In re Interest of Mitoria R. & Cortez T. ( 2016 )


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  •                           IN THE NEBRASKA COURT OF APPEALS
    MEMORANDUM OPINION AND JUDGMENT ON APPEAL
    (Memorandum Web Opinion)
    IN RE INTEREST OF MITORIA R. & CORTEZ T.
    NOTICE: THIS OPINION IS NOT DESIGNATED FOR PERMANENT PUBLICATION
    AND MAY NOT BE CITED EXCEPT AS PROVIDED BY NEB. CT. R. APP. P. § 2-102(E).
    IN RE INTEREST OF MITORIA R. AND CORTEZ T., CHILDREN UNDER 18 YEARS OF AGE.
    STATE OF NEBRASKA, APPELLEE,
    V.
    VICTORIA R., APPELLANT.
    Filed June 21, 2016.    A-15-1049.
    Appeal from the County Court for Madison County: ROSS A. STOFFER, Judge. Affirmed.
    Matthew A. Headley, Madison County Public Defender, and Megan E. Osler for appellant.
    Gail E. Collins, Deputy Madison County Attorney, for appellee.
    Jason Lammli, guardian ad litem for appellant.
    Martin V. Klein, guardian ad litem for children.
    PIRTLE, RIEDMANN, and BISHOP, Judges.
    BISHOP, Judge.
    Victoria R. appeals from the decision of the county court for Madison County, sitting as a
    juvenile court, terminating her parental rights to her children, Mitoria R. and Cortez T. We affirm.
    BACKGROUND
    Victoria is the biological mother of Mitoria, born in June 2012, and Cortez, born in May
    2007. The children’s fathers were not a part of their lives, are not part of this appeal, and will not
    be discussed any further. Mitoria and Cortez were removed from Victoria’s care on October 1,
    2013, after the Nebraska Department of Health and Human Services (DHHS) investigated reports
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    of Cortez’ excessive absences from school (more than 10 days by the end of September), and a “J”
    shaped injury to his abdomen which a doctor opined was non-accidental.
    On October 1, 2013, the State filed a petition alleging that Mitoria and Cortez were children
    as defined by Neb. Rev. Stat. § 43-247(3)(a) (Supp. 2013) due to the faults or habits of Victoria in
    that: Cortez had an non-accidental injury on his stomach for which Victoria refused to cooperate
    with law enforcement and provide an explanation; and due to the above allegation the children
    were at risk for harm. On that same date, the State also filed for, and was granted, immediate
    custody of Mitoria and Cortez; they have been in an out-of-home placement ever since. On October
    13, a guardian ad litem (GAL) was appointed for the children.
    On January 10, 2014, the State filed an amended petition alleging that Mitoria and Cortez
    were children as defined by § 43-247(3)(a) and set forth the same grounds as noted above, but also
    included an allegation that Cortez had an excessive number of school absences.
    On January 13, 2014, after a contested hearing, the juvenile court adjudicated Mitoria and
    Cortez to be within the meaning of § 43-247(3)(a). The court ordered the children to remain in the
    custody of DHHS.
    The court held a disposition hearing on March 25, 2014. In its order filed that same day,
    the court adopted the provisions of the DHHS case plan dated March 12 and ordered all parties to
    comply with the terms of the case plan. The DHHS case plan recommended a permanency plan of
    reunification with an alternative plan of adoption. Among the plan’s provisions were: that Victoria
    comply with the recommendations of her psychological evaluation including, but not limited to,
    individual and family therapy, “parenting skills,” evaluation for medication management, and
    support groups; and that Victoria have supervised visits with two supervising persons in
    attendance. The specific goals and strategies set forth in the case plan will be addressed later in
    our opinion via the testimony of Vickie Christiansen.
    Review hearings were held in June, October, and December 2014. The court continued to
    adopt the provisions of the DHHS case plans, which remained unchanged since March.
    Additionally, in its June order, the court ordered Victoria to attend and cooperate in counseling,
    and attend and cooperate at visits.
    On March 2, 2015, the State filed a supplemental “petition” to terminate Victoria’s parental
    rights to Mitoria and Cortez pursuant to Neb. Rev. Stat. § 43-292(5), (6), and (7) (Cum. Supp.
    2014). The State alleged that: Victoria was unable to discharge parental responsibilities because
    of mental illness or mental deficiency and there were reasonable grounds to believe that such
    condition would continue for a prolonged indeterminate period; reasonable efforts to preserve and
    reunify the family had failed to correct the conditions leading to the adjudication; the children had
    been in out-of-home placement for 15 or more of the most recent 22 months; and termination was
    in the children’s best interests.
