In re C.C. ( 2016 )


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  •                 IN THE COURT OF APPEALS OF TENNESSEE
    AT KNOXVILLE
    Assigned on Briefs August 2, 2016
    IN RE C.C. ET AL.
    Appeal from the Juvenile Court for Jefferson County
    No. 15-00449 Dennis (Will) Roach, II, Judge
    No. E2016-00475-COA-R3-PT-FILED-SEPTEMBER 22, 2016
    _________________________________
    The Department of Children’s Services filed a petition seeking, on the basis of four
    grounds, to terminate the parental rights of H.C. (Mother) to her four children, C.C.,
    D.C., A.D., and S.D. (collectively the Children). In the same petition, DCS also sought
    to terminate, on three grounds, the parental rights of B.D., Mother’s long-time boyfriend
    and father of two of the Children, i.e., A.D. and S.D. (collectively the twins).1 The trial
    court found, by clear and convincing evidence, three grounds to terminate Mother’s
    parental rights and three grounds to terminate B.D.’s parental rights. By the same
    quantum of proof, the court found that termination is in the Children’s best interest.
    Mother and B.D. (collectively the parties) appeal. As modified, we affirm the judgment
    of the trial court.
    Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Juvenile Court
    Affirmed as Modified; Case Remanded
    CHARLES D. SUSANO, JR., J., delivered the opinion of the court, in which ANDY D.
    BENNETT, J, and J. STEVEN STAFFORD, P.J., W.S., joined.
    Kimberly R. Grace, Jefferson City, Tennessee, for the appellant H.C.
    John T. Sholly, Knoxville, Tennessee, for the appellant, B.D.
    Herbert H. Slatery III, Attorney General and Reporter, and M. Cameron Himes, Assistant
    Attorney General, Nashville, Tennessee, for the appellee, Tennessee Department of
    Children’s Services.
    1
    In the same petition, DCS also sought to terminate the parental rights of J.C., the
    biological father of Mother’s other two children, C.C. and D.C. Those rights were terminated in
    an order entered February 3, 2016. That case is not before us on this appeal.
    W. Keith Repass, Dandridge, Tennessee, Guardian Ad Litem.
    OPINION
    I.
    The makeup and dynamics of this “family” are somewhat convoluted. Mother and
    J.C., a convicted sex offender,2 had two children together, i.e., a daughter, C.C., and a
    son, D.C. The couple had lived together for approximately two and a half years when
    they married shortly after D.C.’s birth. Four days after their marriage, J.C. abruptly
    moved out. Neither pursued a divorce. Soon, Mother began cohabitating with B.D., with
    whom she had an “open” relationship, one that included other sexual partners. As
    previously noted, Mother and B.D. had twin daughters. At some point J.C. returned. For
    a time, the parties, the Children, J.C., and J.C.’s girlfriend all lived in the same house.
    The parties and the “others” resided in Kentucky. That state’s equivalent of DCS was
    referred to the house sixteen times. It once removed the Children for two days.
    Around December 25, 2011, the parties and the Children moved from Clay,
    Kentucky to Talbott, Tennessee. Mother contends that they moved in order to be closer
    to her son’s diabetic medical care at Vanderbilt University Hospital. Contrary to
    Mother’s assertion, the “distance” factor could not have been the reason for the move.
    This is because Vanderbilt is approximately two hundred miles from Talbott and
    approximately one hundred and thirty miles from Clay, Kentucky.3 In other words, the
    parties were closer to Vanderbilt when they lived in Kentucky. The evidence indicates
    that Mother moved to Talbott to be near Jamie D. and Joshua D., a married couple who
    lived there. Mother had met them through a chat room on the internet. She began a
    sexual relationship with the couple prior to her family’s relocation to Tennessee. That
    relationship was ongoing at the time of trial in 2015. At trial, Joshua D. estimated that
    the relationship had lasted for “the better part of five years.” Mother and Joshua D.
    describe their relationship as a “master-slave” relationship that involves BDSM.4 The
    2
    Prior to living with Mother, J.C. had been convicted in Michigan of fourth degree
    sexual assault.
    3
    The travel distances stated here are based             on   Google    Maps.      See
    https://www.google.com/maps/ (last visited Sept. 7, 2016).
    4
    The guardian ad litem states in his brief that BDSM is an “acronym . . . for bondage,
    discipline, sadism, and masochism” (citing State v. Bvocik, 
    781 N.W.2d 719
    , 721 n.2 (Wis. Ct.
    2
    proof shows that B.D. was aware of the nature of their relationship, as were the Children.
    Prior to their removal, the Children were in contact with Joshua D. several times a week.
    Joshua D. made sex toys. Mother sold them door-to-door. Mother stated that she
    also earned income by cleaning houses and offices. C.C. testified that Mother engaged in
    prostitution. Mother denied this claim. Mother challenged C.C.’s credibility. B.D. did
    not work. He received a Social Security Disability check for gout – a condition which he
    says has rendered him disabled since 2005. While in Tennessee, Mother was introduced
    to James C. by a person she met at a gas station. After knowing James C. for about six
    months, she allowed him to live with the “family” three days a week for babysitting
    purposes. Shortly thereafter, a restraining order was entered against him after he
    physically abused the child, C.C.
    In October 2012, DCS responded to a referral accusing Mother of physical abuse
    and psychological harm. DCS case manager Desmond Woodruff found no basis for the
    allegations, but “other concerns were noted.” DCS filed a petition for an order against
    Mother, J.C., and B.D. In that petition, DCS stated the following:
    The family’s home was dirty and cluttered with clothes, trash,
    and food strewn throughout the home. . . . Woodruff observed
    gnats and flies in the [C]hildren’s bedroom. One of the
    bathrooms had clothes, trash, and toilet paper in the sink.
    Also in the sink were gnats, flies, and ants.
    There was no food in the home for the [C]hildren. Mother
    admitted there was no food. . . .
    Mother reported that they are past due on this month’s rent.
    DCS had already paid the previous month’s rent during a
    prior case with this family.
    The [C]hildren were not enrolled in school at this time.
    Mother reported that she chose to home school [D.C.] due to
    his behavioral issues. Mother then decided to home school all
    of the [C]hildren. However, [D.C.] stated he does not do any
    school work at home. The remaining children reported that
    the Mother had only “written out some math problems” for
    App. 2010)) “or bondage, domination, sadism, and masochism,” (citing Harrison v.
    Commonwealth, No. 1244-14-2, 
    2015 WL 5945233
    , at *1 (Va. Ct. App., filed Oct. 13, 2015)).
    3
    them to do. Neither the Mother, nor [B.D.], were able to
    produce any documentation of the [C]hildren’s school work
    when asked[.]
    The Mother later showed [case manager] Woodruff
    paperwork to enroll [C.C.],[A.D.], and [S.D.] into [school]
    ....
