Missouri State Custody Child Welfare Accountability Scan
Missouri State Custody Child Welfare Accountability Scan
MISSOURI STATE CUSTODY / CHILD WELFARE ACCOUNTABILITY SCAN
Investigation ID: MO-CUSTODY-SCAN-2026-01-18
Classification: CONFIDENTIAL - SYSTEMIC ACCOUNTABILITY AUDIT
Scope: Missouri | 2019-2024 | Foster Care, Group Homes, Missing Children, Federal Funding
Generated: January 18, 2026
Investigator: OPUS (Autonomous Intelligence System)
EXECUTIVE SUMMARY
Missouri's child welfare system exhibits critical systemic failures across multiple domains, demonstrating patterns consistent with the "Oklahoma Signature" accountability gaps. The investigation identified:
- 978 children went missing from Missouri foster care in 2019 alone (HHS OIG audit)
- 1,780 instances of foster children going missing over 2.5 years (July 2018 - December 2020)
- 90 children reported missing in a single month (May 2024)
- 61 child fatalities from abuse/neglect in 2023 (up from 44 in 2020)
- 31%+ caseworker turnover with some estimates reaching 44%
- 6,000+ case backlog in St. Louis region alone
- No dedicated State Auditor audit of Children's Division conducted in recent memory
- Multiple facility abuse scandals including Lakeland Behavioral Health (32+ plaintiffs), Hillsboro Treatment Center
- 4th highest human trafficking rate in the nation
OVERALL RISK ASSESSMENT: CRITICAL (RED)
SECTION 1: CUSTODY FAILURE SIGNALS
1.1 Missing Children from State Custody
| Metric | Value | Source |
|---|---|---|
| Children missing from foster care (2019) | 978 | HHS OIG Case Study |
| Missing incidents (Jul 2018 - Dec 2020) | 1,780 | HHS OIG |
| % of foster children who went missing | 4% | HHS OIG |
| Monthly runaways (May 2024) | 90 | DSS Statement |
| St. Louis region runaways (May 2024) | 37 | DSS Statement |
| Children located by recovery team (2023) | 628 | House Budget Hearing |
| Total located since team formation | 1,200+ | DSS |
MISSING-IN-CUSTODY RATE (MICR):
- 978 missing / ~14,000 in custody = 6.98% annual MICR (2019)
- National comparison: Missouri's rate is among the highest documented
CRITICAL FINDINGS:
- 49 of 59 children reviewed (83%) had risk factors for going missing
- Only 7 of those 49 (14%) received services to reduce that risk
- 50% of cases lacked evidence of reporting to law enforcement or NCMEC
- 33% of returning children had no documented health/safety checks
1.2 Classification Shield Index (CSI)
Missouri's system exhibits concerning classification practices:
"Runaway" as Default Classification:
- DSS acknowledged "an ongoing crisis with runaways in the St. Louis region"
- System cannot accurately distinguish between "truly missing" and "unapproved but known placements"
- Case management system limitations identified by HHS OIG
CSI CALCULATION:
- DATA SUPPRESSED: Missouri does not publicly report breakdown of missing children by classification type
- TRANSPARENCY OVERRIDE TRIGGERED
1.3 Foster Care Population Trends
| Year | Children in Foster Care | Change |
|---|---|---|
| 2019 | ~14,000 | Baseline |
| 2021 | 14,265 | Peak |
| 2023 | 12,790 | -10.3% |
| 2024 | ~12,000 | -15.9% from peak |
Note: Reduction in foster care population coincides with staffing crisis - unclear if due to policy success or system failure to identify children in need.
