DCPP VS. K.S. AND T.R.IN THE MATTER OF THE GUARDIANSHIP OF Z.B. AND K.A.Z.B.(FG-11-03-16, MERCER COUNTY AND STATEWIDE)(RECORD IMPOUNDED) ( 2017 )


Menu:
  •                              RECORD IMPOUNDED
    NOT FOR PUBLICATION WITHOUT THE
    APPROVAL OF THE APPELLATE DIVISION
    This opinion shall not "constitute precedent or be binding upon any court."
    Although it is posted on the internet, this opinion is binding only on the
    parties in the case and its use in other cases is limited. R.1:36-3.
    SUPERIOR COURT OF NEW JERSEY
    APPELLATE DIVISION
    DOCKET NO. A-0016-16T1
    NEW JERSEY DIVISION OF CHILD
    PROTECTION AND PERMANENCY,
    Plaintiff-Respondent,
    v.
    K.S.,
    Defendant-Appellant,
    and
    T.R.,
    Defendant.
    __________________________________
    IN THE MATTER OF THE GUARDIANSHIP
    OF Z.B. AND K.A.Z.B., minors.
    __________________________________
    Submitted June 1, 2017 - Decided June 21, 2017
    Before Judges Lihotz, O'Connor and Mawla.
    On appeal from Superior Court of New Jersey,
    Chancery Division, Family Part, Mercer County,
    Docket No. FG-11-03-16.
    Joseph E. Krakora, Public Defender, attorney
    for   appellant  (Steven   Edward  Miklosey,
    Designated Counsel, on the brief).
    Christopher S. Porrino, Attorney General,
    attorney for respondent (Melissa Dutton
    Schaffer, Assistant Attorney General, of
    counsel; Joshua P. Bohn, Deputy Attorney
    General, on the brief).
    Joseph E. Krakora, Public Defender, Law
    Guardian, attorney for minor (Louise M. Cho,
    Assistant Deputy Public Defender, on the
    brief).
    PER CURIAM
    Defendant K.S. appeals from an August 15, 2016 judgment,
    terminating    her     parental   rights   and   granting    guardianship      to
    plaintiff, the Division of Child Protection and Permanency (the
    Division) for the purpose of securing the adoption of her two
    biological children, Z.B. and K.A.Z.B., ages eight and three,
    respectively.    On appeal, defendant argues the Division failed to
    prove the statutory prongs necessary to terminate parental rights,
    by clear and convincing evidence.          We have reviewed her arguments
    in light of the record and applicable law.            We conclude the trial
    judge's     findings    are   sufficiently       supported   by   the    record
    evidence.     Accordingly, we affirm.
    Defendant experienced repeated and severe trauma and loss
    starting at age nine, when she was sexually molested by a male
    relative.    A few years later, her stepfather was murdered, shortly
    followed by the death of her mother.               Consequently, defendant
    suffers from post-traumatic stress disorder.           Defendant gave birth
    2                                 A-0016-16T1
    to her older child when she was thirteen.             At that time, defendant
    was diagnosed with bipolar disorder and post-partum depression,
    when   she    reported     auditory    and   visual   hallucinations,         began
    cutting herself, attempted suicide, and experienced thoughts of
    harming her infant.        She was hospitalized, commenced therapy, and
    prescribed Abilify and Lamictal.
    The    Division    became   involved    with    the   family    in     2010.
    Defendant was placed in the residential custody of her maternal
    aunt, and, with defendant's consent, her child was placed in the
    residential custody of another maternal aunt.                 Problems arose.
    Defendant and her custodial aunt became engaged in a physical
    altercation, defendant assaulted a school official when caught
    stealing,      she   experienced   suicidal     ideations,     and    was     again
    hospitalized.        When interviewed by the Division, defendant's aunts
    both requested to relinquish custody of defendant and her child.
    On July 1 and 2, 2011, the Division conducted an emergency
    removal of defendant and her child.           After a short stay at Harbor
    House Adolescent Shelter, defendant and her child were reunited
    in a resource home.
    The    Division's    attempts    to   place    defendant    with      family
    members      was   unsuccessful.       Defendant's    biological      father     was
    unwilling and unable to provide a suitable home for her and her
    child; her grandfather, who lived in Florida, was unable to cope
    3                                  A-0016-16T1
    with defendant's mental health issues.             A cousin in Florida was
    disqualified    when   she   failed   to    complete    half   the    necessary
    parenting classes and maintain contact with the Division.
    Defendant struggled in school, was adjudicated delinquent,
    and failed to follow her resource mother's house rules, as she
    would leave for several hours without telling anyone where she was
    going.
