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In re A.T.

Court of Appeals of Ohio, Second District, Montgomery

August 30, 2019

IN RE: A.T., E.G., & D.G.

          Appeal from Common Pleas Court Case Nos. 2016-4187, 2016-4188, 2016-4189- Juvenile Division

          MATHIAS H. HECK, JR., by SARAH E. HUTNIK, Montgomery County Prosecutor's Office, Appellate Division, Attorney for Appellee

          MARSHALL G. LACHMAN, Attorney for Appellant/Father

          SARA M. BARRY, Attorney for Appellant/Mother


          FROELICH, J.

         {¶ 1} Following the parents' separate objections to a magistrate's decision, the juvenile court awarded permanent custody of three-year-old D.G.[1] to the Montgomery County Department of Job and Family Services, Children Services Division ("the Agency"), and legal custody of D.G.'s siblings, 12-year-old AT. and two-year-old E.G., [2]to the non-family guardians ("Mr. & Mrs. H") with whom AT. and E.G. had been living for more than two years. Mother, who is the parent of all three children, and Father, who is the "legal"[3] parent of D.G. and E.G., [4] filed separate appeals from that judgment, which appeals have been consolidated before this Court. The judgment of the trial court will be affirmed.

         Factual and Procedural Background

         {¶ 2} The Agency first became involved with Mother and her three children in or about January 2015, following a referral related to A.T.'s repeated absences from school. An investigation found that the home where Mother and the children were living was "very cluttered," with "little room for an adult to move or a child to play." (See Case No. 2016-4189, Doc. #73, p. 2.[5]) Other concerns also were recorded, including the "dirty and unkempt" appearance of both AT. and D.G., the two older children. (Id.) However, removal of the children was not found to be warranted at that time.

         {¶ 3} On June 29, 2016, when Mother's mother ("Maternal Grandmother") dropped AT. and D.G. at daycare, she told the staff that D.G. had a "sunburn" on his bandaged left leg. Upon unwrapping that leg, staff at the daycare saw what appeared to be "a severe second degree burn" that was "not consistent with a sunburn." (Id.) The daycare contacted the Agency, which contacted Mother and the police. Both AT. and D.G. immediately were placed in the Agency's emergency custody. D.G. was transported to the hospital, where Mother met with an Agency representative and "gave several different stories as to what had happened" to D.G.'s leg, none of which was consistent with the injury. (Id.) The Agency also became aware of an earlier injury to D.G., evidenced by a large bruise at the base of D.G.'s skull detected by daycare staff on June 1, 2016.

         {¶ 4} E.G., an infant, also was removed from Mother's care and transferred to the Agency's emergency custody at that time. E.G. was placed with non-relative caregiver Mrs. H, while AT. initially was placed with a different caregiver. [6] On June 30, 2016, the Agency filed an abuse, neglect and dependency complaint as to D.G., as well as neglect and dependency complaints as to AT. and E.G. By interim order entered that day, the juvenile court granted temporary custody of E.G. and AT. to their respective caregivers and temporary custody of D.G. to the Agency. (Doc. #69.)

         {¶ 5} Shortly thereafter, the Agency filed an initial case plan with a stated goal of returning all three children to parental custody. (Doc. #67.) The case plan noted that Mother "appear[ed] to love her children very much" and "ha[d] a strong support system." (Id.) However, the plan also noted that Mother acknowledged experiencing mental health issues, lacked independent housing, had limited income, lived in "deplorable" conditions, and was in a relationship with Father, who had been convicted of domestic violence against Maternal Grandmother and also had two recent child endangering charges.[7]

         {¶ 6} The plan set specific objectives for both Mother and Father. Mother was to 1) obtain and maintain stable housing, 2) obtain and maintain sufficient income to support her family, 3) follow up with recommended mental health counseling and comply with any recommendations, including as to medication, and 4) complete a parenting and psychological evaluation and follow through with all recommendations. Father was to 1) comply with all conditions of his probation and receive no new criminal charges, 2) successfully complete a domestic violence/batterer's intervention program, 3) follow through with mental health counseling and medication as indicated, 4) successfully complete a parenting and psychological evaluation and follow through with all recommendations, and 5) have stable income and housing and "financially and emotionally support his children." (Id.) Both Mother and Father signed the plan document.

