Countries which have traditionally relied on institutional care are now undergoing major transformations to their child care and social welfare policies, in order to move towards community care options. Such transformations are rooted in the research-based evidence of the impact of institutions on a child’s development, vulnerability to abuse within institutional settings, and the institution's high operational costs. It is therefore of great concern that the use of institutions is increasing in developing countries with high rates of HIV/AIDS. Such projects are typically funded by foreign donors to the detriment of the local population, and pressure should be placed on the host governments to pursue policies of community rather than institutional care.
Institutions should be divided into small group homes in order to provide care which more closely resembles a family structure, with the close supervision of consistent adult caretakers, and with siblings, cousins and friends kept together. Adolescents, who may find integration into a new family difficult, may benefit from small group home care or supported independent living arrangements. Such homes should be fully integrated in the community to which the children belong, with a comparable standard of living. Any group home must adhere to stringent standards of documentation and care and be regularly monitored by protection workers to ensure the children have their safety, health, psychosocial, and educational needs met.
Any child in an institution must have their needs assessed and planned for, to enable them to return to their families as soon as possible. If a child has become separated from her family in an emergency, documentation, tracing and reunification activities should begin urgently. If a child has been removed from parental care for her safety, support services should be provided to the parents in order to facilitate the return of the child. Children must be kept fully informed and involved in any plans for their care, and encouraged to maintain contact with known relatives where possible.
The literature in this section deals with examples of countries which are working to develop their child care policies away from using large scale institutions to alternative community care options such as kinship care, fostering, and small group homes.