In re Roman A. ( 2019 )


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  • November 18, 2019
    Supreme Court
    No. 2017-113-Appeal.
    (14-897-1)
    In re Roman A.                 :
    NOTICE: This opinion is subject to formal revision before
    publication in the Rhode Island Reporter. Readers are requested to
    notify the Opinion Analyst, Supreme Court of Rhode Island, 250
    Benefit Street, Providence, Rhode Island 02903, at Telephone 222-
    3258 of any typographical or other formal errors in order that
    corrections may be made before the opinion is published.
    Supreme Court
    No. 2017-113-Appeal.
    (14-897-1)
    In re Roman A.                   :
    Present: Suttell, C.J., Goldberg, Flaherty, Robinson, and Indeglia, JJ.
    OPINION
    Justice Flaherty, for the Court. This termination of parental rights case came before this
    Court for oral argument more than five years after the Department of Children, Youth, and
    Families (DCYF or the Department) first petitioned to remove the child, Roman A., from his
    mother, the respondent. On appeal, the non-Indian mother of an Indian child, who was born
    suffering from severe medical issues, asserts that the Family Court erred when it terminated her
    parental rights contrary to the provisions of the Indian Child Welfare Act (ICWA or the Act).1 We
    disagree and affirm the decree of the Family Court.
    I
    Facts and Travel
    Roman A. was born to the respondent, Carla Alvarenga (Mother), and Nicolas Noka, who
    is a member of the Narragansett Indian Tribe of Rhode Island, in February 2014.2 Unfortunately,
    1
    We recognize that many individuals tracing their roots to the native peoples of this country prefer
    the term “Native American” to “Indian.” We use the term “Indian” in this opinion because the
    relevant federal statute and caselaw use that term. We mean no disrespect.
    2
    The parties agree that Mother is not Native American.
    -1-
    Roman required immediate treatment for complex congenital heart disease and the infant was
    hospitalized for nearly all of the first six months of his young life, either in Rhode Island or
    Massachusetts. Roman was diagnosed with Double Inlet Left Ventricle and Ventricle Septal
    Defect, colloquially known as being born with “half of a heart.” In effect, Roman’s heart was
    unable to properly deliver blood to his lungs.
    Roman was required to undergo several medical procedures during the early days and
    months of his life, some of them very serious and life-threatening. In March 2014, Roman was
    transported to Boston for a cardiac catheterization, a less invasive means of achieving open-heart
    surgery whereby wires are inserted through the groin for the purpose of taking pictures of the heart.
    In May 2014, Roman underwent a second cardiac catheterization. The next month, Roman
    underwent open-heart surgery.       In July, because Roman was having difficulty feeding, a
    gastrostomy tube, or G-tube, was inserted so that food could be delivered directly to his stomach.
    Unfortunately, the heart condition was not the only obstacle the child faced. DCYF had
    received reports on its hotline from both Hasbro Children’s Hospital and Boston Children’s
    Hospital about Roman’s family and, in August 2014, a practitioner at Boston Children’s Hospital
    filed a Report of Examination with DCYF. Shortly thereafter, DCYF filed a petition in the Family
    Court alleging neglect on the part of both Mother and Mr. Noka, and the child was removed from
    his mother’s care via an ex parte order of the court. By the end of August 2014, Roman was
    discharged from the hospital to a foster home.3
    DCYF created its first of several case plans in October 2014. It is clear from a review of
    those case plans that reunifying Roman with Mother remained a goal for an extensive period of
    3
    Roman did spend approximately three weeks at Mother’s home between intervening hospital
    stays during this period.
    -2-
    time. By August 2015, however, DCYF filed a petition to terminate Mother’s parental rights,
    alleging that Roman had been placed in DCYF’s custody or care for at least twelve months, that
    “the parents were offered or received services to correct the situation which led to the child being
    placed,” and that “there is not a substantial probability that the child will be able to return safely
    to the parents’ care within a reasonable period of time considering that child’s age and the need
    for a permanent home.”4
    In March 2016, the Family Court was prepared to hold a hearing and take evidence on the
    initial neglect petition that had been filed by DCYF almost two years earlier, and then proceed, if
    necessary, to hear DCYF’s termination petition with respect to Mother.             However, after a
    conference, the initial petition was amended to add a claim of dependency and the trial justice
    explained that she was providing Mother with what she termed “an opportunity” for three
    additional months to become compliant with DCYF case planning. Mother admitted dependency
    and was ordered to comply. However, when the three-month period provided by the trial justice
    came to an end, DCYF sought to terminate Mother’s parental rights, alleging that Mother, despite
    the benefit of additional time, had failed to cooperate and comply. Trial commenced in September
    2016, and continued over diverse dates until November of that year.
    After the trial concluded, the trial justice issued an exhaustive, sixty-two-page written
    decision in which she summarized the testimony of all witnesses and made fifty-three findings of
    fact. The testimony particularly relevant to our review includes, among others, a pediatric
    cardiologist, a social worker, and the director of a department in the Narragansett Tribe. We
    recount the most relevant testimony as follows.
    4
    The parental rights of Roman’s father were terminated on default upon proof of abandonment.
    The father has not appealed that decree.
    -3-
    Dr. Kristin Lombardi
    Kristin Lombardi, M.D., is a pediatric cardiologist who was Roman’s treating physician at
    Women & Infants Hospital and Hasbro Children’s Hospital. At the time of trial, Dr. Lombardi
    had been treating Roman since his birth. She testified as an expert in pediatric cardiology for
    DCYF, opining that Roman will require significant cardiac care throughout his life and that he is
    likely to experience neurodevelopmental and cognitive limitations. She also testified that any
    person who is Roman’s caretaker would need to be able to recognize a number of factors to
    properly care for him, including recognizing changes in his color and his activity level. Doctor
    Lombardi testified that, despite multiple and lengthy conversations with Mother, Mother “did not
    have a good grasp on the severity of [Roman’s] heart disease[,]” and the doctor expressed concerns
    about whether Mother could provide the level of care that Roman required.
