In Re The Dep Of Dmr., Cleve A. Goheen-rengo, App v. Dshs State Of Wa. ( 2018 )


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  •  IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
    In the Matter of the Dependency of           )         No. 76721-6-1
    )        (consol. with Nos. 76722-4-1,
    D.M.R.,                                      )        76723-2-1, 76724-1-1,
    DOB: 10/02/14,                               )        76725-9-1, 76726-7-1)
    )
    M.G.R.,                                      )
    DOB: 10/02/14,                               )         DIVISION ONE
    )
    U.C.R.,                                      )         UNPUBLISHED OPINION
    DOB: 11/28/13,                               -)
    )
    )         FILED: March 5, 2018
    )
    APPELWICK, J. — Carey and Goheen-Rengo appeal orders terminating their
    parental rights to U.R., M.R., and D.R. Carey contends the Department failed to
    offer or provide all necessary and available services capable of correcting her
    parental deficiencies. Goheen-Rengo contends the Department failed to prove
    that there was little likelihood his parental deficiencies could be remedied in the
    near future, that he was unfit to parent, and that termination was in the best
    interests of the children. Substantial evidence supports the relevant findings. We
    affirm.
    FACTS
    Erica Carey and Cleve Goheen-Rengo are the parents of four children:
    U.R. (born 11/28/13), twins D.R. and M.R. (born 10/02/14), and J.E.C. (born
    No. 76721-6-1/2
    10/29/15).1 Since the couple met in 2013, police in several cities have repeatedly
    responded to reports of domestic disputes at the couple's residences.
    In October 2013, before U.R. was born, police in La Center, Washington,
    responded three times in one evening to reported disturbances. An argument
    between Carey and Goheen-Rengo's mother led to the mother's arrest. When
    Carey later attempted to dial 911, Goheen-Rengo reportedly interrupted the call,
    twisted Carey's wrists, and took the phone from her. Police arrested Goheen-
    Rengo and removed him from the home.
    In March 2014, La Center police responded to another dispute at the
    couple's residence. Carey, who was pregnant with twins, was planning to move
    to Bellingham and stay with Goheen-Rengo's father, but Goheen-Rengo would not
    allow her to leave with U.R. After two visits from the police, Goheen-Rengo finally
    allowed Carey to leave with the infant.
    At the time of the twins' birth on October 2, 2014, Carey, Goheen-Rengo,
    and U.R. were sharing a one bedroom apartment in Bellingham with Goheen-
    Rengo's father. The twins were born at home without medical assistance. Carey
    had only minimal prenatal care, and the parents did not seek any medical care
    after the twins were born.
    On October 6, 2014, Bellingham police responded to a call from Goheen-
    Rengo's father about the family's welfare. Carey was "crying hysterically" and told
    J.E.C. is involved in a separate dependency proceeding and is not part of
    this appeal.
    -2-
    No. 76721-6-1/3
    officers that she was struggling to care for and breastfeed the three children. The
    police called paramedics, who checked the children and found no immediate
    medical concerns.
    A Department of Social and Health Services (Department) social worker
    met with the family and developed a protective action plan. Carey agreed to
    schedule a well-child appointment for the twins with a pediatrician and to arrange
    a medical appointment for U.R., who had a deep red rash on his legs. Carey also
    agreed to arrange for nutritional support services.
    On October 9, 2014, Carey called the police for assistance in taking U.R. to
    a medical appointment for his rash. Goheen-Rengo would not allow her to leave
    the apartment with the children. Carey eventually arranged for transportation and
    took the three children to a hospital. After an examination, Carey received an
    antibiotic cream for U.R.'s rash and antibiotics for her urinary tract infection. Carey
    later informed a Department social worker that she did not plan to use the
    prescribed medication for herself or U.R. The physician also provided Carey with
    formula to supplement the children's nutrition.
    Carey and Goheen-Rengo opposed the Department's recommendations
    regarding supplementation to breastfeeding. Although Carey made an appointment
    for nutrition services, she did not keep the appointment.
    On November 5, 2014, citing continuing concerns about the children's
    medical condition, the reports of ongoing domestic disputes, and the parents'
    ability to provide a safe and nurturing environment, the Department filed a
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    No. 76721-6-1/4
    dependency petition and removed the children from the parents' home. Naomi
    Rodriguez, the Department social worker, arranged voluntary services for the
    parents, including domestic violence services and parenting education through
    Francie Gass, a public health nurse. In January 2015, Carey informed Rodriguez
    that Gass had been providing "outdated information." Carey found participation in
    the services pointless because she "knew all she needed to know."
    Dr. Rowena Pusateri, a pediatrician, examined the twins when they were
    about six weeks old. Dr. Pusateri diagnosed a failure to thrive, noting the twins
    were below the third percentile on the weight chart. The parents' expert witness,
    a licensed midwife, disagreed with Dr. Pusateri's analysis and maintained that the
    twins were not underweight.
