in the Interest of J.R.W., Child ( 2013 )


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  • Affirmed and Memorandum Opinion filed February 12, 2013.
    In The
    Fourteenth Court of Appeals
    NO. 14-12-00850-CV
    IN THE INTEREST OF J.R.W., CHILD
    On Appeal from the 315th District Court
    Harris County, Texas
    Trial Court Cause No. 2010-05537J
    MEMORANDUM OPINION
    Appellant, a mother whose parental rights to her young son were terminated,
    challenges the sufficiency of the evidence supporting the trial court’s finding that
    termination of her parental rights was in the child’s best interest. The mother also
    asserts the trial court abused its discretion in its appointment of the child’s
    conservator. We affirm.
    FACTUAL AND PROCEDURAL BACKGROUND
    In August 2010, the Department of Family and Protective Services filed a
    petition in a suit affecting the parent-child relationship, regarding J.R.W., a two-
    and-a-half-year-old boy who was living with his mother, appellant, at the time the
    petition was filed. In its petition, the Department cited an immediate danger to the
    physical health or safety of the child and sought emergency orders for temporary
    sole managing conservatorship of the child. The Department sought termination of
    appellant’s parental rights,1 asserting that such termination would be in the child’s
    best interest because appellant allegedly had committed a number of acts or
    omissions in violation of the Texas Family Code.
    As reflected in a sworn affidavit accompanying the petition, a physician
    made a referral to the Department, alleging that appellant's son had lost some
    function in his hand because she had failed to bring the child to a doctor at
    appropriate intervals for treatment of burns on the child’s hand. After the petition
    was filed, the child was placed in the care of the child’s paternal grandmother; the
    Department was appointed temporary managing conservator of the child. Criminal
    charges relating to appellant’s medical neglect of the child were also filed.
    Appellant answered the suit, generally denying the allegations.                                The child’s
    paternal grandmother filed a petition in intervention seeking conservatorship.
    A family service plan was implemented and signed by appellant on October
    5, 2010.       Although appellant claimed at trial to have completed all of the
    requirements of the family service plan, other witnesses testified that she did not
    1
    The Department also sought to terminate the putative father’s parental rights and any unknown
    father’s parental rights in the child’s best interests. The record reflects that the child’s father voluntarily
    relinquished his parental rights to the child and the trial court terminated his rights to the child in the same
    termination decree subject to our appellate review. The father is not a party to this appeal.
    2
    complete all of the requirements. Multiple permanency plan and permanency
    progress reports from February 2011 through April 2012 reflect that appellant
    completed some but not all of the requirements.
    Trial proceedings commenced in January 2012 and recessed until February.
    At a hearing in February 2012, the parties notified the trial court that they had
    come to a mediated agreement (“Agreement”) that was approved by the
    Department, a child advocate, and an attorney ad litem. Pursuant to the terms of
    the mediated Agreement, in relevant part, the child’s paternal grandparents were
    named joint managing conservators and appellant was named possessory
    conservator who was permitted visitation with the child and also was responsible
    for child support. The trial court approved the Agreement, finding, based on the
    recommendation of the guardian ad litem, that the Agreement was in the best
    interest of the child. One day after the trial court rendered the order on the
    Agreement, the paternal grandmother moved for reconsideration, noting that the
    Agreement was a mistake and that the parties could not satisfactorily work together
    without interference from appellant’s family. In her motion for reconsideration,
    the paternal grandmother asserted that the child’s best interest was served by
    setting aside the Agreement. The record suggests, and it remains undisputed, that
    appellant’s family encouraged her to seek to set aside the final Agreement within
    twenty-four hours of the Agreement being in effect. At a hearing in open court, the
    trial court vacated the rendition of the order, and the trial proceedings resumed in
    May 2012.
    According to the trial record, the child came into the Department’s care due
    to appellant’s failure to follow up with treatment for the child’s hand after he
    sustained serious burns while in his father’s care in July 2009. The child stayed in
    a hospital for two weeks and underwent two surgeries involving a skin graft to
    3
    treat the burn. The child was discharged on August 2, 2009. Although the child
    needed a follow-up appointment one week after discharge, appellant did not appear
    for another appointment until more than three months later on November 24, 2009,
    citing lack of transportation and unstable living arrangements. At that point, the
    Department had opened an investigation regarding the child’s medical treatment
    based on the doctor’s referral.
    When the child was discharged from the hospital, he was wearing a splint to
    keep two of his fingers straight. The child stayed overnight with a relative for two
    days in October 2009, and the relative misplaced the splint. At the child’s medical
    appointment on November 24, 2009, the child was referred to a specialist, who
    made a cast for the child to straighten two of the child’s fingers. Appellant was
    instructed to keep the cast on the child’s hand and told how to remove it if it got
    dirty. Appellant admitted that she had removed the cast one time because it had
    gotten dirty. The record contains a report from a doctor with the University of
    Texas Physicians Department of Plastic Surgery, who noted during the child’s next
    medical appointment visit on December 2, 2009, that appellant had stated that she
    removed the cast because she did not think the child needed it.
