In re M.K.

[Cite as In re M.K., 2023-Ohio-96.]


                                          COURT OF APPEALS
                                      GUERNSEY COUNTY, OHIO
                                      FIFTH APPELLATE DISTRICT


IN THE MATTER OF:                              :       JUDGES:
                                               :       Hon. Earle E. Wise, P.J.
   M.K.                                        :       Hon. W. Scott Gwin, J.
                                               :       Hon. Craig R. Baldwin, J.
   A.K.                                        :
                                               :
   E.K.                                        :       Case Nos. 22CA000030
                                               :                 22CA000031
                                               :                 22CA000032
                                               :
                                               :       OPINION



CHARACTER OF PROCEEDING:                               Appeal from the Guernsey County
                                                       Court of Common Pleas, Juvenile
                                                       Division, Case No. 20JC00255



JUDGMENT:                                              Affirmed



DATE OF JUDGMENT:                                      January 12, 2023


APPEARANCES:

For Plaintiff-Appellant A.P.                           For Defendant-Appellee GCCS

ANDREW E. RUSS                                         MELISSA WILSON
P.O. Box 520                                           1009 Steubenville Ave.
Pickerington, Ohio 43147                               Cambridge, Ohio 43725


For Guardian Ad Litem                                  For CASA/GAL

RICHARD D. HIXSON                                      CHERYL GADD
3808 James Court, Suite 2                              801 Wheeling Avenue
Zanesville, Ohio 43701                                 Cambridge, Ohio 43725
Guernsey County, Case Nos. 22CA000030,31,32                                           2


Baldwin, J.

       {¶1}   Mother, A.P., appeals the decision of the Guernsey County Common Pleas

Court, Juvenile Division, granting appellee Guernsey County Children’s Service’s motion

for permanent custody of her three children, M.K., E.K., and A.K.

                     STATEMENT OF THE FACTS AND THE CASE

       {¶2}   Guernsey County Children’s Services, (GCCS) began providing services to

A.P. and her family in October 2018 after receiving allegations of child neglect and abuse.

The family received assistance from the children’s school, an organization called Creative

Options, the Board of Developmental Disabilities and GCCS.

       {¶3}   Jenny Antill of the Guernsey County Board of Developmental Disabilities

began working with the family in May 2019 assisting with their son, M.K.’s, behaviors and

developing a plan to identify his needs and strengths. She observed that M.K. repeatedly

attempted to run away, used extreme vulgar/sexualized language, was physically

aggressive, acted out and destroyed property. At school he would attack people and other

students, would attempt to bite them and acted out sexually. Though her focus was M.K.,

she was concerned about the behavior of A.P.’s daughter, E.K. E.K. stripped naked and

ran around the house. She ripped the couch cushions and tried to eat the padding from

inside the cushions. E.K. was so disruptive that Antill took a colleague to a visit to deflect

E.K.’s physical attempts to intervene in her meeting with M.K.

       {¶4}   A.P. and the father of the children, W.K., disclosed to Antill that they were

not confident they could parent M.K. and deal with his behaviors. Antill arranged for

services to come to the home and assist with M.K. and while W.K. and A.P. would accept

recommendations, they did not consistently apply the information provided. Antill recalled
Guernsey County, Case Nos. 22CA000030,31,32                                         3


that “[w]e would make a suggestion and they would do it maybe for a week and then it

just kind of fell off the charts.” (Trial Transcript, p. 43, lines 4-6).

       {¶5}    During one visit, Mother mentioned to Antill that A.K. suffered seizures and

Antill explained that A.K. may qualify for services if Mother would obtain a written

diagnosis regarding the seizures, but Mother never provided the diagnosis.

       {¶6}    W.K. and A.P. executed a voluntary agreement of care with GCCS in July

2020, and the agreement was renewed twice. (Juv.R. 38(A)(1)). Despite the services

provided, the parents were unsuccessful in caring for the children. GCCS obtained an ex

parte order on October 1, 2020 granting GCCS temporary custody. The trial court found

the children dependent (Journal Entry, Dec. 15, 2020) and at the dispositional hearing

ordered that they remain in the temporary custody of GCCS and approved the case plans

for the parents. (Journal Entry, Jan. 11, 2021).

