IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON Inthe Matter ofthe Dependency of E.J.L, DOB: 8/24/13, Minor Child. CARRIE LEHNERT,Appellant,

v. STATE OF WASHINGTON, DEPARTMENT OF SOCIAL AND HEALTH SERVICES, Respondent. DIVISION ONE No. 73444-0-I

UNPUBLISHED OPINION

FILED: February 29, 2016 

### Dwyer, J. - Carrie Lehnertappeals from the trial court's order terminating 

### her parental rights toherdaughter, E.L. Lehnert asserts thattheDepartmentof Social and Health Services (Department) did not prove that she is currently unfit 

### to parentE.L. or that it offered orprovided all reasonablyavailable, necessary 

### services, capable ofcorrecting herparental deficiencies within theforeseeable future. Because substantial evidence supports the necessary trial courtfindings,

we affirm.No. 73444-0-1/2

Following a three-day trial in March 2015, the trial court terminated Carrie Lehnert's parental rights to her daughter E.L. The majority ofthe trial court's findings offact are unchallenged and therefore verities on appeal. See In re Dependency of J.A.F.. 168 Wn. App. 653, 667, 278 P.3d 673 (2012). Lehnert is the mother of E.L. (born August 24, 2013) and E.L.'s older brother, A.L (born March 20, 2012). The Department removed A.L. from Lehnert's care shortly after birth, primarily because of Lehnert's mental health issues. The dependency petition alleged concerns about Lehnert's obsessivecompulsive disorder (OCD), including the hoarding ofgarbage, failure to seek prenatal care, and sporadic participation in mental health services. The disposition order required Lehnert to participate in a psychological evaluation, parenting classes, mental health counseling with an emphasis on OCD and hoarding, and medication management. Lehnert did not participate in any ofthe court-ordered services. She acknowledged that she was not ready to care forA.L. and voluntarily relinquished her parental rights in November 2013. On August 26, 2013, two days after her birth, the Department removed 

### E.L. from the hospital and placed herwith the caregivers who later adopted A.L.

-2-No. 73444-0-1/3
E.L. has remained in this prospective adoptive home since her removal and has

never lived with either parent.1 The trial court entered an agreed dependency order as to E.L. on October 22, 2013. Lehnert stipulated that she needed stable housing, mental health 

### counseling, and other services to assist with reunification. The court ordered Lehnert to participate in the same services identified for A.L.'s dependency: a 

### psychological evaluation, parentingclasses, mental health counselingwith an emphasis on OCD and hoarding, and medication management. The Department 

### alsoprovided Lehnertwith contactsfor housing assistance. Atthetime ofE.L.'s dependency order, Lehnert'smental health issues remained essentially
untreated. 

### Initially, Lehnert did not engagein any ofthecourt-ordered services. She began mental health counseling with Compass Health in December2013. Jane Norberg, Lehnert's therapist at Compass, testified that between 

### December 2013 and May 2014, Lehnert participated in a total ofthree counseling sessions and cancelled two scheduled sessions. Lehnert's treatment plan 

### included coping techniques for dealing with herdepression and OCD. Norberg felt that whenLehnert left Compass in May 2014, she had made "someprogress" 

### and had "greater insight" into someofherproblems. Norberg estimated that it would be "at least a year ortwo" before Lehnert could "overcome" hermental

1The parental rights ofE.L.'s father, which the courtterminated in December2014, arenot at issue in this appeal. -3-No. 73444-0-1/4
health issues. Lehnert did not participate in available medication management services. Lehnert did not begin visiting E.L. until February 2014. Although frequently late, she then participated regularly intwice-weekly supervised visits
until the termination trial. In May 2014, Lehnert transferred from Compass Health to Sunrise Services because itwas closer and she intended to schedule more frequent appointments. AtSunrise, Lehnert attended counseling sessions on a relatively regular schedule and participated in cognitive behavioral therapy (CBT) techniques. Lehnert began medication management inJanuary 2015. In March 

### 2015,just before the termination trial, Lehnert attended the first session of a dialectical behavioral therapy (DBT) group Lehnert also participated in court-ordered parenting services. The 

### Department referred Lehnertfor the Incredible Years parenting class in January 2013, during A.L.'s dependency, and again in December 2013, during E.L.'s dependency. In each case, Lehnertfailed to participate. The Department referred Lehnert for a third time in August 2014. She successfully completed the class in February 2015. 

