On appeal from the Superior Court, Chancery Division, Family Part, Union County, Docket No. FG-20-12-08.
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION
Before Judges Lisa, Reisner and Sapp-Peterson.
Defendant, S.R., appeals from a judgment of guardianship entered on July 2, 2008 terminating her parental rights to her son, A.R., who was born on September 2, 2004.*fn1 Defendant argues that the Division of Youth and Family Services (Division or DYFS) failed to present clear and convincing evidence to satisfy its burden of proving all four prongs of the best interest test. We disagree and affirm.
Defendant was born on June 2, 1985. She has never been married. A.R. is her only child. Defendant's relationship with the putative father, J.H., ended, and since DYFS's involvement, he has had no contact or role in A.R.'s life. Defendant reported that J.H. was living somewhere in Virginia, but his particular whereabouts are unknown.
The Division received its first referral on July 4, 2006 from Covenant House, a shelter in Newark, reporting that defendant and A.R. arrived that afternoon. Defendant said her boyfriend had kicked her out. Because Covenant House did not provide housing for children, its staff made efforts to locate a family shelter and requested assistance from the Division. It was determined that A.R. had not eaten all day, and defendant had no diapers for him.
A DYFS representative spoke with defendant, who stated she had been living with her mother in the Bronx, New York, until the past week. She said her mother told her she had to leave because she was twenty-one years old. She said she stayed with friends for the past week and came to New Jersey because she did not know of any shelters in New York. She declined to discuss the circumstances regarding her boyfriend or what friends she had been staying with the prior week.
Covenant House staff transported defendant and A.R. to another shelter, Raphael Lighthouse in Elizabeth. Late at night, defendant left, saying she was going to the store, although she was told no stores would be open at that hour and the shelter could provide whatever she needed. She took A.R. with her and did not return. She was found wandering the streets of Elizabeth in the middle of the night with A.R.
The Division was called on July 5, 2006 from Trinitas Hospital in Elizabeth reporting that the police brought defendant and A.R. to the emergency room. A DYFS record on that date reflected that defendant "seems to have psychiatric problems and at this time she is delusional." Division records reflect that A.R. appeared "groomed, clean, appropriately dressed and healthy," without any signs of abuse or neglect. Defendant's aunt was called and she, along with defendant's father and stepmother, came to Trinitas Hospital.
Defendant was in a delusional state and could not be interviewed. Defendant's father confirmed that defendant had a psychiatric history dating back to her teen years, which included a previous hospitalization. He believed defendant was prescribed medication, but was not taking it. He confirmed that defendant and A.R. lived with defendant's mother in New York, but she was away, and defendant was staying with her aunt in Newark.
Defendant's father and his wife were willing to take custody of A.R. The Division substantiated neglect and immediately removed A.R., placing him with defendant's father and stepmother. This was followed by an order on July 7, 2006 granting the Division's emergent application for care, custody and supervision of A.R. A.R. has continuously been in the custody of his grandfather and step-grandmother since that time, and they wish to adopt him.
An examining physician at Trinitas Hospital noted that defendant appeared delusional and claimed to be an Army captain. She had never served in the military. She also claimed to be a daycare worker and living in California. Defendant was transferred to Trenton Psychiatric Hospital on July 6, 2006. She initially denied any psychiatric history, but then reported a psychiatric hospital admission for two to three weeks in New York when she was sixteen years old. She was prescribed Risperdal, but could not recall why. Defendant was started on Risperdal, Cogentin and Ativan. She "was noted early on to be paranoid and at times verbally aggressive."
An initial psychiatric evaluation on July 6, 2006 revealed that defendant exhibited a psychotic condition with disorganized behavior and delusions, a history of mental illness and noncompliance with medications and follow-up care, and poor insight and lack of cooperation for treatment. She was diagnosed with Psychotic Disorder NOS.
