NOTICE: Summary decisions issued by the Appeals Court pursuant to M.A.C. Rule 23.0, as appearing in 97 Mass. App. Ct. 1017 (2020) (formerly known as rule 1:28, as amended by 73 Mass. App. Ct. 1001 [2009]), are primarily directed to the parties and, therefore, may not fully address the facts of the case or the panel's decisional rationale. Moreover, such decisions are not circulated to the entire court and, therefore, represent only the views of the panel that decided the case. A summary decision pursuant to rule 23.0 or rule 1:28 issued after February 25, 2008, may be cited for its persuasive value but, because of the limitations noted above, not as binding precedent. See Chace v. Curran, 71 Mass. App. Ct. 258, 260 n.4 (2008).
COMMONWEALTH OF MASSACHUSETTS
APPEALS COURT
24-P-318
ADOPTION OF SALLY.1
MEMORANDUM AND ORDER PURSUANT TO RULE 23.0
The mother appeals from a decree issued by a Juvenile Court
judge finding her unfit and terminating her parental rights to
her daughter, Sally. See G. L. c. 119, § 26; G. L. c. 210, § 3.
The mother primarily argues that the judge erred in finding her
indefinitely unfit because the Department of Children and
Families (DCF) did not make reasonable efforts to reunify the
mother and the child. We affirm.
Background. 1. The parties. The mother was born in 1989.
As a child, she experienced a drowning incident that left her
with a central auditory processing disorder. A court-ordered
neuropsychological evaluation performed in February 2022
indicated that the mother had "considerable neuropsychological
1 A pseudonym. impairments across myriad domains of neurocognitive functioning"
and "diagnoses of Probable Major Neurocognitive Disorder Due to
Traumatic Brain Injury (anoxia from drowning); Major Depressive
Disorder; and features of Dependent Personality Disorder." The
mother graduated from a vocational high school and attended two
semesters at community college.
The mother has three children. Her first two children were
born in 2014 and 2017. Their father is the mother's previous
partner. DCF has had extensive involvement in the two
children's lives, and their paternal grandparents have had
guardianship of them since February 2020. In March 2020, the
mother learned that she was pregnant with the child, at twenty-
one weeks of pregnancy, and thus she was late in receiving
prenatal care. The child's father is named on her birth
certificate but he claims he is not her biological father.2
The child was born in July 2020, with several medical
conditions including choanal atresia;3 other congenital
2 The father "has been involved minimally, if at all, with both the child and [DCF] since her birth," and did not appeal from the decree finding him unfit and terminating his parental rights.
3 The judge found that "[c]hoanal atresia is a developmental abnormality characterized by 'a congenital narrowing of the back of the nasal cavity that causes difficulty breathing.' Bilateral choanal atresia specifically indicates that both nasal passages are blocked. This condition is rare, often associated with other developmental anomalies, and is life-threatening.
2 deformities of the skull, face, and jaw; other malformations of
the ear; and candidates stomatitis. Less than one hour after
birth, she experienced respiratory distress requiring intubation
and was transferred to a neonatal intensive care unit. She
remained there for the first month of her life because of the
high risks associated with her medical conditions. In August
2020, the child underwent the first of many surgeries to address
her breathing difficulties.
2. Involvement with DCF. In August 2020, in preparation
for the child's impending release, the hospital staff notified
the parents that they would have to complete a twelve-hour
course on how to care for the child. Over the next week, the
parents came in every day and said they would complete the
training the following day, but they failed to do so each time.
As a result, a mandated reporter filed a G. L. c. 119, § 51A
report, alleging neglect. A DCF investigator spoke to the
parents about the allegations. Despite numerous reminders and
opportunities to do so, the parents never completed the full,
twelve-hour day of training.
The child continued to have serious medical setbacks, and,
Symptoms of choanal atresia appear immediately after birth, and infants with the condition often require intubation immediately after delivery [followed by prompt surgery] to open the nasal airway sufficiently to allow the infant to breathe on their own."
3 in the view of the hospital staff, the parents failed to
demonstrate the competence necessary to care for her.
Specifically, the staff were concerned that the parents "were
not able to follow simple instructions, [and] they would not be
able to provide the difficult medical care that the child needed
and would require in the future."