### Lehnert participated in one-on-one parentcoaching with Marie PreftesArenzfrom February 2014 through December 2014. The coaching sessions, 

### which usually occurred during Lehnert's visits with E.L., focused onmaternalNo. 73444-0-1/5 bonding, infant growth and development, and demonstrating appropriate parenting skills. Preftes-Arenz testified that, over time, Lehnert demonstrated some improvement in maternal bonding with E.L. and in her ability to meet the basic needs of an infant. Although Lehnert was generally able to learn and apply basic skills in caring for E.L. during the visits, Preftes-Arenz noted that "[tjherewere repeated prompts to do the same thing often," including the steps necessary to 

### change diapers and identify appropriate food for a child moving to solid foods. When the current referral ended in December 2014, Preftes-Arenz felt that


### nofurther coaching sessions were necessary because Lehnert had the skills necessary to keep E.L. safe during the twice-weekly supervised visits. But Lehnert continued to struggle with slowresponse times when addressing E.L.'s 

### needs, requiring Preftes-Arenz's prompts. Lehnert also had difficulty in 

### concluding thevisits ontime. Preftes-Arenz observed thatLehnertwould become distracted while packing her belongingsinto bags, leaving E.L. "toddling around the visitation location" unsupervised. Lehnert frequently called Preftes

### Arenz to "perseverate on something that happened at the visit ormy reportto the socialworker." On one occasion during a visit, Lehnertengaged Preftes-Arenz 

### heatedly about a reportthey had discussed at length the previous evening. Preftes-Arenz eventually had to directLehnertto focus herattention on E.L., who had been wandering around unsupervised.No. 73444-0-1/6
Preftes-Arenz explained that the ultimate goal of her parent coaching was notjust a parent's demonstration ofthe necessary specific skills, but rather a "generalization of skills, so that a parent. . . can then apply that same knowledge to other aspects ofparenting that are similar to that particular instance." At the conclusion of the coaching session, Lehnert was still struggling with certain skills and was unable to apply those skills to the frequent unexpected situations that arise during the full-time, unsupervised care of a young child. Preftes-Arenz concluded that Lehnert's continuing mental health issues, 

### including her ongoing struggle to respond quickly to E.L.'s needs and her 

### susceptibility to distractions, raised significant safety concerns forE.L. Despite 

### the lengthy one-on-one parentcoaching, Preftes-Arenz felt that Lehnert was not yet ready to begin a serious effort at reunification or to keep E.L. safe in an unsupervised setting. 

### Angie Clow began supervising Lehnert'svisits with E.L. in December 2014. On several occasions, Lehnert became distracted near the end of the visit. 

### While preparing to leave, Lehnertwould become focused on making sure that she hadpicked upall herbelongings, including checking in rooms that she had not used. In the process, Lehnert lost sight ofE.L., and Clow would have to retrieve her. Lehnert's distractions also prevented her from leaving the facility on
time. In the month before the termination trial, Lehnert continued to become 

### frustrated during the visits and would seek guidance from Clow when -6-No. 73444-0-1/7 encountering difficulties in changing E.L.'s diapers. After Lehnert missed a third visit on February 27, 2015, the visits were suspended until Lehnert obtained a

new referral. The Department referred Lehnert for a psychological evaluation with Dr. Michael O'Leary, a clinical psychologist, beginning in February 2013. After missing several appointments, Lehnertfinally attended the testing portion of the evaluation in May 2014. After Lehnert again failed to appearfor several 

