Shelter-based services for survivors of human trafficking in Cambodia: Experiences and perspectives of survivors

Abstract

In Southeast Asia, services for survivors of human trafficking have historically been centralized within shelter programs. Minimal research has, however, been conducted regarding trafficking-specific shelters, particularly research that highlights the perspectives of survivors themselves. This manuscript presents the perspectives of survivors of human trafficking and sexual exploitation on their own experiences pertaining to trafficking-specific shelter services. We analyzed data from the Butterfly longitudinal research (BLR) study, a 10-year longitudinal study exploring the lives, trajectories, and viewpoints of survivors of human trafficking and sexual exploitation in Cambodia. We analyzed 236 in-depth interviews and narrative summaries of interviews conducted between 2011 and 2016 using an interpretive phenomenological approach (n = 79). Four themes were identified: feeling privileged to live in a shelter; lacking freedom and feeling imprisoned by rules; limited engagement with family; and mixed experiences with counseling. Findings inform critical recommendations for implementing trauma-informed care and strengthening mental health services for survivors, including services provided within shelter programs and within the anti-human trafficking movement more broadly.

Keywords

Exploitation service users social work practice human trafficking longitudinal

Introduction

Cambodia is a source and destination country for human trafficking and, to a lesser extent, a transit country (Keo, 2014). Cambodian women, men, and children are trafficked for a multitude of purposes, including trafficking for sexual exploitation, domestic work, agriculture, fishing, and construction, among others. While estimates regarding the scope of human trafficking remain controversial, evidence suggests high rates of human trafficking in Southeast Asia (UNODC, 2012). Global initiatives to end human trafficking led to an influx of international funding into anti-human trafficking programming in Cambodia (Sandy, 2009).

“Raid and rescue” models – involving law enforcement raids on establishments in which human trafficking is suspected – dominated early anti-trafficking efforts in Southeast Asia (Lee, 2014). Initially, emergency shelters were established to house individuals removed in police raids. Over time, trafficking-specific shelters in Cambodia broadened to include short-term emergency shelters, long-term residential facilities, transitional homes, and foster care programs; the majority of shelters consisted of long-term residential facilities for women and girls trafficked for sexual exploitation. Services for survivors became largely centralized within shelters in Cambodia and in Southeast Asia more broadly (Surtees, 2013; Surtees and Brunovskis, 2016). A resulting consequence was that survivors needed to enter into shelters in order to access key services. In some cases, survivors were not allowed to participate in services unless they agreed to reside within shelters. Though growing, trafficking-specific community-based services continue to be limited (Brunovskis and Surtees, 2012; Surtees, 2017a).

Shelters are depicted as an efficient way of providing services. The effectiveness of residential care in fostering the recovery of clients has, however, been challenged in Cambodia and globally (Groza, 2017). Research regarding residential programs in Cambodia has revealed numerous concerns including: inconsistencies in registration of facilities, insufficient training and therapeutic skills among staff, lack of consideration for alternatives to residential care, bias toward a Western environment, insufficient freedom in care, limited client participation, inadequate re/integration planning, lack of integration with the community, and limited systems to prevent abuse, among others (UNICEF, 2011).

Research pertaining to trafficking-specific shelters is sparse, but has identified several key issues. Involuntary detention of survivors within shelters is common, with some survivors reporting being forcibly detained in shelters due to ongoing legal proceedings (Hacker et al., 2015; Lee, 2014; OHCHR, 2014). Many shelters were established as closed facilities due to concerns regarding retaliation from traffickers and to ensure that survivors could be reached to testify in court (OHCHR, 2014). In closed shelters, restrictions were put in place regarding residents’ capacity to leave shelter grounds, requiring permission to leave shelter premises even for employment and schooling (Hacker et al., 2015; Lee, 2014). Survivors are sometimes held in shelters involuntarily for years at a time, with little to no power to determine how long they remain and on what terms. Survivors in closed shelters in Southeast Asia describe shelters as restrictive and “prison-like,” leading them to feel trapped, anxious, and stressed (Brunovskis and Surtees, 2012; Surtees, 2013: 197). While limited freedom of movement is commonly justified by the need to protect survivors, promote rehabilitation, or facilitate prosecutions, limitations in freedom of movement violate survivors’ rights and echo aspects of survivors’ victimization histories (Hacker et al., 2015; Lee, 2014; OHCHR, 2014).