         {¶ 7} On August 24, 2016, a guardian ad litem ("GAL") appointed as to all three children filed a report with the juvenile court. The GAL reported that AT. had been moved to live with Mr. and Mrs. H and that both AT. and E.G. appeared to feel comfortable there. D.G. was in a different home with a foster family. According to the GAL, AT. stated that Mother "can't take care of the [babies] she has." (Doc. #60, p. 2.) The GAL reported that AT. also recently had "disclosed instances of abuse" by Father (who is not A.T.'s father.) Mother reportedly no longer was in a relationship with Father, but had begun a new relationship. The GAL stated that although AT. said she "missed" Mother, AT. did not want to return to Mother's custody. Mother frequently was late for supervised visits, but did attend those visits and "appeared to care for" the children. (Id.) The GAL recommended that the Agency's temporary custody of D.G. be extended; that Mrs. H be granted temporary custody of AT.; that Mrs. H's temporary custody of E.G. be extended; and that Father be ordered to have no contact with AT.

         {¶ 8} Following a hearing on August 30, 2016, the juvenile court adjudicated AT. and E.G. dependent and neglected children; adjudicated D.G. a dependent, neglected, and abused child; granted temporary custody of AT. and E.G. to Mrs. H through July 1, 2017; and granted temporary custody of D.G. to the Agency through July 1, 2017. (Doc. #58.) The court also approved the previously-filed case plan.

         {¶ 9} A semi-annual review conducted by the Agency in November 2016 reflected that Mother was living with Maternal Grandmother and was engaged to marry a convicted sex offender (not Father). (Doc. #55.) Mother was maintaining "sporadic" contact with the children and was in counseling, but her income was insufficient to meet the children's needs. The review concluded that Mother had made "very little progress" on her case plan. (Id., p. 6.) Father had been investigated for sexual abuse allegations involving AT. He had participated in some domestic violence classes, but had not followed through on mental health referrals.

         {¶ 10} A similar review conducted in May 2017 showed that Mother was compliant with mental health services and had completed parenting classes, but continued to lack independent housing, staying either with her boyfriend (the convicted sex offender) or with Maternal Grandmother. (Doc. #54.) Father was residing with his girlfriend, had no income, had missed multiple parenting classes and had not completed a batterer's program, was "inconsistent with his mental health provider," did not consistently visit his children, and had "voiced the possibility of moving to Oklahoma." (Id., p. 2.) The May 2017 review concluded that a "level of risk" remained as to placing the children with Mother, and that Father had made "marginal progress" toward his case plan objectives. (Id., p. 4.) The Agency recommended that all three children remain in their current placements, but suggested that "a permanency review" might be needed "based on time frames." (Id.)

         {¶ 11} Thereafter, the Agency filed a motion for a first extension of temporary custody as to D.G. (Doc. #53), as well as motions for first extensions of temporary custody to non-relatives with respect to both E.G. and AT. (See Id., Case Nos. 2016-4188 and 2016-4187, Doc. #47.) All three motions were supported by affidavits attesting that Mother had made "some progress" and/or Father had made "minimal progress" on their respective case plan objectives, but detailing shortfalls that the Agency believed to warrant extensions of the children's existing temporary custody placements. (Doc. #53; Case Nos. 2016-4188 and 2016-4187, Doc. #47.) Following an August 15, 2017 hearing, the juvenile court granted the motions and extended the temporary custody orders as to all three children through December 31, 2017. (Doc. #42.)

