In re A.J. ( 2017 )


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    2017 UT App 235
    THE UTAH COURT OF APPEALS
    STATE OF UTAH, IN THE INTEREST OF A.J. AND A.J.,
    PERSONS UNDER EIGHTEEN YEARS OF AGE.
    B.J.,
    Appellant,
    v.
    STATE OF UTAH,
    Appellee.
    Opinion
    No. 20160134-CA
    Filed December 29, 2017
    Fourth District Juvenile Court, American Fork Department
    The Honorable Suchada P. Bazzelle
    No. 1101463
    Janell R. Bryan, Attorney for Appellant
    Sean D. Reyes, Carol L.C. Verdoia, and John M.
    Peterson, Attorneys for Appellee
    Martha Pierce, Guardian ad Litem
    JUDGE MICHELE M. CHRISTIANSEN authored this Opinion, in
    which JUDGES GREGORY K. ORME and DAVID N. MORTENSEN
    concurred.
    CHRISTIANSEN, Judge:
    ¶1     B.J. (Father) appeals the juvenile court’s order terminating
    his parental rights to A.J. (Older Child) and A.J. (Younger Child).
    We affirm.
    In re A.J.
    BACKGROUND
    ¶2     Father and J.E. (Mother) are the natural parents of Older
    Child and Younger Child. In June 2014, the Division of Child
    and Family Services (DCFS) filed a petition for custody after
    Older Child told a teacher at her school that during a May 2014
    argument, Father and Mother had physically pulled her arms
    and legs in different directions, causing Older Child to “slam[]”
    her face on the ground. After a shelter hearing, the children were
    removed from the parents’ custody and placed into DCFS’s
    custody.
    ¶3     In July 2014, the juvenile court ordered DCFS to conduct a
    risk assessment on Father. The risk assessment revealed “serious
    concerns” that Father had a substance abuse problem. Based on
    the risk assessment, DCFS recommended that Father submit to
    random drug tests, reduce his medication dosages, participate in
    substance abuse treatment, participate in psychological testing
    and follow any recommendations therefrom, attend a parenting
    program, and undergo a domestic violence assessment.
    Although the juvenile court did not order services for Father at
    that time, DCFS arranged for random drug testing and
    assessments so that Father could start addressing the identified
    concerns before adjudication. Father did not participate in any
    services until they were later ordered.
    ¶4     In February 2015, the juvenile court held a pretrial
    hearing on the State’s amended verified petition to adjudicate
    the children as neglected. Father entered a plea under rule 34(e)
    of the Utah Rules of Juvenile Procedure, by which he stipulated
    to several allegations in the State’s amended verified petition
    and “neither admitted nor denied” other allegations. The
    juvenile court therefore deemed the allegations in the petition to
    be true. 1 Among other things, the court found the following
    1. Pursuant to rule 34(e), “[a] respondent may answer by
    admitting or denying the specific allegations of the petition, or
    (continued…)
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    allegations to be true: (1) Older Child had been injured as a
    result of the May 2014 incident between Father and Mother;
    (2) Father “[has] a substance abuse problem and such problem
    interfere[s] with [his] ability to parent [the] children”; (3) Father
    and Mother “have a history of domestic violence”; and (4) “the
    children have been present during fights between the parents
    and are impacted by the exposure to domestic violence.” The
    juvenile court adjudicated the children as neglected by Father.
    ¶5      The juvenile court also approved a service plan, which
    required Father to (1) participate in a mental health evaluation,
    “specifically [a] psychological evaluation”; (2) submit to a
    substance abuse assessment; (3) participate in random urinalysis
    tests; (4) “[s]ign any required releases of information for all
    medical, psychological, domestic violence, and/or substance
    abuse treatment providers [and] provide copies to DCFS”;
    (5) participate in a domestic violence assessment; (6) visit with
    the children on a regular basis; (7) “[m]aintain stable and
    appropriate housing”; (8) maintain employment; and
    (9) participate in a parenting program. The court also directed
    DCFS to conduct pill counts of Father’s medications, and Father
    acknowledges this included the requirement to take his pills as
    prescribed.
    ¶6     In March 2015, the juvenile court found that Father had
    made “[l]ittle progress” with his service plan and scheduled a
    permanency hearing for June 15. At the permanency hearing, the
    juvenile court determined that both parents had “failed to
    participate in, comply with, in whole or part, or to meet the goals
    of [the] court approved treatment plan” and changed the
    permanency plan for the children to adoption. Regarding Father
    (…continued)
    by declining to admit or deny the allegations. Allegations not
    specifically denied by a respondent shall be deemed true.” Utah
    R. Juv. P. 34(e).
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    specifically, the court observed that Father had attended a
    substance abuse assessment and was attending the
    recommended therapy. Father had attended thirty drug tests,
    but he had also missed forty drug tests. In addition, “DCFS had
    been conducting pill counts and many of [Father’s] prescriptions
    were off count, indicating he was not using his medications as
    prescribed.” The court observed that Father had completed a
    psychological evaluation but had not followed the
    recommendations from that evaluation. Father also had not
    completed a domestic violence assessment or parenting
    program. Father’s attendance at visits with the children had
    improved, but he had still missed three out of twelve scheduled
    visits.