### appointments, the clinical interview and parent-child observation components of the evaluation were eventually scheduled forAugust 1, 2014. Lehnert was released from a two-weekjail sentence on the day before the 

### appointment. She informed her socialworker, Wyndi Horness, that she was 

### going to keep the appointment, butinsisted thatE.L. not be present. Lehnert failed to appearfor the appointment. At thetermination trial, Lehnert explained that she felt unprepared for the parent-child observation afterbeing injail for two 

### weeks. After so many missed appointments, Dr. O'Leary declined toreschedule the appointment. 

### Despite Lehnert's failure to appearfor the clinical interview and parentchild observation, Dr. O'Leary completed his reportusing Lehnert's test results and other information from the referral. He diagnosed Lehnert with major 

### depressive disorderand anxiety disorderwith obsessive-compulsive symptoms. 

### Dr. O'Leary concluded thatLehnert's "intense self-preoccupation andobsessive characteristics which contribute to disorganization and lack of emotional stability" -7-No. 73444-0-1/8 posed the primary risk of Lehnert's mental health diagnoses to E.L.'s health and safety. Dr. O'Leary recommended that Lehnert engage in comprehensive wrap around psychiatric services, including CBT and DBTcomponents and medication management. Dr. O'Leary's determination that itwill "take at least a year, and
more likely two to three years, of wrap-around psychiatric services before the 

### mother may become sufficiently independent to have the ability to parent [E.L.]" is also unchallenged on appeal. 

### Dr. O'Leary acknowledged that Lehnert had been participating in 

### medication managementfor two months, but described thatperiod as "still kind of in the trial and error stage." Psychiatric medications can take six months to a year to stabilize. 

### Wyndi Horness testified thatLehnert had made progressin correcting parental deficiencies sinceA.L.'s dependency began in 2012. She 

### acknowledged that there had been "improvement andmore stability" for Lehnert in the six months before the termination trial, but that her concerns about 

### Lehnert's ability to parent E.L. safely had not gone away. Based on her observations, Horness felt that Lehnert's mental health issues continued to 

### prevent herfrom meeting even herown needs andraised safety concerns about her ability to care for E.L.: 

### [S]hereally struggleswith parenting in a big picture. She can 

### parent and do thosethings that she has theskills for as long as she has the time to process itand whatwould be the best direction to -8-No. 73444-0-1/9

take in that situation. But when it is an immediate need or unexpected, shejust is not able to immediatelyjump on that or process that as quickly as she should, especially around safety concerns that are present for a toddler.
Horness believed that Lehnert was not yet ready for monitored visits and still needed a controlled environment and constant supervision. Lehnert needed to accomplish at least three months of visits with no safety issues before the Department could consider monitored visits. Lehnert testified at length. The trial court found that she had a good
assessment of her abilities and deficiencies. Lehnert also understood at least

some of the difficulties that her mental health issues caused in parenting E.L. Lehnert acknowledged that she did not yet have the appropriate housing that would permit her to parent E.L. Initially, she indicated that she was "justkind of 

### looking" into a residence that she located on Craigslist. She latertestified that she believed she had located a suitable place to live in Lynnwood. The trial court determined that the Department had established the statutory requirements and terminated Lehnert's parental rights. The court determined that the near future for E.L., who was 19 months old at the time of trial, was three months. The court found that although Lehnert had made some 

### progress, hermental health issues, including obsessive thoughtprocesses and preoccupation, overthinking, delayed decision-making, and difficulties in dealing withthe unexpected situations that arise during parenting a young child,No. 73444-0-1/10 prevented Lehnert from adequately responding to E.L.'s basic needs in the foreseeable future. Lehnert appeals.
II Because parents have a fundamental right to the care and custody of their children, "a trial court asked to interfere with that right should employ great care." In re Welfare ofM.R.H., 145 Wn. App. 10, 23, 188 P.3d 510 (2008); see also Santoskv v. Kramer, 455 U.S. 745, 753, 102 S. Ct. 1388, 71 L Ed. 2d 599 

