In Re Cartier H.

10/31/2023
IN THE COURT OF APPEALS OF TENNESSEE
AT NASHVILLE
Assigned on Briefs July 3, 2023

IN RE CARTIER H. ET AL

Appeal from the Juvenile Court for Davidson County
No. PT267148 Sheila Calloway, Judge
___________________________________

No. M2022-01576-COA-R3-PT
___________________________________

Mother appeals the termination of her parental rights on four grounds. The Tennessee
Department of Children’s Services does not defend two of the four grounds, so we reverse
as to those grounds. We affirm the ground that Mother is unable to parent the children due
to her present mental condition. Because the trial court’s order does not contain sufficient
findings of fact, we vacate the trial court’s findings that the mother failed to manifest a
willingness and ability to parent and that termination is in the children’s best interests.

Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Juvenile Court Affirmed in
Part; Reversed in Part; Vacated in Part and Remanded

J. STEVEN STAFFORD, P.J., W.S., delivered the opinion of the court, in which D. MICHAEL
SWINEY, C.J., and JEFFREY USMAN, J., joined.

Nick Perenich, Tennessee, for the appellant, Amanda H.

Jonathan Skrmetti, Attorney General and Reporter; Carrie Perras, Assistant Attorney
General, for the appellee, State of Tennessee, Department of Children’s Services.

OPINION

I. PROCEDURAL AND FACTUAL BACKGROUND

On April 9, 2018, Petitioner/Appellee the Tennessee Department of Children’s
Services (“DCS”) received a referral alleging psychological harm of two children, Cartier,
born in February 2011, and Cayden, born in December 2014.1 The referral stated that the
children’s mother, Respondent/Appellant Amanda H. (“Mother”), was paranoid and had

1
In cases involving the termination of parental rights, it is this Court’s policy to remove the full
names of children and other parties, to protect their identities.
barricaded herself and her children in her home based on her belief that her neighbor had
hired a man to break into her home to kill her. The referral further alleged that Mother
stated that she planned to buy a gun to protect herself and the children.2 The children
admitted that they had been up all night and that Cartier did not go to school. As a result
of this incident, Mother was involuntarily committed to Tennova Healthcare and the
children were removed and placed in DCS custody.

DCS then moved to be granted emergency custody of the children and for them to
be declared dependent and neglected. On April 11, 2018, the Davidson County Juvenile
Court (“the trial court”) granted DCS’s petition for emergency custody. The children were
placed with a foster family, where they remained throughout the custodial episode.

A juvenile court magistrate later issued an order finding the children dependent and
neglected on August 1, 2018. Therein, the trial court found that at the time of the removal,
Mother was paranoid and delusional, that she had been diagnosed with bipolar disorder,
but was not taking her medication, and that Mother has “unaddressed mental health issues
resulting in her involuntary commitment[.]” Following rehearing, the juvenile court judge
sustained the allegations in the dependency and neglect petition and specifically found that
the children were suffering from the unaddressed mental health issues of Mother, that she
suffered from a mental health breakdown at the time of the removal of the children, and
that Mother was paranoid and delusional.

Eventually, on November 30, 2021, DCS filed a petition to terminate Mother’s
parental rights on the grounds of (1) abandonment by failure to establish a suitable home;
(2) mental condition making her unable to resume care and custody of the children; (3)
persistent conditions; and (4) willingness and ability to parent the children.3 The trial court
held a hearing on the petition on August 11 and 15, 2022. Mother, a court appointed special
advocate, the foster mother (“Foster Mother”), a DCS family services worker, and a
juvenile court officer testified.

Much of the proof at trial focused on Mother’s mental health. Various mental health
records were admitted into evidence. These records showed that Mother had been
hospitalized a number of times in recent years, including at Tennova at the time of removal
in April 2018; at Vanderbilt University Medical Center in June 2018; at Parthenon Pavilion
in July 2018; at TrustPoint in August 2018; and at Middle Tennessee Mental Health
Institute (“MTMHI”) in October 2019. Mother also testified at trial that she had been
hospitalized approximately one year prior to trial in 2021 due to unspecified criminal

2
According to the later adjudication order, Mother instead armed herself with pots of boiling water,
a taser, and a knife. According to a witness at the dependency and neglect hearing, Cayden had access to
this knife and threatened to stab himself with it. Mother also placed salt on the floor to keep evil spirits
away.
3
The petition was also filed against the biological fathers of the children. One father surrendered
his rights, and the other’s rights were terminated. They are not parties to this appeal.

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charges.4 The records indicated, however, that Mother’s mental health issues pre-dated the
removal of the children, as she had been hospitalized on more than one occasion prior to
the removal of the children, including when she was 15 years old. According to the records,
Mother had been diagnosed with bipolar I disorder with psychotic features, depression,
post-traumatic stress disorder, panic disorder, and attention deficit hyperactivity disorder.
Mother denied that she had ever been diagnosed with any conditions other than generalized
anxiety disorder.

The record further showed that Mother often suffered from delusions regarding the
children, believing them to be in a dumpster behind Walgreens or kidnapped and made to
sell drugs; at the time of these delusions, the children were in DCS custody. Mother
participated in a parenting assessment in 2019, which recommended that Mother receive
further mental health treatment before any unsupervised contact with the children.
Following an August 2021 psychological assessment requested by DCS, the examiner
found that Mother “struggles with her mental functioning including psychosis” and is “very
impulsive and unstable in her behaviors.” As a result, the examiner opined that he did “not
believe that parenting education or the implementation of a parenting program through in-
home services is likely to be effective given her current level of psychiatric functioning.”
Instead, he recommended increased pharmaceutical intervention, individual
psychotherapy, and efforts to address her history of inappropriate behavior and impulse
control.

At trial, Mother minimized her mental health issues. Although she did testify that
she had been seeking treatment for approximately twenty years with a psychiatrist, Dr.
Hamilton Small,5 Mother described her treatment with Dr. Small as follows:

A. [W]e just talk about - we mostly have a lot of laughter. It’s mostly about
a lot of good times, just about where I go, what I do, how much fun I have
every day, and places I see and view. You know, that’s mostly what we talk
about.
Q. Are there any kind of stresses or mental health things you work on when
you’re having therapy with him?
A. No. We just talk about me being silly and having a ball in life is pretty
much it.