    ¶7      The State filed a petition to terminate the parents’
    parental rights on July 1, 2015. In the petition, the State asserted
    that it had been provided with a copy of an independent medical
    evaluation (the Medical Evaluation) conducted on Father in
    November 2013. The Medical Evaluation was prepared by Dr.
    Mattingly in response to Father’s complaints of ongoing injuries
    from a September 2011 work accident. Although Father’s doctor
    had cleared him to go back to work later that year, Father did
    not return to work, asserting that he had migraines from the
    work accident. According to the State, Dr. Mattingly had
    concluded in her evaluation that Father’s work injuries had been
    minor and had stabilized, that Father’s complaints of headaches
    had not been substantiated by any objective findings, and that
    Father had “opioid dependence and abuse/opioid dependence.”
    The Medical Evaluation also included Father’s medical records
    from September 2011, the time of Father’s work accident, to
    November 2013.
    ¶8     Father filed a motion in limine seeking to suppress both
    Dr. Mattingly’s testimony and the Medical Evaluation. Father
    observed that the Medical Evaluation included “many pages of
    [his] Medical Records” and asserted that the Medical Evaluation
    was “protected by the confidentiality owed him by his
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    In re A.J.
    physicians and treatment providers.” In its response, the State
    argued that Father’s physical and emotional health were at issue
    and that there was “no violation of confidentiality rules.” The
    State further asserted that Mother had given the Medical
    Evaluation to DCFS. 2 According to the State, Father “had left
    [the Medical Evaluation] in the couples’ home and allowed
    [Mother] to have the document”; therefore, Father had waived
    any privilege to the information in the Medical Evaluation.
    ¶9     The juvenile court did not rule on the admissibility of the
    Medical Evaluation until the first day of the termination trial in
    November 2015. 3 The court initially declined to admit the
    Medical Evaluation but allowed Dr. Mattingly to testify. The
    court noted that it would strike Dr. Mattingly’s testimony if
    Father did not assert a medical defense justifying “his substance
    use.” Father later presented testimony from one of his doctors,
    Dr. Dana, that he had prescribed buprenorphine, commonly
    known as Suboxone or Subutex, based on Father’s frequent
    headaches and migraines. 4 Accordingly, the juvenile court
    observed that “a medical defense [was] being launched.” The
    court then determined that Dr. Mattingly’s testimony had
    2. Mother testified that she found the Medical Evaluation in a
    storage unit she shared with Father and gave the Medical
    Evaluation to DCFS.
    3. Mother voluntarily relinquished her parental rights on the last
    day of the termination trial. She is not a party to this appeal.
    4. Buprenorphine is a schedule III controlled substance intended
    for the treatment of pain (Buprenex) and opioid addiction
    (Suboxone and Subutex). Drug & Chemical Evaluation Section,
    Office of Diversion Control, Drug Enforcement Administration,
    Buprenorphine (July 2013), https://www.deadiversion.usdoj.gov/
    drug_chem_info/buprenorphine.pdf         [https://perma.cc/K3XS-
    NQ8R].
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    In re A.J.
    authenticated the Medical Evaluation, and the court admitted
    the Medical Evaluation in its entirety into evidence.
    ¶10 In its written order terminating Father’s parental rights,
    the juvenile court acknowledged that the Medical Evaluation
    “was performed at the request of an insurance company
    opposing [Father’s] worker’s compensation benefits.” Thus, the
    court determined, “the analysis and conclusions of [the Medical
    Evaluation] were likely to be biased,” and the court “gave them
    no weight in reaching its decision.” However, the court observed
    that the Medical Evaluation also contained “a compilation of
    [Father’s] medical history that was a recitation of treatment notes
    from other treatment providers.” The court found that “this
    section of the evaluation was sufficiently objective to be reliable
    and useful in understanding the context and history of the
    medical treatment [Father] received for his work injury.” The
    court stated that it “did rely on Dr. Mattingly’s compilation of
    [Father’s] medical records” to assess Father’s medical defense
    “that he was using prescription medications for medical
    reasons.” In its written findings, the juvenile court referred to the
    medical history from the Medical Evaluation numerous times
    and concluded that Father “is a drug addict.”
