Volume 21, No. 1, Art. 16 – January 2020

"I Feel Like We Are People Who Have Never Known Each Other Before": The Experiences of Survivors of Human Trafficking and Sexual Exploitation Transitioning From Shelters to Life in the Community

Laura Cordisco Tsai, Vanntheary Lim & Channtha Nhanh

Abstract: In this article, we explore the experiences of survivors of human trafficking and sexual exploitation in Cambodia as they transition from living in trafficking-specific shelter facilities to living in the community. We analyzed data from Chab Dai's Butterfly Longitudinal Research (BLR) project, a 10-year longitudinal study with survivors of human trafficking and sexual exploitation in Cambodia utilizing a prospective panel design. We present findings from our analysis of 236 interviews and narrative summaries of interviews conducted with survivors between the years 2011 and 2016 (n=79). An interpretive phenomenological approach was used to understand survivors' experiences during this transition. Themes included: conflicted feelings about life in the community; difficulties completing school and securing employment; violence in the community; limited follow-up; unfulfilled expectations; feeling loved like a family member in the shelter, but abandoned in the community; vulnerability in the community due to dramatic differences between shelters and the community; and varied experiences with case closure. We underscore the importance of understanding and listening to the voices of survivors about their experiences in the anti-human trafficking sector and discuss implications for the design and implementation of services for survivors of human trafficking and sexual exploitation in Southeast Asia.

Key words: human trafficking; longitudinal research; reintegration; Cambodia; sexual exploitation; interpretive phenomenological analysis

Table of Contents

1. Introduction

2. Methods

2.1 Sampling and data collection

2.2 Data analysis

3. Findings

3.1 Conflicted feelings about life in the community

3.2 Difficulties completing school and securing employment after leaving the shelter

3.3 Violence in the community

3.4 Limited follow-up and supportive services in the community

3.5 Unfulfilled expectations

3.6 Feeling loved like a family member in the shelter, but abandoned in the community

3.7 Vulnerability in the community due to dramatic difference between shelter and community life

3.8 Varied experiences with case closure

4. Discussion

Acknowledgments

Notes

References

Authors

Citation

 

1. Introduction

Cambodia is a source country for human trafficking and, to a lesser degree, a transit and destination country (UNODC, 2006). Men, women, and children in Cambodia are trafficked for a variety of purposes; including trafficking for sexual exploitation, domestic work, agriculture, fishing, and construction, among others. Estimates suggest high rates of human trafficking in Southeast Asia, although estimates are controversial (KEO, BOUHOURS, BROADHURST & BOUHOURS, 2014; UNODC, 2012). The causes of human trafficking and child sexual exploitation are complex and multi-faceted. Contributing factors include economic inequality and poverty, gender norms, social norms condoning violence, weak legal sanctions, sexual entitlement among perpetrators, insufficient protection systems, and discrimination (BERELOWITZ, FIRMIN, EDWARDS & GULYURTLU, 2012; RADFORD, ALLNOCK & HYNES, 2016). Global pressure to end human trafficking has been accompanied by a significant influx of international funding into anti-human trafficking efforts in Cambodia (SANDY, 2007). [1]

In Southeast Asia, social services for survivors of human trafficking have historically been centralized within shelter facilities (HUGUET & RAMANGKURA, 2007; SURTEES, 2013; SURTEES & BRUNOVSKIS, 2016). Globally, numerous types of shelter facilities have been developed for victims of human trafficking—including long-term residential facilities, open shelters, short-term emergency shelters, hostels, apartments, and half-way houses (BJERKAN, DYRLID, NIKOLIC-RISTANOVIC & SIMEUNOVIC-PATIC, 2005). In Cambodia, shelter options for survivors of human trafficking and sexual exploitation have included short-term emergency shelters, transitional/group homes, long-term shelters, and foster care programs. The majority of programs are long-term residential facilities in which survivors stay for several years. [2]

Given the design of the anti-human trafficking service system, people who have experienced human trafficking and sexual exploitation may need to enter into shelter facilities in order to obtain vital social services. Shelter facilities provide access to necessities for survivors such as housing, food, medical care, and education (HACKER, LEVINE-FAIMAN & HALILI, 2015; SIMKHADA, 2008). However, staying in shelters may also be a significant sacrifice for trafficked persons and their families. Survivors residing in shelter facilities are often unable to earn money while there (BRUNOVSKIS & SURTEES, 2012a; HACKER et al., 2015; HUGUET & RAMANGKURA, 2007; SURTEES, 2013). Many survivors have financial responsibilities to their families and need to return to work as quickly as possible. After being separated from their families, many survivors want to return to them (SURTEES, 2013). Prior research in Asia has found that human trafficking survivors are often allowed little contact with family members while in shelters (DUTTA, 2016; UNICEF, 2011). Research on the shelter system in Cambodia has found that staff distrust and negative attitudes toward family members generate reluctance among shelter staff to allow survivors to engage with their family members (REIMER, LANGELER, SOPHEA & MONTHA, 2007). Home visits are often infrequent and family visits within the shelter context are restricted. When communication is permitted, it is regularly controlled through the monitoring and/or confiscation of cell phones (SURTEES, 2013). Survivors frequently report being worried about their family members while in care, particularly their socio-economic wellbeing (SURTEES & BRUNOVSKIS, 2016). [3]

Additionally, the limited existing research regarding the shelter care system for trafficked and exploited persons in Asia has identified involuntary detention of survivors as a key concern. Some survivors report being detained in shelter facilities against their will, often due to ongoing legal proceedings (BRYSK, 2012; HACKER et al., 2015; LEE, 2014; UN OHCHR, 2014). Survivors are sometimes held in shelter facilities for years at a time, with little to no power to determine how long they are held in care and on what terms. Others report being strongly encouraged, but not overtly forced, to stay in shelters for the benefit of their legal cases (SURTEES, 2013). Survivors have raised concerns about restricted freedom of movement within shelter facilities. Research with trafficked persons in Southeast Asia has found that clients in closed shelter facilities commonly have limited engagement with the outside world (BRUNOVSKIS & SURTEES, 2012a; SURTEES, 2013). Survivors have described shelters as too constricting and "prison-like," causing stress and anxiety (SURTEES, 2013, p.197; see also BRUNOVSKIS & SURTEES, 2012a; HACKER et al., 2015). [4]

The process of transitioning out of residential care often involves a mixture of emotions for survivors, including excitement, fear, loss, loneliness, and anxiety (DUTTA, 2017; SURTEES, 2017a).Trafficked and exploited persons face numerous challenges upon leaving shelters and transitioning to life in the community, including difficulties completing school and securing employment, managing conflict with and alienation from family members, experiencing violence, finding stable housing, and encountering social stigma, loneliness, and societal rejection, among others (ADAMS, 2011; CORDISCO TSAI, 2017a, 2017b; CORDISCO TSAI, SEBALLOS LLENA & CASTELLANO DATTA, 2017; DUTTA, 2017). While a range of services are provided within the shelter context, shelters are often isolated from society. Survivors may live in shelters for years without activities that foster social inclusion or help prepare them to engage with the outside world (DUTTA, 2016; LIMANOWSKA, 2007). [5]

Practitioners, survivors, and researchers have all expressed concerns regarding the sufficiency of re/integration1) support services provided by shelters (DUTTA, 2016; LIMANOWSKA, 2007; SURTEES, 2013). In spite of pervasive agreement about the vital importance of thorough re/integration support planning, it is widely lacking (DELAP & WEDGE, 2016; UNICEF, 2011). Research with shelter staff in Cambodia has revealed that many staff themselves are deeply concerned about the breadth and depth of re/integration support programming. As REIMER et al. (2007) wrote in their research regarding shelter care in Cambodia: "Nearly every NGO contacted for this research self-identified follow-up as a deficiency in their reintegration programming. Experience shows that it tends to be sporadic, perfunctory, and quick, conducted by busy staff" (p.41). Limitations in funding and staffing pose obstacles to strengthening re/integration support programming. Many agencies lack social workers who are specifically trained in supporting the re/integration of clients. While stakeholders consistently recognize the importance of re/integration support programming, much "re/integration support" is shelter-based; provision of supportive services in the community has historically been one of the lowest areas of priority for shelters and least funded aspects of services (DUTTA, 2016; HUGUET & RAMANGKURA, 2007; RICHARDSON, POUDEL & LAURIE, 2009). [6]

Although research pertaining to the community re/integration process is limited, prior research in Asia has found that survivors themselves do not feel that they have been adequately prepared to succeed following their departure from shelter care (DAHAL, JOSHI & SWAHNBERG, 2015; SURTEES, 2013; UNICEF, 2009). Survivors report feeling left on their own in the community, wishing that more community-based services were available to help them through the transition (DAHAL et al., 2015; DUTTA, 2017). Additionally, previous research highlights survivors' perceptions of changes in their relationships with shelter staff upon their return to live in the community, i.e., feeling that staff no longer cared for them and that any belonging they had previously experienced in the shelter context had dissipated. Survivors who are able to maintain relationships with shelter staff after returning to live in the community express higher levels of gratitude and a greater sense of support and comfort (DUTTA, 2017). [7]

