By: Alex Busuito
In the first five years of life, children develop the social, emotional, and cognitive capacities that are the foundation for lifelong health and wellbeing. A significant financial investment in a robust system of care to support the mental health of babies, young children, and their caregivers goes a long way towards increasing the health and wellbeing of adolescents and adults and decreasing overall spending on health care. Medicaid is an important source of health system funding, of course, but other sources are necessary, particularly as overall federal investments in childhood programs is in decline. State leaders, however, are finding new and creative ways to advance funding for Infant and Early Childhood Mental Health (IECMH). ZERO TO THREE’s new report highlights the remarkable work of dedicated state teams to create a coherent, comprehensive, and sustainably-funded array of IECMH supports and services, shared as part of last year’s 30-state convening of the ZERO TO THREE’s IECMH Financing Policy Project (FPP).
The FPP is a nationwide learning community where states come together to build, test, and share policy and financing strategies to increase equitable access to IECMH services. Teams include a combination of public (state departments of health, education, or mental health) and private (state associations for infant mental health, universities) sector individuals, and each team is required to include an infant mental health clinician and a high-level Medicaid staff member. State strategies span workforce development, billing approaches, and service delivery innovations, and touch on all parts of early childhood and child-serving health systems. Starting with its first state cohort in 2016, the learning collaborative has grown to 30 states, with a fourth cohort of up to 10 additional states due to begin in January 2025. This collaborative approach to IECMH systems building has been effective in a) advancing policies that support a full continuum of IECMH promotion, prevention, developmentally appropriate assessment diagnosis, and treatment services, and b) propagating successful policies from state to state.
A coherent, comprehensive, and sustainable system of IECMH supports and services is contingent on the strength of its infrastructure. At a minimum, this means sustained support for:
- a diverse, qualified and well-trained workforce (including sufficient reimbursement levels);
- policy adoption and implementation of DC:0–5™, a developmentally appropriate diagnostic classification system for children ages 0-5; and
- clear billing processes for providers.
At the convening, states from the first two of three FPP cohorts shared some of their recent accomplishments in building these foundational elements.
Illinois, a Cohort 1 state, embedded DC:0–5 in Medicaid policy and now requires IECMH clinicians to use DC:0-5 to diagnose infants and young children and the ZERO TO THREE DC:0–5 Crosswalk for billing. Concurrent with this policy change, they passed legislation to secure the funding needed to create and maintain a workforce trained in DC:0–5. Illinois built a network of 15 DC:0–5 trainers spread throughout the state and across systems of care (e.g., early intervention, higher education, and private practice). Now, more than 500 Illinois clinicians have been trained in DC:0–5, and the state has a network of IECMH professionals proficient in the best-practice for clinical case-conceptualization and diagnosis of infants and young children.
In Washington, a member of Cohort 2, IECMH leaders knew, for a well-trained IECMH workforce to be sustainable, that workforce had to be equitably reimbursed for their services. So, leaders came together to create both a system for IECMH billing and a communications structure that would help providers understand and implement new reimbursement policies. Washington Medicaid staff built a partnership with the communications side of their agency, engaged the provider community, and committed to an iterative process that involved retooling polices and guidance based on provider feedback. They started with mass emails, hosted a webinar to explain the new billing policy, and then added “office hours” to answer additional questions. They updated the Medicaid billing guide, developed a web page for essential resources and archived documents, and provided tailored technical assistance for providers who need additional support.
IECMH clinicians, no matter how well-trained or compensated, need ongoing support to provide high-quality services to infants, young children, and their families. Reflective supervision/consultation (RS/C)—the process of reflecting on one’s reactions to and emotions around work with an infant, young child, or family with the support of a trained colleague—is an essential component of workforce development and support for IECMH clinicians. In Massachusetts, a Cohort 1 state, with funding from the Department of Mental Health, the Massachusetts Society for the Prevention of Cruelty to Children (MSPCC) and the Massachusetts Association for Infant Mental Health (MassAIMH) collaborated to develop and implement diversity-informed RS/C groups statewide. This offering aims to expand the availability of RS/C, so that more IECMHC clinicians have access to this professional support.
These stories are merely snapshots of the innovation and persistence driving IECMH policy change in ZERO TO THREE’s FPP states. Even in the context of decreasing federal investment, state policy leaders can find opportunities to take action and are creating meaningful change.
Which states are in the FPP? The first three cohorts include:
Cohort 1 (AK, CO, IL, IN, LA, MA, NC, OK, OR, VA),
Cohort 2 (AL, DC, MD, NV, NH, NM, NY, SC, TN, WA)
Cohort 3 (CT, GA, HI, IA, KA, MS, MO, NJ, UT)
We are seeking new states to join the FPP Learning Collaborative, which will celebrate ten years in 2026. If your state may be interested joining the network’s fourth cohort, see this new request for proposals due October 30.
Alex Busuito is a senior technical assistance specialist at ZERO TO THREE, where the mission is to ensure that all babies and toddlers have a strong start in life.
Related CCF resources:
Medicaid Support for Infant and Early Childhood Mental Health: Lessons from Five States