Secondly, contact and communication with family members and partners are widely limited (Dutta, 2016). While in shelters, 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. Not being allowed to have contact with family members can lead to emotional distress (Surtees, 2013). Survivors frequently report being worried about their family members while in shelters, particularly their families’ socio-economic wellbeing (Surtees and Brunovskis, 2016). Similarly, such restrictions are commonly presented as a mechanism to protect survivors from exploitation by family members and/or to prevent communication with traffickers.

Minimum standards have been developed for shelters in Cambodia. The Cambodian government’s Minimum Standards for Protection of the Rights of Victims of Human Trafficking highlight the importance of victim-centered approaches, sensitivity to survivors’ experiences of trauma, and survivors’ rights to participation and decision-making (MoSVY, 2014). Broader human trafficking care standards and principles of practice consistently underscore the need for trauma-informed approaches emphasizing mutuality, choice, and restoration of autonomy for survivors (Safe Horizon, 2018). Despite the existence of global and local care standards, the level and quality of assistance provided varies across organizations, sometimes significantly (Surtees, 2013). Substantially less clarity exists regarding models that are suited for survivors of human trafficking in comparison to other populations (Hacker et al., 2015). In Southeast Asia, an insufficient number of professionally trained social workers and psychologists is another key barrier. Service providers may not have basic training on working with people who have experienced trauma or trauma-informed approaches (Surtees, 2017a; UNICEF, 2011). Disparities regarding the level of professional preparation of staff are coupled with gaps in systems for monitoring quality of care and upholding accountability to codes of conduct (Surtees, 2013).

Although research on human trafficking has expanded over the past two decades, the perspectives of survivors themselves have been excluded from research on programming and policy (Lockyer, 2020). To our knowledge, no other studies have specifically explored survivors’ perspectives on their experiences in trafficking-specific shelter services in Cambodia. Understanding the perspectives of survivors themselves on shelter-based programming in Cambodia is essential to delivering high-quality services that are informed by the knowledge and experiences of those participating in such programs.

In 2010, a Cambodian nonprofit organization, Chab Dai, launched the Butterfly Longitudinal Research (BLR) study, a pioneering 10-year longitudinal study with survivors of human trafficking and sexual exploitation in Cambodia that aimed to understand the experiences, perspectives, goals, and hopes of survivors themselves. From its inception, the BLR study has aimed to center survivors’ voices in efforts to strengthen anti-trafficking policy and practice. In this manuscript, we present findings from one sub-group of BLR study participants regarding the perspectives of women and girls who experienced human trafficking and/or sexual exploitation on their experiences in trafficking-specific shelter services in Cambodia. This manuscript fills a significant gap in the literature, responding to calls to center survivor voices in efforts to strengthen anti-human trafficking programming (Cordisco Tsai, Lim, Hentschel, & Nhanh, 2021; Lockyer, 2020).

Methods

A prospective panel design was used in the BLR study, with the same participants interviewed for ten years (n = 128). Given challenges building trust with human trafficking survivors, longitudinal designs offer numerous advantages, as data can be collected gradually and at the survivor’s own pace (Cordisco Tsai, 2018). Several shorter longitudinal studies have been conducted with human trafficking survivors, including a one-year longitudinal evaluation in the U.S. (Rothman et al., 2020) and a two-year study in Indonesia (Surtees, 2017b). To our knowledge, the BLR study is the only 10-year longitudinal study with this population globally, providing a unique opportunity to understand survivors’ experiences throughout their participation in services and beyond.

Sampling and data collection

The National Ethics Committee in the Cambodian Ministry of Health and George Mason University granted ethics approval. The Cambodian Ministry of Health reviewed and renewed the ethics protocol annually. Purposive sampling was utilized. A total of 14 shelters and 3 other service providers referred prospective participants to the study. Eligibility criteria included: previous experience of trafficking for sexual purposes and/or sexual exploitation and plans to reside in one of 14 regions in Cambodia.¹ Referral agencies assessed whether potential participants could be classified as victims of human trafficking and/or sexual exploitation in reference to definitions provided by the study team. Human trafficking was defined per the United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons (United Nations, 2000). Per this protocol, any child (below 18) engaged in sex work is a victim of human trafficking regardless of consent. Sexual exploitation was defined as a minor under 18 being involved in a relationship or a situation 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 and Miles, 2011).²

