In re J.M.

[Cite as In re J.M., 2026-Ohio-3478.] IN THE COURT OF APPEALS OF OHIO SIXTH APPELLATE DISTRICT HURON COUNTY In re J.M., D.M. Court of Appeals No. {39}H-25-028 {39}H-25-029 Trial Court No. DNA 2025 038 DNA 2025 039 DECISION AND JUDGMENT Decided: September 4, 2026 ***** Richard H. Palau, for appellee. W. Alex Smith, for appellant. ***** DUHART, J. {¶ 1} This is a consolidated appeal filed by appellant, K.M. (“father”), from the November 14, 2025 judgment of the Huron County Court of Common Pleas, Juvenile Division. The trial court found J.M. and D.M., the twin sons of father and his wife, E.M. (“mother”), dependent, and granted temporary custody of the twins to the Huron County Department of Job and Family Services (“the agency”). For the reasons that follow, we affirm the trial court’s judgment.  {¶ 2} Father1 sets forth five assignments of error: 1. The trial court’s adjudication of the minor children as dependent under R.C. 2151.04(C) was against the manifest weight of the evidence and unsupported by clear and convincing evidence. 2. The trial court committed reversible error at the adjudicatory hearing by admitting and relying upon inadmissible hearsay to establish the children’s “condition or environment” in violation of the Sixth District’s standard in State v. Kamer. 3. The trial court erred in permitting lay social workers to provide specialized medical testimony regarding the children’s “prognosis” and medical “necessity” in violation of Evid.R. 702. 4. The trial court abused its discretion at the dispositional stage by adopting a case plan requirement for a full psychological evaluation to assess “competency” without a demonstrated nexus to the reasons for removal. 5. The trial court erred in f[i]n[]ding that the [a]gency made “reasonable ef[f][]orts” to prevent continued removal when the [a]gency referred parents to services with known waitlists and failed to mitigate state imposed logistical barriers. Background August 6 through August 29, 20252 {¶ 3} Father and mother live in Huron County, Ohio. Their twins were born on August 6, 2025, and both twins suffer from severe medical issues. J.M. has a rare, serious skin disorder and D.M. has a condition in which his esophagus is not connected, 1 Mother did not appeal the trial court’s judgment. 2 There are discrepancies in the record as to when certain events happened, but the record is clear that the events occurred between the August 6 to August 29, 2025 time period. 2. so he requires a feeding tube, future surgery and extended long-term care. Father himself had surgery on his abdomen in early August 2025. {¶ 4} Shortly after D.M. was born, he was admitted to the Neonatal Intensive Care Unit (“NICU”) at Akron Children’s Hospital (“Akron”). A medical social worker (“social worker”) at Akron NICU became involved with the family. Her job responsibilities consisted of making reports to the agency and coordinating children’s discharge plans with the agency and providing support and resources to families with children with long- term NICU admissions. The social worker made a referral to the agency based on concerns she had observed including that parents had very limited visits with D.M.; she recalled seeing parents two times between August 7 and 29, 2025. It was important for parents to visit D.M. in the NICU so they could be involved with D.M.’s care and treatment so they could obtain proper medical information and training in every aspect of the baby’s care to ensure D.M. could eventually be safely discharged to parents. {¶ 5} Medical professionals informed an agency worker (“the agency worker”) that due to the lack of visits and human interaction, D.M. developed a negative response to people because the only interaction he had was when he was poked and prodded. D.M. remained in Akron’s NICU throughout the trial court proceedings. {¶ 6} J.M. was taken to the emergency room (“ER”) at Shelby Hospital by parents because J.M. was vomiting, crying and in distress. During J.M.’s medical treatment, a nurse was concerned that J.M. was in a onesie with no blanket despite it being a cooler day and even cooler in the hospital. The nurse was also troubled that parents did not bring a diaper bag for J.M. so they did not have a bottle or diapers and neither parent 3. attempted to interact with or console J.M., who had been crying for 25 to 30 minutes; mother said she did not want J.M. to get used to being held. The nurse asked parents if J.M. took a pacifier and they indicated he did and there was one in the car, but neither parent went to retrieve it. The nurse wrapped J.M. up in a warmed blanket and held him until he calmed down. The nurse left J.M. with parents for a few minutes and when the nurse came back, J.M. was crying and fussing, but neither parent was paying attention to him. The nurse kind of demanded that mother or father get the pacifier to help soothe J.M. The nurse then made a referral to the agency based on her fear that J.M. was not getting the care he needed from parents. The agency became involved and a safety plan was created. J.M. was discharged to paternal grandmother. {¶ 7} The next morning, J.M. was taken to the Shelby Hospital ER by grandmother because he was vomiting and not eating. J.M. was transferred to Akron’s NICU, where he was admitted and treated for about one week. J.M. was discharged to grandmother and neither parent was present in the NICU at that time. A week or so later, J.M. was treated at Akron’s burn center due to a severe burn that he sustained in his “lower private region” when he was with parents. J.M. was admitted to Akron’s burn unit overnight, then discharged.3 A few days later, J.M. was again admitted to Akron’s NICU. Although the burn unit staff did not make a referral to the agency, the NICU medical team believed J.M.’s wounds were not consistent with the explanation provided by parents. 