    It is undisputed that at the time of the termination trial, all three children had
    special needs. U.R. requires treatment for anxiety and eczema. M.R. was
    diagnosed with autism spectrum disorder. She also has social deficits and speech
    delay. D.R. experienced developmental delays as a result of esophageal reflux.
    He has a sensory processing disorder and a significant hearing loss.
    On December 5, 2014, after a lengthy shelter care hearing, the trial court
    returned the children to the parents. Among other things, the court ordered both
    parents to obtain mental health services and a psychological evaluation with a
    parenting component. The court ordered Carey to participate in the Women,
    Infants, and Children nutrition program, and in domestic violence victim's services.
    Goheen-Rengo agreed to resolve his existing bench warrants and complete a
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    No. 76721-6-1/5
    domestic violence perpetrators evaluation. Carey and Goheen-Rengo also agreed
    to allow a visiting nurse to monitor the children's weights.
    The Department provided both parents with information on how to obtain
    and schedule the court ordered services. But, in the weeks following the shelter
    care hearing, the parents failed to schedule appointments or missed scheduled
    appointments. Angela Paull, a Department social worker, scheduled most of the
    children's medical appointments.
    A few weeks after the shelter care hearing, Carey told the children's
    guardian ad litem (GAL) that Goheen-Rengo had a gun and that she did not feel
    safe in the family home with Goheen-Rengo and his mother. After the police
    arrived, Carey and the children left the home and spent the night in a hotel. Carey
    and the children returned to the family home on the following morning.
    When Carey and Goheen-Rengo failed to engage in any of the court
    ordered mental health or domestic violence services, the Department attempted to
    modify the placement. The Department asked the court to place the children with
    Carey, on condition that she not reside with Goheen-Rengo or his family. In the
    alternative, the Department asked the court to place the children in foster care. On
    January 6, 2015, the court denied the motion, but conditioned continued placement
    with the parents on their full compliance with the court ordered services.
    A few weeks later, concerned about ongoing reports of domestic violence
    in the family, the Department filed a second motion to remove the children. But,
    before the court could rule on the motion, Carey and Goheen-Rengo fled with the
    -5-
    No. 76721-6-1/6
    children to California. While in California, the children's GAL received a text
    message from the parents, asserting that "we are not going to be kissing you all's
    ass anymore, baby stealers. You CPS whores can stop trying to separate us."
    The California Highway Patrol stopped the family in Santa Cruz County and
    arrested Carey and Goheen-Rengo. Carey head-butted and kicked the arresting
    officer and was later charged with resisting arrest. The Department placed the
    children in foster care when they returned to Washington.
    On February 27, 2015, after a contested fact-finding hearing, the trial court
    found all three children dependent under RCW 13.34.030(6)(b) (child abused or
    neglected) and .030(6)(c)(no parent or guardian capable of adequately caring for
    the child). The court rejected the parents' denial of any history of domestic violence
    as not credible. The court expressly found that Carey was "the victim of recurrent
    domestic violence perpetrated on her by [Goheen-Rengo]" and that the children
    had been exposed to Goheen-Rengo's domestic violence.
    The court found both Carey and Goheen-Rengo had mental health issues
    that affected their ability to parent, in particular their ability to remain alert to their
    children's needs and physical safety:
    18.     The parents both are deficient in that they have a lack of
    insight and poor judgment that impairs their ability to safely
    parent and meet the needs of their children. They remain
    unable, without the intervention and direction of others, to
    recognize threats to the safety of their child[ren].
    The court ordered both parents to complete previously ordered domestic violence
    assessments and parenting instruction, mental health assessments, and
    -6-
    No. 76721-6-1/7
    psychological evaluations with a parenting component, and follow recommended
    treatments.
    Both Carey and Goheen-Rengo completed court ordered psychological
    evaluations with Jason Prinster, PhD, in April 2015.        During his evaluation,
    Goheen-Rengo described himself as "a high functioning person" who had no
    significant problems parenting his children. He denied committing any acts of
    domestic violence and denied any personal responsibility for his conflicts with the
    courts and the Department.
    Prinster found that Goheen-Rengo had no prominent emotional or
    psychiatric disorder. But, he expressed concern about Goheen-Rengo's antisocial
    personality traits, criminal history, law enforcement contacts, and his expressions
    of anger and hostility toward others and apparent underlying anger and
    aggression. Prinster also found that these concerns, as well as Goheen-Rengo's
    "pattern of irresponsibility," including the ongoing failure to support himself
    financially or find stable housing and an inability to accept personal responsibility
    or acknowledge any need for change, were risk factors associated with domestic
    violence and child abuse.
