Challenging assumptions about habit: A response to Hagger (2019)

Widely cited literature assumes habits to be: (1) specific and rigid behavioral responses; (2) in response to location- and timing-stable, external contexts, (3) goal-independent, and (4) enacted without conscious awareness. Hagger (2019) recently reviewed this literature as it applies to the physical activity domain. The purpose of this article is to challenge these assumptions in favor of a habit conceptualization that is more applicable to physical activity: (1) behavioral instigation and/or execution can be habitual, allowing for variable responses to cues; (2) stable contexts can be internal or functional (cued by a preceding action) but may vary in timing and physical location; (3) a shift from external to internal goal dependence may characterize habit development; and (4) types of automaticity other than purely nonconscious enactment may characterize habitual action. I present theory and research that supports these alternative characterizations and discuss their ramifications for physical activity adoption and maintenance via habit

Supporting professional development using the VLE in the PGCE/Certificate in Education

This case study is based in Coleg Glan Hafren and focuses on the Post-Compulsory Education and Training Programme franchised from the University of Wales, Newport (UWN). This is a case study into E-Learning Practice in the area of HE in FE. Funding was provided by DeL (JISCs Distributed e-Learning Programme). These case studies are intended to illustrate good/innovative practice in the delivery of HE in FE using e-learning. It concludes that e-learning, coupled with close professional relationships between all parties, can provide an innovative experience for various learners. The fact that the material is online is not paramount to success, and technology itself can cause problems, but with good liaison and support it can offer any time anywhere access for students, and empower them with skills immediately transferable in their own classrooms as teachers. It is presented as a final project report of some 10 page

Australian threshold quantities for ‘drug trafficking’: are they placing drug users at risk of unjustified sanction?

This study uses data on patterns of drug user consumption and purchasing to evaluate Australian legal threshold quantities to see whether Australian drug users are at risk of exceeding the thresholds for personal use alone. Introduction Drug trafficking in Australia is deemed a very serious offence, one for which legislators and courts have ruled general deterrence is paramount and ‘little mercy’ should be shown. A principal challenge has been how to effectively differentiate and sanction participants in the drug trade—particularly how to differentiate ‘traffickers’ from those who consume or purchase illicit drugs for personal use alone. To assist in this endeavour, all Australian states and territories have adopted legal thresholds that specify quantities of drugs over which offenders are either presumed to have possessed the drugs ‘for the purposes of supply’ and liable to sanction as ‘drug traffickers’ (up to 15 years imprisonment in most states), or in the case of Queensland, liable to sanctions equivalent to drug traffickers (up to 25 years imprisonment). Yet, in spite of known risks from adopting such thresholds, particularly of an unjustified conviction of a user as a trafficker, the capacity of Australian legal thresholds to deliver proportional sanctioning has been subject to limited research to date. This paper summarises key findings from a Criminology Research Grant funded project. The broader project examined this issue in two different ways—whether the thresholds are designed to filter traffickers from users and whether they enable appropriate sanctioning of traffickers of different controlled drugs. Herein, the focus is on the former—to what extent Australian legal thresholds unwittingly place users at risk of unjustified and disproportionate charge or sanction as traffickers

Re-remembering Australia: Public memorials sharing difficult knowledge

This paper explores a new genre of public memorials: those which commemorate lived experiences of loss and trauma. This work contributes to the growing body of literature on memory work in settler-colonial and transitional justice settings. Transitional justice has become an internationally accepted framework for societies attempting to move from civil conflict to peaceful democracy. While Australia’s (post)settler-colonial context does not fit this description, transitional justice mechanisms have been widely adopted as a means of coming to terms with the nation’s past. I offer four short case studies through which I discuss memorials that acknowledge human rights abuses, and consider the kinds of cultural ‘work’ such memorials are expected to do in the present. Firstly, public memorials are used by marginalised counterpublics to claim a space in the national story. Secondly, they are used to create spaces where survivors of human rights abuses can have their loss acknowledged and be given space to grieve. Thirdly, they are used as acts of witnessing, to speak back into the dominant public sphere. Finally, and more recently, memorials have been created by governments as part of the widespread adoption of transitional justice mechanisms. Such memorials are seen as acts of symbolic reparations and used to respond to claims of past human rights abuse on the part of the state

Medicaid Expansion, Medicaid Reimbursement Methodologies, and Counselor Employment at Federally Qualified Health Centers

