NEW JERSEY DIVISION OF YOUTH AND FAMILY SERVICES v. B.M.

RECORD IMPOUNDED

NOT FOR PUBLICATION WITHOUT THE

APPROVAL OF THE APPELLATE DIVISION

 

SUPERIOR COURT OF NEW JERSEY

APPELLATE DIVISION

DOCKET NO. A-3632-11T1

NEW JERSEY DIVISION OF YOUTH

AND FAMILY SERVICES,1

Plaintiff-Respondent,

v.

B.M.,

Defendant-Appellant.

____________________________________

IN THE MATTER OF GUARDIANSHIP

OF H.B.M., a minor.

________________________________________________________________

T

April 19, 2013

elephonically argued March 12, 2013 Decided

 

Before Judges Parrillo, Sabatino and Maven.

 

On appeal from the Superior Court of New Jersey, Chancery Division, Family Part, Camden County, Docket No. FG-04-181-11.

 

Kevin G. Byrnes, Designated Counsel, argued the cause for appellant (Joseph E. Krakora, Public Defender, attorney; Mr. Byrnes, on the brief).

 

Nora P. Pearce, Deputy Attorney General, argued the cause for respondent (Jeffrey S. Chiesa, Attorney General, attorney; Lewis A. Scheindlin, Assistant Attorney General, of counsel; Ms. Pearce, on the brief).

 

Phyllis G. Warren, Assistant Deputy Public Defender, argued the cause for minor-respondent (Joseph E. Krakora, Public Defender, Law Guardian, attorney; Ms. Warren, on the brief).

 

PER CURIAM

Defendant B.M. appeals the February 3, 2012 termination of her parental rights to her son H.M., who was born in February 2004. Defendant argues the Division of Youth and Family Services (Division) did not satisfy at trial the four criteria required by N.J.S.A. 30:4C-15.1(a) for termination of parental rights. We disagree and affirm.

I.

A.

The following facts were adduced from the record. The Division first learned of this family in December 2004, when the Lancaster County (Pennsylvania) Child Protective Agency contacted the Division stating that on November 29, 2004, the Pennsylvania state court in Lancaster County had ordered that the agency receive custody of H.M. but that defendant abruptly relocated thereafter to New Jersey. The Lancaster County agency requested the Division's assistance in locating defendant and H.M. Unable to locate defendant, the Division closed the matter.2

Next, on July 28, 2009, the Division received a referral regarding the safety of a young male child alleged to be H.M. The person making the referral observed H.M. naked and crying at his apartment sliding glass door. According to the referent, both defendant and H.M. were heard screaming, whereupon defendant was heard saying, "I'm gonna whip your ass." That day, the Division re-opened its case for investigation as to this matter and visited defendant's home.

Defendant denied the referent's allegations and refused to allow the Division's caseworker inside of the residence. When questioned by the caseworker about prior concerns of the Lancaster County Child Protection Agency, defendant stated that the only involvement was a call when H.M. was an infant. Defendant denied that she had any prior mental health issues or treatment and also denied ever taking psychotropic medication. Sometime during this questioning, H.M. broke free from his mother, ran out of the building, crossed the street and locked himself in an abandoned car.

The caseworker returned two days later, on July 30, 2009, to conduct a home visit and reported that there was very little furniture in defendant's apartment and no beds. Defendant stated that she and H.M. slept on the floor and occasionally on air mattresses located at the bottom of a heavy pile of items in the closet. The caseworker reported that defendant denied the offer of a couch, and that only after much coaxing, she agreed to take the bed for H.M. The caseworker also reported that the home was cluttered, but did not appear unsafe; however, the toilet did not flush.

