ZERO TO THREE Research Articles

The effect of the ZERO TO THREE Infant-Toddler Court Teams on type and time of exits from out-of-home care: A new study ten years after the first competing risks analysis

Infant-Toddler Court Teams (ITCTs) are a collaborative practice that improves, aligns, and integrates systems and builds community capacity to advance the health and well-being of very young children under court jurisdiction who are in foster care or at risk of removal from their homes, and their families. A permanent—forever—home that provides a safe, stable, and nurturing environment is crucial for supporting healthy development in the first three years of life. Through proactive collaborative problem-solving at the family and systems level, ITCTs expedite referrals for both children and their parents to comprehensive services and supports that prevent removal and that promote reunification and other lasting permanency outcomes. This retrospective, quasi-experimental study examines permanency outcomes for children who were served by an ITCT for at least one year between 2010 and 2018. The goal of the study was to examine differences in type and time to permanency between ITCT children in out-of-home care and a comparison group created using propensity score matching from a sample of children in the National Survey of Child and Adolescent Well-Being (NSCAW II). Overall, reunification was the most common type of permanency for ITCT children and was significantly higher among ITCT children compared to the NSCAW II sample (43.7% vs. 25.6%, p <.001). In addition, ITCT children were significantly less likely to remain in foster care by the end of the study period (2.7% vs. 16.9%, p <.001). ITCT children also had a shorter mean time to permanency at 450.6 days compared to 654.9 days for those in the NSCAW II group. In both unadjusted and adjusted survival models, the main effect of ITCT was significant, with children in the ITCT group being 1.6 times as likely to exit foster care to permanency compared to NSCAW II group. These findings replicate those of a previous study published ten years ago. The focus of ITCTs on proactively frontloading services for both parents and children, including integrated trauma and substance use disorder treatment and health and mental health services, is a crucial pathway toward safe and nurturing permanency outcomes for families in vulnerable situations that involve young children.

Alicia F.Lieberman, Chandra GhoshIppen, and Patricia VanHorn, Don't hit my mommy! A manual for child‐parent psychotherapy with young children exposed to violence and other trauma (2nd ed.). Washington, DC: ZERO TO THREE, 2015, pp. 336, ISBN‐13: 978‐1938558528

Alicia F.Lieberman, Chandra GhoshIppen, and Patricia VanHorn, Don't hit my mommy! A manual for child‐parent psychotherapy with young children exposed to violence and other trauma (2nd ed.). Washington, DC: ZERO TO THREE, 2015, pp. 336, ISBN‐13: 978‐1938558528

Postpartum Depression Screening, Referral, and Follow-Up in Pediatric Primary Care: The HealthySteps Effect

BACKGROUND: Postpartum depression (PPD) is estimated to affect up to 20% of new mothers each year. Screening for PPD in the pediatric care setting provides an opportunity for dialogue and referral to treatment, and studies indicate that physician follow up improves maternal outcomes for PPD. HealthySteps for Young Children (HS) is a ZERO TO THREE national initiative supporting integrated pediatric care during the first three years of life. HS embeds an early childhood development specialist, the HealthySteps Specialist (HSS), into the care team. The HSS provides anticipatory guidance and …

The The Effectiveness of Using Mind Mapping Method to Improve Child Development Assessment

The The Effectiveness of Using Mind Mapping Method to Improve Child Development Assessment

DC:0-5TM Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: An Overview

In 2016, ZERO TO THREE published its newest version of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–5™) for children from birth through age 5 years. DC:0–5 is empirically derived and clinically meaningful with foundations in infant and early childhood mental health. This Workshop will provide participants with an understanding of the background, approach, and content of this diagnostic classification system for mental health disorders in children ages <5 years.

CULTURAL ADAPTATIONS OF EVIDENCE-BASED HOME-VISITATION MODELS IN TRIBAL COMMUNITIES.

