Lonnie R. Snowden Jr. Award for Distinguished Contributions to Research in Public Policy C itation
“Over the past several decades, Lonnie R. Snowden Jr. has systematically built a research agenda on the financing and organization of mental health services that has driven much of our current health policy reform efforts. His outstanding population-based research on leveraging Medicaid as a major payer of mental health services and rebalancing of investments provides important modeling for state and fed eral financing policy. In addition, his efforts to “move the dial” on disparities in care have been relentless. Snowden’s commitment to using cutting-edge research to influence public policy and advance social justice represents an ex emplary contribution to the field and to society.” B io g ra p h y
Lonnie R. Snowden Jr. was born in Detroit, Michigan, the second child of Lonnie R. Snowden Sr. and Sylvia Snowden. Snowden Jr. grew up on the near west side of Detroit and attended the Detroit public schools. Snowden Sr. and his brothers reared themselves from their early teenage years until adulthood, maintaining an independent household after their father, who came to Detroit in the African American “Great Migration,” died in a factory explosion and after their mother was unable to care for them. Snowden Sr. excelled as a student and graduated first in his class from the then all-White Detroit College of Law. November 2014 • American Psychologist ©2014 American Psychological Association 0003-066X/14/$ 12.00 Vol. 69, No. 8, 771-773 http://dx.doi.org/10.1037/a0037423
After graduating from Detroit’s Mumford High School, Snowden Jr. received a BA in psychology at the University of Michigan before returning to earn a PhD in clinical and community psychology from Detroit’s Wayne State Uni versity under the guidance of clinical psychologist Gerald Rosenbaum. Snowden’s admission prospects to Wayne State benefited from the diversity-promotion efforts of graduate student James S. Jackson. While a graduate student at Wayne State, Snowden served in administrative and research capacities at the De troit Drug Abuse Treatment Programs, which kindled an interest in understanding how social policy and health, mental health, and social programs come into existence as instruments of social policy and how they are implemented and subsequently operated. Snowden’s master’s thesis, con ducted under the supervision of Sheldon Cotier, investi gated how psychological factors distinguished more suc cessful from less successful drug abuse counselors. Snowden witnessed Detroit’s decline from vibrant metrop olis to troubled remnant, and this experience provides him with a continuing reminder of how untoward sociohistorical contingencies, such as the auto industry’s steep decline, powerfully shape conditions for human development and day-to-day living. Snowden spent one year at the University of Rochester Medical Center as a clinical psychology intern and then accepted a job to become an assistant professor in the Psychology Department at the University of Oregon, where he spent the next three years. While at Oregon, Snowden benefited from the department's strong research culture, and he collaborated with James G. Kelly and Ricardo F. Munoz and then with Norman Sundberg on chapters for the Annual Review o f Psychology. From Oregon, Snowden accepted a position in the School of Social Welfare at the University of California, Berkeley (UC Berkeley), after spending a visiting year in Berkeley’s Department of Psychology. He continues there as an affiliated professor in psychology, sometimes super vising students interested in epidemiologic and health-services-related approaches to disparities. Clinical and com munity psychologist Rona Weinstein was instrumental in facilitating Snowden’s participation. Several experiences helped to crystallize Snowden’s commitment to health services research and health policy analysis for understanding and investigating racial and eth nic disparities in mental health treatment access and quality of care. His mid-1980s service on the research review committee of the National Center for Health Services Re search (now the Agency for Healthcare Research and Qual ity) immersed him in an interdisciplinary environment for rigorously investigating from diverse research perspectives how health policy and the treatment delivery system work. He was involved in several of the activities through which the National Institutes of Health developed its own health 771