    As part of the parenting assessment, Prinster observed Goheen-Rengo's
    visit with the children, which he characterized as "warm and attentive." But,
    Goheen-Rengo became obviously frustrated and upset by the end of session
    about some dietary restrictions for one of the children. Goheen-Rengo directed
    some of his frustration at the supervising social worker.
    -7-
    No. 76721-6-1/8
    Prinster concluded that based on a number of significant risk factors,
    Goheen-Rengo had a "guarded" prognosis for being able to properly parent his
    children in the next 12 months.
    During her evaluation, Carey denied any history of domestic violence in her
    relationship with Goheen-Rengo and disputed all of her statements to the contrary.
    Carey acknowledged having some difficulties in the past, but denied having any
    significant emotional problems or psychiatric distress. Carey reported that she had
    separated from Goheen-Rengo but suggested that the Department's interference
    had caused the separation. Carey's cognitive test results were in the normal
    range. During the parenting observation, Prinster found Carey's interaction with
    the children to be pleasant and positive.
    Among other things, Carey claimed that the Department was using her
    children for "some type of baby formula experiment" and informed Prinster of her
    ability to communicate with her children through clairvoyance. Prinster found these
    "unusual beliefs" were not "prominent enough" to warrant a specific diagnosis, but
    characterized them as "kind of rigid, inflexible. . . uncommon beliefs."
    Prinster found that contrary to Carey's denial, the evidence of her continued
    involvement in a violent relationship, as well as her acknowledged refusal to seek
    out medical care for her children, posed a risk to the safety of the children. Prinster
    concluded that Carey had a "guarded or unclear" prognosis for an ability to change
    behaviors within a reasonable time.
    -8-
    No. 76721-6-1/9
    In April 2015, Carey began mental health counseling with Dr. Jayme
    Fergoda, a licensed clinical social worker with a doctoral degree in clinical
    psychology. Dr. Fergoda's treatment plan addressed a number of topics, including
    depression and anxiety, self-care, and follow through with medical appointments.
    Carey attended 8 of 14 scheduled sessions.
    In September 2015, Carey left the state without notice to the Department
    and settled in Utah, where she gave birth to J.E.C. Carey began seeing Tracy
    Stevens, a mental health therapist, who diagnosed adjustment disorder with
    anxiety and depression.
    After eventually learning that Carey was in Utah, Department social workers
    remained in contact with both Carey and Stevens. The Department arranged for
    Carey to participate in Skype visits with the children.    But, the Department
    discontinued the visits after Carey repeatedly shouted obscenities and threats at
    the social workers.
    Carey participated in a total of 22 sessions with Stevens. Stevens noticed
    that during the last few sessions, Carey seemed unable to engage fully in therapy
    and exhibited signs of disassociation and mania. Among other things, Carey
    claimed that she was Wonder Woman, that she had been various celebrities in
    past lives, and that Goheen-Rengo was having affairs with Department social
    workers.
    Stevens believed that Carey's mental state deteriorated shortly after
    Goheen-Rengo visited Carey in Utah, over Carey's objections. Stevens planned
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    No. 76721-6-1/10
    to recommend that Carey consider an evaluation for antipsychotic medication, but
    Carey ended the sessions and left Utah before Stevens could discuss the matter
    with her.
    Carey returned to Bellingham in the summer of 2016 and resumed
    treatment with Dr. Fergoda.       Fergoda also believed that Carey needed an
    assessment for antipsychotic medication, but both the Department social workers
    and Fergoda encountered difficulties in persuading Carey to seek the appropriate
    evaluation.   Carey missed numerous scheduled sessions with Fergoda and
    eventually stopped participating altogether. Fergoda was unable to schedule any
    appointments with Carey after December 2016.
    Goheen-Rengo participated in various services, including parenting and
    nutrition services with Gass. Goheen-Rengo started, but did not complete, the
    Incredible Years parenting       program.      Goheen-Rengo completed anger
    management and domestic violence counseling sessions with Donald Steal in July
    2016.
    In May 2016, after several months, Goheen-Rengo stopped attending
    mental health counseling sessions with Deb Sawyer, claiming that he could no
    longer afford the insurance co-payment. When Sawyer refused to contract with
    the Department for further services, the Department social worker referred
    Goheen-Rengo to a new mental health counselor. Goheen-Rengo did not pursue
    the referral for additional sessions.
    The Department filed termination petitions on March 18, 2016.
    -10-
    No. 76721-6-1/11
    In June 2016, shortly before he completed his counseling sessions with
    Staal, Goheen-Rengo participated in a supervised visit with his children. At the
    time, the Department had moved Goheen-Rengo's visits to the courthouse so that
    he would have to go through a metal detector.