3 It appears that J.M. was discharged to parents. 4.  {¶ 8} Several days later, J.M. was admitted to Akron’s NICU a third time. The social worker made a formal referral to the agency due to concerns about J.M.’s multiple NICU admissions within a short period of time (three admissions between August 7 and 29, 2025), parents’ lack of involvement and engagement with J.M. and mother having canceled a burn unit follow-up appointment and a dermatologist appointment for J.M. against the advice of J.M.’s treatment team. J.M. was discharged to grandmother. {¶ 9} With respect to both twins, parents were not willing to be present for treatment, despite instructions from medical providers that parents attend and participate. The staff at Akron’s encouraged parents to stay at the hospital while the twins were being treated, as Akron has private rooms which could accommodate the twins and parents. Staff also informed parents that they could stay at the Ronald McDonald House, which was adjacent to Akron, at no cost. Nevertheless, parents declined to stay with the twins. Staff also offered gas vouchers and insurance referrals to parents to help alleviate the travel costs between Huron County and Akron, but parents declined those offers too. {¶ 10} When the agency initiated the case, an on-call worker (“the on-call worker”) met with parents. A safety plan with grandmother was discussed and parents agreed to do the safety plan for only one night. {¶ 11} The next day, the case was handed off to the agency worker, who contacted grandmother. While on the phone, grandmother relayed that J.M. was turning blue around his mouth, vomiting and not breathing. Grandmother hung up and called 911. J.M. was taken to Shelby Hospital, then transferred to Akron’s NICU. 5.  {¶ 12} That same day, parents came into the agency and met with the agency worker. Parents were very upset about the on-call worker’s visit and parents advised the agency worker that they did not want agency involvement. The agency worker mainly spoke with mother because when the agency worker tried to talk to father, he growled at her. The agency worker spoke with grandmother again and learned that J.M. was being admitted once more to Akron’s NICU. J.M. was discharged to grandmother two or three days later. {¶ 13} The agency worker explained that the case was transferred to juvenile court due to concerns with the parents and their behavior, like canceling necessary medical needs (J.M.’s medicine) and appointments for J.M. and failing to interact with the twins. {¶ 14} On August 29, 2025, the shelter care hearing was held. The agency recommended that grandmother be granted temporary custody; the trial court granted grandmother temporary custody of the twins. {¶ 15} That same day, the agency filed complaints alleging that J.M. and D.M. were dependent children, pursuant to R.C. 2151.04(C). October 6, 2025 {¶ 16} The Family Case Plan (“case plan”) was filed by the agency. The following information set forth in the case plan is relevant to father’s appeal. ... [J.M.] . . . [D.M.]4 4 The same information is set forth for J.M. and D.M. and will therefore not be repeated. 6.  Permanency Goal: Return the child(ren) to parent/guardian/or custodian (Reunification) Agency Legal Status: Temporary Custody/Placement and Care Child Location: Certified Foster Home ... 1. What are the concerns/needs for the family? [Father] struggles to be an active father and bond with the boys, understand their serious medical needs, be prepared for anything the children may need and how to care for them. 2. What does the family and Worker want to see happen to address the identified concerns/needs? For [father] to understand that the boys need him to be an active father, attend to their medical needs, be able to care for them in a safe, appropriate manner and bond with the boys. 3. What is causing these concerns/needs for the family? The infant[]s[’] self[-]protection. [Father’s] response to stressors, cognitive abilities to understand his children’s needs, parenting practices and mental health. 4. What strengths and family/community supports does the family have? The family has a home and [father] is employed. They have extended family for support and are connected to community supports. 