    The Division arranged for various services, which included
    individual mental health treatment, medication, grief counseling,
    anger management, life skills, parenting classes, and enrollment
    in   the   Strengthening     Adolescent     Families    through     Empowerment
    "Mommy and Me" program.        Defendant made positive strides in her
    own individual care and that of her child.             Unfortunately, within
    a year, her condition deteriorated.              On November 7, 2012, the
    Division    amended    its   complaint     to   seek   care   and   custody    of
    defendant's child, which was granted.            Defendant's reunification
    efforts were renewed and she and her child were placed in the
    legal and physical custody of her cousin in Florida.                     There,
    defendant became pregnant with her second child and returned to
    New Jersey.    Defendant, now over eighteen, agreed to continue with
    the Division's recommended services and returned to her former
    resource home.
    4                                 A-0016-16T1
    In a few months, defendant expressed frustration complying
    with the services she was to engage.             She told the Division to
    "just take" the children, which prompted an emergency removal from
    her care and the initiation of litigation.
    Defendant resumed participation with the Division, attended
    services, supervised visits, medication monitoring, and therapy,
    which were recommended by Alexander Iofin, M.D., a psychiatrist,
    to control defendant's significant psychiatric and behavioral
    difficulties.      Defendant initiated efforts to find employment and
    housing.     She    maintained    contact      with    the   children     through
    supervised visitation.
    A   psychological    evaluation      by   Amy     Becker-Mattes,      Ph.D.,
    recommended defendant continue medication management and therapy
    and re-enroll in a Mommy and Me program.          Defendant registered for
    evening classes at Mercer County Community College, continued
    supervised visitation, and began overnight-supervised visits at
    the Children's Home Society.       Unfortunately, defendant changed her
    residence, cancelled visits, was terminated from her parenting
    classes for non-attendance, failed to attend one-half of the
    scheduled therapy sessions, and was expelled from the shelter
    residence for violating curfew.       Defendant moved in with a friend.
    The   judge    ordered   a   continuation        of   services,    including
    defendant's participation in a Mommy and Me program.                   Locating a
    5                                   A-0016-16T1
    program proved difficult; defendant's request for placement was
    rejected because she had been dismissed from similar programs.
    The Division located the NJ Mentor program, which proposed placing
    defendant in a therapeutic home under the supervision of resource
    parents,     which     would   demonstrate     stabilization,        a    necessary
    precondition     for    admittance     into    the    Mommy   and    Me    program.
    Defendant declined the arrangement and also refused to participate
    in    an   updated    psychiatric    evaluation      with   Dr.    Becker-Mattes,
    advising she would be out-of-town.
    The Division learned defendant was living with a boyfriend
    and working for Burlington Coat Factory.               Defendant reported she
    was    not   taking    her     prescribed     medications     as    directed     and
    acknowledged     she     experienced    anger        management     difficulties.
    Consequently, the Division reevaluated its permanency goal for the
    children.     Learning this, defendant resumed her medication, agreed
    to attend trauma-focused counseling, restarted parenting classes,
    and had supervised visitation.
    Dr. Iofin updated his psychiatric evaluation on July 1, 2015.
    Although he did not alter his prior findings, he now recommended
    defendant receive random drug screens because of the proclivity
    for drug use among people suffering the types of psychiatric issues
    as defendant.
    6                                   A-0016-16T1
    The Division filed for guardianship on July 29, 2015.                 By
    then defendant had moved again, lost her job, was not maintaining
    her medication, missed counseling sessions despite being provided
    transportation, was terminated from therapy for nonattendance,
    missed the first day of a new job, and tested positive for cocaine.
    Dr. Becker-Mattes updated her psychological evaluation on
    August 14, 2015.      She also performed bonding evaluations between
    the children and their resource parents, then between defendant
    and the children.     Defendant retained Andrew P. Brown III, Ph.D.,
    who performed similar bonding evaluations.
    Other family members were contacted as possible resource
    placements for the children.          Defendant's father, sister, and
    cousin did not respond to the Division's requests, or failed to
    complete the requisites for placement.          The older child's father
    was   located   in   Florida,   and   was   considered,   but   he   neither
    expressed a desire nor expended the effort to cooperate with the
    Division.   The child's paternal grandmother was considered, but
    the Florida Department of Children and Families declined her
    application for licensure.        The Division could not locate the
    younger child's father.
    Trial began on January 12, 2016.           The Division presented
    testimony from caseworker, Tamika Somorin, the children's resource
    mother, and LaToya Gaines, a Division adoption caseworker.                The
    7                              A-0016-16T1
    Division's expert was Dr. Becker-Mattes, and numerous documents
    were admitted into evidence.             Defendant presented expert testimony
    from    Dr.    Brown    and    testimony    from   Edwige   Paul   Theokas,     her
    counselor      and     her   former   foster    mother.     Finally,   defendant
    testified on her own behalf.
