Section 6, Chapter 2 (Training), subsection 1, – (Pre-Service Training)

Section 6, Chapter 2 (Training), subsection 1, – (Pre-Service Training)

(Effective 5/28/2024)

2.1 Pre-Service Training

This section reviews the pre-service training curriculum, explains the competencies upon which the training is based, and provides pre-service training procedure for all non-related foster and adopt applicants, and any adult member of the household with parenting responsibilities (CSR 35-60.030 (5)(A)). The focus of pre-service training is to help participants understand and develop the skills necessary to be a successful foster/adoptive parent. Only when participants understand what skills are needed will they have the information necessary to make an informed decision about whether they are willing or able to take on this very important role. Missouri’s required pre-service training consists of the Missouri Caregiver and Adoption Resource Education curriculum and CPR/First Aid.

2.1.1 Missouri Caregiver and Adoption Resource Education (MO C.A.R.E.)

The Missouri Caregiver and Adoptive Resource Education (MO C.A.R.E) curriculum consists of Missouri-specific training requirements and content adapted from the National Training and Development Curriculum (NTDC) for Foster and Adoptive Parents which was funded through a Cooperative Agreement with the Children’s Bureau, Administration on Children, Youth and Families, and the US Department of Health and Human Services. The full NTDC curriculum may be found at

The MO C.A.R.E. curriculum consists of 10 Sessions:

Session 1 (3 hours)

  1. Introduction and Welcome – This theme provides an overview of the MO C.A.R.E. curriculum and sets the stage for participants to feel welcome and engaged.
  2. Child Development – This theme helps participants understand typical child development as well as disrupted child development. Developmental delays and meeting children’s developmental needs is also covered in this theme. The unique challenges associated with parenting children from each developmental stage are highlighted.

Session 2 (3 hours)

  1. Overview of Child Welfare Video – This theme helps participants understand the child welfare system and how it operates, including the key players and their roles. It covers critical laws affecting the child welfare system, an overview of juvenile court processes, and an explanation of the decision-making process in child welfare cases. Also covered are the reasons children enter the child welfare system, including the types of maltreatment children may face. Participants also learn about the different permanency outcomes, general timelines juvenile courts and the Division adhere to, and the importance of considering a child’s sense of time while in foster care.
  2. Attachment – This theme helps participants understand the importance of attachment in parenting, for both the children and the caregivers who are fostering or adopting. It covers the impact of fractured attachments/lack of attachments on children’s ability to attach and identifies strategies to develop healthy attachment. This theme also covers developing trust and developing children’s sense of connectedness and belonging. How to be attuned to children and recognizing and honoring children’s primary attachment to their families is also highlighted.

Session 3 (3 hours)

  1. Separation, Grief, and Loss – This theme helps participants understand the impact of separation and ambiguous loss, and the different ways children grieve. Life-long grieving and the importance of providing opportunities for grieving is explored. Strategies to help children deal with grief and loss are identified. Participants will understand: loss and fractured attachments with birth family members and previous placements; recognize the importance of establishing and maintaining essential relationships; understand the impact of frequent moves and the importance of managing transitions for children; and understand the separation, grief and loss experienced by all members of the foster/adoption network.
  2. Effective Communication – This theme helps participants understand effective communication including both verbal and non-verbal language and describes how to use open communication with children. The importance of active listening skills and strategies to convey compassion and attunement are highlighted. This theme will also help participants recognize how to talk to children about difficult and/or sensitive issues with openness.

