Geographic Disparities in Access to Specialty Care Programs for Early Psychosis in Washington State

Abstract

Supported by the 10% set-aside funds in the Community Mental Health Block grant, distributed at the state level, coordinated specialty care (CSC) have been widely disseminated throughout the U.S. This study explores variations in the geographical accessibility of CSC programs by neighborhood level characteristics in Washington State. CSC locations were geocoded. Socioeconomic neighborhood deprivation (i.e., Area deprivation index) and rurality (i.e., Rural-Urban Commuting Area codes) were neighborhood level characteristics extracted from the 2018 American Community Survey. Geographic accessibility of CSC was assessed using a two-step floating catchment area technique and multilevel linear models were used to examine the association between specific neighborhood characteristics and geographic accessibility. The association between access and socioeconomically deprived neighborhoods varied differentially by neighborhood rurality (an interaction effect). Model estimates indicated that the least deprived, metropolitan neighborhoods had the best access (M = 0.38; CI: 0.34, 0.42) and rural neighborhoods in the second most deprived quartile had the worst access (M = 0.16; CI: 0.11, 0.21) to CSC. There was a clear decrease in accessibility for more rural neighborhoods, regardless of other neighborhood characteristics. In conclusions, findings provide important insight into how resource distribution contributes to geographic disparities in access to CSC. The use of spatial analytic techniques has the potential to identify specific neighborhoods and populations where there is a need to expand and increase availability of CSC to ensure access to rural and socioeconomically deprived neighborhoods.

Keywords: Coordinated Specialty Care; First-episode psychosis; Geographic Accessibility; Social Determinants; Washington State.

Fig. 1

Access to coordinated specialty care (CSC) programs in Washington State. Access to was calculated using a two-step floating catchment area method with a distance decay function. Larger values represent greater accessibility to CSC programs

Fig. 2

The differential association between access and rurality across socioeconomic neighborhood deprivation quartiles (Q1 is least deprived and Q4 is most deprived) from model predictions. Estimates are adjusted for a neighborhood with Hispanic proportion of 11.43% and Black/African American proportion of 3.47%, the average proportions