In Re: Samone H.

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In re Samone H. and Marchay E., No. 30, September Term, 2004. Family Law: Appeals-- Permanency Plan Hearing. Motion for Independent Study pursuant to Md. Code (1974, 2002 Repl. Vol.), § 3-816 of the Courts and Judicial Proceedings Article. A court ord er de nying a mo tion for independent stud y during a permanency plan review hearing in which the plan remain unchanged is not an appealable final judgment under Md. Code (1974, 2002 Repl. Vol.), § 12-303 (x) of the Courts and Judicial Proceedings Article. IN THE COURT OF APPEALS OF MARYLAND No. 30 September Term, 2004 IN RE: SAMONE H. & MARCHAY E. Bell, C.J. Raker Wilner Cathell Harrell Battaglia Greene, JJ. Opinion by Battaglia, J. Filed: February 9, 2005 In this action betwe en the biolo gical moth er and the S tate, we hav e been ask ed to consider whether the trial court properly denied a motion for independent evaluation of the bonding of Katina M. with her biological children, Marchay E. and Samone H., who had been declared c hildren in need of assistanc e, pursuan t to Maryland Code (1 974, 200 2 Repl. Vol.), § 3-81 6 of the Courts and Ju dicial Pr oceed ings A rticle, during a permanency plan review hearing . At issue also is whether the trial court properly quashed subpoenas for the children to testify during the review he aring or in camera. I. Facts and Procedural History Samone H., born on July 20, 1996, and Marchay E., born on January 19, 1991, are the children of Katina M. On September 24, 1996, after investigating allegations of neglect regarding Samone H., the Baltimore City Department of Social Services (BCDSS) filed a petition in the Circuit Court for Baltimore City, Division of Juvenile Causes, requesting that Samone H. be remove d from Katina M . s care and declared a child in need of assistance (CINA)1 because the BCDSS claimed, among other allegations, that Katina M. had a history of drug abuse and had failed to provide adequate care for Samone H. The court conducted 1 Md. Code (1973, 2002 Repl. Vol.), § 3-801(f) of the Courts and Judicial Proceedings Article defines a CINA as: Child in need of assistance means a child who requires court intervention because: (1) The child has been abused, has been neglected, has a developmental disability, or has a mental disorder; and (2) The child s parents, gu ardian, or cu stodian are u nable or unwilling to give proper care and attention to the child and the child s n eeds. an emergency shelter care hearing2 and ordered BCDSS to provide care and custody for [Samone] in shelter care , pending [ an adjudic atory] hearin g. 3 On February 18, 1997, the Circuit Court ord ered Sam one H. to be placed with a relative who BCDSS identified as her great-grandmother. Subsequently during the adjudicatory hearing Samone H. was declared a CINA by the Circuit Court but returned to Katina M. under an Order of Protective Supervision by BCDSS.4 Six weeks after the Baltimore City Police had responded to a call to the greatgrandmother s residence because Katina M. had locked Samone H., Marchay E., and the great-grandmother in the house, BCDSS took custody of Samone H. and Marchay E. Thereafter, BCDSS petitioned to remove the children from the care of Katina M. and also to declare Marchay E. a CINA. After an emergency hearing , the Circuit Court ordered that both children be committed to the custody of B CDSS and place d in the care of the grea t- 2 Shelter care means a temporary placement of a child outside of the home at any time before disposition. Md. Code (1973, 2002 Repl. Vol.), § 3-801(w) of the Courts and Judicial Proceedings Article. A shelter care hearing means a hearing held before disposition to determine whether the temporary placement of the child outside of the h ome is w arrante d. Md. Code (1973 , 2002 Repl. Vo l.), § 3-801(x) of the Courts and Judicial Proceedings Article. 3 An adjudicato ry hearing is a h earing und er this subtitle [Ju venile Ca uses] to determine whether the allegations in the petition , other than th e allegation th at the child requires the court s intervention , are true. M d. Code (1 973, 200 2 Repl. Vol.), § 3-801(c) of the C ourts an d Judic ial Proc eeding s Article . 4 The Order also specified that Katina M. participate in an outpatient substance abuse program, reside with the great-grandmother, ensure that Samone H. s health needs were met and attend parenting training. The Circuit Court further ordered that BCDSS would be allow ed to remove Sam one H. from Katina M . s ca re if n eces sary. 2 grandm other. Within a month, o n July 18, 199 7, BCD SS reque sted that the Circuit Court remove the children from the great-grandmother s care and commit them to the custody of BCDSS with plac eme nt in the f oster hom e wh ere th ey currently reside. On January 27, 1998, the Circuit Court conduc ted an adjudicatory hearing, determined Marchay E. to be a CINA and ordered both Samone H. and M archay E. to remain in the custody of BCDSS. The court also established a permanency plan5 to have both children live with relatives capable of caring for 5 Md. Code (1984, 1999 R epl. Vol.), § 5-525(e) of the Family Law Article states: Development of a permanency plan. (1) In developing a permanency plan for a child in an out-of-home placement, the local department of social services shall give primary consideration to the best interests of the child. The local department shall consider the following factors in determining the permanency plan that is in the best interests of the child: (i) the child s ability to be safe and healthy in the home of the child s parent; (ii) the child s attachment and emotional ties to the child s natural parents and siblings; (iii) the child s em otional attach ment to the child s current c areg iver and the c areg iver s fa mily; (iv) the length of time the child has resided with the current caregiver; (v) the potential emotional, developmental, and educational harm to the child if moved from the child s current placement; and (vi) the potential h arm to the c hild by remaining in State custody for an excessive period of time. In addition , Md. C ode (19 73, 200 2 Rep l. Vol.), § 3-823 (e) of the Courts and Judicial Proceed ings Article s tates: (contin ued...) 3 them. During this time, Katina M. was allowed one supervised visit per month with each of the child ren. Thereafter, the Circuit Court conducted periodic review hearings6 and on June 24, 5 (...continued) Determinations to be made at hearing. At a permanency planning h earing, the co urt shall: (1) Determine the child s permanency plan, which may be: (i) Reunification with the parent or guardian; (ii) Placement with a relative for: 1. Adoption; or 2. Custody and guardianship; (iii) Adoption by a nonrelative; (iv) Guardianship by a nonrelative; (v) Continuation in a specified placement on a permanent basis because of the child s special needs or circumstances; (vi) Continuation in placement for a specified period because of the child s special needs or circumstances; or (vii) Independent living; and (2) For a child who has attained the age of 16, determine the services ne eded to ass ist the child to make the transition from p laceme nt to ind epend ent livin g. These same provisions of the Maryland Code were in place throughout the pending proceedings. 6 Md. Code (1 973, 200 2 Repl. Vol.), § 3-8 23(h) of th e Courts and Judicial Proceedings Article states: Periodic reviews. (1)(i) Except as provided in subparagraphs (ii) and (iii) of this paragraph, the court shall conduct a hearing to review the permanency plan at least e very 6 mon ths until commitment is rescinded. (ii) The court sha ll con duct a rev iew hear ing e very 12 months after the court determines that the child shall be (contin ued...) 4 1999, the court revised the permanency plan to a concurrent permanency plan of adoption or placemen t with a relative. The Circuit Court again changed the permanency plan to one of adoption after another review hearing had occurred on December 6, 2000. Katina M. then filed a motion for reconsideration seeking to change the permanency plan from adoption to reunification. During an annual review hearing held on March 1, 2002, Mary Gilliard, a BCDSS case worker assigned to the case since 1999, testified that Marchay E. and Samone H. should not be rem oved from their fo ster home because they were very bonded with the foster family. Ms. Gilliard further testified that the visits between Katina M. and the children were going pretty well and that the children were glad to see Katina M. W hen qu estione d abou t the detr imenta l effec t of disc ontinu ing the v isits, Ms. Gilliard appeared to have differing opinions: [CHILD REN S COUNSEL]: There also is some emotional attachment between the children and their biological Mother, that s correct also? [MS. GILLIA RD]: Yes. [CHILD REN S COUNSEL ]: And it would be detrimental to cut off that relationship be tween the children an d their Mo ther, is 6 (...continued) continued in out-of-home placement with a specific caregiver who agrees to care for the child on a permanent basis. (iii) 1. Unless the court finds good cause, a case shall be terminated after the court grants custody and guardianship of the child to a relative or other individual. 