Service Use Patterns of Youth with Autism Spectrum Disorder within a Large-Scale Implementation of Evidence-Based Practices Fiscally Mandated in Children’s Mental Health Services

Background: Children with autism spectrum disorder (ASD) receive care in multiple public service systems (Brookman-Frazee et al., 2009). The mental health (MH) service system plays an important role in caring for children with ASD (Mandell et al., 2005) given that the estimated rates of psychiatric comorbidity for youth with ASD are greater than 70% (Leyfer et al., 2006; Simonoff et al., 2008). There are a growing number of large-scale, system-driven implementations of evidence-based practices (EBPs) in publicly-funded MH systems for children but little is known about the specific types of services and intervention practices delivered to youth with ASD receiving MH care within these implementation efforts. 

Objectives: To address this gap, this study examined MH service penetration and sustainment patterns of children and transition-aged youth with ASD receiving care in the largest public MH system in the United States within the context of a fiscally-mandated implementation effort of multiple EBPs.

Methods: In 2009, the Los Angeles County Department of MH (LACDMH) launched the Prevention and Early Intervention Transformation. Within this system reform, multiple EBPs were mandated through reimbursement reorganization, with initial implementation support (e.g., costs for therapist training) provided for six practices (Child Parent Psychotherapy [CPP], Cognitive Behavioral Intervention for Trauma in Schools [CBITS], Managing and Adapting Practice [MAP], Seeking Safety [SS], Trauma Focused Cognitive Behavioral Therapy [TFCBT], and Triple P) that address a range of child MH problems. Administrative claims data from LACDMH for these six practices from fiscal years 2009/2010 – 2014/2015 were extracted.  Data from over three million claims for 87,100 clients from 94 agencies were used to characterize service utilization patterns for a subset of youth with ASD receiving specific practices.

Results: Preliminary analyses indicate that the total number of MH claims billed for youth with a primary ASD diagnosis was 12,690 from initial implementation to the current time of early sustainment. These claims represent 680 unique providers who delivered services to 499 unique children (76% male; M = 8.25 years, SD = 4.38). The majority of claims (75%) were for psychotherapy, followed by evaluation and assessment (13%), medication management (6%), and case management (6%). At the child-level, 40% of total claims were for Triple P followed by MAP (31%), CPP (11%), TFCBT (11%), SS (6%), and CBITS (<1%). Children with ASD in this sample were ethnically and culturally diverse (65% reported as Latino and 34% whose primary language was Spanish). A matched case-control design will be used to compare penetration and sustainment patterns between youth with ASD and those with non-ASD diagnoses to inform potentially unique implementation considerations for children with ASD. Children will be matched on sociodemographic and service context (e.g., provider type, setting type) characteristics.  

Conclusions: This study is one of the first to use administrative claims data to characterize penetration and sustainment patterns of MH services for youth with ASD served within a large-scale system driven EBP implementation. Study findings provide direction on targeted implementation efforts to evaluate MH services delivered to children with ASD within a public MH system care reform.