DCPP VS. B.C.R. AND J.L.N., IN THE MATTER OF THE GUARDIANSHIP OF J.C.J.N. (FG-11-0047-17, MERCER COUNTY AND STATEWIDE) (RECORD IMPOUNDED) ( 2018 )


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  •                                       RECORD IMPOUNDED
    NOT FOR PUBLICATION WITHOUT THE
    APPROVAL OF THE APPELLATE DIVISION
    This opinion shall not "constitute precedent or be binding upon any court." Although it is posted on the
    internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.
    SUPERIOR COURT OF NEW JERSEY
    APPELLATE DIVISION
    DOCKET NO. A-3318-17T4
    NEW JERSEY DIVISION OF
    CHILD PROTECTION AND
    PERMANENCY,
    Plaintiff-Respondent,
    v.
    B.C.R.,
    Defendant-Appellant,
    and
    J.L.N.,
    Defendant.
    ———————————————
    IN THE MATTER OF THE
    GUARDIANSHIP OF J.C.J.N.,
    a Minor.
    ———————————————
    Submitted December 12, 2018 – Decided December 27, 2018
    Before Judges Alvarez and Mawla.
    On appeal from Superior Court of New Jersey,
    Chancery Division, Family Part, Mercer County,
    Docket No. FG-11-0048-17.
    Joseph E. Krakora, Public Defender, attorney for
    appellant (Phuong V. Dao, Designated Counsel, on the
    briefs).
    Gurbir S. Grewal, Attorney General, attorney for
    respondent (Melissa D. Schaffer, Assistant Attorney
    General, of counsel; Melvina D. Fennell, Deputy
    Attorney General, on the brief).
    Joseph E. Krakora, Public Defender, Law Guardian,
    attorney for minor (Meredith A. Pollock, of counsel;
    Phyllis G. Warren, Designated Counsel, on the brief).
    PER CURIAM
    B.C.R. (Betty1) appeals from a March 9, 2018 judgment terminating her
    parental rights to her son J.C.J.N. (John). We affirm.
    We take the following facts from the record. Betty has had a history of
    involvement with the Division of Child Protection and Permanency (Division) ,
    beginning in 2002, with the birth of her first child. At the time, a psychological
    evaluation conducted on behalf of the Division concluded Betty could not
    adequately parent her child because she was emotionally disturbed, had
    developmental and emotional delays, and was communication-impaired.
    1
    We utilize fictitious names to protect the parties' privacy.
    A-3318-17T4
    2
    Another psychological evaluation performed in July 2007, showed little change
    in Betty's condition and concluded she had a poor prognosis because she was
    incapable of controlling her emotions and her anger. Betty was evaluated by
    five other professionals, all of whom drew similar conclusions.
    John was born to Betty and J.L.N. (Jim) in February 2016. The Division
    received a referral the day after John's birth because he was born premature at
    twenty-nine weeks gestation, weighed three pounds and ten ounces, and both he
    and Betty had tested positive for cannabis. At the hospital, Betty was aggressive
    and irritable and declined to take the medicine prescribed for her. John was
    placed in the neonatal intensive care unit for treatment and monitoring.
    Betty revealed she had smoked cannabis and cigarettes throughout her
    pregnancy, and did not receive prenatal care. She also indicated she had been
    diagnosed with schizo-affective disorder. Betty claimed she self-medicated with
    cannabis because she did not like the effects of the medicine prescribed for her.
    She continued to smoke cannabis after her discharge.
    In March 2016, a caseworker reported Betty admitted to using cannabis
    and appeared to be in need of mental health treatment. The Division also became
    concerned about Betty's potential housing instability because the caseworker
    noted she had not purchased a bed or any supplies for John. Betty claimed Jim
    A-3318-17T4
    3
    did not care for John and only saw him as a means to receive government
    benefits. Betty offered several excuses as to why Jim's family could not care
    for John, including her claim their house was infested with bedbugs.
