IN THE COURT OF APPEALS OF IOWA

No. 18-0380

Filed May 16, 2018

IN THE INTEREST OF K.C.,

Minor Child,

E.C., Mother,

Appellant.

Appeal from the Iowa District Court for Polk County, Joseph W. Seidlin, 

District Associate Judge.

A mother appeals the juvenile court’s termination of her parental rights. 

AFFIRMED.

Elizabeth A. Ryan of Benzoni Law Office, P.L.C., Des Moines, for appellant 

mother.

Thomas J. Miller, Attorney General, and Kathryn K. Lang, Assistant 

Attorney General, for appellee State.

ConGarry D. Williams of Juvenile Public Defender Office, Des Moines, 

guardian ad litem for minor child.

Considered by Danilson, C.J., and Mullins and McDonald, JJ.
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MULLINS, Judge.

A mother appeals a juvenile court order terminating her parental rights to 

her minor child, K.C. She contends the State failed to prove the statutory grounds 

for termination by clear and convincing evidence and to make reasonable efforts 

to reunify her with her child. She also claims the court erred in failing to apply a 

statutory exception to termination. She further claims counsel was ineffective for 

failing to raise the lack-of-reasonable-efforts claim prior to or during the termination 

hearing.

I. Background Facts and Proceedings

K.C. was born in December 2016 and came to the attention of the Iowa 

Department of Human Services (DHS) three weeks later upon allegations the 

mother was denying K.C. critical care. The mother failed to take the child to a 

routine weight-check appointment after discharge from the hospital. Three weeks 

after K.C.’s birth, the mother took the child to the doctor for stomach-related issues. 

During this appointment, the mother admitted to feeding K.C. adult lactate milk and 

prune juice. The mother was resistant to the doctor’s advice that feeding a 

newborn inappropriate substances was dangerous. The mother also denied the 

offer of visiting nursing services due to her house being “too messy.” It was also

noted by medical staff that, despite the outside temperature of fourteen degrees 

Fahrenheit, K.C. was only dressed in a onesie with no other layers and with only 

a thin blanket over the car seat. The mother also admitted during the appointment 

that she felt she was not able to take care of the child while working and she 

reported she was waiting for a bus ticket to send the child to her brother in Kansas 

City.
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DHS commenced its investigation of the allegations of denial of critical care 

(failure to provide adequate shelter and failure to provide proper supervision) after 

receiving a report on January 5, 2017. On January 6, a DHS worker went to the 

mother’s identified address. During this encounter the worker noted the mother 

was holding the child in an unsafe manner. Though she initially acknowledged her 

identity, after the DHS worker explained his/her concerns and asked for 

identification to ensure he/she was speaking with K.C.’s mother, the mother closed 

the door and refused to open it. 

DHS contacted the Des Moines Police Department to assist, as the child’s 

safety had not yet been verified. Due to the medical concerns of the child and the 

mother’s refusal to engage in the assessment process, an emergency removal 

order was granted and police obtained entry into the house. During the ensuing 

interview, the mother made statements about being poisoned in jail and claimed 

“they” were after her, “they” wanted to take her child away from her, and “they” 

pointed an AK-47 at her while she was in Kansas City.

DHS reported the child was not clean, had a strong body odor, and had 

severe cradle cap. K.C. slept in the same bed with her mother, which was soiled 

and had no bedding. In the mother’s home, DHS observed that the floor was 

littered with trash and debris; the furnace had no cover; spoiled food and trash 

were located on the table, floor, and in the sink; there were bugs in the air; ceiling 

tiles, which could contain asbestos, were exposed; and there were gaping holes in 

the floorboards. The mother lived with K.C.’s maternal grandmother, whose 

parental rights to K.C.’s mother were terminated when she was a child and who 
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had medical and mental-health issues of her own. K.C. was reportedly left in her 

grandmother’s care on occasion.

K.C. was subsequently removed from her mother’s care and placed into 

foster care. During further investigation, the mother made additional statements 

that she was poisoned while in jail and that this was likely the reason for K.C.’s 

stomach issues. She also refused assistance for shelter referrals. On February 3, 

DHS completed its investigation and determined both allegations of denial of 

critical care were founded. The child-abuse-assessment report noted concerns 

about the mother’s mental health, including her display of signs of paranoia and 

possible hallucinations.

