.org/10.1136/bmjopen-2016013888.
77 Ruth Emond, “I Am All about the Future World: Cambodian Children’s Views on Their Status as Orphans,” Children & Society 23, no. 6 (September 2009): 407–417, https://doi.org/10.1111/j.1099-0860.2008.00189.x.
78 UNICEF, Residential Care in Cambodia (2013), 1, http://dpaabwfttl39p.cloudfront.net/wp-content/uploads/2013/03/Fact-sheet-residential-care-Cambodia.pdf.
79 Simon Henderson, “Experts Examine Social Work Issues in Cambodia,” The Cambodia Daily, last modified June 36, 2013, https://english.cambodiadaily.com/news/experts-examine-social-work-issues-in- cambodia-32010/.
80 Save the Children, A Last Resort: The Growing Concern About Children in Residential Care (September 2010), 14, https://resourcecentre.savethechildren.net/node/2644/pdf/2644.pdf.
81 Ibid., 15.
82 Save the Children, Keeping Children Out of Harmful Institutions: Why We Should be Investing in Family-Based Care (2009), 11, https://resourcecentre.savethechildren.net/node/1398/pdf/1398.pdf.
85 Ibid., 7.
86 UNICEF, Residential Care in Cambodia (2013), 2, http://dpaabwfttl39p.cloudfront.net/wp-content/uploads/2013/03/Fact-sheet-residential-care-Cambodia.pdf.
87 Juliana Ruhfus, “Cambodia’s Orphanage Business,” HuffPost, last modified December 6, 2017, https://www.huffpost.com/entry/cambodias-orphanage-busin_b_1616255.
88 Juliana Ruhfus, “Cambodia’s Orphanage Business,” HuffPost, last modified December 6, 2017, https://www.huffpost.com/entry/cambodias-orphanage-busin_b_1616255.
89 UNICEF, Residential Care in Cambodia (2013), 2, http://dpaabwfttl39p.cloudfront.net/wp-content/uploads/2013/03/Fact-sheet-residential-care-Cambodia.pdf.
91 Save the Children, Keeping Children Out of Harmful Institutions: Why We Should be Investing in Family-Based Care (2009), 8, https://resourcecentre.savethechildren.net/node/1398/pdf/1398.pdf.
92 UNICEF, Residential Care in Cambodia (2013), 2, http://dpaabwfttl39p.cloudfront.net/wp-content/uploads/2013/03/Fact-sheet-residential-care-Cambodia.pdf.
93 Save the Children, A Last Resort: The Growing Concern About Children in Residential Care (September 2010), 9, https://resourcecentre.savethechildren.net/node/2644/pdf/2644.pdf.
95 Save the Children, Keeping Children Out of Harmful Institutions: Why We Should be Investing in Family-Based Care (2009), 8, https://resourcecentre.savethechildren.net/node/1398/pdf/1398.pdf.
97 Ministry of Women and Child Development: Government of India, Study on Child Abuse: India 2007 (2007), 55, http://www.indianet.nl/pdf/childabuseIndia.pdf.
98 Richard P. Barth, Institutions vs. Foster Homes: The Empirical Base for the Second Century of Debate (Chapel Hill, NC: UNC, School of Social Work, Jordan Institute
99 for Families, 2002), 3, https://www.assembly.ca.gov/sites/assembly.ca.gov/files/BarthInstitutionsvFosterHomes.pdf.
100 Ecaterina Stativa, Survey of Child Abuse in Residential Care Institutions in Romania: 2000 (2000), 19, https://bettercarenetwork.org/sites/default/files/Survey%20on%20Child%20Abuse%20in%20Residential%20Care%20in%20Romania.pdf.
101 UNICEF, Residential Care in Cambodia (2013), 2, http://dpaabwfttl39p.cloudfront.net/wp-content/uploads/2013/03/Fact-sheet-residential-care-Cambodia.pdf.
