This multi-country, longitudinal study collected data during 2006-2024 from orphaned and separated children (OSC) living in Cambodia, Ethiopia, India, Kenya, and Tanzania. Its purpose is to examine the influence of residential characteristics, caregiver characteristics, and culture on child outcomes including emotional adjustment, health status, learning and achievement outcomes, relationship outcomes, HIV risk behaviors, and HIV outcomes. The goal was to identify areas where changes in local, national or international policies would improve child wellbeing trajectories and to identify where interventions could be developed, implemented and sustained that would positively impact the lifelong trajectories of people who were orphaned or permanently separated from their biological parents.

Some of the major findings to date are that:

1. The single most important attribute associated with the health and wellbeing of the child is the caregiver’s wellbeing, yet most interventions and policies to help the OSC focus on the child (e.g. assistance with the orphaned child’s school fees, uniforms, food at school) and not on strengthen the wellbeing of the caregiver and family unit.
2. Supports provided for the orphaned child, such as school fees, are often not used for the intended purpose, but these same supports are associated with improved emotional wellbeing and educational attainment, likely because the supports improved the ability of the caregivers to provide positive parenting.
3. Orphaned or separated children are extremely vulnerable to ongoing potentially traumatic events, and these events are then associated with worse mental health symptomatology and educational attainment.
4. Boy and girl OSC are equally vulnerable to experiencing potentially traumatic events as children, and equally likely to experience the related negative emotional and educational outcomes. Substance abuse and sexual risk taking are equally predicted by childhood traumatic. Yet all gendered policies and interventions to date have focused on girl children.
5. The excessive labor of girl children has been underestimated globally because the traditional ways of measuring excessive labor do not include chores at home and unpaid caretaking of children, the elderly and people in need in the neighborhoods. When families are experiencing financial insecurity, boy children often work for pay on the streets or otherwise and girls take over the work of the adults in the households.
6. Whether a child was living in a residential care (also called group homes, orphanages and institutions) or family home does not explain the variation in OSC emotional wellbeing, educational attainment, risk behaviors or civic engagement. Furthermore, living in a residential home care can provide high quality, family-like, trauma informed care that can be protective of potentially traumatic events . 

Each of these findings has important implications for OSC policy and programming, including:

• the need to better protect OSC, including boys as well as girls, from potentially traumatic events;
• there is a desperate need to provide living options for OSC and residential care can be a very positive. Locally sustainable and monitored residential care should be supported. and
• if we want to improve the lives of OSC, we need to focus on the caregivers and care environment as much as supporting the individual child.

POFO also found significant stigma against children who were orphaned, regardless of the cause of the orphaning. This should be taken into consideration when developing programs to combat orphan stigma and stigma related to HIV/AIDS.