Although the caseworker convinced defendant to participate in services, particularly a psychological evaluation and Treatment Alternatives for Child at Risk services, the Division determined that the neglect allegation at that time was unfounded. The caseworker's report noted, however, that due to defendant's "history of leaving Pennsylvania . . . during [an] investigation and litigation, if at any time [defendant] refuses services, her case should immediately be conferenced with litigation staff."3

On August 24, 2009, Meryl E. Udell, Psy.D., conducted the Division-recommended psychological evaluation on defendant. Defendant denied any prior diagnose of schizophrenia or child neglect allegations. Dr. Udell concluded that defendant demonstrated "behaviors that could indicate serious mental illness."4

With respect to H.M., Dr. Udell further noted:

It is a very serious concern that her son is [five and one-half] years old, has always slept on the floor and that she did not think it [was] important for him to have a bed. It is more concerning that she was given a bed for him and has not yet put it together. In addition and even more serious, according to [defendant] her son has "never" interacted with children his own age and had not yet been to school. The Division reports that [H.M.] appears to have undiagnosed special needs. These could be developmental issues from birth, or could be a result of having lived in relative isolation and repeatedly moving. . . .

Dr. Udell recommended H.M.'s removal from the home and placement with another family until he could be evaluated. Dr. Udell also recommended supervised visitation between H.M. and defendant.

B.

The Division conducted a Dodd removal5 of H.M. from defendant's home on September 9, 2009, and filed a complaint with the Family Part for care, custody and supervision. At that time, the Division reported that the child rarely spoke and had just begun school. In granting the motion and upholding the Dodd removal, the court found that defendant had attempted to thwart the Division's investigation, including relocation "without any reliable reasons." The court ordered, among other things, an assessment of the maternal grandmother for H.M.'s possible placement; that defendant cooperate with psychological treatment services; a Child Study Team Evaluation for H.M.; a referral to Robin's Nest6 for therapeutic visitation; and daily telephonic contact between defendant and H.M. Defendant and H.M. maintained supervised visitation through Robin's Nest with a goal towards reunification.

On December 1, 2009, defendant became verbally abusive and erratic during a Robin's Nest visit. Staff had attempted to stop H.M. from throwing trash and silly string on the floor, but defendant "demanded that her son . . . could do [whatever] he wanted." Shortly thereafter, a staff member's keys disappeared, but defendant denied taking them. The keys later were discovered in the men's bathroom where defendant had escorted H.M. earlier in the visit. As a result of this incident, defendant's visits were limited to inside of the visitation room and she was instructed not to use profanity.

The court ordered defendant to attend counseling with Ronald Gruen, Ed.D., a licensed psychologist. Dr. Gruen counseled defendant from October 2009 until March 2010. Initially, Dr. Gruen was reluctant to diagnosis defendant with paranoid schizophrenia. He also encouraged family reunification if defendant complied with recommended psychiatric services. Months later, Dr. Gruen's assessment began to change as he explained:

Unfortunately, [defendant] is still in denial regarding her personality and parenting deficits.

 

She feels that people are either misunderstanding or misjudging [H.M.]. This, of course, is a function of her own paranoia and defensiveness.

 

In my professional opinion, this matter is taking far too long to establish a realistic case plan.

 

By March 2010, due to defendant's continued canceling of appointments, Dr. Gruen refused to schedule further sessions for defendant.

Also during this same time frame, in March 2010, the Division learned about H.M.'s developmental needs, including speech, language and occupational therapy. H.M. began displaying behavioral problems and developmental delays at school, including lack of communication. He received several disciplinary reports, which noted H.M.'s explosive and disruptive behavior, as well as his aggression towards other students. The Division received test results that diagnosed H.M. with possible Fetal Alcohol Spectrum Disorder, Pervasive Developmental Disorder NOS, Asperger's Syndrome, or some form of autism. As a result, H.M. was referred to the CASTLE Program7 for further evaluation.

In March 2010, defendant attended a mental health evaluation with Linda Jeffrey, Ph.D., a licensed psychologist. Defendant again denied any prior investigations in Pennsylvania. While defendant acknowledged a prior history of mental illness, she maintained, among other things, that she had not experienced psychotic symptoms since she was seventeen years old, and she found counseling irritating and upsetting. Overall, Dr. Jeffrey reported that defendant "presented as impatient and irritable with flat and restricted affect. Her insight was poor." Dr. Jeffrey also expressed concerns with defendant's ability to parent H.M.:

Her inability to manage her son's behavior suggests significant deficits in basic parenting authority. Her not teaching her son to sleep in a bed is also suggestive of deficient parenting authority and judgment.

