A child's environment can constitute a source of physical and emotional medical neglect. In the recent case of In the Interest of J.A.R.R., J.N.R., and M.A.R., the U.S. Court of Appeals for the Fourth Circuit held that termination of parental rights was warranted where parents had no plan in place to meet their children's medical needs.

Where the Texas Department of Family and Protective Services (TDFPS) seeks to terminate a parent's rights, the case is one of constitutional proportion. Because of that, parents are entitled to due process to assure that the Department's attempts to terminate the parent-child relationship is warranted. Appellate courts are charged with ensuring that TDFPS has met its significant burden of proof—by reviewing the record to confirm that TDFPS submitted clear and convincing evidence that a statutory ground was proffered to terminate parental rights, and further, that termination of parental rights serves the best interest of the children made the subject of the case.

Across the country, and in Texas, there is a strong presumption that maintaining the parent-child relationship serves the best interest of our children. In order to rebut that presumption, an entity or an individual seeking to terminate the parent-child relationship has the burden of showing that continuation of the parent-child relationship would not serve the child's best interests. Texas courts will look to the Holley v. Adams factors, including the following: