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标准护理。由5- 社区精神健康整体补助计划预留10%，目标是在循证早期 通过干预，大约350个CSC项目已在全美49个州实施。 个人居住的社区是健康的重要决定因素，而且大多数现存的 关于社区层面的决定因素和早期精神病的研究主要集中在对个人层面的影响 精神病的发病率和发病，以及未经治疗的精神病的持续时间等因素，但很少 研究已经检查了邻里层面的特征作为寻求早期精神病服务的障碍。 研究强调了就近获得心理健康服务的重要性 对于个人社区来说，对CSC的空间分布和可达性知之甚少 在美国的项目。我们对访问CSC的潜在困难的了解存在明显差距 方案以及CSC方案的地理位置和分布是否有助于 不平等。为了解决这一差距，我们提议的研究的首要目标是描述CSC计划的特征 并了解获得CSC项目的地理分布和不平等。我们将创造 一种在全美实施的CSC计划的新型综合多层次地理空间数据库， 将包括客户级别数据(种族、民族、年龄、性别)、计划级别数据(地理编码位置、容量、 大小、设置、支付、角色可用性)、提供商级数据(种族、民族、专业资质)以及 居民区一级的人口普查数据(居住隔离、种族密度、地区贫困、城乡 继续、宽带互联网订阅、公共交通时间)。我们的具体目标是1)描述 CSC项目的设施水平特征随地理位置的变化；2)检查地理位置 基于社区水平特征的CSC项目的可用性和可达性；以及3)开发 一个使用网络地图技术的交互式仪表盘，将使决策者和社区 利益相关方确定获得CSC项目机会较少的地区。这项拟议的研究代表了一种新的 高级空间分析的应用将促进对地理不平等和 CSC项目的可访问性，可用于为CSC的政策和未来的实施提供信息 高需求地区的方案，但准入有限。

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.