    On March 3, 2015, the children’s GAL filed a motion to suspend Victoria’s visitation. The
    GAL alleged: Victoria had not complied with the case plan/court reports as ordered by the court;
    Victoria had not complied with the requests of DHHS and family support workers; Victoria had
    not complied with requests from counselors; and an attached letter from Cortez’ therapist stated
    that it would be in the children’s best interests to suspend visits with Victoria.
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    On March 5, 2015, a GAL was appointed for Victoria. On March 6, Victoria filed a motion
    for change of placement, and asked the court to place Mitoria and Cortez with her.
    A hearing on the motion to suspend visitation was held on April 28, 2015. In its order filed
    on May 7, the juvenile court sustained the motion and suspended visitation between Victoria and
    the children “until such time as this matter is resolved at the Termination Hearing or until such
    time as Victoria demonstrates that visitation between her and the minor children is in the children’s
    best interest[s].”
    The termination hearing began on August 6, 2015, and continued on August 7 and 14.
    Testimony was given and evidence was received as to why Victoria’s parental rights should be
    terminated. Victoria did not testify.
    Traci Fox, a children and family services specialist with DHHS, testified as follows. In
    September 2013, DHHS received a report concerning educational neglect, because even though
    the school year had just begun, Cortez had already missed a significant number of school days.
    Fox was assigned to investigate the report. When Fox went to the family’s home, Victoria did not
    answer the door for several minutes, and when she did open the door she was uncooperative. Later
    in September, DHHS received a second report concerning possible physical abuse of Cortez. Fox
    again went to the family’s home, and when Victoria finally answered the door she was agitated,
    and was hollering and screaming; law enforcement had to step in between Victoria and Fox. After
    Fox, law enforcement, and one of Victoria’s relatives tried to calm her down, Victoria walked
    away and refused to converse any further. Fox and law enforcement obtained an ex parte order to
    remove the children. When they went to remove the children on October 1, Victoria refused to
    open the door or engage in conversation. After a search warrant was obtained, law enforcement
    forcibly entered the home and removed the children. Because of her actions during the removal
    process, Victoria was arrested; the record reflects that Victoria subsequently pleaded guilty to
    obstructing a police officer, a Class I misdemeanor, and was sentenced to 6 months’ probation.
    Based on her interactions with Victoria, Fox was concerned that Victoria had mental health
    and intellectual functioning issues that would impact her ability to parent. Fox testified that
    Victoria would often give responses that were not relevant to the question being asked, would not
    cooperate with workers, and continued to believe that the children would be returned to her “at the
    next hearing.” After she referred Victoria for a psychological evaluation, Fox was no longer
    involved in the case.
    Vickie Christiansen, a child a family services specialist with DHHS, testified as follows.
    She was assigned to this case on October 18, 2013, taking over for Fox. After the children were
    adjudicated in January 2014, Christiansen authored a court report/case plan on March 12, 2014,
    prior to the disposition hearing; the goals and strategies set forth in that case plan remained the
    same throughout this case. The March court report and case plan was received into evidence as
    exhibit 54.
    Christiansen testified that the March 2014 court report and case plan set forth two goals for
    Victoria. Goal number one was that Victoria would “provide a safe and stable environment for
    Cortez and [Mitoria] free of physical discipline where there [sic] physical and emotional needs are
    being met.” Six strategies were listed for achieving that goal. The first strategy was that Victoria
    would work with providers on appropriate, non-physical discipline. Christiansen testified Victoria
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    had not made any progress on this strategy, as she had not been amenable to working with support
    workers, Dr. Snitchler (Cortez’ therapist), or Dr. Hannappel (Victoria’s therapist); she said that
    Victoria did not believe she had a problem as it related to discipline.
    The second strategy was that Victoria would work with providers on developing and
    utilizing coping skills for when she felt anxious or upset. Christiansen testified that family support
    services, individual therapy, and supervised visits had been offered to Victoria to help her develop
    these skills but Victoria felt she did not need help.
    The third strategy was that Victoria would work with providers on engaging with her
    children in nurturing activities and interacting with them both together and individually. Again,
    Christiansen stated that family support workers and individual therapists had given Victoria
    suggestions, but she had not followed through; Victoria rarely engaged Cortez, and when she did
    it was inappropriate, like when she asked him whether he had been sexually molested.
