In Re William B. ( 2021 )


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  •                                                                                           10/22/2021
    IN THE COURT OF APPEALS OF TENNESSEE
    AT NASHVILLE
    Assigned on Briefs August 2, 2021
    IN RE WILLIAM B.
    Appeal from the Juvenile Court for Rutherford County
    No. TC-3799 Donna Scott Davenport, Judge
    ___________________________________
    No. M2020-01187-COA-R3-PT
    ___________________________________
    Mother appeals the termination of her parental rights to one child. In addition to disputing
    the grounds for termination and best interest, Mother argues on appeal that she should have
    been appointed counsel in the termination proceeding and that the Tennessee Department
    of Children’s Services violated Tennessee Code Annotated section 33-6-401. We conclude
    that the record demonstrates that Mother expressly waived her right to counsel and failed
    to show that the waiver was ineffective. We further hold that section 33-6-401 was
    inapplicable in this case. Finally, we conclude that clear and convincing evidence was
    presented of both the grounds for termination and that termination is in the child’s best
    interest. As such, we affirm the decision of the trial court.
    Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Juvenile Court Affirmed
    J. STEVEN STAFFORD, P.J., W.S., delivered the opinion of the court, in which THOMAS R.
    FRIERSON, II and W. NEAL MCBRAYER, JJ., joined.
    Carl R. Moore, Murfreesboro, Tennessee, for the appellant, Tesha L. B.
    Herbert H. Slatery, III, Attorney General and Reporter; Lexie A. Ward, Assistant Attorney
    General, for the appellee, State of Tennessee, Department of Children’s Services.
    OPINION
    I. FACTUAL AND PROCEDURAL HISTORY
    On April 15, 2017, Petitioner/Appellee the Tennessee Department of Children’s
    Services (“DCS”) received a referral regarding a lack of supervision against
    Respondent/Appellant Tesha L.B. (“Mother”).1 The referral stated that Mother called 911
    because the child, who was a little over two months old, was having difficulty breathing.
    The EMS workers who arrived at the scene reported that Mother did not appear to have
    proper infant supplies. While at the hospital, Mother was observed acting in an erratic and
    paranoid state. Mother also informed staff that she was “not in the right mind to make
    medical decisions” for the child and signed all medical decision-making over to the child’s
    doctors.2
    Training officer and child protective services assessor, Maya Sanchez, spoke with
    Mother on April 15. Mother claimed during this meeting that she could lay her child down
    wherever she pleased, even on his stomach. As a result, DCS provided Mother with safe
    sleep information. Mother also informed DCS that the child should be able to sit up at two
    months old, claimed that the child was vegan, and stated that although she was
    supplementing breastfeeding with formula, she was limiting the child to only a certain
    number of ounces per day and was not feeding the child after daycare. Still, DCS
    determined that removal of the child was not necessary.
    Ms. Sanchez and Juliana Potter, another child protective services assessor, met with
    Mother on April 17, 2017 at the DCS office. Mother was calm at times during the meeting,
    but then quickly transitioned to angry yelling and screaming. During the meeting, DCS
    created a noncustodial permanency plan that required, inter alia, that Mother complete a
    clinical psychological assessment. According to later testimony, Mother signed the plan
    but then put a large “X” over her name. Mother also slammed her hand on the table during
    the meeting, which appeared to scare the child.
    On April 21, 2017, DCS filed a non-custodial services petition in the Rutherford
    County Juvenile Court (“the juvenile court” or “the trial court”) to order Mother to
    participate in services with DCS. There is no dispute that Mother was never served with
    1
    To protect the identity of children in parental rights termination cases, initials are used instead of
    last names.
    2
    In her reply brief, Mother asserts that there was no evidence presented that the events that led to
    DCS involvement occurred. Respectfully, we disagree. Here, during the termination trial, DCS workers
    testified as to what led to their involvement with Mother and the child. No objection was ever made that
    the DCS workers could not testify as to those facts or that this testimony could not be presented for the truth
    of the matter asserted, due to a lack of personal knowledge or otherwise. Moreover, Mother did not raise
    any argument in her initial brief that this testimony was not properly considered as substantive evidence.
    Instead, she raised this issue in a cursory fashion in her reply brief. This is not a proper way to raise this
    evidentiary issue. See Tenn. R. Evid. 103 (requiring a timely objection when an error is predicated on the
    admission of evidence); Owens v. Owens, 
    241 S.W.3d 478
    , 499 (Tenn. Ct. App. 2007) (“A reply brief is a
    response to the arguments of the appellee. It is not a vehicle for raising new issues.”). As a result, we
    conclude that DCS did submit proof as to what led to their involvement with the child that can be considered
    in this appeal. Moreover, as made clear throughout this Opinion, DCS’s decision to remove the child
    occurred after a multitude of personal interactions between Mother and various DCS workers, all of whom
    testified about their interactions with Mother at trial.
    -2-
    this petition, and it was ultimately dismissed.
    DCS attempted to work with Mother on the noncustodial plan for the two weeks
    that followed the filing of the non-custodial services petition. Mother was generally
    uncooperative. Mother claimed that she did not need to work services because the child’s
    alleged biological father was going to take custody of the child.3 But Mother provided no
    documentation to support that claim or her claim that she was married to the child’s father.
    Indeed, Mother never provided proof that she and the biological father were married, and
    the father’s conduct throughout the course of this case indicated that he did not intend to
    take responsibility for the child in any manner. At times, DCS was unable to make any
    contact with Mother.
    What came next is somewhat difficult to discern from the record. A hearing on the
    unserved petition for court-ordered services was held before a juvenile magistrate on May
    3, 2017. Mother was unsurprisingly not present. By this time, DCS had apparently come
    to believe that the child needed to be placed in DCS custody. An order was later entered
    on June 19, 2017,4 from this hearing, which states that the matter presented on that date
    was whether there was probable cause to find the child dependent and neglected. As of
    May 3, however, no such petition had been filed. The magistrate nevertheless conducted a
    hearing in which testimony was heard. The magistrate first noted that Mother had not been
    served because she had absconded with the child. The magistrate further found that
    Mother has displayed some disturbing mental and emotional instability as
    evidenced by not only her behaviors but also her actions; Mother exhibited
    very odd behaviors while at the Hospital as alleged in the State’s Petition;
    Mother’s reactions to hospital staff is of concern to the Court and a
    demonstration of Mother’s mental and emotional instability; Mother’s further
    reactions to the DCS Workers to the point where the Mother called 911 on
    DCS during a [Child and Family Team Meeting] gives the Court concerns as
    to Mother’s emotional and mental stability . . . .
    The magistrate also found that Mother failed to comply with any of the requirements and
    tasks requested by DCS. The magistrate therefore ruled that there was probable cause to
    believe that the child was dependent and neglected and placed the child in DCS custody.
    The order was mailed to Mother’s last known address.
    In the afternoon following the May 3, 2017 hearing, DCS workers arrived at
    Mother’s home, but she did not answer the door. A sign on her door indicated that Mother
    3
    Only one man has ever been alleged to be the child’s biological father in this case.
    4
    The order is marked as “lodged” on a date in May. However, the exhibit sticker was placed over
    this stamp and nothing more than a partial date of “5-1” is visible. We assume that this order was therefore
    “lodged” between May 10th and May 19th.
    -3-
    was out of town. But the DCS workers observed Mother leaving her apartment on this date
    and attempted to flag Mother down. She did not stop, and eventually sped away from the
    DCS workers with the child in the car. The DCS workers called 911 for assistance, and a
    “be on the lookout” was requested. Mother did not initially answer calls or texts, but did
    call Ms. Potter later that afternoon. In that call, Mother called Ms. Potter a “psycho b****”
    and directed DCS to stop calling Mother. During this phone call, Mr. Potter informed
    Mother that the child had been placed in DCS custody and that Mother needed to present
    the child to DCS. Mother refused.
    On May 4, 2017, DCS formally filed a petition to declare the child dependent and
    neglected and for emergency temporary legal custody. On May 5, 2017, a juvenile
    magistrate entered an ex parte custody order and an order for Attachment Pro Corpus
    commanding the Sheriff to deliver the child to DCS. Although Mother was informed that
    the child had been placed in DCS custody by the juvenile court, she refused to hand the
    child over to DCS. Instead, DCS did not obtain physical possession of the child until
    August 14, 2017. On that date, DCS located Mother through TennCare and arrived with a
    police escort at the listed address to remove the child. Mother called the police on DCS,
    attempted to leave with the child, and accused DCS of trying to steal her child. Mother
    eventually allowed the child to be removed after being threatened with criminal charges.
    The child was placed in the home of a foster family, where he remained at the time of trial.
    On August 23, 2017, Mother filed a pro se motion in the dependency and neglect
    action for the return of her child. Mother later filed a motion for a court-appointed attorney
    on September 1, 2017. Mother was served with the dependency and neglect petition on or
    about September 6, 2017. On the same day, a juvenile court magistrate appointed attorney
    Richard Roney to represent Mother. Also on that day, Mother, by and through counsel,
    waived her right to a probable cause hearing. A juvenile magistrate later entered an order
    denying Mother’s pro se motion.
    On October 18, 2017, Attorney Roney filed a motion to withdraw on the basis of a
    fundamental disagreement as to how the case should be defended and Mother’s efforts in
    filing pro se motions.5 In this motion, Attorney Roney stated that Mother “insists” that she
    will not complete a psychological assessment requested by DCS. A juvenile magistrate
    granted the motion to withdraw on October 25, 2017, and directed Mother to seek “another
    appointed counsel if she qualifies.” On November 1, 2017, a second attorney, Kim
    Gilleland, was appointed to represent Mother.
    5
    Mother filed a number of pro se motions in the dependency and neglect action throughout its
    pendency. Some motions attacked the entirety of the dependency and neglect action because Mother had
    not been served with the noncustodial petition for court-ordered services. Other motions objected to a third-
    party supervising visitation despite the court order allowing a third-party to do so. None of the motions
    were granted.
    -4-
    A second permanency plan was created on November 29, 2017.6 This plan, like the
    four that followed, contained requirements related to income, housing, drug and alcohol
    use, and transportation. The second permanency plan also specifically required that Mother
    obtain a psychological evaluation and follow recommendations. Mother was also required
    to complete any necessary releases of information concerning her treatment and try to
    obtain required services through her insurance. Mother signed this plan at the time that it
    was created.7 A Criteria and Procedures for Termination of Parental Rights was also
    included with the second permanency plan, but the document indicates that Mother refused
    to sign the document.8 The trial court’s later order ratifying this plan, however, specifically
    found that Mother was provided a copy of the Criteria.
    Funding for the psychological assessment was approved in October 2017; however,
    Mother was initially reluctant to participate. According to family services worker
    Alexandra Brislin, Mother claimed that because DCS paid for the assessment, they “were
    paying for the responses [they] wanted.” Mother also claimed to Ms. Brislin that she had
    the credentials to diagnose herself and that she had already completed an assessment;
    Mother did not, however, sign any releases or provide records to substantiate that claim.
    Despite her reluctance, Mother also began the psychological assessment with
    Licensed Psychologist Janie Berryman in December 2017; a report on the assessment was
    completed March 13, 2018. Mother’s intelligence functioning was reported as average, but
    Dr. Berryman opined that Mother may be suffering from an adjustment disorder “with
    mixed emotional features.” The report, however, ruled out “Personality Disorder NOS”
    and an anxiety disorder. Overall, however, Dr. Berryman opined that “[t]he test results
    were defensive and not considered valid making it difficult to diagnosis for specific
    treatment.” Dr. Berryman therefore recommended that Mother complete anger
    management, parenting classes, and individual therapy, and that supervised visitation
    continue until there was a period of consistent positive interactions with the child. Mother
    did complete both anger management and parenting classes in February 2018 and April
    2018, respectively.
    By and through appointed counsel, Mother entered into an agreed order with DCS
    on January 19, 2018, to have a minimum of four hours of supervised visitation with the
    child supervised by Omni Vision or another person approved by DCS.
    On August 13, 2018, an agreed order was entered finding the child dependent and
    neglected. Although the order stated that Mother’s superior parental rights were reinstated,
    it was agreed that the child would remain in DCS custody due to improper control and that
    6
    The first plan was created while Mother was on the run with the child.
    7
    Mother also signed some of the plans that followed.
    8
    Later permanency plans also indicated that Mother refused to sign the Criteria. The May 2017
    permanency plan has a handwritten note that the Criteria was mailed to Mother.
