NOT FOR PUBLICATION

PER CURIAM.

We review challenges to a Family Part judgment of guardianship terminating the parental rights of defendant A.T.K. and permitting the Division of Youth and Family Services (the Division) to secure her child's adoption. On appeal, A.T.K. argues the trial court's decision is unsupported by clear and convincing evidence. We disagree and affirm.

A.T.K. is the mother of Z.J.T.2 born on April 18, 2009. She has two other children, S.K., born December 1, 2000,3 and G.S.,4 born December 21, 2010, who are not involved in this litigation. On April 28, 2009, the Division received an anonymous referral in which the reporter expressed concerns over A.T.K.'s ability to parent Z.J.T. According to the reporter, A.T.K. appeared at her doctor's appointment with Z.J.T. in a "backpack thing," and the reporter was concerned Z.J.T. was too small for the device and his head was unsupported. The caller further reported the child's skin appeared yellowish and that A.T.K. was feeding him formula followed by water. The Division entered into a Family Plan with A.T.K. that sought to encourage her to attend appointments and to help with obtaining housing and assistance, and with child management skills. This referral ultimately was unfounded.

On May 19, 2009, at 4:30 p.m., C.S., A.T.K's boyfriend, called the caseworker who investigated the April 28 referral, to inform her that A.T.K. had tried to suffocate and also shoved one month old Z.J.T., and otherwise acted strangely. The Division, after an hour of trying to reach A.T.K. by phone, was finally successful, and A.T.K. responded she was on a bus and did not know when she would be home. After the initial call, caseworkers experienced difficultly contacting A.T.K., and a supervisor finally reached her and arranged to meet her and Z.J.T. in Hillside. At the meeting, a caseworker questioned A.T.K. about the allegations reported by C.S. A.T.K. explained that she knew what she did was wrong. She explained that she was upset with her boyfriend and she took her fingers and held Z.J.T.'s nose closed. She could not remember for how long she did this, but Z.J.T. began crying when she removed her fingers. She also could not remember if she shoved Z.J.T. She further explained that she was alone when she did it and, when C.S. came home, she told him what she had done. C.S. told her she was unfit to be a mother. A.T.K. told the caseworkers that, at times, she believed this to be true and that she doubted herself as a mother. She stated that she felt overwhelmed and that while she loved her child, she thought it would be a good idea for someone else to care for him while she got herself together. When asked how she would feel if the Division obtained custody of Z.J.T., A.T.K. began to cry and responded she thought it would be for the best. The caseworkers then explained the Division would file for custody of Z.J.T.

On May 21, 2009, the Division filed for and was granted custody of Z.J.T. He was placed with a foster mother, who is now committed to adoption.

On September 23, 2009, at a compliance review, the court dismissed litigation as to C.S., continued custody with the Division, and ordered that A.T.K. undergo a neurological evaluation, remain compliant with psychiatric services, and obtain individual therapy.

The Division sought reunification, provided A.T.K. with parenting skills classes, parent aide services, psychological evaluations, neuropsychological evaluations, individual therapy, visitation with Z.J.T. and a bus pass.

The Division referred A.T.K. to Wise Women at Essex County Community College for parenting skills classes, which she completed. The Division also referred her to Apostles House for parenting aide, a program that she participated in on a weekly basis for seven months. Apostles House provided the Division with monthly reports on A.T.K.'s status. In June 2009, Apostles House advised A.T.K. to attend to her immigration matters, contacted American Friends Service Committee on her behalf regarding her immigration status, and referred her to parenting classes. In July 2009, the agency reported A.T.K. resided in Isaiah House. In September 2009, Apostles House reported A.T.K. was attending therapy sessions at Hyacinth Foundation, addressing her medical needs, taking her medicines, and that she had completed parenting classes. In October 2009, the agency reported A.T.K. was working on finding suitable housing, the parent aide completed and submitted an application for subsidized housing through the HOPWA housing assistance program, A.T.K. had been attending her medical appointments, and was attempting to address her immigration status. In November 2009, the parenting aide assisted A.T.K. with applying for social security benefits. In December 2009, the report stated that A.T.K. had not met with the parent aide as scheduled, she could not be reached, and they were closing their case with her.

