Across our world, an estimated 5+ million children live in residential care programs, from small group homes to large institutions. Countless more live on the streets, endure exploitative labor, face human trafficking and other tragic circumstances.
Understanding the true reasons these children have been separated from their families isn’t merely an academic endeavor for those involved in caring for vulnerable children — it’s the foundation for effective response. Without an accurate understanding of why children are placed in alternative care, we are likely to develop solutions that address symptoms rather than causes. Meanwhile, failing to appreciate the depth of the challenges can result in simplistic solutions that achieve little and promote disillusionment over time.
This reality compels us to confront several critical questions:
Why are children living in alternative care? How do regional factors impact the separation of children from parental care? What factors contribute to family separation that might be preventable with adequate support and what factors may require out-of-home care, at least temporarily?
The answers to these questions require not only effective research, but a willingness to consider fresh approaches to the age-old challenges facing vulnerable children around the world.
Rethinking orphanhood: Most children in care have living parents
There is a prevailing belief that children in alternative care are typically orphans—children who have lost both parents. The evidence tells a different story.
Comprehensive research reveals that the majority of children in residential care have not been orphaned, and a large majority have at least one living parent. While this does not mean that the living parent(s) are necessarily willing and/or able to care for their child, it does present a much more nuanced picture of the reasons children have come into alternative care.
For people of faith, this insight deepens the call to care for orphans and vulnerable children. Throughout Scripture, we see God’s heart for family preservation whenever possible, while also ensuring that children are well-protected. Fulfilling the biblical mandate today often calls for addressing complex family challenges rather than simply providing alternative care.
Understanding why children are separated from families
Two groundbreaking studies illuminate this complex landscape of reasons children are separated from parental care.
The first study, a 2022 critical review examining 132 peer-reviewed articles, identified 14 distinct reasons children enter residential care. The second study gathered data from 1,054 adults who experienced separation from parental care as children across more than 20 nations, revealing patterns across different regions and development contexts.
Causes for family separation, as revealed in a 2025 study
These studies reveal that family separation stems from diverse causes, ranging from parental death and poverty to disability, maltreatment and legal issues. Importantly, these factors vary significantly by region and a country’s development status.
Regional patterns of family separation
The research findings reveal notable regional differences in why children enter alternative care:
In Africa, parental death and poverty dominate the reasons for placement in alternative care, reflecting the devastating impact of diseases like HIV/AIDS alongside economic hardship.
Across Asia, parental death, poverty and abandonment appear most frequently, shaped by unique cultural dynamics and limitations.
In North America, several factors are drivers of separation: family stress, abandonment, maltreatment, parenting skills and substance abuse. These findings align with stronger child protection systems that typically intervene in cases of abuse and neglect.
Some regions show dominant patterns, while others reveal multiple significant factors. Abandonment, family stress and parental death emerge as common threads across most regions.
The impact of country development on family separation
A country’s development status — measured by the Human Development Index (HDI) — profoundly shapes family separation patterns. In all but the highest HDI countries, parental death emerges as the primary reason for placement in care, often combined with other factors. Poverty — whether a lack of material resources or, most often, a more complex web of personal struggles and family breakdown — drives separation in Low and Medium HDI nations, but plays a lesser role in more developed countries.
The orphanhood status of children in care also varies dramatically by development context. In Low HDI nations, only 46.8% of children in care have living parents, compared to 83.9% in Very High HDI countries. This stark contrast reflects how different forces drive family separation across the development spectrum.
Regional analysis further illuminates these patterns. In Sub-Saharan Africa, only 54.3% of children in alternative care have at least one living parent, while in North America, this figure rises dramatically to 86.3%.
These regional differences reflect varying factors that may influence parental survival, including prevalence and impact of disease, armed conflicts, poverty levels, and the accessibility of family support systems.
Beyond numbers: Implications for effective care
Understanding these patterns helps guide how we approach child welfare globally. They affirm the importance of a full continuum of care options — starting with efforts to help keep children in their families whenever safely possible, and extending to kinship and foster care, reunification supports, and adoption — always aiming for solutions that are as close to a safe, permanent, loving family as is achievable.
While family-based options should be prioritized, small group homes and other specialized programs capable of more intensive services are also an essential part of a complete continuum of care.
Four takeaway principles include:
1. Prioritize prevention of family separation
Most children in residential care have living parents. Although not all parents are willing and/or able to care for their children, many placements in alternative care stem from challenges that could be addressed with appropriate support. In any community, efforts at family strengthening deserve special priority, potentially including economic empowerment, parenting education, healthcare, and relational and spiritual support and care.
2. Develop locally-informed solutions
The significant regional variations in reasons for placement in care underscore the importance of developing context-specific solutions. As the research emphasizes, “The requirements of children and families living in an urban Latin American city impacted by political terrorism are likely distinct from those of children and families experiencing economic instability and disability on a remote Southeast Asian island.” While it may seem easiest to develop a standard approach to caring for vulnerable children, effective care requires thoughtful consideration of local context and unique contributing factors.
3. Consider reintegration possibilities
Given that many children in residential care have living family members, organizations should explore reintegration whenever appropriate and safe. This involves maintaining family connections during placement, addressing root causes that led to separation, providing transition support and oversight, and offering post-reintegration services to ensure sustainable success.
4. Develop diverse care options
When family preservation or reunification isn’t possible, a spectrum of care options beyond large residential facilities may better serve children’s needs. These options might include kinship care with extended family members, adoption (beginning with local options first), foster care programs, and small family-like homes within communities. Small group homes and other specialized services may also be needed, especially as short-term options for children with more intensive needs.
Toward a new vision of child welfare
This research on understanding family separation invites us to reimagine child welfare systems — moving from large institutions to solutions that emphasize family-based solutions, preventing unnecessary separation while also ensuring appropriate protection for children who truly cannot remain safely with their parents. By understanding the reasons for family separation, we can develop interventions that honor a child’s fundamental need for family while addressing the complex realities that threaten those bonds.
– Nicole Wilke is the Director of the CAFO Research Center.
Editor’s Note: This content highlights some of the key findings from the original research of the CAFO Research Center. Find the full article: “Orphanhood Status and Antecedents to Placement Among a Multinational Sample of Adults With Care Experience,” Child and Family Social Work (June 16, 2025). Explore the infographic here.