Both qualitative and quantitative data were collected. From 2011 to 2013, surveys were administered in face-to-face interviews. Questionnaires addressed stigma, discrimination, socioeconomic, education, psychosocial, health, and relationship issues. As the study progressed, in-depth interviews, focus group discussions, play and art projects, and participant observation were incorporated into data collection. In 2014, the study team compiled narrative summaries of all data collected to date for each participant and identified some discrepancies in the data that appeared to be grounded in the need to build further trust. Consequently, in 2014, the BLR team made the strategic decision to shift all data collection for the remainder of the study to in-depth interviews, as survivors themselves expressed greatest comfort with this method. From 2014 to 2019, data was collected via in-depth interviews, with one to two interviews with each participant annually. This methodological shift enabled participants to share more freely about their lives (Cordisco Tsai et al., 2020a). In-depth interviews used semi-structured guides, with participants primarily being invited to discuss what had changed in their lives since they last spoke with interviewers. Interviewers probed about topics consistently raised in participants’ descriptions of their own experiences, such as stigma, discrimination, filial piety, and others.

Interviews lasted from 1 to 3 hours, averaging 1.5 hours. When participants lived in shelters, interviews were conducted in private counseling rooms. After community re-entry, interviews occurred in a safe and confidential location of preference for participants. If safety concerns arose, referrals were provided to a network of pre-screened service providers (Zimmerman and Watts, 2003). Interviews were conducted in Khmer and audio-recorded with participants’ consent. Interviews were transcribed verbatim in Khmer and translated into English for analysis. All translations underwent a minimum of two layers of review by study team leaders and/or consultant translators with prior experience with the study population. When questions arose regarding proper translation of Khmer terms, notes were recorded to unpack the cultural meaning of terminology and provide context for the English translation.

Data analysis

We analyzed qualitative BLR data collected between 2011 and 2016 focusing on the following research question: What are the perspectives of survivors of human trafficking and sexual exploitation on their experiences in shelter programs in Cambodia? While the study included 128 participants, the entire analysis for this research question involved 111 participants who had resided in shelters. Analysis addressed the complete trajectory of survivors’ experiences from shelter intake through community re-entry. We analyzed the aforementioned narrative summaries of all data collected from 2011 to 2014 for each study participant. Additionally, we analyzed all in-depth interviews from 2014, 2015, and 2016.

Through the analysis process, distinct patterns were identified for three sub-groups. First, a unique group of themes emerged for one sub-group of 10 adult women who lived in one specific transitional shelter (Group A); their experiences were sufficiently different from other participants that this shelter was identified as a separate case study (n = 10). Additional differences were seen in the experiences of male survivors (n = 22) and all other female participants (n = 79). Data analysis was, therefore, conducted separately for these sub-groups. Table 1 summarizes all the data analyzed for each of the three participant sub-groups.

Table 1.

Summary of all data analyzed (n = 111).

	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 and 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

In this manuscript, we present the perspectives of women and girls from Group B on their experiences in shelter-based services (n = 79). As Table 1 reflects, a total of 236 interviews and summaries of interviews from Group B were analyzed for this manuscript. Findings pertaining to other study participants’ (i.e. Groups A and C) experiences can be found elsewhere (Cordisco Tsai, Lim, & Nhanh, 2020b; Cordisco Tsai, Lim, Nhanh, & Namy 2021). Additionally, findings regarding other aspects of BLR participants’ experiences – such as relationships with shelter staff and the process of transitioning from shelters into the community – have been published elsewhere (Cordisco Tsai et al., 2020a, 2020c).

We used an interpretive phenomenological approach to data analysis, which centers on the essence of a group’s experiences with a shared phenomenon (Dahlberg, 2006). In interpretive phenomenology, emphasis is placed on understanding how people make sense of their own life experiences, recognizing that the social, cultural, and political contexts in which people are rooted impact people's understandings of their own experiences (Hood, 2016). This approach allows us to situate survivors’ experiences within the cultural, historical, social, and political forces that influence perceptions and lived experiences, and to interpret the implications of findings for practice within participants’ own contexts (Lopez and Willis, 2004).