    ¶11 The juvenile court terminated Father’s parental rights
    based on five different grounds. The court found that (1) Father
    had neglected the children “by exposing them to incidents of
    domestic violence, by not attending to the children’s needs, by
    not providing them a safe and stable home environment, and by
    exposing them to drug use”; (2) Father was an unfit or
    incompetent parent based on his “serious substance abuse
    problem”; (3) the children had been in an out-of-home
    placement, and Father “has substantially neglected, or has been
    unable or unwilling to remedy the circumstances that cause[d]
    the children to be in an out-of-home placement, and there is a
    substantial likelihood that [Father] will not be capable of
    exercising proper and effective parental care in the near future”;
    (4) Father had failed to make a parental adjustment “in that [he]
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    In re A.J.
    was not able to achieve the goals of the DCFS service plan and
    demonstrate he could be a responsible parent”; and (5) Father
    had made “insufficient efforts . . . to support the children, to
    prevent further neglect of them, to eliminate the risk of serious
    harm to the children, and to avoid being an unfit parent.” The
    juvenile court also found that it was “strictly necessary” and in
    the best interests of the children to terminate Father’s parental
    rights.
    ¶12 Father now appeals the juvenile court’s order terminating
    his parental rights.
    ISSUES AND STANDARDS OF REVIEW
    ¶13 Father raises four issues on appeal. First, he contends that
    “[t]he Medical Evaluation was unfairly prejudicial and required
    complete exclusion.” Second, in a related argument, Father
    contends that “[t]he Medical Evaluation was a private document
    and reliance on any portion thereof cannot justify termination of
    parental rights.” “A trial court has broad discretion to admit or
    exclude evidence and its determination typically will only be
    disturbed if it constitutes an abuse of discretion.” In re L.N., 
    2004 UT App 120
    , ¶ 9, 
    91 P.3d 836
     (citation and internal quotation
    marks omitted). “The existence of a privilege [or an exception
    thereto] is a question of law, which we review for correctness.”
    State v. Worthen, 
    2008 UT App 23
    , ¶ 9, 
    177 P.3d 664
     (alteration in
    original) (citation and internal quotation marks omitted), aff’d,
    
    2009 UT 79
    , 
    222 P.3d 1144
    .
    ¶14 Third, Father contends that without the Medical
    Evaluation, “[t]he remaining evidence was insufficient to
    support termination” of his parental rights. We recognize that
    juvenile court judges have special training, experience, and
    interest in their field, as well as the opportunity to judge
    credibility firsthand; consequently, we review a juvenile court’s
    decision to terminate parental rights deferentially and will not
    disturb the juvenile court’s findings and conclusions unless the
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    preponderance of the evidence clearly militates against the
    findings made or the court has otherwise abused its discretion.
    In re A.B., 
    2007 UT App 286
    , ¶ 10, 
    168 P.3d 820
    ; In re R.A.J., 
    1999 UT App 329
    , ¶ 6, 
    991 P.2d 1118
    . “When a foundation for the
    court’s decision exists in the evidence, an appellate court may
    not engage in a reweighing of the evidence.” In re B.R., 
    2007 UT 82
    , ¶ 12, 
    171 P.3d 435
    .
    ¶15 Fourth, Father contends that DCFS failed to make
    reasonable efforts to provide reunification services.
    “[D]etermining whether or not DCFS has provided reasonable
    services to parents requires trial judges to observe facts[] . . .
    relevant to the application of the law that cannot be adequately
    reflected in the record available to appellate courts.” In re A.C.,
    
    2004 UT App 255
    , ¶ 12, 
    97 P.3d 706
     (second alteration and
    omission in original) (citation and internal quotation marks
    omitted). Accordingly, the juvenile court has broad discretion in
    determining whether DCFS made reasonable efforts at
    reunification. 
    Id.
    ANALYSIS
    I. Any Error in Admitting the Medical Evaluation Was Harmless.
    ¶16 Father’s first two contentions involve the Medical
    Evaluation. First, he contends that “[t]he Medical Evaluation was
    unfairly prejudicial and required complete exclusion” under
    Utah Rule of Evidence 403. Second, he contends that “[t]he
    Medical Evaluation was a private document and reliance on any
    portion thereof cannot justify termination of parental rights.”
    More specifically, he asserts that the Medical Evaluation was
    privileged under Utah Rule of Evidence 506.
    ¶17   Rule 403 provides:
    The court may exclude relevant evidence if its
    probative value is substantially outweighed by a
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    danger of one or more of the following: unfair
    prejudice, confusing the issues, misleading the
    jury, undue delay, wasting time, or needlessly
    presenting cumulative evidence.
    Utah R. Evid. 403. Rule 506 provides that “[a] patient has a
    privilege, during the patient’s life, to refuse to disclose and to
    prevent any other person from disclosing information that is
    communicated in confidence to a physician or mental health
    therapist for the purpose of diagnosing or treating the patient.”
    
    Id.
     R. 506(b). But the privilege is not absolute. State v. Worthen,
    
    2008 UT App 23
    , ¶ 10, 
    177 P.3d 664
    , aff’d, 
    2009 UT 79
    , 
    222 P.3d 1144
    . Rule 506 contains certain exceptions to the patient
    privilege, including the directive that “[n]o privilege
    exists . . . [f]or communications relevant to an issue of the
    physical, mental, or emotional condition of the patient . . . in any
    proceeding in which that condition is an element of any claim or
    defense.” Utah R. Evid. 506(d)(1)(A).