    The record reflects that in May 2010 a surgical procedure was performed on
    the child’s hand.     The child was supposed to return for a post-operative
    examination on June 2, 2010, one week following the procedure. Instead, on that
    date, appellant made an appointment for June 10, 2010, which she then
    rescheduled. The child saw the doctor on June 16, 2010, three weeks after the
    procedure. Appellant claimed that the skin graft had fallen off because the stitches
    failed and that the child had an open wound. In a report dated June 16, 2010,
    following that appointment, a doctor noted that the child’s parents had removed the
    4
    dressing and skin graft following the surgery, and that the child had an open
    wound. The doctor’s report, provides in relevant part:
    [I]t is fairly apparent that the parents of this child are not going to do
    what is recommended for this child as far as routine health care is
    concerned and therefore I have instructed the parents to keep the
    wound as clean as possible and let it heal on its own. Eventually
    when the child is old enough to take care of himself he is going to
    need some reconstruction of this digit; however, at this point in time it
    is pointless to try to reconstruct him because his parents will not take
    care of him.
    Appellant testified that although the child could move his fingers after the surgery,
    his fifth digit had grown more limited and restricted in movement by the time the
    petition was filed. She had not sought care or treatment of this finger despite her
    observation. The petition to terminate appellant’s parental rights was filed two
    months later.
    Appellant admitted that she did not have stable living arrangements in
    August 2009, at the time the child was discharged from the hospital. The record
    reflects that appellant stayed with various relatives and friends for days to months
    at a time and that she also lived in three different residences of her own between
    August 2010 and March 2012, when she moved to an apartment on Greens Road.
    That apartment was a one-bedroom unit furnished with some items for the child, an
    air mattress for appellant, and a computer in a closet that appellant used for work
    and school. A Department caseworker observed that the apartment was mostly
    unfurnished with little to no clothing, food, cleaning supplies, personal or hygiene
    items, or furniture; the investigator stated that it appeared as if no one lived in the
    apartment. The caseworker testified that although the family service plan was in
    effect in October 2010, appellant did not obtain appropriate housing until 2012.
    5
    Nor did appellant ever produce a copies of lease agreements for two of the
    apartments she leased.
    The record reflects that when the child came into the Department’s care, the
    child had difficulty urinating and suffered from ringworms and extensive tooth
    decay. Appellant admitted that the child had tooth decay when the child came into
    the Department’s care and that she had been unable to make all the necessary
    appointments. Appellant also stated that the child had a condition, which is a birth
    defect referred to as hypospadias, that affected the child’s ability to urinate. Based
    on her understanding of one doctor’s explanation, the condition resulted from a
    botched circumcision and posed “no issues.” The record reflects that the child
    suffered from painful recurrent urinary tract infections, stemming from the
    untreated condition. Although she confirmed she knew the signs of a urinary tract
    infection and how to seek treatment for it, she was unfamiliar with any medications
    the child had been prescribed since he came into the Department’s care. The
    record also reflects that in addition to having ringworms, the child was over one
    year behind on his immunization schedule when he came into the Department’s
    care at two-and-a-half years of age. According to the record, once the child was
    placed in the paternal grandmother’s care, the child underwent a surgery to
    successfully correct the urinary condition and received treatment for ringworms
    and severe tooth decay; he was still being monitored for recurring urinary tract
    infections. All parties agreed the child, who was age four at the time of trial, was
    developmentally on target.
    Appellant testified that the criminal charges against her, relating to the
    child’s medical neglect, were reduced to a misdemeanor offense of reckless injury
    to a child, for which she was placed on deferred adjudication for one year. At the
    time of trial, she remained on deferred adjudication. She also was sentenced to
    6
    five days’ confinement in a county jail after she pleaded guilty in March 2011 to
    misdemeanor theft. The record reflects that appellant received negative results on
    all random drug tests administered pursuant to the family service plan.
    Appellant claimed that she visited the child every other week for an hour at
    the Department’s office. She acknowledged that she missed many visits in the
    beginning of the case due to transportation issues, unstable living arrangements,
    and not being in a “stable place.” During the visits appellant attended, the child
    was happy to see her. They read books, played, and sang songs together. On
    several occasions, she brought him clothing or gifts. The record reflects that the
    child was unhappy and acted out aggressively when appellant, to whom the child
    referred by a surname, did not attend the visits with the child. The Department
    caseworker testified that appellant was permitted to visit the child twice each
    month, but appellant’s attendance at these visits was inconsistent. According to
    the caseworker, appellant visited once in October 2010, and missed all visits in
    November and December of that year. In 2011, appellant attended seventeen out
    of twenty-four visits.   Appellant missed visits with the child in January and
    February 2012 and attended only one of the visits in each month of April, May,
    and June of 2012.