### (1982). Beforeterminating parental rights, Washington courts mustfollow a two

### step process. In reWelfare ofA.B., 168Wn.2d 908, 911, 232 P.3d 1104(2010). First, the Department mustprove the sixtermination factors specified in RCW 

### 13.34.180(1). A.B., 168Wn.2dat 911-12. In addition, due process requires the trial court tofind that the parent is currently unfit to parent the child. AjB,, 168 Wn.2d at 911. Thefirst step "focuses on the adequacy of the parents and must 

### beproved by clear, cogent, andconvincing evidence." A.B., 168 Wn.2d at911 (footnote omitted). IftheDepartment satisfies thefirst step, thecourtthen determines, by a preponderance oftheevidence, iftermination isin thechild's best interests. RCW 13.34.190(1 )(b). 

### Where, as here, the trial court has weighed the evidence, appellate review 

### islimited to determining whether substantial evidence supports the court's 

### findings offact and whetherthose findings supportthecourt's conclusions oflaw. In re Dependency of P.P., 58 Wn. App. 18, 25, 792 P.2d 159 (1990). "Evidence 

### is substantial ifit is sufficient to persuade a fair-minded person of the truth of the -10-No. 73444-0-1/11
declared premise." In re Welfare of S.J., 162 Wn. App. 873, 881, 256 P.3d 470 (2011). Clear, cogent, and convincing evidence exists when the evidence shows the ultimate fact at issue to be highly probable. In re Dependency of K.R., 128 Wn.2d 129, 141.904P.2d 1132(1995). Because the trialjudge "has the advantage of having the witnesses before him or her, . . . deference to the findings is of particular importance in deprivation proceedings." In re Dependency of K.S.O, 137 Wn.2d 918, 925, 976 P.2d 113(1999). Lehnert contends that the evidence was insufficient to support the trial 

### court'sfinding that she is currently unfit to parent E.L. She maintains that bythe time ofthe termination trial, the evidence demonstrated that she was making 

### progress and that the needfor parenting prompts and assistance during visits was decreasing. Lehnert argues that, viewed in light of her progress, the evidence of her mental health issues, obsessive thought processes, delayed 

### responses during parenting tasks, andchronic tardinessestablished nothing more than the mere possibility of a safety risk to E.L., and was therefore insufficient to establish current parental unfitness. 

### "[Mjental illness isnot, in and ofitself, proofthat a parent isunfit or 

### incapable." In reDependency ofT.L.G., 126 Wn. App. 181,203, 108 P.3d 156 (2005). Rather, toprove current unfitness, theDepartment must establish by clear, cogent, andconvincing evidence that"parenting deficiencies preventthe parentfrom providing thechild with 'basicnurture, health, orsafety.'" In re Welfare ofA.B„ 181 Wn. App. 45, 61, 323 P.3d 1062 (2014) (quoting RCW -11-No. 73444-0-1/12 13.34.020). In determining the likelihood that parental deficiencies will be remedied inthe near future, the trial court may also consider whether there is a "[psychological incapacity or mental deficiency of the parent that is so severe and chronic as to render the parent incapable of providing proper care for the 

### child forextended periods of time or for periods of time that present a risk of imminent harm to the child." RCW 13.34.180(1 )(e)(ii). 

### The evidence was undisputed that Lehnert suffers from significant mental health issues that affect her ability to parent E.L. The trial courtfound that Lehnert's OCD and obsessive thought processes caused her to overthink "even 

### the most basic decisions," resulting in slow response times, indecisiveness, and 

### distractions, and interfering with herability to complete goals and tasks and to make informed decisions about E.L.'s "health, medication, education, and safety needs." These findings are unchallenged on appeal. 