5. What steps will the family take to achieve what the Family and Caseworker want to see happen? Identify the individuals who will complete these action steps. (Services to address the concerns/needs) [Father] will fully participate in the intake and assessment process for mental health concerns. [Father] will complete a Psychological Evaluation. [Father] will follow all recommendations of these assessments. [Father] will be fully engaged in treatment until he is discharged successfully as determined by the service provider. [Father] will complete a parenting program(s) and attend all classes. Parenting education will be specific to [J.M.] and [D.M.’s] age, development, and unique needs. [Father] will actively participate in all visits with [J.M.] and [D.M.]. [Father] will not use his phone or any electronics during visits. [Father] will attend all appointments for [J.M.] and [D.M.]. [Father] will provide safe, sanitary, stable housing for himself and his family. 7.  [Father] will obtain and maintain employment so he can provide financially for his family. [Father] will sign all releases of information as requested by the service provider and the agency. [Father] will allow Agency staff access to his home for all scheduled and unscheduled face[-]to[-]face visits. ... 6. How will the family’s progress be measured? Progress will be measured by treatment providers progress reports, by observing visits, family and by Caseworkers[’] observations during home visits. 7. When will the family’s progress be reviewed? Progress will be reviewed informally through monthly home visits and phone calls and formally every three months at case reviews and semi- annual reviews. ... [J.M.] . . . [D.M.] ... Best Interest /Special Needs Consideration for Child[’s] Location How was it determined this was a safe and appropriate environment for the child? The placement is a certified foster home that is close to Akron Children’s and is able to provide the special care needed for the boys. The foster family has supports so that they are able to have frequent visits and contact with [D.M] while he remains hospitalized. How will the Child[’s] Location meet the best interest of the child? The foster parents are able to visit with [D.M.] while at Akron Children’s almost daily and take [J.M.] there to be with his brother as well. How will the Child[’s] Location meet the special needs of the child? The foster home can and will be able to . . . meet all the boys[’] needs being close to Akron and with their specialized training[.] How will the Child[ren’s] Location meet the [case plan] [g]oals of the Child[ren]? The children will be able to get the medical treatment needed for their special conditions. 8.  What is the proximity of the Child[ren’s] Location to the parent, guardian, custodian? What transportation problems might create obstacles to visitation? How will the agency resolve these obstacles? The boys are placed 2 hours from the parents. The foster parents/parents will meet for visits. The agency can provide gas vouchers. ... November 13, 2025 {¶ 17} The adjudicatory hearing was held. Those in attendance included parents, the agency worker, a nurse from Shelby Hospital, the social worker and the twins’ guardian ad litem (“GAL”). The agency worker, the nurse and the social worker testified after which the trial court found the conditions and environment from August 6 through 29, 2025, justified the agency’s intervention. The court further found the twins were dependent, citing “being new parents,” the “high needs of the children” and “father’s recent surgery.” November 14, 2025 {¶ 18} The court issued its judgment entry which provides in relevant part: These cases came before the [c]ourt on 13 November 2025 for an adjudicatory hearing on Complaints filed by the [agency] alleging that twin infants . . . were Dependent Children pursuant to R.C. 2151.04(C). . . Following the presentation of evidence, the [c]ourt makes the following findings of fact and conclusions of law. Twins . . . were born on 6 August 2025. . . After birth, both soon began to exhibit concerning symptoms that led to hospitalization. While receiving medical treatment, a nurse at a hospital in Shelby, and a social worker at Akron Children’s Hospital both made referrals to [the agency] based on their concerns that the children’s parents were not responding appropriately to the children’s acute medical conditions. ... [The court set forth the events which occurred August 6 through 29, 2025, and which we summarized above.] 9.  Based on the foregoing, the [c]ourt finds clearly and convincingly that the conditions and environment of [the twins] after their birth through 29 August 2025 warranted the agency, in the interest of the children, in assuming their guardianship and otherwise mandating necessary measures to ensure their safety. [Parents] were not appropriately engaged in the necessary treatment of their children’s acute medical conditions, did not comply with treatment recommendations and cancelled necessary appointments. The [c]ourt therefore clearly and convincingly finds that [the twins] are Dependent Children as defined by R.C. 2151.04(C). ... Thereupon the [c]ourt [finds] that the [agency] made all reasonable efforts to prevent the placement and that placement outside the home of . . . []parents[] is in the best interest of the children and that the children’s placement is in the most family-like and least-restrictive setting available and in close proximity to the parents’ home, consistent with the best interest and special needs of the children. The [c]ourt [finds] that reasonable