Colorado

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Colorado Strategies
Workforce Development Training on DC:0-5, Dyadic Treatment, and Parenting Programs: Right Start for Colorado

Right Start for Colorado (RSCO) is a five-year initiative aimed at expanding infant and early childhood mental health services across Colorado communities by building statewide workforce capacity for professionals serving young children birth to five years of age, including both mental health clinicians and allied professionals. The initiative provides free or low-cost training on evidence-based and research-informed assessment, diagnosis, treatment, and promotion to expand the IECMH workforce and make IECMH services and supports more accessible to children age 0-5 years and their families. RSCO’s professional development for clinicians has included training on the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5); Diversity Informed Tenets for Work with Infants, Children and Families; Circle of Security-Parenting, a group parenting reflection program; perinatal mood and anxiety disorders; and soon Child-Parent Psychotherapy, a dyadic treatment model. Allied professionals, including child welfare, early care and education, and public health staff, have received foundational training on IECMH, while more intensive and tailored IECMH training has been provided to early intervention providers and is planned for home visitors.

To inform the work of Right Start, a needs assessment was conducted between July 2019 and January 2020 by the Colorado Health Institute through a contract with the Mental Health Center of Denver (MHCD). The results of the needs assessment identified the types of services that were most in demand and training needs in different parts of the state. Mental Health Center of Denver is the grantee for RSCO, which began its third year in October 2020 and is funded through the Substance Abuse and Mental Health Services Administration (SAMHSA)’s Infant and Early Childhood Mental Health Grant Program, as well as members of the Colorado Early Childhood Funders Network.

Clinical Workforce Training

The clinical workforce refers to professionals providing IECMH treatment. The RSCO training plan for the clinical workforce is designed to impart knowledge across four main areas of IECMH clinical practice: relationship-based assessment, developmentally sensitive diagnosis, evidence-based treatment of very young children and their caregivers, and reflective practice.

RSCO trainings on IECMH diagnosis have focused on the DC:0-5: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood. A 2019 state guidance memorandum issued by the Colorado Office of Behavioral Health (OBH) recommends the use of the DC:0-5 for diagnosis of children ages 0-5 in clinical practices providing infant and early childhood mental health services. The memorandum explains that OBH and the Department of Health Care Policy and Financing (HCPF) support the use of a state-specific diagnostic “crosswalk” that aligns DC:0-5 diagnoses to those found in DSM-5 and ICD-10 and provides appropriate billing codes. A link to this crosswalk is provided in the memorandum. IECMH leaders in Colorado, including two Zero to Three certified trainers for DC:0-5 and the Director of RSCO, developed the Colorado crosswalk by adapting features of crosswalks designed by Zero to Three and other states. (You can visit NCCP’s collection of other state crosswalks.)

In its training on DC:0-5, RSCO has aimed to reach a wide variety of clinicians and allied providers, helping them gain an understanding of IECMH disorders and an appreciation of the importance of referral for treatment, when indicated. RSCO has offered two different DC:0-5 trainings: a diagnostic training for clinicians and an awareness training for allied providers. In its first two years, RSCO has conducted 9 DC:0-5 trainings, reaching 219 clinicians. The state has 12 available Zero to Three certified DC:0-5 trainers, and RSCO partners with numerous trainers to ensure delivery to various parts of the state. Trainings have reached professionals who work with infants and young children in hospital systems, community health centers, mental health clinics, ECE settings, graduate programs, and some private practices throughout the state. In 2021, RSCO will conduct two additional DC:0-5 trainings and also begin a six-month pilot of DC:0-5 virtual “office hours” to offer follow-up support for clinicians who have attended the diagnostic training. The goal is to discuss clinicians’ cases, help them refine their diagnostic skills and embed the use of this diagnostic system into their clinical practice.

RSCO also provides trainings for clinicians on Circle of Security-Parenting (COS-P), an evidence-informed group parenting program (see PRiSM research summary on parenting programs for more information on COS-P), and Child-Parent Psychotherapy (CPP), an evidence-based dyadic therapy model (see PRiSM research summary on dyadic treatment for more information on CPP).  A COS-P training in year two had 51 participants, predominantly IECMH clinicians and IECMH consultants (with a focus on those working in publicly-funded community mental health settings), but also home visitors, public health nurses, and some ECE providers. The training had 150 applicants and based on this demand will be offered annually in years three through five.

An 18-month Child Parent Psychotherapy (CPP) learning collaborative, led by a national trainer from Tulane University, will begin in July 2021 and train 50-70 clinicians, again targeting those working in publicly-funded settings. In order to promote long term sustainability of CPP in Colorado, the learning collaborative will simultaneously function as a train-the-trainer for two apprentice trainers, who are currently rostered CPP therapists. Following this learning collaborative they will be able to provide additional CPP learning collaboratives in Colorado.