    Lena Sousa
    Lena Sousa, a DCYF social worker who had been assigned to Roman’s case in August
    2014 and who remained the social worker on the case throughout its entirety, also testified on
    behalf of DCYF. She testified that she discussed the concerns of Boston Children’s Hospital with
    Mother that Mother had been unavailable for appointments, procedures, and phone calls and that
    Mother had failed to comply with the care plan that the hospital had developed. Ms. Sousa also
    testified about the case plans that DCYF had developed. She said that, in September 2014, she
    had met with Mother and had explained that a case plan involves services DCYF would request
    Mother to complete so that the Department could evaluate the prospects for reunification.
    However, she testified, Mother said that she was not interested in participating in services because
    she was busy. Ms. Sousa also explained to Mother that DCYF would look to a different goal if
    Roman remained in DCYF’s care for an extended period of time. In spite of Mother’s insistence
    -4-
    that she was too busy to participate, the first case plan created by Ms. Sousa nonetheless retained
    the goal of reunifying Roman with Mother. The case plan included several areas in which Mother
    needed to make changes or improvements in order to be reunified with Roman, including
    addressing domestic violence, parenting, mental health, and meeting the medical needs of Roman.
    Mother was required to engage in a parent/child evaluation, demonstrate that she could meet
    Roman’s needs during visits, make use of parenting and mental health services, attend medical
    appointments, and act upon doctors’ recommendations, including those involving Roman’s
    medications.
    Regarding domestic violence, an issue that was included in the case plans as a result of an
    alleged incident that involved Roman’s father at Hasbro Children’s Hospital, Ms. Sousa testified
    that she either made referrals or provided mother with the names of multiple resources. Addressing
    domestic violence remained in the case plans throughout the case’s entirety, because that issue was
    never addressed by Mother. Anger management also became a part of the case plans following
    Mother’s arrest as the result of a road-rage incident. Ms. Sousa testified that she was forced to
    send the same list of anger management providers to Mother about eight times in a single week
    because Mother repeatedly requested the information. Ms. Sousa testified that she was unaware
    as to whether Mother partook of any anger management services.
    With respect to engaging in a parent/child evaluation, Ms. Sousa testified that she referred
    Mother to John Parsons, Ph.D., a clinical psychologist, but Mother never participated in an
    evaluation with him. At one point, Mother told Ms. Sousa “something to the effect that * * * she
    didn’t need anyone to tell her she was a good mother and/or label her as mental[.]” When it became
    clear that the evaluation with Dr. Parsons would not be accomplished, Ms. Sousa made a referral
    to Brian Hayden, Ph.D., also a clinical psychologist. Mother was willing to comply with Dr.
    -5-
    Hayden, according to Ms. Sousa, but after Dr. Hayden conducted the psychological evaluation of
    Mother, she refused to return to Dr. Hayden for the parent/child portion of the evaluation because,
    according to Ms. Sousa, Mother did not like Dr. Hayden’s evaluation. Mother did not participate
    in the parent/child piece of the evaluation until June 2016, nearly two years after the case initially
    was opened, and did so only after the trial justice ordered her to comply. Ms. Sousa made the
    referral, to Spurwink Rhode Island, for that completed evaluation.
    Ms. Sousa testified that making use of parenting and mental health services had been
    included in the initial case plan because of reports that Mother blamed hospital and hospital staff
    and believed that they were targeting her, and also because of conversations Ms. Sousa had with
    Mother. Ms. Sousa also testified that she provided Mother with the names of multiple service
    providers that could address Mother’s mental health issues. She said that Mother told her that she
    was willing to go to the Providence Center, and so Ms. Sousa made a call to set up an appointment
    there on Mother’s behalf. When Ms. Sousa called, however, she was told that Mother was required
    to set up the appointment herself. Mother later informed Ms. Sousa that she had attempted to set
    up an appointment herself, but that she was unable to do so because there was a waiting list. Ms.
    Sousa followed up with the agency to inquire about the waiting period, however, and the agency
    informed Ms. Sousa that there was, in fact, no waiting list. Ms. Sousa testified that she continued
    to remind Mother that receiving mental health services was a part of the plan. To Ms. Sousa’s
    knowledge, the required mental health services in the final plan were never successfully
    completed.
    Ms. Sousa also testified that she would, either by phone or email, inform Mother about
    Roman’s medical appointments. On one occasion, however, Mother refused to provide her new
    phone number to Ms. Sousa, while at the same time insisting that she did not receive her emails.
    -6-
    Ms. Sousa also testified that Mother admitted to attending only two of Roman’s medical
    appointments over the seven-month period that spanned from September 2014 to March 2015,
    even though Roman had approximately three appointments per week. Ms. Sousa testified that on
    one occasion Mother told her she did not understand how attending appointments would prove that
    she was capable of caring for Roman. Ms. Sousa testified that attending medical appointments
    was a part of each case plan DCYF had created, until the termination petition was filed and
    reunification was no longer the goal, and that, over the entirety of the case, Mother failed to
    consistently attend medical appointments.
    Ms. Sousa also explained that, in September 2014, Mother refused to allow Roman to
    receive certain injections that the cardiologist had recommended because of Roman’s weakened
    immune system, and also that Mother did not want Roman to receive a flu shot. Ms. Sousa also
    testified that Mother was not making progress in the area of following doctors’ recommendations
    at the time the second case plan was created. Ms. Sousa testified that Roman’s medical needs were
    a continuous aspect of the case plan.
    Ms. Sousa further recounted several troubling occurrences that she learned took place while
    Mother was with Roman. At one visit, at a time when Roman had a G-tube inserted, Mother
    attempted to give Roman either apple juice or milk. When it was explained to Mother why this
    was inappropriate because of the G-Tube, Mother expressed that she had not followed doctors’
    instructions in the past.    Ms. Sousa also testified to another occasion during which the
    gastroenterologist felt compelled to inform Mother that it was inappropriate for her to give candy
    to Roman. On another occasion, Ms. Sousa had to review Roman’s approved snack list with
    Mother after she fed a doughnut to Roman, which was not an approved snack. Ms. Sousa further
    testified that, following a doctor’s visit in February 2015, Mother expressed to Ms. Sousa that
    -7-
    Roman was getting sick as a result of his then-foster mother kissing him, and Mother requested
    that the foster mother neither kiss nor hug Roman.