On February 17, K.C. was adjudicated to be a child in need of assistance 

(CINA) and remained in the custody of DHS for foster-care placement. On April 

21, the court adopted a case permanency plan which provided for a primary 

permanency goal of reunification. The permanency plan called for the mother to 

address her mental-health issues, complete a psychiatric evaluation, continue in 

individual therapy, engage in parenting sessions, follow recommendations of 

medical providers, and obtain safe and appropriate housing. 

The mother completed a psychiatric evaluation on April 20 and attended a 

follow-up appointment in July; however, after her diagnosis of unspecified 

psychosis and a recommendation for medication, she refused the medication and 

failed to return for follow-up care. Also in July, the mother went to the emergency 

room with a complaint of shortness of breath; before treatment could be completed, 

the mother removed her own IV and left. The mother reported to DHS that she 
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believed the emergency room staff was attempting to give her sodium chloride to 

stop her heart. 

On August 5, the mother was arrested for disorderly conduct after she was 

found unclothed from the waist down threatening to kill people with a rock. The 

police report indicates the mother refused to drop the rock despite commands from 

police and ultimately the police had to physically remove the rock from her

possession. She was arrested and released the same day.

The mother gave birth to another child in December 2017 while at a gas 

station. She admitted receiving no prenatal care for this child and when she went 

into labor, instead of going to the hospital, she attempted to drive to Kansas to 

prevent the child from being born in Iowa. During her hospital stay following the 

delivery, she was admitted to the psychiatric unit on a psychiatric hold due to her 

paranoid ideations, as well as psychotic and delusional behavior. She was 

diagnosed as a paranoid schizophrenic and was discharged in January 2018 after 

stabilizing on medication. The mother’s other child was removed from her care.

The mother had supervised visits after K.C.’s removal and, for several 

months, the mother was regularly attending those visits. Her visits became less 

consistent over the summer of 2017; DHS reported this was a result of the mother’s 

mental health deteriorating. The mother moved to Kansas City, Kansas in the fall 

of 2017 and has had little contact with K.C. since she moved. On November 14, 

the State filed its petition to terminate the parental rights of both K.C.’s mother and 
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alleged father.1 The State alleged the mother’s parental rights should be 

terminated pursuant to Iowa Code section 232.116(1)(h), (i), and (k) (2017). 

During the termination hearing, the State presented testimony from the 

mother and a DHS social worker. The mother testified she does not believe she 

has any mental-health diagnosis or issues and does not believe she would benefit 

from taking medication. The social worker testified to the mother’s mental 

deterioration in the summer of 2017, which resulted in her missing visits, and noted 

the mother’s statements about changing her phone number because she believed 

she was being tracked through her cell phone. The social worker also testified 

she believed the mother would not consistently take her prescribed medication and 

K.C.’s safety would be at issue if she were returned to her mother. The guardian 

ad litem did not offer evidence or testimony at the hearing but recommended 

termination based on the mother’s mental-health struggles and opined termination 

would be in K.C.’s best interests.

Following the hearing, the court terminated the mother’s parental rights

under Iowa Code section 232.116(1)(h). As noted, the mother appeals.2

II. Standard of Review

Our review of termination-of-parental-rights proceedings is de novo. In re 

M.W., 876 N.W.2d 212, 219 (Iowa 2016). “We are not bound by the juvenile court’s 

findings of fact, but we do give them weight, especially in assessing the credibility 

of witnesses.” In re A.S., 906 N.W.2d 467, 472 (Iowa 2018) (quoting In re A.M., 

 

1 The mother named an individual as K.C.’s putative father but was unable to give any 

other information. He has not been located, nor has paternity been established.

2 The court terminated the putative father’s parental rights under Iowa Code section 

232.116(1)(b). He does not appeal. 
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843 N.W.2d 100, 110 (Iowa 2014)). We will uphold an order terminating parental 

rights if there is clear and convincing evidence supporting the grounds for 

termination under Iowa Code section 232.116(1). In re D.W., 791 N.W.2d 703,

706 (Iowa 2010). Evidence is “clear and convincing” when there are no “serious 

or substantial doubts as to the correctness [of] conclusions of law drawn from the 

evidence.” Id. Our principle consideration in termination proceedings is the child’s 

best interests—safety; long-term nurturing; and physical, mental, and emotional 

conditions and needs. Iowa Code § 232.116(2); In re J.E., 723 N.W.2d 793, 798 

(Iowa 2006).

