Infant-Early Childhood Mental Health

IECMH Statewide Tour report

In the summer and fall of 2023, HCA’s IECMH team conducted 10 listening sessions with 96 behavioral health providers across the state, in order to better understand barriers and potential solutions to improving access to quality IECMH services. Through the listening sessions, providers elevated seven core themes:

• IECMH workforce development
• Mental health assessment for young children
• Mental health treatment for young children
• Services in home and community settings
• Caregiver engagement
• Allied professional collaboration
• IECMH financing

Within these core themes, providers shared both best practices and challenges, many of which are supported by the broader literature and evidence base. These were used to inform the development of HCA’s IECMH priorities and next steps HCA is committed to taking.

• Read the executive summary.
• Read the full report.
• Watch a video presentation about the report.
• Review a PowerPoint presentation about the report.

HCA IECMH reports

HCA is committed to gathering, examining, and sharing information about our IECMH work in partnership with communities, providers, and families. The stories told in these reports from HCA help us move towards our vision of building a strong IECMH network in Washington state.

Mental Health Assessment for Young Children Implementation Report

Mental Health Assessment for Young Children (MHAYC) refers to a set of Apple Health billing and clinical policies that support IECMH best practices for diagnosing and assessing mental health conditions for young children. In the Fall of 2022, twenty different providers from across the state completed the MHAYC implementation survey, sharing their experience in adopting the various components of the MHAYC policy. A report of the survey findings was published in April 2023.

Key findings: While this survey only represents a small number of providers, the results indicated a moderate uptake of the mental health assessment for young children (MHAYC) policies. Providers also reported that MHAYC policies have made billing for IECMH services easier, increased provider competence in serving young children, and improved access to developmentally appropriate services.

Read the report.

Behavioral Health Agencies Serving Infants, Toddlers, and Preschoolers in Washington State

The Behavioral Health Provider Survey (BHPS) is a survey of community behavioral health agencies in Washington state, which represent a core component of the publicly funded behavioral health system. While the survey is not completed by all behavioral health agencies, the results provide an important window into the current state of IECMH services in Washington. A report on 2022 survey responses about IECMH services was published in February 2023. 

Key findings: In 2022, about a third of all behavioral health agencies (BHAs) serve children younger than six, and less than 10% serve children younger than three. Of those that do, the majority recommend or require the use of the DC:0-5, but less than half provide dyadic family therapy services.

Read the report.

IECMH Workforce Collaborative reports

HCA contracts with the Infant-Early Childhood Mental Health Workforce Collaborative (IECMH-WC) to coordinate DC:0-5™ training and other professional development supports for mental health assessment for young children. The workforce collaborative published their first annual report in October 2023. 

Key findings: From March 2022 – June 2023, 447 mental health professionals and 405 allied professionals attended DC:0-5 training on the DC:0-5. A Training of Trainers (TOT) increased the pool of diverse DC:0-5 trainers from 2 to 13. Mental health professionals who participated in the DC:0-5 Clinical Training reported that, overall, the training helped them feel more prepared to use the DC:0-5.

The IECMH-WC publishes reports about their work on a regular basis, including the number of trainings offered, the demographics of training participants, and the impact of trainings on knowledge and skills. These reports are available on the IECMH-WC Reports webpage.

Other HCA data about IECMH

Other programs at HCA produce data and reports about mental health services, and sometimes this data is broken down by age. Data and reports like this can be used to understand IECMH strengths and needs across the system.

WISe CANS data

Wraparound with Intensive Services, or WISe, is an approach to helping children, youth, and their families with intensive mental health care. The Child and Adolescent Needs and Strengths (CANS) tool is a way to organize and capture needs and strengths of the child and family. In WISe, the CANS is used for both care planning and outcome measurement.

Key findings: In 2023, the average number of actionable needs for young children (ages 0-5) decreased after 3 months of WISe services, from 12 to 9 needs. After 3 months of WISe services, the percentage of young children with actionable needs decreased for many different items, including tantruming, aggressive behaviors, regulation skills, attention/impulse control, preschool functioning, family functioning, and social functioning.

See CANS data for children birth – age five

Additional data and reports about the WISe program are available on the WISe Reports webpage.

Children's Behavioral Health Access Report

HCA publishes an annual report about access to behavioral health services for children, youth, and young adults enrolled in Apple Health, with data broken down by age.

Key findings: The most recent report found that in 2022, only 60% of young children (ages 0-5) with an identified mental health need received any mental health services.

Read the full report.

Children's Behavioral Health Dashboard Report

In November 2023, RDA published the most recent Children’s Behavioral Health Dashboard, which includes detailed data on behavioral health treatment needs and outcomes among Apple Health enrolled children in Washington state.

Key findings: In 2021, 5% of young children (ages 0-4) were identified as having a mental health need. This number increased to 20% for young children in foster care. These rates have remained about the same from 2014-2021. In 2021, the percentage of young children with an identified mental health need ranged from 4% (in King County and Thurston-Mason regions) to 7% (in Great Rivers region).

The dashboard also includes further details about behavioral health treatment needs and outcomes for young children, including types of mental health and developmental conditions, involvement with other services and systems (DDA, TANF, etc.), and differences across regions.

Review the dashboard report.

Publications featuring HCA’s IECMH work

HCA’s innovative work on infant-early childhood mental health has been featured in several national publications. These reports demonstrate how Washington state is leading the way when it comes to whole-person, high-quality, and community-centered care in the earliest years of life.

• Centering Babies and the Adults Who Care For Them: States Explore Infant and Early Childhood Mental Health Financing and Policy (Stark, 2024)
• Medicaid Support for Infant and Early Childhood Mental Health: Lessons from Five States (Johnson & Burak, 2023)
• Medicaid Partnerships in Washington State Contributing to a Continuum of Infant and Early Childhood Mental Health Supports and Services (Trivedi & Horen, 2022)
• Embedding DC:0–5 Into State Policy and Systems (Cohen & Andujar, 2022)

IECMH data from our partners

Sister state agencies, county governments, community organizations, other states, researchers, and national groups produce data and reports that can help inform IECMH efforts. Please note that the list below is not comprehensive, and it does not represent the views or opinions of HCA.

• Medicaid Policies to Help Young Children Access Infant-Early Childhood Mental Health Services: Results from a 50-State Survey (Smith et al., 2023)
• A meta-analysis of the international prevalence and comorbidity of mental disorders in children between 1 and 7 years (Vasileva et al., 2021)
• Cost-effectiveness of infant and early childhood mental health treatment (Oppenheim & Bartlett, 2022)
• Results of a Washington State Provider Survey of Dyadic Services and Billing (Oxford & Lecheile, 2022)
• Accelerating Progress for Infant and Early Childhood Mental Health in Washington: A Series of Issue Briefs (Perigee Fund, 2021)
• Transforming infant and early childhood mental health: A landscape analysis and strategic plan for King County (King County Best Starts for Kids, 2021)