    Ms. Sousa related that, to her knowledge, since March 2016, when the court gave Mother
    an additional three months to take advantage of the services and comply with DCYF case planning,
    Mother had failed to complete any of the required services. She also testified that Roman had been
    in the same foster home for about sixteen or seventeen months, that Roman was comfortable with
    his foster parents, “wants to be around them all the time[,]” and that the foster home was
    preadoptive in nature.
    Sarah Dodd
    Further germane to this review is the testimony of Sarah Dodd, a family support specialist
    in the family visitation program at Boys Town New England. Ms. Dodd testified that her job at
    Boys Town involves monitoring court-mandated visitations and teaching a class called “Common
    Sense Parenting,” which attempts to develop positive parenting skills. Ms. Dodd was assigned to
    work with Mother in November 2015, and she did so until March 2016. During that period, Ms.
    Dodd testified, she had approximately sixteen or seventeen visits with Mother. In the program,
    Mother was permitted to visit with Roman once per week under the supervision of Ms. Dodd and
    had permission to attend Roman’s medical appointments. Ms. Dodd also interacted with Mother
    through the Common Sense Parenting class.
    Although Ms. Dodd said that Mother completed the Common Sense Parenting class, she
    also testified that Mother struggled to arrive at visitation appointments on time, missed at least one
    appointment, and would not be prepared for appointments, such as failing to provide a snack for
    Roman. Ms. Dodd also testified that Mother had expressed to her that she did not appreciate Ms.
    Dodd’s feedback and did not feel that Ms. Dodd’s services were necessary.
    -8-
    In March 2016, Ms. Dodd’s work with Mother came to an end because Mother was deemed
    to be noncompliant with the Boys Town visitation program. During the last visit, at which Ms.
    Dodd informed Mother that she was being discharged from the visitation program, Mother became
    confrontational and indicated to Ms. Dodd that, in Ms. Dodd’s words, “she did not feel that she
    needed to be part of the program; that she wasn’t going to listen to any of our services; that she
    didn’t have to come prepared with the necessary items for the visits.” 5 Mother’s discharge
    summary from the Boys Town visitation program, signed by Ms. Dodd, further highlights that
    Mother was consistently late for visits and was resistant to Ms. Dodd’s suggestions.6
    Caroline Gojcz
    Caroline Gojcz, a licensed independent clinical social worker employed as a clinical
    supervisor in the family support center at Spurwink Rhode Island, testified as an expert for DCYF.
    Mother was referred to Spurwink by DCYF for a parent/child evaluation in May 2016 after the
    Family Court ordered Mother to comply with DCYF. The purpose of the evaluation was to assess
    Mother’s ability to care for Roman and to determine whether it would be appropriate for Roman
    to return to Mother’s care. Ms. Gojcz met with Mother four times individually and twice while
    Mother was visiting with Roman. It was Ms. Gojcz’s expert opinion, based on her review of the
    5
    During this final visit, Ms. Dodd testified, there was a safety concern involving Mother and her
    other child, who Ms. Dodd testified was approximately three or four years old at the time. Ms.
    Dodd explained that: “[T]here was concern of safety that took place with [the other child] and
    mom. I attempted to intervene several times. Mom told me not to talk to her, not to talk to her
    children. Our visit room was destroyed.” Ms. Dodd later explained that the other child “dumped
    things out all over the room” and that she was concerned the child might leave the building after
    she ran down the hallway.
    6
    Carol Wild, also an employee of Boys Town New England, briefly testified on behalf of DCYF.
    Ms. Wild worked with Mother between January 2015 and September 2015, as part of the family
    visitation program, but ceased working with Mother when she was promoted to a different position
    within Boys Town. Ms. Wild testified that, even though Mother was initially frustrated with the
    program, she did make progress and did cooperate with Ms. Wild. She also testified to a letter she
    wrote that indicated that Mother had made excellent progress.
    -9-
    information she gathered from not only her observations of Mother but also a review of various
    reports and contacts, that “there is a high risk of [Roman] reunifying with [Mother].”
    Brian Hayden
    Testimony was also provided by Dr. Hayden, who was qualified as an expert in clinical
    psychology. Doctor Hayden evaluated Mother in March 2015 for about three to three-and-a-half
    hours. Doctor Hayden explained that the results of Mother’s personality assessment profile were
    consistent with a diagnosis for bipolar mood disorder. Doctor Hayden also opined that Mother
    encounters problems with coping and that she relies on denial and distraction. He also testified
    that she is prone to fits of rage. Doctor Hayden testified that Mother was “lacking in * * * empathy,
    the ability to take the perspective of another person’s point of view, and to go one step further and
    to feel genuine compassion and want to take care of somebody.” Doctor Hayden also had planned
    to observe Mother with her children, but Mother failed to show up for the scheduled visitation
    appointment that Dr. Hayden had attended. Doctor Hayden also testified that when he followed-
    up, he was informed that Mother did not intend to complete this piece of the evaluation. Although
    Dr. Hayden testified that he was not in a position to render an opinion about whether Mother could
    parent Roman safely and effectively, as a result of not having had the opportunity to observe
    Mother with her children, Dr. Hayden nonetheless said that he had “considerable concerns as to
    whether [Mother] fully appreciated the seriousness of Roman’s medical difficulties[.]” Doctor
    Hayden testified that Mother “had difficulty in perceiving [Roman needing medical treatment from
    hospital staff] as individuals who were trying to help her child” and, as an expert in clinical
    psychology, he “would have some concerns about the appropriateness of [Mother] providing
    sufficient care, particularly in terms of the safety of Roman.”