    On March 15, 2016, the Division filed a verified complaint for custody,
    which the court granted. John was placed in a resource home and the Division
    provided weekly visitation for Betty. The Division referred Betty for substance
    abuse and psychological evaluations, which were scheduled for March and
    April, but she did not attend either appointment. Betty did attend a substance
    abuse evaluation, scheduled in March 2016, with a counselor from Child
    Protection Substance Abuse Initiative. There, she tested positive for cannabis .
    As a result of the evaluation, Betty was recommended to an outpatient substance
    abuse treatment program at Catholic Charities Family Growth Program in May
    2016, but was discharged two months later for lack of compliance.
    Betty's statements and conduct in the presence of Division caseworkers
    demonstrated she labored with mental illness. Betty claimed the Division had
    changed her name and birth date because it did not want to obtain the true
    information from a military base. She claimed her father was smothered by a
    pillow while at a hospital and implicated her previous Division caseworker in
    the death of her family members. Betty claimed cancer could be treated with a
    A-3318-17T4
    4
    plant purchased at Home Depot. A caseworker reported Betty ambulated in an
    unusual way while being transported to a visit with John, although she had no
    prior problems with walking. When they arrived for the visit Betty stood silently
    and stared at John. In June 2016, a caseworker reported Betty acted erratically
    during transport, holding her keys in a threatening stabbing manner while she
    sat in the passenger seat of the vehicle.
    Betty continued not to comply with evaluations arranged by the Division.
    The Division provided bus passes for transportation to psychological
    evaluations in June and August 2016, but she failed to attend. Betty claimed she
    missed some of her appointments because she did not feel like attending.
    In July 2016, Betty tested positive for cannabis when she arrived for
    visitation. She ignored a court order which required she maintain sobriety in
    order to have visitation.    Betty also refused to attend court ordered anger
    management and parenting classes. She claimed she would attend only after the
    Division refunded money she believed she was owed.
    During a visit in September 2016, Betty became verbally abusive with
    Division staff and threatened to shoot a security guard. The court ordered that
    visitation would not resume "until [Betty] complete[d] [a] psychological and a
    psychiatric evaluation for medication due to her mental health issues."
    A-3318-17T4
    5
    In 2017, Betty was referred for a psychological evaluation, which found
    she suffered from: psychotic disorder not otherwise specified; history of major
    depressive disorder, severe with psychotic disorder; intermittent explosive
    disorder; rule/out delusional disorder; cannabis use disorder; borderline
    intellectual functioning; unspecified personality disorder, paranoid, antisocial
    and borderline features. The report also concluded Betty was not capable of
    parenting John, nor could she safely resume visitation.           The evaluator
    concluded:
    [Betty's] visits were discontinued due to her volatile
    behavior and refusal to take redirection. Nothing has
    taken place since her visits were suspended that would
    lead her behavior to change. She continues to endorse
    physical discipline, she has an extremely high score on
    the Child Abuse Potential Inventory, she has very low
    scores on the parenting inventory and refuses to take
    any feedback about her parenting, she does not
    understand what structure is or what the importance of
    it is in raising children, she did not acknowledge that
    [John] has any special needs when asked about
    parenting him and also made very unusual statements
    such as it would be acceptable for her children to rob a
    local store with a gun.
    The report further indicated "[a] prior psychological evaluation [performed] . . .
    on July 29, 2009[,] stated that 'her prognosis is at best guarded and most likely
    poor.' In 2017 this remains the case. It is not likely that she will ever be able
    to independently or safely care for a child."
    A-3318-17T4
    6
    The Division referred Betty for a substance abuse evaluation. She failed
    to attend three scheduled appointments and the evaluator closed the case.