    -5-
    Mother would participate in an in-depth psychological assessment and individual
    counseling on a consistent basis. On November 2, 2018, Mother’s second appointed
    attorney filed a motion to withdraw, citing Mother’s increased frustration with the
    representation. A juvenile magistrate entered an order allowing the withdrawal on January
    8, 2019. It appears that no additional counsel was appointed to represent Mother in the
    dependency and neglect proceeding.
    On July 30, 2019, DCS filed a notice with the trial court that it had temporarily
    suspended Mother’s visitation due to her behavior. DCS asked the juvenile court to find
    that its action was appropriate and to order that the suspension remain in effect until Mother
    completed the second psychological assessment. A hearing was held on this motion on
    September 5, 2019, before a juvenile magistrate. Mother appeared pro se at the hearing.
    After hearing the testimony from the Omni supervisor, Megan Bowden, the juvenile
    magistrate found that it was in the child’s best interest for visitation to be suspended until
    the parties agreed or a motion was filed for visitation to resume. The juvenile magistrate
    did not, however, accept the characterization that Mother “has 5 different identities”; but
    the magistrate concluded that Mother experiences “grandiose belief or ideas of degrees,
    doctorates, competencies and professions” without any evidence in support and is unable
    to focus on visiting with the child in a manner that is in the child’s best interest. Nothing
    in the record on appeal indicates that Mother appealed any of the orders entered in the
    dependency and neglect proceeding, including the order suspending her visitation that was
    entered when Mother was not represented by counsel.
    In the meantime, on July 19, 2019, DCS filed a petition to terminate Mother’s
    parental rights on grounds of abandonment by failure to visit, failure to support, and failure
    to establish a suitable home, substantial noncompliance with permanency plans, failure to
    manifest a willingness and ability to personally assume custody, and persistent conditions.9
    Although the petition was also filed in the Rutherford County Juvenile Court, it was filed
    under a different docket number, and is a separate case, from the dependency and neglect
    action. A summons in the record indicates that Mother was personally served with the
    termination petition on July 19, 2019, in the juvenile court lobby.
    DCS, the guardian ad litem for the child, and Mother appeared before a juvenile
    magistrate for a first appearance on the petition on September 5, 2019. At that time, the
    juvenile magistrate explained Mother’s right to request court appointed counsel. Mother,
    however, stated that she wanted to represent herself or hire private counsel. As a result,
    Mother and the juvenile magistrate signed a one-page document in which Mother waived
    her right to appointed counsel. The juvenile magistrate later entered a written order on
    September 17, 2019, noting that Mother had waived her right to appointed counsel
    9
    The petition also alleged grounds to terminate the parental rights of the child’s biological father.
    The trial court terminated the father’s rights in a separate order. He has not appealed, and therefore his
    rights are not at issue in this appeal.
    -6-
    following an explanation of that right and the responsibilities that Mother would assume.
    The termination trial as to Mother began on June 8, 2020 and concluded on June 22,
    10
    2020. At the start of trial, Mother requested that the trial be continued to allow her to
    obtain an attorney. The trial court denied that request, citing Mother’s waiver and her
    failure to make that request in the eight months that the petition had been pending. DCS
    called a variety of DCS employees who had worked with Mother since the start of the case.
    Mother raised a multitude of objections, most of which were denied by the trial court as
    not being proper. Mother’s objections often related to her contention that the case was void
    because she had not been served with the non-custodial services petition or because DCS
    had not complied with the mental health provision in Title 33 of the Tennessee Code.11
    DCS presented a variety of witnesses, including Ms. Sanchez, Ms. Potter, Ms.
    Brislin, other DCS workers who took over the case as the years progressed, Ms. Bowden,
    and the child’s foster mother. At trial, there was generally no dispute that Mother had
    sufficient income and proper housing for the child. Instead, the issues generally concerned
    Mother’s mental health struggles and her refusal to participate in services for that purpose,
    and Mother’s conduct during visitation. The proof demonstrated that six permanency plans
    were created in this case, on May 15, 2017; November 29, 2017; February 22, 2018;
    January 30, 2019; July 17, 2019; and January 7, 2020. Each permanency plan was ratified
    by the juvenile court. The permanency plans contained requirements that Mother (1)
    maintain safe and stable housing and provide proof of same to DCS; (2) obtain required
    services through her insurance or inform DCS of the termination of her insurance; (3)
    obtain and maintain stable employment and provide proof to DCS; (4) provide DCS with
    updated contact information as necessary; (5) present herself to DCS and to the trial court;
    (6) complete a psychological evaluation and follow all recommendations; (7) allow DCS
    to complete home visits; (8) sign a release of information form allowing DCS to obtain
    records from her physicians and service providers; (9) develop a child care and
    transportation plan; (10) submit to and pass drug screens; and (11) complete an alcohol and
    drug assessment and follow recommendations. The plans were updated after Mother
    completed the first mental health assessment and agreed to take part in a second assessment
    to reflect that the second assessment and following the recommendations were among
    Mother’s responsibilities.
    DCS assisted Mother by setting up counseling with Bowdoin Recovery Services,
    LLC. During the more than three years that this case was pending, Mother completed three
    individual therapy sessions from April 18, 2018, to May 9, 2018. The therapist found that
    Mother “displayed in the counseling session, exaggerated distorted description about
    herself and delusional thought patterns. It is very difficult to get her to focus on treatment
    and planning with the goal of regaining custody.” As a result, Mother’s therapist
    10
    The termination of Father’s parental rights occurred following a separate trial in August 2020.
    11
    This issue is discussed in detail, infra.
    -7-
    recommended a more in-depth mental health evaluation “to assess for mental health
    medication and to assist in the treatment planning process.” Thereafter, it appears that
    Mother refused to contact Bowdoin. Mother’s DCS workers testified that Mother provided
    them with no documentation to reflect that she had received any additional counseling.
    Indeed, Mother’s refusal to sign releases of information as required by the permanency
    plans was a consistent issue in this case; Mother either refused to sign the forms or revoked
    the form that she did sign. Although Mother was told that DCS would pay for the
    assessment if she provided proof that her own insurance would not cover the cost, she never
    completed the second assessment.
    Ms. Brislin supervised visitation until November 2017, when Omni took over.12 As
    discussed in more detail, infra, Mother was fairly consistent in the frequency of her visits,
    but her conduct was inconsistent. While in some visits Mother was appropriate, Mother’s
    conduct was highly inappropriate in others. In one early visit, Mother intentionally startled
    and made loud noises in front of the child so that he would not be a “scaredy-cat” even
    though she had been informed that the child was suffering from an ear infection. The child
    was less than one-year old at the time.
    Even during the later visits, Mother was often unable to display parenting skills and
    knowledge. Sometimes, Mother spent more time complaining about the case than
    interacting with her child. Other times she yelled at or became angry with the child when
    he did not meet her standards.13 Mother’s aggression also took the form of rubbing the
    child’s face with the food he refused to eat, holding the child down on the potty when he
    had a bowel movement in his diaper, “bonking” her head gently, but repeatedly against the
    child’s even though he expressed that he did not like it, and getting into the child’s face to
    scold him and threaten to spank him when he did not follow her directions. In yet other
    times, she refused to engage with the child, claiming that adults did not play with toys, or
    spent the visitation time on her phone. The child at times called both Mother and Ms.
    Bowden “mommy.” Both directed the child not to call them that, with Mother telling the
    child to call her by her first name.14 At the end of the visits, the child was often happy to
    see the DCS worker who transported the child to the visits and had no difficulty leaving
    Mother; instead, the child often disengaged from Mother during the visits when she was
    too angry or aggressive toward him. Some of the visits ended early due to Mother’s
    behavior.
    Mother’s erratic behavior was often on full display during the visits. Mother often
    12
    The delay in using Omni related to Mother’s refusal to sign necessary releases.
    13
    Examples are where the child did not complete a puzzle, could not reach the sink to help her
    wash dishes, could not pull up his own pants or diaper, did not respond to Mother’s statements that they
    should “bond,” could not put his own pants or shoes on, and had a bathroom accident. At the time that all
    of these events occurred, the child was little over two years old.
    14
    During a later visit, however, Mother continuously asked the child if he “love[d] Mommy” and
    wanted to “bond with Mommy.”
    -8-
    spoke of her various degrees and credentials, ranging from being a nurse to a doctor to a
    psychologist to owning a successful security company that worked with celebrities; Mother
    never provided any documentation to support those claims. Despite claiming that she had
    a chemistry degree, Mother had to be shown how to make formula for the child. Mother
    continued her claims of degrees and credentials at various visitations throughout the
    pendency of the case. Often, Mother’s mood vacillated from calm and appropriate to angry
    during the visits. At one visit in October 2018, Mother arrived acting “manic” and
    attempted to extort DCS into allowing her to leave with the child with the promise that she
    would provide them with the results of her purported second psychological evaluation.15
    Mother referred to this deal as an “even trade.” When DCS refused, Mother became
    enraged, and Mother was eventually escorted out by non-emergency police officers.
    Mother chose not to visit with the child in November and December 2018 after this
    incident.
    In the Spring of 2019, Mother’s eight hours of supervised therapeutic visitation were
    limited to four hours due to Mother’s conduct. A court appointed special advocate was also
    brought in to provide additional observation of the visitation. But Mother’s conduct during
    visitation did not improve in 2019. Rather, nearly every single visit involved some erratic,
    aggressive, or indifferent behavior by Mother. For example, at the June 28, 2019 visit,
    Mother forced the child to kiss her even after he said no, Mother attempted to force the
    child to remain in a chair, and Mother informed the then two-year-old child not to say “yes,
    ma’am” or “no, ma’am” because those terms were associated with slavery. According to
    Ms. Bowden, Mother then “pulled out her phone and read[] graphic, disturbing details” to
    the child that were not appropriate given the child’s age. When Ms. Bowden asked Mother
    to stop, Mother became so agitated that Ms. Bowden was forced to end the visit early, as
    the child was visibly scared of Mother.
    Mother’s last visit with the child occurred on July 25, 2019, after which DCS
    determined that visitation was no longer in the child’s best interest. In a later order
    suspending the visits, the trial court characterized Mother’s visitation as follows:
    [T]he last visit on July 25, 2019 deteriorated to a greater extent than
    prior visits wherein an original statement by the Child while in a state of play
    was interpreted by [Mother] as a statement of harm, when it was clear from
    the state of play and from the testimony that the Child said “Batman and
    another superhero were fighting and his imaginary character got hurt” and
    the Mother interrupted it as “Badman” and asked the Child where did the
    “Badman” hurt you; further the Mother asked where did the “Badman” hurt
    you and the Child said on his head referring to “Batman”, but of particular
    note is that there was no visible injuries or bruises of any type on the Child’s
    15
    Mother arrived to the visitation with a raincoat for the child, apparently expecting to leave with
    him.
    -9-
    head to support the Mother’s accusations; further the Court notes the Child
    is approximately 2 years of age and is therefore very susceptible to be lead
    down the path that Mother was attempting to lead him on by her efforts to
    try and convince him that his word “Batman” was actually the word
    “Badman”; subsequently [Mother] called 911 and response was made to the
    DCS office by law enforcement, EMTs, fire and medical transport;
    [O]n [] July 25, 2019, upon law enforcement arriving at the DCS
    office the Mother’s interactions with the Police appear to be much like the
    interactions the Court has had with [Mother] as evidenced by the testimony
    by Ms. Bowden as to the interactions between the Mother and Law
    Enforcement on that day, specifically at times the Mother comes across as
    incoherent, sort of rambling, interactions wherein the Mother interjects and
    represents that she has multiple degrees or expertise that she believes or feels
    she holds that she believes give her credence to make decisions to override
    or overrule the concerns that everyone has about a certain situation based
    upon her asserted level of expertise in a particular field that is related to the
    situation that is under discussion at that time; . . . .
    The child’s foster mother, Ursula B. (“Foster Mother”) testified that the child came
    into her custody in August 2017; he has remained continuously with her family since that
    time, a period of nearly three years at the time of trial. The child refers to Foster Mother
    and her Husband as “mommy” and “daddy.” Foster Mother testified that the child is
    thriving in her care, that the child is bonded to her other child, and that she wishes to adopt
    the child should he become available.
    Mother testified on her own behalf.16 Mother’s testimony generally focused on the
    circumstances surrounding DCS’s initial involvement with the case. Mother claimed that
    the DCS workers trespassed in her apartment. Mother further asserted that she took good
    care of her son, and that she had done nothing wrong, as she “take[s] medicine to the police.