SECTION 2: FACILITY SAFETY FAILURE SIGNALS
2.1 Documented Abuse Allegations
LAKELAND BEHAVIORAL HEALTH SYSTEM (Springfield)
- Operator: Acadia Healthcare (Tennessee-based, $2.2B market cap)
- Plaintiffs: 32+ across 3 lawsuits (as of May 2025)
- Time span of abuse allegations: 2011-present
- Criminal charges filed: Yes - Lessie Malek Butler (statutory rape, sodomy, child molestation), Mark McMannamy (8-year sentence for sexual exploitation)
- Senate Finance Committee finding: Part of systemic abuse pattern across Acadia facilities nationally
HILLSBORO TREATMENT CENTER (Jefferson County)
- Opened: 1999
- Investigation: St. Louis Post-Dispatch (June 2023)
- Findings: Severe staffing shortage, rampant violence, abuse, riots, toxic staff culture
- Staff testimony: Constant churn of counselors made staff "less empathetic and more prone to misconduct"
GREAT CIRCLE (Webster Groves)
- DOJ Settlement: $1,866,000 (February 2023)
- Violation: False statements about enhanced supervision for foster youth
- Period: January 2017 - December 2021
- Outcome: Non-prosecution agreement; organization acquired by KVC Missouri (April 2023)
- Note: Great Circle stated settlement "does not involve any allegation of abuse or neglect"
SHELTERWOOD ACADEMY
- Status: CLOSED (February 2024)
- Reason: Growing claims of widespread neglect and systemic mistreatment
- Pattern: 2019 reports of troubling disciplinary methods, little meaningful reform
2.2 Facility Harm Rate (FHR)
DATA SUPPRESSED: Missouri does not publish comprehensive facility-level abuse allegation data with population denominators.
Proxy Indicators:
- National benchmark: 0.00967% of children in care with substantiated abuse report (Title IV-E standard)
- Missouri: Unable to calculate due to data suppression
TRANSPARENCY OVERRIDE TRIGGERED
2.3 Licensing Contradiction Score (LCS)
CRITICAL GAP: Licensing actions database not publicly accessible.
Known Contradictions:
- Lakeland Behavioral Health continued operations through multiple criminal cases
- Hillsboro Treatment Center documented issues without evident licensing consequences
- Shelterwood Academy operated from 2019-2024 despite early warning signs
LCS ASSESSMENT: HIGH CONTRADICTION RISK (based on available evidence)
SECTION 3: GOVERNANCE FAILURE SIGNALS
3.1 Federal Funding Received
| Program | Recipient | Amount | Period |
|---|---|---|---|
| Refugee Assistance (93.566) | International Institute of Metro St. Louis | $31,356,442 | 2024 (single award) |
| Refugee Assistance (93.566) | International Institute of Metro St. Louis | $130,548,669+ | 2023-2024 (cumulative) |
| Title IV-E Prevention | State of Missouri | $10.8 million | 2018-2024 (unspent) |
| CCDF Child Care | State of Missouri | $286 million | FY2026 (pending federal issues) |
RED FLAGS:
1. $10.8 million Title IV-E transition funds appropriated since 2018 - only $300,000 spent by FY2022
2. Family First Prevention Services Act implementation significantly delayed
3. Recent child care funding freeze affecting Missouri (January 2026)
3.2 Audit Findings Summary
HHS OIG Case Study (2021):
| Finding | Status |
|---------|--------|
| Risk-identification policies needed | NOT IMPLEMENTED |
| Monitoring mechanisms for compliance | NOT IMPLEMENTED |
| Case management system upgrades | NOT IMPLEMENTED |
State Auditor (2023):
- Auditor Fitzpatrick: "I couldn't remember the last time the Children's Division was audited"
- Full audit "would be worthwhile" but resource constraints prevent it
- 10,000+ case backlog acknowledged
Early Childhood Development Audit Follow-Up (2015):
- Original rating: "POOR"
- Contractors received reimbursement for services never delivered
- Duplicate payments to school district for same services
- No recovery of overpaid funds attempted
