Opinion ID: 2669632
Heading Depth: 2
Heading Rank: 2

Heading: Joey’s Birth And Subsequent Hospitalization

Text: Emma gave birth to Joey in August 2011.2 She used Covenant House services throughout her pregnancy. Ten days after Joey’s birth, Emma came to the Covenant House shelter in distress. She told staff members that he wouldn’t stop crying and hadn’t eaten since the previous night; she also described feelings of being “overwhelmed” and suffering from “post-partum psychosis.” Emma stated that she had felt like hurting Joey “three different times today” and that “sometimes I think about throwing him against the wall just to get him to shut up.” She described feeling like she couldn’t take care of him and didn’t “even want to touch him.” She had been using maxi pads and garbage bags as diapers, and Joey had developed a persistent rash. Covenant House staff filed a report with OCS and called the police. An OCS specialist attempted to contact Emma and after two days was able to meet with her. Emma denied all the allegations in the Covenant House report but admitted having bipolar disorder for which she was not receiving any treatment or services. The OCS specialist offered Emma mental health services, but Emma declined the services and indicated that she did not want to be medicated. The specialist thought 2 OCS attempted to identify and make contact with men that Emma listed as Joey’s possible father. A paternity test with the man listed on Joey’s birth certificate was negative. Another possible father was ruled out by a paternity test. A third possible father was notified by OCS of Emma’s termination proceedings; this possible father was incarcerated, opposed to a paternity test, and refused to participate in any proceedings. -4- 6893 that Joey appeared healthy and that Emma “was able to articulate how to care for a child”; OCS took no further action at that time. In September 2011 OCS received another report from Covenant House indicating concern about Joey’s health due to Emma’s homelessness, inability to care for an infant, and unrealistic expectations of an infant. After speaking with Joey’s primary care physician, the OCS specialist again determined that no further action was necessary at that time. OCS received an additional report in October 2011indicating that a medical professional had seen Joey and that Joey had smelled of body odor and urine. Another report in January 2012 detailed an incident at the Brother Francis Shelter where Emma appeared at the shelter screaming, temporarily left Joey unattended, and left in an angry and unstable state. On January 28, 2012, Joey was admitted to Providence Hospital with respiratory syncytial virus and dehydration. The hospital record reports that Emma “has had very poor visitation since the date of admission” and that she provided staff with inoperable phone numbers. On several occasions, Emma was aggressive and abusive toward the hospital staff. Hospital staff also reported “aggressive speech towards the infant as well as aggressive touch.” Joey was diagnosed with a heart rhythm disorder called supraventricular tachycardia, meaning that his heart beat could accelerate up to 300 beats per minute. This condition could be life threatening if left untreated or treated improperly. The prescribed treatment was monitoring and medication every eight hours, as well as the application of a cold compress when necessary. C. OCS’s Emergency Custody Of Joey In February 2012 Providence Hospital filed a report of suspected harm with OCS. The OCS specialist was eventually able to get Emma to attend a team decision meeting with OCS staff, nursing staff, and the social worker at Providence on February 8, 2012. They discussed Joey’s medical condition and Emma’s ability to provide care for him as well -5- 6893 as her mental health issues, homelessness, and unpredictable behavior. At the end of the meeting, Emma agreed that Joey should go into a foster home. OCS took emergency custody of Joey, and he was discharged to a foster family able to meet his medical needs. When Joey was discharged on February 9, 2012, the OCS specialist facilitated a meeting between Emma and the foster parent and asked Emma to participate in developing a case plan. Emma indicated that she was receiving treatment through Anchorage Community Mental Health Services (ACMHS), but she declined to sign a release of information for ACMHS. She did sign a release of information for the Brother Francis Shelter. Emma also declined the specialist’s offer to make a referral for mental health assessment, treatment, or medication. The specialist arranged for Emma’s visitation with Joey twice a week. OCS filed an emergency petition for adjudication of Joey as a child in need of aid and for temporary custody on February 9, 2012. D. OCS’s Case Plan And Efforts To Engage Emma On February 24, 2012, Emma and Joey’s case was assigned to OCS child service specialist William James. Prior to joining OCS, James was a school teacher for 22 years with experience in special education, including work with bipolar youth. James attempted to reach out to Emma with phone calls and offers to meet with her at “her comfort and availability.” He found her “reticent to engage with OCS.” He scheduled meetings with her on March 1, 9, and 15, but Emma failed to attend the meetings, despite James’s calls to remind her and emphasis on his “interest in engaging with her and assisting her in her reunification.” They were finally able to meet on March 20, and they developed a case plan. The case plan noted