URJHS Volume 8

URC

Providing Orphan Care Systems in Developing Countries

Rebekka Kelly
The Master’s College


Abstract

Research communicates that orphans, particularly in developing countries, have a significantly greater tendency towards symptoms related to Post Traumatic Stress Disorder. It is strongly suggested that the type of care orphans receive impacts the development of the orphan. The purpose of this study was to determine whether or not the care system received by orphans significantly affects their socioemotional development. A survey using a four point Likert-attitudinal scale for measuring participant responses was distributed to students attending Preparation for Global Outreach (which is a required class for those preparing to go on a short-term missions trip) at the Master’s College. The survey results indicate an agreement with current research suggesting that care systems indeed impact the socioemotional progress of orphans in developing countries. It can be concluded that the symptoms generated by traumatic circumstances undergone by orphans can be alleviated in varying degrees based on the care system.

Review of the Literature

Due to the overwhelming numbers of orphans throughout third-world countries, the importance of researching the effect of their adverse circumstances on their development is crucial. Many studies report psychological trauma associated with the situation experienced by orphans in crisis (Schaal & Elbert, 2006, p. 95). The growing population of orphans must impact the world as potential problems materialize into behavioral outpourings that will affect the societies of numerous countries as a whole. “’Childhood trauma is particularly significant because uncontrollable, terrifying experiences may have their most profound effects when the central nervous system and cognitive functions have not yet fully matured, leading to a global impairment that may be manifested in adulthood in psychopathological conditions’ (p. xii)” (Armsworth & Holaday, 1993, p. 49).

Research communicates that orphans, particularly in developing countries, have a significantly greater tendency towards symptoms related to Post Traumatic Stress Disorder (PTSD) (Schaal & Elbert, 2006, p. 96-101). Furthermore, it is strongly suggested that the type of care received subsequent to becoming an orphan has significant impact on the development of the orphan (Ahmad, et al., 2004, p. 203). The effect of care systems on developmental struggles of orphans is unknown. The problem statement would be categorized as a descriptive study because it is research “used to (1) describe behavior, (2) explore a phenomenon, and (3) test hypotheses about behavior” (Brown, Cozby, Kee & Worden, 1999, p. 75).

Historical Context

Throughout the world, children are undergoing traumatic circumstances such as witnessing the death of their parents. “According to the United Nations Children’s Fund (UNICEF) (1995), during the 1980s alone 2 million children were killed during war; 4 to 5 million were left crippled; more than 1 million were orphaned; and 10 million were psychologically traumatized” (Schaal & Elbert, 2006, p. 95). Apart from the effect of war, AIDS is another producer of orphans in many parts of the world. “By the end of 1999, 13.2 million children had been orphaned worldwide by AIDS” (Makame, Ani, & Grantham-McGregor, 2002, p.459). This incredibly large number of children who have lost one or both parents does not even include the wide range of orphans whose parents may have died from malnutrition, poverty, sources of violence apart from war, and numerous other reasons. “Orphans due to other causes also demand attention. Increases in the number of orphans due to AIDS should be considered as part of a much larger problem of orphaning due to all causes. In 12 African countries, projections show that orphans will comprise at least 15% of all children under 15 years of age by 2010” (Children on the Brink, 2002, p. 5).

In light of these sobering statistics, it is important to consider the ramifications of traumatic events on the lives of the children who are left in chaotic destruction due to crisis. The circumstances surrounding an orphan’s condition in a developing country cannot but compound their internal developmental problems. “…[O]rphans not only have unmet basic needs, but have markedly increased internalizing problems. Their long-term mental health is obviously in jeopardy and this will have implications not only for the individual children but also for society as a whole” (Makame, Ani, & Grantham-McGregor, 2002, p. 464).

Orphan Conditions

Studies document numerous conditions that add to the psychological stress orphans in developing countries must face. For example, “orphans often lack adequate food, shelter, clothing and schooling” and “[s]ignificantly more orphans reported going to bed hungry…compared with nonorphans…”( p. 459, 461). As significant as the physical needs are, even more significant are the relational losses that orphans encounter as a result of crisis conditions. “The children may have had to care for dying parents for some time, and the death of their parent(s) often produces major life changes, which exacerbate the situation (7,14). Children may have to move to a new area, leaving behind friends and school (11). They may be separated from siblings, or even worse, their younger siblings may also die from AIDS (14). They may have frequent changes in caregivers…” (p. 459- 460). It is the sum total of physical, educational, financial, and most importantly, relational losses that cause a negative influence on the psychological development of orphans throughout the developing countries of the world.

