U.S. Department of Health and Human Services 
 
Office of Inspector General 
 
 
 
Case Study: Missouris Efforts 
To Protect Children Missing 
From Foster Care   
 
 
Suzanne Murrin 
Deputy Inspector General for Evaluation and Inspections 
September 2021, OEI-07-19-00372  U.S. Department of Health and Human Services 
O  ffice of Inspector General 
 
Report in Brief  
 
Se ptember 2021, OEI-07-19-00372 
 
Case Study: Missouris Efforts To Protect Children 
Why OIG Did This Review 
On any given day, thousands of 
Missing From Foster Care 
children nationwide are missing from 
their foster care placements.  
What OIG Found 
Children who go missing from foster  Key Takeaway 
Though the Missouri foster care agency 
care often experience adverse 
(Missouri) is not required to do so, we 
In the cases we reviewed in 
outcomes.  In 2019, 978 children 
note that it does not have policies for 
detail, the Missouri foster care 
went missing at some point from 
identifying children who may be at 
agency rarely attempted to 
foster care in Missouri.  That August, 
heightened risk of going missing or 
reduce childrens risk of going 
OIG agents joined the Department 
interventions to reduce their risk.  In the 
missing.  Additionally, it failed 
of Justice and local law enforcement 
59 cases we reviewed in detail, Missouri 
to protect children who went 
in Missouri metropolitan areas to 
rarely demonstrated attempts to reduce 
missing from foster care and did 
locate children who were missing 
childrens risk of going missing.  The 
not effectively use resources to 
from foster care.  OIG agents shared 
majority of the children who went 
assist in locating them.  As a 
concerns that prompted this 
missing (49 of the 59 children) had risk 
result, these children were 
evaluation.  The Administration for 
factors associated with a higher risk of 
exposed to additional risks 
Children and Families (ACF) provides 
going missing.  Missouri rarely provided 
associated with being missing 
Federal funding and oversight to 
these children with services to reduce 
from care, such as a heightened 
States and eligible Tribes to support 
their risk of going missing from care
risk for sex trafficking and 
foster care programs.  
only 7 of the 49 case files indicated that 
poorer outcomes related to 
children received such services. 
How OIG Did This Review  health, safety, education, and 
To follow up on OIG agents  involvement in the criminal 
During the times in which the children 
concerns, we evaluated whether the  justice system.  
were missing from care, Missouri 
Missouri foster care agency followed   
frequently failed to comply with 
applicable Federal and State laws, 
requirements that could have aided in locating them.  Nearly half of the case 
policies, and procedures to protect 
files contained no evidence of Missouri reporting the children as missing, as 
the 59 children whose cases we 
required, to either local law enforcement or the National Center for Missing 
included in our review.  We 
and Exploited Children.  Additionally, for many missing children, there was no 
determined whether Missouri 
evidence that Missouri made the required notifications and contacts to seek 
provided these children with 
information on the childrens potential whereabouts. 
required services before and after 
their episodes of being missing, and  For one in three of the children whose cases we reviewed, there was no 
whether the State followed  documentation that the child received any required health and safety checks 
requirements when the children  following the childs return to foster care.  For these children, there was no 
went missing.  Additionally, we  evidence that their case managers assessed their safety, determined their 
evaluated whether children were  experiences while missing, or determined whether they fell victim to sex 
identified as having any  trafficking while they were missing from care.   
characteristics commonly associated 
In our conversations with Missouri officials, we learned that Missouri cannot 
with a higher risk of going missing 
rely on its case management system to accurately identify children who are 
from care.  This case study is not 
missing from foster care without reviewing individual case files.  The current 
projectable to the entire population 
system alone cannot distinguish between children who are missing from their 
of children who went missing; 
placement and those who are in an unapproved, but known, placement. 
however, it uses insights gained from 
OIG involvement in the joint law 
enforcement task force that point to 
hig  h-risk areas for further review.    What OIG Recommends 
To better protect children from the risks associated with being missing from 
foster care, we recommend that Missouri (1) develop policies to help identify 
(a) children who have a heightened risk of going missing from care and 
(b) interventions that could reduce their risk; (2) implement a monitoring 
mechanism to ensure that case managers comply with requirements and 
document their compliance when children are identified as missing and when 
they are located or return to care; and (3) implement improvements to the 
case management system to enable accurate identification of children who 
are missing from foster care.   
Thousands of children are missing from foster care systems across the 
Nation, andgiven the critical role States must play in protecting these 
childrenStates need additional support and guidance from the national 
level.  Therefore, we recommend that ACF (1) develop a forum for States to 
share experiences and best practices related to reducing childrens risk for 
going missing from foster care, locating missing children, and addressing 
their needs after they return to care; and (2) support Missouri as it works to 
reduce childrens risk for going missing from foster care and improve 
compliance with Federal and State requirements related to children who go 
missing.  
Missouri did not explicitly concur or nonconcur with our three 
recommendations to its agency, but it did note actions it has taken in 
response to our recommendations and agreed to take additional responsive 
actions.  ACF concurred with our two recommendations to its agency. 
 
     
TABLE OF CONTENTS 
 
 
 
 
BACKGROUND  1 
Methodology  6 
FINDINGS  8 
Missouri does not have policies to identify children who may be at heightened risk of going  8 
missing or interventions to reduce their risk 
Frequently there was no evidence that Missouri took the required actions to locate children  9 
who were missing from foster care 
One in three children whose cases we reviewed did not have evidence in their case files of  11 
receiving any required health and safety checks following their return to foster care 
Missouris case management system does not accurately identify children who are missing  13 
from foster care 
CONCLUSION AND RECOMMENDATIONS   14 
Recommendations to the Missouri foster care agency:   
Develop policies to help identify (a) children who have a heightened risk of going missing  14 
from care and (b) interventions that could reduce their risk  
Implement a monitoring mechanism to ensure that case managers comply with  15 
requirements and document their compliance when children are identified as missing and 
when they are located or return to care  
Implement improvements to the case management system to enable accurate  15 
identification of children who are missing from care 
Recommendations to the Administration for Children and Families:   
Develop a forum for States to share experiences and best practices related to the following:  16 
reducing childrens risk for going missing from foster care, locating missing children, and 
addressing their needs after they return to care 
Support Missouri as it works to reduce childrens risk for going missing from foster care  16 
and to improve compliance with Federal and State requirements related to children who go 
missing 
STATE AND AGENCY COMMENTS AND OIG RESPONSE  17 
DETAILED METHODOLOGY  19 
APPENDICES  21 
A.  Missouri Department of Social Services Comments  21 
B.  Administration for Children and Families Comments  23 
  ACKNOWLEDGMENTS AND CONTACT  25 
ABOUT THE OFFICE OF INSPECTOR GENERAL  26 
ENDNOTES  27 
   
BACKGROUND 
 
 
Objectives 
To follow up on OIGs work to locate missing children, by determining the extent to 
whichin a limited number of case studiesthe Missouri foster care agency: 
1.  followed Federal and State requirements to develop a visitation plan, aid in 
locating the missing children, and conduct health and safety checks for 
children following their return to care; and 
2.  provided services after the childrens return to care that may address their 
trauma and/or reduce the risk of that these children may go missing again. 
 