Mother admitted, however, that she was prescribed Zyprexa, an antipsychotic. See Cole v.
State, No. M2016-00625-CCA-R3-PC, 2017 WL 809943, at *2 (Tenn. Crim. App. Mar. 1,

4
Mother stated that she was sentenced to time served on these charges.
5
The record contains a June 3, 2021 letter from Dr. Small, which states that Mother was seen that
day “for her routine, schedule [sic] appointment.” The letter further states that Mother is compliant with
her medications and treatment plan. Dr. Small participated in a phone interview in connection with Mother’s
January 2019 mental health assessment, in which he also asserted that Mother was compliant. Dr. Small
stated that he was not concerned with her current condition or her ability to care for her children.

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2017). Mother initially signed releases for DCS to obtain her mental health records early
in the case, but after those releases expired, Mother refused to sign any further releases.6
As such, the evidence did not include any medical records concerning Mother’s mental
health treatment in the year before trial; a DCS family service worker admitted that DCS
did not attempt to subpoena Dr. Small’s records when Mother refused to sign necessary
releases.

Mother’s criminal history was also discussed. In August 2019, Mother was arrested
for aggravated assault; the charge was dismissed, however, when Mother was deemed
incompetent to stand trial.7 In May 2020, Mother was arrested for assault with bodily
injury; nothing in the record indicates that she was convicted of this crime. In September
2020, Mother was arrested again for assault and resisting arrest. This charge required that
Mother participate in mental health court. Although Mother testified that this case was
closed without conviction, the testimony showed that Mother failed to appear for mental
health court and three failure to appear warrants were pending against her. When asked
how she would care for the children if she was jailed on these warrants, Mother vaguely
answered that she would ask the children’s fathers, who had little to no contact with the
children, to care for them, or look for a “private” foster home.

Mother’s conduct at both the termination trial and other hearings before the trial
court were also discussed. At a hearing in February 2022, Mother had to be removed from
the courtroom when she tried to tear down the COVID-19 barriers after being informed
that her children would not be returned to her that day. Mother admitted that she was
sentenced to ten days in jail for contempt of court as a result of that incident, as she had
“screamed and cussed” at the trial judge and threatened a DCS worker. Mother was also
prone to outbursts during the termination trial, often interjecting to disagree with the
witnesses or asking witnesses questions while the witness was being questioned by an
attorney. For example, when the father of one child was asked to express an opinion as to
whether staying in the foster home was best for his child, Mother asked the witness “[w]hat
the hell did they threaten you with?” Mother was then asked to step outside the courtroom
so the father could testify, at which point she stated as follows upon her exit: “I’m coming.
And call me back in when he (unintelligible). Call me back in, because I ain’t -- your
bullshit. I ain’t scared of you folks. F**k to their face. He’s (unintelligible) what the white
motherf****er told you to do. (unintelligible).”

Mother admitted that after the removal of the children, her lease was not renewed
and she lived in two separate domestic violence shelters for over a year. However, Mother
testified that in 2019 she moved into a three-bedroom apartment, where she pays all of her
bills with social security disability. Mother testified that her first DCS caseworker

6
Mother’s refusal to sign releases is also documented in some of the medical records that DCS was
able to access for purposes of this case.
7
Mother denied that this was the reason the charge was dropped.

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performed a home visit on the home, but the current family service worker testified that
she had asked to perform a home visit but was denied entrance. Mother further testified
without dispute that she had paid child support of $300.00 per month for the last two years.

Mother’s visitation with the children was also at issue. Mother was permitted twice
monthly in-person visits with the children, except when she was incarcerated or during the
COVID-19 Pandemic. Over the years, however, the testimony indicated that approximately
half of the visits were cancelled or cut short when Mother was more than thirty minutes
late or acted inappropriately during the visit. One witness testified that Mother’s
promptness and attendance improved in 2021. For the most part, Mother’s inappropriate
behavior at visits concerned her efforts to tell the children that they would be coming home
with her on a certain date, when no such reunification had been ordered. This caused the
children, especially Cartier, to be fearful and upset. Mother responded to Cartier’s distress
by telling him that she would leave him in foster care and no longer visit. Once, Mother
called the police insisting that the children be returned to her custody. In fact, police were
required to escort Mother or the children out of visitation on more than one occasion. On
another visit in October 2021, Mother stripped the younger child to his underwear to apply
lotion, despite his apparent discomfort. When phone visits occurred during the COVID-19
Pandemic, Mother would tell the children they were coming home on a certain date, then
scream and curse at the children, and hang up on them on occasion; Foster Mother testified
that it happened so frequently that the children would laugh off Mother’s behavior. Even
when the visits went as scheduled, Mother did not engage with the children for the majority
of the visits. Instead, she watched the children play, played on her phone, or occasionally
fell asleep. Mother did bring food and/or gifts for the children to all visits.

The children were placed with their current foster family immediately upon removal
and remained with that family continuously. The testimony shows that in the care of the
foster family, the children have significantly improved in terms of their emotional and
educational development. For example, Cartier could not read and did not know his letters
or colors at seven years old at the time of the removal. He still struggles with reading, but
is good in math. Cayden had issues with speech, for which he was participating in therapy,
which he was anticipated to complete shortly after trial.

The testimony of both Foster Mother and the DCS caseworker was that the children
do not have a strong bond with Mother. According to Foster Mother, Cayden has asked
about Mother twice; Cartier has never asked about Mother. Often, the children were
reluctant to attend visitation with Mother and exhibited behavior problems following the
visits. This caused Foster Mother to sometimes not tell the children that they were going
for a visit until they were on their way. Cartier cried after at least one visit and had to be
consoled by Foster Mother at another after Mother stated that the children would be
returning to her care. The children refer to Foster Mother as “Mom” or “Mimi” and they
fear being separated from their foster family. The foster family wishes to adopt the children
if they become available.