 

Given her immature and egocentric presentation, it is likely that she has significant problems with personal insight, social relations and parenting judgment. . . . This evaluator does not recommend the placement of [H.M.] in the care of [defendant] at this time. He is likely to be at risk of harm in her care.

 

Meanwhile, the Division referred defendant for another psychiatric evaluation with the University of Medicine and Dentistry of New Jersey. On March 23, 2010, defendant informed the Division that she desired to cancel her scheduled March 26, 2010 psychiatric evaluation and on April 6, 2010, she indicated to the Division that she was unwilling to receive any additional counseling services or referrals despite the court order.

Notwithstanding her objection, from May until August 2010, defendant attended counseling sessions with Larry N. Seidman, Ph.D. Dr. Seidman concluded in his progress report to the Division: "It can be said with a reasonable degree of psychological certainty that it would not be in the best interests of . . . [H.M.] to be returned to [defendant's] custody, without dramatic behavioral and personality change[,] for which the prognosis is guarded." (Alteration in original). Defendant later contacted the Division, stating that she no longer wished to receive counseling with Dr. Seidman. The Division made a referral for a new doctor.

On August 9, 2010, defendant completed a psychiatric evaluation with Edward Baruch, M.D. The purpose of the evaluation was to delineate whether B.M. had an underlying psychiatric disorder which might impede her ability to parent. Dr. Baruch reported that defendant denied any prior mental health issues.8 She also denied prior neglect allegations in Pennsylvania or knowledge of the Lancaster County agency being awarded custody. Dr. Baruch concluded that defendant's "insight and judgment for her mental health needs appear significantly impaired." Noting the conflicting diagnoses regarding whether defendant had schizophrenia,9 Dr. Baruch determined that "there is sufficient evidence of a psychotic disorder with paranoia and disorganization . . . . [W]e believe she is schizophrenic." Dr. Baruch recommended that defendant attend an intensive outpatient mental health program at South Jersey Behavioral Health. Defendant refused the service and did not attend.

Defendant received individualized therapy with Rachel Margolin, LCSW, from October until November 2010. A November 29, 2010 Therapy Status Report stated that defendant made "little progress" and "spent a lot of time persevering on how [the Division] took [H.M.] without just cause." Defendant was reported as hostile and distrustful. Moreover, the report noted that defendant "cannot meet her own needs let alone those of her son's." Margolin also expressed concerns with defendant's attendance.

During this time, H.M. also continued to receive services. He attended weekly individualized treatment from September 2010 until December 2010 with Margolin. In a December 2, 2010 report, Margolin wrote:

The therapist has been asked to provide her recommendation with regard to reunification. While the therapist has only met [H.M.'s] mother . . . twice, she feels strongly that reunification is not in [H.M.'s] best interest. . . . [H.M.] has many special needs and the therapist feels strongly that [defendant] is not equipped to handle them. To date, she has shown no insight into her own mental health issues or her son's delays. Parenting a typically developing child would be very hard (if not impossible) for [defendant]; parenting a child with [H.M.'s] issues would certainly put him in the highest risk category. Sadly she is not in the position to meet his very special needs.

 

A permanency hearing was held March 3 and 4, 2011. The court heard testimony from Drs. Kenneth Weiss, Edward Baruch, and Linda Jeffrey; Division caseworker Aneesah Bush-Covington; and defendant. The judge determined at the end of this hearing that defendant "suffers from untreated mental illness and [H.M.] has special needs that she [is] unable to address and is therefore unable to parent [H.M.]. [Defendant] has not complied with court[-]ordered services." The court approved the Division's plan for termination of defendant's parental rights, followed by adoption. The judge ordered that defendant comply with psychological and psychiatric evaluations and treatment; H.M. continue to receive individualized counseling and treatment; and weekly supervised visitation.

C.

On April 18, 2011, the Division filed a complaint for guardianship. Thereafter, on July 11, 2011, Frank J. Schwoeri, Ph.D., a licensed psychologist, completed a psychological evaluation of defendant and a bonding evaluation of defendant and H.M.