    On [October 3, 2012], [D.C.] was charged with aggravated
    assault after attempting to attack a neighbor with a knife. The
    child, [D.C.], has since been committed to . . . a mental health
    facility in Chattanooga, TN.
    Mother reported that [C.C.] has been in therapy . . . since
    January 2012, but admitted that the child has not been to her
    appointments for the last month.
    There have been six (6) investigations of this family in 2012
    alone for the following allegations: medical maltreatment,
    nutritional neglect, sexual abuse, physical abuse,
    environmental neglect, and psychological harm. The last
    DCS case closed in Jefferson Juvenile Court on [September
    18, 2012].
    (Paragraph lettering in original omitted.) On October 15, 2012, the trial court granted
    DCS’s petition. The subsequent order required Mother and B.D. to (1) enroll the girls in
    school and D.C. in an accredited home school; (2) clean the home; (3) develop a home
    cleaning system; (4) create a budget; (5) ensure C.C. attends therapy appointments; and
    (6) report weekly to DCS. The Children were removed from the home on October 26,
    2012, for reasons of environmental neglect, housing issues, medical neglect, and failure
    to enroll the Children in school. At that time, the Children faced several medical
    problems. C.C., A.D., and S.D. had lice and flea bites, among other things. D.C., who
    has a rare form of diabetes, was placed in a residential facility to monitor his high blood
    sugar, which was measured at 600. The Children faced mental health issues. They all
    have mood disorders. C.C. and A.D. threatened suicide. The twins had severe
    nightmares. D.C. had post-traumatic stress disorder, an immune-anxiety disorder, and a
    propensity for violent outbursts.
    The trial court adjudicated the Children dependent and neglected on March 19,
    2013. On May 27, 2015, DCS filed a petition to terminate parental rights. DCS sought
    4
    to terminate the parental rights of the parties on three of the same grounds – abandonment
    by failure to provide a suitable home, pursuant to Tenn. Code Ann. § 36-1-113(g)(1)
    (2014), -102(1)(A)(ii) (2014); persistence of conditions, pursuant to Tenn. Code Ann. §
    36-1-113(g)(3); and mental incompetence, pursuant to Tenn. Code Ann. § 36-1-
    113(g)(8). DCS sought to terminate Mother’s parental rights for a fourth ground –
    abandonment by willful failure to support, pursuant to Tenn. Code Ann. § 36-1-
    113(g)(1), -102(1)(A)(i), (D). The trial court found, by clear and convincing evidence,
    grounds to terminate Mother’s parental rights for persistence of conditions, as well as
    abandonment for failure to support and failure to provide a suitable home. By the same
    evidentiary standard, the trial court found grounds to terminate B.D.’s parental rights for
    abandonment for failure to provide a suitable home, persistence of conditions, and mental
    incompetence. The trial court also found, clearly and convincingly, that termination of
    the parental rights of the parties is in the Children’s best interest. The parties appeal.
    II.
    Mother raises one issue: “Whether the [t]rial [c]ourt erred in terminating [her]
    parental rights on the grounds of abandonment by failure to support, abandonment by
    failure to provide a suitable home, and persistent conditions.”
    B.D. raises the following issues, which we reprint verbatim from his brief:
    Did the trial court err by finding that statutory grounds
    existed to terminate the parental rights of [B.D.]?
    A. Was sufficient evidence presented to find that [B.D.] failed
    to provide a suitable home for his children?
    B. Was sufficient evidence presented to find that the same
    conditions persisted that originally resulted in the [C]hildren
    being brought into custody?
    C. Was sufficient evidence presented to find that [B.D.] is
    mentally incompetent?
    Did the trial court err by finding it was in the Children’s best
    interest to terminate the parental rights of [B.D.]?
    *      *      *
    5
    Did the trial court err by terminating both parents’ rights,
    when Tennessee law allows for the termination of only one
    parent’s rights when their circumstances are different?
    (Paragraph numbering and capitalization in original omitted.)
    III.
    A parent has a fundamental right, based on both the federal and state constitutions,
    to the care, custody, and control of his or her child. Stanley v. Ill., 
    405 U.S. 645
    , 651
    (1972); In re Angela E., 
    303 S.W.3d 240
    , 250 (Tenn. 2010); Nash-Putnam v. McCloud,
    
    921 S.W.2d 170
    , 174-75 (Tenn. 1996). While this right is fundamental, it is not absolute.
    The State may interfere with a parent’s rights in certain circumstances. In re Angela 
    E., 303 S.W.3d at 250
    . Our legislature has listed the grounds upon which termination
    proceedings may be brought. Tenn. Code Ann. § 36-1-113(g). Termination proceedings
    are statutory, In re Angela 
    E., 303 S.W.3d at 250
    ; Osborn v. Marr, 
    127 S.W.3d 737
    , 739
    (Tenn. 2004), and a parent’s rights may be terminated only where a statutory basis exists.
    Jones v. Garrett, 
    92 S.W.3d 835
    , 838 (Tenn. 2002); In the Matter of M.W.A., Jr., 
    980 S.W.2d 620
    , 622 (Tenn. Ct. App. 1998).
    To terminate parental rights, a court must determine by clear and convincing
    evidence the existence of at least one of the statutory grounds for termination and that
    termination is in the child’s best interest. Tenn. Code Ann. § 36-1-113(c); In re
    Valentine, 
    79 S.W.3d 539
    , 546 (Tenn. 2002). “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 586
    , 596 (Tenn. 2010) (citations omitted).
    Unlike the preponderance of the evidence standard, “[e]vidence satisfying the clear and
    convincing standard establishes that the truth of the facts asserted is highly probable.” In
    re Audrey S., 
    182 S.W.3d 838
    , 861 (Tenn. Ct. App. 2005).
    Once a ground for termination is established by clear and convincing evidence, the
    trial court conducts a best interest analysis. In re Angela 
    E., 303 S.W.3d at 251
    (citing
    In re Marr, 
    194 S.W.3d 490
    , 498 (Tenn. Ct. App. 2005)). “The best interest[ ] analysis
    is separate from and subsequent to the determination that there is clear and convincing
    evidence of grounds for termination.” 
    Id. at 254.
    The existence of a ground for
    termination “does not inexorably lead to the conclusion that termination of a parent’s
    rights is in the best interest of the child.” In re C.B.W., No. M2005-01817-COA-R3-PT,
    
    2006 WL 1749534
    , at *6 (Tenn. Ct. App., filed June 26, 2006).
    6
    We are required to review all of the trial court’s findings with respect to grounds
    and best interest. In re Carrington, 
    483 S.W.3d 507
    , 525-26 (Tenn. 2016) (“[W]e hold
    that in an appeal from an order terminating parental rights the Court of Appeals must
    review the trial court’s findings as to each ground for termination and as to whether
    termination is in the child’s best interest[ ], regardless of whether the parent challenges
    these findings on appeal.”).