    The record reflects that appellant worked at a grocery store for several
    months in late 2010, and, when that work ended, she babysat relatives’ children
    part-time and received government assistance. At the time of the January 2012
    trial proceedings, she had worked part-time at a retail store from October 2011
    through April 2012 and continued babysitting. At the May 2012 trial proceedings,
    appellant claimed to have been working at a financial institution for several weeks,
    earning $300 each week along with $80 each week in babysitting revenue.
    7
    Appellant had not provided the caseworker with any type of verification of
    employment or proof of income, as required in the family service plan.
    Appellant testified she had completed all of the requirements of the family
    service plan. In therapy, she admitted her role in failing to take the child to
    medical appointments; the record reflects a therapist’s impression that appellant
    addressed every situation and learned from her mistakes. The record reflects that a
    therapist had to call appellant with wake-up calls to encourage her attendance at
    therapy. Appellant was successfully discharged from therapy. Appellant specified
    her plans for childcare and elementary school if the child were returned to her care.
    Despite appellant’s successful discharge from therapy, the Department caseworker,
    who read the progress notes from appellant’s therapy sessions, placed little
    emphasis on the “successful discharge,” noting that session notes from the last two
    therapy sessions reflect appellant’s belief that she played no role in the child
    coming into the Department’s care.
    The caseworker reported that appellant was not honest and did not provide
    information about her fiancé, who lived with appellant at times and had a criminal
    background, or about her subsequent pregnancy and the birth and whereabouts of
    another child, a daughter.2 Although the Department had opened an investigation
    regarding the daughter, no petition to terminate appellant’s parental rights to the
    daughter had been filed.
    The child’s paternal grandmother testified that the child was placed in her
    home and care, via the Department, in August 2010. In the paternal grandmother’s
    care, the child underwent successful outpatient surgery to correct the urinary
    2
    The daughter, who remained in the care of a maternal grandmother, is not a child subject to this
    appeal.
    8
    condition. The paternal grandmother attended numerous medical appointments
    with the child to obtain updated immunizations, get treatments for the ringworms,
    and address the extensive tooth decay. The grandmother met with the child’s
    doctor to inquire about the child’s curved finger, which likely will require multiple
    surgeries in the future.    The paternal grandmother expressed her belief that
    appellant had engaged in conduct injurious to the physical and emotional welfare
    of the child through inconsistent visitation, failing to research the child’s medical
    conditions, and failing to attend medical appointments. The paternal grandmother
    cited appellant’s inconsistency in providing stability for the child as the reason
    appellant’s parental rights should be terminated in the child’s best interests. The
    paternal grandmother’s long-term goal was to adopt the child, who has bonded
    well with others in the home, noting that the child’s best interest would be met
    with continued placement in her home.
    The Department caseworker testified that at the time the petition was filed,
    the Department’s goal for the child was “relative conservatorship” and “relative
    adoption,” both of which would implicate termination of appellant’s parental
    rights; the Department likely would have changed its goal had appellant provided
    accurate and verifiable information and demonstrated stability in housing and in
    providing for the child financially.    The caseworker testified that appellant’s
    parental rights should be terminated on best-interest grounds, noting that the child
    has a need for permanency.       The caseworker testified that appellant has not
    demonstrated an ability to provide a safe, stable home for the child, an ability to
    independently support him, or any ability to understand and meet the child’s
    medical needs.
    Regarding the parties’ mediated Agreement, when asked whether the child’s
    best interests would be met by appointing the paternal grandmother as managing
    9
    conservator with appellant as a possessory conservator as set out by the parties’
    mediated Agreement, the caseworker opined that such an arrangement would not
    provide the child permanency because appellant did not consistently attend her
    visits with the child. The caseworker believed that the Agreement also proved to
    be unworkable because appellant’s family members created an unsafe and
    threatening environment for the child by parking outside of the paternal
    grandmother’s home, noting that appellant was not assertive with her family
    members in explaining how the child’s best interest were met through the
    Agreement and was not putting the child’s needs ahead of her own needs. In terms
    of why the Agreement was no longer a workable option that was in the child’s best
    interests, the paternal grandmother stated that the child and the rest of her family
    would be placed in a “hostile” environment, noting that appellant’s family
    members made an obscene hand gesture towards her during a break in the trial
    proceedings.