2. If the Court finds good cause not to terminate a case, the court shall conduct a review hearing every 12 month s until the case is te rminate d. 5 that correct? [MS. GILLIARD]: Yes, it would at this time. While in response to questioning by Katina M. s attorney on the same subject, Ms. Gilliard testified: [KATINA M. s COUNSEL]: Okay, do you think the children have an emo tional bond with their M other? [MS. GILLIARD]: I can t [answer] that question for you right now. [KATINA M. s COUNSEL]: Do you thin k stopping the visits between the children and the Mother would be detrimental to the children? [MS. GILLIARD]: I don t think so, no no. [KATINA M. s CO UNS EL]:It wo uld be okay, you don t think they would mind? [MS. GILLIARD]: Nah, I don t think so at all. *** [KATINA M. s COUNSEL]: Even though they re loving and caring with their Mo ther? [MS. GILLIARD]: For the time that they re with them, they are you know, f or that hour , but I don t think it would be detrimental to them if they don t see their biological Mom, because with the foster Mom they have been there so long so this is [KATINA M. s CO UNS EL]: Ok ay, but I m just talking about as far as the biological Mom and her children and you re saying it would be, there would be no harm do ne to stop the visits toda y? [MS. GILLIARD]: Maybe to the biological Mom, but not to the 6 children, no. During the Marc h 1, 2002 hearing, K atina M . also testified ab out her visits w ith Marchay E. and Samone H: My visits are great. They don t want to be leaving, they get sad. Like I said, Samone tells me to follow them and March ay told me that any I aske d Marc hay when do she rath er see me, the beginning of the mo nth or the en d. She said it doesn t really matter just as long as she [sees] me. She just don t want to not see me. After hearing the testimony, the jud ge conclu ded that it w ould be in the children s best interests to rem ain in foster c are: [There] is no do ubt in m ind as to . . . what s in the best interest of the children and that s what I m concerned with. Not the best interest of the Father, not the best interest of the M other, not in the best inte rest of th e foster parents . It s what s in the best interest of the children. There s n o question in this Court s mind that the children have been in foster care for a v ery, with the same family, for a very substantial time. Most of their lives. One child is only 5, the other child is 11 . They have b een in foster care since 1997. So, for a good part of their lives, for one almost the who le life and the other for at least half their lives, approxim ately half. There is no question in the Court s mind that they re bonde d to the foster parents. That they consider the foster family as their fa mily. I don t que stion that the Mother has turned hers elf around, but for many years she hadn t turned herself around and so to disrupt the children, to remove the children from the place where they ve lived for a good part of their lives would be detrimental to them and would serve no usefu l purpo se . . . . At the same time that the court ordered the permanency plan for adoption to continue, the judge also ordered Katina M . s supervised visits with the children to be increased to one hour 7 two times per m onth and is sued a sep arate order d enying Katina M. s motion for recons ideratio n, whic h she ap pealed to the C ourt of Specia l Appe als. Thereafter, in an unreported opinion, the Court of Special Appeals affirmed the Circuit Court s ruling and held that the trial judge did not abuse his discretion in denying Katina M. s requ est to chang e the perm anency plan . The intermediate appellate court emphasized that the trial judge properly had cons idered the c hildren s be st interests in reviewing the perma nen cy plan based upon the guidelines set forth in Maryland Code, Section 5-525 (e) of the Family Law Article, beca use he ha d assessed the potential h arm to Marchay E. and Sa mone H . if removed from their current placement; the length of time the children were with their foster family; and any bond the children had with th e foster fam ily and their biological mother. As such, the Court of Special Appeals held that there was sufficient evidence in the record to support the Circuit Court s decision that a permanency plan of adoption [was] in the best interests of Marchay and Samone. Within one year, on March 13, 2003, the Circuit Co urt held another review hearing. Prior to the hearing Katina M. filed a motion for independent study seeking to have the children evaluated by a psychiatrist to provide an assessment of her relationship with her children and whether removing the children from foster care would be harmful; she also subpoenaed both Marchay E. and Samone H. to testify. At the hearing, before the judge who had presided at the March 2002 hearing, Katina M. argued that an independent study of her bond with her children would assist the court in determining whether to change the 8 permanency plan: [KATINA M. s COUNSEL]: Your Honor, I did file a motion for independent study concerning matters relevant to the case. In that motion, I stated that the Department had in the past alleged that there was not a sufficient bond between the children, respondents, and my clients that they are that stated that removal of the respondents from the foster pa rents would be harmf ul to the r espon dents. Obv ious ly, there is a TPR [7] pending to terminate my clients rights. That the allegations regarding the bond ing were made by the worker but not by any clinician, that the only way for the mother to rebut these allegations was to have an independent examination that the foregoing was sufficient good cause to order an examination, and that the exam ination wo uld be conducted by our expert at a place and time convenient for the respondents, and that would not be harmful to the respon dents. Just to give you a little background, Your H onor, we did have a hearing before you on March 1 st, 2002. *** 7 In cases where the permanency plan is changed to adoption, Maryland Code (1973, 2002 Repl. Vol.), § 3-823 (g) of the Courts and Judicial Proceedings Article states that the court shall: (1) Order the local department to file a petition for g uardiansh ip in accordance with Title 5, Subtitle 3 of the Family La w Article within 30 days or, if the local department does not support the plan, within 60 days; and (2) Schedule a TPR hearing instead of the next 6-month review hearing. Pursuant to Md. Code (1973, 2002 Rep l. Vol.), § 3-801(y) of the Courts and Judicial Proceedings Article, a TPR procee ding m eans a procee ding to termina te paren tal rights. According to testimony by Ms. Gilliard during the March 1, 2002, hearing, a TPR petition was filed in this case and dismissed in December of 2001; BCDSS then filed a new petition in January of 2002. On November 11, 2004, the trial court entered an order staying the TPR procee dings p ending this app eal. 9 Again, Your Honor, we did not hear from any clinician about any bond. M y client would lik e, and the co urt should want, an independent evaluation of the bond between the children and the m other beca use that w ould assist the court, and certainly all parties, in ma king a dec ision in this m atter. This examination would not cause harm to the children. This issue had b een throug h the appe llate courts before, Your Honor. And In re: Mark M., In re: Adoption of Mark M., I have th ose cas es if you d like to tak e a look at them . If I could get the clerk to hand these up. In those cases, the Department alleged that Mark was in a fragile mental state, and would be harmed by the evaluation. They claimed that the examination would have a catastrophic effect on Mark. In that case, the c hild had not seen his m other for over a year. Now, in this case, Y our H onor, my client sees these children twice a month. I m not aware of any allegations that an examination would cause harm or would