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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Amiri, S., McDonell, M. G., Denney, J. T., Buchwald, D., & Amram, O. (2020). Disparities in access to opioid treatment programs and office-based buprenorphine treatment across the rural-urban and area deprivation continua: A US nationwide small area analysis. Value in Health. https://doi.org/10.1016/j.jval.2020.08.2098
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10. https://doi.org/10.2307/2137284
Cabassa, L. J., Piscitelli, S., Haselden, M., Lee, R. J., Essock, S. M., & Dixon, L. B. (2018). Understanding pathways to care of individuals entering a specialized early intervention service for first-episode psychosis. Psychiatric Services, 69(6), 648–656. https://doi.org/10.1176/appi.ps.201700018
Chow, J.C.-C., Jaffee, K., & Snowden, L. (2003). Racial/ethnic disparities in the use of mental health services in poverty areas. American Journal of Public Health, 93(5), 792–797
Correll, C. U., Galling, B., Pawar, A., Krivko, A., Bonetto, C., Ruggeri, M., Craig, T. J., Nordentoft, M., Srihari, V. H., Guloksuz, S., Hui, C. L. M., Chen, E. Y. H., Valencia, M., Juarez, F., Robinson, D. G., Schooler, N. R., Brunette, M. F., Mueser, K. T., Rosenheck, R. A., … Kane, J. M. (2018). Comparison of early intervention services vs treatment as usual for early-phase psychosis: A systematic review, meta-analysis, and meta-regression. JAMA Psychiatry, 75(6), 555–565. https://doi.org/10.1001/jamapsychiatry.2018.0623
Cummings, J. R., Allen, L., Clennon, J., Ji, X., & Druss, B. G. (2017). Geographic access to specialty mental health care across high- and low-income U.S. communities. JAMA Psychiatry, 74(5), 476–484. https://doi.org/10.1001/jamapsychiatry.2017.0303
Cummings, J. R., Case, B. G., Ji, X., & Marcus, S. C. (2016). Availability of youth services in U.S. mental health treatment facilities. Administration and Policy in Mental Health and Mental Health Services Research, 43(5), 717–727. https://doi.org/10.1007/s10488-015-0685-2
Cummings, J. R., Wen, H., Ko, M., & Druss, B. G. (2014). Race/ethnicity and geographic access to medicaid substance use disorder treatment facilities in the United States. JAMA Psychiatry, 71(2), 190–196. https://doi.org/10.1001/jamapsychiatry.2013.3575
Dinwiddie, G. Y., Gaskin, D. J., Chan, K. S., Norrington, J., & McCleary, R. (2013). Residential segregation, geographic proximity and type of services used: Evidence for racial/ethnic disparities in mental health. Social Science & Medicine, 1982(80), 67–75. https://doi.org/10.1016/j.socscimed.2012.11.024
Everett, A., & Heinssen, R. (2019). Agency priority goal action plan: Serious mental illness. Department of Health and Human Services. Retrieved from https://www.performance.gov/health_and_human_services/2019_dec_HHS_Serious_Mental_Illness.pdf
Graves, J. M., Amiri, S., Mackelprang, J. L., Abshire, D. A., Beck, A., & Olsen, M. (2020). Nowhere to go for help: Geographic disparities in access to mental health facilities for youth. Retrieved from https://apha.confex.com/apha/2020/meetingapi.cgi/Paper/482179?filename=2020_Abstract482179.html&template=Word
Guagliardo, M. F. (2004). Spatial accessibility of primary care: Concepts, methods and challenges. International Journal of Health Geographics, 3(1), 3. https://doi.org/10.1186/1476-072X-3-3
Kane, J. M., Schooler, N. R., Marcy, P., Correll, C. U., Brunette, M. F., Mueser, K. T., Rosenheck, R. A., Addington, J., Estroff, S. E., & Robinson, J. (2015). The RAISE early treatment program for first-episode psychosis: Background, rationale, and study design. The Journal of Clinical Psychiatry, 76(3), 240–246
Kind, A. J. H., & Buckingham, W. R. (2018). Making neighborhood-disadvantage metrics accessible—The neighborhood Atlas. The New England Journal of Medicine, 378(26), 2456–2458. https://doi.org/10.1056/NEJMp1802313
Knighton, A. J., Savitz, L., Belnap, T., Stephenson, B., & VanDerslice, J. (2016). Introduction of an area deprivation index measuring patient socioeconomic status in an integrated health system: Implications for population health. EGEMs, 4(3), 9. https://doi.org/10.13063/2327-9214.1238
Ku, B. S., Pauselli, L., Manseau, M., & Compton, M. T. (2020). Neighborhood-level predictors of age at onset and duration of untreated psychosis in first-episode psychotic disorders. Schizophrenia Research. https://doi.org/10.1016/j.schres.2019.12.036
Mathis, W. S., Woods, S., & Srihari, V. (2018). Blind spots: Spatial analytics can identify nonrandom geographic variation in first episode psychosis program enrollments. Early Intervention in Psychiatry, 12(6), 1229–1234. https://doi.org/10.1111/eip.12681