Emma’s “self-proclaimed mental health concerns that prevent her from behaving responsibly, or predictably on a day to day basis. Aggressive moo[d] swings and anger management [problems] create an unsafe environment for her child who has specific medical needs.” The case plan listed reunification as the initial -6- 6893 goal and stated OCS’s “desire . . . to assist [Emma] in obtaining the help she requires in stabilizing her observed and self-proclaimed depression and mood swings, as well as helping her to learn to care for her son’s medical needs.” Throughout the case plan, reference was made to Emma’s observed and self-reported mental health issues and strategies for addressing them. The case plan detailed OCS’s plan to refer Emma to the service providers that she identified as acceptable: ACMHS and CHOICES for mental health services, and Safe Harbor for housing services. The OCS caseworker was to maintain regular contact with the service providers, to provide a bus pass, and to support Emma by scheduling planning meetings with her. The case plan also described Emma’s resistance to receiving services, noting that “[Emma] did not believe she needed any support. She stated she just needed to straighten out her housing situation. [Emma] declined assistance with obtaining an assessment at [ACMHS], and she chose not to sign a release of information for ACMHS.” She also refused James’s help in communicating with Safe Harbor about the possibility of obtaining housing there. James scheduled additional meetings with Emma, but she failed to attend most of them. James was able to speak with her by telephone on April 5, 2012, and he asked her if she had followed her case plan; she said no. He offered to assist her with the services, including by providing transportation, and she declined his assistance. She also continued to decline to release any information from the mental health service providers to OCS. Emma received a screening survey from CHOICES on March 19, 2012, which was not sent to OCS at the time because she had not yet signed a release. Under the survey question “Does Client need [fetal alcohol spectrum disorder] assessment?” the staff member wrote “Yes” but for follow-up steps indicated “inappropriate for intervention.” On March 30, 2012, CHOICES conducted a behavior health assessment, which recommended case management and psychopharmacology management. -7- 6893 James continued to try to establish regular contact with Emma through March and April with limited success, mostly by telephone but also once by looking for her at the Brother Francis Shelter. Emma attended a court hearing on April 20, 2012, and James was able to speak with her at the court. He asked her to sign the OCS case plan as well as releases of information from her mental health service providers; she again refused. Emma missed the next scheduled meeting but called James on April 25. She was angry because a visit with Joey had been canceled due to his illness, and she accused James of being a liar. James continued to try to meet with Emma through May, but she continued to not attend the scheduled meetings. Emma also missed several appointments at CHOICES. There were also incidents at Brother Francis Shelter that resulted in Emma being barred from the shelter until she attended a grievance meeting; she failed to attend a grievance meeting. On May 14, 2012, James called Emma to inform her that due to the number of missed visits with Joey, they needed to reevaluate the visitation schedule. OCS visitation supervisors had removed Emma from the visitation schedule, but James had intervened to put her back on the schedule and continued to try to get her to attend the visits. She responded to James’s call by again calling him a liar and declaring that she would not be coming to OCS. Emma’s attorney eventually intervened and arranged for a meeting on May 21. Emma did attend this meeting, and she signed releases for ACMHS and CHOICES. James contacted those providers; CHOICES confirmed that Emma had received their services. CHOICES told James that they were helping Emma with managing her calender, seeing other people’s perspectives, not speaking violently, maintaining contact, and seeking housing. ACMHS told James that they had no record of Emma. James sent referrals for her to both agencies. -8- 6893 E. Child In Need Of Aid Adjudication In July 2012 the superior court held an adjudication hearing to determine if Joey was a child in need of aid. Emma failed to attend the hearing. She also failed to attend her scheduled visits with Joey; out of the 29 visits that were scheduled as of July 11, three were canceled due to weather; one due to illness; and 17 were missed by Emma. At the hearing, James reported that at the end of June and beginning of July he had seen some progress with Emma in her willingness to work with him and in her visits with Joey. He indicated, however, that he wanted to see her maintain that level of positive engagement for several more months before considering a return of custody. At the hearing, Emma’s lawyer commented briefly on OCS’s efforts, including the lack of a parenting class, and argued that OCS’s case plan “needs to be sort of blunt and concrete so that my client clearly understands what needs to be done and what happens if it doesn’t need to be done.” The court acknowledged that Emma’s “mental health issues are the crux of the matter” but found that OCS had made reasonable efforts toward family reunification “because everybody here has offered and she has rejected. We can’t