be, have a catastrophic effect on the child ren. And even if the re were, Y our Hon or, in In re: Mark M. and In re: Adoption Guardianship of Mark M., the court ordered that the mother be allowed to conduct an examination anyway. D espite th e Dep artmen t s allega tion. A nd if you look at In re: Adop tion/Gua rdianship , Your Hono r, it s very clear in that matter. And without a c linical evalua tion, there is no way for the mother to rebut the Departm ent s conclusion that there is no bond. The Court of Appeals in Adoption/Guardianship of Mark M. found that to deny such an evaluation would mean that Social Services is the only one able to present evidence on bonding. And because of that, because to otherwise not allow a mother s ability to defend her parental and constitutional rights, ordered that she be allowed to conduct an evaluation. Also in Mark M., Your Honor, the Court of Ap peals found that the mother, this is Adoption Guardianship of Mark M., the Court of Appeals found that the mother was a caring parent, had overcome her substance abuse problem, and considering the magnitude of the mother s rights, said an evaluation was ap propria te. Here, again, Your Honor, my client has done all those things. Sh e does care for the children. And it would be appropriate to have an evaluation be done. I would ask the Court to apply both In re: Mark M. and 10 In re: Adop tion Gua rdianship o f Mark M., and order that evaluation be done b y the mother s e xpert. Your Honor, we are offering Brian Zamitsky, who is a psychiatrist who works at the Crown sville Hospital Center. He is responsib le for conducting in patient and out patie nt juvenile fo rensic psychiatric evaluations for the juvenile court system. We believe that this examination can be done with no harm to the child. The only harm I ve heard alleged so far from child s counsel is th at the children would be removed from school for the evaluation. Certainly, we could work I m not sure if that rises to the level of harm, but certain ly we could work around the children s schoo l schedule in order to accommodate the examination. (emphasis added ). Both BCDS S and the children s attorney objected to the independent study arguing that an evalua tion wou ld be harm ful to the children because the psychiatrist would be unfamiliar with the ch ildren and m ight delve into their past. Katina M. countered that the expert s evaluation would be limited to the bonding issue, without having to probe into the children s past experience with their mother. When the court denied the motion for independent study, the following dialogue occurred: [KATINA. M. s C OUN SEL] : In rebu ttal, You r hono r, I do think that there is controversy over whether the children have a bond with their mother or not. And I think that [THE COUR T]: Well, I don t think there is because [KATINA. M. s COUNSEL]: Well, the other thing, Your Honor [THE COURT]: Because I heard the work er testify as to viewing the meetings between the children and the mother *** and I was satisfied then and I m satisfie d now th at there is 11 very little bond, if an y, between, ve ry little bond with the mother. All the bon ding is with the foster fa mily, the custodians. *** THE COURT: I am not going to have an independent, in the sense of having some psychologist or psychiatrist say, interview the children . I am not go ing to put the m throug h that. [KATINA M. s COU NSEL]: Y our Honor, how can I rebut that, then? [CHILDREN S C OUNSEL]: It s harmful to the children. [KATINA M. s CO UNS EL]: Ho w can I re but it? Tha t is the question. If I can t rebut it, then we re just saying well, the court THE COU RT: No. [KATINA M. s COUNSEL]: DSS rolls along without me having a say so. THE COURT: You rebutted it by the mother s description of her relationship with the children. [KATINA M. s COUNSEL]: Now you re saying I ca n t. I mean, how am I going to I think that s why we need the independ ent. We ve got my client and the Department of Social Services who both clearly have biases in this case. That s why an independent evaluation would be appropriate. After lengthy argument between the parties, the trial judge stated: Okay. I am not at this point going to grant an independent evaluation by mom s expert or anybody else s expe rt. Period . That en ds it. BCDSS thereafter, moved to quash the subpoenas to have Marchay E. and Samone H. testify or , in th e alte rnative, to have th e chi ldren testify in camera. Katina M . objected 12 to having the child ren testif y in camera and expr essed con cern abou t allowing th e judge to question the children in her absence. In response to the motion to quash, the trial judge ruled: I am not putting young children on the stand. Period. and stated, [a]nd I m not going to do I m not going to interview them in chambers. I m not going to interview them in the courtroom . . . I am going to quash the subpoena. The review hearing then proceeded to the merits of the case in w hich the court heard testimony from M s. Gilliard and Katina M . regarding th e children s p lacement a nd their relationship with both their foster family and Katina M. At the conclusion of the testim ony, the court reaffirmed the permanency plan of adoption and held that the children should remain committed to the custody of BCDSS. Katina M. noted an appeal to the Court of Specia l Appe als, wh ich aff irmed th e judgm ent of th e Circu it Cour t. In an unreported opinion, the intermediate appellate court first addressed whether the lower court had erred in den ying Katina M. s request for an independent study and held that she had failed to meet her burden of demonstrating good cause for the examination. The intermediate appellate court further opined that Katina M. had failed to show that the examination would not be harmful to the children. In reaching its decision, the Court of Special Appeals held that although Katina M. had tendered the name of the expert and had proposed that a study of the c hildren w ould excl ude a discuss ion o f the ir past his tory, she did not proffer how the study would be conducted. The intermediate appellate court then addre ssed the trial co urt s decision to quash the 13 subpoenas for M arch ay E. and Samone H., and concluded that the children had been represented by counsel at both hearings and that their wishes . . . clearly [had been] before the court for its consideration without there being evid ence of m isrepresenta tion by their counsel. The intermediate appellate court emphasized that Katina M. ha d objected to opposing counsel s suggestion that the children be interviewed in camera and had not claim[ed] that the childre n s wishe s regarding visitation with her had be en misr eprese nted. Thus, the Court of Special Appeals held that the lower court had not abused its discretion in quas hing th e subp oenas. Katina M. filed a petition for writ of certiorari in this Court to consider the following questions: 1. Is this Court s decision in In re Mark M., 365 Md. 687, 782 A.2d 332 (2001), approving independent examinations of children in CIN A cases lim ited to situations where the proposed examination is the subject of other expert opinion offered in the proceedin g, and, in this case, did the trial court fail to adequately balance the Mark M. considerations when it refused to grant a requested independent bonding evaluation because it was satisfied that there is a very little bond, if any . . . with the mother and it was not in the children s best interests to put them through that? 2. Did the trial court ab use its discretion when it refused to hear from the children at the permanency planning review hearing on the grounds that I am not putting young children on the stand. Period. and I m not going to interview them in chambers? 14 We gran ted the petition and issued the writ of c ertiorari. 8 II. Discussion In the present case, Katina M. asks us to review the trial court s order denying her motion for independent study during a permanency plan review hearing in which the plan remained static. As a threshold matter, we must consider whether the trial court s order is proper ly appeala ble. In general, appeals may only be taken from a final judgment of the trial court pursuant to Md. Code (1974, 2002 Repl. Vol.), § 12-301 of the Courts and Judicial Proceedings Article, which states tha t a party m ay appea l from a final jud gmen t entered in a civil . . . case . . . [whether] entered . . . in the exercise of origina l, special, limited, or statutory jurisdiction, unless . . . expressly denied by law. Smith v. Taylor, 285 Md. 143, 146, 400 A.2d 1130, 1132 (1979) (internal citations omitted). For the trial court s ruling to be a final judgment it must either determine and conclude the rights of th e par ties in volv ed or den y a party the means to prosecut[e] or defend[] his or her rights and interests in the subject matter of the proceeding. Rohrbeck v. Rohrbeck, 318 Md. 28, 41, 566 A.2d 767, 773 (1989 ). In considering whether a particular cou rt order or ruling constitutes an appealable judgment, we assess whether any further order was to be issued or whether any further action was to be taken in the case . See Rohrbeck, 318 M d. at 41- 42, 566 A.2d a t 774. An order that is not a final judgmen t is considered to be an interlocutory order and 8 In re Samone H., 381 Md. 674, 85 1 A.2d 593 (2 004). 