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 The trial court entered its final order terminating Mother’s parental rights on
October 26, 2022. Therein, the trial court found that DCS had proven the following grounds
against Mother: (1) abandonment by failure to establish a suitable home; (2) mental
condition making her unable to resume care and custody of the children; (3) persistence of
conditions; and (4) willingness and ability to parent the children. The trial further found
that termination was in both children’s best interests. Mother thereafter appealed to this
Court.

II. ISSUES PRESENTED

In this appeal, Mother asserts that the trial court erred in finding any of the four
grounds of termination were proven by clear and convincing evidence and further erred in
finding that termination was in the children’s best interests.

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).
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
1021618, at *7 (Tenn. Ct. App. Apr. 29, 2005)). “[P]arents are constitutionally entitled to
fundamentally fair procedures in parental termination proceedings.” In re Carrington H.,
483 S.W.3d at 511. These procedures include “a heightened standard of proof—clear and
convincing evidence.” Id. at 522 (citation omitted); accord In re Addalyne S., 556 S.W.3d
774, 782 (Tenn. Ct. App. 2018) (“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.”).

Thus, a party seeking to terminate a parent’s rights must prove by clear and
convincing evidence (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. In re Valentine, 79
S.W.3d 539, 546 (Tenn. 2002). “Clear and convincing evidence enables the fact-finder to
form a firm belief or conviction regarding the truth of the facts, and eliminates any serious
or substantial doubt about the correctness of these factual findings.” In re Carrington H.,
483 S.W.3d at 522. The standard “ensures that the facts are established as highly probable,
rather than as simply more probable than not.” Id. (citing In re Audrey S., 182 S.W.3d 838,
861 (Tenn. Ct. App. 2005); In re M.A.R., 183 S.W.3d 652, 660 (Tenn. Ct. App. 2005)).

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 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. “The
trial court’s ruling that the evidence sufficiently supports termination of parental rights is
a conclusion of law, which appellate courts review de novo with no presumption of
correctness.” In re Carrington H., 483 S.W.3d at 524 (citation omitted).

IV. ANALYSIS

A. Grounds for Termination

In this case, the trial court found that four grounds were proven by clear and
convincing evidence: (1) abandonment by failure to establish a suitable home; (2) inability
to parent due to her present mental condition; (3) persistent conditions; and (4) willingness
and ability to parent the children. DCS does not defend the grounds of abandonment by
failure to establish a suitable home or persistent conditions, so we reverse those grounds
for termination. See In re Aniyah W., No. W2021-01369-COA-R3-PT, 2023 WL 2294084,
at *6 (Tenn. Ct. App. Mar. 1, 2023) (“Given DCS’s choice not to defend these grounds and
for purposes of judicial economy, we reverse the trial court’s findings related to all grounds
involving abandonment and consider only the three grounds defended by DCS.” (citing In
re Mason C., No. E2018-00535-COA-R3-PT, 2018 WL 4771109, at *3 (Tenn. Ct. App.
Oct. 2, 2018))). We will consider each of the two remaining grounds in turn.

1. Impairment of Mental Condition

DCS argues, and the trial court found, that Mother’s parental rights should be
terminated on the ground that she is unable to parent due to her present mental condition,
pursuant to Tennessee Code Annotated section 36-1-113(g)(8), which states:

(8)(A) The chancery and circuit courts shall have jurisdiction in an adoption
proceeding, and the chancery, circuit, and juvenile courts shall have
jurisdiction in a separate, independent proceeding conducted prior to an
adoption proceeding to determine if the parent or guardian is mentally
incompetent to provide for the further care and supervision of the child, and
to terminate that parent’s or guardian’s rights to the child;
(B) The court may terminate the parental or guardianship rights of that
person if it determines on the basis of clear and convincing evidence
that:
(i) The parent or guardian of the child is incompetent to
adequately provide for the further care and supervision of the
child because the parent’s or guardian’s mental condition is
presently so impaired and is so likely to remain so that it is
unlikely that the parent or guardian will be able to assume or

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 resume the care of and responsibility for the child in the near
future; and
(ii) That termination of parental or guardian rights is in the best
interest of the child;
(C) In the circumstances described under subdivisions (8)(A) and (B),
no willfulness in the failure of the parent or guardian to establish the
parent’s or guardian’s ability to care for the child need be shown to
establish that the parental or guardianship rights should be terminated;
....

We have previously explained that

[t]he standard for this issue has been described as inquiring as to whether “by
clear and convincing evidence that the parent of the child is incompetent to
adequately provide care and supervision because the parent’s mental
condition is so impaired and likely to remain so that it is unlikely that the
parent will be able to assume care and responsibility for the child in the
future.” State Dept. of Children’s Services v. Whaley, No. E2001-00765-
COA-R3-CV, 2002 WL 1116430, at *14 (Tenn. Ct. App. May 30, 2002), no
appl. perm. appeal filed. This Court has affirmed this ground, in one
instance, where the parent “functioned in such a low range that no amount of
training, education, or counseling ‘could bring him up to the level where he
could parent these children.’” State, Dept. of Children’s Services v. Mims,
285 S.W.3d 435, 449 (Tenn. Ct. App. 2008).

In re Lorenda B., No. M2016-01841-COA-R3-PT, 2017 WL 1416858, at *9 (Tenn. Ct.
App. Apr. 19, 2017).

In concluding that clear and convincing evidence supported this ground for
termination, the trial court found as follows:

[Mother] is incompetent to provide adequately for the care and supervision
of the children because her mental condition is impaired and is so likely to
remain impaired to a level that she will probably not be able to resume the
care and responsibility for the children in the near future. There is little
chance that the condition can be improved to such an extent that the children
can be placed safely with Mother in the foreseeable future.
The children were removed from Mother when she was involuntarily
committed due to her untreated mental health issues. As a result of the
involuntary commitment, Mother was admitted to Tennova Healthcare in
Lebanon, Tennessee. She was treated for agitations and psychosis. Tennova
diagnosed Mother with Bipolar l disorder, anxiety disorder, and possible
amphetamine abuse. Her condition at discharge was improved but not