    ¶18 We need not address Father’s evidentiary arguments at
    great length because, even if the juvenile court erred by
    admitting the Medical Evaluation, any error in admitting such
    evidence was harmless. See State v. Hamilton, 
    827 P.2d 232
    , 240
    (Utah 1992) (“We do not determine whether the evidence was
    admitted improperly, because we conclude that any error in its
    admission was harmless.”). “Harmless error ‘is an error that is
    sufficiently inconsequential that there is no reasonable likelihood
    that it affected the outcome of the proceedings.’” In re A.R., 
    2017 UT App 153
    , ¶ 12, 
    402 P.3d 206
     (quoting H.U.F. v. W.P.W., 
    2009 UT 10
    , ¶ 44, 
    203 P.3d 943
    ).
    ¶19 Here, the juvenile court initially declined to admit the
    Medical Evaluation, but the court allowed Dr. Mattingly to
    testify on the condition that “at the conclusion of the trial[,] if
    any kind of medical defense has not been launched by [Father],
    it’s possible that this testimony is not relevant and I could then
    strike that testimony.” Later in the trial, Dr. Dana testified that
    when Father came into his clinic, he was having frequent, severe
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    In re A.J.
    headaches that “seemed to have characteristics of migraine.” Dr.
    Dana testified that based on Father’s frequent headaches and
    migraines, he prescribed buprenorphine. Observing that “a
    medical defense is being launched,” the juvenile court
    determined that Dr. Mattingly’s testimony had authenticated the
    Medical Evaluation, and the court admitted the Medical
    Evaluation into evidence.
    ¶20 In its written order terminating Father’s parental rights,
    the juvenile court determined that “the analysis and conclusions
    of [the Medical Evaluation] were likely to be biased,” and the
    court “gave them no weight in reaching its decision.” However,
    the court observed that the Medical Evaluation also contained “a
    compilation of [Father’s] medical history that was a recitation of
    treatment notes from other treatment providers.” The court
    “found that this section of the evaluation was sufficiently
    objective to be reliable and useful in understanding the context
    and history of the medical treatment [Father] received for his
    work injury.” The court stated that it “did rely on Dr.
    Mattingly’s compilation of [Father’s] medical records” to assess
    Father’s medical defense “that he was using prescription
    medications for medical reasons.”
    ¶21 On appeal, Father does not dispute that he launched a
    medical defense at trial. See Utah R. Evid. 506(d)(1)(A). Indeed,
    he acknowledges that his “defense at trial was that he suffered
    from migraines, which justified his prescription medication.”
    Father asserts that “the Medical Evaluation had the undue
    tendency to improperly suggest [he] was a drug addict, which
    was unfairly prejudicial,” and that his use of a medical defense
    “did not entitle the State to access all of [his] past medical
    records to rebut such defense in favor of termination.”
    According to Father, the juvenile court erred when it “found his
    entire medical history as discoverable and admissible based on
    his defense of one medical complaint for headaches.”
    ¶22 Our supreme court has acknowledged that “[r]ule 506 is
    only broad enough to allow the disclosure of information
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    In re A.J.
    relevant to an element of any claim or defense.” Sorensen v.
    Barbuto, 
    2008 UT 8
    , ¶ 10, 
    177 P.3d 614
    . “Therefore, rule 506(d)(1)
    is a limited waiver of privilege, confined to court proceedings,
    and restricted to the treatment related to the condition at issue.”
    
    Id.
     “[A] waiver under rule 506(d)(1) does not mean that the
    patient has consented to the disclosure of his entire medical
    history.” 
    Id.
    ¶23 Assuming, for the sake of argument, that the Medical
    Evaluation contained privileged information, 5 the fact that
    Father asserted a medical defense did not automatically entitle
    the juvenile court to rely on Father’s comprehensive medical
    history in terminating his parental rights. Cf. 
    id.
     After reviewing
    the record, it does appear that the juvenile court failed to
    properly assess the admissibility of the Medical Evaluation and
    to limit its consideration of the evaluation “to the treatment
    related to the condition at issue.” See 
    id.
     Nevertheless, we
    conclude that any error in the juvenile court’s admission of, and
    reliance on, the Medical Evaluation was harmless. See In re A.R.,
    
    2017 UT App 153
    , ¶ 12. As explained in Part II of this opinion,
    there was sufficient independent evidence demonstrating that
    Father had a substance abuse issue and sufficient evidence to
    5. Father asserts, without citation to the record, that “[t]he
    parties agree the Medical Evaluation is privileged and meets the
    definitions of [Utah Rule of Evidence] 506(b).” This assertion
    appears to be incorrect, as the State asserts that “[n]either Dr.
