In 2007, Missouri enacted into law a Foster Parents' Bill of Rights. In addition to other rights, the law formally established foster parents as colleagues on the child welfare team, requiring that foster parents be engaged in a manner consistent with the National Association of Social Workers’ Ethical Responsibilities to Colleagues. This designation recognizes foster parents as professionals whose expertise is on par with caseworkers, mental health providers, and other members of the team, and also provides them with access to formal appeal processes that are established in law. In 2011, the state legislature enacted the Missouri State Foster Care and Adoption Board. Comprised of foster and adoptive parents from across the state, the Board is charged by law with providing consultation and assistance to the Department of Social Services on policies and procedures related to foster care and adoption, and also determining the nature and content of in-service training.

Missouri has a goal that 50 percent or more of children entering care will be placed with relatives. It created a Relative First Program Development Specialist position in the central office and is piloting a relative therapeutic foster care program.

Missouri’s Children’s Division is partnering with the National Council for Adoption and Northeastern University to conduct focus groups of foster parents to refine recruitment and retention strategies.

Missouri used the Diligent Recruitment Navigator to compile data on the number of foster and adoptive homes by region, availability and race. Staff of the Children’s Division Quality Assurance unit are able to provide localities with data for specific zip codes and school districts and are gathering data on reasons foster parents quit other than adoption in order to improve training and retention. The plan also reports that the Children’s Division is working on a methodology to determine the number of homes and preparation level needed to assure adequate placement capacity.

Ohio, Missouri and Washington are key examples of collaboration and demonstrated ability to overcome challenges in care delivery. A key feature of all three states is partnership with their state chapter of the American Academy of Pediatrics. Engaging AAP chapters in the HOCP development process offers agencies health expertise and the perspective of professionals currently caring for children in foster care. Missouri’s HOCP emphasizes trauma-informed care, data collection and sharing, and ongoing quality improvement. Ohio’s HOCP also adopts a trauma-informed approach and incorporates responses to parental opioid use and FASD. The Ohio HOCP outlines partnering with school health systems, medical homes, Medicaid managed care plans, and the Fostering Connections Program at Nationwide Children’s Hospital. The Washington state HOCP reflects strengths in data and information sharing, upcoming integration of physical and behavioral health systems, and formal psychotropic medication utilization review.

The National Training and Development Curriculum for Foster and Adoptive Parents program is a a five-year federal grant project focused on developing a state-of-the-art training program to prepare foster and adoptive parents to care for children exposed to trauma. Intended outcomes include improved placement stability, improved permanency rates and enhanced child and family well-being. Seven states a tribal community have been selected to partner as pilot sites, including: Colorado, Missouri, Oklahoma, Illinois, Georgia, Florida, Kansas and Salt River Pima Maricopa Indian Community.