National Estimation of Children in Residential Care Institutions in Cambodia HEILBRUNN DEPARTMENT OF POPULATION & FAMILY HEALTH NATIONAL ESTIMATION OF CHILDREN IN RESIDENTIAL CARE INSTITUTIONS IN CAMBODIA 1 Contents 1. Executive Summary ............................................................................................................ page 2 2. Background .......................................................................................................................... page 4 3. Methods ............................................................................................................................... page 6 4. Findings ............................................................................................................................. page 10 5. Learning and Implications ................................................................................................ page 14 6. References .......................................................................................................................... page 18 1. Executive OVERVIEW There is increasing international mobilization around the importance of family care for optimal child development. Summary Recently the Royal Government of Cambodia has made a commitment to reduce the numbers of children living in residential care in Cambodia and to invest in initiatives focused on prioritizing supportive family care. However, before rolling out the programs intended to achieve the reduction goals, rigorous baseline data on the numbers of children currently living in residential care institutions was needed to illuminate the scope of the issue and serve as a benchmark of future progress. This report describes the methodology and findings from Cambodia’s first national measurement exercise to enu- merate the population of children living in residential care institutions. Data were collected at the commune level across 24 sentinel sites. The work was led by the National Institute of Statistics (NIS) within the Ministry of Planning, with technical support from Columbia University (CU) in the United States and Moulathan Consulting (MLT) in Cambo- dia. The project was also guided by a technical working group, which included members from MoSVY, the Ministry of Interior, the Ministry of Labor, UNICEF Cambodia, the United States Agency for International Development (US- AID) and Friends International (FI). USAID provided fund- ing for the project, via John Snow International (JSI). NATIONAL ESTIMATION OF CHILDREN IN RESIDENTIAL CARE INSTITUTIONS IN CAMBODIA 3 KEY FINDINGS • We estimate that there are approximately 48,775 children living in residential care institutions in Cambodia. This is in comparison to the previous government estimate of 11,453 children living in residential care institutions in Cambodia (Kingdom of Cambodia, 2014). • This means that nearly 1 out of every 100 children in Cambodia is estimated to be living in residential care. • We estimate that there are approximately 1,658 residential care institutions in Cambodia. • 32% of institutions do not have a Memorandum of Understanding with the Ministry of Social Affairs, Veterans and Youth Rehabilitation (MoSVY) and, 70% of institutions were not inspected by MoSVY in 2014. • There are significantly more boys, compared to girls, living in residential care institutions in Cambodia (57.03% boys versus 42.97% girls). • The vast majority of children are school-aged, with more than half of all children between 13 to 17 years of age. • Almost 80% of 13-17 year olds have at least one living parent, and amongst children with at least one living parent, almost half of the children reported that their parent(s) live in the same province as the residential care institution. • When asked about their primary reason for entering residential care, 75% of 13-17 year old children named either escape from poverty or educational opportunities. NEXT STEPS • The intention is to repeat this enumeration exercise in approximately three years in order to gauge Cambodia’s progress towards meeting its stated goal to reduce the number of children living in residential care institutions. There is increasing international mobilization around the 2. Background importance of family care for optimal child development (Clay et al., 2012; US Department of State & USAID, 2012). In many instances, this mobilization has been in response to the rapid expansion of residential care institutions in many low- and middle-income countries (LMICs). In the United States and much of Western Europe, children were de-institutionalized in waves starting in the 1940’s, but this trend has not yet been realized in much of the Global South (Dozier, Zeanah, Wallin, & Shauffer, 2012). There are grave concerns amongst policymakers and child protection specialists that children who live in res- idential care institutions will experience cognitive, emo- tional and physical developmental delays, compared to children who live with families. These concerns arise from a large body of scientific evidence that has con- sistently found adverse outcomes associated with chil- dren’s exposure to extraordinary stress, including vio- lence, emotional abuse and neglect (Anda et al., 2006). Intervening to reduce early childhood stress are amongst the most impactful and cost- effective mechanisms to prevent poverty and chronic health problems over the life course (Chan, 2013; Irwin, Siddiqi, & Hertzman, 2007). The harmful effects of residential care institutions have been a particular focus within the scientific literature on NATIONAL ESTIMATION OF CHILDREN IN RESIDENTIAL CARE INSTITUTIONS IN CAMBODIA 5 Ministry of Social Affairs, Veterans and Youth Rehabili- tation (MoSVY), Cambodia has taken laudable efforts to increase oversight and accountability of residential care institutions (Kingdom of Cambodia, 2006, 2008). Relat- ed to these efforts, recently the government has made a commitment to reduce the numbers of children living in residential care and to invest in initiatives focused on prioritizing supportive family care. However, before roll- ing out the programs intended to achieve the reduction goals, rigorous baseline data on the numbers of children currently living in residential care institutions was needed to illuminate the scope of the issue and serve as a bench- mark of future progress. childhood exposure to stress (The Leiden Conference on the Development and Care of Children without Perma- This report describes the methodology and findings from nent Parents, 2012). In both Russia and Romania, where Cambodia’s first national measurement exercise to enu- residential care was epidemic, several well designed merate the population of children living in residential care studies have documented exceptionally detrimental out- institutions. To our knowledge, this is the first time such comes for children growing up in institutions (McCall et al., an enumeration has been conducted in a resource-lim- 2013; Merz, McCall, & Groza, 2013; Nelson et al., 2007). ited setting. Cambodia does already track the number In these countries, children who were living in residential of children in residential care institutions through routine care institutions were found to be severely malnourished, administrative sources (e.g., MoSVY), but an enumeration socially and emotionally deprived and intellectually de- provided an opportunity to independently assess the ficient. However, in Romania, when some of these chil- completeness of the existing MoSVY databases. MoSVY dren were removed from residential care institutions and has also recently completed a comprehensive national placed with foster families before the age of two years, mapping of the number of residential care institutions they were able to recover to nearly the same levels as in Cambodia. Though the focus of the mapping was on children who were never institutionalized. Dramatic im- counting institutions rather than children, the mapping provements were observed for the de-institutionalized (like the enumeration) was also conducted to support children on multiple measures, including scans of brain the government’s ultimate goal of reducing the number activity (Bick et al., 2015). For children who remained in of children in residential care institutions. This report is residential care institutions, the damage was generally intended to be read in conjunction with the findings from irreparable and reverberated into adulthood (Nelson et the mapping. al., 2007). Studies of children from residential care insti- tutions who were adopted have also found that adopt- The work was led by the National Institute of Statistics ed children typically exhibit impressive catch-up growth (NIS) within the Ministry of Planning, with technical sup- and cognitive and behavioural advancement immediately port from Columbia University (CU) in the United States after they begin to live with their adoptive families (The and Moulathan Consulting (MLT) in Cambodia. The proj- Leiden Conference on the Development and Care of Chil- ect was also guided by a technical working group, which dren without Permanent Parents, 2012; van Ijzendoorn, included members from MoSVY, the Ministry of Interior, Bakermans-Kranenburg, & Juffer, 2007). the Ministry of Labor, UNICEF Cambodia, the United States Agency for International Development (USAID) In light of these findings, the Royal Government of Cam- and Friends International (FI). USAID provided funding for bodia has begun to see residential care institutions as a the project, via John Snow International