In Re Ashley E.

DEBORAH S. EYLER, J. The Circuit Court for Montgomery County, sitting as the juvenile court, issued orders changing the permanency plans for four children of Toisha B., the appellant, from reunification to termination of parental rights/adoption. This appeal challenges the decision underlying those orders. The Montgom ¹⁴⁶ ery County Department of Health and Human Services (“Department”) is the appellee in this Court. The appellant’s questions presented, as combined and reworded, are: I. Did the juvenile court err by denying her motion to sequester witnesses and otherwise failing to strictly apply the Maryland Rules of Evidence in the permanency plan review hearing?

II

Did the juvenile court err by refusing to exclude non-parties from the courtroom?

III

Did the juvenile court err in changing the children’s permanency plans from reunification to adoption when the evidence was insufficient to show that the Department had made reasonable efforts to reunify the appellant with the children? For the following reasons, we shall affirm the orders of the juvenile court. 1 FACTS AND PROCEEDINGS I. The children in this case are Gregory B.-G., born August 6, 1993 (now 10 years old); Matthew B., born August 26, 1994 (now 9 years old); Laione D., born December 6, 1995 (now 8 years old); and Ashley E., born November 24, 1997 (now 6 years old). The appellant is the children’s biological mother. She has identified putative fathers for the children.

According to the appellant, the children all have different fathers. The children and the appellant first came to the attention of the Department in the late summer of 2001, when they were ¹⁴⁷ living in Rockville. The appellant contacted the Department because she thought she was going to be incarcerated on an outstanding warrant (which did not happen). The Department assisted the family financially; located a temporary shelter for them when, later that year, they became homeless; arranged medical treatment for Gregory for a mass on his vocal cord; and twice placed the children in temporary foster care when the appellant was hospitalized for complications of a difficult pregnancy (which ended in a miscarriage).

On January 31, 2002, Laione, then 6, told her first grade teacher that “her dad” had “pushed [her] down and stuck a .. . beer bottle in [her] butthole.” The teacher immediately made a report of suspected child sexual abuse to the Department’s Child Protective Services unit. The teacher stated that Laione was upset and crying when she made the disclosure, that she demonstrated the position in which she had been restrained when the abuse happened, and that she was having problems in school, specifically with exhibiting sexually inappropx-iate behavior. In addition, the teacher reported that Laione wore dirty clothes to school, smelled bad from lack of proper hygiene, and urinated or defecated on herself daily, usually immediately before leaving school to go home. The Department interviewed Laione.

Using anatomically correct dolls, she demonstrated that a male family member, whom she identified as “Sean,” had put his penis in her mouth. Laione then described her mother’s sexual activities to the social worker; in doing so, she spontaneously got on a cot in the interview room and imitated her mother’s actions and sounds when engaged in sexual intercourse. The next day, the appellant brought all four children to the Department for interviews. Laione denied having “sa[id] anything about penises in the mouth” the day before but then talked about Ashley and Gregory “sexing.” Gregory denied any sexual contact, but demonstrated a “horsie” game he played with the girls, which was sexual in nature.

(The social worker did not interview Matthew and Ashley that day because the children were too tired.) ¹⁴⁸ At the social worker’s direction, the appellant took the children to the Sexual Abuse and Assault Center at Shady Grove Hospital to be examined. Laione’s physical examination revealed signs of “chronic vaginal penetration” and that the “circumference around the anus and the area around the vaginal opening [were] colored with ... magic marker.” The forensic nurse concluded from the precision of the markings and the fact that they would have caused pain that they were not self-inflicted. Laione told the nurse that “Sean” put a beer bottle in her vagina; she later said that a glass had been inserted. She denied having had sex with anyone, saying: “nobody’s ever sexed me because I’m too ugly.” She reported that Gregory did “nasty stuff” and that Ashley had “stopped doing that nasty stuff.” When the social worker confronted the appellant about her children’s medical and behavioral problems, she denied them and became angry and defensive.

She blamed the children’s problems on the school system and told the social worker she was going to move out of the country. Later, the appellant did not bring Matthew and Ashley to scheduled interviews, and complained that the investigation was ongoing. The appellant did not respond to the social worker’s offer to schedule the inteiviews at an evening time convenient to the appellant’s work schedule. Apparently, during this period, the appellant was sexually involved with two men: “Big Gregory” and “Monte,” Ashley’s putative father.

