Opportunities of Care at What Cost: Findings from a Qualitative Study Exploring Care Leavers Experiences of Residential Care Homes for Children in Thailand

Abstract

The social problem of children’s homes in Thailand is a complicated one to address. Much of the research on this topic specific to Southeast Asia is relatively new, with many relevant articles published in the past 10 years. For over 80 years, research mainly from Eastern Europe has widely acknowledged the severe long-term cognitive, emotional and developmental effects on children raised in institutional care. However, to date, there has been very little published qualitative research addressing the lived experiences of Thai children growing up in children’s homes from the perspective of the care leavers themselves. This article seeks to learn more about the experiences and perspectives of those who spent their childhoods in institutional care and how they compare with international research on this topic. The results show complicated feelings towards their time in care, with the majority stating that despite the negative aspects, they would still choose a children’s home for themselves over staying in a village without access to secondary school. However, they unanimously expressed that they would not choose the same path for their own children.

Introduction

In Thailand, the child protection system addresses the needs of vulnerable children through a combination of governmental and non-governmental organisations. The system aims to uphold children’s rights, support families and also provide care for those who are orphaned or unable to remain with their families due to child protection concerns. However, resources and opportunities for vulnerable children are often limited, particularly in rural areas. The availability of social protection measures can be inconsistent, leading families to seek alternative care solutions such as residential children’s homes. The entry into care can often be through private arrangements between parents and care providers, and gatekeeping and oversight of placement are often limited and variable (Rogers & Karunan, 2020).

While there is a growing workforce of professional social workers and developing procedures for formal gatekeeping into care, they are often constrained by limited resources and staffing, resulting in varied practices across the country. This variability is particularly pronounced in border regions with Myanmar, where the migration of vulnerable children places significant demands on the child welfare system. Additionally, in the border regions, there are many unregistered homes operating outside the formal regulatory framework, which complicates efforts to ensure consistent standards of care and protection (Lillicrap, 2020).

Thai society is growing increasingly aware of the problems associated with residential care, and the Thai Government has published an Alternative Care Action Plan to transition away from the institutional care model and move towards a family-based provision. Therefore, it is important to learn from the recipients of alternative care, both what their experiences have been and to include their participation in decisions that affect their lives. This article seeks to understand the perceptions of people who were raised in residential care and to discover how they view their experiences there.

Literature Review

Care for Vulnerable Children in Thailand

In Thailand, there are an estimated 120,000 children living in residential care, primarily in institutional settings, a high percentage of which are non-governmental and unregistered (Ladaphongphattha et al., 2022). Despite the research showing institutional care can harm a child’s development and the evidence of benefits and cost-effectiveness of family-based care (Ladaphongphatthana, 2021), residential care remains prevalent due to government and societal endorsement.

There are many scenarios wherein children may reside in residential care, including orphanhood. However, despite the common use of the term orphanage to describe residential children’s settings, in Thailand, it is estimated that 95 per cent of children in care have at least one living parent (Lillicrap, 2020). Many children are sent by parents due to poverty, lack of access to advanced education, behaviour problems, parental substance abuse or an unsafe community environment (Rogers et al., 2023). Furthermore, others straddle both worlds, living on site with relatives who work in a children’s home.

Participation of Children in Residential Care

Several studies globally have critically analysed the long-term impacts of residential care. The OECD report ‘Assisting Care Leavers: Time for Action’ offers an extensive overview of the challenges faced by care leavers regarding health, education and employment. Sacker et al. (2021) found that individuals who have been in care experience different health and well-being trajectories compared to those who have not, emphasising the lasting effects of early care experiences. The prevailing wisdom, supported by the United Nations Guidelines for Alternative Care (UN General Assembly, 2010), suggests that children thrive best in family settings, and residential homes should be a last resort.

Research on children’s experiences in alternative care settings in Southeast Asia is notably limited. Our previous scoping review (Rogers et al., 2021) identified only 23 relevant articles, most of which focused on physical development, the experiences of staff and community members, and the techniques children use to manage stress. Strikingly, at the time, none of these studies directly explored the lived experiences of children in Thai residential care (Rogers et al., 2021).