    A child advocate coordinator/ad litem testified that she attempted to visit
    appellant’s homes on six occasions, but was never permitted to enter because
    appellant was not home. The coordinator noted appellant’s lack of stability in
    housing and employment as a basis for terminating appellant’s parental rights,
    describing appellant as “coming in and out of” the child’s life. The coordinator
    noted that her organization had approved the Agreement, believing it to have met
    the child’s best interests at the time, but that it became immediately apparent that
    appellant was not able to meet the requirements of the Agreement.               The
    coordinator learned that in the days after the Agreement was signed, appellant’s
    family members were pressuring appellant and interfering with appellant’s ability
    to uphold the Agreement. According to the coordinator, to proceed with the
    Agreement under such conditions would have been against the child’s best
    10
    interests. The coordinator also stated that appellant had “no-showed” or cancelled
    forty-three percent of her visits with the child even during the trial proceedings.
    The coordinator cited this statistic as the basis of her belief that the Agreement
    would have been unworkable and not in the child’s best interest because, even had
    the Agreement been in place, appellant’s attendance at scheduled visits would have
    remained inconsistent.
    In a written decree for termination, signed August 31, 2012, the trial court
    terminated appellant’s parental rights to the child, finding clear and convincing
    evidence that termination of the parent-child relationship was in the child’s best
    interest. The court also found by clear and convincing evidence that appellant
    engaged in conduct or knowingly placed the child with persons who engaged in
    conduct which endangered the physical or emotional well-being of the child,
    pursuant to section 161.001(1)(E) of the Texas Family Code and failed to comply
    with provisions of a court order that specifically established the actions necessary
    for appellant to obtain the return of the child pursuant to section 161.001(1)(O) of
    the Texas Family Code. The trial court found that appointment of a parent as a
    managing conservator would not be in the child’s best interest, and appointed the
    Department as sole managing conservator, finding the appointment to be in the
    best interest of the child. Appellant’s motion for new trial was denied.
    ANALYSIS
    Is the evidence legally and factually sufficient to support the trial court’s
    finding that termination of the mother’s parental rights is in the best interest
    of the child?
    The Department had to prove by clear and convincing evidence that
    appellant engaged in conduct specified in sections 161.001(1)(E) or (O) of the
    11
    Texas Family Code3 and that termination of her parental rights was in the child’s
    best interest. See Tex. Fam. Code Ann. § 161.001; In re J.L., 
    163 S.W.3d 79
    , 84
    (Tex. 2005). Because termination of parental rights is a drastic remedy, due
    process and the Texas Family Code require the Department to have proved the
    necessary elements by the heightened burden of proof of “clear and convincing
    evidence.” See Tex. Fam. Code Ann. § 161.001 (West 2011); In re B.L.D., 
    113 S.W.3d 340
    , 353–54 (Tex. 2003). “‘Clear and convincing evidence’ means the
    measure or degree of proof that will produce in the mind of the trier of face a firm
    belief or conviction as to the truth of the allegations sought to be established.”
    Tex. Fam. Code Ann. § 101.007 (West 2011). Appellant does not challenge the
    sufficiency of the evidence to support the trial court’s findings authorizing
    termination under sections 161.001(1)(E) or (O). But, a statutory act or omission
    under section 161.001(1) must also be coupled with a finding that termination of
    the parent-child relationship is in the best interest of the child. See Tex. Fam. Code
    Ann. § 161.001; Yonko v. Dep’t Fam. & Prot. Servs., 
    196 S.W.3d 236
    , 242 (Tex.
    App.—Houston [1st Dist.] 2006, no pet.). In her first issue, appellant challenges
    the legal and factual sufficiency of the evidence to support the trial court’s finding
    that termination of the parent-child relationship is in the child’s best interest.
    In reviewing legal-sufficiency challenges to termination findings, we
    consider all of the evidence in the light most favorable to the termination findings
    to determine whether a reasonable factfinder could have formed a firm belief or
    conviction that these findings are true. 
    J.L., 163 S.W.3d at 85
    . Considering the
    evidence in the light most favorable to the findings means we presume the
    factfinder resolved disputed facts in favor of its findings if a reasonable factfinder
    3
    Unless otherwise specified, any reference to “section” pertains to the Texas Family Code.
    12
    could do so. 
    Id. We disregard
    any evidence that a reasonable factfinder could
    have disbelieved or found to have been incredible. 
    Id. In reviewing
    factual-sufficiency challenges to termination findings, we give
    due consideration to evidence that the factfinder reasonably could have found to be
    clear and convincing. In re J.F.C., 
    96 S.W.3d 256
    , 266 (Tex. 2002). The factual-
    sufficiency inquiry is whether the evidence is such that the factfinder reasonably
    could form a firm belief or conviction about the truth of the Department’s
    allegations.     