In this article, we explore the experiences of survivors of human trafficking and sexual exploitation in Cambodia as they transition from living in trafficking-specific shelter facilities to living in the community. For our analysis, we utilized data from the Butterfly Longitudinal Research (BLR) project, a 10-year longitudinal study with survivors of human trafficking and sexual exploitation. Research regarding the long-term trajectories of survivors of human trafficking and sexual exploitation following their discharge from shelter facilities is extremely limited. The data from this study provide a unique opportunity to understand the experiences of and challenges faced by survivors as they transition from residential care to life in the community, making a novel contribution to the extant literature. Findings hold important implications for the design and implementation of services in the anti-human trafficking sector. First, we begin with a description of study methods (Section 2), followed by an overview of study findings (Section 3) and discussion of implications (Section 4). [8]

2. Methods

Despite considerable advances within the counter-trafficking movement, significant gaps still exist in the availability of primary research with trafficked persons, research presenting the perspectives of survivors themselves, and research regarding the long-term trajectories of survivors (CURRAN, NAIDOO & MCHUNU, 2017; MARCUS, HORNING & CURTIS, 2014; RICHARDSON et al., 2009; RUSSELL, 2018). In response, a Cambodian nonprofit organization, Chab Dai, commenced the BLR project in Cambodia in 2010. In this study, we aim to understand survivors' lives, perspectives, goals, and hopes for the future. Since 2011, the BLR team has followed 128 survivors, interviewing them about their experiences through the service provision process and their re/integration in the community. The study's goals include elevating the voices of survivors receiving services from anti-human trafficking organizations and strengthening programming and policy in the sector. [9]

A prospective panel design has been utilized in this study, with the same research participants being interviewed over the course of ten years. There are numerous advantages to longitudinal designs, including the capacity to gather data from a wide variety of methods, to observe changes in patterns and trajectories within a population over time, and to generate a more comprehensive and in-depth understanding of the experiences of participants (HUA & DAVID, 2009). In light of the challenges involved in building trust with human trafficking survivors, researchers have recommended the use of longitudinal designs with trafficked persons, as data can be collected gradually over time (CORDISCO TSAI, 2018; EASTON & MATTHEWS, 2016; YEA, 2016). With the use of longitudinal approaches, survivors can share their viewpoints with some distance from their prior experiences, providing them the opportunity to gain additional perspective (KRIŽ & ROUNDTREE-SWAIN, 2017). A handful of shorter longitudinal studies have been conducted with survivors of human trafficking, including a two-year study in Indonesia (SURTEES, 2017b) and a one-year study in Moldova (OSTROVSCHI et al., 2011). To our knowledge, the BLR study is the only 10-year longitudinal study with this population globally, providing particularly rich insights into the experiences and trajectories of survivors. [10]

2.1 Sampling and data collection

Ethics approval was granted by the National Ethics Committee in the Cambodian Ministry of Health and George Mason University, Fairfax, Virginia. Purposive sampling was utilized in this study (EMMEL, 2013). To recruit study participants, referrals were obtained from 14 shelters and 3 other service providers in Cambodia. Partnering with service providers can be the safest method for recruiting research participants with a trafficking history (TYLDUM, 2010; ZIMMERMAN & WATTS, 2003). Eligibility criteria included: prior experience of trafficking for sexual purposes and/or sexual exploitation and plans to return to living in one of 14 regions in Cambodia.2) Referral agencies evaluated whether prospective participants could be classified as victims of human trafficking and/or sexual exploitation according to definitions provided by the study team. Human trafficking was defined according to the UN protocol to prevent, suppress and punish trafficking in persons:

"The recruitment, obtaining, hiring, providing, offering, transportation, transfer, maintaining, harboring, or receipt of persons with or without the victim's consent or knowledge, within or across national borders by means of threat, or use of force, or other forms of coercion, abduction, fraud, deception, abuse of power or of position, taking advantage of the vulnerability of the person, or, the giving or receiving of payments or benefits to achieve the consent of a person having control over another person for the purpose of exploitation" (UNITED NATIONS, 2000, p.1). [11]

According to this protocol, any minor (below the age of 18) engaged in sex work is classified as a trafficking victim regardless of consent. Sexual exploitation was defined as a child (under 18) being involved in a situation or a relationship where they are being used sexually, and the child, or a third party, receiving something in return, such as money, gifts, affection, or favors, i.e., alcohol, food, or shelter (MILES & MILES, 2011).3) [12]

A mixed-methods approach to data collection was utilized. In 2011, a four-part questionnaire survey tool was administered in face-to-face interviews over four sessions. In 2012 and 2013, surveys were implemented three times per year. Initial questionnaires covered numerous topical areas, including socioeconomic, education, psychosocial, health, relationship issues, stigma, and discrimination. Over time, additional data collection techniques were integrated into the study, including in-depth interviews, focus group discussions (FGDs), play and art projects, and participant observation (CORDISCO TSAI, LIM & NHANH, 2018; MILES, HENG, LIM, NHANH & SREANG, 2014). In 2014, the study team compiled narrative summaries of existing data and identified inconsistencies in some participants' stories. Prior research with trafficking survivors has shown that inconsistencies in the narratives shared by survivors are common (DUONG, 2015). These discrepancies appeared to be predominately linked to the need to build further trust between respondents and researchers. As a result, the study team shifted to an intensive focus on qualitative methods, as the team determined that in-depth interviews were more conducive to participants being able to share freely about their lives. Since 2014, data has been collected via in-depth interviews, with 1 or 2 interviews conducted with each participant per year. Interviews ranged from 1 to 3 hours, with an average of 1.5 hours. [13]

As referenced earlier, the Cambodian nonprofit organization, Chab Dai, implemented the study. Cambodian research team staff of Chab Dai, including both women and men, collected all study data. Survivors' preferences for the gender of their interviewers were taken into consideration when assigning staff to interview participants. All interviews were conducted in Khmer, audio-recorded with the participants' consent, and transcribed verbatim in Khmer. Interviews were subsequently translated into English. While survivors lived in residential care facilities, interviews were conducted inside private counseling rooms within the shelter programs, a location that study participants described as familiar and safe. Following survivors' return to the community, interviews were conducted in a safe and confidential location of preference for the study participants. [14]

2.2 Data analysis

From 2017 to 2018, we analyzed BLR data collected between 2011 and 2016, addressing the following research question: What are the perspectives of survivors of human trafficking and sexual exploitation on their experiences in shelter care in Cambodia? The research question was intentionally broad to reflect the entirety of survivors' experiences in shelters from intake through their re-entry into the community. Although the study involved a total of 128 participants, analysis for this project centered on the experiences of 111 participants who had lived in shelter facilities. To generate a comprehensive understanding of participants' perspectives on their experiences in shelter care, data across multiple time points was analyzed. First, analysis was conducted of the narrative summaries compiled for each research participant by the study team in 2014; these narratives summarized all data collected between 2011 and 2014. Secondly, in-depth interviews conducted in 2014, 2015, and 2016 were analyzed for this article. See Table 1 (below) for a summary of all data included in this analysis.

 

Group A: Case study of adult women

(n=10)

Group B: All other female participants

(n=79)

Group C: Male participants

(n=22)

 

 

Total

(n=111)

Narrative summaries of interviews conducted between 2011-2014

10

79

22

111

2014 In-depth interviews (IDIs)

9

27

14

50

2015 IDIs

17

79

29

125

2016 IDIs

9

51

16

76

Total IDIs / narrative summaries analyzed

45

236

81

362

Table 1: Data analyzed to understand participants' perspectives on their experiences in trafficking-specific shelters in Cambodia [15]

During data analysis, differing patterns were observed for three sub-groups of participants. A distinct set of themes was identified for one sub-group of 10 women who resided in a transitional shelter facility for adults. These women's experiences were so different from other participants that their experiences were separated as its own case study (n=10). Further, variations were observed between male participants (n=22) and the remaining female participants (n=79). Consequently, we conducted data analysis separately for these sub-groups. In this article, we present one sub-set of findings vis-à-vis the experiences of study participants from Group B (n=79). Specifically, we address the experiences of participants in Group B transitioning from life in shelter facilities to life in the community. For this article, we analyzed 236 interviews and summaries of interviews from Group B utilizing data from 2011 to 2016 (refer to Table 1). [16]

Data analysis was led by Laura CORDISCO TSAI, the first author and study's academic adviser, a social work researcher and practitioner who specializes in human trafficking. She is a white woman with over 15 years of research and practice experience pertaining to human trafficking in Southeast Asia; she previously lived in Cambodia. Analysis was conducted collaboratively with the other two co-authors, two Cambodian women who managed implementation of the BLR study. They collected study data over the course of 9 years, giving them rich insights into the experiences of study participants. [17]

