Acknowledgements The authors are grateful to everyone who provided advice and cooperation during the course of this research, especially the hundreds of children, parents, directors, staff members, and others who shared their personal experiences and impressions of residential child care facilities in Haiti. Jean Louis Roosevelt at IBESR provided insightful and steady guidance at every stage of the project, from the development of the research strategy to the development of the survey instruments to the completion of the research and analysis. The investigators are also grateful to Arielle Jeanty Villedrouin, director general of IBESR, for her support and commitment to the study. Numerous other people at IBESR also provided welcome assistance, including Abraham Joseph in Nippes, Marie Garlene Dupoux in Grand’Anse, Enel Andre in the South, Jacques Greguy Regis in the Southeast, Cinedais Jean in the Artibonite, Anostal Justin in the Northwest, Louis- Mary Petit-Frere in the North, Occean Remy in the Northeast, and Abbe Bernard in the Center Department. Pierre Ferry of UNICEF provided direction, and helped the research team through difficult moments with his understanding and guidance. Jules Hans Beauvoir at UNICEF was instrumental in enriching the methodology. Kristine Peduto, also of UNICEF, made significant contributions to the questionnaires. The team also wishes to express its appreciation for the contributions of the members of the original steering committee, including Tessa Marks of Rescue International for her contributions to preparing and insights, as well as Islande Georges and Camilla Dogliotti of Terre de l’Homme, and Claire Perrin Houdon of Handicap International, whose contributions were critical to the success of the research. The staff of Save the Children, including David Marcelin, Stephen Vaughan, and deputy director Denise Rocks, also provided their thoughts and reviewed the questionnaire. Rachel Whetten, Kate Whetten, lead author of “A Comparison of the Wellbeing of Orphans and Abandoned Children Ages 6-12 in Institutional and Community-Based Care Settings in 5 Less Wealthy Nations,” and Anna Koons, Karen O’Donnell, Lynne Messer, Kyle Hamilton, and Amy Hobbie of Duke University reviewed the questionnaire and shared valuable reflections on residential child care, orphans, and survey methodology. We also are indebted to journalist Kathryn Joyce, author of “Child Catchers,” and Professor Karen Rotabi, an expert on international adoption, for invaluable suggestions. Professor Gerald Murray and Glenn Smucker, anthropologists and authors of numerous articles and reports on Haitian society in general and children in particular, generously shared their insights in lengthy and rewarding exchanges. Missionary and filmmaker Corrigan Clay made extensive contributions during the development of the questionnaires, which were greatly enhanced by his depth of understanding and patient guidance. Jacob Sangster, director of CorLuv children’s home in Gonaives, deserves our heartfelt thanks for his insights and inside knowledge, as does former sub- minister of MSPP Patrick Delorme, who wrote lengthy notes that were included in this report. Isabel Munroy, a French nurse with 20 years of experience in Haiti, also contributed notes cited in the report, as did Thor Burnham, PhD in history. Missionairies Gregory and Barbara Van Schoyck also contributed written commentary. John Bickel, a U.S. missionary and co-director/founder of God’s Littlest Angels provided invaluable help, as did missionaries Carol Anne and George Trulelove, who spent 40 years and raised 22 Haitian children as their own. Business woman, school director and former adoption agent Yoland Mackey also shared insights from her work in the adoption process. Shasta Grimes and Tamara Palinka provided crucial insights into the international adoption process in Haiti from the view of prospective parents, and Michelle Reed of America World Adoption and Debra Parrish of European Adoption Consultants helped explain the process from the view of adoption agencies. RCCI Residential Child Care Institutions l’IBESR (l'Institut Du Bien-Etre Social Et De Rechercches), The following is an update The Government of Haiti’s Child Welfare Service. l’IBESR (l'Institut Du Bien-Etre Social Et De Rechercches), was founded in 1958 as part of the Ministry of Work and Social Affairs (Ministère des Affaires Sociales et du Travail). It has the specific mandate of “responding to the many and varied social afflictions that plague disadvantaged sectors of the Haitian population” and is especially focused on vulnerable women, prostitution, unemployed youth, the physically disabled and, most important of all with respect to the present study, “children in difficult circumstances.” Any