    Mattingly’s testimony nor the [Medical Evaluation] were
    privileged because of the nature of Father’s encounter with Dr.
    Mattingly,” i.e., Father had no physician-patient relationship
    with Dr. Mattingly, because Dr. Mattingly “did not examine
    Father or prepare [the Medical Evaluation] for treatment; it was
    conducted for the sole purpose of determining his fitness to
    return to work.” The State further asserts that “even if privilege
    exists,” Father waived the privilege when he launched a medical
    defense at trial.
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    support the juvenile court’s ultimate decision to terminate
    Father’s parental rights. 6
    II. Sufficient Evidence Supports the Juvenile Court’s Termination
    of Father’s Parental Rights.
    ¶24 Father contends that “if the Medical Evaluation and Dr.
    Mattingly’s testimony [had] been properly excluded,” the
    remaining evidence was insufficient “to support the juvenile
    court’s findings and conclusion that the children are neglected as
    to Father.” The State, on the other hand, contends that “[e]ven
    assuming admitting Dr. Mattingly’s testimony and the [Medical
    Evaluation] was error, it was necessarily harmless because other
    sufficient evidence existed to terminate Father’s parental rights.”
    We agree with the State.
    ¶25 “Utah law requires a court to make two distinct findings
    before terminating a parent-child relationship.” In re R.A.J., 
    1999 UT App 329
    , ¶ 7, 
    991 P.2d 1118
    . “First, the court must find that
    the parent is below some minimum threshold of fitness, such as
    finding that a parent is unfit or incompetent based on any of the
    grounds for termination under section [78A-6-507] of the Utah
    Code.” 
    Id.
     (citation and internal quotation marks omitted); see
    also Utah Code Ann. § 78A-6-507(1) (LexisNexis 2012) (listing the
    grounds for termination of parental rights). Pursuant to section
    78A-6-507(1), the finding of a single enumerated ground is
    sufficient to warrant the termination of parental rights. See Utah
    6. Father also asserts that the State “had no right to the Medical
    Evaluation provided . . . by Mother” because it is a private
    medical record under the Government Records Access and
    Management Act and that the State violated the Health
    Insurance Portability and Accountability Act “by disclosing the
    Medical Evaluation without Father’s consent.” Given our
    determination that there was sufficient evidence to terminate
    Father’s parental rights without the Medical Evaluation, we need
    not address these issues.
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    Code Ann. § 78A-6-507(1). “Second, the court must find that the
    best interests and welfare of the child are served by terminating
    the parents’ parental rights.” In re R.A.J., 
    1999 UT App 329
    , ¶ 7;
    see also Utah Code Ann. § 78A-6-506(3) (LexisNexis 2012). “A
    petitioner has the burden of establishing both of these elements
    by clear and convincing evidence.” In re R.A.J., 
    1999 UT App 329
    ,
    ¶ 7; see also Utah Code Ann. § 78A-6-506(3). Father does not
    challenge the juvenile court’s determination that termination of
    his parental rights was in the children’s best interests, and we
    therefore address only the parental fitness element of the
    statutory test. 7
    ¶26 The juvenile court terminated Father’s parental rights on
    five different grounds: (1) Father had neglected the children “by
    exposing them to incidents of domestic violence, by not
    attending to the children’s needs, by not providing them a safe
    and stable home environment, and by exposing them to drug
    use”; (2) Father was an unfit or incompetent parent based on his
    “serious substance abuse problem”; (3) the children had been in
    an out-of-home placement, and Father “has substantially
    neglected, or has been unable or unwilling to remedy the
    circumstances that cause[d] the children to be in an out-of-home
    placement, and there is a substantial likelihood that [Father] will
    not be capable of exercising proper and effective parental care in
    the near future”; (4) Father had failed to make a parental
    adjustment “in that [he] was not able to achieve the goals of the
    DCFS service plan and demonstrate he could be a responsible
    parent”; and (5) Father had made “insufficient efforts . . . to
    support the children, to prevent further neglect of them, to
    eliminate the risk of serious harm to the children, and to avoid
    being an unfit parent.” See Utah Code Ann. § 78A-6-507(1)(b)–(f).
    7. In his reply brief, Father generally asserts that if grounds for
    termination are present, “best interests can then be considered.”
    But Father provides no analysis regarding the children’s best
    interests in this case.
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    So long as sufficient evidence existed to support at least one of
    the grounds found by the court, the termination of Father’s
    parental rights was appropriate.
    ¶27 On appeal, Father focuses his arguments on the juvenile
    court’s determination that he had neglected the children “by
    exposing them to drug use” and was an unfit parent based on
    his “serious substance abuse problem.” See Utah Code Ann.
    § 78A-6-507(1)(b), (1)(c). As previously discussed, Father asserts
    that if the Medical Evaluation had not been admitted into
    evidence, “the remaining evidence would have been insufficient
    to terminate [his parental] rights.”