    We     detail     the    expert     testimony.       Dr.    Becker-Mattes
    administered standardized testing, reviewed defendant's records,
    and conducted clinical interview sessions.                  She concurred with
    defendant's diagnosis of bipolar disorder, which required regular
    mood stabilizing medication and ongoing therapy.                     Dr. Becker-
    Mattes explained people suffering from bipolar disorder commonly
    avoid   taking       medication    during      manic   episodes,   which   becomes
    problematic during subsequent depressive episodes.                   Specific to
    defendant, she reviewed her history of stability periods followed
    by lapses and noncompliance.               Dr. Becker-Mattes explained these
    periods of lapsed medication posed a significant risk to the
    children because, when defendant did not take her medication, she
    experienced mood swings, excessive irritability, excessive energy,
    and impaired judgment.
    From her evaluation, Dr. Becker-Mattes concluded defendant
    could not serve as an independent caretaker for the children.                     Of
    particular concern was defendant's inconsistencies with medication
    monitoring, which in turn resulted in defendant's abandonment of
    8                               A-0016-16T1
    other   services.         Dr.    Becker-Mattes        also   noted    defendant's
    standardized       test   results      showed   an    "elevated      [g]randiosity
    subscale."     She interpreted the results as showing defendant
    displayed interpersonal overconfidence, preventing her willingness
    to   listen   to    others,     even   though   she    needed     assistance    and
    guidance.
    In discussing the bonding evaluation results, Dr. Becker-
    Mattes observed defendant was very affectionate with the children;
    she nuzzled and kissed them.            She later withdrew emotionally and
    was "on edge."      Defendant issued many instructions and reprimanded
    the one-year-old when she dropped cards, causing the child to cry.
    She deflected this by stating: "I don't care about that attitude
    stuff; I'm not [the children's resource mother]."                 Further, in Dr.
    Becker-Mattes' opinion, defendant overstimulated the children,
    which was a stressful and unhealthy dynamic for all.
    Dr. Becker-Mattes opined defendant's very sudden change in
    behavior reflected she was not properly taking her medication.
    Overall, Dr. Becker-Mattes concluded the bond between mother and
    children was "quite negative."
    In contrast, Dr. Becker-Mattes concluded the bonding between
    the children and their resource parents was strong and positive.
    The resource parents participated in structured and goal-oriented
    activities and provided the children with positive feedback and
    9                                A-0016-16T1
    encouragement.          The    younger    child     appeared        particularly
    affectionate, putting her head on the resource mother's knees;
    also, the older child appeared calmer and more relaxed than with
    defendant.
    Dr. Becker-Mattes concluded the children would suffer harm
    if   separated   from   their    resource   parents.         She    also    stated
    defendant was not likely, or able, to mitigate the harm resulting
    from such a loss.
    Dr.    Brown    was     qualified   as   an    expert        in   clinical
    neuropsychology.        Dr. Brown's methodology was similar to Dr.
    Becker-Mattes, as he administered different standardized tests and
    conducted a clinical interview.           He rejected the use of various
    projective tests, including the personality assessment inventory
    cited by Dr. Becker-Mattes, because they were of poor "reliability
    and validity."       Further, he noted defendant had no confirmed
    history of child abuse, making tests measuring that possibility
    more likely to result in a false positive.               He criticized the
    Division's treatment of defendant as unfair, suggesting it was
    "paying lip service" to the goal of reunification.
    Dr.   Brown    reviewed    defendant's      records,    confirming        she
    suffered from bipolar disorder, for which she was prescribed
    medication, and engaged in "sporadic" treatment.                   He emphasized
    defendant's efforts and successes, including graduating from high
    10                                    A-0016-16T1
    school, gaining employment, and maintaining a residence.                  He
    reviewed her current circumstances of housing and employment,
    describing them as stable, and noted she was making future plans.
    He highlighted defendant was "putting forth a great deal of effort
    at her young age . . . despite her past, despite her traumas, to
    be a mother to her children."            He noted defendant expressed
    awareness of her inappropriate behavior and agreed she needed
    help.
    Dr. Brown noted defendant's continued success hinged upon
    education, and a developed awareness and understanding of bipolar
    disorder, asserting "if [defendant] remains compliant with her
    psychiatric management, then I think the prognosis is very good."