Post Traumatic Stress Disorder Symptoms

One of the most effective categorizations of symptoms of orphans who have undergone crisis is Post Traumatic Stress Disorder. One study simply states that, “Orphans’ special circumstances predispose them to major psychological problems (7)” (p. 459). More specifically, however, symptoms such as mood swings, eating disorders, phobias, internalizing and externalizing behaviors, anxiety and depression, withdrawal, aggressiveness, and social difficulties are common among those who experience traumatic circumstances.

PTSD is linked to a number of specific circumstances that many orphans face. One researcher suggests that “[p]osttraumatic stress reactions of children were associated with parental loss, violence exposure, and, most importantly, the feeling that their life was perpetually in danger” (Schaal, & Elbert, 2006, p. 96) while another study soberly states, “Among the traumatic events, the number of PTSD symptoms was most strongly associated with the respondent’s having witnessed the murder of a parent…or having believed that he or she would die…Orphans who witnessed the murder of their mother or father suffered from more PTSD symptoms than those who had not witnessed their parent’s dying…” (p. 101). “…[T]he shame and loss of self-confidence associated with such events may enhance the vulnerability to posttraumatic stress disorder (PTSD) and depression” (p. 95). Again, research strongly indicates that the severity of circumstances regarding the loss of one’s parents positively relates to the symptoms of PTSD, saying, “Witnessing of the murder of mother or father and the belief that the youth themselves would die were the two traumatic events most strongly related to posttraumatic stress symptoms” (p. 103). Since an alarming number of children who experience problems associated with posttraumatic stress are orphans, their potentially negative impact on society should motivate governments, nongovernmental organizations, and community-based organizations to create the most effective means of providing assistance for orphans’ socioemotional development. “…[E]arly intervention is seen as essential to avoid the development of chronic responses and to prevent maladaptive functioning or psychopathology” (Armsworth & Holaday, 1993, p. 49). Regarding these conclusions, it is important to understand the most effective systems of intervention and care in which orphans may thrive intellectually, psychologically, and socioeconomically.

Child-Headed Households

In many countries, without the means of monitoring and providing for orphaned children, child-headed households (CHHs) are being formed by surviving family members. This type of care system entails one or more siblings within the family taking initiative to support and raise the other siblings due to the loss of one or both parents. This type of family unit may result in the unity of children within a family; however, the negative effects of this lifestyle for orphans in developing countries cannot be ignored. Researchers find that, “…more youth living in a CHH, compared to those from the orphanage, met the criteria for a PTSD diagnosis” (Schaal & Elbert, 2006, p. 101). This report clearly states, “Youth living in a CHH…suffered considerably more from posttraumatic stress” (p. 102). As for the reasons for this phenomenon, one study suggests, “…children in a CHH face the adult responsibilities of supporting themselves and maintaining a household at an age when the care and protection of an adult are needed. This daily strain is possibly a contributing factor to the higher rate of PTSD in the CHH group” (p. 102).

Orphanages

The most common system of care throughout the world is that of institutionalized orphanages. The research regarding orphanages is more encouraging, and states, “[The] Rate of PTSD diagnosis was higher among youth living in a CHH than those living in an orphanage…” (p. 100). Much positive feedback has been reported concerning the effectiveness of orphanages to assist orphans as they develop into adults.

Although there are many advantages to orphanages, many of the positive results are related to the availability of adult interaction with the needy and parentless children. In general, “[t]here are a number of factors that may have contributed to the finding of less posttraumatic symptoms among those living in an orphanage. For example, they may feel accepted and safe knowing that they are not alone with their pain and sorrow. It also might be argued that the psychosocial environment may have a healing effect on traumatic reactions. Additionally, basic needs of food, shelter, and medical services are better met in an orphanage than in a CHH” (p. 102). More specifically, “[i]n the orphanage, the staff may eventually take a parenting role and give the youth a feeling of warmth and protection” (p. 102).