Braitstein (2015) emphasises that most data on institutional care come from high-income countries, lacking comparative results from low- or middle-income countries. While studies from the region are scarce, some notable research provides context and underscores the need for further investigation. In Vietnam, Collins and Tuyền (2016) observed that children often enter residential care due to economic hardships and lack of educational opportunities, which parallels findings in Thailand (Rogers et al., 2023). Additionally, Roche et al. (2021) studied the relational lives of children in residential care in the Philippines, highlighting the significant impact on children’s well-being of strong, supportive relationships with caregivers.

Our recent qualitative study in Thailand explored how children and families navigate the challenges of alternative care in Thailand (Rogers et al., 2023). Findings showed children strive to preserve their family connections and engage in family practices despite the constraints of the alternative care system. Furthermore, the children in care often develop strong, family-like bonds with their caregivers and peers, which help mitigate the adverse effects of institutional living. The study also underscored the significant role of cultural practices, such as filial piety, in shaping these relationships and providing emotional support. Additionally, it was observed that maintaining some level of contact with birth families, despite challenges, played a crucial role in the children’s emotional well-being and sense of identity.

In summary, while existing studies on children’s experiences in alternative care in Southeast Asia are limited, recent research provides valuable insights and highlights significant gaps. This study with care leavers builds on these findings by focusing on adults who can retrospectively reflect on their experiences in residential care. This approach allows for a deeper understanding of how early care experiences have shaped their lives. By incorporating the voices of care leavers, this study contributes to the existing literature by providing insights into the long-term impacts of residential care and the importance of family connections.

The study aimed to capture the lived experiences of adults who grew up in Thai residential care, contributing to addressing the research gap in this area. Interviews with 17 care-experienced adults provided first-hand insights, bringing to the forefront voices and perspectives that offer a comprehensive understanding of residential care’s impacts. The question this article seeks to answer is: How do care leavers who grew up in alternative care perceive their own experiences?

Methodology

The research was designed as a qualitative exploration of care leavers’ perceptions of life in residential care and its impact on their psychosocial development and relationships. Conducted in Chiang Mai Province, home to nearly 50 per cent of Thailand’s private orphanages, most of which are unregistered, this context is particularly significant (Ladaphongphatthana et al., 2022a).

Participants were selected through non-probability convenience sampling, comprising individuals with whom the lead researcher had prior working relationships, from their involvement in community support services during their transition from residential care. While this prior relationship may introduce potential bias, it also facilitated rapport and in-depth data collection.

Seventeen participants aged 18–43 (5 males and 12 females) from various minority tribal groups and two ethnic Thai were interviewed. Semi-structured interviews covered life before entering care, benefits and disadvantages of residential care, and whether participants would choose this placement for themselves or their future children. Interviews were conducted in Thai and transcribed into English.

The sample included care leavers from 10 residential homes representing several types of care: registered family-like group homes (fewer than 10 children per home) in an urban setting; registered and unregistered large residential care facilities (10 or more children) in a rural setting; and large, registered residential care facilities in an urban setting. Types of residential care missing in this sample are government-run homes and small group homes in rural areas.

The study received full approval from the University’s Ethical Review Board, ensuring adherence to ethical guidelines. Informed consent was crucial, especially given the lead researcher’s pre-existing relationship with participants. All participants received detailed information about the study’s objectives, methodology and potential implications both before the interviews and before publication. They were assured the research was separate from previous engagements and had ample opportunity to seek clarifications, ensuring fully informed and voluntary participation. The consent process emphasised participants’ rights, including the freedom to withdraw at any time without consequence. The study prioritised participant anonymity and confidentiality, implementing data management protocols to protect sensitive information and ensure findings were reported without identifying individuals.

