Mental health assessment for young children

Background

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 did the legislation do?

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

HCA must:

• Allow reimbursement for up to five sessions for mental health 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

Beginning January 1, 2022, all Apple Health mental health professionals who provide mental health assessments to children birth through age five became eligible for reimbursement for up to 5 sessions for the mental health assessment. These providers became eligible for reimbursement for travel to home and community settings for these sessions.

Supporting the use of the DC:0-5^TM

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 mental health professionals in providing culturally and developmentally appropriate assessment and diagnosis, and in adopting the DC:0-5™, the HCA is taking steps to build workforce knowledge and capacity, create tools to support mental health professionals' practice, and to align internal policies.

DC:0-5™ Crosswalk

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 providers, 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 providers 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 has published an Apple Health DC:0-5™ crosswalk. To access the crosswalk and resources that support its use, please visit the Mental Health Assessment for Young Children provider webpage.

Infant-Early Childhood Mental Health Workforce Collaborative DC:0-5 training

Because providers may not receive training in providing culturally and developmentally appropriate assessment and diagnosis for infants and young children (including training on the DC: 0-5™ manual) as part of their education, additional professional development is needed to support implementation. In 2021, the legislature allocated funds to provide free DC: 0-5™ training and professional development supports for Apple Health mental health and allied professionals.

These trainings and professional development supports are provided through the Infant-Early Childhood Mental Health Workforce Collaborative (IECMH-WC). In March 2022, HCA awarded the contract for the IECMH-WC to the Washington Association for Infant Mental Health (WA-AIMH). WA-AIMH will coordinate DC:0-5™ trainings and professional development supports, from June 2022 through June 2023. To learn more about DC:0-5™ trainings and other professional development opportunities, please visit IECMH-WC's About DC:0-5 webpage.

If you have questions about the IECMH-WC, please reach out.

Project updates

HCA hosted a community presentation on July 21, 2022 about the past year of implementation of MHAYC.  The presentation outlines the shared progress, lessons learned, and details on what is coming up next. 

• View the presented slides

HCA sends periodic bulletin updates on implementation progress. Sign up for the Prenatal - Age 25 Behavioral Health GovDelivery to stay informed. Recent bulletins are linked below, and older bulletins are available upon request. 

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.