    The Division arranged for Betty to attend a psychological evaluation with
    Barry Katz, Ph.D. After the initial session, Dr. Katz opined that Betty displayed
    delusional and psychotic thinking, it was unsafe to resume visitation, and
    recommended partial hospitalization. At the conclusion of a different session in
    November 2017, Dr. Katz informed the Division Betty had stated she possessed
    machine guns she obtained while she was in the military, a claim she had also
    made to another evaluator. However, there was no evidence Betty had ever
    served in the military.
    Dr. Katz's report concluded Betty "presented as highly agitated, irrational
    and volatile."   She "intermixed racial slurs with irrational, paranoid and
    nonsensical statements. [She] expressed recurring themes that she did not have
    the patience or time to meet, that she was being exploited, [and] that [the
    Division's involvement] was a conspiracy[.]" Dr. Katz's opined as follows:
    Across interviews, [Betty] presented as in the
    throes of an active psychotic episode. [Betty] displayed
    impaired reasoning, impaired judgment, delusional
    ideation and thought disorder. [Betty] was impaired in
    her ability to control her impulses and continually
    appeared on the verge of becoming overwhelmed.
    [She] showed evidence of a thought disorder and was
    frequently on the verge of losing control of her anger
    A-3318-17T4
    7
    . . . . [Her] anger toward the paternal family equaled
    her anger toward the Division and those she believed
    aligned with [the Division]. [Betty] made delusional
    accusations in general of pedophilia and various other
    criminal behavior and exploitive behavior. [She] would
    repeatedly show loss in functioning, self-control and
    reality when questioned about parenting, her past, her
    paramour, her situation and her children. [Betty]
    presented with this same impaired state across
    interviews. The [Division] worker and [the Division]
    staff reported observing similar behaviors by [Betty]
    over many instances. These problems in function were
    also noted throughout the record with origins in early
    adolescence.
    [Betty] was steadfast in her commitment not to
    comply with medication, treatment and any other
    services. This pledge on the part of [Betty] was
    reflected in her ongoing behavior as was reported in the
    record. [She] not only expressed her desire not to
    comply with any services during the interview, but the
    record indicates that [she] has been chronically
    noncompliant with services, including therapy and
    medication.
    ....
    [Betty] displayed loss of control of her emotions
    and cognition during the current assessment. [She]
    displayed poor frustration tolerance that was repeatedly
    on the brink of explosive outbursts that would be fueled
    by internal psychotic processes and cognitive
    distortion. This behavior during the interview is
    consistent with the reports in the record of [Betty]
    having loss of functioning along with psychotic and/or
    explosive behaviors. This has led to [Betty] having her
    visits suspended. Such behaviors would put others at
    risk, especially a vulnerable child.
    A-3318-17T4
    8
    The report also stated Betty's chronically impaired condition would likely cause
    her to act out in violent impulses, and concluded she would likely act violently
    toward a child in her care. Dr. Katz found a child in Betty's care would be at
    imminent risk of harm and she would be unable to care for a child in the
    foreseeable future. He recommended visitation be suspended.
    In August 2017, Betty and John attended a bonding evaluation with Dr.
    Katz. John did not make eye contact with Betty during the observation, and
    instead looked around the room and out the window with a concerned
    expression. John rested his head against Betty, but peered through the window
    or looked directly at Dr. Katz. John had a "flat affect" and looked somber and
    withdrawn. Dr. Katz observed that when Betty put John down he did not cry,
    and when she picked him up he continued to display a concerned expression.
    He also noted John did not reciprocate the affection displayed by Betty.
    Dr. Katz also conducted a bonding evaluation with the resource parent.
    The resource parent provided a complete history of John's placement, and
    provided a detailed description of his medical and developmental history. John
    smiled and laughed with the resource parent during the observation, and seemed
    excited and joyful. He also noted John crawled around the room and generally
    exhibited a full range of emotion.
    A-3318-17T4
    9
    Dr. Katz concluded John did not have an attachment to either of his
    biological parents and did not recognize them. He concluded the resource parent
    was John's primary parent and he would not suffer a significant harm if Betty's
    parental rights were terminated. Rather, Dr. Katz found John would suffer a
    substantial harm if his relationship with the resource parent was severed, and
    concluded Betty was incapable of remediating such harm.