Yet, it is precisely the necessity for adult interaction that also limits an orphanage’s effectiveness towards encouraging the development of orphans. One situation that is not uncommon in orphanages notes that while there are pediatricians, basic needs, and baths available, the ratio of workers to children is quite low during the day (1:10) and even lower during the evening (1:50) (Hakimi – Manesh, Mojdeh, & Tashakkori, 1984, p. 644). “To make the situation worse, caretakers are held responsible for a variety of other chores such as cleanliness of the rooms, changing the linen and washing the linen and the children’s clothes. These, in turn, leave even less time for interaction with children. Thus, it is not uncommon for a crying child to continue unattended for several hours” (p. 644). Another study more explicitly states, “we know that the institutional environment can have a detrimental effect on intellectual and socioemotional development” (Ahmad, A. & Mohamad, K., 1996, p. 1161). This begs the question as to whether orphanages are the most effective means for caring for orphans.

Foster Homes

“With a few exceptions, investigators have reported striking differences between orphanage children and their matched counterparts in natural homes on a variety of measures” (Hakimi – Manesh, Mojdeh, & Tashakkori, 1984, p. 643). The third and most effective means of providing care to orphans, especially those who have undergone trauma, is through foster care. Although orphanages provide the camaraderie that eases the strains of posttraumatic stress symptoms, still, “Children living in a collective shelter have been found to be at greater mental health risk than their peers housed with the host families” (Ahmad, A. & Mohamad, K., 1996, p. 1162).

Foster care provides a family atmosphere that is necessary for the maximal development of orphans. Ahmad and Mohamad (1996) write, “[W]e suggest that the improvement among the foster care children [intellectually and socioemotionally] is mainly caused by the family construction of this care system, in contrast to the collective care of the orphanage system where a family environment is totally lacking” (p. 1161). Although the problem of PTSD cannot be alleviated overnight, the improvements in the social and emotional status of orphans can be traced to the provision of a family unit. The study by Ahmad, et al (2004) suggests, “…externalizing problems and PTSD-related symptoms showed more obvious improvement in the foster care than did the orphanages” (p. 211). It is little wonder that research shows such significant improvements in orphans who have been given a family with which to interact, rather than just the minimal amount of adults available at an orphanage. “Traumatized children living in a collective shelter have been found to be at greater mental health risk than their peers housed with host families” (p. 204).

Caring for the Future of Orphans

The effects of war, crisis, and other circumstances surrounding the lives of orphans in developing countries, categorized best by the PTSD descriptions in the Diagnostic and Statistical Manual of Mental Disorders IV, can possibly be counteracted by more effective systems of care. Without the assistance of organizations and governmental care, some orphans can only resort to CHH, and suffer more severe consequences as a result. Many orphans are able to receive care from orphanages, through which their basic needs can be met, and they even can interact with adults. However, “[a]lthough many orphanages provide better environment than the deplorable circumstances of the biological families, they cannot provide the individualized nurturing that could be found in loving and responsible families” (Ahmad, et al., 2000, p. 203).

In order to prepare for the future of many developing countries, it must be noted that, “The quality of the foster care is suggested to be the most significant factor in breaking the traumatizing process for orphans after man-made disasters” (Ahmad, et al., 2005, p. 204). These orphans have the potential to enhance, as well as tear down, facets of society within their realm of influence. The solution may be as simple as structuring more quality and quantity foster care programs for orphans throughout the world. “Adding family characteristics to the institutional life of the orphanages, or improving the living conditions of the orphaned child living with a foster family seems to be the two most appropriate ways to take care of orphans and improve their well-being” (p. 204). Orphanages, despite all their assets, can be better replaced by the designed care of a family unit. “…[I]f the traditional foster care system still, in replicating studies, shows better results than any orphanage care, we have to support the foster families instead of building more orphanages” (p. 211).

Method

The purpose of this study is to determine whether orphans in crisis situations in developing countries, characterized by depression and PTSD symptoms, experience differing rates of progress due to subsequent systems of care. Generating from the general purpose stated above, the following research questions were cited:

  1. What effect do the typical circumstances experienced by orphans in developing countries have on their socioemotional development?
  2. What care system provides orphans in developing countries the most socioemotional progress?

These research questions provided the focus of this study (Brown, Cozby, Kee, & Worden, 1999, p. 106).

Data Collection

The survey instrument used in this study investigated whether or not students in The Master’s College missions training class perceive there to be a significant impact on an orphan’s development correlating to the care subsequently received. A personal data sheet requested demographic data in addition to the responses to the nine survey Likert-scale questions with the range of one to four. The survey instrument was distributed to students enrolled in Preparation for Global Outreach, a class designed to prepare summer missions teams at The Master’s College. It was distributed in spring of 2007 manually, both as a group distribution and individually, with the majority being returned immediately to the researcher upon completion of the survey.