    At the conclusion of the visit, Goheen-Rengo became upset. He then
    placed his foot in the elevator door to prevent the supervising social workers and
    children from leaving. When one of the social workers began to call the police,
    Goheen-Rengo removed his foot and allowed the elevator door to close. Goheen-
    Rengo then began shouting profanities at the social workers. As a result of the
    outburst, Goheen-Rengo was later convicted of two counts of unlawful
    imprisonment.
    Goheen-Rengo participated in a second psychological evaluation and
    parenting assessment with Dr. Prinster in July 2016.        During the interview,
    Goheen-Rengo continued to deny having any emotional difficulties and refused to
    accept any responsibility for his difficulties with the Department. Goheen-Rengo
    informed Prinster that he had completed all recommended services.
    During the parenting observation, which occurred in Prinsters office,
    Goheen-Rengo had difficulty monitoring and managing the three toddlers. Part
    way through the observation, Goheen-Rengo became increasingly frustrated while
    attempting to change M.R.'s diaper. At one point, he abruptly told the visit
    supervisor that he had seen bruises on M.R.'s legs and claimed that"my daughter
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    No. 76721-6-1/12
    is being abused, what are you going to do about this." Without waiting for a
    resolution, Goheen-Rengo called 911 and reported the alleged abuse.
    At this point, the visit supervisor and social worker Paull told Goheen-Rengo
    that the observation was over and attempted to leave with the children, who were
    visibly upset. Goheen-Rengo became increasingly agitated and stood outside the
    office door, asserting that no one was leaving until the police arrived. Goheen-
    Rengo left once the police arrived and did not return to finish the evaluation.
    Prinster concluded that not much had changed in the year since Goheen-
    Rengo's first evaluation.     Despite participation in services, Goheen-Rengo
    continued to exhibit significant anger management issues that created risks for the
    children. Nor had he made progress in securing stable employment and housing.
    Prinster believed that dialectical behavior therapy might be beneficial for Goheen-
    Rengo if he were motivated. But, because Goheen-Rengo "was clear that he did
    not feel that he.. . needed any further treatment," Prinster believed that a referral
    would not have been appropriate.
    In October 2016, the children's GAL asked the court to appoint a GAL for
    Carey, because of concerns about Carey's competence. After a hearing on
    October 26, 2016,the court granted the motion. Stacy Ziegler, the children's GAL,
    testified that Carey had been evaluated at Western State Hospital and diagnosed
    with bipolar disorder. The evaluation recommended medication for treatment.
    Prinster began a second evaluation of Carey in December 2016. But,
    Carey's obviously deteriorated mental state prevented her from participating in a
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    No. 76721-6-1/13
    full evaluation or a parenting assessment. Among other things, Carey claimed that
    she was assisting a federal investigation into the Department's trafficking of
    children. She also informed Prinster that a prominent actor was the father of her
    youngest child and that she was currently playing music with Eric Clapton, the Red
    Hot Chili Peppers, and Metallica.
    Prinster's primary concern was that Carey's delusional and grandiose
    beliefs, coupled with her rigidity in thinking, refusal to recognize any need for
    assistance, including medical advice, in the care of her children, and her rejection
    of most services, compromised her ability "to make rational informed decisions"
    and posed significant risks to the safety of both Carey and her children.
    Prinster concluded that Carey's short term prognosis for improvement was
    poor. He recommended that she participate in a medication assessment for her
    condition, but acknowledged that she would first have to be willing to meet with a
    psychiatrist. Prinster testified that absent extraordinary circumstances, "we have
    no way of compelling" involuntary medication.
    After a 12 day trial in February 2017,the trial court granted the Department's
    petitions and terminated both Carey's and Goheen-Rengo's parental rights to all
    three children. The court found that despite the provision of numerous services
    over the course of two years, neither parent had made any meaningful progress in
    correcting the identified parenting deficiencies. Both parents steadfastly refused
    to acknowledge any parenting deficiencies or the need for services to address
    those deficiencies. The court found that under the circumstances, there was little
    -13-
    No. 76721-6-1/14
    likelihood that either parent could remedy the deficiencies in the foreseeable
    future.
    The termination order included the following findings of fact:
    [2.11(A)(6)] The mother has been afforded many opportunities to
    understand the need for her to engage in services; she has been
    notified regarding them repeatedly and they have been expressly
    and understandably offered or provided. In addition to the mother's
    active participation in the dependency contested fact-finding, and the
    dependency court's entry of a dispositional order which set forth the
    initial service requirements, the mother also was made aware of the
    need for services following the shelter care hearing in December
    2014. The Department has provided the mother with numerous
    letters explaining her need for services and how to engage in them.
    Finally, Department social workers and the guardians ad !item have
    also had many conversations with the mother detailing her services.
