1 B.B.'s father surrendered his parental rights in September of 1998. 

### IN THE COURT OF APPEALS OF TENNESSEE

AT NASHVILLE
IN THE MATTER OF B.B.
Direct Appeal from the Juvenile Court for Davidson County No. 9719-0003807 Burton Glover, Judge

No. M1999-00643-COA-R3-CV - Decided June 20, 2000

The trial court termin

ated the mother's

parental rights to

B.B. on the grounds th

at: (1) th e child had been removed from the mother for more than six (6) months and the conditions which led to removal or other

conditions which in

all reasonable p

robabilit y would cause

the child to be subjectedto further abuse or neglect still persisted; (2) the mother substantially failed to comply

with the plan of care established by the Department of Chi ldren 's Services; and (3) the mother was incompetent

to adequately provide for the further care and supervision of the child. Because clear and convincing evidence supports the trial court's findings and its conclusion that termination was in the best interest of the child, we affirm.

Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Juvenile Court

Affirmed and Remanded

C OTTRELL , J., delivered the opinion of the court, in which C ANTRELL , P .J., M.S. and K OCH , J., joined. Jennifer Lynn Thompson, Nashville, Tennessee, for the appellant, Lisa Ann Mears.

Paul G. Summers, Attorney General and Reporter, Do uglas Ear l Dimond, Assistant Attorney General, for th

e appellee, State

of Tennessee, D

epartment of Child

ren's Services.
OPINION

This case involves the termination of the parental rights of the mother of B.B., a minor chil

d born in May 1991. 1 The trial court terminated the mother's parental rights after finding that: (1) the child had been removed from the mother for more than six (6) months and the conditions which led to removal or other conditions which in all reasonable probability would cause the child to be subjectedto further abuse or neglect still persisted; (2)

the mother substan

tially failed to

comply with the plan of

care established by the Department of Children's Services ("DCS"); and (3) the mother
w as incompetent to adequately provide for the further care and supervision of the child. For the2 According to the r ecord, B.B. told two teachers that her mother had threatened her with a knife. The mother purportedly stated that she would kill B.B. if B.B. did not leave home.
-2- following reason

s, we affirm.

B.B. was placed

in State custody on October 7, 1997, after DCS filed a petition for custody and emergency removal. The petition alleged that B.B. was at serious risk because her mother, the petitioner herein, had threatened to kill her. 2 The petition stated:

The mother . . . is unable and unwilling t o car e for . . . [B.B.] a t this time due to ongoing mental hea

lth issues. [B.B.] is

ADHD and

oppositional defia

nt . . . Home Ties was placed in the home in Aug ust. They recognized that [the mother] had mental health issues and made a referral to Mental Health Coop. A removal order was issued the day the petition was filed and a hearing date was set. The next day, B.B.'s mother w

as hospitalized f

or me ntal heal th treatment. Shortly thereafter, counsel was appointed for B.B.'s mother and a guardian ad litem was appointed for B.B. After an October

10, 1997 hearing, the trial court found that the parties agreed that B.B. would remain in DCS custody, while B.B.'s grandmother

explored the possibility of assistance from the family. The court reported that DCS would prepare a comprehensive plan of care and would attempt to place B.B. so that

she could continue at the special school she had been attending. The court also directed DCS to work closely with the grandmother to assess whether B.B. really needed to stay in State custody.

DCS formulated a plan of care which was staffed on November 6, 1997, and agreed to by the mother, grandmother, an

d guardian ad lite

m for the child. Its

stated goals

were to reunite thechild withher mother or place her with a relative. The plan recognized B.B.’s diagnoses of oppositional defiant disorder and attention deficit disorder as well as her behavioral problems, and incorporated requireme

nts f or continued trea

tment, including med

ication and couns

eling. The plan al

so contemplatedvarious medical e xaminations, conti

n u ed placement in a school with special education classes, and transportation from her foster h ome to the school. T

he plan permitted

weekly visits with her mother at her grandmother's home. The plan also recognized the mother’s diagnosis of severe depression and required the mother to continue the medication prescribed by he r psychiatrist and

to
accessother mental health services with the goal that she become stable enough to resu me caring for B.B. Metro Mental He

alth Coop and DCS were to monitor mother’s perfor

mance and assist w

ith obtaining needed

services.