Statistical Procedures

STATPAK was employed to examine the data; the desired scale of measurement was ordinal. “Ordinal scales allow us to rank … the levels of the variable being studied and therefore involve quantitative comparisons” (Brown, Cozby, Kee, & Worden, 1999, p. 56). People responded by indicating the number for each question that best encapsulated their response. Once completed, the majority were handed back immediately to the researcher. The Chi-square statistical test was used since “the data consist of frequencies – the number of subjects who fall into each of several categories” (Brown, Cozby, Kee, & Worden, 1999, p. 340). A .05 level of significance was used to test the results of the study.

Table 1 Summary of Responses to Survey Questions

SURVEY QUESTION

SCALE NUMBER

TOTAL RESPONSES

COMPUTED

CHI-SQUARE

VALUE

TABLED

CHI-SQUARE

VALUE

1

2

3

4

4

0

0

11

14

25

0.3600

3.841

5

0

1

9

15

25

11.8400

5.991

6

0

0

11

14

25

0.3600

3.841

7

0

0

17

8

25

3.2400

3.841

8

9

13

2

1

25

15.800

7.815

9

0

5

15

5

25

8.0000

5.991

10

0

1

6

18

25

18.3200

5.991

11

0

0

8

17

25

3.2400

3.841

12

0

1

13

11

25

9.900

5.991

Research Question One

What effect do the typical circumstances experienced by orphans in developing countries have on their socioemotional development? Questions 4, 5, and 7 of the survey instrument located in Appendix A addressed this research question.

Despite the computed Chi-square value (0.3600) for question 4 calculating less than the tabled Chi-square value (3.841) at the 0.05 level of significance, subjects’ answers indicate that they agree with current research findings from Makame, Ani, & McGregor (2002) who state, “Significantly more orphans reported going to bed hungry…compared with nonorphans…” (p. 459, 461).

Because the computed Chi-square value (11.8400) for question 5 is greater than the tabled Chi-square value of 5.991 at a 0.05 level of significance, it can be concluded that participants believe orphans have experienced trauma beyond just the loss of their parents. Makame, Ani, & Grantham-McGregor support this interpretation, saying “…the death of their parent(s) often produces major life changes, which exacerbate the situation (7, 14). Children may have to move to a new area, leaving behind friends and school (11). They may be separated from siblings, or even worse, their younger siblings may also die from AIDS (14). They may have frequent changes in caregivers…” (p. 459-460).

Because the computed Chi-square value (3.2400) for question 7 is less than the tabled Chi-square test value of 3.841 at the 0.05 significance level, it can be concluded that those surveyed did not think the traumatic experiences faced by orphans affect their socioeconomic development. However, since the survey question was intended to address the socioemotional development of orphans, perceptions regarding their emotional development may have aligned with current research. The research completed by Makame, Ani, & Grantham-McGregor (2002) states, “Orphans’ special circumstances predispose them to major psychological problems” (p. 459).

Research Question Two

What care system provides orphans in developing countries the most socioemotional progress?

Questions 6, 8, 9, 10, 11, and 12 of the survey located in Appendix A addressed this research question.

Although the computed Chi-square value (0.3600) for question 6 is less than the tabled Chi-square statistical value (3.841) at the 0.05 significance level, subjects’ answers indicated that they perceive orphanages to be significantly understaffed. This finding aligns with one study (Haimi-Manesh, Mojdeh, & Tashakkori, 1984) communicating the ratio of workers to children as normally being quite low, and even lower during evenings.

Seeing that the computed Chi-square value of 15.8000 for question 8 is greater than the tabled Chi-square statistical value of 7.815 at the 0.05 significance level, it can be concluded that participants strongly believe orphaned siblings should not learn how to take care of themselves without adult intervention. This finding corresponds with research that states, “…[C]hildren in a CHH face the adult responsibilities of supporting themselves and maintaining a household at an age when the care and protection of an adult are needed” (Schaal & Elbert, 2006, p. 102).

Because the computed Chi-square value (8.0000) for question 9 is greater than the tabled Chi-square statistical value (5.991) at the 0.05 level of significance, it can be concluded that subjects perceive orphans do find comfort from relating to other children within an orphanage. Schaal & Elbert (2006) support this interpretation with their research, stating, “There are a number of factors that may have contributed to the finding of less posttraumatic symptoms among those living in an orphanage. For example, they may feel accepted and safe knowing that they are not alone with their pain and sorrow” (p. 102).

