Court Opinion

ID: 9943199
Source: CourtListenerOpinion
Date Created: 2024-02-22 20:10:47.540917+00
Date Added: 2024-06-11T13:46:29.948339
License: Public Domain

02/22/2024
               IN THE COURT OF APPEALS OF TENNESSEE
                          AT KNOXVILLE
                          Assigned on Briefs January 2, 2024

                            IN RE KAMDYN H., ET AL.

                 Appeal from the Juvenile Court for Sullivan County
                    No. J39995         Mark H. Toohey, Judge
                     ___________________________________

                            No. E2023-00497-COA-R3-PT
                       ___________________________________

This is an appeal of a termination of a mother’s parental rights. The Juvenile Court for
Sullivan County (“the Juvenile Court”) terminated the parental rights of Tara C. (“Mother”)
to two of her children, Kamdyn H. and Bentyn H. upon finding that the Tennessee
Department of Children’s Services (“DCS”) proved by clear and convincing evidence that
Mother was mentally incompetent and that it was in the best interest of Kamdyn and Bentyn
for Mother’s parental rights to be terminated. Mother has appealed. Upon our review, we
affirm the Juvenile Court’s judgment.

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

D. MICHAEL SWINEY, C.J., delivered the opinion of the court, in which FRANK G.
CLEMENT, JR., P.J., M.S., and ARNOLD B. GOLDIN, J., joined.

Alice Alexander, Kingsport, Tennessee, for the appellant, Tara C.

Jonathan Skrmetti, Attorney General and Reporter, and Amber L. Barker, Senior Assistant
Attorney General for the appellee, Tennessee Department of Children’s Services.

                                       OPINION

                                      Background

       This appeal is the most recent stage of a nearly fourteen-year long case involving
DCS and Mother, who has suffered from severe mental illnesses for many years. During
the pendency of this case, Mother and Ronald H. (“Father”) had four children together:
Ethyn H., Kamdyn H., Bentyn H., and Makinlyn C. 1 Although DCS was involved with all
four children to varying degrees throughout the case, its ultimate petition to terminate
Mother’s parental rights related only to Kamdyn and Bentyn (“the Children”). Maternal
grandmother, Whitney M. (“Grandmother”), has custody of Makinlyn, and Makinlyn was
never a subject of DCS’s termination petition or its subsequent amendments. Ethyn, the
eldest child, was placed under the guardianship of relatives, and DCS accordingly removed
Ethyn from its ultimate termination petition. Our focus is limited to the Children.

       DCS first became aware of problems in the family’s home in 2010 after it received
a referral alleging that Father had assaulted Mother while she was pregnant with Bentyn.
Father’s domestic violence was a central concern for DCS, but Mother’s substance abuse
and mental condition eventually became the main issue. In December 2010, DCS filed a
petition, seeking an order enjoining Father from having any unsupervised contact with
Ethyn and Kamdyn. When this case first began, Bentyn and Makinlyn had not yet been
born.

       DCS also requested the Juvenile Court to order Mother to undergo a mental health
evaluation, receive domestic violence counseling, and seek an order of protection from
Father. The Juvenile Court accordingly entered an ex parte restraining order, prohibiting
Mother from allowing Father to have unsupervised contact with Ethyn and Kamdyn. In
another order, the Juvenile Court found that there was probable cause that Ethyn and
Kamdyn were dependent and neglected.

       A few months later, in February 2011, DCS filed a petition for temporary legal
custody of Ethyn and Kamdyn, alleging that Mother and Father had continued their
relationship and that Father had assaulted Mother again two weeks earlier. The Juvenile
Court entered a “No Contact Order” between Father and Mother. In July 2011, DCS filed
another petition with respect to Bentyn, who had recently been born. DCS alleged that
Mother had taken Bentyn to Father’s home where Father and his brother engaged in a
physical altercation. Around this time, Grandmother filed her own petition for temporary
custody alleging that Mother had been using illegal drugs and violating the no-contact order
by seeing Father.

       In August 2011, the Juvenile Court entered an order, providing that Mother, Ethyn,
Kamdyn, and Bentyn were to reside with Mother’s grandmother (“Great-Grandmother”)
and that Grandmother would be allowed two consecutive weeks of visitation. The Juvenile
Court ordered all contact between Mother and the three boys to be supervised by Great-
Grandmother or Grandmother. Soon after, the Juvenile Court changed the arrangement
again, this time granting Grandmother physical custody and guardianship of Ethyn and

1
  Father passed away in 2018, prior to the conclusion of the termination trial, and is not a party to
this appeal.
                                                -2-
Kamdyn at her residence in Virginia and granting Scott C. (“Grandfather”) and his wife
physical custody and guardianship of Bentyn. Mother retained legal custody.

       In March 2012, DCS filed an amended petition for temporary legal custody, alleging
that Grandmother was no longer able to provide for Ethyn and Kamdyn and that
Grandfather was no longer able to provide for Bentyn. DCS requested the Juvenile Court
award temporary legal custody of the three children to Brian and April E., their first foster
parents. In addition, DCS alleged Mother had continued to violate the no-contact order by
having contact with Father and allowing the three boys to have contact with Father. DCS
further alleged Mother had tested positive for cocaine, opiates, and benzoylecgonine, that
she had been admitted to the Bristol Regional Medical Center Emergency Room as a result
of using bath salts, that she had been diagnosed with bipolar disorder, and that she had been
uncooperative.

       By June 2012, DCS filed another amended petition for temporary legal custody of
the three children, this time notifying the Juvenile Court that Brian and April E. were no
longer able to provide care for the three children non-custodially. The Juvenile Court
entered a protective custody order moving the three children back to DCS custody.
Testimony at trial established that Ethyn, Kamdyn, and Bentyn began residing with their
second foster parents, Mark and Vicky H. (“Foster Parents”) in January 2013. Ethyn left
the foster home in 2018, but the Children remained with Foster Parents throughout the
pendency of the case. In October 2012, the Juvenile Court adjudicated the Children
dependent and neglected.

        In January 2013, DCS sought suspension of Mother’s weekend visitation with the
Children alleging that Mother had tested positive for suboxone, opiates, oxycodone, and
methamphetamines at various points since November 2012, and that Mother had abused a
prescription for oxycodone. DCS also alleged Mother was not cooperating with
Comprehensive Community Services, an inpatient and outpatient program. The Juvenile
Court accordingly suspended Mother’s weekend visitation and restricted her to supervised
visitation.

        In January 2014, the Juvenile Court entered an order stating that Mother had not
visited the Children since September 2013, had been discharged from three rehabilitation
facilities for noncompliance, and had continued to use illegal drugs. The Juvenile Court
accordingly suspended Mother’s visits with the Children.

       DCS filed its first petition to terminate both parents’ rights to the Children on
January 24, 2014. DCS alleged the following grounds for termination of Mother’s parental
rights: (1) abandonment by failure to support, (2) substantial noncompliance with the
permanency plans, and (3) persistence of conditions. After the first petition was filed, DCS
alleged in later filings that Mother had continued to use illegal drugs and had done so while
nursing her newborn daughter, Makinlyn. In January 2015, the Juvenile Court adjudicated
                                             -3-
Makinlyn dependent and neglected and awarded temporary custody of Makinlyn to
Grandmother.

       The Juvenile Court provided that Mother would be allowed supervised visitation
with all four children at Grandmother’s home. In February 2016, the Juvenile Court again
suspended Mother’s visitation until she could demonstrate evidence of “stable mental
health.” At this point in the case, Mother had been in multiple inpatient and outpatient
programs for substance abuse and mental health treatment and hospitalized due to mental
health issues.

        Mother filed a motion to reinstate her supervised visitation, stating that she had
undergone extensive and intensive treatment and therapy at Woodridge Hospital and was
discharged in August 2016. The Juvenile Court entered an order reflecting that the parties
agreed that Mother’s supervised visitation would be reinstated starting November 1, 2016.
However, Elizabeth Kemp, a DCS caseworker assigned to the family’s case at the time,
testified that Mother’s last supervised visit with the Children was in November 2016
because of Mother’s continued hospitalizations due to her mental condition. In December
2016, Mother was again admitted to Woodridge Hospital for psychiatric care.

