Doctor of Philosophy, The Ohio State University, 2024, Educational Studies

Each year in the United States, an estimated 57.8 million adults and 7.7 million children experience mental health issues with far-reaching implications (National Alliance on Mental Illness [NAMI], 2023). Despite our increased awareness in the aftermath of the COVID-19 pandemic, which both exposed and exacerbated the problem, access to services remains severely limited for 163 million Americans living in Mental Health Professional Shortage Areas (NAMI, 2023). There is an insufficient supply of mental health providers in America, and an additional 8,251 practitioners are needed immediately to adequately meet the needs of the people (Health Resource & Services Administration [HRSA], 2023b). However, this deficit will not be resolved soon, as nearly half of mental health practitioners currently report intentions to leave their employment (Centers for Disease Control [CDC], 2023). Furthermore, resolving the shortage will require more than hiring additional mental health professionals (HRSA, 2023b). Compared to the larger workforce, mental health providers have a higher risk of experiencing detrimental occupational outcomes (Cocker & Joss, 2016; Ledoux, 2015; Ondrejkova & Halamova, 2022; Sinclair et al., 2017; Sorenson et al., 2016). Burnout, one of the occupational harms associated with the unique demands of care work, is a driving force in the provider retention problem (CDC, 2023; Hoge et al., 2007; Morse et al., 2012). Although there is a direct link between burnout and a lack of organizational support (Schaufeli & Greenglass, 2001), there is a lack of research examining systemic causal factors. Most existing studies neglect to explore links between work characteristics and employee well-being and are restricted to investigating individual traits as contributors (CDC, 2023). The present study confronts the gap in the literature through a systemic exploratory analysis. This quantitative study examined the link between workplace environments and mental health (open full item for complete abstract)

Committee: Darcy Haag Granello (Committee Chair); Paul Granello (Committee Member); Noelle Arnold (Committee Member) Subjects: Behavioral Sciences; Behaviorial Sciences; Clinical Psychology; Counseling Education; Counseling Psychology; Health Care; Health Care Management; Medical Ethics; Mental Health; Occupational Health; Occupational Psychology; Organization Theory; Organizational Behavior; Psychology; Psychotherapy; Public Health; Public Health Education; Systems Design; Therapy

Doctor of Philosophy in Urban Education, Cleveland State University, 2016, College of Education and Human Services

Two decades after the civil war in Bosnia, more than fifty percent of population is suffering from various war aftereffects. However, most studies focused on objective outcomes, including gathering data on quantity of affected individuals. Very few studies focused on exploration of the experience itself, as well as Bosnian refugees' perception of their own health and well-being. The purpose of this study was to explore war and post-war experiences, as well as health and well-being of Bosnian refugees. Particular interest focused on the meaning making of their experience through personal narratives. Following the Qualitative Consensual Research analysis, seven domains emerged: pre-immigration experience, arrival process to United States, adjustment experience, influence of war and post-war experience, current lifestyle, mental health and well-being education and resources, and recommendations. Most significant take away from this study is the need to do more research and utilize it for practice implications on this particular group. This study shows there are major deficiencies in the resources extended to this refugee population, which needs to be advocated for. The field and practice of psychology has to find a better way to prepare and adjust in order to serve this population in a more efficient way. Other service workers who interact with this population ought to be trained to address these issues as well, as they may be act as the first contact within the host country and can enact a bridging role to the actual mental health resources and services, as well as other pertinent general resources.

Committee: Kathryn MacCluskie Ed.D. (Committee Chair); Anne Galletta Ph.D. (Advisor); Joshua Bagaka's Ph.D. (Committee Member); Graham Stead Ph.D. (Committee Member); Katherine Judge Ph.D. (Committee Member) Subjects: Counseling Psychology; Psychology