    The Supreme Court has recently delineated our standard of 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). 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 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
    convincing evidence of the elements necessary to terminate
    parental rights. 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. Additionally, all other
    questions of law in parental termination appeals, as in other
    appeals, are reviewed de novo with no presumption of
    correctness.
    
    Id. at 523-24
    (internal citations omitted). “When a trial court has seen and heard
    witnesses, especially where issues of credibility and weight of oral testimony are
    involved, considerable deference must be accorded to . . . the trial court’s factual
    findings.” In re Adoption of S.T.D., No. E2007-01240-COA-R3-PT, 
    2007 WL 3171034
    ,
    at *4 (Tenn. Ct. App., filed Oct. 30, 2007) (citing Seals v. England/Corsair Upholstery
    Mfg. Co., Inc., 
    984 S.W.2d 912
    , 915 (Tenn. 1999)).
    IV.
    B.D. questions whether the trial court erred by terminating both his and Mother’s
    parental rights “when Tennessee law allows for the termination of only one parent’s
    rights when their circumstances are different.” (Capitalization and emphasis in original
    7
    omitted.) Citing In re Audrey 
    S., 182 S.W.3d at 838
    , he argues that “[i]n most all areas
    on [sic] consideration, the circumstances of [B.D.] are substantially different from the
    circumstances of [Mother].” He asserts that, different from Mother, he only has parental
    rights to the twins, paid support, faces the ground of mental incompetence on appeal, and
    has a more “easy going” approach to parenting.
    We recognize that termination of parental rights cases require “individualized
    decision making” due to “the gravity of [the] consequences.” In re K.H., No. W2008-
    01144-COA-R3-PT, 
    2009 WL 1362314
    , at *7 (Tenn. Ct. App., filed May 15, 2009)
    (citation and internal quotation marks omitted). DCS must establish that a ground for
    termination exists against each parent and that termination of each parent’s parental rights
    is in the best interest of the children. Tenn. Code Ann. § 36-1-113(c). However, the
    relevant facts of In re Audrey S. differ significantly from the case now before us. There,
    of the two fathers involved, one was the mother’s high school boyfriend whom she lived
    with briefly before their relationship ended in 1995. 
    Id. at 849.
    The other was a man the
    mother dated briefly in 1998. 
    Id. at 851.
    Both fathers filed a petition to terminate the
    mother’s parental rights in 2003. 
    Id. at 856-57.
    At that time, the mother, who had been
    in and out of incarceration for most of her children’s lives, had begun a lengthy sentence
    for especially aggravated kidnapping and aggravated robbery convictions. 
    Id. at 855.
    Neither father was involved in those crimes. 
    Id. In that
    case, the mother’s circumstances
    were different from those of the fathers.
    Here, Mother and B.D. have been in a relationship and lived together for well over
    a decade. Together, they moved in 2011 with the Children to Tennessee. The Children
    were removed from a house they shared. The two continued to live together through the
    time of trial, despite several changes in their residence. The trial court found only two
    grounds for termination had been established against both Mother and B.D. – failure to
    provide a suitable home and failure to remedy persistence of conditions. DCS must
    establish proof of these grounds against each individual parent. However, given Mother
    and B.D.’s living situation during the relevant time period, as well as issues that caused
    the Children’s removal from the home, we disagree that B.D. and Mother generally had
    “substantially different . . . circumstances” as it relates to these two grounds.
    V.
    A.
    The trial court concluded as follows with regard to whether Mother abandoned the
    Children through willful failure to support in the four consecutive months immediately
    preceding the filing of the petition to terminate parental rights:
    8
    [Mother] was aware of her duty to pay support, as she was
    under court order to do so. She was aware of the
    consequences of her failure to support, as she signed the
    Criteria for Termination of Parental Rights. [Mother] had the
    capacity to provide support and had no justifiable excuse for
    not paying support. [Mother] was able to work during the
    four months prior to the filing of termination, and did in fact
    work as a house cleaner and a manufacturer of sex toys.
    [Mother] has no justifiable excuse for her failure to support.
    Our review of the record demonstrates that the evidence does not preponderate against
    the trial court’s factual findings on this ground. From the above facts, the trial court
    concluded the ground of abandonment by failure to support was proven against Mother
    by clear and convincing evidence.
    Termination is proper if the parent abandons the child. Tenn. Code Ann. § 37-1-
    113(g)(1). Tenn. Code Ann. § 36-1-102(1)(A)(i), (D) defines abandonment as:
    For a period of four (4) consecutive months immediately
    preceding the filing of a proceeding or pleading to terminate
    the parental rights of the parent . . . of the child who is the
    subject of the petition for termination of parental rights . . .
    that the parent . . . [has] willfully failed to support or [has]
    willfully failed to make reasonable payments toward the
    support of the child;
    *      *      *
    For purposes of this subdivision (1), “willfully failed to
    support” or “willfully failed to make reasonable payments
    toward such child’s support” means the willful failure, for a
    period of four (4) consecutive months, to provide monetary
    support or the willful failure to provide more than token
    payments toward the support of the child[.]
    As this court previously stated, “[f]ailure to support a child is ‘willful’ when a person is
    aware of his or her duty to support, has the capacity to provide the support, makes no
    attempt to provide support, and has no justifiable excuse for not providing the support.”
    In re Adoption of Muir, No. M2002-02963-COA-R3-CV, 
    2003 WL 22794524
    , at *5
    9
    (Tenn. Ct. App., filed Nov. 25, 2003) (citations omitted). Further, “[t]he willfulness of
    particular conduct depends upon the actor’s intent. Intent is seldom capable of direct
    proof, and triers-of-fact lack the ability to peer into a person’s mind to assess intentions
    or motivations. Accordingly, triers-of-fact must infer intent from the circumstantial
    evidence, including a person’s actions or conduct.” 
    Id. In the
    present case, Mother signed the Criteria and Procedures for Termination of
    Parental Rights on November 19, 2012. The document outlined her duty to make support
    payments, as well as the consequences for failing to do so. In March 2013, the trial court
    had ordered her to begin paying monthly support of $50 for each child, as well as $60 in
    arrears. On October 21, 2013, by court order, Mother was referred to the Tennessee
    Child Support Employment and Parenting Program (TCSEPP), which aims “to help non-
    custodial parents overcome problems which have caused or may cause them to be unable
    to pay child support regularly,” according to the order. Mother’s TCSEPP case was
    closed on March 13, 2014 because of her “fail[ure] to job search or complete
    assignments.” Mother was “not eligible for re-enrollment.” Prior to filing the
    termination petition, Mother had made less than one month’s full support payment. As of
    September 30, 2015, she owed $6,198.48 for child support arrears. She was held in
    contempt in October 2015 for non-payment of support.