Session 4 (3 hours)

  1. Parenting Paradigm – This theme helps participants understand why traditional parenting is not effective for children who have experienced separation, loss, or trauma. The theme helps identify parental strengths as well as the need to adapt parenting techniques to support these children, including necessary changes to parenting values and beliefs. The importance of adapting parental expectations, the need to not take things personally, and the value of cultural humility are highlighted. Characteristics for successfully parenting children who have experienced separation, loss or trauma are identified, including flexibility, patience, nurturing, compassion, and sense of humor.
  2. Trauma-Related Behaviors – This theme helps participants learn how chaos, threat, neglect, and other adversity during development can alter the developing brain, which can change the ways children think, feel, and act. Participants will understand the major stress responses we use to cope with perceived or actual threat as well as adaptive symptoms that can include inattention, distractibility, avoidance, and shut-down. Also covered are the reasons for rejection and testing, as well as recognition of the survival skills and coping strategies that result in a complex range of behaviors.

Session 5 (3 hours)

  1. Trauma Informed Parenting – This theme helps participants learn the three Rs (Regulate, Relate, Reason) and other practical Trauma-informed Parenting strategies. Trauma support resources for children are described. Participants will: recognize the importance of finding activities to have fun with children; recognize the importance of connected parenting and the relationship as the foundational cornerstone; understand how to promote healthy behaviors; and recognize the importance of parent’s self-regulation. Also highlighted are ways to be proactive versus reactive and the difference between discipline and punishment.
  2. In this section there will be a video added from another module, called “Creating a Stable, Nurturing, Safe Home Environment” and is available on the Intranet. It will be followed by discussion.

Session 6 (3 hours)

  1. Reunification as the Primary Permanency Goal – This theme helps participants understand the permanency options that exist and the role of resource providers during permanency planning—especially when reunification is the permanency goal. Permanency from the child’s perspective is explored. This theme helps participants understand their role in caring for children while at the same time preparing them to return home and the role of resource providers in working with the child’s family to achieve reunification. Concurrent planning is described.
  2. In this section there will be a video added from another module, called “Foster Care: A Means to Support Families”.
  3. Maintaining Children’s Connections – This theme helps participants understand the importance of integrating and maintaining ongoing communication and connection between siblings, including understanding sibling dynamics and the importance of sibling bonds. Tips for how to navigate and support visits with siblings are shared. This theme also helps participants recognize the importance of maintaining connections with extended family members and the community at large (i.e., schools, church, friends, sporting teams) and identifies strategies to keep children connected to their community.

Session 7 (3 hours)

  1. Cultural Humility – This theme provides participants with an overview of cultural humility and helps participants recognize the importance of honoring children’s cultural identity and respecting families from varying races, religions, ethnicities, and economic statuses. This theme provides research and considerations for caregivers with regards to sexual orientation, gender identity, and expression issues impacting youth in foster care. This theme shares strategies for caregivers who are fostering or adopting to respect as well as navigate differences in values from the children and families, while acknowledging imbalances of power and inequities.
  2. Parenting in Racially and Culturally Diverse Families – This theme helps participants understand the impact of parenting children from different racial/ethnic/cultural backgrounds and honoring and incorporating a child’s race/ethnicity/culture into their existing family system. Strategies are identified to help children develop positive and proud identities and to help children and families prepare for and handle intolerance in all forms.

Session 8 (3 hours)

  1. Impact of Substance Abuse – This theme helps participants understand the short and long-term impact on children exposed to substances prenatally including fetal alcohol spectrum disorders (FASD), and shares parenting strategies for children who have experienced prenatal substance exposure. Also covered are issues that may be present if parents use(d) substances and medical issues that can arise due to substance exposure including higher risk of later addiction. The genetic component of addiction and understanding addiction as a chronic disease is described.
  2. Parenting a Child with a History of Sexual Abuse – This theme identifies the indicators of sexual abuse and the impact of interrupted sexual development, highlighting the unique challenges associated with parenting children who have been sexually abused. The potential risk factors for children who have experienced sexual trauma including re-victimization, sexual trafficking, and re-enactment behaviors are covered. Effective parenting strategies that can help keep children safe and help them heal from sexual trauma are highlighted.