McGrail, M. R. (2012). Spatial accessibility of primary health care utilising the two step floating catchment area method: An assessment of recent improvements. International Journal of Health Geographics, 11(1), 50. https://doi.org/10.1186/1476-072X-11-50
Moe, A. M., Rubinstein, E. B., Gallagher, C. J., Weiss, D. M., Stewart, A., & Breitborde, N. J. (2018). Improving access to specialized care for first-episode psychosis: An ecological model. Risk Management and Healthcare Policy, 11, 127–138. https://doi.org/10.2147/RMHP.S131833
O’Donoghue, B., Lyne, J. P., Renwick, L., Lane, A., Madigan, K., Staines, A., O’Callaghan, E., & Clarke, M. (2016). Neighbourhood characteristics and the incidence of first-episode psychosis and duration of untreated psychosis. Psychological Medicine, 46(7), 1367–1378. https://doi.org/10.1017/S003329171500286X
Oluwoye, O., Cheng, S. C., Fraser, E., Stokes, B., & McDonell, M. G. (2019). Family experiences prior to the initiation of care for first-episode psychosis: A meta-synthesis of qualitative studies. Journal of Child and Family Studies, 29, 2530–2541
Oluwoye, O., Reneau, H., Stokes, B., Daughtry, R., Venuto, E., Sunbury, T., Hong, G., Lucenko, B., Stiles, B., & McPherson, S. M. (2019). Preliminary evaluation of Washington State’s early intervention program for first-episode psychosis. Psychiatric Services, 71, 228–235
Oluwoye, O., Stiles, B., Monroe-DeVita, M., Chwastiak, L., McClellan, J. M., Dyck, D., Cabassa, L. J., & McDonell, M. G. (2018). Racial-ethnic disparities in first-episode psychosis treatment outcomes from the RAISE-ETP study. Psychiatric Services (Washington DC). https://doi.org/10.1176/appi.ps.201800067
Reichert, A., & Jacobs, R. (2018). Socioeconomic inequalities in duration of untreated psychosis: Evidence from administrative data in England. Psychological medicine.Cambridge University Press.
Rosenblatt, A. (2018). SAMHSA-Funded Programs for First Episode Psychosis Across the United States. The NIMH Mental Health Services Research Conference.
Schuurman, N., Bérubé, M., & Crooks, V. A. (2010). Measuring potential spatial access to primary health care physicians using a modified gravity model. The Canadian Geographer / Le GéographeCanadien, 54(1), 29–45. https://doi.org/10.1111/j.1541-0064.2009.00301.x
Singh, G. K. (2003). Area deprivation and widening inequalities in US mortality, 1969–1998. American Journal of Public Health, 93(7), 1137–1143. https://doi.org/10.2105/AJPH.93.7.1137
Stain, H. J., Halpin, S. A., Baker, A. L., Startup, M., Carr, V. J., Schall, U., Crittenden, K., Clark, V., Lewin, T. J., & Bucci, S. (2018). Impact of rurality and substance use on young people at ultra high risk for psychosis. Early Intervention in Psychiatry, 12(6), 1173–1180. https://doi.org/10.1111/eip.12437
U.S. Census Bureau. (n.d.). American Community Survey (ACS). Retrieved from http://www.census.gov/programs-surveys/acs
USDA. (n.d.). Rural-Urban Commuting Area Codes. Retrieved December 27, 2020 from https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/
van der Ven, E., Susser, E., Dixon, L. B., Olfson, M., & Gilmer, T. P. (2020). Racial-ethnic differences in service use patterns among young, commercially insured individuals with recent-onset psychosis. Psychiatric Services, 71(5), 433–439. https://doi.org/10.1176/appi.ps.201900301
Wright, A., Browne, J., Mueser, K. T., & Cather, C. (2019). Evidence-based psychosocial treatment for individuals with early psychosis. Child and Adolescent Psychiatric Clinics, 29(1), 211–223
WWAMI Rural Health Research Center. (n.d.). Rural urban commuting area codes—RUCA. Retrieved December 27, 2020 from http://depts.washington.edu/uwruca/
Funding
This work was supported by the National Institute of Mental Health [Grant Number K01MH117457].
Author information
Authors and Affiliations
Contributions
OO conceptualized the study, interpreted the results of the analyses, and drafted the initial version of the manuscript. SA and GK conducted the spatial and statistical analyses. BS, EF, RD, JL, and MM contributed multiple iterations of the manuscript. All authors have given final approval for submission of the current version of the manuscript and agree to be accountable for all aspects of the work.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to disclose.
Ethical Approval
The Washington State University Institutional Review Board (IRB) determined that this study did not require IRB review because it was not classified as human subjects’ research.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Oluwoye, O., Amiri, S., Kordas, G. et al. Geographic Disparities in Access to Specialty Care Programs for Early Psychosis in Washington State. Adm Policy Ment Health 49, 5–12 (2022). https://doi.org/10.1007/s10488-021-01137-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-021-01137-3