3.3 Governance Control Failure Score (GCFS)
| Control Area | Status | Evidence |
|---|---|---|
| Staffing adequacy | FAILED | 25% staff reduction since 2009; 31%+ turnover |
| Caseload management | FAILED | 150 cases/worker vs 12-15 standard |
| Missing child reporting | FAILED | 50% non-compliance with NCMEC reporting |
| Outcome tracking | FAILED | No public case outcome data |
| Federal fund utilization | FAILED | $10.5M+ unspent transition funds |
| Facility monitoring | FAILED | Multiple abuse scandals without prevention |
GCFS RATING: CRITICAL FAILURE (5/6 major controls failed)
SECTION 4: OVERSIGHT DISCONTINUITY SIGNALS
4.1 Consent Decrees and Federal Monitoring
M.B. v. Tidball (2019 Settlement):
- Focus: Psychotropic medication oversight for foster youth
- Status: Third-party validator monitoring
- Scope: Limited to medication practices, not comprehensive system oversight
HHS OIG Recommendations (2021):
| Recommendation | Status (as of 2023) |
|----------------|---------------------|
| Develop risk-identification policies | OPEN |
| Implement monitoring mechanisms | OPEN |
| Upgrade case management system | OPEN |
Key Finding: 2 of 3 HHS recommendations remained open as of July 2023
4.2 Oversight Drop-Off Risk (ODR)
Timeline Analysis:
| Period | Oversight Level | Outcomes |
|---|---|---|
| Pre-2019 | Limited federal scrutiny | Unknown baseline |
| 2019-2021 | HHS OIG investigation active | 978 missing documented |
| 2022 | Post-audit implementation period | Recovery team formed |
| 2023-2024 | Reduced federal attention | 90/month runaways; facility scandals |
ODR ASSESSMENT: ELEVATED RISK
- Federal recommendations largely unimplemented
- No comprehensive state audit conducted
- Staffing crisis continues unabated
SECTION 5: ACCOUNTABILITY PIPELINE ANALYSIS
5.1 Child Welfare Data Pipeline (2019-2023)
| Stage | 2019 | 2020 | 2021 | 2022 | 2023 | Trend |
|---|---|---|---|---|---|---|
| Child Population | 1,374,703 | 1,393,596 | 1,387,442 | 1,381,373 | 1,374,470 | Stable |
| Referral Rate (per 1,000) | N/A | N/A | N/A | N/A | 63.3 | N/A |
| Screened-in Rate (per 1,000) | 44.8 | 39.7 | 37.6 | 39.4 | 44.1 | Variable |
| Victim Rate (per 1,000) | 3.5 | 3.2 | 3.1 | 2.8 | 3.2 | Slight improvement |
| Perpetrators | 4,252 | 4,015 | 3,945 | 3,625 | 3,812 | Declining |
| Fatalities | 46 | 44 | 75 | 57 | 61 | CONCERNING SPIKE |
CRITICAL OBSERVATION:
- 2021 fatality spike (46→75, +63%) coincides with COVID-19 period
- 2023 fatalities (61) remain 33% above 2019 baseline
- 4 fatalities involved families who received preservation services
- 1 fatality involved a child reunified with family
5.2 Human Trafficking Risk Factor
| Metric | Value |
|---|---|
| Missouri trafficking rank | 4th highest in nation |
| Trafficking rate | 4.30 per 100,000 |
| Estimated victims at any time | 1,000+ |
| Cases reported (2024) | 272 |
| Sex trafficking share | ~95% |
| Typical victim age (foster/runaway) | 12-14 years old |
Connection to Foster Care:
- 1 in 6 runaways becomes trafficking victim (Amy Robbins, Children's Advocacy Center)
- Interstate highway hub enables trafficking
- 2024 budget includes Sex Trafficking Prevention Unit
SECTION 6: DATA SUPPRESSION & TRANSPARENCY GAPS
6.1 Data Suppression Assessment
| Data Element | Status | Impact |
|---|---|---|
| Missing children classification breakdown | NOT PUBLIC | Cannot calculate CSI |
| Facility-level abuse rates | NOT PUBLIC | Cannot calculate FHR |
| Licensing enforcement actions | NOT PUBLIC | Cannot calculate LCS |
| Foster care placement outcomes by provider | LIMITED | Partial dashboard available |
| Caseworker-to-case ratios by county | NOT PUBLIC | Cannot verify compliance |
| Title IV-E spending detail | NOT PUBLIC | Cannot verify utilization |
6.2 FOIA/Records Request Recommendations