The Tribal Maternal, Infant, and Early Childhood Home Visiting (Tribal MIECHV) Program provides federal grants to tribes, tribal consortia, tribal organizations, and urban Indian organizations to implement evidence-based home-visiting services for American Indian and Alaska Native (AI/AN) families. To date, only one evidence-based home-visiting program has been developed for use in AI/AN communities. The purpose of this article is to describe the steps that four Tribal MIECHV Programs took to assess community needs, select a home-visiting model, and culturally adapt the model for use in AI/AN communities. In these four unique Tribal MIECHV Program settings, each program employed a rigorous needs-assessment process and developed cultural modifications in accordance with community strengths and needs. Adaptations occurred in consultation with model developers, with consideration of the conceptual rationale for the program, while grounding new content in indigenous cultures. Research is needed to improve measurement of home-visiting outcomes in tribal and urban AI/AN settings, develop culturally grounded home-visiting interventions, and assess the effectiveness of home visiting in AI/AN communities.

CATEGORICAL DIAGNOSIS OF EXTREME HYPERACTIVITY, IMPULSIVITY, AND INATTENTION IN VERY YOUNG CHILDREN.

Severe hyperactivity and impulsivity are common reasons for referral to infant mental health services. Past versions of ZERO TO THREE's () diagnostic nosology, the Diagnostic Classification of Mental and Developmental Disorders in Infancy and Early Childhood (DC:0-3), did not address this clinical issue because it had been addressed in other nosologies. These general diagnostic nosologies describe attention deficit hyperactivity disorder (ADHD), but with little attention to developmentally specific aspects of the diagnosis in very young children. Categorical diagnosis related to hyperactivity and impulsivity in very young children warrants careful review of existing literature. Explicit attention must be paid to ensure that categorical diagnoses serve to describe syndromes that cause significant impairment to the family to allow children and families to access effective supports and ensure that behaviors typical of the developmental level are not described as pathologic. This article reviews proposed diagnostic criteria for ADHD and overactivity disorder of toddlerhood as well as the rationale for the criteria and evidence supporting validity and reliability of the diagnoses in very young children. Clinical implications also are presented.

DEFINING RELATIONAL PATHOLOGY IN EARLY CHILDHOOD: THE DIAGNOSTIC CLASSIFICATION OF MENTAL HEALTH AND DEVELOPMENTAL DISORDERS OF INFANCY AND EARLY CHILDHOOD DC:0-5 APPROACH.

Infant mental health is explicitly relational in its focus, and therefore a diagnostic classification system for early childhood disorders should include attention not only to within-the-child psychopathology but also between child and caregiver psychopathology. In this article, we begin by providing a review of previous efforts to introduce this approach that date back more than 30 years. Next, we introduce changes proposed in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood DC:0-5 (ZERO TO THREE, in press). In a major change from previous attempts, the DC:0-5 includes an Axis I "Relationship Specific Disorder of Early Childhood." This disorder intends to capture disordered behavior that is limited to one caregiver relationship rather than cross contextually. An axial characterization is continued from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood DC:0-3R (ZERO TO THREE, 2005), but two major changes are introduced. First, the DC:0-5 proposes to simplify ratings of relationship adaptation/maladaptation, and to expand what is rated so that in addition to characterizing the child's relationship with his or her primary caregiver, there also is a characterization of the network of family relationships in which the child develops. This includes coparenting relationships and the entire network of close relationships that impinge on the young child's development and adaptation.

DIAGNOSTIC CLASSIFICATION OF MENTAL HEALTH AND DEVELOPMENTAL DISORDERS OF INFANCY AND EARLY CHILDHOOD DC:0-5: SELECTIVE REVIEWS FROM A NEW NOSOLOGY FOR EARLY CHILDHOOD PSYCHOPATHOLOGY.

The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-5; ZERO TO THREE) is scheduled to be published in 2016. The articles in this section are selective reviews that have been undertaken as part of the process of refining and updating the nosology. They provide the rationales for new disorders, for disorders that had not been included previously in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-3R; ZERO TO THREE, 2005), and for changes in how certain types of disorders are conceptualized.

SYMPTOM PRESENTATIONS AND CLASSIFICATION OF AUTISM SPECTRUM DISORDER IN EARLY CHILDHOOD: APPLICATION TO THE DIAGNOSTIC CLASSIFICATION OF MENTAL HEALTH AND DEVELOPMENTAL DISORDERS OF INFANCY AND EARLY CHILDHOOD (DC:0-5).