### Dr. O'Leary diagnosed Lehnertwith anxiety disorderwith obsessive

### compulsive symptoms and majordepressive disorder. He noted that Lehnert 

### had struggled with OCD since adolescence and that its symptoms had interfered with her social competence and ability to parentfor more than 10years. 

### According to Dr. O'Leary, Lehnert's "intense self-preoccupation and obsessive characteristics" contributed to herdisorganization and lack ofemotional stability 

### and created the primary risks toE.L. resulting from her mental health issues. Dr. O'Leary explained that Lehnert's chronic OCD stresslevels and frustrations

-12-No. 73444-0-1/13 posed particular challenges for dealing with the frequent novel situations that

occur while caring for a young child: Decision-making, doesn't go according to plan, the lack of selfconfidence, the lack of decisiveness that is often necessary, especially in fast-moving or critical situations, stopping to think if this is the right decision rather thanjust taking action. Aparent's indecisiveness when faced with potential hazards or distraction raises "critical" safety concerns for a child. 

### Lehnertargues that Dr. O'Leary's testimony must be discounted because his evaluation occurred in August 2014, without her participation in the clinical 

### interview and parent-child observation components. Butthe trial court also had 

### before it ample evidence ofLehnert's parenting abilities during the monthsjust before the termination trial. That evidence was consistent with Dr. O'Leary's
evaluation. 

### The trial court found that, although Lehnert had made some progress, the 

### improvement in her abilitytoparent E.L. outside the limited and highly controlled environment ofsupervised visits was minimal. Both Lehnert's parenting coach and the visit supervisortestified thatLehnert's chronic tardiness, overthinking, 

### perseverating, delayed responses toparenting situations, and obsession with personal belongings persisted throughoutthethree months preceding the termination trial. Even in February 2015, Lehnert's mental health issues continued to distract her from childcare and allowed E.L. to wander away without supervision. -13-No. 73444-0-1/14
Marie Preftes-Arenz, Lehnert's parent coach, acknowledged that Lehnert had demonstrated an ability to keep E.L. safe during the supervised visits, although she still needed repeated prompts. Buteven after nearly a year of oneon-one coaching, Preftes-Arenz found that Lehnert had not yet acquired the skills to keep E.L. safe in an unsupervised setting and "still needed another party to 

### just observe and make sure that [E.L.] was safe." Moreover, Lehnertwas unable to "generalize" those skills she had learned byapplying them to the unanticipated situations that arise during full-time childcare. Preftes-Arenz concluded that Lehnert was not yet ready even to begin a serious attempt at reunification. The trial court observed some of Lehnert's mental health issues during the


### course of hertrial testimony. The court found that Lehnert was overthinking issues when confronted with unanticipated questions during her trial testimony. 

### In addition, Lehnertwas frequently late tocourt and returned latefrom almost all

court breaks. 

### In summary, although Lehnert had also demonstrated progress, the evidence established that her mental health issues, including OCD, chronic 

### tardiness, susceptibility todistractions, indecisiveness and delayed responses, 

### and inability torespond tonovel situations arising during childcare, directly 

### impaired her abilitytorespond to E.L.'s basic needs. The identified deficiencies clearly involved more than mere "subtle safety risks" toE.L. AJL, 181 Wn. App. at 64. The evidence was sufficient to permit the trier of fact to find ithighly 

### probable that Lehnert's parental deficiencies created a serious riskto E.L.'s -14-No. 73444-0-1/15
health and safety and prevented her from meeting E.L.'s basic needs within the foreseeable future. Substantial evidence supported the trial court's finding of current parental unfitness.
Ill Under RCW 13.34.180(1 )(d), the Department must prove that itoffered or provided all court-ordered services and "all necessary services, reasonably available, capable of correcting the parental deficiencies within the foreseeable future." The services "must be tailored to each [parent's] needs." In re Pep, of T.R.. 108 Wn. App. 149, 161, 29 P.3d 1275(2001). Lehnert contends that 

