In the Int. of: N.S., Appeal of: S.B.

J-A13017-20
2020 Pa. Super. 195
IN THE INTEREST OF: N.S., A : IN THE SUPERIOR COURT OF
MINOR : PENNSYLVANIA
:
:
APPEAL OF: S.B., MOTHER :
:
:
:
: No. 2980 EDA 2019
Appeal from the Order Entered September 20, 2019
In the Court of Common Pleas of Philadelphia County Juvenile Division at
No(s): CP-51-DP-0000514-2012
BEFORE: BENDER, P.J.E., LAZARUS, J., and STRASSBURGER, J.*
OPINION BY LAZARUS, J.: FILED AUGUST 14, 2020
S.B. (Mother) appeals from the order, entered in the Court of Common
Pleas of Philadelphia County, removing her minor daughter, N.S. (born 9/06),
from her custody, and committing N.S. to the care of the Philadelphia
Department of Human Services (DHS), pursuant to section 6351 of the
Juvenile Act, 42 Pa.C.S.A. §§ 6301-6375. After careful review, we reverse.
N.S. has a significant mental health history and a history of physical and
verbal aggression. N.S. began mental health treatment in 2010, when she
was four years old. At that time, N.S. was diagnosed with Oppositional Defiant
Disorder (ODD). When N.S. was seven years old, she was hospitalized at
Horsham Clinic and diagnosed with Attention Deficit Disorder (ADD).
Thereafter, N.S. was admitted to Horsham Clinic’s Acute Partial Program, and
____________________________________________
* Retired Senior Judge assigned to the Superior Court.
J-A13017-20
she was diagnosed with a disruptive behavior disorder. N.S. has also been
diagnosed with insulin-dependent diabetes mellitus.
On March 24, 2015, the court adjudicated N.S. dependent pursuant to
section 6302(1) of the Juvenile Act. 42 Pa.C.S.A. §§ 6302(1).1 N.S. remained
in Mother’s custody under court and DHS supervision. N.S. attended a
specialized private school where she received services, and she participated
in individual and family therapy.
From May 21, 2016 through June 19, 2016, and again from June 20,
2016 through July 26, 2016, Mother placed N.S. in Fairmount Behavioral
Hospital, a residential treatment facility, to address her mental health needs.
At the August 4, 2016 permanency review hearing, the court noted this. N.S.
was discharged from Fairmount on January 31, 2017.
At a permanency review hearing on December 5, 2017, the court found
that N.S. continued to receive services, but also continued to exhibit
behavioral issues at school. At the February 16, 2018 permanency review
hearing, the court found that N.S. had accrued approximately 40 incident
reports during the 2017-2018 school year. On June 4, 2018, N.S.’s therapy
provider recommended placement in a residential treatment facility. On July
____________________________________________
1 The dependency petition alleged that N.S. was diagnosed with attention
deficit hyperactivity disorder (ADHD), posttraumatic stress disorder (PTSD),
and dissociative disorder; that she was not taking any prescribed medications;
that she was receiving therapeutic services at the Joseph J. Peters Institute to
address a past sexual trauma; and that Mother had used physical punishment
to discipline her. DHS implemented in-home protective services, but Mother
requested additional assistance due to the difficulty in managing N.S.’s
behaviors. Dependency Petition, 2/5/15.
-2-
J-A13017-20
19, 2018, Mother placed N.S. in Belmont Behavioral Health Hospital (Belmont)
on a voluntary admission.
In August 2018, N.S.’s treating psychiatrist at Belmont recommended
N.S. be referred to a residential treatment facility that could address her
mental health needs as well as her medical needs as N.S. was not compliant
with her diet or medication plan to control her diabetes. Several facilities,
both in-state and out-of-state, declined to accept N.S. for treatment, and so
she remained at Belmont.
At the August 17, 2018 permanency review hearing, the court found
that N.S. remained hospitalized at Belmont on a voluntary admission. The
court ordered Mother to participate in a parenting capacity evaluation (PCE).
The court also ordered DHS to obtain an order of protective custody if Mother
attempted to have N.S. discharged from Belmont against medical advice.