    The record demonstrates John's brain had not fully developed in utero and
    he will likely remain mentally challenged throughout his life. He presently has
    numerous developmental challenges and issues hearing, seeing, walking, and
    feeding. He has required treatment from specialists including a neurologist, a
    nutritionist, an occupational therapist, a physical therapist, and an ear, nose, and
    throat specialist.
    The guardianship trial took place in February and March 2018. The
    Division presented testimony from Dr. Katz and the caseworker, Monique Ford.
    Betty testified on her own behalf and presented no other testimony.
    Ford's testimony explained the Division's involvement since the removal,
    its assessment of relative placements, the services provided to the family, and
    John's progress in his resource home, as we have summarized it. Dr. Katz was
    A-3318-17T4
    10
    qualified without objection as an expert in the field of psychology, and testified
    consistent with the conclusions in his psychological and bonding evaluation s.
    Dr. Katz's conclusions explained Betty's prognosis. He testified she likely
    suffered from mental impairment since adolescence, and the disorder was
    progressing and worsening over time. He opined the combination of Betty's
    psychotic disorder, propensity for violence, and poor understanding of parenting
    responsibilities would put John at a high risk of danger because she was
    incapable of parenting him. Dr. Katz concluded there was an "imminent risk of
    severe harm leading to potential catastrophic consequences for the child."
    Dr. Katz linked Betty's conduct with the harms John had suffered. He
    testified because John will potentially struggle with his developmental delays
    throughout his lifetime, he required a parent with knowledge of the delays who
    was capable of addressing them. Dr. Katz explained his findings by referencing
    Betty's poor track record. He noted John had lost hearing in one ear because of
    Betty's failure to consent to ear surgery. Betty's delusional thinking placed John
    at significant risk of harm if he were left to her care. Additionally, Dr. Katz
    opined John would potentially experience bouts of anger, depression,
    maladjustment, or regression if his relationship with the resource parent were
    severed, which Betty could not remediate because of the lack of a bond.
    A-3318-17T4
    11
    Betty's testimony blamed the Division for failing to provide services.
    Despite the lack of evidence, she claimed both she and John had autism, which
    the Division failed to treat. She further asserted the Division abused her and
    generally abuses autistic and deaf children. Betty claimed the Division did not
    compensate her for a radiation test and owed her millions of dollars. She
    testified her plan to parent John was to have him returned to her care, and to "let
    him know that he got the problem."
    The trial judge delivered an oral decision on March 9, 2018. The judge
    reviewed Betty's extensive history with the Division and the services it offered
    her following the birth of her first two children. The judge credited Ford's
    testimony regarding the services offered to Betty after John's birth. The judge
    accepted the extensive findings made by Dr. Katz, which she noted were
    unrebutted. The judge concluded the Division had proven all four prongs of the
    best interest of the child test, codified in N.J.S.A. 30:4C-15.1(a), by clear and
    convincing evidence.
    With respect to prongs one and two, the judge found Betty had harmed
    John by failing to provide a caring family for him. The judge noted Betty did
    not maintain stable housing and failed to obtain parenting necessities when John
    was born. She also found Betty's severe mental health problems prevented her
    A-3318-17T4
    12
    from understanding or meeting John's special needs. The judge also noted Betty
    had harmed John by failing to seek prenatal care or treatment for her own mental
    health issues, and instead resorting to drug use.
    The trial judge recounted Betty's erratic and abusive behavior during
    visits, which caused them to be canceled. She also concluded Betty had not
    demonstrated she could provide a safe and stable home for John or remedy the
    issues which caused the removal. The judge credited Dr. Katz's testimony,
    which highlighted the high risk of severe and enduring harm John would suffer
    if he were removed from this resource parent.