       Trial on the initial termination petition began on November 16, 2015. The Juvenile
Court heard testimony from Margaret Finely, a therapist with Frontier Health, and Mother.
For reasons not entirely clear, two days of testimony were heard in November 2015, but
the rest of the testimony was not presented to the Juvenile Court until May and July of
2022. DCS claims in its appellate brief that the nearly seven-year long gap between trial
dates was the result of “numerous attorneys being involved throughout the case, the
COVID-19 pandemic, and various time-consuming pleadings that were filed by an attorney
who no longer is involved in the case.” This Court has gleaned from its review of the
record that the delay may also have been due in part to DCS losing contact with Mother
for several years, as well as the complexity of Mother’s mental health status and her various
hospitalizations and inpatient stays in mental health facilities. Mother’s mental health
further deteriorated shortly after the trial dates in late 2015.

       DCS filed a motion to amend the termination petition in April 2016, seeking to add
the ground of mental incompetence pursuant to Tenn. Code Ann. § 36-1-113(g)(8) with
respect to Mother. The Juvenile Court granted DCS’s motion, and the matter was
continued due to Mother’s inpatient stay in a mental health facility. On April 24, 2017,
DCS filed its amended petition adding the ground of mental incompetence with respect to
Mother and detailing Mother’s long history of mental health hospitalizations.

       Prior to the filing of the amended petition, Grandmother was awarded a
conservatorship over Mother in an order entered by the Chancery Court for Sullivan
County (“the Chancery Court”) in May 2016. The Chancery Court found that Mother was
“a person who by reason of mental and physical infirmity is unable to manage her own
                                        -4-
affairs. Due to these medical and mental limitations, she is unable to manage her own
property or otherwise make decisions in her own best interest and needs a Conservator to
manage her affairs.” This conservatorship later was dismissed.

       In September 2019, a circuit court in Virginia (“the Virginia Court”) appointed
Mother’s sister (“Aunt”) and Grandmother as joint guardians of Mother. The Virginia
Court adjudicated Mother to be an incapacitated person, making the following findings:

              Physicians at NOVANT/Prince William Medical Center have
       diagnosed the Respondent with persistent delusional disorder, schizophrenia,
       and seizure disorder. Respondent was evaluated by Kossi P. Eklou, NP and
       Imran Akram, MD who each have the opinion that the Respondent is unable
       to make medical decisions, and that improvement would not be expected.
       The probable duration of her disability is permanent in nature.

               Pursuant to the findings and conclusions of the guardian ad litem, the
       Respondent is capable of making decisions regarding her personal care and
       financial affairs; however, during some periods her schizophrenia manifests
       itself as elaborate conspiracies and an alternate reality about her life which
       affects her ability to make sound decisions and keep herself from harm.
       Respondent is then in need of a Guardian.

(Paragraph numbering omitted.) The Virginia Court granted Aunt and Grandmother
decision-making authority in regards to Mother’s health care, specifically authority to
consent to medications and treatments on her behalf.

       In July 2021, DCS filed a motion to supplement its termination petition. DCS noted
that over four years had passed since it last amended its petition; that new laws had been
passed regarding termination of parental rights, including a revision of the best interest
factors; that Father had passed away and was no longer a party to the action; and that Ethyn
was no longer in DCS custody and no longer subject to the action.

       On October 12, 2021, DCS filed its final amended termination petition, removing
Ethyn and Father from the action. The final amended petition related only to the Children.
DCS added the additional termination ground of failure to manifest an ability and
willingness to assume custody of or financial responsibility for the Children, and alleged
the best interest factors as amended by the Legislature in 2021.

       Trial was held on May 12-13 and July 14 of 2022. The evidence at trial established
that Mother had extensive experience in mental health facilities over the past decade and
that her symptoms only began to stabilize once Grandmother and Aunt were appointed her
guardians. The evidence also included the Social Security Administration’s decision that
Mother had been disabled since May 31, 2013 based upon her mental condition. The Social
                                           -5-
Security Administration’s decision outlined Mother’s long history of mental illnesses,
hallucinations, psychosis, hospitalizations, and mental health treatment. On March 15,
2023, the Juvenile Court entered judgment terminating Mother’s parental rights to the
Children upon finding that DCS had proven the ground of mental incompetence by clear
and convincing evidence and that termination of Mother’s parental rights was in the
Children’s best interest. The Juvenile Court found that DCS had failed to carry its burden
of proof for the other alleged grounds. The Juvenile Court made the following findings of
fact in pertinent part:

                                  GROUND 6
                               (Amended Petition)
                            MENTAL INCOMPETENCE
                             T.C.A. §§ 36-1-113(g)(8)

      22. The Court finds based on the testimony of witnesses, and thorough
      review of the voluminous records from various mental health providers over
      the years that [Mother] is incompetent to provide adequately for the further
      care and supervision of the children because her mental condition is impaired
      and is so likely to remain impaired to a level that she will probably not be
      able to resume the care and responsibility for the children in the near future.

      23. The testimony of [Mother’s] family members was that she first
      manifested issues with her mental health at the age of six years old and
      continued throughout her childhood and early adulthood.

      24. [Mother’s] mental health problems were further exacerbated by her use
      of illegal drugs, and failure to follow her doctors’ orders in the use of her
      prescription medication.

      25. [Mother] had over a dozen hospitalizations with many instances wherein
      she would appear at an emergency room displaying thoughts and statements
      that were not based in reality and was subsequently hospitalized.

      26. [Grandmother] testified that several hospitalizations were due to the
      mother not taking her psychotropic medications as prescribed. Further that
      due to the same issue on one occasion the mother struck [Grandmother] on
      her arm. On another occasion when the mother requested [Grandmother] [to]
      take her [to] get cigarettes and when [Grandmother] refused the mother held
      a knife close to [Grandmother’s] face requiring several individuals to restrain
      her and remove the knife. The mother was subsequently hospitalized after
      that event.

                                           -6-
27. [Mother] has a persistent history of being prescribed medication to
address her mental health, not taking it appropriately leading to psychotic
episodes and decompensation. This was the driving factor for her mother
and sister to eventually gain conservatorship in Tennessee and guardianship
in Virginia in order to take control over [Mother’s] person to ensure she
received proper mental health treatment.

28. The conservatorship and guardianship orders were supported by qualified
physicians who evaluated [Mother] and determined that she was not able to
manage her own affairs in that her mental condition was severe, persistent,
disabling, and most likely permanent.

29. [Mother] was diagnosed with schizoaffective disorder characterized by
psychotic features with deterioration from a previous level of functioning.
She has experienced delusions or hallucinations[,] grossly disorganized
behavior and incoherence, loosening of associations, illogical thinking, and
poverty of content of speech with blunt affect. She has depression
characterized by anhedonia, sleep disturbance, decreased energy, feelings of
guilt or worthlessness, difficulty concentrating or thinking, thoughts of
suicide, and hallucinations, delusions, and paranoid thinking.

30. [Mother’s] psychological evaluation states that her impairments cause
marked restriction in activities of daily living, marked difficulties in
maintaining social functioning, moderate difficulties in maintaining
concentration, persistence or pace, and episodes of decompensation each of
extended duration.

31. [Mother’s] medical records indicate a history of severe mental illness
going back to childhood to wit:

      a) On May 24th 1994 [Mother] was hospitalized at HCA
      Dominion Hospital and the treating physician noted the day
      previous to admission she was planning to kill herself by
      jumping into the family swimming pool, but stopped at the last
      minute. [Mother] tried to run away but her parents stopped her.
      Over the previous week [Mother] was disruptive at school and
      unable to follow directions.

      b) [Mother] was in the fourth grade and had a long history of
      aggressive behavior and depression. She had outbursts
      wherein she screamed, bit and scratched herself, banged walls,
      and threw objects. She also attacked her parents and became
      increasingly rageful in the past week.         Her academic
                                  -7-
functioning had declined since February 1994, decreased
concentration and hypersexual behavior. She had been in
counseling since age five, and been treated with Mellaril,
Imipramine, and Zoloft.

c) [Mother] was placed at Springwood inpatient facility in
1990 and 1992 and was diagnosed with major depression and
attention deficit hyperactivity disorder and treated with Ritalin,
Clonidine, and Prozac and was discharged on June 7th, 1994.

d) From August 2011 to December 2015 [Mother] received
treatment from Frontier Mental Health for depression and
anxiety. The records indicate she experienced symptoms of
hopelessness, helplessness, problems with sleep, and feeling
overwhelmed and she was diagnosed with mood disorder,
bipolar disorder, depressive disorder, and anxiety disorder and
was treated with medication and case management. She
completed intensive outpatient program for substance abuse
and attended group meetings to assist with recovery.

e) From November 25th, 2013, to February 5th, 2014, [Mother]
completed Rainbow Residential treatment program for cocaine
addiction.

f) From June 2014 to October 2014 [Mother] received mental
health treatment at the Lloyd C. Elam Mental Health Center,
whose records show she had a history of bipolar disorder and
substance dependence. She reported having depressive
symptoms and manic and hypomanic symptoms. The records
also state [Mother] had decreased concentration, focus, and
hallucinations and she was treated with Topamax, Lithium,
Cymbalta, and Neurontin.

g) From September 15th, 2014, to September 18th, 2014,
[Mother] was hospitalized at Middle Tennessee Mental Health
Institute. The records indicate she reported symptoms of
depression, memory loss, auditory and visual hallucinations for
the last couple of weeks; feeling electrical shocks all over her
body; and having suicidal thoughts. She was diagnosed with
bipolar disorder with psychotic features, and was discharged
with Venlafaxine, Lithium, Topamax, Gabapentin, Vistaril,
Haldol, Cogentin, and Buspar.