       {¶7}    The case plan included a requirement that A.P. complete a drug and alcohol

assessment at the provider of her choice and follow any recommendations provided,

participate in random drug screens, complete a mental health assessment and follow any

recommendations. She was asked to attend a parenting class that specializes in dealing

with challenging behaviors to assist her with parenting her three children and she was

obligated to demonstrate that she could provide a safe and stable home for the children.

She was also asked to demonstrate that she could provide for the children’s basic needs

including nutrition, shelter, clothing, bedding, supervision, medical and educational

needs.

       {¶8}    GCCS moved for permanent custody on September 15, 2021, but

requested that motion be dismissed without prejudice in February 2022. A second motion
Guernsey County, Case Nos. 22CA000030,31,32                                         4


for permanent custody was filed on February 25, 2022 and amended March 1, 2022.

GCCS contended that the parents had failed to remedy the issues that resulted in the

children being removed from the home despite receiving services from a number of

different agencies during the voluntary agreement of care and during the time the children

were in temporary custody of GCCS. The motion also described each child’s mental

health status and their placement in residential treatment.

       {¶9}   GCCS offered testimony regarding the diagnoses of each child as well at

their behavioral issues at the hearing on the motion for permanent custody.

                                 The Children’s Status

       {¶10} GCCS discovered that each child suffered serious mental health diagnoses

and their behaviors made placement with foster parents untenable. They were first placed

into a foster home as a group, but it soon became evident that M.K.’s behavior with his

sister’s required a separate placement. He was not only physically abusive to his foster

parents, he was also acting-out sexually with his sisters, and frequently engaged in

“humping” his sisters, an action imitating sexual intercourse. M.K.’s behaviors lead to an

institutional placement where he was closely monitored and where he has had more

success in controlling his inappropriate behavior.

       {¶11} The two girls, E.K. and A.K., were initially kept together, but their behaviors

overwhelmed the ability of foster parents to provide care and supervision and they were

separately placed in residential facilities that had the resources to manage their behavior

and provide therapy.

                                           M.K.
Guernsey County, Case Nos. 22CA000030,31,32                                           5


       {¶12} Danielle Oddo, M.K.’s therapist, described his initial diagnosis as ADHD,

oppositional defiant disorder, and unspecified mood disorder. He committed repeated

sexually vulgar behaviors that led to his being restrained once or twice every day. He has

made improvement, but this eleven-year-old is still in a sexual aggressor’s therapy group,

aggressive replacement training group, and individual therapy and is taking three

medications to address his behaviors.

       {¶13} When M.K. is prepared to leave his current residential placement, Oddo

recommended “a therapy to foster home, preferably one that's foster to adopt. Somebody

that -- ideally a two-parent home that has experience with children transitioning out of

residential services. If not, someone willing to work with us in therapy to allow the

transition to be smooth.” (Trial Transcript, p. 75, lines 1-6). She expected M.K. to need

therapy for a period of time and an environment with a consistent schedule and regimen.

                                            E.K.

       {¶14} M.K.’s sister, E.K., had mental health issues as well and was treated by

Kristina Morgan beginning on June 13, 2022. E.K. came to Morgan with a diagnosis of

post-traumatic disorder, attention-deficit/hyperactivity disorder, adjustment disorder, and

disruptive mood dysregulation disorder. This seven-year-old girl receives two-and-a-half

hours of mental health, day-treatment group each day and individual therapy twice a

week. She meets with a psychiatric nurse practitioner at least once a month. She receives

daily nursing services, and community supportive psychiatric treatment and is taking two

medications.

       {¶15} E.K. has made improvement, but it is limited. She too was transferred to a

residential facility after unsuccessful placements in foster homes. Initially she was striking
Guernsey County, Case Nos. 22CA000030,31,32                                         6


staff or peers every two hours, but now she can control her assaults for one-half of the

day before she lashes out. She is now taking her medication instead of refusing them or

spitting them out. Once she has sufficiently improved and can be released from residential

placement, she would need one-on-one care, structure and firm boundaries and further

individual, family and group counseling.


                                           A.K.