    The court has also ordered the mother to engage in services, and
    she has signed some of the court orders acknowledging her
    obligations. However,the mother has adopted a belief that this court
    lacks authority, that a higher court will overrule this court's
    determinations, and that therefore, it is unnecessary to follow the
    court's orders. Despite the frequent communication with the mother
    regarding services, the mother's engagement in services has been
    sporadic and, to the extent she has engaged, have not resulted in
    any appreciable improvement in her capacity to parent the child; in
    fact, the mother's ability to safely and capably care for the child
    appears worse today than it did at the outset of the case.
    [2.11(B)(2)] Although the father adamantly denies it, he has a long
    history of domestic violence abuse involving the mother. There have
    been numerous law enforcement contacts involving domestic
    disputes in the family home and social workers and the previous
    guardian ad litem have witnessed the father interacting with the
    mother in a manner that strongly suggests coercive control. The
    mother has also reported to numerous parties, the guardians ad
    litem, social workers, and her service providers that at various times
    she has felt threatened or unsafe in the father's presence, on at least
    two occasions leaving the family home.. . . At trial, the father testified
    that Mr. Staal only aske[d] once whether the father believed he was
    a perpetrator of domestic violence. The father testified that he denied
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    No. 76721-6-1/15
    it to Mr. Staal, and that Mr. Staal never asked about it again. Mr.
    Staal, by comparison, testified that that he could not recall if he had
    specifically asked the father this question, and that, despite a "mass
    of documents" provided by the Department, did not believe the father
    to be a domestic violence abuser. Therefore, Mr. Staal provided
    services to address the father's anger management. It is notable
    that, several months into treatment with Mr. Staal, the father traveled
    to see the mother in Utah in or about late February 2016, apparently
    against her wishes, and was reported by the mother to have forced
    his way into her room and then refused to leave. Although Mr. Staal
    originally recommended 30 to 50 sessions, to address anger
    management, he graduated the father after 30 sessions, determining
    that the father did not require further anger management. It is
    remarkable that, contemporaneous to the conclusion of services with
    Mr. Staal, the father, apparently unable to control his anger, trapped
    two social workers in a courthouse elevator. Later in the summer of
    2016,the father again had an angry dispute about his children during
    a parent-child observation for an updated psychological evaluation
    where he again blocked the social workers' egress, and also broke
    into the mother's home through a window after she returned to
    Bellingham. The father was charged with two counts of unlawful
    imprisonment involving the social workers, for which he was
    convicted following a jury trial in December 2016. Whether Mr. Staal
    misdiagnosed the father's needs for treatment is not relevant by
    comparison to the father's own testimony, which demonstrates his
    denial regarding domestic violence and his consequent endorsement
    that he requires no treatment for it. To the extent he received
    treatment from Mr. Staal for anger management, it was not effective
    given his numerous angry outbursts since anger management
    treatment concluded, including several involving impulsive behavior
    that was threatening or disturbing to the peace of others. At trial, the
    father continued to displace the importance of recognizing the extent
    of his responsibility for controlling his behavior: When asked whether
    he has any anger management problem, he dismissed it by stating
    that everyone does. Further, the father's anger management issues
    were evident to this court during the trial, as evidenced by this court's
    repeated interventions with the father. The court had to interrupt his
    testimony several times when he began yelling at attorneys during
    questioning. During his testimony, he continued to engage in a
    belligerent and threatening manner stating, for example, "You
    [referring to the social workers, attorneys and others in the
    courtroom]should all be in a box in the desert." During his testimony,
    in response to questions about whether he behaved in an
    intimidating manner during the case and whether he'd attempted to
    bring knives into the courthouse, he stated "The fact that 1 have a
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    No. 76721-6-1/16
    gun and tried to bring 3 knives into the courthouse makes me seem
    pretty scary, doesn't it?" As Dr. Prinster opined in his second
    psychological evaluation, it does not appear that the father is
    amenable to any interventions at this time. Domestic violence, if
    perpetrated by the father in the presence of the child, places the child
    at risk. This can include either physical injury or psychological or
    emotional injury.
    [2.11(3)(3)] The father received significant parenting education
    through the services of a public health nurse. Parenting education
    began shortly after the Department became involved with the family
    in October 2014. The public health nurse met with the father on
    numerous occasions, both when the child was placed in the family
    home, and during and after removal. The consistent theme
    throughout the course of the dependency involved the father's
    resistance accepting feedback and advice regarding his parenting,
    even to the point of repeatedly ignoring recommendations regarding
    how to safely feed the children and engage with them in play. The
    father made little progress in addressing his parenting deficits which
    include a lack of insight into the special needs of the children. In
    addition to the public health nurse, the father was also referred to a
    separate parenting program called Incredible Years. However, he
    failed to participate in sufficient classes and ultimately dropped out
    of the program. During visits, the father continued to demonstrate
    his deficiencies at parenting, failing to adopt or demonstrate having
    learned safe feeding techniques or bringing age-appropriate toys for
    the child. He also was unable to maintain consistent supervision of
    all of the children without substantial support by other family
    members or visit supervisors. He regularly engaged in inappropriate
    conversation with or around the child about such things the child
    coming home, using menacing speech directed at visit supervisors,
    and having angry, impulsive outbursts. His last visit with the child
    ended when he continued to violate visit rules, and then trapped the
    social workers in the elevator while berating them with obscenities.