services research program, and subsequent service on Na tional Institute of Mental Health (NIMH) and National Insti tute on Drug Abuse health services research review commit tees and on several research center advisory boards, as well as on ethnic minority research center review committees, further consolidated his commitment to a health services research perspective. Especially influential was Snowden’s participation, first as co-investigator and later as principal investigator and direc tor, in an NIMH-funded Center on the Organization and Financing of Care for the Severely Mentally 111. There Snowden’s disparities-focused research was informed by his working closely with key collaborators, including health economist and econometrician Teh-wei Hu, social ecologist and economics researcher Ralph Catalano, sociologist Joan Bloom, epidemiologist William Vega, and other colleagues from UC Berkeley’s School of Public Health and the Uni versity of California, San Francisco’s Psychiatry Department. Later, as director of the Center for Mental Health Services Research housed in UC Berkeley’s Institute for Personality and Social Research, Snowden procured funding from NIMH and other sources to investigate key developments in mental health policy and programming that have important conse quences for disparities. Among policy changes he studied were “program realignment” and “outpatient consolidation,” measures taken as California devolved its mental health treat ment system fully to county-level responsibility; mental health treatment of foster-care-placed children treated away from their home counties; Colorado’s public mental health treatment’s transition to a system of capitation-financed man aged care; the “Fresno Study” of Latino epidemiology and mental health treatment; California’s “threshold language” policy enacted to meet the State’s obligation to serve persons with limited English proficiency; and the loosening of mental health funding under Medicaid’s Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program. His findings have been presented in numerous scholarly publications and at policy briefings held in Sacramento, California (the state capital) and elsewhere. Snowden’s expertise and record of achievement led to his contributing to several landmark events for elevating mental health’s visibility and its being accorded a higher priority for concern by policymakers and the public. At the invitation of Surgeon General David Satcher, Snowden contributed to Mental Health: A Report o f the Surgeon General. He served as science editor, along with Jeanne Miranda, Stanley Sue, Steve Lopez, and Spero Manson, of Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report o f the Surgeon General. After long-term service as a faculty member in the Health Services and Policy Analysis doctoral program located in the UC Berkeley School of Public Health’s Health Policy and Management Program (HPM), in 2008 Snowden moved his appointment fully to HPM, where he continues to work in the 772
company of highly accomplished economists, sociologists, and political scientists on health and mental health policy and service delivery. He continued in his affiliations as a faculty member with the Robert Wood Johnson Foundation’s Health & Society Scholars program and as a senior scholar at the Brown School of Social Work, Washington University in St. Louis. From 2009 to 2012, Snowden served on UC Berkeley’s Committee on Budget and Interdepartmental Relations, where he worked closely with eight distinguished faculty members drawn from the physical and social sciences, hu manities, and professional schools in analyzing personnel and policy matters and making recommendations to then-Chancellor Robert Birgeneau and other senior administrators. Snowden retired from his regular faculty position in 2012, receiving a Berkeley Citation “for distinguished achievement and notable service.” He was immediately recalled to con tinue his research and mentorship as Professor of the Grad uate School. Snowden is married to Alice Hines, interim dean of San Jose State University’s largest college, the College of Ap plied Sciences and Arts. Hines also directs a multimillion dollar U.S. Agency for International Development-funded social work and social service development project in Viet nam, to which she has traveled 16 times in the past five years. Snowden remains devoted to his older son Alexander Snowden and to his younger son Jonathan Snowden, who is a Stanford University- and UC Berkeley-trained epidemiol ogist and health services researcher at Oregon Health & Science University. S e le c te d B i b l io g r a p h y Catalano, R., Libby, A. M., Snowden, L. R., & Evans-Cuellar, A. E. (2000). The effect of capitated financing on mental health services for children and youth: The Colorado experience. American Journal of Public Health, 90(12), 1861-1865. Goldhaber-Fiebert, J. D„ Snowden, L. R., Wulczyn, F., Landsverk, J., & Horwitz, S. M. (2011). Economic evaluation research in the context of child welfare policy: A structured literature review and recommenda tions. Child Abuse & Neglect, 35(9), 722-740. doi: 10.1016/j.chiabu.2011 .05.012 McClelland, S. R., Wu, F. M., & Snowden, L. R. (2012). The impact of threshold assistance programming on the accessibility of mental health services for persons with limited English proficiency in the Medi-Cal setting. Medical Care, 50(6), 554-558. doi:10.1097/MLR .ObOl3e3182463432 Scott, M. R., Snowden, L. R., & Libby, A. M. (2002). Effects of capitated managed care on youth contact with the juvenile justice system. Journal o f the American Academy o f Child and Adolescent Psychiatry, 41, 14621469. Sentell, T., Shumway, M., & Snowden, L. R. (2007). Access to mental health treatment by English language proficiency and race/ethnicity. Journal o f General Internal Medicine, 22(Suppl. 2), 289-293. doi: 10.1007/sl 1606-007-0345-7 Snowden, L. R. (2005). Racial, cultural and ethnic disparities in health and mental health: Toward theory and research at community levels. Amer ican Journal o f Community Psychology, 35(1-2), 1-8. doi:10.1007/ s10464-005-1882-z Snowden, L. R. (2012). Flealth and mental health policies’ role in better understanding and losing African American-White American disparities