We analysed the interview transcripts by using thematic analysis. This means we marked sections of the text to identify recurring ideas or themes. By repeatedly reviewing the data and refining our codes, we were able to identify the most important themes from the participants’ experiences (Smith & Firth, 2011). This approach ensured a systematic and comprehensive understanding of the data (Braun & Clarke, 2006).

Results

The results section is structured to first provide an in-depth view of participants’ complex experiences in residential care, highlighted by direct quotations. We then outline the specific advantages and disadvantages of this care, supported by firsthand accounts. The section concludes with participants’ reflections on choosing residential care for themselves and their considerations for their own children’s upbringing.

Pull Factors

Of the sample, 9 participants entered residential care before the age of 12, while 8 entered at age 12 or older. In the challenging Thai context of limited finances, opportunities and social protection, families often navigate difficult decisions, sometimes leading to the children’s placement in residential care facilities. Some explained they were actively involved in the decision to go to residential care in order to continue their studies. For some, like Participant A, the journey begins with an innate desire for education.

I finished 6th grade and told my grandma I wanted to study more but didn’t have the opportunity to study further.—Participant A

This reflection underscores the dilemma faced by families unable to access educational opportunities, forcing children to seek them in alternative spaces. Economic hardship is another compelling factor. Participant B recounts the impact of her father’s death and the subsequent financial strain.

Because my dad had died… and my mom had to raise the 3 kids by herself… they [community members] said they should send the youngest [herself] to the orphanage.—Participant B

Here, the intersectionality of economic hardship and societal support (or lack thereof) comes to the fore, with residential care emerging as a viable alternative for families in distress.

Accordingly, the allure of comprehensive care and education provided by orphanages is a powerful draw. Participant F notes the tangible benefits. ‘If we stayed at the orphanage, they paid school fees, food, toiletries, everything’. The contrast between the scarcity within familial settings and the provision in residential care is stark, elucidating the pull factors rooted in basic needs and survival.

Yet, it isn’t solely about economic or educational insufficiencies. The emotional and social aspects intertwine in this complex narrative. Participant shares, ‘I knew why I went because my family was really poor so I decided to go… I felt happier than staying at home’.

Here, the juxtaposition of material poverty and emotional well-being is evident, highlighting the multifaceted nature of the children’s experiences. Indeed, while material and educational deficiencies are paramount, social connections and relationships should not be understated. Participant N’s motive ‘to follow my older brother’ and Participant H’s incidental stay originating from a playful visit, ‘I went to play with my friends and just ended up sleeping over there’, illuminate the nuanced and often understated social pull factors that influence children’s placements in these facilities.

In summary, the children’s narratives unveil a tapestry of compelling pull factors—ranging from economic hardship and limited educational opportunities to social and relational dynamics—that led to them entering residential care. Every story is different and reveals that factors resulting in residential placements are nuanced, reinforcing the need to understand and consider all aspects of care leavers’ varied experiences with empathy.

Impact on Relationships and Culture

The impact of residential care on family relationships and cultural ties is evident in the narratives of the young adults who spent their childhood in children’s homes. A significant finding is the shared sentiment of the loss of biological family connections, identified as the most distressing aspect of their upbringing in institutional environments. The majority of participants had at least one living parent, challenging the assumption that children’s homes predominantly house orphans.

They forced us to speak Thai, they didn’t let us speak our own language because there were kids from all different tribes and they were worried we would gossip about each other or have misunderstandings…—Participant A

Language and cultural preservation emerge as central themes. While most were allowed to communicate in their native languages, fostering a connection to their cultural roots, others recount the imposition of Thai language, a policy attributed to the diversity of tribes within the homes and the quest for a common medium of communication.

The home had a rule that we couldn’t speak our own language because they wanted the other kids to be able to understand each other.—Participant L

The dichotomy of experiences extends to visits home. Over half of the participants had periodic returns to their familial environments during school breaks which facilitated a semblance of connection, albeit fragmented.

when I first came to the orphanage, I was excited. But after a while I started to feel noi jai [small hearted, neglected] and wanted to go home. But I knew if I went home, I would have no future, so I had to have patience.—Participant A

The narratives paint a complex picture of emotional turbulence. Participant A’s account, oscillating between the excitement of a new environment and the nostalgia for family, echoes a common sentiment. The dichotomy of emotions—a sense of abandonment contrasted by the pragmatic acceptance of the opportunities the homes present—is a recurring theme.