103 Juliana Ruhfus, “Cambodia’s Orphan Business,” Aljazeera, last modified June 27, 2012, https://www.aljazeera.com/programmes/peopleandpower/2012/05/201252243030438171.html.
104 UNICEF, Residential Care in Cambodia (2013), 2, http://dpaabwfttl39p.cloudfront.net/wp-content/uploads/2013/03/Fact-sheet-residential-care-Cambodia.pdf.
106 Denise Hruby, “In Cambodia, Fake Orphanages Soak Up Donations by Duping Tourists,” PRI, last modified July 21, 2014, https://www.pri.org/stories/2014-07-21/cambodia-fake-orphanages-soak-donations-duping-tourists.
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108 Lindsay Stark, Beth L. Rubenstein, Kimchoeun Park, and Sok Kosal, “National Estimation of Children in Residential Care Institutions in Cambodia: A Modelling Study,” BMJ Open (2017): 5, https://doi.org/10.1136/bmjopen-2016013888.
109 “Sexual Exploitation of Children in Cambodia,” Universal Periodical Review (July 9, 2018), 3, https://www.ecpat.org/wp-content/uploads/2018/07/Universal-Periodical-Review-Sexual-Exploitation-of-Children-2018-Cambodia.pdf.
110 UNICEF, Residential Care in Cambodia (2013), 2, http://dpaabwfttl39p.cloudfront.net/wp-content/uploads/2013/03/Fact-sheet-residential-care-Cambodia.pdf.
111 Save the Children, A Last Resort: The Growing Concern About Children in Residential Care, September 2010: 9, https://resourcecentre.savethechildren.net/node/2644/pdf/2644.pdf.
113 Nathan Thielman, Jan Ostermann, Kathryn Whetten, Rachel Whetten, and Karen O’Donnell, “Correlates of Poor Health among Orphans and Abandoned Children in Less Wealthy Countries: The Importance of Caregiver Health,” PLOS One 7, no. 6 (June 2012): 3, https://doi.org/10.1371/journal.pone.0038109.
114 Ibid., 7.
115 Ibid., 8.
116 Save the Children, Keeping Children Out of Harmful Institutions: Why We Should be Investing in Family-Based Care, (2009), 6, https://resourcecentre.savethechildren.net/node/1398/pdf/1398.pdf.
118 Better Care Network, Families, Not Orphanages (September 2010), 5, https://bettercarenetwork.org/sites/default/files/Families%20Not%20Orphanages_0.pdf.
119 UNICEF, Residential Care in Cambodia (2013), 2, http://dpaabwfttl39p.cloudfront.net/wp-content/uploads/2013/03/Fact-sheet-residential-care-Cambodia.pdf.
120 National Institute of Statistics, National Estimation of Children in Residential Care Institutions in Cambodia (May 2016), 10, http://www.cpcnetwork.org/wp-content/uploads/2016/09/National-Estimation-of-Children-20-May-16.pdf.
121 Save the Children, A Last Resort: The Growing Concern About Children in Residential Care (September 2010), 13, https://resourcecentre.savethechildren.net/node/2644/pdf/2644.pdf.
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123 Michael Rutter, Emma Colvert, Jana Kreppner, Celia Beckett, Jenny Castle, Christine Groothues, Amanda Hawkins, Thomas G. O’Connor, Suzanne E. Stevens, and Edmund J.S. Sonuga-Barke, “Early Adolescent Outcomes for Institutionally-deprived and Non-deprived Adoptees. I: Disinhibited Attachment,” Journal of Child Psychology and Psychiatry 48, no. 1 (2007): 1, https://doi.org/10.1111/j.1469-7610.2006.01688.x.
124 Save the Children, Keeping Children Out of Harmful Institutions: Why We Should be Investing in Family-Based Care (2009), 6, https://resourcecentre.savethechildren.net/node/1398/pdf/1398.pdf.