    As to prong three, the judge found the Division made reasonable efforts
    to provide services to Betty to remedy the circumstances which led to John's
    removal. The judge found Betty only minimally complied with services. She
    found the Division met its burden to consider alternatives to termination , citing
    the Division's initial plan of reunification with Betty and the Division's
    continued provision of services to her despite her unwillingness to comply. The
    judge also found the Division had conducted a sufficient investigation of relative
    resources, but determined none were suitable.
    The trial judge found the Division had proven prong four. She concluded
    a termination of parental rights would not do more harm than good because Betty
    A-3318-17T4
    13
    had no plan to care for John and address his developmental needs. The judge
    found Betty incapable of parenting because of her untreated mental health
    issues. She concluded Betty's conduct and testimony reinforced Dr. Katz's
    determinations regarding Betty's inability to parent.      Noting the respective
    bonding evaluations performed by Dr. Katz, the trial judge concluded the
    resource parent understood and met all of John's developmental needs and was
    willing to adopt him.
    The judge signed a judgment terminating the parental rights of both Betty
    and Jim to John. Jim did not file an appeal. This appeal by Betty followed.
    I.
    "Appellate review of a trial court's decision to terminate parental rights is
    limited[.]" In re Guardianship of J.N.H., 
    172 N.J. 440
    , 472 (2002). "Because
    of the Family Part's special jurisdiction and expertise in family matters, we
    accord particular deference to a Family Part judge's fact-finding." N.J. Div. of
    Youth & Family Servs. v. T.M., 
    399 N.J. Super. 453
    , 463 (App. Div. 2008)
    (citing Cesare v. Cesare, 
    154 N.J. 394
    , 413 (1998)). Deference is appropriate
    because the trial judge has a "'feel of the case' that can never be realized by a
    review of the cold record." N.J. Div. of Youth & Family Servs. v. R.G., 
    217 N.J. 527
    , 552 (2014) (quoting N.J. Div. of Youth & Family Servs. v. E.P., 196
    A-3318-17T4
    
    14 N.J. 58
    , 104 (2008)).    A reviewing court will not disturb a family court's
    termination of parental rights so long as they are "supported by 'substantial and
    credible evidence' on the record." N.J. Div. of Youth & Family Servs. v. F.M.,
    
    211 N.J. 420
    , 448 (2012) (quoting N.J. Div. of Youth & Family Servs. v. M.M.,
    
    189 N.J. 261
    , 279 (2007)).
    "When the credibility of witnesses is an important factor, the trial court's
    conclusions must be given great weight and must be accepted by the appellate
    court unless clearly lacking in reasonable support." N.J. Div. of Youth & Family
    Servs. v. F.M., 
    375 N.J. Super. 235
    , 259 (2005) (citing In re Guardianship of
    DMH, 
    161 N.J. 365
    , 382 (1999)). In other words, a family court decision is
    overturned only when the fact-findings are "so 'wide of the mark' that [the
    Appellate Division's] intervention is necessary to correct an injustice." F.M.,
    211 N.J. at 448 (quoting E.P. 196 N.J. at 104). The factual findings of the trial
    court should not be disturbed on appeal unless "they are so wholly unsupportable
    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. Inv'rs Ins. Co.
    of Am., 
    65 N.J. 474
    , 483-84 (1974)). When the trial court’s findings are
    "supported by adequate, substantial and credible evidence[,]" those findings
    A-3318-17T4
    15
    should be upheld on appeal. 
    Ibid.
     (quoting Rova Farms Resort, Inc., 
    65 N.J. at 484
    ).
    On appeal, Betty challenges the trial court's findings under prong one,
    three, and four. As to prong one, she argues there was no evidence presented
    showing her mental health and drug use harmed John. As to prong three, she
    contends the Division failed to meet its reasonable efforts mandate because she
    did not receive sufficient visitation and the Division failed to help her enroll in
    a recommended partial hospitalization program. As to prong four, she claims
    she did not harm John when she interacted with him, and therefore, the Division
    did not establish it would be more harmful than not to terminate parental rights.