A second hearing was held on November 17, 1997 for settlement and presentation of the plan of care. At that time, the court found that B. B. was doing "very w ell" in the foster h

ome. During this hearing, the parties reported that the case had been settled. The court subsequently made findings that B.B. was a dependent and neglected child in that her mother suffered from severe depr ession which rendered her incapable of parenting the child. The court stated that B.B.'s attention deficit disorder and hyperactivity ex

acerbated the m

other's inability

to parent B.B. The court ther

efore ordered

B.B. to remain in the custody of DCS, an d continued s upervised visitation with the mother and3 The mother, who was of borderline intellectual ability, had also tested "significantly high" for child abuse poten

tial. The te st showed that the mother "endorses numerous traits known to be present in physical child abusers," although the report noted that "no test can actually predict abusive behavior."

4 The order included a statement that the grandmother reported that the mother did not attend the hearing bec

ause she gets upse

t in court.
-3- grandmother. The

court further sta

ted:

The mother shall continue to cooperate with Mental Health Coop

and her psychiat

rist, Dr. Rosenshein, and sh

al l continue to take h

er medication as

prescribed, an

d shall continue to follow the Plan of Care so that the goal can remain reunification.

The case was heard again on February 20, 1998, pursuant to the court's earlier order for a ninety-day review. The court found that B.B.'s behavior had improved and that the foster mother

had reported that B.B. was a "delightful child." The court found that B.B. was on Ritalin, had s tarted counseling, and visited her grandmother and mother every weekend, staying for a day and sometimes all night. It noted that the mother was taking medication for depression and co-dependent personality and was continuing to go to Metro Health Coop and to see her psychiatrist. The court also advised the grandmother that the family needed to decide if anyone in the family could provide a permanent home for B.B.

After another hearing to reviewthe foster care placement on May 18, 1998, the court found that the mother was und

ergoing psycholog

ical evaluations but h ad been either unable or unwilling to answer the questions on the written portion of the test. The court also noted that the foster mother and B.B.'s counselor had reported that the child exhibited more behavioral problems after overnight visits with the mother a nd grandm other. The grand mother reported

that no one else in t

he family could take B.B. and that her own health proble ms created a difficulty in her taking B.B. The trial court determined that

progress toward

the goal of retur

ning B.B. to her mother was n ot appropriate and that the goal needed to be changed. The court ordered a new staffing and a r evised plan.

After a June 24 h ea ring, the trial cou rt entered a per

manency planning

order in which it reported that the mother's psychological exa mination demonstra

ted that she could

not care for

B.B. The court determined that progress on the goal of reunitingB.B. with her mother wa s inappropriate and needed to be changed to adoption or relative placement. The court ordered that the new staffing be held immediately. The above mentioned evaluation 3 concluded with a recommendation that the child not be returned to

the mother's car

e at that time

on the basis that the mother "does not have some of the basic qualities necessary for even adequate parenting."

After a July 27 hearing, the trial court entered a permanency planning order which approved changing the plan of

care goal from reunification to adoption. 4 DCS had reviewed the revised plan of care with t he mother and the grandmother. B.B.'s guardian ad litem concurred in the change i n5 In add ition to the grounds found to exist by the court, the petition also alleged that the

mother had willfully abandoned B.B. for more than four (4) consecutive months preceding the filing of the petition in that she failed to support the child. That ground did not form a basis for the trial court's terminati

on and is not an issue

in this appeal.
-4- goal. Supervised visitation between mother and daughter was subsequently reduced to one hour per week.