    Mother testified that she earned about $200 to $450 each week cleaning houses
    after the Children were removed from her home. However, she could not produce proof
    of her legal income due to, she said, her clients’ request for privacy and the direct
    application of her earnings to pay her bills. Mother later got a job with home health
    agency AllCare, through which child support could be garnished from her wages. B.D.
    received $930 each month in disability payments. His testimony indicated that, together,
    their monthly household expenses totaled about $1,200 – $650 for rent, $112 for cable,
    $112 car payment, $67 car insurance payment, $85 for a cell phone, and $200 for
    utilities. He had a $100 child support payment for the twins garnished from his disability
    benefit.
    Although their reported household income exceeded their reported expenses,
    Mother denies that her failure to pay support was willful. At trial, she testified that she
    made child support payments whenever she was able. She states in her brief that she
    experienced medical issues with Bell’s Palsy and a hormonal imbalance, both of which
    “prevented her from being able to work or significantly limited her ability to work.” She
    provided no documentation of these illnesses. Mother also argues in her brief that “[a]t
    no point in the record did DCS provide evidence of the fact [Mother] had money and
    rather than giving it to her children, she willfully kept it for herself[.]” This is not the
    standard. Instead, we find Mother was aware of her duty to provide support payments,
    10
    had the capacity to provide support, made no attempt to pay more than token support, and
    had no justifiable excuse for not providing the support. In re Adoption of Muir, 
    2003 WL 22794524
    , at *5. Taking all of these factors into account, we hold that the evidence
    clearly and convincingly demonstrates Mother willfully failed to support the Children.
    B.
    For both of the parties, the trial court made separate, but nearly identical, findings
    of fact and conclusions of law on the ground of abandonment by failure to provide a
    suitable home, which we present together. For both, the trial court held that this ground
    was proven by clear and convincing evidence based on the following:
    The [C]hildren were removed from the home of [the parties]
    and placed into DCS custody on October 26, 2012. The
    Jefferson County Juvenile Court adjudicated the [C]hildren
    dependent and neglected and found that DCS had made
    reasonable efforts to prevent removal of the [C]hildren from
    the home. The Court finds that DCS made reasonable efforts
    to assist [Mother] in establishing a suitable home; however,
    [the parties] did not make any reasonable efforts to provide a
    suitable home.        Case Manager Susan Moyers made
    reasonable efforts to assist [the parties] in finding a home
    during the four month period from October 26, 2012 until
    February 26, 2013, by working diligently to find a home for
    the [parties] in both Hamblen and Jefferson counties. The
    [parties] were subsequently evicted from their mobile home,
    and temporarily moved into a motel in Cocke County before
    finally settling at their current address. As of August 2014
    the home of the [parties] had one bed in the house, and as of
    May 2015 two beds were in the home, which remains an
    inadequate number for six individuals. Finally, and most
    noteworthy in the eyes of this [c]ourt, three years from the
    date of removal, and in spite of a permanency plan
    requirement allowing access to their home, at the final home
    visit on October 28, 2015, the DCS caseworker was denied
    access to the home. However, when the door was opened by
    [B.D.], the caseworker was able to notice that the floor was
    filled with trash. Three years have passed since removal, and
    based on the evidence at hand, this court is clearly convinced
    that the home of [the parties] remains unsuitable for [the]
    11
    [C]hildren. Furthermore, the [c]ourt has no confidence that it
    will become suitable anytime in the near future.
    The evidence does not preponderate against the trial court’s factual findings for this
    ground.
    Tenn. Code Ann. § 36-1-102(1)(A)(ii) explains abandonment as a result of failure
    to provide a suitable home:
    [F]or a period of four (4) months following the removal, the
    department or agency has made reasonable efforts to assist
    the parent . . . to establish a suitable home for the child, but
    that the parent . . . ha[s] made no reasonable efforts to provide
    a suitable home and ha[s] demonstrated a lack of concern for
    the child to such a degree that it appears unlikely that [the
    parent] will be able to provide a suitable home for the child at
    an early date. The efforts of the department or agency to
    assist a parent . . . in establishing a suitable home for the child
    may be found to be reasonable if such efforts exceed the
    efforts of the parent . . . toward the same goal, when the
    parent . . . is aware that the child is in the custody of the
    department[.]
    Moyers worked with the family the first four or five months the Children were in
    State custody. She described that, at the time of removal, “[t]he trailer itself was really
    rough,” had only “sparse” furnishings, and “was in disarray.” She stated the utilities had
    been off for a time. Mother agreed that, at this time, the house was in “poor condition,”
    but stated the Children were at a neighbor’s home. DCS provided funding to help the
    family move into the trailer, but declined Moyers’ request for funding for the parties after
    the Children were removed. The parties were evicted in January 2013. They next lived
    in a hotel until they were evicted later that spring. Moyers tried unsuccessfully to get the
    parties into housing. “[Mother] didn’t have . . . a form of identification. She didn’t have
    a driver’s license and there was a problem with getting her [b]irth [c]ertificate out of
    Kentucky,” Moyers stated at trial. The housing authorities required these items. Moyers
    said she also reached out to others in the community to get housing for the family. The
    parties could not afford rent for the housing options Moyers presented. Katie Ferguson,
    DCS case manager for this matter from March 2013 to June 2014, worked with the
    parties through the Coalition for Homelessness to secure housing for them, but those
    efforts, too, were unsuccessful. The parties moved into their current home in September
    2013 with the help of Youth Villages, a contract agency with DCS.
    12
    The condition of the parties’ home remains unsuitable. It does not have an
    adequate number of beds. Trash appeared to cover the floor of the home during an
    October 2015 DCS home visit. Mother denied this. She stated that the items were bags
    of Halloween decorations or leaves. Jan Carmella Schoonover, the DCS case worker
    present during that home visit, testified to observing, from the doorway of the home, the
    smell of decaying food.
    The parties each argue that termination on this ground is improper because some
    of the problems with the current home could be “easily remedied by a quick trip to the
    thrift store or Big Lots” to get some furniture for the Children. The Children had been in
    custody for three years by the time of trial. The parties had been in their home for about
    two years. Their unwillingness to make the home suitable for the Children in that time
    when, according to them, some of the problems could have been easily resolved,
    “demonstrate[s] a lack of concern for the [C]hild[ren] to such a degree that it appears
    unlikely that [the parent] will be able to provide a suitable home for the child[ren] at an
    early date.” Tenn. Code Ann. § 36-1-102(1)(A)(ii).