DNP, Kent State University, 2023, College of Nursing

Depression and anxiety are common and problematic mental health disorders for individuals. Patients with these disorders may not obtain significant symptom improvement with psychotherapy and psychotropic medication. The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to see if anxiety and depression symptoms improved through a standardized walking intervention. Project participants at an outpatient mental health office were asked to track walking, 5,000 steps per day, five days per week. The Generalized Anxiety Disorder -7 (GAD-7), Patient Health Questionnaire -9 (PHQ-9), for depression, and subjective scoring were used in pre- and post-testing to rate symptoms at baseline and three-month follow-up appointments. Objectives included that 50% of the participants would complete the intervention, that of those GAD-7 and PHQ-9 scores would decrease by four points, and that participants would verbalize subjective improvement in depression and anxiety. Fifty percent of participants completed the intervention. Data analysis, including paired and independent samples t-tests for scores and descriptive interpretation for categorical data, demonstrated a decrease in GAD-7 scores, but not PHQ-9 scores and subjective improvement of depression and anxiety symptoms. Four of the five project objectives were met. Clinical significance was seen with participant improvement, yet statistical significance was not shown. A walking intervention demonstrated benefits for participants' depression and anxiety symptoms.

Committee: James Tudhope (Committee Member); Eldora Lazaroff (Committee Member); Louise Knox (Committee Chair) Subjects: Behavioral Sciences; Health Care; Nursing

Bachelor of Arts (BA), Ohio University, 2019, Music

The purpose of this study was to present non-playing practice techniques for the development of the melodic vocabulary for jazz improvisation. Specific research questions included: 1) What non-playing practice techniques have shown to be effective in cultivate music performance skills? 2) What are the most commonly recommended practice techniques for developing the melodic vocabulary for jazz improvisation? Why are these important? 3) What, if any, non-playing practice techniques have been recommended for developing the melodic vocabulary for jazz improvisation? Why are these important? Relevant literature was reviewed from the following 7 categories: (a) studies of non-playing practice techniques within instrumental music education, (b) historical accounts of top improvisers; (c) mainstream printed jazz pedagogy; (d) recently-published alternative jazz pedagogy; (e) online jazz pedagogical resources; (f) dissertations/theses relating to jazz pedagogy; and (g) Music education research related to jazz pedagogy. Semi- formal interviews were also conducted with pedagogues Jamey Aebersold and Hal Crook. The study concludes with a presentation of a 5-step method for the development of melodic vocabulary which includes: 1) Engage in immersive listening, 2) Develop an intellectual understanding, 3) Internalize the language, 4) Connect theoretical and aural understanding to fingering technique, and 5) Apply ideas in context.

Committee: Matthew James (Advisor) Subjects: Music

PHD, Kent State University, 2018, College of Nursing

Complementary approaches to health and wellness are widely used and research is needed to provide evidence of their utility. Rosen Method Bodywork (RMB) is a complementary approach with a small, but growing body of evidence. The purpose of this research study was to explore the processes of Rosen Method Bodywork to develop a theoretical framework about what occurs over the course of receiving sessions RMB, both within the recipient and between the recipient and the practitioner. In this grounded theory study, data from interviews of twenty participants was analyzed and a theoretical model of the overall process of RMB was constructed. The model consists of the five integrative phases through which these participants moved within the iterative RMB process from Feeling Stuck and Disconnected to Feeling Connected. Mindfulness is observed to be a central component of the RMB process which participants describe as helpful for trauma recovery. Implications of these findings for mental health care providers, including advanced practice mental health nurses, for Rosen Method Bodywork practitioners, and for future research are discussed.

Committee: Denice Sheehan PhD, RN (Committee Chair); Christine Graor PhD, RN (Committee Member); Pamela Stephenson PhD, RN (Committee Member); Clare Stacey PhD (Committee Member) Subjects: Alternative Medicine; Health; Health Care; Nursing; Psychology; Psychotherapy