    - 10 -
    Wenonah Harris
    The testimony of Wenonah Harris, the Director of Tribal Child and Family Services for
    the Narragansett Tribe, which included the roles of the ICWA Director and Child Advocate, was
    also important. Ms. Harris testified that Roman’s father is a member of the Tribe and that Roman
    also had become an enrolled member of the Tribe. Ms. Harris testified that the Narragansett Tribe
    had been provided with appropriate notice of the DCYF proceedings involving Roman. She
    explained that the Tribe declined to accept jurisdiction and participate from the outset because, if
    the Tribe had accepted jurisdiction in this case, “[Roman] would be dead” because the Tribe does
    “not have the ability to be [as] sophisticated [as] DCYF” and that “[DCYF] kept him alive when
    he should have been dead before his first year[.]”
    Mother
    Mother testified on her own behalf over the course of two days. Mother explained that she
    felt she “had a very good understanding” of how to care for Roman. Mother also testified that
    taking care of Roman is not “rocket science.” She said that she missed some of his doctor
    appointments because she either was informed too late, was unable to secure transportation to the
    locations, or was unfamiliar with the locations. Mother also testified that, at the beginning, she
    was not allowed to attend Roman’s doctors appointments. When explaining her understanding of
    why DCYF got involved in the first place, she testified that, early on when Roman was in the
    hospital, she would not go to the hospital because Roman’s father was stalking her there and
    therefore she did not feel comfortable at the hospital. Mother testified that she had attended all the
    medical appointments that she knew about since March 2016. In regard to engaging in DCYF
    services, she admitted that she did not participate in services initially, that she had engaged in some
    services prior to being ordered to follow through with services by the Family Court justice in
    - 11 -
    March 2016, and that she did engage with the majority of services when the Family Court ordered
    her to do so in March 2016. Mother’s partial response to a question on cross-examination is largely
    representative of her testimony as a whole: “I took the domestic violence classes. My attitude was
    a problem; I remedied the situation by taking counseling. So I really don’t know what else you
    guys want from me. I did the parent-child eval. I did the psych eval. What else do you want,
    make you a turkey for Thanksgiving?”7
    The Trial Justice’s Decision
    After hearing all the testimony, and specifically finding Mother’s testimony incredible, the
    trial justice entered a decree granting DCYF’s petition to terminate Mother’s parental rights.
    Applying the ICWA, the trial justice found in her written decision that DCYF had met the burden
    under the ICWA of engaging in active efforts to reunify Roman with Mother, and that she was
    satisfied beyond a reasonable doubt that Roman would face serious emotional and physical harm
    if Mother was given custody of Roman. Mother timely appealed.
    Before this Court, Mother argues that DCYF failed to engage in active efforts at reunifying
    Roman with her, that no “qualified expert witness” testified at trial pursuant to the ICWA, and that
    the trial justice erred in finding beyond a reasonable doubt that she was unfit to parent Roman.
    DCYF contends that the ICWA does not apply to this case because Mother is non-Indian and
    Roman’s Indian father never had custody, and further argues that if the ICWA does apply, DCYF
    met its burden under the ICWA.8
    7
    Thanksgiving in 2016 fell on November 24, nine days after Mother made this statement during
    her testimony. We also note that Roman’s foster parent, Adam Connell, testified for DCYF as a
    rebuttal witness following Mother’s testimony. We see no need to recount his testimony for
    purposes of this opinion.
    8
    The guardian ad litem in this case sides with respondent as relates to the application of the ICWA
    but with DCYF with respect to the contention that the record supports the finding that DCYF
    satisfied the ICWA’s requirements.
    - 12 -
    II
    Discussion
    There can be no dispute that, as an enrolled member of the Narragansett Tribe, Roman is
    within the ambit of the ICWA, chapter 21 of title 25 of the United States Code. Nonetheless, this
    case raises questions about the extent of that coverage and whether all the provisions of the ICWA
    are applicable to the facts presented here. Specifically, do the provisions of § 1912(d) and (f) of
    the ICWA, which relate to “remedial services and rehabilitative programs designed to prevent the
    breakup of the Indian family[,]” 25 U.S.C. § 1901(d), and the heightened standard of proof the
    ICWA demands in a termination of parental rights case, apply to an Indian child who, at the time
    of termination, is not a part of an Indian family? Second, does § 1912(f) require “testimony of
    qualified expert witnesses” in a termination of parental rights case such as this, where the Indian
    child is in the custody of a non-Indian parent? Third, what constitutes “active efforts” under §
    1912(d) of the ICWA?
    Application of the Indian Child Welfare Act
    As this Court discussed ten years ago, the ICWA recognizes that “there is no resource more
    vital to the continued existence and integrity of Indian tribes than their children[.]” In re Tamika
    R., 
    973 A.2d 547
    , 550 (R.I. 2009) (deletion omitted) (quoting 25 U.S.C. § 1901(3)). The ICWA
    further recognizes an unfortunate occurrence in this country’s history,
    “that an alarmingly high percentage of Indian families are broken up
    by the removal, often unwarranted, of their children from them by
    nontribal public and private agencies and that an alarmingly high
    percentage of such children are placed in non-Indian foster and
    adoptive homes and institutions; and
    “[T]hat the States, exercising their recognized jurisdiction over
    Indian child custody proceedings through administrative and
    judicial bodies, have often failed to recognize the essential tribal
    relations of Indian people and the cultural and social standards
    - 13 -
    prevailing in Indian communities and families.” 
    Id. (deletion omitted)
    (quoting 25 U.S.C. § 1901(4) and (5)).
    As such, Congress set forth “minimum Federal standards for the removal of Indian children from
    their families and the placement of such children in foster or adoptive homes which will reflect the
    unique values of Indian culture.” 
    Id. at 550-51
    (quoting 25 U.S.C. § 1902). The primary purpose
    of the ICWA was “to stem the unwarranted removal of Indian children from intact Indian families.”
    Adoptive Couple v. Baby Girl, 
    133 S. Ct. 2552
    , 2561 (2013) (emphasis added).
