Opinion of the Court by
Appellees A.G.G. (“mother”) and W.E.G. (“father”) are the natural parents of two boys, N.E.G., born June 15, 1996, and A.E.G., born January 7, 2001. Following a two-day trial, the Barren Family Court entered judgments terminating the parental rights of the mother and father to the two children and committing the children to the custody of Appellant, Cabinet for Health and Family Services (“CHFS”). The Court of Appeals vacated the judgments and remanded for a new trial, perceiving that the family court judge had admitted improper hearsay evidence in contravention of the holdings in
Crawford v. Washington,
Both parents are mentally disabled due to “lower intellectual functioning.” Evidence introduced at trial proved that the family lived primarily at two residences, their own rented mobile home and a residence owned by the children’s paternal grandparents. CHFS employees testified at trial that their home visits revealed both residences 1 to be filthy, unsanitary, unsafe for human habitation (broken windows, exposed electrical wires, holes in the ceiling and floor), infested with cockroaches (including one found in A.E.G.’s nebulizer), and strewn with mouse feces. The children and their clothing were filthy, their hygiene was poor, and they emitted a foul odor. CHFS had been attempting with limited success to provide the mother and father with services, including parenting education services, since shortly after N.E.G.’s birth in 1996, and continuously after December 2001. Mostly, the parents ignored their scheduled appointments with social workers. There was evidence that N.E.G. was absent from school nine times and tardy on thirteen other occasions over a two-month period prior to his removal from the custody of his parents. He could neither count nor recite the alphabet. CHFS referred the children to day care, but they failed to attend regularly.
CHFS ultimately learned that two persons (later identified as the children’s paternal uncles, J.G. and E.G.), who lived primarily at the paternal grandparents’ residence, had been identified as possible sexual offenders. As will be further discussed,
infra,
there was evidence at trial that J.G. sexually abused N.E.G. at the paternal grandparents’ residence. A dis-positional report prepared by CHFS on June 20, 2002, and adopted as a disposition
On October 17, 2002, the children were removed from the custody of their mother and father and placed in foster care because of the failures of the mother and father to abide by the provisions of the disposition order. On October 21, 2002, the family court held both parents in contempt of court for violating the conditions of the order. The foster mother later reported to CHFS that she had observed N.E.G. sexually “acting out” with A.E.G. and other children. On October 1, 2003, almost a year after the children were removed from their parents’ custody, and after repeated unsuccessful attempts to convince the mother and father to respond to family services and to upgrade their living conditions so that they could be reunited with their children, CHFS filed this petition for involuntary termination of their parental rights.
Among the findings of fact entered by the family court in support of its judgments were, inter alia:
8.[N.E.G. and A.E.G.] are abused and neglected children as defined in KRS 600.020(1) and termination of parental rights would be in the best interest of the children; in that Respondents have caused or allowed each child to be sexually abused or exploited (See also KRS 625.090(2)(f) and KRS 600.020(l)(e)) and in that Respondents have failed to provide sanitary living conditions in the children’s home (See also KRS 625.090(2)(e) and KRS 600.020(l)(d)).
9. [The mother and father] have caused or allowed the children to be sexually abused or exploited.
10. [The mother and father], for a period of not less than six (6) months have continuously or repeatedly failed or refused to provide or have been substantially incapable of providing essential parental care and protection for the children and there is no reasonable expectation of improvement in parental care and protection, considering the age of the children.
11. [The mother and father], for reasons other than poverty alone, have continuously or repeatedly failed to provide or are incapable of providing essential food, clothing, shelter, medical care or education reasonably necessary and available for the children’s well-being and there is no reasonable expectation of significant improvement in the parents’ conduct in the immediately foreseeable future, considering the age of the children.
12. It is in the best interest of [N.E.G. and A.E.G.] that termination of parental rights be ordered because the children need the stability provided by CHFS placing them for adoption.
13. CHFS has rendered or attempted to render all reasonable services to [the mother and father] in an effort to bring about a reunion of the family.
14. [The mother and father] have made few, if any, adjustments in their circumstances, conduct or conditions to make it in the best interest of the children to be returned home.
15. [N.E.G. and A.E.G.] have made substantial improvements while in foster care and they are expected to make more improvements upon termination of parental rights.
Parental rights are so fundamentally esteemed under our system that they are accorded Due Process protection under the Fourteenth Amendment of the United States Constitution.