    In his brief, B.D. asserts that “[p]art of the suitability of a home for [B.D.]’s
    children is stability which is shown by the fact that he lived at the same home for almost
    three years prior to the October 30, 2015 trial date.”5 This assertion is not supported by
    the record. Instead, the record indicates, that on October 26, 2012 – about three years
    before trial – the Children were removed from a trailer where the parties resided in White
    Pine from which they were later evicted. At the time of trial, B.D. lived with Mother in a
    home in Morristown.
    Mother argues on appeal that the home was suitable because it was free of drugs
    and domestic violence and was not “uninhabitable to the point the building should be
    condemned.” Again, this is not the standard. We find DCS put forth reasonable efforts
    to help the parties establish a suitable home for the Children, though the parties failed to
    provide a suitable home and demonstrated a lack of concern for the Children to such a
    degree that it seems unlikely either parent will be able to provide a suitable home for the
    Children at an early date. For the reasons stated above, we find, by clear and convincing
    5
    B.D.’s brief also states, “[B.D.] and his wife have lived at the same residence . . . for
    about three years as of [October 30, 2015].” (Emphasis added.) Shortly thereafter, the brief
    states “[Mother] and [B.D.] are not now married, nor have they ever been.” (Emphasis added).
    We found no other suggestion in the record or the appellate briefs that B.D. is married. It is
    unclear whether reference to B.D.’s “wife” in his brief is simply an error. The parties are in an
    “open” relationship. Schoonover stated that, during a visit to their home, she observed that a
    person appeared to be living in one of the bedrooms intended for the Children.
    13
    evidence, grounds to terminate the parental rights of both the parties for abandonment
    due to failure to provide a suitable home.
    C.
    The trial court found, by clear and convincing evidence, that termination was
    proper for both the parties under Tenn. Code Ann. § 36-1-113(g)(3) due to their failure to
    remedy persistent conditions. In making this finding, the court relied on the following
    facts with regard to its individual holding against them:
    The [C]hildren were removed from the home of [the parties]
    more than six (6) months prior to the filing of the Petition for
    Termination of Parental Rights.          The [C]hildren were
    removed for, among other things, environmental neglect,
    housing issues, medical neglect, and failure to enroll the
    [C]hildren in school. At the time of removal, [D.C.], a Type I
    and Type II diabetic, was undergoing life threatening blood
    sugar issues, the home of the [parties] was in disarray, the
    [parties] were on the verge of being evicted, and all three
    female children had lice and flea bites. For the reasons
    mentioned above . . . the [c]ourt has found that the [parties]
    have not provided a suitable home for the [C]hildren and have
    not shown that such a home will or can be provided at any
    time in the near future. [D.C.] requires a high level of
    medical care due to his diabetes, and all the [C]hildren have
    mood disorders which require monthly management and
    appointments. However, both [of the parties] have displayed
    a significant lack of interest in the well-being of their
    [C]hildren as evidenced by their failure to attend the vast
    majority of the [C]hildren’s medical appointments while in
    custody. This lack of concern on the part of the [parties]
    leaves the court in a position of disbelief as to the probability
    that the most basic and pressing medical and psychological
    needs of the [C]hildren will be met in the near future if
    returned to the [parties].
    With regard only to Mother, the trial court concluded the following:
    The testimony has also shown that in addition to the
    conditions existing at the time of removal, another issue has
    14
    come to light regarding the personal affairs of the family.
    [Mother] is in a master-slave sexual relationship with an
    individual named [Joshua D.]. This in addition to being
    married to [J.C.], and living with [B.D.]. [Mother] is the
    “Slave”, and [Joshua D.] is the “Master.” Until two years
    ago, or 2013, [Mother] was also working with [Joshua D.] as
    a door-to-door “salesman” who assisted him in his business of
    marketing sex toys. She would “demonstrate” to potential
    clients how the toys worked. The testimony has also
    established that the [C]hildren were both exposed to, and took
    note of this lifestyle. The [c]ourt has found [Mother]’s
    testimony to lack credibility when questioned about the lack
    of attendance at medical appointments, the condition of her
    home, her failure to allow DCS entry to examine the home in
    August of 2015, and the multiple interpersonal conflicts she
    has had with various providers, doctors’ offices, and DCS
    caseworkers.
    As to B.D., the court also found, “[he] has borderline intellectual functioning, and the
    evidence would show he has taken very little interest in the medical and psychological
    conditions of his [C]hildren, or the master/slave sexual relationship of [Mother].” With
    regard to the parties, the trial court made the following individual findings that we
    present together: “Finally, and most tellingly, after three years of removal, and in the face
    of everything mentioned above, [the parties each] refuse[ ] to acknowledge a problem
    with [their own] parenting skills or those of [their partner].” The court found that both of
    them “continue[ ] to shift responsibility for the problems [they each face] to [the
    Children] and DCS.” The trial court concluded that DCS made reasonable efforts to help
    the parties remedy those conditions, but that there is little chance the conditions will be
    remedied soon so that the Children can be returned safely home.
    The evidence does not preponderate against the trial court’s findings of fact.
    Tenn. Code Ann. § 36-1-113(g)(3) authorizes termination of parental rights when:
    The child has been removed from the home of the parent . . .
    by order of a court for a period of six (6) months and;
    (A) The conditions which led to the child’s
    removal or other conditions which in all
    reasonable probability would cause the child to
    be subjected to further abuse or neglect and
    15
    which, therefore, prevent the child’s safe return
    to the care of the parent[s] . . . still persist;
    (B)    There is little likelihood that these
    conditions will be remedied at an early date so
    that the child can be safely returned to the
    parent[s] . . . in the near future; and
    (C) The continuation of the parent . . . and child
    relationship greatly diminishes the child’s
    chances of early integration into a safe, stable
    and permanent home.
    The parties each put forth several reasons that DCS failed to establish that the conditions
    that led to the Children’s removal have persisted. First, the parties each assert that the
    problems with housing had been remedied. Based on our analysis in the prior section, we
    disagree and reiterate our holding that the parties have failed to provide a suitable home
    for the Children.
    B.D. also asserts that the issue of “[m]edical neglect is inapplicable to [him], nor is
    it something that [he] is in a position to address” because he is not the biological father of
    D.C. and C.C. and “has no legal responsibility for their care.” We strongly disagree that
    this issue is inapplicable to B.D. His biological daughters, S.D. and D.D., faced several
    health problems at the time of removal. Both had impacted ear wax that required
    treatment by several medical professionals and caused speech and hearing problems. His
    daughters also had vision problems. M.H., foster mother of C.C., A.D., and S.D. from
    October 27, 2012 until August 14, 2015, testified that when the girls came to her home
    “they were very sick” with “pretty severe colds and coughs,” as well as “bedbug bites,
    lice, and UTIs.” M.H. further testified that “[e]motionally they were pretty devastated by
    their circumstances.” The twins regularly had trouble sleeping due to severe nightmares.