Analysis was conducted according to the process outlined by Smith et al. (2012). We immersed ourselves in original data through active, repeated reading of the data. Data were grouped into segments of meaning, and codes were identified for each segment of meaning, using a line-by-line coding approach (Van Manen, 1990). We organized codes into conceptually similar categories; categories were compared against one another (Houston and Mullan-Jensen, 2012). We reviewed all possible themes, compared themes to the coded data extracts relevant to each theme, and reviewed themes in comparison to the entire data set. Finally, themes were refined and defined. We focused on identifying superordinate themes, but highlighted individuals’ experiences in order to illustrate themes (Hood, 2016). The researchers’ multi-year engagement with participants generated a richer understanding of survivors’ perspectives, which many shared openly after years in the study (Barusch et al., 2011). Data were triangulated across six years of study data (Leech and Onwuegbuzie, 2007). Negative case analysis was conducted to check patterns arising during analysis (Barusch et al., 2011). We utilized thick description while prioritizing confidentiality (Guest et al., 2012).

Findings

Sociodemographic characteristics of Group B members (the sub-group whose experiences are presented in this manuscript) are shown in Table 2. Four themes emerged regarding Group B participants’ experiences in shelter-based services: feeling privileged to live in a shelter; lacking freedom and feeling imprisoned; limited engagement with family; and mixed experiences with counseling. Each is discussed below.

Table 2.

Characteristics of sub-sample (n = 79).

	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)

Sociodemographic characteristics are presented for the participants for whom they were available.

Feeling privileged to live in a shelter

In contrast to the poverty they experienced in their communities, survivors expressed that shelters provided a standard of living that made them feel privileged in comparison to their family and community members. Makara³ said: “They (staff) helped us more than their own children. We had money to spend, more than some richer (people)” (2015).⁴ Dara described privileges of living in the shelter, including having more food and more educational opportunities than many children in the community:

Although we were shelter kids, we had enough food for eating. Sometimes we had more food than other kids do… I often felt privileged as a shelter kid. We were able to study more than we were outside of the shelter. (Dara, 2016)

The opportunity to study in high-quality educational institutions gave survivors access to new social networks. Chivy said: “I remembered that the shelter gave me the opportunity to study in a good quality school, to have good friendships, rich friends, to know society” (2015). Linda described how her needs were met in a way she had not experienced at home given the poverty experienced by her family:

The meal was enough for us, included snacks as well. They bought clothes for us and sent us to school. It much better than at our home! Our home cannot serve food 3 times per day like them every day. Everything is enough for us! … There were housemothers available for us to look after when we got sick. They were responsible for our meals, living, schooling, counseling, and everything. They helped me a lot! (Linda, 2016)

Survivors articulated that shelters provided a standard of living they had never had access to, including riding in a taxi to school, having a chef prepare food for them, and being able to focus exclusively on their education without other responsibilities. Several even indicated that living in a shelter made them feel like a “princess” due to the level of comfort they experienced. Romdoul said: “When I lived in the shelter, the shelter supported me with everything. I was just like a princess. It was very easy” (2015). Sim said:

[I] act as a princess. I do not do anything. After eating, I just sleep. It is easy for me and it is not like other places where people need to work hard and do not have enough food to eat. (Sim, 2016)

However, for some survivors, the level of staff involvement was excessive, with participants sometimes feeling infantilized. Phary said:

Living in the shelter is good in one way. Under their management, I am just like a child. In fact, I could do it myself, but it was the staff’s role to look after us. They worried about many things and I had tension sometimes, but it is their role. (Phary, 2015)

The dramatic contrast between the standard of living clients experienced in the shelter and what survivors encountered upon their return to the community created significant challenges for the re/integration process. Upon re-entry, many ultimately struggled to adapt to community life, where they returned to experiencing significant poverty within their families accompanied by considerable stress pertaining to the inability to meet basic needs and pressure from family members to provide financial assistance (Cordisco Tsai et al., 2020a).

