Continuum of Care
The Continuum of Care depicts the vital processes, mechanisms, and care options necessary for supporting children at risk of being or already separated from their parents.
Click on the various care options to learn more.
LONG-TERM SOLUTIONS: FAMILY CARE
Growing up in the nurturing care of a family provides children with love, a sense of belonging, and a lifelong connection to a community of people, shared history, and culture. Scripture and academic research are in agreement on this fundamental truth: children develop best in families.
The goal in any situation where a child is either at risk of being separated from his or her parents or already separated is long-term placement in an authentic family. Long-term family solutions include care of a child by either the child’s birth family, extended family, or an adoptive family (or custody/guardianship when adoption is not an option).
Family-strengthening, or family support services, helps prevent family separation. These services include a range of measures including counseling, parent education, day care, and livelihood and material support.
BIRTH FAMILY
The continuum of care begins with the child’s birth family, which is also called the family of origin or biological family. Family provides the belonging, identity, and care a child needs to thrive. Keeping children within their family of origin whenever safe prevents the trauma of separation and disruption of relational bonds.
Strategies that strengthen the capacity of birth families to care for children, such as micro loans, mental healthcare, and medical support, are vital to preventing unnecessary separation and ensuring safe environments for children.
EXTENDED FAMILY
Extended family, such as aunts, uncles, grandparents, older siblings, and other relatives, is an important option for children who are unable to live with their parents. This type of care is often called kinship care and may also include close family friends in some contexts.
The vast majority of children separated from their parents live with extended family members. It is the most prevalent and indigenous model of alternative care throughout the world. It may be formal, meaning that it is arranged through social services or judicial authority, but is more commonly informal in nature—often a matter of extended family stepping up to care for their loved ones. Care by extended family may begin as temporary, but can shift over time to permanent or long-term, even resulting in legal adoption.
Care by extended family helps sustain and protect family ties. It prevents a child from losing his or her culture and, most importantly, provides children with a strong sense of belonging and identity. For these reasons, care with extended family is often preferred by children over other types of alternative care. Because caring for a child may put additional strain on relatives and aging grandparents who may be affected by poverty or other challenges, extended family members benefit from family strengthening, including support services and case management to ensure quality care for children.
ADOPTIVE FAMILY
Adoption provides a legal and permanent family for children who cannot live with their biological mother or father. It involves the permanent legal transfer of parental rights and responsibilities to either family or non-family members. An adoptive family offers a stable, nurturing environment and the security of lifelong family connections. However, adoption is not yet legally available in some parts of the world, so other options, like permanent guardianship may be considered instead.
Domestic adoption can help children remain connected to their cultural ties. Intercountry adoption is utilized in cases where local permanency options have been exhausted in the child’s country of origin, therefore providing children with the opportunity to have a permanent family, albeit outside of their cultural and familial ties.
It is essential that there is a significant process of investigation and professional case management before it is determined that a child is available for adoption. This ensures that children and their families are not being coerced, that the possibility of reunification with the birth family has not been overlooked, and all implications have been considered, including inheritance rights.
FAMILY STRENGTHENING
Family strengthening efforts, or family support services, are the very center of the continuum of care because it is integrated throughout each part. It applies to any family who provides care for the child, both short or long-term care. Family strengthening builds the capacity of families to provide and care for children and is tailored to the unique challenges and assets of each family through an individualized approach.
Family strengthening strategies can address the challenges that put children at risk of separation from family care. Services that help strengthen families include:
- livelihood and material support,
- medical care,
- mental health support,
- cash transfers,
- microloans and savings programs,
- food and agricultural support,
- access to education and daycare,
- parent education and support groups,
- home-based care, and
- spiritual support
These services can be delivered as programs in the community or as part of case management with individual families. Individualized case management for families who need complex support utilizes caseworkers as guides or coordinators to help map out a personalized plan and connect the family with the right services, keeping an eye on their progress and making sure everything is working smoothly.
Family strengthening helps more children grow up in a family, while also protecting children from mistreatment or abuse. When the safety net of care is strengthened, fewer children are neglected, abandoned, or otherwise separated from family care.
Local formal and informal child protection mechanisms identify when a child is experiencing or at risk of abuse, exploitation, neglect, or when a family is in crisis. These concerns are then reported to the appropriate authorities or child welfare agencies to ensure timely assessments and support. Child protection mechanisms include police, community leaders, faith-based groups, neighborhood committees, friends and family members, or school officials.
CHILD AT RISK OF SEPARATION
There are many reasons why a child is either at risk of or already separated from his or her family. Poverty and lack of access to basic services are often underlying factors. In most cases, it is poverty combined with another crisis or challenge that leads to separation or family breakdown, such as illness, unemployment, death of a caregiver, disability, natural disaster, or armed conflict. Sometimes children are separated from family to access resources not available in the community, including quality education, food, and shelter. In other cases, children are separated from family due to abuse, neglect, or exploitation.
When a child is identified as at risk of separation, gatekeeping involves assessing their needs to determine the least invasive support and to prevent unnecessary family separation.
When a child is in crisis, best practice is to prioritize family preservation, when safe and possible. Keeping families together reduces the trauma of separation and protects relational bonds and attachment.
GATEKEEPING
When a child is either at risk of separation or already separated from his or her family, gatekeeping is the process of assessing the situation of the child and family to determine the least invasive and most suitable form of support to match their individual needs. Gatekeeping is often part of a larger case management process, where a caseworker supports children and their caregivers to understand their needs and connects them to helpful services.
How gatekeeping is managed will look different depending on national policies and local practices. In some countries, gatekeeping may involve a judicial process in which decisions about children’s care are made. In other contexts, gatekeeping may be overseen by mandated child protection authorities or a multidisciplinary panel.