The computed Chi-square value of 18.3200 for question 10 is greater than the tabled Chi-square statistical value of 5.991 at the 0.05 level of significance; therefore, it can be concluded that subjects perceive a basic need of orphans in developing countries is adult interaction. Research (Schaal & Elbert, 2006) again supports this finding, saying, “In the orphanage, the staff may eventually take a parenting role and give the youth a feeling of warmth and protection” (p. 102).

Although the computed Chi-square value (3.2400) for question 11 is less than the tabled Chi-square statistical value of 3.841 at the 0.05 level of significance, closer analysis of the subjects’ choices portrayed their opinion that orphans should be put into a traditional family unit if given the opportunity. This finding aligns with researchers Ahmad and Mohamad (1996) who state, “[W]e suggest that the improvement among foster care children [intellectually and socioemotionally] is mainly caused by the family construction of this care system, in contrast to the collective care of the orphanage system where a family environment is totally lacking” (p. 1161).

Since the computed Chi-square value of 9.900 for question 12 is greater than the tabled Chi-square statistical value of 5.991 at the 0.05 significance level, it can be concluded that the rate of developmental progress is influenced by the type of care an orphan experiences after being orphaned (such as CHH, orphanages, or foster families). Ahmad, et al (2005) agrees, saying, “The quality of the foster care is suggested to be the most significant factor in breaking the traumatizing process for orphans…” (p. 204).

Findings

The results of the Chi-square statistical test suggest that orphans have experienced trauma beyond the loss of parents, and their trauma does not affect their socioeconomic development. In addition, subjects perceive orphans should not survive without adult intervention and interaction and that they gain comfort from other orphans. Further responses not represented by the Chi-square statistical test communicate that participants experience greater trauma than national peers, orphanages are significantly understaffed, and a traditional family unit would be ideal for orphans who have the option. In short, orphans are affected significantly by the form of care which they receive.

Discussion

Within the stated purpose and findings of this study, the following conclusions appear warranted:

  1. According to participants, orphans often experience trauma greater than just the loss of parents and at a greater level than their national peers; this may have a significant effect on their socioemotional development.
  2. Orphans ideally need to live with a traditional family, need adult interaction, and are affected by the type of care they receive. Orphanages may not have enough workers to take care of orphans, and orphans find comfort from being around other orphans.

As countries predict the effect that growing numbers of orphans within their societies will have in the future, their initial response should address care systems available to orphans. As these orphans develop, research communicates that they often experience Post Traumatic Stress Disorder symptoms, which is characterized by internalizing and externalizing responses to their circumstances. Thus there is a growing need to provide preventative methods for assisting orphans in their socio-emotional development (Makame, Ani, & Grantham-McGregor, 2002, p. 464).

The type of care that an orphan receives subsequent to the loss of one or more parents seems to affect the amount of socioemotional progress. Child-headed households are by far the least effective means of providing care for orphans. In an orphanage, children are surrounded by peers that can empathize with their plight, and they receive adult interaction that is necessary to their successful recovery after traumatic experiences. However, the most effective form of care available to orphans in developing countries is the traditional family unit including a mother and father.

Foster families provide orphans with a number of necessities that seem to alleviate symptoms of PTSD. In a family unit, orphans are able to relate with adults on a much smaller ratio. Although the Chi-square statistical test indicated that orphans need not be put into traditional families units, all of the results of the survey instrument corresponded with either “Agree” or “Strongly Agree” on the Likert Attitudinal Scale. Accordingly, the importance of a mother and father in the life of an orphan cannot be overestimated, as many research findings also communicate.

Limitations of the Study

A number of limitations exist within this study. It was conducted in spring 2007 and limited to those who are enrolled in a class geared toward humanitarian efforts, not necessarily those who have directly observed orphans. In addition, the research instrument restricted the study by misusing a word, and individual subjects may not have been able to express themselves in a manner they preferred. Lastly, not all of the research is sufficiently up-to-date.