    It is apparent that the father has not improved even marginally his
    ability to safely and capably parent the child despite the ample
    opportunity afforded him through the parenting education he was
    provided.[2]
    Carey and Goheen-Rengo appeal.
    2  For purposes of this appeal, the court's findings for each child were
    essentially identical.
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    No. 76721-6-1/17
    DISCUSSION
    I.   Standard of Review
    Parents have fundamental liberty and privacy interests in the care and
    custody of their children. In re Welfare of A.J.R., 
    78 Wn. App. 222
    , 229, 
    896 P.2d 1298
     (1995); Santosky v. Kramer, 
    455 U.S. 745
    , 753, 
    102 S. Ct. 1388
    , 
    71 L. Ed. 2d 599
     (1982).
    Before terminating parental rights, Washington courts must follow a two-
    step process. First, the State must prove the six statutory elements of RCW
    13.34.180(1) by clear, cogent, and convincing evidence.
    (a) That the child has been found to be a dependent child;
    (b) That the court has entered a dispositional order pursuant
    to RCW 13.34.130;
    (c) That the child has been removed . . . from the custody of
    the parent for a period of at least six months pursuant to a finding of
    dependency;
    (d) That the services ordered under RCW 13.34.136 have
    been expressly and understandably offered or provided and all
    necessary services, reasonably available, capable of correcting the
    parental deficiencies within the foreseeable future have been
    expressly and understandably offered or provided;
    (e) That there is little likelihood that conditions will be
    remedied so that the child can be returned to the parent in the near
    future.[;and]
    (f) That continuation of the parent and child relationship
    clearly diminishes the child's prospects for early integration into a
    stable and permanent home.
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    No. 76721-6-1/18
    Clear, cogent and convincing evidence exists when the evidence shows the
    ultimate fact at issue to be highly probable. In re Dependency of K.R., 
    128 Wn.2d 129
    , 141, 
    904 P.2d 1132
     (1995).
    Second, if the State proves the six termination factors, the court then
    determines, by a preponderance of the evidence, if termination is in the child's best
    interests. RCW 13.34.190(1)(b); In re Welfare of A.B. 
    168 Wn.2d 908
    , 911, 
    232 P.3d 1104
     (2010).
    We necessarily defer to the trier of fact on issues of conflicting testimony,
    credibility of witnesses, and the persuasiveness of the evidence.           State v.
    Camarillo, 
    115 Wn.2d 60
    , 71, 
    794 P.2d 850
     (1990). Our deference is particularly
    important in proceedings affecting the parent and child relationship because of"the
    trial judge's advantage in having the witnesses before him or her." In re Welfare
    of A.W., 
    182 Wn.2d 689
    , 711, 
    344 P.3d 1186
     (2015).
    II.   Mother's Appeal
    Carey challenges the finding that the Department offered or provided all
    reasonably available services capable of correcting her parental deficiencies within
    the foreseeable future.    See RCW 13.34.180(1)(d).        In order to satisfy this
    requirement, the Department must prove it offered services specifically tailored to
    the individual's needs. In re Dependency of T.R., 
    108 Wn. App. 149
    , 161, 
    29 P.3d 1275
     (2001). A protracted delay in identifying and offering necessary services
    where parents have not resisted or refused services may undermine a finding that
    the Department offered or provided all necessary services under RCW
    -18-
    No. 76721-6-1/19
    13.34.180(1)(d). In re Dependency of T.L.G., 
    126 Wn. App. 181
    , 198-203, 
    108 P.3d 156
     (2005).
    Carey contends the Department became aware of her mental health issues
    early in the dependency and that no later than February 2016, a year before the
    termination trial, the Department knew from her Utah therapist that she was
    becoming increasingly delusional. She argues that the Department should have
    offered her referrals for a psychiatric evaluation or medication management
    consultation. Carey acknowledges there was evidence she would have resisted
    such a referral, but asserts that had the Department attempted to persuade her
    through people she trusted, she likely would have engaged in the services and
    made significant progress by the time of the termination trial. The record fails to
    support these arguments.
    The Department initially assisted Carey in obtaining mental health
    counseling with Dr. Fergoda. But, Carey's participation in the sessions was
    inconsistent, and she left the state in September 2015. Carey eventually resumed
    mental health counseling in Utah with Stevens, who consulted regularly with
    Department social workers. When Carey became increasingly delusional, Stevens
    planned to refer her for medication management, but Carey returned to
    Washington before Stevens could discuss the plan with her.