    The fourth strategy was that Victoria would involve her children in activities outside of the
    home to help promote improved social skills and interaction in public. Christiansen testified they
    never got to this strategy because visits never really progressed beyond one hour.
    The fifth strategy was that Victoria would work to improve her relationship with the school,
    including working with providers to understand the children’s needs. Christiansen testified that
    Victoria initially refused to give consent for Cortez to be tested for special education services, and
    only signed the consent after being threatened with a court order.
    The sixth strategy was that Victoria would work with providers to be able to identify her
    children’s developmental milestones. According to Christiansen, Victoria had made limited
    progress in this area, as she would not let Mitoria off of the couch to explore and play, and was
    not in favor of any testing when there were concerns about Mitoria’s speech development.
    Christiansen testified that goal number two was that Victoria would “be able to express her
    feelings, emotions, concerns and wants without becoming emotionally upset as evidenced by not
    becoming physically aggressive, yelling, crying uncontrollably and becoming defiant.” Five
    strategies were listed for achieving this goal. The first strategy was that Victoria would comply
    with the recommendations of the psychological evaluation, which included individual and family
    therapy, “parenting skills,” evaluation for medication management, and support groups. Victoria
    completed the psychological evaluation, but refused to do a psychiatric evaluation for medication
    because she insisted that she was fine and did not need medication. Victoria also insisted that her
    parenting skills were fine and that she did not need any help in that regard.
    The second strategy was that Victoria would work with providers on being able to identify
    coping skills that she could use when she felt herself becoming emotionally upset; this was to
    include identifying triggers that caused her to become upset, identifying situations that she could
    remove herself from, and learning how to take feedback and constructive suggestions from others
    who were working with her and her children. Christiansen testified that Victoria had done “very
    poorly” on this and had “been very rude,” had “sworn at family support workers when they’ve
    been trying to help her,” had “a lot of emotional outbursts in front of the children,” and had “sucked
    her thumb herself walking around the visitation room.” Victoria was “not open to suggestions from
    family support workers.”
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    The third strategy was that Victoria would become more involved in outside activities.
    Christiansen said they never really got to this strategy, other than Victoria reported going on walks
    to the library and the post office.
    The fourth strategy was that Victoria would develop a support system to improve her social
    skills and interactions with others and which she could use when she was feeling stressed or when
    she needed assistance getting her children to school. Again, Christiansen said that they never got
    to this strategy because anytime Victoria was asked about her friends and family she refused to
    give any information and told Christiansen it was none of her business.
    The fifth strategy was that Victoria would work with providers on identifying past traumas
    in her life that still affected her and affected her parenting and relationships with her children.
    Christiansen testified that based on her conversations with Victoria and with Dr. Hannappel,
    Victoria made “very limited, if no progress at all” on this strategy.
    Christiansen testified that she read all of the family support worker notes and also had
    numerous conversations with the family support workers. When the case began in October 2013,
    Victoria had two one-hour visits per week. On November 26, visits were reduced to one one-hour
    therapeutic visit each week, with two supervising persons (Dr. Snitchler and a family support
    worker) present at each visit due to safety concerns. Six months later, in the early summer of 2014,
    Dr. Snitchler was no longer part of the therapeutically supervised visits; visits continued to be once
    each week, supervised by two family support workers, until visitation was suspended in May 2015.
    (Although Christiansen testified that visits continued to be one one-hour visit each week, other
    testimony and evidence reveals that visits were briefly increased to one two-hour visit each week
    at the end of 2014 and into early 2015.)
    Christiansen testified that she personally observed some of the visits between Victoria and
    her children. During a visit in November 2013, she observed Victoria: thoroughly examine
    Mitoria’s anal and vaginal areas during a diaper change and excessively wipe in those areas; have
    little to no interaction with Cortez; and not be receptive to the support workers, yelling and
    swearing at them. During a visit in January 2014, she observed Mitoria seek out support workers
    when she needed assistance rather than Victoria, and noticed that Cortez was “meek” around
    Victoria, who yelled at him during the visit. During a February visit, Victoria would not let Mitoria
    off of the couch and made her sit beside her during the entire visit. During a November visit,
    Victoria read a book out loud, but was not reading it to either child as they were off playing on
    their own; Victoria was not receptive to suggestions on how to get the children to engage with her.