DCS filed a petition to terminate the parental rights of the mother on October 27, 1998. The hearing on the petition was held on February 9 and on March 11, 1999. The court specifically applied Tenn. Code Ann. § 36-1-113(g)(3)(A), findingthat B.B. had been removed from her parent for over six months and the cond itions which led to r

emoval or other c

onditions which in

all reas onable probability

would cause furt

her abuse or neg

lect still p ersisted and there was little likelihood that these conditions would be remedied. The court found that the continuat

ion of the legal re

lationship betweenparent and child g reatly diminished t

he child's chanc

es of early

integration into a stable and permanent

home. The court a

lso found that the mo

ther failed to

follow the foster care plan, which t he court found to be reasonable and related to remedying the conditions which necessitated fo ste r care. In addition, the court applied Tenn. Code Ann. § 36-1-113(7)(B)(i), finding that the mother was incompetent

to adequately provide for the child's further care a nd supervision because her mental condition was impaired, an d likely to remain so, to the extent that it was unlikely that she would be able to resume care of the child in the near future. The court determined that the mother had failed to make an adjustmen

t of circumstance

s, conduct, or con

ditio ns so as to mak e it in the child's be st interest to return home, that the mother failed to maintain regula

r visitation or othe

r contact, that the mother failed to pay any portion of substitute physical care and maintenance, and that there was no meaningful relationship between the mother and child. The court specifically found that the mother had failedto effect a lasting adjustment after reasonable efforts by social agencies "for such a duration of time t hat lasting adjustment does not reasonably appear possible.” The court terminated the mother's parental rights a nd awarded custo

dy, control, and gu

ardianship to

the State of Tennessee. 5 The mot her then commenced this appeal, based solely on a claim that the evidence preponderates against the trial court's finding that grounds for termination were shown by clear and c onv incing evidence.

I. Standard of Proof

Because the decision to ter

minate parental r

ights affec ts fundamental co nstitutional rights, courts apply a higher st

andard of pr oof when adjudicating termination cases. See O'Daniel v. Messier , 905 S.W.2d 182, 186 (Tenn. Ct. App. 1995). To justify the termination of par ental rights, the grounds for termination must be established by clear and convincing evidence. See Tenn. Code. Ann. § 36-1-113(c)(1) (Supp. 1999); State Dep’t of Human Servs. v. Defriece , 937 S.W.2d 954, 960 (Tenn. Ct. App. 1996). Evidence which satisfies the clear and convincing standard "eliminates any serio us or substantial doubt concerning the correctness of the conclusion to be drawn fr om th e evidence." O'Daniel , 905 S.W.2d at 188. "This height e ned standard . . . serves to prevent the unwarranted

termination or inte

rference with t

he biological par

ents' rights to

th eir children." In re6 Although the court's order specifically refers to only two of the statutory grounds by citation

to code section, the trial court's finding that the mother did not follow the plan of care relates to an additional statutory ground, Tenn. Code Ann. § 36-1-113(g)(2), as alleged in the petition.
-5- M.W.A. , 980 S.W.2d 620, 622 (Tenn. Ct. App. 1998).

Parental rights may be terminated in o nly a limited number of statutorily defined circumstances.

Before termination, one or more of theasserted statutory grounds must be proved by clear and convincing ev

idence and the c

ourt must determine, also by clear and convincing evidence, that termination is in the child's best interests. See Tenn. Code Ann. § 36-1-113(c)(2) (Supp. 1999).

The mother argues tha

t the trial cour t erred in finding clear and convincing evidence of a fa ctual basis to terminate her parental rights. The trial court based its decision to terminate th e mother's parental rights on three subsections of Tenn. Code Ann. § 36-1-113. 6 We must affirm the trial court's judgment if any one of these bases exists in this case.

II. The Evidence

The record shows tha

t B.B. was removed f

rom the parental

home because th

e mother was unable or unwilling to prov ide car e for B.B. due to mental health issues. The mother had been suffering from depression for a number of years. She had been recei

ving social servic

es, through the HomeTies program

and other agencies, even before the removal. The record shows that the mother sp ecifically

declined to follow the recommendations of the Home Ties representat ive in handling B.B

. The reco rd also shows that B.B. had signifi cant behaviora

l problems relate

d to her diagnoses

with oppositional defiant disorder and attention deficit disorder. B.B. had been attending a special needs school and was receiving counseling and other services. The mother had f ailed to coopera

te in parenting classe

s and other counse

ling related to B.B. ’s needs.

