This chapter discusses the research findings and innovative theoretical approaches on the topic of the rights of children and adolescents to participate in out-of-home care. It also discusses the legal foundations, theoretical approaches to promote participation in alternative care, gaps in the implementation of participative rights and empirical findings on potential opportunities for and barriers to the participation of children and adolescents in residential and foster care. The term out-of-home care covers a broad and diverse spectrum of out-of-home placements, ranging from children’s homes and residential group care to foster care and other “family-like” care settings. Participation is a multi-faceted and complex term that leads to the misunderstanding. The English word participation describes different forms of social engagement. The organization or institution must ensure that the aforementioned conditions are met. Participation is ensured only when the four preconditions are fulfilled.