         {¶ 12} On October 31, 2017, the Agency filed motions, again with supporting affidavits, seeking second extensions of temporary custody as to all three children. The following month, the Agency conducted its semi-annual review. The report of that review chronicled a variety of medical issues afflicting each child, including A.T.'s diagnoses of post traumatic stress disorder (PTSD) and attention deficit hyperactivity disorder (ADHD) and her hospitalizations due to self harm and flashbacks; E.G.'s diagnoses of celiac[8] disease and "global developmental delays" and his participation in speech, occupational, and physical therapy; and D.G.'s diagnoses of Chiara malformation and developmental delays and his participation in speech, occupational, and physical therapy. (Doc. #39.) The report disclosed that Mother's visits with AT. had been "suspended" and that Father was "no longer involved" in visits with E.G. and D.G. (Id.)[9] Mother continued to have visits with both boys, although D.G. displayed "very flat effect" [sic] during those visits. Mother had no independent housing and worked "only a few hours a week." She recently had completed a parenting psychological assessment, based on which the assigned psychologist "did not support unification." (Id.) Father had completed a parenting class and a program for batterers, but he had no known income or stable housing, he had not completed a parenting psychological assessment or anger management, and he was "refusing to take medications." (Id.) Father was on probation as a result of "threatening the case worker and the deputy" during a supervised visit, and he had not been in contact with the Agency since.

         {¶ 13} The review concluded that the existing placements of all three children remained safe and appropriate. Based on Mother's recent psychological assessment results, the Agency on November 28, 2017 moved for permanent legal custody of D.G. (who remained with the same foster family), and that legal custody of AT. and E.G. be given to Mr. and Mrs. H, their existing custodians.

         {¶ 14} In a report filed on November 29, 2017, the children's GAL described her recent individual visits with each child. (Doc. #37.) AT. was struggling in school and with "delicate" mental health after revealing incidents of past sexual and psychological abuse. (Id., p. 3.) The GAL reported that AT. had not seen Mother in over a year based on the recommendation of A.T.'s psychologist, who believed that visits with Mother were triggers for AT.'s "mental health crises" (i.e., "episodes of hospitalization and/or breakdowns"); such episodes could be triggered by visits or voice communications with Mother, or "even if [AT.] is only reminded of [Mother] by smell o[r] the mention of her name." (Id.)

         {¶ 15} The GAL described E.G. as "clean and happy," but "atypical in appearance." (Id.) According to the GAL, E.G. was "extremely small for his age and ha[d] not reached many of his age[-]related goals." (Id.) E.G. was deemed "likely * * * [to] require special services for the foreseeable future." (Id.) D.G. had undergone surgery for Chiari malformation and was progressing well physically, but was at risk for developmental disabilities. The GAL described D.G. as "walking * * *[, ] playing * * *[, ] well cared for and content." (Id.) All three children reportedly were bonded with their caregivers. Both boys continued to have visits with Mother.

         {¶ 16} Mother missed her first appointment with the GAL, but did appear for a rescheduled appointment. Mother expressed determination to "fight for all three of her children," and said she believed that her separation from AT. was not in A.T.'s best interest. Mother had attended medical appointments for and visits with both E.G. and D.G. and asserted that she was "learning to engage" with them. (Id.) Mother continued to live with Maternal Grandmother and work part-time. She had no contact with Father or with AT.'s father. Mother said she "would have taken action" had she realized that AT. was being sexually abused. (Id., p. 4.) Mother denied being in a relationship, but said she had a helpful "friend," the man previously identified as her boyfriend and a sex offender. (Id.) Mother claimed, however, that the friend's conviction "was a mistake." (Id.) She said she would be willing to "remov[e] him from her life" if necessary to reunite with her children. (Id.)

         {¶ 17} AT. reportedly told the GAL that she did "not wish to return to the care of her mother and wished to remain with Mr. and Mrs. H. (Id., p. 5.) The GAL expressed "multiple concerns" about reunifying any of the children with Mother, including a concern that Mother was "cohabitating with a sex offender despite her denial." (Id.) Mother told the GAL that she (Mother) would have "no concern leaving the children, including AT.," in that man's care while Mother was at work. (Id.) The GAL also was concerned about Mother's "minimiz[ing] AT.'s trauma" and Mother's lack of awareness at the time of the alleged abuse. Further, the GAL doubted Mother's ability to consistently schedule and attend the children's necessary appointments. "Most importantly," the GAL doubted Mother's ability to provide adequate parental care for the medical, developmental, and/or mental health issues of all three children.