After B.B. was removed from the home, DCS established a plan of care with the stated goal of reunification of mother and child. The plan required the mother

to continue seeing

a psychiatrist, continue taking medication for her condition

, and conti

nue using Metro Mental Hea lth Case Management. The representative from DCS testified that the mother provided no proof that she had complied with any of these directives. On the contrary, the mother admitted that she had maintained her medication "off and on" even though she was aware that compliance with the plan was necessary for reunification. The mother also admitted that she saw the psychiatrist only sporadically and had ceased her relationship with Metro Mental Health.

At trial, the DCS representative testified that the mother had not taken advantage of the services, such as parenting classes, that Home Ties offered. He stated t hat "more than once" he soughtparenting instruc

tion for the mother

at the Mental Hea

lth Coop, but the mother

refused to go there, notwithstand ing the fact that sh e was offered d

oor to door transpo

rtation. The DCS representativereported that the mother essentially avoided him, to the point that he w as unable to-6-

inspect h er residence to determine whether she was maintaining it properly. No family placement
was available; the gr

andmother test

ifi ed at trial that ne

ither she nor eith

er of mother's sist

ers could take custody of B.B

. The DCS representative testified that the conditions which precipitated

B.B.'s removal from the home, or other co

nditions, which in a

ll reasonable pr

obability would subject the child to further abuseor neg lect and preven t the child's retur

n still persisted. Th

e DCS representa

tive expresse

d apprehension about the mother's mental health:

I'mconcerned that she retrea ts into her own little world and becomes no longer approachable so the social service workers like myself or from Mental Health Coop can't approach her with serv ices. I can see that as a great danger. I believe that the child would return to he

r and she would re

treat into this shel

l, for la c k of a better word, that the child would be at risk. . . . You know, it's hard for me to sit here and say thi s, but I just don't believe that the child would be safe with her, you know, in a situation where bo

th parties, both ha

ve got such tremen

dous needs.

As previously noted, shortly after B.B. was removed from the home, her mother was admitted to a psychiatric care

hospital. She rece

ived diagnoses of

major depression

, recurrent with

psychotic features,and dependent personality disorder. During this admission, it was reported that the mother had been treated in the past for major depression and had been “very noncompliant with medications generally and with treatment.” The mother was also hospitalized after a purported suici d e attempt during th e w eek prior to the first day of the termination hearing. The mother denied that she had attempted suicide, but reported that she was glad for the intervention because she got started back
on her medication. She testified she had been compliant with her medication for approximately one week before the first day of the hearing.

After removal of B.B., DCS

arranged for a psychological evaluation of B.B.’s mother. The psychologist

who performed the evaluation testified that he h

ad been asked to

perform the evaluation because there were questions regarding the m othe r’s intellectual

functioning and pa

renting ability raisedby the mother’s history of referrals and interventions. The psyc hologist testified that the mother scored in the borderline range in intellectual performance, but concluded t hat the mot her’s intellectual functioning alone would not interfere with effective parenting although her psychological problems would prevent her from parenting appropriately.

He reported clear and striking contradictions in the mother’s desc

riptions of B.B. and i

n her descriptions of her own parenting ability. In particular, he noted t hat the mother’s answers on the Parent ing Stress I ndex indicated she perceived herself as having no problems in parenting and perceived B.B. as having no probl ems. The se answers, however, were contradictory to other statements by the mo

ther. The evalua

tion stated that:
[The mother] has a rig

id and overly simplis

tic cognitive sty

le in which important elementsin the environment are ignored in de

cision-making. She

has vir t ually no skills in dealing appropriately with negative emotions and is at risk for impulsive and-7-

damaging behavior when un der stress. A stri

king self-cente

redness is indica

ted in which it will be very difficult to put others' needs before hers. Im maturity is indicated in which a child's ac

tions are likely to b

e taken persona

lly when appropriat

e parenting would call for distancing and objective thinking in responding.