15 ordinarily is not appea lable unless it f alls within one of the statutory exceptions set forth in Md. Code (1974, 2002 Repl. Vol.), §12-303 of the Court and Judicial Proceedings Article. See In re Damon M., 362 Md. 429, 434, 765 A.2d 624, 627 (2001). Relevant to our discussion is the exception embodied in Section 12-303 of the Courts and Judicial Proceedings Article, which provides: A party may appeal from any of the following interlocutory orders entered by a circuit court in a civil case: *** (3) An order: *** (x) Depriving a parent, grandparent, or natural guardian of the care and custody of his child, or changing the terms of such an order . . . . Md. Code (1974, 1998 Repl. Vol.) § 12-303 (x) of the Court and Judicial Proceedings Article. In In re Damon M., we assess ed whe ther an app eal would lie from an order entered after a permanency plan review hearing in which the plan had been amended from reunification to long-term foster care, id. at 432-33, 762 A.2d at 626, and held that an order amending a permanency plan calling for reunification to foster care or adoption [was] immedia tely appealable. Id. at 438, 765 A.2d at 628. In so holding, we explained that the amendment of the permanency plan to long-term or permanent foster care and adoption [was] a change in the terms of the custody order, and thus, had affected the custody rights of the petitioners. Id. at 437, 765 A.2d at 437. We left open the q uestion of wheth er other orders that the court might pass after [permanency plan review] hearings [were] appealable. Id. at 433 n.4, 765 A.2d at 626 n.4. 16 To be appealable under Section 12-303(x), an order denying a motion for independent study either must operate to deprive Katina M. of the care and custody of Marchay E. and Samone H. or change the terms of her care and custody of the children. R esolution of this questio n is at the heart of the issue before us. A. Funda mental Righ ts of Parents The United States Supreme Court has long recognized that a parent has a constitutiona lly protecte d fund amen tal right to raise his or her c hildren . See Troxel v. Granville , 530 U.S. 57, 66, 120 S.Ct. 2054, 2060, 147 L. Ed.2d 49, 57 (2000); Santosky v. Kramer, 455 U.S. 745, 753, 102 S. Ct 1388, 13 94-95, 71 L. Ed.2d 5 99, 606 (1 982); Stanley v. Illinois, 405 U.S. 645, 651, 92 S. Ct. 1208, 1212, 31 L. Ed .2d 551, 55 8 (1972); Prince v. Massa chusetts, 321 U.S. 158, 166, 64 S.Ct. 438, 442, 88 L. Ed. 645, 652 (1944); Meyer v. Nebraska, 262 U.S. 390, 399, 43 S. Ct 625, 626, 67 L. Ed. 1041, 10 45 (1923 ). Recently, in In re Yve S., 373 Md. 551, 819 A.2d 1030 (2003), we iterated this principle and stated that a parent s interest occupies a unique place in our legal culture, g iven the cen trality of family life as the focus for personal meaning and responsibility. [Far] more precious . . . than property rights, parental rights have bee n deeme d to be am ong those essential to the orderly pursuit of happiness by free men . . . . Id. at 567, 819 A.2d at 1039, quoting In re Adoption /Guardia nship No. 10941, 335 Md. 99, 11 2, 642 A.2d 20 1 (1994), in turn quoting Lassiter v. Department of Social Services, 452 U.S. 18, 101 S.Ct. 2153, 68 L.Ed.2d 640 (1981); see also, Shurupoff v. Vockroth , 372 M d. 639, 650 , 814 A.2d 543, 550 (2003); In re 17 Mark M., 365 Md. 687, 705, 782 A.2d 332, 342 -43 (2001 ); Boswe ll v. Boswe ll, 352 Md. 204, 218, 721 A.2d 66 2, 669 (1998). Likewise, in In re Mark M., we emphasized the importance of parentin g as a fun damenta l right: A parent s interest in raising a ch ild is, no doub t, a fundamental right, recognize d by the Un ited States Su preme C ourt and this Court. The U nited States Supreme Court has long avowed the basic civil right encompassed by child rearing and family life. See Troxel v. G ranville, 530 U.S. 57, 66, 120 S. Ct. 2054, 2060, 147 L. Ed. 2d 49, 57 (2000) (statin g that the Fo urteenth Amendment protects the fundamental right of parents to make decisions concernin g the care, cu stody, and con trol of their children ); See also Santosky v. Kramer, 455 U.S. 745, 753, 102 S. Ct. 1388, 1394-95, 71 L. Ed. 2d 599, 606 (1982) (discussing the fundamental liberty interest of natural parents in the care, custody, and man agemen t of their child ) ; Stanley v. Illinois, 405 U.S. 645, 651, 92 S. Ct. 1208, 1212-13, 31 L. Ed. 2d 551, 55859 (1972)(statin g that [t]he rig hts to conceive and to raise one s children have b een de emed essenti al, and that [t]he integrity of the family unit has found protection in the Due Process Clause of the Fourteenth Amendment . . . the Equal Protection Clause of the F ourteen th Am endm ent . . . and the Ninth Amendment . . . . )(internal citations omitted)). Maryland, too, has declared a parent s interest in raising a child to be so fundamental that it cannot be taken aw ay unless clearly justified . Boswe ll v. Boswe ll, 352 Md. 204, 218, 721 A.2d 662, 669 (1998)(citing In re Adoption No. 10941, 335 Md. 99, 112, 642 A .2d 201 (1994 )). 365 Md. at 705, 782 A.2d at 342-43. A parent s right to raise his or her children, howev er, is not absolute, and there may be countervailing considerations that the State, pursuant to its parens patriae authority, must protect. Indeed, in In re Mark M. we stated: That fundam ental interest, however, is not absolute and does not 18 exclude other important considerations. Pursuant to the doctrine of parens patriae, the State of Maryland has an interest in caring for those, such as mino rs, who canno t care fo r thems elves. See Boswe ll, 352 Md. at 218-19, 721 A.2 d at 669. W e have he ld that the best interests of the child may take precedence over the parent s liberty interest in the course of a custody, visitation, or adoption dispute. Boswe ll, 352 Md. at 219, 721 A.2d at 669; see also In re Adoption No. 10941, 335 Md. at 113, 642 A.2d at 208 (stating that the controlling factor . . . is . . . what best serves the interest of the child ). That which w ill best promo te the child s welfare becomes particularly consequential where the interests of a child are in jeopa rdy, as is often the case in situations involving s exual, physi cal, o r emotional a buse by a parent. As we stated in In re Adoptio n/Guardianship No. A91-71A, 334 Md. 538, 640 A.2d 1 085 (1994), the child s welfare is a consideration that is of transcendent importance when the child might o therwi se be in jeopard y. Id. at 561, 640 A.2d a t 1096 ( citation o mitted). *** We have recognized that in cases where abuse or neglect is evidenced, particularly in a CINA case, the court s role is necessarily more p ro-activ e. See In re Justin D., [357 Md. 431, 448, 745 A.2d 408, 417 (2000 )]. *** A trial court, acting under the State s parens patriae auth ority, is in the unique po sition to marshal the applicable facts, assess the situation, and determine the correct means of fulfilling a child s b est intere sts. Id. at 365 Md. at 705-07, 782 A.2d at 343-44 . B. Permanency Plans in CINA Proceedings In response to concerns that children were being lost in the foster care system without belonging to a permanent family, Congress enacted Public Law 96-272, the Adoption Assistance and Ch ild Welfare Act of 1980, codified at 42 U.S.C. §§ 670-79 (1988), which required states, among other things, to provide a written case plan for each child for whom 19 the state claims federal foster care maintenance payments. 