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

摘要 协调专科护理（CSC）是美国早期精神病的护理标准。支持5- 10%预留在社区心理健康整笔赠款计划，针对循证早期 在干预措施方面，美国49个州实施了大约350个CSC项目。 个人居住的社区是健康的重要决定因素， 社区水平的决定因素和早期精神病的工作集中在对个人水平的影响， 因素，如发病率和精神病的发作，以及未经治疗的精神病的持续时间，但很少 研究已经检查了作为寻求早期精神病服务的障碍的社区水平特征。 研究强调了就近提供心理健康服务的重要性 然而，对CSC的空间分布和可达性知之甚少 在美国的节目。我们对进入CSC的潜在困难的了解存在明显差距 计划以及CSC计划的地理位置和分布是否有助于 不平等为了解决这一差距，我们提出的研究的总体目标是描述CSC程序 并了解在获取CSC程序的地理分布和不公平。我们将创建 一个新的综合多层次的地理空间数据库的CSC计划在美国各地实施， 将包括客户级数据（种族、民族、年龄、性别）、方案级数据（地理编码位置、能力， 规模、设置、支付、角色可用性）、提供者级别的数据（种族、民族、专业证书），以及 社区一级的人口普查数据（居住隔离、族裔密度、地区贫困、城乡 continua、宽带互联网订阅、公共交通时间）。我们的具体目标是：1）描述 按地理位置划分的CSC计划的设施级特征的变化; 2）检查地理位置 基于社区水平特征的CSC计划的可用性和可访问性;以及3）开发 一个交互式仪表板，使用网络地图技术，将使决策者和社区 利益攸关方确定难以获得CSC方案的地区。这项拟议中的研究代表了一种新颖的 应用先进的空间分析，促进对地理不平等的理解， CSC计划的可访问性，可用于告知政策和CSC的未来实施 在高需求地区的方案，有限的访问。

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.