In January 2019, because an appropriate residential treatment facility
remained unavailable, N.S.’s attending psychiatrist and clinical team began
discharge planning rather than keeping N.S. hospitalized indefinitely. Mother
agreed to work with family-based services, which included in-home family
therapy, family education and skill building, 24/7 crisis intervention services,
and medication management. Mother also agreed to high fidelity wraparound
services, which includes a parent-support partner, who has personal
experience raising a child with complex emotional needs, a youth-support
partner, who is a young person with previous personal experience with
-3-
J-A13017-20
behavioral health challenges, as well as a coach and facilitators who help the
family and child develop a plan to achieve shared goals.
Belmont continued to work with N.S. and Mother, and Belmont reported
that both N.S. and Mother were receptive to the intensive support services
and that they actively engaged in them. At a July 12, 2019 permanency
review hearing, the court ordered DHS to obtain an order of protective custody
to place N.S. in treatment-level foster care upon discharge from Belmont if
DHS could find a foster home willing to accept her; the court also ordered DHS
to explore the availability of out-of-state residential treatment centers.
In September 2019, N.S.’s treatment team at Belmont met with Mother
and Community Behavioral Health (CBH) to discuss viable options for N.S. In
the addendum to N.S.’s Interim Psychiatric Evaluation, N.S.’s attending
psychiatrist, Chioma Iheagwara, D.O., noted:
Due to her history of aggression, eloping from approved private
school, poor medication adherence, issues with communicating
effectively with adults and family[,] the treatment team met with
[M]other and CBH. Mother and Belmont are in agreement and
recommend residential treatment for further stabilization in a
structured setting. Treatment foster care is not recommended
given her current behaviors.
Interim Psychiatric Evaluation, June 2019-September 2019 Addendum, at 20
(electronically signed on 9/13/2019) (emphasis added).
On September 20, 2019, the court held a permanency review hearing
to determine whether N.S. should remain in Mother’s custody. N.S was
thirteen years old at the time. At that hearing, DHS argued that the court
-4-
J-A13017-20
should remove N.S from Mother’s custody and place her in DHS custody.2
DHS maintained that N.S. required total immersion in mental health services
____________________________________________
2 Regarding the disposition of a dependent child, section 6351(b) of the
Juvenile Act provides:
(b) Required preplacement findings.—Prior to entering any order
of disposition under subsection (a) that would remove a
dependent child from his home, the court shall enter findings on
the record or in the order of court as follows:
(1) that continuation of the child in his home would be
contrary to the welfare, safety or health of the child; and
(2) whether reasonable efforts were made prior to the
placement of the child to prevent or eliminate the need for
removal of the child from his home, if the child has remained
in his home pending such disposition; or
(3) if preventive services were not offered due to the
necessity for an emergency placement, whether such lack
of services was reasonable under the circumstances; or
(4) if the court has previously determined pursuant to
section 6332 (relating to informal hearing) that reasonable
efforts were not made to prevent the initial removal of the
child from his home, whether reasonable efforts are under
way to make it possible for the child to return home; and
(5) if the child has a sibling who is subject to removal from
his home, whether reasonable efforts were made prior to
the placement of the child to place the siblings together or
whether such joint placement is contrary to the safety or
well-being of the child or sibling.
42 Pa.C.S.A. §§ 6351(b)(1)-(5). Further, section 6351(e) provides in
pertinent part:
(e) Permanency hearings.—
-5-
J-A13017-20
in order for treatment to be successful, and that if Mother retained custody
she could remove N.S. from the residential treatment facility at any time.
Additionally, DHS stated that Mother had failed to complete her court-ordered
PCE, had ceased communicating with DHS on a regular basis, and had stopped
visiting N.S. See N.T. Permanency Review Hearing, 9/20/19, at 1-10.
Following the permanency hearing, the transcript of which amounts to
a total of ten pages, the court determined there was clear and convincing
evidence to establish “clear necessity” for the removal of N.S. from Mother’s
____________________________________________
(1) [t]he court shall conduct a permanency hearing for the
purpose of determining or reviewing the permanency plan
of the child, the date by which the goal of permanency for
the child might be achieved and whether placement
continues to be best suited to the safety, protection and
physical, mental and moral welfare of the child. In any
permanency hearing held with respect to the child, the court
shall consult with the child regarding the child’s permanency
plan in a manner appropriate to the child’s age and maturity.