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 recovered. Mother was prescribed medication, including Invega for
psychosis and Depakote for mood, along with other medications.
Records submitted in trial clearly indicate that [Mother] has an
extensive history of untreated mental health issues. Records indicate
[Mother] receiving psychiatric treatment from as far back as 1999. In the
records, there is proof of several hospitalizations for her mental health issues.
In the four years since the children’s removal, Mother has continued to be
unable to manage her mental health, resulting in numerous psychiatric
hospitalizations and arrests.
On August 12, 2019, [Mother] was arrested and charged with
aggravated assault with a deadly weapon. As a result of this charge, [Mother]
was admitted to MTMHI for treatment and evaluation. After evaluation,
[Mother] was found to be incompetent to stand trial. MTMHI also gave her
a diagnosis of Bipolar l disorder and post-traumatic stress disorder.
In September of 2020, [Mother] was arrested on multiple charges,
including robbery, assault of an officer, and resisting arrest. As a result of
those charges, she was ordered to participate in Mental Health Court in the
General Sessions Court of Davidson County. Documentation was presented
indicating that Mother had not attend[ed] court as ordered since March of
2022 and that she was out of compliance. As a result, there was a failure to
appear warrant issued for her.[8]
Mother completed a parenting assessment with Dr. Janie Berryman in
2019. Dr. Berryman’s report indicated a need for further mental health
treatment before the mother should receive any unsupervised contact with
the children.
On August 30, 2021, [Mother] participated in a psychological
assessment with Allied Health Professionals. The evaluation diagnosed
Mother with Bipolar I disorder, current or most recent episode unspecified[,]
and prescribed her antipsychotic medication. The evaluator indicated that
[Mother] was likely experiencing more significant symptoms than she was
willing to admit and that based on her history it was suspected that Mother
struggled with her mental functioning including psychosis. The evaluation
recommended that her medications likely needed to be adjusted and that she
needed additional psychotherapy with the goal of regular engagement with
the therapist to ground her in a more consensual view of reality.
Mother remains presently unable to demonstrate any comprehension
of her need for mental health treatment. Mother testified that she did not
believe she had any mental health diagnosis and that she was completely
healthy. When confronted with the information about her hospitalizations for

8
The trial court stated the following in a footnote: “Mother became aware of the outstanding
warrant during the course of the trial. This court finds that she left the courthouse during a court recess in
order to avoid having the warrant served and returning to jail.”

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 psychiatric treatment, Mother was either unable to remember that she was
hospitalized or was unable to acknowledge that she was being treated for
mental health issues. Mother remains unable to recognize her delusional
beliefs and continues to behave in an erratic and volatile manner. Her records
demonstrate that she has been unable to manage her mental health for any
significant duration of time. Her inability to acknowledge her diagnosis or
make any changes to her treatment make it unlikely that there will be any
change in her mental condition in the future. DCS has proven, by clear and
convincing evidence, the ground of incompetence pursuant to T.C.A. §36-1-
113(g)(8).

On appeal, Mother asserts that the trial court’s findings are not supported by clear
and convincing evidence, citing the lack of expert proof presented as to this ground, her
testimony regarding her consistent mental health treatment, and Mother’s admission that
she suffers from anxiety. Mother also argues that this case is analogous to In re
PrinceKenyan F., No. M2020-01306-COA-R3-PT, 2021 WL 3855713 (Tenn. Ct. App.
Aug. 30, 2021). In that case, the trial court relied heavily on medical records from the
mother’s stay at two mental health facilities and testimony that the mother’s refusal to
admit that she is mentally ill and needs treatment. Id. at *9. On appeal, DCS further cited
the mother’s long history of involuntary hospitalizations and a letter to the court in which
the mother claimed she was being stalked by a clown.

We held, however, that this testimony did not amount to clear and convincing
testimony that the mother’s present mental condition prevented the mother from parenting
her child. In addition to noting the lack of expert testimony, we cited the lack of “clinical
evidence” that the mother’s mental health issues negatively affected her parenting abilities.
Id. And there was no expert proof regarding the mother’s present mental state at the time
of trial. So we held that DCS failed to show that the mother’s mental state was “presently
so impaired” as to warrant termination of her parental rights under this ground. Id.

On appeal, Mother asserts that the testimony and proof presented in this case is
essentially the same as in In re PrinceKenyan: proof of prior mental health treatment and
hospitalizations without expert proof that Mother’s condition makes her presently unable
to care for her children. DCS disagrees. For one, DCS points out that it is fairly well settled
that the mental condition ground for termination does not require expert proof. See In re
Katrina S., No. E2019-02015-COA-R3-PT, 2020 WL 5269236, at *11 (Tenn. Ct. App.
Sept. 3, 2020) (“Mother points us to no authority, nor have we found any, that expressly
requires expert proof in order to satisfy this ground.”); In re Jayda J., No. M2020-01309-
COA-R3-PT, 2021 WL 3076770, at *8 (Tenn. Ct. App. July 21, 2021) (“[T]he law does
not require that DCS provide expert proof in all circumstances to support this ground for
termination[.]”); In re Shaneeque M., No. E2014-00795-COA-R3-PT, 2014 WL 6499972,
at *9 (Tenn. Ct. App. Nov. 20, 2014) (“[E]xpert testimony on the effect of a parent’s mental
illness on his or her ability to parent a child is not required[.]”), perm. app. denied (Tenn.

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Feb. 20, 2015); In re Alicia K. A., No. E2012-02614-COA-R3-PT, 2013 WL 3422973, at
*30 (Tenn. Ct. App. July 8, 2013); In re B.L.S.C., No. M2008-02301-COA-R3-PT, 2009
WL 971286, at *8 (Tenn. Ct. App. April 7, 2009). Moreover, DCS points out that this Court
has held that the parent’s own erratic behavior at trial can be evidence in support of this
ground. See Lorenda B., No. M2016-01841-COA-R3-PT, 2017 WL 1416858, at *10
(Tenn. Ct. App. Apr. 19, 2017) (declining to overturn the trial court’s finding on the basis
that no expert proof was offered, and noting that the “most glaring evidence” as to the
mother’s mental competence in that case was her erratic testimony at trial).

We conclude that sufficient evidence was presented to clearly and convincingly
establish this ground for termination. The proof in the record clearly shows that Mother
has been hospitalized a number of times since the removal of the children, sometimes due
to allegations that she committed violent criminal conduct. Although the record does not
show that Mother was convicted of these crimes, she admitted that she threatened a witness
at a prior juvenile court hearing and that she had spent stints in jail or mental health
institutes of up to six months following the removal.