    In this case, the parties agreed to the applicability of the ICWA, and the trial justice applied
    the provisions in § 1912(d) and (f) of the ICWA after stating on the record that “everyone is in full
    agreement that ICWA applies.” Section 1912(d) states:
    “Any party seeking to effect a foster care placement of, or
    termination of parental rights to, an Indian child under State law
    shall satisfy the court that active efforts have been made to provide
    remedial services and rehabilitative programs designed to prevent
    the breakup of the Indian family and that these efforts have proved
    unsuccessful.”
    Section 1912(f) states:
    “No termination of parental rights may be ordered in such
    proceeding in the absence of a determination, supported by evidence
    beyond a reasonable doubt, including testimony of qualified expert
    witnesses, that the continued custody of the child by the parent or
    Indian custodian is likely to result in serious emotional or physical
    damage to the child.”
    DCYF asserts that, because Roman’s mother is not of Indian heritage and Roman was not
    at any time in the custody of his father, from whom Roman takes his Indian heritage, the ICWA is
    inapplicable. This is so, according to the Department, because a breakup of an Indian family never
    occurred in this case. The Department maintains that its position is supported by the intent of the
    ICWA, and it draws this Court’s attention to the United States Supreme Court’s 2013 opinion in
    Adoptive Couple, cited supra.
    - 14 -
    In Adoptive Couple, the biological father, a member of the Cherokee Nation, objected to
    the adoption of his biological daughter, who was 3/256 Cherokee. Adoptive 
    Couple, 133 S. Ct. at 2558
    , 2559. The biological mother, who was non-Indian, relinquished her parental rights and had
    previously consented to the adoption. 
    Id. at 2558.
    The South Carolina Supreme Court determined
    that the ICWA applied and that the provisions contained in § 1912(f) and (d) were not satisfied.
    
    Id. at 2559.
    The Supreme Court, however, held that, because the father, despite his efforts to
    invoke the ICWA, “had never had legal or physical custody of [the child] as of the time of the
    adoption proceedings[,]” he was not entitled to invoke § 1912(f). 
    Id. at 2562.
    This interpretation
    of § 1912(f), according to the Court, “comports with the statutory text demonstrating that the
    primary mischief the ICWA was designed to counteract was the unwarranted removal of Indian
    children from Indian families due to the cultural insensitivity and biases of social workers and state
    courts.” 
    Id. at 2561.
    Further, the Supreme Court held that Ҥ 1912(d) applies only in cases where
    an Indian family’s ‘breakup’ would be precipitated by the termination of the parent’s rights.” 
    Id. at 2562.
    The Court reasoned that “when an Indian parent abandons an Indian child prior to birth
    and that child has never been in the Indian parent’s legal or physical custody * * * the ‘breakup of
    the Indian family’ has long since occurred, and § 1912(d) is inapplicable.” 
    Id. Mother and
    the guardian ad litem, on the other hand, each argue that the ICWA does apply.
    Mother points out that the ICWA applies because the Code of Federal Regulations states that the
    “ICWA includes requirements that apply whenever an Indian child is the subject of * * * [a] child-
    custody proceeding[.]” 25 C.F.R. § 23.103(a)(1) (2016). Mother also argues that the holding in
    Adoptive Couple is inapposite.
    We are of the opinion that, simply because the ICWA may in general apply “whenever an
    Indian child is the subject of * * * [a] child-custody proceeding,” 25 C.F.R. § 23.103(a)(1), it does
    - 15 -
    not follow that every provision of the ICWA applies each time the ICWA is implicated. For
    example, § 1912(a) of the ICWA dictates that notice shall be given to the tribe of the Indian child
    any time there is an “involuntary proceeding in a State Court[.]” This provision would seem to
    apply even to an Indian child who had been previously adopted by non-Indian parents who are
    subsequently subject to a termination of parental rights proceeding. In such a case, even though
    the child has already been removed from his Indian family, the tribe would still have an interest in
    the child’s placement, and the tribe must be notified. See § 1912(a) (requiring notice to child’s
    tribe in termination of parental rights cases); see also Mississippi Band of Choctaw Indians v.
    Holyfield, 
    109 S. Ct. 1597
    , 1609 (1989) (“The numerous prerogatives accorded the tribes through
    the ICWA’s substantive provisions * * * must * * * be seen as a means of protecting not only the
    interests of individual Indian children and families, but also of the tribes themselves.”).
    On the other hand, § 1912(d), which addresses remedial services and rehabilitative
    programs “designed to prevent the breakup of the Indian family,” would seem far less relevant.
    See Adoptive 
    Couple, 133 S. Ct. at 2563
    (“Section 1912(d) is a sensible requirement when applied
    to state social workers who might otherwise be too quick to remove Indian children from their
    Indian families. It would, however, be unusual to apply § 1912(d) in the context of an Indian
    parent who abandoned a child prior to birth and who never had custody of the child.”).9
    9
    We note that Mother also argues that the so-called “existing Indian family doctrine,” which
    apparently allows state courts, according to Mother, “to refuse to apply provisions of the [ICWA]
    * * * when the court finds the connection between the parent or the child to Indian culture to be
    too tenuous[,]” is a minority position. Nevertheless, Mother does not have a tenuous relationship
    with Indian culture, she is simply not of Indian heritage. What’s more, at the time of the
    termination trial, Roman did not have a custodial parent who was Indian because his father’s rights
    were previously terminated. In any event, we have already 
    noted supra
    that the ICWA, as a whole,
    applies in any relevant case based on the existence of an Indian child, but that every provision may
    not necessarily be relevant.
    - 16 -
    After reviewing the relevant case law, this Court has grave reservations as to whether the
    provisions contained in § 1912(d) and (f) apply in this case.10 Nevertheless, because (1) all parties
    agreed at trial that the Act should apply; (2) relying on that agreement, the trial justice applied both
    provisions; and (3) it was not until this appeal that one of the parties, DCYF, first questioned the
    applicability of the Act, we will assume without deciding that the provisions contained in § 1912(d)
    and (f) of the ICWA apply in this case. We observe that the application of these provisions will
    in no way prejudice the child because, as discussed below, the ICWA imposes a higher burden on
    the state than does our traditional framework in a case involving the termination of parental rights.
