Opinion
F076271
07-09-2018
In re CHRISTOPHER A., a Person Coming Under the Juvenile Court Law. KERN COUNTY DEPARTMENT OF HUMAN SERVICES, Plaintiff and Respondent, v. ANGELICA A., Defendant and Appellant.
Susan M. O'Brien, under appointment by the Court of Appeal, for Defendant and Appellant. Mark L. Nations, County Counsel, and Bryan C. Walters, Deputy County Counsel, for Plaintiff and Respondent.
NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115. (Super. Ct. No. JD136329)
OPINION
APPEAL from orders of the Superior Court of Kern County. Louis L. Vega, Judge. Susan M. O'Brien, under appointment by the Court of Appeal, for Defendant and Appellant. Mark L. Nations, County Counsel, and Bryan C. Walters, Deputy County Counsel, for Plaintiff and Respondent.
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Angelica A. (mother) appeals from the juvenile court's findings at the six- and 12-month review hearings (Welf. & Inst. Code § 366.21, subds. (e) & (f)), held within weeks of each other, that reasonable reunification services were provided. We affirm.
Undesignated statutory references are to Welfare and Institutions Code.
FACTUAL AND PROCEDURAL BACKGROUND
In July 2016, 14-year-old Christopher A. was admitted to a behavioral health center on a section 5150 hold for threatening to kill his parents. Christopher was depressed and diagnosed with bipolar disorder not otherwise specified, but he refused to take his prescribed medications. When he was discharged nearly two weeks later, his parents refused to pick him up due to his threats; they were concerned for their safety and unable to address his mental health needs.
Christopher's father is A.A. (father). Father and mother did not live together; they had been separated for about two and a half years, and divorced for nearly a year. Father is not a party to this appeal.
The Kern County Department of Human Services (Department) took Christopher into protective custody and filed a dependency petition alleging he was suffering, or at risk of suffering, serious emotional damage as evidenced by his severe anxiety, depression, or withdrawal; his untoward aggressive behavior toward self or others; and his lack of a parent capable of providing appropriate care. (§ 300, subd. (c).) At the detention hearing, Christopher's attorney asked that parental visits not be ordered, as Christopher did not wish to visit either parent. The juvenile court, however, ordered twice weekly supervised visits, noting it was legally required to offer visits, although the parties knew it was "subject to the minor wishing to participate."
The petition also alleged Christopher had been left without any provision for support. (§ 300, subd. (g).) This allegation was dismissed at the jurisdiction hearing.
At the combined jurisdiction and disposition hearing, the juvenile court sustained the petition's allegations after the parents submitted on the petition, and assumed dependency jurisdiction. The court ordered reunification services for both parents. The reunification plan required them to participate in conjoint counseling with Christopher, as well as individual counseling which would include a parenting component. The plan also required individual counseling for Christopher. The court ordered twice weekly supervised visitation.
Christopher first was placed at Jamison's Children's Center (JCC) and then moved to a group home at the beginning of September 2016. Christopher was assigned a therapist, Dr. Jeffrey Cheeney of Child Guidance Center. After meeting with Dr. Cheeney four times in August 2016, Christopher refused to attend any further therapy sessions. According to Dr. Cheeney, Christopher was rigid, fixated on killing his parents, had mental health issues relating to distinguishing fantasy from reality, and struggled with anger management. Christopher stopped taking his anti-psychotic medication at the beginning of September 2016.
A provider's meeting was held at Child Guidance Center on October 5, 2016. Christopher did not want to participate in counseling because what he told Dr. Cheeney was put in the court report. The psychiatrist, Dr. Rowe, agreed to put Christopher back on his medication. A plan was developed to see if Christopher would see a new psychiatric nurse and therapist, and to renegotiate confidentiality. Dr. Cheeney said he would continue to go to the group home once a week to speak with the staff.
Christopher was removed from the group home on December 2, 2016, and a section 5150 hold was placed on him, after he threatened to kill a number of the group home boys and staff members. Christopher was admitted to Bakersfield Behavioral Health (BBH), where he remained until December 12, 2016, when he was taken back to JCC. The next day, Christopher ran away from JCC and went to a mental health center, where he was assessed and admitted to BBH. Christopher was complying with taking his medication, but still refused to see anyone at Child Guidance.