Accordingly, in September 2020, DCF filed a care and
protection petition and was granted temporary custody of the
child. In the same month, the child was discharged from the
hospital and placed in an unrestricted foster home. In October
2020, the child was placed in her current, long-term foster
home, which became her preadoptive home in 2022. She has never
been in the mother's physical custody.
Following the child's removal, DCF developed and
implemented an action plan for the mother, including, but not
limited to, requirements to engage in parenting classes, work
with a parent aide, complete a neuropsychological evaluation,
engage in therapy, and attend visitation with the child. The
mother testified that the purpose of the plan was "to waste
[her] time."
3. The mother's engagement with services. a. Visitation.
Between September 2020 and December 2022, the mother attended
visits inconsistently, frequently arriving late or not following
visitation policies. The mother missed eight in-person visits
4 and also missed most of one virtual visit because her phone
"died" and she failed to rejoin the visit. The mother arrived
late to seven visits. When the mother did attend visits, they
"typically went well and Mother presented as caring, engaging
and overall appropriate with [the child]."
The mother has not visited the child since December 2022.
In February 2023, after canceling several visits in December,
the mother informed the DCF social workers that she stopped
attending visits because of the price of gasoline. She then
demanded more frequent visits closer to her residence. The DCF
social worker recommended that the mother take the bus to visits
and offered to request an Uber gift card to assist her. The
mother refused to consider the bus because of a "bad experience"
and refused to attend visits at a DCF office. Despite the
mother's refusal to attend visits, the DCF worker continued to
attempt to schedule monthly visits and to offer transportation
assistance to the mother.
b. Parenting skills. At the direction of DCF, the mother
attended and completed a twelve-week parenting class. The
mother testified that she had learned nothing from the parenting
class about the child's medical needs.
The mother did not effectively comply with her action plan
task that she work with a parent aide or complete a parenting
evaluation. Although the mother initially engaged with an aide
5 during home visits, the parent aide terminated the service in
2021 because of the mother's canceling and missing weekly
meetings. At the meeting terminating services, the mother
stated that she did not understand why she was involved with DCF
and why "everyone [was] targeting her." DCF assisted the mother
to reengage with her parenting aide, but ultimately, the aide
and the mother mutually agreed to terminate the relationship
because the mother was not benefiting from the services or
working on any goals. Furthermore, although the parent
evaluator observed three parent-child visits, and the mother
claimed she completed the evaluation, the mother refused to sign
a release to allow DCF to obtain the results, claiming it was
"never written up because the parent evaluator felt it would be
used against [the mother]."
c. Mental health and neurological concerns. The mother
complied with the action plan task that she engage in individual
therapy, but DCF struggled to confirm the mother's engagement.
The mother also complied with her task to receive a
neuropsychological evaluation. The mother testified that the
sole recommendation of the evaluation was to work with a parent
aide, but she later admitted that she had not read the
evaluation. The mother was therefore unaware of the
recommendations therein, namely, to obtain a full psychiatric
consult, medical evaluation, cognitive behavioral therapy, and
6 bloodwork, and did not follow them.
4. The mother's engagement during concurrent planning. In
January 2022, DCF changed the child's goal from reunification to
adoption. Nonetheless, DCF continued to assist the mother to
prepare for the possibility of reunification with the child as
part of its "concurrent planning." This change triggered
resistance from the mother.
In April 2022, the judge reappointed an investigator for an
update on the case. The mother informed the investigator that
she was being "mentally and emotionally abused by [DCF]," she
was not given a chance to learn about the child's medical needs,
and she was not being provided with services. Specifically, the
mother believed DCF had left her out of the child's medical
treatment and already made the decision to "have her adopted,"
so DCF was not providing "services to help her raise [the
child]." At that point, the father was the mother's only
support, as she was no longer speaking with the maternal
grandmother or engaging with her parent aide.
In 2022, the mother stopped meeting with DCF regularly.
The mother also began occasionally refusing home visits. On
July 19, 2022, the mother informed her social worker that she
was not willing to let DCF see her living space because "if you
guys see the room I'm staying in then you guys are going to hold
my child from me."
