Section 4, Chapter 2 (Placements), Subsection 2 – Initial Placement Activities

Effective Date:  10-1-21


Placement with a Resource Family (Foster or Relative)

When a child enters the Division’s custody and needs placement with a resource family, the Children’s Service Worker will prepare the resource provider for placement, providing all available information about the child. The Children’s Service Worker shall provide to resource providers and potential adoptive parents prior to placement, all pertinent information including but not limited to, full disclosure of all medical, psychological, and psychiatric conditions of the child, as well as information from previous placements that would indicate that the child or children may have a propensity to cause violence to any member of the resource family home. The resource providers shall be provided with any information regarding the child or child’s family, including but not limited to the case plan, any family history of mental or physical illness, sexual abuse of the child or sexual abuse perpetrated by the child, criminal background of the child or the child’s family, fire-setting or other destructive behavior by the child, substance abuse by the child or child’s family, or any other information which is pertinent to the care and needs of the child and to protect the resource or adoptive family.

The resource providers shall be given at time of placement full access to the child’s medical, psychological, and psychiatric records in its possession, including reports prior to the child coming into care; continued full access to all records that come into the possession of the division or of which the division becomes aware; access shall include providing information and authorization for the resource parent to review or to obtain the records directly from the medical, psychological, or psychiatric services provider; and resource parents may decline access to any or all of the child’s records.

To prepare the child for placement, the Children’s Service Worker will provide the child with information about the resource family. The worker will help with the trauma of separation, reinforcing the belief that the child is not the cause of the family disruption. The child will also need help to understand the reasons the parents/caretakers cannot care for him/her. If age and developmentally appropriate, assure the child they will be directly involved in long-term planning and will be expected to maintain personal responsibility for their actions.

  • All youth, at an age and developmentally appropriate level, should be informed of and given a copy of the Foster Care Bill of Rights.
  • Youth, ages 14-21, shall receive a copy of “What’s It All About?” A Guidebook for Teens in Out-of-Home Care, and shall be referred to the Older Youth Program for Chafee Foster Care Independence Program (CFCIP) services. The book is intended to assist youth while in care and transitioning out of care.  The last page of the guidebook contains an acknowledgement form for the youth to sign. Documentation of a youth being provided the guidebook should also occur in the case narrative, in a FACES contact entry.

The Children’s Service Worker shall arrange pre-placement visits, except in emergencies, per Section 210.566, RSMo.

Any pre-placement visits must be discussed with the Family Support Team and the pre-placement provider.  The Family Support Team should review the Foster Family Profiles of potential resource providers in determining and selecting the most appropriate placement for the child. Decisions regarding the pre-placement visit plan and its details are on a case-by-case basis and are unique to the needs of the child.

The licensed resource home of the pre-placement visit is not eligible for any payment for the child while on the visit, except allowable mileage reimbursement if applicable. Any exception must be pre-approved through supervisory channels with final approval by Central Office.

After transporting the child to the resource family, the Children’s Service Worker will confirm or clarify any information previously shared. The worker will provide a copy of the court order placing the foster youth in CD custody. The resource provider shall be provided with a copy of subsequent court orders while the foster youth is placed in their home until the release of jurisdiction is signed by the judge. The worker will also provide full and accurate medical information (current conditions and history) to the resource provider at the time of placement, including information contained within the CW-103. If none or only part of the above is known, the case manager shall share what is available and continue obtaining needed information. If the child has tested HIV positive, provide complete information for caring for the child’s special medical needs and infection control (see below).

The Children’s Service Worker should provide the following additional information at the time of placement:

  •    A copy of the Authorization to Provide Alternative Care form, CS-33 (if available).
  •    A MO HealthNet form and instructions for obtaining a complete health examination.
  •    Procedures for obtaining clothing for the child.
  •    The name and phone number of the child’s current school and instructions to enroll the child in a new school, if needed.
  •    The name and 24-hour contact telephone numbers of the worker and supervisor.
  •    The Universal Placement Letter which contains a link to the Foster Parent Bill of Rights and Responsibilities.
  •    Families who do not have access to the internet shall be provided a printed copy of the Foster Parent Bill of Rights and Responsibilities at their request.  