When the appellant told the social worker that the men were no longer having contact with the children, the Department transferred the case to the intensive family services unit, which provided a parent aide several times a week. That arrangement lasted until April 22, 2002, when Laione made another sexual abuse disclosure to her teacher. Laione told the teacher that she had seen her mother “sexing it up” with two men in the bathroom; and when the three adults moved to another room “to do it harder,” her mother told her to “come join in” and watch Big Gregory perform a sex act ¹⁴⁹ upon her. Laione quoted her mother, using explicit adult sexual language that would not be in the ordinary vocabulary of a young child.

When the teacher suggested to Laione that they speak to the school counselor, Laione screamed and begged the teacher not to tell for fear that the appellant would kill her. Laione also told the teacher that Big Gregory had banged Gregory’s head against a wall. That day, the teacher made a second report of sexual abuse to the Child Protective Services unit, and the children were placed in emergency shelter care and interviewed. Laione at iirst was fearful, saying that what had happened was a “secret” she was “afraid to tell” and that it was none of the social worker’s business.

She then spelled out the word “sex” and described her mother and Big Gregory and Monte “in the bathroom ... sexing” with their clothes off. She talked about a time when the appellant and Big Gregory were in bed and the appellant, seeing her in the room, asked her to join in and perform a sex act. Again, Laione quoted her mother by using explicit adult sexual language. Laione also described seeing Gregory in the closet with Ashley, “sexing,” and said that afterward Ashley complained, “My poo-poo hurts.” In her interview, Ashley, then four years old, said Big Gregory was “licking everybody’s stomach” and that he then would lick the appellant’s breasts.

Ashley used explicit adult sexual language in describing Big Gregory’s conduct. In his interview, Gregory, then nine years old, again demonstrated the “horsie” game and said Ashley had touched his “private parts” but he only had touched her through her clothing. He told the social worker he learned that behavior by seeing the appellant and Big Gregory having sex in a motel room, when the children were in one bed and the adults were in another. Matthew, who was then seven, told the social worker that he had not been sexually abused but had seen Gregory touching “Lae-Lae’s poo-poo” and her “butt” with his hand and mouth.

When Matthew told his mother what he had seen, she “whipped” Gregory and Laione. Gregory later told Matthew ¹⁵⁰ that the appellant had said “not to tell our business.” Matthew told the social worker he dreame.d that something would come down from the sky and lift him away. He also talked about his imaginary “bad” brother, “Invisible Gregory,” whom he feared. After the interview, the social worker found Matthew crouching behind a door in the waiting room, anxiously saying that “Invisible Gregory” had taken money from his pocket.

The appellant’s reaction upon being informed of the children’s disclosures was to say she was not surprised about the sexual activity between them, because Matthew had told her about it and she had told them it was inappropriate. She also said there was “an episode when the children walked in on her having sex” and “a time when Laione walked in and saw her performing fellatio on Monte.” The next day, April 23, 2002, the Circuit Court for Montgomery County, sitting as the juvenile court, held an emergency shelter care hearing, and committed the children to the Department for foster care placement. The appellant agreed to drop off medication for Matthew the next day, but did not do so, and also did not give the Department forms so they could access the children’s medical records. Thereafter, on allegations of fact derived from the children’s interviews, the Department filed Child In Need of Assistance (“CINA”) petitions for all four children.

The court held adjudicatory and disposition hearings on May 23 and 24, 2002. The court sustained most of the factual allegations, including allegations that the appellant had engaged in sexual activity with Laione. The court found the children CINA and committed them to the Department’s continuing care for foster care placement. It further ordered that the appellant be permitted supervised visitation with the children.

The Department’s permanency plan for the children at that point was reunification with the appellant. Eleven months later, on March 25, 2003, the juvenile court conducted a permanency plan review hearing, pursuant to Md.Code (2002) section 3-823(b)(l)(i) of the Courts and Judi ¹⁵¹ cial Proceedings Article (“CJ”). At that hearing, the Department took the position that the permanency plan for the children should be changed to termination of parental rights(“TPR”)/adoption. The appellant opposed such a change.

The Department called two witnesses: Nancy Atikkan, the Department social worker assigned to the children since September 2002, taking over for Josie Traum, their original social worker; and Polly H. Kraft, M.D., a psychiatrist who examined the children at The Reginald S. Lourie Center for Infants and Young Children (“Lourie Center”), and participated with others at that center in evaluating their emotional and mental health problems. The appellant did not call any witnesses. Counsel for the children participated in the hearing but did not call any witnesses. The evidence showed that the children at first were placed in two foster homes in Montgomery County: Gregory and Matthew together and Laione and Ashley together.