7 In January 2023, a DCF social worker sought to schedule a
home visit, but the mother refused unless the goal was changed
back to reunification. In between these refusals, as noted
above, the mother permitted home visits of her apartment in
November 2022 and February 2023. But even then, the mother
"made it clear . . . that she felt meeting with [DCF] was not
beneficial to her unless her child is to be reunified." In
January 2023, the parent aide reported that the mother was
unwilling to work with her if the goal was not reunification.
After February 2023, the mother refused to meet with DCF
altogether unless the child's goal was changed to reunification.
In August 2021, DCF held a permanency planning conference
at which DCF determined a need to engage both parents more in
the child's medical care. DCF obtained Zoom video links that
the mother could use to attend the child's appointments
virtually. The mother initially regularly attended those
appointments.
Beginning in 2022, after DCF changed the child's goal from
reunification to adoption, the mother's participation in the
child's appointments began declining as well. After a session
in December 2022, the mother reported that she would no longer
attend "because [the child] was going up for adoption." The
mother attended no further appointments.
By the time of trial in April 2023, despite DCF's
8 considerable efforts, the mother admitted she still did not know
all of the child's medical needs and did not know how to meet
the child's most basic needs. For example, the child continued
to struggle with oral intake of food and required feeding
primarily via gastronomy tube (G-tube).4 The mother admitted she
did not know what kind of tube it was and had never fed her with
it.
5. Termination of parental rights. On April 15, 2022, DCF
filed a motion for review and redetermination5 and a notice of
intent to terminate parental rights. The judge allowed the
motion on April 19, 2022, and held a termination trial over the
course of three days beginning on April 10, 2023, and ending on
May 10, 2023. On May 25, 2023, the judge found the mother and
the father unfit and terminated their parental rights.
The judge based his decision to terminate the mother's
parental rights on her "lack of consistent and cooperative
engagement with DCF, [her] lack of insight into the reasons for
[DCF]'s initial involvement and continued concerns, [her]
extremely limited understanding of [the child's] complex medical
4In January 2021, the G-tube was inserted into the child's stomach because she was unable to obtain sufficient nourishment from oral feedings.
5Prior to this, on November 15, 2021, the judge found the mother unfit at a previous trial but had not terminated her parental rights. The mother did not appeal that judgment.
9 needs and the care required to address them, and [her] inability
and/or unwillingness to place [the] child's needs above [her]
own."
Discussion. 1. Standard of review. "To terminate
parental rights to a child and to dispense with consent to
adoption, a judge must find by clear and convincing evidence,
based on subsidiary findings proved by at least a fair
preponderance of evidence, that the parent is unfit to care for
the child and that termination is in the child's best interests"
(citation omitted). Adoption of Darlene, 99 Mass. App. Ct. 696,
702 (2021). See Adoption of Ilona, 459 Mass. 53, 59 (2011).
"Because termination of a parent's rights is an 'extreme step,'
a judge must decide both whether the parent is currently unfit
and whether, 'on the basis of credible evidence, there is a
reasonable likelihood that the parent's unfitness at the time of
trial may be only temporary.'" Id., quoting Adoption of Carlos,
413 Mass. 339, 350 (1992). "Even where a parent has
participated in programs and services and demonstrated some
improvement, we rely on the trial judge to weigh the evidence in
order to determine whether there is a sufficient likelihood that
the parent's unfitness is temporary." Adoption of Ilona, supra
at 59-60. "Because childhood is fleeting, a parent's unfitness
is not temporary if it is reasonably likely to continue for a
prolonged or indeterminate period." Id. at 60. The judge must
10 measure this in terms of "probabilities rather than
possibilities." Adoption of Nicole, 40 Mass. App. Ct. 259, 261
(1996). We keep in mind that, in the context of parental
fitness, "[t]he judge who hears the evidence, observes the
parties, and is most familiar with the circumstances remains in
the best position to make the judgment." Guardianship of
Estelle, 70 Mass. App. Ct. 575, 579 (2007).
"We give substantial deference to a judge's decision that
termination of a parent's rights is in the best interest of the
child, and reverse only where the findings of fact are clearly
erroneous or where there is a clear error of law or abuse of
discretion." Adoption of Ilona, 459 Mass. at 59. An abuse of
discretion occurs only where "the judge made a clear error of
judgment in weighing the factors relevant to the decision such
that the decision falls outside the range of reasonable
alternatives" (quotation and citation omitted). L.L. v.