III. Analysis

Termination of parental rights under chapter 232 follows a three-step 

analysis. D.W., 791 N.W.2d at 706. First, the court must determine if a ground for 

termination under section 232.116(1) has been established. Id. If a ground for 

termination is established, the court must then apply the best-interests framework 

set out in section 232.116(2) to decide if the grounds for termination should result 

in termination of parental rights. Id. at 706–07. Third, if the statutory best-interests 

framework supports termination of parental rights, the court must consider if any 

of the statutory exceptions set out in section 232.116(3) should serve to preclude 

termination of parental rights. Id. at 707.

A. Statutory Grounds for Termination and Best Interests

The court terminated the mother’s parental rights pursuant to Iowa Code 

section 232.116(1)(h). Section 232.116(1)(h) authorizes termination when (1) the 

child is three years of age or younger, (2) the child has been adjudicated a CINA, 

(3) the child has been removed from the physical care of the child’s parents for at 
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least six of the last twelve months, or for the last six consecutive months and any 

trial period at home has been less than thirty days, and (4) there is clear and 

convincing evidence that the child cannot be returned to the parent’s custody at 

the time of the termination hearing. See A.M., 843 N.W.2d at 111 (indicating the 

statutory language “at the present time” refers to the time of the termination 

hearing).

Elements one through three are not contested. The mother contests the 

State’s establishment of element four. She contends that at the time of the 

termination hearing, she was living in a safe home in Kansas City with family 

friends in which she reportedly has a room set up for K.C. She argues DHS has 

not visited this home and is therefore not in a position to make an assessment 

about the safety of this home. She also argues that with the support of the family 

friends, her mental-illness symptoms could be addressed. The district court found 

the mother “refuses to address, let alone resolve, the obvious and serious mental 

health concerns raised at the time of the child’s removal one year ago.”

The mother contends that with the support of her friends, she could address 

any mental-illness symptoms. However, her testimony at the termination hearing 

indicated otherwise. The mother testified she was not receiving any care for her 

mental illness at the time of the hearing and admitted she does not believe she 

has any metal-health issues. Her petition on appeal includes an admission that 

she is not taking recommended medication and has not returned for recommended 

follow-up as she does not believe she has a mental illness. The mother was only 

recently released from a stay in the psychiatric hospital unit where she was 
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medicinally stabilized. The mother’s petition also admits she has made several 

statements that appear to present as paranoia. 

Given that the mother’s mental-health issues were the reason for K.C.’s 

removal from her care and that the mother continues to deny the existence of 

mental-health issues coupled with her unwillingness to address them, we find clear 

and convincing evidence that K.C. could not be returned to her mother’s care at 

the time of the termination hearing and therefor conclude the State met its burden 

for termination under section 232.116(1)(h). 

Next, section 232.116(2) requires us to “give primary consideration to the 

child’s safety, to the best placement for furthering the long-term nurturing and 

growth of the child, and to the physical, mental, and emotional condition and needs 

of the child.” Iowa Code § 232.116(2). “Insight for the determination of the child’s 

long-range best interests can be gleaned from ‘evidence of the parent’s past 

performance for that performance may be indicative of the quality of the future care 

that parent is capable of providing.’” In re C.B., 611 N.W.2d 489, 495 (Iowa 2000) 

(quoting In re Dameron, 306 N.W.2d 743, 745 (Iowa 1981)).

“It is well-settled law that we cannot deprive a child of permanency after the 

State has proved a ground for termination under section 232.116(1) by hoping 

someday a parent will learn to be a parent and be able to provide a stable home 

for the child.” In re A.B., 815 N.W.2d 764, 777 (Iowa 2012) (quoting In re P.L., 778 

N.W.2d 33, 41 (Iowa 2010)). “[A]t some point, the rights and needs of the children 

rise above the rights and needs of the parent.” In re C.S., 776 N.W.2d 297, 300 

(Iowa Ct. App. 2009). If the child has been placed in foster care, we consider the 

extent to which the child has become integrated into that family. Iowa Code 
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§ 232.116(2)(b). For integration, we look at how long the child has been living with 

the foster family and consider the desirability of continuity for the child. Id.

§ 232.116(2)(b)(1).

The mother’s serious mental-health issues brought K.C. to the attention of 

DHS and the court, but she continues to deny the existence of those issues. She 

has two founded child-abuse reports based on her denial of critical care to K.C. 