Over the past 5 years, a great deal of information about the early course of autism spectrum disorder (ASD) has emerged from longitudinal prospective studies of infants at high risk for developing ASD based on a previously diagnosed older sibling. The current article describes early ASD symptom presentations and outlines the rationale for defining a new disorder, Early Atypical Autism Spectrum Disorder (EA-ASD) to accompany ASD in the new revision of the ZERO TO THREE Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5) (in press) alternative diagnostic classification manual. EA-ASD is designed to identify children who are 9 to 36 months of age presenting with a minimum of (a) two social-communication symptoms and (b) one repetitive and restricted behavior symptom as well as (c) evidence of impairment, with the intention of providing these children with appropriately tailored services and improving the likelihood of optimizing their development.

USING THE PARENT-INFANT RELATIONSHIP GLOBAL ASSESSMENT SCALE TO IDENTIFY CAREGIVER-INFANT/TODDLER DYADS WITH ABUSIVE RELATIONSHIP PATTERNS IN SIX EUROPEAN COUNTRIES.

The study examined whether the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised Edition (DC: 0-3R; ZERO TO THREE, 2005) Parent-Infant Relationship Global Assessment Scale (PIR-GAS) is applicable to six European countries and contributes to the identification of caregiver-infant/toddler dyads with abusive relationship patterns. The sample consisted of 115 dyads with children's ages ranging from 1 to 47 months. Sixty-four dyads were recruited from community settings without known violence problems, and 51 dyads were recruited from clinical settings and already had been identified with violence problems or as being at risk for violence problems. To classify the dyads on the PIR-GAS categories, caregiver-child interactions were video-recorded and coded with observational scales appropriate for child age. To test whether the PIR-GAS allows for reliable identification of dyads with abusive relationship patterns, PIR-GAS ratings were compared with scores on the the International Society for the Prevention of Child Abuse and Neglect's (ISPCAN) Child Abuse Screening Tool-Parental Version (ICAST-P; D.K. Runyan etal., ), a questionnaire measuring abusive parental disciplinary practices. It was found that PIR-GAS ratings differentiated between the general and the clinical sample, and the dyads with abusive patterns of relationship were identified by both the PIR-GAS and the ICAST-P. Interrater reliability for the PIR-GAS ranged from moderate to excellent. The value of a broader use of tools such as the DC: 0-3R to promote early identification of families at risk for infant and toddler abuse and neglect is discussed.

Assessment of mental disorders in preschoolers: the multiaxial profiles of diagnostic classification 0-3.

A group of 291 preschoolers consecutively enrolled at the Early Childhood Mental Health Service of IRCSS Stella Maris (Italy) were assessed using the Diagnostic Classification Zero to Three (DC:0-3; ZERO TO THREE, 1994). All active variables were extracted from its five axes, and a multiple correspondence analysis was performed. This analysis evidenced four multiaxial clinical profiles: (a) Multisystem developmental disorders (Axis I) were correlated with the underinvolved quality of relationship (Axis II), medical conditions (Axis III), and a low level of emotional functioning (Axis V); (b) regulatory disorders (Axis I) were correlated with maladaptive or angry/hostile relationship (Axis II), medical conditions (Axis III), and an immature level of emotional functioning (Axis V); (c) affective disorders (Axis I) were correlated with anxious/tense relationship (Axis II), stress factors (Axis IV), and emotional functioning vulnerable to stress (Axis V); and (d) adjustment, feeding, and sleeping disorders (Axis I) were correlated with mild relationship disorders (Axis II) and important impact of stress factors (Axis IV). These findings support DC:0-3 as a valid tool to detect multiaxial profiles that could be useful to plan comprehensive treatments of the disorders.

Development of regulation disorders into specific psychopathology

Underlying deficits in self-regulation and sensory processing are seen in children with regulation disorders (RD) and might lead to emotional and behavioral problems as the child develops. However, little is known about the specific developmental course of RD. This follow-up study was conducted to investigate the development of a clinical sample of RD children, diagnosed by means of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC:0-3R; ZERO TO THREE, 1994), toward specific psychopathology 4 to 10 years later based on parent- and teacher-reports on the Child Behavior Checklist (T.M. Achenbach & L.A. Rescorla, 2007). Parental reports showed that 39 to 69% of children with RD had internalizing, externalizing, and total problems above borderline cutoffs, as compared to norm group data (16%). In addition, higher rates of affective, anxiety, attention deficit/hyperactivity, oppositional defiant, and conduct problems were reported. Analyses between RD subtypes showed significant differences on future attention problems and rule-breaking behavior, wherein less favorable results were found for the Hypersensitive subtype Type A (fearful/cautious) in comparison to the sensory stimulation-seeking/impulsive subtype. The current results indicate persistence of emotional and behavioral problems into middle childhood and adolescence in children with preschool RD diagnoses. More attention should be paid to differentiation of psychopathology in these children since developmental outcomes may differ between RD subtypes.