Commonwealth, 470 Mass. 169, 185 n.27 (2014).
2. The mother's indefinite unfitness. The mother
challenges the judge's finding that her "unfitness will continue
undiminished into the future with an attendant harmful effect on
[the child]." More specifically, the mother argues that the
judge's finding of indefinite unfitness was in error because it
was influenced by an erroneous finding that DCF made reasonable
efforts to reunify the mother and the child. We disagree.
11 "Before seeking to terminate parental rights, [DCF] must
make 'reasonable efforts' aimed at restoring the child to the
care of the . . . parents." Adoption of Uday, 91 Mass. App. Ct.
51, 53 (2017), quoting Adoption of Ilona, 459 Mass. at 60. DCF
"must match services with needs, and the trial judge must be
vigilant to ensure that it does so" (quotations and citations
omitted). Adoption of Ilona, supra at 61.
"This duty 'includes a requirement that [DCF] provide
services that accommodate the special needs of a parent.'"
Adoption of Uday, 91 Mass. App. Ct. at 53, quoting Adoption of
Ilona, 459 Mass. at 61. "However, even where [DCF] has failed
to meet this obligation, a trial judge must still rule in the
child's best interest." Adoption of Uday, supra, quoting
Adoption of Ilona, supra. "While courts protect the rights of
parents, the parents' rights are secondary to the child's best
interests and . . . the proper focus of termination proceedings
is the welfare of the child" (quotation and citation omitted).
Adoption of Ilona, supra. See Adoption of Inez, 428 Mass. 717,
720 (1999), quoting Care & Protection of Robert, 408 Mass. 52,
62 (1990) ("While parents have a constitutionally recognized
interest in maintaining the family unit, a 'child's interest in
freedom from neglect or abuse is absolute'"). See also Custody
of a Minor, 375 Mass. 733, 749 (1978) (best interests of child
paramount consideration where child's well-being at issue).
12 The judge made 377 findings of fact and forty-three
conclusions of law. Ultimately, the judge found that "[DCF] has
made reasonable efforts to make it possible for [the child] to
be placed in Mother's . . . custody." The judge found that,
despite these efforts, "Mother . . . [is] not able, fit or ready
to assume parental responsibility for [the child] and that [the
mother] will remain unfit indefinitely." Having carefully
reviewed the record, we discern no clear error in the trial
judge's finding that DCF made reasonable efforts to address the
mother's unfitness and that the mother remained indefinitely
unfit.
Our analysis must begin with the fact that the child was
born with profound medical needs. As noted, the hospital staff
tried to provide the mother with the information necessary to
care for the child, but the mother never completed the necessary
training. From that point forward, DCF made repeated efforts to
help the mother learn how to care for the child. DCF obtained
Zoom links for the mother to attend the child's medical
appointments, offered assistance for her to attend visits,
helped her engage with a parenting aide, and recommended
classes, evaluations, and therapy. Although the mother took
advantage of some DCF resources and completed some tasks on her
action plan, she also repeatedly rejected DCF resources designed
to improve her fitness to care for the child. Critically, she
13 never learned how to feed the child through her G-tube and
stopped visiting the child for the four months before the
termination trial. DCF's obligation to provide services aimed
at strengthening the family and reunifying children with their
parents is contingent on the parents' willingness to engage in
those services and fulfill their parental obligations. See
Adoption of Eduardo, 57 Mass. App. Ct. 278, 282 (2003); Adoption
of Mario, 43 Mass. App. Ct. 767, 774 (1997).6
For these reasons, we discern no clear error in the judge's
determination that DCF made reasonable efforts to address the
mother's unfitness or that "her unfitness is likely to continue
into the indefinite future to a near certitude."