efforts to prevent removal were not made by the [agency] because the minor children were removed during an emergency in which the children could not safely remain at home. The [c]ourt [finds] that the children’s parents are currently unfit or unsuitable for temporary custody because both currently lack the capacity to appropriately respond to the twin newborns’ acute medical needs. ... It is further ORDERED, ADJUDGED and DECREED that . . . mother is granted supervised visitation with said children at the [agency] or supervised by persons approved by the [agency] at locations approved by the [agency] as arranged between mother and the [agency]. It is further ORDERED, ADJUDGED and DECREED that . . . father is granted supervised visitation with said children at the [agency] or supervised by persons approved by the [agency] at locations approved by the [agency] as arranged between father and the [agency]. ... 10. November 20, 2025 {¶ 19} The dispositional hearing was held. In attendance were, inter alia, parents, the agency worker, on-going agency caseworker (“the caseworker”) and GAL. The witness testimony is summarized below. The Agency Worker {¶ 20} The agency worker testified about events which occurred after August 29, 2025. She testified that on September 12, 2025, grandmother called and said J.M. was not waking up and was very limp. The agency worker advised grandmother to take J.M. to the hospital if it was an emergency. Grandmother took J.M. to Fisher-Titus Hospital where it was determined that his blood sugar was very low; J.M. was sent to Akron for treatment. Mother went with grandmother and J.M. to Akron. While at Akron, grandmother called the agency worker and said she was no longer able to provide care for J.M. and his needs. After J.M. was discharged from Akron, grandmother and mother took him to the agency where an ex parte proceeding was held to place J.M. in the agency’s care. In order for the agency worker to have J.M. prepared for his foster placement, she asked mother and grandmother routine questions, like the last time J.M. ate and if they had formula or diapers. They gave the agency worker formula in a salsa can, but when asked, they did not know how much formula was in the can. They were also asked about J.M.’s feeding routine, like how many ounces he was taking and how often, but they changed their story multiple times and showed a lack of understanding of when he ate last and how much he was eating on a regular basis. 11.  {¶ 21} On September 16, 2025, the agency worker went with the family to a dermatology appointment for J.M. during which she observed parents, as she was supervising that contact. Father did not pick up J.M. and had very limited interaction with the baby. At the end of the appointment, parents were asked if they wanted to put J.M. in the carrier, but they did not know how to buckle him in and asked the agency worker for help. While walking out to the agency worker’s car, J.M. got fussy so parents took him out of the carrier. At the car, parents were again asked if they wanted to place J.M. back in the carrier. Parents were able to sit J.M. in the carrier but did not know how to buckle him in or fasten the carrier into place in the car. {¶ 22} With respect to D.M., a hearing was held on or about September 16, 2025, to ask that D.M. come into care as well. There were concerns, after speaking with multiple hospital staff, that parents were still continually not visiting D.M., and D.M. was at the point where he had not bonded with anyone, which could lead to issues as he got older. The agency wanted someone to start to create a bond with D.M. and offered assistance to parents such as gas vouchers, hospital services like the Ronald McDonald House and working with grandmother to see if parents could ride with her. {¶ 23} The agency worker completed a family assessment and there were some safety risk factors such as parenting practices, which is essentially how the parents interact as a whole with their children, and mental health for both parents. Mother had some mental health history as a child and was really never able to get the care she needed from the custodian with whom she was placed. After giving birth to the twins, mother said she had postpartum depression and was on medication and was looking to get into 12. counseling services. The agency worker offered to help mother with a referral if needed. The reason for the agency worker’s risk assessment contributor for father was that he would not communicate with her, and she did not know if he just did not want to communicate, if it was a mental health diagnosis or if he had a cognitive delay. Even at the dermatology appointment, father did not ask any follow-up questions to the doctors who explained J.M.’s skin condition diagnosis, regarding what that would look like lifelong. The agency worker did not know what the barrier was with father, but she wanted to try to overcome it and work toward the case plan goal. {¶ 24} On September 19, 2025, the agency worker took J.M. to his foster care placement in Youngstown and shortly thereafter, an agency caseworker came in to do the hand-off and provide services. {¶ 25} Prior to foster placement, grandmother was the supervisor of parents’ visits with the twins and there were no time limits for visits. After placement, parents’ supervised visits were limited to one two-hour visit per week. The safety risk of parents having unsupervised interaction with D.M. in the NICU was that D.M. has a lot of wires and tubes on him, which can make it challenging to pick him up, change his diaper and provide for his basic needs. The hospital staff educated parents numerous times on how to handle D.M. but there were still concerns that parents were not able to appropriately handle the baby. The agency worker also received the same education as parents, and she thought it would be very easy to handle D.M. once you learn how to do it and apply those practices. 