An interpretive phenomenological approach to data analysis was utilized. Phenomenological research identifies the essence of a group's experiences with a shared phenomenon (DAHLBERG, 2006). Interpretive phenomenology centers on understanding the experiences of people on their own terms and on how people make sense of their own life experiences (SMITH, FLOWERS & LARKIN, 2012). An interpretive phenomenological approach acknowledges that individuals' experiences are embedded within their cultural, political, and social contexts, all of which affects people's understandings of their own experiences (HOOD, 2016). Interpretive phenomenology provides the opportunity not only to describe participants' experiences in shelter care, but also to situate their experiences within the social, cultural, historical, and political forces that influence their experiences and perceptions (LEONARD, 1999). This interpretive orientation allows researchers to develop a deeper understanding and to interpret the implications of findings for practice and research (LOPEZ & WILLIS, 2004). [18]

We analyzed data consistent with the process outlined by SMITH et al. (2012). First, we immersed ourselves in the original data through active, repeated reading of narrative summaries and in-depth interviews. Secondly, data were grouped into segments of meaning, and codes were identified for each segment of meaning. A line-by-line coding approach was adopted, with codes developed for each segment of meaning (VAN MANEN, 1990). Codes were organized into conceptually similar categories, which were compared against one another and compared across transcripts (HOUSTON & MULLAN-JENSEN, 2012). Attention was directed toward identification of superordinate themes for the entire group given the size of the study sample. All possible themes were reviewed, comparing the themes to the coded data extracts relevant to that theme and reviewing the themes in comparison to the entire data set. In the final stage, themes were defined and refined (BRAUN & CLARKE, 2006). Individual participants' unique experiences were drawn out to illustrate themes that recurred across transcripts (HOOD, 2016; SMITH et al., 2012). [19]

Multiple strategies were used to establish trustworthiness. The study team's extensive engagement with participants over time provided a deeper understanding of survivors' perspectives on their own experiences, which many participants only divulged years into the study (BARUSCH, GRINGERI & GEORGE, 2011). Data were triangulated across multiple interviews drawing from six years of study data (LEECH & ONWUEGBUZIE, 2007). To monitor for potential bias, we consulted with other scholars and practitioners about research findings (MORROW, 2005). Additionally, we engaged in negative case analysis to challenge emerging patterns during the analysis process (BARUSCH et al., 2011). Thick description was used, with an emphasis on presenting participants' experiences in their own words while maintaining confidentiality (GEERTZ, 1973; GUEST, MacQUEEN & NAMEY, 2012). [20]

3. Findings

As demonstrated in Table 2, the average age of participants in the sub-group discussed in this article was 16 years in 2011. More than half of participants reported being ethnic Khmer, with Vietnamese comprising the second largest ethnic group.4)

 

n (%)

M (SD)

Age (2011)

 

 

 

Below 12

10 (12.7)

16.1 (3.3)

 

13 – 17

41 (51.9)

 

 

18 – 21

25 (31.6)

 

 

22 – 25

3 (3.8)

 

Ethnicity

 

 

 

Khmer

45 (60.8)

 

 

Vietnamese

15 (20.3)

 

 

Khmer and Vietnamese

7 (9.5)

 

 

Other

7 (9.5)

 

Relationship status (2013)

 

 

 

Single

67 (89.3)

 

 

Domestic partner / married

7 (9.3)

 

 

Separated

1 (1.3)

 

Table 2: Characteristics of sub-sample (n=79) [21]

Eight themes were identified in our analysis: conflicted feelings about life in the community; difficulties completing school and securing employment; violence in the community; limited follow-up and supportive services in the community; unfulfilled expectations; feeling loved like a family member in the shelter, but abandoned in the community; vulnerability in the community due to dramatic differences between shelter/community; and varied experiences with case closure. We discuss each theme separately below. [22]

3.1 Conflicted feelings about life in the community

Survivors shared mixed feelings about life in the community compared to life in the shelter. According to participants, the biggest advantage of living in the community was a heightened sense of freedom and self-determination, which survivors contrasted with feeling constrained by rules in the shelter environment. Participants expressed pride in being able to take care of themselves and make their own decisions in the community. Romdoul5) spoke of her gratification in caring for herself in the community. Although she quit school to seek employment when she returned home, Romdoul described how living and working in the community required her to grow:

"The happiest thing is that I can live independently by myself. So, I don't need to depend on anyone as I did in the past when I lived in the shelter. After I left the shelter, they don't support me anymore. I have to work with my own strength to get money to support myself and I can support my family as well ... These are my success ... Before I didn't have work to do because I only studied. The organization supported me with everything, as well as food for eating and clothes, but after I reintegrated to live in the community, I faced my real life and work ... In the past, I lived in an organization. It was really easy. I only focused on going to school, eating and sleeping all the time, but when I left to live outside, I can earn money by myself and that makes me understand how real life is... It is difficult, but I am happy. The first time that I got my salary was really happy for me" (Interview from 2015). [23]

Similarly, Khema described the satisfaction she felt in being capable of managing her own finances and renting a place to live in the community. She spoke about how she had become more independent since living in the shelter:

"I can have freedom and know how to manage a budget by myself now, such as renting a place to live by myself. Before, no! I often depended upon the housemother to do it for me. So sometimes this makes me feel [independent] because I can hold my money and work to support myself. I am happy because I know how to live by myself. I think I am happy that I can do it" (Interview from 2016). [24]

Study participants described the transition to the community as a learning process. In the shelter, clients shared that they did not feel as challenged to grow because the shelter made decisions on their behalf. Life in the community required them to exercise greater critical thinking skills in solving problems:

"Under their management, I cannot do anything. Everything was ordered by them. We just find our breakfast in the early morning and go to school. We didn't think much. When we left from the shelter, we realize how hard it is to live ... I feel like I think more [living in the community]" (Rangsei, Interview from 2014). [25]

Makara shared similar sentiments about how she came to appreciate the value, as well as the burden, of supporting herself financially upon returning to live in the community, saying:

"When they [the shelter] gave me 25USD per week, I didn't think of anything. I spent it all (laugh). When I can earn an income by myself, I know it is quite hard ... I told the younger batch [at the shelter], but they didn't believe me. They spent it all in one week ... I said it does not matter if you believe me or not, but when you earn money by using your force, you will know how hard it is. You will never understand the feeling of people who earn money to support you" (Interview from 2015). [26]

While some participants appreciated the heightened independence and freedom they experienced in the community, others found it burdensome to find ways to provide for their own needs. For instance, Sokchea described how her needs and wishes were attended to in the shelter environment in a way that she did not experience living at home:

"In the shelter, we had some people to manage us, but living outside we have to be independent. We have nobody to take care and prevent us. When we need to eat, we have to do it by ourselves. Nobody cooks for us. [In the shelter], we could get what we wanted by telling the staff, but now if we want, we have to save up money to buy it ... In the previous time, I had an organization to control me, but now I live independently so I meet a lot of hardship" (Interview from 2015). [27]

Dary described the conflict between appreciating greater freedom while struggling to survive:

"Living in community is difficult, but I have more freedom than living in the shelter. I have freedom, so I can go anywhere I want. No one is against me, no one goes with me or limits my going out time. I'm not afraid to come back late and be blamed! But living in the shelter I had food to eat. People cooked for me, so I didn't care about food. Living outside has freedom, but [I'm] a bit tired and have many things to worry about. ... I live in the community and I have a job to do. I start to feel that I am grown up ... I am thinking about daily expenses for food and have to save money. I think about my future. The biggest burden for me is ... I need to support my family a lot" (Interview from 2015). [28]

Chan also expressed mixed feelings about living in both environments:

"I was difficult with my mental [health] ... They were strict in the shelter. They even followed us one step. In general, they did not trust us... I am not difficult with my physical and mental [health] when I live outside the shelter, but I do not have money ... I have freedom. I am not sad and afraid that I will be blamed. I am happy when I live outside alone. However, I do not have money remaining. It is difficult with money" (Interview from 2016). [29]

Chan's experiences echo those of other participants. While the freedom and independence survivors experienced in the community were beneficial for their mental health, financial burdens in the community led to difficulties meeting basic needs, as well as other forms of psychological distress. [30]

3.2 Difficulties completing school and securing employment after leaving the shelter

Prior to being discharged from shelter facilities, numerous participants were hesitant to return to the community due to fear that they would not succeed in completing their education. For many participants, this fear was actualized. Some found it difficult to concentrate on their education without the structure of the shelter environment. In the community, family financial pressures interfered with their capacity to complete their education, leading many survivors to drop out of school to pursue employment. After she returned to live with her family, Achariya reported struggling in school, stating she would collapse at school due to hunger, exhaustion, and low blood pressure. Her family did not have enough money to take her to the hospital. She decided to drop out of school at the age of 14, cut and sell her hair, and move to another province to harvest cassava to earn money for her family. She described her decision:

"At that time, I did not want to stop [school] yet. However, my mom told that she will go to work in [Province A] and she did not want me to stay at home alone. So, she brought me there with her. Therefore, I decided to stop school. My social worker used to ask me when I come back from [Province A], would I want to continue my school? ... Maybe I will not go back to school because I realize that my mom is already old and we have no one to earn money to support her" (Interview from 2015). [31]

Likewise, Chivy quit school because of financial pressures in the family. Although her former shelter helped her register for classes, she did not receive any financial assistance:

"I don't have enough money for family spending: no food, not enough for morning, not enough for dinner. So I was often absent from class. I was able to go to school only two times per week. Therefore, I informed the teacher that I will stop. I cannot go to school anymore" (Interview from 2015). [32]

In addition to experiencing pressure from family members to focus on earning an income, some participants indicated that other adults in their lives, including shelter staff, advised them to focus on work instead of schooling. Although numerous participants stopped attending school in the community in order to pursue employment, participants also reported struggling to find sustainable employment in the community. Study participants noted that even when survivors completed their education, they still faced challenges obtaining secure employment. For example, Mony shared that although she learned sewing skills in the shelter and tried to establish a sewing business in the community, her business was ultimately unsuccessful. Speaking about her peers, one participant said: "even though they finished their studies, it is hard for them to find a job" (Bormey, Interview from 2015). [33]

Sean's experienced echoed those of her peers. She stated that while she had participated in various training programs in the shelter, she struggled to find suitable employment in the community. Her family members consistently teased her for spending so much time in school at the shelter, but being unable to achieve sustainable livelihood at home. She said:

"I feel I don't have any improvement. Before I thought that after I left from NGOs, I could be strong, but with this current situation, I feel I don't improve. I feel I am worsened ... My family doesn't like me ... not many of them like me. They don't care about me much ... They [family members] said I was better educated than them but useless ... They tease me, saying I 'learn a lot until crazy, but have no job to do.' They really look down on me, which makes me feel disappointed ... Since I come to stay here [at home], no one understands about me at all" (Interview from 2015). [34]

Sean's inability to utilize her education in obtaining a job following her return to the community contributed to a sense of isolation and disconnection from her family and the community. While her peers in the shelter related to her experiences, she felt that no one in the community understood her anymore. Although Sean thought that she had grown stronger in the shelter, when she returned to the community, she felt as if she had regressed. [35]

3.3 Violence in the community

Many survivors reported experiencing violence after returning to live in the community, primarily from family members. Some lived in home environments in which numerous members of the family committed violence against one another. For example, Sean described violence as a common part of her home environment: "There are people [at the shelter] who support me and the staff encourage me a lot, but if I go home, no one counsels me and mostly my family uses actions such as hitting" (Interview from 2014). Upon returning home, her parents often hit each other, leading her to be worried about both of their physical safety. When she was unable to find work to support the family, Sean's sister became physically violent toward her:

"When I left from the organization, it is difficult because I don't have a job and also the difficulty in my own feeling ... Sometime she [elder sister] beats me. Sometime she scolds me ... She said that I am stupid, so she beats me a lot" (Interview from 2015). [36]

Likewise, Soriya experienced numerous forms of abuse upon leaving the shelter and returning to live in the community. Soriya ran away from the shelter with one of her friends. She went to live with her friend's parents, whom she called her "foster parents." However, she experienced multiple forms of abuse from her "foster parents." Her foster father repeatedly sexually harassed her. Her foster mother encouraged the abuse, telling her husband to rape Soriya. Moreover, Soriya experienced labor exploitation, with her foster mother forcing her to fish and surrender all of her earnings. Soriya was ultimately able to escape the abuse, fleeing her foster parents' household. [37]

Another participant, Botum, reported experiencing emotional and physical violence from her mother after leaving the shelter environment. Botum's mother cursed her for having been sold into sex work by her sister, thereby causing neighbors to look down upon their family. Botum described the abuse she experienced from her mother:

"When my mother cursed me, she will just curse 'if you want to be a prostitute girl, you can go or you want to sell your sex, just go.' But even if I didn't do this, but they [neighbors] will think that I do it because my mother always curses this terrible thing everyday. 'If you want to sell your sex, you can just go. Go away from my house.' It is hard for me... We were in front of the factory and she just cursed at me like this, but I didn't know how to stop my mother from cursing. That time even the village chief came to discipline her, but she didn't listen to him. She continues to curse at me" (Interview from 2016). [38]

When shelter staff came to visit Botum in the community, they tried to intervene in the emotional abuse her mother inflicted upon her:

"The last time when teachers from the shelter came and they told her not to curse me like this, it is embarrassing. And if she still curses like this, they will bring her and give her discipline, a warning. And then after the village chief came for 3-4 days, she hit us [me and my younger sister] instead. She hit us and only now, this past 3-5 months that my mother didn't hit me" (Interview from 2016). [39]

Some participants experienced abuse from a range of family and community members. After her discharge from a shelter, Suon, who has a disability, was forced by her mother to beg to support the family financially:

"To be honest, I didn't want to be a beggar, so I learned how to massage [while in the shelter], but they sent me back home as I was having convulsions during study time. Do you know what happened after they sent me back? I said that I would stop being the beggar, but my mother told me to do it again. The shelter would not be happy if they find out that I do this job again. I was really unhappy and I didn't know what I should do. I could not think of any ways to support my family ... My mother insulted me and said that I tend to stay at home without doing any work. I have to beg for money here! If I stay at home, she would feel uncomfortable toward me. That's why I have to do this job. Nobody wants to be the beggar! I sometimes get money and sometimes not. If I do not get money, she [mother] is not happy. I am experiencing hardship. It hurts me a lot! Honestly, I want to commit suicide when I have such difficulty!" (Interview from 2015) [40]

Suon informed shelter staff about the challenges she was experiencing at home, which further enraged her mother. When shelter staff visited her in the community, they interviewed her in front of her mother instead of meeting her privately, placing Suon at greater risk for violence:

"When the staff came to visit me, they mostly asked me in front of my mother. They asked me while my mother was here, so when they left, my mother insulted me. She was scared of the shelter because she realized that the shelter was aware of her matters. I told her that 'you should tell them the truth rather than hate them.' I said like this! At that time, the shelter staff came to see me together with my mother. They didn't see me individually like your team. They met the children together with their mum in order to see who tells the truth between them. However, when they left, my mother scorned them with very impolite words. She said 'I won't forgive those dogs' [the shelter staff]" (Interview from 2015). [41]

In addition to experiencing abuse from her family, Suon shared that a man in the community had tried to rape her while she was begging. At the time of the assault, she did not tell her parents, as she was afraid they would hit her for having been abused. Suon intentionally chose not to disclose the abuse to the shelter staff because staff had previously broken confidentiality by sharing Suon's prior experiences of abuse with her mother. When her mother learned of the previous abuse, she became even more abusive toward Suon, hitting her, blaming her, and telling her that she "let men abuse her for free." Due to all of the violence Suon experienced in her family, she tried to commit suicide. Suon survived this attempt, but continued to experience suicidal ideation. Suon reported having no social support in the community to help her cope with violence in her family. When in pain, she would call a radio program, requesting to listen to songs. She articulated an urgent need to live elsewhere to escape violence in her family: "I will live with anyone since my family does not consider me as their family member. I have nowhere to go besides living with an outsider" (Interview from 2015). Apart from the research team, she reported having no one else to speak with in the community and being alone in trying to protect herself from violence within the family. [42]

3.4 Limited follow-up and supportive services in the community

Participants received several forms of support from shelters after they returned to live the community, primarily financial assistance. Survivors commonly noted receiving one-time in-kind assistance, including items such as rice, fish sauce, pillows, mosquito nets, bicycles, clothing, and kitchen supplies. Those enrolled in school often received financial assistance for schooling expenses, such as school fees, supplies, books, and uniforms; financial support terminated when participants dropped out of school. Some clients indicated that shelter staff visited them in the community. The frequency of home visits varied substantially across participants, along with survivors' perceptions of the helpfulness of those visits. The majority, however, reported that the assistance they received from shelters in the community was limited—both in terms of the amount of support, as well as the duration. Sokchea shared her experience:

"When I left, they didn't help me with anything as well. They just gave me a pillow, one blanket, and one mattress only. I have to be responsible for all besides these... When I left, I hadn't finished their program yet, so they didn't help me with anything. Even the mattress, they hesitated to give it to me, but because they know I have nothing to sleep on, so they give me one mattress and one pillow" (Interview from 2015). [43]

Similarly, Kravann expressed that when she was sent home, she received in-kind assistance, saying: "they can help me with a package of rice only. There is nothing else! Only one time!" (Interview from 2015). During the subsequent interview, she elaborated:

"The organization does not help me anymore. In short, the organization has helped me only the two months that I was really too poor.... After that, they told me there is no [more money]...because that money was taken from different places in order to help because they don't have budget for that and then they let us find a solution for ourselves with the family" (Interview from 2015). [44]

Some participants reported feeling saddened by a lack of support and follow-up. To her disappointment, Sean stated that shelter staff called her only once after she returned home:

"My friends from the same shelter are also grumbling about this ... They said the shelter said they would keep meeting us after we left. They said they will call once a month and if we ask for help, they will help us. But so far, they didn't call us ... Totally speaking, they cared about us only in the beginning, but not in the later months" (Interview from 2015). [45]

Likewise, Maly explained her disappointment at the lack of follow-up and support she received. After she was sent to the community, she felt that the shelter staff no longer cared for her:

"When I stayed at the shelter, they provided lots of love, but when I left, the level of love has been cutting down ... I left for my house and they did not care about us so much from the time that I stayed out for about two months. They never called and visited. ... They told me that they will come to visit and continue to have relations, but they did not do it ... I told them back that you only called me when I had problems [quit job]. They told me back that they wanted to visit me several times, but they could not make it. I told them that if you do not want to come, do not come then" (Interview from 2016). [46]

Some participants felt that shelter staff stopped following up with them in the community when the clients went against the wishes of staff. For instance, Khema shared that the shelter had tried to find her a job, which she did not ultimately pursue. She felt that shelter staff were displeased with her decisions, leading them to stop contacting her:

"I think that sometimes they are unhappy with me as well because they tried to find me a job, but I went to [Province A]. I think they are upset with me, but they do not say and let me hear it ... They did not [contact me]. They stopped ... If they do not connect with me, I also do not contact them because I think that I bother them, as they stopped accepting me" (Interview from 2015). [47]

Several participants shared that once they transitioned to living in the community, their perception was that shelter staff were no longer interested in following up with them, or were prevented from doing so by their organizations. According to Dary, her shelter social worker wanted to visit her in the community, but management would not permit it:

"I pitied my social worker, but the manager did not allow [her to visit me] ... They finished helping me at once and they did not ask or care about me. When I needed to meet them, they asked me to stop working for a half-day... They did not take their time for me while they asked me to take time to go there. I was so upset because they worked on my case, but they did not take any time for my case. They wanted the case to follow them, but I did not blame my social worker and I loved my social worker because she took a lot of time for me ... I do not blame her because her managers, they do not want her to follow me anymore" (Interview from 2015). [48]

Some participants reported maintaining stronger relationships with staff from other organizations than with shelter staff in the community. Sokchea explained that when she faced problems in the community, a social worker from another organization continued to follow-up, but not shelter staff, saying: "I also tell it [problems] to the shelter, but the shelter does not help me as much. Honestly, they never help me" (Interview from 2015). In the following interview, Sokchea elaborated:

"Normally I don't cut off the communication with any organization, even for some children, the organization stopped communication, but for me they didn't even support me. When I came out, they never gave me anything, even materials ... At first, I felt angry because I need my encourager" (Interview from 2016). [49]

Several participants mentioned their appreciation to the BLR research team for continuing to visit them in the community, indicating that the consistency in the follow up from the BLR team led them to maintain stronger relationships with the research team than with shelter staff. Phary said: "I just want to say thanks to your team for sharing and visiting me, as well as the other children. To be honest, since we left from shelter, staff rarely visit us" (Interview from 2015). Similarly, Sothy stated:

"[There is] no one whom I can trust. I only trust organizations like you. Once I had a problem, I called to the organization [shelter] to tell about my story. [Staff A] gave me another organization's phone number ... When they said like, that made me disappointed. After that, I turned my phone off" (Interview from 2014). [50]

Sothy and other participants' experiences reveal that lack of follow-up in the community evoked in survivors a loss of trust, discouragement, and a sense of being unwanted. [51]

3.5 Unfulfilled expectations

Some participants described a discrepancy between what they believed they had been promised by shelters and what they actually received in practice. Survivors expressed disappointment when the level of services provided in the community did not meet their expectations. Keo shared her experience after being followed up in the community for one week:

"For a week, they [shelter staff] brought me to Province A, but they didn't give me any money. They bought a bike that cost $50 and a bag that cost $5. In total, it cost $55, but they noted in receipt a cost more than $300. I was really angry and disappointed! ... She [shelter staff] called to check-up only one time with me. She asked what is my job? Since then, I never heard anything from them. Even if they went to [Province A], they didn't come to see me ... They did like that to everyone! Not only me! ... Before she brought me back home, she told me that she will buy a sewing machine for me. After I arrived home, she told my mother that she didn't have the role to be responsible for every problem I made and I didn't get anything from her" (Interview from 2016). [52]

At this point, research team members clarified whether or not she received the sewing machine. Keo said: "No, I didn't!" When asked why, she started crying and said:

"I don't know. When I went back, she [shelter staff] told me like that and signed for me to leave that place. She closed the rights for me to go inside the shelter ... For my family, didn't get anything ... Who will earn money to support my grandmother, mother and younger sister? So I decided to migrate! I went to work out of Cambodia. She never asked about my wellbeing. I chatted with her through Facebook Messenger, but she didn't add me" (Interview from 2016). [53]

At this point during the interview, Keo began crying more heavily and continued, saying: "I told [a former manager at the center] that no one [staff] cares about me and later they started caring about me" (Interview from 2016). [54]

Other participants shared that the shelter had promised them assistance they never received. For example, Botum explained that although the shelter staff visited her in the community and assured her that they would assist her with home repairs, she had not subsequently heard from them:

"I can't depend on my mother and relatives. I can only depend on myself and with all my strength, but the last time the organization also helped me a lot. But now I didn't really see them coming anymore ... They seemed not to say anything. They met with me the last time and they interviewed me. They took pictures of my house and my picture and they said they will help me. When they came to see my house like this, they said they will help with my house, but since then I never see them anymore" (Interview from 2016). [55]

Kravann explained that the shelter had promised her to support her education through college, but then reported that their policies had changed:

"They already told me that they will help me. At first, they told me that they will help me until at university, but later they told me that they will help until grade 12 only; and when I go to university, I need to take care by myself" (Interview from 2016). [56]

Kravann and others noted that there seemed to be confusion among shelter staff themselves regarding the level of support they were able to provide, particularly in the midst of policy changes within the shelter programs. [57]

3.6 Feeling loved like a family member in the shelter, but abandoned in the community

Many participants described their relationships with shelter staff as akin to family relationships instead of professional relationships. Clients depicted shelter staff, particularly housemothers, as members of their family. While clients shared that they valued the love they received from staff in the shelter context, when they returned home to live in the community, they felt as if they lost a member of their family. For instance, when she returned home, Achariya described missing her foster mother, whom she had lived with for four years:

"First I felt happy, but a night later I feel like I miss my foster mother ... It's something like I miss my mother, so when I first met her, I was so happy. I want to sleep with her and kiss her. However, in the second day, I feel that I miss my foster mother... I just heard her voice when she called to my sister because my sister's phone [had a] low battery. However, I feel better when I see she called to me. I worried she would cry if I called to her because when we left, she cried a lot. She did not want us to leave" (Interview from 2014). [58]

Since participants viewed shelter staff as members of their family, they expected their relationships with shelter staff to continue in a similar manner after they returned to live in the community. In practice, clients shared that shelter staff rarely came to visit them in the community, leaving the clients to feel as if people whom they had previously viewed as family members had abandoned them. [59]

Maly shared painful experiences about the changes in her relationship with shelter staff upon returning to live in the community. When she lived in the shelter, Maly stated that she felt loved by staff, indicating that shelter staff gave more love to her than her own family provided. However, upon leaving the shelter, Maly felt that staff members abandoned her: "It is not only me, but also my friends who said that they [staff] love only in the shelter, but they did [not] do it outside" (Interview from 2016). Maly spoke about a hurtful encounter with shelter staff when her father died:

"When my father died, I called the mother at the shelter and I said my father has just died now. They said I was busy learning. I said 'please listen to me' and they disconnected the phone. She then left the school and called me back, but I did not pick up the phone. I then called another mother and told her and she tried to comfort me. She cared about me and I asked her to tell the authority about that. I told her that some mothers did not pick up my phone and cannot help me. She then helped me to tell the organization and I was helped $50. I told them that I do not want the money, I just want to inform you. The mother then tried to talk and she could get another $20, so totally it was $70. They gave me for the funeral. I said I did not want to talk about money. I just wanted to tell them that my father had died" (Interview from 2016). [60]

Whereas the staff member approached the conversation with Maly in the context of providing for material needs associated with her father's death, Maly simply wanted to talk to the people whom she considered to be parent-like figures in her life. Maly felt hurt that shelter staff did not attend her father's funeral. Those who attended and those who provided assistance to her family during this time were extended relatives and people that she did not know. In the moment in which she felt that she needed those who cared for her the most, they were not present. [61]

Similarly, Bormey shared painful experiences with shelter staff after she returned to live in the community. In the shelter context, she described shelter staff as "working as our second parents" (Interview from 2016). However, when she left the shelter, she felt abandoned by the people whom she had viewed as her second parents:

"Sometimes I feel warm and sometimes when we live in the organization like this, we treat each other like brothers and sisters, parents and children. But when I left from the organization, no one called me. There was a time one mom called me, but I could not remember who she is but I told her 'Mom it seems like you just throw me away and never called to me' because I also missed them. I always called to them but they never called me back ... Maybe that time they still followed up with me and they didn't end my case yet, but they seemed to not really communicate with me much ... That time I felt really lacking warmth from them" (Interview from 2015). [62]

Bormey described another incident in which she visited her former shelter to meet friends who still lived there, but the shelter did not allow her to come inside. Although she understood the shelter had rules about visitors, she felt hurt that she was not allowed to visit her friends, as she had previously lived with them:

"There was another time that I had stopped staying in the shelter anymore, but I wanted to meet with other children or friends there, but they didn't allow me to come in the organization ... I want to say that I was a child who stayed there before. It is fine if they don't allow me to enter to the place or to talk with friends or go upstairs, but they didn't even allow me to see each others' faces" (Interview from 2015). [63]

Likewise, Keo shared that shelter staff turned her away from the shelter after she returned to live in the community. After Keo left the shelter, she migrated to another country where she experienced physical abuse in her workplace. Upon her return to Cambodia, she walked on a public street in front of her previous shelter, for which she was reprimanded by shelter staff. She was hurt by the staff members' reaction, as she had previously lived there several years:

"I helped to sell food in my brother's shop after I left my boss. He beat me until my nose bled and I ran away from him to Cambodia. When I arrived in Cambodia, the first day I walked across the shelter. The next day, [Teacher X] called to me and said I didn't have any rights to walk across the shelter, even the road to the shelter. When I heard this, I felt very disappointed" (Interview from 2016). [64]

Phary shared her disappointment about the change in her relationships with shelter staff upon returning to live in the community. Similarly, Phary expressed that clients often viewed shelter staff as their own mothers. Given the abuse history experienced by clients, Phary explained that clients often looked for love from shelter staff and treated staff as their own family members: "most of the abused adults like me lack warmth and something else, but I believe that every shelter has a mother who is considered as their mother" (Interview from 2014). In spite of this, Phary described feeling that staff no longer cared about her during her discharge from the shelter and after she had already moved to live in the community:

"She [Staff A] did not participate on my reintegration day. There were only tuk tuk driver... and police officers in the area I moved to. They called the police to sign the contract and accept that I came from the shelter and reintegrated to this community, so if anything happened, the shelter is not responsible at all, as I am not living under their management anymore. [Staff A] did not come and since I reintegrated to the community, she never contacted me at all. In the previous days, I chatted with [Staff B] in order to send my pre-wedding photos to her. However, she did not reply to me, as she assumes that all children who reintegrate from the shelter never have a better or successful life. That's why she does not want to contact us! I sent photos to her with a message that I graduated and am going to marry soon. She does not even know when I take the exam or graduated. I said I miss her and I want her to see how my life is going on. My life is better than before and I am not a child anymore, but she does not reply to me at all. About a month later, she said sorry to me as she does not go online to her Facebook account when I sent my pre-wedding photos to her. I don't know what happened if [Staff A] or [Staff B] told her anything that pushed her to call me. She called to ask me the date I finished grade 12 and the date I graduated. She only called to ask me these questions! She might need this information to write down in a report, I guess" (Interview from 2015). [65]

Phary felt deeply disappointed with how shelter staff responded to her wedding invitation, as well as the wedding invitation of her friend, Akara. According to Phary, Akara took initiative to reach out to and maintain relationships with shelter staff after she returned to live in the community. Although Akara invited shelter staff to attend her wedding, there was confusion regarding the delivery of the wedding invitations, leading staff to choose not to attend. Phary felt that Akara had loved shelter staff as her own parents and yet these individuals were not present for such an important day in Akara's life:

"I very much pity her [Akara]. Whether she was happy or unhappy, she called to the housemother, but the housemother didn't answer her calls and even more, she blamed that Akara didn't invite her to join the wedding. Some staff said that Akara called to invite only this staff or that staff, didn't call to invite them, but as a result, no one went to join her wedding. For me, if they do like this, I would feel disappointed because I had loved them as my parent, as they had helped me a lot" (Interview from 2014). [66]

Given her observations of what transpired with Akara's wedding, Phary shared that she was careful to prepare separate invitations for each shelter staff. Despite her efforts to be considerate, she stated staff were too busy to receive her invitations in person and accused her of not sending the invitations:

"Suddenly, she [shelter staff] called to me. She asked me how many people I wanted to invite. Did I call to inform them? She spoke like I never knew her or was not a child under her management. It seems like when I left the shelter, everything is gone too. ... When I heard what she said to me, I was really disappointed and it remind me of Akara's wedding. She said Akara did not invite her to join her wedding and she meant that Akara now has wings and wants to fly away. Her words have judged Akara in bad ways like this and that. I heard it by myself, so I do not want it happen on me. I went to her office, but she said those words to me. She told me that she did not see my invitation letters, but I am sure that I counted it ... I feel really disappointed" (Interview from 2015). [67]

Nimul summarized the feelings of many participants when she talked about her interactions with staff upon her return to the community. She had asked shelter staff multiple times for assistance in the community, including support for her family. However, she felt that staff were unresponsive and stopped communicating with her even though she reached out to them. When asked by the interview team how she felt about her communication with staff in the community, she said: "I feel like we are people who have never known each other before" (Interview from 2015). Nimul's comments encapsulate the sense of disconnection and abandonment expressed by survivors in the community. [68]

3.7 Vulnerability in the community due to dramatic difference between shelter and community life

Survivors described the transition from living in a shelter to living in the community as a dramatic change that was difficult to navigate. Participants depicted the long-term shelter environment as one in which their needs were taken care of and decisions were made on their behalf. For example, Maly shared: "When I live in the shelter, they give love to me more than my family does. They do a lot of things for me ... When we need something, they report it to the manager and find it for us" (Interview from 2015). However, when participants transitioned to living in the community, the standard of living and level of intervention that they were accustomed to in the shelter context were often not present and participants felt that they had lost connection to their home communities. Linda described the contrast between her experience in the shelter and her experience upon returning home. In describing her experience in the shelter, she said:

"It seemed like a mother looks after her children, but their [shelter staff's] work was stronger than what our mother does at home. They looked after us and if we got sick, such as headache, we could tell them and they would give us medicine. That's how the housemother treated me ... They took good care of us although we were not their biological children. Our parents might not able to treat us as good as them" (Interview from 2016). [69]

However, when Linda left the shelter and returned to live with her family, she felt deeply disconnected from her "home" community: "When I left there [the shelter], I felt I was alone and cannot come back. When coming back there [in the community], I felt it was not my home anymore. My home is home, but people there, they were not" (Interview from 2015). Like Linda, Suon described alienation from her home community, and feeling as if there was nowhere she belonged: "When I come to stay here [at home], I feel like I don't know how to live here. I can't live here, but I don't know what to do. Everywhere I go, they don't accept me" (Interview from 2016). [70]

Similarly, Kakada highlighted the contrast between her experiences in the shelter and her life in the community, depicting a sense of disorientation upon returning to the community. Kakada described living in a highly structured and protected environment in the shelter. However, when she returned to the community, she was exposed to experiences that she had not encountered in the shelter context. She was accustomed to receiving a degree of emotional support in the shelter that she did not experience at home, leading to a sense of loneliness:

"It is different from the shelter when compared to this community. When I lived at the shelter, the rules that they put in force we obeyed. But here [in the community] something we do not want to see, we can see with our eyes. It is 24 hours. ... For example, a mother beats her kids. People insult and argue with each other in this area. It is very noisy. There are drug users/drug dealers too. Police come to arrest people. The dogs bark every night; I cannot sleep well ... In the shelter ... the staff always talked and encouraged me. I have been changing a lot after leaving the shelter because I do not have anyone who encourages me. Instead, there are people who discourage me. After my father died, I have been living separately even though I have a mother, siblings and relatives. I think I am so lonely. I sometimes just sleep without eating" (Interview from 2016). [71]

Achariya stressed the stark contrast between living conditions in the shelter and her experiences in the community. Like Kakada, the shelter provided a structured environment in which her needs were met. Upon returning home, she struggled when encountering experiences she had been shielded from in the shelter:

"Living in a shelter and living at home is completely different ... It's something like we have breakfast in the early morning, shower and have everything for living at the shelter, but it is hard when I live at home. I have nothing to eat in the morning. Sometimes I have and sometimes I don't. It is also hard in the early morning because I cannot sleep and am not able to go outside, as my villagers are not actually good... Because boys in this village smoke and also use drugs, so I dare not to talk to them. I always stay at home! My mum does not allow me to go anywhere ... Older people here are not good as well because they play cards and drink beer. I am scared of them too" (Interview from 2014). [72]

While survivors expressed that the objective of shelter facilities was to help them live healthy, successful lives, numerous participants acknowledged that this often did not happen as they had hoped. Nimul shared similar concerns about her peers' capacity to thrive in the community after adjusting to the shelter environment. Nimul expressed that clients within the shelter became accustomed to their needs being cared for. When they returned home, she felt that her peers struggled to take care of themselves and experienced conflict with their families:

"Most of the victims who stayed in the shelter were not successful. They succeeded only 3 to 4 of them ... They sometimes said that it was easy to live in the organization and they did not do anything. They have someone to take care them. They have food to eat. They have people to bring the food for them and they can sleep well. They can learn and so on. They thought that it was easy for them and when they go home, they think work at home is difficult for them. They speak badly to the members of the family" (Interview from 2016). [73]

While many participants expressed appreciation for the care they received in the shelter context, clients' narratives revealed how their isolation from the community while living in shelters hindered them from sustaining and strengthening skills needed to navigate the financial, environmental, and relational challenges they would encounter in the community. [74]