Lacking freedom and feeling imprisoned

Universally, the most frequently discussed topic was the lack of freedom survivors felt within shelters. Although participants appreciated opportunities afforded within shelters, they expressed that shelter “rules are too much,” as articulated by Sokchea (2015). Participants described security guidelines, such high gates, multiple locked doors to enter/exit the shelter, guards, restrictions on leaving, and limited and closely monitored communication with anyone outside the shelter. Survivors asserted that rules were developed with the intention of keeping them safe from perpetrators. While clients understood that staff desired to protect them, most felt that rules were disproportionate to the level of risk. Sokchea said:

They block us. Even small windows were blocked too. In short, they tried to prevent us. I know they are trying to keep us safe, but it is too much… They have a lot of rules. I cannot even see the outsiders when I go out. In the previous time, when I went to get a training course offered by the shelter, I saw a man and he looked at me too, so I have to meet them in the office because of it. It wasn’t serious – I just looked at his face…. (We are monitored) 24 hours, except for the time I go to the restroom only. I am telling you the truth. (Sokchea, 2015)

Achariya expressed similar sentiments:

They don’t give us freedom to go outside because they are afraid that we will have problems when we go out from the shelter or if there is someone who persuades us to do something. They are afraid that the perpetrator will come to find us. They didn’t give any freedom for us to go outside. They allowed us to stay inside the organization only. (Achariya, 2016)

Such regulations led survivors to feel bored and trapped inside shelters, sometimes feeling encaged. Khema stated:

In the beginning, they did not let me take many classes. They only gave me the opportunity to study Khmer inside the shelter. They did not allow me to go out yet, so I felt very bored. I wanted to see the sunrise and I wanted to land my foot on the grass. I told staff about this feeling. I was bored of always being inside the house. Then the shelter staff replied ‘you will be able to step on the grass soon.’ I did not like to stay in the shelter because it was so boring. I was like an animal inside its cage. I did not like it. You know what I wished for at that time was to only have freedom. They kept telling me to wait ‘please a little longer’. (Khema, 2016)

Survivors compared living within shelters to living inside a prison, describing the impact of regulations on their mental health. Sean said:

There were a lot of rules which made children feel bad… There were staff who took care of us, but in our minds, we didn’t have freedom. I felt like we were imprisoned… The rules were tight and staff’s words were mean to us. They said they don’t care about anything, but only punished us if we did something wrong… It seemed like talking about rules for 1^st mistake, 2^nd mistake, we would be stopped from living there. They brought some rules to make us afraid. (Sean, 2015)

Shelter rules varied per participants, in part due to the status of their legal cases. Kesor stated that she was allowed outside more than others because she did not have an ongoing court case: “I can go out of the shelter while the others cannot… Other children have a different case from me so they cannot leave the shelter…. It seems like they are still involved with the court regarding their past cases” (2015). Naravy also shared that rules differed per the client. Although the client’s age appeared to be one factor that determined freedom of movement, Naravy stated that rules were not consistently applied for those of the same age group:

We need to inform them every time we go outside…because I am still young… I am 18 years old, but they said my age is not yet full 18 years old… Sometimes I feel discouraged and disappointed. Some of them are the same age as me, but they don’t need to follow the complicated rules like me. (Naravy, 2016)

While survivors universally described excessive restrictions on freedom of movement across institutions, regulations at times varied per the organization. Rachana described rules tightening in her facility over time, which she attributed to changes in management in her shelter:

I feel very difficult staying in the shelter. I feel like staying in the shelter becomes harder for the children – most of the girls become stressed… We have to come back home at 7:30pm, stop talking on phone by 9pm, and obey the rules for staying in the shelter… When I was new in the shelter, it was not like that. Now even if we play with the computer, we have to record how much time we use the computer… If we do not go to church to worship, they will not allow us to go outside. (Rachana, 2014)

Some clients ultimately asked to leave shelters because they felt smothered by shelter rules. Although Sokchea was encouraged to transfer to a transitional home with more freedom, she declined, saying:

I worried I would do something opposite the organization’s rules, as they have a lot of rules. I feel that living in the shelter is really strict because they have a lot of rules. I don’t have freedom!… In the shelter, we cannot see any view outside as they try to keep it separate. I cannot see anything. That’s why I feel like I am living in the prison. I cannot go anywhere and need to have somebody follow me when I go out. I don’t want to live in the shelter anymore! (Sokchea, 2015)

Survivors shared that many clients broke rules, but kept it a secret from staff. Numerous clients mentioned jumping over the shelter gate at night to see their friends and go for walks. Chouma explained how she would scale the gate at night because she was angry at staff. Over time, Chouma’s perspective shifted:

I jumped over the gate because I wanted to go out and I wanted to stop staying in the shelter because I hated the housemothers. I have the counselor and now I love them a lot. They tried their best for me. They told us not to go out, not to ride the bicycle alone because it was not safe for you to stay alone. I was always mad at them, but now I understand it and I realized it is because they wanted us to be ok. (Chouma, 2014)

