Opinion
NOT TO BE PUBLISHED
Alameda County Super. Ct. No. OJ08009828
Reardon, J.
In July 2009, the juvenile court found that returning minor J.J. to the home of his mother—petitioner Julie J.—would be detrimental to him. It terminated her reunification services and set a November 23, 2009 date for a permanency planning hearing. (See Welf. & Inst. Code, § 366.26.) Julie petitions for review of the order terminating reunification services and setting a permanency planning hearing. (See § 387.) She challenges the termination of reunification services, asserting that the juvenile court’s findings that reasonable services were provided to the family and that she made only partial progress toward alleviating the cause necessitating placement were not supported by substantial evidence. She also seeks a stay of the November 2009 permanency planning hearing. Real party in interest Alameda County Social Services Agency (agency) opposes her petition and her request for a stay. We deny the petition on the merits.
All subsequent statutory references are to the Welfare and Institutions Code.
I. FACTS
J.J. was born to petitioner Julie J. and her husband, father John M., at Highland Hospital in Oakland in May 2008. J.J. had severe medical needs including a congenital heart defect, a nonfunctioning spleen and a twisted intestine. By the time this medically fragile infant was six days old, J.J. had been moved to the perinatal intensive care nursery at Children’s Hospital in Oakland. Because of his nonworking spleen which would normally fight infections, J.J. may require antibiotics for the rest of his life. There was also a risk that he had been exposed to an immunodeficiency syndrome, requiring regular administration of antiviral medications.
John M. is not a party to the petition. We discuss facts related to his situation as they are relevant to Julie’s petition.
Julie also had two older children.
These medical conditions require a daily medication regimen and constant monitoring. Julie did not visit J.J. in the hospital until four days after his admission. When she finally appeared at the hospital, Julie administered J.J.’s medications incorrectly and was not willing to be trained to learn the correct medication regimen. She refused to consent to the multiple surgeries needed to repair J.J.’s potentially lethal heart defect, instead minimizing his extensive medical needs. Repeatedly, Julie fell asleep while holding J.J. and lost her grip on him. She was unable to explain why this happened.
After Julie threatened to remove the child from the hospital against medical advice, hospital officials obtained an order precluding Julie from visiting J.J. in the hospital. When he was 12 days old, the agency placed J.J. in protective custody at the hospital.
On May 16, 2008, the agency filed a juvenile dependency petition on J.J.’s behalf, alleging that his parents had failed to protect him from harm. (See § 300, subd. (b).) The agency reported to the juvenile court that Julie had been referred to child protective services in 2000, on charges of general neglect of another child. The charges were never substantiated. It also reported that Julie had been convicted of misdemeanor welfare fraud. She had been exposed to an immunodeficiency syndrome, raising the concern that J.J. may also have been exposed. J.J.’s father worked full time, Julie was caring for two ailing grandparents, and a doctor believed that Julie might be suffering from depression. Although J.J. was reportedly doing well in the hospital, he continued to throw up formula and had trouble keeping on weight.
On May 19, 2008, the juvenile court approved the detention. Counsel was appointed for Julie. The juvenile court ordered the agency to begin providing services to Julie. The following day, Julie was at the hospital, learning and practicing the tasks required to care for J.J. On May 21, 2008, an agency social worker visited Julie’s home, the parents agreed to participate in an informal family maintenance program, and J.J. was released from the hospital into their care. By May 27, 2008, Julie had returned to the hospital with J.J. for his scheduled appointment. Julie was more engaged, J.J. was gaining weight, and his medical signs were normal.
In advance of the June 3, 2008 jurisdiction hearing, the agency—with the parents’ agreement—recommended that the petition be dismissed without prejudice and that the case be transferred to an informal family maintenance program. At the jurisdiction hearing, the juvenile court dismissed the petition, with informal supervision to occur.
