Section 4, Chapter 4 (Working with Children), Subsection 1 – Children in Placements

Effective Date:  7-2-2021


Upon entry into care, the case manager must either take or obtain a photograph of each child. An updated photo should be taken at least every six (6) months for children six (6) years old or younger and then once a year for older children. An updated photo should also be taken whenever the child’s appearance changes. Staff should obtain a digital photograph whenever possible.

Tips for Child Photographs:

  • Photo should be a head-and-shoulders color photo in which the child’s face is clearly seen, similar to a school portrait.
  • The background should be plain or solid.
  • The child should not be overly posed.
  • There should be no other people, animals, or objects in the photo.
  • The photograph should be taken indoors or out of direct sunlight.

Child Contact (all placements)

The child’s Children’s Service Worker shall meet face-to-face, individually and jointly, with the child and the resource provider, at the placement, no later than the next business day following initial placement and any time a child changes placement during out-of-home care, including trial home visits. Arrangements may be made for someone other than the case worker to complete this visit with supervisory approval.  The case manager should then meet face-to-face with the child a minimum of one time per month with the majority of the visits being in the placement to monitor and assess the safety of the child.  The case manager is required to have at least monthly contact with the placement provider, of which the majority should be in placement setting. 

Examples of the majority include:

  • If a child is in foster care for 6 months during October 1 thru September 30, 4 out of the 6 required visits during that time frame must be in the child’s placement.
  • If a child is in foster care for only 2 months during the Federal Fiscal year, 2 visits must occur in their placement as the majority of the visits are required in that setting.
  • If a child has been placed in a foster home for 5 months, 3 of the visits held with the provider must be in the provider’s home.

The visit with the child is to continually assess:

  • The child’s safety in the placement
  • The child’s reaction to separation from his family
  • The child’s perception/understanding of the problem and what he would like to see happen
  • The child’s adjustment to placement
  • The resource provider’s perception of the child’s adjustment to placement
  • The Children’s Service Worker’s observation of the child’s adjustment to placement
  • The resource provider’s response to the sibling group’s adjustment and
  • The sibling group’s response to the resource provider.

The Children Service Worker must also provide and explain the Foster Care Bill of Rights to the child during the first visit.  This explanation should be done at a developmentally appropriate level and the case manager can include the foster parent or other support to the child in the discussion if needed.

Each visit should be of a high quality. Visits should be purposeful and provide a chance for the worker to engage with the child.  Some characteristics of a high quality visit include:

  • Good Communication
  • Informing the child on the status of the case (events, goals, dates)
  • Asking what the child wants (getting the child’s voice)
  • Speaking with the child alone
  • Responding timely to previous requests

The Division has the authority to provide services to a child and parent when the child is not in custody but is under court ordered supervision by the Division. This includes visiting with the child. Face-to-face visits in the home should be done no less than once a month or more as needed to assure the safety of the child and to achieve the case goal.

Assessing Safety in the Placement

Safety of the resource home should be assessed to ensure the placement provides the necessary support to the child. The resource family should be engaged to involve them in meeting the needs of the child and his/her parents. The following activities can help ensure this occurs:

  • Assist the resource family in understanding the circumstances and behavior of the parent
  • Encourage the resource provider to be a model for good parenting. This will be beneficial to the foster youth and parents
  • Encourage child care practices which promote and protect the psychological, physical, and emotional well-being of the child
  • Ensure the placement resource understands the Division’s restriction on use of physical punishment

The Children’s Service Worker and placement provider will discuss:

  • The child’s adjustment
  • The child’s reaction to visits
  • The child’s behavioral, emotional/mental, trauma history, education, dental and physical concerns, progress or needs.
  • The child’s educational and developmental progress
  • The child’s loss and grief issues
  • Any unmet needs identified in the Social Service Plan
  • Parent’s progress in resolving identified risk factors and safety concerns
  • Resource provider’s adjustment to the child’s placement
  • Additional services necessary to maintain the placement
  • Any new needs not already identified in the Social Service Plan Child Section
  • Any progress made toward addressing previously identified needs in the Social Service Plan Child Section
  • Next steps to address any ongoing or newly identified needs of the child
  • Next steps in determining ability of child to be reunited with siblings, after therapist recommendation

If the child is placed in a residential setting, safety should still be assured by meeting with facility staff and discussing progress and plans for the child at least monthly. See chapter 2 for more information on Residential Rehabilitation Services.

4.1.1 Preparing the Child for Reunification

When the recommendation of the FST is to return the child to the parent(s), steps should be taken to prepare the child for this move. The amount and kind of preparation necessary will vary according to the child’s age, length of time in out-of-home care and relationship with the parent(s) and resource provider. The resource provider shall be involved in, and aware of, the plans to return the child to the birth parent(s). The resource provider will need to take appropriate steps to prepare the child for separation. The positive attitude of the resource provider toward the return of the child to the birth parent(s) will influence the child’s view of return.

The following steps should be taken by the Children’s Service Worker, resource provider, and parents in preparing the child for reunification with his/her family:

  • Privately discuss with the child their feelings regarding reunification with the parent. Address fears, anxiety, expectations, responsibilities and safeguards that ensure the child’s safety. The Children’s Service Worker should recognize that the child may feel more comfortable discussing reunification issues with the current resource provider. Conversely, the child may experience feelings of disloyalty to the resource provider for wanting to return home. Also, the child may experience feelings of disloyalty to parents demonstrated by new acting out behavior.
  • The child’s visits with the parent(s) should become more frequent and longer in duration with increasing child care responsibility given to the parent. When the child will be with the parent for a week or longer, the Children’s Service Worker should make at least one home visit with the family during the extended visit to assure safety and provide support to the family.
  • Provide opportunity for the parents, child, resource provider, and Children’s Service Worker to identify and resolve problems which occur during visits.
  • The resource provider shall assist the child in making the transition to the birth family.
  • The Children’s Service Worker and the resource provider should review the child’s life book with the child and biological parent during the transition phase of reunification.