    Id. We consider
    whether the disputed evidence is such that a
    reasonable factfinder could not have resolved that disputed evidence in favor of its
    finding.   
    Id. “If, in
    light of the entire record, the disputed evidence that a
    reasonable factfinder could not have credited in favor of the finding is so
    significant that a factfinder could not reasonably have formed a firm belief or
    conviction about the truth of the petitioners’ allegations, then the evidence is
    factually insufficient.” 
    Id. We give
    due deference to factual findings, and we do
    not supplant the factfinder’s judgment with our own. See In re H.R.M., 
    209 S.W.3d 105
    , 108 (Tex. 2006).
    A strong presumption exists that the best interest of the child is served by
    keeping the child with its natural parent and the burden is on the Department to
    rebut that presumption. See In re S.M.L., 
    171 S.W.3d 472
    , 480 (Tex. App.—
    Houston [14th Dist.] 2005, no pet). Factors for consideration in determining the
    best interest of a child include the following: (1) the desires of the child, (2) the
    present and future physical and emotional needs of the child, (3) the present and
    future emotional and physical danger to the child, (4) the parental abilities of the
    persons seeking custody (in promoting the best interest of the child0, (5) the
    programs available to assist these individuals to promote the best interest of the
    child, (6) the plans for the child by the individuals or agency seeking custody, (7)
    13
    the stability of the home or proposed placement, (8) acts or omissions of the parent
    which may indicate the existing parent-child relationship is not appropriate, and (9)
    any excuse for the parent’s acts or omissions. See Holley v. Adams, 
    544 S.W.2d 367
    , 371–72 (Tex. 1976). A finding in support of “best interest” does not require
    proof of any unique set of factors, nor does it limit proof to any specific factors.
    
    Id. The list
    of factors is not exhaustive, nor is evidence required on all nine of the
    factors to support a finding terminating a parent’s rights. 
    Id. at 372.
    Appellant
    points to the Holley factors as weighing in favor of preserving the parent-child
    relationship, asserting that the Department produced scant evidence to rebut the
    parental presumption.
    For cases in which the Department or another government agency is the
    petitioner, section 263.307(a) provides that “the prompt and permanent placement
    of the child in a safe environment is presumed to be in the child’s best interest.”
    Tex. Fam. Code Ann. § 263.307(a) (West 2008). A trial court may also consider
    the following statutory factors and any other relevant information in determining
    the best interest of a child:      (1) the child’s age and physical and mental
    vulnerabilities; (2) the frequency and nature of out-of-home placements; (3) the
    magnitude, frequency, and circumstances of the harm to the child; (4) whether the
    child has been the victim of repeated harm after the initial report and intervention
    by the Department or other agency; (5) whether the child is fearful of living in or
    returning to the child’s home; (6) the results of psychiatric, psychological, or
    developmental evaluations of the child, the child’s parents, or other family
    members or others who have access to the child’s home; (7) whether there is a
    history of abusive or assaultive conduct by the child’s family or others who have
    access to the child’s home; (8) whether there is a history of substance abuse by the
    child’s family or others who have access to the child’s home; (9) whether the
    14
    perpetrator of the harm to the child is identified; (10) the willingness and ability of
    the child’s family to seek out, accept, and complete counseling services and to
    cooperate with and facilitate an appropriate agency’s close supervision; (11) the
    willingness and ability of the child’s family to effect positive environmental and
    personal changes within a reasonable period of time; (12) whether the child’s
    family demonstrates adequate parenting skills, including providing the child and
    other children under the family’s care with: (A) minimally adequate health and
    nutritional care; (B) care, nurturance, and appropriate discipline consistent with the
    child’s physical and psychological development; (C) guidance and supervision
    consistent with the child’s safety; (D) a safe physical home environment; (E)
    protection from repeated exposure to violence even though the violence may not be
    directed at the child; and (F) an understanding of the child’s needs and capabilities;
    and (13) whether an adequate social support system consisting of an extended
    family and friends is available to the child. See Tex. Fam. Code Ann. § 263.307(b)
    (West 2008); see also In re J.J.C., 
    302 S.W.3d 436
    , 447–48 (Tex. App.—Houston
    [14th Dist.] 2009, pet. denied).
    We address the evidence pertaining to the various factors all together
    because it is overlapping and interconnected. The child, at four years old during
    the trial proceedings, was unable to articulate his desires at trial. The evidence
    reflects that during his visits with appellant, the child was happy. The evidence
    suggests that he and appellant bonded some as they played, read books, and sang
    songs together during their visits. But, the record also reflects that the child
    referred to appellant by a surname or a nickname derivation of her first name,
    which suggests that they have not bonded as a parent-child. Appellant admitted
    that her attendance at the scheduled visitations with the child were inconsistent in
    the beginning of the case, citing transportation issues as the main reason she could
    15
    not consistently attend the planned visits. She testified that on some occasions, if
    she was one minute late to a visit with the child, the visit would be cancelled. She
    denied missing any visitations in 2012 in the months leading up to trial. The
    paternal grandmother asserted that appellant had engaged in conduct injurious to
    the physical and emotional welfare of the child through inconsistent visitation.