The mother is not currently able to provide a safe, supportive, and structured home 

and is not in a position to be able to do so in the foreseeable future. We must 

consider each child’s needs with a sense of urgency. See C.B., 611 N.W.2d at

495.

Additionally, the child has not lived with her mother since she was three

weeks old. There is nothing in the record which indicates the lack of contact has 

had any detrimental effect on K.C. DHS reports that K.C. has bonded with her 

foster parents who are attentive to her needs and who are willing and able to adopt 

K.C. Upon our de novo review, we agree with the court’s determination that 

termination is in the best interests of K.C., as returning her to her mother would 

subject her to instability and uncertainty given her mother’s refusal to address her 

mental-health issues.

B. Statutory Exceptions to Termination

The mother claims termination of her parental rights would be detrimental 

to K.C. because of the bond between the mother and child, contending that during 

her supervised visitation, K.C. demonstrated a bond with her and was excited to 

see her. She also contends the bond of the extended family would be severed as 

a result of termination.
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“The court need not terminate the relationship between the parent and child 

if . . . the termination would be detrimental to the child at the time due to the 

closeness of the parent-child relationship.” Iowa Code § 232.116(3)(c). The 

application of the statutory exceptions to termination is “permissive not 

mandatory.” M.W., 876 N.W.2d at 225. “We may use our discretion, ‘based on 

the unique circumstances of each case and the best interests of the child, whether 

to apply the factors in this section to save the parent-child relationship.’” Id.

(quoting In re D.S., 806 N.W.2d 458, 475 (Iowa Ct. App. 2011)). 

K.C. was removed from her mother’s care at the age of three weeks and 

has not been returned to her care. The mother moved to Kansas City at some 

point in the fall of 2017 and has had little contact with the child since that time. She 

has little insight into K.C.’s present condition, health, or needs. The loss of the 

relationship of extended family members is not a factor to consider under section 

232.116(3). 

K.C. has bonded with her foster parents who seek to adopt her, and there 

is nothing in the record which indicates that lack of contact with her mother has 

had any effect on K.C. The closeness of the parent-child relationship in this case

does not preclude termination. Upon our de novo review, we affirm the court’s 

decision not to apply any of the statutory exceptions to termination.

C. Reasonable Efforts and Extension

The mother’s final argument is that the State failed to make reasonable 

efforts to reunify her with K.C. because the reasonable effort of granting her 

additional time to have K.C. returned to her care was denied. Additionally, she 

contends DHS has not reviewed her home in Kansas City for suitability nor has 
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action been initiated to work with officials in Kansas. Since reasonable efforts and 

an extension of time are separate matters to analyze, we will address each in turn. 

The State contends the mother failed to preserve error on the issue of 

reasonable efforts because she failed to raise the issue prior to or at the 

termination hearing. Anticipating this argument, the mother claims that she 

received ineffective assistance of counsel for failing to timely raise the issue. See,

e.g., In re A.R.S., 480 N.W.2d 888, 891 (Iowa 1992). To establish an ineffectiveassistance-of-counsel claim in a termination-of-parental-rights case, a parent must 

show deficiency in counsel’s performance and actual prejudice. See In re D.W., 

385 N.W.2d 570, 580 (Iowa 1986).

“The State must show reasonable efforts as a part of its ultimate proof the 

child cannot be safely returned to the care of a parent.” C.B., 611 N.W.2d at 493; 

accord Iowa Code § 232.102(7) (providing that if custody is transferred to DHS, it 

“shall make every reasonable effort to return the child to the child’s home as quickly 

as possible consistent with the best interests of the child”). “The reasonable efforts 

concept would broadly include a visitation arrangement designed to facilitate 

reunification while protecting the child from the harm responsible for the removal.” 

In re M.B., 553 N.W.2d 343, 345 (Iowa Ct. App. 1996). The reasonable-efforts 

requirement is not, however, viewed as a strict substantive requirement at 

termination. C.B., 611 N.W.2d at 493. Instead, it impacts the State’s burden of 

proving those elements of termination that require reasonable efforts. Id. In 

determining whether reasonable efforts have been made, the court considers “[t]he 

type, duration, and intensity of services or support offered or provided to the child 

and the child’s family.” Iowa Code § 232.102(12)(a)(1). “[T]he nature and extent 
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of visitation is always controlled by the best interests of the child.” M.B., 553 

N.W.2d at 345.