J.J. resided with Julie and John during the summer. Julie failed to comply with the minor’s medical regimen. In July, Julie failed to give J.J. his daily required dose of aspirin, which prevents the child’s shunt from clotting. Such a clot could result in J.J.’s death. She also failed to comply with a doctor’s order to stop giving a heart medication several days before a doctor visit, so that J.J.’s heart condition could be assessed. The assessment could not be made, because the medication continued to be given, against doctor’s orders. In July and August, Julie also repeatedly failed to take J.J. to his medical appointments. She had also refused to allow a home health care nurse to enter the home. J.J. had lost weight, but Julie continued to minimize his medical needs.
On August 14, 2008, the agency again placed J.J. in protective custody at Children’s Hospital. On August 18, 2008, a new petition was filed, alleging that Julie and John had failed to protect J.J. (§ 300, subd. (b).) The juvenile court approved the detention the following day. Two days later, J.J. was placed in a foster home on his release from Children’s Hospital.
The agency recommended that J.J. be declared a dependent child and placed out of the home. Julie opposed this request. In September 2008, the petition was amended. Julie submitted the amended petition on the basis of the agency report and other documentary evidence. The juvenile court found that Julie minimized J.J.’s serious medical needs and had failed to follow the necessary medication regimen to deal with these issues. J.J. was declared to be a dependent child. The juvenile court approved a reunification plan requiring Julie to undergo a psychological evaluation, obtain counseling and complete a series of parenting classes.
In October 2008, the agency sought court approval for two cardiac procedures for J.J. Julie gave her consent to the procedures. The juvenile court authorized the procedures. One was completed in October and another in early November 2008. Both were successful. In late November, the agency again sought medical approval from the juvenile court for a surgical procedure for J.J.—this time, to remove excess fluid in his lungs. Julie gave her consent to the procedure, as did the juvenile court. The procedure was successfully conducted in early December.
In the meantime, John moved out of the family home. By mid-November 2008, Julie began attending parenting classes. Julie continued to have some difficulty remaining awake, which she reported to be the result of her anemia. Sometimes, Julie seemed to drift off to sleep while holding J.J. She underwent a psychological evaluation, resulting in a diagnosis of schizoaffective and personality disorders. The symptoms observed were depression, delusions, behavioral peculiarities and eccentricities that can create major personality disorders. She was found to have anger management and impulse control issues, and she responded negatively to stress. A concern was expressed that she might be an abusive parent if burdened by stressful circumstances.
There was evidence that the indicators for child abuse in the psychological evaluation might have been the result of having been abused as a child rather than having the potential to be a child abuser herself.
After his third surgical procedure, J.J. required special care. Although the child remained at his original foster home, his foster mother was not willing to provide a legal permanent home for J.J. In January 2009, the agency searched for a concurrent planning foster care placement with people skilled in caring for a medically fragile infant. In advance of the February 2009 six-month review hearing, the agency recommended that Julie’s reunification services be continued. Julie had only attended some parenting classes, but was expected to make up the ones that she had missed. The psychological evaluation had also prompted a December 2008 agency referral for Julie to participate in individual therapy.
All subsequent calendar dates refer to the 2009 calendar year.
Julie also made weekly visits with J.J. She continued to fall asleep during visits, claiming an iron deficiency as the source of her drowsiness. The social worker noted that Julie appeared to hold J.J. while sleeping and woke if he moved or made noise. Julie began attending her child’s medical appointments. She attended J.J.’s development assessment, minimizing his developmental delays that were described to her. By this time, John had been jailed in Nevada.
The agency noted that Julie still needed to complete parenting classes and to begin individual therapy. In February, the juvenile court found that the agency had provided reasonable services and that Julie had made partial progress toward alleviating or mitigating the causes requiring placement.
Julie requested that the April review hearing be set for a contest. She wanted J.J. to be returned to her custody. The agency initially recommended that reunification services to Julie be continued; by the date of the hearing, it recommended termination of reunification services. Julie’s aunt and uncle were being considered as a placement for J.J. In April, Julie completed a parenting class, but had only begun individual therapy. She did not begin therapy for four months after receiving the referral because the therapist was not free to see her. In light of the agency’s changed recommendation, the April hearing was continued until June. The juvenile court again found that the agency had provided reasonable services and that Julie had made partial progress alleviating or mitigating the causes requiring placement. It also found that it was likely to set a permanency planning hearing date at the June hearing. After the hearing, Julie’s was given a referral to obtain a medical evaluation addressing her narcolepsy.