    Other witnesses testified that appellant’s attendance at the visitations remained
    inconsistent even up to and throughout the trial proceedings and that appellant had
    missed forty-three percent of her visits with the child in a span of nearly two years.
    The evidence in the record reflects that when appellant missed these visits, the
    child would act out aggressively toward others, suggesting that the child had
    bonded with appellant and was unhappy when she missed the visitation.               A
    parent’s inconsistent visits may serve as an example of acts or omissions indicating
    that termination is in the child’s best interest. See In re S.N., 
    287 S.W.3d 183
    , 193
    (Tex. App.—Houston [14th Dist.] 2009, no pet.).
    The record evidence reflects that the child was placed in a safe, stable home
    with the paternal grandparents who have reared ten children; five of those children
    remained in the home at the time of trial. The evidence reflects that the child had
    bonded well with others in the home, including an uncle who was just a year or
    two older than the child. The paternal grandmother hoped to adopt the child.
    Appellant expressed her plans to place the child in daycare and then to enroll him
    in one of two elementary schools when he was of age. The record reflects that the
    child needed permanency in his life and that appellant had “come in and out of” the
    child’s life.   The need for permanence is paramount in considering a child’s
    present and future needs. In re M.C.H., No. 14-12-00103-CV, 
    2012 WL 1795123
    ,
    at *4 (Tex. App.—Houston [14th Dist.] May 17, 2012, no pet.) (mem. op.).
    Appellant admitted, and the record reflects, that she had unstable living
    16
    arrangements for some of the time after the child came into the Department’s care
    in 2010, staying with others or moving to several residences of her own. Appellant
    asserts on appeal that she has turned her life around and now can provide a stable
    home for her son.        But, the caseworker believed that appellant had not
    demonstrated that she could obtain stable housing until 2012, at the time the trial
    proceedings were beginning, even though the family service plan imposed that
    requirement on October 2010. The record also reflects that, although appellant
    was employed at the time of trial, she had switched jobs several times or remained
    unemployed and received government assistance in the same two-year time frame
    despite the requirement in the family service plan for appellant to obtain and
    maintain verifiable employment.        Repeatedly, the paternal grandmother, the
    Department caseworker, and the child advocate coordinator cited appellant’s
    instability in maintaining a home and employment as the basis for termination
    being in the child’s best interest. A parent who lacks stability, income, and a home
    is unable to provide for a child’s emotional and physical needs. See In re C.A.J.,
    
    122 S.W.3d 888
    , 894 (Tex. App.—Fort Worth 2003, no pet.) (concluding evidence
    was sufficient to support best-interest findings for mother who admitted being
    unable to care for child, had no stable source of income or permanent home). This
    evidence weighs in favor of the trial court’s best-interest finding. See 
    id. The paternal
    grandmother testified as to her belief that appellant had
    engaged in conduct injurious to the physical and emotional welfare of the child
    through failing to research the child’s medical conditions and failing to attend
    medical appointments. The record reflects that the paternal grandmother ensured
    the child was treated for his various medical issues and acknowledged that the
    child will need more surgeries on his hand as he grows older. The paternal
    grandmother committed to ensuring the child will continue to receive medical care
    17
    and treatment so that he can fulfill his dreams of holding a football. Appellant
    acknowledged that the child is clean and well-cared-for in his current placement.
    Appellant admitted her failure to take the child for medical treatment as the reason
    the child came into care, citing lack of transportation as one reason for not taking
    the child to medical appointments. When deciding that termination is in the child’s
    future best interest, the trial court reasonably could have considered that appellant
    neglected her son’s medical treatment during a critical time, which potentially
    impacts the physical and emotional needs of the child. See In re C.H., 
    89 S.W.3d 17
    , 28 (Tex. 2002) (recognizing evidence establishing a statutory ground for
    termination also may be probative of best-interest issue); In re B.K.D., 
    131 S.W.3d 10
    , 17 (Tex. App.—Fort Worth 2003, pet denied) (recognizing that factfinder may
    infer that past conduct endangering child’s well-being may recur in the future if
    child is returned to the parent). The parties disagreed at trial whether appellant
    understood and admitted her role in the child coming into the Department’s care.
