Compared to Western Europe, Romania has a very high proportion of children in residential care. Most of these children live in the type of large institutions, erroneously labelled as ‘orphanages’, which featured so prominently in Western media coverage of the country immediately after the 1989 overthrow of President Ceausescu. Jonathan Dickens and Julia Watts have worked since October 1994 for the Romanian Orphanage Trust. Focusing on the aims and achievements of that organisation, they describe attempts to develop alternatives to residential care in a society beleaguered by financial hardship and in which social work has only recently re-emerged as a profession, following some twenty-five years of abolition under communist rule. They show how the Trust has deliberately moved away from directly providing and managing services for children and families towards an approach bent on stimulating and helping the growth of Romanian led and managed initiatives. Despite the high number of children in institutions, and obstacles such as poverty and traditional attitudes to substitute family care, the authors conclude that adoption and fostering have an important role to play in an overall programme of prevention, rehabilitation and anti-poverty measures in Romania.