While Makara acknowledged that her peers felt imprisoned, she attributed rules to lack of compliance:

Unfortunately, we (clients) do not obey the rules and make mistakes. That’s why they add more rules. Some people might consider that living in shelter is not a house, but like a prison. In fact, their rules aim to improve us. They want us to be good citizens, but we don’t obey it… To me, the shelter is doing a great job. (Makara, 2015)

Limited engagement with family

Participants expressed a desire to have greater contact with their families while living in shelters. Many indicated that they were only allowed to visit their families two to three times annually on major holidays, that family members were not permitted to visit shelters, and that other communication was kept to a minimum. Strict rules regarding communication with family members contributed to sadness, anxiety, and frustration among survivors, as articulated by Keo:

I attributed that the shelter provided a lot of knowledge, but it also provided me pain. Sometimes you saw the children in here smile, laugh and dress well, but it was different from their real feelings, and sometimes they pretended to do so. Why did the children here use the phone furtively? No one was allowed to call the family for 3 minutes (per month). (Keo, 2016)

While survivors appreciated the benefits of living in a shelter, they worried about the wellbeing of their family members who did not have access to the same resources. Vanna said:

I am bored with living in the shelter as I miss my family, but it is also the place where I can obtain love and studies… It is easier to stay home, but I can eat enough in the shelter. I do not know about their [family’s] status while they are living outside…When I got something to eat, I always thought about them. (Vanna, 2016)

Participants expressed disappointment and frustration that in most shelters, their families were not allowed to visit them. Keo described a painful incident in which her mother came to visit her at the shelter, but was not allowed inside, leading her to want to be discharged:

The time that I was the most sad was when my mom visited me, but shelter didn’t allow her to come in. I was really angry. The first time that she visited me, they allowed her to sleep here one night, but later they didn’t. I don’t want to live in the shelter anymore…I asked them to leave, but they didn’t agree so I still live here but my attitude became worse. (Keo, 2015)

Likewise, Linda shared her frustration that family members were not allowed to visit, noting the stress caused for both clients and their families:

Visiting home was the most difficult… As I wanted to visit my home, I had to ask for permission from the first housemother and then the second housemother. It was so inconvenient… For kids, they missed their families. I knew their [families’] feelings – they were worried about our safety. There was no rule for parents to visit their kids in the shelter at that time. It would be so good if there was that rule in the shelter, but they did not allow. (Linda, 2015)

Policies for home visits differed per organization, with some shelters more strict than others. Dara shared her happiness at being transferred to a shelter that allowed more contact with her family:

I started to have more hope when I left [shelter A] to stay in [shelter B]. It was like I started to know how to read and write. Moreover, staying at [shelter B], I had more opportunities to meet my mom. I met her often… They brought me to visit my family at home, so it made me not to miss my mom a lot. I started to reduce my concern toward my mom. Then I realized I could focus more on studying. (Dara, 2016)

From the participants’ perspectives, shelter policies regarding family engagement reflected staff distrust of families and concern for clients’ safety rather than strengthening healthy family relationships. Restrictions did not prepare clients for eventually returning to live with their families in the community, which was overwhelmingly the most common path for participants given Khmer cultural norms regarding the centrality of the family.

Mixed experiences with counseling

Participants shared varied experiences with counseling services in shelters. Participants who spoke positively about counseling shared that they felt happy, safe, and warm. Chouma said: “The shelter provided counseling service to girls and I really like it. The counselors valued each of us and always kept their word. What they promised, they would do it. They comforted, loved, and provided warm feelings to us” (2016). Some found counseling helpful in learning how to talk about their feelings and process traumatic experiences. Leakena explained how counseling sessions helped her talk openly about prior experiences of abuse:

I love the time that I have with the counselor because I can share stories with her when I have bad feelings. She knows how to make me feel free to talk. If she did not do it, I would not be able to talk about the time that I have been harmed. (Leakena, 2016)

Similarly, Romdoul shared how she learned to identify and process painful feelings that she had been hiding:

I met with my counselor and she let me release my hidden feelings. She advised me to note down my sad feelings and the effect of them in my notebook. That made me face and stand up to accept what I got. So, it changed my life. (Romdoul, 2015)

Others shared neutral feedback about counseling, describing it as neither helpful nor harmful. These participants depicted their engagement with counselors as akin to everyday interactions, stating they just “met for fun” (Sorn, 2016). Chariya said: “I met with the counselor only 2–3 times and we didn’t talk much. I just played and did the manicure” (Chariya, 2015). However, when she actually experienced difficulties, Chariya said that she had “no one to talk to” and “always kept it in my mind” (Chariya, 2015).