                              -8-
h) From December 27th, 2015, to December 29th, 2015,
[Mother] was hospitalized at Indian Path Medical Center due
to an altered mental status. Their records indicate that she was
having confusion and auditory hallucinations. She reported
that she had not taken her Lithium in two days and was having
severe anxiety. [Mother] was diagnosed with altered mental
state, auditory hallucinations, and bipolar disorder and was
prescribed Gabapentin, Lithium, Lorazepam, Montelukast,
Tamsulosin, Tizanidine, and Topiramate.

i) On January 9th, 2016, [Mother] was seen at Indian Path
Medical Center emergency room and the records indicate she
exhibited significant confusion, anxiety, rambling, moderate
paranoia with disjointed thought processes. The treating
physician noted that her sentences would begin only to quickly
trail off and virtually all her verbal output ended with little
coherent or purposeful conclusions. She was observed to
wring her hands and seemed to be at a loss to express herself
satisfactorily, and that her frame of mind was frightening to
her. She was transferred to Woodridge Hospital for mental
health treatment.

j) From January 9th, 2016, to January 15th, 2016, [Mother] was
hospitalized at Woodridge Hospital for mental health
treatment.

k) On January 19th, 2016, [Mother] was seen at the emergency
room whose records indicate she had an altered mental state,
confusion, paranoia, manic, rambling, and tangential speech.
She was diagnosed with psychosis and transferred to
Woodridge Hospital for mental health treatment.

l) On February 24th, 2016, [Mother] was seen at the emergency
room, whose records indicate she had severe paranoia, anxiety,
agitation and withdrawal. She was noted to have illogical
though[t] processes and flight of ideas and was unable to
answer questions appropriately and was transferred to
Woodridge Hospital for mental health treatment.

m) On March 15th, 2016 [Mother] [was] seen at the emergency
room whose records indicate she was displaying anxiety,
depression, and hallucinations. The treating physician noted
                             -9-
       that she was at the emergency room a few days prior but left
       prior to treatment. The physician reported [Mother] had
       difficulty formulating answers, and she appeared scared and
       anxious, and was scratching her body and scalp. She was
       diagnosed with psychosis and transferred to Woodridge
       Hospital for mental health treatment.

       n) In August 2016 [Mother] was released from Woodridge
       Hospital inpatient treatment and returned in December 2016
       and remained there. Her discharge plan was to be committed
       permanently to a mental health facility once placement had
       been found.

       o) Dr. Rajesh Kadam recommended a conservator be appointed
       for [Mother] because she suffered from a mental condition of
       such severity that she is unable to make reasonable decisions
       regarding her medical or her health in general. Dr. Kadam
       reports that [Mother] is severely chronically mentally ill, and
       her mental illness was severe in degree and had led to mental
       impairment. He further reports that she had poor chronic
       mental condition, social conditions, adaptive behavior, and
       social skills, and poor physical condition, and had fair, poor,
       chronic educational condition.

32. [Mother] was declared disabled due to her mental illness by the Social
Security Administration effective May 31st, 2013.

33. [Mother] contacted DCS while she was a patient at Woodridge hospital
in 2016 and 2017 and made outrageous claims that she was then pregnant
with seven children; that Woodridge stole a previous child she was pregnant
with; that she has been drugged and physically abused; that she has a myriad
of physical ailments including various cancers; that she is the mother of thirty
three children and the majority of them were embryos housed by the State
and placed in surrogates; that [Father] has all of the children in his custody
at this time.

34. Since 2017 [Mother] has been relocated to Virginia and having reviewed
the medical and mental health records from her various providers in that state
it is noteworthy that some of the medications she was prescribed seem to
have exacerbated her symptoms. Some of the complaints she made to
medical professionals that were deemed to be illogical may have been actual
side effects of the medications.

                                     - 10 -
      35. In reviewing Exhibit 13, records from Prince William County dated
      January 27th, 2022, it details her past medications, treatment, and her plan for
      her future care with her legal guardians. Since that time the records reflect
      that [Mother’s] condition has stabilized at least to the extent she has not
      experienced the severe psychosis she suffered in the past.

      36. [Mother’s] diagnosis reflects, and this Court so finds that her mental
      impairment is most likely a permanent one. She has demonstrated over the
      years that she is not capable of maintaining her medication and treatment on
      her own and has done better recently due to her guardians overseeing her
      care. This has been for a limited time of approximately two years of a thirty-
      year mental impairment.

      37. [Mother] has been able to obtain employment and assist with caring for
      other children in the home but is not left alone with them as her guardians or
      other adults are always present.

      38. [Mother] does not have a drivers license, does not have a car, and her
      income is approximately $540 per month. She relies extensively on her
      family for support and for her own care.

      39. [Mother] testified that if she had custody of the children, she would need
      the assistance of others to care for them as would any parent. This Court
      finds that to be true to a certain extent however due to the foregoing [Mother]
      is not mentally capable of providing care for her children.

      40. The Court finds there is little chance that [Mother’s] condition can be
      improved to such an extent that the children can be placed safely with her in
      the foreseeable future.

The Juvenile Court further found that DCS proved by clear and convincing evidence that
termination of Mother’s parental rights was in the Children’s best interest. Mother timely
appealed.

                                        Discussion

       Although not stated exactly as such, Mother raises one issue on appeal: whether the
Juvenile Court erred by finding the statutory ground of mental incompetence by clear and
convincing evidence. Even though Mother does not raise an issue related to the Juvenile
Court’s best interest determination, we nevertheless must review this issue as well. See In
re Carrington H., 483 S.W.3d 507, 525-26 (Tenn. 2016) (“[I]n an appeal from an order
terminating parental rights the Court of Appeals must review the trial court’s findings as

                                           - 11 -
to each ground for termination and as to whether termination is in the child’s best interests,
regardless of whether the parent challenges these findings on appeal.”).

        As our Supreme Court has instructed regarding the standard of review in parental
rights termination cases:

               A parent’s right to the care and custody of her child is among the
       oldest of the judicially recognized fundamental liberty interests protected by
       the Due Process Clauses of the federal and state constitutions.2 Troxel v.
       Granville, 530 U.S. 57, 65, 120 S.Ct. 2054, 147 L.Ed.2d 49 (2000); Stanley
       v. Illinois, 405 U.S. 645, 651, 92 S.Ct. 1208, 31 L.Ed.2d 551 (1972); In re
       Angela E., 303 S.W.3d 240, 250 (Tenn. 2010); In re Adoption of Female
       Child, 896 S.W.2d 546, 547-48 (Tenn. 1995); Hawk v. Hawk, 855 S.W.2d
       573, 578-79 (Tenn. 1993). But parental rights, although fundamental and
       constitutionally protected, are not absolute. In re Angela E., 303 S.W.3d at
       250. “‘[T]he [S]tate as parens patriae has a special duty to protect minors .
       . . .’ Tennessee law, thus, upholds the [S]tate’s authority as parens patriae
       when interference with parenting is necessary to prevent serious harm to a
       child.” Hawk, 855 S.W.2d at 580 (quoting In re Hamilton, 657 S.W.2d 425,
       429 (Tenn. Ct. App. 1983)); see also Santosky v. Kramer, 455 U.S. 745, 747,
       102 S.Ct. 1388, 71 L.Ed.2d 599 (1982); In re Angela E., 303 S.W.3d at 250.
       “When the State initiates a parental rights termination proceeding, it seeks
       not merely to infringe that fundamental liberty interest, but to end it.”
       Santosky, 455 U.S. at 759, 102 S.Ct. 1388. “Few consequences of judicial
       action are so grave as the severance of natural family ties.” Id. at 787, 102
       S.Ct. 1388; see also M.L.B. v. S.L.J., 519 U.S. 102, 119, 117 S.Ct. 555, 136
       L.Ed.2d 473 (1996). The parental rights at stake are “far more precious than
       any property right.” Santosky, 455 U.S. at 758-59, 102 S.Ct. 1388.
       Termination of parental rights has the legal effect of reducing the parent to
       the role of a complete stranger and of “severing forever all legal rights and
       obligations of the parent or guardian of the child.” Tenn. Code Ann. § 36-1-
       113(l)(1); see also Santosky, 455 U.S. at 759, 102 S.Ct. 1388 (recognizing
       that a decision terminating parental rights is “final and irrevocable”). In light
       of the interests and consequences at stake, parents are constitutionally
       entitled to “fundamentally fair procedures” in termination proceedings.
       Santosky, 455 U.S. at 754, 102 S.Ct. 1388; see also Lassiter v. Dep’t of Soc.
       Servs. of Durham Cnty., N.C., 452 U.S. 18, 27, 101 S.Ct. 2153, 68 L.Ed.2d

2
  U.S. Const. amend. XIV § 1 (“[N]or shall any State deprive any person of life, liberty, or property,
without due process of law . . . .”). Similarly, article 1, section 8 of the Tennessee Constitution
states “[t]hat no man shall be taken or imprisoned, or disseized of his freehold, liberties or
privileges, or outlawed, or exiled, or in any manner destroyed or deprived of his life, liberty or
property, but by the judgment of his peers or the law of the land.”
                                               - 12 -
         640 (1981) (discussing the due process right of parents to fundamentally fair
         procedures).

                Among the constitutionally mandated “fundamentally fair
         procedures” is a heightened standard of proof – clear and convincing
         evidence. Santosky, 455 U.S. at 769, 102 S.Ct. 1388. This standard
         minimizes the risk of unnecessary or erroneous governmental interference
         with fundamental parental rights. Id.; In re Bernard T., 319 S.W.3d 586, 596
         (Tenn. 2010). “Clear and convincing evidence enables the fact-finder to
         form a firm belief or conviction regarding the truth of the facts, and
         eliminates any serious or substantial doubt about the correctness of these
         factual findings.” In re Bernard T., 319 S.W.3d at 596 (citations omitted).
         The clear-and-convincing-evidence standard ensures that the facts are
         established as highly probable, rather than as simply more probable than not.
         In re Audrey S., 182 S.W.3d 838, 861 (Tenn. Ct. App. 2005); In re M.A.R.,
         183 S.W.3d 652, 660 (Tenn. Ct. App. 2005).

               Tennessee statutes governing parental termination proceedings
         incorporate this constitutionally mandated standard of proof. Tennessee
         Code Annotated section 36-1-113(c) provides:

                Termination of parental or guardianship rights must be based
                upon:

             (1) A finding by the court by clear and convincing evidence that
                 the grounds for termination of 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.

         This statute requires the State to establish by clear and convincing proof that
         at least one of the enumerated statutory grounds3 for termination exists and
         that termination is in the child’s best interests. In re Angela E., 303 S.W.3d
         at 250; In re F.R.R., III, 193 S.W.3d 528, 530 (Tenn. 2006); In re Valentine,
         79 S.W.3d 539, 546 (Tenn. 2002). “The best interests analysis is separate
         from and subsequent to the determination that there is clear and convincing
         evidence of grounds for termination.” In re Angela E., 303 S.W.3d at 254.
         Although several factors relevant to the best interests analysis are statutorily
         enumerated,4 the list is illustrative, not exclusive. The parties are free to offer
         proof of other relevant factors. In re Audrey S., 182 S.W.3d at 878. The trial

3
    Tenn. Code Ann. § 36-1-113(g)(1)-(13).
4
    Tenn. Code Ann. § 36-1-113(i).
                                               - 13 -
court must then determine whether the combined weight of the facts
“amount[s] to clear and convincing evidence that termination is in the child’s
best interest.” In re Kaliyah S., 455 S.W.3d 533, 555 (Tenn. 2015). These
requirements ensure that each parent receives the constitutionally required
“individualized determination that a parent is either unfit or will cause
substantial harm to his or her child before the fundamental right to the care
and custody of the child can be taken away.” In re Swanson, 2 S.W.3d 180,
188 (Tenn. 1999).

        Furthermore, other statutes impose certain requirements upon trial
courts hearing termination petitions. A trial court must “ensure that the
hearing on the petition takes place within six (6) months of the date that the
petition is filed, unless the court determines an extension is in the best
interests of the child.” Tenn. Code Ann. § 36-1-113(k). A trial court must
“enter an order that makes specific findings of fact and conclusions of law
within thirty (30) days of the conclusion of the hearing.” Id. This portion of
the statute requires a trial court to make “findings of fact and conclusions of
law as to whether clear and convincing evidence establishes the existence of
each of the grounds asserted for terminating [parental] rights.” In re Angela
E., 303 S.W.3d at 255. “Should the trial court conclude that clear and
convincing evidence of ground(s) for termination does exist, then the trial
court must also make a written finding whether clear and convincing
evidence establishes that termination of [parental] rights is in the [child’s]
best interests.” Id. If the trial court’s best interests analysis “is based on
additional factual findings besides the ones made in conjunction with the
grounds for termination, the trial court must also include these findings in the
written order.” Id. Appellate courts “may not conduct de novo review of the
termination decision in the absence of such findings.” Id. (citing Adoption
Place, Inc. v. Doe, 273 S.W.3d 142, 151 & n. 15 (Tenn. Ct. App. 2007)).

                     B. Standards of Appellate Review

       An appellate court reviews a trial court’s findings of fact in
termination proceedings using the standard of review in Tenn. R. App. P.
13(d). In re Bernard T., 319 S.W.3d at 596; In re Angela E., 303 S.W.3d at
246. Under Rule 13(d), appellate courts review factual findings de novo on
the record and accord these findings a presumption of correctness unless the
evidence preponderates otherwise. In re Bernard T., 319 S.W.3d at 596; In
re M.L.P., 281 S.W.3d 387, 393 (Tenn. 2009); In re Adoption of A.M.H., 215
S.W.3d 793, 809 (Tenn. 2007). In light of the heightened burden of proof in
termination proceedings, however, the reviewing court must make its own
determination as to whether the facts, either as found by the trial court or as
supported by a preponderance of the evidence, amount to clear and
                                   - 14 -
      convincing evidence of the elements necessary to terminate parental rights.
      In re Bernard T., 319 S.W.3d at 596-97. The trial court’s ruling that the
      evidence sufficiently supports termination of parental rights is a conclusion
      of law, which appellate courts review de novo with no presumption of
      correctness. In re M.L.P., 281 S.W.3d at 393 (quoting In re Adoption of
      A.M.H., 215 S.W.3d at 810). Additionally, all other questions of law in
      parental termination appeals, as in other appeals, are reviewed de novo with
      no presumption of correctness. In re Angela E., 303 S.W.3d at 246.

In re Carrington H., 483 S.W.3d 507, 521-24 (Tenn. 2016) (footnotes in original but
renumbered). In conjunction with a best interest determination, clear and convincing
evidence supporting any single ground will justify a termination order. E.g., In re
Valentine, 79 S.W.3d 539, 546 (Tenn. 2002).