42 U.S.C. § 671 (a)(16); see also In re Yve S., 373 Md. at 574-75, 819 A.2d at 1044. Pursuant to Congress s mandate, Maryland created a statutory scheme directing the department of social services to develop and implement a permanency plan that [was] in the best interests of those children committed to the local department of soc ial servic es. In re Yve S., 373 Md. at 574, 819 A.2d at 1044, quoting In re Adoption/Guardianship No. 10941, 335 Md. at 103-06, 642 A.2d at 203-05 (1994); M d. Code (1984, 1999 Repl. Vol., 2002 Cum. Supp.), § 5-525(e) of the Family Law Article. In In re Damon M., we identified the importance of a permanency plan: The permanency plan is an integral part of the statutory scheme designed to expedite the movement of Maryland s children from foster care to a perma nent living, an d hopefu lly, family arrangem ent. It provides the goal toward which the parties and the court are committed to work. It sets the tone for the parties and the court an d, indeed, m ay be outcom e determin ative. Services to be provided by the local social service department and commitments that must be made by the parents and children are dete rmin ed by the permanency plan. And, because it may not be changed without the court first determining that it is in the child s best interest to do so, the permanency plan must be in the child s best interest. These are the reasons, no doubt, that the court is charged with determining the plan and w ith periodically reviewing it, evaluating all the w hile the exten t to which it is being complied with. 362 Md. at 436, 765 A.2d at 627-28. Most recently, in In re Yve S. we explained the need for trial courts to review permanency plans to ensure that children are being cared for in the best possible manne r: As In re: Damon M. observes, the purpose of a permanency plan is to set the direction in which the parent, agencies, and the c ourt 20 will work in te rms of rea ching a satisfactory conclusion to the situation. Once set initially, the goal of the perm anency plan is re-visited periodically at hearings to determine progress and whether, due to historical and contemporary circumstances, that goal should be c hanged. It is n ot the purpo se of the initial permanency plan hearing, however, to resolve all issues involved in that final resolution. If that were the ca se, there would be no need for review of how, on a regular basis, the plan is progressing or not. Also as In re: Damon M. indicates, the initial permanency plan hearing is to be held and conducted expediti ousl y. Protracted p roceeding s in establishing the initial plan defeat the purpose of the statute. The statute presume s that, unless there are compelling circumstances to the contrary, the plan should be to work toward reunification, as it is presumed that it is in the best interest of a child to be returned to his or her natural pare nt. 373 Md. at 582, 819 A.2d at 1049. In In re Y ve S. quoting from In re Damon M., we also delineated the requirements a trial court must follow when implementing a permanency plan: [T]he court has the responsibility for determining the permanency plan, § 3-826.1(a)(1) and justifying the placement of children in out of home placements for a specified period or on a long-term or permane nt basis, § 3-8 26.1(d), in ad dition to condu cting pe riodic, six month review s. § 3-82 6.1 (f). *** Section 3-826.1 [ now co dified as Se ction 3-823 of the Co urts and Judicial Proceedings A rticle] requires the court, not later than 11 months after a child found to be in need of assistance has been placed in foster care, see also Md. Code (1989, 1991 Repl. Vol., 1997 Cum . Supp.) § 501(m) of the Family Law Article, to hold a permanency planning hearing to determine the permanency plan for that child. § 3-826.1(a)(1) [now § 3823(b)(1)]. At that hearing, for each c hild in placem ent and in determining the plan, the court is required to make certain decisions and findings, § 3-826.1(c), [now § 3-82 3(e)] spec ifica lly, whether the child sho uld be: return ed to the parent 21 or guardian, § 3-826.1(c)(1)(i) [now § 3-823(e)(1)(i)]; placed with relatives to whom adoption o r guardians hip is granted, § 3826.1(c)(1 )(ii) [now § 3-823(e)(1)(ii)]; placed for adoption, § 3826.1(c)(1 )(iii) [now § 3-823(e)(1)(iii)]; emancipated, § 3826.1(c)(1)(iv) [now deleted]; or because of the child s special needs or circumstances, continued in placement on a permanent or long-term basis or for a specified period. § 3-826.1(c)(1)(v) and (vi) [now § 3-823(e)(1)(v) and (vi)]. There are restrictions on the court s ability to continue a child in placement because of the child s special needs or circumstances. § 3-826.1(d) [now § 3-823(f)]. That section prohibits the court from using that option unless it finds that the agency to which the child is committed has documen ted a compelling reason for determining that it would not be in the best interest of the child to: (1) Return home; (2) Be referred for termination of parental rights; or (3) Be placed for adoption or guardianship with a specified and appropriate relative or legal guardian willing to care for the child. Id. at 577-81, 819 A.2d at 1046-48 (additions in original). We explained: Section 3-826.1(f) [now § 3-823(h)] mandates periodic reviews of the permanen cy plan by the cou rt. Subsection (f)(1)(i) provides [now § 3-823(h)(1)(i)] that such reviews will be no less frequently than every six mo nths until com mitment is rescind ed. If, however, at the permanency planning hearing or a subsequent review hearing, the court, inter alia, orders a child continued in permanent foster care, the court is no longer required to hold the review hearings at six month intervals. Subsection (f)(1)(ii) [now § 3-823(h )(1)(ii), is revised to require review hearings every 12 months.]. As is true of the initial permanency planning hearing, the court must make some determinations at the hearing to review the permanency plan. § 3-826.1(f)(2) [now § 3-823(h)(2)]. Among other things, in addition to determining whether the commitment remains necessary and appropriate, subsection (f)(2)(i) [now § 3823(h)(2)(i)], and evalu ating the progress made tow ard alleviating or mitigating the causes o f the com mitment, 22 subsection (f)(2)(iii) [now § 3-823(h)(2)(iii)], the cou rt is required to determine the extent of compliance with the permanency plan, Subsection (f)(2)(ii) [now § 3-823 (h)(2)(ii)], and to change it if a change in the permanency plan would be in the child s best interest. Subsection (f)(2)(v) [now § 3-823 (h)(2)(vi)]. Id. at 581, 8 19A.2 d at 104 8 (addi tions in o riginal). Motions for Independent Study As part of a court s determination regarding the appropriate perman ency plan for a child s placement, a judge may authorize an independent study concerning matters arising in juvenile proceedings pursuant to Section 3-816 of the Courts and Judicial Proceedings Article:9 (a) Study authorized. After a petition if filed und er this subtitle, the court may order the local department or another qualified agency to make or arran ge for a study concerning the child, the child s family, the child s environment, and other matters relevant to the disposition of the case. (b) Examin ation by professionally qualified person. (1) As part of a study under this section, the court may order that the child or any parent, guardian, or custodian be e xamined at a suitable place by a physician, psych iatrist, psychologist, or other professionally qualified person. (2)(i) The court may not order an inpatient evaluation unless, after a hearing, the court finds that an inpatient evaluation is necessary and there are no less re strictive mean s to obtain an evaluation. (ii) Placement in an inpatient facility may not exceed 21 days unless the court finds good cause. (c) Admissibility; inspection; impeachment evidence. (1) The 9 Section 3-816 was derived from f ormer M aryland C ode (19 74, 199 8 Rep l. Vol., 2001 Cum. Supp.), § 3-818 of the Courts and Judicia l Proce edings Article. See 2001 Laws of Maryland, ch. 415 § 3, effective October 1, 2001. 23 report of a study unde r this section is admissible as evidence at a disposition hearing but not at an adjudicatory hearing. (2) The attorney for each party has the right to receive the report at least 5 days before its presentation to the court, to challenge or impeach its findings and to present ap propriate evidence with respe ct to it. Md. Code (1974, 20 02 Rep l. Vol.), § 3-816 of the Courts and Judicial Proceedings Article. Similarly, in juvenile proceedings, Maryland Rule 11-105 provides the procedure for mental an d physical exa minations: a. Examination Procedure. 1. Order for examination. Any order for a physical or mental examination pursuant to Section 3 -818 of th e Courts Article shall specify the time, place, manner, conditions and scope of the examination and the person or persons by whom it is to be mad e. The cou rt shall order that the examination be conducted on an outpatient basis if, considering the child s condition, that is feasible and appropriate. The order may regulate the filing of a report of findings and conclusions and the testimony at a hearing by the examining physician, psychiatrist, psychologist or other professionally qualified person, the payment of the expenses of the examination and any other relevant matters. 