The effect of the ZERO TO THREE Court Teams initiative on types of exits from the foster care system — A competing risks analysis

ZERO TO THREE: National Center for Infants, Toddlers, and Families developed the Court Teams for Maltreated Infants and Toddlers initiative to accelerate the time to permanency for young children in the child welfare system. This paper considers how the Court Teams children exit the child welfare system. Court Teams children from the four initial sites (n = 298) are compared to a group of similar cases from the National Survey of Child and Adolescent Well-Being (NSCAW) (n = 511). Propensity score weights are combined with a competing risks analysis to isolate program effect on types of foster care exits. Findings indicate that Court Teams cases experience a different pattern of exits from the foster care system. Reunification is the most common type of exit for Court Teams cases (38%) while adoption is the most prevalent for the comparison group (41%). Descriptive data suggest that Court Teams children exit the foster care system faster regardless of the type of exit. The competing risks analysis shows that Court Teams children are significantly more likely to exit foster care for reunification, relative custodianship, and non-relative legal guardianship rather than stay in foster care.

Developmentally sensitive diagnostic criteria for mental health disorders in early childhood: The diagnostic and statistical manual of mental disorders—IV, the research diagnostic criteria—preschool age, and the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood—Revised.

As the infant mental health field has turned its focus to the presentation, course, and treatment of clinically significant mental health disorders, the need for reliable and valid criteria for identifying and assessing mental health symptoms and disorders in early childhood has become urgent. In this article we offer a critical perspective on diagnostic classification of mental health disorders in young children. We place the issue of early childhood diagnosis within the context of classification of psychopathology at other ages and describe, in some detail, diagnostic classifications that have been developed specifically for young children, including the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R; ZERO TO THREE, 2005), a diagnostic classification for mental health symptoms and disorders in infants, toddlers, and preschoolers. We briefly outline the role of diagnostic classification in clinical assessment and treatment planning. Last, we review the limitations of current approaches to the diagnostic classification of mental health disorders in young children.

Pathways to prevention: A training and technical assistance initiative to increase program capacity to address infant mental health issues in Early Head Start.

This article provides an overview of a training and consultation program aimed at enhancing the capacity of Early Head Start (EHS) and Migrant and Seasonal Head Start (MSHS) programs to address infant mental health issues from a promotion, prevention, and treatment perspective. This program was implemented by the Early Head Start National Resource Center (EHS NRC), operated by ZERO TO THREE. The EHS NRC is funded by the Head Start Bureau to provide a diverse array of training and technical assistance support services to Early Head Start programs throughout the country. In the fall of 2001, ZERO TO THREE was funded to design and implement the Pathways Initiative. While ZERO TO THREE was not funded to test the efficacy of the Pathways Initiative as a research intervention similar to other papers described in this special issue, we worked creatively to identify resources that allowed us to engage an external evaluator to look at both process and outcome measures. This paper describes the consultation program, evaluation activities, and key lessons learned.

Case Study: Possible Traumatic Stress Disorder in an Infant With Cancer

The posttraumatic stress disorder model has been used to describe some children's experience with cancer. This article presents the case of a 5-month-old infant in whom a neuroblastoma was diagnosed at age 2 weeks. His symptoms at the time of the psychiatric consultation were consistent with the criteria for traumatic stress disorder in infants from the ZERO TO THREE: Diagnostic Classification. This case study invites future clinical and research queries about traumatic stress disorder in infants with serious medical illnesses.

Diagnosing Regulatory Disorders Using DC:0-3: A Framework and a Case Illustration

ZERO TO THREE'S Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DCO-3) is designed to foster the development of a common vocabulary that will enhance communication among professionals, an agreed-upon set of diagnostic categories, and a well-defined process for organizing observations and other information from assessments in order to create a coherent and individualized intervention plan. Regulator)' Disorders, a unique contribution of DCO-3, are described, and a case report illustrates the assessment process and diagnostic thinking leading to a diagnosis of regulatory disorder in a 32-month-old boy, as well as collaborative intervention planning and implementation.