    II.
    "A parent's right to enjoy a relationship with his or her child is
    constitutionally protected." In re Guardianship of K.H.O., 
    161 N.J. 337
    , 346
    (1999) (citations omitted). However, this protection "is tempered by the State's
    parens patriae responsibility to protect the welfare of children." 
    Id.
     at 347
    (citing In re Guardianship of J.C., 
    129 N.J. 1
    , 10 (1992)); see N.J.S.A. 30:4C-
    1(a).
    Under N.J.S.A. 30:4C-15.1(a), the Division must prove by clear and
    convincing evidence termination is in the best interest of the child. F.M., 211
    A-3318-17T4
    16
    N.J. at 447 (citing N.J. Div. of Youth & Family Servs. v. R.D., 
    207 N.J. 88
    , 113
    (2011)). Our Supreme Court has determined the clear and convincing evidence
    standard is satisfied when, in the mind of the factfinder, there is a "firm belief
    or conviction as to the truth of the allegations sought to be established, evidence
    so clear, direct and weighty and convincing as to enable the factfinder to come
    to a clear conviction, without hesitancy, of the precise facts in issue." N.J. Div.
    of Youth & Family Servs. v. I.S., 
    202 N.J. 145
    , 168 (2010) (quoting In re
    Seaman, 
    133 N.J. 67
    , 74 (1993) (citation, internal quotation and editing marks
    omitted)). "Because of the elemental nature of the parent-child relationship, and
    recognizing that the severing of that relationship is among the most 'severe and
    . . . irreversible' forms of state action," E.P., 196 N.J. at 102 (quoting Santosky
    v. Kramer, 
    455 U.S. 745
    , 759 (1982)), courts "consistently impose[] strict
    standards for the termination of parental rights" and "all doubts must be resolved
    against termination of parental rights."     K.H.O., 161 N.J. at 347 (citations
    omitted). The issue under the statute is "the 'best interests of any child,' not
    simply the presence or absence of culpable fault" on the part of the parent. In
    re Guardianship of R., 
    155 N.J. Super. 186
    , 195 (App. Div. 1977) (quoting
    N.J.S.A. 30:4C-15(c)).
    A-3318-17T4
    17
    Under the "best interest of the child" standard, the Division must prove by
    clear and convincing evidence:
    (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 Division 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).]
    "Importantly, those four prongs are not 'discrete and separate,' but 'relate to and
    overlap with one another to provide a comprehensive standard that identifies
    [the] child's best interests.'" N.J. Div. of Youth & Family Servs. v. G.L., 
    191 N.J. 596
    , 606-07 (2007) (quoting K.H.O., 161 N.J. at 348).
    A-3318-17T4
    18
    A.
    We reject Betty's argument that she did not harm John through her
    conduct. Under prong one, the Division must prove a harm to the child exists,
    and that the harm is "one that threatens the child's health and will likely have
    continuing deleterious effects on the child." M.M., 
    189 N.J. at 281
     (quoting
    K.H.O., 161 N.J. at 352). The harm need not be physical, as "[s]erious and
    lasting emotional or psychological harm to children as the result of the action or
    inaction of their biological parent[] can constitute injury sufficient to authori ze
    a termination of parental rights." In re Guardianship of K.L.F., 
    129 N.J. 32
    , 44
    (1992) (citing J.C., 129 N.J. at 18). The focus of the harm is not on any isolated
    incident, but rather "the focus is on the effect of harms arising from the parent-
    child relationship over time on the child's health and development." K.H.O.,
    161 N.J. at 348. "Moreover, '[c]ourts need not wait to act until a child is actually
    irreparably impaired by parental inattention or neglect'" before acting. Dep't of
    Children & Families v. E.D.-O., 
    223 N.J. 166
    , 178 (2015) (quoting DMH, 161
    N.J. at 383). Prong one may be satisfied where a parent exposes the child to the
    risk of future harm. N.J. Div. of Youth & Family Servs. v. A.G., 
    344 N.J. Super. 418
    , 440 (App. Div. 2001).