         {¶ 18} The GAL's report subsequently was amended after AT. again was treated at the emergency room for flashbacks following contact "with Mother and other maternal relatives." (Doc. #26, p. 2.) The GAL opined that "contact with mother is detrimental to [A.T.]'s mental health well-being." (Id.)

         {¶ 19} The matter was scheduled for a dispositional hearing on January 31, 2018 as to the pending motions for permanent and legal custody. (Doc. #36)

         a. Agency's Evidence

         {¶ 20} On January 31, 2018, a juvenile court magistrate held a hearing at which both Mother and Father appeared. D.G.'s foster mother ("Foster Mother) testified that D.G. had been living with her since June 2016, when he was just over one year old. Foster Mother said that when D.G. arrived in her care, he "was covered * * * in bug bites[, ][10]* * * had a large burn on his leg[, * * * and had] light bruising sporadically on his body." (Tr., Vol. I, p. 16.) She said he later had "chronic ear infections" and was "sick almost continuously," eventually leading her to take him to an immunology specialist. (Id., p. 21.) Foster Mother said that D.G. had been hospitalized three times for various ailments while in her care. (Id., p. 25.) One of those was for brain surgery in November 2016, to treat Chiari malformation, a condition in which part of D.G.'s brain protruded out of his skull and "down in his neck." (Id., p. 23.) She said that D.G. would need continued monitoring for that condition in order to detect headaches, balance issues, speech impairment, or other altered motor functioning that could be signs of a new problem. (Id., pp. 23-24.)

         {¶ 21} Foster Mother also expressed concern about D.G.'s "emotional state." (Id., p. 16.) She said that from the time he arrived in her home, D.G. behaved differently than other foster children for whom she had cared. For example, when she tried to put D.G. to sleep, "[h]e just kept waking up and jerking * * *." (Id.) She opined that D.G. "didn't [seem to] feel like it was safe to go to sleep." (Id.) In addition, "it would take an hour to change his diaper because he would fight so violently"; "[h]e would claw at me. He would kick at me, and he would scratch. He would like be swinging his arms, trying to hit me. * * * [H]e acted like someone who was afraid of everything." (Id., p. 17.) At the time of the hearing, D.G. continued to have behavioral outbursts "[m]ultiple times a week," including hitting adults and other children. (Id., p. 27.) D.G. had begun to see a counselor for help with managing those issues. (Id.)

         {¶ 22} Foster Mother described developmental delays that affected D.G. When he arrived in her care, "[h]e couldn't sit up yet on his own. * * * He wasn't walking." (Id., p. 16.) He could "kind of" crawl, but not a "normal crawl"; "his balance was really bad," and "he would fall over when trying to sit up. (Id.) At the time of the hearing, D.G. was participating in speech therapy, physical therapy, and occupational therapy, and was "catching up, but * * * still somewhere between six and twelve months behind where he should be for his age." (Id., pp. 19-20.) Foster Mother said that D.G. had been diagnosed with "complex developmental trauma" that contributed to his delays. (Id., pp. 20, 28-29.)

         {¶ 23} Foster Mother said that she and her husband were interested in adopting D.G. They had two biological children, one of whom was grown and out of the house, and two other adopted children. (Id., p. 32.) Foster Mother said that D.G. was "really * * * attached" to the other children in the home. She described D.G. as being "like our birth child. * * * We just really love him." (Id., p. 31.)

         {¶ 24} Dr. Rhonda Lilley, a clinical psychologist, appeared as the Agency's expert witness. Dr. Lilley testified that she met with Mother on three occasions - on December 22, 2016, with Mother alone, and again in March and June 2017, when D.G. and E.G. also were present with Mother. During the first meeting, Dr. Lilley conducted a clinical interview to learn about Mother's background, "what led her to be involved with Children Services," "her issues and concerns," and to "explore [Mother's] mental history[, ] and * * * strengths and weaknesses as a parent." (Id., pp. 42-43.) Mother also was asked to complete various psychological tests at that time. (Id., p. 43.)

