This chapter describes findings from a longitudinal cohort of orphaned and separated children and adolescents in western Kenya, comparing those living in extended family households (HHs), institutional settings (Charitable Children’s Institutions, CCIs), and on the street (street children, SC). The present analysis is from 1158 orphaned and separated adolescents aged 10–18 years at baseline. The ISPCAN Child Abuse Screening Tool for Children at Home (ICAST-CH) was used to ascertain child abuse and neglect. At baseline, 43% of participants reported having ever experienced any abuse: 31% emotional, 38% physical, and 15% sexual. After 2 years of follow-up, 44% of participants reported new abuse, 30% emotional (26–28% in CCIs and HHs, 71% among SC), 38% physical (33–37% in CCIs and HHs, 81% among SC), and 15% sexual (11% in CCIs, 15% in HHs, and 40% among SC). Overall, 40–44% of participants in CCIs and HHs, and 82% of SC, reported experiencing any new abuse during the follow-up period. After adjusting for age, sex, orphan status, and length of time in the household and clustering at the household or institutional level, we found no difference in the prevalence or incidence of abuse comparing participants in CCIs and those in HHs, but SC were 4.7 times more likely than participants in HHs to experience abuse, both at baseline and follow-up. These data suggest unacceptably high levels of child abuse occurring among orphaned and separated children and adolescents living in CCIs and HHs, with the highest levels of child abuse occurring among street-connected children and youth.