Early Childhood System of Care Community of Practice Call
6/01/06, 2:30 ET

Diagnostic Classification 0-3 (DC 0-3 R)

Nancy Seibel, Director of Training, Zero to Three
(Click here to view PowerPoint Slides)

• What is DC:0-3R?
  • Developmentally-based approach
  • Recognizes key importance of caregiving relationships to babies’ mental health
  • Comprehensively takes into account all areas of functioning in children’s mental health
  • Includes diagnostic categories that are not found in other classification systems
• Why do we want to diagnose babies and toddlers? Is it stigmatizing to apply diagnostic labels?
• Creates a common language so that professionals and parents can develop a shared approach to treatment.
• To help further our knowledge by stimulating research
• History of DC:03:
• First edition in 1994: Multidisciplinary approach – brought together mental health and early childcare professionals
• Developed DC:0-3R in 2005
• Now busy training practitioners in the revised version
• Training Levels:
  1. Introductory Training
  2. Awareness
  3. Intensive Case Discussion
  4. Advanced
  5. Training for Trainers
• A training task force took the original DC:03 training program and worked together to standardize the training, add to the numbers, improve materials, and continue learning to do a better job.
• States participating in DC:0-3R: See slides

Kathryn Shea, Chief Operating Officer, Florida Center for Child and Family Development
(Click here to view PowerPoint Slides)

• History:
• September 2000: Florida finalized its strategic plan for infant mental health services
• A task force worked on policy changes for Community Mental Health services
• The new policy recommended the use of DC:0-3
• Despite state endorsement, the billing system would not reimburse for DC:0-3 à Kathryn Shea developed a crosswalk between the DC: 0-3 and ICD-9 codes
• The Florida Center for Child and Family Development participated the Florida Infant Mental Health pilot project from 2000-2003
• The agency continued to serve the families who participated in the pilot and brought in new families after the pilot project funding ended
• Over 400 families have been served by the Florida Center for Child and Family Development
• Medicaid has reimbursed for all services and assessments that used the crosswalk; private insurance has reimbursed for 80%.
• Why a crosswalk with ICD-9-CM?
• ICD-9-CM is required by Medicaid à it is easier and has a better chance of reimbursement
• ICD-9-CM codes may be more young child “friendly” than DSM-IV
• Florida’s Limitations:
• Cannot bill for V codes on Axis I
• Florida Medicaid does not pay for community mental health services for treatment of autism, pervasive developmental delay, non-emotional or non-behavioral based developmental disability, or mental retardation.
• DC:0-3 cannot be used in isolation – supervision and ongoing training is needed (yet fiscally difficult to do)
• Promising Practices/Next Steps:
• Diagnostic Decision Tree looks very promising
• Video tapes of assessment/clinical discussion/ diagnosis/crosswalk code would be very helpful
• National data base on birth to three Axis I & II Diagnosis w/ MH diagnosis in primary caregiver

Discussion and Questions:

• Have you tried cross walking Axis II diagnosis in the absence of Axis I? Is your center able to bill for this?
• We can bill for treatment of Axis I disorders without comorbid Axis II disorders. But we cannot bill for Axis II exclusively.
• You cannot diagnose a personality disorder in anyone under age of 18.
• Is there the incentive to get DC:03 recognized in and of itself instead of having to use a crosswalk?
• It is an embedded practice to be willing to reimburse for DSM or ICD. Accepting a whole new system is not a winnable issue at this point. ICD is an international classification system à DC:03 would have to be accepted on a worldwide level.
• The regulation disorders are the only section of DC:03 where it seems to be difficult to crosswalk. They are related to an organic issue rather than a mental health issue.
• It sounds like different states accept different diagnoses for reimbursement…
• Yes, it does vary state by state for what you can bill for.
• Each state has its own plan. If your state lets you use EPSDT funds (like CA), things are much easier.
• DC:03R is really the training opportunity for getting providers who have not worked with infant and toddlers to understand what to look for developmentally, what are developmental milestones.
• Youthnet project did a training last week on infant mental health. They are planning to do another series of trainings looking at intervention strategies.

Next call: An overview of MCH funded State Early Childhood Comprehensive Systems Grants, Friday, June 30, 2:30 - 4:00 ET.