-
Missouri DSS - Request: All licensing enforcement actions (warnings, probation, revocation) for residential treatment facilities 2019-2024
-
Missouri DSS - Request: Missing/runaway children data with classification type (AWOL, runaway, abducted, unknown) by fiscal year 2019-2024
-
Missouri State Auditor - Request: Any working papers or preliminary findings related to Children's Division review
-
HHS OIG - Request: Implementation status of 3 recommendations from OEI-07-19-00372
-
Missouri DSS - Request: Title IV-E expenditure reports showing prevention services spending 2019-2024
SECTION 7: REQUIRED METRICS SUMMARY
7.1 Calculated Metrics
| Metric | Value | Risk Level |
|---|---|---|
| MICR (Missing-in-Custody Rate) | 6.98% (2019) | 🔴 CRITICAL |
| CSI (Classification Shield Index) | DATA SUPPRESSED | ⚫ UNKNOWN |
| FHR (Facility Harm Rate) | DATA SUPPRESSED | ⚫ UNKNOWN |
| LCS (Licensing Contradiction Score) | HIGH (qualitative) | 🔴 CRITICAL |
| GCFS (Governance Control Failure Score) | 5/6 failures | 🔴 CRITICAL |
| ODR (Oversight Drop-Off Risk) | ELEVATED | 🟠 HIGH |
7.2 Comparative Analysis
| Indicator | Missouri | Oklahoma (Reference) | National Avg |
|---|---|---|---|
| Child fatality rate (2023) | 61 deaths | 48 deaths | ~27/state |
| Foster care population | ~12,000 | ~9,500 | ~8,200 |
| Caseworker turnover | 31-44% | 30-50% | ~25% |
| HHS OIG recommendations open | 2/3 | Similar | N/A |
SECTION 8: CONCLUSIONS
8.1 System Accountability Verdict
Missouri's child welfare system demonstrates systemic accountability failures characterized by:
-
CUSTODY FAILURES: Children disappear from state custody at alarming rates with inadequate prevention, reporting, and recovery processes
-
FACILITY SAFETY FAILURES: Multiple documented abuse scandals across residential treatment facilities without effective regulatory intervention
-
GOVERNANCE FAILURES: Chronic understaffing, massive case backlogs, and federal funds sitting unspent while children are at risk
-
OVERSIGHT FAILURES: No comprehensive state audit, federal recommendations unimplemented, and limited public transparency
8.2 Accountability Gap Summary
| Domain | Gap Severity | Primary Evidence |
|---|---|---|
| Missing Children | CRITICAL | 978 missing in one year; 50% unreported |
| Facility Safety | CRITICAL | 32+ abuse plaintiffs at single facility |
| Federal Funds | SEVERE | $10.5M+ unspent; audit findings unaddressed |
| Staffing | CRITICAL | 25% workforce reduction; 44% turnover |
| Data Transparency | SEVERE | Key metrics not publicly reported |
| Licensing Oversight | HIGH | Facilities operate despite documented issues |
8.3 Risk Projection
Without significant intervention:
- Missing children crisis will continue/worsen
- Additional facility abuse scandals likely
- Federal funding may face increased scrutiny
- Trafficking of foster youth will persist
- Child fatalities may remain elevated
SOURCES
Federal Government Sources
- HHS OIG Case Study: Missouri's Efforts to Protect Children Missing from Foster Care (2021)
- DOJ: Great Circle Settlement (February 2023)
- ACF Children's Bureau: Title IV-E Programs Expenditure Data
- National Human Trafficking Hotline: Missouri Statistics
State Government Sources
- Missouri DSS Children's Division Reports
- Missouri Child Fatality Review Program
- Missouri Child Abuse and Neglect Annual Report FY2024
- Missouri State Auditor Reports
News Sources
- Missouri Independent: States lose track of thousands of foster children
- Missouri Independent: High turnover, low morale plague Missouri child welfare agency
- KSMU: Lakeland Behavioral Health abuse lawsuits
- First Alert 4: Missouri kids in crisis
- KCUR: Missouri Auditor on Children's Division
Database Sources (CivicOps PMC Database)