       {¶16} A.K., now ten years old, has also suffered significant problems. Her

therapist, Jacqueline Witzberger, noted that she had poor attention span, difficulty staying

on task, significant sleep issues and significant anxiety initially, then began exhibiting

significant sexual acting-out behaviors and sexualized behaviors prior to the hearing on

permanent custody. She had urinated on herself and in hallways. She defecated in the

hallways and had eaten her own feces. She is stripping clothing off and engaging in

sexual acts or mimicking sexual acts with other children.

       {¶17} A.K. was diagnosed with ADHD, unspecified type, post-traumatic stress

disorder, simple febrile convulsion and behavioral insomnia of childhood, sleep onset,

association type.

       {¶18} A.K. has an Individualized Education Plan and receives speech therapy.

She participates in CSPT (Community Supportive Psychiatric Treatment) groups that

assist her with life skills and social development seven days a week. She participates in

recreational therapy groups seven days a week and attends a psychotherapy group

provided by a licensed professional counselor five days a week. She receives individual

therapy at least twice a week and she sees a psychologist twice every month. At the time
Guernsey County, Case Nos. 22CA000030,31,32                                          7


of the hearing she had been prescribed five medications to address mental health issues

and her inability to sleep.

       {¶19} A.K.’s progress has stalled as she deals with stages of grief and she is

currently exhibiting anger at people in her family and “at where her life is now.” Her

therapist felt this was a typical occurrence in residential placement since “[r]esidentials

are facilities for the children who have had the most traumatic, darkest early childhood

experiences. They can't function in the community safely. And so, they come in with a

host of difficulties and struggles and issues. And they go through periods of time where

you see them play out those behaviors, those situations, those events in their life.” (Trial

Transcript, p. 89, lines 17-24).

       {¶20} Once A.K. is able to leave her residential placement, her therapist

recommended intensive home-based services so that she has people that are in the

home providing support to the family and to her, so she feels safe. A.K. will require

continued psychiatric care for medication management and specialized education

services.

       {¶21} Each child has extensive needs that require the attention of several

professionals and each is under constant close supervision. Each is progressing as

expected in their separate residential placement, and the record shows that placement of

the children together would not be safe and would interrupt their progress toward

recovery.


                                   MOTHER’S PROGRESS
Guernsey County, Case Nos. 22CA000030,31,32                                            8


       {¶22} Mother completed a mental health assessment with Dr. Aimee Thomas on

July 8, 2020, prior to the children being taken into custody, and she diagnosed Mother as

suffering from Schizoaffective Disorder, Borderline Personality Disorder, Borderline

Intellectual Ability, Alcohol Use Disorder, Severe, Cannabis Use Disorder, Severe,

Stimulant Use Disorder, Severe. Dr. Thomas concluded that “This family requires

intensive intervention. However, even with the support of intensive services, their

prognoses is poor given the severity of [A.P.’s] mental health diagnoses, her ongoing use

of alcohol, and her children's special needs” and she questioned “the safety and wellbeing

of [M.K., A.K. and E.K.] in the [parent’s] home.” (Thomas Deposition, Exhibit GCCS 2, p.

13, 15).

       {¶23} Dr. Thomas conducted a second assessment on May 17, 2022 and May 29,

2022 during which she found that Mother “is essentially functioning at the level of a 14-

year-old with regards to verbal skills and at the level of a 7-year-old with regards to

problem-solving or analytical skills.” (Thomas Deposition, Exhibit GCCS 3, p. 13). She

found that Mother’s “prior evaluation and current disclosures reveal ongoing symptoms

that preclude her from addressing her children's special needs at present” and that her

“non-verbal IQ of 72 reflects significant problems with problem solving, cause and effect

thinking, and the ability to learn, internalize and apply information taught in mental

health/substance abuse counseling and parenting skill training.” (Thomas Deposition,

Exhibit GCCS 3, p. 13, 16).

       {¶24} Dr. Thomas updated her diagnoses at the second evaluation to:

Schizoaffective Disorder (based on prior evaluation), Other Specified Personality

Disorder - borderline traits, childlike, poor insight, Borderline Intellectual Ability, Alcohol
Guernsey County, Case Nos. 22CA000030,31,32                                       9


Use Disorder, Severe, in remission, Cannabis Use Disorder, Severe, Stimulant Use

Disorder, Severe, in remission.

      {¶25} A.P. completed a parenting class, but when asked about her performance,

the coordinator of the group offered only that she attended and participated, and did not

comment on the quality of her involvement or any improvement in her abilities.