In both situations, the children were aggressive and assaultive, to each other and to property, and had to be moved to separate homes. In addition, Laione told “sexual lies” and Ashley engaged in “sex talk.” In mid-May, Matthew was moved to a second foster home, also in Montgomery County, where he remained and had adjusted well. The other three children went through multiple placements in the first few months after entering shelter care and eventually were placed in therapeutic foster homes in Baltimore City, through the Pressley Ridge Center. (Their dates of entry into therapeutic foster homes were: Gregory— May 10, 2002; Ashley — June 4, 2002; and Laione — August 15, 2002).

The three children received therapy at the Pressley Ridge Center, near their foster homes, and Pressley Ridge arranged their visitations with the appellant. In the summer of 2002, with three of the children in foster care in Baltimore City, the appellant moved there. Visits were scheduled to take place once a week at the Pressley Ridge Center with all four children, with Matthew being ¹⁵² transported to Baltimore by the Department. The appellant immediately requested that the visits be changed to every other week, to accommodate her work schedule at the time.

According to Ms. Atikkan, even though the appellant lived within walking distance of the Pressley Ridge Center, she did not attend the scheduled visits consistently or reliably. When the visits with all four children together took place, they were chaotic — the children ran around, darting in and out of the room and aggressively interacting with each other, with the appellant exercising little control. As a consequence, the visits were rescheduled to happen individually, every other week, with Matthew’s visits in Montgomery County. The appellant continued to miss many of the scheduled visits, and to be late for others.

For part of that time, the appellant was working in Takoma Park. When she lost her job and was not employed, however, she did not schedule any additional visits with the children and continued to miss and be late for visits. The appellant was very late attending the children’s evaluation at the Lourie Center and failed to bring lunch for them (which was necessary because part of the evaluation involved assessing her interactions with the children during a meal together). The Department had recommended that the appellant undergo a psychological evaluation, but she had not submitted to one.

Dr. Kraft testified about the evaluation of the children performed by the Lourie Center in the summer of 2002, and the children’s mental health issues. The evaluation was conducted by a team of therapists, including Dr. Kraft, and covered a period of 40 to 50 hours. It consisted of an interview of the appellant; individual sessions with the children; sessions with the children together; sessions with the children with the appellant, and separately with foster parents; and psychological testing. Dr. Kraft performed the interview of the appellant.

The strongest persistent theme in the interview was that, in the appellant’s view, the children’s problems were caused by mal ¹⁵³ treatment by the child welfare system. The appellant expressed anger in insisting that the children were not being tended to properly. She took the position that nothing was wrong with them before they were removed from her care. She would not acknowledge that she had any role in their problems, and would not take responsibility for the problems.

Dr. Kraft opined that the children’s emotional and mental problems were the result of long-term abuse, probably for their entire lives, which could not have been caused merely by being removed from their mother’s custody. The appellant’s ability to properly socialize the children and keep them safe was, in Dr. Kraft’s view, “severely impaired.” According to Dr. Kraft, Gregory, Laione, and Ashley had suffered serious emotional damage as a result of sexual and physical abuse in their mother’s home. They each had diagnosed mental illnesses as a consequence. Gregory’s sense of trust was harmed to the point that he exhibited deviant antisocial features, such as lying, stealing, and attempting to trick people as a reaction to feeling tricked himself.

Ashley was the most severely emotionally damaged, to the point that the evaluators at first thought she was psychotic. Her sexualized and inappropriate behavior included making an overt sexual advance to one of the interviewing therapists. Laione had suffered serious personality damage, marked by a very low sense of self worth. She sexualized all relationships, and resorted to sexual self-stimulation when stressed.

Matthew was the only child who had suffered moderate, as opposed to serious, emotional damage. His problems were primarily with anxiety. Dr. Kraft opined that all the children would need to be “resocialized.” At the conclusion of the hearing, the court decided that the permanency plan would remain reunification, stating, “I do not think TPR is yet appropriate.” The court expressed the view that some of the initial problems with the appellant’s not participating in visitation could have been a function of distance, and that it was essential that the appellant participate in a psychological evaluation in which she discussed her own ¹⁵⁴ background and what had happened to the children while they were in her care. The judge stated that, without such an evaluation, he could not make a judgment about the appropriate plan for the children.