    After the November visit, Cortez asked Christiansen if he still had to have visits with Victoria and
    said he only felt comfortable and safe when there were two support workers in the room.
    Christiansen was called into a February 2015 visit because Victoria felt that one of the support
    workers was harassing her by asking what she brought with her in her backpack (the worker just
    wanted to know if Victoria had brought activities or food for the children). After Christiansen left,
    she was called back to the visit a second time because Victoria was upset and thought that the
    support worker injured Mitoria’s arm (the worker had assisted Mitoria in getting out from under a
    table) and told the worker she would file charges; Victoria was “very emotional, very out of
    control, would not settle down, yelling[,] [j]ust really out of control.”
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    Christiansen also testified about problems at visits in general, and her testimony was
    supported by the family support workers’ visitation notes received into evidence as exhibit 70. She
    said there were problems with Victoria taking things from the children, Cortez in particular, which
    caused a lot of stress and unhappiness for the child; for example, she took bracelets from Cortez
    that he had been given for good behavior and kept them for herself. There were safety concerns
    including Victoria’s explosive behaviors and the amounts and kinds of food she brought for the
    children. Victoria was also unwilling to work with family support workers to engage in appropriate
    conversations and interactions with her children. Throughout the case there was a continuing
    problem with Victoria examining the children and talking to them about sexual contact; despite
    discussions with Victoria, no improvement was made.
    The visitation notes, exhibit 70, reveal the following. Victoria often gave her children hugs
    and kisses. She brought the children food every visit, but sometimes she allowed them to eat too
    much (to the point of sickness) or gave Mitoria food that was a choking hazard. Victoria would
    play with the children at the beginning of a visit, but would quickly turn her attention to Mitoria
    and leave Cortez to entertain himself; if Cortez tried to engage Victoria, she often ignored him.
    When Cortez’ behaviors needed redirection, Victoria would yell at him or ignore him; her
    discipline was inconsistent and there was no follow-through. Victoria often discussed
    inappropriate topics with Cortez; for example, she would talk about serial killers and adult movies
    and characters like “Chucky” (a killer doll), Freddy Krueger, and “The Exorcist.” Victoria
    repeatedly questioned Cortez about whether anyone was sexually abusing him or his sister. She
    often had emotional outbursts and would yell and curse at the children and the visitation
    supervisors.
    Christiansen testified that throughout this case, Victoria repeatedly accused numerous
    persons (Christiansen, family support workers, therapists, and the foster parents) of either having
    a sexual interest in her children or sexually abusing her children. When someone gave Cortez
    something for a headache or when Mitoria needed nebulizer treatments, Victoria feared everyone
    was trying to overmedicate her children; the record reveals that at one point she said, “On no.
    They’re going to kill them.” Christiansen tried to talk to Victoria about specific things she needed
    to work on to get her children back and what services would be helpful, but Victoria would not
    engage in the conversation; Victoria said nobody was going to tell her what to do and “everything
    was just fine and she just needed to get her children back.”
    Numerous services were provided to Victoria. Christiansen testified that Victoria was
    provided: supervised visitation; family support services to help her gain parenting skills; family
    team meetings (Victoria only “minimally” participated); taxi cab vouchers to various appointments
    and court dates; a psychological evaluation; and individual therapy. And Victoria would have been
    provided a psychiatric evaluation had she been willing to participate. Despite these services,
    Victoria made little to no progress. In Christiansen’s opinion, Victoria is not able to provide her
    children with care and protection or a safe and stable living environment. Christiansen does not
    believe that Victoria can provide for the children’s emotional needs, nor does she believe that
    Victoria has established a positive bond with the children. Christiansen testified that it would be
    in the children’s best interests to terminate Victoria’s parental rights.
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    The children’s foster father testified as follows. He is the assistant principal at a junior high
    school and his wife is a secretary at the elementary school Cortez attends. Mitoria and Cortez have
    been placed with them since April 2014. Prior to placement, the foster parents first met Victoria
    who asked them if they were serial killers and pedophiles; even after the foster parents explained
    that they were neither and that they had gone through background checks, Victoria still questioned
    them.
