Following Children from Institutions into Communities

Child transitions from residential facilities to other communities: predictors of child wellbeing


Globally, 153 million children are estimated to have been orphaned as defined by the death of one or both parents due to diseases such as malaria, tuberculosis, and cancers, maternal mortality, unintentional injuries, natural disasters and armed conflict: AIDS accounts for 16.6 million of these children. We can anticipate that numbers will increase with economic declines, decreased agricultural output due to environmental changes and increased natural disasters. In Ethiopia, an estimated 650,000 children have lost one or both parents to AIDS. The majority of orphaned children and children whose biological parents have left them are cared for by the remaining parent, other family members, or non-relatives in family settings. A small proportion live in residential facilities.

The primary goal of this pilot study is to understand the emotional and physical well-being of children transitioning out of residential care to better inform good policy and practice on the protection of children. The intent is to understand factors associated with positive and negative transition outcomes. Care transitions occur for a variety of reasons, such as family placement, aging out (reaching the maximum age allowed in residential facilities), child self-initiated departures, community or family initiated retrievals, residential facility initiated expulsions, and residential facility closures.  This study attempts to assess children’s mental and physical well-being while still living in residential care and then follow them out of residential facility care into other living environments.

The study is designed to determine the feasibility of finding, following and maintaining communication with children as they leave residential facilities, and to examine if there are trends or associations in how transitions are made. In particular, pre-transition child characteristics (e.g., age of entry into residential care, years in residential care, age at placement in a community setting), facility characteristics, transition planning characteristics, community placement characteristics, and child wellbeing outcomes will be analyzed and compared to data from matched controls who did not leave residential facilities and those raised in community-family settings. The study will collect important description information such as: what percentage of children leaving residential facilities are traceable, what types of different living environments do children end-up in after leaving residential facilities, what types of social networks do they have, what support systems and resources do they have access to, and what coping and adaptive strategies are used by them and the communities they transition into. Short-term descriptive information such as documenting the range of living environments children transition into is vital.  However, short-term outcomes may not reflect longer-term physical or emotional trends.  If the pilot study methodology proves successful, and children are able to be followed over time, a longer, multi-country longitudinal study will be proposed.

Policy Implications :

  1. To examine how transition out of residential facility care affects the positive and negative physical and mental health trajectories of children, young adults, and their families. Reasons for transitions include residential facility closures, aging out and self-other initiated departures.
  2. To examine key characteristics of transition experiences including transition planning process, presence or absence of individual case plans, case-management services provided, preparation of the receiving family and community, level and type of monitoring, availability of resources and services provided.
  3. To better understand associations between characteristics of the residential facilities and post-residential facility care, and child emotional, physical and social well-being before and after re-location.


Principal Investigator: Sumedha Ariely

Investigators: Kathryn Whetten (Duke University), Jan Ostermann (Duke University), Misganaw Eticha (Stand for the Vulnerable Organization)

Project Coordinator: Anna Both Koons