Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
Washington State Center of Excellence in Early Psychosis, Seattle, WA, USA.
Adm Policy Ment Health. 2022 Jan;49(1):5-12. doi: 10.1007/s10488-021-01137-3. Epub 2021 Apr 20.
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.
在社区心理健康拨款中的 10%预留资金的支持下，协调专业护理（CSC）已在美国广泛传播。本研究探讨了华盛顿州社区特征对 CSC 项目地理可达性的变化。CSC 地点进行了地理编码。从 2018 年美国社区调查中提取了社会经济社区剥夺（即区域剥夺指数）和农村性（即农村-城市通勤区代码）作为社区特征。使用两步浮动集水面积技术评估 CSC 的地理可达性，并使用多水平线性模型检查特定社区特征与地理可达性之间的关联。访问与社会经济贫困社区之间的关联因社区农村性的不同而存在差异（交互效应）。模型估计表明，最不贫困的城市社区的可达性最好（M=0.38；置信区间：0.34，0.42），而最贫困的第四季度农村社区的可达性最差（M=0.16；置信区间：0.11，0.21）。无论其他社区特征如何，农村社区的可达性明显下降。总之，这些发现为资源分配如何导致 CSC 获得方面的地理差异提供了重要的见解。空间分析技术的使用有可能确定需要扩大和增加 CSC 可用性的特定社区和人群，以确保农村和社会经济贫困社区能够获得服务。