125 Marinus H. van Ijzendoorn, Maartje P.C.M. Luijk, and Femmie Juffer, “IQ of Children Growing Up in Children’s Homes: A Meta-Analysis on IQ Delays in Orphanages,” Merrill-Palmer Quarterly 54, no. 3 (July 2008): 341, http://faculty.uml.edu/darcus/47.361/FOSTER%20CARE/vanijzendorn_etal_2008_IQ.pdf.
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127 UNICEF, Residential Care in Cambodia (2013), 2, http://dpaabwfttl39p.cloudfront.net/wp-content/uploads/2013/03/Fact-sheet-residential-care-Cambodia.pdf.
128 Scott D. Landes, Monika Ardelt, George E. Vaillant, and Robert J. Waldinger, “Childhood Adversity, Midlife Generativity, and Later Life Well-Being,” Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, (2014): 1–11, https://doi.org/10.1093/geronb/gbu055.
129 Michael Rutter, Emma Colvert, Jana Kreppner, Celia Beckett, Jenny Castle, Christine Groothues, Amanda Hawkins, Thomas G. O’Connor, Suzanne E. Stevens, and Edmund J.S. Sonuga-Barke, “Early Adolescent Outcomes for Institutionally-deprived and Non-deprived Adoptees. I: Disinhibited Attachment,” Journal of Child Psychology and Psychiatry 48, no. 1 (2007): 1, https://doi.org/10.1111/j.1469-7610.2006.01688.x.
130 Commission to Enquire into Child Abuse, Report on the Commission to Enquire into Child Abuse, Ireland (2009), http://www.childabusecommission.ie/rpt/ExecSummary.php.
132 UNICEF, Residential Care in Cambodia (2013), 2, http://dpaabwfttl39p.cloudfront.net/wp-content/uploads/2013/03/Fact-sheet-residential-care-Cambodia.pdf.
133 Save the Children, A Last Resort: The Growing Concern About Children in Residential Care (September 2010), 13, https://resourcecentre.savethechildren.net/node/2644/pdf/2644.pdf.
134 David Tobis, Moving from Residential Institutions to Community-Based Social Services in Central and Eastern Europe and the Former Soviet Union (The World Bank, 2000), 33, https://www.academia.edu/5239849/Moving_from_Residential_Institutions_to_Community-Based_Social_Services_in_Central_and_Eastern_Europe_and_the_Former_Soviet_Union.
135 UNICEF, Residential Care in Cambodia (2013), 2, http://dpaabwfttl39p.cloudfront.net/wp-content/uploads/2013/03/Fact-sheet-residential-care-Cambodia.pdf.
136 Save the Children, A Last Resort: The Growing Concern About Children in Residential Care (September 2010), 3, https://resourcecentre.savethechildren.net/node/2644/pdf/2644.pdf.
137 Ibid., 13.
138 “About,” Cambodian Children’s Trust, accessed February 27, 2020, https://cambodianchildrenstrust.org/about/.
139 “Village Hive Model,” Cambodian Children’s Trust, accessed February 27, 2020, https://cambodianchildrenstrust.org/village-hive/.
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152 SOS Children’s Villages International, 70 Years of Impact: Improving the Lives of Children Without Adequate Parental Care (April 2019), 11, https://www.sos-childrensvillages.org/getmedia/6bc4dad4-d496-4761-aa0f-e1fa572e428f/SOS_70_years_of_impact_report_SPREADS-WEB.pdf.
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156 SOS Children’s Villages International, 70 Years of Impact: Improving the Lives of Children Without Adequate Parental Care (April 2019), 18, https://www.sos-childrensvillages.org/getmedia/6bc4dad4-d496-4761-aa0f-e1fa572e428f/SOS_70_years_of_impact_report_SPREADS-WEB.pdf.
157 Ibid., 28.
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159 SOS Children’s Villages International, 70 Years of Impact: Improving the Lives of Children Without Adequate Parental Care (April 2019), 16, https://www.sos-childrensvillages.org/getmedia/6bc4dad4-d496-4761-aa0f-e1fa572e428f/SOS_70_years_of_impact_report_SPREADS-WEB.pdf.
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