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

Research on racial and ethnic disparities in the U.S. has consistently found that the Black community faces obstacles to behavioral health services, particularly compared with non-Hispanic whites. But a new paper on first-episode psychosis programs showed that they had a disproportionately high number of Black clients. Overall, 71 percent of coordinated specialty care (CSC) programs, which provide evidence-based early intervention for young adults experiencing their first episode of psychosis, had a percentage of Black clients that exceeded the percentage of Black residents in the surrounding service area.

As part of a national study of CSC sites in the U.S., 35 programs documented race for 772 clients and identified a geographic service area for their clients. Using Census data, the authors identified the proportion of Black clients in this service area and then examined the extent of disproportionality. The findings of disproportionality were still evident after sensitivity analyses that included adjusting for sampling error in the service area population estimates.

Using data from diverse CSC programs, the authors illustrate that the odds of Black residents receiving services through a CSC program are much higher than would be expected based on the population living in the area being served by the program. The paper found no evidence of a relationship between this disproportionality and factors such as receipt of Medicaid, recent experience with hospitalizations, crisis services, or probation.

Multiple reasons may explain this finding. Possibilities include agency characteristics, biases in referral pathways and in family choice, and differential outreach efforts by programs. In the absence of clear explanatory factors, however, the results suggest the need for further discussion and investigation.

“In this particular situation, the overrepresentation of Black clients in CSC programs may be a positive development if clinicians are sensitive to these clients’ needs,” says Tamara C. Daley, Ph.D., lead author of the paper, who worked on it while at Westat and now is a principal associate at Abt Global and leads its behavioral health practice.

The paper, written by researchers from Abt, Westat, and the University of Maryland, was supported by the Substance Abuse and Mental Health Services Administration and the National Institute of Mental Health.