There are currently more than 1,300 children with developmental disabilities residing in Texas institutions. Research on child development confirms that children need a strong attachment to a nurturing adult in order to maximize their developmental potential. Institutionalization results in decreased emotional, physical, cognitive, and psychological development. Many states have recognized the need to find family-based alternatives to institutionalization for children with developmental disabilities who cannot remain with their birth-families. States are recognizing the need for children to grow up in families and the necessity of providing sufficient family support to help families thrive. This report explores some of those options and the experiences of six states in developing family-based alternatives to institutional care.