         {¶ 25} During the two later visits, Dr. Lilley focused on observing Mother's interactions with D.G. and E.G. She said that the March 2017 visit was "very brief * * * because of the distress of one of the children." (Id.) The June 2017 visit then was scheduled to allow Dr. Lilley to witness more interaction with the children. At that time, Dr. Lilley also sought updated information about Mother's employment, housing, and life.

         {¶ 26} Dr. Lilley identified a report she prepared based upon her clinical interview with, and her observations and testing of, Mother. (State's Exh. 1.) The report recorded Dr. Lilley's assessment that Mother displayed "excessive" defensiveness, indicative of a person "who tends to deny a lot of responsibility for [her] behavior." (Id., p. 48.) Dr. Lilley said that Mother's "limited insight" into her "dysfunctional" behavior could affect her parenting ability, leaving Mother less likely to "see a reason to change" and "more likely to make decisions that are in [her] own best interest rather than in the interest of [her] children." (Id., pp. 49-50.) Dr. Lilley termed that "a significant concern," manifested through examples such as Mother's blaming AT. for causing D.G.'s leg burns by placing him in a swing, and Mother's defending Father instead of advocating for AT. with respect to A.T.'s allegations of sexual abuse. (Id., pp. 50-51.) Dr. Lilley noted that at the time of the interview, Mother was involved with a man who "had a history of sexual abuse of a minor," yet Mother claimed the prior abuse history was not her partner's fault because "the child had lied about her age." (Id., pp. 52-53.) Dr. Lilley expressed concern about Mother's failure to acknowledge the "red flag" indicating that the man posed a potential risk to her children. (Id., p. 53.) Dr. Lilley said that Mother's pattern with regard to people she brought into her life "creates a high risk factor" as to "providing a safe environment for her children[, ] * * * where the child's interest and needs are primary rather than secondary." (Id., p. 53-54.)

         {¶ 27} As to the results of the Parenting Stress Index ("PSI") test Mother completed, Dr. Lilley noted that Mother did not identify any life stressors, despite "not having a job," her children being absent from her home, A.T.'s refusal to visit Mother, and D.G.'s having recently been diagnosed with Chiari malformation. (Id., pp. 55-56.) Dr. Lilley stated that Mother's failure to recognize those factors as stressors could indicate a lack of empathy or ability to make accommodations. She said that Mother did report feeling "strongly bonded with her children." (Id., p. 56.)

         {¶ 28} Dr. Lilley said that on another psychological test, Mother described "feelings of persecution" related to the custody issues with her children. (Id., p. 59.) Mother "did express regret" about her selection of partners around her children and about having AT. "assume some of the parenting responsibilities" while AT. lived with Mother. (Id.)

         {¶ 29} According to Dr. Lilley, her interview with Mother revealed that Mother "had some very difficult life experiences," including abuse, that "likely have affected her emotional well-being" and her parenting. (Id., p. 60.) Mother reported "a long pattern of * * * living with her mother, trying to live on her own unsuccessfully, and then back living with her mother." (Id., p. 61.) As of June 2017, Mother again was living with Maternal Grandmother. Mother provided no history of long-term stability in housing or employment. Dr. Lilley observed that "it's very hard to provide a stable environment for your children if you don't have a stable residence, if you don't have a stable income from which to support them. Those are two critical elements in providing a safe and consistent environment" for one's children. (Id.) Dr. Lilley concluded that Mother tended "to be dependent upon others," including "considerable dependency" on Father during their relationship, as well as dependency on Maternal Grandmother. (Id., pp. 61-62.)

         {¶ 30} Regarding her observations of Mother with D.G. and E.G., Dr. Lilley reported that Mother arrived 30 minutes late for the March 31, 2017 visit. While awaiting Mother's arrival, Dr. Lilley observed E.G. and D.G. engaging in "very positive" interactions with their caregivers. (Id., p. 63.) After Mother arrived, however, E.G., the younger son, was "so distressed" to be separated from his caregiver that Dr. Lilley "terminated the parent/child interaction." (Id., p. 62.)