Recommendations for Further Study

This study provides some information regarding the tendency of orphans towards exhibiting symptoms of Post Traumatic Stress Disorder and the impact of the type of care on their socioemotional development (Ahmad, A., et al., 2005, p. 203; Schaal & Elbert, 2006, p. 96-101). Additional questions pertaining to the alleviation of PTSD symptoms and the socioemotional development of orphans due to systems of care warrant further investigation; thus, the following recommendations for further research and study are offered:

  1. This study should be replicated, using a different population to determine how circumstances affect orphans who tend toward PTSD symptoms, and how care systems affect their development.
  2. A study should be conducted to determine the influence of a traditional Christian family in comparison to a secular family on the development of orphans.
  3. The effects of a family unit in comparison to increased staff within an orphanage should be studied.
  4. Whether or not an orphan’s age at the time of leaving an orphanage in order to live with a family affects their socioemotional development is suggested for further research.
  5. Another study should implement a revised survey instrument for question 7, substituting “socioeconomic” with the term “socioemotional.”

References

Ahmad, A., & Mohamad, K. (1996). The socioemotional development of orphans in orphanages and traditional foster care in Iraqi Kurdistan. Child Abuse & Neglect. 10 (12), 11661-1173.

Ahmad, A., Qahar, J., Siddiq, A., Majeed, A., Rasheed, J., Jabar, F., et al. (2004). A 2-year follow-up of orphans’ competence, socioemotional problems and post-traumatic stress symptoms in traditional foster care and orphanages in Iraqi Kurdistan. Child Care, Health & Development, 31 (2), 203-215.

Ahmad, A., Sundelin – Wahlsten, V., Sofi, M. A., Qahar, J. A., & von Knorring, A. L. (2000). Reliability and validity of a child-specific cross-cultural instrument for assessing posttraumatic stress disorder. European Child & Adolescent Psychiatry, 9, 285-294.

Armsworth, M.W., & Holaday, M. (1993). The effects of psychological trauma on children and adolescents. Journal of Counseling & Development, 72, 49-56.

Brown, K. W., Cozby, P. C., Kee, D. W., & Worden, P. E. (1999). Research methods in human development. Mountain View: Mayfield.

Hakimi – Manesh, Y., Mojdeh, H., & Tashakkori, A. (1984). Short communication: effects of environmental enrichment on the mental and psychomotor development of orphanage children. Journal of Child Psychology and Psychiatry, 25 (4), 643-650.

Makame, V., Ani, C., & Grantham-McGregor, S. (2002). Psychological well-being of orphans in Dar El Salaam, Tanzania. Acta Paediatr, 91, 459-465.

Schaal, S., & Elbert, T. (2006). Ten years after the genocide: trauma confrontation and posttraumatic stress in Rwandan adolescents. Journal of Traumatic Stress, 19 (1), 95-105.


APPENDIX A

RESEARCH INSTRUMENT

How Systems of Care Affect Orphaned Children in Developing Countries

This survey instrument is designed to provide data for my undergraduate thesis concerning the potential developmental problems characteristic of orphans in developing countries.

1. Do you have an interest in orphans in developing countries? Y / N

2. Have you visited an orphanage in a developing country? Y / N

3. If so, have you either observed or interacted with the orphans? Y / N

Please respond to the following concerning orphans in developing countries:

4. Orphans have generally experienced greater trauma than their national peers.

            1                          2                           3                               4

Strongly Disagree      Disagree                 Agree                  Strongly Agree

5. Orphans have experienced trauma beyond just the loss of parents.

            1                          2                           3                               4

Strongly Disagree      Disagree                 Agree                  Strongly Agree

6. Orphanages are understaffed.

            1                          2                           3                               4

Strongly Disagree      Disagree                 Agree                  Strongly Agree

7. Traumatic experiences affect the socioeconomic development of orphans.

            1                          2                           3                               4

Strongly Disagree      Disagree                 Agree                  Strongly Agree

8. The orphaned siblings should learn how to take care of themselves (without adult intervention).

            1                          2                           3                               4

Strongly Disagree      Disagree                 Agree                  Strongly Agree

9. Orphans find comfort from relating to other children within an orphanage.

            1                          2                           3                               4

Strongly Disagree      Disagree                 Agree                  Strongly Agree

10. One of an orphan’s basic needs is adult interaction.

            1                          2                           3                               4

Strongly Disagree      Disagree                 Agree                  Strongly Agree

11. Orphans should be put into a traditional family unit (including a mother and father) if given the option.

            1                          2                           3                               4

Strongly Disagree      Disagree                 Agree                  Strongly Agree

12. The rate of developmental progress is influenced by the type of care an orphan experiences after being orphaned (such as care solely from siblings, an orphanage, a foster family).

            1                          2                           3                               4

Strongly Disagree      Disagree                 Agree                  Strongly Agree


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