    Dr. Brown agreed, "80% of bipolar patients stop taking their
    medication," which was a very likely possibility in defendant's
    case.      He   advocated   defendant   would   overcome   relapses    with
    "cognitive behavior therapy," which he did not find referenced in
    defendant's records. Dr. Brown "had no concerns" about defendant's
    ability to provide independent care for the children because her
    composite score on testing "did not render her to be outside of
    the norm of the community."
    Dr.    Brown   also    concluded   the   children   were   bonded    to
    defendant, she did not display "episodes of anger, . . . shallow
    frustration tolerance or irritability or . . . anything that would
    11                              A-0016-16T1
    indicate she was a threat to harm her children."               Further, "[s]he
    showed patience.        She responded gently to her children.            So her
    symptoms, again, appear to be under control."
    He agreed the children were comfortable with their resource
    parents, with whom they were bonded and appeared closer to the
    resource mother than the father.            Dr. Brown testified the resource
    parents were the children's psychological parents, but defendant
    was their natural parent, and consequently, their bond with her
    was stronger, particularly the bond by the older child.                Dr. Brown
    believed it was rare for children to have a stronger bond by a
    third-party than with their natural parent.
    Dr. Brown opined both children would suffer irreparable harm
    from losing contact with defendant: the older child because the
    bond was so strong and the younger child, who would sense the loss
    experienced by the older sibling.            The younger child would have a
    deeper sense of loss when separated from the resource parents and
    would need therapy.         Any loss could be mitigated if defendant
    maintained    a     relationship   between     the   younger   child    and   the
    resource parents or if defendant could maintain contact with the
    children if adopted by the resource parents.
    On cross-examination, Dr. Brown noted defendant told him the
    positive     hair    follicle   test    occurred     because    she    "touched
    cocaine."     When asked whether he believed defendant or thought
    12                                A-0016-16T1
    that was possible, he stated it "was not [his] field of expertise,"
    but conceded those with bipolar disorder who do not take their
    medication have a tendency to self-medicate with illicit drugs.
    Dr. Brown acknowledged he did not follow-up with information
    related by the resource mother           regarding the children.        For
    example, the older child wets the bed prior to seeing defendant
    and expressed fear when discussing her.        In April 2016, the older
    child told defendant he wanted to live with his resource mother
    during this time.       Dr. Brown conceded a "primary byproduct of
    bipolar disorder is a dysregulation of anger and emotion and sleep
    and so on" and agreed "in the past without medication, [defendant]
    was probably very horrible"; yet Dr. Brown refuted the future
    possibilities were governed by this past conduct.
    Finally, Dr. Brown agreed his bonding conclusions were based
    on defendant's assertion she cared for her older child for the
    first five years; Dr. Brown admitted he had no knowledge the child
    was in the custody of defendant's aunt.
    The   children's    resource   parent   discussed   the   children's
    status.    She agreed she would allow defendant future contact with
    the children were she permitted to adopt them.                 Defendant's
    counselor stated she consistently attended parenting classes for
    six months and self-reported maintaining stable housing for three
    months and employment.     The counselor discussed defendant's self-
    13                             A-0016-16T1
    reports, made six months earlier, regarding medication compliance,
    which were later learned to be inaccurate.
    Defendant's      former    foster      mother   discussed    their    past
    relationship, refuting any claim she asked defendant to leave.
    She emphasized her willingness to provide help to defendant and
    the children in the future.        The Division's adoption caseworker
    confirmed defendant was working at an Amazon warehouse and lived
    in the same residence for the past six months.
    Defendant      confirmed    her     sustained    housing    and   current
    employment.     She insisted she remained medication compliant since
    her younger child was born in 2014, even though she did not always
    attend   the    medication   monitoring      sessions.    When    confronted,
    defendant asserted no current need for medication.               She described
    her apartment of nine months, which accommodated the children, and
    stated she enrolled in a nursing program at Mercer County Community
    College.    Supplemental information showed defendant completed the
    educational course and was hired as a certified nursing assistant
    at a nursing home.     She currently attended therapy and maintained
    participation in medication monitoring since December 2015, noting
    her dosage of Abilify was recently lowered.              She expressed love
    for her children and her intention to provide stable, safe care
    for them.      She continued therapeutic visits.
    14                              A-0016-16T1
    The judge delivered a comprehensive oral opinion on August
    11, 2016.     She found the Division established all four prongs of
    the best interests test, and ordered defendant's parental rights
    terminated to free the children for adoption. On appeal, defendant
    argues the findings were not supported by the weight of the
    evidence.     She requests we reverse the guardianship judgment.
    The scope of our review of a trial court's decision to
    terminate parental rights is limited.               In re Guardianship of
    J.N.H., 
    172 N.J. 440
    , 472 (2002).              We are obliged to accord
    deference to the trial judge's factual findings, based upon the
    opportunity    of   the   judge   to   see   and   hear   the   witnesses,   as
    "[p]articular deference is owed to credibility determinations."
