Geographic Disparities in the Availability and Accessibility of Coordinated Specialty Care Programs for Early Psychosis

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ABSTRACT Coordinated specialty care (CSC) is the standard of care for early psychosis in the US. Supported by the 5- 10% set-aside in the Community Mental Health Block Grant program, targeted at evidence-based early interventions, approximately 350 CSC programs have been implemented in 49 states across the US. Neighborhoods where individuals reside are important determinants of health and the majority of the extant work on neighborhood-level determinants and early psychosis has focused on the impact on individual-level factors such as the incidence and onset of psychosis, and duration of untreated psychosis, but very few studies have examined neighborhood-level characteristics as barrier to seeking services for early psychosis. Research has highlighted the importance of mental health services being available in proximity to an individual’s community, yet very little is known about the spatial distribution and accessibility of CSC programs in the US. There is a clear gap in what we know about the potential difficulties accessing CSC programs and whether the geographical placement and distribution of CSC programs contributes to inequities. To address this gap, our overarching goal of the proposed study is to characterize CSC programs and understand the geographical distribution and inequities in access to CSC programs. We will create a novel integrative multi-level geospatial database of CSC programs implemented throughout the US, that will include client-level data (race, ethnicity, age, gender), program-level data (geocoded location, capacity, size, setting, payment, role availability), provider-level data (race, ethnicity, professional credentials), and neighborhood-level census data (residential segregation, ethnic density, area deprivation, rural-urban continua, broadband internet subscription, public transit time). Our specific aims are to 1) Characterize the variations in facility-level characteristics of CSC programs by geographical location; 2) Examine geographic availability and accessibility of CSC programs based on neighborhood-level characteristics; and 3) Develop an interactive dashboard, using web-mapping technology, that will enable decision makers and community stakeholders to identify areas with poor access to CSC programs. The proposed research represents a novel application of advanced spatial analytics that will advance understanding on geographic inequities and accessibility of CSC programs, which can used to inform policy and the future implementation of CSC programs in high-need areas with limited access.