13. The Caseworker {¶ 26} The caseworker then testified to the following. The agency continued supervised visits because parents struggled to bond with the boys, mother struggled to change diapers appropriately (father did not usually change diapers), father struggled to participate in visits - mother had to prompt him - but he still did very little, mother struggled with burping J.M. after his pace feedings5 and parents struggled to hold the twins appropriately. Father adjusted D.M.’s G-tube (feeding tube) when he put the baby up on his shoulder to hold him. When the tube was adjusted, it made D.M. bleed, and he was in a lot of pain. In addition, parents got very frustrated during visits and tended to leave early and on one occasion, medial staff told parents to wash their hands before a visit, but they resisted (father worked at a tire business). Parents also responded inappropriately when the twins were in distress or in pain by laughing instead of being concerned about what was wrong or trying to soothe them and leaving the visit early. {¶ 27} Parents had the ability to attend the twins’ medical appointments and per the case plan, parents were asked to go to all of the appointments, so they could stay informed about the twins’ medical needs. D.M. had a very major surgery a few days before the dispositional hearing, but parents did not show for it; they called the night before stating they did not feel well. D.M. had another surgery scheduled for the day after the hearing on his stomach and esophagus.6 D.M. was struggling; his lung collapsed 5 J.M.’s pace feedings require that he is fed some, he is given a break, burped, and then fed again because he struggles with his digestion. 6 D.M.’s stomach and esophagus were whip-stitched, trying to pull them together. 14. and the tubing in his lung was bleeding. D.M. was very uncomfortable and in a lot of pain. {¶ 28} The agency had concerns for mother and father’s mental health, as mother had a history of self-harming and father had a history of not complying with case plans on other cases. {¶ 29} Mother’s case plan requirements included fully participating in the intake and assessment process for mental health concerns, completing a psychological evaluation and parenting education programs. Parenting programs were offered to the parents at the hospital regarding how to take care of D.M., but otherwise, parents did not engage in programing although it was suggested to mother, the month before, that she and father go to Abigail Pregnancy Center due to the age of the twins. The caseworker did not make a referral for those services, rather, she gave mother the information and the phone numbers so mother could set up appointments for times convenient for mother and father. {¶ 30} The caseworker treated parents like any other family with respect to their case plan services - she explained what was expected of them, gave them places where they could go and she always asked if parents had any questions or if they needed help with anything. She noted that mother picked Firelands for counseling. {¶ 31} The twins’ medical conditions were a lot and there was extensive medical information. At surgery appointments, parents were able to ask the surgeons questions, and for other general questions, parents were to contact Akron’s social worker, who provided information to parents when they called, or they could ask the agency. 15. The GAL {¶ 32} The GAL testified she was assigned to J.M. and D.M. at the initial shelter care hearing. She believed parents should have supervised visitation with the twins due to concerns she observed. For example, on November 10, 2025, the GAL was at a hospital visit and J.M. cried excessively while father held him. Father was unable to soothe J.M., but made some attempts, with prompting, to adjust how he was holding and feeding the baby. Mother suggested that she hold J.M., but that never occurred. Parents could not figure out how to transfer the twins amongst themselves, so the GAL suggested parents could lay either or both of the twins in the crib if they wanted; mother seemed thankful for that suggestion. Eventually, J.M. was screaming so inconsolably that the GAL felt his distress was harmful, so she asked if foster dad could hold J.M. Father was very amenable and immediately passed the baby to the foster dad, who soothed J.M. in less than a minute. The GAL did not know how either parent would have been able to soothe J.M. if they were not supervised. The GAL left the visit about 25 minutes early and later learned that parents left shortly after she did. Thereafter, the GAL spoke with a supervisor about the possibility of having in-person, hands-on parenting classes with parents at the hospital; the supervisor explored securing those classes soon.7 7 The caseworker, when asked by the judge after the GAL’s testimony, confirmed that the agency reached out to Help Me Grow for in-person parenting classes at Akron, in Summit County, and parents were on the wait list; there was no indication of the timeline on the wait list. The caseworker also explained that when the twins were back in Huron County, Help Me Grow in that county could conduct parenting classes. 