    N.J. Div. of Youth & Family Servs. v. I.S., 
    202 N.J. 145
    , 185
    (2010); see also N.J. Div. of Youth & Family Servs. v. M.M., 
    189 N.J. 261
    , 279 (2007); Cesare v. Cesare, 
    154 N.J. 394
    , 411-12
    (1998).     A judgment of a trial judge "should not be overthrown
    except upon the basis of a carefully reasoned and factually
    supported (and articulated) determination, after canvassing the
    record and weighing the evidence, that the continued viability of
    the judgment would constitute a manifest denial of justice."                 In
    re Adoption of a Child by P.F.R., 
    308 N.J. Super. 250
    , 255 (App.
    Div. 1998) (quoting Baxter v. Fairmont Food Co., 
    74 N.J. 588
    , 597-
    98 (1977)).    Reversal is required only in those circumstances when
    15                             A-0016-16T1
    the stated findings are "so wide of the mark that a mistake must
    have been made." 
    M.M., supra
    , 189 N.J. at 279 (citations omitted).
    However, the "traditional scope of review is expanded" when
    the   appellant    challenges,    in     particular,   the   trial   judge's
    evaluation of the underlying facts and the implications drawn from
    those facts.      Ibid.; see also N.J. Div. of Youth & Family Servs.
    v. G.L., 
    191 N.J. 596
    , 605 (2007) ("There is an exception to that
    general rule of deference: Where the issue to be decided is an
    'alleged error in the trial judge's evaluation of the underlying
    facts and the implications to be drawn therefrom,' we expand the
    scope of our review" (quoting In re Guardianship of J.T., 269 N.J.
    Super. 173, 189 (App. Div. 1993))).          "Despite such circumstances,
    deference will still be accorded to the trial judge's findings
    unless it is determined that they went so wide of the mark that
    the judge was clearly mistaken."            
    G.L., supra
    , 191 N.J. at 605.
    Indeed, this court accords no special deference to the trial
    court's "interpretation of the law and the legal consequences that
    flow from established facts[,]" Manalapan Realty, L.P. v. Twp.
    Comm. of Manalapan, 
    140 N.J. 366
    , 378 (1995), which this court
    reviews de novo.     Dep't of Envtl. Prot. v. Kafil, 
    395 N.J. Super. 597
    , 601 (App. Div. 2007).
    "The   Federal     and     State      Constitutions    protect      the
    inviolability of the family unit."           In re Adoption of a Child by
    16                            A-0016-16T1
    W.P. & M.P., 
    308 N.J. Super. 376
    , 382 (1998) (citing Stanley v.
    Illinois, 
    405 U.S. 645
    , 651, 
    92 S. Ct. 1208
    , 1212-13, 
    31 L. Ed. 2d
    551, 558-59 (1972)), vacated on other grounds, 
    163 N.J. 158
    (2000).       Parents hold a constitutionally protected, fundamental
    liberty interest in raising their biological children.                  Santosky
    v. Kramer, 
    455 U.S. 745
    , 753, 
    102 S. Ct. 1388
    , 1394, 
    71 L. Ed. 2d 599
    ,    606        (1982).     However,    government     "is     not   without
    constitutional control over parental discretion in dealing with
    children when their physical or mental health is jeopardized."
    Parham v. J.R., 
    442 U.S. 584
    , 603, 
    99 S. Ct. 2493
    , 2504, 
    61 L. Ed. 2d
    101, 119 (1979) (citing Wisconsin v. Yoder, 
    406 U.S. 205
    , 230,
    
    92 S. Ct. 1526
    , 1540, 
    32 L. Ed. 2d 15
    , 33 (1972)).               The State, as
    parens patriae, may sever the parent-child relationship to protect
    the child from serious physical and emotional injury.                    W.P. &
    
    M.P., supra
    , 308 N.J. Super. at 382.
    When    a    child's   biological   parent   resists     termination     of
    parental rights, the court must determine whether the parent can
    raise the child without causing harm.          In re Guardianship of J.C.,
    
    129 N.J. 1
    , 10 (1992).           The cornerstone of our inquiry is not
    whether the parent is fit, but whether the parent can "cease
    causing their child harm" and become fit to assume the parental
    role within time to meet the child's needs.             
    Ibid. "The analysis .
    . . entails strict standards to protect the statutory and
    17                                 A-0016-16T1
    constitutional rights of the natural parents."         