...
(2) If the county agency or the child’s attorney alleges the
existence of aggravated circumstances and the court
determines that the child has been adjudicated dependent,
the court shall then determine if aggravated circumstances
exist. If the court finds from clear and convincing evidence
that aggravated circumstances exist, the court shall
determine whether or not reasonable efforts to prevent or
eliminate the need for removing the child from the child’s
parent, guardian or custodian or to preserve and reunify the
family shall be made or continue to be made and schedule
a hearing as provided in paragraph (3).
42 Pa.C.S.A. § 6351(e).
-6-
J-A13017-20
custody and for her placement in a residential treatment facility. See In re
A.L., 779 A.2d 1172, 1175 (Pa. Super. 2001) (following adjudication of
dependency, child may not be removed from care of parent absent showing
of clear necessity for removal, namely, where welfare of child requires it).3
That same day, the court entered an order placing N.S. in the custody of DHS,
see Permanency Review Order, 9/20/19, and N.S. remained hospitalized at
Belmont.
On October 4, 2019, Mother filed a motion for reconsideration. Mother
argued that the court had no basis for concluding removal from Mother’s legal
custody was “clearly necessary.” Motion for Reconsideration 10/4/19, at 2.
On November 4, 2019, the court entered an order granting a rule to show
cause why Mother’s motion should not be granted and scheduled a rule
returnable hearing for November 14, 2019. See Order, 11/4/19. In the
interim, however, on October 21, 2019, Mother filed a timely notice of appeal.
On November 14, 2019, the court entered an order, which provides, in part:
“Motion is denied as the court has lost jurisdiction.” Status Review Order,
____________________________________________
3 When a trial court removes a child from his or her home, our Rules of
Juvenile Court Procedure provide that the court must determine whether “the
child’s placement is the least restrictive placement that meets the needs of
the child, supported by reasons why there are no less restrictive alternatives
available[.]” See Pa.R.J.C.P. 1242(C)(3)(c); see also Pa.R.J.C.P.
1514(A)(2).
-7-
J-A13017-20
11/14/19. See 42 Pa.C.S.A. § 5505 (Modification of Orders). Both Mother
and the trial court complied with Pa.R.A.P. 1925.4
Mother raises one issue for our review: “Did the trial court err as a
matter of law and abuse its discretion by removing N.S. from Mother’s custody
in the absence of clear and convincing evidence that removal was clearly
necessary?” Appellant’s Brief, at 3. Mother does not challenge the
adjudication of dependency; rather, she claims DHS did not meet its burden
of proof, and therefore, the court’s finding of clear necessity for removal is not
supported in the record. Based on our review of the record before us, in
particular, the notes of testimony from the September 20, 2019 permanency
review hearing, we agree that the evidence was insufficient to support the trial
court’s placement of N.S. in the legal custody of DHS.
When reviewing a dependency case, we accept the trial court’s findings
of fact and credibility determinations that are supported in the record.
However, we are not required to accept the court’s inferences or conclusions
of law. In re R.J.T., 9 A.2d 1179, 1190 (Pa. 2010). We review for an abuse
of discretion. In Interest of L.Z., 111 A.3d 1164, 1174 (Pa. 2015).
In In re D.A., A Minor, 801 A.2d 614 (Pa. Super. 2002) (en banc), we
explained:
If the court finds that the child is dependent, then the court may
make an appropriate disposition of the child to protect the child’s
physical, mental and moral welfare, including allowing the child to
____________________________________________
4The guardian ad litem on behalf of N.S. joined in the brief filed by the City
Solicitor’s Office for DHS.
-8-
J-A13017-20
remain with the parents subject to supervision, transferring
temporary legal custody to a relative or a private or public agency,
or transferring custody to the juvenile court of another state. 42
Pa.C.S. § 6351(a).
Id. at 617 (citation omitted). See In re M.L., 757 A.2d 849, 850–51 (Pa.