16.  {¶ 33} The GAL also requested that parents have some visits separate from each other to gauge each parent’s abilities and needs, like 15 minutes or a half hour for each parent. The GAL hoped that individual parenting instruction could occur during that time. The GAL thought father was very reliant on mother to do most of the things, and the GAL did not know if he just wanted mother to do things first or if he was capable of doing things. The GAL thought it was important to know each parent’s independent parenting skills to determine if one parent could provide care for both twins. {¶ 34} The GAL found parents receptive to suggestions on parenting skills. In one instance, father made efforts to follow multipart recommendations, but he may have gotten lost after the first or second part of the recommendation. {¶ 35} Parents’ visits with the twins occurred once a week for two hours, yet parents cancelled some visits. Parents did not attend all of the medical appointments for the twins. Just before the hearing, D.M. had a very serious surgery and was under anesthesia for more than four hours but neither parent was present for the surgery. {¶ 36} The GAL heard that parents said they did not want the twins to become accustomed to being held all of the time, but she never heard them say that. However, parents were informed multiple times of the error in the theory of letting babies cry it out and not letting babies get used to always being held. Conclusion of the Hearing {¶ 37} The agency requested that the court approve the case plan and continue the current orders. Parents requested that visitation be expanded, with the approval of the agency and the GAL, as far as frequency, time, even from eyes on to eyes off supervised 17. visits as parents have shown growth and they are learning. In addition, father objected to the requirement of a full psychological evaluation. Trial Court’s Findings {¶ 38} The judge addressed the parents, and stated: Parents, I definitely want you to be able to see your children. It definitely needs to be supervised at this point in time. And I, you know, I’ve picked up during the course of the Adjudicatory Hearing and today, that there have been significant efforts to get you . . . up to Akron to be able to have regular consistent contact with your children. You need to take advantage of every one of those opportunities. Don’t leave early. There is another procedure coming up tomorrow. You need to be there. And . . . you’re going to demonstrate through your actions much more than your words whether or not you’re committed to your children. And significant surgeries like the one I just heard about, where your son was under anesthesia for four hours, there better be some monumental reason for you not being there. ... And there are going to be other procedures like that. You need to be there. Your physical presence there is going to send a clear message to me one way or another. If you’re not there, it’s going to send a pretty big message too. So your contact does need to be supervised. I haven’t put any judicial limitation on the duration of those visits or the frequency of those visits, but clearly, given what’s going on with each of them right now, there are some practical limitations that are necessitated by the medical conditions at this point. So you need to be observant of that. And as those improve, hopefully, there may be additional time that’s available for supervised visitation. Maybe some other places for that supervised visitation could occur. But you need to follow the, you know, the medical team’s recommendation about that, about where those visits can occur. And obviously the [agency] is going to have the discretion to identify who is the supervisor and where the supervision of those visits occurs. 18.  I am open. There is going to be a further Dispositional Hearing set several months down the road. If improvements take place or request of change orders or more specificity with orders as we approach the holidays, anything like that, certainly the Court can address that, but the Court is going to be involved. The [agency] is not going to have discretion to just go to eyes-off supervision or eliminate supervision at all. Those requests need to come through the Court so all parties will have an opportunity to be heard before any decision like that is made. I am going to adopt the Case Plan here today. I do see a distinction between a mental health assessment and psychological evaluation. I think there is some concern about competency, and whether or not there are some other services that might