Antioch University AURA - Antioch University Repository and Archive Student & Alumni Scholarship, including Dissertations & Theses Dissertations & Theses 2015 Solutions for Recruitment and Retention of Rural Psychologists by Rural Psychologists Beth Briggs Antioch University - New England Follow this and additional works at:http://aura.antioch.edu/etds Part of theClinical Psychology Commons Recommended Citation ORCID Scholar ID # : orcid.org/0000-0002-4504-2437 This Dissertation is brought to you for free and open access by the Student & Alumni Scholarship, including Dissertations & Theses at AURA - Antioch University Repository and Archive. It has been accepted for inclusion in Dissertations & Theses by an authorized administrator of AURA - Antioch University Repository and Archive. For more information, please [email protected], [email protected]. Running head: RURAL PSYCHOLOGISTS RECRUITMENT AND RETENTION Solutions for Recruitment and Retention of Rural Psychologists by Rural Psychologists by Beth Briggs B.A., Cabrini College, 2010 M.S., Antioch University New England, 2013 DISSERTATION Submitted in partial fulfillment for the degree of Doctor of Psychology in the Department of Clinical Psychology at Antioch University New England, 2015 Keene, New Hampshire RURAL PSYCHOLOGISTS RECRUITMENT AND RETENTION ii Department of Clinical Psychology DISSERTATION COMMITTEE PAGE The undersigned have examined the dissertation entitled: SOLUTIONS FOR RECRUITMENT AND RETENTION OF RURAL PSYCHOLOGISTS BY RURAL PSYCHOLOGISTS presented on August 18, 2015 by Beth Briggs Candidate for the degree of Doctor of Psychology and hereby certify that it is accepted*. Dissertation Committee Chairperson: Susan Hawes, PhD Dissertation Committee members: James Fauth, PhD Gina Pasquale, PsyD Accepted by the Department of Clinical Psychology Chairperson George Tremblay, PhD On 8/21/15 * Signatures are on file with the Registrar’s Office at Antioch University New England. RURAL PSYCHOLOGISTS RECRUITMENT AND RETENTION iii Table of Contents List of Tables .................................................................................................................................. v List of Figures ................................................................................................................................ vi Acknowledgements ....................................................................................................................... vii Abstract ........................................................................................................................................... 1 Chapter 1 ......................................................................................................................................... 3 Statement of the Problem ............................................................................................................ 3 Purpose of the Study ................................................................................................................... 4 Research Questions ..................................................................................................................... 4 Rationale of the Study ................................................................................................................. 5 Significance of the Study ............................................................................................................ 5 Definition of Terms .................................................................................................................... 6 Chapter 2 ......................................................................................................................................... 8 Unique Characteristics of Rural Environments .......................................................................... 8 Barriers to Treatment ................................................................................................................ 12 Barriers to Recruitment and Retention of Rural Psychologists ................................................ 17 Facilitators of Rural Practice .................................................................................................... 23 Implications and Future Directions ........................................................................................... 26 Chapter 3 ....................................................................................................................................... 28 Participants ................................................................................................................................ 28 Survey ....................................................................................................................................... 30 Procedure .................................................................................................................................. 31 Data Analysis ............................................................................................................................ 31 Ethical Considerations .............................................................................................................. 32 Chapter 4 ....................................................................................................................................... 34 Professional Practice ................................................................................................................. 34 Training Experiences ................................................................................................................ 36 Personal Experiences ................................................................................................................ 37 Suggestions ............................................................................................................................... 38 Salient Quantitative and Qualitative Results ............................................................................ 46 Chapter 5 ....................................................................................................................................... 49 Demographic, Training, and Practice Characteristics of Rural Psychologists ......................... 49 Factors that Attract Psychologists to Rural Communities ........................................................ 51 Reasons that Psychologists Remain in Rural Communities ..................................................... 