Mental health service utilization in autism spectrum disorders Jaime Ballard a, *, D. Russell Crane b , James M. Harper b , David Fawcett c , Jonathan Sandberg b a University of Minnesota, 275 McNeal Hall, 1985 Buford Ave., Saint Paul, MN 55108, USA b Brigham Young University, School of Family Life, Marriage and Family Therapy Program, 257 Taylor Building, Provo, UT 84602, USA c Northcentral University, School of Marriage and Family Sciences, 10000 E University Drive, Prescott Valley, AZ 86314, USA A R T I C L E I N F O Article history: Received 26 January 2015 Received in revised form 3 December 2015 Accepted 14 December 2015 Available online 28 December 2015 Keywords: Autism Cost Health care Age Mental health services A B S T R A C T Purpose: The purpose of this study is to examine patterns in autism spectrum disorder (ASD) outpatient mental health services including cost and length of services, return to care rates, and dropout by the presence of commonly co-morbid mental health conditions, modality and provider type. Methodology: This study is a longitudinal, retrospective study using administrative data from Cigna, a leading health care insurance provider in the U.S. Participants (n = 1614, ages 1–61) included individuals diagnosed with an ASD from 2001 to 2006, who had claims for outpatient mental health services. Results: Across all age groups, the cost and length variables were lowest for family therapy, followed by individual therapy. Mixed therapy (combination of family and individual therapy) was significantly longer and more costly. Rates of dropout and return to care were lowest for mixed therapy. Dropout was significantly higher for children than for adults or adolescents. Among provider types, social workers had the lowest cost among adolescents and the highest return to care rates among adults and counselors had the longest service length and the lowest dropout rates among children. ã 2015 Elsevier Ltd. All rights reserved. 1. Introduction Healthcare expenses for autism spectrum disorders (ASD) are substantial. Annual health care costs for children with an ASD are $3020 greater than costs for children without an ASD, and there are additional costs for ASD-specific therapies (Lavelle et al., 2014). Mental/behavioral health services are among the most commonly utilized services, with 30–55% of those with an ASD in the U.S. accessing mental health services annually (Boulet, Boyle, & Schieve, 2009; Shattuck, Wagner, Narendorf, Sterzing, & Hensley, 2011). However, little research has addressed service use or expenditures. Such research is necessary to understand how to meet the needs of individuals with ASDs (Cidav, Lawer, Marcus, & Mandell, 2013). The limited research that has been completed on service use has primarily looked at public health programs such as Medicaid (i.e., Cidav, Lawer, Marcus, & Mandell, 2013), and little research has addressed service use in managed care (Ruble, Heflinger, Renfrew, & Saunders, 2005). The current study is an assessment of mental health service utilization among individuals with an ASD in a managed care context. This study will assess differences in mental health service cost, length, dropout rates, and return to care rates by age * Corresponding author at: University of Minnesota, Department of Family Social Science, Couple and Family Therapy Program, 275 McNeal Hall, 1985 Buford Ave, Saint Paul, MN 55108, USA. E-mail address: jeballard@umn.edu (J. Ballard). http://dx.doi.org/10.1016/j.rasd.2015.12.002 1750-9467/ ã 2015 Elsevier Ltd. All rights reserved. Research in Autism Spectrum Disorders 23 (2016) 84–93 Contents lists available at ScienceDirect Research in Autism Spectrum Disorders journal home page: htt p://ees.e lsevier.com/RASD/default .asp