The Division provided A.T.K. with weekly visitation with Z.J.T., which A.T.K. attended regularly. During these visits, A.T.K. would read to her son, change and feed him, and act in an appropriate manner towards him.

Dr. Elizabeth Grossier conducted a psychological evaluation of A.T.K. A report by the doctor concluded that A.T.K. did not currently present symptoms of psychosis, that the incident giving rise to removal resulted not from post-partum depression, but rather from A.T.K. being overwhelmed and unable to handle stress appropriately. She further concluded that A.T.K. had cognitive limitations resulting from an early-childhood head injury and that she had difficulty being able to identify her emotional state. Dr. Grossier also noted that A.T.K. was very motivated to get support and assistance with Z.J.T. and that she demonstrated the capacity to care for him.

In a second report, Dr. Grossier noted A.T.K.'s treating physician had diagnosed her with major depressive disorder and was looking into the possibility that she also suffered from HIV related dementia because she was reporting periods of blacking out. Psychological examinations revealed A.T.K. "typically vents upsetting feelings and overreacts to conflicts and difficulties." Dr. Grossier detected a "prominent theme of abandonment and mistrust of others... [and] an overriding sense of hopelessness and helplessness" in A.T.K. She concluded that the incident giving rise to this litigation "may have been related to a `black out' or to feeling overwhelmed with anger towards her then paramour and lack of coping abilities to properly attend to [Z.J.T.]'s needs in that moment." At the time the report was written, Dr. Grossier concluded that it would be premature to give A.T.K. custody of Z.J.T. because of her reported "black outs." She recommended that A.T.K. undergo a neurological examination and that she consult with her infectious disease physician to determine whether she was suffering from HIV related dementia.

A neurological examination of A.T.K. revealed she had excessive delay in processing new or unfamiliar material, that she has difficulty engaging in independent and effective problem solving, that she had a "borderline to low average" IQ, and that she placed in the "mentally deficient" range on a test designed to uncover her level of understanding and awareness of social mores. Dr. Brown, the author of the report, concluded A.T.K. had slow cognitive processing and impaired executive functioning because she has difficulty conceptualizing solutions to problems in a timely manner. He also concluded that "[w]ith respect to parenting, the current results indicate that [A.T.K.] is not able to sustain attendance to the needs of her child when she is required to acquire, incorporate, and execute novel parenting variables without sustained supervision."

Dr. Kirschner also evaluated A.T.K.'s psychological functioning and parenting abilities. In a report, he stated she lacked nurturing skills and tended to place her child's needs secondary to her own. After conducting a bonding evaluation, he noted that while Z.J.T. appeared comfortable with his mother, "the behavioral observation suggested that he did not relate to his mother in a manner commonly observed between a securely attached child and a parental attachment figure." Dr. Kirschner concluded that, "based on a reasonable degree of psychological certainty that [Z.J.T.] would not likely experience serious and enduring psychological harm if his relationship with [A.T.K.] was to be severed." He also observed that Z.J.T. was at ease with his foster parents, that they engaged him, but that he also initiated physical contact with them. He also stated that "based on a reasonable degree of psychological certainty that if [Z.J.T.'s] relationship with his foster parents was to be severed that he would likely experience psychological harm or trauma, as manifested by feelings of sadness and loss, as well as behavioral regression." His ultimate conclusion was that it would be in the best interest of Z.J.T. to terminate A.T.K.'s parental rights.

On May 20, 2010, at a permanency hearing, the Division presented its plan to terminate A.T.K.'s parental rights followed by adoption of Z.J.T. by his foster parents. The Division filed a complaint seeking guardianship of Z.J.T. on June 30, 2010. While this litigation was pending, A.T.K. gave birth to G.S., and the Division was granted custody on January 18, 2010. G.S. initially went into foster care but is now under the legal custody of her father, C.S.5

The guardianship trial for Z.J.T. began on April 8, 2011, continued on May 4, 2011, and concluded on June 10, 2011. The Division first called Dr. Mark Sanchez, a board certified psychiatrist, who had been treating A.T.K. at University Hospital since May 2009. He explained that during his initial evaluation, A.T.K. did not present any depressive symptoms but that a month later, after Z.J.T. was removed by the Division, she reported she was feeling very depressed; he subsequently diagnosed her with "major depression." He described her medications, including Paxil and Prozac, which she stopped taking on her own accord without any explanation. He stated that the last time he treated her was in November 2010, and that at that time, in his medical opinion, she was still in need of treatment.

