Section 8, Chapter 9 (Critical Events), Subsection 2 – Alternative Care Child Fatality Notification and Final Arrangement Planning

(Effective: 01/24/2025)

8.9.2.1 Child Fatality Notification

The following procedures apply to the death of a child who is in the legal custody of the Children’s Division (CD), a child of a youth in alternative care (CYAC), or in circumstances in which a child is placed in the custody of CD, does not leave the care of a parent and the legal status is tracked through the Family Centered Services function.

Upon learning of the death, the following actions should be taken:

Worker Responsibility

Immediately notify the supervisor of the child’s death, circumstances surrounding the event, and whether any other children remain in the home or under the care of any alleged perpetrator(s) and/or deceased child’s caretaker.

Supervisor/Manager Responsibility

Immediately notify the Circuit Manager, Field Support Manager, Regional Director and assigned Division of Legal Services (DLS) attorney.
Initiate the Fatality/Critical Event Reporting and Review Protocol. If there is media attention or the possibility for media attention regarding the death, that information shall be provided on the CS-23 Critical Event Report/Alert Notification when completing the critical event reporting process.
Be mindful of the impact these events may have on all involved and collaborate to determine the best staff member(s) to complete the responsibilities. The Division shall conduct a preliminary evaluation to determine whether a review of the ability of the involved staff to perform their duties competently is necessary. Provide support to the staff member(s) both involved and affected by the child’s death. See CWM 8.9.1 for information regarding the evaluation process.

Worker or Designated Staff Responsibility

Ensure safety of other children:
- Take action to ensure no other children residing in the home or under the care of the alleged perpetrator are at risk of harm. Law enforcement may be utilized to ensure the immediate safety of children with follow-up contact by the worker. Coordinate with all parties involved to prevent duplication of efforts.
- Document how safety was ensured for any other children residing in the home and any other children the alleged perpetrator and/or deceased child’s caretaker may have access to, if applicable.
- In the event of an accidental death, ensure any potential risk factors that may have contributed to the child’s death are remedied if other children are currently residing in the home or there is the potential for other children to be placed in the home.
Report to the Child Abuse and Neglect Hotline Unit (CANHU)
- All child deaths are to be reported to CANHU. If there is no reasonable cause to suspect abuse or neglect, and another entity has already filed a non-CAN fatality report with CANHU, the death does not need to be reported again.
- If the child died under suspicious circumstances, or if there is reasonable cause to suspect abuse or neglect, report the allegations to CANHU regardless of whether it has been reported by another entity.
Make or cause personal notification to be made to the biological/adoptive parents and guardians of the child’s death. Notification decisions should be made in collaboration with other involved agencies.
- In-person contact is the preferred way to notify family members of the death of a child, however, there may be times when notification by phone or virtually is advisable. Each situation must be carefully assessed to ensure the notification is completed in a trauma-informed manner and without undue delay. Seek consultation from a supervisor and other involved individuals, such as law enforcement and parent’s attorney, when determining the notification method and timeline.
- When the biological/adoptive parents or guardians reside in another county or out-of-state, the worker may request assistance from the other county or state (if ICPC applies) to make personal notification. When necessary, request law enforcement make in-person contact with parents.
- In the event the biological/adoptive parents and guardian are incarcerated in a Department of Corrections facility, local jail or otherwise residing in a facility in which in-person notification is not feasible or allowed, contact the institution to request designated staff provide in-person notification.
- Exhaustive efforts should be made to locate and notify all parents. If all means of locating the parent have been exhausted and a parent’s whereabouts remain unknown, notification to other family members can continue.
Make or cause personal notification to be made to siblings and if applicable, children of a parenting youth who has died.
- Work with the Family Support Team members to determine who should have these conversations with children in a trauma-informed and compassionate manner. All affected children and youth should be provided ongoing support which meets their individual needs.
Make non-family notifications, as applicable:
- Resource Licensing Worker and/or Supervisor if the child resided in a resource home
- Juvenile Officer
- Juvenile Court of jurisdiction (following local court protocols for judicial communication)
- Guardian ad Litem
- CASA
- The child’s school and/or childcare provider
- Coroner or medical examiner if the child was less than 18 years of age
- Agencies providing services to the child (e.g., mental/behavioral health, physicians, home visiting, IIS/IFRS)
- Agencies providing benefits to the child (e.g., Veterans Affairs, insurance companies)
- Division of Finance and Administrative Services Social Security Specialist, if the child was receiving any Social Security benefits. DFAS Social Security Specialists Map & Contact Information
- KIDS account specialist at DFAS.KIDSAccount@dss.mo.gov, if the child had a KIDS Account. The balance of the account will be dispersed as provided by law for descent and distribution.
- FACES Payment Unit at DFAS.FACESPaymentUnit@dss.mo.gov
- Other individuals deemed appropriate based on their professional or personal relationship with the child.
Provide support to the family, parents/guardians, siblings, and placement providers. Be particularly sensitive to the family’s loss and offer to identify with the family any services or supports that could help the family through their grief.
Coordinate a Family Support Team meeting. The timing of the FST meeting will be dependent on individual case circumstances. Continue to work with the family as directed by the Supervisor.