November 2014 • American Psychologist
in treatment access and quality of care. American Psychologist, 67(1), 524-531. doi: 10.1037/a0030054 Snowden, L. R., Catalano, R. F., & Shumway, M. (2009). Disproportionate use of psychiatric emergency services by African Americans. Psychiatric Services, 60(12), 1664-1671. doi:10.1176/appi.ps.60.12.1664 Snowden, L. R., & Cheung, F. K. (1990). Use of inpatient mental health services by members of ethnic minority groups. American Psychologist, 45(3), 347-355. doi:10.1037/0003-066X.45.3.347 Snowden, L. R., Hastings, J., & Alvidrez, J. (2009). Overrepresentation of Black Americans in psychiatric inpatient care. Psychiatric Services, 60(6), 779-785. doi: 10.1176/appi.ps.60.6.779 Snowden, L. R., Masland, M., & Guerrero, R. (2007). Federal civil rights policy and mental health treatment access for persons with limited Eng lish proficiency. American Psychologist, 62(2), 109-117. doi: 10.1037/ 0003-066X.62.2.109 Snowden, L. R„ Masland, M. C., Libby, A. M., Wallace, N., & Fawley, K. (2008). Racial/ethnic minority children’s use of psychiatric emergency care in California’s public mental health system. American Journal o f Public Health, 95(1), 118-124. doi:10.2105/AJPH.2006.105361 Snowden, L. R„ Masland, M. C., Peng, C. J„ Lou, C., & Wallace, N. (2011). Limited English proficient Asian Americans: Threshold language policy and access to mental health treatment. Social Science & Medicine, 72(2), 230-237. doi: 10.1016/j.socscimed.2010.10.027 Snowden, L. R., Masland, M. C., Wallace, N., & Evans-Cuellar, A. (2007). Effects on outpatient and emergency mental health care of strict Medicaid Early Periodic Screening, Diagnosis, and Treatment enforcement. Amer ican Journal o f Public Health, 97(11), 1951-1956. doi:10.2105/AJPH .2006.094771 Snowden, L. R., Masland, M. C„ Wallace, N., Fawley-King, K., & Cuellar, A. E. (2008). Increasing California children’s Medicaid-financed mental health treatment by vigorously implementing Medicaid’s Early Periodic Screening, Diagnosis and Treatment (EPSDT) program. Medical Care, 46(6), 558-564. doi:10.1097/MLR.0b013e3181648e82 Snowden, L. R., & McClelland, S. (2013). Spanish language communitybased mental health treatment programs, policy-required language-assis tance programming, and mental health treatment access among Spanish speaking clients. American Journal o f Public Health, 103(9), 1628-1633. doi:10.2105/AJPH.2013.301238 Snowden, L. R., Wallace, N., Kang, S. H., Cheng, J. S., & Bloom, J. R. (2007). Capitation and racial and ethnic differences in use and cost of public mental health services. Administration and Policy in Mental Health and Mental Health Services Research, 34(5), 456-464. doi: 10.1007/s 10488-007-0126-y Snowden, L. R., & Yamada, A. M. (2005). Cultural differences in access to care. Annual Review o f Clinical Psychology, I, 143-166. doi: 10.1146/ annurev.clinpsy. 1.102803.143846 Thomas, K., & Snowden, L. R. (2001). Minority response to health insur ance coverage for mental health services. Journal o f Mental Health Policy and Economics, 4(1), 35-41. Zhang, A. M., Scheffler, R„ & Snowden, L. R. (2000). State health care reform: The effects of program realignment on severely mentally ill persons in California’s community-based mental health system. Psychi atric Services, 51(9), 1103-1110. doi:10.1176/appi.ps.51.9.1103
are especially likely to slip into poverty, and over the course of a lifetime, very many African Americans will experience poverty. Accordingly, African Americans are disproportion ately likely to be assisted by safety net programs providing income support and health and social assistance. When men tal health-related outcomes are assessed, U.S.-focused and international studies of safety net programs sometimes find that adults and children show a decline in symptoms of mental illness after participating. All things being equal, these improvements can disproportionately benefit African Americans’ mental health. Safety net programs’ mental health-related impact should be routinely assessed when evaluating the programs’ economic and social outcomes and the impact they have on African Americans’ mental health. Policy research of this kind can help us to understand whether these very large interventions show society-wide mental health-related improvement in the disproportionately large number of African Americans who participate in them.