make her do things, but they have to be offered to her.” The superior court adjudicated Joey to be a child in need of aid, particularly due to Joey’s medical need for careful and consistent attention. F. OCS’s Efforts Between The Adjudication Hearing And The Termination Of Parental Rights In August 2012 Emma underwent a behavioral health assessment at ACMHS, and James received the results. The assessment indicated that she had a serious and persistent mental illness but that she was able to express her feelings and make decisions. ACMHS’s case management plan included a psychiatric evaluation, individual therapy, medication management, communication with OCS, and help with establishing safe housing. James attempted to maintain monthly contact with both -9- 6893 ACMHS and CHOICES. However, sometimes his messages with ACMHS went unreturned. He also attempted to maintain “near weekly” contact with Emma although she responded only once a month on average. When James had an opportunity to speak with Emma, he would ask her if “she was getting the services she felt she needed, if ACMHS was following through on . . . their promises to her and if she needed other services and she typically would respond that she was following her case plan.” In September and October 2012, James spoke with Emma’s case manager at ACMHS who reported difficulty in contacting or meeting with Emma. When James contacted CHOICES in November 2012, he was informed that Emma had not been in contact with CHOICES since early June and that she had been discharged due to a lack of participation. James attempted to communicate with Emma about her case plan and her need to engage in services through multiple phone calls and letters mailed to Covenant House and to her mother’s address. In November 2012 James was able to meet with Emma, and she responded to his concerns by saying that she was following her case plan and actively engaged with ACMHS. She also told him that she did not need to participate in a case plan, would not work with CHOICES, had no contact with her attorney, and did not want to visit her son or respond to her case worker because she was afraid of being arrested. Because Emma reported greater engagement with ACMHS than the ACMHS case worker reported, James attempted to communicate with ACMHS while Emma was in his office, but they were unable to speak with her ACMHS case worker. When James was able to contact ACMHS in December, the case worker informed him that Emma had missed her recent appointments, including an appointment with a psychiatrist, and had not followed their plan since August. In January 2013 James was informed that Emma was making “sporadic contact” with ACMHS though she appeared to be “disengaged and had been missing recent appointments.” -10- 6893 On January 28, 2013, James filed a petition for the termination of Emma’s parental rights. The petition detailed Emma’s failure to engage with mental health services, work her case plan, establish safe housing, and consistently attend her scheduled visits with Joey. On February 4, 2013, James met with Emma and her attorney. Prior to this meeting, Emma had told James that she was taking the medication prescribed to her by ACMHS. At this meeting, Emma denied taking medication and said that she had not taken medication for several years. Emma told James that she had been assigned a new psychiatrist at ACMHS who refused to prescribe her medication; when James contacted ACMHS, he was informed that she had missed her appointment with her psychiatrist. In March 2013 the ACMHS case worker told James that Emma had moved into Safe Harbor, which provides housing for “individuals with mental health assessments and recommendations.” The case worker told James that the case worker had taken Emma shopping for food and clothes but that Emma remained inconsistent in her interactions and was in danger of losing her housing at Safe Harbor due to her lack of attendance at meetings. The case worker told James that when she was able to meet with Emma, the case worker found that Emma was “belligerent and demanding” and not making progress. G. Termination Of Emma’s Parental Rights The trial on OCS’s petition to terminate Emma’s parental rights was held on April 29, 2013. Between the time of Joey’s removal in February 2012 until the termination trial in April 2013, Emma was scheduled for 64 visits with Joey; she attended 17. She had 33 scheduled meetings with James; she attended 13. In response to Emma’s expressed sleep problems, James asked her to choose a time and location comfortable for her for scheduling meetings and visits. When he scheduled afternoon visits with Joey, she failed to attend. Emma agreed with James’s testimony that she had -11- 6893 missed two-thirds of her scheduled visits with Joey. She testified that she missed visits because of family issues and “legal issues with an assault charge and a [domestic violence] order against me.” The superior court found that Joey continued to be a child in need of aid due to Emma’s neglect and mental illness and that termination of the parental rights of Emma and any possible father was in Joey’s best interests. The superior court also found that OCS’s reunification efforts were reasonable, noting James’s difficulty in communicating with Emma as well as her misleading statements to James. The superior court terminated Emma’s parental rights. She now appeals the superior court’s finding that OCS’s reunification efforts were reasonable and that she failed to remedy her conduct in a reasonable time.