3.8 Varied experiences with case closure

Participants reported a wide range of experiences with case closure in the community. Some shared that shelters formally closed their cases immediately upon their return to the community, while others reported staff providing follow-up support in the community before formally closing their cases. Yet others indicated that they simply lost contact with shelter staff without ever discussing formal case closure. Although Malis was not sure about the reasons for her case closure, she believed that her case had been closed due to the success she had experienced:

"They [staff] said I am already strong ... They thought I can walk on my own and when they meet me, they advise me about family relationships and the way I speak with them. I am not sure about the reason as well [why case was closed], but I think they might see that I am grown up now. They think like this, that's why they close my case" (Interview from 2015). [75]

In contrast, another client explained that the shelter had already ceased to provide assistance to her in the community before her case was formally closed. As a result, case closure was a non-event for her because she already felt that she was not being supported:

"When I had a problem, no organization staff came to help me! I had to solve it myself. I knew they didn't close my case yet after I left the shelter. They noted me as under case follow up, but in reality, I am the one that follows up with them ... They asked permission from me to close my case. I said as you don't help me anymore, you can close my case!" (Keo, 2016). [76]

Although participants' experiences with case closure varied substantially, clients most commonly described case closure as an end to a relationship or a feeling of being discarded. Some felt that case closure meant that shelter staff no longer cared for them:

"I am happy to see and talk to you because even [NGO] who works based in my community, they had never come to visit and ask me like you do. I am happy. It seems like they don't care about us anymore after my case was closed. They don't care what I am doing right now" (Chivy, 2016). [77]

Suon expressed that she felt hurt by the shelter's decision to close her case. Upon her return to the community, Suon's family pressured her to beg for money to support the family. Suon believed that her involvement in begging caused shelter staff to close her case:

"They are angry at me. That was why they finish my time. They are angry that I beg for money—that's why they stop coming to meet me. Last time, she said 'Now I came to close your case. Now you can earn money by begging, so I stop coming to meet you now. Once in a while, I will come and visit you. If you have any problem, you can deal with it by yourself'" (Interview from 2016). [78]

Suon expounded upon her concerns about her case closure, stating that she worried for her safety once shelter staff stopped visiting. Suon believed that visits from staff provided some accountability for her family, as she would report the abuse she experienced to staff. She expected this to change upon case closure:

"The shelter came ... to close my case. They said they will stop visiting me ... They said now I have the right to go wherever I want. They said they will stop coming and complete the deadline already ... I didn't know how to think about them. I also asked them what if I got a lot of violence within my family. They said then just leave it to the local authorities to solve this. I said it is good that I still have your organization [research team]. What if you also finish your deadline with me? It will be finished with me as well. I don't know who I can meet with ... I worried that I will have another case like before again. I am afraid of the violence and my mother will hit me. And because she knows that the organization stopped with me, she can do whatever she wants. That is why if you also stop with me, I don't know who I can report to. I only have one [phone] number and if they stop contacting me, I don't know what to do. That is why I don't want you to stop with me ... I still want to continue to meet with you because the shelter already finished their deadline with me, so please don't finish your meeting with me as well" (Interview from 2016). [79]

Suon's concerns that she would experience further abuse from her family once her case was closed reinforces the lack of social support available to survivors upon their return to the community. [80]

4. Discussion

In this article we explored the experiences and perspectives of survivors of human trafficking and sexual exploitation as they transitioned from living in trafficking-specific shelter facilities to living in the community. The process of adjusting from institutional settings to life in society is highly complex (DUTTA, 2016; SURTEES, 2017b). The same factors that initially make a person vulnerable to human trafficking are often still present upon community re-entry, underscoring the risks experienced by survivors during this transition (CHOI-FITZPATRICK, 2012; CORDISCO TSAI, 2017a, 2017b). Given the centrality of shelter facilities in the anti-human trafficking service delivery system, it is critical that proper supportive services are provided to survivors transitioning out of these programs. Findings from this analysis hold several implications for strengthening programming and policy in this regard. [81]

Findings reveal the need to bridge the divide between life inside shelters and the outside world. As demonstrated in this study's findings, shelter facilities in Cambodia are often isolated from society, with clients lacking exposure to the community during years of residence within shelters (UNICEF, 2011). The conditions of shelter facilities do not mimic life in the community. Although shelters' objectives include healthy re/integration, the level of physical and social isolation clients experience in care is often counterproductive (STEPANOVA & HACKETT, 2014; SURTEES, 2013). Emphasis should be placed on reducing isolation and further integrating shelter homes with the community (DELAP & WEDGE, 2016; DUTTA, 2016; GROZA & BUNKERS, 2017). Shelter-based services should involve constant preparation for community life throughout the client's stay, programming that is relevant for life in the community, and comprehensive re/integration support planning that begins upon intake (DELAP & WEDGE, 2016; DUTTA, 2016; GROZA & BUNKERS, 2017; JOHNSON & MENDES, 2014; STEPANOVA & HACKETT, 2014). [82]

Findings reflect the critical importance of client participation in decision-making about their experiences in care and planning for their return to the community. When decisions are consistently made on the client's behalf, survivors are "stripped of their autonomy and ability to make decisions" (DELAP & WEDGE, 2016, p.20). Supporting survivors' self-determination and engaging clients as active partners in decision making about their own lives is vital to adopting a rights-based approach (BALSELLS, FUENTES-PELÁEZ & PASTOR, 2017; DELAP & WEDGE, 2016; GROZA & BUNKERS, 2017; MOSVY, 2014). Survivors should be partners in all aspects of planning their own lives and have the opportunity to help develop systems within the institutions in which they are living (RUS, PARRIS, STATIVA & POPA, 2017). Client participation in decision making can lead to greater self-efficacy and confidence and ultimately improve client outcomes, particularly since survivors articulated difficulty adapting to an unfamiliar level of autonomy in the community (BALSELLS et al., 2017; KRIŽ & ROUNDTREE-SWAIN, 2017). [83]

It is recommended that shelters phase out services and support more gradually. Consistent with the findings of this study, other research on shelter care has identified concerns regarding clients being abruptly discharged from shelters due to age limits and/or insufficient internal planning (BALSELLS et al., 2017; DUTTA, 2016; JOHNSON & MENDES, 2014). Perfunctory transitions out of care can be traumatic for clients, leading to helplessness and a sense of abandonment, heightening risk for re-trafficking, and impeding the success of the re/integration process (ADAMS, 2011; DAHAL et al., 2015; DUTTA, 2016; JOHNSON & MENDES, 2014). In addition to a more gradual scale-down of services, the current study highlights the importance of greater relational continuity during the process of transitioning to the community. When there is a sudden change in relationships with staff, clients question whether staff ever genuinely cared for them and feel abandoned by staff, some of whom they viewed as members of their own family (CLAWSON & GOLDBLATT GRACE, 2007; KRIŽ & ROUNDTREE-SWAIN, 2017). Continuity in relationships with core support persons is critical throughout the transition process (DUTTA, 2017; JOHNSON & MENDES, 2014; STEPANOVA & HACKETT, 2014). These findings substantiate the importance of service providers in the anti-human trafficking sector understanding attachment theory, how insecure attachment may play out in relationships between survivors and staff, and how attachment theory can be incorporated into the design of interventions (MOSES, 2000). [84]

Along with a gradual scale-down of services and support, findings reinforce the need for greater depth in community-based models of service provision. As noted earlier, community-based services have historically been under-prioritized in the anti-human trafficking sector in Southeast Asia and insufficient funding and staffing have been dedicated to community-based models of care (BRUNOVSKIS & SURTEES, 2012b; DUTTA, 2016; SURTEES, 2013, 2017a; SURTEES & BRUNOVSKIS, 2016). Although the sector has increasingly transitioned away from shelter-centric models, skepticism among donors contributes to limitations in funding for community-based services (UNICEF, 2011). A key challenge in this process is the limited availability of basic services, such as health care, education, and counseling, in the clients' home communities (REIMER et al., 2007; UNICEF, 2009). In addition to broadening community-based services provided by anti-human trafficking agencies, capacity building and more comprehensive collaboration with broader child protection and social service systems are needed (ANDREATTA, WITKIN & ROBIANT, 2015; SURTEES, 2017b). Supplementing shelter care with deeper community-based services would enable survivors to receive necessary supports in a way that is individualized to their needs, personal circumstances, goals, and rights as service users (ILO, 2009; LISBORG, 2009). [85]

Furthermore, findings underscore the importance of survivor feedback systems. Within the Cambodian cultural context, it can be difficult for survivors to openly express concerns to staff in light of cultural norms regarding respect for authority and the acceptance of existing power dynamics and hierarchies. As BIT (1991) wrote: "Cambodian culture places a high value on harmony in interpersonal relationships and in the functioning of society at large" (p.22), leading to a hesitation to confront others or express anger or dissatisfaction. Research has, however, demonstrated that clients respond favorably to and are more likely to trust staff who acknowledge the challenges they face in voicing their concerns, take their viewpoints seriously, and put their ideas into action (AUGSBERGER & SWENSON, 2015; MOORE, McARTHUR, DEATH, TULBURY & ROCHE, 2018). To facilitate genuine participation of clients, it is important for professionals to engage with clients in a supportive and empowering manner, i.e., being good listeners, not reacting defensively, and showing genuine interest in and responsiveness to the perspectives of clients (KRIŽ & ROUNDTREE-SWAIN, 2017; MOORE et al., 2018). Given authority patterns, time and consistent norm-setting may be required for survivors to become comfortable openly vocalizing their viewpoints (CORDISCO TSAI & SEBALLOS-LLENA, 2019). Attention to developing such systems and norms is important, as prior research has demonstrated that clients have greater confidence in processes that are informed by input from clients themselves (MOORE et al., 2018). [86]