3. The child's best interests. In any event, "a
determination that reasonable efforts were not made does not
6 The mother also argues that DCF did not accommodate her disability as required by its own disability policy. Because the mother did not raise this claim at any point prior to the termination trial, it is waived. See Adoption of Gregory, 434 Mass. 117, 124 (2001) ("If a parent believes that [DCF] is not reasonably accommodating a disability, the parent should claim a violation of [her] rights under either the ADA or other antidiscrimination legislation, either when the parenting plan is adopted, when [s]he receives those services, or shortly thereafter"). In any event, DCF did in fact communicate with the mother in multiple modalities, including phone, e-mail, and text, in an effort to accommodate her central auditory processing disability. And again, "even where [DCF] has failed to meet this obligation [to accommodate the special needs of a parent], a trial judge must still rule in the child's best interest." Adoption of Uday, 91 Mass. App. Ct. at 53, quoting Adoption of Ilona, 459 Mass. at 60.
14 preclude . . . even the ultimate termination of parental
rights," Care & Protection of Rashida, 489 Mass. 128, 133
(2022), "[b]ecause our lodestar is necessarily the best
interests of the child," Adoption of Bea, 97 Mass. App. Ct. 416,
417 (2020). "[T]he best interests analysis . . . requires a
court to focus on the various factors unique to the situation of
the [child] for whom it must act." Custody of a Minor, 375
Mass. 733, 753 (1978). "The standard for parental unfitness and
the standard for termination are not separate and distinct, but
'reflect different degrees of emphasis on the same factors.'"
Adoption of Nancy, 443 Mass. 512, 515 (2005), quoting Petition
of the New England Home for Little Wanderers to Dispense with
Consent to Adoption, 367 Mass. 631, 641 (1975).
The judge found that "[the child]'s best interests would be
served by a decree terminating her legal relationship with
Mother." Moreover, he found that "[t]he permanency plan
proposed by [DCF] has sufficient content and substance. It
establishes a superior plan for [the child] and it is in her
best interests. [DCF]'s plan is adoption of [the child] by her
current pre-adoptive mother. . . . [DCF]'s plan of adoption by
the current, pre-adoptive foster parent represents the best plan
for [the child]'s stability and future success."
Having carefully reviewed the record, we are persuaded that
the judge acted within his discretion in finding that it was in
15 the child's best interests to terminate the mother's parental
rights and approve DCF's plan of adoption, and that the judge's
findings of fact in support of that decision were not clearly
erroneous.
Again, our analysis must begin with the fact that the child
was born with profound medical needs. The trial judge found
that:
"[The child] has been placed with her current foster mother . . . since she was eleven weeks old and all evidence clearly shows a positive, supportive, and loving parent-child relationship. Despite [the child]'s extensive medical and developmental needs, [DCF] has never expressed concerns for [the foster mother's] ability or willingness to care for her and she takes [the child] to all of her appointments. [The child] is comfortable in the home and looks to [the foster mother] for affection, engagement, and reassurance. Most important, [the foster mother] is committed to adopting [the child] and is willing to maintain her connection with Mother as long as it is appropriate. [The child] is in a safe and stable home environment with [the foster mother], and all evidence indicate[s] that she will be able to meet her present and future needs. In consideration of the foregoing, forcing [the child] to be placed in [the mother]'s care for the first time would not be in her best interests."
By contrast, the mother's own testimony confirmed that at
the time of the termination trial in April 2023, she did not
"know anything of what's going on with [the child] medical-
wise." She did not know why the child was in occupational
therapy. She did not know what medical specialists followed the
child. The mother also acknowledged that she had not developed
16 any bond with the child. She testified that during visits, the
child "looks confused. She looks like she doesn't know who I
am." Nothing in the record suggests any likelihood that these
issues would resolve even if DCF provided more services.
Instead, the mother's lack of engagement in the child's medical
care supports the judge's conclusion that it was in the best
interests of the child to terminate the mother's parental
rights. Contrast Adoption of Chad, 94 Mass. App. Ct. at 840,
840 (judge's findings did not adequately address how termination
of parental rights was in children's best interests, where
children had "bond and positive relationship" with mother).
Finally, the judge considered the provisions of G. L.
c. 210, § 3 (c), and found factors (ii), (iii), (v), (vi),
(vii), (viii), (x), and (xii) to be applicable. The record
evidence amply supports the judge's findings and determination
that the mother is unfit, that she is likely to remain so
indefinitely, and that termination of her parental rights was in
the child's best interests.
Decree affirmed.
By the Court (Neyman, Ditkoff & Wood, JJ.7),
Clerk Entered: March 6, 2025.
7 The panelists are listed in order of seniority.