      {¶26} A.P.’s case manager at Cedar Ridge explained that she was first evaluated

on August 10, 2021 and began receiving case management, maternal health services,

individual therapy, psychiatric and nursing services. Neither her case manager not any

other witness offered testimony regarding the status of her therapy or what progress she

made during the time between her evaluation and the hearing.

      {¶27} A.P. did conceive two children while her children were in the custody of

GCCS. The first was a child of W.K., the father of her other children. The second was

conceived with a third man that she accompanied to Florida. She revealed to the Court

Appointed Special Advocate that some months prior to the hearing she was in Florida

with this man, they argued and he struck her. She made her way back to Ohio and

discovered she was pregnant. Both children were lost to miscarriages.

      {¶28} Also, during her first assessment with Dr. Thomas, in July 2020, A.P.

described her relationship with W.K. as toxic and that “we fight, argue and cannot get

along” clashing most frequently about parenting approaches. Despite the conflict, A.P.

believed that W.K. was supportive of her plan to undergo gender reassignment. She

claimed that she felt like a misfit in her own body, planned to go by the name of Angel

after transition and she believed that W.K. supported her decision. She abandoned these
Guernsey County, Case Nos. 22CA000030,31,32                                        10


plans and reported to Dr. Thomas that she was no longer pursuing a gender change

during her second assessment in May 2022.

       {¶29} GCCS acknowledged that Mother was cooperative and completed goals in

the case plan, but contended that she was not prepared to assume responsibility for the

children. The guardian ad litem and the Court Appointed Special Advocate for the children

agreed that the parents were not capable of parenting the children.

       {¶30} The guardian ad litem recommended that the children be placed in the

permanent custody of the GCCS, focusing on the serious behavioral issues suffered by

the children and the parents’ apparent difficulty in applying rudimentary parenting

techniques as a result of their own mental health issues. He noted that the behaviors of

each child were challenging the skills of persons trained to counsel and treat troubled

children and that the children were in facilities that provided constant supervision. The

parents were struggling with their own mental health and could not provide the guidance

and support that one child needed and would be overwhelmed by the task of caring for

all three.

       {¶31} The guardian ad litem also expressed concern that if the children were

returned to the parents, the children’s sexualized behaviors would not be controlled. He

reported that Mother overestimated her ability to care for the children and placing them

together would not be safe for the children and would exceed her ability to care for them.

       {¶32} The Court Appointed Special Advocate (CASA) for the children came to the

same conclusion. She recommended that the court grant permanent custody to GCCS

because:
Guernsey County, Case Nos. 22CA000030,31,32                                                11


       * * each child is in treatment, residential treatment, their case plans all three

       outline trauma therapy due to posttraumatic stress. They have displayed

       sexualized behaviors. And they even -- in the beginning of this case the

       agency tried to put the girls together but had to split them up because of

       their sexualized behaviors and acting out. So to protect the children, they

       had to be split, the girls did. And they're each on medication that has to be

       given accordingly as ordered, not missed. By testimony we heard

       yesterday, that even the father had to be taken off his medication because

       he would forget to take his meds. And these children must have their

       medication on time. It is part of their treatment regime.

Trial Transcript, p. 348, line 13 to p. 349, line 3

       {¶33} She concluded that Mother lacked the ability to parent these high needs

children due to her cognitive ability, her lack of insight into each child's medical diagnosis,

mental health issues, and the children’s need for medication, structure and consistency.

She noted that the children need a structured environment that the parents cannot

provide:

              In part, Mother, her heart's in the right place, but I don't believe she

       has the insight into what these needs are for her children. In her own words,

       she said, they just need love, I need to be kind, I need to pick my battles.

       Every day would be a battle. She forgets. And these children had issues

       when they came into care. [M.K.’s] doing better, but he's a long way to go.

       [E.K.] is just starting residential treatment and starting to cooperate a little

       bit. She still has good days, bad days. And [A.K.] is a child in crisis.
Guernsey County, Case Nos. 22CA000030,31,32                                          12


Trial Transcript, p. 349, lines 13-24

       {¶34} She confirmed that neither parent appreciated the severity of the children’s

behaviors, and that, even with additional time, the children could not be reunited with their

parents because once they complete residential treatment, they will need a therapeutic

foster home to continue to address their needs. And she discounted the complaint that

visitation had been stopped by observing that the children improved when visitation

ended. M.K. still had phone contact, but it was brief and was usually ended by him.