In light of the preponderance of family-related challenges experienced by survivors, this study reinforces the importance of models that address survivors' needs within their family systems and the broader socio-cultural context. In Southeast Asia, services in the anti-human trafficking sector commonly focus on the victim himself or herself, not the broader family system (BRUNOVSKIS & SURTEES, 2012b; SURTEES, 2013). The individualistic nature of trafficking-specific services is, however, surprising given the collectivist orientation of Cambodian society. Survivors' sense of self is intricately linked to fulfillment of responsibilities to the family and family wellbeing (BEARUP, 2016; BIT, 1991). Sensitivity to the socio-cultural context, including community-oriented, collectivist values, is needed to ensure that services are provided in a manner that is congruent with client needs and effective within the Khmer context (BEARUP, 2016; CORDISCO TSAI, 2017a; LE, 2017). At a concrete level, services to strengthen family systems could include greater engagement with families while the client is in the shelter, collaboration with both families and clients in planning for re-entry, programming to prepare family members for the client's return, economic interventions with family members, emotional support and counseling for the family, family mediation, and crisis intervention services for families, among others (BALSELLS et al., 2017; CORDISCO TSAI et al., 2017; DELAP & WEDGE, 2016; RUS et al., 2017; SURTEES, 2017a, 2017b). [87]

Findings speak to the need for enhanced capacity building and clinical supervision for shelter staff, along with mechanisms to prevent burnout and address vicarious trauma among staff (CORDISCO TSAI, LIM & NHANH, 2019). Insufficient training and therapeutic skills among shelter staff have been identified as key concerns regarding residential care in Cambodia (UNICEF, 2011). Anti-trafficking shelter staff may not have received basic training on trauma or working with people who have experienced trauma (SURTEES, 2013, 2017a). Service providers in the anti-human trafficking sector are at heightened risk for vicarious trauma and burnout (ANDREATTA et al., 2015; SURTEES, 2008). Research in Cambodia has shown that residential care staff report feeling overwhelmed, unsupported, isolated, and stressed (HILTON, 2008). Burnout can result in poor service delivery, inappropriate interactions with clients, diminished concern for clients, decreased commitment, job dissatisfaction, and feelings of professional inadequacy, among others (ANDREATTA et al., 2015; SURTEES, 2008; TRIPPANY, WHITE KRESS & WILCOXON, 2004). Shelter systems should include regular clinical supervision, ongoing professional development and training for staff, psycho-education programs for staff, facilitation of staff peer support systems, manageable and balanced caseloads, and organizational cultures that prioritize self-care and do not stigmatize workers for experiencing burnout or vicarious trauma (BOBER & REGEHR, 2006; CLEMANS, 2004; CORDISCO TSAI et al., 2019; SALSTON & FIGLEY, 2003; TRIPPANY et al., 2004). [88]

Findings should be considered in light of study strengths and limitations. The BLR study is the only 10-year longitudinal study with survivors of human trafficking and sexual exploitation globally. As such, the study provides a unique opportunity to learn more about the perspectives and experiences of survivors throughout and beyond their engagement in anti-trafficking programs. Data were not collected from other stakeholders, including shelter staff/administration, family members, and community representatives. Future analyses should consider the perspectives of these stakeholders on the community re-entry process. While findings from this analysis hold important implications for the Cambodian context, findings are not necessarily transferable to other contexts. This article does not reflect the experiences of male survivors through the community re-entry process; these findings are presented elsewhere (CORDISCO TSAI, LIM & NHANH, submitted). Findings do not capture the experiences or perspectives of survivors who identify outside the gender binary. [89]

The provision of shelter-based services is challenging and complex. Evidence-based shelter models for trafficked and exploited persons are still lacking (HACKER et al., 2015). Service providers in the anti-human trafficking movement have identified re/integration support programming as a key challenge and have expressed a desire to strengthen services (MILES et al., 2014; REIMER et al., 2007). Analysis for this article was launched in response to this feedback. While listening to participants' narratives may engender discomfort in the listener, hearing survivors' stories can deepen empathy for their experiences and ultimately contribute to improved care (FRANK, 1995), Our hope is that study findings can be used to promote dialogue and reflection within the anti-human trafficking sector around efforts to strengthen post-trafficking assistance services. Ultimately, we aim for these findings to be used constructively to uplift the voices of survivors and enhance the shelter experience for both clients and shelter staff. [90]

Acknowledgments

Many thanks to Helen SWORN, Phaly SREANG, Phallen PHOEUK, Sopheara OU, Chimey KANG, James HAVEY, Yeng ROS, Siobhan MILES, and the BLR participants.

Notes

1) The term "re/integration" is used in place of "reintegration" to show that survivors can choose to return to their home communities, or build a home in a new community of choice (SURTEES, 2010, p.24). <back>

2) These geographic areas included: Banteay Mean Chey, Battambang, Kompong Cham, Kompong Chhang, Kompong Thom, Kampot, Kandal, Phnom Penh, Preah Vihear, Prey Veng, Pursat, Siem Riep, Takeo and Oddar Meanchey. Later in the study, participants were also located in Kampong Speu, Koh Kong, Kratie, Preah Sihanouk, and Svay Rieng. <back>

3) Debates surrounding the definitions of human trafficking and sexual exploitation are complex. A complete discussion of the nuances of these definitions is beyond the scope of this article. <back>

4) Data are presented for the participants for whom it was available. <back>

5) All names included in the manuscript are pseudonyms. <back>

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Authors

Dr. Laura CORDISCO TSAI is a social work researcher and practitioner specializing in human trafficking and gender-based violence. She is a fellow at the Carr Center for Human Rights Policy at Harvard John F. Kennedy School of Government. Dr. CORDISCO TSAI has over 15 years of experience working in Southeast Asia, predominantly in direct practice and consulting work with NGOs serving survivors of violence and exploitation. As a researcher, she conducts a combination of participatory, qualitative, and quantitative research primarily centering on the development of more empowering and effective services for survivors of human trafficking. She has served as the academic adviser for the Butterfly Longitudinal Research study since 2015 and spearheaded the analysis pertaining to survivors' perspectives on their experiences in shelter care. She holds a BA from Brown University, MSSW and PhD from Columbia University, and has received post-doctoral training in researching gender-based violence, global mental health and trauma recovery from LSHTM and Harvard Medical School.

Contact:

Laura Cordisco Tsai

Harvard University John F. Kennedy School of Government
Carr Center for Human Rights Policy
79 JFK Street, Cambridge, MA, 02138, USA

Tel.: +1-617-495-5819

E-mail: Laura_Cordisco_Tsai@hks.harvard.edu
URL: https://carrcenter.hks.harvard.edu/people/laura-cordisco-tsai

 

Ms. Vanntheary LIM serves as the project manager for the Butterfly Longitudinal Research project of Chab Dai Coalition. As a member of project's original research team, she has spent nine years conducting interviews, analyzing data, and disseminating study findings. In her role, she has collaborated on data analysis pertaining to resilience, stigma, economic reintegration, experiences of male survivors, and experiences in shelter care. She holds a double bachelor of art degree in sociology and English education in addition to a masters of development studies, all from the Royal University of Phnom Penh, Cambodia.

Contact:

Vanntheary Lim

Chab Dai Coalition
Phnom Penh, Cambodia

Tel.: +855-92-700-488

E-mail: lim.vanntheary@chabdai.org

 

Mrs. Channtha NHANH is the assistant project manager for the Butterfly Longitudinal Research project of Chab Dai Coalition. She has conducted interviews, collaborated on data analysis, and disseminated study findings. She has co-authored numerous publications addressing survivor resilience, perceptions of stigma, economic reintegration, experiences of male survivors, and experiences in shelter care. She holds a bachelor's of art in sociology from the Royal University of Phnom Penh and a master's degree in holistic child development.

Contact:

Channtha Nhanh

Chab Dai Coalition
Phnom Penh, Cambodia

Tel.: +855-92-700-488

E-mail: nhanh.channtha@chabdai.org

Citation

Cordisco Tsai, Laura; Lim, Vanntheary & Nhanh, Channtha (2020). "I Feel Like We Are People Who Have Never Known Each Other Before": The Experiences of Survivors of Human Trafficking and Sexual Exploitation Transitioning From Shelters to Life in the Community [90 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 21(1), Art. 16, http://dx.doi.org/10.17169/fqs-21.1.3259.



Copyright (c) 2020 Laura Cordisco Tsai, Vanntheary Lim, Channtha Nhanh

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