And at the time of the removal, the children were present to witness the effects of
Mother’s mental health issues and were exposed to weapons as a result of her delusions.
Mother admitted prior to the removal that she was sometimes too overwhelmed to care for
her children. Concerningly, the mental health records indicated that Mother suffered from
delusions about the children, once threatening someone with a knife and claiming that they
kidnapped her children to make them sell drugs. Several assessments recommended that
Mother needs to seek additional mental health treatment in order to parent her children,
with at least one stating that Mother could not make improvement sufficient to make it safe
for her to parent her children. Thus, it was clear from the proof that Mother has mental
health issues that prevent her from safely parenting her children.

Mother’s inability to appreciate her own limitations and the limitations placed on
her by the trial court also continued to harm the children. Despite being asked several times
not to do so, Mother continually told the children that they would be coming home with
her or had been returned to her. These comments distressed Cartier in particular. Mother
herself even called the police to a visitation once in a misguided attempt to have the
children returned to her.

Mother continued to minimize her mental health needs and treatment at trial, despite
displaying at times erratic and unreasonable behavior during the trial. Lorenda B., 2017
WL 1416858, at *10. Mother denied that she had been diagnosed with bipolar disorder,
despite the medical records clearly showing that she had. Moreover, Mother claimed that
none of her prior hospitalizations were due to mental health issues, but each were instead
for the purpose of having sex with a man.9 Later when Mother was asked about her stay in

9
Mother specifically testified that she “went to a couple of psychiatric hospitals to have sex with a

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a domestic violence shelter by counsel for DCS, Mother answered as follows:

A. You tell me why I went in there.
Q. Well, I wouldn’t know. I’m asking you.
A. I mean, I wouldn’t know neither. Are you looking for some sex?
Q. You don’t --
A. Are you looking for some sex?
Q. You don’t remember --
A. Are you looking for some sex? I’m going to ask straight up now. Don’t
f**k my life up.

As previously discussed, Mother also often interjected during the testimony of other
witnesses.

Furthermore, while Mother insisted that she was seeking treatment, as she had done
for years, from a Dr. Small at the time of trial, she refused to sign releases for DCS to
obtain mental health records to confirm her claims that she was receiving appropriate
treatment.10 Even crediting Mother’s testimony that she has been consistently participating
in mental health treatment, when asked about what kind of treatment she undergoes with
Dr. Small, Mother testified that they generally just discuss how much fun Mother has. So
Mother’s treatment apparently does not involve treating her delusions, her anxiety, or her
paranoia. Clearly, then, even if Mother is receiving treatment from Dr. Small, it is not of
the type that is sufficient to address the significant mental health challenges that negatively
affect her ability to parent her children. Without adequate treatment, it appears unlikely
that Mother will be able to make sufficient progress to ever safely parent her children.
Under these circumstances, we conclude that DCS met its burden to establish that Mother
is incompetent to adequately provide for the further care and supervision of her children
because Mother’s mental condition is presently so impaired and is so likely to remain so
that it is unlikely that Mother will be able to resume the care of and responsibility for the
children in the near future.

2. Willingness and Ability

DCS next contends that Mother failed to manifest a willingness and ability, whether
by act or omission, to personally assume legal and physical custody or financial
responsibility of the child and that placing the child in her legal and physical custody would
create a risk of substantial harm to the child’s physical or psychological welfare. See Tenn.

man” then explained that “I went to have sex with a man, I’m telling you. I went to have sex with a man.
Wasn’t nothing with me, the same man that would f**k me before we left the house was f***ing me in the
hospitals. . . . Everywhere I went, that’s what we did.”
10
The letter from Dr. Small cited by Mother was dated over a year prior to the termination trial.
However, the testimony indicated that Mother had produced several letters from Dr. Small throughout the
case.

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Code Ann. § 36-1-113(g)(14). Essentially, the statutory ground has two distinct elements
which must be proven by clear and convincing evidence:

First, DCS must prove that Mother failed to manifest “an ability and
willingness to personally assume legal and physical custody or financial
responsibility of the child[ren].” DCS must then prove that placing the
children in Mother’s “legal and physical custody would pose a risk of
substantial harm to the physical or psychological welfare of the child[ren].”

In re Maya R., No. E2017-01634-COA-R3-PT, 2018 WL 1629930, at *7 (Tenn. Ct. App.
Apr. 4, 2018) (alterations in original) (quoting Tenn. Code Ann. § 36-1-113(g)(14)). As for
the first element, the petitioner must “prove[] by clear and convincing proof that a parent
or guardian has failed to manifest either [an] ability or willingness” to parent the child. In
re Neveah M., 614 S.W.3d 659, 677 (Tenn. 2020).

Mother argues on appeal that the trial court’s order is deficient in that it did not
make sufficient findings as to the first prong of the analysis. We agree that the trial court’s
order is deficient. In relevant part, the trial court’s ruling as to this ground is as follows:

The children are placed in a pre-adoptive foster home which has been their
home since their removal more than four years ago in April of 2018. The
children have a strong bond with their foster parents. The foster parents have
helped the boys progress with their education and have been engaged in the
boys’ therapeutic services. Since coming into foster care, the children have
changed from being shy and quiet to very outgoing and social. They have
developed a sibling relationship with the other children in the foster home.
Removing the children from this stable home and depriving them of the
relationships they have developed with their foster family would have
devasting effects on the children.
The children do not have a bonded relationship with their mother.
Since they have been in DCS custody, Mother’s visits have been inconsistent.
When they have had visits, they have been problematic. Mother has
demonstrated a lack of engagement with the children during the visits.
Additionally, there were multiple incidents where her behavior during the
visits was inappropriate and distressing to the children.
[Omitted discussion of a biological father].
Neither parent at this time has manifested an ability or willingness to
assume legal or physical custody or financial responsibility of the children.
Furthermore, placing the children in their legal and physical custody would
pose a risk of substantial harm to the welfare of the children. DCS has proven,
by clear and convincing evidence, the ground for termination contained in
T.C.A. § 36-1- 113(g)(14).