be necessary to enable you parents to fulfill the Case Plan objective, which right now is reunification. . . But there are some elements above and beyond you just simply receiving some treatment for mental health conditions might have; there may be some . . . additional instructions, additional resources, additional services that might be necessary to put you in a position to be competent parents moving forward. And I think the psychological evaluation will be instructive to that particular issue. ... {¶ 39} That same day, the court issued its judgment entry which provides in relevant part: This cause came to be heard on November 20, 2025, for a dispositional hearing. . . ... Thereupon the [c]ourt found that the [agency] made all reasonable efforts to prevent the placement and that placement outside the home of . . . []parents[] is in the best interest of the children and that the children’s placement is in the most family-like and least-restrictive setting available and in close proximity to the parents’ home, consistent with the best interest and special needs of the children. The [c]ourt found that reasonable efforts to prevent removal were not made by the [agency] because the minor children were removed during an emergency in which the children could not safely remain at home. 19.  The [c]ourt found that the children’s parents are currently unfit or unsuitable for temporary custody because both currently lack the capacity to appropriately respond to the twin newborns’ acute medical needs. ... It is therefore ordered that [the twins] be committed to the temporary custody of the Director of the [agency] pending further hearing herein. It is further ordered that . . . mother is granted supervised visitation with said child at the [agency] or supervised by persons approved by the [agency] at locations approved by the [agency] as arranged between mother and the [agency]. It is further ordered that . . . father is granted supervised visitation with said child at the [agency] or supervised by persons approved by the [agency] at locations approved by the [agency] as arranged between father and the [agency]. ... The [c]ourt having reviewed the case plan filed on October 06, 2025; it is hereby ordered that the aforementioned be approved, and that all parties comply with the same. ... Assignments of Error {¶ 40} For ease of discussion, we will address father’s assignments of error out of order. Second Assignment of Error {¶ 41} Father argues that the trial court erred by admitting inadmissible hearsay at adjudication. He submits that at the adjudicatory hearing, the agency worker testified regarding D.M.’s psychological state as reported by hospital staff, “We were told by the medical professionals at Akron that [D.M.] had developed a response where every time a person would come touch him . . . it was a negative response because he was only being poked and prodded, never held . . .” Father contends that counsel objected, but the court 20. admitted the statement “for that limited purpose” of explaining why the case was referred to the agency. Father asserts that this hearsay, alleging a lack of bonding, served as a substantive pillar for the court’s dependency finding. He maintains that if the State uses hearsay to “fill in the blanks” for witnesses who do not testify, it is prejudicial error. {¶ 42} Father further argues that adjudicatory hearings require the strict application of the Rules of Evidence, and on appeal, the admission of hearsay is reviewed de novo because a trial court has “no discretion to admit hearsay.” Father cites to State v. Kamer, 2022-Ohio-2070, ¶ 172 (6th Dist.). Standard of Review {¶ 43} A trial court has discretion to determine which evidence to admit or exclude at trial, and such decisions will not be reversed on appeal absent an abuse of discretion. State ex rel. VanDyke v. Pub. Emp. Retirement Bd., 2003-Ohio-4123, ¶ 43. A trial court abuses its discretion if its evidentiary ruling is unreasonable, arbitrary, or unconscionable. Blakemore v. Blakemore, 5 Ohio St.3d 217, 219 (1983). Law {¶ 44} Hearsay is an out-of-court statement made by the declarant offered in evidence to prove the truth of the matter asserted. Evid.R. 801(C). A statement is not hearsay when offered for a purpose other than to prove the truth of the matter asserted, for instance, to show its effect on the listener. State v. Osie, 2014-Ohio-2966, ¶ 118, 122, citing State v. Davis, 62 Ohio St.3d 326, 343 (1991). Therefore, “‘testimony which explains the actions of a witness to whom a statement was directed, such as to explain the 21. witness’ activities, is not hearsay.’” State v. LaMar, 2002-Ohio-2128, ¶ 59, quoting State v. Maurer, 15 Ohio St.3d 239, 262 (1984). {¶ 45} If, however, a statement is hearsay, under Civ.R. 61, “[n]o error in either the admission or the exclusion of evidence . . . is ground for . . . vacating, modifying or otherwise disturbing a judgment or order, unless refusal to take such action appears to the court inconsistent with substantial justice.” Generally, to find substantial justice has been achieved to prevent reversal for errors which occurred at trial, an appellate court “must not only weigh the prejudicial effect of those errors but also determine that, i