(PS3-10) Exposure Therapy Access in Rhode Island: A Geospatial Analysis

Abstract Text: Anxiety disorders are among the most common pediatric mental health diagnoses nationwide. In Rhode Island (RI), 12.7% of youth (aged 3-17) experience clinical levels of anxiety. Despite the high prevalence, only 20% of youth experiencing anxiety symptoms access treatment, and fewer access exposure-based cognitive behavioral therapy (exposure therapy), the “gold-standard” intervention. Research has identified various personal (e.g., stigma, distrust of the healthcare system) and structural (e.g., affordability, access to transportation) barriers that differentially influence access to care. While it remains important to address individual-level barriers, neighborhood-level factors are often overlooked despite having an independent effect on access to care. The present study addresses this gap by visualizing the geographic distribution of exposure therapy providers in RI, and examining neighborhood-level provider choice in relation to socioeconomic disadvantage and insurance coverage.

Exposure therapy providers were identified by searching professional (IOCDF, ADAA, RI APA, MA APA) and open-access (Psychology Today, Zencare) provider directories according to the following inclusion criteria: providers treat pediatric populations (ages 3-18), treat anxiety and/or OCD using exposure therapy, list a practice address, and practice within RI or a 15-mile radius of RI. Authors independently reviewed and classified providers, coming to a consensus in the event of disagreement.

Providers likely or potentially using exposure therapy were geocoded using the World Geocoding Service within ArcGIS Pro Version 3.2.2 (Esri) software. Isochrones (rThresholds of 10-, 20-, and 30-minutes) were created to assess drive time. A spatial intersection of the isochrones with census block groups determined provider choice, classified as no access (0 providers), no choice (1 provider), limited choice (2 - 4 providers), high choice (5 or more providers). Statewide Area Deprivation Index (ADI) percentiles were used to characterize census block groups as having low (1-3) or high (4-10) socioeconomic deprivation.

Authors identified 111 unique providers. Among these, n=18 (16.2%) were classified as “likely uses exposure”, n=64 (57.7%) as “potentially uses exposure”, and n=29 (26.1%) as “likely does not use exposure”. Based on the 20-minute driving threshold, among 764 block groups and 1.06 million RI residents, 83 block groups (n = 119,913, 11.3%) had no access, 12 block groups (n = 23,562, 2.2%) had no choice, 59 block groups (n = 89,679, 8.5%) had limited choice, and 610 block groups (n = 823,384, 78.0%) had high choice. The unique contribution of this project is the use of sophisticated maps; thus, analyses related to socioeconomic disadvantage and insurance coverage are not fully conveyed in this abstract but will be visually represented on the poster.

While areas surrounding Providence appear to have greater geographic access to providers, this may not translate into a greater likelihood of receiving care due to personal and structural barriers. Results from this study shed light on challenges in the care seeking process and may help inform policies and provider training programs to increase the geographic availability of providers in RI.