The mother contends DHS failed to review the home she lives in Kansas 

City and no action was taken to work with officials in Kansas to review the home 

for suitability. She claims counsel was ineffective for failing to request this action 

under the Interstate Compact for the Placement of Children (ICPC), either before 

or during the termination hearing. We note that appellate counsel is the same 

counsel who represented the mother at the termination hearing, but not at prior 

dispositional hearings. 

Upon our de novo review, we agree with the district court that reasonable 

efforts towards reunification have been made in this case. The DHS social worker 

testified to the supervised visitation that was provided to the mother, referrals to 

mental-health professionals, along with bus passes and gift cards. The worker

also testified the mother was fairly consistent with attending the visits until the 

previous summer when her mental health deteriorated. This led to the mother 

missing visits. The mother subsequently chose to move to Kansas City and since 

has had little contact with K.C. 

The court terminated the mother’s rights under Iowa Code section 

232.116(1)(h). The mother has not proved that she would have prevailed in 

countering the evidence in support of termination under paragraph (h). Even if her 

attorney had requested action under ICPC, action was initiated, and officials in 

Kansas had reviewed her current housing for suitability, the issue of her mental 

health and her unwillingness to address those issues remain. K.C. could not be 

returned to her mother’s custody at the time of the termination hearing nor in the 
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foreseeable future because the mother remains in denial about her mental-health

issues. Accordingly, we find the mother failed to show she was actually prejudiced 

by trial counsel’s alleged failure, and her claim of ineffective assistance of counsel 

fails.

The mother also claims she should have been granted additional time to 

have her child returned to her care. She contends she should be granted an 

additional six months to work toward reunification as it would provide her the 

opportunity to welcome and settle K.C. into the lives of the mother’s extended 

family in Kansas City and allow the mother time to find the best balance of 

psychiatric medications to treat her mental-health disorders. 

If, following a termination hearing, the court does not terminate parental 

rights but finds there is clear and convincing evidence that the child is a CINA, the 

court may enter an order in accordance with section 232.104(2)(b). Iowa Code 

§ 232.117(5). Section 232.104(2)(b) affords the juvenile court the option to 

continue placement of a child for an additional six months if the court finds “the 

need for removal . . . will no longer exist at the end of the additional six-month 

period.” The court here found that “[t]o think that lasting change will be established 

by [the mother] in any reasonable length of time is not realistic.” 

The mother has mental-illness issues that she, thus far, refuses to admit 

she has and has taken little to no action to address. Her mental health is the 

underlying problem, which adversely affects her ability to effectively parent and 

was the impetus for K.C.’s removal from her care. Despite her contention that 

additional time would give her the opportunity to find the best balance of 

medications to properly treat her issues, her testimony at the termination hearing 
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indicates she is still in denial about her mental-health issues. The mother has 

also recently given birth to another child who was removed from her care shortly 

after birth due to the mother’s mental-health issues. 

The mother was placed on a psychiatric hold due to her paranoid ideations, 

as well as psychotic and delusional behavior. Despite her stabilization and 

release, she testified during the termination hearing that she was not taking any 

medication for her issues. She has provided no evidence that she is taking steps 

to address her mental-health issues before or since her release from the hospital. 

See M.W., 876 N.W.2d at 224; see also A.B., 815 N.W.2d at 778 (noting a parent’s 

past conduct is instructive in determining the parent’s future behavior); C.B., 611 

N.W.2d at 495 (noting parents cannot wait until the eve of termination to begin to 

take interest in their children because “[t]ime is the critical element” in parenting 

situations); In re C.K., 558 N.W.2d 170, 172 (Iowa 1997) (stating that when 

considering what the future holds if a child is returned to the parent, we must look 

to the parent’s past behavior because it may be indicative of the quality of care the 

parent is capable of providing in the future).

K.C. requires stability and permanency and it would not be in her best 

interests to delay termination. Therefore we affirm the juvenile court’s denial of the 

requested six-month extension.

IV. Conclusion

We conclude there is clear and convincing evidence to support the 

termination of the mother’s parental rights under Iowa Code section 232.116(1)(h), 

termination is in K.C.’s best interests, application of a statutory exception to 

termination is unwarranted, and an extension of time is unwarranted and contrary
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to the child’s best interests. We reject the mother’s claims regarding reasonable

efforts and ineffective assistance of counsel. Therefore, we affirm the termination 

of the mother’s parental rights.

AFFIRMED.