On any given day, thousands of children are missing from their foster care 
placements.  In 2019, 978 children were missing at some point from Missouri foster 
care.  That August, OIGalong with the Department of Justice (DOJ) and local law 
enforcementtargeted Missouri metropolitan areas to locate children who were 
missing from foster care.  During the operation, 23 children missing from Missouri 
foster care were successfully located.  OIG agents involved in that operation shared 
concerns that prompted this evaluation.  Similar operations have been carried out in 
other States; Missouri was the most recent operation at the start of this evaluation.  
We will continue to review the results of ongoing and future operations and consider 
whether additional evaluations are warranted.  
Children may go missing from foster care for many reasons.  One of the primary 
reasons for which children may go missing from foster care is to gain access to 
friends, romantic partners, and families of origin.1  Children may also choose to leave 
their placements to escape restrictive rules; caregivers or other youth; bullying; 
boredom; or isolation.2  Additionally, they may be coerced or enticed to leave to gain 
access to drugs, alcohol, or sex.3  Research and literature use both the terms missing 
and runaway to describe children who are absent from their foster care placements.  
For this report, we refer to all children who are missing, have run away, or are 
otherwise absent as missing. 
Published research shows that children who go missing from foster care often 
experience adverse outcomes.4  After going missing from foster care, children have a 
heightened risk of sexual exploitation and being victimized by sex trafficking, as well 
as poorer outcomes related to health, safety, education, and subsequent involvement 
in the criminal justice system.5   
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Background | 1  ACF funding and guidance for State foster care programs 
Under Title IV-B of the Social Security Act (the Act), the Administration for Children 
and Families (ACF) provides Federal funding to States and eligible Tribes (which we 
refer to collectively as States) to support child and family welfare, including programs 
that provide care and services for children in foster care.6  Additionally, ACF 
administers the Federal foster care program under Title IV-E of the Act, which 
provides funding to States for the board and care of certain children in foster care 
who meet eligibility requirements.  To receive Federal funding, States must submit to 
ACF a Child and Family Services Plan every 5 years with Annual Progress and Services 
Reports, and a Title IV-E Plan as necessary to reflect new Federal requirements or 
changes within the State.7  Child and Family Services Plans and Title IV-E Plans 
document the official policies and procedures that each State agency will follow to 
fulfill the funding requirements of the respective programs.  ACF reviews and 
approves Child and Family Services Plans and Title IV-E Plans.  
ACF provides technical assistance and guidance to States.8  In the guidance that it 
issued to States in 2014, ACF details characteristics of children who go missing from 
foster care, based on State-submitted case-level data and broader research.9  In other 
guidance and reports, ACF suggests targeting prevention efforts towards children 
with multiple foster care placements and those placed in residential care facilities, as 
they have a higher risk of going missing from care.10, 11  ACF cites that when children 
are placed in residential care facilities, creating a more family-like environment with 
personalized staff attention may help to reduce the higher rates of childrens going 
missing from residential care.  ACF recommends providing appropriate care that is 
trauma-informed, culturally appropriate, and individualized to address physical and 
mental health needs of all children in foster care.12, 13  Additionally, ACF recommends 
that foster care agencies work with the Runaway and Homeless Youth Programa 
program administered by ACFto develop coordinated strategies for providing 
effective services to children who have gone missing from foster care placements.14 
ACF identified characteristics and factors associated with an 
increased risk of going missing from foster care 
In August 2019, ACF issued a report to Congress that summarized research on 
characteristics associated with an increased risk of going missing from foster care.15  
The report highlighted that a history of multiple foster care placements increases 
a childs likelihood of going missing from care.  Specifically, one study that the report 
cited found that a history of going missing from foster care is consistently associated 
with increased risk of going missing againchildren who had gone missing at least 
once were 92 percent more likely to going missing again than children who had never 
gone missing.16  Another cited study found that with every additional foster care 
placement, children experienced a nearly 70-percent increase in risk of going 
missing.17  Children who went missing from care had experienced an average of 
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Background | 2  six prior placements, compared to three prior placements for children who were not 
missing from care.18 
Research has also shown that the setting of a childs placement can be a risk factor for 
going missing from care.19  A large longitudinal study found that children in group 
and residential care were more than twice as likely, and those in emergency shelter 
settings were more than nine times as likely, to go missing compared to children 
placed with a relative.20  
The 2019 ACF report to Congress also emphasized the importance of relationships 
with caring adults, as they can be an especially valuable protective factor for children 
in foster care.21  Further, ACF asserted that strengthening relationships with caring 
adults is one way in which State agencies can attempt to reduce childrens risk of 
going missing from foster care.22 
Federal requirements related to children missing from foster 
care 
In 2014, Congress passed the Preventing Sex Trafficking and Strengthening Families 
Act (Strengthening Families Act), which amended the Act to require that as a 
condition of receiving Federal foster care funding, States must implement protocols 
for locating any child missing from foster care.23  State agencies must report 
information on missing or abducted children immediatelyand in no case later than 
24 hours after receiptto law enforcement authorities, so that those authorities can 
enter that information into the databases of the National Crime Information Center 
and to the National Center for Missing and Exploited Children.24, 25  Additionally, 
States are required to develop policies and procedures to identify, document, and 
determine services for children in foster care who are, or are at risk of becoming, 
victims of sex trafficking.26  
Missouri foster care agency policies related to children missing 
from care 
In each Title IV-E State Plan, the State must designate a State agency to administer its 
foster care program.27  In Missouri, the Department of Social Services Childrens 
Division (hereinafter referred to as Missouri) is designated to administer child welfare 
services, including foster care.  The Missouri Child Welfare Manual documents the 
policies and procedures of the foster care program.28 
Before children go missing  
The Missouri policy that requires visitation plans for all children in foster care is 
particularly important, because visitation with their families can potentially reduce 
childrens risk of going missing from care.  This policy aligns with ACFs emphasis on 
the importance of relationships with caring adults.  Missouri policy recommends that 
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Background | 3  visits between parents, children, and siblings should occur weekly, or as frequently as 
possible, with a minimum of one time per month.29  Missouri policy states that case 
managers must develop visitation plans.30  For children in foster care, visitation with 
their families is meant to enhance and increase the bond between the parent, child, 
and siblings.31  No other policies are explicitly intended to reduce childrens risk of 
going missing from foster care. 
When children go missing 
As required by the Strengthening Families Act, Missouri implemented policies for 
locating any child missing from foster care.32, 33  According to Missouri policy, children 
in foster care are considered to be missing as soon as their physical whereabouts are 
unknown to the Missouri foster care agency.34  The case manager should file a 
missing child report with local law enforcement within the first 24 hours after a child 
is determined to be missing, as required by both State policy and Federal law.35  
Within that same timeframe, the case manager should report the child as missing to 
the National Center for Missing and Exploited Children.  Additionally, Missouri policy 
states that the case manager should notify several other individuals that the child is 
missing, including the juvenile officer, court representative, and childs parent(s).36  
Missouri policy instructs the case manager to contact the childs family members, 
friends, counselors, school faculty, or others who may have information about the 
childs whereabouts.37  The policy states that the case manager should continue to 
make these contacts a minimum of once per month until the child is located, and that 
the case manager should record all contact or attempted contact in the case file. 
When children return to foster care 
Missouri has policies to direct case managers actions when children return to foster 
care after going missing.38  When a child returns or is located, the case manager 
should immediately assess the childs safety.  Upon the childs return to care, the case 
manager should arrange for a medical examination within 24 hours.  Additionally, the 
case manager should schedule a meeting of the childs Family Support Team within 
72 hours of the childs return.  This team is composed of numerous people involved in 
the care of the child, including the childs parents, foster parents, legal guardian, 
juvenile officer, guardian ad litem, court-appointed special advocate, and others.39  
The purpose of a Family Support Team meeting after the child returns to care is to 
assess concerns such as the childs safety, foster care placement, and preventing 
future episodes of the child going missing.   
As required by Federal law and Missouri policy, the case managers must interview 
children once the children are located or returned to care to determine the factors 
that led to the childrens absences and their experiences while missing.40  Missouri 
policy states that in the childs subsequent placements, case managers should 
addressto the greatest extent possiblethe factors that led to the childs absence.  
Further, the case manager should determine the childs experiences while absent from 
care, including whether the child became a victim of sex trafficking.41  Missouri policy 
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Background | 4  states that it may be appropriate for the case manager to make a referral to a child 
advocacy center for a forensic interview, especially for children who have frequently 
gone missing, even if the child made no disclosure or provided no information about 
involvement in trafficking.42 
Case management system 
Federal law requires States, including Missouri, to report certain foster care case-level 
information to ACF.43  Examples of data reported include demographic information on 
the child, the number of times a child has been removed from their home, and the 
current placement setting.  The Missouri case management system uses the label 
RUN to track when children are missing from their assigned placement.   
Related Work 
OIG has participated in multiple operations to locate missing children, including 
children missing from foster care.  OIG joined DOJ and local law enforcement for an 
operation in Kansas in November 2018.44  (In such joint operations, OIG, DOJ, and 
local law enforcement are collectively known as the task force.)  The task force for 
this operation identified and located children missing from foster care, including 
those at high risk for human trafficking.  The task force successfully located 
18 children.  In June 2021, OIG joined the Department of Homeland Security and local 
law enforcement for an operation to rescue victims of human trafficking and sexual 
exploitation in Wichita, Kansas; Independence, Missouri; and Kansas City, Missouri.45  
This operation resulted in the rescue of 31 victims of trafficking and exploitation.  Of 
those rescued, 14 were children who had been missing from foster care, and the 
youngest of these children was 4 years old. 
Additionally, OIG has conducted previous work evaluating the health and safety of 
children in foster care.  In March 2021, OIG found that some States lack oversight 
systems to ensure that every child victim has a court representative, and found that 
some States have challenges that impede their ability to appoint a representative to 
every child victim.46  In 2020, OIG found thatcontrary to Federal laws and 
regulations Kansas did not ensure that all foster care group homes complied with 
State licensing requirements related to the health and safety of children in those 
homes.47  In 2018, OIG found that in five States, one in three children in foster care 
who were treated with psychotropic medications did not receive treatment planning 
or medication monitoring as required by States.48  In 2015, OIG found that in four 
States, nearly a third of children in foster care who were enrolled in Medicaid did not 
receive at least one required health screening.49 
OIG has begun work to evaluatein selected Statesthe extent to which children in 
foster care are screened to determine whether the children are, or are at risk of 
becoming, a victim of sex trafficking.50   
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Background | 5  Methodology 
This study focused on Missouris attempts to locate children who were missing from 
care, and on its provision of services before and after their episodes of going missing.  
Missouri provided the task force (e.g., OIG, DOJ, and local law enforcement) with a list 
of 94 children who were missing from care on July 31, 2019 (i.e., children who were 
categorized as being in RUN status).51  The task force used this list from 
July 31, 2019, to locate children missing from Missouri foster care.  For this case study, 
we used the same list to identify 65 children who were either located or removed 
from foster care custody (i.e., Missouri had ended its legal authority and responsibility 
to care for them) by August 30, 2019. 
First, we determined which of the 65 childrens case files showed evidence that they 
had an episode of being missing; the case files for 6 children showed that they had 
not had such an episode.  For the 59 children whom we identified with an episode of 
being missing, we evaluated whether Missouri followed applicable Federal and State 
laws, policies, and procedures to protect these children before and during their 
episodes of being missing.  We also evaluated whether Missouri provided services to 
these children that may reduce the risk of going missing. 
We determined that 41 of these 59 children returned to foster care during our review 
period.  For these 41 children, we evaluated whether Missouri followed applicable 
Federal and State laws, policies, and procedures to provide health and safety checks 
for these children.  The remaining 18 children were removed from foster care custody 
(i.e., Missouri ended its legal authority and responsibility to care for them).  See 
Exhibit 1 for an illustration of the number of children whom we included at each stage 
of this evaluation. 
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Background | 6  Exhibit 1: Flowchart of children in foster care whom our review included 
Source: OIG analysis of documentation in foster care case files, 2021. 
For additional information on our methodology, see the Detailed Methodology on 
page 19 of this report. 
Limitations 
It is possible that some children in our review received services that were not included 
in the documentation that Missouri submitted; therefore, this study may have 
underestimated the extent to which these children received required services and 
supportive services.  
Standards 
We conducted this study in accordance with the Quality Standards for Inspection and 
Evaluation issued by the Council of the Inspectors General on Integrity and Efficiency.    
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Background | 7   
FINDINGS 
 