issue, organization, or social situation that touches on the lives of Haitian children is, by implication, of interest to IBESR. The mandate to oversee the welfare of Haitian children extends to Residential Child Care Institution (RCCI), the subject of the present study. Within this framework l’IBESR commissioned the present investigation of Residential Child Care Centers. The objective is to develop profiles of the institutions with respect to staff and infrastructure, the individuals and organizations that run the institutions, the families whose children live in the institutions and not least of all, the children themselves. Review of the Literature Executive Summary 1) Residential Child Care Institutions (RCCIs) are hospices where children live 24 hours per day, 7 days per week. They include boarding schools, orphanages for parentless or abandoned children, group homes for disabled children, therapeutic rehabilitation centers for addicts and psychologically troubled youth, and detention centers for delinquents. The definition is sometimes limited to a residence housing 30 or more children. 2) L”IBESR 2012 study of RCCIs in Haiti identified 723 institutions, over 80% of which were defined as “orphelinats.” The remainder was crèches, institutions specifically for disabled children, and those identified as serving street children including the recently inaugurated government’s 400 bed Welcome Center at Delmas 3. We also know that 3 institutions exist in Haiti specifically for youthful delinquents. 3) To understand RCCIs in Haiti, it helps to know that prior to the 19th century abandoned, neglected and delinquent children in contemporary developed countries were frequently apprenticed to craftsmen and wealthier households as domestic servants. Residential Child Care Centers only became a significant feature of Western society in the 18th and 19th centuries. They came about as a reaction to an explosion in the number of street children, a process linked to urbanization and a decline in dependency on labor intensive craft production and agricultural strategies. i 4) Since WWII, evolving official and scholarly interpretations of the impact of RCCIs on child growth and developed has been driven by the division of value systems. On the one side was the educated liberal, largely secular movement. They also were associated with increasing tolerance of alternative life styles, single motherhood and same sex marriage and parenthood. On the other side were the conservative social values typical of the Catholic Church and traditional protestant denominations. The divide between the two value systems crystalized in the debate over abortion. In the late 1960s and throughout the 1970s a series of laws legalized abortion in most developing countries. In the US Roe vs Wade decision was a catalyst in bringing them together the formation of organizations such as the 1976 Moral Majority and the Family Movement. The evangelicals US citizens who belonged to this movement have been most responsible for the recent emergence tens of thousands of RCCIs in developing countries, not least of all those in Haiti. The extent of their power and influence cannot be understated. As a politically active block of voters, they are credited with the success of the Reagan and Bush presidencies in the United States. 5) In developed countries adoption was a focal point in the ensuing value struggle. Prior to the legalization of abortion was an era of adoption known as “baby scoop” where “unwed mothers homes” linked to adoption agencies pressured young mothers to relinquish custody of their newborns for adoption into “whole families,” most often middle and upper class Christians. The US, Britain, Spain, Canada, France, Australia and Argentina all had their own versions of baby scoop eras. It occurred within these countries rather than across international border and it later became associated with unethical practices of lying to mothers, closed abortion and falsification of paperwork. With the legalization of abortion, liberalization of reproductive rights, tolerance of alternative marriage and single motherhood, open adoption became the norm, women were significantly less inclined to give up their babies. The era was been remembered as oppressive and government officials in most of the developed countries were it occurred have recently issued public apologies for their complicity. But more importantly for the present research is the impact it had on developing countries and the eventual emergence of RCCIs 6) One consequence of the end of the baby scoop era and open adoption was that domestic adoption plummeted. There was a corresponding increase in demand for babies from overseas. Paraguay, Brazil, Guatemala, Nepal, Colombia, Vietnam, Cambodia, and many