This new working paper focuses on the role of gatekeeping in strengthening family-based care and reforming alternative care systems. Gatekeeping refers to systematic procedures aimed at ensuring that alternative care for children is used only when necessary, and that the type of care provided is suitable to the individual child. This working paper reviews different approaches to gatekeeping in five countries–Brazil, Bulgaria, Indonesia, Moldova, and Rwanda–to consider what has and has not worked, to analyze lessons learned from practice, and to reflect on the implications for improving policy and programs in this area.