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Mental health assessment for young children

Clinicians can help support the mental health of children ages birth through five by providing developmentally appropriate mental health assessments. In order to support clinicians with this endeavor, the legislature made changes to policy impacting the Apple Health system. The Health Care Authority (HCA) will implement these policy changes by restructuring reimbursement, developing billing guidance, and providing free training opportunities about mental health assessments.

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Scope of work

Approximately 10-14 percent of children birth to 5 years-old experience emotional, relational, or behavioral disturbances (Brauner and Stephens, 2006). These disorders, if properly identified using diagnostic criteria relevant to infant and early childhood development, can be effectively treated. Appropriate assessment leads to more effective treatment and reduces behavioral, school, and physical health risk factors over the long term.

What are the changes?

To support best clinical practices for the birth through five population, policy changes were needed within the Apple Health program. In April 202, 2SHB 1325 Sec(2)(11) was signed into law, initiating several statewide policy changes that took effect on July 1, 2021.

HB 1325 requirements

HCA must:

  • Allow reimbursement for three to five sessions for mental health intake and assessment.
  • Allow reimbursement for mental health assessments in home or community settings, including reimbursement for clinician travel.
  • Require clinician use of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0 – 5™).

Reimbursement policies

On January 1, 2022, all Apple Health clinicians who provide mental health services to children birth through age five will be eligible for reimbursement for up to 5 sessions for the diagnostic intake assessment. These clinicians will also be eligible for reimbursement for travel to home and community settings for these sessions.

To support clinicians in accessing these reimbursements, HCA is making updates to several systems, including Washington Administrative Code (WAC), integrated managed care (IMC) contracts, Service Encounter Reporting Instructions (SERI), mental health billing guides, Provider One, and fee-for-service (FFS) reimbursement systems.

Supporting the use of the DC:0-5TM

The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Child hood (DC:05TM) is the internationally accepted system for developmentally appropriate assessment of young children’s mental health. The DC: 0 – 5™ uses developmentally specific diagnostic criteria that reflects mental health disorders that are typically diagnosed in infancy and early childhood.

To support clinicians in adopting the DC: 0 – 5™, the HCA is taking steps to build workforce knowledge and capacity, create tools to support clinicians’ practice, and to align internal policies.

In 2021, the legislature allocated funds to fund DC: 0 - 5™ training for Medicaid mental health clinicians and allied professionals. HCA will collaborate with external partners to provide the following trainings:

  • Clinical DC: 0 – 5 Training is designed to support mental health clinicians in adopting the approach, understanding the multi-axial system, and utilizing the classification system in their work with children birth through age five. Clinicians will be supported in adopting approaches to diagnosis and assessment that are developmentally informed, relationship based, and culturally competent.
  • Overview DC: 0 – 5 Training serves as an overview of DC:0-5™, providing a foundation for understanding this diagnostic system for professionals who work with infants and young children. The training will provide participants with an overview of the background, approach, and content areas of DC:0-5™ and is particularly helpful for allied professionals in understanding the importance of developmentally appropriate diagnostic practices.

The DC: 0 - 5™ is recognized as the clinically appropriate manual for diagnosing infants and young children but, in our current behavioral health system, other diagnostic manuals may still be necessary. For Apple Health clinicians, federal Medicaid guidance requires that all claims be submitted with an ICD (International Classification of Disease) code. Many mental health systems may also require a DSM (Diagnostic and Statistical Manual) diagnosis in the documentation of services.

To support the use of DC: 0 - 5™ in their practice, many clinicians refer to a tool called a “DC: 0 - 5™ crosswalk.” A DC: 0 - 5™ crosswalk is a reference guide for clinicians that helps to convert DC: 0 – 5™ diagnoses to associated ICD diagnostic codes and DSM diagnoses. Zero to Three, the publisher of DC: 0 – 5™, includes a crosswalk within the DC: 0 - 5™ manual.

HCA will publish an interim Apple Health DC: 0 - 5™ crosswalk, based upon the national crosswalk from Zero To Three. To develop a crosswalk that is informed by clinician, stakeholder, and advocate feedback, HCA will convene a community workgroup tasked with reviewing and revising the interim crosswalk for the purpose of developing a community-informed Apple Health DC: 0 - 5™ crosswalk.

Stay informed with project updates

HCA will work to implement 2SHB1325 from July 1, 2021 through June 30, 2023. Periodically, we will send updates on implementation progress via our Prenatal through age 25 Behavioral Health listserv. If you are not already registered, visit the GovDelivery signup page, to choose which topics you would like to stay informed on.

To sign up for alerts regarding the prenatal through 25 listserv

  • Visit the GovDelivery signup page to create a new account
  • Under subscription topics, click on behavioral health and recovery
  • Scroll down and check the box for “Prenatal through Age 25.”
  • Click SUBMIT.

History of the work

Work on developmentally appropriate assessment and diagnosis for infants and young children has been ongoing for several years in Washington State. The Children and Youth Behavioral Health Workgroup (CYBHWG) first recommended advocacy around developmentally appropriate diagnosis tools for children birth through five in their 2016 report to the legislature.

In 2018, a cross-agency team participated in the Infant-Early Childhood Mental Health Finance and Policy Project, a year-long national learning collaborative sponsored by Zero To Three. The team identified statewide adoption of the DC:0-5 as their top legislative priority. By partnering with the CYBHWG, the team was able to advance this priority as a legislative recommendation, and in the 2020 legislative session, a budget proviso required the HCA to conduct an analysis of the costs associated with statewide adoption.

For the 2021 legislative session, the CYBHWG recommendations to the legislature included statewide implementation of DC:0-5; the cost analysis was instrumental in informing the fiscal estimates associated with this recommendation and the resulting legislation. Following this recommendation, HB1325: Implementing Policies Related to Children and Young Behavioral Health was signed into law in April 2021.


Kimberly “Kiki” Fabian, M. Ed
Infant and early childhood mental health systems analyst

Christine Cole, LCSW, IMH-E®
Infant and early childhood mental health program manager