Missouri does not have policies to identify children who may be 
at heightened risk of going missing or interventions to reduce 
their risk 
ACF has identified risk factors associated with an increased risk of going missing from 
foster care and reported publicly to Congress that prevention efforts should be 
targeted towards children with these risk factors.  However, there is no Federal law or 
regulation that requires States to develop policies for identifying such children and 
targeting efforts to reduce their risk, and Missouri does not have such policies. 
In our review of case files, we found that before children went missing from Missouri 
foster care, 83 percent of the children (49 out of 59) had evidence in their case files of 
at least one of the risk factors that ACF identified as being associated with an 
increased likelihood of going missing from foster care.  However, in only a few of the 
49 case files did case managers note this heightened risk.  Over half of the children 
who were missing from Missouri foster care had one or more previous episodes of 
going missing.  More than a third of the children had six or more previous foster care 
placements.  In our findingswhich were consistent with research on the subject
the most common placement types from which children went missing were group 
homes and residential facilities.  ACF has reported that prevention efforts should be 
targeted toward children with these risk factors.   
Additionally, the case files for 39 percent of the children whose files we reviewed 
(23 out of 59) had no evidence of family visitation plans, which would have allowed 
the children to remain connected to caring adults and are required by Missouri policy.   
See Exhibit 2 on the next page for the number of children who had evidence of each 
risk factor. 
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Findings | 8  Exhibit 2: Most of the children had at least one risk factor associated with 
increased likelihood of going missing from care.   
Source: OIG analysis of documentation in foster care case files, 2021. 
Though many children had these risk factors, there was little evidence that Missouri 
attempted to reduce their risk of going missing.  Prior to childrens episodes of going 
missing from foster care, Missouri provided only 7 of the 49 children (14 percent) with 
services to reduce their risk of going missing.  Two case files contained evidence that 
children had been referred to a child advocacy center.  One child had a tracking 
device placed on the childs phone to help locate the child if the child did go missing 
from care.  The other four children were moved to a placement that could provide a 
more secure setting to prevent them from going missing.  None of the case files 
contained evidence that case managers had discussed with the children the dangers 
of their going missing or provided additional services to reduce the potential that the 
children would go missing. 
Frequently there was no evidence that Missouri took the 
required actions to locate children who were missing from 
foster care 
Federal law requires Missouri to develop policies that require case managers to aid in 
locating children who have gone missing from foster care.  Although Missouri 
developed these policies, the documentation we reviewed showed that case 
managers often did not follow them.  These policies require case managers to 
(1) report children as missing to entities who assist in locating missing children and 
(2) make contact with individuals who may have information about a childs 
whereabouts. 
   