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 As detailed above, the trial court’s order contains no findings as to how Mother
failed to demonstrate either a willingness or an ability to take physical custody of her
children or provide them with financial support.11 Instead, the trial court’s order appears to
address only the effect to the children if they were removed from their current foster home,
which we infer was intended to address the substantial harm prong of this ground.

The failure to make specific findings in support of each prong of this ground for
termination prevents meaningful appellate review:

With respect to termination cases, the trial court is specifically directed by
the statute to “enter an order that makes specific findings of fact and
conclusions of law.” Tenn. Code Ann. § 36-1-113(k). Furthermore, neither
the trial court nor this Court may proceed to termination absent clear and
convincing evidence of each necessary element of a ground for
termination. In re R.L.M., No. E2013-02723-COA-R3-PT, 2015 WL
389635, at *4 (Tenn. Ct. App. Jan. 29, 2015). Because the trial court did not
make specific findings regarding each of the elements applicable to the
failure to manifest ground, we are compelled to vacate the termination order
with respect to this ground for termination as to the [parent] and remand for
the preparation of appropriate findings of facts and conclusions of law as is
required by the statute. See In re Mickeal Z., No. E2018-01069-COA-R3-
PT, 2019 WL 337038, at *14 (Tenn. Ct. App. Jan. 25,
2019) (vacating termination order as to the [parent’s] rights because of a
failure to make proper findings to each element as required under Tennessee
Code Annotated section 36-1-113(g)(14)); In re Brianna B., No. M2017-
02436-COA-R3-PT, 2018 WL 6719851, at *8 (Tenn. Ct. App. Dec. 19,
2018) (noting that the trial court failed to issue any specific findings of fact
concerning the substantial harm element of the statute).

In re Nevaeh B., No. E2020-00315-COA-R3-PT, 2020 WL 4920020, at *3 (Tenn. Ct. App.
Aug. 20, 2020); see also In re Autumn D., No. E2020-00560-COA-R3-PT, 2020 WL
6306056, at *5 (Tenn. Ct. App. Oct. 28, 2020) (relying on In re Nevaeh B. to vacate this
ground for termination).

Here, the trial court’s order makes no findings that explicitly or implicitly address
the first prong of this ground. And to the extent that we read the trial court’s order as ruling
that the negative effect on the children of being removed from their foster home is sufficient
to constitute substantial harm under the second prong of this ground, Mother argues that
this focus was error. Indeed, while this Court has held that forcing a child to reunite with a
virtual stranger can constitute substantial harm for purposes of this ground, see In re

11
The financial support aspect of this ground for termination does not appear to be at issue in this
case.

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Brianna B., No. M2019-01757-COA-R3-PT, 2021 WL 306467, at *6 (Tenn. Ct. App. Jan.
29, 2021), we have also held that “[r]emoval of a child from foster parents that the child
has been living with for a long time and may have bonded with does not constitute
substantial harm.” In re Nakayia S., No. M2019-00644-COA-R3-PT, 2020 WL 4558376,
at *8 n.6 (Tenn. Ct. App. Aug. 7, 2020) (quoting the father’s argument) (citing In re Alysia
S., 460 S.W.3d 536, 576–77 (Tenn. Ct. App. 2014)). DCS does not assert that Mother is a
stranger to the children, but contends that the negative effect of the removal, coupled with
other factors, including Mother’s ongoing mental health issues and her repeated
incarceration, all amount to a probable risk of substantial harm. But the trial court’s order
does not discuss any of these additional facts with regard to this ground. So the trial court’s
ruling that DCS established this ground for termination is vacated, and this cause is
remanded for the entry of an order that contains specific findings of fact and conclusions
of law with regard to both prongs of this ground for termination.

B. Best Interest

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 children’s best interest.
Tenn. Code Ann. § 36-1-113(c)(2); White v. Moody, 171 S.W.3d 187, 192 (Tenn. Ct. App.
1994). In determining the best interest of a child, the court “shall consider all relevant and
child-centered factors applicable to a particular case before the court.” Tenn. Code Ann. §
36-1-113(i)(1). The factors “may include, but are not limited to”:

(A) The effect a termination of parental rights will have on the child’s critical
need for stability and continuity of placement throughout the child’s
minority;
(B) The effect a change of caretakers and physical environment is likely to
have on the child’s emotional, psychological, and medical condition;
(C) Whether the parent has demonstrated continuity and stability in meeting
the child’s basic material, educational, housing, and safety needs;
(D) Whether the parent and child have a secure and healthy parental
attachment, and if not, whether there is a reasonable expectation that the
parent can create such attachment;
(E) Whether the parent has maintained regular visitation or other contact with
the child and used the visitation or other contact to cultivate a positive
relationship with the child;
(F) Whether the child is fearful of living in the parent’s home;
(G) Whether the parent, parent’s home, or others in the parent’s household
trigger or exacerbate the child’s experience of trauma or post-traumatic
symptoms;
(H) Whether the child has created a healthy parental attachment with another
person or persons in the absence of the parent;

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 (I) Whether the child has emotionally significant relationships with persons
other than parents and caregivers, including biological or foster siblings, and
the likely impact of various available outcomes on these relationships and
the child’s access to information about the child’s heritage;
(J) Whether the parent has demonstrated such a lasting adjustment of
circumstances, conduct, or conditions to make it safe and beneficial for the
child to be in the home of the parent, including consideration of whether there
is criminal activity in the home or by the parent, or the use of alcohol,
controlled substances, or controlled substance analogues which may render
the parent unable to consistently care for the child in a safe and stable
manner;
(K) Whether the parent has taken advantage of available programs, services,
or community resources to assist in making a lasting adjustment of
circumstances, conduct, or conditions;
(L) Whether the department has made reasonable efforts to assist the parent
in making a lasting adjustment in cases where the child is in the custody of
the department;
(M) Whether the parent has demonstrated a sense of urgency in establishing
paternity of the child, seeking custody of the child, or addressing the
circumstance, conduct, or conditions that made an award of custody unsafe
and not in the child’s best interest;
(N) Whether the parent, or other person residing with or frequenting the
home of the parent, has shown brutality or physical, sexual, emotional, or
psychological abuse or neglect toward the child or any other child or adult;
(O) Whether the parent has ever provided safe and stable care for the child
or any other child;
(P) Whether the parent has demonstrated an understanding of the basic and
specific needs required for the child to thrive;
(Q) Whether the parent has demonstrated the ability and commitment to
creating and maintaining a home that meets the child’s basic and specific
needs and in which the child can thrive;
(R) Whether the physical environment of the parent’s home is healthy and
safe for the child;
(S) Whether the parent has consistently provided more than token financial
support for the child; and
(T) Whether the mental or emotional fitness of the parent would be
detrimental to the child or prevent the parent from consistently and
effectively providing safe and stable care and supervision of the child.