2000). However, even after a child has been adjudicated dependent, a court
may not separate that child from his or her parent unless it finds that the
separation is clearly necessary. 42 Pa.C.S.A. § 6301(b)(3); In re G.T., 845
A.2d 870 (Pa. Super. 2004). “‘Such necessity is implicated where the welfare
of the child demands that he [or she] be taken from his [or her] parents’
custody.’” Id. at 873 (citations omitted) (alterations in original). Clear
necessity is established when the court determines that alternatives are not
feasible. A.N. v. A.N., 39 A.3d 326 (Pa. Super. 2012). After review, we
conclude that DHS did not establish clear necessity for removal.
At the September 20, 2019 hearing, Mother was unavailable due to
medical issues. Mother was, however, represented by counsel, who appeared
on her behalf. N.T. Permanency Review Hearing, supra at 2. At the time of
the hearing, N.S. remained hospitalized at Belmont, and Belmont’s psychiatric
evaluation of September 13, 2019, as indicated above, recommended
residential treatment for N.S. See Interim Psychiatric Evaluation, June 2019-
September 2019 Addendum, supra at 20. Mother agreed with this
recommendation. See id. At the hearing, counsel for Mother stated:
Ms. Buck: Your Honor, my client is in agreement with [residential
treatment facility] placement. And as CBH has approved the
placement there’s no need for a commit for her to be able to go
to RTF placement.
-9-
J-A13017-20
The Court: Okay.
Ms. Buck: It could be just a mental health placement, so I ask
that the order be [DHS] supervision to stand, and that [N.S.] can
go to RTF when placement is located[.]
N.T. Permanency Review Hearing, supra at 8. Counsel for DHS argued as
follows:
Ms. Pontious: And, Your Honor, I would be asking for the commit,
the reason being that Your Honor had previously ordered once she
was ready for discharge for us to get an [order for protective
custody] due to the issues of mom. The issue is that if she’s in an
RTF, [Mother] still retains legal custody as opposed to the
department. She can sign her out if she wants, and there’s as you
know, Your Honor, the history of this case there’s a lot of issues.
The Court: I’ll commit the child.
Id. at 9.
We agree, “there [are] a lot of issues” in this case. N.S. has multiple
psychiatric diagnoses, poorly controlled verbal and physical aggression
impulses, and a history of noncompliance in managing her diabetes, as well
as a history of defiant and sexualized behavior and running away from home.
None of this, however, supports a finding that it is clearly necessary to remove
N.S. from Mother’s custody, especially where Mother agrees that N.S. requires
placement in a residential treatment facility, has other young children at
home, and has been supportive and consistently engaged in N.S.’s treatment
throughout her life, as noted extensively in the record by the attending
psychiatrists. See N.T. Permanency Review Hearing, supra at 8 (“Your
Honor, my client is in agreement with RTF [residential treatment facility]
- 10 -
J-A13017-20
placement.”); Belmont Interim Psychiatric Evaluation, June 2019-September
2019 Addendum, at 20 (“Mother and Belmont are in agreement and
recommend residential treatment for further stabilization in a structured
setting.”); see also Belmont Interim Psychiatric Evaluation, supra, December
2018 Addendum, Steve Cartun, M.D. (“[M]other . . . has been pretty actively
involved during [N.S.’s] stay here.”); January 2019 Addendum, Chioma
Iheagwara, D.O. (“The treatment team continued to work with [N.S.], her
mother, her stepfather and her clinical team. Mother continued to be an
advocate for her daughter and supports the team’s efforts in health
maintenance.”); June-September 2019 Addendum, Chioma Iheagwara, D.O.
(“Mother would join with the team in stressing the importance of following unit
rules.”); Comprehensive Behavioral Psychiatric Evaluation, 12/19/17,
Roomana M. Sheikh, M.D. (“[N.S.’s] mother is very involved and a strong
advocate for her daughter.”).