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Findings | 9  Nearly half of the children were not reported as missing to either 
local law enforcement or to the National Center for Missing and 
Exploited Children, as required by Federal law 
For 46 percent of children (27 out of 59) who were missing from foster care, there was 
no evidence of that their case managers reported them as missing to either local law 
enforcement or to the National Center for Missing and Exploited Children (NCMEC), 
as required by Federal law and Missouri policy.52  Specifically, the case files of 
33 children had no evidence that the children were reported as missing to law 
enforcement, and the case files for 38 children had no evidence that the children were 
reported as missing to the NCMEC.  Without documentation of such reporting, 
Missouri cannot be assured that case managers reported children missing as required.  
When case managers fail to report children as missing to law enforcement or the 
NCMEC, these entities are not able to provide assistance in locating the missing 
children. 
Law enforcement and the NCMEC both provide avenues for locating and identifying 
children who are missing from foster care.  Notifying law enforcement provides 
officers with the information they need to identify and return children who are 
missing from foster care.  Notifying the NCMEC provides additional supports to the 
foster care agency while it searches for a missing child, as the NCMEC coordinates the 
creation and dissemination of missing-children posters.53  Without these supports, the 
number of people actively looking for missing children decreases.   
Missouri often failed to make State-required notifications and 
contacts to seek information on childrens potential whereabouts 
For 61 percent of children (36 out of 59), there was no evidence that the case 
managers notified the adults in the childs life when the child went missing from care, 
as required by Missouri policy.  The adults include 
O the juvenile officer, court representative, and 
ne child who was missing from Missouri 
parent(s) of the child.  These notifications are 
foster care was identified as having been 
important because these adults may have 
sex-traffickedin as many as four States
information about a childs whereabouts, and the 
while missing.  There was no evidence that 
child could contact one of these adults while 
this child had been reported as missing or 
that any requirements that could have aided  missing.  When none of these individuals are 
in locating this child were complied with.  contacted, the foster care agency could miss 
critical information to aid in locating the child.  
Additionally, Missouri policy requires the foster care case manager to contact family 
members, friends, or others who may have information about the childs whereabouts.  
The policy requires the case manager to make these contacts at a minimum of once 
per month until the child is located.  For 63 percent of the children (37 out of 59), 
there was no evidence of any contacts being made within the first month of the 
childs being missing.   
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Findings | 10  One in three children whose cases we reviewed did not have 
evidence in their case files of receiving any required health and 
safety checks following their return to foster care 
Of the 41 children who returned to Missouri foster care after being missing, 
32 percent (13 out of the 41 children) had case files that did not have evidence that 
the children received any required health and safety checks following their return.  
Missouri policy requires case managers to complete several checks related to 
childrens health and safety after children return from being missing.  The majority of 
files did not show evidence that children received a screening to identify victims of 
sex trafficking, a medical exam, a family service team meeting (i.e., a meeting 
involving a multidisciplinary team to assess concerns such as the childs safety and 
foster care placement), or an assessment of their safety.  Additionally, the files for 
many children did not have evidencecontrary to requirementsthat a case 
manager attempted to determine the factors that led to the childs going missing or 
the childs experiences while missing from care.  See Exhibit 3 for the numbers of 
children who did not receive each check.   
Exhibit 3.  There was no evidence that many children received required 
health and safety checks following their return to care.  
Source: OIG analysis of documentation in foster care case files, 2021. 
These health and safety checks are an important first step to understanding the 
experiences of children who go missing from foster care.  Children may encounter 
dangerous situations, such as sexual exploitation or sex trafficking, and may 
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Findings | 11  experience adverse health outcomes.  Our review identified several of these 
dangerous situations and experiences.  For example, several children had experiences 
living in unsafe environments and using drugs while missing.  Additionally, a few of 
the children became pregnant while missing and one child was trafficked for sex.   
If these required checks are not performed, childrens trauma may go undetected and 
children may not receive critical supportive services to help address trauma they 
experienced while missing from care.  A child may benefit from supportive services 
such as therapy to address the childs mental health needs, or a change in placement 
to reduce the childs risk of going missing in the future.   
O
ne child who returned to foster care after having been missing had no evidence in her case file of 
receiving any required health and safety checks.  The day this child returned to care, she told her 
case manager that she had met a man online and asked the case manager to drive her across the 
State to live with him.  When the case manager refused to drive the child, the child attempted to 
hitchhike there.  
It is possible that this child was being recruited for sex trafficking, or that she had already been 
trafficked while she was missing from care.  But without her having been properly screened, it is 
difficult to know for sure.  Because the case manager had not ensured that any of the required 
health and safety checks were conducted, the case manager could not know what traumas this child 
had experienced and therefore could not know which services might be needed. 
In our review, there was no evidence that 63 percent of children (26 out of 41) 
received any supportive services following their return.  Of the children who received 
supportive services, some children were placed with family or friends, as preferred by 
the child, while others were placed in residential or therapeutic homes54 to attempt to 
prevent additional episodes of their going missing.  Some children were referred for 
therapy or counseling, and a few children were placed in the home of a supportive, 
trusted adult.  Additionally, three children were referred to a child advocacy center for 
further screenings and services.  
   