    A-3318-17T4
    19
    Betty's arguments are not supported by the record. The trial judge found
    her inability to provide a safe and stable home for John, her severe and untreated
    mental health issues, and continued use of drugs put John at a substantial risk of
    harm. Betty's erratic conduct during the Division's involvement in this case
    proved Dr. Katz's findings she had not improved, could not address her mental
    health problems, and would continue to harm John. As Dr. Katz noted, Betty
    was likely to act out in violent impulses due to her psychotic disorder and
    inability to control her emotions.      This was problematic because John's
    developmental delays made him more vulnerable to harm.
    Moreover, Betty's reliance on N.J. Div. of Youth & Family Servs. v. V.T.,
    
    423 N.J. Super. 320
    , 330-31 (App. Div. 2011), a case in which we held illicit
    drug use does not automatically support a finding of abuse and neglect , is
    misplaced. V.T. is inapposite because here the Division's case and the judge's
    findings under prong one did not find harm to John relying solely on Betty's
    drug use. Rather, the judge considered the fact Betty smoked cannabis during
    her pregnancy, continued to abuse it afterwards, refused to comply with
    substance abuse treatment services, exhibited aggressive and erratic behavior
    indicative of the lack of treatment, and failed to maintain a stable home.
    A-3318-17T4
    20
    The trial judge's prong one findings were supported by substantial credible
    evidence in the record. For these reasons, we decline to disturb them.
    B.
    We also reject Betty's challenges to the judge's prong three findings.
    Under prong three, the court must consider whether the Division "made
    reasonable efforts to provide services to help the parent correct the
    circumstances which led to the child's placement outside the home." N.J.S.A.
    30:4C-15.1(a)(3). The Division's efforts must be analyzed "with reference to
    the circumstances of the individual case," including the parent's degree of
    participation. DMH, 161 N.J. at 390.
    N.J.S.A. 30:4C-15.1(c) defines "reasonable efforts" as "attempts by an
    agency authorized by the [D]ivision to assist the parents in remedying the
    circumstances and conditions that led to the placement of the child and in
    reinforcing the family structure." The statute sets forth examples of "reasonable
    attempts" at reunification, including, but not limited to:
    (1)    consultation and cooperation with the parent in
    developing a plan for appropriate services;
    (2)    providing services that have been agreed upon, to
    the family, in order to further the goal of family
    reunification;
    A-3318-17T4
    21
    (3)    informing the parent at appropriate intervals of
    the child's progress, development, and health;
    and
    (4)    facilitating appropriate visitation.
    [Ibid.]
    Further, "the Division's efforts in providing classes and parenting
    programs must by their very nature take into consideration the abilities and
    mental conditions of the parents[,]" but the determination of reasonableness does
    not turn on the success of those efforts. A.G., 
    344 N.J. Super. at 442
    . Such a
    determination is fact specific and depends on the circumstances of each case.
    DMH, 161 N.J. at 390. "'Even if the Division ha[s] been deficient in the services
    offered to' a parent, reversal of the termination order is not necessarily
    'warranted, because the best interests of the child controls' the ultimate
    determination regarding termination of parental rights." N.J. Div. of Youth &
    Family Servs. v. L.J.D., 
    428 N.J. Super. 451
    , 488 (App. Div. 2012) (quoting N.J.
    Div. of Youth & Family Servs. v. F.H., 
    389 N.J. Super. 576
    , 621 (App. Div.
    2007)).
    Citing I.S., 
    202 N.J. at 178-80
    , Betty argues one-hour weekly visitation
    supervised in the Division's office was unreasonable. In I.S., the Court found
    the Division failed to satisfy the third prong of the best interest test. 