    Ibid. "The burden rests
    on the party seeking to terminate parental rights                     'to
    demonstrate by clear and convincing evidence' that risk of 'serious
    and lasting [future] harm to the child' is sufficiently great as
    to require severance of the parental ties."           W.P. & 
    M.P., supra
    ,
    308 N.J. Super. at 383 (quoting 
    J.C., supra
    , 129 N.J. at 10).
    Examination   "focuses   upon    what   course    serves    the     'best
    interests' of the child."     Ibid.; see also N.J. Div. of Youth &
    Family Servs. v. A.W., 
    103 N.J. 591
    , 612 (1986) (requiring the
    State to satisfy the "best interests of the child" test by clear
    and convincing evidence before termination of parental rights can
    be ordered).   More specifically, the four-pronged statutory test
    requires the Division to prove:
    (1) The child's safety, health or development
    has been or will continue to be endangered by
    the parental relationship;
    (2) The parent is unwilling or unable to
    eliminate the harm facing the child or is
    unable or unwilling to provide a safe and
    stable home for the child and the delay of
    permanent placement will add to the harm.
    Such harm may include evidence that separating
    the child from his resource family parents
    would cause serious and enduring emotional or
    psychological harm to the child;
    (3) The [D]ivision has made reasonable
    efforts to provide services to help the parent
    correct the circumstances which led to the
    child's placement outside the home and the
    18                                    A-0016-16T1
    court   has   considered    alternatives           to
    termination of parental rights; and
    (4) Termination of parental rights will not
    do more harm than good.
    [N.J.S.A. 30:4C-15.1(a); see also In re
    Guardianship of K.H.O., 
    161 N.J. 337
    , 347-48
    (1999).]
    These   standards   are   neither   discrete   nor    separate;      they
    overlap to provide a composite picture of what may be necessary
    to advance the best interests of the children.            
    I.S., supra
    , 202
    N.J. at 167; 
    K.H.O., supra
    , 161 N.J. at 348 (stating the statute's
    four parts "relate to and overlap with one another to provide a
    comprehensive    standard      that    identifies    a      child's       best
    interests.").
    "The considerations involved in determinations of parental
    fitness are 'extremely fact sensitive' and require particularized
    evidence that address the specific circumstances in the given
    case."   
    K.H.O., supra
    , 161 N.J. at 348 (quoting In re Adoption of
    Children by L.A.S., 
    134 N.J. 127
    , 139 (1993)).
    Clear-and-convincing evidence is "that which
    'produce[s] in the mind of the trier of fact
    a firm belief or conviction as to the truth
    of the allegations sought to be established,'
    evidence 'so clear, direct, and weighty and
    convincing as to enable [the factfinder] to
    come to a clear conviction without hesitancy
    of the precise facts in issue.'"
    [In re Seaman,      
    133 N.J. 67
    , 74            (1993)
    (alterations in     original) (quoting         In re
    19                                  A-0016-16T1
    Boardwalk Regency Casino License Applicant,
    
    180 N.J. Super. 324
    , 339 (App. Div. 1981),
    modified, 
    90 N.J. 361
    (1982)).]
    We turn to defendant's arguments, challenging the weight of
    the Division's evidence and whether it satisfactorily met this
    high burden.   Defendant maintains the judge erred when concluding
    the first prong was satisfied because "injury to children need not
    be physical to give rise to State termination of biological parent-
    child relationships."       In re Guardianship of K.L.F., 
    129 N.J. 32
    ,
    44 (1992) (citing 
    J.C., supra
    , 129 N.J. at 18).        Emphasizing there
    is no proof of physical harm to either child and the children were
    not subjected to her past unstable housing, defendant believes she
    fully refuted the Division's evidence directed to prove prong one.
    We are not persuaded.
    It is not necessary to wait "until a child is actually
    irreparably impaired by parental inattention or neglect" in order
    to find child harm.    In Guardianship of D.M.H., 
    161 N.J. 365
    , 383
    (1999).    The Supreme Court has instructed "[s]erious and lasting
    emotional or psychological harm to children as the result of the
    action or inaction of their biological parents can constitute
    injury    sufficient   to   authorize    the   termination   of   parental
    rights."    
    K.L.F., supra
    , 129 N.J. at 44 (citing 
    J.C., supra
    , 129
    N.J. at 18).    "The child's right to a permanent home has gained
    increasing prominence" in this analysis.          N.J. Div. of Youth &
    20                             A-0016-16T1
    Family Servs. v. P.P., 
    180 N.J. 494
    , 505 (2004) (quoting In re
    Adoption of Children by G.P.B., Jr., 
    161 N.J. 396
    , 404 (1999)).