Tenn. Code Ann. § 36-1-113(i)(1). “All factors considered by the court to be applicable to
a particular case must be identified and supported by specific findings of fact in the court’s
written order.” Tenn. Code Ann. § 36-1-113(i)(3).

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 In this case, the trial court ostensibly cited only seven factors in its best interest
determination. But arguably, it cited even fewer than seven of the above twenty factors in
its order. To be sure, the trial court cites factors (A), (B), (H), and (O) in its order. But
factor (B) is cited twice. The trial court then cites two other factors that better resemble the
best interest factors prior to the 2021 amendment. Specifically, the trial court cites as a
factor in consideration “[w]hether the parent or guardian has made such an adjustment of
circumstance, conduct, or conditions as to make it safe and in the children’s best interest
to be in the home of the parent or guardian[.]” See also Tenn. Code Ann. § 36-1-113(i)(1)
(2020) (directing the court to consider “[w]hether 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”). This is similar to factor (J), but not
identical. The trial court also considered “[w]hether a meaningful relationship has
otherwise been established between the parent or guardian and the children,” which most
resembles factor (D). See also Tenn. Code Ann. § 36-1-113(i)(5) (2020) (directing the court
to consider “[w]hether a meaningful relationship has otherwise been established between
the parent or guardian and the child”). So then, it appears that the trial court has applied
some amalgam of the old best interest factors and the new without considering the entirety
of either set.

In some prior cases, we have held that it was not reversible error for the trial court
to consider both some of the old and new factors in reaching its ultimate decision as to best
interest. See In re Mitchell B., No. M2022-01285-COA-R3-PT, 2023 WL 3619561, at *6
(Tenn. Ct. App. May 24, 2023); In re Da’Moni J., No. E2021-00477-COA-R3-PT, 2022
WL 214712, at *23 (Tenn. Ct. App. Jan. 25, 2022), perm. app. denied (Tenn. Apr. 1, 2022).
Rather, we held that if the trial court’s ruling provides a detailed summary of the trial
court’s reasoning such that this Court can make a meaningful review of the trial court’s
findings, this practice is not error “so long as the factors considered are relevant to the facts
presented in th[e] case.” In re Mitchell B., 2023 WL 3619561, at *6. In both cited cases,
however, the trial courts entered detailed and thorough orders considering an abundance of
best interest factors.

Here, even acceding that the trial court’s reference to the old factors is a proper
substitute for consideration of similar new factors, the trial court considered no more than
six of the twenty factors that are applicable in this case. Although we have held with regard
to the pre-amendment statute that “the statute does not require a trial court to find the
existence of each enumerated factor before it may conclude that terminating a parent’s
parental rights is in the best interest of a child,” In re M.A.R., 183 S.W.3d 652, 667 (Tenn.
Ct. App. 2005), trial courts are still required to make specific findings as to each factor
found to be applicable. Tenn. Code Ann. § 36-1-113(i)(3). Moreover, to the extent that the
trial court may have found none of the other factors to be applicable to this case, we simply
cannot agree.

To be clear, some factors cited by the trial court involve such similar considerations

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as other uncited factors as to not be an issue. For example, factors (A) and (C) focus on the
stability and continuity of the children. The trial court also considered Mother’s visitation,
relevant to factor (E), when it discussed whether a meaningful relationship existed between
Mother and the children. Likewise, the trial court briefly discussed the bond that the
children have with their foster siblings, a consideration under factor (I), when it discussed
the effect of a change in caretakers on the child. Finally, the trial court clearly considered
Mother’s mental health issues and the risk of psychological harm her behavior poses to the
children, while inexplicably failing to cite the factors most focused on those considerations.
See Tenn. Code Ann. § 36-1-113(i)(1)(N), (T).

The same, however, is not true of many other factors. For example, Factors (K) and
(L) concern the efforts DCS has made in the case to assist the parent and whether the parent
has taken advantage of those programs. Obviously DCS was a party to this case, and its
efforts are relevant to the best interest analysis. See In re Kaliyah S., 455 S.W.3d 533, 555
(Tenn. 2015) (applying the old factors, which also considered the reasonable efforts by
DCS). But the trial court did not consider either of these factors during its best interest
analysis.12 Likewise, the trial court did not consider Mother’s sense of urgency in
addressing the circumstances that led to the removal of the children, as detailed in factor
(M). The trial court also did not discuss Mother’s home environment, relevant to factors
(Q) and (R), despite considerable testimony on this issue. Similarly, while the trial court
noted that the children received counseling as a result of their past trauma, the trial court
did not make findings as to whether the children are fearful of living in Mother’s home or
whether Mother or her home trigger the children’s trauma, as relevant to factors (F) and
(G), when several witnesses testified as to this issue. Finally, the trial court did not discuss
Mother’s history of child support payments, as detailed in factor (S), despite her testimony
that she consistently paid child support, or the fact that she always provided food, gifts,
and clothing at visitations for the children. See Tenn. Code Ann. § 36-1-113(i)(1)(P).