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Findings | 12  Missouris case management system does not accurately 
identify children who are missing from foster care 
In our interviews with officials from Missouris foster care agency, we learned that the 
agencys case management system does not distinguish between children who are 
missing from their placement but whose whereabouts are unknown from those who 
are in an unapprovedbut knownplacement.  Both types of children appear in 
Missouris system with the status RUN.  This lack of distinction between the two 
types makes it difficult to determine if a child is truly missing.   
The RUN status encompasses many scenarios, such as a childs location being 
known but unapproved; a childs whereabouts being unknown; and a childs location 
being unknown but the childs having occasional contact with the case manager.  
Some children leave their assigned placements to live in a location not assigned by 
their case managerfor example, with a friend or family member who is not 
approved by the foster care agency.  They are then described as being in 
unapproved placements, but the case managers often know where the children are 
and continue to provide required visits and other services to these children.  Nearly 
1 in 5 children selected for our review (12 of 65) were not missing from foster care at 
the time they were included on the list of missing children that was provided to the 
task force.  Instead, these children were in unapproved placements. 
This limitation within Missouris case management system creates challenges for case 
managers and those conducting oversight.  For the cases we reviewed, the case 
managers knew the true status of the children in their caseloads (as evidenced by 
their notes and documentation in the case files).  However, if a case manager does 
not sufficiently document a childs status and the childs whereabouts, a new case 
manager who takes over the childs case may not know where the child is located.  
Further, the ambiguity of the RUN status may impede the ability of supervisors
and others who oversee case managersto determine whether case managers 
completed every required action that was applicable to the childs situation.  
Additionally, this data limitation makes it extremely difficult to know the true number 
of missing children, and to coordinate with law enforcement and others who should 
be attempting to locate these missing children. 
 
  
 
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Findings | 13   
CONCLUSION AND RECOMMENDATIONS 
 
 
The Missouri foster care agency (Missouri) missed opportunities to identify and 
mitigate childrens risk for going missing from foster care.  Additionally, there is no 
evidence that once children went missing, Missouri complied with State and Federal 
requirements or effectively used all resources available to assist in locating the 
children.  Further, once the children were located, Missouri appeared to do little to 
ensure that they would not go missing again, or to ensure that they received 
supportive services to address trauma they experienced while missing from care.   
These findings raise concerns about Missouris ability to protect vulnerable children 
from the risks associated with being missing from foster care. 
In response to engagement with OIG during this evaluation, Missouri has taken steps 
to improve in some of these areas of concern.  With regard to human trafficking, 
Missouri developed a policy, training, and assessment tools.  Missouri also developed 
and implemented a checklist of procedures for case managers to complete when a 
child is identified as missing from care and when the child is located.  In addition, 
Missouri informed OIG that it had requested a change to its case management system 
to add additional status labels to distinguish between children who are missing from 
their placement and those who are in an unapproved placement.  However, as of 
August 2021, this change had yet to be implemented because of budget constraints. 
Thousands of children are missing from foster care systems across the nation.  These 
findings in Missouri provide potential insight into systemwide challenges and 
deficiencies that other State foster care agencies may share.  These findings suggest 
that other States may benefit from engaging with ACF about potential deficiencies in 
their States.  Such deficiencies may include problems with fulfilling requirements 
when children go missing from and return to foster care, as well as challenges in 
identifying and attempting to reduce risk factors for childrens going missing. 
We recommend that the Missouri foster care agency: 
Develop policies to help identify (a) children who have a 
heightened risk of going missing from care and 
(b) interventions that could reduce their risk  
The Missouri foster care agency should use risk factorssuch as those that ACF has 
identifiedto identify children who are at greater risk of going missing from care and 
target interventions and resources that could reduce that risk.  Some of the risk 
factors that ACF identified include having a history of going missing; having had 
multiple previous foster care placements; being placed in a group home or 
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Conclusion and Recommendations | 14  a residential facility; and lacking relationships with caring adults.  Missouri should use 
these risk factors to develop policies that assist case managers in identifying children 
who have a heightened risk of going missing.  Additionally, Missouri should develop 
policies to instruct case managers on ways to reduce this risk.  Missouri should 
increase use of existing resourcessuch as child advocacy centersto reduce 
childrens risk of going missing, and it should evaluate the development of additional 
interventions. 
Implement a monitoring mechanism to ensure that case 
managers comply with requirements and document their 
compliance when children are identified as missing and when 
they are located or return to care 
Missouri should ensure that case managers are consistently complying with and 
documenting each requirement within the specified timeframes in which children are 
identified as missing and when they are located or return to care.  To do this, Missouri 
could monitor the use of the checklist it developed.  Further, to facilitate this 
oversight, Missouri could consider integrating the checklist into a data system, 
including fields for case managers to add the date each requirement is completed.  
Additionally, Missouri could consider providing additional training to case managers 
on how to complete and document these requirements effectively.  For example, 
Missouri could provide a standard screening tool to identify victims of sex trafficking 
and could provide standard questions to determine childrens experiences while 
missing and factors that led to their going missing. 
Implement improvements to the case management system to 
enable accurate identification of children who are missing from 
care 
We recommend that Missouri implementafter seeking the necessary funding
a case management system change that would allow for the accurate identification of 
the status of each child in Missouris foster care program.  Missouri should be able to 
accurately and easily identify the status of each child in its foster care program, such 
as location known but unapproved, whereabouts unknown, and location 
unknown but in occasional contact with the case manager. 
   
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Conclusion and Recommendations | 15  We also recommend that ACF: 
Develop a forum for States to share experiences and best 
practices related to the following: reducing childrens risk for 
going missing from foster care, locating missing children, and 
addressing their needs after they return to care 
ACF offers many opportunities for States to share ideas and experiences with each 
other.  ACF should develop a new forum or use an existing forum for States to share 
how they are working to reduce childrens risk for going missing from foster care and 
how they attempt to locate and return children to care after they have gone missing.  
The forum should also discuss best practices related to addressing the needs of 
children after they return to care. 
Support Missouri as it works to reduce childrens risk for going 
missing from foster care and to improve compliance with 
Federal and State requirements related to children who go 
missing 
ACF should support Missouri in its efforts to reduce childrens risk for going missing 
from foster care and to improve compliance with Federal and State requirements 
related to children who have gone missing.  For example, Missouri may need 
assistance in ensuring that case managers comply with State and Federal 
requirements when a child is identified as missing or located after being missing, or 
assistance in improving its case management system to accurately identify children 
who are missing from care.  Other States may also need the same kind of support that 
ACF provides to Missouri. 
 
 
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Conclusion and Recommendations | 16  STATE AND AGENCY COMMENTS AND OIG 
RESPONSE
  
 
The Missouri Department of Social Services (Missouri) did not explicitly concur or 
nonconcur with our three recommendations to its agency, but it did note actions it 
has taken in response to our recommendations and agreed to take additional 
responsive actions.  ACF concurred with our two recommendations to its agency. 
Missouri agreed with our recommendation to develop policies to identify children 
who have a heightened risk of going missing from foster care and interventions that 
could reduce their risk.  Missouri stated that it developed and implemented policy, 
training, practice alerts, and assessment tools related to human trafficking while this 
review was being completed.  Additionally, Missouri is collaborating with community 
partners to provide services for children who have been trafficked or are at 
heightened risk for trafficking. 
Missouri did not explicitly agree or concur with our second recommendationto 
implement a monitoring mechanism to ensure that case managers comply with and 
document required actions that are taken when children are identified as missing and 
when they are located.  However, Missouri did state that it developed policies and 
procedures, effective September 2020, to ensure that its staff document compliance 
with requirements to notify law enforcement and others when children go missing 
from foster care. 
Missouri agreed with our recommendation to implement improvements to the case 
management system to enable accurate identification of children who are missing 
from care.  Missouri stated that it is evaluating potential system and document 
management changes to address this recommendation.  
ACF concurred with both of our recommendations.  With regard to our first 
recommendation to ACFto develop a forum for States to share experience and best 
practices related to reducing childrens risk for going missing from foster care, 
locating children, and addressing their needs after they return to careACF stated 
that it will work in fiscal year 2022 to develop new, or build upon existing, forums for 
States to share strategies for these issues.  With regard to our second 
recommendation to ACFto support Missouri as it works to reduce childrens risk for 
going missing from foster care and to improve compliance with Federal and State 
requirements related to children who go missingACF stated that its Regional Office 
will work with Missouri to provide a forum to discuss this topic and to provide 
Missouri with information for requirements and best practices for prevention and 
addressing the children and familys needs when the children are located after being 
missing. 
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  State and Agency Comments and OIG Response | 17  We appreciate Missouris and ACFs steps to address these important issues.  OIG 
urges both Missouri and ACF to continue their work in this area to ensure that 
children in foster care are protected from the dangers of going missing from care. 
For the full text of Missouris comments, see Appendix A.  For the full text of ACFs 
comments, see Appendix B. 
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  State and Agency Comments and OIG Response | 18    
DETAILED METHODOLOGY 
 