O.S. v. C.F., 655
S.W.2d 32, 33 (Ky.App.1983). They can be involuntarily terminated only if there is clear and convincing evidence that the child has been abandoned, neglected, or abused by the parent whose rights are to be terminated, and that it would be in the best interest of the child to do so. KRS 625.090;
Santosky v. Kramer, 455
U.S. 745, 769-70,
The family court’s findings of facts set forth above were not clearly erroneous, CR 52.01, and were supported by clear and convincing evidence. While the evidence that N.E.G. was sexually abused was stronger than the evidence that A.E.G. was sexually abused, there was ample evidence that the parents “[c]reate[d] or allowed] to be created a risk that an act of sexual abuse ... [would] be committed upon [A.E.G.],” KRS 600.020(l)(f), when they ignored the disposition order’s mandate that the children not be taken to the home of the paternal grandparents and either ignored or failed to notice that A.E.G. was being sexually abused by N.E.G. Further, while abandonment or abuse of an older child alone is not clear and convincing evidence sufficient to support termination of parental rights to a younger child, such evidence coupled with other evidence of abuse or neglect of the younger child may be sufficient. O.B.C. v. Cabinet for Human Res., 705 S.W.2d 954, 956 (Ky.App.1986).
II. HEARSAY.
The Court of Appeals vacated the judgments because it perceived that the testimony of N.E.G.’s therapist, Julie Griffey, and that of Dr. Jeffrey Blackerby, a pediatrician, violated the proscription against the introduction of testimonial hearsay enunciated in
Crawford v. Washington,
Julie Griffey is a licensed marriage and family therapist employed by “Life Skills,” a regional comprehensive care center. She holds a masters degree in marriage and family therapy and has twenty-seven years of experience in the field. ‘Years ago,” Life Skills designated her as its specialist in child sexual abuse, a designation requiring continuing education in sexual abuse, including child-interviewing skills. Due to behavioral problems exhibited by N.E.G. while still living with his parents, CHFS referred him to Griffey for diagnosis and therapy. Griffey testified that during the initial session on July 25, 2002, N.E.G. made no statements indicating that he had been sexually abused. Two followup appointments were scheduled but not kept. Griffey did not see N.E.G. again until October 24, 2002, after he was removed from the custody of his parents. She testified that, on this occasion, N.E.G. exhibited delayed speech, aggression, and disruptive behavior. Again, however, he made no statements indicating that he had been sexually abused. Griffey saw N.E.G. again on May 23, 2003, after being advised of the foster mother’s report that N.E.G. was exhibiting sexually aggressive behavior. This time, Griffey initiated a “good touch — bad touch” vocabulary with N.E.G., using anatomically correct dolls. Griffey testified that during this session, N.E.G. described being sexually abused by his two uncles, especially J.G., and by both of his parents. Specifically, he told Griffey that J.G. had made him put his mouth on J.G.’s penis and that J.G. had ejaculated into his
Dr. Jeffrey Blackerby, a pediatrician, physically examined both children on July 15, 2003, and testified that A.E.G.’s physical examination was normal. However, he testified that N.E.G.’s examination revealed “anal dilation” that was “somewhat suspicious” because it is common where there has been anal penetration, but that it was not necessarily abnormal. When Dr. Blackerby specifically asked N.G. about sexual abuse, the child was reluctant to respond. When asked how many times “this had happened” with J.G., N.E.G. responded that J.G. had abused him many times; that it happened at “J.G.’s house” and that his “nanny and pa” and uncle (E.G.) lived there too; and that his mother and father were there when the abuse occurred but that they did not see it happen. N.E.G. then confirmed to Dr. Black-erby that what he had told Griffey was true.
KRS 625.080(2) provides, inter alia:
Upon motion of any party, the child may be permitted to be present during the proceedings and to testify if the court finds such to be in the best interests of the child. In its discretion, the Circuit Court may interview the child in private, but a record of the interview shall be made ....
N.E.G. was not present at the trial and did not testify by videotaped deposition or otherwise. Nor was he interviewed by the family court judge. No motion for his presence or his testimony was made. Thus, he was not available for cross-examination.
A. KRE 803(h).
Under our existing case law, the statements made by N.E.G. to both Griffey and Blackerby were admissible under KRE 803(4), the hearsay exception for statements made for purposes of medical treatment or diagnosis, even though Grif-fey was not a physician. In
Edwards v. Commonwealth,
In
Prater v. Cabinet for Human Resources,
Similarly, the United States Court of Appeals for the Sixth Circuit, construing Federal Rule 803(4), which is identical to KRE 803(4), recently held that a licensed psychotherapist and state-certified clinical social worker specializing in child sexual abuse could testify to verbal disclosures made to her by victims of child sexual abuse describing the abuse even though the witness, like the witness in
Ediuards,
did not, herself, provide therapy but only interviewed the children for the purpose of diagnosis to determine what treatment would be appropriate.
United States v. Kappell,
418 F.3d
550, 556
(6th Cir.2005). “Waters testified that these interviews were needed to obtain the information necessary for an accurate medical diagnosis before seeking mental health treatment for the children.”
Id.
at 552. Griffey testified similarly, except that she intended to provide any needed therapy for N.E.G.’s mental health problems. As noted in
Kappell, id.
at 556, several other federal circuit courts of appeals have recognized that Rule 803(4) covers statements made to non-physicians.
