Building a Better Mental Health System for North Carolina’s Babies and Toddlers

Babies and toddlers can have mental health and developmental disorders that impact their healthy development. North Carolina is working on putting in place a system that can properly identify, diagnose and treat these conditions, getting children back on track developmentally.

Just like a high school English exam would not be an effective way to assess a first-grader’s reading ability, the system used to diagnose and classify adult mental illness is not appropriate for babies and toddlers.

An infant and toddler-specific tool was first published 20 years ago, and a lot of progress has been made in the mental health field since then to understand and diagnose very young child mental health. In 2016, ZERO TO THREE published the most recent version of the tool – DC:0–5™: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–5). Clinicians can use DC:0-5 to accurately diagnose and classify infant and early childhood mental health (IECMH) disorders.

States, including North Carolina, have been integrating the new tool into their policies and systems. A new report from ZERO TO THREE provides states with recommendations about how to use the tool and offers examples from states around the country. North Carolina is highlighted as a leader.

 As part of an effort to improve state IECMH and overall early childhood health policy, the report suggests strategies to increase the use of DC:0-5, including:

  • Formally recognize DC:0–5 in public and commercial insurance programs, including Medicaid, through legislation, contract language, or regulatory changes.
  • Develop and disseminate resources (e.g., crosswalk to other disorder classification, practical guidance documents) to help providers use the DC:0–5 for eligibility determination, treatment planning, and billing purposes.
  • Recognize DC:0–5 disorders as eligibility criteria for Part C Early Intervention services.
  • Include DC:0–5 in cross-sector IECMH workforce development.

North Carolina is used as an example in the report for two of these recommendations.

Formally recognize DC:0–5 in public and commercial insurance programs, including Medicaid, through legislation, contract language, or regulatory changes.

North Carolina does not yet explicitly promote DC:0–5 in Medicaid policy. However, the state allows behavioral health providers to bill for a certain number of visits (six) without a specific medical diagnosis. This policy allows providers the necessary time to effectively use DC:0–5 to arrive at a diagnosis. North Carolina will begin including DC:0–5 in Medicaid guidance for clinicians when DC:0–5 training has been completed in the state.

Develop and disseminate resources to help providers use the DC:0–5 for eligibility determination, treatment planning, and billing purposes.

Since North Carolina has not yet integrated the DC:0-5 tool into Medicaid, providers need to link the diagnosis in the DC:0-5 to a recognized mental health condition or diagnostic code from the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM, used by Medicaid and other insurance providers, is appropriate for adults and older children. North Carolina has developed a state-specific tool that crosswalks the DC:0–5 with the adult tool, for providers to use for billing. North Carolina leaders also engaged stakeholders on how to implement DC:0–5 through a statewide IECMH summit. The state is currently supporting workforce training in DC:0–5 and exploring how to expand use of DC:0–5 and the crosswalk. Advocates are also seeking funding for infrastructure for the North Carolina Infant Mental Health Association, a statewide organization dedicated to the healthy emotional, cognitive and social development of children prenatal to five years old. The North Carolina team has also made recommendations for IECMH in the plan for upcoming Medicaid changes in the state.


The ZERO TO THREE report recommends additional improvements in state IECMH policy and practice, many of which overlap with early recommendations coming out of the North Carolina Pathways to Grade-Level Reading Design Team.

  • Make efforts to significantly increase the availability of qualified IECMH providers. States can support training and reflective supervision opportunities, review the adequacy of current reimbursement rates for IECMH providers, raise reimbursement rates for providers using the DC:0–5 diagnostic classification, and ensure adequate insurance coverage for multiple diagnostic assessment sessions.
  • Include DC:0–5 diagnoses in medical necessity criteria for children under 5 years old.
  • Consider creating or updating standard Medicaid, behavioral health, and managed care contract language requiring (or at a minimum, encouraging) providers to use DC:0–5 in their diagnostic assessment of children under 5 years old.
  • Include DC:0–5 training in the requirements for child psychiatry, psychology, and social work, as well as mental health continuing education, IECMH endorsement, and related early childhood professional credentials.
  • Use DC:0–5 as a consistent tool in research and data collection to better understand children’s need for and use of mental health services and how current service delivery meets these needs.


Young children’s social-emotional health is critical for well-being and is one of the three areas prioritized by the NC Pathways to Grade-Level Reading Initiative Design Teams, along with high quality birth-through-age-eight education, and regular school attendance. Pathways is creating partnerships among the state’s early learning and education, public agency, policy, philanthropic and business leaders to define a common vision, shared measures of success and coordinated strategies that support children’s optimal development beginning at birth.