Dr. Schwoeri diagnosed defendant with schizophrenia, residual type. He noted a number of behaviors suggesting a "chronic history of poor functioning." He ultimately concluded:

[Defendant's] very frequent changes of residence without seeming cause or explanation appear[] to have . . . contributed to the isolation of this mother and child. Characteristic of a chronic severe mental illness, [defendant] exhibits impaired judgment and no insight into the nature of her own difficulties along with denying that her son has any.

 

As to the bonding evaluation, Dr. Schwoeri noted that defendant has affection for her son, but H.M. has an insecure attachment to her. He was concerned that defendant was unaware of or unwilling to recognize H.M.'s significant behavioral developmental and emotional problems. The doctor would later testify at the guardianship trial that H.M. would be at risk if he were returned to defendant's care.

Defendant's expert, James L. Loving, Psy.D., also conducted a bonding evaluation between H.M. and defendant, and a psychological evaluation on defendant on August 4, 2011. Dr. Loving acknowledged the divergent diagnoses of defendant's mental health, but agreed that the most likely diagnosis is Schizotypal Personality Disorder. He testified at trial that defendant's mental health condition is treatable; however, it would require a long-term commitment to treatment. Dr. Loving opined that defendant's prognosis for successful treatment is guarded. As to her ability to parent H.M., Dr. Loving determined in his written report that defendant "could effectively care for [H.M.] under low-stress conditions . . . as long as she feels comfortable that her professional contacts will not cause her to lose custody or parental rights." (Alteration in original).

With respect to the bonding evaluation, Dr. Loving noted the child's attachment with defendant and his stated desire to return home to her. He testified that because of the autism spectrum disorder, any transition, either back to defendant or to another home, would pose risks for H.M. As between the alternatives, he opined that terminating parental rights and placing the child in select home adoption would pose the higher risk of long-term emotional harm.

A three-day guardianship trial was conducted in February 2012. During trial, the court heard testimony from Drs. Schwoeri, Loving, and Jeffrey; Division caseworkers Aneesah Bush-Covington and Charmain Bryant; and defendant. Upon considering that testimony and various exhibits, the trial judge found that the Division had satisfied each of the four prongs of N.J.S.A. 30:4C-15.1(a) by clear and convincing evidence and terminated defendant's parental rights.

First, the judge found that, notwithstanding the lack of physical abuse, defendant s untreated and unresolved mental health problems, behavioral issues and history of residential instability, coupled with a failure to appropriately attend to H.M.'s developmental, autism-like condition, demonstrated that the child's safety, health, or development had been endangered. Second, the court found that defendant's failure to accept her mental health problems and reluctance to comply with recommended treatment and counseling demonstrated an unwillingness or inability to eliminate the harm facing H.M. Third, the judge found that the Division had made reasonable efforts to provide services to defendant both before and after the permanency hearing to try to work towards reunification. Finally, the judge determined that placing the child "in a home with stable, loving foster parents mindful of his problems and willing to work toward those problems[] is the best course and is in the [child's] best interest."

On appeal, defendant contests the court's finding on each of the four prongs. The Law Guardian joins the Division in asking us to affirm the court's decision.

II.

Our task is to determine whether the trial court's decision "was based on clear and convincing evidence supported by the record before the court." N.J. Div. of Youth & Family Servs. v. P.P., 180 N.J. 494, 511 (2004). The scope of our review is limited, and the trial court's factual findings "should not be disturbed unless 'they are so wholly insupportable as to result in a denial of justice.'" In re Guardianship of J.T., 269 N.J. Super. 172, 188 (App. Div. 1993) (quoting Rova Farms Resort, Inc. v. Investors Ins. Co. of Am., 65 N.J. 474, 483-84 (1974)). In fact, "'because of the family courts' special expertise in family matters, appellate courts should accord deference to family court fact[-]finding.'" N.J. Div. of Youth & Family Servs. v. R.D., 207 N.J. 88, 112 (2011) (alteration in original) (quoting Cesare v. Cesare, 154 N.J. 394, 413 (1998)). Moreover, consideration of the four prongs of the statutory test must be made as a whole. See In re Guardianship of K.H.O., 161 N.J. 337, 348 (1999).

