University of Minnesota’s Birth to Three Clinic: Comprehensive Assessment and Diagnosis Across Diverse Settings
The University of Minnesota’s Birth to Three Clinic has adopted a holistic approach to supporting children’s needs within an attachment-focused, trauma-informed, and neurodevelopmental framework rooted in the DC:0–5TM classification framework. This clinical framework of infant and early childhood mental health (IECMH) assessment has been applied in two settings: (1) a pediatric inpatient intensive care unit (PICU) working with medically complex young children and (2) a multidisciplinary outpatient clinic for children in the foster care system or post-adoption. In both settings, our work is focused on young children who have experienced a variety of early life stressors and adversity.
In recent decades, the understanding of the complexities underlying variation in development trajectories has been propelled by the academic field of developmental psychopathology. Advances in basic and translational science have yielded complex theoretical models and a more nuanced conceptualization of children’s vulnerability to their environment, the importance of primary caregivers, and the capacity for resilience in the first years of life. Nevertheless, bridging scientific advancements and clinical practice within the field of infant and early childhood mental health (IECMH) remains an important area for future growth. While still limited, IECMH clinics and programs have become more available in recent years. Yet, even with the increased access to IECMH services, comprehensive assessment and diagnosis of young children still lags behind the research literature. More specifically, there is a need for systematic implementation of IECMH assessment that goes beyond clinical diagnosis, and simultaneously holds the child, the parent(s), their relationships, and the broader environment/social context in mind.
Despite understanding the complexities of early brain and social–emotional development, many young children are still diagnosed under a single axial system, in line with approaches to mental health diagnosis among older children, adolescents, and adults. The DC:0–5TM: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Version 2.0 (DC:0–5; ZERO TO THREE, 2021) provides an exception to this single axial system, outlining diagnostic criteria and important cultural, developmental, and other contextual considerations affiliated with mental health diagnoses for young children from birth to 5 years old. Decades of research have underscored the impact of multilevel systems and their interactions on child development, which is reflected in the DC:0–5 diagnostic framework. More specifically, it is critical to acknowledge the unique vulnerability of young children to external factors and the importance of considering early brain development in the context of relationships; not attending to these key components does a disservice to the assessment process, diagnostic process, case conceptualization, clinical practice, and intervention planning. The DC:0–5 diagnostic classification system provides a framework for clinicians to consider the complexities of early childhood when determining an appropriate diagnosis and when formulating clinical recommendations and subsequent treatment.
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