The psychologist concludedthat the mother’s “very maladaptive cognitive style” interfered with her ability to interact with her environme

nt on most levels.He characterized the mother as at risk for being overwhelmed by even minimal stress and observed that she used most of her mental energy to deny or avoid ne gati ve feelings and had difficu lty dealing effe

ctively and appro

priately with her emotions. According to the psychologist, the mother avoided facing emotion, and didn’t take in enough evidence of her e nviro nment to make proper decisions or show proper judgments. He predicted that attempts to force her to cons ider other people or pay atte ntion to other things

would likelytrigger irritability and she would have an especially difficult time trying to paren t a child as difficult as B.B. After explaining that the mother’s social isolation removed one method of dealing withstress, he psychologist stated, “Her social skills being weak and her emotional skills being weak are the two biggest things that tell about parenting.” According to the psychologist, the results fromthe test suggested that providing intervention to correct the significant problems in the mother’s functioning w ould be extr emely difficult. He explainedthat the mother’s d ifficulties were

not the result of ps

ychological st

resses “but

they are characterolog

ical, deeply ingrained difficulties dealing with people, dealing with emotions, and dealing withstress.” He was pessimistic that changing her environment would result in significant changes. The psychologist also testified that improvements in the mother’s functioning w ould be difficult to effect because she did n ot perceive that

any of the proble

ms she experienced in parenting B.B. were her fault o

r that she had any

significant proble

ms, except depre

ssion. The psycholo

gist concluded

that the mother’s m

ental condition wa

s so impaired and lik

ely to remain

so impaired that she would be unable to resume care and responsibility of B.B. in the near future.

Another psychologist, who had treated the mother in the two months prior to the h earing, also testified. Her initial diagnosis of the mot he r, having performed no psychological evaluation, was major depression with recurrent psychotic features. According to the psychologist, thatdiagnosis is normally treated with medication, psychotherapy, and family education. She re ported t hat stabilization through medication often takes a number of months if the patient is compliant, but the mother hadreported a histor

y of noncomplianc

e with treatment.

The psychologist had referred the mother to a psychiatrist, who prescribed some medications, all of which the mother refused t

o accept. This psychologist saw the mother only once before she was involved a cri sis interven tion about a week before the hearing when the mother, depressed about the prospect of losing contact with B.B., became self harmful. The mother was place d in respite care

for three days, a

lthough the psychol

ogist had recommende

d hospitalization f

or a month in order

to stabilize her me

dications.

The psychologist

testified she would like to see the mother continue the course of medication she was on, continue in psychotherapy, and undergo social skills training. If the mother were to treat her mental health issues consistently for at least six months and

participate

in appropriate education, this psychologist thought there was a possibility the mother could beco

me able to parent her child.-8-

If the mother did not treat those issues, the re wa s no possibility. The psychologist agreed that the mother needed to take care of her own needs in order to be able to care f or her child.

The record shows that

initially, the mother seemed uninterested in getting treatment; however, at trial she expressed a desire to maintain her medications. The mot her di d not comply with psychiatrist’s medication recommendations made approximately one month before the hearing. The record shows that the mother

has a long history of resistance to treatment and her condition, with the additional stresses of a chi ld with special nee

ds, could, in the opinion of the psychologist, place her at risk for homicidal and suicidal ideation if left untreated.

III. Termination under Tenn. Code Ann. § 36-1-113(g)(3)(A)

We first examine the record for clear and convincing proof

of the criteria enumerated in Tenn. Code Ann. § 36-1-1 13(g)(3)(A) a s grounds for term

ination of parent

al or guardianshi

p rights:
(3) (A) The child has been removed from the home of the parent or guardian by order of a court for a p

eriod of six (6) mo

nths and: (i) The conditions which led to the child's removal or other conditions which in all reasonable probability would cause the ch ild to be subjectedto further abuse or neglect and which, therefore, prevent the child's safe return to the care of the paren t(s) o r guardian(s), s

till persist; (ii) There is little like

lihood that these

conditions will

be remedied at
an early date so that the child can be safely returned to the parent(s) or guardian(s) in the near future; and (iii) The continuation of

the parent or gua

rdian and child re

lationship greatly diminishes the child's chances of early integration into a safe, stable and permanent home.