    Carey resumed sessions with Dr. Fergoda in July 2016. But, Fergoda was
    extremely cautious about attempting to refer Carey for psychiatric services or a
    medication evaluation because of Carey's trust issues. Fergoda successfully
    -19-
    No. 76721-6-1/20
    encouraged Carey to provide a release for Dr. Prinster's second evaluation.
    Fergoda also persuaded Carey to try an antidepressant drug through Carey's
    primary care physician. But, Carey did not believe the medication was effective
    and eventually stopped using it.         Fergoda was unable to schedule any
    appointments with Carey after December 21, 2016.
    Social worker Rodriguez testified that simply providing Carey with a referral
    for a psychiatric consultation would not have been effective. Rather Rodriguez
    discussed the matter with Carey and encouraged her to accept the service. But,
    Carey refused the offer. After Dr. Prinster's second evaluation, social worker
    Skinner attempted to find a psychiatric services provider who would be acceptable
    to Carey. Skinner repeatedly asked Carey for a release so that she could arrange
    a referral, but Carey never responded.
    According to Carey, Dr. Fergoda believed Carey would have participated in
    psychiatric services if the Department had referred her. But, Fergoda testified only
    that "[i]t is possible that she would have gone."       Carey asserts that if the
    Department had worked through one of the people that she obviously trusted,
    including Fergoda, she likely would have participated. But, after December 21,
    2016, Dr. Fergoda was unsuccessful in arranging for Carey to attend her own
    counseling sessions.
    Although the Department social workers did not provide Carey with a
    specific referral for a psychiatric or medication consultation, it made repeated
    efforts to persuade Carey to accept such services. Carey rejected all these
    -20-
    No. 76721-6-1/21
    attempts. Given the nature of Carey's mental health issues, the Department's
    approach and efforts were reasonable. In addition, Carey's trial testimony clearly
    reinforced her unwillingness to participate in possible psychiatric or medication
    services. "[A] parent's unwillingness or inability to make use of the services
    provided excuses the state from offering extra services that might have been
    helpful." In re Dependency of Ramquist, 
    52 Wn. App. 854
    , 861, 
    765 P.2d 30
    (1988). Substantial evidence supports the finding that the Department offered or
    provided Carey all necessary services under RCW 13.34.180(1)(d).
    III.   Father's Appeal
    A. Likelihood of Reunification
    On appeal, Goheen-Rengo concedes the Department established the
    statutory elements in RCW 13.34.180(1)(a), (b), (c), (d), and (f) by clear, cogent,
    and convincing evidence. He contends, however, that the Department failed to
    prove there was "little likelihood that conditions will be remedied so that the child
    can be returned to the parent in the near future." RCW 13.34.180(1)(e). Goheen-
    Rengo claims that he willingly participated in, and successfully completed, the
    court ordered services, including anger management counseling, parenting
    services, and psychotherapy sessions. He also points to favorable testimony
    about his visits with the children. He argues that the evidence was therefore
    insufficient to establish that his parental deficiencies would not likely be remedied
    in the near future. We disagree.
    -21-
    No. 76721-6-1/22
    Gass provided parenting services to Goheen-Rengo for about one year.
    Her services were designed to focus Goheen-Rengo's attention on issues
    involving the children's safety and to develop skills for responding to the children's
    special needs. But, Gass found that Goheen-Rengo was only "occasionally"
    receptive to her assistance. She testified that at the conclusion of the services,
    Goheen-Rengo had not improved his ability to parent and that he needed
    additional services.    Goheen-Rengo began the Incredible Years parenting
    program, but dropped out after three sessions because he felt the class was
    neither appropriate nor beneficial.
    The Department referred Goheen-Rengo to Staal for domestic violence and
    anger management services. Staal did not believe the evidence of domestic
    violence. He therefore provided Goheen-Rengo with services for only anger
    management and found• that Goheen-Rengo successfully completed those
    services after 30 sessions. But, substantial evidence supports the trial court's
    finding that Staal's anger management services were not successful.
    As the trial court noted, Goheen-Rengo's angry outbursts and hostile
    behavior continued despite Staal's services. In June 2016, shortly before he
    completed the sessions with Staal, Goheen-Rengo became upset during a visit
    with his children and prevented the social workers and children from leaving. The
    incident resulted in Goheen-Rengo's conviction for two counts of false
    imprisonment. In July 2016, Goheen-Rengo's angry outbursts prevented him from
    completing the parenting observation during Dr. Prinster's second evaluation.