Christopher was released from BBH on December 27, 2016 and taken back to JCC. The social worker attempted to find an appropriate available group home for him. Christopher was accepted at a group home in Fresno on January 17, 2017, and he was taken there on January 31. That same day, Christopher called the social worker and said he was going to shoot himself if his parents' parental rights were not taken away. The social worker told Christopher there were therapists at the group home to help him and urged him to give the new home a try, but Christopher said he could only open up to the people at BBH. The next day, the group home gave a seven-day notice due to Christopher's homicidal ideation, and Christopher was taken back to BBH.
Subsequent references to dates are to dates in 2017.
Over the next month, Christopher was returned to JCC and remained there as another group home refused to take him. Christopher was arrested on March 3, and taken to juvenile hall, as he made threats to maim and kill JCC staff. On March 7, he was released and returned to JCC. After that, Christopher was denied placement at another group home.
A section 602 petition was filed on March 29, alleging Christopher had violated Penal Code section 422. The petition was dismissed without prejudice on April 24, as the delinquency court found that dependency would best serve Christopher's interest.
The social worker reported that although the parents wanted to see Christopher, he refused to visit or speak with them, or anyone connected to them, and he maintained his homicidal ideation toward them. Therefore, conjoint therapy could not occur. The Department was trying to get Christopher help through therapy and medication treatment, but he refused to do anything. Mother was attending parenting classes, which she was scheduled to complete in May, after which she would receive individual counseling. The Department recommended that mother and father continue to receive reunification services.
At the March 13 six-month review hearing, the juvenile court interviewed Christopher in-camera. Christopher told the court that he did not want to go back to his parents and he wanted their parental rights terminated. Christopher said his parents emotionally abused and threatened to kill him, which made him want to kill people. Christopher threatened to kill himself if parental rights were not terminated. The court ordered an evaluation of Christopher by Dr. Thomas Middleton and continued the hearing.
Dr. Middleton evaluated Christopher on March 27. Christopher's psychotic symptoms had become more problematic. He was diagnosed with psychotic disorder and given a rule out diagnosis of schizoaffective disorder. Christopher had progressed from having a mood disorder in 2016 to having overt psychotic symptoms in 2017. Christopher was receptive to medication management of his symptoms, as his auditory hallucinations and other symptoms, such as paranoia, disturbed him. Christopher's diagnosis would become clearer as he matured - he may end up qualifying for a diagnosis of either schizoaffective disorder or schizophrenia, paranoid type.
It was clear to Dr. Middleton that Christopher needed mental health counseling and medication management of his symptoms. Christopher apparently was receptive to treatment through Child Guidance, which Dr. Middleton said should be encouraged. Dr. Middleton recommended that Christopher sign a behavioral contract, which would directly tie the benefits or privileges he was receiving at his group home, such as cellphone or computer use, to his participation in counseling and medication compliance. If Christopher became agitated, he should be "timed out" in a quiet room, and staff should not give him undue attention unless he was willing to be redirected and participate meaningfully in relaxation and counseling procedures.
Dr. Middleton opined that conjoint counseling should be considered only as part of his behavioral contracting, since Christopher continued to threaten his parents. Dr. Middleton suggested that a reward be attached to conjoint sessions, but if he resisted, he may need additional individual counseling and his medications may need adjustment. It was likely Christopher would stabilize as he stayed on his anti-psychotic and anti-anxiety medications, and participated in counseling. Dr. Middleton recommended that a clear behavioral program be developed with the involvement of a behavioral specialist. Christopher appeared appropriate for a high level behavioral group home.
Christopher was placed in another group home on March 29. In April, the juvenile court granted the Department's application to increase the dosage of one anti-psychotic medication, continue with an anti-anxiety medication, and authorize administration of a different anti-psychotic medication if the first one failed to control his psychotic symptoms. On May 26, Christopher told a social worker who visited him at the group home that he did not want to see any more counselors, although he was willing to take his medications. By May, mother had completed the parenting counseling program and ten individual counseling sessions.