    At one point, A.D. threatened suicide, prompting M.H. to take her to the hospital. At
    trial, B.D. stated that when the twins were taken into custody “they were sick,” but, so far
    as he was aware, they had no problems. While in custody, the twins had regular
    psychiatric appointments. M.H. created and maintained an online calendar of their
    medical appointments, along with C.C.’s, that she shared with the parties. B.D. attended
    one medical appointment while the twins were in custody. At trial, B.D. said he often
    was unable to attend “[b]ecause most of the time I was working,” though he testified to
    being employed for only nine months of the three years the Children were in custody. He
    was aware of the online calendar, but stated he was often unaware of the appointments.
    16
    When asked to describe A.D. and S.D.’s medical needs, B.D. responded “[a]s far as I
    know, they just see a psychiatrist” because of “them being taken from us.”
    In response to the condition of medical neglect, Mother asserts that she knows a
    great deal about D.C.’s rare form of diabetes. Still, when D.C. entered custody, his blood
    sugar level was 600. He told DCS either he or C.C. often had to administer his medicine
    without adult supervision. Mother was generally absent from the Children’s medical
    appointments. She attributes this to problems with transportation, being asked to no
    longer attend certain appointments after being perceived as “combative,” being “refused
    access to the appointments” by her daughter, C.C., or her own medical problems. The
    trial court found Mother’s testimony about her absence at these appointments lacked
    credibility. We accord “considerable deference” to the trial court on issues of a witness’s
    credibility. In re Adoption of S.T.D., 
    2007 WL 3171034
    , at *4. We note, too, that
    Mother’s presence was, at times, counterproductive. For example, at a psychiatrist
    appointment for S.D., Mother became so belligerent that the psychiatrist said he would no
    longer see S.D. as a patient.
    Mother also challenges this ground as it relates to her “BDSM relationship with
    [Joshua D.] and her participation in the sex toy business[.]” Mother stated in her brief:
    It is unclear whether the [C]hildren actually saw [Mother] and
    [Joshua D.] engaging in BDSM activities, or if they found the
    sex toys [Mother] sold and drew their own conclusions.
    However, the [C]hildren did have some knowledge of what
    BDSM activities were and did see [Mother] at some point
    with the sex toys, either in transporting them for a sales party
    or by making said items.
    At the time of the removal, the Children were ages twelve, ten, and six. Testimony at
    trial indicated aspects of Mother’s alternate lifestyle had a negative impact on the
    Children. Specifically, M.H. testified as follows6:
    6
    The trial court allowed this testimony under Tenn. R. Evid. 803(25), which provides
    that the hearsay rule does not exclude the following:
    Provided that the circumstances indicate trustworthiness,
    statements about abuse or neglect made by a child alleged to be the
    victim of physical, sexual, or psychological abuse or neglect,
    offered in a civil action concerning issues of . . . termination of
    parental rights pursuant to Tenn. Code Ann. § 37-1-147 and Tenn.
    17
    [M.H., foster mother:] The twins stated that they had
    witnessed the making of whips and floggers and had been
    actually physically abused with one of [Mother]’s paddles
    that she uses for whatever purpose that they [are] made.
    [Attorney for DCS:] Okay. Did they say who made those?
    [M.H.:] They said that Josh [D.], Jamie [D.], [Mother], and
    [B.D.] sit around and make . . . the paddles and whips and
    stuff, yes.
    *      *      *
    [M.H.]: There was paddles [sic] – metal paddles that was
    used that the kids claimed – that the twins had stated that
    [C.C.] would hide them in the bathroom wall because they
    would use them on the kids and that [C.C.] busted out a
    bathroom wall in one of the homes that they lived in – the
    twins told me this – and that [C.C.] would place the paddles
    to hide them from [Mother] and whoever – and Jamie, who
    she had stated – they had stated would hit them with them.
    M.H. further testified that she understood the paddle at issue was a sex toy. On August 8,
    2013, the trial court ordered Joshua D. and Jamie D. to “have absolutely no contact” with
    the Children. However, C.C. testified that Mother told her “no matter what anybody
    says, [Jamie D. and Joshua D.] are still going to be a part of our lives.” M.H. reported
    that, Joshua D. occasionally attended visits with the Children or drove Mother to visits or
    the Children’s appointments. Joshua D. testified at trial that his relationship with Mother
    was ongoing. Mother remained married to J.C., a registered sex offender, who she said
    “always had an open invitation” to visit. B.D. was aware of these relationships.
    The above evidence establishes, clearly and convincingly, that neither of the
    parties remedied the conditions that led to the Children’s removal. Their actions further
    indicate little likelihood the conditions will be remedied at an early date. Should the
    Code Ann. § 36-1-113. . . . Declarants of age thirteen or older at
    the time of the hearing must testify unless unavailable as defined
    by Rule 804(a); otherwise this exception is inapplicable to their
    extrajudicial statements.
    18
    Children continue a relationship with the parties it would greatly diminish their chance of
    early integration into a safe and stable home. For these reasons, we find cause to
    terminate the parties’ parental rights under this ground.
    D.
    The court found, by clear and convincing evidence, cause to terminate B.D.’s
    rights on the ground of mental incompetence, pursuant to Tenn. Code Ann. § 36-1-
    113(g)(8). The court stated, “[B.D.] is incompetent to adequately provide for the further
    care and supervision of his two children.” The court added that “[B.D.]’s mental
    condition is presently so impaired and is so likely to remain so that it is unlikely that he
    will be able to assume or resume the care of and responsibility for his children in the near
    future.” In reaching its holding, the court relied in part on a deposition by Dr. Scott
    Swan, a licensed clinical psychologist at the University of Tennessee Psychological
    Clinic. On appeal, B.D. objects to the use and consideration of Dr. Swan’s deposition
    and asks for it to be excluded. He suggests Dr. Swan’s curriculum vitae and the
    psychological evaluation are not in the record. B.D. is wrong on this part. B.D. also
    asserts that Dr. Swan, who was deposed, “is not the person who met with, interviewed, or
    tested the [parties],” pointing out that, instead, this was done by a student clinician, Sam
    Manring, under Dr. Swan’s supervision. B.D. further asserts on appeal that Dr. Swan did
    not review any of the documents filled out by the parties, the parties’ records received by
    third-party sources, or the results of the tests used to create the psychological evaluation
    of the parties, but that he only reviewed and revised Manring’s evaluation. Similarly, as
    part of a motion filed September 23, 2015, B.D. declined to stipulate that the
    psychological evaluation was admissible. Instead, he stated that the psychological report
    was hearsay because the person who signed it was not the person who interviewed the
    parties and that it would be wrong to admit it without offering an opportunity to cross
    examine. The relevant portion of the motion did not give any supporting legal argument.