2. Service of copies of repo rt. Copies of all studies and reports of examinations made to the court und er this Rule shall be furnished by the court to counsel for the parties when received by the court, but not later than two days before any hearing at which the results of the examinations will be offered in evidence. We have held that in addition to the State, a parent or other party in a CINA proceeding may make a motion for independent study, and whether a study should be conducted is left to the court s discretion; furthermore, the person performing the 24 independent examina tion must b e professio nally qualified to conduct the examination. In re Mark M., 365 M d. at 715 , 782 A.2d at 348-49. When a party moves for an independent evaluation, that party must demonstrate good cause for such an examination, show that the examina tion should be reason ably calculated to assist the trier of fact in rendering its decisio n, and must demonstrate that the proposed examination will not be harmful to the child. Id. at 717- 18, 782 A.2d a t 350. Bonding Studies In the case before us, Katina M. made a motion for independent study to have a psychiatrist examine any bond she may have had with Marchay E. and Samone H . Drs. James and Constance Messina, psychologists who have specialized in working with children, describe bo nding as: [T]he forming of a mutual emotional attachment between parent and child. [T]he giving of unconditional love b y the parent to the child. [T]he development of an emotional connection between parent and child. [T]he development of a sense of security for the child. [T]he establishment of an emotional intimacy and sense of closeness between parent and child. [T]he beginning step in helpin g the child to feel a health y self-worth and self-esteem. [T]he transmission of familial ties between child and paren t through which nonverbal communication and understanding takes place . [A] mea ns of prov iding the child with a sense of belonging to a family. [A] way of bringing the child into the larger network of caring and love present in the parent s extended family. [T]he concern a nd love fo r the child by the parent, and for the parent by the child, which is exhibited in all aspects of both their lives. James J. Messina & Constance Messina, Tools for Parents of Children with Disabilities and 25 Special Needs: Bonding with Your Child 1 (2004). In the context of the relationship between a parent and child, the term bonding has come to be used synonymo usly with attach ment. B RUCE P ERRY, B ONDING AND A TTACHMENT IN M ALTREATED C HILDREN: C ONSEQUENCES OF E MOTIONAL N EGLECT IN C HILDHOOD 4 (Caregiver Educ. Series, 2001) [hereinafter C ONSEQUENCES OF E MOTIONA L N EGLECT ]. Dr. Perry, a psychiatrist specializing in child trauma, explained that bonding is the process of forming an attachment . . . and involves a set of behaviors that will help lead to an emotional connection (attachment). Id. at 3. In articulating the importance of the parent-child relationship to the development o f a child, Dr. Perry has opine d that the attachment bond has several key elements, namely, that it is an enduring emotional relationship with a specific person; . . . the relationship brings sa fety, comfort, soothing and pleasure; . . . and loss or threat of the person evoke s intense distress. Id. at 4. Studies of bon ding, then, involve an eva luation of emotional relationsh ips, or more specifically, as the Judicial Ed ucation C enter of N ew M exico (JEC ) has stated: The purpose of a bonding study is to determine whether a bond or attachmen t exists betw een a parent and a child . . . . The bonding issue in permanency planning is the extent to which the parent is capable of caring for the child from the perspective of bonding and attac hme nt. T he bonding s tudy d raws data from observation, from social and interpersonal reports, and from cognitive and emotiona l asse ssments. The Bon ding stud y moves in two dir ections . One track is the child s bonding issues with the parent. The other track comprises the bonding and attachmen t issues of the parent. (internal citations omitted). JEC, 37 C HILD W ELFARE H ANDBOOK, B ONDING OR 26 INTERACTIONAL S TUDY 37.1.3 (Jud. Educ. Ctr. 1997, 2003 Supp.) [hereinafter C HILD W ELFARE H ANDBOOK ]. Bonding studies trace their roots back to the 1930s when researchers began to analyze th e interac tion betw een m other an d child. See David E. Arredondo, M.D ., and H on. Le onard P . Edw ards, Attachment, Bonding, And Reciprocal Connectedness, 2 J. C TR. FOR F AM., C HILD . & C TS. 109, 110 (2000) [hereinafter Attachment & Bonding ]. Eventually, during the 1960s and 1970s, Dr. Mary Ainsworth, a distinguished researcher in developmental psychology, with other researchers and clinicians, conducted experime nts in which she monitored the behavior of an infant child by having the child sit with the p aren t in a f urnished playroom while a stranger would enter and then leave. Sub sequ ently, the parent would then leave and reen ter. Id. at 13. As a part of the experime nt, Dr. Ainsw orth would observe the child for signs of distress, attachment, and any exploratory behavior when the caregiver would leave and reenter the room. Based upon the child s respon ses, Dr. A insworth w ould prov ide an opin ion about th e child s relatio nship with the pare nt. Id. Her experiments became the basis for modern bonding studies that are often p resente d in juv enile an d fam ily court pr oceed ings. Id. at 113. Although bonding studies apparently have been conducted during the last thirty years, if not longer, there appear to be no uniform procedures for conducting such studies. In 1988, the American Psychiatric Association (APA) published guidelines for conducting a psychological evaluation of a child in custody dispute, see C HILD C USTODY C ONSULTATION: R EPORT OF THE T ASK F ORCE ON C LINICAL A SSESSMENT IN C HILD C USTODY 1 (1988) 27 [hereinafter T ASK F ORCE R EPORT ], and suggested that when assessing the parent-child bond, the psychiatrist sho uld observ e the interactio n between the child and parent and measure whether the pare nt is able to emp athize a nd com munic ate with the child . Id. at 6. To discern any bond, the task f orce report suggested that the psychiatrist also may ask the child to draw p ictures of the family and make w ishes about wha t is important to him or her, and also could present scenarios to elicit responses from the child evidencing his or her feelings toward each p arent. Id. Although it cannot be predicted how many interviews the psychiatrist would need to conduct with the child, the task force report opined tha t eight to eighteen session s may be require d. Id. at 8. In additio n, the task force indicated that the psychiatrist should conduct interviews of the parents and other persons of importance, such as the grandparents, stepparents, or caregiver, and examine any social service records, school reports, p sycholog ical test re sults, or m edical re cords o f the ch ild. Id. at 6-7. In the juvenile or family court context, bonding studies are used to evaluate the quality of the parent-child relationship, which may assist the court in determining the nature and extent of the cust ody it cou ld chos e to aw ard to th e paren t figure . See Bonding & Attachment, at 114. In particular, these studies have been used to decide questions regarding permanency planning, f oster care, a p arent s ability to nu rture the child , custody disputes, and other placement decisions and arise when a psychologist or psychiatrist is called to testify in a court p roceed ing. See Bonding & Attachment, at 114. The American Psychological Association explained the role of a psychologist or psychiatrist in a juvenile proceeding as 28 that of a professional expert who maintains an impartial stance when informing and advising the court of the relevant psychologica l factors invo lved in a custo dy disput e. See American Psychological Association, 49 G UIDELINES FOR C HILD C USTODY E VALUATIONS IN D IVORCE P ROCEEDINGS No. 7, 677-80 (July 1994) [hereinafter C HILD C USTODY E VALUATIONS ]. In addition, social workers also offer o pinions on the existenc e of bond ing in the pa rent-child relationship. See Bonding & Attachment, at 114. According to the American Association for the Advancement of Science (AAAS), clinicians participate in