       {¶35} The CASA was also concerned by Mother’s use of medical marijuana to

self-medicate and feared it would impact her ability to parent. Mother was legally using

medical marijuana under the supervision of a physician, but neither the physician nor any

other expert testified as to its purpose. Mother asserted that the medical marijuana helped

relieve the “blackouts” she claimed to have experienced, where her vision was interrupted

for a period of time. She explained that they were not true blackouts, but acknowledged

that her vision was affected and mentioned that an unidentified hospital recommended

that she “get to neurology for it” but she had not seen a neurologist prior to the hearing.

Aimee Thomas, a licensed psychologist who evaluated A.P. on June 22, 2022, affirmed

the need for a neurological consult to resolve this issue.

       {¶36} The trial court took the matter under advisement and issued a journal entry

on August 24, 2022 granting the motion for permanent custody. After a thorough analysis

of the testimony and evidence, the trial court concluded that:

              The Court finds that these children have been subjected to much

       trauma, neglect and abuse in their young lives. Father denies all wrong

       doing and mother has remained silent about this issue from the start. On
Guernsey County, Case Nos. 22CA000030,31,32                                            13


       the one hand, the parents admit they have problems addressing their

       children’s behaviors. On the other hand, they don’t accept responsibility for

       much of the trauma. Mother and Father have limited insight into their own

       mental health concerns. The Court does not believe, based on the

       testimony and evidence presented, that they truly understand the

       magnitude of the challenges their children face. The Court does not find the

       testimony of either parent to be credible as to how they got to this place or

       how they plan to remedy the problems that resulted in the children being

       removed.

Journal Entry, August 24, 2022, p. 17

       {¶37} The trial court also found that GCCS made reasonable efforts to finalize a

permanency plan and to eliminate the continued removal of the children from the home

and have attempted to make it possible for the children to return home, but the parents

were unable to remedy the reasons leading to the removal of the children. The court found

that it was in the best interest of the children that the parental rights of the Father and

Mother were terminated and that permanent custody be granted to GCCS.

       {¶38} A.P. filed a timely appeal and submitted two assignments of error:

       {¶39} “I. THE TRIAL COURT ERRED IN ALLOWING THE MOTION FOR

PERMANENT CUSTODY TO PROCEED AND/OR IN GRANTING THE MOTION DUE

TO A LACK OF REASONABLE EFFORTS BY THE GUERNSEY COUNTY CHILDREN

SERVICES AGENCY.”
Guernsey County, Case Nos. 22CA000030,31,32                                         14


       {¶40} “II. THE TRIAL COURT ABUSED ITS DISCRETION BY NOT PROPERLY

CONSIDERING THE BEST INTERESTS OF THE CHILDREN AS REQUIRED BY R.C.

§ 2151.414(D).”

                                STANDARD OF REVIEW

       {¶41} As to our standard of review, generally we review the trial court’s decision

in this context for abuse of discretion. We would examine the entire record and determine

whether there is sufficient competent and credible evidence to support the judgment

rendered by the trial court. Seasons Coal Company v. Cleveland, 10 Ohio St.3d 77, 80,

461 N.E.2d 1273 (1978). Trickey v. Trickey, 158 Ohio St. 9, 13, 106 N.E.2d 772 (1952).

The trial court must resolve disputed issues of fact and weigh the testimony and credibility

of the witnesses. Bechtol v. Bechtol, 49 Ohio St.3d 21, 23, 550 N.E.2d 178 (1990). We

would defer to the trial court's discretion because the trial court had the opportunity to

observe the witnesses and parties in weighing the credibility of the proffered testimony in

a way a reviewing court cannot.

                                  BURDEN OF PROOF

       {¶42} “[T]he right to raise a child is an ‘essential’ and ‘basic’ civil right.” In re

Murray, 52 Ohio St.3d 155, 157, 556 N.E.2d 1169(1990), quoting Stanley v. Illinois, 405

U.S. 645, 92 S.Ct. 1208, 31 L.Ed.2d 551(1972). A parent's interest in the care, custody

and management of his or her child is “fundamental.” Id.; Santosky v. Kramer, 455 U.S.