Others presented a more negative portrayal. Kesor shared an experience in which she felt a counselor had broken her confidentiality, leading her to lose trust. Kesor felt safer discussing her problems with friends:

I have problems, but I still keep them in my mind. I don’t want to talk with the counselor because I do not trust them. I am afraid that they will break my confidentiality, as my experience in the previous time was that my counselor raised my problem with another counselor. (Kesor, 2015)

In addition to concerns regarding trust, others felt counselors were too forceful in asking about their past experiences. Sokchea explained:

I didn’t really like counseling… Honestly, I don’t like people when they asked me about my past… I don’t want them to ask me, but the counselors, they need to ask me to confirm… Sometimes I just feel that they asked me questions that were too direct. For example, when I stayed at the shelter, there was a foreign counselor… When she asked questions, her questions were too loud and I feel I don’t like her and especially I didn’t like the counseling session. During the counseling session, whoever asked questions, I never answered. I kept my face on bad mode. I always caused trouble. I felt like they asked me too many questions… It caused stress! I didn’t like it. They asked questions that were too difficult. Whenever we got stuck, they forced us. They didn’t force me at that time, but 2-3 days later, they came back to these questions. When they asked these questions again, we remembered that story again. (Sokchea, 2016)

According to Sokchea, the shelter would not allow her transfer to a transitional home until she completed counseling: “She asked me about my feelings and if I couldn’t finish it, I cannot move to the next shelter. I cannot go unless I complete the counseling level successfully” (2015). The linkage between access to greater freedom and perceived progress in counseling heightened Sokchea’s stress regarding her counseling experiences.

Discussion

The anti-human trafficking movement has been widely critiqued for consistently intervening on behalf of trafficked persons without listening to or partnering with people who have experienced human trafficking – a concern illustrated by a lack of research from the perspectives of survivors themselves (Lockyer, 2020; Russell, 2018). Given the longitudinal nature of this study and the rapport developed between researchers and participants, this study makes an important contribution to understanding survivors’ own viewpoints on shelter-based programs. Listening to the experiences of trafficked persons themselves is critical to ensuring that services match the needs and priorities of people who have experienced human trafficking (Cordisco Tsai, Lim, & Nhanh, 2020a, 2020b; Lockyer, 2020).

This study reveals priorities for strengthening services to reflect survivors’ feedback and adhere to a trauma-informed approach. Key trauma-informed principles include choice and restoration of autonomy, physical and emotional safety, transparency and trustworthiness, collaboration, empowerment, and sensitivity to cultural, historical, and gender issues (SAMHSA, 2014). Findings regarding participants feeling imprisoned with trafficking-specific shelters and not being allowed to communicate with family members are antithetical to principles of trauma-informed practice.

Findings echo prior research detailing restricted freedom of movement and in the most extreme cases involuntary detention with trafficking-specific shelters (Lee, 2014; Surtees, 2013). Shelters may implement such restrictions out of a desire to prevent survivors from returning to traffickers, to ensure cooperation in legal cases, and/or to prevent clients from running away; survivors, however, report feeling they are kept in closed shelters even when no safety risks have been identified (Brunovskis and Surtees, 2012; OHCHR, 2014; Surtees, 2013). Human rights conventions and standard of care guidelines assert survivors’ rights to freedom of movement (OHCHR, 2014; MoSVY, 2014). Restricted freedom of movement within shelters mirrors victimization experiences during human trafficking (Hacker et al., 2015). Survivors who experience restricted freedom of movement during their trafficking histories are more than twice as likely to report post-traumatic stress disorder, depression, and anxiety (Kiss et al., 2015). Previous research in Southeast Asia has revealed that “in a handful of cases, trafficked persons described having more freedom of movement while trafficked than they did while being assisted in some shelter programs,” raising significant concerns regarding re-traumatization from participation in anti-trafficking programming (Surtees, 2013: 197).