Poverty, Safety Net Programs, and African Americans’ Mental Health
Editor’s note. Lonnie R. Snowden Jr. received the Award for Distin guished Contributions to Research in Public Policy. Award winners are invited to deliver an award address at APA’s annual convention. A version of this award address was presented at the 122nd annual meeting, held August 7-10, 2014, in Washington, DC. Articles based on award addresses are reviewed, but they differ from unsolicited articles in that they are expressions of the winners’ reflections on their work and their views of the field.
Lonnie R. Snowden University o f California, Berkeley
Keywords: African Americans, poverty, mental illness, epi demiology, poverty policy African Americans’ high poverty rates are sometimes ac knowledged as an unfortunate fact of American life, but rarely do the scope and depth of African Americans’ poverty receive sufficient attention. Nor is enough attention paid to nonpoor African Americans’ greater likelihood of entering, and lesser likelihood of exiting, poverty, or to African Amer icans’ very high lifetime chances of experiencing poverty. Because of their disproportionate poverty, African Ameri cans are disproportionately eligible for, and also dispropor tionately participate in, the safety net programs providing poor persons with income and in-kind material support. Conventional wisdom notwithstanding, safety net pro grams have been shown to lower poverty rates and, in a handful of carefully conducted studies, to reduce mental illness as a byproduct. All things being equal, African Amer icans’ disproportionate participation in safety net programs due to their greater poverty will translate into disproportion ate improvement in African Americans’ mental illness rates if the programs’ economic, health, and social benefits positively
http://dx.doi.org/l 0.1037/a0037422
African Americans’ poverty and deep-poverty rates are higher than those of Whites, and African Americans ’ poverty spells last longer. Furthermore, nonpoor African Americans November 2014 • American Psychologist
Author’s note. Correspondence concerning this article should be ad dressed to Lonnie R. Snowden Jr., Health Policy and Management Program, School of Public Health, University of California, Berkeley, 235 University Hall, 1090 Warfield Avenue, Oakland, CA 9410. E-mail: [email protected]
773
Copyright of American Psychologist is the property of American Psychological Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
“Over the past several decades, Lonnie R. Snowden Jr. has systematically built a research agenda on the financing and organization of mental health services that has driven much of our current health policy reform efforts. His outstanding population-based research on leveraging Medicaid as a major payer of mental health services and rebalancing of investments provides important modeling for state and fed eral financing policy. In addition, his efforts to “move the dial” on disparities in care have been relentless. Snowden’s commitment to using cutting-edge research to influence public policy and advance social justice represents an ex emplary contribution to the field and to society.” B io g ra p h y
Lonnie R. Snowden Jr. was born in Detroit, Michigan, the second child of Lonnie R. Snowden Sr. and Sylvia Snowden. Snowden Jr. grew up on the near west side of Detroit and attended the Detroit public schools. Snowden Sr. and his brothers reared themselves from their early teenage years until adulthood, maintaining an independent household after their father, who came to Detroit in the African American “Great Migration,” died in a factory explosion and after their mother was unable to care for them. Snowden Sr. excelled as a student and graduated first in his class from the then all-White Detroit College of Law. November 2014 • American Psychologist ©2014 American Psychological Association 0003-066X/14/$ 12.00 Vol. 69, No. 8, 771-773 http://dx.doi.org/10.1037/a0037423
After graduating from Detroit’s Mumford High School, Snowden Jr. received a BA in psychology at the University of Michigan before returning to earn a PhD in clinical and community psychology from Detroit’s Wayne State Uni versity under the guidance of clinical psychologist Gerald Rosenbaum. Snowden’s admission prospects to Wayne State benefited from the diversity-promotion efforts of graduate student James S. Jackson. While a graduate student at Wayne State, Snowden served in administrative and research capacities at the De troit Drug Abuse Treatment Programs, which kindled an interest in understanding how social policy and health, mental health, and social programs come into existence as instruments of social policy and how they are implemented and subsequently operated. Snowden’s master’s thesis, con ducted under the supervision of Sheldon Cotier, investi gated how psychological factors distinguished more suc cessful from less successful drug abuse counselors. Snowden witnessed Detroit’s decline from vibrant metrop olis to