I didn’t feel much, it was like someone I knew, but I didn’t really have a relationship with.—Participant H

Participant H’s indifferent reaction to the parent/child relationship underscores the erosion of familial bonds, an unintended consequence of prolonged separation. The children’s homes, while providing essential needs and educational opportunities, serve to sever the intimate connections that define family relationships.

In essence, these accounts highlight the convoluted impact of institutional care on familial and cultural connections. Every participant’s narrative underscores the intricate balance between the benefits of care and the irreplaceable loss of intimate family bonds and cultural identity. The participants’ experiences highlight the necessity of advocating for policies and practices that ensure care is provided where necessary, while ensuring preservation of familial and cultural ties.

Attachment, Love and Emotional Support

Perspectives on attachment and love present as a unique and complex space in the narratives of individuals raised in Thai children’s homes. Participants found themselves navigating the terrain of broken familial attachments and transient bonds formed with volunteer tourists, a situation which impacts their sociopsychological development (Proyrungroj, 2013).

In this complex environment, the participants’ experiences are varied and nuanced. A striking aspect is the disparity between attachments to biological family members and caretakers in the children’s homes. A divided sentiment emerges among participants, with six feeling a stronger attachment to biological parents, an equal percentage to other relatives, and caretakers in the children’s home forming the strongest bond for only three.

Strongest Attachment} My grandparents on my mom’s side… But, I feel like I get the most love from the missionaries…—Participant A

Participant A’s narrative illuminates a poignant dynamic, where familial ties persist yet an expressed sense of love is attributed to non-familial caregivers. This dichotomy might be attributed to caregivers’ training in child development and varied expressions of affection, or the transient yet intense bonds formed with foreign visitors.

{Strongest attachment} The foreigners… And my sponsor, who visited me every year.—Participant D

Participant D’s attachment to a sponsor accentuates the complexity of bonds formed in institutional care settings. This intricate weave of relationships underscores the dynamic, at times conflicting, landscapes of attachment experienced by children in these settings. Interestingly, the narrative unfolds to reveal a resilience in familial bonds. Despite the detachment experienced during their stay in children’s homes, half of the participants felt most loved by someone in their biological family. This finding lends weight to the intricate, enduring nature of familial bonds, seemingly resilient to the strains of separation.

{Strongest attachment and love} My grandparents. Because they took care of me since I was really little…—Participant F

Participant F’s narrative underscores the enduring nature of early-formed attachments, persisting despite years of separation and institutional care. The varied responses from other participants delineate a narrative rich in complexity, where attachments are not only maintained but evolve and adapt in the interplay between biological family connections and relationships formed within the institutional care environment.

Some participants have developed an attachment to their parents in adulthood that was missing or denied as children.

Now, when I go back [to the village], they take care of me. I feel thankful to God that now they love me and have attachment with me.—Participant H

If you ask me about attachment…before, I really hated her [my mom], you know? I thought ‘why did you do that? Why didn’t you take care of me?’ But now I feel like, ok, we have better attachment now. I understand her more…—Participant I

Emotional support is a vital part of psychological well-being, allowing a person to develop empathy, confidence and a sense of self, as well as learning to trust and seek help from others. Of the participants, only six reported receiving emotional support from their caretakers in residential care, with another five getting this from family members. They also sought emotional support from teachers or friends, but a few reported that the only person they could trust was themselves. This supports the finding from Rogers and Karunan (2020) that removing children from families to place them in residential care ‘may ensure that needs are met during childhood, but this is often at the expense of severing connections with their family and disrupting social networks, which could have served as vital support across the life cycle’ (p. 628).