Furthermore, we assess the trial court's determination in light of the statutory four-prong test for termination:

(1) The child's safety, health or development has been or will continue to be endangered by the parental relationship;

 
(2) The parent is unwilling or unable to eliminate the harm facing the child or is unable or unwilling to provide a safe and stable home for the child and the delay of permanent placement will add to the harm. Such harm may include evidence that separating the child from his resource family parents would cause serious and enduring emotional or psychological harm to the child;

 
(3) The [D]ivision has made reasonable efforts to provide services to help the parent correct the circumstances which led to the child's placement outside the home and the court has considered alternatives to termination of parental rights; and

 
(4) Termination of parental rights will not do more harm than good.

 
[N.J.S.A. 30:4C-15.1(a).]

 

These standards, "neither discrete nor separate . . . [,] overlap to provide a composite picture of what may be necessary to advance the best interests of the children." N.J. Div. of Youth & Family Servs. v. T.S., 417 N.J. Super. 228, 242 (App. Div. 2010), certif. denied, 205 N.J. 519 (2011). Based on our review of the record, we are satisfied that the trial judge reasonably found that the Division met the statutory test by clear and convincing evidence.

A.

As to the first prong, defendant claims that the Division failed to prove by clear and convincing evidence that the child's health and development was endangered by defendant. This argument focuses on the alleged injustice of the Division's initial intervention. Defendant primarily contends that her home environment was safe and having her child sleep on an air mattress rather than a bed was a "judgment call." With respect to her mental state, defendant argues that although there was disagreement as to whether she required treatment, she cooperated with Division evaluations and services, including a day program and parenting classes.

We turn first to the identification of the harm. The trial judge referred to the expert testimony offered at the permanency and guardianship trials, and found that there was clear evidence that defendant has "mental health problems." The record reflects that defendant was evaluated multiple times during the course of the litigation. Beginning with the initial psychological evaluation that Dr. Udell performed in 2009 through the 2011 evaluations by Drs. Loving and Schwoeri, all of those experts expressed similar concerns and opinions that defendant suffers from at least a form of schizophrenia and paranoia, such that it affected her current ability to parent her son. Notably, even defendant's own expert, Dr. Loving, reported that defendant's actions, including her denials of mental illness, her defensiveness, her attempts to control her therapy including cancelling sessions, and refusing to take medication, are all symptoms of paranoia and indicia of her mental illness. While there were early contradictory opinions that defendant had no mental health concerns, we are satisfied that the weight of the evidence, including reports from Lancaster County, defendant's admissions and subsequent mental health evaluations, supports the court's conclusion that defendant experienced mental health issues.

Defendant next contends that the court erred in finding that she endangered the child. She argues that since there is an absence of evidence of specific harm, such as physical or sexual abuse, or drug or alcohol abuse, the alleged harm in this case is "speculative." We disagree.

Actual harm need not be demonstrated in order for prong one

to be satisfied. N.J. Div. of Youth & Family Servs. v. A.G.,

344 N.J. Super. 418, 440 (App. Div. 2001), certif. denied, 171 N.J. 44 (2002). The absence of physical abuse or neglect is not conclusive; the "potential for serious psychological damage" must also be taken into account. In re Guardianship of R., G. & F., 155 N.J. Super. 186, 194 (App. Div. 1977); see A.G., supra, 344 N.J. Super. at 439-40. The test is "whether the child's safety, health or development will be endangered in the future and whether the parent[] [is] or will be able to eliminate the harm." A.G., supra, 344 N.J. Super. at 440. Moreover, the first prong can be satisfied by establishing that the parent suffers from a mental illness that renders her unable to parent. See id. at 439-440; see also R., G. and F., supra, 155 N.J. Super. at 194-95 (where the court considered that the parents' mental illnesses created an environment in which they were unable to adequately care for and raise their children despite the absence of physical abuse or neglect).