troubled remnant, and this experience provides him with a continuing reminder of how untoward sociohistorical contingencies, such as the auto industry’s steep decline, powerfully shape conditions for human development and day-to-day living. Snowden spent one year at the University of Rochester Medical Center as a clinical psychology intern and then accepted a job to become an assistant professor in the Psychology Department at the University of Oregon, where he spent the next three years. While at Oregon, Snowden benefited from the department's strong research culture, and he collaborated with James G. Kelly and Ricardo F. Munoz and then with Norman Sundberg on chapters for the Annual Review o f Psychology. From Oregon, Snowden accepted a position in the School of Social Welfare at the University of California, Berkeley (UC Berkeley), after spending a visiting year in Berkeley’s Department of Psychology. He continues there as an affiliated professor in psychology, sometimes super vising students interested in epidemiologic and health-services-related approaches to disparities. Clinical and com munity psychologist Rona Weinstein was instrumental in facilitating Snowden’s participation. Several experiences helped to crystallize Snowden’s commitment to health services research and health policy analysis for understanding and investigating racial and eth nic disparities in mental health treatment access and quality of care. His mid-1980s service on the research review committee of the National Center for Health Services Re search (now the Agency for Healthcare Research and Qual ity) immersed him in an interdisciplinary environment for rigorously investigating from diverse research perspectives how health policy and the treatment delivery system work. He was involved in several of the activities through which the National Institutes of Health developed its own health 771
services research program, and subsequent service on Na tional Institute of Mental Health (NIMH) and National Insti tute on Drug Abuse health services research review commit tees and on several research center advisory boards, as well as on ethnic minority research center review committees, further consolidated his commitment to a health services research perspective. Especially influential was Snowden’s participation, first as co-investigator and later as principal investigator and direc tor, in an NIMH-funded Center on the Organization and Financing of Care for the Severely Mentally 111. There Snowden’s disparities-focused research was informed by his working closely with key collaborators, including health economist and econometrician Teh-wei Hu, social ecologist and economics researcher Ralph Catalano, sociologist Joan Bloom, epidemiologist William Vega, and other colleagues from UC Berkeley’s School of Public Health and the Uni versity of California, San Francisco’s Psychiatry Department. Later, as director of the Center for Mental Health Services Research housed in UC Berkeley’s Institute for Personality and Social Research, Snowden procured funding from NIMH and other sources to investigate key developments in mental health policy and programming that have important conse quences for disparities. Among policy changes he studied were “program realignment” and “outpatient consolidation,” measures taken as California devolved its mental health treat ment system fully to county-level responsibility; mental health treatment of foster-care-placed children treated away from their home counties; Colorado’s public mental health treatment’s transition to a system of capitation-financed man aged care; the “Fresno Study” of Latino epidemiology and mental health treatment; California’s “threshold language” policy enacted to meet the State’s obligation to serve persons with limited English proficiency; and the loosening of mental health funding under Medicaid’s Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program. His findings have been presented in numerous scholarly publications and at policy briefings held in Sacramento, California (the state capital) and elsewhere. Snowden’s expertise and record of achievement led to his contributing to several landmark events for elevating mental health’s visibility and its being accorded a higher priority for concern by policymakers and the public. At the invitation of Surgeon General David Satcher, Snowden contributed to Mental Health: A Report o f the Surgeon General. He served as science editor, along with Jeanne Miranda, Stanley Sue, Steve Lopez, and Spero Manson, of Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report o f the Surgeon General. After long-term service as a faculty member in the Health Services and Policy Analysis doctoral program located in the UC Berkeley School of Public Health’s Health Policy and Management Program (HPM), in 2008 Snowden moved his appointment fully to HPM, where he continues to work in the 772