    Some of the notes from appellant’s therapy sessions reflect that she admitted her
    role in failing to take the child to medical appointments; notes from appellant’s last
    two therapy sessions reflect that she did not accept her role in the child coming into
    the Department’s care. Though the Department caseworker testified that appellant
    did not demonstrate that she understood or expressed concerns over the child’s
    medical needs, evidence in the record reflects that appellant did ask some questions
    about the child’s medical treatment and conditions.         However, even at trial,
    appellant was unfamiliar with the child’s current medications and could not
    demonstrate any understanding of the child’s urinary condition, from which the
    child’s recurring urinary-tract infections still continued. A trier of fact could have
    inferred that appellant’s past medical neglect of the child and apparent apathy
    regarding the child’s prescribed medications would continue, and this evidence
    18
    supports the best-interest finding. See In re J.S.G., No. 14-08-00754-CV, 
    2009 WL 1311986
    , at *9 (Tex. App.—Houston [14th Dist.] May 7, 2009, no pet.) (mem.
    op.) (providing evidence that a parent who could not produce or locate a child’s
    pharmacy records in a medical-neglect case supported a finding that termination
    was in the child’s best interest).
    While appellant acknowledged her failure to keep up with the child’s
    medical appointments, she asserts on appeal that she successfully completed first
    aid and parenting courses, earned a high-school diploma, became gainfully
    employed, and obtained her own apartment.          The undisputed record evidence
    reflects that appellant did not fully comply with the requirements set forth in the
    family service plan.     Although appellant successfully completed some of the
    services, the record reflects that she did not complete the services in the time-frame
    set out by the family service plan. Appellant testified that the therapist would call
    her in the mornings with a wake-up call to ensure she made it to her therapy
    sessions. On this basis, the evidence weighs in favor of the trial court’s ruling. See
    In re R.D.S., No. 14-09-00980-CV, 
    2010 WL 4882457
    , at *7 (Tex. App.—Houston
    [14th Dist.] Nov. 30, 2010, no pet.) (mem. op.) (considering parent’s completion of
    the family service plan in determining best-interest finding).        To the extent
    appellant has made positive strides in her life, a trier of fact is not required to
    ignore a long history of irresponsible choices and abusive behavior simply because
    the behavior abates as trial approaches. See In re J.O.A., 
    283 S.W.3d 336
    , 343
    (Tex. 2009) (providing that significant evidence of improved conduct, especially in
    short duration, does not conclusively negate the probative value of a history of
    irresponsible choices); In re M.G.D., 
    108 S.W.3d 508
    , 513–14 (Tex. App.—
    Houston [14th Dist.] 2003, pet. denied) (providing that evidence of a recent
    19
    turnaround should be determinative only if it is reasonable to conclude that the
    positive improvements will surely continue).
    Appellant points to the Agreement, in which the paternal grandparents were
    appointed permanent managing conservators and appellant was appointed a
    possessory conservator, noting that, at one time, it was agreed to be in the child’s
    best interest. Although the record reflects that the parties had agreed that the
    Agreement was in the best interest of the child, the record also reflects that within
    twenty-four hours of signing the Agreement, appellant expressed to others that she
    was being encouraged by her family members to back out of the Agreement.
    When the paternal grandmother learned from appellant that family members were
    pressuring appellant to seek to set aside the Agreement, the paternal grandmother
    testified that the Agreement would have been unworkable, noting hostilities
    between the families. In particular, as discussed above, the paternal grandmother
    testified that appellant’s family members created an unsafe and threatening
    environment for the child by parking outside of the paternal grandmother’s home,
    that appellant was not assertive with her family members in explaining how the
    child’s best interest were met through the Agreement and was not putting the
    child’s needs ahead of her own needs, and that a family member made an obscene
    hand gesture towards the paternal grandmother during a break in the trial
    proceedings.
    On appeal, appellant characterizes the reasons for backing out of the
    Agreement as being weak and claims that the child would retain the same stability
    and permanency in the paternal grandmother’s home under the arrangements in the
    20
    Agreement with appellant as a possessory conservator.4                       But, the record also
    reflects one witness’s belief that even had the Agreement been in effect,
    appellant’s continued inconsistent visitation with the child would not have been in
    the child’s best interest, rendering the Agreement effectively unworkable and not
    in the child’s best interest. The caseworker, paternal grandmother, and child
    advocate coordinator all testified the child needed permanency, stability, and
    consistency, and the record reflects that appellant expressed concern over the
    Agreement within twenty-four hours of signing it, suggesting inconsistency in her
    actions with regard to the child’s best interest. The record also reflects evidence
    that appellant told others that if the Agreement were final, she planned to file a
    petition for modification of the Agreement six months later. Ongoing proceedings
    would not have provided the child the permanency, stability, and consistency that
    he needed. See In re D.R.A., 
    374 S.W.3d 528
    , 533 (Tex. App.—Houston [14th
    Dist.] 2010, no pet.) (noting that the need for permanence is a paramount
    consideration in determining the child’s present and future physical and emotional
    needs).