approximately one million legal cases a nnually. See David Faust & Jay Ziskin , The Expert Witness in Psychology and Psychiatry, S CIENCE R ESOURCE C ENTER 1 (1988). Often, when p sychologists or p sychiatrists are asked to complete a bonding study or evaluation they submit a report to the court detailing their findings and opinio ns. Id. Dr. David Arredondo and Judge Leon ard Edwards, Superior Court of California , identified pra ctical questions a judge should ask when evaluating a clinician s report, including the expert s qualifications, the methods employed in condu cting the evalua tion, and the child s fami ly relations hip. Bonding & Attachment at 121-22.10 10 An exa mple of the methods that psychologist John Mealy utilizes when conducting evaluations of children decla red to be in need of assistance, can be found in In re Adoption /Guardia nship of Mark M., 147 Md.A pp. 99, 807 A.2d 78 9 (2002). D r. Mealy testified in Mark M. s TPR proceeding that if he were to conduct an evaluation of Mark M. he would review the files of the Department of Social Services and the Public Defender s Office, examine the testimon y of Mark M . s therapist, and interview Mark M. abou t his biological mothe r and gr andm other. Id. at 103-04, 807 A.2d at 791-92. During the interview, Dr. Me aly also wou ld ask Mark M. qu estions a bout hi s home life and schoo l. Id. at 104, 807 A.2d at 792. In addition, Dr. Mealy would interview Mark M. s biological (contin ued...) 29 Furthermore, the American Academy of Child and Adolescent Psychiatry (AACAP) set forth criteria developed by several clinicians and researche rs on how to conduc t a child custody evaluation: when conducting the evaluation of the child the psychiatrist should assess the continuity and quality of the attachment between the parent and ch ild. See AACAP, P RACTICE P ARAMETERS FOR C HILD C USTODY E VALUATIONS at 5 (1997) [hereinafter P RACTICE P ARAMETERS ]. In making such assessments, the clinician should examine all medical, educational, and psychiatric records that are available and that may provide information on the parenting of the ch ild. Id. at 13. In add ition, the evalu ator should interview the parents, the car egiver, and the children to ascertain th e nature of their interactio ns with each o ther. Id. at 13-1 5. The Fresno C ounty, California Mental Health Plan Provider Manual (July 2002) [hereinafter Fresno County Manual ] also provides insight into the conduct of bonding studies, which are conducted w hen the case is set for a permane nt plan hea ring and p ossible termination of parental rights : It is a structured analytical interview including a mental he alth assessment (define or rule out clinical diagnosis using DSM IV) of both paren t(s) and the ch ild(ren), c onducted by a Licensed Mental Health Clinician with appropriate experience. Assessment of the interaction between the parent(s) and the child(ren). Use of testing instruments as needed, to more accurately gauge the strength of the bond between parent and child. 10 (...continued) mother. Id. He estimated that a thorou gh evalua tion of M ark M. w ould take appro ximately 20 hou rs. Id. 30 Fresno Coun ty Manu al, §14.2 .5 Bond ing Stu dy (July 200 2). Accord ing to the Fre sno Cou nty Manu al, when ordering a bonding evaluation the court should request that the clinician answer the following questions: 1. Do the child and the parent h ave a pare nt/child relation ship (as opposed to that of a child with a frie nd, o ccas iona l bab ysitter, or extended family member)? If yes, describe the relationship. 2. If the answer to question #1 is yes, does the child have a substantial, positive emotional attachment to the parent such that the child would be greatly harmed if this parent/child relationship were terminated? 3. If the answer to question #2 is yes, w ould contin uing this parent/child relationship p romote the well-be ing of the c hild to such a degree as to outweigh the well-be ing the child would gain in a permanent home with adoptive parents? Fresno Coun ty Manu al, § 14.2 .5 Bon ding S tudy. Although model pra ctices and procedures for conducting bonding studies have not been adopted, some of the courts from our sister states have recognized the studies as beneficial in deciding what is in the ch ild s bes t interest. See In re T .S. et al., 7 Cal.Rptr.3d 173, 175 (Cal.App .Dep t.Super.Ct. 2003 ); In re Adoption of Rhona, 784 N.E.2d 22, 32 (Mass.App. 2003); In re J.J.G., 954 P.2d 1120 , 1123-24 (M ont. 1998); In re Guard ianship of J.P. and B.P., 852 A.2d 109 3, 1100 (N.J. 2004 ); In the Matter of Adoption of a Child by P.S. and H.S., 716 A.2d 117 1, 1188 (N.J. 1992 ); In the M atter of th e Gua rdians hip of J.C ., J.C., and J.M.C., 608 A.2d 1312, 13 23-24 (N .J.App. 19 98); In re Julissa O., 746 A.2d 1137, 1140-41 (Pa.Supe r.Ct. 2000). N one of the courts in these cases, however, have opined that 31 the decision to grant or deny a motion for a bonding study would be considered a deprivation of parental rights or alteration of the term s of a custody order per se.11 Is the Denial of a Bonding Study in a Permanency Plan Situation Appealable? To determine appealability in this case, it is necessary for us to consider what parental rights, if any, are implicated in a motion for independent bonding study made during a permanency plan review hearing that resulted in, continuation of the same permanency plan. In the case before us, Katina M. sought a change of the existing permane ncy plan to reunification during the review hearing, and in support thereof, requested a bonding study under Section 3-816 to refute the testimony, which she classified as expert, of the social worker who testified about the level of bonding between the children and Katina M. and the foster parents. We recognize that the levels of bonding or attachment and emotional ties to the child s parent, and to the caregiver, testified by the social worker, are significant facts to be considered in the development of a permanency plan pursuant to Section 5-525 11 For example, in New Mexico, one statutory ground for terminating a parent s righ ts is based upon a court s assessment of the child s bond with the caregiver and the biological parent. See NMSA § 32A -4-28(B)(3) (1978, Repl. Pamp. 199 5). Under this statute a finding by a court that the natural parent has purpo sefully sough t to destroy the bo nd with th e child creates a rebuttable presumption that the biological parent has abandoned the child. See NMSA § 32A-4-28(C) (1978, 1995 Repl. Pamp. 1995). Other state courts, however, have found that whether a parent-child bond ex ists aids the co urt in draw ing legal co nclusions in the case, but tha t a lack of b onding a lone cann ot result in a term ination of the parties rights. See A.M . v. State, 891 P .2d 815 , 822 (A laska 1 995), overruled on other grounds in In re S.A., 912 P.2d 1235, 1239 (Alaska 1 996); In re Alana S., 802 A.2d 976, 980 (Me. 2002); In the Matter of the Adoption of a Child by P.S. and J.S., 716 A.2d 1171, 1182 (N.J.Super. 1998); In re E.M . a/k/a E.W.C. and L.M. a/k/a L.C., Jr., 620 A.2d 481, 485 (Pa. 1993). 32 (e)(ii) and (iii) of the Family Law Article, but are not the only factors, so that the denial of a bonding study would not per se affect parental rights in the perma nency plann ing contex t. We also have not previou sly addressed whether a social worker s testimony on bonding should be considered as factual or as expe rt opinion, go verned b y Maryland R ule 5-702,12 as Katina M . has asked us to do, which she posits supports appealability of the denial of the bonding study. In this regard, the C ourt of Special Appeals, although not addressing this specific question, has limited a social worker s testimony during CINA proceedin gs to lay observations of the children. In In re Adoption/Guardianship Nos. 2152A, 2153A, 2154A, 100 Md.App. 262, 641 A.2d 889 (1994), the Court of Special Appeals held that the social worker was competent to testify as a lay witness about the behavior of the children that she heard and saw first hand and the efforts that she undertook to prepare the children for the changes that they w ere fac ing, id. at 276, 641 A.2d at 895, all of which we re factual matters compared to evaluative opinions, but limited the social worker so that she would not be permitted by the trial court to express any expert opinion about the adjustments of the children to their foster homes. Id. 12 Md. Rule 5-702 states: Expert testimony may be admitted, in the form of an opinion or otherwise, if the court determines that the testimony will assist the trier of fact to