4.1.2 Working with Resource Parents

The worker for a child in Alternative Care will meet often with the Resource Provider for the child. During these discussions, the following items can help guide and inform conversations.

  • Provide the necessary support to the resource family to involve them to meet the needs of the child and his/her parents, to include information, technical assistance, advice and counsel as follows:
    • Assist the resource family in understanding the circumstances and behavior of the parent;
    • Encourage the resource provider to be a model for good parenting. This will be beneficial to the foster youth and parents; and
    • Encourage child care practices which promote and protect the psychological, physical, and emotional well-being of the child including the physical, developmental, and mental health screenings which are required every six months for children from birth to age 10 as long as the child remains in care.
  • Discipline deserves special mention since resource providers are vulnerable to the accusation of child abuse, and many children exhibit problematic and provocative behavior. Physical punishment of foster youth is not permitted. Resource providers shall use discipline methods which are consistent with Children’s Division policy, Section 210.566, RSMo. It is crucial for children to be exposed to alternative ways of problem solving aside from force or threat of force. Limit setting is necessary in a consistent and firm way. Resource providers must be offered training to manage the behavior of the child in ways other than spanking, slapping, or hitting. Briefly, these ways include:
    • Distraction
    • Isolating a child in his room when he is out of control until he quiets down and can discuss things. “Time out” should be understood by both the resource provider and the child before it is used
    • Spontaneously rewarding a child for good behavior
    • Removing a child from dangerous situations
    • Removing dangerous objects
    • Explaining
    • Specific natural or logical consequences (“If you fight with Jim, then you can’t play with him today.”)
  • Address the following issues with child and resource family or other care provider during regular placement support contacts:
    • Stabilization in child’s life so that development and learning can proceed at a normal rate. (Excessive anxiety and insecurity interfere with normal development and learning.)
    • Help the child deal with the trauma of separation. Explore with him and reinforce the belief that he is not the cause of the family breakdown.
    • Assure the healthy growth and development of the child by reviewing the child’s progress and response to care provided by the resource family, including integration any special evaluations, treatment and treatment recommendations.
    • Give attention to the child’s special interests, talents, and vocational interests.
    • Assist the child in rebuilding parental relationship, if the child does not want to visit.
      Authorization from the court must be obtained if visits with parents are to be restricted.
    • Begin and maintain a “life book” with or for the child, to reinforce continuity in care and relationship to parents.
  • Determine if the child has any learning or developmental needs. If needs are identified, develop a plan to address these needs in a manner that best supports the child.  Document these needs in the Social Service Plan Child Section.
  • If such services are warranted, implement any treatment recommendations made by the physician, dentist, other professionals, and mental health professionals, including any recommendations for assisting the resource family to participate when needed.  Document these plans as next steps in the Social Service Plan Child Section.
  • Assist the resource family to cooperate with the parent/child visiting plan:
    • Visitation should be scheduled at a time that meets the needs of the child, the biological family members, and the resource family whenever possible. Recognizing that visitation with family members is an important right of children in foster care, resource providers shall be flexible and cooperative with regard to family visits, RSMo 210.566.
    • Seek progress reports after each visit, if the resource providers carry out the visitation plan.
    • Resource families must be informed that visits should never occur in homes in which a known or suspected methamphetamine laboratory exists or has existed unless it has been professionally treated or decontaminated by a hazardous waste clean-up agency according to the guidelines of the Environmental Protection Agency (EPA).
  • Assist the resource family in providing necessary guidance and behavior management of the child:
  • Assess the need for elevated needs of the child.
  • Assist the resource family and child in terminating or maintaining the relationship to family and other significant persons as desired and as appropriate to the child’s needs when the child is reunified with parents or is placed with another resource family.
  • The resource providers shall make every effort to support and encourage the child’s placement in a permanent home, including but not limited to providing information on the history and care needs of the child and accommodating transitional visitation, Section 210.566 RSMo.
  • Prepare the child for adoptive placement if this becomes the child’s permanency plan.
  • Maintain healthy growth and development through the provision of the usual community health, educational, religious (if appropriate) and socialization services, including participating in normal activities.
  • Provide the resource provider with a copy of court reports regarding the placements in their home.
  • Explain to the resource provider they must use medical services for the foster youth placed in their home who are enrolled with MO HealthNet (MH) or MO HealthNet/Managed Care (MH/MC).
  • Explain to the resource provider that obtaining medical services from a provider not enrolled with MO HealthNet (MH) or MO HealthNet/Managed Care (MH/MC) will result in the resource provider paying for the services out of pocket and may not be reimbursed. Any invoice or paid receipt received by the resource provider for services provided to a foster placement in their home must be submitted to the foster youth’s case manager immediately. The case manager will scan the invoice to the Medicaid Liaison at Central Office to review. If the claim cannot be paid by MH/MC, the Liaison will inform the case manager they need to utilize the Reimbursement Review process provided below.
    Reimbursement Review Process:
    • Submit Payment Request (PR) to FACES Payment Unit
    • If resource provider paid out of pocket, attach receipt for services to the PR
    • If resource provider received an invoice, attach the invoice to the PR
    • If the service is not covered by MH or MH/MC, attach the denial from the MH or MH/MC provider to the PR