In essence, the narratives present a mosaic of experiences, where attachment and love are not binary but exist in a fluid state, shaped and reshaped by the dynamics of institutional care, biological family ties and transient relationships. Each contributes to a broader understanding, suggesting that love and attachment, while impacted by the environment of care, retain an enduring, adaptable quality. The complex interplay of these forces underscores the multifaceted nature of attachment and love in the lives of those in children’s homes, prompting a nuanced, empathetic approach to their care and support.

Choices: Education and Options to Return Home

The narrative of choices, particularly concerning education and the option to return home, weaves through the lived experiences of children in residential care, each strand coloured by individual circumstances and institutional policies. The narrative begins with the universal appeal of education, a critical pull factor drawing children into these homes. Mala (2021) casts a light on a paradox—villages bereft of children leading to closed schools, perpetuating a cycle driving more children towards residential care.

They would always ask me what I wanted to study, what I wanted to do [You got to choose?] Yes, I got to choose but they chose the school I had to go to for high school…—Participant A

I really wanted to study music. When I finished 9th grade, I wanted to be a mechanic, when I finished 12th grade, I wanted to study music but I didn’t get to do either.—Participant J

In relation to educational choices, a dichotomy emerges in the data. Voices like Student A’s punctuate the narrative with tales of constrained choices, a juxtaposition where the illusion of choice meets the reality of constraints in the institutions.

[T]hey asked where I wanted to go to school and what I wanted to study.—Participant C

Yet, not all voices echo the sentiment of constrained choices. Student C and others weave strands of autonomy into the narrative, painting a picture of agency and self-direction, albeit within the confines of institutional care.

normally I would tell them what I want to do, what I want to study. But me telling them didn’t have any effect because the people who paid for everything was the orphanage... I didn’t have the chance to decide where I wanted to go to school.—Participant E

Participant E’s voice introduces another layer of complexity—the intersection of choice and financial control. The power dynamics inherent in the funding source become evident, as choices are mediated by those holding the purse strings.

The option to return home, another critical aspect of the narrative of choice, unfolds in a similar complex terrain. Voices of children seeking to rejoin their families are met with institutional barriers, painting a stark picture of the limitations inherent in the system.

I asked to go home once. [And what did they say?] I said I wanted to go live with my mom but they said ‘you can’t. They can’t take care of you.’— Participant H

Participant H’s narrative underscores a prevailing theme—the institutional belief in the inadequacy of the familial environment juxtaposed against the child’s innate pull towards home. Here, the children’s voices narrate a tale of constrained choices and dictated paths, illuminating the intricate, often contentious dance between individual agency and institutional control.

They did ask once if we wanted to go home. All of us wanted to go home. When we were at the orphanage, we couldn’t go anywhere. When we went out, we had to all go together. No freedom.—Participant M

Participant M’s testimony underscores a narrative of restrained liberty and amplified constraints, a juxtaposition of the promise of education and the reality of limited freedoms. In this narrative of choices—education and the option to return home—each voice contributes to a nuanced, multifaceted tale. Data reveal a narrative characterised by the intersection of institutional structures and individual aspirations, where education emerges as both a pull factor and a terrain of often constrained choices.

Positive and Negative Experiences in Residential Care

The participants provide narratives that reveal a complex mix of both positive and negative experiences of residential care, offering an intricate view of life within these settings. These firsthand accounts serve as valuable insights into the systemic challenges inherent in this care structure. A notable issue that stands out is bullying, highlighted by a statement from Participant H:

They always beat me up. Sometimes, like if I did something they didn’t like, they would beat me up.—Participant H

Participant I’s similar account underscores the urgent need for enhanced supervision and support mechanisms for children in these settings.