    ¶28 Utah Code section 78A-6-507 provides, among other
    things, that a court may terminate a parent’s parental rights if
    the court finds that “the parent has neglected or abused the
    child” or that “the parent is unfit or incompetent.” Id. Section
    78A-6-508 provides, in relevant part, that “[i]n determining
    whether a parent or parents are unfit or have neglected a child
    the court shall consider, but is not limited to, the following
    circumstances, conduct, or conditions: . . . (c) habitual or
    excessive use of intoxicating liquors, controlled substances, or
    dangerous drugs that render the parent unable to care for the
    child.” Id. § 78A-6-508(2)(c) (LexisNexis 2012). We conclude that,
    even after setting aside the Medical Evaluation, sufficient
    independent evidence exists to support the juvenile court’s
    conclusion that Father had a substance abuse problem and had
    exposed the children to drug use.
    ¶29 To begin with, in his rule 34(e) plea, Father admitted that
    he had a “substance abuse problem” and that it interfered with
    his ability to parent the children. Nevertheless, when confronted
    by this admission at trial, Father denied having a substance
    abuse problem.
    ¶30 Mother’s trial testimony also indicated that Father had a
    substance abuse problem. Mother testified that after his work
    accident, Father “pretended to have headaches and different
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    things to get pain medication.” Mother stated, “[W]e’d go to the
    doctors and on the way there [Father would] be rubbing his
    eyes, . . . or doing certain things to get prepared to go to the
    doctor before we got there.” Mother explained, “[W]e were
    going for the pain pills, that’s what we were doing it for.”
    Mother stated that when Father got pain medication, they would
    “split the bottle.” She stated they “smoked [instant release
    oxycodone] and we would sniff them, we’d swallow them.”
    Mother explained:
    [I]t took about a year and a half to actually get that
    high dosage of the medication. But before then we
    were just . . . sniffing the [L]ortab or the low dose
    of the [Percocet] that [Father] got at first. [H]e did a
    whole bunch of different treatments to get what we
    wanted. Once we got what we wanted, that’s
    where we stayed with it every time we went to the
    doctor.
    According to Mother, Older Child sometimes went to the doctor
    with them, and Father “would just start acting . . . sad . . . so
    [Older Child] would be like putting her arms around him like,
    it’s okay[,] but it’s just putting on a show for the doctor to be
    looking at him like, he’s really hurt.”
    ¶31 Mother further testified that when the family lived in a
    different house, she and Father used drugs in their bedroom or
    in a shed behind the house. The parents would leave Older
    Child to watch Younger Child when they did this. Older Child
    told DCFS that Mother and Father would “do nothing but sit in
    the shed” and that when Mother and Father were in the shed,
    she and Younger Child “couldn’t spend . . . time with them.”
    According to a DCFS caseworker, in her first visits with the
    children, Older Child understood that the children had been
    removed from their parents’ custody, in part, because their
    parents had been doing drugs in the shed.
    20160134-CA                     15               
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    In re A.J.
    ¶32 As part of his service plan, Father was required to submit
    to random urinalysis tests. The DCFS caseworker testified that
    Father “did fairly well in the beginning” and only “missed a few
    here and there.” However, between August 27, 2015, and
    October 6, 2015, Father missed six urinalysis tests. He also tested
    positive for Xanax in October 2015. Father did not have a
    prescription for Xanax. Rather, at that time, Father had
    prescriptions only for Ambien and Suboxone, so the DCFS
    caseworker presumed he had gotten the Xanax illegally. This
    occurred approximately one month before the beginning of the
    termination trial. Father acknowledged at trial that he had
    missed some tests, but he claimed it was due to his work.
    ¶33 The juvenile court had also ordered DCFS to conduct pill
    counts of Father’s prescription medications. The court noted that
    “[a]t times the counts were off and at other times [Father] forgot
    to bring the pill[s]. The counts were not reliable because of the
    inconsistencies and [Father’s] non-compliance.” The DCFS
    caseworker testified that Father’s pill counts were often
    unsuccessful because Father would forget to bring his
    medications, and he once brought three pills in his wallet
    without the prescription bottle, “so [she] couldn’t double check
    when the prescription was filled.” At the very first pill count,
    Father did not bring his Ambien with him, claiming that “he was
    told by the pharmacist that the Ambien would interact with the
    Suboxone and would kill him.” Ultimately, Father “never
    brought his Ambien” to the pill counts, but when the DCFS
    caseworker called Father’s doctor, “Ambien was still being
    prescribed to [Father].” The DCFS caseworker also testified that
    Father had told her that he was trying to get off of his
    prescription medications. The caseworker had requested several
    times that Father sit down with his current doctor and “come up
    with an actual written plan to [wean him] off of the Suboxone if
    that’s what he was planning on doing,” but Father never
    submitted a plan.
    20160134-CA                     16              
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    In re A.J.