Similar concerns arise regarding restrictions placed on communication with family members in trafficking-specific shelters. Trafficked persons have at times reported they were permitted more contact with their families while trafficked than in shelters (Surtees, 2013). Family separation can cause deep anxiety, frustration, and distress for survivors (Lee, 2014; Surtees and Brunovskis, 2016). Minimum standards assert that survivors should have freedom to meet with family and friends, except when the safety and welfare of the person is compromised (MoSVY, 2014). While staff may again be motivated out of a desire to protect clients, survivors’ family situations differ considerably and family units are not themselves homogenous; some individuals may be supportive, while others destructive (Surtees, 2017b).

Familial relationships are central within Cambodian society and play a critical role in survivors’ lives post-trafficking, both positively and negatively, as the overwhelming majority of clients return to live with their families upon shelter discharge (Aberdein and Zimmerman, 2015; Cordisco Tsai et al., 2020a; Le, 2017). The individuation of the self in the Khmer context differs from Western conceptions of the self (Bit, 1991). Survivors’ sense of self is intricately linked with family wellbeing and fulfillment of responsibilities to the family. Sensitivity to the socio-cultural context, including community and family-oriented, collectivist values, is needed to ensure that services are provided in a manner that are congruent with survivor needs and priorities and effective within the Khmer context ( Le, 2017). It is recommended that service providers further examine why they are reluctant to engage families in services and facilitate safe, structured opportunities for survivors to connect with family, with support from staff.

In some cases, shelter rules appear to be focused on controlling or correcting behavior rather than facilitating healthy recovery (Brunovskis and Surtees, 2012). Traumatic experiences can steal a person’s sense of control over their own lives and experiences. Restoring a sense of control is vital to trauma recovery (Hacker et al., 2015). As Herman (1997) writes: “no intervention that takes power away from the survivor can possibly foster her recovery, no matter how much it appears to be in her immediate best interest” (Herman, 1997: 133). A trauma-informed practice requires service providers to be mindful not to recreate aspects of survivors’ previous traumatic experiences, to do no harm through service provision, and to continually respect the need for emotional safety (Andreatta et al., 2015). Investments in staff capacity building and clinical supervision will be critical in ensuring that services are provided in a manner consistent with the principles of trauma-informed practice.

Additionally, survivors’ experiences reinforce the importance of agency in day-to-day decision making, another core aspect of a trauma-informed approach. While survivors appreciated shelters’ provision for their basic needs and educational support, they described a lack of empowerment, with decisions being made and simple tasks being completed on their behalf. As discussed in (Cordisco Tsai et al., 2020a), survivors described a stark contrast between the standard and way of living participants experienced within shelters and that which they experienced in the community upon their return. When coupled with limited engagement with the outside world and rare communication with families, a lack of participation in day-do-day decision making made their ultimate transition into the community exceptionally challenging (Cordisco Tsai et al., 2020a).

Findings hold implications for the provision of culturally-competent mental health services for survivors. In Southeast Asia, a lack of trained social workers and psychologists significantly hinders access to mental health and psychosocial support services (Aberdein and Zimmerman, 2015). In some cases, persons providing counseling have not received training on working with people who have experienced trauma (Surtees, 2013; UNICEF, 2011). Although Western models for mental health services are increasingly being taught and implemented in Cambodia, insufficient attention has been paid to the cultural responsiveness of Western therapy models within the Cambodian context (Seponski et al., 2014). As survivors’ mixed experiences with counseling in this study demonstrate, further research is needed to explore culturally congruent models for providing mental health services in the Khmer context and to understand the treatment modalities that survivors responded to positively and negatively.

Providing shelter-based services for survivors of human trafficking and sexual exploitation is a complex and difficult undertaking. Given the lack of research evaluating trafficking-specific shelter-based services, this study makes a contribution to understanding survivors’ own perspectives on their experiences participating in shelter programming in Cambodia. Further research is needed to understand the perspectives of other stakeholders, including service providers and family members. We hope that this analysis can be used to foster dialogue among service providers regarding ongoing efforts to improve the quality of services, strengthen cultural competence, and ensure adherence to trauma-informed principles not only within shelter programs, but also within the broader anti-human trafficking movement.

Footnotes

Acknowledgements

Many thanks to Helen Sworn, Sreang Phaly, Phoeuk Phallen, Ou Sopheara, Kang Chimey, James Havey, Rous Yeng, Siobhan Miles, and the BLR participants.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Laura Cordisco Tsai

Notes

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