There were kids who bullied me. Because there were a lot of bigger, older kids there with us. Like, if I didn’t obey them, they’d beat me up and I never told our house parents because I was worried they’d beat me up worse.—Participant I

The issue of physical punishment from staff is shown in the experience of Participant B:

She hit us really hard and took away our snack money for a month.—Participant B

This experience of physical punishment was echoed by Participant G:

If I did something wrong, or didn’t listen or didn’t do my chores, I’d get hit as a punishment.—Participant G

Instances of perceived injustice are also recurrent, as captured by Participant A:

‘They were really biased and sometimes they were unfair’. This is echoed by Participant E’s narrative: ‘There was a lot of injustice all the time… I felt it wasn’t fair’. These experiences underline the need for enhanced training and sensitivity among caregivers to cultivate an environment of fairness and equity.

On a positive note, educational opportunities are widely valued. Participant G acknowledged this benefit: ‘I got to study Thai, I got a new family to live with, I got to go to school’. Field trips also emerge as a memorable positive experience of residential care, described by Participant A:

We got to go on lots of field trips… to Night Safari, to eat, to ride elephants.—Participant A

However, these enriching encounters introduce ethical considerations about balancing these opportunities against the impact of family separation. Spiritual development adds another layer of complexity. Participant Q shared a transformational narrative:

I got to know Jesus well… I changed a lot, I was able to talk to others more and express myself more.—Participant Q

This brings up questions about the balance between fostering spiritual growth and respecting individual freedom to explore and choose diverse belief systems.

Taking this data into account, there is a compelling case for the re-evaluation and refinement of residential care practices. The objective should be to retain positive elements, such as enriched educational and cultural opportunities while addressing pressing issues of bullying, physical punishment and perceived injustice.

Advantages and Disadvantages of Residential Care

Advantages

The accounts from care leavers offer valuable perspectives on the dichotomy of experiences in residential care. The variety of experiences, both positive and negative, shed light on the complex nature of these environments. Participants highlighted several benefits of their time in residential care. For instance, Participant A credited the care system for providing an escape from early marriage:

It saved my life a lot. I have friends my age in the village who have been married so many times and have so many kids…—Participant A

Participant B noted they missed their mother but they valued the spiritual aspect of their placement, with the introduction to Christianity being perceived as an advantage of their time in care, aligning with the four care leavers who found this aspect significant.

I got to know God more….but I didn’t get to see my mom very often.—Participant B

Participant H’s account on self-reliance and learning necessary life skills resonate with the seven participants who, alongside learning about God, also viewed learning how to take care of themselves as a primary advantage.

When I was there, I got to know God more and I got to learn how to take care of myself for when I was older and ready to leave.—Participant H

Education was often referred to as a privilege valued by five participants, including Participant P:

I was able to study until I finished university.—Participant P

Participant N’s account exemplifies the social and disciplinary benefits derived from these settings, echoing the sentiments of participants who appreciated the structured environment and opportunities to integrate into broader society.

I could practice being in larger society. We were with so many people that I learned how to adjust to be with different people so I could be happy.—Participant N

Disadvantages

Contrastingly, the disadvantages emphasise restrictions and emotional voids. Participant D’s account of limited privacy is a sentiment shared by eight participants who felt restrained by a lack of freedom, privacy or flexibility.

If we wanted to have privacy, there was no chance because we all had to stay together.—Participant D

A significant 9 of the 17 participants, including Participant L, identified restricted contact with their family as a major drawback, highlighting the emotional and relational gaps resulting from such separations.

Disadvantages would maybe be that we only had the chance to go home during the school breaks.—Participant L

Participants E and F’s accounts underscore the developmental delays and restrictions incurred due to the overly structured and controlled environments, echoing the sentiments of the six who felt unloved, neglected or unwanted.

Kids in the orphanage had to do things precisely, at the same time. Like 8 am, we have to do this, they would have a schedule with exact times for everything and force us to be disciplined. But not build attachment or love the kids.—Participant F

When it came time for me to leave, I felt like I had no self-confidence to do anything or to make decisions.—Participant E

Participant Q’s shift in experience from being well cared for to feeling neglected as the number of residents increased encapsulates the scaling challenges faced by these homes.

when there were just over 20 kids they took good care of us really well, but then they went up to 80 plus kids and the love and care diminished.—Participant Q

These firsthand accounts exemplify the complexity of residential care experiences. The advantages, including educational opportunities, spiritual development and enhanced self-reliance, are significant yet contrasted sharply by the emotional, social and developmental challenges highlighted.

