Introduction to the APA Guidelines for Psychological Practice for People with Low-Income and Economic Marginalization
Socioeconomically disadvantaged adults and children constitute a large and relatively stable proportion of people in the United States. More than 48 million people live in low-income working families, and more than 10.3 million working families in the United States earn less than 200% of the poverty level income (U.S. Department of Commerce, 2015). In 2018, the official poverty level for the continental U.S. was 12,140ドル for an individual and 25,100ドル for a family of four. The supplemental poverty measure (Fox, 2018) uses a more inclusive set of factors than the official poverty level, and results in a slightly higher percentage of U.S. citizens living in poverty. For example, in 2017 12.3% of Americans lived in official poverty according to the U.S. Department of Commerce (Fontenot, Semega, & Kollar, 2018) and the supplemental poverty measure identified 13.9% of Americans living in poverty (Fox, 2018).
The U.S. Department of Commerce reports that the percentage of people living in poverty, as defined by federal policy, has consistently remained between 10–16% since 1965 (U.S. Department of Commerce, 2017). Further, as economic inequality has increased in the United States (Congressional Budget Office, 2013), it has been accompanied by a growing disparity in mortality rates (Bosworth, 2018). Unlike other developed countries such as Canada and European nations, U.S. citizens with lower levels of income and education are dying younger at increasingly higher rates than those with greater income and education (Bosworth, 2018).
Economic marginalization is a complex and multifaceted social issue that can be examined in many ways. One of the ongoing difficulties that this complexity presents is a lack of common terminology, constructs or measures. In one review of the literature, Liu, Soleck, Hopps, Dunston and Pickett (2004) discovered that there were over 400 different terms being used to describe social class and related constructs. Because such a variety of language is used in the literature, as well as in public policy and the media, these guidelines have adopted an encompassing term—low-income and economic marginalization (LIEM)—that is intended to cut across the common characteristics of current language. In order to further explicate the definitional issues of this area of study, we have provided a set of definitions of common LIEM-relevant language. The definitions (Appendix A) serve two purposes. The first is to provide a common language with which to discuss social class concerns within the field. The current differentiation within the language contributes to confusion and inefficiency in reviewing literature, which stifles the acquisition and growth of knowledge. The second purpose of the definitions is to better inform psychologists of culturally sensitive language that can be used when describing economically disenfranchised people and the societal constructs that contribute to marginalization. The goal of establishing the term LIEM is to draw attention to the contextual importance of economic marginalization, not to serve as an identifier. Throughout the guidelines, we have attempted to reinforce this by using phrases such as "persons from LIEM backgrounds," rather than "LIEM individuals" to ensure that person-first language is not compromised by this new terminology.
We propose that developing a common language, such as LIEM, will actually help to foster effective research and applied work in psychology. This is intended to be an umbrella term that incorporates many aspects of what it is to be economically oppressed, including both limited financial resources and marginalization related to social class. However, we recognize that the existing literature is saturated with the wide variation in terminology in current use. Further, the words researchers have used in formulating questions and measuring variables may have influenced the conclusions and implications drawn. Therefore, the language in these guidelines is consistent with the original works that are cited, in an effort to maintain accuracy and the extant variation in language will be apparent throughout the guidelines, as social class, socioeconomic status (SES), working poor, lower income and similar terms are used throughout all of the supporting evidence relevant to the guidelines and the application. When more inclusive observations were available in the literature, we utilized LIEM to include all aspects of income and economic marginalization. We also used LIEM to identify the recommendations and contributions specific to the guidelines. We encourage others to use the common language established in these guidelines in future research.
The implications of economic marginalization are apparent across multiple aspects of life in contemporary society. The economic and social status into which one is born is a powerful factor in determining one’s access to resources and supports and, therefore, access to available opportunities (Blustein, 2006; Evans, 2004). Such limited access has important implications for employment, education, achievement, and physical and mental health—all areas of relevance to psychologists. Indeed, the associations between SES and indicators of health, including behavioral, mental, and physical health, are well-documented (American Psychological Association [APA], 2006; Lorant, Deliege, Eaton, Robert, Philippot, & Anssearu, 2003; Siefert, Heflin, Corcoran, & Williams, 2001; APA, 2010; Smith, 2010; Smith, 2013), and researchers have identified poverty as the most pervasive risk to the health of children in America (Schickedanz, Dreyer, & Haffon, 2015).