       The Juvenile Court found that DCS proved by clear and convincing evidence the
statutory ground of mental incompetence, pursuant to Tenn. Code Ann. § 36-1-113(g)(8),
which provides:

      (A) The chancery and circuit courts shall have jurisdiction in an adoption
      proceeding, and the chancery, circuit, and juvenile courts shall have
      jurisdiction in a separate, independent proceeding conducted prior to an
      adoption proceeding to determine if the parent or guardian is mentally
      incompetent to provide for the further care and supervision of the child, and
      to terminate that parent’s or guardian’s rights to the child;

      (B) The court may terminate the parental or guardianship rights of that person
      if it determines on the basis of clear and convincing evidence that:

      (i) The parent or guardian of the child is incompetent to adequately provide
      for the further care and supervision of the child because the parent’s or
      guardian’s mental condition is presently so impaired and is so likely to
      remain so that it is unlikely that the parent or guardian will be able to assume
      or resume the care of and responsibility for the child in the near future; and

      (ii) That termination of parental or guardian rights is in the best interest of
      the child;

      (C) In the circumstances described under subdivisions (8)(A) and (B), no
      willfulness in the failure of the parent or guardian to establish the parent’s or
      guardian’s ability to care for the child need be shown to establish that the
      parental or guardianship rights should be terminated[.]

                                           - 15 -
      This Court has previously explained the components of this statutory ground as
follows:

      The statute is intended to prevent a child from remaining indefinitely in foster
      care when the parents will not be able to properly care for the child due to
      mental illness. In re Diamond F., No. M2020-01637-COA-R3-PT, 2022 WL
      905791, at *10 (Tenn. Ct. App. Mar. 29, 2022). The relevant inquiry is
      whether clear and convincing evidence establishes that “the parent of the
      child is incompetent to adequately provide care and supervision because the
      parent’s mental condition is so impaired and likely to remain so that it is
      unlikely that the parent will be able to assume care and responsibility for the
      child in the future.” In re Jayda J., No. M2020-01309-COA-R3-PT, 2021
      WL 3076770, at *6 (Tenn. Ct. App. July 21, 2021) (quoting State Dept. of
      Children’s Services v. Whaley, No. E2001-00765-COA-R3-CV, 2002 WL
      1116430, at *14 (Tenn. Ct. App. May 30, 2002)). A finding of mental
      incompetence does not require a condition that is untreatable. In re Josie G.,
      [No. E2021-01516-COA-R3-CV,] 2022 WL 4241987, at *10 [(Tenn. Ct.
      App. Sept. 15, 2022)]. Instead, the statute requires impairment to the extent
      that the parent cannot adequately provide care and supervision of the child.
      Id. DCS must show (1) that the parent is presently unable to care for the
      child; and (2) that the parent is unlikely to be able to care for the child in the
      near future. In re Joseph D., No. M2021-01537-COA-R3-PT, 2022 WL
      16848167, at *19 (Tenn. Ct. App. Nov. 10, 2022) (citing In re David J.B.,
      No. M2010-00236-COA-R3-PT, 2010 WL 2889265, at *7 (Tenn. Ct. App.
      July 23, 2010)).

In re B.D.M., No. E2022-00557-COA-R3-PT, 2023 WL 3019005, at *14 (Tenn. Ct. App.
Apr. 20, 2023).

     We further note that this statutory ground is not limited to a condition for which “no
amount of intervention can assist.” In re S.M.R., No. M2008-01221-COA-R3-PT, 2008
WL 4949236, at *6 (Tenn. Ct. App. Nov. 18, 2008). This Court has previously explained:

      This Court has instead affirmed the termination of parental rights when
      parents have suffered from unalleviated mental disorders such as bipolar
      disorder, adjustment disorder with anxiety and depressed mood, dependent
      personality disorder, and schizophrenic disorder. See e.g., [State, Dep’t of
      Human Servs. v.] Smith, 785 S.W.2d [336] at 337-39 [(Tenn. 1990)]
      (affirming the termination of parental rights of a parent diagnosed with
      schizophrenic disorder on the basis of mental incompetence although the acts
      of the mentally disabled parent were not willful); In re S.M.R., [No. M2008-
      01221-COA-R3-PT,] 2008 WL 4949236, at *6 [(Tenn. Ct. App. Nov. 18,
      2008)] (affirming termination of parental rights on the statutory ground of
                                          - 16 -
       mental incompetence when the parent was diagnosed with bipolar disorder
       and personality disorder, not otherwise specified); Dep’t of Children’s Servs.
       v. M.R.N., No. M2006-01705-COA-R3-PT, 2007 WL 120038, at *10 (Tenn.
       Ct. App. Jan. 17, 2007) (affirming termination of parental rights on the
       statutory ground of mental incompetence based on a diagnosis of adjustment
       disorder with anxiety and depressed mood as well as dependent personality
       disorder). The parent’s mental condition, however, must impair the parent
       to an extent that he or she cannot adequately provide for the care and
       supervision of the child. See Tenn. Code Ann. § 36-1-113(g)(8)(B)(i).

In re Kenneth D., No. M2022-01466-COA-R3-PT, 2023 WL 4249519, at *8 (Tenn. Ct.
App. June 29, 2023).

       In summarizing the Juvenile Court’s findings of fact, we note that the Juvenile Court
found that DCS had proven this statutory ground for termination based upon Mother’s long
and persistent history of severe mental illnesses, numerous hospitalizations, her history of
not taking prescription medication as directed, the likely permanence of her mental
illnesses, Grandmother’s and Aunt’s guardianship of her, and the significant facts that
Grandmother does not permit her to be alone with children in the household and
Grandmother’s and Aunt’s continued administration of her prescription medication. The
evidence does not preponderate against these findings.

        In the decade preceding trial, Mother had been in and out of numerous inpatient and
outpatient programs and mental health facilities and hospitals, her most recent
hospitalization occurring in October 2019 after she threatened Grandmother with a knife.
Mother has consistently been diagnosed with various mental illnesses such as
schizoaffective disorder, bipolar disorder, delusional disorder, depression, and anxiety.
She also experienced periods of delusions and hallucinations in the past. Her most recent
medical records reflect a diagnosis of “Bipolar Disorder, Severe, with Psychotic Features.”
Mother testified that she has been diagnosed with anxiety, post-traumatic stress disorder,
attention deficit hyperactivity disorder, schizoaffective disorder, and bipolar II disorder.

       On appeal, Mother primarily argues that her mental condition has stabilized since
her last hospitalization and that she is not presently so impaired that she cannot assume
care and custody of the Children. Mother points to the fact that she is not currently
hospitalized, that she lives with and has the support and assistance of Grandmother and
Aunt, that she lives with and helps care for Makinlyn, and that she has been compliant with
her treatment plan. We agree, as did the Juvenile Court, that Mother’s condition improved
once Grandmother and Aunt were appointed guardians for her. However, we ultimately
agree with the Juvenile Court’s finding of this statutory ground, emphasizing that Mother’s
mental stability is a relatively new development and that she relies heavily on Grandmother
and Aunt to maintain that stability.

                                           - 17 -
        Mother’s last hospitalizations were in May and October of 2019. Mother was
hospitalized in May 2019 after she attempted to withdraw money from a non-existent bank
account, believed she was married to and had children with country music artist Luke
Bryan, and believed that Grandmother was holding her hostage. In September 2019, the
Virginia Court appointed Grandmother and Aunt as Mother’s guardians upon finding that
she was unable to make medical decisions and that her disability likely was permanent.
Shortly thereafter, in October 2019, Mother was hospitalized after assaulting her brother’s
girlfriend and threatening Grandmother with a knife. Her most recent medical records
reflect that her hospitalization was the result of “bizarre and reckless behavior such as
spending nights on the front porch and refusing to come inside, walking from Novant
Hospital to I-66 and catching a ride from a stranger to her sister’s house [ ], and delusional
beliefs such as working for the FBI and President Trump ‘helping secure the borders.’”

       Mother was discharged from an inpatient mental health facility in January 2020.
The record reveals no other psychotic or violent episodes since then. Mother’s last
hospitalization and inpatient treatment was approximately two and half years prior to the
conclusion of trial. Nevertheless, given Mother’s long and persistent history of psychotic
episodes, delusions, and recurring hospitalizations, we conclude that the Juvenile Court
reasonably treated Mother’s new-found stability cautiously and did not afford it great
weight in the face of decades of untreated or mistreated mental illnesses and the Virginia
Court’s finding that her mental condition likely was permanent.

       Even more concerning are the facts that Grandmother and Aunt continue to
administer Mother’s medication, keep her medication in a lock box, and do not leave
Mother alone with Makinlyn or any other children in the household. During her testimony,
Grandmother affirmed that she and Aunt petitioned for a guardianship of Mother because
she had been diagnosed with “persistent delusional disorder, schizophrenia, and seizure
disorder.” Grandmother testified that Mother continues to split time living between
Grandmother’s home and Aunt’s home. She explained that, as her guardians, Aunt and
she ensure that Mother “takes proper medical care, she shows up for appointments, she has
her medications correctly, housing, and just looking after her general well-being.”