Dr. Kirschner testified consistently with his report. Dr. Kirschner stated that he had significant concerns about A.T.K.'s overall psychological functioning, particularly the cognitive and neuropsychological component. He further stated that his ultimate conclusion was that A.T.K.'s parental rights should be terminated. Dr. Kirschner noticed A.T.K. had an ambivalence towards Z.J.T. from the very beginning, and she discussed with him that she contemplated aborting the pregnancy, putting him up for adoption, or just leaving him at the hospital after he was born. He explained that he is concerned that a child's needs would be compromised where a caregiver has serious memory impairments and a sustained inability to concentrate for a long period of time. By way of example, he stated that A.T.K.'s memory impairments could harm Z.J.T. because if he required medicine A.T.K. may forget to give it to him or forget she already gave it to him and, as a result, give him more. He further opined that because her intellectual functioning is limited, it raised questions about her ability to use good judgment and to provide proper guidance to Z.J.T. He added that A.T.K.'s history of victimization had impacted her psychological functioning and indicated an inability to provide safety for herself, which he felt raised questions about her ability to provide safety for Z.J.T.

Dr. Kirschner also expressed concern that A.T.K.'s ambivalence toward Z.J.T. could negatively affect him by manifesting itself as a lack of emotional availability to him. He explained that "[a] child who feels as though their parent is not emotionally available to them can often come away developing a sense of self that they're inadequate or that there's something defective or something damaged about them" that causes the parent to be emotionally unavailable. He further explained that as a result of this, Z.J.T. would likely struggle socially because of an inability to manage and regulate his own emotions.

With regard to A.T.K.'s mental health, he noted she had been diagnosed with major depressive disorder and that her lack of insight into her own mental health would prevent her from seeking proper treatment. He was also concerned with the inconsistency in A.T.K.'s treatment.

He further opined that A.T.K. would not be receptive to services, based on her history of inconsistency in obtaining treatment, and based on her admission that she had been attending Hyacinth for six years but was only just beginning to feel as though she could open up. He further stated that her ability to gain from psychotherapy would be tempered by her limited cognitive abilities. He explained that because A.T.K. has a borderline to low average IQ, combined with her attention and memory limitations, she would not be able to obtain the full benefit of therapy.

Dr. Kirschner reviewed the results of several tests he administered to A.T.K. A test designed to measure one's attitudes and beliefs regarding parenting revealed that A.T.K. lacked a basic understanding of normal childhood development. A low score on this test indicates a person has unreasonable expectations of a child and results in safety concerns for the child indicating A.T.K. may leave Z.J.T. alone at a young age without realizing he cannot take care of himself. In addition, a test designed to measure her level of empathy revealed that she has an inability to recognize and respond to a child's emotional state. He concluded that the Division should not give A.T.K. more time from which to benefit from treatment because she had been receiving services for five to ten years and, in his opinion, has not sufficiently benefited due to her limited abilities. He further explained that affording A.T.K. more time would harm Z.J.T. because at his age he is beginning to develop internal attachments to people, such as his foster parents, and removing him from them could cause psychological harm. In addition, the bonding evaluation revealed that Z.J.T. had a foundation for a secure attachment with his foster parents, whereas he showed no such foundation with his mother. In Dr. Kirschner's opinion, Z.J.T. would not suffer any harm if A.T.K.'s parental rights were terminated.

A Division caseworker, Shannon Johnson, testified as to the Division's involvement with A.T.K. and the services provided to her. She stated that A.T.K. was provided services after the two initial referrals including assistance with electricity and housing, a referral to a hospital, and parent aide services. After the removal of Z.J.T., the Division provided A.T.K. with parenting skills classes, parent aide services, psychological evaluations, neuropsychological evaluations, individual therapy, visitation, and bus cards. The Division also assisted her with housing through Isaiah House and the Hyacinth program and referred her to individual therapy through Family Connections, which was determined to be duplicative because she was already receiving those services. Ms. Johnson testified that the two resource caretakers offered by A.T.K. were not plausible, one due to a long history of drug abuse and the other could not be contacted. In addition, C.S. did not offer himself nor did A.T.K. suggest him as a potential caretaker for Z.J.T. Also, A.T.K.'s father and stepmother were unwilling to care for Z.J.T. unless A.T.K. moved back into their home.