It is undisputed that B.B. ha s been removed from the home by court order for over six (6) months. She was removed in October of 1997 because her mother’s mental condition prevented the mother from appropriately caring for B.B. The petition for termination of parental rights was filed in October of 1998, and the trial was held in February and March of 1999. Having considered this record, we find that clear and convincing evidence supported the trial court's conclusion that the conditions which le

d to B.B.'s r

emoval or other conditions w hich in all reasonable

probability would cause her to be subjected to fu rther abuse or neglect and which, therefore, prevent the child's safe return to the care of the mother still persist. See Tenn. Code Ann. § 36-1-113(g)(3)(A) (Supp. 1999). Nothi ng in the re cord shows a likelihood that these conditions will be remedied at a

n early date

so that the child co

uldbe returned safely to the mother in the near future. On the co ntrary, the record shows that the mother had a history of failing to take her-9-

medica tions or to undergo regular psychological treatment, as required by the plan of care an d a s necessary to enable her to prepare to parent a child. Further, the mothe r has demo nstrated an unwillingness

to consistently ava

il herself of

social services needed by her and by B.B. During the period since B.B. was rem oved from the home

, these problems w

ere not r ectified. The mother attendedno parenting classes, and pursued no other regular instruction to i mprove herself or her relationship

with her daughter. She did not continue regular psychiatric treatment or take medication prescribed

for her condition. We see no evidence that the mother is in any better

position to parent B.B. now than she was at the time the child was removed from her home. The record also contains no evidence that B.B.'s grandmother and aunts would provide any greater assistance with the child than they did before her removal from the home.

Nor can we say the trial court er red in f inding that the cont

inuation of the par

ent and child relationship

greatly diminished B.B.'s chances of early integration into a

safe, stable and permanent home. The foster mother testified that her family loved B.B. and they had not ruled out adoption. The record shows that the stability provided B.B. in the foster home had improved her mental health and behavior. This child, who has special problems of her own, needs a stable environment which the mother cannot provide.

We are not persuade d that the mother’s last minute willingness to take her medication as prescribed

alters the conclusion that there is little likelihood that the mother’s inability to parent B.B. would be remedied at a

n early date

so thatB.B. could safely return to the mother in the near future. The mother’s history and the experts’ prognosis for improvement in her condition which would allow her to properly care

for her child com

pel us to agree wi

th the trial court t

hat return of B.B.

to th e mother is not likely to be possible anytime in the near future.

A parent’s failure to make fundamental adjustments which could make a safe return of a child possible is a basis for termination. See State v. Hunter , No. M1999-02606-COA-R3-CV, 2000 WL 313549 at *4 (Tenn. Ct. App. March 29, 2000) (no Tenn. R. App. P. application filed).

IV. Termination under Tenn. Code Ann. § 36-1-113(g)(2) Tenn. Code Ann. § 36-1-113(g)(2) permits termination of parental rights when
[t]he re ha s been substantial noncompliance by the parent or guardian with the statement of responsibilities in a permanency plan or a plan of care pur su ant to the provisions of title 3 7, chapter 2, par t 4;

As note d above, the mother failed to comply with several aspects of the plan of care, all of which directly affec

ted her ability to e

ffectively parent B.B. The plan of care required the mother the7 This psychologist testified at the February 9, 1999 hea ring that s he had been treating the mother since December.
-10- obtain treatment for her mental health problems, continue taking her medications for treatment of her mental health problems,

and continue using Metro Mental Health Case Management. It also required her to maintain her

home in a clean, habitable condition, to pay child support, and to attend parenting classes. The record contains no evidence that the mother seriously pursued any of these aspects of the plan of care. During the time the plan of care was in

