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Consultation and Case Formulation Using DC:0–5: The Centrality of Relational Context

Dec 12, 2021

Sharla Green Kibel and Amanda Rojas Hernandez, County of Santa Clara Behavioral Health Services Department San Jose, California


The use of the multiaxial dimensions of the DC:0–5 classification system during the assessment process provides an organizing framework for understanding the impact of family relationships on a child’s functioning. In this article, the authors describe an assessment with a high-conflict family and how contrasting the impact of parental conflict with the strengths of each parent provided deeper insight into the child’s and family’s needs and opportunities. The authors highlight the interplay between reflective inquiry during an assessment, and the role of assessment in the earliest steps of intervention.

This article is focused on how the dimensions 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) organized our thinking and practice during the assessment process for 3-year-old Jorge and his parents as they navigated the difficulties of parental separation and shared custody in the face of painful mutual distrust. (This case represents a composite of client experiences, therefore personal health information is de-identified.) A diagnostic process asks us to gather and organize information, and the multiaxial structure of DC:0–5 demands of us a relational and reflective capability—especially when considering the relative impact of the relational context/Axis II. We will each share our own thoughts and experiences as we describe the consultative process. Amanda, an infant and early childhood mental health specialist, is a therapist providing assessment through a county behavioral health clinic. Sharla’s role, as a reflective consultant, was to support Amanda (and indirectly the parents) to tolerate the ambiguity of waiting to understand what may not be ready to be named or defined while the assessment process unfolds.

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