    I’m around the police all day long. So I know good and well that I don’t have no warrants
    for the police to be chasing me around.” Mother also took issue with the petition for court-
    ordered services, as it was dismissed. Mother also claimed for the first time that she had
    not been served with the dependency and neglect petition. Finally, Mother argued that the
    proceeding was void because DCS did not present a “certification of need for mental health
    services as required by Title 3,—Chapter 3, 4, 5, and 6.”
    On August 7, 2020, the trial court entered a fifty-seven-page order terminating
    Mother’s parental rights. Therein, the trial court first addressed Mother’s request for
    16
    Mother often interjected comments during her objections to DCS’s proof. For example, Mother
    referred to DCS’s actions as “terrorism” and told a DCS witness that she could “burn in hell.” The trial
    court admonished Mother on multiple occasions not to commit these outbursts and not to attempt to testify
    during DCS’s case-in-chief.
    - 10 -
    counsel, ruling that she had waived her right to appointed counsel months prior to trial.
    The trial court then noted that DCS had elected to “drop” its allegation of failure to support.
    But the trial court found that DCS had presented clear and convincing evidence of all other
    grounds for termination alleged in the petition and that termination was in the child’s best
    interest.
    An order was later entered terminating the parental rights of the child’s biological
    father. Mother thereafter timely appealed to this Court. On September 9, 2020, Mother
    filed a motion to proceed as indigent in this appeal. On September 10, 2020, we granted
    Mother’s motion and remanded the matter to the trial court for the sole purpose of
    appointing counsel to represent Mother in this appeal. On October 5, 2020, the trial court
    appointed Mother’s current counsel to represent her in this appeal.
    II. ISSUES PRESENTED
    Mother raises the following issues for review, which are taken from her appellate
    brief:
    1. Whether DCS and the juvenile court violated Mother’s rights by
    attempting to force her into unwanted medical treatment.
    2. Whether the trial court erred in denying Mother’s request for counsel.
    3. Whether the trial court properly determined that grounds existed to
    terminate Mother’s parental rights.
    4. Whether the trial court properly determined that termination of Mother’s
    parental rights was in the child’s best interest.
    III. STANDARD OF REVIEW
    Parental rights are “among the oldest of the judicially recognized fundamental
    liberty interests protected by the Due Process Clauses of the federal and state
    constitutions.” In re Carrington H., 
    483 S.W.3d 507
    , 521 (Tenn. 2016) (collecting cases).
    Therefore, “parents are constitutionally entitled to fundamentally fair procedures in
    parental termination proceedings.” 
    Id. at 511
    . These procedures include “a heightened
    standard of proof—clear and convincing evidence.” 
    Id. at 522
     (citations and quotations
    omitted). “Clear and convincing evidence is evidence in which there is no serious or
    substantial doubt about the correctness of the conclusions drawn from the evidence.” In re
    Valentine, 
    79 S.W.3d 539
    , 546 (Tenn. 2002) (quotation marks and citation omitted).
    In Tennessee, termination of parental rights is governed by statute, which identifies
    “‘situations in which [the] state’s interest in the welfare of a child justifies interference with
    a parent’s constitutional rights by setting forth grounds on which termination proceedings
    can be brought.’” In re Jacobe M.J., 
    434 S.W.3d 565
    , 568 (Tenn. Ct. App. 2013) (quoting
    In re W.B., Nos. M2004-00999-COA-R3-PT, M2004-01572-COA-R3-PT, 2005 WL
    - 11 -
    1021618, at *7 (Tenn. Ct. App. Apr. 29, 2005) (citing Tenn. Code Ann. § 36-1-113(g))).
    Thus, a party seeking to terminate a parent’s rights must prove (1) the existence of at least
    one of the statutory grounds in section 36-1-113(g), and (2) that termination is in the child’s
    best interest. See In re Valentine, 
    79 S.W.3d at 546
    . “Considering the fundamental nature
    of a parent’s rights, and the serious consequences that stem from termination of those
    rights, a higher standard of proof is required in determining termination cases.” In re
    Addalyne S., 
    556 S.W.3d 774
    , 782 (Tenn. Ct. App. 2018). The clear and convincing
    evidence standard applicable here is “more exacting than the ‘preponderance of the
    evidence’ standard, although it does not demand the certainty required by the ‘beyond a
    reasonable doubt’ standard. To be clear and convincing, the evidence must eliminate any
    substantial doubt and produce in the fact-finder's mind a firm conviction as to the truth.”
    In re S.R.C., 
    156 S.W.3d 26
    , 29 (Tenn. Ct. App. 2004) (internal citation omitted).
    In termination cases, appellate courts review a trial court’s factual findings de novo
    and accord these findings a presumption of correctness unless the evidence preponderates
    otherwise. See Tenn. R. App. P. 13(d); In re Carrington H., 483 S.W.3d at 523–24
    (citations omitted). “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.” Id. at 524 (citation 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 M.L.P., 
    228 S.W.3d 139
    , 143 (Tenn. Ct. App. 2007) (citing Seals v.
    England/Corsair Upholstery Mfg. Co., Inc., 
    984 S.W.2d 912
    , 915 (Tenn.1999)). “Further,
    ‘[o]n an issue which hinges on the credibility of witnesses, the trial court will not be
    reversed unless there is found in the record clear, concrete, and convincing evidence other
    than the oral testimony of witnesses which contradict the trial court’s findings.’” 
    Id.
    (quoting Galbreath v. Harris, 
    811 S.W.2d 88
    , 91 (Tenn.Ct.App.1990)).
    IV. DISCUSSION
    A. Counsel
    We begin with Mother’s argument concerning the appointment of counsel. As this
    Court recently explained,
    Although the Due Process Clause of the United States Constitution does not
    “require[] the appointment of counsel in every parental termination
    proceeding[,]” Lassiter v. Dep’t of Soc. Servs. of Durham Cnty., N.C., 
    452 U.S. 18
    , 31, 
    101 S. Ct. 2153
    , 
    68 L.Ed.2d 640
     (1981), “Tennessee statutorily
    provides the right to appointed counsel for indigent parents in every parental
    termination proceeding,” In re Carrington H., 483 S.W.3d at 527; see also
    Tenn. Code Ann. § 37-1-126(a)(2)(B)(ii) (“A parent is entitled to
    representation by legal counsel at all stages of any proceeding under this part
    - 12 -
    in proceedings involving . . . [t]ermination of parental rights pursuant to § 36-
    1-113.”).
    In re Tavarius M., No. M2020-00071-COA-R3-PT, 
    2020 WL 7479411
    , at *3 (Tenn. Ct.
    App. Dec. 18, 2020). The right to counsel, however, is not absolute, and may be waived by
    the parent. Specifically, Rule 13 of the Tennessee Supreme Court Rules provides that
    indigent parties are entitled to the appointment of counsel in “[p]roceedings to terminate
    parental rights.” Tenn. Sup. Ct. R. 13(d)(2)(D). Rule 13 further provides, however, that
    “[u]pon finding a party indigent, the court shall enter an order appointing counsel unless
    the indigent party rejects the offer of appointment of counsel with an understanding of the
    legal consequences of the rejection.” Tenn. Sup. Ct. R. 13(e)(3). “If an indigent party
    refuses to accept the services of appointed counsel, such refusal shall be in writing and
    shall be signed by the indigent party in the presence of the court.” Tenn. Sup. Ct. R.
    13(f)(1). The rule further provides as follows:
    The court shall acknowledge thereon the signature of the indigent party and
    make the written refusal a part of the record in the case. In addition, the court
    shall satisfy all other applicable constitutional and procedural requirements
    relating to waiver of the right to counsel. The indigent party may act pro se
    without the assistance or presence of counsel only after the court has fulfilled
    all lawful obligations relating to waiver of the right to counsel.
    Tenn. Sup. Ct. R. 13(f)(2).
    Much of the caselaw concerning the waiver of the right to appointed counsel in the
    context of a termination of parental rights trial concerns whether the parent implicitly
    waived the right through his or her conduct. See, e.g., In re A.P., No. M2017-00289-COA-
    R3-PT, 
    2019 WL 1422927
    , at *3 (internal citation removed) (quoting In re Jamie B., No.
    M2016-01589-COA-R3-PT, 
    2017 WL 2829855
    , at *4 (Tenn. Ct. App. June 30, 2017))
    (Tenn. Ct. App. Mar. 29, 2019) (“While a parent’s right to appointed counsel in a
    termination of parental rights proceeding is well-established in Tennessee, this Court has
    also acknowledged that where a parent fails to adequately cooperate or communicate with
    their counsel before trial, the client may have impliedly waived the right to appointed
    counsel by his or her conduct.”); In re Elijah B., No. E2010-00387-COA-R3-PT, 
    2010 WL 5549229
    , at *5 (Tenn. Ct. App. Dec. 29, 2010) (“The issue becomes whether Father
    effectively waived his right to counsel by failing to communicate with Ms. Luther in the
    months leading up to the hearing and then leaving her to appear without him.”); In re M.E.,
    No. M2003-00859-COA-R3-PT, 
    2004 WL 1838179
    , at *12 (Tenn. Ct. App. Aug. 16,
    2004) (“Thus, we must determine whether Father’s conduct constituted such a waiver.”).
    That is not the situation presented in this case.
    Instead, this case involves an express waiver by Mother of her right to appointed
    counsel despite her indigency. In particular, the record indicates that the parties appeared
    - 13 -
    before a juvenile magistrate on September 5, 2019 for a first appearance in the termination
    proceeding. On that date, Mother and the presiding magistrate, Magistrate Adam Dodd,
    signed a document entitled “Waiver of Right to Have Appointed Counsel (Termination of
    Parental Rights).” The document states as follows:
    The undersigned represent to the court, under oath, as follows:
    I have been fully informed by the court of the nature of the Petition (Petitioner
    seeks to terminate forever parental rights to my child/children pursuant to
    T.C.A. §[]36-1113) and the relief sought by Petitioner(s) (to make my
    child/children available for adoption) in this case; AND
    The legal consequences thereof (loss of my parental rights) should said relief
    be granted by the court; AND
    The right to appointment of counsel (an attorney) upon my representation to
    the court, that I am unable to employ counsel, the reasons therefore, and the
    court concurring with my assertion by finding me indigent.
    All of which I fully understand.
    Having so acknowledged, I, the undersigned, now state to the court that I do
    not desire the appointment of counsel, that I expressly waive the same and
    that I desire to appear in all respects in this case on my own behalf, unless and
    until such time as counsel is employed by me, all [of] which I understand I
    have a right to do. Further, by signing below, I appear before the court today
    with full knowledge of the consequences of my decision and sign this Waiver
    of Appointed Counsel freely and voluntarily believing it to be in my best
    interest.
    Magistrate Dodd’s September 17, 2019 order related to the September 5 appearance
    also contains findings relative to this issue:
    Mother was personally served with the State’s Petition on July 19, 2019.
    Mother has appeared today and the Court, on the record, explained to the
    Mother her right to request court appointed counsel and the process for
    requesting the same. Mother stated under oath that she is competent to
    understand today’s proceedings. The Court, in great detail, went over the
    Mother’s options regarding representation in that she could request court
    appointed counsel, represent herself or hire private counsel. Upon being
    informed of the same the Mother informed the Court of her desire and intent
    to retain her own attorney or to represent herself as a Pro Se Respondent. The
    Court explained to the Mother that if she did not retain counsel she would
    need to be prepared and ready to go on the trial dates set herein, further the
    Court directed the Mother that if she does retain counsel that her counsel
    would need to be prepared to go forward on the trial dates set herein and
    further that if the dates set herein did not work with her counsel’s calendar
    - 14 -
    that such would not be a basis for continuing the trial dates set herein.
    The order set a trial date eight months in the future, on June 8, 2020.
    Nothing in the record indicates that Mother ever again raised the question of
    appointed counsel until the morning of June 8, 2020, when she sought a continuance
    because she “need[ed] a lawyer” due to the case being “very complex” and her “mental
    state.” The trial court responded as follows:
    No, ma’am. We have given you every opportunity to get attorneys, have
    appointed attorneys, retained attorneys, get appointed attorneys, and I am
    going to go ahead and find the record speaks for itself that you’ve had every
    opportunity if you wish to retain an attorney yourself to do so. . . .