    The foster father testified that when the children first came to their home, there was concern
    that both children were behind. Mitoria, who was almost 2 years old at the time, did not seem to
    be speaking at the level she should be or interacting and responding to stimuli as expected. Cortez,
    who was almost 7 years old at the time, struggled with behaviors, emotional control, and being
    redirected, as well as in his interactions with other children and adults. Cortez was delayed in his
    learning and they questioned whether he needed to be held back a year in school; the foster parents,
    teachers, and administrators felt that the delayed learning was the result of missing too much
    school, and they all wanted to wait awhile before pursuing special education testing. As of August
    2015, Cortez was doing “much better”; he interacted well with others and no longer had “fits of
    rage.” Mitoria was also doing well; she was able to run and jump, and she talked “constantly,” was
    asking questions, and was very observant.
    The foster father testified regarding the children’s behavior changes when they had visits
    with Victoria. The days he was scheduled to have a visit, Cortez woke up and did not want to go,
    saying he had a stomachache or a headache. When the children came home from visits they were
    “bouncing off the walls,” would not eat meals (because they had lots of snacks and fast food during
    visits), and were more aggressive in their behavior; also, Cortez would laugh when the foster
    parents tried to redirect him. The foster mother’s testimony was in agreement with her husband’s
    testimony.
    Both Christiansen and the foster father testified that Cortez had therapy immediately
    following visits with Victoria. According to Christiansen, it was so that Cortez could have a “safe
    place” to discuss how the visit went.
    Dr. Eric Snitchler, a clinical psychologist, began working with Cortez in October 2013;
    therapy had been weekly until a few weeks before the termination hearing when it switched to
    every other week. Other than during the summer of 2014, Cortez’ therapy appointments would
    immediately follow his visits with Victoria.
    Dr. Snitchler testified as follows. When Cortez first began therapy, he was unable to
    regulate his emotions or behavior, could not sit still or focus for very long, sucked his thumb
    continuously, had no ability to make friends, was behind academically, had poor boundary issues,
    and was anxious and depressed. Cortez was diagnosed with attention deficit hyperactivity disorder
    and prescribed medication. While it took some time, Cortez made significant progress and was
    doing “remarkably better.” And Cortez was “definitely calmer” during therapy sessions after visits
    were suspended in May 2015. Dr. Snitchler testified that during therapy, Cortez never spoke about
    missing Victoria or wanting more time with her; in fact, Cortez said he did not want to live with
    Victoria.
    In addition to having therapy appointments with Cortez, Dr. Snitchler, along with a family
    support worker, attended weekly supervised therapeutic visits involving Cortez, Mitoria, and
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    Victoria from November 2013 to June 2014; he supervised one additional visit in December 2014.
    He also reviewed all visitation worker notes from June 2014 to May 2015, when visits were
    suspended. Dr. Snitchler testified that if Cortez was misbehaving during visits, Victoria would
    either yell at him or ignore the behavior, but there was rarely consistency or follow-through.
    Victoria “infrequently” made an effort to play with or engage Cortez; most of Victoria’s attention
    was towards Mitoria. Victoria spent significant amounts of time each visit combing Mitoria’s hair,
    changing her diapers, or wiping her nose; Mitoria was usually crying because Victoria was rough
    with her actions. Victoria did not appear to show appreciation for the children’s emotional needs.
    Dr. Snitchler testified that the biggest safety issue he observed was Victoria providing food to
    Mitoria that was a choking hazard--he specifically referenced “gummies” that were difficult for
    Mitoria to chew; Mitoria would often choke on the object, cough it up, and then Victoria would
    still give her more despite warnings from visitation supervisors. During visits, Victoria examined
    Cortez for injuries and would question any marks she found. And during almost every visit,
    Victoria asked Cortez if anybody had touched him or his sister sexually. Victoria also accused Dr.
    Snitchler of having a sexual interest in her children.
    Another DHHS worker testified that she observed one visit between Victoria and her
    children in March 2014. During the visit, Victoria was “mumbling and talking to herself, reaching
    in the air for things that only she could see, would start -- burst out laughing or start talking just
    kind of randomly to herself.” Also during that visit, Victoria had Mitoria on her lap and ignored
    Cortez for a majority of the hour; at the end of the hour Victoria discussed appropriate touching
    with Cortez and asked him if he had been molested.
    Dr. Snitchler testified that if Cortez was placed back with Victoria, “I’d expect the
    consequence would be significant. The prognosis would drop, his progress that he’s made would
    go down”; he believed that Cortez’ social, emotional, and academic functioning would all be
    negatively impacted. Cortez did not show much of a bond with Victoria. And Dr. Snitchler said
    that based on his observations and what was written in the family support worker notes, it did not
    appear that Mitoria had an emotional attachment to Victoria; he said that Mitoria “does not seek
    her mom for emotional comfort, attention, and often resists contact.” He testified that children
    need security, safety, and stability.
