Over the last two decades, the model for care of orphans has greatly changed. Decades ago, long-term, large homes were the prevalent model for orphan care. Big dormitories, or at least large group homes, dominated the landscape of care facilities.

Without question—and especially in the emerging world—this model had its problems. Sometimes the problems were fairly minor—kids needed more interaction with society outside the grounds of the orphanage. At other times they were quite severe—children essentially warehoused to get them off the streets and out of sight. Think Oliver Twist repeated around the world. Abuse of children in these facilities was very common. Something clearly needed to be done.

The response of the international orphan-care community was to move away from longterm, residential care to foster care systems that push adoption. This move is so pronounced that, in many countries, longterm residential care facilities have been made illegal, with requirements that children be placed in mixed-gender, mixed-aged foster care for no longer than two years.

Last summer I was involved in a search to find an organization to partner with a residential care facility in Brazil. Unfortunately, the foster care/adoption model is so prevalent that every organization I talked to (including some of the largest international caregivers for orphans in the world) all had the same response, “We no longer do longterm care.” Not some, not most, every single organization.

Which then brings the question, “What happens when the child is not adoptable, is not a candidate for foster care?” Millions of children worldwide cannot be adopted, and for one reason or another, would not make it in foster care. A child that is fourteen years old, that has spent seven years on the streets of a Sao Paulo, that has suffered abuse at the hands of virtually everyone he has encountered will never thrive in foster care. A fifteen-year-old girl who was first prostituted when she was nine will fit in with a mixed-gender foster family? I don’t think so. A twelve-year-old orphan that has spent two years in a children’s prison is not adoptable.

Adolescents like these need specialized care, the kind that can only be provided by a team of caregivers in a long-term residential facility. They need the context of family, but it needs to be in a larger less-intimate setting that is prepared to deal with problems common to older orphans like reactive attachment disorder. And a two year limit on residential care will get these kids nowhere but back to the streets.

Should foster care and adoption be the primary model? Absolutely. But there will always be a place for longterm residential care. Residential programs must be closely regulated and monitored to assure standards of care, but they must not become relics of the past. Too many young lives depend on them.