A Child and Family Team (CFT) team meeting was held on June 13 to determine how to implement Dr. Middleton's recommendations. The team decided to create a behavioral contract between Christopher and the group home regarding his medication management, mental health treatment, sobriety, emotional regulation, and school attendance. Christopher, however, refused to sign the contract. When the group home social worker tried to speak to Christopher about the contract, his homicidal ideations became very strong and he said there was no reason to discuss a contract as he wanted to leave the group home. Christopher was compliant with his medications, but still refused to speak to a psychologist.
Dr. Middleton testified at the continued six-month review hearing on June 19. Dr. Middleton recommended that Christopher have mandatory joint counseling sessions with his parents, with a consequence attached if he refused to participate, such as making him come under the jurisdiction of probation rather than dependency, and be put in juvenile hall. Christopher's parents should be reintroduced to him in incremental steps through therapy. Dr. Middleton believed Christopher's threats were more attention seeking than true suicide attempts or homicidal ideations, and there should be rewards for positive behavior and consequences for negative behavior. Moreover, if Christopher left his placement, he would need to be shadowed and returned there as soon as possible.
Dr. Middleton believed Christopher needed to be in the highest level of group home available that had behavioral programming and a structured, supervised setting. Dr. Middleton suggested Christopher be "timed out" as soon as his behavior began to escalate, and he could leave his room or the group home only when he calmed down. Mother's attorney asked Dr. Middleton what the next step would be if Christopher refused to participate in counseling and did not want to stay in his placement. Dr. Middleton responded that he needed to be educated about his mental illness and the behavior contract should be explained to him, including that parental contact was required. If Christopher refused contact, he should be put in a time-out room with nothing in it and given a reward, such as his cellphone or Xbox, only if he was willing to see his parents.
Dr. Middleton explained that it was Christopher's mental illness that caused him to view his parents as "demonic." Medication and counseling would help Christopher understand his disorder caused him to misperceive his parents and enable him maintain a relationship with them. These things needed to be addressed before reintroducing Christopher's parents to him.
The social worker testified that mother had completed her case plan with the exception of conjoint counseling, which mother wanted but Christopher refused. Christopher was doing well in his current group home placement - his outbursts were less frequent and he "got along pretty well" with the staff and other group home boys. He refused to attend counseling, so no one was educating him on his mental illness. The group home was capable of providing therapeutic services to Christopher and could implement Dr. Middleton's suggestions. At the CFT meeting, the supervisor of Kern Behavioral Health and Recovery stated it would be unethical and unbeneficial to force Christopher to participate in therapy if he refused. Moreover, the Department could not force Christopher to participate in counseling or take his medications.
County counsel made an offer of proof that Dr. Middleton would testify that Christopher's permission was not needed to have a behavioral contract and mother could require him to attend therapy.
The hearing was continued to July 10. At the continued hearing, County counsel asked for a continuance, as Christopher had been moved to JCC because the group home gave a seven-day notice. Christopher had stopped taking his medications and his verbal threats toward other children had escalated. The Department located a facility in San Francisco that was recommended by Kern Mental Health, which had a hospital associated with it, but there was a "kink in this plan" because the facility and the hospital required a contract with the county, which needed to be drafted and approved. The juvenile court granted the request and continued the hearing to August 29.
Ultimately, Christopher was not placed at the San Francisco facility, but the record does not reveal why.
Between July 7, when Christopher was removed from the group home, and August 22, Christopher was placed in two different group homes, but he refused to remain at either one for more than a few weeks. The social worker was trying to locate an out-of-county group home that could accommodate Christopher's mental health needs.
At the August 29 hearing, mother's attorney argued the Department had not made reasonable efforts in providing reunification services to mother, as Dr. Middleton's recommendations were not being implemented, no information had been provided as to why Christopher was not at the San Francisco facility, and it did not seem the Department was able to provide appropriate services to aid in the family's reunification.
County counsel acknowledged mother completed her case plan, but this was a unique case involving a child with significant mental health problems. The Department had been trying everything it could to get Christopher stabilized in a placement, but he was consistently and constantly "blowing placements." Christopher was spending a lot of time at JCC, but he refused to participate in anything, talk about mental health counseling, and consider seeing his parents. Nothing had changed for Christopher since the inception of the case, but it was not because the Department failed to provide reasonable services.