company of highly accomplished economists, sociologists, and political scientists on health and mental health policy and service delivery. He continued in his affiliations as a faculty member with the Robert Wood Johnson Foundation’s Health & Society Scholars program and as a senior scholar at the Brown School of Social Work, Washington University in St. Louis. From 2009 to 2012, Snowden served on UC Berkeley’s Committee on Budget and Interdepartmental Relations, where he worked closely with eight distinguished faculty members drawn from the physical and social sciences, hu manities, and professional schools in analyzing personnel and policy matters and making recommendations to then-Chancellor Robert Birgeneau and other senior administrators. Snowden retired from his regular faculty position in 2012, receiving a Berkeley Citation “for distinguished achievement and notable service.” He was immediately recalled to con tinue his research and mentorship as Professor of the Grad uate School. Snowden is married to Alice Hines, interim dean of San Jose State University’s largest college, the College of Ap plied Sciences and Arts. Hines also directs a multimillion dollar U.S. Agency for International Development-funded social work and social service development project in Viet nam, to which she has traveled 16 times in the past five years. Snowden remains devoted to his older son Alexander Snowden and to his younger son Jonathan Snowden, who is a Stanford University- and UC Berkeley-trained epidemiol ogist and health services researcher at Oregon Health & Science University. S e le c te d B i b l io g r a p h y Catalano, R., Libby, A. M., Snowden, L. R., & Evans-Cuellar, A. E. (2000). The effect of capitated financing on mental health services for children and youth: The Colorado experience. American Journal of Public Health, 90(12), 1861-1865. Goldhaber-Fiebert, J. D„ Snowden, L. R., Wulczyn, F., Landsverk, J., & Horwitz, S. M. (2011). Economic evaluation research in the context of child welfare policy: A structured literature review and recommenda tions. Child Abuse & Neglect, 35(9), 722-740. doi: 10.1016/j.chiabu.2011 .05.012 McClelland, S. R., Wu, F. M., & Snowden, L. R. (2012). The impact of threshold assistance programming on the accessibility of mental health services for persons with limited English proficiency in the Medi-Cal setting. Medical Care, 50(6), 554-558. doi:10.1097/MLR .ObOl3e3182463432 Scott, M. R., Snowden, L. R., & Libby, A. M. (2002). Effects of capitated managed care on youth contact with the juvenile justice system. Journal o f the American Academy o f Child and Adolescent Psychiatry, 41, 14621469. Sentell, T., Shumway, M., & Snowden, L. R. (2007). Access to mental health treatment by English language proficiency and race/ethnicity. Journal o f General Internal Medicine, 22(Suppl. 2), 289-293. doi: 10.1007/sl 1606-007-0345-7 Snowden, L. R. (2005). Racial, cultural and ethnic disparities in health and mental health: Toward theory and research at community levels. Amer ican Journal o f Community Psychology, 35(1-2), 1-8. doi:10.1007/ s10464-005-1882-z Snowden, L. R. (2012). Flealth and mental health policies’ role in better understanding and losing African American-White American disparities
November 2014 • American Psychologist
in treatment access and quality of care. American Psychologist, 67(1), 524-531. doi: 10.1037/a0030054 Snowden, L. R., Catalano, R. F., & Shumway, M. (2009). Disproportionate use of psychiatric emergency services by African Americans. Psychiatric Services, 60(12), 1664-1671. doi:10.1176/appi.ps.60.12.1664 Snowden, L. R., & Cheung, F. K. (1990). Use of inpatient mental health services by members of ethnic minority groups. American Psychologist, 45(3), 347-355. doi:10.1037/0003-066X.45.3.347 Snowden, L. R., Hastings, J., & Alvidrez, J. (2009). Overrepresentation of Black Americans in psychiatric inpatient care. Psychiatric Services, 60(6), 779-785. doi: 10.1176/appi.ps.60.6.779 Snowden, L. R., Masland, M., & Guerrero, R. (2007). Federal civil rights policy and mental health treatment access for persons with limited Eng lish proficiency. American Psychologist, 62(2), 109-117. doi: 10.1037/ 0003-066X.62.2.109 Snowden, L. R„ Masland, M. C., Libby, A. M., Wallace, N., & Fawley, K. (2008). Racial/ethnic minority children’s use of psychiatric emergency care in California’s public mental health system. American Journal o f Public Health, 95(1), 118-124. doi:10.2105/AJPH.2006.105361 Snowden, L. R„ Masland, M. C., Peng, C. J„ Lou, C., & Wallace, N. (2011). Limited English proficient Asian Americans: Threshold language policy and access to mental health treatment. Social Science & Medicine, 72(2), 230-237. doi: 10.1016/j.socscimed.2010.10.027 Snowden, L. R., Masland, M. C., Wallace, N., & Evans-Cuellar, A. (2007). Effects on outpatient and emergency mental health care of strict Medicaid Early Periodic Screening, Diagnosis, and Treatment enforcement. Amer ican Journal o f Public Health, 97(11), 1951-1956. doi:10.2105/AJPH .2006.094771 Snowden, L. R., Masland, M. C„ Wallace, N., Fawley-King, K., & Cuellar, A. E. (2008). Increasing