    Standard of Review
    Having determined that § 1912(d) and (f) of the ICWA will be applied given the posture
    of this case, it is necessary to discuss how those provisions impact the typical framework this Court
    applies in review of a decree terminating parental rights. In the typical review, this Court: “(1)
    examine[s] the trial justice’s finding of parental unfitness; (2) review[s] the finding that reasonable
    efforts at reunification were made by the state agency charged with that duty; and (3) review[s]
    the finding that termination is in the child[ ]’s best interests.” In re James H., 
    181 A.3d 19
    , 25 (R.I.
    2018) (quoting In re Max M., 
    116 A.3d 185
    , 193 (R.I. 2015)). In conducting this review, the Court
    determines if the state’s allegations are supported “by clear and convincing evidence.” 
    Id. (quoting In
    re Max 
    M., 116 A.3d at 193
    ). While clear and convincing evidence must be found, this Court
    nonetheless affords the trial justice considerable discretion and examines “the record to determine
    whether legally competent evidence exists to support the findings of the trial justice.” 
    Id. (quoting 10
       The Court does recognize that at least one other court has held that in a case involving the
    termination of parental rights of a non-Indian parent, that parent must still receive active efforts
    under § 1912(d) of the ICWA, in spite of the Supreme Court’s holding in Adoptive Couple v. Baby
    Girl, 
    133 S. Ct. 2552
    (2013). See In re Adoption of T.A.W., 
    383 P.3d 492
    , 506-07 (Wash. 2016).
    - 17 -
    In re Natalya C., 
    946 A.2d 198
    , 202 (R.I. 2008)). “[T]he trial justice’s findings ‘are accorded great
    weight on appeal and will not be disturbed unless it can be shown that they are clearly wrong or
    that the trial justice overlooked or misconceived material evidence.’” 
    Id. (brackets omitted)
    (quoting In re Max 
    M., 116 A.3d at 193
    ). Questions of law, including those of statutory
    construction, however, are reviewed, as always, de novo. In re Tamika 
    R., 973 A.2d at 550
    .
    With respect to this appeal, the contours of our review are altered by the application of both
    § 1912(d) and (f). Again, § 1912(f) dictates that there will be no termination of parental rights
    without “a determination, supported by evidence beyond a reasonable doubt[.]” (Emphasis added.)
    Moreover, § 1912(d) dictates that the “party seeking to effect * * * termination of parental rights
    * * * shall satisfy the court that active efforts have been made to provide remedial services and
    rehabilitative programs[.]” (Emphasis added.) Therefore, when considering a parent’s appeal from
    a decree terminating parental rights in which those particular provisions of the ICWA are
    implicated, this Court will first determine whether there exists “legally competent evidence[,]” In
    re James 
    H., 181 A.3d at 25
    (quoting In re Natalya 
    C., 946 A.2d at 202
    ), sufficient to support the
    trial justice’s finding beyond a reasonable doubt that “the continued custody of the child by the
    parent or Indian custodian is likely to result in serious emotional or physical damage to the child.”
    Section 1912(f). If so, then it can be said that the parent is unfit.
    Second, this Court will evaluate whether there exists “legally competent evidence”
    sufficient to support the trial justice finding “by clear and convincing evidence” that active “efforts
    at reunification were made by the state agency charged with that duty[.]” In re James 
    H., 181 A.3d at 25
    (quoting In re Max 
    M., 116 A.3d at 193
    ); see § 1912(d). While Mother argues that whether
    active efforts were made is a question of law that should be reviewed de novo, we disagree.
    Whether there exists evidence sufficient to support a finding of active efforts is within the purview
    - 18 -
    of the factfinder, who hears the testimony and is uniquely suited to make credibility
    determinations. See State v. Paola, 
    59 A.3d 99
    , 106 (R.I. 2013) (“This Court affords ‘a great deal
    of respect to the factual determinations and credibility assessments made by the judicial officer
    who has actually observed the human drama [of the] trial and who has an opportunity to appraise
    witness demeanor and to take into account other realities that cannot be grasped from a reading of
    a cold record.’”) (brackets omitted) (quoting State v. DiCarlo, 
    987 A.2d 867
    , 872 (R.I. 2010)). It
    is also worth noting that the guardian ad litem argues before this Court that all factual findings
    needed to be made beyond a reasonable doubt when considering both § 1912(d) and (f). This is
    not quite accurate. While § 1912(f) relating to parental unfitness specifically uses the reasonable
    doubt language, § 1912(d), involving active efforts, does not. In reviewing whether active efforts
    were made by DCYF, then, such efforts need only be established by clear and convincing evidence,
    per our typical review. See In re James 
    H., 181 A.3d at 25
    .
    Finally, the Court will evaluate whether “legally competent evidence exists[,]” again to
    support the trial justice’s finding “by clear and convincing evidence[,]” that the termination is in
    the child’s best interest. In re James 
    H., 181 A.3d at 25
    (quoting first In re Natalya 
    C., 946 A.2d at 202
    , then In re Max 
    M., 116 A.3d at 193
    ). This three-pronged approach comports with the
    state’s heightened burden requirement where necessary and ensures fairness to both the parent and
    the child. In this appeal, Mother contests only the trial justice’s analysis under § 1912(d) and (f).
    We therefore cabin our review to whether parental unfitness and active efforts were sufficiently
    proven.11
    11
    While we do not analyze the third prong of this tripartite test, based on the arguments advanced
    on appeal, an exhaustive review of the record leaves this Court thoroughly convinced that the
    termination of Mother’s rights is in Roman’s best interest.
    - 19 -
    Parental Unfitness
    Mother asserts that the trial justice erred in finding, beyond a reasonable doubt, that her
    continued custody would likely result in serious damage to the child. Mother also argues that no
    “qualified expert witness” was presented to the trial justice, as Mother insists is required by
    § 1912(f) of the ICWA.