745, 753, 102 S.Ct. 1388, 71 L.Ed.2d 599(1982). The permanent termination of a parent's

rights has been described as, “* * * the family law equivalent to the death penalty in a

criminal case.” In re Smith, 77 Ohio App.3d 1, 16, 601 N.E.2d 45(6th Dist. 1991).
Guernsey County, Case Nos. 22CA000030,31,32                                             15


Therefore, parents “must be afforded every procedural and substantive protection the law

allows.” Id.

       {¶43} An award of permanent custody must be based upon clear and convincing

evidence. R.C. 2151.414(B)(1). The Ohio Supreme Court has defined “clear and

convincing evidence” as “[t]he measure or degree of proof that will produce in the mind

of the trier of fact a firm belief or conviction as to the allegations sought to be established.

It is intermediate, being more than a mere preponderance, but not to the extent of such

certainty as required beyond a reasonable doubt as in criminal cases. It does not mean

clear and unequivocal.” In re Estate of Haynes, 25 Ohio St.3d 101, 103-104, 495 N.E.2d

23 (1986).

       {¶44} R.C. 2151.414 sets forth the guidelines a trial court must follow when

deciding a motion for permanent custody. R.C. 2151.414(A)(1) mandates the trial court

schedule a hearing and provide notice upon filing of a motion for permanent custody of a

child by a public children services agency or private child placing agency that has

temporary custody of the child or has placed the child in long-term foster care.

       {¶45} Following the hearing, R.C. 2151.414(B)(1) authorizes the juvenile court to

grant permanent custody of the child to the public or private agency if the court

determines, by clear and convincing evidence, it is in the best interest of the child to grant

permanent custody to the agency, and that any of the following apply:

       (a)     The child is not abandoned or orphaned, has not been in the

       temporary custody of one or more public children services agencies or

       private child placing agencies for twelve or more months of a consecutive

       twenty-two-month period, or has not been in the temporary custody of one
Guernsey County, Case Nos. 22CA000030,31,32                                           16


       or more public children services agencies or private child placing agencies

       for twelve or more months of a consecutive twenty-two-month period if, as

       described in division (D)(1) of section 2151.413 of the Revised Code, the

       child was previously in the temporary custody of an equivalent agency in

       another state, and the child cannot be placed with either of the child's

       parents within a reasonable time or should not be placed with the child's

       parents;

       (b)    the child is abandoned;

       (c)    the child is orphaned and there are no relatives of the child who are

       able to take permanent custody; or

       (d)    the child has been in the temporary custody of one or more public

       children services agencies or private child placing agencies for twelve or

       more months of a consecutive twenty-two-month period, or the child has

       been in the temporary custody of one or more public children services

       agencies or private child placing agencies for twelve or more months of a

       consecutive twenty-two-month period and, as described in division (D)(1) of

       section 2151.413 of the Revised Code, the child was previously in the

       temporary custody of an equivalent agency in another state.

       {¶46} Therefore, R.C. 2151.414(B) establishes a two-pronged analysis the trial

court must apply when ruling on a motion for permanent custody. In practice, the trial

court will usually determine whether one of the four circumstances delineated in R.C.

2151.414(B)(1)(a) through (d) is present before proceeding to a determination regarding

the best interest of the child.
Guernsey County, Case Nos. 22CA000030,31,32                                          17


       {¶47} In her first assignment of error, A.P. contends the trial court erred by

allowing the motion for permanent custody to proceed because GCCS failed to use

reasonable efforts. She argues that GCCS’s referral to Goodwill Parenting in Canton to

address the special needs of the children was not reasonable due to the prohibitive cost

and the lack of transportation. She also contends she was not permitted to visit with her

children for several months prior to the hearing on the motion for permanent custody and

that she was assigned “several caseworkers” but provides no argument or explanation

regarding how these allegations impact the analysis of the efforts of GCCS.

       {¶48} Overall, Ohio's child welfare laws are designed to care for and protect

children, “whenever possible, in a family environment, separating the child from the child's

parents only when necessary for the child's welfare or in the interests of public safety.”