    Viewing all the evidence in the light most favorable to the judgment, we
    conclude that a factfinder could have formed a firm belief or conviction that
    termination of appellant’s parental rights was in the child’s best interest. See Tex.
    Fam. Code Ann. § 161.001(2); 
    J.F.C., 96 S.W.3d at 265
    –66. Considering the same
    evidence in a neutral light, we conclude the disputed evidence is not so significant
    as to prevent a trier of fact from forming a firm belief or conviction that
    termination of appellant’s parental rights was in the child’s best interest. See Tex.
    4
    Although appellant asserts that the Agreement is similar to one that appellant reached with the
    maternal grandmother regarding conservatorship of appellant’s daughter, the record does not contain any
    such agreement for the daughter or testimony about those specific arrangements.
    21
    Fam. Code Ann. § 161.001(2); In re C.A.J., 
    122 S.W.3d 888
    , 894 (holding that
    evidence was factually sufficient to support termination in the child’s best interest
    when evidence reflected that the mother was unable to maintain a stable home or
    employment). The evidence is legally and factually sufficient to support the trial
    court’s findings that termination of the parent-child relationship is in the child’s
    best interest. See Tex. Fam. Code Ann. § 161.001; 
    C.A.J., 122 S.W.3d at 894
    .
    Therefore, we overrule appellant’s first issue.
    Did the trial court abuse its discretion in its appointment of the managing
    conservator?
    In a second issue, appellant asserts the trial court abused its discretion in
    appointing the Department as the child’s sole managing conservator and in failing
    to appoint her as a managing or possessory conservator of the child.             She
    challenges several of the trial court’s findings of fact and conclusions of law
    related to the conservatorship. Appellant refers to the strong presumption that the
    child’s best interest is served by keeping the child in the custody of a natural
    parent.   Section 153.131, entitled “Presumption That Parent to be Appointed
    Managing Conservator,” provides:
    (a) Subject to the prohibition in Section 153.004, unless the court
    finds that appointment of the parent or parents would not be in the
    best interest of the child because the appointment would significantly
    impair the child’s physical health or emotional development, a parent
    shall be appointed sole managing conservator or both parents shall be
    appointed as joint managing conservators of the child.
    (b) It is a rebuttable presumption that the appointment of the parents
    of a child as joint managing conservators is in the best interest of the
    child. A finding of a history of family violence involving the parents
    of a child removes the presumption under this subsection.
    Tex. Fam. Code. Ann. § 153.131 (West 2008).
    22
    In cases where a trial court’s termination of the parent-child relationship is
    reversed, a parent is required to independently challenge a trial court’s finding
    under section 153.131(a) to obtain reversal of the conservatorship appointment.
    See In re J.A.J., 
    243 S.W.3d 611
    , 616–17 (Tex. 2007); In re A.S., 
    261 S.W.3d 76
    ,
    92 (Tex. App.—Houston [14th Dist.] 2008, pet. denied). In this case, however, we
    have overruled appellant’s challenge to the termination, and the trial court’s
    appointment of the Department as sole managing conservator may be considered a
    “consequence of the termination pursuant to Family Code section 161.207.” In re
    
    A.S., 261 S.W.3d at 92
    . Section 161.207, entitled “Appointment of Managing
    Conservator on Termination,” provides: “If the court terminates the parent-child
    relationship with respect to both parents or to the only living parent, the court shall
    appoint a suitable, competent adult, the Department of Protective and Regulatory
    Services, a licensed child-placing agency, or an authorized agency as a managing
    conservator of the child.” Tex. Family Code Ann. § 161.207(a) (West 2008).
    Appellant provides no authority for the proposition that she is a “suitable,
    competent adult” as contemplated by section 161.207(a) or that the presumption in
    section 153.131(a) applies to a parent whose parental rights have been terminated
    under Chapter 161. See In re A.W.B., No. 14-11-00926-CV, 
    2012 WL 1048640
    , at
    *7 (Tex. App.—Houston [14th Dist.] Mar. 27, 2012, no pet.) (mem. op.). Rather,
    when a trial court terminates the parent-child relationship, the court also “divests
    the parent and the child of all legal rights and duties with respect to each other.”
    Tex. Fam. Code Ann. § 161.206 (West 2008); A.W.B., 
    2012 WL 1048640
    , at *7.
    Accordingly, appellant’s challenge to the trial court’s appointment of the
    Department as sole managing conservator, rather than appellant, is without merit.
    We overrule appellant’s second issue.
    23
    The trial court’s judgment is affirmed.
    /s/       Kem Thompson Frost
    Justice
    Panel consists of Justices Frost, Brown, and Busby.
    24