- [CHILD_WELFARE_CHILD_FATALITIES_2019_2023] Missouri fatality data
- [CHILD_WELFARE_CHILD_VICTIMS_2019_2023] Missouri victim rates
- [MISSING_CHILDREN] NCMEC records (125 active Missouri cases)
- [PROGRAM_93676_SUBAWARDS] Federal child welfare subawards
- [PROGRAM_93566_REFUGEE_ASSISTANCE] Refugee assistance awards
APPENDIX A: RECORDS REQUEST TEMPLATES
Template 1: Missouri DSS - Missing Children Classification
Missouri Department of Social Services
Children's Division
PO Box 88
Jefferson City, MO 65103
RE: Sunshine Law Request - Missing Children from State Custody
Pursuant to Missouri Revised Statutes Chapter 610 (Sunshine Law), I request:
1. The total number of children reported as missing/AWOL from Missouri foster care custody for each fiscal year from 2019-2024
2. For each year, please provide breakdown by classification type:
- Runaway
- Abducted
- Unknown whereabouts
- Other (specify)
3. Time-to-recovery data: Average/median days from reported missing to location
4. Recovery outcomes by disposition
Template 2: Missouri DSS - Facility Licensing Actions
RE: Sunshine Law Request - Residential Treatment Facility Licensing
I request all licensing enforcement actions for residential treatment facilities serving children, 2019-2024, including:
1. Corrective action plans issued
2. License probations
3. License suspensions
4. License revocations
5. Substantiated abuse/neglect allegations by facility
APPENDIX B: NEXT INVESTIGATION STEPS
- Deep dive on International Institute of Metro St. Louis ($130M+ in federal funds)
- PBRF-LE analysis on Missouri child welfare nonprofit network
- Cross-reference missing children locations with trafficking patterns
- FOIA HHS for Title IV-E eligibility review results
- Interview requests to former caseworkers (per news reports)
- Monitor Lakeland Behavioral Health lawsuit developments
APPENDIX C: ADDITIONAL DATA (January 18, 2026 Update)
CFSR Round 4 Detailed Findings (July 2023)
Racial Disparities Documented:
- Black children over-represented in foster care entries compared to general child population
- Black children consistently experienced lower percentages of permanency vs. state performance
- White children comprised greater proportion of exits than entries
- Black children made up greater proportion of children in care across all lengths of stay
Relative Caregiver Support Failures:
- Support for relative caregivers "worse than when the placement provider was a traditional foster parent"
- In many cases, no quality needs assessments for relative foster parents
- When assessments conducted, appropriate services "not always provided"
- Relative caregivers expressed being "overwhelmed" needing respite/childcare agency couldn't provide
Permanency by Age Group:
- Children under age 1: 20.6% of entries, 16.3% of exits
- Rate of permanency within 12 months LOWEST for infants (21.2%)
- Missouri's 25.3% permanency rate "continues to decline"
Backlog Resolution Progress (2024)
| Date | Statewide Backlog | St. Louis | Kansas City | Change |
|---|---|---|---|---|
| Aug 2023 | 10,167 | 6,124 | 3,036 | Peak |
| Jan 2024 | ~8,000 | ~4,500 | ~2,500 | -20% |
| July 2024 | 1,869 | ~370 | 1,136 | -82% |
Key Factor: $30M legislative appropriation + consulting firm engagement
Hospital Housing Crisis Statistics
- 50% of residential beds lost since pandemic (per SSM Health)
- Mercy Hospital: $400,000+ unreimbursed care for non-traditional patients
- SSM Health: Typically houses 6+ children + 18+ adults in psychiatric wards
- 200 beds for boys vs. 60 beds for girls in QRTPs statewide
- 450 bed reduction over past year
New Legislation Impacts
2023 Missing Children Reporting Law:
- Requires police report within 2 hours of determining child missing
- Expands "missing child" definition to include:
- Persons under 18