Psy. D., Antioch University, 2017, Antioch New England: Clinical Psychology

Like the community, correctional institutions have been ill-prepared in providing care to persons with serious mental illnesses (SMIs) who engage in combative behaviors, in what generally seems to amount to innocuous social interactions. These persons have been increasingly incarcerated over the past several decades because of violent behaviors, severely complicating the effort to provide effective mental health treatment for this population. Even though correctional residential mental health units have been instituted, successfully implementing what works has shown to be, at best, transient in these settings. Through the emergence of implementation science principles, though, there is now a pathway to implement Evidence Based Programs (EBPs) in these correctional residential settings, as implementation science provides guidance for implementing state-of-the-art rehabilitative services. Key implementation drivers (i.e., competency, organizational, and leadership) correlates with the correctional science literatures, supporting the use of implementation science. This dissertation develops a model for implementing EBP in correctional residential mental health treatment units through a systematic review of both the implementation science and correctional literatures. Themes emerged for each of these drivers that provided explicit guidance to implement EBP with fidelity through this systematic review. These themes are described in the Correctional Active Implementation Frame ([CAIF]; Bertram, Blase, & Fixsen, 2015), a model that interfaces implementation science principles with correctional science intervention principles to guide the implementation process and establish a framework of best practices for implementing EBP in these correctional residential mental health treatment units. The CAIF leverages opportunities and addresses barriers that constrain EBP implementation in this complex, stressful correctional setting, thus contributing to a pathway for rehabilitation (open full item for complete abstract)

Committee: James Fauth PhD (Committee Chair); Lorraine Mangione PhD (Committee Member); David Hamolsky PsyD (Committee Member) Subjects: Clinical Psychology

Psy. D., Antioch University, 2015, Antioch New England: Clinical Psychology

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 experi (open full item for complete abstract)

Committee: Susan Hawes Ph.D. (Committee Chair); James Fauth Ph.D. (Committee Member); Gina Pasquale Psy.D. (Committee Member) Subjects: Clinical Psychology

Psy. D., Antioch University, 2015, Antioch New England: Clinical Psychology

Mental health clinicians are bound by professional ethics codes that are intended to ensure beneficence toward clients. When clinicians reside in rural areas, ethical dilemmas result from the distinct nature of rural life and clinical practice. Despite extant literature on the ethical dilemmas of rural practice, little research has examined the effect of ethical dilemmas on the social-emotional functioning of clinicians. In response to this need, the study investigated the relationships of frequency of and discomfort from ethical dilemmas on clinician social-emotional functioning. Participants were rural and small town clinicians (N = 60) between ages 24-65 and primarily Caucasian (83.3%), from 19 states of the U.S., and one from Costa Rica. They responded to an online survey. Answer formats ranged from a Likert scale to open-ended statements to multiple choice options. Survey questions addressed demographic information; frequency and discomfort related to ethical dilemma types; decision-making strategies used; confidence in and stress relief from use of decision-making strategies; and frequency of service denial due to payment problems. The Friedman Well-Being Scale and Maslach Burnout Inventory were also included. Hypotheses predicted that frequency of encounters with ethical dilemmas and increased discomfort from ethical dilemmas would relate to lower well-being and higher burnout. Research questions were aimed at understanding the types and frequency of ethical dilemmas experienced by rural and small-town clinicians and decision-making strategies used. Differences between well-being and burnout scores of the study participants and participants of the normative studies for these measures were studied. Results indicated that frequency of and discomfort level from ethical dilemmas predicted the burnout dimension of Emotional Exhaustion. Dual role and clinician visibility dilemmas were most common. Most participants used a case-by-case, multiple-strategy approach fo (open full item for complete abstract)

Committee: Gargi Roysircar-Sodowsky PhD (Committee Chair); Gina Pasquale PsyD (Committee Member); Daniel Lafleur PhD (Committee Member) Subjects: Clinical Psychology

Doctor of Philosophy, The Ohio State University, 2010, Music

Two studies examined the influence of mental imagery type and instruments' tone-decay times on tempo fluctuations between repeated rehearsals and performances of musical works. The first experimental study tested the predictions that 1) motor imagery – in contrast to non-motor imagery – would lead to smaller discrepancies between imagined and performed tempos; and 2) musical works having high note density would tend to be slowed down when imagined, whereas works having low note density would tend to be sped up when imagined. The second correlational study tested the prediction that the same work would exhibit significant changes of average tempo when performed on instruments having different tone-decay times. In the first study, musicians performed slow and fast musical excerpts either vocally or on their major instrument. These excerpts were recorded. Then, each participant repeatedly attempted to mentally replicate their excerpts' tempos by using motor or non-motor imagery. Excerpt beginnings were signaled by three-second prompts from the recordings of each excerpt, and participants indicated excerpt endings by ringing a call bell. Excerpt duration discrepancies were calculated by subtracting the performed excerpt length from the imagined excerpt length. The results did not yield support for either of our hypotheses. There was no significant difference of tempo discrepancies when using motor versus non-motor imagery; and there was no significant main effect of variable note density on tempo discrepancies. Post hoc analyses suggested that successive mental rehearsals might lead to smaller and less variable tempo discrepancies across musicians of diverse skill levels. Other post hoc analyses suggested that repeated practice attempts might improve or at least maintain tempo accuracy, except in music exhibiting low note density – below approximately 1.5 notes-per-second. However, musicians do not seem to have immediate conscious access to the gains or losses of temp (open full item for complete abstract)