The juvenile court found that reasonable services had been provided. While mother was dedicated to the plan, it could not be implemented unilaterally - Christopher's participation was required, but he was not inclined to participate. The court was satisfied the Department had done everything it could and noted Christopher had been placed in a new group home that day, which showed the Department was committed to providing whatever services it could. If services had not been provided, it was only because Christopher had not accepted them. The court continued the parents' reunification services. The 12-month review hearing was set to take place two weeks later, on September 13.
In a report prepared for the 12-month review hearing, the Department recommended that reunification services continue. A CFT meeting was held on August 30 to discuss placement stability. The team decided to offer Christopher a program that would assist him with his goal of emancipation and hopefully allow him to stabilize and move in a positive direction. Christopher had refused to take his medications since June 17. He disagreed with his diagnosis and refused to participate in counseling or take his medications as long as his parents were involved. He also continued to refuse counseling or receive services from Kern Behavioral Health and Recovery Services.
At the September 13 review hearing, mother's attorney asked the juvenile court to find that reasonable services were not provided or offered to mother or Christopher. The attorney argued that the social worker's report did not address the issues Dr. Middleton raised in his testimony, and nothing was being done to ensure Christopher took his medications. The attorney was not sure what services were actually being offered and asserted there did not seem to be a plan except to let Christopher do what he wanted and see if he came around.
Christopher's attorney informed the court that Christopher wanted reunification services and parental rights terminated. The attorney had encouraged Christopher to participate in counseling and take his medications, but he was extremely unstable and any mention of his parents, let alone the possibility of seeing them, set him off. The attorney had spoken with the social worker extensively about this and the Department was making every effort to get him to participate, but they could not hold him down and forcibly medicate him. The attorney asked the juvenile court to find reasonable services had been provided and hopefully Christopher would at some point participate or be placed in a facility where he would participate.
County counsel joined in these comments. Christopher was still in the group home he entered on August 29. He refused to go to school, so the Department was exploring an independent study situation. He was not regularly taking his medications, but the Department could not do anything more with that. The Department was trying to stabilize him and being in the group home for a few weeks was a positive step. Christopher's attorney added that he refused to go to school because he believed his family members were either at the school or the school next to it.
Mother's attorney thought Dr. Middleton's recommendations needed to be followed. She believed Christopher should continue to be educated on his mental illness and be in a controlled environment, then some contact should be allowed and they would see what happens. County counsel added that a social worker could not carry out Dr. Middleton's suggestions, as the social worker is not a mental health provider, therapist, psychologist, or psychiatrist, and Christopher refused to meet with any other professionals who could provide him services.
The juvenile court stated it would not order Christopher to be medicated against his will, as that would be improper. While mother's attorney asserted nothing was being done, the juvenile court responded that he was in a group home, which was "not nothing." The juvenile court recognized the case was in a stalemate, but the record clearly reflected that the Department had offered services, yet Christopher refused to participate. The court did not think Christopher was being ignored or that he had not been assessed for appropriate services. There was a limitation on how the Department could respond to him, and other than putting him in a straight-jacket and carrying him out, the court did not know what else could be done. The court found that reasonable services had been provided, continued out-of-home placement and reunification services, and set an 18-month review hearing for February 2018. Mother filed a timely notice of appeal from both the six- and 12-month review findings and orders.
DISCUSSION
Mother claims the Department failed to reasonably implement the case plan and, therefore, the juvenile court erred in finding, at both the six- and 12-month review hearings, that reasonable services were provided.
The reasonableness of reunification services is judged according to the circumstances of the particular case. (In re Ronell A. (1996) 44 Cal.App.4th 1352, 1362.) "[T]he record should show that the supervising agency identified the problems leading to the loss of custody, offered services designed to remedy those problems, maintained reasonable contact with the parents during the course of the service plan, and made reasonable efforts to assist the parents in areas where compliance proved difficult ...." (In re Riva M. (1991) 235 Cal.App.3d 403, 414.) " 'The standard is not whether the services provided were the best that might be provided in an ideal world, but whether the services were reasonable under the circumstances.' " (In re A.G. (2017) 12 Cal.App.5th 994, 1001 (A.G.).)
"We review a reasonable services finding to determine if it is supported by substantial evidence." (A.G., supra, 12 Cal.App.5th at p. 1001.) "We consider the evidence in the light most favorable to the prevailing party and indulge all legitimate and reasonable inferences to uphold the court's ruling. [Citation.] The burden is on the [appellant] to show that the evidence is insufficient to support the juvenile court's findings." (Ibid.)
