As any realtor will tell you, it’s all about location. For one married psychologist couple just finishing their post-doctoral training in Boston and making decisions about their next steps in life, the real question was not “what to do?” but “where to do it?”
In 2010, newly-minted psychologists Adam Ameele, Psy.D., and Kristen Hurd, Psy,D., decided to move to rural Vermont to kick off their careers. While Hurd struck gold with her first opportunity, finding work as the district psychologist for the 1,500-student Springfield school system, Ameele bounced around a bit before landing with the Springfield Medical Care System where he is clinical director of the behavioral health system.
New England Psychologist’s Catherine Robertson Souter spoke with the couple about the move, why they made the decision and how moving to an area with, what some may argue, less opportunity in some ways provided much greater opportunity for each of them so early in their careers.
Q: Prior to 2010, you were both in Boston, finishing post-doctoral training. What compelled you to move?
A: AA: It was a combination of lifestyle, looking for a change pace of life and recognizing that staying in a more urban area was not of interest to us.
KH: A slower pace of living and the environment to raise a family, while also being able to find job opportunities that met our interests.
Q: What do you miss, or not miss, about being in a bigger city?
A: AA: For me, it’s a more sustainable pace of living. I drive through one stop light to get to work from my house. You get to know people more easily socially and professionally and there is a connection to the outdoors without much effort as opposed to living in Boston where it was drive for 20-30 minutes to go for a hike.
I guess the things we miss at times are the diversity in terms of entertainment and connecting with more professionals.
KH: I do miss the greater range in activities, but I don’t miss the pace of living.
Q: Vermont has a reputation as being more liberal than many other rural settings. Was that part of your decision to choose the state?
A: AA: Vermont is often thought of as a very liberal state, but a lot of that hovers around the greater Burlington area – whereas the rest of Vermont tends to be more conservative. At times, that carries over into a hesitation about mental health care.
Q: Has that reticence been an issue with you finding work there?
A: AA: I work in a federally qualified health center (FQHC) and being in that setting gives us easier access to folks presenting to their primary care providers with mental health concerns. With the older model of a primary care provider giving a referral to someone in the community, the lack of follow up is pretty high. Because of the integration here, we are able to collaborate actively with the primary care provider and even be present in the exam room.
Q: You both seem to have taken on a lot of responsibility relatively early in your careers. Tell us about your work.
A: AA: Springfield Medical Care System is a unique FQHC in that it services approximately 30,000 patients over a span of seven regional primary care clinics and a critical access hospital. I provide both direct clinical and administrative services. Administratively, I am the clinical director of the behavioral health department with 10 social workers and five psychiatric prescribers and the consultative services for the nursing homes and rehabilitation centers.
Over time, I have helped add social workers to every primary care practice that we have to take our services to the patients, rather than use a referral to someone down the road.
Kristen is in a school setting and applies a very similar approach. She does identification of disabilities and appropriate intervention for students and also works with a consultation model where she is consulting with teachers, students and administrators alike about pragmatic behavioral and emotional intervention to help kids better access the educational curriculum.
She has been able to develop a mental health delivery program where she oversees clinical social workers and psychology practicum students doing short term interventions for students in school settings. It is very similar to what we are doing with behavioral health and primary care: she sees it is important to acknowledge the setting of the treatment so that you are helping students develop skills during the school day versus delivering traditional psychotherapy that just happens to be in school setting.
KH: We bring the perspective of a clinical psychologist in a school setting to not only identify disability and the need for service, but the nuances of varying cognitive, psychological, health and trauma based disorders in how they impact learning and a child’s functioning in the classroom. I work to empower teachers and administrators to better support the students in the classroom through regular consultation, as well as in response to varying levels of crisis.
Q: You would like to see more professionals reach out the rural areas to deliver care. What are you doing to help this idea grow?
A: KH: I have developed a practicum site for doctoral psychology students and, additionally, an internship consortium with SMCS to respond to first need.
AA: The internship is called the Rural Vermont Consortium of the Precision Valley. It is an internship for doctoral level clinical psychology students as required for licensure, with the idea of sharing what our experience has been. The first year of this internship program will be this upcoming academic year, 2016-17. The intern will split time between practicing in primary care setting and in the school district.
Q: What would you recommend to someone interested in exploring rural professional work?
A: AA: Talk to behavioral health providers in those areas but also be in touch with organizations like primary cares and hospitals and schools in terms of their needs and ability to collaborate and work together.
KH: Visit the communities you are considering and talk to people to get a sense of professional, recreational, and living opportunities. Think outside the box to consider how you might apply your training and experience from urban settings. Although I had not previously considered working in a school, I find that my experience, training, and interest are highly suited to this setting. The rigor and variety of work are stimulating and it has been exciting to develop programming and consultation skills while also creating training opportunities for graduate students.
Q: Do you think we will see more people going to these rural areas where they may have more opportunity to have a greater impact?
A: AA: It is hard to say – Kristen and I have the flexibility of occupations where we can both relocate to a rural area and find work. For a couple where one partner is in a different industry, relocating to rural areas can be a bit of a challenge – finding jobs in marketing or banking is not quite as easy in rural areas.
The need is there for people to do rural psychology and rural health care. The challenge is making it happen.