    . . . . So I’m going to note that this case has been set for eight months. You’ve
    had that time to come in and ask the Court for an appointed attorney and you
    have had plenty of time to retain an attorney. So I’m also going to deny that
    motion to appoint you an attorney, and I will note your objection to that.
    The trial court noted, however, that Mother was permitted to file an oral motion that Mother
    was unable to proceed on the morning of trial due to her mental state. But the trial court
    explained that Mother would “have to have the proof” to support such an argument. Mother
    responded that “I’m not a lawyer, and I need a lawyer.”
    The trial court also addressed this issue in its order terminating Mother’s parental
    rights. After reiterating Magistrate Dodd’s findings from the September 5, 2019 hearing,
    the trial court stated that
    the Mother executed a waiver of her right to have or request appointed counsel
    and the same has been admitted as Exhibit 70 in this matter. Mother
    throughout the underlying Dependency and Neglect action had a total of 3
    different Attorneys appointed to represent her and each Attorney had to
    eventually withdraw due to the actions of the Mother. Therefore the Court
    believes the Mother raised the issue of wanting an appointed Attorney on the
    first day of trial, June 8, 2020, for the sole purpose of delaying this matter
    therefore the Mother’s oral motion for counsel is denied and the Mother will
    proceed as a Pro Se Respondent. Further based upon the Mother’s statements
    to the Court on September 5, 2019, as previously noted, the Mother informed
    the Court of her intent to retain private counsel which tells the Court the
    Mother had the financial means to do so but has elected to proceed without
    counsel.
    On appeal, Mother asserts that the trial court erred in denying her request for
    counsel. It is somewhat difficult to discern the exact basis for Mother’s objection to the
    - 15 -
    trial proceeding. Specifically, Mother asked the trial court to continue the case to allow her
    to obtain counsel, pointing to her mental state. This request does not indicate if Mother
    wanted to revoke her waiver of appointed counsel or if Mother was merely seeking a
    continuance to retain her own counsel. Moreover, Mother did not argue on the morning of
    trial that she ever lacked the competency to exercise a waiver of her right to counsel, only
    that she was presently incompetent to represent herself. See generally State v. Hester, 
    324 S.W.3d 1
    , 29–31 (Tenn. 2010) (discussing the difference between these two questions, as
    detailed infra). On appeal, however, Mother’s argument clearly concerns whether the
    initial waiver was effective on procedural and substantive grounds, as she does not address
    in any manner the trial court’s decision to deny Mother’s request for a continuance.
    Although we have serious doubts that this issue was properly raised in the trial court, we
    will nevertheless address it on appeal. See Tenn. R. App. P. 13(b) (“Review generally will
    extend only to those issues presented for review. The appellate court . . . may in its
    discretion consider other issues in order, among other reasons: (1) to prevent needless
    litigation, (2) to prevent injury to the interests of the public, and (3) to prevent prejudice to
    the judicial process.”).
    Mother cites no law beyond Rule 13 to support her argument that the magistrate did
    not do all that was required of him to effectuate a waiver of counsel. Specifically, she cites
    no specific “applicable constitutional or procedural requirement” that was not met in this
    case. Generally, arguments made in no more than a skeletal fashion are waived in this
    Court. See Sneed v. Bd. of Pro. Resp. of Supreme Ct., 
    301 S.W.3d 603
    , 615 (Tenn. 2010)
    (“It is not the role of the courts, trial or appellate, to research or construct a litigant's case
    or arguments for him or her, and where a party fails to develop an argument in support of
    his or her contention or merely constructs a skeletal argument, the issue is waived.”).
    We do note, however, that the Tennessee Rules of Criminal Procedure contain more
    explicit requirements for a waiver of counsel to be effective. See generally Tenn. R. Civ.
    P. 44. These include the duty of the trial court to “determine whether there has been a
    competent and intelligent waiver” of the right to appointed counsel. Tenn. R. Crim. P.
    44(b)(1)(B). Although we have applied this rule where counsel was constitutionally
    mandated in the criminal contempt context, see Miller v. Kelk, No. E2003-02180-COA-
    R3-JV, 
    2005 WL 1669849
    , at *9 (Tenn. Ct. App. July 18, 2005) (citing Tenn. R. Crim. P.
    44) (“[I[f Mother was indigent and faced with being held in criminal contempt, then she
    would have been entitled to court appointed counsel.”), we have not applied this rule in the
    termination of parental rights context. Indeed, this Court has previously held that certain
    law applicable in criminal cases that provides for “a far stricter standard” regarding the
    forfeiture of appointed counsel through misconduct is not applicable in matters involving
    termination of parental rights, which matter is civil in nature and involves a statutory right
    to counsel, rather than a constitutional mandate. In re A.P., No. M2017-00289-COA-R3-
    PT, 
    2019 WL 1422927
    , at *3 n.2 (Tenn. Ct. App. Mar. 29, 2019). Thus, we have previously
    recognized that the question of waiver of counsel in a termination matter is not identical to
    the question presented in a criminal matter.
    - 16 -
    Still, DCS appears to concede in its brief that the waiver of counsel in this case
    “must be ‘voluntary knowing, and intelligent’ and usually ‘occurs only after a trial judge
    advises a defendant of the dangers and disadvantages of self-representation and determines
    that the defendant knows what he is doing and his choice is made with open eyes.’” For
    this proposition, however, DCS only cites law from the criminal context. See State v.
    Maxwell, No. M2009-00467-CCA-R3-CD, 
    2011 WL 915670
    , at *3 (Tenn. Crim. App.
    Mar. 16, 2011) (“[W]aiver of the right to counsel must be voluntary, knowing, and
    intelligent. In addition, waiver usually occurs only after the trial judge advises a defendant
    of the dangers and disadvantages of self-representation and determines that the defendant
    ‘knows what he is doing and his choice is made with eyes open.”) (internal citations and
    quotation marks omitted).
    In a similar vein, Mother argues on appeal that there is no evidence in the record to
    support Magistrate Dodd’s finding that Mother understood the consequences of the
    rejection or that her decision to waive counsel was “free and voluntary.” Mother further
    argues that the signature on the waiver form was “not authenticated on the record” because
    no witness was asked about this document at the termination trial. Finally, Mother argues
    that this case was “founded upon the allegation that Mother has some mental defect or lack
    of capacity to care for the child” and that the waiver cannot be effective without “an attempt
    to determine whether Mother’s alleged mental deficit impairs her ability to understand the
    grave decision of rejecting appointed counsel.”
    Respectfully, we disagree. Here, the record contains a waiver of the right to
    appointed counsel that bears Mother’s signature. Mother presented no evidence and no
    argument at trial that the signature on this waiver was not her own or that she did not
    voluntarily sign this document. Indeed, Mother’s brief concedes that this document
    “appears to bear Mother’s signature.” This document specifically provides that Mother
    signed the waiver “with full knowledge of the consequences of my decision[.]” This
    document therefore meets the requirement under Rule 13(f) for a signed waiver of the right
    to appointed counsel.
    We also disagree with Mother’s assertion that the lack of evidence in the record as
    to Mother’s understanding and competence is fatal to this case. As explained by the
    Tennessee Supreme Court in the context of a criminal prosecution:
    The determination of whether a defendant has exercised his or her right
    of self-representation and has concurrently waived his or her right to counsel
    is a mixed question of law and fact. United States v. Kimball, 
    291 F.3d 726
    ,
    730 (11th Cir. 2002); United States v. Robinson, 
    913 F.2d 712
    , 714 (9th Cir.
    1990); Spencer v. Ault, 
    941 F. Supp. 832
    , 851 (N.D. Iowa 1996); State v.
    Jordan, 
    118 Conn. App. 628
    , 
    984 A.2d 1160
    , 1166 (2009); 1 Kevin F.
    O’Malley et al., Federal Jury Practice & Instructions § 5:6 (6th ed. 2009).
    - 17 -
    Tennessee appellate courts review “mixed questions of law and fact de novo,
    accompanied by a presumption that the trial court’s findings of fact are
    correct.” State v. Holmes, 
    302 S.W.3d 831
    , 837 (Tenn. 2010).
    Hester, 
    324 S.W.3d at 29
    –30. Moreover, “‘the competence that is required of a defendant
    seeking to waive his right to counsel is the competence to waive the right, not the
    competence to represent himself.’” 
    Id. at 31
    . (quoting Godinez v. Moran, 
    509 U.S. 389
    ,
    399, 
    113 S. Ct. 2680
    , 
    125 L.Ed.2d 321
     (1993)). “The United States Supreme Court has
    declared that “a criminal defendant’s ability to represent himself [or herself] has no bearing
    upon his [or her] competence to choose self-representation.” Godinez, 
    509 U.S. at 400,
     
    113 S. Ct. 2680
    . Thus, a litigant’s “lack of capacity to present an effective defense is not a basis
    for denying the exercise of the right of self-representation.” Hester, 
    324 S.W.3d at 32
    (citing State v. Herrod, 
    754 S.W.2d 627
    , 630 (Tenn. Crim. App. 1988)). As our supreme
    court has explained:
    A trial court may properly conclude that a defendant is likely to be
    incompetent and ineffective as an advocate in his or her own defense and that
    the defendant lacks important knowledge about substantive and procedural
    law; however, these conclusions, without more, do not render the defendant
    incompetent or unable to waive the right to counsel. Deficiencies in legal
    skills and legal knowledge do not deprive a person of his or her right to self-
    representation.
    
    Id. at 32
    .
    In this case, Magistrate Dodd made an explicit finding that he explained Mother’s
    options regarding appointed counsel in “great detail.” The magistrate’s order further stated
    that he explained the consequences of Mother’s decision, in that she would need to be
    prepared to go to trial on the date set by the trial court. Magistrate Dodd further found that
    Mother was questioned under oath about her competency “to understand today’s
    proceedings.” As a result of Mother’s testimony under oath, Magistrate Dodd ruled that
    Mother would be allowed to represent herself going forward.
    To the extent that Mother now takes issue with our inability to evaluate these
    findings due to the lack of a record as to Mother’s testimony on September 5, 2019, it is
    Mother’s own failure to provide this Court with a record that results in the lack of evidence
    to evaluate. Here, Mother has filed no transcript or statement of the evidence from the
    September 5, 2019 hearing. “When no transcript or statement of the evidence is included
    in the record on appeal, we conclusively presume that the findings of fact made by the trial
    court are supported by the evidence and are correct.” In re M.L.D., 
    182 S.W.3d 890
    , 894
    (Tenn. Ct. App. 2005).
    Mother cites no law to suggest that this presumption is inapplicable in this context.
    - 18 -
    Indeed, our research reveals that it is. Specifically, in State v. Hufford, No. E2012-02162-
    CCA-R3-CD, 
    2014 WL 4403831
     (Tenn. Crim. App. Sept. 8, 2014), the defendant argued
    on appeal that the trial court did not “protect his right to counsel during the proceedings.”
    
    Id. at *7
    . The State argued that the issue was waived because the defendant failed to provide
    a transcript from the hearing in which the issue of counsel was decided. 
    Id.
     We agreed with
    the State:
    Appellant had the benefit of appointed counsel prior to his first trial. He filed
    a motion to dismiss his attorney and proceed pro se. He executed an
    appropriate “Waiver of Counsel” form, which was included in the record.
    However, appellant did not include a transcript of the hearing that contained
    a colloquy with the trial court. It is appellant’s responsibility to prepare a
    record that conveys a fair, accurate, and complete account of what transpired
    in the trial court with respect to the issues forming the basis of the appeal.
    Tenn. R. App. P. 24(b). We will not presume error from a silent record. We
    must conclude that appellant’s first waiver of counsel was not in error.
    Hufford, 
    2014 WL 4403831
    , at *7. Other courts have come to similar conclusions under
    somewhat similar circumstances. Cf. State v. Jones, No. M2015-00720-CCA-R3-CD,
    
    2016 WL 3621513
    , at *9 (Tenn. Crim. App. June 29, 2016) (holding that the defendant
    could not show reversible error in the trial court’s denial of his purported request to proceed
    pro se because “[w]ithout the transcript of the March 1, 2013 hearing, we
    must presume that the trial court was correct when it ruled that Defendant’s request, made
    three days before the scheduled trial date, was merely a delay tactic”); see also Freels v.
