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Published Online: 2 June 2022

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

Tamara C. Daley, Ph.D. [email protected], Preethy George, Ph.D., Howard H. Goldman, M.D., Ph.D., Tom Krenzke, Ph.D., Xiaoshu Zhu, Ph.D., Weijia Ren, Ph.D., Michael Giangrande, M.A., Shoma Ghose, Ph.D., and Abram Rosenblatt, Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 73, Number 12
https://doi.org/10.1176/appi.ps.202100587
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Abstract

Objective:

The authors examined the extent to which clients served by first-episode psychosis programs reflected the racial composition of the surrounding service area and, to the extent that they did not, explored possible explanatory factors.

Methods:

As part of a national study of coordinated specialty care (CSC) sites in the United States, 35 programs documented race for 772 clients. Programs identified a geographic service area for their clients. Using Census data, the authors identified the proportion of clients in this service area who were Black and then examined the extent of disproportionality, calculated as a risk ratio and as a relative difference in racial composition between CSC programs and their service areas.

Results:

Overall, 71% of CSC programs had a disproportionately greater proportion of Black clients than Black residents within the service area. This disproportionality was still evident after conducting sensitivity analyses that included adjusting for sampling error in the service area population estimates; however, smaller study sites displayed greater fluctuations in disproportionality in the sensitivity analyses.

Conclusions:

Using data from diverse CSC programs, the authors illustrate that the odds of Blacks receiving services through a CSC program are much higher than would be expected on the basis of the population living in the area being served by the program. Multiple reasons may explain this finding, but in the absence of clear explanatory factors, this result may be ripe for discussion and further investigation.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 73 • Number 12 • December 01, 2022
Pages: 1373 - 1379
PubMed: 35652193

History

Received: 30 September 2021
Revision received: 21 February 2022
Accepted: 1 April 2022
Published online: 2 June 2022
Published in print: December 01, 2022

Keywords

  1. Psychoses
  2. Racial-ethnic disparities
  3. Schizophrenia
  4. Outpatient clinics

Authors

Details

Tamara C. Daley, Ph.D. [email protected]
Abt 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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Preethy George, Ph.D.
Abt 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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Howard H. Goldman, M.D., Ph.D.
Abt 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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Tom Krenzke, Ph.D.
Abt 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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Xiaoshu Zhu, Ph.D.
Abt 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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Weijia Ren, Ph.D.
Abt 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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Michael Giangrande, M.A.
Abt 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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Shoma Ghose, Ph.D.
Abt 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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Abram Rosenblatt, Ph.D.
Abt 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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Notes

Send correspondence to Dr. Daley ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

The Community Mental Health Block Grant 10% Set Aside Study was supported by the Substance Abuse and Mental Health Services Administration and the National Institute of Mental Health (task order HHSS283201200011I/HHSS28342008T; reference 283-12-1108).

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