R.C. 2151.01(A). To that end, various sections of the Revised Code refer to the agency's

duty to make reasonable efforts to preserve or reunify the family unit, including the

requirement that the agency prepare and maintain a case plan with the goal to eliminate

the need for the out-of-home placement so that the child can safely return home (R.C.

2151.412) and the burden on the agency to prove it made reasonable efforts to prevent

the child's removal (R.C. 2151.419).

       {¶49} The agency's duty to use reasonable efforts applies only to efforts to avoid

removal of a child from their home or to reunify the child with the family following removal.

In re Warren, 5th Dist. Stark No.2007CA00054, 2007-Ohio-5703. While the agency did

not have to show reasonable efforts at the permanent custody hearing, to the extent that

the trial court relied on R.C. 2151.414(E)(1) at the permanent custody hearing, the court

must examine the reasonable case planning and diligent efforts by the agency to assist
Guernsey County, Case Nos. 22CA000030,31,32                                         18


the parents when considering whether the child cannot and should not be placed with the

parent within a reasonable time. In re C.F., 113 Ohio St.3d 73, 2007-Ohio-1104, 862

N.E.2d 816, ¶ 42. The issue is not whether there was anything more the agency could

have done, but whether the agency's case planning and efforts were reasonable and

diligent under the circumstances of the case. In re J.D., 3rd Dist. Hancock No. 5-10-34,

2011-Ohio-1458, ¶ 14. The child's health and safety is paramount in determining whether

reasonable efforts were made. In re R.P., 5th Dist. Tuscarawas No. 2011AP050024,

2011-Ohio-5378, ¶ 47.

       {¶50} A.P. focuses her argument regarding reasonable efforts on the requirement

that she obtain parenting skills that would permit her to parent children with behavioral

problems. She complains and GCCS conceded that the program in Canton was

prohibitively expensive and that transportation to the program was not available. While

A.P. was not able to attend that program or any similar instruction, the representative from

GCCS clarified that the motion for permanent custody was not filed because the parents

did not complete the parenting class. (Trial Transcript, p. 182, lines 13-16).

       {¶51} The program that was discussed at the hearing was described as a sixteen

week program for multiple evenings each week. The testimony of Dr. Aimee Thomas

regarding the parents’ cognitive abilities and mental health issues in conjunction with the

described behaviors of the children individually and as a group provided a reasonable

basis for the trial court to conclude that parents would not be able to successfully apply

what they learned and that they would once again be overwhelmed by the challenge of

raising these children in one home. Dr. Thomas, speaking in the context of basic parenting

class, stated that “[g]iven concerns with both [M.K.’s] learning issues, as well as [A.P.]
Guernsey County, Case Nos. 22CA000030,31,32                                         19


issues, I had concerns that they would be able to recite information but not necessarily

apply it.” (Thomas Deposition, p. 13, line 25 to p. 14, line 3). The trial court could

reasonably conclude that the same concern would apply to a more intensive parenting

program.

       {¶52} Even if the parents could attend the specialized parenting program, the

severity of the children’s mental health issues and the cognitive issues suffered by the

parents support a conclusion that inability to provide access to the training was not the

basis for seeking or granting permanent custody. Dr. Thomas described A.P.’s ability to

internalize and apply complicated parenting techniques as limited at best because she

possessed the problem-solving aptitude of a seven-year-old. Her completion of a lengthy

parenting program would not resolve that disability and, relying upon the evaluation of Dr.

Thomas and the balance of the record, there is no support for a finding that A.P. would

be able to successfully apply the techniques that she might learn.

       {¶53} Each of the children currently require the constant focus of trained

professionals and, while they are making progress in their own way, they present serious

challenges to the skills of the staff of their respective residential treatment centers. The

trial court was offered no evidence to support a conclusion that if A.P. had been able to

attend a class that provided training to parent troubled children, she would be better

prepared than the experts caring for her children.

       {¶54} Consequently, the trial court’s finding that reasonable efforts were made is

not undermined by the failure to finance the parent’s participation in a program that Dr.