While our review of the factors indicates that some of the factors that the trial court
chose not to cite would still favor termination, such as Mother’s clear mental health issues
under factor (T), others are less clear or may even favor Mother, such as Mother’s history
of child support payments or the stability and environment of Mother’s physical home.
While we tend to agree that Mother’s mental health and her interactions with the children
during visitation hold considerable weight in this case, it is somewhat troubling that the
trial court essentially chose to ignore all the factors that weighed even slightly in favor of
Mother. Still, the Tennessee Supreme Court has held that courts have a duty to “consider
all of the statutory factors, as well as any other relevant proof any party offers” even when
one factor “dictate[s] the outcome of the analysis.” In re Gabriella D., 531 S.W.3d 662,
12
The trial court did make a finding that DCS made reasonable efforts to assist Mother in
establishing a suitable home as it pertained to the grounds for termination. But as previously discussed,
DCS does not defend the abandonment by suitable home ground for termination. Moreover, the reasonable
efforts considered with regard to that ground is limited to a four-month period following removal. See Tenn.
Code Ann. § 36-1-102(1)(a)(ii)(c). The best interest factors contain no such limitation.

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682 (Tenn. 2017) (noting that the fact that one factor may be outcome determinative “does
not mean that a court is relieved of the obligation of considering all the factors and all the
proof”).

Thus, it is the trial court’s duty to consider whether DCS met its burden to produce
evidence of each applicable factor and to make specific findings thereon. See In re Kaliyah
S., 455 S.W.3d at 555 (noting that “factual findings made in connection with the best-
interest analysis . . . must be proven by a preponderance of the evidence, not by clear and
convincing evidence”). And this Court has held that DCS’s failure to submit sufficient
proof as to a factor does not necessarily mean that the factor is inapplicable. For example,
where DCS puts on no proof of brutality, abuse, or neglect by the parent or others residing
in or frequenting the home, that factor is not inapplicable, but not proven to weigh in favor
of termination; so, it weighs against termination. See In re Erin N., No. E2021-00516-
COA-R3-PT, 2022 WL 444284, at *27 (Tenn. Ct. App. Feb. 14, 2022) (“Based on the lack
of evidence concerning Father’s mental or emotional status, we determine that the court
erred by weighing the factor neutrally instead of against termination.”); see also In re
Braelyn S., No. E2020-00043-COA-R3-PT, 2020 WL 4200088, at *20 (Tenn. Ct. App.
July 22, 2020) (“In the absence of evidence that tied Father to abuse, an unsafe home, or
an unstable mental or emotional state, we must conclude that these factors weigh against
termination.”); In re London B., No. M2019-00714-COA-R3-PT, 2020 WL 1867364, at
*12 (Tenn. Ct. App. Apr. 14, 2020) (concluding that the eighth factor under the pre-
amendment statute weighed against termination because no proof related to the father’s
mental or emotional status was presented). Thus, characterizing a factor as inapplicable
should not be used as a means of minimizing the points in a parent’s favor.

So then, the trial court here failed to make specific findings as to a number of
relevant factors. As this Court has explained, “Tennessee Code Annotated section 36-1-
113(k) ‘explicitly requires courts terminating parental rights to enter an order which makes
specific findings of fact and conclusions of law whether they have been requested to do so
or not.’” In re Maria B.S., No. E2011-01784-COA-R3-PT, 2012 WL 1431244, at *2
(Tenn. Ct. App. Apr. 25, 2012) (quoting In re Audrey S., 182 S.W.3d 838, 861 (Tenn. Ct.
App. 2005)). As we have explained,

“Meticulous compliance with the mandates of Tenn. Code Ann. § 36-1-
113(k) [is] required by appellate courts.” In re MEI, No. E2004-02096-
COA-R3-PT, 2005 WL 2346978, at *3 (Tenn. Ct. App. Sept. 26, 2005).
“When a trial court has not complied with Tenn. Code Ann. § 36-1-113(k),
we cannot simply review the record de novo and determine for ourselves
where the preponderance of the evidence lies as we would in other civil, non-
jury cases.” In re K.N.R., [No. M2003-1301-COA-R3-PT,] 2003 WL
22999427, at *3 [(Tenn. Ct. App. Dec. 23, 2003)].

A trial court’s failure to comply with Tenn. Code Ann. § 36-1-

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 113(k) affects more than the standard of appellate review. It
affects the viability of the appeal. When a trial court fails to
enter an order containing adequate findings of fact and
conclusions of law with regard to all alleged grounds for
termination, the Tennessee Supreme Court has instructed the
appellate courts to remand the case to the trial court for the
preparation of appropriate written findings of fact and
conclusions of law. In re D.L.B., [118 S.W.3d 360, 367 (Tenn.
2003)].

In re C.R.B., No. M2003-00345-COA-R3-JV, 2003 WL 22680911, at *4
(Tenn. Ct. App. Nov. 13, 2003) (footnote omitted).

In re Maria B.S., 2012 WL 1431244, at *3. This rule has been applied when the trial court
fails to make findings of fact in support of either the grounds for termination or the best
interest determination. See, e.g., id. (involving the ground for termination); In re Zoey L.,
No. E2019-01702-COA-R3-PT, 2020 WL 2950549, at *3 (Tenn. Ct. App. June 3, 2020)
(involving the best interest determination); In re B.L.R., No. W2004-02636-COA-R3-PT,
2005 WL 1842502, at *17 (Tenn. Ct. App. Aug. 4, 2005) (involving the best interest
determination).

We recognize that vacating the trial court’s ruling will only prolong the proceedings
and delay finality for the children at issue in this case. However,

[a]ll parties affected by these proceedings have a right to a prompt and just
adjudication of their rights and interests. . . . [T]he parties also have a
reasonable and legally enforceable expectation that . . . the courts will comply
with the plain statutory requirements when they undertake to extinguish the
relationship between a parent and his or her children.

In re Maria, 2012 WL 1431244, at *5 (quoting In re C.R.B., 2003 WL 22680911, at *4).
Here, the Tennessee General Assembly has clearly directed courts to consider and make
specific findings as to all applicable factors. The trial court did not comply with this
mandate. As such, “we are left with no choice but to remand the case with directions to
make the required specific written findings of fact and conclusions of law.” Id.

V. CONCLUSION

The decision of the Juvenile Court of Davidson County is affirmed in part, reversed
in part, and vacated in part, and this cause is remanded to the trial court for further
proceedings consistent with this Opinion. Costs of this appeal are taxed to Appellee the
Tennessee Department of Children’s Services, for which execution may issue if necessary.

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 S/ J. Steven Stafford
J. STEVEN STAFFORD, JUDGE

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