    The first argument is one of factual analysis, and the second is a legal matter. We will
    evaluate the second argument first. As 
    noted supra
    , § 1912(f) of the ICWA dictates that: “No
    termination of parental rights may be ordered * * * in the absence of a determination * * * including
    testimony of qualified expert witnesses, that the continued custody of the child * * * is likely to
    result in serious emotional or physical damage to the child.” Regarding Mother’s assertion that
    there was no “qualified expert witness,” this raises two issues. First, was a “qualified expert
    witness” required in this case, and, if so, what kind of expert?
    A plain reading of the ICWA directs that, in every termination of parental rights case under
    the ICWA, the testimony of at least one qualified expert witness is required to support a conclusion
    beyond a reasonable doubt that continued custody is likely to result in serious damage to the child.
    Section 1912(f).    A qualified expert witness is thus required. See Alessi v. Bowen Court
    Condominium, 
    44 A.3d 736
    , 740 (R.I. 2012) (“It is well settled that when the language of a statute
    is clear and unambiguous, this Court must interpret the statute literally and must give the words of
    the statute their plain and ordinary meanings.”) (quoting Waterman v. Caprio, 
    983 A.2d 841
    , 844
    (R.I. 2009)). The second, and slightly more difficult, question is, in which area must this expert
    be qualified?
    The United States Department of the Interior, Bureau of Indian Affairs, recently
    promulgated updated guidelines to “promote compliance with ICWA’s stated goals and
    - 20 -
    provisions[.]” Guidelines for State Courts and Agencies in Indian Child Custody Proceedings, 80
    Fed. Reg. 10146-02 (Feb. 25, 2015). The updated guidelines state that “[a] qualified expert witness
    should have specific knowledge of the Indian tribe’s culture and customs.” 
    Id. at 10157.
    The
    supplementary information explaining updates to the guidelines states that “[c]ommenters
    indicated that some States rely on witnesses’ qualifications as child care specialists, or on other
    areas of expertise, but do not require any expert knowledge related to the tribal community” and
    that “[t]he updated guidelines establish a preferential order for witnesses who are experts in the
    culture and customs of the Indian child’s tribe” to “ensure that the expert witness with the most
    knowledge of the Indian child’s tribe is given priority.” 
    Id. at 10149.
    This clearly suggests that
    the Bureau of Indian Affairs envisions the “qualified expert witness” to be an individual with
    expertise in the cultural affairs of the child’s Indian tribe.
    The guidelines, however, are not binding on this, or any, court. Moreover, it would exceed
    the bounds of common sense to hold that an expert witness on Indian cultural affairs was necessary
    to prove that a child’s reunification with a parent was “likely to result in serious emotional or
    physical damage to the child” when the evidence for and against termination is noncultural. Section
    1912(f); see In re Tamika 
    R., 973 A.2d at 552
    (suggesting that some grounds for separation may
    be “sufficiently ‘culturally neutral’ as to vitiate the need for testimony from a qualified expert
    witness” under § 1912(e)). Simply put, in culturally-neutral termination cases, such as the one
    before us now, about what would an expert in Indian affairs testify? It is our considered opinion
    that, while at least one qualified expert witness is necessary under § 1912(f), that expert may be
    qualified in any relevant area if, as here, the case presents no culturally-relevant issues. In this
    case, DCYF elicited the testimony of three relevant expert witnesses: Dr. Kristin Lombardi, who
    testified about Roman’s serious and tenuous medical condition; Ms. Gojcz, a licensed independent
    - 21 -
    clinical social worker possessing more than a decade of experience, who testified with respect to
    her parent/child evaluation of Mother and Roman; and Dr. Brian Hayden, who testified about the
    psychological evaluation that he administered with respect to Mother.          This Court is thus
    convinced that the expert witness component of § 1912(f) was satisfied in this case.12
    With respect to the trial justice’s finding beyond a reasonable doubt that Mother’s
    continued custody would likely result in serious damage to the child, Mother marshals several
    arguments as to why this finding was in error.          She asserts that her own trial testimony
    demonstrated that she had a comprehensive understanding of the care that Roman requires. She
    also argues that her ability to care for Roman was supported by a favorable report issued by Ms.
    Wild, Mother’s first contact at Boys Town of New England. Nevertheless, the trial justice
    specifically found Mother’s testimony to be lacking in credibility; and a needle or two of favorable
    evidence reposited in a veritable haystack of unfavorable evidence cannot lead us to say that the
    trial justice was clearly wrong.
    Mother further asserts that “[b]oth the parent-child evaluator and the child protection
    consultant at the Habsro Children’s Hospital Aubin Child Protection Center agreed that Mother
    understood what was going on medically with Roman.” This statement, however, when viewed
    in context, is at best misleading and at worst simply untrue. Even though the child protection
    consultation report says that “Mother showed an extensive understanding of Roman’s condition
    and asked reasonable and well thought out questions throughout[,]” that same report states:
    12
    The trial justice considered Wenonah Harris, the ICWA Director and Child Advocate for the
    Narragansett Tribe, to have testified as an expert. We note, however, that, in the main, Ms. Harris
    provided testimony relating to the notice requirement of the ICWA rather than testimony about
    whether Roman would be harmed if he remained in the custody of Mother. Therefore, in
    evaluating whether an appropriate “qualified expert witness” testified under § 1912(d), we do not
    factor Ms. Harris’s testimony into our analysis.
    - 22 -
    “[M]other has not been present at the bedside to receive teaching regarding Roman’s medical care
    including NG tube feeds, his methadone wean and care the wound from the IV infiltrate.” This
    document clearly cuts both ways.       Moreover, our review of the record indicates that the
    parent-child evaluator at Spurwink, Ms. Gocjz, did not testify that Mother understood what was
    going on medically with Roman.
    Lastly, Mother argues that the testimony by Ms. Gocjz and Dr. Hadyen, the clinical
    psychologist, does not support the conclusion that Roman’s reunification with Mother would
    create a likelihood of harm to Roman. We are not persuaded by this argument. The question as
    to whether reunifying Roman with Mother would likely result in harm to Roman is to be
    determined based on the entirety of the evidence presented to the trial justice. As a review of the
    testimony and the record in this case reflect, there was an abundance of evidence at trial from
    which the trial justice could make such a determination. We will not disturb her conclusion.