The Residential Care Choice

The final two questions explored were: if you were given the choice at the time you entered care between entering the children’s home versus providing support to stay with your family, which would you choose? And, finally, when you have a child of your own, will you put them in a children’s home?

The participants’ perspectives on these questions illustrate the complexity of the residential care experience. Even with the negative aspects highlighted across these findings, a surprising 13 participants stated they would still choose the children’s home over family if given a choice to go back, citing the opportunities and resources available in the homes as critical for their personal development. Participant A’s reflection captures this sentiment:

I would choose the orphanage because as I was growing up, I went back and saw my dad and knew if I stayed there, I wouldn’t have a chance to study because his life was so difficult.—Participant A

Participant B emphasised the expanded worldview offered by living in a city-based children’s home:

[K]nowing what I know now, I would choose to stay here because it’s better. I can see the outside world. In the city, I see so much more. In the village, all I really see is the mountains.—Participant B

The narrative becomes more complex when participants are asked about the prospect of placing their own children in residential care. Unanimously, none would opt for this unless as a last resort. As the data show, the experience of residential care was clearly challenging for them, and none of the participants wished such experiences for their children. Participant A is firm in this conviction:

No, I will keep them with me. I don’t want them to feel like I did… It might be safer for their bodies, but their spirits might be crushed.—Participant A

Participant M expresses a powerful resolution rooted in her experiences:

If I have my own kids, I shouldn’t throw them away, like my mom did. I feel like they are from my own body. If they have life, that’s a really good thing. And I would need to take good care of them because I wanted them.—Participant M

This paradox, where participants appreciate the opportunities provided by the children’s homes yet would not want their children to undergo similar experiences, underscores the multifaceted nature of residential care. The structured environment, discipline and opportunities for education are valued. Yet, the emotional toll, feelings of neglect and the erosion of family bonds leave an indelible mark. Participant G voices the internal conflict:

Half of my heart says I’d want them to live in a foundation/orphanage because I want them to learn discipline, but the other half of me would want to take care of them and love them myself so they know they have a mom and dad who take care of them.

The consensus points towards a revaluation of the residential care system. While acknowledging its role in offering life-changing opportunities, the emotional and psychological costs necessitate a holistic approach. Balancing the provision of resources and opportunities with the preservation of family bonds and emotional well-being emerges as a critical focus, steering the conversation towards inclusive, compassionate and holistic models of child care and development.

Discussion

In Western countries, when a child is removed from a family due to abuse or neglect, often the child is already suffering from emotional and psychological trauma (Rogers, 2015). However, removing a child from their home and community and putting them into a children’s home simply because of poverty or the lack of a school nearby may be the source of trauma for many children. Quinley references (2018) Little and Monkolransey, saying ‘being in the orphanage separates them from their families, and alienates them from their communities to such an extent that when they leave the orphanages they have broken relationships with those families’ (2018, p. 285). How do we align these opinions with the current study, where a majority of participants retained their tribal language, ties to the community and family and are still connected to their culture? One possibility is location. Push and pull factors for children in Bangkok, Isaan and other areas of Thailand may be different than those in Northern Thailand, where many families live close enough for children to go home during holidays and long weekends. This may also be why Chiang Mai has the highest concentration of children’s homes in Thailand (Ladaphongphatthana et al, 2022b). Private children’s homes tend to be smaller and some cater to specific tribes and are run by tribal people who are able to help children maintain a connection to their culture. The care leavers in this study who grew up in smaller homes often entered at a later age, allowing them to understand the reasons they went into residential care, some making the decision for themselves as a way to further their education. Most participants who were involved in this decision completed university and some even completed a Master’s Degree, which they believe would not have been possible had they remained in their villages after completing primary school. Despite this, each of the care leavers interviewed in the current study said the lack of connection to their biological families was the worst part of growing up in institutional care.