       Although Grandmother testified that Mother is much better since her last
hospitalization in 2019, she was not confident that Mother could assume care and custody
of the Children and maintain their care and custody without assistance, as shown by this
interaction between DCS’s attorney and Grandmother:

       Q. Is she in the position to take custody of her children at this point? Do
       you think that Kamdyn and Bentyn should be placed in her custody and care?

       A. With help she can do it.

                                            - 18 -
Q. No, do you think, based on your knowledge of her as her mother, as her
conservator and as her guardian, do you think that she is currently, and
knowing her as well as you do, living under the same roof for however many
years and now living with your other daughter and having daily contact as
you previously testified to, is she today in a position to take care and custody
of Kamdyn and Bentyn?

A. Yes.

Q. Yes?

A. Yes.

***

Q. Okay, fine. Is she able to take care of [Makinlyn] on her own without
assistance?

A. Is she able to take care of . . .

Q. Any child.

A. Any child?

Q. Any child, on her own, with no assistance from any adult?

A. On a normal day, yeah.

Q. Why haven’t you transferred custody of [Makinlyn] back to her then?

A. Because I have a guardianship of [Mother].

***

Q. How does that answer the question? Is it because you have a guardianship
of [Mother] and she can’t have custody of [Makinlyn]?

A. We just haven’t done that.

***

                                       - 19 -
      Q. Yes, Tennessee will come to Virginia and take [Makinlyn] away from
      [Mother]. That is why you have not transferred legal custody back to
      [Mother]? It’s not because [Mother] can’t do it, right?

      A. [Mother] is still getting better. She is getting better everyday.

      ***

      Q. Yes, living independently on her own, caring for children, twenty-four
      hours a day, on her own without the assistance of another adult living with
      her. Can she do that?

      A. If she had to, yes, I think she could. Would it be extremely difficult? It
      is extremely difficult on any parent.

      ***

      Q. So you do trust [Mother] with children?

      A. Am I somewhere in the house or close by?

      Q. I don’t know.

      A. I am.

      Q. You would trust her with children as long as you were around?

      A. Someone was around.

      Q. As long as someone was around, another adult, right?

      A. Yeah.

(Emphasis added.) With respect to Mother’s medication, Grandmother explained that she
keeps Mother’s prescription medication in a “locked box” and that Aunt or she gives the
medication to her at “8:00 in the morning and 8:00 at night and they are handed to her.”
Mother’s most recent medical assessment reflects that the stabilization of her symptoms is
due to medication management.

        In sum, Grandmother’s testimony demonstrated that although Mother’s mental
stability had improved, her treatment and improvement were still ongoing but not yet fully
realized. Grandmother further testified that Mother could care for a child without
assistance on a “normal day.” Nevertheless, a parent must be able to care for his or her
                                           - 20 -
child every day. Moreover, it is troubling that Grandmother affirmed that she would not
leave Mother alone with a child without another adult’s supervision.

      Mother candidly testified how she feels about the guardianship over her:

      Q. You are aware that your mom and your sister have legal guardianship
      over you at this point, right?

      A. Yes.

      Q. What does that mean to you?

      A. I don’t really like it. I am almost forty years old and I think I can take
      care of myself. I don’t think I need that. I think at one point I did but I don’t
      think I need it now.

      Q. What is different? Well, let’s back up, [Mother], why would you say at
      one point you did need it?

      A. Because I wasn’t stable and I wasn’t able to take care of myself let alone
      anyone else. I think I am doing really well now and I am able to take care of
      myself and can take care of other people. I don’t see that it is necessary
      anymore.

      Q. Have you talked to them about getting rid of it?

      A. They know that.

      Q. They know what?

      A. They know I don’t like the idea of the guardianship.

      Q. I guess my question and I know it is broad when I said what does it mean
      to you. I guess I should ask more specifically how does your mom and sister
      use the guardianship? How does that come into play in your daily life? How
      does that work with your interactions with them and with other people and
      other institutions, I guess?

      A. I was used to keeping my medicines or other certain things put where I
      wanted to put them and take them when I wanted to take them like at 6:00 in
      the morning and at 6:00 at night or you know stuff like that. I had my own
      little routine down. That got messed up when they took over doing that stuff.

                                           - 21 -
       They started a whole new routine for me then. That messed me up and
       bothered me. It is just little stuff like that.

       Q. Is there other stuff that bothers you about the guardianship? Is there other
       things they have changed that you disagree with?

       A. I just feel restricted.

       Q. Are you not allowed to go places if you want to go somewhere? Do they
       not let you if you ask to go somewhere?

       A. Yeah.

       ***

       Q. Is the conservatorship an issue for you? Does your mother and your sister
       say that you can’t be alone with those other kids?

       A. No, they don’t say I can’t be alone with them or anything but . . . well,
       like yesterday she said didn’t want me going without my brother’s girlfriend
       to take [Makinlyn] to Pal’s. That bothered me.

       ***

       A. One minute she is okay with me doing something and the next minute
       she is not and it confuses me. I don’t know why. I don’t know.

       Mother’s testimony reflects several important facts. First, it is significant that she
does not think she needs a guardianship, revealing that she does not fully grasp the gravity
of her mental illnesses or her dependency on Grandmother and Aunt. Mother later testified
that she believed the Children should have never been removed from her custody.
Additionally, it is significant that Grandmother did not let Mother accompany Makinlyn
alone to a restaurant as recent as the day before Mother’s testimony, which clearly
demonstrates that Grandmother, who lives with and sees Mother every day, is not ready to
leave a child alone with Mother. We therefore conclude that DCS provided clear and
convincing evidence that Mother would be unable to supervise and care for the Children
due to her mental illnesses. See Tenn. Code Ann. § 36-1-113(g)(8)(B)(i) (“The parent or
guardian of the child is incompetent to adequately provide for the further care and
supervision of the child because the parent’s or guardian’s mental condition is presently so
impaired . . . .”) (emphasis added).

       The evidence also supports the Juvenile Court’s finding that Mother’s mental
condition likely is permanent and that Mother is unlikely to be able to provide care for the
                                          - 22 -
Children in the near future. In 2016, the Chancery Court appointed Grandmother Mother’s
conservator in part based upon the affidavit of a physician who examined Mother. In the
affidavit, the physician stated that Mother was “severely chronically mentally ill.” In
appointing Grandmother and Aunt guardians of Mother, the Virginia Court found that
Mother was “unable to make medical decisions”, “improvement would not be expected”,
and that the “probable duration of her disability is permanent in nature.” Mother’s long
history of mental illness, hospitalizations, and psychotic episodes, dating back to her
childhood, also supports the Juvenile Court’s determination that Mother’s mental
incompetence likely is permanent.

       The Juvenile Court’s determination is further supported by Grandmother’s and
Mother’s testimony that at the time of trial, Grandmother and Aunt were in full control of
Mother’s medication, kept it locked away, and administered it to Mother. Mother cannot
be expected to adequately care for the Children when she cannot be trusted to adequately
care for herself. This is compounded by the fact that Mother no longer desires to be under
their guardianship and would like to administer her prescription medication herself.
Mother does not wish this arrangement to continue, despite the fact that the guardianship
appears to be the reason why her symptoms have stabilized in the last two years.

        Furthermore, there was no indication that Grandmother and Aunt were ready to
dismiss the guardianship or return custody of Makinlyn to Mother at the time of trial. As
already noted, Grandmother would not let Mother accompany Makinlyn alone to a
restaurant the day before the final day of trial. Mother’s mental stability has improved, but
Mother’s own advocates are unwilling to trust Mother on her own at the time of trial.
Grandmother insisted that Mother was getting better every day, implying that her progress
is ongoing. There is simply no evidence in the record to indicate that the guardianship will
end any time soon or, more importantly, that it should end any time soon. We acknowledge
Mother’s recent improvement, but in light of her long history of mental illnesses and
recurring psychotic episodes, we conclude that her recent improvement is tenuous and
fragile. Accordingly, we conclude, as did the Juvenile Court, that DCS proved by clear
and convincing evidence that Mother’s mental illnesses likely were permanent and that it
is unlikely that Mother would be able to assume the care of and responsibility for the
Children in the near future.