Session 9 (3 hours)

  1. Mental Health Considerations – This theme provides a basic understanding of mental health disorders and conditions that commonly occur in childhood and incorporates Missouri-specific required training on psychotropic medications and informed consent. Content is shared to illustrate that not all ‘survival’ behaviors or symptoms of grief are connected with mental health disorders. Commonly administered psychotropic medications are described and information about how to obtain consistent, adequate, and appropriate access to mental health services is highlighted.

Session 10 (3 Hours)

  1. Caregiver Resources and Support – This is the last session and provides participants with information specific to Missouri processes, expectations, benefits, supports, and administrative procedures.

2.1.2 Competencies

Competencies take into account the person’s knowledge, attitude, and practice in performing the desired skills necessary to successfully parent the children in the custody of the Division.  

  1. Understanding Trauma and Trauma Informed Parenting.
  • Realize how childhood trauma, including abuse and neglect, can impact the developing brain, and how this can have an ongoing impact on the child’s development, relationships, attachment and behaviors.
  • Understand challenging behaviors can be coping skills or survival strategies caused by underlying trauma and triggers.
  • Understand the main strategies (arousal or disassociation) we use when under threat or experiencing fear and how the threat of change can affect the way we think, feel, and behave.
  • Identify trauma-informed parenting strategies/techniques for responding to behaviors children may exhibit.
  • Recognize the reasons why parents who are fostering need to manage their own anger, avoid reactive behavior, and increase their empathy.
  • Describe the reasons that trauma informed parenting techniques work more effectively for children who have experienced loss and trauma.
  • Describe the difference between discipline and punishment.
  1. Supporting Families and Maintain Children’s Connections.
  • Understand why reunification is the primary permanency goal for most children in care.Identify strategies to support reunification efforts and help children plan for a successful integration back to their family.
  • Understand concurrent planning, the various possible permanency outcomes, and how a child’s permanency plan is determined during the time the child is in care.
  • Define the role that resource providers play in permanency planning.
  • Understand the challenges birth families may be facing and how challenges facing birth parents can impact the consistency and quality of visits with children.Describe strategies to nurture children’s ongoing relationships so that they can maintain strong connections to their birth family.
  • Describe the importance of co-parenting and strategies parents who foster can employ to do this. Identify specific examples of how resource providers can support birth parents.
  • Explain how resource providers can help children maintain connections with extended family members and community of origin.
  • Identify effective strategies to help children maintain communication between separated siblings.Know the complexity of sibling dynamics and the importance of maintaining these relationships.
  • Identify issues that may arise when promoting communication between family members and potential solutions to these issues.
  • Be aware of strategies to discuss difficult or sensitive issues with children in a supportive manner.
  • Know strategies to convey empathy.Identify empowering and inclusive language.
  • Be aware of the components of effective communication, including both verbal and non-verbal language.
  • Be able to describe what effective listening skills are for parents.
  1. Understanding the Child Welfare System; and the Social, Emotional and Physical Impact on Children and Families.
  • Understand typical child development as well as disrupted child development. 
  • Understand developmental delays and how to meet children’s developmental needs.
  • Recognize the unique challenges associated with parenting children from each developmental stage.
  • Recognize the various losses that children may experience and how these losses can impact their current and future behaviors.
  • Describe the grieving process for children and what behaviors may be associated with it. Identify barriers to healing and helping children with unresolved grief.
  • Define ways that children grieve and how that may look different than the way adults express grief. Understand how ambiguous and disenfranchised grief impact children.
  • Understand how to support children by acknowledging their losses and grieving those losses throughout the grief cycle. Recognize grief and loss is a possible underlying cause of behaviors.
  • Identify caregiver behaviors that enhance and strengthen relationships.
  • Understand the importance of caregivers’ own attachment style and history in developing and maintaining relationships with children.
  • Describe the relationship between attachment, attunement, safety, and relationships.
  • Define the impact of fractured attachments/lack of stable relationships on children’s ability to connect with others.
  • Understand the importance of supporting the children’s primary attachment to their birth families for them to connect to others.
  1. Understanding the Importance of Cultural Identity in Foster Care and Adoption.
  • Understand the importance of cultural humility and cultural responsiveness when speaking to a child about their birth family, and identify ways in which the foster family may be culturally responsive when parenting children whose culture or identity is different from their own.
  • Know strategies to help children develop positive identities.
  • Understand the impact fostering children of a different racial, ethnic, or cultural background will have on both the family and the child.
  • Describe strategies to help children prepare for and handle racism and macroaggressions. 
  • Understand that additional knowledge, skills, and attitudes are needed when parenting children from a different culture or race of their own.
  • Understand the importance of supporting children’s exploration of race/culture.
  1. Understanding the Impact of Mental Health and Substance Use on Children.
  • Understand common childhood mental health conditions.
  • Understand the complexity of diagnosing children with mental health conditions when they have experiences of loss, separation, and trauma.
  • Know where and how to access information on psychotropic medications through the child’s medical professionals. Understand the informed consent process for psychotropic medications and children in care.
  • Learn accurate and sensitive language to describe behavioral symptoms and diagnoses.
  • Understand the genetic component of addiction and addiction as a chronic disease. 
  • Understand FASD and the lifelong impact it and other prenatal abuse may have on children’s social, emotional, and cognitive functioning..
  • Understand the impact substance use has on the brain- both in utero and throughout the lifetime.
  • Identify strategies to effectively parent children who have been exposed to substances prenatally.