    ¶34 Based on the foregoing, we conclude that there was
    sufficient evidence apart from the Medical Evaluation from
    which the juvenile court could conclude that Father was unfit
    due to his failure to address his substance abuse problem. 8 Thus,
    8. We note that Father does not directly address the juvenile
    court’s grounds for termination under Utah Code section 78A-6-
    507(1)(d) and (1)(f). See Utah Code Ann. § 78A-6-507(1)(d)
    (LexisNexis 2012) (failure to “remedy the circumstances that
    cause the child to be in an out-of-home placement” and “there is
    a substantial likelihood that the parent will not be capable of
    exercising proper and effective parental care in the near future”);
    id. § 78A-6-507(1)(f) (failure of parental adjustment). We could
    affirm on this failure alone. See, e.g., In re B.C., 
    2016 UT App 208
    ,
    ¶ 6, 
    385 P.3d 705
     (per curiam) (“Because Mother does not
    challenge the grounds of neglect, unfitness, or token efforts, this
    court need not review her claim that the evidence was
    insufficient to support the grounds of abandonment.”); In re
    N.M., 2007 UT App 16U, para. 2 (per curiam) (observing, where
    the juvenile court terminated the mother’s parental rights on
    multiple grounds and the mother challenged only one ground
    on appeal, that the mother had implicitly conceded that there
    was adequate evidentiary support for the juvenile court’s other
    grounds for termination).
    Further, Father does not address the issue of domestic
    violence. Instead, he cursorily asserts that domestic violence was
    “not the focus at trial.” Where a party fails to marshal the
    evidence in support of a challenged finding, the party “will
    almost certainly fail to carry its burden of persuasion on appeal.”
    State v. Nielsen, 
    2014 UT 10
    , ¶ 42, 
    326 P.3d 645
    . Father has not
    marshaled the evidence supporting the juvenile court’s finding
    of domestic violence, nor has he demonstrated that the evidence
    clearly preponderates against the findings made regarding
    domestic violence or that the juvenile court otherwise abused its
    discretion. See In re A.B., 
    2007 UT App 286
    , ¶ 10, 
    168 P.3d 820
    ; In
    re R.A.J., 
    1999 UT App 329
    , ¶ 6, 
    991 P.2d 1118
    .
    20160134-CA                      17              
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    In re A.J.
    the evidence supports the juvenile court’s decision to terminate
    Father’s parental rights on the basis of unfitness.
    III. DCFS Made Reasonable Efforts to Reunite Father with
    the Children.
    ¶35 Lastly, Father contends that DCFS failed to make
    reasonable efforts to provide reunification services.
    ¶36 Pursuant to Utah Code section 78A-6-507, “in any case in
    which the court has directed the division to provide
    reunification services to a parent, the court must find that the
    division made reasonable efforts to provide those services before
    the court may terminate the parent’s rights under Subsection
    (1)(b), (c), (d), (e), (f), or (h).” Utah Code Ann. § 78A-6-507(3)(a)
    (LexisNexis 2012). “DCFS [complies] with its statutory obligation
    to make reasonable efforts toward reunification if it makes a fair
    and serious attempt to reunify a parent with a child prior to
    seeking to terminate parental rights.” In re A.C., 
    2004 UT App 255
    , ¶ 14, 
    97 P.3d 706
    .
    ¶37 The juvenile court determined that “[r]easonable efforts
    were made by DCFS to facilitate treatment for [Father].” The
    court observed:
    Although the Petition was not adjudicated as to
    [Father] until February 2015, DCFS immediately set
    him up with services in July 2014, so as not to
    delay [Father] receiving necessary treatment. He
    was set up with random drug testing, he was
    provided referrals for assessments and given
    information for parenting programs. If there was
    delay in treatment, the delay was caused by
    [Father]. DCFS could not have done anything more
    to assist [Father] in addressing identified concerns
    in being a parent.
    20160134-CA                      18              
    2017 UT App 235
    In re A.J.
    The court also noted that Father did not participate in any
    services until they were ordered by the court.
    ¶38 Although Father’s argument is framed as such, Father
    does not truly argue that DCFS failed to provide him with the
    proper level of assistance in obtaining the required services.
    Instead, the thrust of Father’s argument is that, despite his
    alleged substantial compliance with the service plan, DCFS still
    sought termination of his parental rights. However, Father’s
    argument mischaracterizes the factual record, because Father did
    not substantially comply with the terms of his service plan.
    ¶39 Father’s service plan required him to (1) participate in a
    mental health evaluation, “specifically [a] psychological
    evaluation”; (2) submit to a substance abuse assessment;
    (3) participate in random urinalysis tests; (4) “[s]ign any required
    releases of information for all medical, psychological, domestic
    violence, and/or substance abuse treatment providers [and]
    provide copies to DCFS”; (5) participate in a domestic violence
    assessment; (6) visit with the children on a regular basis;
    (7) “[m]aintain stable and appropriate housing”; (8) maintain
    employment; and (9) participate in a parenting program. The
    juvenile court also directed DCFS to conduct pill counts of
    Father’s medications. Father acknowledges this included the
    requirement to take his pills as prescribed.