### individual transportation to the psychological evaluation and an updated 

### psychological evaluation were necessary services that the Department should have provided to comply with this termination factor. Lehnert testified that she did not drive and had long relied primarily on the 

### bus toparticipate in herservices. Forthefirst time onappeal, she now contends that because her OCD was directly related to her chronic tardiness and failure to 

### consistently keepappointments, the Department should have provided herwith individual transportation to her scheduledclinical interview and parent-child observation with Dr. O'Leary onAugust 1, 2014. She relies primarily on her 

### testimony aboutexperiencing "anxiety" while riding the bus and thefact she 

### successfully completed the Incredible Years parenting class,which included transportation.

•15-No. 73444-0-1/16
Because Lehnert did not raise the issue of bus transportation, either in opening or closing statements or in her own testimony, the trial court had no occasion to consider the necessity of individual transportation or enter relevant findings. Nordoes the record contain evidence that Lehnert's reliance on bus transportation presented a meaningful barrier to her participation in necessary services. Lehnert's testimony about "anxiety" whileriding the bus did not involve


### a complaint, but rather the techniques she was applying to deal with anxiety in all situations. Lehnert explained that she occasionally felt anxious when she was on 

### a bus with many other people, but she then added, "that's pretty much easily 

### worked through" and "I've found ways to dealwith itthrough counseling and
classes." 

### Finally, the record does notsupport Lehnert's claim that the lack of individual transportation resulted in a late and incomplete psychological evaluation. Lehnert had already missedmultiple scheduled appointments before 

### she agreed to theAugust 1,2014 appointment. On the daybefore the 

### appointment, Lehnerttold her social workerthat shewould beattending the clinical interview, but she did notpermitthe social workerto transportE.L. for the 

### parent-child observation component. Consequently, even ifLehnert had appeared for the August 1 appointment, theparent-child observation component would not have been completed. The record fails to demonstrate that individual transportation was a necessary service. -16-No. 73444-0-1/17

IV Lehnert also challenges the trial court's finding that an updated psychological evaluation was not a necessary service. She claims that Dr. O'Leary's evaluation, which was prepared about seven months before the termination trial, was incomplete because it lacked the clinical interview and parent-child observation components. She further argues that an updated evaluation was necessary to provide the trial court with updated information about her current parenting abilities, deficiencies, and prognosis. 

### Although Dr. O'Leary acknowledged that it would have been preferable to include the clinical interview and parent-child observation components as part of 

### Lehnert's psychological evaluation, hetestified that he hadsufficient information 

### toprovide a meaningful assessment, including thetesting portion ofLehnert's evaluation, two complete psychosocial summaries, and othermaterials from the 

### Department, including visit supervision notes. Pr. O'Leary is anexperienced 

### psychologistwho hasconducted more than 1,000 parental evaluations. Thetrial court's acceptance ofhis testimony involves a credibility assessment thatthis court cannot review. See In re Welfare ofT.B.. 150 Wn. App. 599, 607, 209 P.3d 497 (2009). 

### Moreover, the trial court also had before it updated information about 

### Lehnert'sefforts after Pr. O'Leary'sevaluation, including Lehnert's extensive 

### testimony. Lehnert's social worker, parenting coach, visitation supervisor, and 

### therapisttestified in detail about her currentparenting abilities, deficiencies, and -17-No. 73444-0-1/18 prognosis. Pr. O'Leary's opinion that Lehnert would need at least a year to remedy parental deficiencies, but more likely two to three years, is unchallenged
on appeal. InJanuary 2015, at a dependency review hearing, the court denied Lehnert's request for an updated evaluation because she had failed to demonstrate sufficient progress. Substantial evidence supports the trialcourt's finding that an updated 

### psychological evaluation was not a necessary service and that the Pepartment offered orprovided Lehnertwith all necessary services capable ofcorrecting parental deficiencies within the foreseeable future. The order terminating Lehnert's parental rights is affirmed.

We concur: 

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