    Dr. Hannappel, a psychologist, performed a psychological evaluation of Victoria in
    October 2013, and shortly thereafter began having weekly therapy sessions with her; he was still
    treating her at the time of the termination hearing. In the 2013 psychological evaluation, which
    was received into evidence, Dr. Hannappel stated that Victoria’s performance on the intellectual
    assessment was not considered a valid indicator of her abilities because she did not put forth good
    effort on all aspects of the testing and was “quite uncooperative at times”; however, he stated that
    “[i]t does appear likely that she has fairly limited intellectual abilities.” Victoria’s report and
    intellectual assessment indicated “Mild Mental Handicapped Intellectual Abilities and limited
    academic abilities.” Dr. Hannappel’s evaluation also noted that Victoria “appears to have serious
    psychiatric problems” that he could not specifically identify because she was not forthcoming
    about her psychiatric history or current mental status. He noted that “Victoria tends to have a low
    level of empathy for her children and will likely find it hard to nurture Cortez and [Mitoria],
    especially Cortez, in a manner that will allow for healthy development for the long term.” Further,
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    “Victoria’s responses suggested that she will use Cortez and [Mitoria] to meet her needs as
    opposed to her meeting [their] needs.” In his evaluation, Dr. Hannappel opined that Victoria had
    limited potential to improve her ability to become an adequate parent.
    At the termination hearing, Dr. Hannappel testified as follows. Victoria had been diagnosed
    with mood disorder, not otherwise specified; personality disorder, not otherwise specified; and a
    provisional diagnosis of mild mental handicap. There was also a “rule out” diagnosis for bipolar
    disorder. Dr. Hannappel worked with Victoria to “increase her insight into her
    psychiatric/psychological issues, as well as her intellectual abilities, how they impact her adult
    functioning as well as how they might impact her ability to adequately parent the children.” During
    therapy sessions, Victoria said visits with the children were going well and that she was doing fine,
    but her impressions were inconsistent with the visitation notes provided to Dr. Hannappel; when
    confronted with the inconsistencies, Victoria’s response was that the family support workers were
    lying.
    The notes he received from the family support workers caused Dr. Hannappel a number of
    concerns. The primary concern was Victoria’s “over focus” and worry that the children were being
    sexually abused in some way by the family support workers and the foster care parents; Victoria
    would ask Cortez about it and would check Mitoria’s private parts. (In an April 2015 letter
    authored to Christiansen, which was received into evidence as exhibit 72, Dr. Hannappel noted
    that Victoria had accused him of making a sexual pass at her and also accused him of asking to
    touch Mitoria in a sexualized manner.) Another concern was that the family support notes
    suggested there was a lack of a bond between Victoria and the children, which was inconsistent
    with Victoria’s report to Dr. Hannappel that she had a good bond with her children.
    Dr. Hannappel testified that at a team meeting in December 2014, he recommended that
    visits be extended because Victoria had not been given enough opportunity to demonstrate whether
    she would be capable of adequately caring for her children. Based on his recommendation, visits
    were increased from one to two hours each week. However, after reviewing the visitation notes,
    his impression was that Victoria did not do any better at the two-hour visits, and “some things
    actually deteriorated with the extended period of time.”
    When asked what kind of progress Victoria made on her counseling therapy sessions, Dr.
    Hannappel responded “minimal to none.” In terms of parenting, he said that Victoria had not really
    made any type of progress, “and that’s primarily related to her lack of insight or lack of willingness
    to acknowledge limitations.” He further testified that it was his opinion that Victoria did not have
    the capability of being an adequate parent because of her psychiatric and personality problems,
    and that her “mental illness will persist into the foreseeable future.”
    In its order filed on October 27, 2015, the juvenile court terminated Victoria’s parental
    rights to Mitoria and Cortez pursuant to § 43-292(5), (6) and (7), and found that termination was
    in the children’s best interests.
    Victoria has timely appealed the termination of her parental rights.
    ASSIGNMENTS OF ERROR
    Victoria assigns, consolidated and restated, that the juvenile court erred in: (1) finding
    grounds exist to terminate her parental rights under § 43-292(2), (5), (6), and (7); (2) finding it was
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    in the children’s best interests to terminate her parental rights; and (3) denying her “Motion for
    Change of Placement” and “Objection to Letter Update/Case Plan.”
