More than 48 million people in the United States live in low-income working families, and more than 10.3 million working families earn less than 200% of the poverty income level. Increasing economic inequality has been accompanied by a growing disparity in mortality rates. Research has repeatedly demonstrated the significant relationship of indicators of socioeconomic status (SES), such as income and education level, to length of life, quality of life and health.
The APA Guidelines for Psychological Practice for People with Low-Income and Economic Marginalization (LIEM) are designed to assist psychologists in providing culturally competent care for people whose economic position negatively impacts their health or well-being. Such care considers financial barriers, social marginalization, and a host of other variables, such as access to quality schools, childcare, adequate health insurance and quality healthcare, cultural capital and other factors that are affected by people’s economic position.
Psychologists are encouraged to consider these challenges in how they facilitate access to care and administer services. In addition, psychologists working with LIEM populations will benefit from an understanding of the intersection between socioeconomic status and multiple other individual characteristics, such as age, gender, ethnic/racial minority identity, sexual orientation, gender identity and (dis)ability status.
Socioeconomic status has powerful implications for employment, education, achievement, and physical and mental health—all areas of relevance to psychologists. Accordingly, in 2017, the APA Council of Representatives authorized the creation of a task force to review scientific research and identify empirically-supported guidelines for psychology practice. After two years of collaborative work and many levels of expert review, the Task Force produced the Guidelines document that was ratified by APA in August 2019.
The nine guidelines cover four major domains:
- training and education,
- health disparities related to economic position,
- treatment considerations, and
- career concerns and unemployment.
Each guideline comes with a rationale supporting the value or need for the guideline and applications at the individual, community and structural/policy levels. This multilevel approach demonstrates the importance of attending to social context and policy, as well as individual concerns, when working in clinical, training and research situations.
The guidelines encourage psychologists to:
- gain awareness of their own biases related to social class in order to minimize their impact on the training and education they provide;
- increase their knowledge and understanding of social class issues through training, continuing education, supervision, and consultation;
- better understand how economic and social marginalization contributes to health disparities;
- strive to promote equity in the access to, and quality of, healthcare available for people with LIEM backgrounds;
- understand the ways that social class differences impact the experiences of clients in mental health treatment;
- strive to lower individual and systemic barriers to mental health treatment for LIEM individuals;
- understand how SES factors impact clinical issues and how to best address those in treatment settings;
- appreciate the impact of social class on academic success, career aspirations and career development through the lifespan;
- understand the interaction between economic insecurity, unemployment and underemployment;
- attempt to contribute to re-employment processes for individuals.
In summary, psychologists can take many steps to increase their knowledge and understanding of the impact of low income and economic marginalization on the individuals they serve in many settings. These APA Guidelines detail substantive, practical actions in which psychologists can engage on individual, community, structural and policy levels to minimize the negative impact of low income and economic marginalization on people’s lives, health and well-being.
iU.S. Department of Commerce (2015, November). American Community Survey. Retrieved from https://www.census.gov/programs-surveys/acs/news/data-releases.2015.htmlopens in new window
iiCongressional Budget Office. (2016, August). Trends in family wealth, 1989 to 2013. Retrieved from https://www.cbo.gov/publication/51846opens in new window
iiiBosworth, B. (2018). Increasing disparities in mortality by socioeconomic status. Annual Review of Public Health, 39, 237–251. doi/10.1146/annurev-publhealth-040617-014615opens in new window