       On appeal, Mother argues that she should be able to parent the Children with the
assistance of Grandmother and Aunt. Mother references the Americans with Disabilities
Act (“the ADA”), arguing that “mentally disabled parents are entitled to accommodations
to help them with parenting.” Neither party cites a Tennessee law or court decision
addressing this issue, nor have we found one. We accordingly look to other jurisdictions
for guidance. Summers Hardware & Supply Co., Inc. v. Steele, 794 S.W.2d 358, 362
(Tenn. Ct. App. 1990) (“Cases from other jurisdictions, including federal cases, are always
instructive, sometimes persuasive, but never controlling in our decisions.”).

                                           - 23 -
We find the Alabama Court of Civil Appeal’s analysis of this issue to be instructive:

       “The ADA, specifically 42 U.S.C. § 12132, provides:

       “‘Subject to the provisions of this subchapter, no qualified
       individual with a disability shall, by reason of such disability,
       be excluded from participation in or be denied the benefits of
       the services, programs, or activities of a public entity, or be
       subjected to discrimination by any such entity.’

        “The [parent] contends that DHR [Department of Human Resources]
is a public entity that discriminated against her by terminating her parental
rights on the basis of her mental deficiency. Pursuant to the ADA, a ‘mental
impairment that substantially limits one or more of the major life activities
of [an] individual’ is a disability. 42 U.S.C. § 12102(2). The ADA requires
a public entity to make ‘reasonable accommodation’ to allow the disabled
person to receive the services or to participate in the programs provided by
the public entity. 28 C.F.R. § 35.130(b)(7)(1994).

       “Most of the ADA challenges to parental-rights-termination
proceedings have been based on the premises either (1) that the ADA
preempts a state’s termination-of-parental-rights statutes by virtue of the
Supremacy Clause of Art. VI of the United States Constitution and,
accordingly, that the party seeking termination must show that the
requirements of the ADA have been met or (2) that the ADA constitutes a
defense to a parental-rights-termination proceeding. Both types of
challenges have been rejected by the vast majority of the courts that have
considered them. See generally Sherry S. Zimmerman, Annot., Parents’
Mental Illness or Mental Deficiency as Ground for Termination of Parental
Rights—Applicability of Americans with Disabilities Act, 119 A.L.R.5th 351
(2004). The Hawaii Supreme Court presented an accurate summary of the
law with respect to this issue in In re Doe, 100 Haw. 335, 60 P.3d 285 (2002):

               “‘Many of the cases examining the issue of parental
       rights and the ADA hold that a termination proceeding is not a
       “service, program, or activity” within the definition of the
       ADA and, consequently, the ADA does not apply to such
       proceedings. See In re Anthony P., 84 Cal. App. 4th 1112, 101
       Cal.Rptr.2d 423, 425 (2000) (“a proceeding to terminate
       parental rights is not a governmental service, program, or
       activity”); In re Antony B., 54 Conn. App. 463, 735 A.2d 893,
       899 (1999) (the ADA “neither provides a defense to nor creates
       special obligations in a parental rights termination
                                     - 24 -
              proceeding”); M.C. v. Dept. of Children and Families, 750
              So.2d 705, 706 (Fla. Dist. Ct. App. 2000) (“[D]ependency
              proceedings are held for the benefit of the child, not the
              parent.”); In re Terry, 240 Mich. App. 14, 610 N.W.2d 563,
              569 (2000) (“Termination of parental rights proceedings are
              not ‘services, programs or activities’ . . . [and] therefore a
              parent may not raise violations of the ADA as a defense to
              termination of parental rights proceedings.”); In re Adoption of
              Gregory, 434 Mass. 117, 747 N.E.2d 120, 125 (2001)
              (“Proceedings to terminate parental rights are not ‘services,
              programs, or activities,’ under provision of [the ADA] . . . and
              therefore, the ADA is not a defense to such proceedings.”).

                                            ***

              “100 Haw. at 340-41, 60 P.3d at 290-91.”

       13 So.3d at 975-76.

S.G. v. Barbour Cnty. Dep’t of Human Res., 148 So.3d 439, 446-47 (Ala. Civ. App. 2013)
(quoting K.J. v. Tuscaloosa Cnty. Dep’t of Human Res., 13 So.3d 971, 975-76 (Ala. Civ.
App. 2008)) (emphasis added). The Alabama Court of Civil Appeals in S.G. v. Barbour
Cnty. Dep’t of Human Res. concluded: “Consistent with the majority of courts that have
considered ADA challenges to termination-of-parental-rights proceedings, we hold that a
termination-of-parental-rights proceeding is not a service, program, or activity within the
meaning of the ADA and that, therefore, the ADA does not apply to such a proceeding.”
Id. at 447.

        We first note that, in making its best interest determination, the Juvenile Court found
that DCS made reasonable efforts to assist Mother, and that Mother does not contest this
finding. Moreover, the evidence does not preponderate against this finding. However,
Mother instead argues that she is entitled to retain her parental rights to the Children
because she has the assistance of Grandmother and Aunt. She does not argue that a state
agency or the Juvenile Court discriminated against her based upon her disability. We fail
to discern how the ADA protects her parental rights just because she currently has the
assistance of relatives, particularly when there is no guarantee such assistance will continue
given Mother’s desire to shed her guardianship. Furthermore, as demonstrated by S.G. v.
Barbour Cnty. Dep’t of Human Res., numerous state courts have rejected the proposition
that the ADA is a defense to a termination of parental rights proceeding.

      Mother also points to this Court’s opinion, State Dep’t of Children’s Servs. v.
Whaley, No. E2001-00765-COA-R3-CV, 2002 WL 1116430 (Tenn. Ct. App. May 30,
2002), in arguing that the Juvenile Court should have accounted for the assistance she
                                         - 25 -
receives from Grandmother and Aunt. With assistance, Mother argues that she can care
for and maintain responsibility for the Children. In Whaley, this Court reversed the juvenile
court’s termination of a blind and mentally impaired mother’s parental rights, finding the
following:

       Ms. Whaley has managed to live alone and take care of herself for several
       years. She has attended almost every scheduled visitation with her son.
       When Ms. Whaley lived in Smyrna and was in vocational training she rode
       a Greyhound bus back to Cleveland every other weekend to visit with her
       son. She has been able to regulate and properly administer her own
       prescription medications. She has completed vocational training and has
       obtained a job. She is able to move about the community using public
       transportation. Ms. Whaley manages to get herself to work on the correct
       days and at the correct time as well as attending church every Sunday. Most
       importantly, Ms. Whaley has a friend who is a retired educator and foster
       parent willing to assist her in the parenting of her child. These factors negate
       the argument that Ms. Whaley is incompetent to provide care and supervision
       to a child.

Id. at *14.

        However, the mother’s assistance by her friend in Whaley was just one of many
factors that weighed against a finding of this statutory ground. Unlike the mother in
Whaley, Mother does not regulate and administer her own prescription medications, a
significant fact in this case given Mother’s history of not taking medication as prescribed.
When Mother did live alone, her mental illnesses were not managed or were managed
poorly. Mother is entirely reliant on the stable environment Grandmother and Aunt have
fostered. They do not provide merely supplemental assistance to Mother but rather the
entire framework and environment in which Mother’s mental health remains stable. We
accordingly find Whaley distinguishable from the facts in this case and conclude that there
was clear and convincing evidence to support this statutory ground for termination.