    STANDARD OF REVIEW
    An appellate court reviews juvenile cases de novo on the record and reaches a conclusion
    independently of the juvenile court’s findings. In re Interest of Isabel P. et al., 
    293 Neb. 62
    , 
    875 N.W.2d 848
    (2016).
    ANALYSIS
    Grounds for Termination.
    In Nebraska statutes, the bases for termination of parental rights are codified in § 43-292.
    Section 43-292 provides 11 separate conditions, any one of which can serve as the basis for the
    termination of parental rights when coupled with evidence that termination is in the best interests
    of the child. In re Interest of Elizabeth S., 
    282 Neb. 1015
    , 
    809 N.W.2d 495
    (2012).
    In its order terminating Victoria’s parental rights to Mitoria and Cortez, the juvenile court
    found that grounds for termination existed under § 43-292(5), (6), and (7).
    Section 43-292(7) provides for termination of parental rights when “[t]he juvenile has been
    in an out-of-home placement for fifteen or more months of the most recent twenty-two months.”
    This section operates mechanically and, unlike the other subsections of the statute, does not require
    the State to adduce evidence of any specific fault on the part of a parent. In re Interest of Aaron
    D., 
    269 Neb. 249
    , 
    691 N.W.2d 164
    (2005).
    Mitoria and Cortez were removed from Victoria in October 2013. At the time the
    supplemental “petition” to terminate parental rights was filed in March 2015, the children had been
    in an out-of-home placement for 17 months. At the time of the termination hearing in August 2015,
    the children had been in an out-of-home placement for 22 months. Our de novo review of the
    record clearly and convincingly shows that grounds for termination of Victoria’s parental rights
    under § 43-292(7) were proven by sufficient evidence.
    We note that Victoria asserts the court erred in finding grounds exist to terminate her
    parental rights under § 43-292(2) (substantial and continuous or repeated neglect and refusal to
    give the juvenile, or a sibling, necessary care and protection). However, that ground was neither
    alleged by the State in its supplemental “petition,” nor used by the court as a basis for termination.
    Accordingly, we need not consider whether termination of Victoria’s parental rights was proper
    under § 43-292(2).
    Furthermore, we need not consider whether termination of Victoria’s parental rights to
    Mitoria and Cortez was proper under § 43-292(5) and (6) since any one ground of the 11 identified
    in § 43-292 can serve as the basis for the termination of parental rights when coupled with evidence
    that termination is in the best interests of the child. See In re Interest of Elizabeth 
    S., supra
    . Thus,
    the next inquiry is whether termination is in the children’s best interests.
    Best Interests.
    Under § 43-292, once the State shows that statutory grounds for termination of parental
    rights exist, the State must then show that termination is in the best interests of the child. In re
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    Interest of Ryder J., 
    283 Neb. 318
    , 
    809 N.W.2d 255
    (2012). But that is not all. A parent’s right to
    raise his or her child is constitutionally protected; so before a court may terminate parental rights,
    the State must also show that the parent is unfit. In re Interest of Nicole M., 
    287 Neb. 685
    , 
    844 N.W.2d 65
    (2014).
    There is a rebuttable presumption that the best interests of a child are served by having a
    relationship with his or her parent. In re Interest of Nicole 
    M., supra
    . Based on the idea that fit
    parents act in the best interests of their children, this presumption is overcome only when the State
    has proved that a parent is unfit. 
    Id. The term
    “unfitness” is not expressly used in § 43-292, but the
    concept is generally encompassed by the fault and neglect subsections of that statute, and also
    through a determination of the children’s best interests. 
    Id. Parental unfitness
    means a personal
    deficiency or incapacity which has prevented, or will probably prevent, performance of a
    reasonable parental obligation in child rearing and which caused, or probably will result in,
    detriment to a child’s wellbeing. 
    Id. The best
    interests analysis and the parental fitness analysis are
    fact-intensive inquiries. 
    Id. And while
    both are separate inquiries, each examines essentially the
    same underlying facts as the other. 
    Id. Victoria consistently
    attended visitation and therapy. The visitation notes showed that she
    would often give the children hugs and kisses during visits. She was also concerned about her
    children’s safety, sometimes to the extreme. While there were some positives during the visits,
    there were more negatives. Victoria would bring food for the children, but there were concerns
    about the amounts and kinds of food she brought for the children. There were also concerns about
    Victoria’s explosive behaviors, where she would yell at the visitation workers. Victoria was also
    unwilling to work with family support workers to engage in appropriate conversations and
    interactions with her children. Throughout the case there was a continuing problem with Victoria
    examining the children and talking to them about sexual contact; she repeatedly accused numerous
    persons (Christiansen, family support workers, Dr. Snitchler, Dr. Hannappel, and the foster
    parents) of either having a sexual interest in her children or sexually abusing her children.