A full HCY examination including eye, hearing, and dental examinations should be completed no later than 30 days after the child is placed in Children’s Division custody. In addition, children should receive a developmental, mental health, and drug and alcohol screening within 30 days of the child’s entry into care. If needs are identified, these needs must be treated as soon as possible.

If the Children’s Service Worker is unable to obtain the initial medical exam prior to placement, the initial medical examination shall occur, if possible, within 24 hours of the child coming into care. This initial health examination does not need to be a full Healthy Children and Youth (HCY) assessment. The purpose of the initial health examination is to identify the need for immediate medical or mental health care and assess for infectious and communicable diseases. When possible, this initial health examination should be completed by the child’s current primary care physician as they know the child and have knowledge of the child’s medical history.

If a provider is not readily accessible, this exam must occur within 72 hours of the initial placement.

Children, who enter CD custody should have continued follow up as needed following the initial examination. It is the Children’s Service Worker’s responsibility to ensure that children in CD custody receive the appropriate screening, assessment, and follow-up services as necessary. Children’s Division shall maintain best practices in monitoring the child’s health as required by federal and state laws, and as recommended by the American Academy of Pediatrics (AAP) and the Child Welfare League of America (CWLA), which set forth that certain medical appointments occur timely to assess and monitor the child’s health.   More information regarding medical exams can be found in Section 4, Chapter 4, Subsection 3 – Medical and Behavioral Health Planning.

The medical examination should include an HIV screening (ELISA test) for children displaying symptoms of AIDS or AIDS Related Complex (ARC) or at high risk of HIV exposure.

Children at risk of HIV infection include:

  •    Hemophiliacs or those children who received blood transfusions prior to 1985
  •    Intravenous (IV) drug users
  •    Infants born to a mother who tests HIV positive
  •    Children with one or both parents who have tested HIV positive, have ARC, AIDS, or is at high risk for AIDS
  •    Sexually active youth who have had a sexual contact with a high-risk individual or an HIV infected individual
  •    Subjects of sexual abuse where the perpetrator is at high risk of AIDS or is an HIV infected individual

The worker will utilize the team approach to determine the most appropriate resource family for a child who tests HIV positive. Team members should include:

  •    The child’s physician
  •    Public health personnel
  •    The child’s parent or caretaker
  •    Case manager
  •    The potential resource family provider, i.e., foster parent, adoptive parent, residential care provider
  •    The child (age 13 or older)
  •    Residential licensing representative, if appropriate
    • The team may need to meet at regular intervals to assess the child’s health status and the appropriateness of the placement setting.
    • A child placed in an out-of-home care setting has a right to privacy. This right is necessary to protect the child. Only those persons directly responsible for the child’s care or defined as a person with the need to know (see Sections 191.650 – 191.695 and 210.566, RSMo) should be informed of his/her condition.
    • Report immediately any accidental injuries to a child in Children’s Division’s custody, and who is a MO HealthNet recipient, using procedures in the Income Maintenance Manual, Chapter VII.

Placement of a Child in a Different Circuit

If the Children’s Service Worker or the contracted agency place a child in a different circuit it is vital for the circuit to know so they can offer local services as needed and provide support to the family.

If the child is placed in a different circuit the Children’s Service Worker or Supervisor must obtain permission from the licensing worker/contracted agency in the receiving county prior to placement. The Children’s Service Worker or Supervisor shall also ensure that the receiving circuit is notified of the placement by emailing the circuit’s courtesy email box within 24 hours of the placement. Circuit courtesy email box addresses can be found at the following link Courtesy Email Box Addresses.

If the child is being placed with a relative, follow the policies in the Out of County Home Assessment located in Section 6, Chapter 9. The Children’s Service Worker or Supervisor shall ensure the receiving circuit is notified of the relative placement by emailing the circuit’s courtesy email box within 24 hours of the placement.

If the child is being placed after hours, and permission cannot be obtained, the Children’s Service Worker or Supervisor shall ensure that the receiving circuit is notified by emailing the circuit’s courtesy email box within 24 hours of placement.


Placement in a Residential Setting

When a child enters the Division’s custody and requires placement in a residential setting, the Children’s Service Worker will coordinate with the Residential Care Screening Team (RCST) Coordinator and the residential provider to coordinate the care and treatment.  Case management of children in residential placements require specific actions as further described in Section 4, Chapter 2 (Placements), Subsection 3 – Residential Rehabilitative Services.