Medically Fragile Children in DCPP/DYFS Custody


Children who are considered “special needs” that end up in resource care are required to be placed with special placement providers who are trained to provide a higher degree of care. These homes are referred to as “ships” placements. “Ships” is abbreviated as SHSP (Special Home Service Provider).

Children who are placed in SHSP’s homes are typically those with medical injuries that require more frequent medical attention than children in the same age category without such injuries. However, not every child who has some form of medical ailment or injury requires such a placement. For instance, a baby who was not yet ambulatory at the time of an injury that is now in a cast requires no higher degree of attention and care than any other baby, except that she must have her cast carefully cleaned, examined, et cetera.

The determination of whether a child requires a SHSPs home is an important one. If the child is placed in such a home, the parent will likely receive substantially less parenting time with the child, as relative placements are unlikely. With standard placements, relatives can be provisionally approved, subject to completing the foster parent training (i.e., referred to as the Pride training course). If a child is medically fragile, the placement must be a SHSPs foster placement, and the division and the court are less likely to approve a relative for placement, subject to subsequent training.

Of course, one must question why this is the case. After all, if a parent leaves the hospital with a child in a cast, with a medical problem, one requiring higher attention in the detailed medical instruction, that child is still released to his parents with instruction from his doctors. Yet, with foster placements, the state takes the position that some “high degree” of medical training is required in order to have placement of the child, no matter the degree of injury or ailment from which the child suffers. This is likely because parents are entitled to commit simple negligence when caring for their children, whereas the state is not. As such, the state is less likely to accept well-intentioned foster placements that do not meet their highest criteria for care if the child has already been physically injured, resulting in removal from the parents and placement in foster care.

It is important to look to the child’s specific injuries when evaluating whether or not a SHSP home is required. Many times, when such a placement is not required, exploring the basis for the placement can give helpful insights to the court when evaluating the case as a whole. Specifically, if the Division has reached the knee-jerk conclusion that it must have been the parent’s abuse that caused the child’s injuries, the division often takes draconian measures to ensure the parent is afforded as little contact with the child as possible while in placement. This often occurs by the Division’s insisting upon a SHSP’s placement when one is not required.

One way of uncovering such a tactic is by demanding a copy of the nurse’s notes that must be maintained for every SHSP’s placement. The division’s nurse is required to see the child weekly and make a detailed log of the child’s medical status, feeding schedule and care instructions administered by the resource parents in order to ensure that the child’s medical needs are being met in that placement. The parent is entitled to receive a copy of this nurse’s log upon request.

Rarely are these logs kept consistent with the training protocols and the requirements set forth in the administrative code. When these deficits are highlighted, the court will often grow weary of the division’s position as to the necessity of the placement, thereby calling into question the division’s position as to other issues in the case, including the parents’ culpability for the child’s injuries. One never knows what will be found until the information is sought and explored.

If you or someone you know has a child in placement that has been declared medically fragile when that designation appears unwarranted, please contact Paragano and Williams, LLC for assistance.

DYFS (n/k/a DCPP) can only do so much


In an unpublished opinion, DYFS v. J.M., the Appellate Division has created a significant loophole in the notion, first established in DYFS v. G.M., that the offending parent is entitled to a dispositional hearing once he or she has remedied the harm that commenced the litigation.

In J.M., the Appellate Division upheld a trial court’s decision to terminate litigation once the father had performed all services to address an act of excessive corporal punishment. During dependency of the case, custody had been transferred to the mother. At the end of the case, everyone agreed that the father had addressed the issue. However, because the father has lost his job and was not able to be neatly resume custody of the child, the case was closed. The Appellate Division affirmed the trial court’s decision to close litigation and noted that, once the father obtained stable housing, he could apply for custody any non-dissolution (FD) proceeding.

Of course, this ruling leaves open a series of questions. Normally, once the parent has addressed the division’s concerns, the pre-litigation custody arrangement is reinstated. In this case, that could not yet happened. But, what happens when the father does obtain housing? Will the custody arrangement then resume based upon the father filing an FD action? Or, will the father have to prove a change of circumstances, because the Appellate Division directed him to file a “custody action”?

What a significant amount of time passes between this Appellate Division decision and the time when father obtains employment? One could argue that the passage of time that the child has been with the mother constitutes a change of circumstances. However, isn’t that what typically happens during the pendency of a protracted, DCPP case, which usually lasts about one year? The parent is still entitled to have the prior arrangement reinstated. Why, in this case, is the father required to file a new matter for custody?

It appears that this is yet another circumstance in child welfare law where the rules implemented are inconsistent with long – established family law principles. Another area is in foster parent litigation. We know that foster parent bonding, in and of itself, is not sufficient to warrant a custody application by the foster parents with the child has been in their care for several years. Yet, when that same child had been placed into the custody of a relative by the parent for a period as lengthy, that relative could have filed for custody, premised upon being the psychological parent of the child. See, V.C. v. M.J.B. Because of the policy of family reunification between parent and child, trumping the emotional pull of a foster parent, we gloss over that psychological bond between the child and the foster parent to serve what our society says is a superior goal.

Perhaps that is what the J.M. appellate court also sought to accomplish – namely, to support stability for a child as between his biological parents. In that sense, the father’s unemployment and inability to provide stable housing, inadvertently, led to a de facto change in custody as in the Ohloff decision – and hence, after the “test period” time has passed, a new application to modify custody must be filed.

It is uncertain the reasoning behind this decision; however, its vague directives leave much argument for future litigation for this family. What is clear from the decision, notably, is that DYFS (DCPP) is not required to be involved at that point – to assist with financing father reunification or otherwise. And as economic times continue to remain dismal, it is likely that similar decisions will be entered by the Appellate Division in the future, shifting the burden to parents to remedy child welfare concerns promptly or risk losing the agencies assistance with restoring the family unit altogether.

Defense counsel should be mindful to address this issue with parents as child welfare litigation unfolds and life circumstances may hamper and ultimate reunification, through no fault of the parent or the division.