Keeping families stable, secure, and together
Editorial, The Lancet Child and Adolescent Health
The United Nations Convention on the Rights of the Child enshrines the rights of children, as far as possible, to know and be cared for by their parents, to preserve their identities, including family relations, and to not be separated from their parents against their will. UNICEF estimates that in 2023, 102 of every 100 000 children globally were living away from their parents in residential care (small group homes or large institutions), and few global data exist on children placed in family-based alternative care (non-relative foster or kinship care). A Human Rights Watch report from March 26, 2025, details the devastating disproportionate removal of children from Aboriginal women in Australia, and exemplifies the over-representation of marginalised families in child protection systems and alternative care placement. First Nations children in Canada are also more often placed in alternative care than non-Indigenous children. In Europe and Central Asia, children with disabilities are the majority of children in residential care.
Placement of children in alternative care, away from their parents, is seldom due to individual parent failure but rather the culmination of complex family stressors—physical or mental health challenges in the parent or the child, poverty, alcohol and substance misuse, family violence, stigma, and discrimination amongst them. Families experiencing these challenges are more likely to miss out on basic services such as health care, education, and social support that help families stay together. As a result of deep-rooted social norms and ableist attitudes about effective parenting and disability— experienced most intensely by minoritised people—child protection interventions often come after many missed opportunities for systems and societies to address the specific drivers of family vulnerability.
Child protection systems have the intention to safe-guard and act in a child's best interest when placing children in alternative care. However, institutionalised care has damaging effects on children's physical, cognitive, and emotional development. Although foster or kinship care is preferable to institutionalised care, they are in most cases no substitute for keeping families together. Children growing up away from their parents are more likely to face continued exclusion from society, struggle with alcohol and drug use, and experience violence, arrest, and imprisonment. The changes in caregivers, home, neighbourhood, school, and friends and the disconnection from culture impact profoundly on the wellbeing of children. Children in alternative care often lack secure, trusting relationships with caring adults. Without these pillars of stability, youth transitioning from care to independent living face cycles of mental and physical health consequences that establish a harsh trajectory into lifelong discrimination and disadvantage for themselves and their future families.
Effective evidence-based interventions to promote family strengthening are those in which parents are active partners in community mental health interventions, social protection schemes, supportive case management, and parenting skills development programmes. Bias, discrimination, and stigma experienced by marginalised families must be recognised and overcome for parents to be empowered and adequately supported to care for their families. Inclusion of young people's voices is essential, and wishes around their care and welfare must be taken seriously. Culturally appropriate approaches to raising children and facilitators of family healing must be prioritised and led by the communities affected.
Placement in alternative care seldom provides greater stability for children than remaining with their parents. When efforts directed to enabling children to remain in their parent's care have been unsuccessful, the UN Guidelines for the Alternative Care of Children recognises that placement with other close family members should be prioritised. Ultimately, when alternative care is the safest option for children, stability and caring relationships beyond the immediate family can still pave the way to positive long-term educational and employment outcomes. Connecting children and youth with trusted adults who offer mentorship and encouragement can support young people's development of competence, autonomy, and self-determination, which are associated with lasting health outcomes after leaving care.
The health impact of family separation is lifelong. Greater societal and political action is needed to invest in early identification of family stressors and remove barriers to family stability well before children are put at risk of harm. While governments and global organisations must safeguard children from harm, the value in keeping families stable, secure, and together cannot be underestimated.
Read this on the website of Lancet Child and Adolescent Health here.