By June, in advance of the next review hearing, the agency formally recommended that reunification services to Julie be terminated. Julie disagreed, wanting J.J. returned to her care. She regularly attended therapy sessions. Her therapist reported that Julie did not appear to understand why she was involved in social services or why her child was not being returned to her. After initial reluctance to engage with the therapist, Julie was making moderate progress toward her treatment goals by late June.
Julie continued to visit with J.J. weekly, although she still fell asleep during visits while holding the child. She also fell asleep while holding her son as she waited to see his cardiologist and while in the examining room. Julie underwent a medical examination that revealed no physical cause for her sleeping issues. The doctor suggested that Julie might have mental health issues.
J.J.’s medical conditions made it difficult for his body to absorb oxygen. When he reaches five years of age, another surgery will be needed to increase the amount of oxygen to the lower part of his body. He displayed severe developmental delays, particularly on one side. He attended physical therapy once a week and occupational therapy twice a week. Because of his fragile medical condition, his cardiologist recommended against placement in daycare until J.J. was two years old. The child continued to require a great deal of attention and care. For example, if held incorrectly, J.J. would be in great pain.
A physical therapist estimated that at 12 months old, J.J.’s gross motor skills were consistent with those of a normal four-month-old child. He was underweight for a child his age. Even at this age, J.J. was unable to sit up on his own.
The agency expressed the concern that Julie did not see the risk that her sleep issues posed to J.J. It was also troubled that she continued to express the view that medical professionals exaggerated J.J.’s condition and developmental delays. The child’s high demands and the mother’s limited understanding of his needs led the agency to conclude that there was no substantial probability of reunification for Julie and J.J.
At the contested six-month review hearing in June and July, the juvenile court heard evidence that the mother had a tendency to nod off during visits and medical visits. However, Julie’s ongoing narcolepsy was only one issue of concern. The agency cited the fact that she continued to lack understanding of the medical needs of a fragile child.
The social worker testified that Julie was not meeting J.J.’s needs. Julie downplayed her own physical problems and those of J.J. Without a full understanding of J.J.’s needs, the social worker believed that Julie’s ability to meet those needs was hampered. For example, J.J. needed to be prompted to eat throughout the day and night, but Julie did not take active efforts to feed him during their visits. There was also evidence that Julie made few efforts to contact the foster parent to learn about J.J.’s medical needs.
The social worker testified that in order to assist Julie in achieving her case objective of meeting J.J.’s physical, emotional, medical and educational needs, the agency had offered services including individual therapy, parenting classes, and encouraging the mother to attend all of the child’s medical appointments. The social worker did not believe that the services Julie had received had improved the mother’s ability to provide adequate care for the child, nor did she believe that another six months of services would improve Julie’s ability to meet J.J.’s needs.
At the close of evidence, the agency argued that J.J. would be at risk if returned to Julie’s care. While the mother had complied with much of her case plan, she still failed to understand the child’s needs and continued to fall asleep during visits and medical appointments. The agency asked the juvenile court to terminate reunification services, noting that there were only six weeks left before the 12-month review date and that it was unlikely that Julie could make sufficient progress in that short time to allow J.J. to be returned to her home. It also argued that reasonable services had been provided to Julie.
For her part, Julie argued that the agency had not offered her reasonable services. No follow-up services had been offered to address the sleeping issue, once the medical examination had been completed. Julie was not given information about J.J.’s feeding, and had not been allowed to participate in J.J.’s occupational or physical therapy. She was not allowed to administer J.J.’s medication. J.J.’s counsel argued that the agency did not seek termination of reunification services because Julie fell asleep, but because she had virtually no understanding or appreciation of his severe needs. The minor’s attorney argued that there was no evidence that Julie was precluded from participating more fully in J.J.’s care, noting instead that Julie failed to take advantage of opportunities to familiarize herself with his situation and then failed to ask for additional information.