Because of her hospital admission, no visitation with A.R. had been ordered. On July 19, 2006, a DYFS worker visited defendant and informed her that any visitation would have to be court ordered. Defendant failed to understand why she could not see her son, and she denied having a problem.
Defendant was discharged on August 18, 2006. Her level of functioning was "fair." She was prescribed Risperdal, Cogentin and the Ortho Evra patch.
Defendant moved in with her mother in the Bronx. She was scheduled for participation in the partial hospitalization program (PHP) at North Central Bronx Hospital. Defendant apparently had conflicts with her mother. She left her mother's home and took up residence at the Renaissance Women's Shelter in the Bronx. She began visitation with A.R. on September 15, 2006, during which she interacted appropriately with him.
Upon commencement of the PHP at North Central Bronx Hospital, defendant was diagnosed with Bipolar 1 Disorder, manic, severe. Her initial treatment plan was to continue with medications, participate in a medication assurance plan, and attend five group therapy sessions per week and two individual therapy session per week.
PHP records reflect that defendant was "guarded with information but interpersonally related and engageable." She had "no clear sense of why she was taking medications" and suggested she did not need them. She expressed an interest in "getting her life together and being able to care for her child." Soon after admission to PHP, she enrolled in Bronx Community College. Her class schedule conflicted with her PHP schedule. She continued to present with manic symptoms, including "rapid speech and decreased sleep." At times, she "appeared restless and exhibited psychomotor agitation with labile affect." The PHP records further reflect that defendant "exhibited poor judgment and impulsivity." Defendant apparently transferred to a Brooklyn shelter, and was unable to attend PHP regularly. She was discharged from PHP on September 18, 2006. Her final diagnosis upon discharge was "Bipolar 1 disorder most recent episode manic, in partial remission." Her discharge medications were Risperdal and Cogentin. Her final assessment upon discharge was:
Pt is a young woman who is most likely experiencing a significant amount of difficulty coming to terms with her mental illness. Pt has the capacity for relatedness but at the same time can be quite guarded about her life experiences and her feelings. Pt is likely to stop taking her medications and decompensate if effort isn't made to help her understand her mental illness.
Defendant was referred to the Interboro Mental Health Clinic,*fn2 where she attended her initial appointment on September 25, 2006. DYFS provided defendant with a train pass to facilitate her travel from New York to New Jersey for meetings with the Division and visitation with A.R. The pass would also be used to attend psychotherapy and a parenting skills program. Reunification was the Division's objective.
On January 3, 2007, at the request of DYFS, Dr. Mark Singer, a psychologist, evaluated defendant. Defendant expressed her understanding that she was there because of a court order, and she explained that A.R. was taken away from her after she was out late with him looking for a shelter. However, she denied being disoriented or delusional at the time. She further related that she had lived in a shelter since September 2006, but that A.R. could not live there with her, and she expressed her desire to move to an apartment, complete college and have a career. She acknowledged her hospitalization in the summer of 2006 and her diagnosis with bipolar disorder. She said she was currently under the care of a psychiatrist and taking medication. She also reported attending therapy since September 2006 and her current parenting skills training.
In his report of the evaluation, Singer noted that defendant's responses indicated her attempt "to present herself in a highly favorable manner . . . suggestive of an individual who minimizes personal faults and holds unrealistically positive perceptions of one's level of psychological functioning." He further noted that defendant "has a personality style consistent with Obsessive-Compulsive Personality Disorder with narcissistic features." These characteristics are typically found in "an individual who engages in moralistic thinking, has significant difficulty acknowledging and responding to the needs of others, and tends to engage in public displays of compliance."
He found a significant risk posed to A.R. by defendant's behavior, which was, in part, the result of an apparent untreated mental illness. Individuals diagnosed with bipolar disorder "have a high rate of non-compliance with treatment." Singer was also concerned that defendant continued to have difficulty acknowledging and responding to the needs of others, which would present difficulty responding to the demands involved in parenting a child. He felt defendant continued to lack the necessary resources to care for A.R.