2.1.3  Pre-Service Training Procedure

  1. Enroll pre-screened applicant(s) in MO C.A.R.E. and ensure a home assessor has been assigned prior to Session 1.
  2. During Session 1, remind applicants of their options regarding CPR/FA training and certification requirements and provide applicants with a CPR/FA training schedule:
  • Attend a scheduled CPR/FA training and become CPR certified using an approved contracted provider at no cost; or
    • Record 6 hours of CPR/FA training using the V252 code.
  • Provide documentation of current CPR/FA Certification; or
    • Record 6 hours of CPR/FA training using the V252 code.
  • Complete and provide documentation of an online CPR/FA training course and registration for CPR certification. Certification should be scheduled and completed within 90 days of licensure.
    • If certification is completed after licensure, record 3 hours of online First Aid training using code V249. Once CPR certification is completed, record 3 training hours of CPR Certification using the code V248.
    • If online CPR/FA training and CPR certification is completed separately but prior to licensure, record all 6 hours of CPR/FA training using the V252 code.

The following CPR/FA curriculums are approved: American Safety & Health Institute; Advanced Cardiac Life Support; Pediatric Advanced Life Support; Emergency Medical Response; Advanced First Aid; BLS; Basic First Aid; CPR/AED; Wilderness First Aid; Bloodborne Pathogens; Emergency Oxygen Admin; Child/ Babysitting Safety and Pediatrics; MS Safety; EMS-CPR/AED, First Aid, Bloodbourne, Emergency Oxygen and Childcare.

  1. Evaluate the training experience with foster applicant and training facilitators.
  2. All newly licensed foster homes should complete the following trainings within the first ninety days:
  • Reasonable and Prudent Parenting Standard; Two (2) training credit hours using code V280. RPP must be completed within 3 months of the license/approval begin date.
  • Foster Care Bill of Rights; one (1) hour training credit using code V160.
  • Second Hand Smoke (2) two hours training credit using code V113.
  1. Verify all training hours completed and provide each participant with a certificate of completion. A copy should be kept in the vendor record.
  2. Record required training information in FACES on the Resource Parent Training screen.

V080        Missouri Caregiver and Adoption Resource Education    26 Hours

V150         Informed Consent                                                                               2 Hours

V013        Psychotropic Medication Management                                       2 Hours

Chapter Memoranda History: (prior to 01-31-07)


Memoranda History:

CD07-48, CD09-106, CD12-30, CD13-100, CD16-65, CD17-42. CD19-07