Data Collection 
We collected information from Missouri.  We received confirmation from Missouri 
that (1) we correctly interpreted its policies, which are publicly available; (2) our list of 
its policies was comprehensive; and (3) these policies were all applicable during the 
relevant time period.  We received the foster care case files for the 65 children we 
selected from the listprovided to the task forceof missing children who were 
located or released from Missouri foster care custody.  The list of missing children 
included a date on which each child went missing.  For each child, we received 
documentation from 6 months prior to the date the child went missing through 
6 months following the date the child returned to care or was removed from Missouri 
foster care custody.   
Data Analysis 
We determined whether documentation indicated that the selected children received 
services according to Missouri foster care policy.   
We reviewed the foster care case files for evidence that the children were provided 
the required services.  Specifically, we reviewed the documentation for evidence that 
Missouri followed (1) the requirement to develop a visitation plan with family 
members, (2) the requirements for when children went missing, and (3) the 
requirements to conduct health and safety checks for children following their return 
to care.  Further, we reviewed the documentation to determine which, if any, 
supportive services Missouri provided after the children were located.  We asked 
Missouri officials clarifying questions to ensure accurate interpretation of the material 
that we found in the case files.  Additionally, we shared our preliminary results with 
Missouri and provided an opportunity for it to submit additional case file 
documentation. 
In addition to reviewing the documentation of services that the children received, we 
determined whether the children had any characteristics associated with a higher risk 
of going missing from care.  We determined whether Missouri identified these 
children as having any of these characteristics, and whether it attempted to address 
these characteristics to reduce the risk of the childrens going missing.  We accepted 
any evidence indicating that a case manager attempted to reduce a childs risk of 
going missing.  Some examples of specific things we looked for include the following: 
evidence of conversations between the case manager and child discussing the 
dangers of going missing or strategies for the child to remain in the childs 
placement; changes in placement settings; referrals to child advocacy centers; and any 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Detailed Methodology | 19  other services or strategies that could potentially reduce a childs risk of going 
missing from care. 
During our review, we found that 12 of the 65 children were not missing from care at 
the time the list of missing children was provided, July 31, 2019.  Rather, the case 
managers knew these childrens whereabouts, but the children were in unapproved 
placements.  We did not consider these instances of unapproved placements when 
we evaluated whether requirements were fulfilled, as these requirements were not 
applicable to these childrens situations.  However, six of these children had been 
missing from care just prior to their unapproved placements.  In our evaluation of 
whether requirements were fulfilled, we included these 6 childrens episodes of being 
missing, resulting in a review of 59 childrens episodes of being missing.  
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Detailed Methodology | 20  Appendix A:  Missouri Department of Social Services Comments
Case Study: Missouris Efforts To Protect Children Missing From Foster Care
OEI-07-19-00372                          Appendix A | 21 Case Study: Missouris Efforts To Protect Children Missing From Foster Care
OEI-07-19-00372                        Appendix A | 22 Appendix B 
Administration for Children and Families Comments 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Appendix B | 23   
 
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Appendix B | 24   
ACKNOWLEDGMENTS AND CONTACT 
 
Acknowledgments 
Abbi Warmker, a Deputy Regional Inspector General for Evaluation and Inspections in 
the Kansas City regional office, served as the team leader for this study.  Haley Lubeck 
and Andrea Staples served as analysts.  Office of Evaluation and Inspections 
headquarters staff who provided support include Althea Hosein, Kevin Manley, and 
Christine Moritz. 
We would also like to acknowledge the contributions of other Office of Inspector 
General staff, including Jessica Swanstrom. 
This report was prepared under the direction of Brian Whitley, Regional Inspector 
General for Evaluation and Inspections in the Kansas City regional office, and 
Dana Squires, Deputy Regional Inspector General. 
Contact 
To obtain additional information concerning this report, contact the Office of Public 
Affairs at Public.Affairs@oig.hhs.gov.  OIG reports and other information can be found 
on the OIG website at oig.hhs.gov. 
Office of Inspector General 
U.S. Department of Health and Human Services 
330 Independence Avenue, SW 
Washington, DC 20201 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Acknowledgments and Contact | 25   
ABOUT THE OFFICE OF INSPECTOR GENERAL 
 
 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 
95-452, as amended, is to protect the integrity of the Department of Health and 
Human Services (HHS) programs, as well as the health and welfare of beneficiaries 
served by those programs.  This statutory mission is carried out through a nationwide 
network of audits, investigations, and inspections conducted by the following 
operating components: 
The Office of Audit Services (OAS) provides auditing services for HHS, 
either by conducting audits with its own audit resources or by overseeing audit work 
done by others.  Audits examine the performance of HHS programs and/or its 
grantees and contractors in carrying out their respective responsibilities and are 
intended to provide independent assessments of HHS programs and operations.  
These audits help reduce waste, abuse, and mismanagement and promote economy 
and efficiency throughout HHS. 
The Office of Evaluation and Inspections (OEI) conducts national 
evaluations to provide HHS, Congress, and the public with timely, useful, and reliable 
information on significant issues.  These evaluations focus on preventing fraud, waste, 
or abuse and promoting economy, efficiency, and effectiveness of departmental 
programs.  To promote impact, OEI reports also present practical recommendations 
for improving program operations. 
The Office of Investigations (OI) conducts criminal, civil, and administrative 
investigations of fraud and misconduct related to HHS programs, operations, and 
beneficiaries.  With investigators working in all 50 States and the District of Columbia, 
OI utilizes its resources by actively coordinating with the Department of Justice and 
other Federal, State, and local law enforcement authorities.  The investigative efforts 
of OI often lead to criminal convictions, administrative sanctions, and/or civil 
monetary penalties. 
The Office of Counsel to the Inspector General (OCIG) provides 
general legal services to OIG, rendering advice and opinions on HHS programs and 
operations and providing all legal support for OIGs internal operations.  OCIG 
represents OIG in all civil and administrative fraud and abuse cases involving HHS 
programs, including False Claims Act, program exclusion, and civil monetary penalty 
cases.  In connection with these cases, OCIG also negotiates and monitors corporate 
integrity agreements.  OCIG renders advisory opinions, issues compliance program 
guidance, publishes fraud alerts, and provides other guidance to the health care 
industry concerning the anti-kickback statute and other OIG enforcement authorities.
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  About the Office of Inspector General | 26   
EEEENNNNDDDDNNNNOOOOTTTTEEEESSSS    
 