Thomas contended the parents may not be able to apply.
Guernsey County, Case Nos. 22CA000030,31,32                                          20


       {¶55} We also find that the termination of visitation does not have any impact on

the finding of reasonable efforts. First, A.P. provides only a conclusion that it interfered

with reunification, but no argument to support her conclusion. GCCS halted visitation and

noted that the behavior of the children improved. On February 28, 2022 Father filed a

motion requesting the trial court order visitation, noting that he last visited M.K. and E.K.

in August 2021. and A.P. filed a similar motion thereafter. The trial court found “[n]either

the Agency, the CASA nor the GAL would recommend any visitation with the parents and

the children based upon the current situation. Clearly, these children have many problems

as the result of the parenting, or the lack of parenting of the Mother and Father. The best

interests of the children dictate that there be no visitation with the children until further

order of this court.” (Journal Entry, July 1, 2022, p. 3). The children’s health and safety

are the paramount concern when evaluating reasonable efforts and the trial court’s ruling

is consistent with that requirement. In re R.P., supra.

       {¶56} We have reviewed the entire record and find that the trial court did not abuse

its discretion in finding that agency's case planning and efforts were reasonable and

diligent under the circumstances of the case. The parents took advantage of the services

and recommendations of GCCS, but the underlying problems that led to the removal of

the children from the home nevertheless were not resolved.

       {¶57} The first assignment of error is denied.

                                             II.

       {¶58} In her second assignment of error, A.P. argues that “the trial court abused

its discretion by not properly considering the best interests of the children as required by

R.C. § 2151.414(D).” In her abbreviated argument, she states “had she been provided
Guernsey County, Case Nos. 22CA000030,31,32                                         21


the necessary services, i.e., parenting classes specifically designed for children with

behavioral problems, the family could have been reunited and kept together. There is no

higher standard of “best interest” than a natural parent raising her own flesh and blood.”

(Appellant’s Brief, p. 5).

       {¶59} The record shows that the children were taken into the custody of GCCS on

October 1, 2020, adjudicated dependent December 15, 2020 and remained in the

custody of GCCS until February 25, 2022, the day the motion for permanent custody was

filed, so the children had “been in the temporary custody of one or more public children

services agencies or private child placing agencies for twelve or more months of a

consecutive twenty-two-month period * * *.” R.C. 2151.414(B)(1)(d). The trial court also

found that the children could not be placed with the either of the child’s parents within a

reasonable time, and that finding is supported by the record. The CASA offered

unrebutted testimony that the children could not be reunified with the parents if they were

given additional time, and the evidence of the mental health issues that afflict each family

member supports that conclusion. Consequently, we find that the trial court did not err

when it found that the children cannot be placed with either of the child's parents within a

reasonable time or should not be placed with the child's parents.

       {¶60} The trial court moved to an analysis of the best interest of the children,

referring to the elements described in 2151.414(D)(1)(a)-(e). The trial court completed a

thorough analysis of the facts supporting its conclusion for each of the elements listed in

2151.414(D)(1) and concluded that the children needed a legally secure placement that

could not be achieved without a grant of permanent custody to the agency. The trial court

provided a succinct analysis of its findings in a concluding paragraph:
Guernsey County, Case Nos. 22CA000030,31,32                                        22


              The Court finds that GCCS has made diligent and reasonable efforts

      to finalize a permanency plan for M.K., A.K. by providing referrals for

      service, exploring kinship, case management, and exploring permanency

      planning. GCCS has made reasonable efforts to eliminate the continued

      removal of the minor children and have attempted to make it possible for

      the children to return home to the mother and/or father. The parents have

      been unable to remedy the reasons for the children being removed in the

      first place. GCCS has established a safe, stable and secure environment

      for M.K., A.K., and E.K.

Journal Entry, Aug. 24, 2022, p. 16

      {¶61} A.P. does not direct us to any evidence in the record to support her

conclusion that her attendance at the specialized parenting class would have altered the

outcome of this case. The evidence does support a conclusion that A.P.’s cognitive status

and the problems suffered by the children would overwhelm her ability to parent the

children, even had she taken the class.

      {¶62} The trial court did not err in finding that the record contains clear and

convincing evidence that the best interest of the children will be served by granting

permanent custody to GCCS and that permanent custody was supported by the facts in

the record.

      {¶63} A.P.’s second assignment of error is denied.
Guernsey County, Case Nos. 22CA000030,31,32                              23


       {¶64} The August 24, 2022 decision of the Guernsey County Court of Common

Pleas, Juvenile Division is affirmed.

By: Baldwin, J.

Wise, Earle, P.J. and

Gwin, J. concur.