understand the evidence or to determine a fact in issue. In making that determination, the court shall determine (1) whether the witness is qualified as an expert by knowledge, skill, experience, training, or education, (2) the appropriateness of the expert testimony on the particular subject, and (3) whether a sufficient factual basis exists to support the expert testim ony. 33 Various of our sister states have determined social worker s testimony about bonding to be equivalent to expert testimony when it was evaluative in nature. See In re Luke M. et al., 132 Cal.Rptr.2d 907, 917 (Cal.App .Dep t.Super.Ct. 2003 ) (considering social work er s testimony, it wo uld be detrimental for [the children] to liv e with [the biological fa ther] in Ohio becau se they w ere bon ded w ith [the f oster pa rents], to be evaluative in nature); In the Interest of S.O. et al., 483 N.W.2d 602, 604 (Iowa 1992) (determining that social wo rker s testimony was evaluative when she described the bond between the mother and her two older daughters as unhea lthy); In re the Adoption of M.T.S., 489 N.W.2d 285, 287 (Minn.App. 1992) (qualifying two social workers as experts to testify about the child s bond with the natural parents); In the Matter of Amanda Broadway, 81 P.3d 99, 103 (Or.App. 2003) (viewing social worker s testimony that the m other and her children had a strong attachmen t to each other as ev aluative in na ture); Roberts v . Roberts, 835 P.2d 193, 195 (Utah.App. 1992) (considering a social worker s testimony regarding the strength of [mother s] bond w ith the children as evaluative in n ature); In re D.C., 659 A.2d 1145, 1148 (Vt. 1995) (treating social worker s testimony that taking a special needs child from the family with which the child had bonded would have negative therapeutic implications for the child a s appro priate ex pert testim ony). Whether social workers testify about their observations regarding the bond between the parent or caregiver and child as a fact witness, or give an evaluation about the state of a bond between the parent or caregiver and the child as an expert, the court in its discretion 34 may order an independent medical examination of the child. In re Mark M., 365 Md. at 715, 782 A.2d at 348-49. It is not necessarily the nature of the testimony in the action that controls the decision, but whether the proponent of the examination satisfies the factors articulated in In re Mark M., to demo nstrate good cause for such an examination, show that the examination is reasonably calculated to assist the trier of f act in ren dering its decisio n, and establish that th e propo sed exam ination will n ot be harm ful to the child. Id. at 717-18, 782 A .2d at 35 0. With respect to the last factor in deciding whether a psycholog ical examin ation wou ld be harmful to a child, courts of other jurisdictions have considered the age and emotional condition of the child, the nature of the allegations of abuse and neglect, the strength of the relationship betwe en the c hild and parent, a nd the child s d ifficulty in discus sing family related issues. See In the M atter of Thea T., 663 N.Y.S.2d 5 02, 504 (N.Y.F am.Ct. 1997); Matter of Nicole, 551 N.Y .S.2d 749 , 751-52 (N .Y.Fam.C t. 1990); In re Child M., 681 A.2d 793, 802 (Pa.Super.Ct. 1996). In addition, courts have assessed the nature of the examination by probing the qualifications of the clinician conducting the evaluation, including: his or her training, background, experience; the number of sessions the child would meet with the therapist; and the methodology emplo yed durin g the se ssions. See In the Matter of Kaitlyn S., 560 N.Y.S.2d 88, 93 (N.Y .Fam.Ct. 19 90); Matter of N icole, 551 N.Y .S.2d at 752 -53; In re Child M., 681 A.2d at 802. In the case sub judice, the court exercised its discretion in denying Katina M. s motion 35 for a bonding stud y, but confirm ed the perm anency plan with additional time for visitation based, in part, upon the court s view of the bond that the children had with Katina M. and the caregiver. As such , the denial o f the bonding study would only be appealable as an interlocutory order und er Section 1 2-303 (x) if it deprived Katina M. of her right to care and custody of the children or chan ged the terms o f her pa rental rig hts. See In re Damon M., 362 Md. at 438, 765 A.2d at 628. In maintaining the permanency plan to proceed with the adoption of the children, the trial court continued the perma nency plan from the p rior year, as well as allowed Katina M. increased access to her children. Katina M. s rights would have been implicated had she made the motion for bonding study and appealed its denial when the court changed the permanency plan from reunification to adoption pursuant toSection 3-823 (e) and (g) of the Courts and Judicial Proceedings Article, and our decision in In re Damon M., 362 M d. 429, 765 A.2d 624 (2001), but not when the judge continued the plan and increas ed visita tion. We acknowledge that bonding studies can be beneficial to the determination of a permanency plan and m ay assist the cour t in making decisions a bout a child s placeme nt. Nevertheless, based upon the c ircumstances of this case, w e conclude that the trial court s order denying the motion for such a study is not an appealable final judgment and does not constitute an interlocutory order under S ection 12-303 (x). 13 13 Court orders den ying a motion for indepe ndent study likewise a re not appe alable under the collateral order doctrine. To be appea lable unde r this narrow exception, the order must satisfy the following four requirements: (contin ued...) 36 The second issue for consideration is whether the trial court erred in quashing the subpoenas for the children to testify during the permanency plan review hearing and declining to interview the children in camera. The trial judge s actions arose within the context of a permanency plan review hearing, after which he continued the previous permanency plan of adoption, as well as increased Katina M. s visitation. Because the order 13 (...continued) (1) it must conclusively determine the disputed question; (2) it must resolve an important issue; (3) it must be completely separate from the merits of the action; and (4) it must be ef fectively unrev iewable o n appeal f rom a fin al judgmen t. See Dawk ins v. Baltim ore City Police D epartme nt, et al., 376 Md. 53, 58, 827 A.2d 115, 118 (2003); In re Foley, 373 Md. 627, 633-34, 820 A .2d 587, 591 (200 3); Montg omery C ounty v. Stevens, 337 Md. 471, 477, 65 4 A.2d 877, 88 0 (199 5). We have emphasized that [t]he four elements of the test are conjunctive in nature and in order for a prejudgment order to be appealab le and to fall within this exception to the ordinary operation of the final judgment requireme nt, each of th e four elem ents must be met. Dawkins, 376 Md. at 59, 827 A.2d at 118. Furthermore, in Maryland the four requireme nts of the collateral order doctrine are very strictly applied, and appeals under the doctrine may be entertained only in extraordinary circum stances . Id., quoting Pittsburgh Corning v. James, 353 Md. 657, 666, 728 A.2d 210, 214 (2002). A court order denying a motion for independent study is not appealable as a collateral order. First, an order denying a motion for indep endent stud y does not co nclusively determine the question of whether the permanency plan should have been changed from adoption to reunification. The trial court pursuant to Maryland Code, Section 3-801 (f) of the Courts and Judicial Proceedings Article and Maryland Code, Section 5-525(e) of the Family Law Article, considers several factors in reviewing the permanency plan, one of which is the parent-child relationship. Second, although a motion for indepe ndent stud y is important in permanency planning, it is not completely separate from the merits of the action because such studies a re one fac tor that the cou rt relies upon to assess child p lacement. Fina lly, the motion for independent study is reviewable on appeal when its denial affects the parental custod ial rights. Thus, the collateral order doctrine is also unavailable as a means to appe al the co urt s ord er denyin g Katin a M. s motion for ind epend ent stud y. 37 continuing the perma nency plan d id not adve rsely affect K atina M. s parental rights or change the terms of the permanency plan to Katina M. s increased detrime nt, the trial judge s actions are not r eview able by th is Cou rt. JUDGMENT OF THE COURT OF SPECIAL APPEALS VACATED, AND CASE R E M A N D E D T O T H AT COURT WITH INSTRUCTIONS TO DISMISS APPEAL; PETITIONER TO PAY COSTS. 38