    Jones, No. E2002-00895-COA-R3-CV, 
    2003 WL 104621
    , at *1 (Tenn. Ct. App. Jan. 13,
    2003) (citing Turner v. Turner, 
    739 S.W.2d 779
     (Tenn. Ct. App. 1986)) (holding that the
    defendant could not show a reversible error in the failure to have a jury trial because the
    trial court “found that defendant had waived her right to a jury trial, and absent
    any transcript of evidence to show otherwise, this Court must presume that the evidence
    would support the [t]rial [c]ourt’s ruling”). Thus, even in the criminal law context, with its
    heightened procedures, a party’s failure to present a proper record upon which this Court
    can evaluate the trial court’s decision has proven fatal to his or her argument on appeal.
    We certainly agree that Mother’s conduct at trial indicated that she lacked important
    knowledge to be an effective legal advocate on her own behalf. And as we have found
    infra, Mother’s mental health issues persist in a manner that persuades us that returning the
    child to her would be unsafe. But as the Tennessee Supreme Court has made clear, those
    conclusions do not necessarily render Mother incompetent to waive the right to counsel;
    instead, those are distinct questions. Here, Magistrate Dodd was tasked with making the
    determination as to whether Mother could and did waive her right to counsel. After hearing
    Mother testify under oath and having Mother complete the required written waiver,
    Magistrate Dodd found that Mother had effectively waived her right to appointed counsel.
    The record on appeal contains neither a transcript nor a statement of the evidence from the
    - 19 -
    September 5, 2017 hearing. We therefore must presume that the trial court’s implicit and
    explicit findings that Mother was both competent to execute the waiver and did so
    voluntarily are correct on appeal. And at trial, while Mother testified on her own behalf,
    she did not present any testimony concerning her mental health diagnoses or anything
    remotely relevant to the question of whether she could understand the consequences of her
    waiver of appointed counsel that occurred in September 2017.17 While Mother’s ability to
    parent due to her mental health issues is squarely at issue in this case, without some
    evidence presented to show that Mother could not properly understand the waiver of her
    right to counsel or did not do so voluntarily, we cannot disturb the ruling in the trial court.
    The trial court therefore did not err in proceeding to hear the termination petition despite
    Mother’s pro se status.
    B. Grounds for Termination
    I.      Substantial Noncompliance with Permanency Plans
    Pursuant to Tennessee Code Annotated section 36-1-113(g)(2), a ground for
    termination exists when “[t]here has been substantial noncompliance by the parent or
    guardian with the statement of responsibilities in a permanency plan pursuant to title 37,
    chapter 2, part 4[.]” As discussed by this Court in In re M.J.B., 
    140 S.W.3d 643
     (Tenn. Ct.
    App. 2004):
    Terminating parental rights based on Tenn. Code Ann. § 36-1-113(g)(2)
    requires more proof than that a parent has not complied with every jot and
    tittle of the permanency plan. To succeed under Tenn. Code Ann. § 36-1-
    113(g)(2), the Department must demonstrate first that the requirements of the
    permanency plan are reasonable and related to remedying the conditions that
    caused the child to be removed from the parent’s custody in the first place, In
    re Valentine, 
    79 S.W.3d at 547
    ; In re L.J.C., 
    124 S.W.3d 609
    , 621 (Tenn. Ct.
    App. 2003), and second that the parent’s noncompliance is substantial in light
    of the degree of noncompliance and the importance of the particular
    requirement that has not been met. In re Valentine, 
    79 S.W.3d at 548
    –49; In
    re Z.J.S., 
    2003 WL 21266854
    , at *12. Trivial, minor, or technical deviations
    from a permanency plan’s requirements will not be deemed to amount to
    substantial noncompliance. In re Valentine, 
    79 S.W.3d at 548
    ; Department
    of Children’s Servs. v. C.L., No. M2001-02729-COA-R3-JV, 
    2003 WL 22037399
    , at *18 (Tenn. Ct. App. Aug. 29, 2003) (No Tenn. R. App. P. 11
    application filed).
    
    Id. at 656
    –57.
    17
    Indeed, the evidence presented by DCS indicates that Mother repeatedly refused to sign releases
    that would have made Mother’s mental health records available to them.
    - 20 -
    Six permanency plans were created following the removal of the child. The plans
    generally required that Mother (1) maintain safe and stable housing and provide proof of
    same to DCS; (2) obtain required services through her insurance or inform DCS of the
    termination of her insurance; (3) obtain and maintain stable employment and provide proof
    to DCS; (4) provide DCS with updated contact information as necessary; (5) present herself
    to DCS and to the trial court; (6) complete a psychological evaluation and follow all
    recommendations; (7) allow DCS to complete home visits; (8) sign a release of information
    form allowing DCS to obtain records from her physicians and service providers; (9)
    develop a child care and transportation plan; (10) submit to and pass drug screens; and (11)
    complete an alcohol and drug assessment and follow recommendations. A fourth
    permanency plan included a requirement that Mother complete an additional psychological
    evaluation and follow recommendations, maintain a bond with the child, and demonstrate
    appropriate parenting behaviors. Two additional permanency plans were created that
    included these requirements.
    We begin with the question of whether Mother’s responsibilities under the plans
    were “reasonable and related to remedying the conditions that caused the child to be
    removed from the parent’s custody in the first place[.]” In re M.J.B., 
    140 S.W.3d at 656
    .
    Here the trial court found that the plans’ requirements were reasonable and related to the
    reasons that necessitated removal both at the conclusion of the termination trial. The trial
    court further found that Mother’s responsibilities were explained to her in detail. Mother
    does not argue that the plans’ requirements were unreasonable or unrelated to the
    conditions that led to the removal of the child. Instead, Mother raises as a separate issue
    that DCS and the trial court violated Mother’s rights by attempting to force her into
    unwanted medical treatment, citing Tennessee Code Annotated section 33-6-401. Section
    33-6-401 provides as follows:
    IF AND ONLY IF
    (1) a person has a mental illness or serious emotional disturbance, AND
    (2) the person poses an immediate substantial likelihood of serious harm
    under § 33-6-501 because of the mental illness or serious emotional
    disturbance,
    THEN
    (3) the person may be detained under § 33-6-402 to obtain examination for
    certification of need for care and treatment.
    Tennessee Code Annotated section 33-6-402 further provides as follows:
    If an officer authorized to make arrests in the state, a licensed physician, a
    psychologist authorized under § 33-6-427(a), or a professional designated by
    the commissioner under § 33-6-427(b) has reason to believe that a person is
    subject to detention under § 33-6-401, then the officer, physician,
    - 21 -
    psychologist, or designated professional may take the person into custody
    without a civil order or warrant for immediate examination under § 33-6-404
    for certification of need for care and treatment.
    See also Tenn. Code Ann. § 33-6-404 (involving the situation where a person “is brought
    to” a medical provider “for examination under this section” to determine “whether the
    person is subject to admission to a hospital or treatment resource under § 33-6-403”); cf.
    Tenn. Code Ann. § 33-6-403 (involving the question of whether a person “may be admitted
    and detained by a hospital or treatment resource for emergency diagnosis, evaluation, and
    treatment under this part”).
    To the extent that this argument requires us to engage in statutory construction, we
    follow the familiar rules applicable to that inquiry:
    “The most basic principle of statutory construction is to ascertain and give
    effect to the legislative intent without unduly restricting or expanding a
    statute’s coverage beyond its intended scope.” Owens v. State, 
    908 S.W.2d 923
    , 926 (Tenn. 1995) (citing State v. Sliger, 
    846 S.W.2d 262
    , 263 (Tenn.
    1993)). “The text of the statute is of primary importance.” Mills v.
    Fulmarque, 
    360 S.W.3d 362
    , 368 (Tenn. 2012). A statute should be read
    naturally and reasonably, with the presumption that the legislature says what
    it means and means what it says. See BellSouth Telecomms., Inc. v.
    Greer, 
    972 S.W.2d 663
    , 673 (Tenn. Ct. App. 1997).
    In re Kaliyah S., 
    455 S.W.3d 533
    , 552 (Tenn. 2015).
    Our review of the text of the above statutes persuades us that they are simply
    inapposite here. Section 33-6-401 clearly provides that only if its requirements are met can
    an individual “be detained” under section 33-6-404. Likewise, section 33-6-404 speaks in
    terms of taking an individual “into custody.” In determining the meaning of a statute, we
    must      determine      the   Legislature’s    intent     without      “unduly    .   .   .
    expanding [the] statute’s coverage beyond its intended scope.” Limbaugh v. Coffee Med.
    Ctr., 
    59 S.W.3d 73
    , 83 (Tenn. 2001). The statutes cited by Mother clearly involve a
    situation wherein an individual is physically detained for purposes of providing treatment.
    See Tenn. Code Ann. 33-6-401 (concerning whether an individual may “be detained”);
    Tenn. Code Ann. 33-6-402 (concerning the situation where an individual is taken “into
    custody” for treatment); Tenn. Code Ann. 33-6-404 (involving an examination to
    determine whether to release an individual or if “the person is subject to admission”). In
    this case, Mother was never taken into custody for the purposes of mental health treatment,
    nor was the question of her admission to any facility ever at issue. Indeed, Mother concedes
    in her appellate brief that “Mother was not physically coerced into psychological diagnosis
    and treatment[.]” As such, this situation simply is not governed by the cited statutes.
    Indeed, our research has indicated that none of the cited statutes have ever been cited in
    - 22 -
    the context of a child protective action.
    Mother argues, however, that DCS nevertheless sought to coerce Mother to obtain
    mental health treatment by making it a condition to exercise her fundamental right to parent
    her child. Moreover, Mother contends that these requirements were based on nothing more
    than “allegation[s] of psychological problems.” As result, Mother argues that we should
    hold that DCS cannot rely on grounds for termination that rely on Mother’s refusal to
    participate in mental health treatment in the absence of compliance with Section 33-6-404.
    Respectfully, we disagree.
    DCS correctly points out in its brief that the State has a compelling interest in
    protecting children from harm. See Davis-Kidd Booksellers, Inc. v. McWherter, 
    866 S.W.2d 520
    , 524 (Tenn. 1993) (quoting Sable Communications of California, Inc. v.
    F.C.C., 
    492 U.S. 115
    , 126–27 
    109 S. Ct. 2829
    , 
    106 L.Ed.2d 93
     (1989)) (“We have
    recognized that there is a compelling interest in protecting the physical and psychological
    well-being of minors.”). The right to parent children is therefore not absolute. See In re
    S.M., 
    149 S.W.3d 632
    , 638–39 (Tenn. Ct. App. 2004) (“While this right is fundamental
    and superior to the claims of other persons and the government, it is not absolute. It
    continues without interruption only as long as a parent has not relinquished it, abandoned
    it, or engaged in conduct requiring its limitation or termination.”). Consequently, the State
    may interfere with a parent’s fundamental right when there is a risk of substantial harm to
    a child. See Hawk v. Hawk, 
    855 S.W.2d 573
    , 577 (Tenn. 1993) (“In light of this right to
    privacy, we believe that when no substantial harm threatens a child’s welfare, the state
    lacks a sufficiently compelling justification for the infringement on the fundamental right
    of parents to raise their children as they see fit.”).
    The Tennessee Legislature has recognized that mental health issues may result in
    substantial harm to a child, as a ground for termination exists when the parent’s present
    mental condition renders the parent incompetent to adequately parent the child. See Tenn.
    Code Ann. § 36-1-113(g)(8). And Tennessee courts have held that mental health issues can
    justify interference in the parental-child relationship due to the substantial harm that it can
    cause children. See, e.g., State v. Smith, 
    785 S.W.2d 336
    , 338 (Tenn. 1990) (“The holding
    of the Court of Appeals in this case—that ‘mental disability’ cannot be the basis of
    termination of parental rights since the acts of the mentally disabled parent are not willful—
    would nullify a significant part of the legislative plan for the welfare of dependent and
    neglected children. An obvious result of the holding is to condemn a child, whose parents
    are unfit to properly care for the child because of mental illness, to a life in serial foster
    homes without any possibility of a stable, permanent home.”).
    In this case, the trial court entered an order on May 5, 2017, finding that the child
    was “subject to an immediate threat of harm” and placing the child in DCS custody. Later,
    Mother chose to waive her right to the probable cause hearing. And finally, the juvenile
    court entered an order, upon Mother’s own stipulation, adjudicating the child as dependent
    - 23 -
    and neglected. Thus, it was a judicial finding of substantial harm, not merely an allegation,
    that justified DCS’s interference with Mother’s fundamental parental rights. And based on
    the removal of the child, DCS had both the right and the responsibility to create
    permanency plans with action steps for Mother to complete in order to achieve the goals
    of the plans. See generally Tenn. Code Ann. § 37-2-403 (governing the requirement that
    DCS create a permanency plan within thirty days of foster care placement).