Since almost all participants stated they would still choose a children’s home for themselves, we should consider the five aspects of positive care researched by Huyn et al. (2018): (year-round food security, safe shelter, a consistent caregiver at least 18 years of age ‘who provides consistent care, attention, and support’ (Huyn et al., 2018, p. 5), regular access to health care services and the child’s psychosocial well-being (Huyn et al., 2018)). The key difference in responses may hinge on the presence of a consistent caregiver who provided not only food and shelter but also ‘care, attention and support’. All the participants’ residential homes provided food, shelter and access to health care but not all provided a consistent caregiver who addressed the child’s psychosocial well-being. We should also consider a sixth aspect: access to education. Considering that education is the number one way to break the cycle of poverty, keeping children in families while continuing to deny them access to education may address the negative aspects of residential care but at the same time ensure that they remain trapped in poverty.

Based on these semi-structured interviews with 17 care leavers, a key finding is that while they may have had both positive and negative experiences in a children’s home, the benefits outweighed the disadvantages and they would choose this path for themselves again. However, the hopeful part of this research is that care leavers recognise the importance of family, are able to articulate the negative emotional and psychological impact family separation had on them, and would not choose to place their own child into a children’s home. This indicates a potentially changing landscape of children’s homes and their necessity in Thai life and culture. As more children leave care after completing secondary school or university and enter society, we can assume they are learning more about the psychosocial benefits of children remaining in families. In the future, these care leavers may be part of the solution, changing how society views children’s homes.

Acknowledging the Problem

‘Everybody is responsible but nobody is ultimately accountable’ (UNICEF, 2015, p. 15). This, in a nutshell, perfectly describes the situation of the children’s home system in Thailand and is a large reason why it is a very difficult problem to address. When no one is accountable, children languish unnecessarily for years in children’s homes when they could be reintegrated with families with minimal financial or educational support. According to UNICEF, in 2015, orphanhood ranked as only the number six reason that a child in Thailand was in a government orphanage. The number one reason was abandonment, followed by poverty and inability to provide proper care including access to education (UNICEF, 2015).

Additionally, Wade et al. (2018) say the psychosocial neglect experienced by children in large institutions has a profound effect on cognitive development. According to one study participant:

we learned things slower than other kids. I observed this from the time I started studying, that kids who lived with their parents had more ideas or could think more broadly than me… Those of us who grew up in a children’s home never had a chance to decide anything for ourselves

Recommendations for Further Study and Policy and Practice

Future research should interview a broader cross-section of children and care leavers from various regions of Thailand to compare experiences. While many care leavers in Chiang Mai would still choose to grow up in a children’s home, this may not be true in other areas. A larger sample size including care leavers from government homes would provide a more comprehensive comparison between government-run and privately funded homes.

Thailand’s government is investing in family strengthening to reduce reliance on residential care. The national group Alternative Care Thailand has created a manual to guide organisations in supporting families within their communities, rather than defaulting to residential care. This approach emphasises understanding family-defined success, often linked to children’s secondary education.

However, the closure of rural schools by the Ministry of Education in 2021, due to low attendance and a lack of qualified teachers, highlights a critical issue. Strengthening secondary education in rural areas could both encourage parents to keep their children in local schools and allow children to grow up with their families while receiving a quality education.

Private children’s homes should focus on gatekeeping and providing family-strengthening services rather than accepting new children. They should also identify children who could reintegrate into their families with educational or financial support and extend their impact to the broader community. Additionally, organisations can train rural parents to enhance parenting skills and highlight the importance of attachment and psychosocial well-being for children.

Conclusion

While existing research shows there are more psychosocial benefits to children remaining in family-based care, the findings from this study show tangible physical benefits residential care provides, which often entices families to send their children away to access more opportunities. However, the care leavers interviewed for this study recognise that the cost of these opportunities is the separation of children from families, and this cost is not one they are willing to pay for their own children, regardless of the perceived benefits they may receive.