He explained: So, I want to make it clear by saying it a third time that the mother must participate in this psychological evaluation, in which she tells the evaluator what happened in her childhood that may be significant and what happened in the lives of the children while they were with her that may be significant, so we can look to what has to be done to reunify the children. I do not think we’ve had a full enough opportunity to do that. That’s why I can’t approve today a Permanency Plan of Termination of Parental Rights. I do not think we’ve had enough opportunity on behalf of the mother for that to be an appropriate Plan....

The court ordered that the psychological evaluation of the appellant be performed within 30 days. A second permanency plan review hearing was held on October 1, 2003. The Department again requested that the permanency plan be changed to TPR/adoption, and the appellant again opposed that request. Since the first permanency plan review hearing, a psychological evaluation of the appellant had been performed by Michael Gelles, Ph.D., in July 2003.

The Department called Dr. Gelles and Ms. Atikkan as witnesses. Counsel for the children called Shelby Morgan, Ph.D., Gregory and Laione’s therapist at Pressley Ridge, who also was the supervisor for Ashley’s therapist there. The appellant testified on her own behalf. Dr. Gelles, a psychologist, testified that, before conducting the evaluation of the appellant, he reviewed documents pertaining to her and to the children, including an intake evaluation of the appellant by a social services agency in Montgomery County, in September 2001.

He then interviewed the appellant for about hours and administered psychological tests. He concluded that the appellant does not have a major psychological condition, but has a personality disorder with ¹⁵⁵ passive, aggressive, and avoidance traits that affects her behavior. Dr. Gelles found the appellant to have difficulty being consistent and reliable, as a person and consequently as a parent. She told people what she wanted them to hear, in order to portray herself as she wanted to be seen.

For example, in her interview in 2001, she reported that, as a child, she was sexually abused by a relative, saw her mother and uncle engaged in sexual relations, and witnessed a murder. She told Dr. Gelles that none of that was true, however, and that she had deliberately lied so she could get housing assistance. Dr. Gelles opined that the appellant’s unreliability and her extreme desire to please was such that one could not trust what she said, and only could go by her actions. The appellant told Dr. Gelles that none of the abuse reported by the children in her household had happened.

She persisted in her denial even when shown a letter Laione had written, in therapy, about the appellant’s having engaged in sex acts with Laione. The appellant’s reaction was that the letter might have been written by someone else, or that Laione could have been influenced by an outsider to write it. The appellant was angry and upset with the Department, and blamed the children’s problems on it. Dr. Gelles testified that the appellant had no insight into the impact her past behavior had had on the children, because she was defensive and in denial about it.

Ms. Atikkan testified that the children had been in foster care for 16 months. During that time, the appellant had not complied with the service agreements (one of which she signed and two of which she did not). She had not participated in parenting classes that had been offered. She had not consistently signed releases for medical treatment for the children.

She had not consistently attended visitation with the children. Out of 68 weeks of visitation, she had seen Gregory 26 weeks, Matthew 14 weeks, Laione 21 weeks, and Ashley 18 weeks. She had not attended school meetings for the children. She had lost several jobs since September 2002. ¹⁵⁶ Ms. Atikkan further explained that the appellant refused to acknowledge the abuse the children had experienced in her household, and therefore refused to take responsibility for it.

Her lack of honesty in acknowledging the circumstances in which the children were sexually abused and consequent lack of empathy for them made it difficult for the children to heal emotionally from their trauma. As noted above, the children’s counsel called Ms. Morgan to testify. Ms. Morgan, the Clinical Coordinator for Pressley Ridge, is a therapist who specializes in treating sexually abused children. She started treating Laione in September 2002.

At that time, Laione would engage in sexual talk during therapy and sexualized behavior at school and in her foster home. She would touch other children sexually at school. She also would ask her foster mother to have sex with her, and would become angry and intentionally wet the bed when her foster mother refused. During therapy sessions over the course of a year, Laione made progress and developed some sense of trust.

She disclosed more sexual abuse during that time, including sexual abuse by the appellant. Laione worked with Ms. Morgan to try to deal with her persistent sexual thoughts and dreams, by labeling them the “sex monster,” and by writing about her feelings. When Ms. Morgan discussed Laione’s problems with the appellant, the appellant acknowledged that Laione had been sexually abused, but said she did not know who the perpetrator was. Ms. Morgan began treating Gregory in April 2003, after his first counselor left Pressley Ridge.

Gregory at first had difficulty expressing any feelings at all. Later, he would talk about his anger. He has engaged in bizarre behavior at his foster home, such as defecating in a potato bag, which