    Moreover, the agreed order of disposition in the dependency and neglect action
    provided that Mother “stipulate[d] and consent[ed] to the findings of fact and conclusions
    of law contained herein.” One of those findings was that Mother would consistently
    participate in counseling and complete an additional mental health assessment. Thus,
    Mother, by and through her attorney, voluntarily agreed to complete these tasks. See
    Memphis Bd. of Realtors v. Cohen, 
    786 S.W.2d 951
    , 953 (Tenn. Ct. App. 1989)
    (citing Moody v. Moody, 
    681 S.W.2d 545
     (Tenn. 1984)) (“While defendant may have a
    grievance against her attorney, as to the other party to the suit she is bound by
    the attorney’s knowledge and his actions in her behalf.”).
    Finally, we note that Mother’s argument essentially attacks the findings made and
    the requirements put in place in the dependency and neglect action. Nothing in the record,
    however, indicates that Mother ever appealed any of the rulings from the dependency and
    neglect matter, despite the fact that she was represented when the dependency and neglect
    order was entered. Thus, the orders from the dependency and neglect action are final and
    cannot now be attacked.18 See In re Jimmy B., No. E2015-02070-COA-R3-PT, 
    2016 WL 2859180
    , at *6 (Tenn. Ct. App. May 11, 2016) (declining to entertain father’s collateral
    attack of the juvenile court’s dependency and neglect order in the termination of father’s
    parental rights proceeding because they are “separate proceeding[s]”). Thus, the only
    question in this case involved whether the permanency plans’ requirements were
    reasonable and related to the issues that caused the child to come into custody; if so, DCS
    is entitled to rely on Mother’s substantial noncompliance therewith as a ground for
    termination of her parental rights.
    We also cannot conclude that it was unreasonable for DCS to insist in its
    permanency plans that Mother complete tasks related to her mental health, as those tasks
    clearly appear related to the issues that led to DCS involvement in this case. Indeed, the
    proof showed that DCS first became involved in this case when Mother reported to the
    hospital that she was having trouble making decisions as to the child due to mental health
    issues and was acting erratically at the hospital. Although DCS did not initially believe that
    18
    We note that while Mother asserted in the termination trial that she had not been served with the
    dependency and neglect petition, she did not raise this argument on appeal. Moreover, the record on appeal
    contains a summons from the dependency and neglect action that was served on Mother on September 6,
    2017. Mother also participated in the dependency and neglect action by and through her counsel without
    ever objecting to the lack of service of a summons or personal jurisdiction. Thus, even to the extent that
    this issue is at all relevant to this action, it lacks merit.
    - 24 -
    removal was necessary, Mother’s mental health issues became more pronounced when
    DCS met with Mother in the days following the hospital visit. Mother’s behavior gave DCS
    serious concerns about her mental health, leading ultimately to the removal of the child and
    DCS’s insistence that she complete certain mental health requirements.
    We have generally held that expert proof is not required to show “the effect of a
    parent’s mental illness on his or her ability to parent a child[.]” In re Shaneeque M., No.
    E2014-00795-COA-R3-PT, 
    2014 WL 6499972
    , at *9 (Tenn. Ct. App. Nov. 20, 2014)
    (concerning the ground for termination related to a present mental condition that prevents
    a party from adequately caring for a child). Mother’s own interactions with DCS workers
    and visitation supervisors confirmed that her mental health was at issue. Mother was
    certainly free to ignore DCS’s recommendations, but she did so at the risk that her refusal
    could prevent reunification with the child, so long as her mental health issues continued to
    place the child at substantial risk of harm. Simply put, Mother’s fundamental right to refuse
    treatment did not mean that DCS had to sit idly by when Mother’s untreated mental health
    issues presented a risk of substantial harm to the child. Thus, we hold that DCS was entitled
    to rely on grounds for termination that implicate Mother’s mental health and her refusal to
    comply with reasonable requests to remedy issues related to that issue, without compliance
    with Tennessee Code Annotated section 33-6-401 and its related statutes. Moreover, we
    conclude that the evidence does not preponderate against the trial court’s finding that the
    plans’ requirements were reasonable and related to the conditions that led to the removal
    of the child.
    Mother next argues that she did substantially comply with the requirements of the
    plans. We agree that Mother did meet many requirements, as there were no concerns with
    her housing, her income, or her drug use at the time of trial. The trial court also made no
    finding that Mother failed to create a transportation plan or complete an alcohol and drug
    assessment.
    But as DCS points out, the central focus of this case was Mother’s mental health.
    And the requirements related to this issue are where Mother’s compliance was woefully
    deficient. For example, while Mother did complete a psychological assessment, the
    testimony indicated that she did not follow the recommendations, such as regularly
    attending counseling. Instead, throughout the nearly thirty-three months that the child was
    in DCS’s physical custody, Mother attended only three counseling sessions, and her
    counselor reported that she did not focus on treatment. As a result, another mental health
    assessment was recommended; while Mother sometimes agreed that she would complete
    this assessment, she ultimately refused to do so. Mother also declined DCS’s offer of
    assistance in obtaining this assessment and yet failed to determine whether her insurance
    would cover the cost. This refusal to check her insurance coverage was typical of Mother’s
    behavior throughout the pendency of this case. Mother also refused on multiple occasions
    to sign releases allowing DCS to obtain her medical records, or later revoked the releases
    that she did sign.
    - 25 -
    Finally, the proof concerning Mother’s conduct at the visitations indicated that
    Mother’s mental health issues did not improve over the time that the child was in custody;
    indeed, in July 2019, visitations were terminated because of Mother’s erratic and
    aggressive behavior. Thus, Mother efforts were deficient in completing the actions steps
    related to maintaining a bond with the child and demonstrating appropriate parenting
    behaviors during visitation.
    As previously discussed, “the real worth and importance of noncompliance should
    be measured by both the degree of noncompliance and the weight assigned to that
    requirement.” In re Valentine, 
    79 S.W.3d 539
    , 548 (Tenn. 2002). Thus, a parent’s
    completion of many tasks may still constitute substantial noncompliance when the parent
    made little effort to complete the tasks that relate to the “central requirements” of the plans
    that “are integral to the successful reunification of th[e] family.” In re Aaralyn O., No.
    W2017-01411-COA-R3-PT, 
    2018 WL 468246
    , at *10 (Tenn. Ct. App. Jan. 18, 2018). In
    a similar situation, we explained as follows:
    It is quite evident from the record before us that the primary reason for
    Mother’s inability to properly care for her children was her ongoing drug
    dependency and thus, we agree with the juvenile court’s conclusion that her
    failure to comply with her plans’ requirement that she lead a drug free lifestyle
    constitutes substantial noncompliance.
    In re J.C.D., 
    254 S.W.3d 432
    , 442 (Tenn. Ct. App. 2007); see also In re Destiny S., No.
    M2016-00098-COA-R3-PT, 
    2016 WL 4186731
    , at *9 (Tenn. Ct. App. Aug. 4, 2016)
    (affirming the ground of substantial noncompliance where the parent completed some
    tasks but failed to complete the tasks related to sobriety, the “primary concern in this case
    from the very beginning”). Here, the record reflects that the primary issue preventing
    reunification was Mother’s mental health, including her erratic behavior, paranoia, and
    aggression toward her own child. Mother made very little effort to complete any of the
    requirements that related to her ongoing mental health issues. As a result, we cannot
    conclude that the trial court erred in concluding that Mother’s noncompliance with the
    permanency plans was substantial under the circumstances. This ground for termination is
    therefore affirmed.
    2. Abandonment by Failure to Visit
    DCS next argues Mother’s parental rights should be terminated on the ground of
    abandonment by failure to visit, pursuant to Tennessee Code Annotated sections 36-1-
    102(1)(A)(i) and 36-1-113(g)(1). Section 36-1-113(g)(1) states that termination of parental
    rights may be based upon “[a]bandonment by the parent or guardian, as defined in § 36-1-
    102.” At the time of the filing of the termination petition, section 36-1-102(1)(A)(i), in
    turn, defined “abandonment” as follows:
    - 26 -
    For a period of four (4) consecutive months immediately preceding the filing
    of a proceeding, pleading, petition, or any amended petition to terminate the
    parental rights of the parent or parents or the guardian or guardians of the
    child who is the subject of the petition for termination of parental rights or
    adoption, that the parent or parents or the guardian or guardians either have
    failed to visit or have failed to support or have failed to make reasonable
    payments toward the support of the child[.]
    Failure to visit refers to
    the failure, for a period of four (4) consecutive months, to visit or engage in
    more than token visitation. That the parent had only the means or ability to
    make very occasional visits is not a defense to failure to visit if no visits were
    made during the relevant four-month period[.]
    Tenn. Code Ann. § 36-1-102(1)(E). Token visitation, in turn, is defined as “visitation,
    under the circumstances of the individual case, [which] constitutes nothing more than
    perfunctory visitation or visitation of such an infrequent nature or of such short duration as
    to merely establish minimal or insubstantial contact with the child[.]” Tenn. Code Ann. §
    36-1-102(1)(C). Under Tennessee Code Annotated section 36-1-102(1)(I), as amended,
    it shall be a defense to abandonment for failure to visit or failure to support
    that a parent or guardian’s failure to visit or support was not willful. The
    parent or guardian shall bear the burden of proof that the failure to visit or
    support was not willful. Such defense must be established by a
    preponderance of evidence. The absence of willfulness is an affirmative
    defense pursuant to Rule 8.03 of the Tennessee Rules of Civil Procedure[.]
    “Proving an allegation by a preponderance of the evidence requires a litigant to convince
    the trier-of-fact that the allegation is more likely true than not true.” McEwen v. Tennessee
    Dep’t of Safety, 
    173 S.W.3d 815
    , 825 (Tenn. Ct. App. 2005) (citing Austin v. City of
    Memphis, 
    684 S.W.2d 624
    , 634–35 (Tenn. Ct. App. 1984)). “Failure to visit or support a
    child is ‘willful’ when a person is aware of his or her duty to visit or support, has the
    capacity to do so, makes no attempt to do so, and has no justifiable excuse for not doing
    so.” In re Audrey S., 
    182 S.W.3d 838
    , 864 (Tenn. Ct. App. 2005) (citing In re M.J.B., 
    140 S.W.3d 643
    , 654 (Tenn. Ct. App. 2004)).
    Here, the relevant four-month period is March 19, 2019 to July 18, 2019. There is
    no dispute that while Mother was late for some of the visits and some of the visits were cut
    short, Mother did in fact attend all of the visits that were provided to her by DCS during
    this time. This led the trial court to find that Mother visited the child “on a fairly regular
    basis.” The central focus of the trial court’s findings as to this ground for termination was
    - 27 -
    not, however, on the quantity of visits exercised by Mother, but the quality of those visits.
    Specifically, the trial court made detailed findings as to Mother’s conduct at each visit that
    occurred in the four-month period, finding that with the exception of a single visit in the
    four-month period, in each and every visit, there were significant issues with Mother’s
    conduct. Some of these issues included acting erratically, becoming unreasonably angry
    with the child, yelling at the child, frightening the child, threatening to take the child to the
    hospital, being aggressive toward the child, acting indifferently toward the child, expecting
    behavior beyond the child’s current development, becoming paranoid about the child’s
    safety or privacy, refusing to play with the child even when asked, refusing to end the visits
    as asked, telling the child that he was coming home tomorrow without basis, holding the
    child down, demanding that the child bond with her rather than performing the tasks that
    the supervisor asserted would naturally create a bond, playing on her phone rather than
    attending to the child, talking with the supervisor about her case instead of interacting with
    the child, claiming that she had multiple degrees and professions, bringing in items
    smelling of alcohol, showing the child inappropriate pictures of violence on her phone, and
    arguing with the child. These issues did not seem to improve as time went on, but actually
    appeared to worsen, resulting in the suspension of Mother’s visitation shortly after the
    termination petition was filed.
    On appeal, Mother argues that the trial court’s focus on the quality of the visits was
    inappropriate. Instead, Mother contends that under the definition of token visitation in
    section 36-1-102, the only question is whether Mother’s visits were perfunctory,
    infrequent, or of short duration. As Mother states, “[b]ad visits are not the same thing as
    infrequent perfunctory visits.” Respectfully, we must disagree.