Judge Verna G. Leath issued a written opinion ordering the termination of A.T.K.'s parental rights. Before parental rights may be severed, the State must establish by clear and convincing evidence each element of a four pronged test. This test was formulated by the Court in N.J. Div. of Youth & Family Servs. v. A.W., 103 N.J. 591, 602-11 (1986), and was codified in N.J.S.A. 30:4C-15.1a. The trial judge found prong one was established because of the incident in which A.T.K. attempted to suffocate Z.J.T. Prong two was established because Z.J.T. would suffer from being removed from his foster parents. Under the third prong, the judge determined that the Division had provided appropriate services to A.T.K. in the form of parenting skills classes, housing assistance, immigration assistance, counseling, therapy, and psychological evaluations. Prong four was established because Z.J.T. would experience psychological trauma if his relationship with his foster parents were to be severed. In addition, relying on Dr. Kirschner's medical opinion, the judge concluded that A.T.K. "lacks the ability to adequately meet [Z.J.T.'s] needs for protection, nurturance, stability and guidance and that [Z.J.T.] would be at heightened risk of harm if he were to be placed in the care of [A.T.K.]." Therefore, the trial judge determined terminating A.T.K.'s parental rights would not do more harm than good.

As a threshold matter, the scope of appellate review of an award of guardianship is limited. In re Guardianship of J.N.H., 172 N.J. 440, 472 (2002). "The factual findings which undergird a judgment in such a case should not be disturbed unless `they are so wholly insupportable as to result in a denial of justice,' and should be upheld whenever they are `supported by adequate, substantial and credible evidence.'" In re Guardianship of J.T., 269 N.J.Super. 172, 188 (App. Div. 1993) (quoting Rova Farms Resort, Inc. v. Investors Ins. Co. of Am., 65 N.J. 474, 483-84 (1974); Meshinsky v. Nichols Yacht Sales, Inc., 110 N.J. 464, 475 (1988)). "[I]n reviewing the factual findings and conclusions of a trial judge, we are obliged to accord deference to the [] court's credibility determination[s] and the judge's `feel of the case' based upon his... opportunity to see and hear the witnesses[,]" N.J. Div. of Youth & Family Servs. v. R.L., 388 N.J.Super. 81, 88 (App. Div. 2006) (quoting Cesare v. Cesare, 154 N.J. 394, 411-13 (1998)), certif. denied, 190 N.J. 257 (2007), which "can never be realized by a review of the cold record." N.J. Div. of Youth & Family Servs. v. E.P., 196 N.J. 88, 104 (2008) (stating deference is afforded to a trial court's findings of fact as the trial court "has the opportunity to make first-hand credibility judgments about the witnesses" who testify).

We also recognize the special expertise of those judges assigned to the Family Part. Cesare, supra, 154 N.J. at 412-13.

When reviewing a Family Part order terminating parental rights, we consider these legal principles. "A parent's right to enjoy a relationship with his [or her] child is constitutionally protected." In re Guardianship of K.H.O., 161 N.J. 337, 346 (1999). Parents have a fundamental liberty interest in raising their children. Santosky v. Kramer, 455 U.S. 745, 753, 102 S.Ct. 1388, 1394, 71 L. Ed. 2d 599, 606 (1982). Both the federal and state Constitutions protect the inviolability of the family unit. See Stanley v. Illinois, 405 U.S. 645, 651, 92 S.Ct. 1208, 1212-13, 31 L. Ed. 2d 551, 558-59 (1972); N.J. Div. of Youth & Family Servs. v. A.W., 103 N.J. 591, 599 (1986). However, "the right of parents to be free from governmental intrusion is not absolute." A.W., supra, 103 N.J. at 599. See also J.N.H., supra, 172 N.J. at 471 (holding parental rights are not absolute). "The constitutional protection surrounding family rights is tempered by the State's parens patriae responsibility to protect the welfare of children." K.H.O., supra, 161 N.J. at 347.