 
 
1 ACF, Report to Congress: The Child Welfare System Response to Sex Trafficking of Children, September 2019.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/report_congress_child_trafficking.pdf on April 26, 2021.  This report 
was mandated by Section 105 of the Preventing Sex Trafficking and Strengthening Families Act of 2014 and addressed 
(1) children who run away from foster care and their risk of trafficking victimization; (2) State efforts to serve children who are 
sex trafficking victims; and (3) State efforts to support long-term connections to caring adults for children in foster care. 
2 ACF, Report to Congress: The Child Welfare System Response to Sex Trafficking of Children, September 2019.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/report_congress_child_trafficking.pdf on April 26, 2021.  (See also 
note in endnote 1.) 
3 ACF, Report to Congress: The Child Welfare System Response to Sex Trafficking of Children, September 2019.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/report_congress_child_trafficking.pdf on April 26, 2021.  (See also 
note in endnote 1.) 
4 ACF, Report to Congress: The Child Welfare System Response to Sex Trafficking of Children, September 2019.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/report_congress_child_trafficking.pdf on April 26, 2021.  (See also 
note in endnote 1.) 
5 ACF, Report to Congress: The Child Welfare System Response to Sex Trafficking of Children, September 2019.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/report_congress_child_trafficking.pdf on April 26, 2021.  (See also 
note in endnote 1.) 
6 See  428 and 432(b)(2) of the Act for Title IV-B eligibility requirements for Tribes, and  479B of the Act for Title IV-E 
eligibility requirements for Tribes.  Tribes refers to Indian Tribes and Tribal organizations as defined in 25 U.S.C. 450(b). 
7 45 CFR  1357.15(b) and 1356.20(c)(2). 
8 ACF, Capacity Building Services.  Accessed at https://www.acf.hhs.gov/cb/capacity on April 27, 2020. 
9 ACF, Information Memorandum ACYF-CB/FYSB-IM-14-1, 2014.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/fysb_im1401.pdf on April 26, 2021. 
10 ACF, Report to Congress: The Child Welfare System Response to Sex Trafficking of Children, September 2019.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/report_congress_child_trafficking.pdf on April 26, 2021.  (See also 
note in endnote 1.) 
11 Residential care facilities are a type of live-in, out-of-home care placement in which staff are trained to work with children 
whose specific needs are best addressed in a highly structured environment.  ACF, Group and Residential Care.  Accessed at 
https://www.childwelfare.gov/topics/outofhome/group-residential-care/ on February 4, 2020. 
12 ACF, The Importance of a Trauma-Informed Child Welfare System.  May 2020.  Accessed at 
https://www.childwelfare.gov/pubPDFs/trauma_informed.pdf on September 27, 2021. 
13 ACF, Guidance to States and Services on Addressing Human Trafficking of Children and Youth in the United States.  
September 2013.  Accessed at https://www.acf.hhs.gov/cb/resource/human-trafficking-guidance on April 24, 2019.  
14 ACF, Guidance to States and Services on Addressing Human Trafficking of Children and Youth in the United States.  
September 2013.  Accessed at https://www.acf.hhs.gov/cb/resource/human-trafficking-guidance on April 24, 2019.  
 
 
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Endnotes | 27 
   
 
15 ACF, Report to Congress: The Child Welfare System Response to Sex Trafficking of Children.  September 2019.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/report_congress_child_trafficking.pdf on April 26, 2021.  (See also 
note in endnote 1.) 
16 ACF, Report to Congress: The Child Welfare System Response to Sex Trafficking of Children.  September 2019.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/report_congress_child_trafficking.pdf on April 26, 2021.  (See also 
note in endnote 1.) 
17 ACF, Report to Congress: The Child Welfare System Response to Sex Trafficking of Children.  September 2019.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/report_congress_child_trafficking.pdf on April 26, 2021.  (See also 
note in endnote 1.) 
18 ACF, Report to Congress: The Child Welfare System Response to Sex Trafficking of Children.  September 2019.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/report_congress_child_trafficking.pdf on April 26, 2021.  (See also 
note in endnote 1.) 
19 ACF, Report to Congress: The Child Welfare System Response to Sex Trafficking of Children.  September 2019.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/report_congress_child_trafficking.pdf on April 26, 2021.  (See also 
note in endnote 1.) 
20 ACF, Report to Congress: The Child Welfare System Response to Sex Trafficking of Children.  September 2019.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/report_congress_child_trafficking.pdf on April 26, 2021.  (See also 
note in endnote 1.) 
21 ACF, Report to Congress: The Child Welfare System Response to Sex Trafficking of Children.  September 2019.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/report_congress_child_trafficking.pdf on April 26, 2021.  (See also 
note in endnote 1.) 
22 ACF, Report to Congress: The Child Welfare System Response to Sex Trafficking of Children.  September 2019.  Accessed at 
https://www.acf.hhs.gov/sites/default/files/documents/cb/report_congress_child_trafficking.pdf on April 26, 2021.  (See also 
note in endnote 1.) 
23 P.L. No. 113-183 (Sept. 29, 2014),  101(a)(3)(C)(i), incorporated at  471(a)(35)(A)(i) of the Act. 
24 The Act  471(a)(35)(B). 
25 The National Center for Missing and Exploited Children is a private nonprofit organization whose mission is to help find 
missing children, reduce child sexual exploitation, and prevent child victimization.  National Center for Missing and Exploited 
Children, About Us.  Accessed at https://www.missingkids.org/footer/about on September 17, 2021. 
26 The Act  471(a)(9)(C)(i). 
27 The Act  471(a)(2). 
28 This report evaluates Missouris compliance with policies from the Child Welfare Manual effective during the scope of this 
review.  The Child Welfare Manual has subsequently been updated and policies may be located in different chapter 
subsections; however, the policies remain unchanged.  The current manual is online at https://dssmanuals.mo.gov/child-
welfare-manual/child-welfare-manual-2019-update/. 
29 Missouri Department of Social Services (DSS), Child Welfare Manual (see note in endnote 28),  4 ch. 10.3. (eff. date 
5/1/2019).  Accessed at https://dssmanuals.mo.gov/child-welfare-manual/section-4-chapter-10-case-management-activities-
subsection-3-visitation-between-parents-children-and-siblings/ on January 21, 2020. 
 