    Discussions were had with Victoria about specific things she needed to work on to get her
    children back and what services would be helpful, but Victoria would not engage in the
    conversation; Victoria said nobody was going to tell her what to do and “everything was just fine
    and she just needed to get her children back.” When Victoria’s version of events differed from that
    of the visitation workers’, she accused the workers of lying. Her visits were limited to one or two
    hours per week and remained fully supervised by two persons until such time as visits were
    suspended in May 2015.
    Dr. Hannappel’s evaluation noted that Victoria “appears to have serious psychiatric
    problems” that he could not specifically identify because she was not forthcoming about her
    psychiatric history or current mental status. He noted that “Victoria tends to have a low level of
    empathy for her children and will likely find it hard to nurture Cortez and [Mitoria], especially
    Cortez, in a manner that will allow for healthy development for the long term.” Further, “Victoria’s
    responses suggested that she will use Cortez and [Mitoria] to meet her needs as opposed to her
    meeting [their] needs.” In his evaluation, Dr. Hannappel opined that Victoria had limited potential
    to improve her ability to become an adequate parent. When asked what kind of progress Victoria
    made on her counseling therapy sessions, Dr. Hannappel responded “minimal to none.” In terms
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    of parenting, he said that Victoria had not really made any type of progress, “and that’s primarily
    related to her lack of insight or lack of willingness to acknowledge limitations.” He further testified
    that it was his opinion that Victoria did not have the capability of being an adequate parent because
    of her psychiatric and personality problems, and that her “mental illness will persist into the
    foreseeable future.” See In re Interest of D.A.B. and J.B., 
    240 Neb. 653
    , 
    483 N.W.2d 550
    (1992)
    (finding that although the mother was provided with extensive services to assist her in properly
    raising her children, she was unable to profit from the instruction provided because of her mental
    deficiency).
    Dr. Snitchler testified that if Cortez was placed back with Victoria, “I’d expect the
    consequence would be significant. The prognosis would drop, his progress that he’s made would
    go down”; he believed that Cortez’ social, emotional, and academic functioning would all be
    negatively impacted. In Dr. Snitchler’s opinion, Cortez did not show much of a bond with Victoria.
    Cortez never spoke about missing Victoria or wanting more time with her; in fact, Cortez said he
    did not want to live with Victoria.
    Numerous services were provided to Victoria including supervised visitation, family
    support services, family team meetings, a psychological evaluation, and individual therapy.
    Despite these services, Victoria made little to no progress. Christiansen testified that Victoria made
    little to no progress on the case plan, is not able to provide her children with care and protection
    or a safe and stable living environment, cannot provide for the children’s emotional needs, and
    does not have a positive bond with the children. Accordingly, Christiansen testified that it would
    be in the children’s best interests to terminate Victoria’s parental rights. We agree. “[W]hen a
    natural parent suffers from a mental deficiency and cannot be rehabilitated within a reasonable
    period of time, the best interests of the child require that a final disposition be made without delay.”
    In re Interest of Natasha H. & Sierra H., 
    258 Neb. 131
    , 141, 
    602 N.W.2d 439
    , 448 (1999). See,
    also, In re Interest of D.A.B. and 
    J.B., supra
    (stating same). We find that the State has rebutted the
    presumption of parental fitness. We further find that it is in Mitoria and Cortez’ best interests that
    Victoria’s parental rights be terminated.
    Remaining Assignment.
    Victoria asserts that the juvenile court erred when denying her “Motion for Change of
    Placement” and “Objection to Letter Update/Case Plan.” We need not address this assignment of
    error because we are affirming the termination of Victoria’s parental rights and such matters would
    have no bearing on that decision. See In re Interest of Jackson E., 
    293 Neb. 84
    , 
    875 N.W.2d 863
    (2016) (appellate court is not obligated to engage in analysis that is not necessary to adjudicate
    case and controversy before it).
    CONCLUSION
    For the reasons stated above, we affirm the order of the juvenile court terminating
    Victoria’s parental rights to Mitoria and Cortez.
    AFFIRMED.
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