The record is replete with evidence of the harmful effects of defendant's parenting. Defendant and H.M. inexplicably relocated at least five times prior to H.M.'s removal in 2009, including her move to New Jersey from Lancaster County, Pennsylvania. When the Division performed a home visit, defendant informed the caseworker that she and H.M. slept on the floor and occasionally on air mattresses. Concerned about the sleeping arrangements, the Division purchased a bed; however, defendant never unwrapped it from the packaging. At the time H.M. was removed, he was five years old but did not speak. Several reports diagnosed H.M. with behavioral and emotional disorders.

The judge found that medical professionals concluded that defendant had difficulties in caring for the child, commencing with Dr. Udell's initial recommendation for removal. Dr. Schwoeri testified that defendant denied her son had any developmental issues. While he acknowledged that defendant was not incapable of parenting and showing concern for her son, Dr. Schwoeri opined that H.M. "needs more care than his mother is able to provide because of her own limitations." He added that defendant had difficulty with "recognizing [H.M.'s] needs, being able to recognize his needs as separate from hers, and being attuned to him in a way that . . . recognized his separateness as an individual from her own needs."

Dr. Jeffrey testified that she

would have grave concerns that [defendant] is not prepared to provide the kind of stability, attunement, acceptance of [H.M.'s] problems, dealing with [H.M.'s] problems[,] and being able to work with the helping professionals to help [H.M.] continue to make progress and to deal with what he still has to deal with.

 

Dr. Loving could not reach a conclusive recommendation on defendant's ability to provide safe care for her son, or her likelihood to work with professionals to ensure his needs are met because of the "limited information that she offered and because of it being guarded [and] sometimes under[-]elaborated."

A careful review of the record indicates that not one of the experts opined that defendant has the present ability to effectively parent her child given her own condition and her denial of the child's problems. We are satisfied that the judge's findings on the requisite harm to the child were clearly and convincingly supported by the record.

B.

Turning to prong two, we examine the trial judge's determination as to "whether the parent has cured and overcome the initial harm that endangered the health, safety, or welfare of the child, and is able to continue a parental relationship without recurrent harm to the child." K.H.O., supra, 161 N.J. at 348. The relevant inquiry is "whether the parent can become fit in time to meet the needs of the child." T.S., supra, 417 N.J. Super. at 244.

Defendant contends that she followed the advice of Drs. Weiss, Loving and Bodacki, all of whom concluded that there was nothing to treat.10 She testified, however, that in an effort to reunite with her son, she was willing to consider a day treatment program.

The Division contends that defendant steadfastly refused to address her longstanding mental health needs. The Division and the Law Guardian argue that defendant continues to be uncooperative and noncompliant with treatment. Therefore, the problems that initiated H.M.'s removal continue.

Defendant's reluctance to address her mental health concerns negatively affects H.M. With respect to H.M.'s care, caseworker Bush-Covington testified that she and defendant discussed the doctors' diagnoses of H.M. and recommendations following each evaluation, but defendant told the Division staff workers that she did not want H.M. to receive his prescribed medication and did not understand why he was receiving certain treatments. At trial, defendant denied that she ever received any information pertaining to H.M.'s medical evaluations. Defendant also testified that attending counseling was "the equivalent of torture" and "I'm thoroughly convinced that any Division doctor wouldn't be able to help me." Dr. Loving testified that defendant described therapy to him "as being something of an inquisition." Dr. Loving acknowledged that if H.M. were placed in her care, there is a risk that defendant would see his treating professionals in the same way.

The judge reasonably found that defendant failed to follow through with numerous services offered to her since the initial referral in August 2009. Specifically, the judge stated:

[Defendant] has mental problems, mental health problems[.] [S]he has a[n] unwillingness or inability because of her mental problems to accept that and to make a credible effort toward[s] solving those problems. She has gone to services from time to time for a short period of time and then found some reason to stop going to services basically and primarily because she believes that they were not doing her any good, that she didn't need them, [and] that she had no problems. That[,] I had hoped after the permanency hearing[,] would have changed but it's approximately a year . . . from that time and nothing has changed. The pattern is basically the same.