"The law's concept of the family rests on a presumption that parents possess what a child lacks in maturity, experience, and capacity for judgment required for making life's difficult decisions." Parham v. J.R., 442 U.S. 584, 602, 99 S.Ct. 2493, 2504, 61 L. Ed. 2d 101, 118 (1979). Nevertheless, some parents "may at times be acting against the interests of their children[.]" Id. at 602, 99 S. Ct. at 2504, 61 L. Ed. 2d at 119 (internal quotations and citations omitted). When "experience and reality [] rebut[s] what the law accepts as a starting point," the State's parens patriae obligations are triggered. Ibid. "More recently, `concern has arisen for the best interests of children whose parents have forsaken their parental duties. The child's right to a permanent home has gained increasing prominence.'" N.J. Div. of Youth & Family Servs. v. P.P., 180 N.J. 494, 505 (2004) (quoting In re Adoption of Children by G.P.B., Jr., 161 N.J. 396, 404 (1999)). Undoubtedly, a child's need for permanency and stability is a critical factor in guardianship cases.

When a child's biological parents resist the termination of their parental rights, the court's function is to decide whether the parents can raise the child without causing further harm. In re Guardianship of J.C., 129 N.J. 1, 10 (1992). "[T]he cornerstone of the inquiry is not whether the biological parents are fit but whether they can cease causing their child harm." Ibid. "The analysis of harm entails strict standards to protect the statutory and constitutional rights of the natural parents[,]" and the "burden falls on the State to demonstrate by clear and convincing evidence that the natural parent has not cured the initial cause of harm" and "will continue to cause serious and lasting harm to the child." Ibid.

While recognizing the fundamental nature of parental rights and the need to preserve and strengthen family life, the Legislature has also recognized "the health and safety of the child shall be the State's paramount concern when making a decision on whether or not it is in the child's best interest to preserve the family unit[.]" N.J.S.A. 30:4C-1(a). This responsibility, in some cases, requires that the parent-child relationship be severed. A.W., supra, 103 N.J. at 599.

"The balance between parental rights and the State's interest in the welfare of children is achieved through the best interests of the child standard." K.H.O., supra, 161 N.J. at 347. The best interest standard, initially formulated by the Court in A.W., supra, 103 N.J. at 602-11, was codified in N.J.S.A. 30:4C-15.1a, and requires the State to establish each of the following standards by clear and convincing evidence before parental rights may be severed:

These four requirements "are not discrete and separate; they relate to and overlap with one another to provide a comprehensive standard that identifies a child's best interests." K.H.O., supra, 161 N.J. at 348. The considerations involved are "`extremely fact sensitive' and require particularized evidence that addresses the specific circumstances of each case." N.J. Div. of Youth & Family Servs. v. F.M., 375 N.J.Super. 235, 258-59 (App. Div. 2005) (quoting K.H.O., supra, 161 N.J. at 348). With each of these principles in mind, we turn to our review of the arguments advanced by A.T.K.

Challenging the evidence found by the trial judge to support satisfaction of the first two prongs of the best interest test, A.T.K. maintains she never put Z.J.T. at risk and proved she was willing to eliminate any perceived harm and was willing and able to parent her son. We reject these arguments as meritless. See In re Guardianship of D.M.H., 161 N.J. 365, 383 (1999) ("Courts need not wait until a child is actually irreparably impaired by parental inattention or neglect.").

The record reflects the Division solidly proved by clear and convincing evidence the first prong of the four-part test. The facts showed that Z.J.T.'s "safety, health or development has been or will continue to be endangered by the parental relationship." N.J.S.A. 30:4C-15.1a. The child suffered harm and could have been asphyxiated when his mother attempted to suffocate him. Thereafter, constructive harm to the child occurred as A.T.K.'s inability to parent her son mandated Z.J.T. remain in foster placement, a circumstance existing for the entirety of his short three-year life. N.J.S.A. 30:4C-15.1a(2). Moreover, A.T.K. had not resolved her parenting skills at the time of trial. Consequently, actual harm, as well as the risk of future harm, was evinced. See N.J. Div. of Youth & Family Servs. v. A.G., 344 N.J.Super. 418, 435-36 (App. Div. 2001), certif. denied, 171 N.J. 44 (2002); see also A.W., supra, 103 N.J. at 607.

