A Multi-Stage Exploration of Equity and Access to Care Disparities in Clinical High-Risk Psychosis (CHR-P) Through a Referral Lens
Joey Rodriguez (1,2,3,4), James Green B.A. (1,2,3,4), Michal Musikavanhu B.A. (1,2,3,4), Claire Goods (1,2,3,4) B.S. Olivia Aveson M.S. (1,2,3,4), Pilar Tucker M.A. (1,2,3,4), Isabel Brown (1,2,3,4), Wenhui Qi (1,2,3,4), Michelle Friedman-Yakoobian Ph.D. (1,2,3,4)
1. Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston MA
2. Harvard Medical School Department of Psychiatry, Boston MA
3. Center for Detection Assessment, and Response to Risk (CEDAR), Brookline Center for Community Mental Health, Brookline, MA
4. Response to Risk Research, Massachusetts Mental Health Center, Boston MA
Abstract
Background: Based on previous research exploring First Episode Psychosis (FEP) incident rate in the 2016 Massachusetts All-Payer Claims Database, it is estimated that 4,544 individuals experience symptoms consistent with Clinical High-Risk for Psychosis (CHR-p) in Massachusetts every year. Previous studies demonstrated an association between duration of untreated psychosis and treatment outcomes. Given the limited resources of CHR-p care, this study seeks to explore if demographic characteristics of individuals such as age, race, and gender identity are associated with access to care, and duration of undertreated CHR-p symptoms. These demographics are examined to identify possible inequities in access to care to better inform equitable practice.
Methods: Quality assurance data was analyzed from the Center for Early Detection, Assessment and Response to Risk (CEDAR), a specialty clinic for youth at CHR-p. Demographic data was examined to explore frequency of age, gender, race, and referral source at four stages along the intake process (referrals, pre-screening, evaluation, and intake). Race/ethnicity was examined at evaluation and intake. Frequencies and percentages were analyzed and compared to U.S. Census data to examine differences that may indicate inequities.
Results: Clients had a mean age of 17 years, were female (41%) and typically white (64.60%). Results suggest racial disparities (Suffolk County= 55.1% white residents, CHR-p care= 64.60% white (n=51) at evaluation and intake and gender disparities at original referral. Most frequent successful referrals were taken from community agencies (28%) (n=72). Most frequent ineligibility after pre-screening (n=675) was due to a FEP (61%).
Conclusions: Results show significant differences in gender/racial demographics when comparing U.S census bureau data to clinic quality assurance data. Future research may explore cultural beliefs about mental health, individuals' socio-economic-status, and technological accessibility at each stage of care to continue to understand factors that may contribute to accessing CHR-p and impact the length of untreated CHR-p symptoms.