 
 
Case Study: Missouris Efforts To Protect Children Missing From Foster Care 
OEI-07-19-00372  Endnotes | 28 
   
 
30 Missouri DSS, Child Welfare Manual (see note in endnote 28),  4 ch. 10.3. (eff. date 5/1/2019).  Accessed at 
https://dssmanuals.mo.gov/child-welfare-manual/section-4-chapter-10-case-management-activities-subsection-3-visitation-
between-parents-children-and-siblings/ on January 21, 2020. 
31 Missouri DSS, Child Welfare Manual (see note in endnote 28),  4 ch. 10.3. (eff. date 5/1/2019).  Accessed at 
https://dssmanuals.mo.gov/child-welfare-manual/section-4-chapter-10-case-management-activities-subsection-3-visitation-
between-parents-children-and-siblings/ on January 21, 2020. 
32 P.L. No. 113-183 (Sept. 29, 2014),  101(a)(3)(C)(i), incorporated at  471(a)(35)(A)(i) of the Act. 
33 Missouri DSS, Child Welfare Manual (see note in endnote 28),  4 ch. 4.9. (eff. date 5/1/2019).  Accessed at 
https://dssmanuals.mo.gov/child-welfare-manual/section-4-chapter-4-working-with-children-subsection-9-missing-person-
report-procedure/ on January 21, 2020.  
34 Missouri DSS, Child Welfare Manual (see note in endnote 28),  4 ch. 4.9. (eff. date 5/1/2019).  Accessed at 
https://dssmanuals.mo.gov/child-welfare-manual/section-4-chapter-4-working-with-children-subsection-9-missing-person-
report-procedure/ on January 21, 2020. 
35 Missouri DSS, Child Welfare Manual (see note in endnote 28),  4 ch. 4.9.1. (eff. date 5/1/2019).  Accessed at 
https://dssmanuals.mo.gov/child-welfare-manual/section-4-chapter-4-working-with-children-subsection-9-missing-person-
report-procedure/ on January 21, 2020.  Missouri DSS has since updated this policy. 
36 Missouri DSS, Child Welfare Manual (see note in endnote 28),  4 ch. 4.9.1. (eff. date 5/1/2019).  Accessed at 
https://dssmanuals.mo.gov/child-welfare-manual/section-4-chapter-4-working-with-children-subsection-9-missing-person-
report-procedure/ on January 21, 2020.  The Missouri DSS has since updated this policy. 
37 Missouri DSS, Child Welfare Manual (see note in endnote 28),  4 ch. 4.9.1. (eff. date 5/1/2019).  Accessed at 
https://dssmanuals.mo.gov/child-welfare-manual/section-4-chapter-4-working-with-children-subsection-9-missing-person-
report-procedure/ on January 21, 2020.  The Missouri DSS has since updated this policy. 
38 Missouri DSS, Child Welfare Manual (see note in endnote 28),  4 ch. 4.9.4. (eff. date 5/1/19).  Accessed at 
https://dssmanuals.mo.gov/child-welfare-manual/section-4-chapter-4-working-with-children-subsection-9-missing-person-
report-procedure/ on January 21, 2020.  The Missouri DSS has since updated this policy. 
39 Missouri DSS, Child Welfare Manual (see note in endnote 28),  4 ch. 7.2. (eff. date 5/1/2019).  Accessed at 
https://dssmanuals.mo.gov/child-welfare-manual/section-4-chapter-7-family-support-teams-subsection-2-composition-of-
family-support-teams/ on January 21, 2020. 
40 Missouri DSS, Child Welfare Manual (see note in endnote 28),  4 ch. 4.9.4. (eff. date 5/1/2019).  Accessed at 
https://dssmanuals.mo.gov/child-welfare-manual/section-4-chapter-4-working-with-children-subsection-9-missing-person-
report-procedure/ on January 21, 2020.  The Missouri DSS has since updated this policy. 
41 Missouri DSS, Child Welfare Manual (see note in endnote 28),  4 ch. 4.9.4. (eff. date 5/1/2019).  Accessed at 
https://dssmanuals.mo.gov/child-welfare-manual/section-4-chapter-4-working-with-children-subsection-9-missing-person-
report-procedure/ on January 21, 2020.  The Missouri DSS has since updated this policy. 
42 Child advocacy centers are community-based, child-friendly, multidisciplinary services for children and families affected by 
sexual abuse or severe physical abuse.  These centers bring togetheroften in one locationchild protective services 
investigators, law enforcement, prosecutors, and medical and mental health professionals to provide a coordinated, 
comprehensive response to victims and their caregivers.  ACF, Child Advocacy Centers.  Accessed at 
https://www.childwelfare.gov/topics/responding/iia/investigation/multidisciplinary/advocacy/ on July 6, 2021. 
 
 
 
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43 45 CFR  1355.40. 
44 ACF, OTIP Partners with HHS Office of Investigations to Locate Missing Kansas Foster Children.  January 2019.  Accessed at 
https://www.acf.hhs.gov/otip/news/projecthope on October 24, 2019. 
45 U.S. Immigration and Customs Enforcement, HSI operation nets 82 arrests and 31 rescued from human trafficking 
operation.  June 29, 2021.  Accessed at https://www.ice.gov/news/releases/hsi-operation-nets-82-arrests-and-31-rescued-
human-trafficking-operation on July 7, 2021. 
46 OIG, ACF Cannot Ensure That All Child Victims of Abuse and Neglect Have Court Representation, March 2021.  Accessed at 
https://oig.hhs.gov/oei/reports/OEI-12-16-00120.pdf on July 7, 2021. 
47 OIG, Kansas Did Not Ensure That Group Homes for Children in Foster Care Complied With All State Health and Safety 
Requirements, July 2020.  Accessed at https://oig.hhs.gov/oas/reports/region7/71906087.pdf on September 8, 2021. 
48 OIG, Treatment Planning and Medication Monitoring Were Lacking for Children in Foster Care Receiving Psychotropic 
Medication, September 2018.  Accessed at https://oig.hhs.gov/oei/reports/OEI-07-15-00380.pdf on July 7, 2021. 
49 OIG, Not All Children in Foster Care Who Were Enrolled in Medicaid Received Required Health Screenings, March 2015.  
Accessed at https://oig.hhs.gov/oei/reports/OEI-07-13-00460.pdf on July 7, 2021. 
50 OIG Work Plan.  Accessed at https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000396.asp on 
July 7, 2021. 
51 During our review, we found that not all children included on the list were missing from care on July 31, 2019.  Twelve 
children were in unapproved placements, and six children had been located or released from custody days or weeks prior. 
52 Missouri officials reported that case workers had challenges in convincing local law enforcement to accept reports that 
children in care were missing, particularly for children who were 17 years old or older.  Officials stated that this challenge may 
have discouraged case workers from continuing to report children as missing to law enforcement, as required.  Since our 
review, Missouri has developed alternative protocols with the Missouri State Highway Patrol to implement procedures for 
reporting children in care as missing when local law enforcement failed to accept reports. 
53 National Center for Missing and Exploited Children, Endangered Runaways.  Accessed at 
https://www.missingkids.org/theissues/runaways on April 1, 2021. 
54 Therapeutic foster care is designed to provide safe and nurturing care to a child or youth in a more structured home 
environment than typical foster care, and it can be a cost-effective alternative to residential treatment.  ACF, What Is 
Treatment Foster Care?  Accessed at https://www.childwelfare.gov/topics/outofhome/foster-care/treat-foster/what-treat/ on 
September 22, 2021.  (See also endnote 11.) 
 
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