    We note that during the November 3, 2015 deposition of Dr. Swan, at which
    B.D.’s counsel was present, Dr. Swan explained how his student clinicians and
    supervising psychologists conduct an evaluation. Counsel for DCS then stated regarding
    Mother and B.D.’s psychological report, “We’d move to have this as the State’s second
    exhibit.” There was no objection by B.D.’s counsel. At trial, the court later allowed Dr.
    Swan’s deposition into evidence because both parties had been present and had the
    opportunity to cross-examine. The decision of whether to admit evidence is within the
    discretion of the trial court. White v. Vanderbilt Univ., 
    21 S.W.3d 215
    , 222-23 (Tenn.
    Ct. App. 1999) (citing Seffernick v. Saint Thomas Hosp., 
    969 S.W.2d 391
    , 393 (Tenn.
    1998)). “Appellate courts will set aside a discretionary decision only when the trial court
    has misconstrued or misapplied the controlling legal principles or has acted inconsistently
    19
    with the substantial weight of the evidence.” 
    White, 21 S.W.3d at 223
    (citing Overstreet
    v. Shoney’s, Inc., 
    4 S.W.3d 694
    , 709 (Tenn. Ct. App. 1999)). Here, before admitting the
    deposition, the trial court determined both sides were present and had an opportunity to
    cross-examine. At trial, B.D.’s counsel did not object to the court’s holding on this issue.
    On appeal, B.D. does not assert a legal argument supporting the exclusion of the
    deposition. We find no abuse of discretion.
    The trial court found as follows in holding, by clear and convincing evidence,
    grounds to terminate B.D.’s parental rights due to mental incompetence:
    According to the deposition for proof, [B.D.] is borderline
    intellectual functioning, yet suffers from no diagnosis, and
    while calling into question [B.D.]’s ability to parent, Scott
    Swan, Ph.D., in his deposition for proof, ultimately stated it
    was “difficult to say” whether [B.D.] could adequately parent.
    However, Dr. Swan also stated that [B.D.] has failed to take
    responsibility for the family problems, and that [B.D.]
    continues to blame his children and DCS for the custody
    issues. Dr. Swan also stated that [B.D.] would most likely
    fare better as a parent if he could have another adult be there
    to help. This [c]ourt would normally be extremely hesitant to
    find that there is clear and convincing evidence of mental
    incompetence when an expert has left the matter open to
    question; however, the [c]ourt finds that the totality of the
    testimony and evidence before it leaves little to question.
    The trial court went on to find “[B.D.] is unable to understand and appreciate the ongoing
    medical and psychological issues faced by his children.” The court cited B.D.’s failure to
    take responsibility for the twins’ removal into State custody, his inability to name either
    of the twin’s psychological diagnoses, and his failure “to attend the overwhelming
    majority of the medical appointments of his children.” Next, the trial court found that
    B.D’s “parenting record . . . speaks for itself, and to hold otherwise would fly in the face
    of history and the evidence in this case.” In support of this position, the court stated:
    The [C]hildren were removed from his home at one time in
    Kentucky. At the time, [B.D.] lived in the same home in
    Kentucky with [Mother], her husband (a sex offender), and all
    of the [C]hildren. [B.D.], while bringing home a modest
    income due to his disability, has allowed [Mother], who has
    never been divorced from her husband in Kentucky, to
    20
    maintain before his children an open master/slave
    sadomasochistic relationship while in Tennessee. [B.D.]
    appears to be managed by [Mother] to such a degree that the
    [c]ourt cannot imagine [B.D.] as parenting in any other form
    than that of a bystander. When [Mother] shut the door at the
    DCS home visit, [B.D.] stood by and allowed it to happen.
    When [Mother] is ordered to engage in sexual affairs with
    [J.D.], [B.D.] does not object.
    Finally, the trial court found B.D.’s “borderline intellectual functioning . . . was also
    exhibited in more subtle, yet telling ways.” The court cited B.D’s inability to recall
    certain information from 2013, such as how long he lived at the White Pine residence, its
    address, or the last name of James C., the babysitter, who lived in his family’s home. The
    court also stated that “the evidence has shown [B.D.] has little emotional connection with
    his daughters, and is relatively unengaged at visits.”
    Previously, we have declined to terminate parental rights under Tenn. Code Ann. §
    36-1-113(g)(8) where “both psychologists opined that [f]ather and [m]other could learn
    to competently parent with intensive, long-term intervention.” In re Christopher S., No.
    E2012-02349-COA-R3-PT, 
    2013 WL 5436673
    , at *17 (Tenn. Ct. App., filed Sept. 27,
    2013). Even when a parent had been diagnosed with a mild intellectual disability, we
    have declined termination on this ground when the parent “had successfully obtained
    vocational training, maintained employment, utilized public transportation, maintained a
    household, and secured a competent support system.” 
    Id. (citing State,
    Dep’t of
    Children’s Servs. v. Whaley, No. E2001-00765-COA-R3-CV, 
    2002 WL 1116430
    , at *14
    (Tenn. Ct. App., filed May 30, 2002)). For this ground, we have found termination
    appropriate when expert testimony revealed that a parent suffers from a “lifelong
    condition” in which the parent “functioned in such a low range that no amount of
    training, education, or counseling could bring him up to the level where he could parent
    these children.” State, Dep’t of Children’s Servs. v. Mims, 
    285 S.W.3d 435
    , 449 (Tenn.
    Ct. App. 2008) (internal quotation marks omitted; emphasis added).
    In the present case, Dr. Swan described B.D. as “somewhat simplistic and concrete
    in his attitudes about parenting.” He questioned B.D.’s “ability to parent these children
    specifically.” Significantly, however, Dr. Swan added, “it would be difficult to say
    whether he would or would not be capable. . . . I take issue with saying . . . that he has no
    ability [to parent] because of his cognitive functioning because it’s in this borderline
    range.” (Emphasis added.)
    21
    We are aware that the trial court cited various examples to indicate B.D.’s
    “borderline intellectual functioning” and perceived inability to “parent[ ] in any other
    form than that of a bystander.” However, while the evidence does not preponderate
    against the trial court’s factual findings on this ground, we disagree that the totality of the
    evidence shows this ground clearly and convincingly. As can be seen, Dr. Swan was
    ambivalent on this issue. It is important to recognize that the issue is not whether B.D.
    has impaired cognitive functioning. He clearly does. However, the real issue is whether
    this impairment adversely affects his ability to parent his children. On this latter issue,
    we cannot say, clearly and convincingly, that it does. We hold, as a matter of law, that
    the evidence is not sufficient to, clearly and convincingly, show that B.D.’s parental
    rights should be terminated based upon mental incompetence. See In re 
    Carrington, 483 S.W.3d at 524
    (“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 convincing evidence of the elements necessary to terminate parental
    rights. 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.”).
    VI.