    ¶40 The juvenile court found that Father “did work on some
    objectives in the service plan” but that he “only partially
    complied with the plan by working on a few of the objectives.”
    For example, Father failed to complete or make substantial
    progress on the domestic violence objective in his service plan.
    Indeed, before the start of the termination trial, Father had
    completed only two of the recommended twenty weeks of
    domestic violence treatment. Consequently, the juvenile court
    observed that “[t]he domestic violence objective contained in the
    service plan has not been addressed by [Father]” and that Father
    was still in need of domestic violence treatment.
    20160134-CA                     19               
    2017 UT App 235
    In re A.J.
    ¶41 Regarding the urinalysis testing requirement, Father
    missed six tests between August 27, 2015, and October 6, 2015.
    He also tested positive for Xanax in October 2015, a controlled
    substance for which he did not have a prescription. Father also
    made it difficult for DCFS to conduct pill counts by failing to
    bring his medications with him and by bringing three pills in his
    wallet without the prescription bottle, “so [the DCFS
    caseworker] couldn’t double check when the prescription was
    filled.” The juvenile court determined that “[t]he counts were not
    reliable because of the inconsistencies and [Father’s] non-
    compliance.”
    ¶42 Additionally, Father’s compliance with the service plan’s
    requirement that he “maintain safe, stable and appropriate
    housing” was questionable at best. Although Father had
    housing, he was sharing an apartment with another man who
    was receiving housing assistance for the unit. Father’s name was
    not on the lease. Instead, Father was “allowed to live at the
    apartment at the will of the roommate.” The juvenile court noted
    that “[t]here could be a possible violation of the housing
    assistance agreement because the housing authority was not
    informed [that Father] was living in the unit and there was no
    check of eligibility with [Father’s] income.” Thus, the juvenile
    court determined, “[t]here is concern about the stability of
    [Father’s] housing.”
    ¶43 Based on the foregoing, Father’s assertion that he
    substantially complied with the service plan lacks merit. 9 As
    9. Although Father does not specifically address the juvenile
    court’s determination regarding failure of parental adjustment,
    supra ¶ 34 note 8, we note that Father’s failure to substantially
    comply with his service plan is evidence of his failure of parental
    adjustment. See In re J.T., 
    2012 UT App 253
    , ¶ 3, 
    286 P.3d 960
     (per
    curiam); see also Utah Code Ann. §§ 78A-6-507(1)(e), -508(5)
    (LexisNexis 2012).
    20160134-CA                     20              
    2017 UT App 235
    In re A.J.
    such, Father cannot demonstrate that DCFS’s decision to seek
    termination is evidence of its failure to offer reasonable services
    when he failed to fully avail himself of the services DCFS did
    offer.
    ¶44 Father also briefly asserts that “DCFS had given up by the
    time of adjudication.” However, the record speaks to the
    contrary. At trial, Father acknowledged that the DCFS
    caseworker encouraged him to begin services before they were
    ordered by the juvenile court, but he chose not to begin services
    because he was “upset.” Father testified, “I didn’t know how any
    of this was happening or how it was right because . . . I’m a great
    father.”
    ¶45 The DCFS caseworker testified that after the State’s
    petition was adjudicated in February 2015, she gave Father the
    information he needed to obtain his substance abuse assessment;
    Father did not complete the assessment until the end of March.
    She also stated that Father did not complete his psychological
    evaluation until the end of May and that he had canceled several
    appointments. The DCFS caseworker testified that she reminded
    Father that those assessments needed to be done, “especially
    since it wasn’t just the assessment, he would have to follow
    whatever recommendations were [made] in that assessment.”
    She testified that Father often acted like “he was hearing [what
    she told him] for the first time” and that she “wasn’t sure if he
    was being manipulative necessarily or if he really truly didn’t
    understand.” The DCFS caseworker sent Father reminders via
    text message and in person; she tried “to use all different kinds
    of communication to make sure he understood everything.” She
    also testified that she had ordered cognitive evaluations to
    determine if Father was capable of understanding what was
    required of him and that the test results indicated that Father
    “should be able to do these things.”
    ¶46 In sum, we conclude that Father did not substantially
    comply with the service plan and that the juvenile court acted
    within its discretion when it found that DCFS had made
    20160134-CA                     21              
    2017 UT App 235
    In re A.J.
    reasonable efforts to reunify Father with the children prior to
    terminating his parental rights. The record demonstrates that
    DCFS made reasonable efforts both before and after the State’s
    petition was adjudicated to facilitate treatment for Father.
    CONCLUSION
    ¶47 We affirm the juvenile court’s order terminating Father’s
    parental rights.
    20160134-CA                   22             
    2017 UT App 235