Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript.
Psychiatr Serv. 2024 Feb 1;75(2):155-160. doi: 10.1176/appi.ps.20220112. Epub 2023 Aug 2.
Although coordinated specialty care (CSC) is an effective service model to address first-episode psychosis, CSC is not widely accessible in the United States, and funding for this service model often remains challenging. The authors examined whether community- or program-level factors predict the use of public and private funding streams in a national sample of 34 CSC programs in 22 U.S. states and territories.
As part of a larger mixed-methods study, CSC program leaders completed a brief questionnaire regarding funding sources. Statistical modeling was used to examine program- and community-level predictors of the use of funding sources.
Most CSC programs (20 of 34, 59%) reported that Mental Health Block Grant (MHBG) set-aside funds accounted for more than half of their total funding, and 11 of these programs reported that these funds contributed to >75% of their funding. Programs ≤5 years old were more likely to rely on MHBG set-aside funds. Programs in Medicaid expansion states were more likely to rely on Medicaid funding than programs in nonexpansion states. Programs in higher-income service catchment areas used more state funds than did those in lower-income areas, and among programs in lower-income service catchment areas, those that were >4 years old were more likely than those ≤4 years old to rely on state funds other than Medicaid.
CSC programs remain largely dependent on MHBG set-aside funding. Some programs have diversified their funding streams, most notably by including more Medicaid and other state funding. A more comprehensive funding approach is needed to reduce reliance on the MHBG set-aside funds.
尽管协调专科护理（CSC）是一种有效的服务模式，可以解决首次发作的精神病问题，但在美国，CSC 无法广泛获得，而且这种服务模式的资金往往仍然存在挑战。作者在 22 个美国州和地区的 34 个 CSC 计划的全国样本中，考察了社区或项目层面的因素是否可以预测公共和私人资金来源的使用情况。
作为一项更大的混合方法研究的一部分，CSC 计划负责人完成了一份关于资金来源的简短问卷。使用统计模型来检查计划和社区层面的预测因素，以确定资金来源的使用情况。
大多数 CSC 计划（34 个中的 20 个，占 59%）报告说，精神健康专项拨款（MHBG）专款资金占其总资金的一半以上，其中 11 个计划报告说这些资金贡献了其资金的>75%。成立时间不超过 5 年的计划更依赖 MHBG 专款资金。在 Medicaid 扩大的州中，计划更依赖 Medicaid 资金，而不是在非扩张州中的计划。在高收入服务覆盖地区的计划比低收入服务覆盖地区的计划使用更多的州资金，而在低收入服务覆盖地区的计划中，成立时间超过 4 年的计划比成立时间不超过 4 年的计划更有可能依赖于 Medicaid 以外的州资金。
CSC 计划仍然主要依赖于 MHBG 专款资金。一些计划已经使资金来源多样化，最显著的是增加了 Medicaid 和其他州资金。需要采取更全面的资金方法，以减少对 MHBG 专款资金的依赖。