See United States v. Running Horse, 175 F.Sd 635,
638 (8th Cir.1999) (applying Rule 803(4) to a child victim’s statements to a psychologist);
United States v. Tome,
B. Crawford v. Washington.
The Court of Appeals’ reliance on Crawford v. Washington was misplaced. Crawford was a criminal case, and its reasoning turned solely on the language of the Confrontation Clause of the Sixth Amendment to the United States Constitution.
The question presented is whether this procedure complied with the Sixth Amendment’s guarantee that, “[i]n all criminal prosecutions, the accused shall enjoy the right ... to be confronted with the witnesses against him.”
Crawford,
Accordingly, we once again reject the view that the Confrontation Clause applies of its own force only to in-court testimony, and that its application to out-of-court statements introduced at trial depends upon “the law of Evidence for the time being.” Leaving the regulation of out-of-court statements to the law of evidence would render the Confrontation Clause powerless to prevent even the most flagrant inquisitorial practices.
Id.
at 50-51,
The historical record also supports a second proposition: that the Framers would not have allowed admission of testimonial statements of a witness who did not appear at trial unless he was unavailable to testify, and the defendant had had a prior opportunity for cross-examination. The text of the Sixth Amendment does not suggest any open-ended exceptions from the confrontation requirement to be developed by the courts.
Id.
at 53-54,
Where testimonial statements are involved, we do not think the Framers meant to leave the Sixth Amendment ⅛ protection to the vagaries of the rules of evidence, much less to amorphous notions of “reliability.”
Id.
at 61,
In this case, the State admitted Sylvia’s testimonial statement against petitioner, despite the fact that he had no opportunity to cross-examine her. That alone is sufficient to make out a violation of the Sixth Amendment. Roberts notwithstanding, we decline to mine the record in search of indicia of reliability. Where testimonial statements are at issue, the only indicium of reliability sufficient to satisfy constitutional demands is the one the Constitution actually prescribes: confrontation.
Id.
at 68-69,
Nothing in
Crawford
suggests that its reasoning was intended to apply where the Sixth Amendment does not apply; and the Sixth Amendment does not apply to civil cases.
United States v. Zucker,
Prior to
Crawford,
it was almost universally held that the right to personally confront and cross-examine witnesses was not required in a civil action to terminate parental rights.
3
The jurisdictions that have considered the issue after
Crawford
was decided have held that
Crawford
has no application to those or similar cases.
4
We
C. G.E.Y. v. Cabinet for Human Resources.
The Court of Appeals’ reliance on
G.E.Y. v. Cabinet for Human Resources,
The worker’s narrative record in the instant case contains, in part, bits and pieces of gossip gathered from all over creation, the sources of which are frequently unidentified. The record contains the subjective and unverifiable impressions of the workers and their contacts of G.E.Y. and letters from third parties who did not testify containing highly inflammatory and prejudicial accusations against the appellant.
Id. at 715.
In
Cabinet for Human Resources v. E.S.,
[I]t is the opinions and conclusions expressed in the social worker’s records, rather than the factual observations, which cause difficulty. We hold that those entries in the case record made by the social worker which constitute statements of factual observations are admissible under the business entries exception to the hearsay rule, and those statements which express opinions and conclusions are not.
Id.
at 932. As we later explained in
Prater v. Cabinet for Human Resources,
[E]ven if a public agency’s investigative report satisfies the foundation requirements of KRE 803(6), that does notauthorize a carte blanche admission of each individual entry contained in the report. KRE 803(6) and KRE 803(8) only satisfy the hearsay aspects of the business or public record, itself. If a particular entry in the record would be inadmissible for another reason, it does not become admissible just because it is included in a business or public record.
Id. at 958.
Prater also upheld the admission under KRE 803(4) of statements made by child sexual abuse victims to the physician to whom they had been referred for examination, diagnosis, and treatment; and under KRE 803(3) (the “state of mind” exception to the hearsay rule) of statements by the children expressing fear of the dark. Id. at 960. Clearly, G.E.Y. is no longer (if it ever was) authority for the proposition that hearsay exceptions do not apply in actions to terminate parental rights.
In conclusion, the holdings in Crawford v. Washington and G.E.Y. v. Cabinet for Human Resources do not preclude introduction of the statements made by N.E.G. to Julie Griffey and Dr. Jeffrey Blackerby; and the statements were properly admitted under KRE 803(4).
Accordingly, we reverse the Court of Appeals and reinstate the judgments of the Barren Family Court.
Notes
. The paternal grandfather refused to admit the Cabinet’s employees into his residence; however, they were able to perceive the general condition of the home, including a foul odor, through a broken window.
. See also Ky. Const. § 11 ("In all criminal prosecutions the accused has the right ... to meet the witnesses face to face .... ” (Emphasis added.)).
.
See In re A.S.W.,
.
In re April C.,
.
But see Crawford,
. Kentucky did not codify its rules of evidence until July 1, 1992. KRE 107(b).
