Countries throughout Eastern Europe and Central Asia struggle to change their childcare systems from one that is predominantly based on large-institution care to one that has a continuum of services and is family-focused. Georgia has shown, in large part, that the laudable goal of ending large-scale institutions for children is possible, including for children under the age of 6 years. Between 2005 and 2013, the Government in the Republic of Georgia closed 32 large, state-run institutions housing children without adequate family care. Social work was strengthened, a robust program was created to reunite children with their families, a foster care system was put into place and scaled up, and small group homes housing 8 to 10 children were established. What happened in Georgia is unique in the region. The Ukraine, which by many accounts has 100,000 children living in large, Soviet-style orphanages, has struggled to reform its childcare system. It has been estimated by childcare professionals in the Ukraine that institutional care for children accounts for over 1% of the gross domestic product. Romania, which has made considerable progress over the past 10 years, still has over 40,000 children in large-institution care. This article aims to tell how this transformation was accomplished, the conditions in Georgia that made the reform possible, how the institutions were closed, how the alternatives were established, and how sustainable the progress has been.