To work toward the goal of reunification, Singer made a number of recommendations. These included completion of the parenting skills training program, obtaining appropriate housing, employment and daycare arrangements, continued participation in individual psychotherapy, and compliance with prescribed medications and monitoring by a qualified psychiatrist. Finally, Singer recommended continuation of supervised visits, which, ideally, should increase in frequency and duration if possible. Singer concluded:
The above recommendations, if followed, are anticipated to assist [defendant] in becoming a more viable placement option for her son. Should she comply with and benefit from these recommendations, this case may be revisited in 3-6 months. At that time, treatment updates should be obtained from all treating professionals. Should [defendant] be unable or unwilling to comply with these recommendations, or should any other evidence arise suggesting [A.R.] would be at risk if reunited with his mother, alternative placement options may be explored.
The prognosis for this case is dependent upon [defendant]'s ability and willingness to continue to address the issues that have brought about DYFS involvement. Ideally, through compliance with the above recommendations, [defendant]'s mental illness will stabilize as she develops the ability to become a more responsive parent.
Supervised visits continued into 2007, and for the most part, went well. However, on June 6, 2007, the Division had an unannounced visit with defendant's father and stepmother at their home. The stepmother expressed concern about defendant's visits with A.R. because of defendant's inadequate attention to A.R. She reported that defendant needed to be reminded to feed A.R., and defendant napped after she fed A.R. Defendant's father and stepmother also expressed concern about defendant's lack of quality time with A.R. during her visits.
And, at a supervised visit on June 15, 2007*fn3 at the Division office another significant incident occurred. At the beginning of the visit, the Division worker observed that defendant "sat on a chair and appeared to be gazing into space, once in a while she will look towards [A.R.] but there was not interaction with her and [A.R.]." A.R. had climbed on a chair and was in danger of falling, but defendant made no effort to remove A.R. from the chair. After the Division worker told defendant she needed to remove A.R. from the chair, she did so, and sat back down. The worker instructed defendant that being a parent includes identifying and removing a child from a dangerous situation, and explained that defendant needed to learn how to play with A.R. to bond with him. Defendant was receptive, played with A.R., and appeared to enjoy it. When defendant realized A.R. had walked into the hallway, she brought him back into the room. The worker noted that the visit "went well," and A.R. appeared comfortable and happy in the presence of defendant.
On January 10, 2007, defendant had attended her court-ordered psychiatric evaluation by Dr. Ronald W. Crampton. Defendant reported the medications she was prescribed and said she was living with her mother at Renaissance Women's residence in Brooklyn. She denied past psychiatric history prior to her July 2006 admission to Trenton Psychiatric Hospital. In his review of records, Crampton noted in his report defendant's prior mental health intervention at age sixteen. He also had available to him and reviewed the records from North Central Bronx Hospital. He noted her discharge diagnosis from that facility of "Bipolar I Disorder, most recent episode manic, in partial remission."*fn4
Defendant told Crampton that on July 5, 2006, when she was found wandering the streets of Elizabeth in the middle of the night, she was merely lost and trying to find her way back to Brooklyn. Crampton found defendant alert and anxious and initially guarded and evasive, although she became "more related as the interview progress[ed]." He further described her mental status as follows:
Speech is clear, spontaneous and productive with a normal rate, rhythm and tone. Thought processes are goal directed with no indication of a formal thought disorder or acute mania. [Defendant] is evasive regarding certain aspects of her interpersonal functioning, the status of her children's father or the extent of financial support she receives. No persecutory or referential ideation or fixed delusional set revealed or elicited. After describing her current dwelling as a "private three story house in Brooklyn," [defendant] then rummages through her wallet to produce a photo identification card establishing her as [a] resident at the Renaissance Women's Shelter. [Defendant] reiterates her desire to continue her college education at Bronx Community College with the goal of becoming a "recreational therapist." [Defendant]'s explanation for wandering the streets of Elizabeth with her child was that she was merely "lost." She states "I was just trying to get back [to ...