On July 22, the juvenile court found that the agency had provided reasonable services to Julie, but that the extent of her progress toward alleviating or mitigating the causes necessitating placement had been only partial. It terminated Julie’s reunification services and set a November 23 date for a permanency planning hearing. (See § 366.26.)
Julie filed a timely notice of intent to file a writ petition challenging these rulings. On September 4, she filed a petition for extraordinary writ relief. She challenges the juvenile court’s finding that the agency offered her reasonable services and that she failed to make substantial progress on her case plan. She asks us to order the juvenile court to vacate its order setting a permanency planning hearing and to order that reunification services be continued. She also asks us to stay the November 23 permanency planning hearing if this matter is not resolved by that date. We issued an order to show cause. The agency opposes the petition and the request for a stay.
II. REASONABLE SERVICES
First, Julie challenges the juvenile court’s finding that the agency offered her reasonable services. When a child is removed from a parent’s custody, the juvenile court must order reunification services to be provided for the minor and the parent. (§ 361.5, subd. (a); Cal. Rules of Court, rule 5.695(f)(1).) If the child was under age three at the time of the initial removal, reunification services are typically limited to six months, although the period of those services can be extended. (§§ 361.5, subd. (a)(2), 366, subd. (a)(1); Tonya M. v. Superior Court (2007) 42 Cal.4th 836, 843.)
The reunification services offered to a parent must be reasonable. The agency must make a good faith effort to provide services that respond to the unique needs of each family—services designed to eliminate the conditions that led to the court’s dependency finding. (Mark N. v. Superior Court (1998) 60 Cal.App.4th 996, 1010.) On appeal, we judge the adequacy of the reunification services and the agency’s efforts to provide those services based on the circumstances of the particular case. (Id. at p. 1011.)
We recognize that in some cases, more services might have been provided and that some services that are provided are imperfect. We judge not whether the services provided were the best that might be provided in an ideal world, but whether the services actually provided were reasonable under the circumstances. (In re Julie M. (1999) 69 Cal.App.4th 41, 48; Elijah R. v. Superior Court (1998) 66 Cal.App.4th 965, 969; In re Misako R. (1991) 2 Cal.App.4th 538, 547.) When reviewing the reasonableness of services provided, we view the evidence in the light most favorable to the judgment and indulge in all legitimate and reasonable inferences in support of the finding. If substantial evidence supports the finding, we must affirm it. (In re Monica C. (1995) 31 Cal.App.4th 296, 306.)
At the six-month hearing, if the juvenile court does not return a minor to the parent, it must find whether or not reasonable services designed to overcome the problems that led to the initial removal have been offered or provided to the family. (§ 366.21, subd. (e); Cal. Rules of Court, rule 5.710(e)(2)(A).) In J.J.’s case, the juvenile court found that the agency had offered or provided reasonable reunification services to Julie and her child. On appeal, Julie challenges this finding, arguing that the agency failed to offer her services related to her narcolepsy and anemia until too late in the reunification period. Thus, she argues that clear and convincing evidence does not support the finding that the agency provided reasonable reunification services to her.
The record should show that the agency identified the problems leading to the loss of custody, offered services designed to remedy those problems, maintained reasonable contact with the parent during the course of the service plan, and made reasonable efforts to assist the parent in areas in which compliance proved difficult. (Mark N. v. Superior Court, supra, 60 Cal.App.4th at p. 1011; In re Riva M. (1991) 235 Cal.App.3d 403, 414.) In the case before us, the record shows that the agency properly identified the causes of J.J.’s dependency as his serious medical issues and Julie’s refusal to acknowledge the serious nature of those medical concerns. In the case plan, the agency offered Julie services designed to help her achieve the service goal of meeting her child’s physical, emotional, medical and educational needs. Those services included referrals for therapy and parenting classes, as well as encouragement to attend J.J.’s medical appointments. It also provided referrals for psychological and medical evaluations, including one prompted by the narcolepsy issue.