 

. . . .

 

I find that [H.M.'s] health has been and will continue to be endangered by the parental relationship were he to be returned to [defendant], [and] that she is unable to eliminate the harm facing him because she doesn't accept the fact that there is harm facing her child.

 

"Courts need not wait to act until a child is actually irreparably impaired by parental inattention or neglect." In re Guardianship of D.M.H., 161 N.J. 365, 383 (1999). This "second prong may be met by indications of parental dereliction and irresponsibility." K.H.O., supra, 161 N.J. at 353. If a parent s mental condition is such that the parent does not have the "mental status sufficient to eliminate the risk of future harm to the child," the risk of that future harm is grounds for showing whether the child will be endangered by the parent. A.G., supra, 344 N.J. Super. at 440.

Applying these principles, we conclude that the court's findings that defendant was unwilling or unable to accept her mental health problems, and failed to make credible efforts toward solving those problems such that she continued to put H.M. at risk are adequately supported by the evidence.

C.

The third prong of the best interests standard requires proof of the Division's reasonable efforts to reunify the parent and child by assisting the parent in addressing the problems that led to placement. K.H.O., supra, 161 N.J. at 354. These efforts, defined in the statute as "reasonable efforts," oblige the Division to assist the parent in providing the child with a safe and secure home and in reinforcing family structure. See N.J.S.A. 30:4C-15.1(a)(3). The reasonable efforts should be tailored to fit the unique circumstances of each family. D.M.H., supra, 161 N.J. at 390. In this case, the Division tailored its efforts to fit the unique circumstances of defendant and H.M.'s needs. During H.M.'s placement with the foster family, reunification was the Division's goal to support the family structure. Defendant was offered parenting classes and therapeutic supervised visitation through Robin's Nest. These visits never progressed to an unsupervised status, however, because of defendant's inappropriate behavior during these sessions that resulted in restrictions. The child was provided with services ancillary to his unique educational and emotional needs, including a comprehensive health evaluation, individualized education plans, and therapy. Further, the Division considered alternatives to termination by investigating the relatives that defendant offered.

The trial court found that the Division made reasonable efforts toward reunification, including psychological and psychiatric evaluations and treatment, supervised visitation, bus passes, partial care program referrals, and individual therapy. Despite these many services, defendant's denial of the need for counseling and her negative attitude about therapy resulted in her failure to complete any extensive treatment. In this circumstance, the Division cannot be faulted for failing to do more. Therefore, we see no error in the judge's conclusion that the Division met its burden of proof by clear and convincing evidence as to the reasonableness of its reunification efforts.

D.

Lastly, defendant disputes the court's finding that the Division proved by clear and convincing evidence that termination of parental rights would not do more harm than good. For this fourth prong, defendant argues that the bonding evaluations show that H.M. remains strongly and emotionally attached to his mother. Further, she argues that since there is no pending adoption placement for H.M. "courts have recognized that terminating parental rights without any compensating benefit, such as adoption, may do great harm to a child." N.J. Div. of Youth & Family Servs. v. E.P., 196 N.J. 88, 109 (2008).

The Division focused on the experts' assessment of H.M.'s need for stability and structure with someone who possesses the ability to understand and assimilate all of the information about his condition, and has the ability and willingness to work with his treating professionals. Since the foster care placement, H.M.'s I.Q. has increased twenty-five points, and his behavior and social interactions have improved. However, given these guarded improvements, Dr. Schwoeri testified that defendant was not appropriately attuned to H.M.'s needs and concluded that if he returned to his mother's care, there was a significant chance that he would regress.

The trial judge recognized the difficulties of addressing this portion of the analysis, and described the challenge by stating:

I [have] three options as the judge, one to terminate [defendant's] parental rights; two, to not terminate her rights and return [H.M.] to her; or three, to do neither, that is to not terminate her parental rights but . . . preserve the status quo with the hope that with further treatment . . . she could be reunited with [H.M.]. . . .