Gatekeeping can result in children staying in their birth families when their families are safe while receiving support and monitoring. However, when it is not possible for a child to remain in the care of his or her birth family, either temporarily or for the long-term, then the gatekeeping process determines the most appropriate placement for that individual child.
Gatekeeping is especially critical for assessing all family care options and preventing unnecessary separation and inappropriate placement in residential care. Gatekeeping should always be a group process that is informed by the active participation of children and youth, families, and key stakeholders—such as social workers, child protection authorities, legal representatives, foster carers, educators, health professionals, and community or cultural leaders. Children and youth are important partners in identifying their own needs and determining possible solutions.
TEMPORARY SOLUTIONS
When it is determined that care within a child’s family is unsafe, or not in a child’s best interest, temporary solutions can provide care for a child while issues with the child’s birth family are being addressed or a long-term family solution is being assessed and prepared. Temporary solutions may include family-based alternative care, supported independent living, or residential care.
FAMILY-BASED ALTERNATIVES
A robust body of evidence shows that nurturing family environments support healthy child development. For children separated from their biological parents, best practice calls for them to be placed in family-based alternatives. Temporary family-based care options, such as care with extended family, foster care, or guardianship, provide stability within a caring family while issues with a child’s birth family are addressed or until another long-term family care solution is identified. These family-based alternatives are authentic family environments, not the same as family-style or family-like small group settings, which are considered residential care.
Extended family or kinship care is care by relatives, such as aunts, uncles, grandparents, older siblings, and other family members. It can also include close family friends in some contexts. When safe, care by extended family reduces disruption, stress and trauma for a child and preserves familial ties.
Foster care with a nonrelative may be used in situations where extended family members cannot be identified or are not able to care for children. Foster care is typically a temporary arrangement authorized and arranged by an administrative or judicial authority. While the government usually retains legal custody, foster families in the community provide daily care for the child. Caregivers often receive some form of support such as a small stipend or assistance with food and a child’s education. Proper screening, training, support, and oversight of foster families is crucial to providing a safe, stable, and nurturing environment for a child. While foster care is typically used as a temporary placement for a child, it may also serve as a pre-adoption placement, often called foster-to-adopt. In some cultures and countries, especially where adoption is not currently legally recognized, foster care can serve as a permanent family placement.
Guardianship is similar to foster care, but unlike foster care, it normally involves a court granting an adult legal custody and the authority to make decisions on behalf of a child. This arrangement can be more permanent, though it may not always terminate the biological parents' rights. In Islamic contexts, kafala functions similar to guardianship, where a sponsor cares for a child without severing ties to the birth family and retains the child’s original family name and inheritance rights.
SUPPORTED INDEPENDENT LIVING
Supported independent living can help older youth and young adults transition to adulthood as they reach the age and capacity to live more independently and express a strong desire to do so. Those entering into supported independent living require individualized care planning and follow-up. Older youth and young adults should be actively and fully involved in developing their care plans including identifying solutions to obstacles, to overcome to be in place for them to be successful, identifying their strengths, and needs, and discerning goals to attain. A care plan may include assistance in strengthening life skills, budgeting, cooking, job seeking, and integration into the community. Identifying and preparing mentors, linking to peer support groups, and arranging work apprenticeships in the community can provide those in supported independent living with key relationships and guidance as they navigate their individual paths to independence.
RESIDENTIAL CARE
Residential care, often referred to as an orphanage or children’s home, is a broad term that encompasses large-scale institutional care, small group homes, family-style or family-like homes, and short-term group care facilities. Its basic characteristic is care provided by paid staff and/or volunteers to a group of children. Residential care can vary significantly in the model and quality of care provided.
Residential care is considered a last resort when family-based alternative care is not appropriate for a child. In exceptional circumstances, residential care may be an appropriate option for some children. However, placement in residential care should always be temporary and transitional, ultimately leading to family care or supported independent living.
Residential care could be needed temporarily for some children and families as:
- Respite care services to provide birth, kinship, foster and adoptive families with a brief break in caring for children, especially those with special needs;
- Targeted therapeutic or rehabilitative services, such as psychological counseling or medical services, preparing a child for reintegration into family; and
- Safe houses or emergency shelters for especially vulnerable children who require protection for a period of time during a crisis or in an emergency context.
Once a child has been placed within residential care, a priority is to transition the child back into family care whenever possible through reunification or placement in family-based alternative care.
Institutional care is widely recognized as an unsuitable option for any child due to its inability to provide individualized care to children, resulting in harm to a child's development and protection.
Once a child is placed in temporary alternative care, the priority is to quickly determine and prepare for a permanent or long-term family-based solution.
PERMANENCY PLANNING
Permanency planning is a vital case management process for assessing the best possible long-term family care option for a child and ensuring stability, continuity, and a sense of belonging within a supportive family. Its goal is to provide a safe, loving, and permanent family as quickly as possible to support a child’s well-being and development.
Like gatekeeping, permanency planning is a group process that is informed by the active participation of children and youth, families, and key stakeholders—such as social workers, child protection authorities, legal representatives, foster carers, educators, health professionals, and community or cultural leaders— to identify the needs and possible solutions for long-term placement and support.
Permanency planning may result in reunification and reintegrating of a child permanently back with his or her family, which could include extended family members. The reintegration process is not a one-time event but a series of steps, including assessing the root causes for the separation, determining how best to address those causes, preparing the child and the family, facilitating access to appropriate services and support, and ongoing monitoring.
Permanency planning may also result in adoption for children when prospects for reunification with family has been ruled out. When moving toward adoption, it is important to prepare the child and adoptive family through open communication, emotional support, and honoring the child’s cultural and relational connections whenever possible.
Reintegration back into a safe, loving, and permanent family is the goal of the continuum of care, supporting the child’s well-being and long-term development.