effect, she did n

ot seriously and re

gularly obtain mental health

care. In addition, she severed her ties with Metro Mental Health, refused to take her medications for any meaningful length of time, and failed to take parenting classes. The record shows that she evaded the DCS representative who cam e to inspect h

er house. Although she had begun taking her m

edications immedia

tely before the termination hearing and was communicating occasionally

with a psychologist,

“[t]oken attend

ance [in counseling session and token maintenance of medication] without addressing the real issues present here [are] not sufficient to indic

ate compliance with the foster care plan.” Dep’t of Hum an Servs. v. Adams , No. 03A01-9403-CV-00114, 1994 WL 579911 at *9 (Tenn. Ct. App. Oct. 24, 1994) (no Tenn. R. App. P. 11 application filed). Based on the evidence,

we cannot s ay that the trial court erred in finding by clear and convincing evidence that the mother had substantially failed to comply with the plan of care.

V. Termination und

er Tenn. Code Ann . § 36-1-113(g)( 7)(B)(i)

Nor can we say that the trial court's decision to terminate the mother's parental rights pursuant to Tenn. Code Ann. § 3 6 -1-113(g)(7)( B)(i) was erron

eous. That subsec

tion permits courts

to terminate paren

tal rights if they de

termine on the bas

is of clear and c

onvincing evidenc

e that: (i) The parent or guardian of the child is incompet ent to adeq uately provide for the further care an d su pervision of the child because the parent's or guardian's mental condition is presently so impaired and is so likely to remai

n so that it

is unlikely that the parent or guard

ian will be able to a

ssume or resume

the careof and responsibil ity for the child in the near future . . .
Here, the record

shows that the mothe

r was diagnosed w

ith major depression

withpsychotic fea tures. Her treating psychologist testified that someone with this diagnosis is more at risk fo r homicidal and suicidal idea tion and the additio

nal stress of havi

ng a child with

special needs wo

uld increase that risk. 7 The doctor advised that the mother could not resume custody of B.B. until she had complied withtreatment for a minimum of six months , and then only a pos sibility she would be able to parent the child w

ould exist. The re

cord shows that the

mother had alway

s resi sted med ical treatment to varying degre

es and had not cont

inued her medica

tion for any meani

ngful length

of time. In addition, psycholo

gical testing rais

ed questions about

the mother's abilit

y to parent the child. This evidence is sufficient to jus tify the trial cour

t's conclusion that

the mother was inc

ompetent to adequately

provide for the further care and supervision of the child because her mental condition was so impaired.-11-

Our Supreme Court has h

eld that mental illne

ss which makes a

parent unfit for care for a

child
can constitute grounds for termination of parental rights. See State Dep’t of Human Servs. v. Smith , 785 S.W.2d 336, 338 (Tenn. 1990). In reversing a C o urt of Appeals decision to the contrary, the Supreme Court stated:

The holding of the Court of Appeals in this case - - that “mental disability” can not be the basis of termina tion of pare ntal rights since the acts of the mentally disabled parent are not willful - - would nullify asignificant part of the legislative plan for the welfare of

dependent and

neglected childr

en. An obvious res

ult of the holding is to condemn a child, whose parents are unfit to properly care for the ch ild because o f mental illne ss, to a life in serial foster homes without any possibility of a stable, permanent home.

Id.

The evidence in this case, primarily the mother’s historyof noncompliance with medication and treatment recommendations and t he psy chologists’ description of the mother’s condition, supports a finding that her condition is likely to remain so impaired as to prevent her from adequately parenting the child.