    -22-
    No. 76721-6-1/23
    Despite Goheen-Rengo's repeated denials, substantial evidence also
    supports the trial court's finding that he had a lengthy history of domestic violence
    that required treatment. He argues that the trial court improperly relied on Carey's
    accounts of the alleged domestic violence because she was suffering from a
    severe delusional disorder. But, many of Carey's reports occurred before her
    condition deteriorated. Moreover, social workers and law enforcement personnel
    were able to corroborate significant portions of Carey's accounts.
    What constitutes the near future depends on the age of the child and the
    circumstances of the child's placement. In re Welfare of C.B., 
    134 Wn. App. 942
    ,
    954, 
    143 P.3d 846
     (2006). All three children here had special needs involving
    unaddressed medical and developmental issues.            Despite Goheen-Rengo's
    lengthy participation in services, the evidence established that he made no
    meaningful progress in developing the parental skills and demeanor necessary to
    recognize and respond appropriately to the children's special needs. As Dr.
    Prinster noted during his second evaluation, Goheen-Rengo's continuing rigid
    personality traits prevented him from even recognizing his parental deficiencies
    and limited his ability to correct the identified deficiencies.          Under the
    circumstances, substantial evidence supports the finding that there was little
    likelihood Goheen-Rengo could remedy parental deficiencies within the near
    future. See, e.o., In re Welfare of Hall, 
    99 Wn.2d 842
    , 850-51, 
    664 P.2d 1245
    (1983)(eight months not within near future of four year old); In re A.W. 53 Wn.
    -23-
    No. 76721-6-1/
    24 App. 22
    , 32, 
    765 P.2d 307
    (1988)(one year not within near future of three year
    old).
    Goheen-Rengo's reliance on T.L.G. is misplaced. In T.L.G., this court
    reversed a termination order, concluding that the State failed to establish how the
    parents' mental health issues related to their ability to care for their children. Id. at
    205-06.     Moreover, the Department failed to identify the specific parental
    deficiencies or provide obviously needed mental health and anger management
    services to the parents for over a year until they completed a psychological
    evaluation. Id. at 198-99. Here, unlike T.L.G., the Department clearly identified
    Goheen-Rengo's parental deficiencies, and he has not challenged the finding that
    the Department offered or provided all necessary services, capable of correcting
    those deficiencies within the foreseeable future.
    A. Current Unfitness
    Goheen-Rengo contends that the Department failed to establish that he is
    currently unfit to parent. He relies on testimony that he was loving and affectionate
    during visits with his children and on evidence challenging the pediatrician's
    diagnosis of the twins' failure to thrive.
    To satisfy its burden of proving current unfitness, the Department must
    establish by clear, cogent, and convincing evidence that "parenting deficiencies
    prevent the parent from providing the child with 'basic nurture, health, or safety."
    In re Welfare of A.B., 
    181 Wn. App. 45
    , 61, 
    323 P.3d 1062
     (2014)(quoting RCW
    13.34.020). For the reasons set forth above, the evidence established that despite
    -24-
    No. 76721-6-1/25
    a variety of services, Goheen-Rengo failed to make meaningful progress in
    rectifying parental deficiencies and in developing the skills necessary to safely
    parent his children. Goheen-Rengo's anger and hostility continued to disrupt his
    visits with the children. The inability to recognize his parental deficiencies or the
    need for change, coupled with the rigidity in thinking and resistance to advice or
    intervention from professionals, prevented Goheen-Rengo from responding to the
    special needs of his children and posed significant risks to their safety. Goheen-
    Rengo demonstrated little likelihood of improving his skills in the foreseeable
    future. Substantial evidence supports the court's finding of current parental
    unfitness.
    B. Best Interests
    Goheen-Rengo contends that even if the Department proved the elements
    of RCW 13.34.180, it failed to establish that termination was in the children's best
    interests. Whether termination of parental rights is in the best interest of the child
    is necessarily a highly fact-specific inquiry. In re Welfare of Aschauer, 
    93 Wn.2d 689
    , 695, 
    611 P.2d 1245
     (1980).
    At the time of the termination trial, the children had been out of the family
    home for more than two years. Social worker Skinner testified that the children
    had unaddressed medical and developmental issues and needed stability and
    permanency. Both parents generally blamed the Department or service providers
    for these circumstances.     Neither parent had been able to visit the children
    -25-
    No. 76721-6-1/26
    regularly for many months. Nor was there any real likelihood that either parent
    would be able to rectify parental deficiencies in the foreseeable future.
    "Where a parent has been unable to rehabilitate over a lengthy dependency
    period, a court is 'fully justified' in finding termination in the child's best interests
    rather than 'leaving [the child] in the limbo of foster care for an indefinite period"
    while the parent attempts rehabilitation. T.R., 108 Wn. App. at 167 (alteration in
    original) (quoting A.W., 
    53 Wn. App. at 33
    ). Substantial evidence supports the
    court's determination that termination was in the best interests of the children.
    The orders terminating parental rights are affirmed.
    *7
    - 14                         1
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