    Active Efforts
    Mother argues that DCYF failed to engage in “active efforts” to reunify Roman with her,
    as is required by the ICWA in § 1912(d). This Court has yet to examine what constitutes “active
    efforts” under the ICWA. Some courts may have adopted various phraseologies for determining
    what such efforts are. See e.g., Dashiell R. v. State, Department of Health and Social Services,
    Office of Children’s Services, 
    222 P.3d 841
    , 849 (Alaska 2009) (“As opposed to passive efforts
    such as simply developing a plan for the parent to follow, active efforts require that the state
    actually help the parent develop the skills required to keep custody of the children.”); In re J.S.,
    
    177 P.3d 590
    , 594 (Okla. Civ. App. 2008) (describing active efforts as “leading the horse to
    water”); Department of Human Services v. D.L.H., 
    284 P.3d 1233
    , 1240 (Or. Ct. App. 2012) (“We
    have defined ‘active efforts’ to ‘impose on DHS an obligation greater than simply creating a
    - 23 -
    reunification plan and requiring the client to execute it independently. Active efforts means that
    DHS must assist the client through the steps of a reunification.’”) (brackets omitted) (quoting State
    ex rel. Juvenile Department of Multonomah County v. T.N., 
    203 P.3d 262
    , 263 (Or. Ct. App.
    2009)). We need not undertake that type of task here, however, because this Court is satisfied that
    DCYF’s efforts constituted “active efforts” by any conceivable definition of the term.13
    While Mother advances several reasons in support of her argument that DCYF did not
    provide “active efforts” at reunification, each is unavailing. For example, Mother asserts that
    DCYF “did not seem to have been operating under the impression that ‘active efforts’ were
    required[,]” and cites to Ms. Sousa’s testimony that she was only “[k]ind of” aware that the ICWA
    requires “active efforts.” Nevertheless, the knowledge of Ms. Sousa, who is a social worker, as to
    the requirements of a complicated federal statute that has been the subject of litigation at the
    Supreme Court does not determine whether the “active efforts” requirement in the ICWA was
    satisfied in this case. Additionally, Mother’s argument, made both in her brief and at oral
    13
    We observe that on December 12, 2016, less than a month before the trial justice issued her
    decision in this case, a new federal regulation promulgated by the Bureau of Indian Affairs was
    made effective, defining “active efforts” under the ICWA:
    “Active efforts means affirmative, active, thorough, and timely efforts intended primarily
    to maintain or reunite an Indian child with his or her family. Where an agency is involved
    in the child-custody proceeding, active efforts must involve assisting the parent or parents
    or Indian custodian through the steps of a case plan and with accessing or developing the
    resources necessary to satisfy the case plan. To the maximum extent possible, active
    efforts should be provided in a manner consistent with the prevailing social and cultural
    conditions and way of life of the Indian child’s Tribe and should be conducted in
    partnership with the Indian child and the Indian child’s parents, extended family
    members, Indian custodians, and Tribe. Active efforts are to be tailored to the facts and
    circumstances of the case.” 25 C.F.R. § 23.2 (2016).
    This Court is satisfied that, even under this definition, appropriate “active efforts” were made by
    DCYF in this case.
    - 24 -
    argument, that the services in the case plans were not tailored, and that she should have been
    provided access to a special support program at Boston Children’s Hospital related to families with
    children having heart problems, is also not persuasive. It defies logic, based on the record and
    facts of this case, to think that Mother would have been an avid participant in DCYF’s services if
    only she had been referred to this one particular program. Ms. Sousa testified that, at the beginning
    of the case, Mother felt she was too busy to work with DCYF and, in a conversation that took place
    in January 2015, Mother again told Ms. Sousa that she was too busy to participate in services.
    Further, Mother was not successful in meeting case plan requirements such as attending Roman’s
    medical appointments with regularity.
    Other arguments that Mother asserts on the issue of active efforts are similarly
    unpersuasive. They either rely on Mother’s testimony, which the trial justice found to be
    incredible, or they are outweighed by other facts in the record. The record clearly establishes that
    DCYF created multiple case plans with the express objective of reunification. Ms. Sousa, the
    social worker assigned to work on Roman’s case throughout its entirety, made referrals to various
    resources throughout the case and explained to the Family Court that DCYF would pay for those
    services when necessary. The trial justice’s findings “that DCYF continued to do more than merely
    offer a plan to mother and wait for her to act” and that “[t]here was no credible evidence that
    contradicted the active efforts made by DCYF to reunify Roman with his mother” are not clearly
    wrong. It is our firm opinion that the trial justice did not err when she found that DCYF had
    satisfied its burden to show that it made active efforts to attempt to reunify Roman with Mother.
    - 25 -
    III
    Conclusion
    For the reasons set forth in this opinion, the decree of the Family Court is affirmed. The
    record in this case may be returned to the Family Court.
    - 26 -
    STATE OF RHODE ISLAND AND                                  PROVIDENCE PLANTATIONS
    SUPREME COURT – CLERK’S OFFICE
    OPINION COVER SHEET
    Title of Case                        In re Roman A.
    No. 2017-113-Appeal.
    Case Number
    (14-897-1)
    Date Opinion Filed                   November 18, 2019
    Suttell, C.J., Goldberg, Flaherty, Robinson, and
    Justices
    Indeglia, JJ.
    Written By                           Associate Justice Francis X. Flaherty
    Source of Appeal                     Providence County Family Court
    Judicial Officer From Lower Court    Associate Justice Laureen A. D’Ambra
    For Petitioner:
    Karen A. Clark
    Department of Children Youth and Families
    Attorney(s) on Appeal                Susan M. Fink, Esq.
    Guardian Ad Litem
    For Respondent:
    Megan F. Jackson
    Office of the Public Defender
    SU‐CMS‐02A (revised June 2016)