In August 2018, Mother supported Belmont’s recommendation that N.S.
enter a residential treatment facility, but no facility would accept N.S. at that
time. Doctor Iheagwara noted, “[M]other loves her child and is open to
significant supports to maintain [N.S.] in the community.” Belmont Interim
Psychiatric Evaluation, January 2019 Addendum, Chioma Iheagwara, D.O., at
15-16. These “significant supports” included family-based services, high-
fidelity wraparound services, in-home nursing support and medical case
management. From all accounts, it appears that Mother has followed and
supported the recommendations of the treatment team. There was no
- 11 -
J-A13017-20
evidence presented at the hearing that indicated Mother is a barrier to N.S.’s
treatment.
In its opinion, the trial court relies on brief testimony from the
Community Umbrella Agency caseworker, Tracy McNair, who stated that
Mother had not completed her PCE or contacted McNair since the last court
date.5 N.T. Permanency Review Hearing, supra at 6. Notably, there was no
indication at that hearing that Mother’s lack of communication with McNair
presented an obstacle to N.S.’s treatment or the clear goal of placement in an
appropriate residential treatment facility. Significantly, there was no evidence
that Mother was incapable or unwilling to consent to N.S.’s admission into
residential treatment. See A.N., supra at 330 (“It is this Court’s
responsibility to ensure that the record represents a comprehensive inquiry
and that the hearing judge has applied the appropriate legal principles to that
record.”).
Based on our review, we agree with Mother’s argument that DHS
presented no evidence that established Mother’s exercise of her legal custody
rights was detrimental to N.S.’s welfare and that DHS’s argument that Mother
might remove N.S. from residential treatment was unfounded. Notably,
____________________________________________
5 In the Belmont Interim Psychiatric Evaluation, Dr. Iheagwara noted there
was a period of approximately three weeks when the clinical team was unable
to reach Mother. Doctor Iheagwara stated, “Mother reports that her phone
was misplaced with all of her contacts and she had to obtain a new phone.
Once communication was reestablished Mother was more consistent in
communicating with the treatment team as well as with her daughter.”
Belmont Interim Psychiatric Evaluation, June-September 2019 Addendum,
supra at 20.
- 12 -
J-A13017-20
Mother has not sought to remove N.S. against medical advice, and instead
has followed the treatment recommendations from Belmont staff since the
start of N.S.’s hospitalization.
We find nothing in the record that indicates anything other than the fact
that Mother has been supportive and encouraging of the treatment team’s
recommendations, in particular, residential treatment. Further, there is
nothing in the record that indicates Mother is opposed to agency supervision
or N.S.’s “total immersion in mental health services[.] See Trial Court
Opinion, 1/9/20, at 3. Neither the 10-page transcript of the permanency
review hearing, nor the trial court’s 3-page opinion, exhibits the
comprehensive inquiry required in a removal case, or explains why removal
of N.S. from Mother’s custody promotes N.S.’s best interests or welfare. See
In re R.W.J., 826 A.2d 10, 12 (Pa. Super. 2003); In re G.T., supra at 873;
see also Interest of S. M. S., 424 A.2d 1365, 1369 (Pa. Super. 1981)
(hearing judge should conduct comprehensive inquiry and support decision in
opinion discussing and analyzing evidence fully).
Where the record indicates Mother has supported and advocated for her
daughter’s mental and physical health, and Mother is in agreement with the
treatment team’s and DHS’ recommendation for residential treatment and the
agency’s protective supervision, we are unable to accept the court’s conclusion
that DHS has established by clear and convincing evidence that removal is
“clearly necessary.” Id. Mother’s failure to complete her PCE and the court’s
speculation that it is possible that Mother could remove N.S. from treatment
- 13 -
J-A13017-20
“at any time[,]” without more, is insufficient to establish a “clear necessity”
for N.S.’s removal from Mother’s custody. Id. The trial court’s findings are
not supported by the record, and we conclude, therefore, that N.S.’s health,
safety, and welfare do not mandate removal of custody from Mother.
We encourage Mother to continue her steadfast support for N.S.’s health
and well-being and to continue to work with the agency. We recognize, as
the treatment team does, that Mother is an integral part of her daughter’s
mental and physical health management.
Order reversed.
Judgment Entered.
Joseph D. Seletyn, Esq.
Prothonotary
Date: 8/14/20
- 14 -