The coroner, medical examiner, law enforcement or other entities may ask CD to provide information, including information contained in the case record. For more guidance refer to Section 5, Chapter 4 (Record Access) and consult DLS.

Documentation

Document in the Alternative Care electronic case record how safety was ensured for any other children residing in the home and any other children the alleged perpetrator and/or deceased child’s caretaker may have access to, if applicable.

Document all pertinent facts including:
- Cause, date, time, location, and circumstances surrounding the child’s death.
- All contacts made with any individual surrounding the child’s death.
- The hotline case number and any law enforcement report numbers, if applicable.

Upload relevant documents to OnBase (e.g., law enforcement reports, coroner report, hospital records, death certificate).
Document all efforts to identify next-of-kin and notifications made regarding the child’s death.
Ensure all contacts made with the family and child prior to the child’s death are current in the electronic case record.
In the Individual Information screen indicate the date of the child’s death.
- On the Alternative Care Monitoring screen, select Case Member → Select the child in the Case Member List → Display → Select the child’s name in blue → Update Individual → Select ‘Deceased’ and enter the date of death → Update.

Close the child’s AC Function. The case closing date should be the child’s date of death to ensure overpayment to the placement provider does not occur. If CD becomes responsible for any portion of the final expenses, payment can be issued to the vendor after the AC function is closed.

8.9.2.2 Final Arrangements

Each family situation is unique and unanticipated situations may arise. This information is provided as a guide to aid in best judgment to help equip individuals navigating these difficult situations.

When initial notification to family members is made, consider the emotional impact, and use best judgment to determine what discussion should occur at that time. It may be appropriate to provide the notification and allow time before conversation regarding the child’s final arrangements is had. Workers or designees may invite the family to let them know when they are prepared to discuss arrangements and that the Division is able to provide both financial and other means of support they might need.

After a child dies, CD is no longer the legal or physical custodian. The right to pay the expenses, and plan the final arrangements for the deceased, reverts to the appropriate next-of-kin.

The term “next-of-kin” means a person eighteen (18) years of age or older, who is mentally competent, and is willing to assume responsibility for both the expenses and planning of final arrangements. This also includes minor children of the deceased whose legal or natural guardian may serve in the place of the child unless that guardian is subject to action in dissolution from the deceased.

CD should utilize the Right of Sepulcher (Section 194.119 RSMo) next-of-kin hierarchy when determining the order in which to contact those that may assume responsibility for the expenses and planning of final arrangements. Right of Sepulcher means the right to choose and control the burial, cremation, or other final disposition of the deceased. CD should contact all individuals for whom we can obtain contact information in the order of the next-of-kin hierarchy and provide a timeline for response to determine if they wish to assume responsibility.

If no next-of-kin is willing or able to assume responsibility for both expenses and planning of final arrangements, CD becomes the last resort option. CD should document in the electronic case record all contacts and efforts to identify the appropriate next-of-kin and to whom notification was provided.

Special Circumstances

If there was a Legal Guardianship prior to the child entering Alternative Care

Upon the death of the child, the guardianship/conservatorship terminates. However, if there are no other next-of-kin available to pay for the final arrangements, the prior legal guardian/conservator may, with the approval of the Probate Court, enter into a contract with the funeral home to cover the funeral and burial expenses with any funds received on behalf of the child. If the guardian/conservator is using their own personal funds and not funds of the deceased child, permission from the Probate Court is not needed. (Section 475.083(5) RSMo).

If parental rights have been terminated

Parents whose rights have been terminated may be considered in the next-of-kin hierarchy as the next nearest relative by adoption, blood or marriage or any friend or other person who assumes financial responsibility.