In March and April 2021, RSCO is offering two trainings on infant-early childhood relationship-based assessment: the Working Model of the Child Interview (WMCI) and the Crowell Parent-Child Interaction Procedure (Crowell). Clinicians in the state will also be offered annual training on diversity-informed tenets and interventions for perinatal mood and anxiety conditions.

A key activity of years 3 to 5 will be conducting clinical communities of practice. In year 3, RSCO launched its inaugural Clinical Community of Practice and successfully recruited 8 clinicians from across the state, prioritizing high risk, high readiness areas as identified in the RSCO needs assessment. RSCO also prioritized clinicians who are Spanish/English bilingual and from diverse backgrounds, in alignment with its goal to promote diversification of the IECMH workforce. The Clinical Community of Practice is designed to impart knowledge across three main areas of IECMH clinical practice: relationship-based assessment, developmentally sensitive diagnosis, and evidence-based treatment of very young children. Trainees receive monthly trainings as well as ongoing reflective supervision/consultation (both group and individual) with a seasoned infant mental health mentor. Clinicians are also given financial support to attain the infant or early childhood mental health endorsement through the state association of infant mental health. This cohort model will be repeated in years 4 and 5.

Training for Allied Professionals

Allied professionals are involved in work that includes IECMH promotion, prevention, identification, and referral, rather than the delivery of IECMH clinical treatment.  These  professionals work in sectors such as child welfare, primary care, home visiting, public health, early intervention, and early care and education.

RSCO conducts monthly “lunch and learn” trainings with child welfare workers in Denver, targeting case workers, supervisors, and visitation staff. Topics include trauma, referrals, and promoting nurturing visitation in infancy and early childhood. In year two, 14 of these trainings reached 153 participants.

Colorado Foundations of Infant and Early Childhood Mental Health for Early Childhood Professionals and Partners is an eight-module course developed by The Colorado Association for Infant Mental Health. It is delivered over approximately 20-24 hours and introduces allied professionals to the principles of IECMH.  Using this course, RSCO reached 155 participants, including ECE providers, home visitors, and early intervention providers, in three trainings to date. RSCO plans to continue to offer this curriculum twice annually.

RSCO is also offering year-long training to a cohort of 33 Early Intervention providers to increase their IECMH knowledge and skills and to support attainment of IMH endorsement. The training is specialized for EI providers, with an initial three-day training completed in September 2020 on foundational IECMH topics including attachment, trauma, infant mental health, parent mental health, and reflective practice. Following the training, providers participate in monthly reflective supervision/consultation with IECMH mentors to discuss cases. Participants are predominantly occupational therapists, physical therapists, speech-language therapists, and other non-mental health clinicians in EI. A similar cohort training model will be offered to home visitors.

Additional ad hoc trainings offered by RSCO have included an IECMH overview for a federally qualified health center beginning to deliver perinatal services, and two self-care trainings on how to care for oneself when treating trauma via telehealth during the pandemic.

Financing

Right Start for Colorado is one of nine initiatives funded in the first cohort of SAMHSA’s Infant and Early Childhood Mental Health Grant Program. The program requires a local funding match, which is provided by five Colorado philanthropic foundations in the case of RSCO: Buell, Caring for Colorado, Community First, Piton and ZOMA Foundations.

Colorado has secured Medicaid coverage for all of the assessment visits needed to use DC:0-5 for diagnosis, which range between three and five. Additionally, Medicaid covers dyadic treatment, including CPP, with various billing codes including 90847 and 90846 (family therapy with and without client present). COS-P delivered by credentialed mental health clinicians can be reimbursed by Medicaid.

Monitoring and Evaluation

RSCO collects demographic and evaluation data from participants in its trainings. In addition, for DC:0-5 clinician trainings, evaluation data from participants examined whether participants thought training was effective, what additional supports they would like, and how they plan to use what they learned. A pre/post-test of participant knowledge showed a 30 percent increase. A six-month follow-up survey collected data on participant reports of their changes in practice following the training. These data have not been analyzed yet, but anecdotally clinicians appreciate the DC:0-5 framework and its focus on relationships.

Participants in the COS-P training agreed to fill out data surveys, which will be sent out in early 2021. The survey will ask about number of parenting groups they have offered and the number of families served in these groups. So far, since the training ended in September 2020, 70 parents and caregivers have received COS-P from the training participants. Similarly, data will also be collected from participants in the CPP learning collaborative and from the Clinical Community of Practice on the IECMH services they deliver post-training. Data will also be collected on EI cohort participants’ experiences of reflective supervision they receive.

Last updated February 2021

Special thanks to Shannon Bekman, Director, Right Start for Colorado, Mental Health Center of Denver, for providing information for and reviewing this profile.