    "Children must not languish indefinitely in foster care while a
    birth parent attempts to correct the conditions that resulted in
    an out-of-home placement."      N.J. Div. of Youth & Family Servs. v.
    S.F., 
    392 N.J. Super. 201
    , 209 (App. Div. 2007).
    Accordingly,   when   reviewing    the   evidence,   a   trial   judge
    should not focus "on a single or isolated . . . or past harm";
    instead, the judge must consider "the effect of harms arising from
    the parent-child relationship over time on the child's health and
    development."    
    K.H.O., supra
    , 161 N.J. at 348.                Indeed, "[a]
    parent's withdrawal of . . . solicitude, nurture, and care for an
    extended period of time is in itself a harm that endangers the
    health and development of [a] child."           
    D.M.H., supra
    , 161 N.J. at
    379.
    We applaud defendant's efforts made immediately prior to
    trial: she continued her education in the nursing profession; she
    had not moved for nine months; and retained employment.              We wish
    defendant   continued   success   in     maintaining   milestones    as   she
    conquers the difficulties presented by her illness.             If these six
    months were isolated as the basis for review, our conclusions
    might be different.     However, we cannot ignore the totality of the
    evidence.    Defendant's successes as demonstrated at trial remain
    21                                A-0016-16T1
    fragile,   particularly     in     light   of   her    sporadic,      inconsistent
    history of repeated compliance and relapse.
    The Division's involvement with the family began in 2010.
    The   trial    judge    correctly     considered       defendant's      acts     and
    omissions beginning in 2014, rather than emphasizing behaviors
    during her youth.       Since the younger child was born, the evidence
    reveals defendant's inability to sustain a safe and secure home
    for the children.       She engaged in explosive episodes of anger when
    things were not as she wished; she rejected assistance from the
    Division and its providers as working against her. Other behaviors
    reflected a deterioration of her mental health and her decision-
    making skills by inconsistently engaging in treatment; rebuffing
    the   importance   of    counseling,       which   included     an    emphasis    on
    medication    compliance     and    monitoring        because   her     claims    of
    consistent medication compliance were untrustworthy; declining
    services she felt unnecessary or restrictive; allowing services
    to terminate because of excessive absences; rejecting house rules
    with which she found fault; living in nine different residences
    during the prior two-year period; withholding information from the
    Division and even her own evaluator, including                       at times her
    whereabouts;    engaging    in     criminal     conduct,   which      resulted    in
    incarceration; and dabbling in cocaine use.
    22                                   A-0016-16T1
    The judge concluded the evidence showed a very high risk of
    harm to the children as a result of the parental relationship,
    before and after the Division obtained custody.         See 
    M.M., supra
    ,
    189   N.J.   at   290.   The   judge   emphasized   defendant's    lack    of
    demonstrated stability, essential for the children's security.
    She found the Division demonstrated erratic, unpredictable, and
    dangerous behaviors by defendant when she was not engaged in
    treatment.    Even defendant's expert conceded repeated relapses by
    sufferers of bipolar disorder were common and expected.            The lack
    of a safe, permanent home constitutes           "harm" under the best
    interests standard.      
    D.M.H., supra
    , 161 N.J. at 383; 
    J.C. supra
    ,
    129 N.J. at 26 (holding as an underlying concern a child's need
    for permanency within a reasonable amount of time).               Also, the
    judge acknowledged defendant's conduct during these periods was
    "probably very horrible."       See N.J. Div. of Youth & Fam. Servs.
    v. A.G., 
    344 N.J. Super. 418
    , 439-40 (App. Div. 2001) (noting
    mental illness of a parent may create an environment where the
    parent is incapable of safely caring for the children), certif.
    denied, 
    171 N.J. 44
    (2002).
    Defendant's syllogism suggesting a finding of harm because
    of her illness opens the possibility for all bipolar parents to
    be considered unfit is rejected.        The trial judge very precisely
    found it was not defendant's mental disorder itself, but her
    23                               A-0016-16T1
    failure      to   engage    in   necessary     treatment       consistently,      which
    satisfied prong one.
    Dr.    Brown's      hypothesis,    which     blamed      the   Division       for
    triggering defendant's relapses, is also rejected.                        The record
    shows when an extended visit was cancelled because the children
    were   ill,       defendant's     disappointment        triggered       her   relapse.
    However, life is filled with disappointments, large and small.                         If
    similar disappointments are sufficient to trigger defendant's
    relapse, serious exposure to potential harm is present.
    The    evidence      further   satisfies      the      related    prong      two.