Prior biological relatives may be categorized in the next-of-kin hierarchy as an adult sibling, the next nearest relative by adoption, blood or marriage or any friend or other person who assumes financial responsibility.

Court jurisdiction and end of life decisions

Courts may consider terminating jurisdiction to allow for the family to make all final decisions for the child, however, in some situations, it may be best for the court to maintain jurisdiction. If a court maintains jurisdiction, the court should order that the GAL or the parent has consenting authority to make all medical and end of life decisions for the child as medical and end of life decisions should not be made by CD. The assigned DLS attorney should file a motion to address these issues and if a DLS attorney is not assigned, a DLS referral should be made.

The following should be considered when determining CD’s position on whether the court should terminate jurisdiction:

Which option best supports the needs and wishes of the family;
If the child is on life support and the court releases jurisdiction, the child’s Medicaid benefits will likely terminate at the end of the month the case closes; and
How we can support the family to make a Medicaid application with the Family Support Division in the event there are extensive medical costs anticipated to accumulate following release of jurisdiction.

These considerations should be discussed with the Family Support Team and the position of the Family Support Team shared with the assigned DLS attorney.

When a child dies after the court releases jurisdiction, Children’s Division will contribute to or cover the final arrangement expenses up to the allowable amount, up to 30 days following the date the court released jurisdiction.

Final Arrangement Planning

If a will is in place, it should be honored to the extent possible.

Next-of-kin willing and able to pay for final arrangements

If a next-of-kin indicates they will take responsibility for final arrangements, they shall have all financial responsibility and decision-making authority. CD should offer to help the identified next-of-kin to explore financial resources to assist with final expenses which may include a burial policy, KIDS account funds if applicable, military dependent or tribal affiliation resources, fundraising and memorial donations, local community programs, religious organizations, hospital foundations and consumer advocate organizations.

If CD is not providing financial contribution, the CD-312 Final Arrangement and Expense Authorization does not need to be completed.

Disagreement regarding final arrangements

When CD is not responsible for the expenses or planning of final arrangements, any disagreement between those that are responsible shall be handled by the funeral home director. For more information refer to Section 194.119 RSMo.

If next-of-kin and CD are sharing the expenses of final arrangements and disagreements arise regarding final arrangement planning, the funeral home director holds the responsibility to resolve such conflicts. CD should contact DLS if additional guidance is needed.

Next-of-kin and Children’s Division expense-sharing

If next-of-kin and CD are sharing the expense of the final arrangements, CD should defer to the next-of-kin on arrangements and provide information regarding CD’s process and parameters of contribution. The CD-312 Final Arrangement and Expense Authorization should be completed to document the shared expense.

No next-of-kin willing and able to pay for final arrangements

If no next-of-kin are willing and able to be responsible for final arrangement planning and expense, CD will be responsible for planning and paying for final arrangements.

If any next-of-kin desires to have input into the final arrangements, CD shall compassionately engage with the next-of-kin and consider all wishes. Should disagreements arise, CD shall hold final decision-making authority when CD is paying for the expenses.

CD shall contact a local funeral home to provide dignified final arrangements within the acceptable standards of the community, with respect to the child/family’s religious and cultural practices and norms.

When possible, the next-of-kin, regardless of ability to financially contribute, shall be given the opportunity to write the obituary. Should CD be solely responsible for doing so, contact DLS for guidance.

The CD-312 Final Arrangement and Expense Authorization should be completed to document the efforts to locate next-of-kin willing and able to take responsibility for the final arrangement planning and expense, along with any other financially contributing sources.

Autopsy Process

CD does not have the statutory authority to request an autopsy for a child who dies while in the custody of the CD. In Re Exhumation of Body of D.M., 808 S.W.2d 37 (Mo. Ct. S.D. App. 1991).

When a child under the age of eighteen years, who is eligible to receive a certificate of live birth, dies, the medical examiner or coroner shall notify a certified child death pathologist to determine the need for an autopsy. The certified child death pathologist, in conjunction with the medical examiner or coroner, shall determine the need for an autopsy. If there is disagreement concerning the need for the autopsy, the certified child death pathologist shall make the determination unless the child fatality review panel, within twelve hours, decides against the certified child death pathologist. Autopsy expenses are the responsibility of the Department of Health and Senior Services (DHSS) or the city or county. CD does not cover the expense of autopsies.

