This study asks how policy advancements and shifts in practice in Malta have influenced the evolution of the alternative care system, and how these changes have impacted the welfare and rights of children and families. It also examines the challenges posed by the current legal framework under the Minor Protection (Alternative Care) Act and considers whether further reforms are necessary. Focal to this study is the introduction of the Minor Protection (Alternative Care) Act, Chapter 602. This Act substituted the old legal regime regulated by the Children and Young Persons (Care Orders) Act, the Foster Care Act and the Placing of Minors Regulations. This study sifts parliamentary debates to comprehend the rationale leading to this legislative shift, to explore how policy developments and changes in practice have shaped the evolution of the alternative care system. The framework remained unchanged for 40 years as the Child Protection (Alternative Care) Act was never enforced. Chapter 602 was enacted to reflect societal changes, incorporating reforms, such as prioritising the child’s best interests, the right to appeal, increased judicial involvement, mandatory reporting and independent legal representation. The study takes a law-and practice approach to examine how these changes have affected the welfare and rights of children and their families, presenting stakeholder perspectives, assessing the application of the law in practice as well as its progress and gaps in policy and practice. It also highlights deficiencies that could hinder the progressive development of alternative care. Lastly, it proposes specific amendments in response to the challenges posed by the current legal framework and to improve the implementation of Chapter 602. This study aims to contribute to ongoing alternative care reforms, and to address the evolving needs of children and their families, especially in care proceedings.