Committee: David Huron PhD (Advisor); Lora Gingerich Dobos PhD (Committee Member); David Clampitt PhD (Committee Member) Subjects: Music; Psychology

Doctor of Philosophy (PhD), Ohio University, 2003, Curriculum and Instruction (Education)

The retention of mental health professionals stands as a major problem in rural areas. Although a number of studies have examined the retention of rural allied health professionals and physicians, few, if any, have looked specifically at rural mental health providers. Two major contributing factors cited in the literature are (1) isolation of practitioners (both personal and geographic) and (2) lack of educational activities for professional development and continuing education. One solution suggested in the literature is the use of technology to address the needs of rural practitioners such as isolation, little or no access to experts and consultants, lack of peer support, and difficulty obtaining education and career development programs. This study examined(1) technology use and expertise in relationship to job satisfaction and (2) the difference in job satisfaction between mental health providers who state that they plan to remain in rural practice and those who plan to leave within two years. Three hundred and twenty rural mental health providers in southeast Ohio were surveyed, of which 163 returned usable surveys. The study did find a significant, but weak, relationship between technology use and expertise and job satisfaction, but no significant difference in job satisfaction between those who plan to stay and those who plan to leave their rural practice within the next two years. The study found that, despite the fact that over 90% of respondents have access to both a computer and the Internet, they are not using them to communicate with friends or peers nor are they accessing professional resources and educational programs via the internet or other distance technology. Two other factors emerged that influence job satisfaction, household income and years in rural practice, neither of them cited as significant contributors in the retention literature. This study raises questions about the use of technology as a tool to improve job satisfaction and thus reten (open full item for complete abstract)

Committee: Sandra Turner (Advisor) Subjects:

Psy. D., Antioch University, 2009, Antioch Seattle: Clinical Psychology

Due to continued fragmentation and gaps in mental health services and the increase in the prevalence of mental health problems for children, youth, and their families, these populations remain underserved. In 2003, the federal New Freedom Commission (Commission) responded by publishing policies to address these concerns. As directed in 2005, the Substance Abuse and Mental Health Services Administration (SAMHSA) funded planning incentive grants to states to transform their delivery of care.The study reviewed the federal policy, specifically the recommendations of the Commission's Subcommittee on Children and Families, and Washington State's policy and implementation actions of its five-year SAMHSA incentive grant. The method included searching, reviewing, and analyzing the literature on the topic published since approximately 2002. The analysis distilled the recommended determinants in children's mental health care transformation: prevention, early intervention, and screening in child welfare (juvenile justice and foster care) strategies; evidence-based practices; geographic disparities; workforce barriers; cultural competence aspirations; and consumer, schoolbased mental health, and primary care providers' role expectations. Despite innumerable studies, policies and services remain fragmented with gaps. The following topics from the outcome data require continuing attention: increasing the 2 cultural competency of professional services that are efficacious, and designing and promulgating measures for evidence-based practice specific to children. Three themes emerged regarding how to serve children's mental health needs in Washington State in a more efficacious manner. Within the penumbras of cultural competency and outcome-based measures, constructs for evidence-based practice for children need to be age-developmentally appropriate. Simultaneously, both the family role and venues of service delivery need to be considered, e.g., schools, out-of-home placement, and c (open full item for complete abstract)

Committee: Liang Tien Psy. D. (Committee Chair); Margaret Heldring Ph.D. (Committee Member); Molly Reid Ph.D. (Committee Member) Subjects: Mental Health; Psychology