California children’s Medicaid-financed mental health treatment by vigorously implementing Medicaid’s Early Periodic Screening, Diagnosis and Treatment (EPSDT) program. Medical Care, 46(6), 558-564. doi:10.1097/MLR.0b013e3181648e82 Snowden, L. R., & McClelland, S. (2013). Spanish language communitybased mental health treatment programs, policy-required language-assis tance programming, and mental health treatment access among Spanish speaking clients. American Journal o f Public Health, 103(9), 1628-1633. doi:10.2105/AJPH.2013.301238 Snowden, L. R., Wallace, N., Kang, S. H., Cheng, J. S., & Bloom, J. R. (2007). Capitation and racial and ethnic differences in use and cost of public mental health services. Administration and Policy in Mental Health and Mental Health Services Research, 34(5), 456-464. doi: 10.1007/s 10488-007-0126-y Snowden, L. R., & Yamada, A. M. (2005). Cultural differences in access to care. Annual Review o f Clinical Psychology, I, 143-166. doi: 10.1146/ annurev.clinpsy. 1.102803.143846 Thomas, K., & Snowden, L. R. (2001). Minority response to health insur ance coverage for mental health services. Journal o f Mental Health Policy and Economics, 4(1), 35-41. Zhang, A. M., Scheffler, R„ & Snowden, L. R. (2000). State health care reform: The effects of program realignment on severely mentally ill persons in California’s community-based mental health system. Psychi atric Services, 51(9), 1103-1110. doi:10.1176/appi.ps.51.9.1103
are especially likely to slip into poverty, and over the course of a lifetime, very many African Americans will experience poverty. Accordingly, African Americans are disproportion ately likely to be assisted by safety net programs providing income support and health and social assistance. When men tal health-related outcomes are assessed, U.S.-focused and international studies of safety net programs sometimes find that adults and children show a decline in symptoms of mental illness after participating. All things being equal, these improvements can disproportionately benefit African Americans’ mental health. Safety net programs’ mental health-related impact should be routinely assessed when evaluating the programs’ economic and social outcomes and the impact they have on African Americans’ mental health. Policy research of this kind can help us to understand whether these very large interventions show society-wide mental health-related improvement in the disproportionately large number of African Americans who participate in them.
Poverty, Safety Net Programs, and African Americans’ Mental Health
Editor’s note. Lonnie R. Snowden Jr. received the Award for Distin guished Contributions to Research in Public Policy. Award winners are invited to deliver an award address at APA’s annual convention. A version of this award address was presented at the 122nd annual meeting, held August 7-10, 2014, in Washington, DC. Articles based on award addresses are reviewed, but they differ from unsolicited articles in that they are expressions of the winners’ reflections on their work and their views of the field.
Lonnie R. Snowden University o f California, Berkeley
Keywords: African Americans, poverty, mental illness, epi demiology, poverty policy African Americans’ high poverty rates are sometimes ac knowledged as an unfortunate fact of American life, but rarely do the scope and depth of African Americans’ poverty receive sufficient attention. Nor is enough attention paid to nonpoor African Americans’ greater likelihood of entering, and lesser likelihood of exiting, poverty, or to African Amer icans’ very high lifetime chances of experiencing poverty. Because of their disproportionate poverty, African Ameri cans are disproportionately eligible for, and also dispropor tionately participate in, the safety net programs providing poor persons with income and in-kind material support. Conventional wisdom notwithstanding, safety net pro grams have been shown to lower poverty rates and, in a handful of carefully conducted studies, to reduce mental illness as a byproduct. All things being equal, African Amer icans’ disproportionate participation in safety net programs due to their greater poverty will translate into disproportion ate improvement in African Americans’ mental illness rates if the programs’ economic, health, and social benefits positively
http://dx.doi.org/l 0.1037/a0037422
African Americans’ poverty and deep-poverty rates are higher than those of Whites, and African Americans ’ poverty spells last longer. Furthermore, nonpoor African Americans November 2014 • American Psychologist
Author’s note. Correspondence concerning this article should be ad dressed to Lonnie R. Snowden Jr., Health Policy and Management Program, School of Public Health, University of California, Berkeley, 235 University Hall, 1090 Warfield Avenue, Oakland, CA 9410. E-mail: [email protected]
773
Copyright of American Psychologist is the property of American Psychological Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