    Whether a visit is token “under the circumstances of the individual case” is a
    particularly fact-intensive inquiry. Tenn. Code Ann. § 36-1-102(1)(C); In re Keri C., 
    384 S.W.3d 731
    , 748 (Tenn. Ct. App. 2010). In making this determination, courts look at the
    “frequency, duration, and quality of the visits that occurred.” In re Keri C., 384 S.W.3d at
    750. We also consider any evidence of “the parent’s conduct and the relationship between
    the child and the parent up to this point.” Id. at 749. Based on this law, we have previously
    affirmed a finding on this ground when the parent appeared at every weekly visitation that
    he was able prior to incarceration, but the visitation was nevertheless token in nature
    because the parent was physically aggressive and inappropriate with the children. In re
    Joseph G., No. E2012-2501-COA-R3-PT, 
    2013 WL 3964167
    , at *9 (Tenn. Ct. App. July
    31, 2013) (also concluding that the mother’s few visits were perfunctory because the
    mother was intoxicated, verbally abusive, and inappropriate with the children). In another
    case, the mother attended all but two visitations that were provided during the four-month
    period. See State Dep’t of Children’s Servs. v. L.L.T., No. E2003-00501-COA-R3-JV,
    
    2003 WL 23094559
    , at *4 (Tenn. Ct. App. Dec. 30, 2003). But the DCS caseworker
    testified that the mother fell asleep during some of the visits, was intoxicated during some
    sessions, and got into an argument with father during some sessions. 
    Id.
     We therefore
    affirmed the trial court’s finding that the mother’s visitation was merely “perfunctory” and
    - 28 -
    that the mother had in fact failed to visit the child in more than a token fashion. 
    Id.
    We cannot deny that this case is unusual. Here, Mother attended every single
    visitation that was permitted by DCS in the relevant period. But she did not spend all of
    her allotted time with the child, as she was sometimes late and some visits were cut short
    due to her own conduct. While quantity may be in Mother’s favor, quality certainly is not.
    Here, the evidence supports the trial court’s findings that Mother’s visits were more often
    than not, fraught with deplorable conduct by Mother. Indeed, it appears that the visits with
    the child were counter-productive, as Mother’s escalating aggression and erratic behavior
    caused the child to grow frightened of her. Mother was not able to string together even two
    visits in a row that did not suffer from serious issues. As a result, the visits were not helpful
    in developing any meaningful bond with the child. As a whole, we cannot conclude that
    the evidence preponderates against the trial court’s finding that Mother’s visits were only
    token under the circumstances. DCS therefore proved this ground by clear and convincing
    evidence.
    3. Abandonment by Failure to Establish a Suitable Home
    DCS also argues that Mother abandoned the child in another way, by failing to
    establish a suitable home for the child. Under Tennessee Code Annotated section 36-1-
    102(a)(1)(A)(ii), abandonment may be found under the following circumstances:
    (a) The child has been removed from the home or the physical or legal custody
    of a parent or parents or guardian or guardians by a court order at any stage
    of proceedings in which a petition has been filed in the juvenile court alleging
    that a child is a dependent and neglected child, and the child was placed in the
    custody of the department or a licensed child-placing agency;
    (b) The juvenile court found, or the court where the termination of parental
    rights petition is filed finds, that the department or a licensed child-placing
    agency made reasonable efforts to prevent removal of the child or that the
    circumstances of the child’s situation prevented reasonable efforts from being
    made prior to the child’s removal; and
    (c) For a period of four (4) months following the physical removal, the
    department or agency made reasonable efforts to assist the parent or parents
    or the guardian or guardians to establish a suitable home for the child, but that
    the parent or parents or the guardian or guardians have not made reciprocal
    reasonable efforts to provide a suitable home and have demonstrated a lack of
    concern for the child to such a degree that it appears unlikely that they 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 or guardian in establishing a
    suitable home for the child shall be found to be reasonable if such efforts equal
    or exceed the efforts of the parent or guardian toward the same goal, when the
    parent or guardian is aware that the child is in the custody of the department;
    - 29 -
    ....
    Providing a suitable home “requires more than providing a proper physical living
    location.” In re Navada N., 
    498 S.W.3d 579
    , 595 (Tenn. Ct. App. 2016) (citations,
    quotation marks, and alterations omitted). A parent’s failure to address mental health issues
    can also lead to a finding that the parent has failed to establish a suitable home. See, e.g.,
    In re Draven K., No. E2019-00768-COA-R3-PT, 
    2020 WL 91634
    , at *8 (Tenn. Ct. App.
    Jan. 7, 2020) (“Mother’s failure to address her mental health issues renders her unable to
    provide a safe and stable environment for the child and shows a lack of concern for the
    child and a lack of interest in regaining custody.”); In re Roderick R., No. E2017-01504-
    COA-R3-PT, 
    2018 WL 1748000
    , at *12 (Tenn. Ct. App. Apr. 11, 2018) (“Mother’s own
    failure to comply with her mental health treatment regimen demonstrated her lack of
    concern for the Children and resulted in her inability to provide
    a suitable home environment.”).
    Here, Mother does not dispute that the conditions in subsections (a) and (b) are
    satisfied: the children were removed by the juvenile court dependency and neglect orders
    and placed in DCS custody, and the trial court found that reasonable efforts were made by
    DCS to prevent the removal of the child. Moreover, Mother does not assert that DCS failed
    to make reasonable efforts in this case, as the trial court specifically found. We agree that
    they did. Here, DCS provided Mother with a variety of services following the removal and
    throughout the pendency of this case. Cf. In re Jakob O., No. M2016-00391-COA-R3-PT,
    
    2016 WL 7243674
    , at *13 (Tenn. Ct. App. Dec. 15, 2016) (“As long as the proof relates to
    ‘a period of four (4) months following the removal,’ Tenn. Code Ann. § 36-1-102(1)(A)(ii),
    the ground may be established. The statute does not limit the court’s inquiry to a period of
    four months immediately following the removal.”). This includes assisting Mother with
    obtaining assessments and counseling services, setting up supervised visitation, repeatedly
    informing Mother of the tasks that she was required to complete, and attempting to assist
    her in completing those tasks. Thus, the trial court’s finding that DCS’s efforts were
    reasonable is affirmed.
    Mother argues, however, that DCS failed to present clear and convincing evidence
    that her home was unsuitable. In this case, there is no dispute that Mother’s physical home
    is suitable for a child. Instead, the trial court relied again on Mother’s unaddressed mental
    health concerns as the basis for this ground, citing “Mother’s failure to participate in
    individual counseling, sig[n] releases and complete a more in-depth psychological
    evaluation[.]” Thus, the trial court found that “Mother is unable to provide a suitable home
    due to her refusal to address her mental/emotional health issues that created barriers to not
    only visitation but reunification.” We agree. As previously discussed, Mother failed to
    attend more than three individual counseling sessions and failed to complete the
    recommended second assessment, even after agreeing to do so. Moreover, Mother’s
    conduct at the visitations before they were suspended indicated that her behavior was not
    safe for the child, even in that highly supervised situation. Mother vacillated between
    - 30 -
    extreme interest, aggression, indifference, and anger. She did not make significant progress
    in her parenting skills. Thus, Mother’s own behavior demonstrates a lack of concern for
    the child such that it appears unlikely that she will be able to provide a suitable home for
    him at an early date. See Tenn. Code Ann. § 36-1-102(1)(A)(ii)(c). This ground for
    termination is therefore affirmed.
    5. Failure to Manifest an Ability and Willingness to Assume Legal and Physical
    Custody
    The next ground upon which DCS relies, and which the trial court found, is that
    Mother failed “to manifest, by act or omission, an ability and willingness to personally
    assume legal and physical custody . . . of the child, and placing the child in [Mother’s] legal
    and physical custody would pose a risk of substantial harm to the physical or psychological
    welfare of the child.” Tenn. Code Ann. § 36-1-113(g)(14). As the Tennessee Supreme
    Court explained,
    section 36-1-113(g)(14) places a conjunctive obligation on a parent or
    guardian to manifest both an ability and willingness to personally assume
    legal and physical custody or financial responsibility for the child. If a person
    seeking to terminate parental rights proves by clear and convincing proof that
    a parent or guardian has failed to manifest either ability or willingness, then
    the first prong of the statute is satisfied.
    In re Neveah M., 
    614 S.W.3d 659
    , 677 (Tenn. 2020) (citation omitted).
    We begin with the willingness and ability prong. “Ability focuses on the parent’s
    lifestyle and circumstances.” In re Cynthia P., No. E2018-01937-COA-R3-PT, 
    2019 WL 1313237
    , at *8 (Tenn. Ct. App. Mar. 22, 2019) (citing In re Maya R., No. E2017-01634-
    COA-R3-PT, 
    2018 WL 1629930
    , at *7 (Tenn. Ct. App. Apr. 4, 2018)). “When evaluating
    willingness, we look for more than mere words.” 
    Id.
     (citing In re Keilyn O., No. M2017-
    02386-COA-R3-PT, 
    2018 WL 3208151
    , at *8 (Tenn. Ct. App. June 28, 2018)). “Parents
    demonstrate willingness by attempting to overcome the obstacles that prevent them from
    assuming custody. . . .” 
    Id.
     Although we may consider evidence from both before and after
    the petition was filed, see In re Maya R., 
    2018 WL 1629930
     at *7, a parent’s ability and
    willingness may be measured as of the time the petition is filed. See In re Serenity W., No.
    E2018-00460-COA-R3-PT, 
    2019 WL 511387
    , at *7 (Tenn. Ct. App. Feb. 8, 2019) (citing
    In re M.E.N.J., No. E2017-01074-COA-R3-PT, 
    2017 WL 6603658
    , at *7 (Tenn. Ct. App.
    Dec. 27, 2017)).
    Here, the trial court again based its finding on this ground on Mother’s unaddressed
    mental health issues: “Mother has unaddressed emotional and/or mental health issues that
    would pose a risk of substantial harm to this Child’s physical and psychological welfare if
    the Child was returned to the Mother’s care.” Mother’s only argument in response to this
    - 31 -
    ground is that she cannot be forced into psychiatric treatment or testing without compliance
    with Tennessee Code Annotated section 33-6-401. As previously discussed, however, DCS
    was not required to comply with section 33-6-401, and it was reasonable for DCS to require
    Mother to obtain mental health testing and treatment in this case.
    We agree with the trial court that Mother has not exhibited the ability or willingness
    to personally assume physical custody of the child. As previously discussed, Mother has
    refused to participate in the treatment that is clearly necessary to address her mental health
    concerns. Thus, Mother has made little effort to overcome the obstacles that prevent
    reunification. See In re Cynthia P., 
    2019 WL 1313237
    , at *8. Mother also has not
    demonstrated the ability to parent the child in a safe and appropriate manner during
    supervised visitations. Instead, the visits were suspended due to Mother’s inappropriate
    behavior, which caused the child to become frightened of her. Accordingly, DCS has
    shown that Mother has manifested neither the ability nor a willingness to assume physical
    custody of the child.
    The second prong of this ground involves whether the children would suffer
    substantial harm if returned to her custody. As we have explained regarding this prong:
    The courts have not undertaken to define the circumstances that pose a risk of
    substantial harm to a child. These circumstances are not amenable to precise
    definition because of the variability of human conduct. However, the use of
    the modifier “substantial” indicates two things. First, it connotes a real hazard
    or danger that is not minor, trivial, or insignificant. Second, it indicates that
    the harm must be more than a theoretical possibility. While the harm need not
    be inevitable, it must be sufficiently probable to prompt a reasonable person
    to believe that the harm will occur more likely than not.
    Ray v. Ray, 
    83 S.W.3d 726
    , 732 (Tenn. Ct. App. 2001) (footnotes omitted). Here, we agree
    with the trial court that Mother’s unaddressed mental health issues pose serious risk of
    substantial harm to the child. Mother has not had unsupervised visitation with the child in
    nearly three years. And she has had no visitation with him of any kind in over ten months
    by the time of trial. The visits were terminated because Mother’s own behavior was highly
    inappropriate; she was at times aggressive, indifferent, or angry with the child. Mother’s
    conduct caused the child to become frightened. As a result, we have little difficulty
    affirming the trial court’s finding that returning the child to Mother would pose a risk of
    substantial harm to the child.