 

[H.M.] needs permanency. There is a risk in terminating parental rights, especially in this situation where we don't have a foster parent out there in place ready to adopt who has bonded with the child. . . . I conclude that it is not likely that [defendant] will[] [or] can change things in the near or even in the distant future because of her own mental problems. . . .

 

. . . .

 

[I]n the final analysis, to have him in a home with stable, loving foster parents mindful of his problems and willing . . . to work out those problems[] is the best course and is [in] the best interest of [H.M.] under the circumstances.11

While the bonding evaluations established that severing H.M.'s life with defendant would cause him some harm, the judge carefully weighed the alternatives and justifiably concluded that the best interests of the child required a stable home with parents who would attend to his needs. The evidence sufficiently shows that defendant has not shown a willingness to address her mental health concerns or acknowledge that her child has an autism spectrum disorder that contributes to his behavioral problems. Therefore, the record reflects that defendant has no present or likely ability to deal with H.M.'s emotional or intellectual needs. Accordingly, we agree with the trial judge that the Division met its burden of proof as to this prong of the statute as well.

In sum, we are satisfied that the Division proved all four prongs of the best interests of the child standard by clear and convincing evidence. Thus, the judge's decision terminating defendant's parental rights was based on adequate, substantial, credible evidence in the record. See Cesare, supra, 154 N.J. at 412. Consequently, we are compelled to affirm.

A

ffirmed.

1 On June 29, 2012, the Governor signed into law A-3101, which reorganizes the Department of Children and Families, which includes the renaming of the Division as the Division of Child Protection and Permanency. L. 2012, c. 16, eff. June 29, 2012.

2 The date on which the Division closed the matter was omitted from the appellate record.

3 The Division learned that defendant had been previously involved with the Lancaster County Mental Health/Mental Retardation Program for mental health concerns. Notably, the Division discovered that defendant received inpatient psychiatric treatment when she was seventeen years old. Since 1998, defendant was diagnosed with paranoid schizophrenia and subsequently under psychiatric care.

4 Dr. Udell provided a follow-up letter to the Division on September 10, 2009, stating that while she could not specifically diagnose defendant with schizophrenia, further evaluation was necessary.

5 A "Dodd removal" refers to the emergency removal of a child from the home without a court order, pursuant to the Dodd Act, which, as amended, is found at N.J.S.A. 9:6-8.21 to -8.82.

6 Robin's Nest is a program with a graduated progressive approach that allows families to engage in various forms of visitation.

7 The Children Achieving Success through Therapeutic Life Experiences (CASTLE) Program provides mental health services geared to help children who have severe emotional, behavioral, or psychiatric disorders.

8 She reported being previously prescribed Loxitane, which is used to treat symptoms of schizophrenia. Her medical records also showed prescriptions for Zyprexa and Seroquel, mood-stabilizing antipsychotic medications. Dr. Baruch reported that she denied taking these medications.

9 Namely, the reports of Leon I. Rosenburg, M.D., Kenneth Weiss, M.D. and David F. Bogacki, Ph.D. Dr. Baruch's documentation noted that Dr. Rosenberg, who completed psychiatric evaluations of defendant in October and November 2009, documented that "I cannot make a diagnosis of paranoid schizophrenia. . . . [T]here is no evidence this patient is a danger to [her]self and others," and that Dr. Bogacki completed a psychological evaluation on defendant in November 2009, where he wrote "there was nothing to suggest a diagnosis of Schizophrenia, Paranoid type." Dr. Baruch's evaluation also stated that Dr. Weiss performed a psychiatric evaluation in April 2010, which noted that defendant was "psychiatrically cleared for reunification with her son." Drs. Rosenberg, Bogacki and Weiss' reports, however, are not included in the record on appeal.

10 Defendant makes an argument that she followed Dr. Weiss' recommendations, and "[a]s long as Dr. Weiss'[] medical opinion was in the mainstream, [defendant's] medical decisions are entitled to deference by virtue of her constitutional right to privacy." She further states that: "Under no circumstances should she be required to yield her right to privacy as a condition for asserting her right to be a parent."

11 At oral argument, the Division advised this panel that during the pendency of this appeal, H.M. had been placed in an adoptive home.