Mother does not challenge the content of her services plan, but rather the Department's efforts in implementing it. Substantial evidence, however, supports the juvenile court's findings at both hearings that the Department's efforts were reasonable.
The greatest obstacle to reunification in this case was Christopher's mental illness. The Department devised a plan to address his mental health issues, offering him individual therapy and medications, as well as conjoint therapy and visitation with his parents. Over time it became clear that Christopher was not amenable to therapy, taking his medications, or seeing his parents, because he harbored delusions that involved his perception that his parents were threats to his safety.
At that point, in order to facilitate reunification the Department needed to address Christopher's resistance and attempt to encourage his participation in services. The juvenile court ordered a psychological evaluation, which showed that Christopher needed to be stabilized by taking anti-anxiety and anti-psychotic medications, and participating in individual counseling, before conjoint therapy could begin. The Department attempted to stabilize Christopher by encouraging him to engage in counseling, trying to find psychotropic medications that would reduce his psychotic symptoms, and looking for a group home that could address his mental health needs. Despite these efforts, Christopher refused to engage in counseling and take his medications, and he had not been able to maintain a group home placement, primarily because he stopped taking his medications. Short of physically forcing Christopher to take his medications and engage in counseling, there was nothing more the Department could do.
Mother contends the Department's efforts were not reasonable because it failed to follow Dr. Middleton's recommendations that would have moved Christopher from refusing to see her to working with her in conjoint counseling. The Department, however, did attempt to put Dr. Middleton's suggestions into practice by developing a behavioral contract, but Christopher refused to sign or even discuss it. Ultimately, as the Department points out, Dr. Middleton's recommendations did not offer a practical solution to Christopher's problems. While Dr. Middleton recommended Christopher attend counseling, believing he was receptive to treatment through Child Guidance, Christopher steadfastly refused to participate in counseling with anyone. Dr. Middleton believed Christopher was receptive to taking his medications, but he had stopped taking them by July. Dr. Middleton clearly envisioned that Christopher would stabilize with counseling and medication, which would allow conjoint therapy and visits to begin, but Christopher refused to participate in either. Moreover, Dr. Middleton's recommendations for behavioral modification were impossible to implement in the group home context because Christopher could walk out of any group home at will. Until Christopher was willing to take his medications and participate in counseling, it was impossible to move toward visitation and conjoint counseling.
Mother argues the Department effectively handed control of the case over to Christopher, by allowing him to decide whether to participate in individual and conjoint counseling, as well as visitation. She asserts the juvenile court affirmed this "ce[ding] of power" when it took no action to enforce its orders. But the juvenile court did not give Christopher discretion to decide whether visits would occur or whether he would participate in services, and therefore did not improperly delegate judicial power to Christopher, as in the case mother relies on, In re Julie M. (1999) 69 Cal.App.4th 41, 48-49, where the court's order gave the children the option to refuse any future visits with their mother. While mother faults the juvenile court for not enforcing its orders, a juvenile court is not required to force a child to visit a parent against his or her will. (See In re Danielle W. (1989) 207 Cal.App.3d 1227, 1238-1239.) Here, given Christopher's mental state, it was reasonable for the juvenile court, as well as the Department, to decline to force Christopher to have contact with his parents or participate in services. The juvenile court and Department were caught in a balancing act between being responsive to Christopher's mental illness and trying to facilitate parental contact. Contrary to mother's assertions, deferring parental contact until Christopher stabilizes is not giving him control over visitation or services.
In sum, the record demonstrates the Department made reasonable efforts to stabilize Christopher and encourage his participation in services. Short of physically coercing him, there was little more the Department could do to facilitate his participation. The juvenile court did not err in finding, at the six- and 12-month review hearings, that reasonable services were provided.
DISPOSITION
The juvenile court's August 29, 2017 and September 13, 2017 findings and orders are affirmed.
/s/_________
ELLISON, J. WE CONCUR: /s/_________
PEÑA, Acting P.J. /s/_________
SMITH, J.
Retired judge of the Fresno Superior Court, assigned by the Chief Justice pursuant to article VI, section 6 of the California Constitution. --------