53 Rural Psychologists’ Suggestions for Improved Recruitment and Retention ........................... 54 Implications for Increasing Psychologist Availability .............................................................. 57 Limitations of the Study ........................................................................................................... 58 Future Directions ...................................................................................................................... 59 Conclusion ................................................................................................................................ 60 RURAL PSYCHOLOGISTS RECRUITMENT AND RETENTION iv References ..................................................................................................................................... 62 Appendix A: Survey ..................................................................................................................... 69 Appendix B: Letter to Prospective Participants ............................................................................ 73 Appendix C: Text of Informed Consent ....................................................................................... 74 Appendix D: Table 3. Distribution of Practice Characteristics ................................................... 75 RURAL PSYCHOLOGISTS RECRUITMENT AND RETENTION v List of Tables Table 1. Distribution of Geographic Region Resided in During Early Life ................................ 38 Table 2. Consolidated Themes of Suggestions and Their Frequency by Question ..................... 46 Table 3. Distribution of Practice Characteristics ......................................................................... 75 RURAL PSYCHOLOGISTS RECRUITMENT AND RETENTION vi List of Figures Figure 1. Distribution of reasons participants were recruited to and retained in a rural practice .......................................................................................................... 36 Figure 2. Frequency of participants spending time in rural areas by time period ....................... 39 RURAL PSYCHOLOGISTS RECRUITMENT AND RETENTION vii Acknowledgements I could not have completed this dissertation without the support and guidance of many. First, I would like to acknowledge my friends. There are too many amazing people to name here, but I will start with a few. Danielle, thank you for your endless support, your countless pep talks, edits, and so much more. Casey, Ted, and Paul—your friendship carried me through graduate school and this dissertation. I could always count on you all for laughter, empathy, and kindness. Lastly I would like to acknowledge my intern cohort, Melissa, Laura, and Taylor. The many hours we spent working on our dissertations, supporting each other, and discussing our futures sustained my motivation to reach the finish line. I would like to thank my family for their love and support, even when it seemed like I would never reach the end of this dissertation. Thank you for being patient with the time and attention this project took. Mom, thank you for genuine curiosity in this dissertation and gentle reminders to take breaks for self-care. Dad, thank you for your unquestioned support of my decision to enter into doctoral studies and my ability to achieve my goals. Mike, Kate, and Sarah – I could not ask for more supportive siblings. Mike I am grateful for your ability to express sincere pride yet bring levity and humility to my life. Kate, neither you nor I knew how integrated you would be into my graduate training when I started this journey. But I am so thankful that you were. I could not have made it through school or this dissertation without your love or humor. Sarah, thank you for being an endless source of joy and encouragement as I completed my dissertation. Finally, I would like to acknowledge my mentors, who continuously pushed me to strive for excellence and always seemed to know what I could achieve before I did. There are so many to thank, but I would like to acknowledge my dissertation committee Susan Hawes, Jim Fauth, RURAL PSYCHOLOGISTS RECRUITMENT AND RETENTION viii and Gina Pasquale. I could not have completed this dissertation without your expertise, warmth, encouragement, or mentorship. RURAL PSYCHOLOGISTS RECRUITMENT AND RETENTION 1 Abstract There are too few mental health providers to meet the needs of residents of rural communities. Rural inhabitants often present for treatment with severe symptoms, high risk for suicide, comorbid chronic health conditions, and socioeconomic stressors. It is difficult to recruit psychologists to rural communities due to limited training in rural psychology, financial barriers to sustaining a practice, frequent ethical dilemmas posed by small towns, and limited cultural amenities. While there is a significant amount of scholarly literature describing the needs of this population and the challenges of maintaining a practice in such geographic regions, there is scarce literature on solutions to these problems. This study addressed this gap in the literature by exploring possible solutions for recruitment and retention of rural doctoral-level psychologists. Forty-eight psychologists practicing in towns with a population of 5,000 or fewer across the United States responded to mailed surveys inquiring about their background information, the factors which contributed to their initiation of and maintenance of a career in rural psychology, and their recommendations for improving recruitment and retention. Most participants worked in private practice providing individual psychotherapy and/or evaluation with adults despite having minimal training in rural mental health during graduate school. The most frequently listed reasons participants had chosen and maintained a rural practice were: a preference for a rural lifestyle, a desire to be close to family and friends, and the population. The most frequently reported suggestions for increasing the number of rural psychologists included: improved financial incentives, highlight the benefits of rural practice (e.g., limited competition, meaningful work), highlight the appeal of a rural lifestyle, and create a professional network of rural providers. Professional incentives such as owning a private practice, meaningful experiences in rural areas including being raised in a rural town, and completing predoctoral internship and