Julie is critical of the agency’s failure to refer her for a medical evaluation until April 2009. However, as the results of the medical evaluation suggested no physical cause for the sleeping problem and the mother repeatedly downplayed any suggestion that she might have such a problem, we fail to see how the lack of an earlier medical assessment would have assisted Julie.
We also note that Julie’s fact-specific challenge to the juvenile court’s finding is inappropriate if it ignores the substantial evidence test we must apply on appeal. Applying that test, we determine only if the record shows substantial evidence to support that juvenile court’s finding. (Angela S. v. Superior Court (1995) 36 Cal.App.4th 758, 762.)
The key problem for Julie was not her ongoing narcolepsy, but her ongoing inability to accept the seriousness of her son’s fragile medical condition and to learn the skills necessary to provide for his special needs. An adult cannot be an effective parent if he or she denies the extent of the issues that interfere with a proper parent-child relationship. (See Angela S. v. Superior Court, supra, 36 Cal.App.4th at pp. 763-764; see also Elijah R. v. Superior Court, supra, 66 Cal.App.4th at pp. 969-971.)
Reunification services need not be perfect to be reasonable. (In re Alvin R. (2003) 108 Cal.App.4th 962, 972.) Even if the agency could have provided more services, this fact does not necessarily render the services that it did offer unreasonable. (See id. at p. 973.) In the case before us, there is substantial evidence to support the juvenile court’s finding that the agency provided reasonable reunification services designed to address the issues prompting J.J.’s removal from Julie’s custody.
III. MOTHER’S PROGRESS
Julie also argues that she made substantial progress on her case plan. At the close of the six-month hearing, the juvenile court found that she had made only partial—and not substantial—progress in meeting the goals of her case plan. Julie’s claim of error on appeal is, in essence, an attack on this finding of the juvenile court. Thus, we review the record to determine if it contains substantial evidence in support of the juvenile court’s finding. (See Angela S. v. Superior Court, supra, 36 Cal.App.4th at p. 763.)
In a case involving a child who was under three years of age on the initial removal date, if the juvenile court finds at the six-month review hearing that there is a substantial probability that the child may be returned to his or her parent by the time of the 12-month review hearing, the juvenile court must continue the case to the 12-month permanency hearing. (§ 366.21, subd. (e); Tonya M. v. Superior Court, supra, 42 Cal.4th at pp. 845-847.) By challenging the juvenile court’s finding that she failed to make substantial progress on her case plan, Julie hopes to establish that setting a date for a permanency planning hearing was in error and to extend her reunification services.
In this matter, because the six-month hearing was continued until well into the next review period, the juvenile court assessed whether J.J. was likely to be returned to Julie by the time of the 12-month review hearing. (See Tonya M. v. Superior Court, supra, 42 Cal.4th at pp. 845-847.)
In her petition, Julie emphasizes the progress that she has made in satisfying the various elements of her case plan. She completed a parenting class, had begun participating in individual therapy, and attended J.J.’s medical appointments. She had also had a psychological evaluation, a medical evaluation and regular visitation with her son. She contends that her compliance with the case plan warranted an additional six months of reunification services.
Julie’s petition fails to acknowledge the most significant aspect of her parenting deficiencies—specifically, her failure to sufficiently appreciate the fragility of her child or his serious medical needs, such that she could provide him with adequate care. She continually downplayed the extent of his needs and failed to demonstrate the ability to address those needs, if she were to accept them. The record before us contains substantial evidence to support the juvenile court’s finding that Julie had not made substantial progress in addressing the issues that led to J.J.’s dependency to allow the court to contemplate the possibility of returning him to her care by the time of the upcoming 12-month hearing. Thus, the juvenile court properly set a date for a permanency planning hearing and terminated Julie’s reunification services. (§ 366.21, subd. (h).)
The petition for writ of mandate is denied on the merits. (§ 366.26, subd. (l); Cal. Rules of Court, rule 8.452(i); In re Julie S. (1996) 48 Cal.App.4th 988, 990-991.) The request for a stay of the November 23, 2009 hearing is denied. Our decision is final immediately, in the interests of justice.
We concur: Ruvolo, P.J. Rivera, J.