       Having concluded that DCS established at least one statutory ground for termination
of Mother’s parental rights, we now consider the Juvenile Court’s determination that
termination of her parental rights is in the Children’s best interest. On October 12, 2021,
when DCS filed its second amendment to its termination petition, the statutory best interest
factors read as follows:

       (i)(1) In determining whether termination of parental or guardianship rights
       is in the best interest of the child, the court shall consider all relevant and
       child-centered factors applicable to the particular case before the court.
       Those factors may include, but are not limited to, the following:

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(A) The effect a termination of parental rights will have on the child’s critical
need for stability and continuity of placement throughout the child’s
minority;
(B) The effect a change of caretakers and physical environment is likely to
have on the child’s emotional, psychological, and medical condition;
(C) Whether the parent has demonstrated continuity and stability in meeting
the child’s basic material, educational, housing, and safety needs;
(D) Whether the parent and child have a secure and healthy parental
attachment, and if not, whether there is a reasonable expectation that the
parent can create such attachment;
(E) Whether the parent has maintained regular visitation or other contact with
the child and used the visitation or other contact to cultivate a positive
relationship with the child;
(F) Whether the child is fearful of living in the parent’s home;
(G) Whether the parent, parent’s home, or others in the parent’s household
trigger or exacerbate the child’s experience of trauma or post-traumatic
symptoms;
(H) Whether the child has created a healthy parental attachment with another
person or persons in the absence of the parent;
(I) Whether the child has emotionally significant relationships with persons
other than parents and caregivers, including biological or foster siblings, and
the likely impact of various available outcomes on these relationships and
the child’s access to information about the child’s heritage;
(J) Whether the parent has demonstrated such a lasting adjustment of
circumstances, conduct, or conditions to make it safe and beneficial for the
child to be in the home of the parent, including consideration of whether there
is criminal activity in the home or by the parent, or the use of alcohol,
controlled substances, or controlled substance analogues which may render
the parent unable to consistently care for the child in a safe and stable
manner;
(K) Whether the parent has taken advantage of available programs, services,
or community resources to assist in making a lasting adjustment of
circumstances, conduct, or conditions;
(L) Whether the department has made reasonable efforts to assist the parent
in making a lasting adjustment in cases where the child is in the custody of
the department;
(M) Whether the parent has demonstrated a sense of urgency in establishing
paternity of the child, seeking custody of the child, or addressing the
circumstance, conduct, or conditions that made an award of custody unsafe
and not in the child’s best interest;
(N) Whether the parent, or other person residing with or frequenting the
home of the parent, has shown brutality or physical, sexual, emotional, or
psychological abuse or neglect toward the child or any other child or adult;
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      (O) Whether the parent has ever provided safe and stable care for the child
      or any other child;
      (P) Whether the parent has demonstrated an understanding of the basic and
      specific needs required for the child to thrive;
      (Q) Whether the parent has demonstrated the ability and commitment to
      creating and maintaining a home that meets the child’s basic and specific
      needs and in which the child can thrive;
      (R) Whether the physical environment of the parent’s home is healthy and
      safe for the child;
      (S) Whether the parent has consistently provided more than token financial
      support for the child; and
      (T) Whether the mental or emotional fitness of the parent would be
      detrimental to the child or prevent the parent from consistently and
      effectively providing safe and stable care and supervision of the child.
      (2) When considering the factors set forth in subdivision (i)(1), the prompt
      and permanent placement of the child in a safe environment is presumed to
      be in the child’s best interest.
      (3) All factors considered by the court to be applicable to a particular case
      must be identified and supported by specific findings of fact in the court’s
      written order.
      (4) Expert testimony is not required to prove or disprove any factor by any
      party.
      (5) As used in this subsection (i), “parent” includes guardian.

Tenn. Code Ann. § 36-1-113(i) (West July 1, 2021 to June 30, 2022).

       With regard to making a best interest determination, the Tennessee Supreme Court
has instructed:

              These statutory factors are illustrative, not exclusive, and any party to
      the termination proceeding is free to offer proof of any other factor relevant
      to the best interests analysis. In re Carrington H., 483 S.W.3d at 523 (citing
      In re Audrey S., 182 S.W.3d 838, 878 (Tenn. Ct. App. 2005)). Facts
      considered in the best interests analysis must be proven by “a preponderance
      of the evidence, not by clear and convincing evidence.” In re Kaliyah S., 455
      S.W.3d at 555 (citing In re Audrey S., 182 S.W.3d at 861). “After making
      the underlying factual findings, the trial court should then consider the
      combined weight of those facts to determine whether they amount to clear
      and convincing evidence that termination is in the child’s best interest[s].”
      Id. When considering these statutory factors, courts must remember that
      “[t]he child’s best interests [are] viewed from the child’s, rather than the
      parent’s, perspective.” In re Audrey S., 182 S.W.3d at 878. Indeed, “[a]
      focus on the perspective of the child is the common theme” evident in all of
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       the statutory factors. Id. “[W]hen the best interests of the child and those of
       the adults are in conflict, such conflict shall always be resolved to favor the
       rights and the best interests of the child. . . .” Tenn. Code Ann. § 36-1-101(d)
       (2017).

               Ascertaining a child’s best interests involves more than a “rote
       examination” of the statutory factors. In re Audrey S., 182 S.W.3d at 878.
       And the best interests analysis consists of more than tallying the number of
       statutory factors weighing in favor of or against termination. White v.
       Moody, 171 S.W.3d 187, 193-94 (Tenn. Ct. App. 2004). Rather, the facts
       and circumstances of each unique case dictate how weighty and relevant each
       statutory factor is in the context of the case. See In re Audrey S., 182 S.W.3d
       at 878. Simply put, the best interests analysis is and must remain a factually
       intensive undertaking, so as to ensure that every parent receives
       individualized consideration before fundamental parental rights are
       terminated. In re Carrington H., 483 S.W.3d at 523. “[D]epending upon the
       circumstances of a particular child and a particular parent, the consideration
       of one factor may very well dictate the outcome of the analysis.” In re
       Audrey S., 182 S.W.3d at 878 (citing White v. Moody, 171 S.W.3d at 194).
       But this does not mean that a court is relieved of the obligation of considering
       all the factors and all the proof. Even if the circumstances of a particular
       case ultimately result in the court ascribing more weight—even outcome
       determinative weight—to a particular statutory factor, the court must
       consider all of the statutory factors, as well as any other relevant proof any
       party offers.

In re Gabriella D., 531 S.W.3d 662, 681-82 (Tenn. 2017).5

        In its best interest analysis, the Juvenile Court considered each of the relevant
factors enumerated in Tenn. Code Ann. § 36-1-113(i). The Juvenile Court made findings
of fact for each factor, and the evidence does not preponderate against those findings. The
Juvenile Court reasoned that the Children had spent most of their lives in Foster Parents’
home and noted that Kamdyn testified that he desired to stay with Foster Parents and that
he viewed them as his parents. The Juvenile Court found that to remove the Children from
their current home would be devastating to them. In contrast, Mother only recently had
developed a semblance of mental stability and, as the Juvenile Court found, her
commitment to maintaining consistent mental health is uncertain. Given her long history

5
 In In re Gabriella D., a prior version of the best interest factors was in effect. However, we
believe the Tennessee Supreme Court’s analysis applies to the amended version of Tenn. Code
Ann. § 36-1-113(i), as well.

                                            - 29 -
of hospitalizations, desire to have control over her medication, and frustration with the
guardianship, the evidence certainly supports this finding.

        In contrast to their parental attachment with Foster Parents, the Juvenile Court found
that there was no secure and healthy parental attachment between Mother and the Children.
There is no meaningful relationship between the Children and Mother given that Mother
had not seen the Children since 2016. Kamdyn testified that he wanted to stay with Foster
Parents because he had lived with them his whole life, and he described Mother’s and
Grandmother’s home as “chaotic.” The Juvenile Court further found that Mother had not
provided safe and stable care for the Children and would not be able to “one on one.”
Mother’s and Grandmother’s testimony supported this finding. Mother is not left alone
with children.

       Much depends on Mother’s continued medication management and supervision. As
the Juvenile Court noted with respect to factor (P), whether Mother understands the
Children’s needs depends on whether Mother is taking her medication as prescribed. With
respect to factors (Q) and (R), the Juvenile Court found that she is not yet able to provide
the Children with consistent and proper care, and that her ability to provide the Children
with a safe and healthy environment depends on the supervision of another adult. Although
the Juvenile Court found that these factors did not weigh in favor of or against termination,
the Juvenile Court’s findings related to these factors reflect the fragility of Mother’s mental
status and that she cannot parent alone. The Juvenile Court further found that Mother’s
mental unfitness would be detrimental to the Children and prevent her from consistently
and effectively providing safe and stable care and supervision for the Children. The
evidence does not preponderate against the Juvenile Court’s findings and clear and
convincing evidence supports its determination that termination of Mother’s parental rights
was in the Children’s best interest. We accordingly affirm the Juvenile Court’s judgment.

                                         Conclusion

       The judgment of the Juvenile Court is affirmed, and this cause is remanded to the
Juvenile Court for collection of costs below. The costs on appeal are assessed against the
appellant, Tara C., and her surety if any.

                                                     _________________________________
                                                     D. MICHAEL SWINEY, CHIEF JUDGE

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