VI. Best Interest of the Child

The legislature has st

ated that “[i]n a

ll cases, when the b

est interests of the child and those of the adults are in conf

lict, such conflic

t shall always be r

esolved to favor t

he rights an d the best interests of the child . . .” Tenn. Code Ann. §36-1-101(d) (Supp. 1999). Further, Tenn. Code Ann. § 36-1-113(c) requires that termination of parental rights must be based upon:
(1) A finding by the court by clear and convincing evidence that the grounds for termination or [sic] parental or guardianship rights have been established; and
(2) That termination of the parent's or guardian's rights

is in the best

interests of the child. Having found that the grounds for termination were properly established, we turn to the fundamental question of the best interest of the child. Factors to consider in making that determination include:
(1) Whether the par

ent or guardian h

as made such an a

dju stmen t of circumstance, conduct, or conditions as to make it safe and in the child's best interest to be in the home of the parent or guardian; (2) Whether the par

ent or guardia

n has failed to effect a lasting adjustment after reasonable

efforts by available social services agencies for such duration of time that lasting adjustment d

oes not reasonab

ly appear possible ; (3) Whether the parent or guardian has maintained regular visitation or other contact-12-

with the child; (4) Whether a m eaningful relationship has otherwise been established between the parent or guardian and the child; (5) The effect a

change of caretakers and physical environment is likely to have on the child's emotional, psychological and medical condition; (6) Whether the parent or guardian, or other person residing with the parent or guardian, has shown brutality , physical, sexual, emotional or psychological abuse, or neglect toward other children in the family or household; (7) Whether the physical environment of the parent's or guardian's home is healthy and safe, whether t

here is criminal activity i

n the home, or whet

her there is such

use of alcohol or controlled

substances as may render the parent or guardian consistently unable to care for the child in a safe and stable manner; (8) Wheth e r the parent's or guardian's mental and/or emotional status would be detrimental to the child or prevent the parent or guardian from effectively providing safe and stable care and supervision for the child; or (9) Whether the par

ent o r guard ian has paid child s upport consistent w

ith the child support guidelines promulgated by the department pursuant to § 36-5-101. Tenn. Code Ann. § 36-1-113(i) (Supp. 1999).

We find abundant evidence showing that the mother failed to adjust her conduct so as to make it safe and in B.B.'s best interest to be in her home at present. See Tenn. Code Ann. § 36-1-113(i)(1). It is likewise clear from the evidence before us that th e mother failed a djust her circumst

ances, conduct or conditions to mak

e it in B.B.’s best interest to return to her in the foreseeable future. The mother failed to effect a lasting adjustment after reasonable efforts by social agencies to bring about
c hange. See Tenn. Code Ann. § 36-1-113(i)(2). Nor does a lasting adjustment appear reasona bl y possible. See Adams , 1994 WL 579911 at *9. Notwithstanding the facts that B.B. had been removed from the home for over a year and the mother had been informed that treatment for her mental condition was necessary for reunification, at the beginning of the termination hearing, the mother's track record for taking her medication was approximately one week. The mother failed to continue in counseling, or seek parenting instruction. The record show s that the mother refused to take responsibility

for her failure to comply with many of the suggestions made by DCS, blaming various social service agencies. The mother’s failure to make the adjustments of conduct urged by DCS and her care givers assured that the conditions in her home that led to the court’s determination that B.B.
was a "dep endent and ne glected" child would not change. See Smith , 785 S.W.2d at 339. Further, clear and convincing evidence established that B.B. needs a stable, permanent home. See id. The record shows that B.B. has thrived in the stable environment of her foster home and that she has been able to receive the treatment and other services she need s for her own significant problems. The General Assembly has decided that the c hild’s need for a permanent, stable, and safe environment must outweigh a paren

t’s interest in

retaining paren

tal rights where t

hose two interests

conflict. See Smith , 785 S.W.2d at 338. As this court observed in Adams :
Based upon the record b

efore us, if

we do not affirm the Judgment of the tria l court,
we would place the children in an endlessly hopeless situation, caught in the system-13-

withno escape. . . . The children need and d eserve a chance to thrive and grow in a loving permanent home th at offers them the

opportunity to

re ach their fullest potential, despite the neglect and abuse they suffered in early childhood.

Adams , 1994 WL 579911 at *10.

Under these circumstances, we must conc lude that the trial court did not err in finding that termination was in

B.B.'s best interes

t.

VII.

Accordin gly, we affirm the trial court's decision. This cause is remanded for such fur the r proc eedings which may be necessary. Costs of this appeal are taxed to the mother, fo r whic h execution may issue if necessary.