    After finding that statutory grounds warrant termination of the parties’ parental
    rights, we now focus on whether termination is in the Children’s best interest. When
    considering the issue of “best interest,” we are guided by the following statutory factors:
    (1) Whether the parent or guardian has made such an
    adjustment of circumstance, conduct, or conditions as to
    make it safe and in the child’s best interests to be in the home
    of the parent or guardian;
    (2) Whether the parent or guardian has failed to effect a
    lasting adjustment after reasonable efforts by available social
    services agencies for such duration of time that lasting
    adjustment does not reasonably appear possible;
    (3) Whether the parent or guardian has maintained regular
    visitation or other contact with the child;
    (4) Whether a meaningful relationship has otherwise been
    established between the parent or guardian and the child;
    22
    (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
    the child, or another child or adult in the family or household;
    (7) Whether the physical environment of the parent’s or
    guardian’s home is healthy and safe, whether there is criminal
    activity in the home, or whether there is such use of alcohol,
    controlled substances or controlled substance analogues as
    may render the parent or guardian consistently unable to care
    for the child in a safe and stable manner;
    (8) Whether 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 parent or guardian has paid child support
    consistent with the child support guidelines promulgated by
    the department pursuant to § 36-5-101.
    Tenn. Code Ann. § 36-1-113(i). “The above list is not exhaustive[,] and there is no
    requirement that all of the factors must be present before a trial court can determine that
    termination of parental rights is in a child’s best interest.” State Dep’t of Children’s
    Servs. v. B.J.N., 
    242 S.W.3d 491
    , 502 (Tenn. Ct. App. 2007) (citing State Dep’t of
    Children’s Servs. v. P.M.T., No. E2006-00057-COA-R3-PT, 
    2006 WL 2644373
    , at *9
    (Tenn. Ct. App., filed Sept. 15, 2006)). In addition, “[t]he child’s best interest must be
    viewed from the child’s, rather than the parent’s, perspective.” In re 
    Marr, 194 S.W.3d at 499
    (citing White v. Moody, 
    171 S.W.3d 187
    , 194 (Tenn. Ct. App. 2004)).
    The trial court found that termination of both the parties’ parental rights was in the
    best interest of the Children. It made a nearly identical finding that, although the parties
    have “stabilized [their] home situation, inasmuch as [they have] resided in the same home
    for a number of years, the evidence does not show that [their] home is suitable or safe for
    minor children.” As to Mother, the court found that she “has been and is unlikely to
    23
    make a lasting change in her parenting pattern.” She maintained visits and a relationship
    with the Children. Still, she “continues to deny the majority of the responsibility for the
    conditions which led to removal, and has consistently struggled against the efforts of
    those who would could [sic] have helped her had she only been willing.” The court
    stated again that B.D. “functions at a low intellectual level.” It also found he “has not
    made a lasting change in his parenting skills.” Despite maintaining a relationship with
    the Children, “the evidence has shown that during his visits he has been generally
    unengaging” with them. Finally, B.D. “continues to deny the majority of the
    responsibility for the conditions which led to removal.” The Children have been in foster
    care for several years. The trial court found the Children are “thriving” there. They have
    received “consistent,” “continuing psychological and medical care.” The court concluded
    that “[t]o disrupt their healthy and stable lifestyle only to place them back in the custody
    of their parents would likely have a devastating effect on both their mental and physical
    well-being.” The evidence does not preponderate against the trial court’s factual
    findings.
    When the Children were taken from the parties’ home, they had several health
    problems. While the Children were in custody, Mother did not make an adjustment of
    circumstances, conduct, or conditions such that it would be safe or in the Children’s best
    interest to return them to her home. Most notably, she failed to provide a suitable home,
    failed to pay more than token support, and failed to attend most of the Children’s medical
    appointments.
    B.D. has also failed to make an adjustment of circumstances, conduct, or
    conditions to make it safe and in the twins’ best interest to be in his home. In his brief, he
    provides several examples to indicate that he is engaged with the twins. However,
    according to M.H., his phone conversations with the twins generally lasted only a few
    sentences. She also stated that he sometimes failed to distinguish between them. He had
    little knowledge of the twins’ medical needs. B.D. testified that he did not talk with M.H.
    about his daughters or their medical appointments, but instead relied on Mother for
    information. We note that B.D. did have his disability check garnished to provide
    support and had bought the twins school supplies. Although we declined to find that
    DCS established a ground for termination due to his mental incompetence, we note that
    Dr. Swan questioned B.D.’s ability to parent the twins independently because of limited
    intellectual functioning. Dr. Swan testified during the deposition that B.D. “would need
    some kind of ongoing assistance” such as “another parenting figure in the home.”
    On appeal, Mother maintains that, as it relates to her, the “main component” of the
    trial court’s best interest determination “is [her] alternative lifestyle.” She adds that,
    “While BDSM and slave/master relationships might seem unconventional to the average
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    person, a reasonable person could not automatically conclude that BDSM and selling
    adult toys is equivalent to being an unfit parent.” The testimony at trial revealed the adult
    toys were made in front of and used to discipline the Children. In her own brief, Mother
    states “the [C]hildren did have some knowledge of what BDSM activities were and did
    see [Mother] at some point with the sex toys[.]” Further, the trial court ordered Joshua D.
    and Jamie D. to have no contact with the Children, though C.C. testified that Mother told
    her they would be in their life “no matter what.” Joshua D. testified at trial that his
    relationship with Mother was ongoing. Finally, Mother remained married to J.C., a
    registered sex offender to whom she gave “an open invitation to visit.” Mother suggests
    in her brief that “DCS was reluctant to assist [her] and [B.D.] because of their alternative
    lifestyle[.]” On the contrary, we find DCS worked with both Mother and B.D. to help
    them establish a home, ensure that the home was suitable, execute and implement a
    permanency plan, facilitate visitation, and attend the Children’s medical appointments.
    C.C. testified that she wishes “to move on with [her] life.” C.C. also stated that
    she “hope[s] we get adopted” by her current foster home. Trial testimony indicates S.D.,
    A.D., and D.C. also wish to be adopted. They are currently placed with R.C. and her
    husband, who wish to adopt them. R.C.’s trial testimony indicated that she is
    knowledgeable about the Children’s unique health and treatment needs. With these
    factors in mind, we affirm the trial court’s holding, by clear and convincing evidence,
    that termination of the parties’ parental rights is in the Children’s best interest.
    VII.
    We modify the order of the trial court by excluding its holding that termination of
    B.D.’s parental rights is proper under Tenn. Code Ann. § 36-1-113(g)(8). The judgment
    of the trial court is affirmed as modified. The costs on appeal are assessed to the
    appellants, H.C. and B.D. This case is remanded for enforcement of the trial court’s
    judgment and for collection of costs assessed by the trial court.
    _______________________________
    CHARLES D. SUSANO, JR., JUDGE
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