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Advancing Infant and Early Childhood Mental Health: The Integration of DC:0-5TM Into State Policy and Systems

Amanda Szekely, Therese Ahlers, Julie Cohen, and Cindy Oser, ZERO TO THREE, Washington, DC


This article discusses why and how states are integrating DC:0–5TM: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–5) into state policy and systems; provides state examples to highlight some of the strategies that states have used to allow, promote, or require the use of DC:0–5; and provides recommendations for further improvements in state infant and early childhood mental health policy and practice. The article provides a point-in-time overview of how DC:0–5 is being integrated into state systems and policies and is a sample of the innovative work going on across the United States. The article is adapted from a paper of the same name published in 2018 by the ZERO TO THREE Policy Center.

Infants and young children can have mental health and developmental disorders that affect development. When a young child has a mental health disorder, it is important to identify and treat the disorder as early as possible so that impairment, suffering, and effects on overall health and development can be reduced. Early childhood mental health and developmental disorders can be seen as early as infancy or may emerge through the preschool years. These include disorders that are specific to the early childhood stage of development (e.g., Overactivity Disorder of Toddlerhood or Excessive Crying Disorder) as well as general disorders that manifest in unique ways in the infant and early childhood population (e.g., Social Phobia or Autism Spectrum Disorder). If properly identified using diagnostic criteria relevant to infant and early childhood development and experiences, these disorders can be effectively treated.

Accurate identification of a mental health disorder for a young child is only possible with a developmentally appropriate diagnostic classification system. In this article, we explore how states are integrating an age-appropriate diagnostic classification, DC:0–5TM: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–5; ZERO TO THREE, 2016) into state policy and systems. DC:0–5, published by ZERO TO THREE in December 2016, is a tool used by clinicians to accurately diagnose and classify infant and early childhood mental health (IECMH) disorders (see Box 1). Adopting DC:0–5 as a standard of practice can be an effective strategy for (a) improving access to IECMH services and supports and (b) improving outcomes for children, and many states are pursuing this approach.

Box 1. What Is IECMH, and Why Is It Important?

Infant and early childhood mental health (IECMH) is the developing capacity of the child from birth to 5 years old to form close and secure adult and peer relationships; experience, manage, and express a full range of emotions; and explore the environment and learn—all in the context of family, culture, and community.

IECMH, also known as healthy social and emotional development, is the cornerstone of early brain development, providing the foundation upon which all future development rests. Babies who engage with responsive, consistent, and nurturing caregivers are more likely to have strong emotional health throughout life.

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