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DC:0–5 in the Nordic Countries: Results and Experiences From the First 5 Years of Implementation in Norway and Sweden

Dec 12, 2021

Catarina Furmark, Region Norrbotten, Luleå, Sweden; and Nina Sanner, Innlandet Hospital Trust, Elverum, Norway

Abstract

The DC:0–5TM: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–5) includes significant revisions, making it a substantially different diagnostic framework from its predecessor, DC:0–3R. The Nordic countries have a long history of using the DC system. The Nordic DC:0–5 collaboration was formalized in 2015 when a Nordic DC:0–5 working group was initiated by the Nordic affiliation of the World Association of Infant Mental Health (NAIMH) and the Finnish affiliation PIRPANA. This article describes efforts to explore applicability of the DC:0–5 during introduction training courses and supervision sessions. The revised DC:0–5 is overall considered an improvement over earlier experiences with DC:0–3R. In this article, the authors present reflections and experiences from clinicians, researchers, students, and trainers who have provided feedback about training and use of the DC:0–5 system from the first 5 years of implementation.

Implementation of the DC:0–5TM: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–5; ZERO TO THREE, 2016) in the Nordic countries has been enabled by the fact that the Nordic countries have a long history of using ZERO TO THREE’s previous diagnostic classification systems (DC:0–3, 1994; DC:0–3R, 2005) for mental health and developmental disorders. Norway started in the 1990s and Sweden from around 2000 in using DC:0–3R. Extensive use and familiarity with the DC system has also allowed successful infusion into university clinical psychology pre-service training programs and development of in-service trainings throughout both Sweden and Norway. Throughout these first 5 years of implementation of DC:0–5, clinicians, researchers, students, and trainers have provided feedback about training programs, comments and questions about the DC:0–5 system and the use of the system, as well as challenges and ideas concerning how to further support implementation. In this article we will present some of these reflections and experiences.

Infant mental health clinicians and researchers in Scandinavia have collaborated closely for more than 20 years. The Nordic affiliation of the World Association of Infant Mental Health (NAIMH) has been one of the main forums for co-construction of knowledge and mutual support and inspiration as infant mental health emerged as a small, but thriving, field in clinical work and research in Scandinavia. Implementation of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood has been a main priority during these years. A Nordic DC:0–5 working group was initiated by the NAIMH and the Finnish affiliation PIRPANA with the mandate to facilitate DC:0–5 research and implementation in the Nordic countries. The group established dialogue with multiple agencies in the different Nordic countries and with ZERO TO THREE, and consulted international research communities and clinics. Due to the pandemic, there was a delay in meetings during 2020–2021. The working group is now focused to discuss the kinds of support clinicians need to continue their learning process after the introduction courses and discuss research questions. Acknowledging that there are also important differences between the Nordic countries concerning how the respective national health care systems are organized, all working group members are also members of national DC:0–5 implementation teams.

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