         {¶ 31} During the rescheduled June 23, 2017 visit, Dr. Lilley began with Mother and the caregivers in the same room with E.G. and D.G. When the caregivers left, E.G. "whined a little bit, but * * * did not act distressed." (Id., p. 64.) Dr. Lilley said the boys at first exhibited "no reaction" to Mother's presence; "They didn't run to her. They didn't smile in greeting with her." (Id., p. 66.) E.G. eventually engaged in play with Mother, while D.G. "played more independently;" D.G. "didn't avoid contact" with Mother, but "he didn't actively engage her in play. (Id., p. 65.) Although Dr. Lilley felt that Mother initially did not react "very proactively," she later "did a good job of getting each one of the kids a toy to play with." (Id.) It was Dr. Lilley's understanding that AT. had refused to participate in the March and June 2017 visits with Mother.

         {¶ 32} Based on her observations during the June 2017 visit, Dr. Lilley concluded that Mother "was bonded with her sons, * * * cared very much about them, and * * * wanted to have a relationship with them." (Id., p. 66.) However, E.G. and D.G. "did not demonstrate a strong attachment or even a strong bond" to Mother. (Id.)

         {¶ 33} Dr. Lilley diagnosed Mother as having an adjustment disorder with both depression and anxiety, as well as a personality disorder, "undifferentiated with dependency features." (Id., p. 67.) She opined that the combination of those disorders created "significant concerns" regarding Mother's "decision making, problem solving, [and] tendency to make decisions that are in [Mother's] own best interests." (Id., p. 68.) Dr. Lilley stated that such "entrenched" behaviors amount to "risk factors for * * * an environment where the parent's needs may come first rather than the child's, where the parent's need for love and security may come at the expense of the child's needs for safety and security." (Id.) She testified that caring for children with special needs "would increase and exacerbate the risk." (Id., p. 70.)

         {¶ 34} Dr. Lilley said she hoped that with "adequate treatment," Mother "could overcome some of the problematic aspects of her personality dynamics," but "it is not a short term process." (Id., p. 68-69.) Dr. Lilley opined that such entrenched characteristics "aren't cured in * * * even six months of counseling" (Id., p. 69.) On cross-examination, she termed the prospect of Mother overcoming such issues in five months "[h]ighly unlikely" and "very doubtful." (Id., pp. 70, 71.)

         {¶ 35} Also on cross-examination, Dr. Lilley stated that "the issue was never whether [Mother] loved her children or whether she wanted to parent them. The issue was capacity to parent, which is where I found her lacking." (Id., p. 73.) She noted that since A.T.'s birth, Mother

has failed to demonstrate financial stability, interpersonal stability, relationship stability; has consistently made choices that were in the best interest of herself rather her children. That's a ten-year period. For every ten years of dysfunction, we need almost an equivalent amount of intensive therapy * * * so that we can say this person is not a risk factor for themselves and/or for their children.

(Id., pp. 73-74.)

         {¶ 36} On re-direct, Dr. Lilley reiterated that, as a "[g]eneral rule," in order to expect significant progress, "for every year of dysfunction, we want at least a year or two of intensive therapy. Not months or weeks. Years." (Id., p. 76.)

         {¶ 37} The Agency's final witness was Cathie Stokes, a child services caseworker who had been involved with Mother and her family "off and on since January 2015." (Id., p. 78.) Stokes said the Agency opened a case in October 2015 after a referral alleged "deplorable conditions in [Mother's] home" and raised concerns about A.T.'s school attendance. (Id.) The investigation at that time found Mother's home to be "in pretty poor shape," but not bad enough to warrant A.T.'s removal. (Id., p. 79.) Instead, the Agency developed a case plan "to work with [M]other to address the concerns." (Id.) Ultimately, however, the children were removed from the home in June 2016, and had not returned to Mother's care or the care of their respective fathers since.

         {¶ 38} Stokes testified that when the children were removed in June 2016, AT. was placed with a relative, D.G. was placed in foster care, and E.G. was placed with Mrs. H, a non-relative caregiver. In August 2016, after the relative proved unable to pass a home study, A.T.'s placement was changed to the home of Mr. and Mrs. H, where A.T.'s brother E.G. already was living. D.G. had remained in the same foster home since June 2016, and E.G. and AT. had remained with Mr. and Mrs. H.

         {¶ 39} Stokes said that Foster Mother lived in a large home with adequate space for D.G., and that Foster Mother had expressed interest in adopting D.G. Stokes said that from her observations, D.G. appeared to be "[v]ery much" bonded with both Foster Mother and her husband, as well as with their biological and adopted children. (Id., p. 82.) Although Stokes testified that D.G. had special needs, including Chiari malformation and related brain issues, global developmental delays, and complex developmental trauma, Stokes had no concerns about his foster parents' ability to meet those needs. She said D.G. recently had started to see a psychologist.

         {¶ 40} Stokes expressed similar confidence in E.G.'s and A.T.'s placement with Mr. and Mrs. H, despite each child's special needs. She said that AT. had been in counseling one or two times a week for seven months for PTSD and anxiety. Stokes said that, because AT. "has experienced so much trauma," counselors "are using trauma-focused cognitive behavioral therapy" to help her work through that trauma. (Id., p. 85.) According to Stokes, AT. had had "multiple emergency room visits" and been hospitalized twice, most recently in the fall of 2017, due to experiencing "flashbacks" where she became "out of touch with reality, [wa]s in danger of hurting herself, bec[a]me aggressive with herself and others." (Id., pp. 84, 86-87.) Stokes said that A.T.'s therapist had recommended that AT temporarily not have contact with Mother because Mother seemed to be a "trigger" for those flashbacks. (Id., p. 85.) AT. had begun taking prescribed medication to help address her condition, and "seem[ed] to be doing better." (Id., p. 87.)

         {¶ 41} Stokes said that AT. had "struggled for the past semester" in school due to the consequences of her flashbacks. AT. was in an online school program and on an IEP due her special needs. Again, Stokes said that AT. "seem[ed] to be doing better" on her new medication. (Id., p. 90.) Stokes testified that AT. also had been referred for genetic testing for "possible genetic issues," and that both AT. and E.G. were being examined for "possible alcohol-related neuro developmental disorders." (Id., p. 84.)

         {¶ 42} Turning to E.G., Stokes testified that he was "in physical, occupational[, ] and speech therapy for some global developmental delays." (Id., p. 88.) She said that E.G. also had been diagnosed with celiac disease, hearing issues, weakness on one side of his body, and "vestibular ataxia, where his balance is off." (Id.) Stokes said she had no concerns about the ability of Mr. and Mrs. H to meet E.G.'s special needs.

         {¶ 43} Stokes stated that the Agency was seeking permanent custody of D.G. She confirmed that the goal of the original case plan developed by the Agency had been reunification of each child with Mother or his or her respective father. (Id., pp. 92-93.) Stokes testified that Mother had agreed to the case plan's objectives for her, including that Mother continue to attend counseling; have a medication evaluation and follow through with any recommendations; complete a parenting and psychological evaluation and follow through with any recommendations; obtain and maintain stable income and housing; complete a parenting education class; sign releases of information to the Agency; visit the children regularly; and attend the children's medical, educational, and mental health appointments, as recommended by the providers. The counseling and medication objections were included because Mother "admitted that she had experienced mental health issues," and later was diagnosed with adjustment disorder. (Id., p. 94.) No medication had been recommended for Mother, and she had been mostly compliant with counseling. (Id., p. 95.)

         {¶ 44} Stokes said that the Agency supported Dr. Lilley's recommendations. (Id., pp. 96-97.) Mother had been employed for over eight months in the same part-time job and admitted that her income was not sufficient to provide for the children's needs. According to Stokes, she had been referring Mother for other job opportunities for over a year and a half, "but I don't believe she ever did follow through," except with one call to Goodwill. (Id., p. 99.) Mother previously had one ...

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