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Client Racial Composition in First-Episode Psychosis Programs Compared With Compositions in Program Service Areas.

Tamara C Daley1, Preethy George1, Howard H Goldman1

  • 1Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman).

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Summary

Black individuals are disproportionately represented in first-episode psychosis programs, receiving services at higher rates than their presence in the community suggests. Further investigation into these disparities in coordinated specialty care (CSC) is warranted.

Keywords:
Outpatient clinicsPsychosesRacial-ethnic disparitiesSchizophrenia

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Area of Science:

  • Psychiatry and Mental Health Services Research
  • Health Disparities Research
  • Racial Equity in Healthcare

Background:

  • First-episode psychosis (FEP) programs aim to provide timely and effective care.
  • Understanding the racial demographics of clients in FEP programs is crucial for equitable service delivery.
  • Coordinated Specialty Care (CSC) is a leading evidence-based model for FEP treatment.

Purpose of the Study:

  • To assess the racial composition of clients in FEP programs compared to their service area demographics.
  • To identify potential factors contributing to any observed racial disproportionality in FEP services.
  • To examine the representation of Black individuals within CSC programs nationally.

Main Methods:

  • A national study analyzed data from 35 Coordinated Specialty Care (CSC) sites in the United States.
  • Race data for 772 clients were collected and compared with Census data for program service areas.
  • Disproportionality was calculated using risk ratios and relative differences in racial composition.

Main Results:

  • 71% of CSC programs served a disproportionately higher percentage of Black clients than Black residents in their service areas.
  • This disproportionality persisted after sensitivity analyses adjusting for sampling error.
  • Smaller study sites showed greater variability in disproportionality during sensitivity analyses.

Conclusions:

  • Black individuals are more likely to receive services from CSC programs than expected based on their population in the service area.
  • The findings highlight a significant overrepresentation of Black clients in FEP services.
  • The reasons for this disproportionality require further investigation and discussion to ensure equitable access to care.