    Ibid.
     The
    A-3318-17T4
    22
    Court noted the importance of providing appropriate visitation to assist in
    reunification of the parent and child. 
    Id. at 178-79
    . Although the Court found
    the Division offered services in the form of visitation, paternity testing for the
    defendant, and considered relatives as resource placements, it concluded the
    Division failed to offer services sufficiently tailored to facilitate reunification in
    order to satisfy its burden under prong three of the best interests test. 
    Id.
     at 177-
    78.
    The circumstances here were different, and Betty's argument that the
    inadequate visitation was the reason for the adverse outcome misreads the
    record. Indeed, the Division made extensive efforts on other fronts to engage
    Betty in mental health and substance abuse services designed to remedy the
    circumstances which led to John's removal. From the time John was removed
    until the trial, it was Betty's mental impairments and behavioral instability which
    prevented her from taking advantage of the visitation, not the reverse.
    Moreover, Betty's drug use prior to visitation, and her conduct during it,
    demonstrated increased visitation would continue to place John at risk of harm
    and would not facilitate the Division's obligations under the third prong .
    We also reject Betty's arguments that prong three was not met because the
    mental health services provided were unreasonable because she was "not the
    A-3318-17T4
    23
    typical client based on her history and mental impairments[,]" and thus could
    not be entrusted to enroll in the services on her own. The record demonstrates
    the Division made substantial efforts to engage Betty in mental health services,
    including requiring she have psychological evaluations, substance abuse
    evaluations and treatment, referrals to mental health services, transportation
    assistance, and family team meetings. However, Betty refused to comply with
    services and claimed she did not need them. The record does not support the
    notion the Division merely referred Betty for services without follow -up. The
    trial judge's prong three determination is supported by substantial credible
    evidence in the record.
    C.
    Finally, Betty argues there is no evidence to support the trial judge's
    finding that John's continued contact with her would do more harm than good.
    Betty argues the fourth prong was not established because she never harmed
    John, but instead fed him, changed his diapers, and displayed affection during
    visitation, and claims Dr. Katz's observations corroborated this. We disagree.
    Prong four "serves as a fail-safe against termination even where the
    remaining standards have been met." G.L., 
    191 N.J. at 609
    . "The question to
    be addressed under [prong four] is whether, after considering and balancing the
    A-3318-17T4
    24
    two relationships, the child will suffer a greater harm from the termination of
    ties with [his] natural parents than from permanent disruption of [his]
    relationship with [his] foster parents." I.S., 
    202 N.J. at 181
     (citations and
    quotation marks omitted). "[T]o satisfy the fourth prong, the [Division] should
    offer testimony of a well[-]qualified expert who has had full opportunity to make
    a comprehensive, objective, and informed evaluation of the child's relati onship
    with both the natural parents and the foster parents." F.M., 211 N.J. at 453
    (citations and internal quotations omitted).
    The court's prong four determination is supported by ample credible
    evidence in the record, including the unrebutted expert testimony of Dr. Katz
    regarding Betty's parenting deficits and lack of a bond with John. As Dr. Katz
    opined, John's developmental delays required a caregiver who would address
    them. Betty had no plan to meet the child's needs, and her failure to address her
    own mental health deficits, which manifested themselves during the case
    through paranoid delusions and threats of violence, only underscored that she
    would place John at substantial risk of harm.
    Dr. Katz's unrebutted testimony proved John had significant attachment
    to the resource parent and would suffer harm if the relationship were severed.
    John was happy and joyful with the resource parent, unlike his demeanor when
    A-3318-17T4
    25
    with Betty. Dr. Katz opined Betty would be incapable of remediating the severe
    and enduring harm John would suffer if his relationship with the resource parent
    were severed. The judge's determination as to prong four of the best interest test
    was supported by substantial credible evidence in the record and we will not
    disturb it.
    Affirmed.
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    26