- Foster children regardless of age
- Emancipated minors
- Homeless youth
2024 Privatization Bill (Pending):
- Allows DSS to contract private agencies for abuse/neglect investigations
- Supported by KVC Missouri
- Concerns raised about "fraught" decision point in child welfare
NCMEC Missing Children - Missouri (Current)
Total Active Missing: 125 children (PMC CivicOps database)
By Geography:
| Location | Count |
|----------|-------|
| St. Louis City/County | 39 |
| Jackson County (KC) | 12 |
| Greene County | 4 |
| Perry County | 2 |
| Henry County | 2 |
| Other Counties | 66 |
Age Distribution:
- Under 13: 78 (62%)
- Teens 13-17: 36 (29%)
- Age unknown/adult: 11 (9%)
Federal Funding Sources (TAGGS Database)
Missouri DSS - Refugee/Entrant Assistance:
- Total tracked in TAGGS: $47,679,949
- Multiple grants from ACF Refugee and Entrant Assistance programs
Title IV-E Disallowance (2020):
- Amount: $1,336,156 (federal share)
- Total improper claims: $2,068,033
- Issue: Professional Parenting Payments incorrectly classified
- Finding: 59 of 80 sampled cases included "ineligible payments"
APPENDIX D: RECORDS REQUEST PACKETS (Generated)
Packet 1: Missouri DSS Children's Division
Records Requested:
1. All AWOL/missing child reports (2019-2024)
2. Placement facility incident logs by facility
3. Investigator caseload data by region/month
4. Risk assessment data for children who went missing
5. Post-return health/safety check completion rates
6. Trafficking screening results for returned children
7. County-level permanency outcomes by race/ethnicity
Packet 2: Missouri Division of Professional Registration
Records Requested:
1. Inspection reports - residential treatment facilities (2019-2024)
2. Corrective Action Plans (CAPs) issued
3. Enforcement actions, suspensions, revocations
4. Complaint investigations and outcomes by facility
5. License-exempt facility registrations (post-HB557)
Packet 3: Missouri State Auditor
Records Requested:
1. Audit findings related to DSS/Children's Division (2019-2024)
2. Federal single audit findings for CFDA 93.658, 93.556, 93.558
3. Title IV-E eligibility review results
4. Grant monitoring reports
5. Administrative cost allocation issue documentation
Packet 4: Law Enforcement Coordination
Records Requested:
1. Missing person reports filed by Children's Division (2019-2024)
2. Recovery reports for children located
3. Cases where missing foster children never reported
4. Sex trafficking cases involving children missing from foster care
Packet 5: Tribal Coordination (ICWA)
Records Requested:
1. Number of Indian children in state custody (2019-2024)
2. ICWA compliance documentation
3. Tribal notification records
4. Placement preference compliance data
5. Cases where "existing Indian family" exception applied
INVESTIGATION STATUS: COMPLETE - READY FOR SCRIBE REVIEW
Investigation ID: MO-CUSTODY-SCAN-2026-01-18
Total Database Queries: 15
Total Web Searches: 12
Total OSINT Tools: 3
Report Length: ~430 lines
Report generated by OPUS Autonomous Intelligence System
Project Milk Carton | 501(c)(3)
https://projectmilkcarton.org
501(c)(3) Nonprofit
Disclaimer: This report contains information gathered from publicly available sources (OSINT). All findings should be independently verified. This report does not constitute legal advice or accusations of wrongdoing. Project Milk Carton is a 501(c)(3) nonprofit organization dedicated to child welfare transparency.
501(c)(3) Nonprofit
Disclaimer: This report contains information gathered from publicly available sources (OSINT). All findings should be independently verified. This report does not constitute legal advice or accusations of wrongdoing. Project Milk Carton is a 501(c)(3) nonprofit organization dedicated to child welfare transparency.