    Defendant's        repeated      relapses,     caused    by     her   inability        or
    unwillingness        to    consistently      address     and    treat    her     mental
    illness, constituted harm.            These relapses, which went unabated,
    posed a risk to the safety and security of the children.                       See Div.
    of Youth & Family Servs. v. F.M., 
    211 N.J. 420
    , 450-51 (2012).
    The sustained success immediately before trial was the longest
    experienced by defendant.           The judge considered this and concluded
    six months were insufficient to show defendant had conquered the
    impediments        to     reunification      and   would      consistently       follow
    through, placing the children's needs first.                   The judge, crediting
    Dr.       Becker-Mattes'            evaluation,          concluded            defendant
    "over[]estimated her capabilities and minimized her limitations."
    24                                    A-0016-16T1
    A myriad of efforts, extended by the Division to achieve
    reunification, was recounted by the trial judge.       The Division
    provided "coordinated" services, which had a "realistic potential"
    of success.   N.J. Div. of Youth & Family Servs. v. J.Y., 352 N.J.
    Super. 245, 267 n.10 (App. Div. 2002).      The judge acknowledged
    programs which defendant completed.    She also discussed those not
    completed because of defendant's unwillingness to cooperate, which
    impeded achieving reliability as an independent caregiver.         The
    judge rejected Dr. Brown's suggestion the Division's efforts were
    not addressed to reunification or the services were insufficient.
    Reasonable efforts to locate family members as viable placements
    for the children was also proven.    See N.J. Div. of Youth & Family
    Servs. v. K.L.W., 
    419 N.J. Super. 568
    , 582 (App. Div. 2011)
    (commenting the Division is not obligated "to search the fifty
    states or even the twenty-one counties to identify [relatives]
    . . . .").
    We defer to these findings grounded on unrefuted evidence in
    the record.   We also reject defendant's argument the Division was
    required to re-investigate and re-assess family members determined
    to be unqualified caregivers.
    The final prong demands proof "[t]ermination of parental
    rights will not do more harm than good" to the affected children.
    N.J.S.A.   30:4C-15.1(a)(4).    This   "fail-safe"   guards   against
    25                            A-0016-16T1
    termination of rights where a judge concludes termination is
    inappropriate, even in light of proof of the first three prongs.
    
    G.L., supra
    , 191 N.J. at 609.
    Defendant    relies    on   the   experts'   observation   she    is    an
    affectionate mother, who has a bond with her children.          She argues
    insufficient weight was given to Dr. Brown's opinion the older
    child will suffer irreparable harm if the bond with his mother is
    permanently severed.
    The bonding experts were at odds on this point.             The trial
    judge credited the analysis of the Division's expert, Dr. Becker-
    Mattes, finding Dr. Brown's opinion was "not in accord with the
    overwhelming credible evidence offered in this trial . . . to the
    contrary."       Further,   she    found    Dr.   Brown's   conclusion       of
    defendant's mental stability was internally inconsistent with his
    suggested expectation she would experience relapses, as well as
    the record showing a pattern of "primarily noncompliance."                  The
    judge also discredited Dr. Brown's opinion because it heavily
    relied on defendant's clinical interview statements rather than
    "the voluminous information chronicled in her long history with
    the Division."
    The judge evaluated the evidence of the stress experienced
    by the children, before, during, and after visits.           She noted Dr.
    Brown admitted the younger child's stronger bond rests with the
    26                             A-0016-16T1
    resource parents, who are the only caregivers the child has known.
    Further, the older child considers them as psychological parents
    and had the fortitude to reveal to his resource mother the desire
    to stay in their care.         Both experts acknowledged the safe and
    secure bond between the children and their nurturing resource
    parents, who can aid them to overcome a loss. The resource parents
    readily recognized the children's needs and were committed to
    facilitating those needs.
    We defer to the judge's factual findings, based on her ability
    to hear the witnesses and watch their testimony.                    Her thorough
    findings fulfill her "responsibility to make sense of the competing
    views presented by the experts and to assure a complete and
    balanced   presentation       of    all    relevant     and    material   evidence
    sufficient to enable it to make a sound determination of the
    child's best interests."           
    K.L.F., supra
    , 129 N.J. at 44.
    In    light   of   our    review,         we   conclude   Judge   Audrey     P.
    Blackburn's judgment terminating defendant's parental rights and
    awarding guardianship to facilitate adoption of the children by
    their resource parents is amply supported by the evidence and will
    not be disturbed.       Judge Blackburn properly weighed the testimony
    of each witness, as well as the other evidence to determine the
    children's best interests, which she concluded were stability and
    27                               A-0016-16T1
    permanency.   
    J.C., supra
    , 129 N.J. at 26.   We discern no error in
    applying the facts to the applicable law.
    Affirmed.
    28                           A-0016-16T1