    6. Persistence of Conditions
    The final ground DCS relies on is persistence of conditions, pursuant to Tennessee
    Code Annotated section 36-1-113(g)(3):
    - 32 -
    (A) The child has been removed from the home or the physical or legal
    custody of a parent or guardian for a period of six (6) months by a court
    order entered at any stage of proceedings in which a petition has been
    filed in the juvenile court alleging that a child is a dependent and
    neglected child, and:
    (i) The conditions that led to the child’s removal still persist,
    preventing the child’s safe return to the care of the parent or guardian,
    or other conditions exist that, in all reasonable probability, would
    cause the child to be subjected to further abuse or neglect, preventing
    the child’s safe return to the care of the parent or guardian;
    (ii) 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 or
    guardian in the near future; and
    (iii) The continuation of the parent or guardian and child relationship
    greatly diminishes the child’s chances of early integration into a safe,
    stable, and permanent home;
    (B) The six (6) months must accrue on or before the first date the termination
    of parental rights petition is set to be heard[.]
    There is no dispute in this case that the child was removed from Mother’s custody
    for a period of six months by an order entered in a dependency and neglect action. Thus,
    the dispositive questions are whether conditions persist that prevent the safe return of the
    child, whether the conditions will likely be remedied at an early date, and whether the
    continued relationship prevents early integration of the child into a stable, permanent home.
    As we have previously explained,
    “A parent’s continued inability to provide fundamental care to a child, even
    if not willful, . . . constitutes a condition which prevents the safe return of the
    child to the parent’s care.” In re A.R., No. W2008-00558-COA-R3-PT, 
    2008 WL 4613576
    , at *20 (Tenn. Ct. App. Oct. 13, 2008) (citing In re T.S. &
    M.S., No. M1999-01286-COA-R3-CV, 
    2000 WL 964775
    , at *7 (Tenn. Ct.
    App. July 13, 2000)). The failure to remedy the conditions which led to the
    removal need not be willful. In re T.S. & M.S., 
    2000 WL 964775
    , at *6
    (citing State Dep’t of Human Servs. v. Smith, 
    785 S.W.2d 336
    , 338 (Tenn.
    1990)). “Where . . . efforts to provide help to improve the parenting ability,
    offered over a long period of time, have proved ineffective, the conclusion []
    that there is little likelihood of such improvement as would allow the safe
    return of the child to the parent in the near future is justified.” 
    Id.
     The
    purpose behind the “persistence of conditions” ground for terminating
    parental rights is “to prevent the child’s lingering in the uncertain status of
    foster child if a parent cannot within a reasonable time demonstrate an ability
    to provide a safe and caring environment for the child.” In re A.R., No.
    - 33 -
    W2008-00558-COA-R3-PT, 
    2008 WL 4613576
    , at *20 (Tenn. Ct. App. Oct.
    13, 2008) (quoting In re D.C.C., No. M2007-01094-COA-R3-PT, 
    2008 WL 588535
    , at *9 (Tenn. Ct. App. Mar. 3, 2008)).
    In re Navada N., 
    498 S.W.3d 579
    , 605–06 (Tenn. Ct. App. 2016).
    Mother’s argument as to this ground is sparse. As we perceive it, Mother essentially
    argues that the conditions that led to the removal initially, that she lacked appropriate
    materials to care for an infant and that she was not in her “right mind to make medical
    decisions,” had been remedied.19 Mother further argues that the only significant condition
    that arose after the removal was her reluctance to submit to psychological testing and
    treatment. As to this condition, Mother again contends that DCS was not permitted to
    coerce Mother into mental health treatment, which we will not further address. As
    previously discussed, DCS was entitled to require Mother to submit to mental health
    treatment and testing prior to reunification under the facts of this case.
    Moreover, as we have repeatedly stated, Mother’s mental health issues continued to
    persist at the time of trial. Mother’s visits with this child in the Spring and Summer of 2019
    provide a clear indication that Mother’s unaddressed mental health issues prevented her
    from appropriately parenting her child; not only did Mother never have consistent enough
    interactions with the child to progress to unsupervised visitation, her visitation was
    terminated due to her own conduct. Thus, these conditions “in all reasonable probability,
    would cause the child to be subjected to further abuse or neglect, preventing the child’s
    safe return to the care of the parent or guardian[.]” Tenn. Code Ann. § 36-1-113(g)(3).
    There was also little likelihood that these conditions would be remedied at an early date,
    as Mother repeatedly refused to participate in meaningful mental health treatment or to
    listen in any way to DCS’s advice.20 The proof also shows that the child is in a loving pre-
    adoptive home. A continued relationship with Mother prevents the child from achieving
    permanence with the family that has cared for him for three years. As a result, this ground
    for termination is likewise affirmed.
    C. Best Interest
    19
    Mother does not actually state in her brief that these conditions were remedied. In her reply brief,
    she asserts that there was no evidence that these conditions even existed, somewhat of a change from her
    argument in her initial brief. Regardless, the persistent conditions ground makes clear that it applies to both
    conditions that caused the removal and “other conditions” that become apparent following the removal. See
    In re Antonio J., No. M2019-00255-COA-R3-PT, 
    2019 WL 6312951
    , at *6 (Tenn. Ct. App. Nov. 25, 2019)
    (“This ground for termination, however, is not limited only to those conditions that led to the child's
    removal, but allows the court to also consider “other conditions that in all reasonable probability would
    cause the child to be subjected to further abuse or neglect[.]” Tenn. Code Ann. § 36-1-113(g)(3)(A). Thus,
    neither the trial court nor this Court is confined in our review only to those conditions that were expressly
    found to support the dependency and neglect findings.”).
    20
    Even during trial when DCS testified about the advice that they gave Mother about safe parenting,
    Mother objected that DCS could not tell her how to parent her child.
    - 34 -
    Because we have determined that at least one statutory ground has been proven for
    terminating Mother’s parental rights, we must now decide if DCS has proven, by clear and
    convincing evidence, that termination of Mother’s rights is in the child’s best interests.
    Tenn. Code Ann. § 36-1-113(c)(2); White v. Moody, 
    171 S.W.3d 187
    , 192 (Tenn. Ct. App.
    1994). If “the interests of the parent and the child conflict, courts are to resolve the conflict
    in favor of the rights and best interest of the child.” In re Navada N., 498 S.W.3d at 607.
    The statutory factors that courts should consider in ascertaining the best interest of
    the children include, but are not limited to, the following:
    (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
    interest 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;
    (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).21 “This list is not exhaustive, and the statute does not
    21
    This is the version of section 36-1-113(i) that was in effect when the termination petition was
    filed. The Tennessee General Assembly amended the statutory best interest factors in 2021. See 2021 Tenn.
    - 35 -
    require a trial court to find the existence of each enumerated factor before it may conclude
    that terminating a parent’s rights is in the best interest of a child.” In re M.A.R., 
    183 S.W.3d 652
    , 667 (Tenn. Ct. App. 2005) (citations omitted).
    Again, Mother’s argument here is sparse at best. Although Mother concedes “that
    to a great extent the record supports the Juvenile Court’s findings of fact” with regard to
    best interest, Mother argues on appeal that the trial court’s order fails to address the nine
    factors above. We respectfully disagree. Although the trial court did not explicitly
    reference the above factors by number, the trial court’s order contains detailed findings of
    fact as to best interest that clearly correspond to each of the above factors. For example, in
    subsection (b) of the trial court’s best interest findings, the trial court found that Mother
    “failed to make changes in her conduct and she has failed to make an adjustment of her
    circumstances and/or conditions as to make it safe for the Child to go back into the
    Mother’s home[.]” This clearly references best interest factor (1). Likewise, in subsection
    (b), the trial court noted that Mother was unable to make changes despite “herculean”
    efforts by DCS. This clearly references best interest factor (2). In our review of the trial
    court’s findings, it appears that it properly addressed seven of the nine best interest
    findings.22 This is more than sufficient for appellate review in this case. See In re M.A.R.,
    
    183 S.W.3d at 667
     (Tenn. Ct. App. 2005) (holding that every single factor need not be
    examined).
    We further agree with the trial court that the factors favor termination in this case.
    The trial court was correct that Mother has been unable to make a lasting adjustment of
    circumstances so as to make the return of the child safe, despite the best efforts of DCS.
    See Tenn. Code Ann. § 36-1-113(i)(1), (2). The evidence also does not preponderate
    against the trial court’s finding that while Mother maintained visitation with the child, it
    was “harmful to the Child’s wellbeing and the visits were not constructive toward creating
    a bond or relationship with the child.” As a result, the evidence supports the trial court
    finding that “there is not a bond between the Mother and the Child” and that other than a
    single visit, there was “never any positive interactions between the Mother and the Child
    during visits[.]” See Tenn. Code Ann. § 36-1-113(i)(3), (4). The evidence also clearly
    shows that the child is thriving with and bonded to his pre-adoptive family and that any
    Laws Pub. Ch. 190 (S.B. 205), eff. April 22, 2021. Neither party asserts that the revised version of the
    statute is applicable in this case.
    22
    Mother’s brief correctly points out that the when the trial court reaches the final two best interest
    factors, the trial court’s order contains clear omissions and references to individuals that were not part of
    the proof in this case. These appear to be mere typographical errors. Moreover, the trial court’s findings of
    fact are extremely detailed and responsive to the proof that was presented in this case. Cf. In re Colton B.,
    No. M2017-00997-COA-R3-PT, 
    2017 WL 6550620
    , at *4 (Tenn. Ct. App. Dec. 22, 2017) (holding that a
    trial court’s final termination order was insufficient when the order, inter alia, contained “not a single
    mention of any of the proof presented at the termination hearing, such as the testimony of the witnesses or
    the depositions submitted as exhibits”). As such, to the extent that these issues are errors, they are harmless.
    See Tenn. R. App. P. 36(b).
    - 36 -
    change in caretakers would therefore be “extremely detrimental to his emotional well-being
    and [] would result in extreme psychological harm to the Child[.]” See Tenn. Code Ann. §
    36-1-113(i)(5). The trial court further found that Mother’s behavior during the visitation
    rose to the level of psychological abuse, as her conduct was traumatic for the child; the
    evidence does not preponderate against this finding. See Tenn. Code Ann. § 36-1-113(i)(6).
    And of course, as the trial court found, Mother’s mental health and her refusal to seek help
    “created a significant barrier in achieving permanency for the Child.” See Tenn. Code Ann.
    § 36-1-113(i)(7). Thus, all of these above factors support termination in this case.
    Therefore, at best, only the two factors that were not specifically addressed by the trial
    court weigh against termination. See Tenn. Code Ann. § 36-1-113(i)(8), (9).
    In sum, the vast majority of the factors at issue in this case favor termination.
    Importantly, while Mother did visit with the child before the visits were terminated, she
    was unable to parent effectively or to establish any meaningful bond with the child. “This
    Court has held that both the existence of a meaningful relationship and the lack of
    meaningful relationship may be considered important factors in the best interest analysis.”
    In re P.G., No. M2017-02291-COA-R3-PT, 
    2018 WL 3954327
    , at *16 (Tenn. Ct. App.
    Aug. 17, 2018) (citing In re Addalyne S., 
    556 S.W.3d 774
    , 795 (Tenn. Ct. App. 2018));
    see In re Jayvien O., No. W2015-02268-COA-R3-PT, 
    2016 WL 3268683
    , at *9 (Tenn. Ct.
    App. June 7, 2016) (affirming a trial court’s holding that termination was in the child’s best
    interest where the trial court found that “‘most importantly,’ . . . a meaningful relationship
    had not been established between” the mother and child); In re Terry S.C., No. M2013-
    02381-COA-R3-PT, 
    2014 WL 3808911
    , at *18 (holding that termination was in the
    children’s best interest including because, “perhaps most importantly, [the mother] has
    failed to maintain regular visitation with the children and therefore has no meaningful
    relationship with them”). The child is in a safe, loving pre-adoptive home where he is
    bonded to his foster parents and siblings. Indeed, the child has spent more of his life with
    this family than he did in Mother’s custody. The trial court’s ruling that termination is in
    the child’s best interest is therefore affirmed.
    V. CONCLUSION
    The judgment of the Rutherford County Juvenile Court is affirmed as to both the
    grounds for termination and the finding that termination is in the child’s best interest. The
    termination of Mother’s parental rights is therefore affirmed. Costs of this appeal are taxed
    to Appellant Tesha L.B., for which execution may issue if necessary.
    S/ J. Steven Stafford
    J. STEVEN STAFFORD, JUDGE
    - 37 -