8.9.2.3 Final Arrangement Expense Authorization (CD-312)

If no next-of-kin are willing or able to be responsible for final arrangement planning or expense, CD will be responsible for planning and paying for final arrangements. Expense-sharing may also occur between CD and next-of-kin. If CD becomes responsible for any portion of payment for final arrangements, the CD-312 Final Arrangement and Expense Authorization shall be completed.

Local offices must ensure family/community resources are utilized prior to requesting CD funds. CD staff should explore and utilize available financial resources such as: burial policy, KIDS account funds if applicable, military dependent or tribal affiliation resources, fundraising and memorial donations, local community programs, religious organizations, hospital foundations and consumer advocate organizations. Any contributions from those sources should be documented via the CD-312 Final Arrangements Expense Authorization.

Allowable Expenses (Burial or Cremation) include:

Professional services of funeral director and staff
Use of facility
Dressing, casketing, and cosmetology
Post autopsy care/post organ donation
Embalming
Transportation/transfer of the deceased
Casket, cremation urn or container
Burial plot
Monument (headstone) or memorial marker
Death certificate
Other reasonable and necessary burial expenses
Floral arrangements*
Limousine transportation for the family or other individuals*

*These items are only allowed when CD’s portion of the expenses totals less than $4,500.

8.9.2.4 Final Arrangements Approval and Payment Process

Payment Contracts or Written Agreements

Should the funeral home present a payment contract or written agreement, CD staff cannot sign or otherwise agree to such documents. If the funeral home requires a signed contract or written agreement in order to proceed, staff must submit the contract/agreement to the Fiscal Liaison at CD.FISCAL@dss.mo.gov.

If CD’s portion of expenses is less than $4,500

Obtain an itemized list of expenses from the vendor (funeral home/service provider) for the expense CD is responsible for paying. This itemization should not include expenses being paid by non-CD funds.
Complete the CD-312 Final Arrangements Expense Authorization and obtain supervisory approval.
Vendor
1. Determine if the vendor is registered in SAM II.
2. If not registered, provide the Vendor Input/ACH-EFT Application (MO3001489) for completion by the vendor. When complete, send the form to vendor@oa.mo.gov for processing.
Payment Request
1. Verify the vendor has been registered in SAM II.
2. Review the itemized invoice to ensure all information is billed correctly.
3. Send the Payment Request Form, the itemized invoice and the CD-312 with supervisor signature to accountspayable@dss.mo.gov for the payment to be processed.
Upload the CD-312 and the itemized list of expenses to OnBase, indexed to ‘Other CD Forms’ and add a description of ‘Form CD-312 – Child’s name’.

If CD’s portion of expenses exceeds $4,500

In circumstances where CD’s portion of the final expenses will exceed $4,500, the amount payable must be approved prior to the delivery of services by completing the following:

Obtain an itemized list of expenses from the vendor (funeral home/service provider) for the expense CD is responsible for paying. This itemization should not include expenses being paid by non-CD funds.
Complete the CD-312 Final Arrangements Expense Authorization and obtain supervisory approval.
Vendor
- Determine if the vendor is registered in SAM II.
- If not registered, provide the Vendor Input/ACH-EFT Application (MO3001489) for completion by the vendor. When complete, send the form to vendor@oa.mo.gov for processing.
Email the itemized list of expenses and signed CD-312 to the Regional Director/Designee for approval.
If approved, the Regional Director/Designee will email the itemized list and CD-312 to the Fiscal Liaison at FISCAL@dss.mo.gov.

If denied, the Regional Director/Designee will provide an explanation and suggest adjustments be made. Once adjustments are made, resubmit the itemized list of expenses and signed CD-312 to the Regional Director/Designee for approval.

If approved, the Fiscal Liaison will sign and return the CD-312 to the local office.

If denied, the Fiscal Liaison will provide an explanation and additional guidance.

Payment Request
1. Verify the vendor has been registered in SAM II.
2. Review the itemized invoice to ensure all information is billed correctly.
3. Send the Payment Request Form, the itemized invoice and the CD-312 with Fiscal Liaison signature to accountspayable@dss.mo.gov for the payment to be processed.
Upload the CD-312 and the itemized list of expenses to OnBase, indexed to ‘Other CD Forms’ and add a description of ‘Form CD-312 – Child’s name’.