The second prong requires the Division to show that the parent is unable or unwilling to eliminate the harm facing the child. N.J.S.A. 30:4C-15.1a(2). The focus of this inquiry is to determine "whether the parent has cured and overcome the initial harm that endangered the health, safety, or welfare of the child, and is able to continue a parental relationship without recurrent harm to the child." K.H.O., supra, 161 N.J. at 348. Alternatively, the State may show "that the parent is unable to provide a safe and stable home for the child and that the delay in securing permanency continues or adds to the child's harm." Id. at 348-49. "The question is whether the parent can become fit in time to meet the needs of the child." N.J. Div. of Youth & Family Servs. v. T.S., 417 N.J.Super. 228, 244 (App. Div. 2010), certif. denied, 205 N.J. 519 (2011). A.T.K. argues that, with appropriate support, any harm to Z.J.T. can be eliminated. However, the evidence supports the judge's conclusion that the delay in permanent placement caused by A.T.K.'s inability to assume a parental role would harm Z.J.T. The expert evaluations established that Z.J.T.'s foster mother had strong bonds with him, and that separation from his foster parent would cause him further harm. See N.J. Div. of Youth & Family Servs. v. M.M., 189 N.J. 261, 283-85 (2007) (holding where there was no evidence that the father's situation was improving or would improve in the future, and where the father had failed to create a stable home, the delay in permanent placement would add to the harm). Therefore, the judge's finding that the second prong of the statutory test was satisfied is fully supported by the record.

Under the third prong of the best interest standard, the Division must demonstrate it undertook "diligent efforts to reunite the family" and assist "the parent to correct and overcome those circumstances that necessitated the placement of the child[.]" Id. at 354. See also N.J.S.A. 30:4C-15.1a(3).

The trial judge delineated that the Division arranged for visitation, offered parenting classes, attempted to assist A.T.K. with obtaining housing and social security income, attempted to help her resolve immigration issues, and fostered her participation with counseling services. The Division assessed viable relatives, which ultimately were ruled out. The judge noted that the efforts made by the Division were "frustrated by [A.T.K.]'s inability to take advantage of the Division's overtures."

The final prong, requiring the Division to prove "[t]ermination of parental rights will not do more harm than good[,]" N.J.S.A. 30:4C-15.1a(4), often poses the most difficult and delicate balance of presented facts. K.H.O., supra, 161 N.J. at 355. Under this prong, the question is "whether, after considering and balancing the two relationships, the child will suffer a greater harm from the termination of ties with her natural parents than from the permanent disruption of her relationship with her foster parents." Ibid. "[W]here it is shown that the bond with the foster parents is strong and, in comparison, the bond with the natural parent is not as strong, that evidence will satisfy the requirement of N.J.S.A. 30:4C-15.1a(4)[.]" Id. at 363.

Here, crediting the expert's testimony, the trial judge concluded termination would not do more harm than good. We agree.

Children experience harm when parental contact is severed. F.M., supra, 375 N.J. Super. at 264. However, there is overwhelming evidence Z.J.T. is securely bonded to his foster mother, and severing the bond would cause significant and long-standing psychological trauma. Dr. Kirschner clearly opined that Z.J.T. would likely experience psychological harm or trauma if his relationship with his foster parents was severed. Moreover, Z.J.T.'s foster mother demonstrated her nurturing parental ability as well as the capability to satisfactorily mitigate any possible harm following termination of A.T.K.'s parental rights.

A delay in Z.J.T.'s permanent placement with a loving, capable caregiver, in favor of an uncertain hope A.T.K. could one day assume the care of her child is unwarranted. Dr. Kirschner's opinion that Z.J.T. would not suffer trauma once his relationship with A.T.K. ended was based on Z.J.T.'s foster mother's ability to mitigate any harm. On the other hand, separation from his foster mother would cause enduring harm.

Following our review, we find no basis to interfere with the judgment terminating A.T.K.'s parental rights and awarding the Division guardianship for the purposes of assisting the foster parent's adoption of Z.J.T.

Affirmed.