Advocacy for the counseling profession necessitates a thorough understanding of the factors influencing the hiring and reimbursement of licensed professional counselors. The Patient Protection and Affordable Care Act (ACA) enacted several health care reforms that may influence the utilization of mental health services and the employment of mental health professionals. These reforms included the option for states to expand their Medicaid population (effective January 1, 2014), mental health parity requirements for most insurance plans including Medicaid plans, and increased funding for Federally Qualified Health Centers (FQHCs or health centers). FQHCs, created by Congress in 1989, provide primary care services, including mental health services, to approximately 24 million Americans annually and function as a vital safety net for medically underserved communities and populations. The largest source of revenue for FQHCs is Medicaid, and FQHCs receive enhanced reimbursement for services provided to Medicaid patients, known as the Medicaid Prospective Payment System (PPS) rate. Federal law, however, explicitly approves only certain health care professions as billable PPS providers. Licensed clinical social workers (LCSWs), along with psychologists and psychiatrists, are included as billable PPS providers under federal law, but not licensed professional counselors (LPCs). Some states have expanded the list of health care professions able to generate billable PPS encounters at FQHCs to include licensed professional counselors. It is vital for the counseling profession to understand the impact of these reforms and the interplay of federal and state policies related to reimbursement upon the mental health industry. The optional Medicaid expansion provision of the ACA created an opportunity for a natural experiment to compare mental health service utilization and employment at FQHCs in Medicaid expansion states versus non-Medicaid expansion states. This quasiexperimental study first tested the causal impact of Medicaid expansion on the number of mental health visits and full-time equivalent (FTE) mental health staff at FQHCs, using state-level data gathered from FQHC reports submitted annually to the Uniform Data System. A count model difference-in-differences analysis strategy compared utilization and employment numbers in 2012-2013 (pre-Medicaid expansion) and 2014-2015 (post- Medicaid expansion) between Medicaid expansion states and non-Medicaid expansion states. Then, a two-sample test of proportions utilizing data from a research-developed employment survey examined the relationship between states approving counselors and states not approving counselors as billable FQHC mental health providers under the enhanced PPS reimbursement and the proportion of LPCs at FQHCs (of the total number of LPCs and LCSWs). In both groups of states (Medicaid expansion states and non-Medicaid expansion states), it was evident that there was a substantial increase in the number of mental health visits and FTE mental health staff at FQHCs from 2012 to 2015. Contrary to prediction, the first count model difference-in-differences analysis indicated that non-Medicaid expansion states had a significantly higher rate of change in the number of mental health visits from pre-Medicaid expansion (2012-2013) to post-Medicaid expansion (2014- 2015), as compared to Medicaid expansion states (α = .05, p = .01). Then, contrary to prediction, the second count model difference-in-differences analysis indicated that there was not a significant difference in the rate of change for the number of FTE mental health staff between Medicaid expansion states and non-Medicaid expansion states from pre- Medicaid expansion (2012-2013) to post-Medicaid expansion (2014-2015; α = .05, p = .13). As predicted, the two-sample test of proportions resulting from the survey responses of 138 FQHCs (60% response rate) indicated that there was a significantly higher proportion of LPCs employed at FQHCs in states approving LPCs as billable FQHC mental health providers under PPS as compared to states not approving LPCs ( = 4.24, p \u3c .001, Cohen’s h = .76). Thus, counselor employment at FQHCs was significantly improved in those states approving counselors as billable PPS providers. It is essential for counselors to understand the impact of federal and state health care policies, such as Medicaid expansion, increased funding of FQHCs, and various Medicaid reimbursement methodologies, to successfully advocate for the profession in the dynamic health care landscape. Counselor educators have a responsibility to convey information to students related to the potential repercussions of billable mental health provider status on their employment opportunities following graduation

Clinical leadership training: an evaluation of the Welsh fellowship programme

Background These days doctors are required not only to be clinically proficient, but also motivate teams, influence service delivery and improve patient care. In the UK, Fellowship schemes have been set up to address a low level of engagement of doctors with leadership roles. Established in 2013, the Welsh Clinical Leadership Fellowship (WCLF) programme aims to recruit aspiring future clinical leaders and equip them with knowledge and skills to lead improvements in healthcare delivery. Aim Our aim was to evaluate the 12-month WCLF programme in its first two years of operation. Focused on the participants (n=8), we explored expectations of the leadership programme, reactions to the academic component (provided by Academi Wales) and learning from workplace projects and other opportunities. Method We adopted a qualitative approach, collecting data from four focus groups, 20 individual face-to-face or telephone interviews with fellows and project supervisors, and observation of Academi Wales training days. Results Although from diverse specialties and stage in training, all participants reported the Fellowship met expectations. Fellows learned leadership theory, developing understanding of leadership and teamwork in complex organisations. Through workplace projects, they applied their knowledge, learning both from success and failure. The quality of communication with fellows distinguished the better supervisors and impacted on project success. Conclusion The WCLF programme addresses both the need for leadership theory (through the Academi Wales training) and the application of learning through the performance of leadership roles in the projects

Stroke and TIA survivors’ cognitive beliefs and affective responses regarding treatment and future stroke risk differentially predict medication adherence and categorised stroke risk

Cognitive beliefs and affective responses to illness and treatment are known to independently predict health behaviours. The purpose of the current study is to assess the relative importance of four psychological domains – specifically, affective illness, cognitive illness, affective treatment and cognitive treatment – for predicting stroke and transient ischemic attack (TIA) survivors’ adherence to stroke prevention medications as well as their objective, categorised stroke risk. We assessed these domains among stroke/TIA survivors (n = 600), and conducted correlation and regression analyses with concurrent and prospective outcomes to determine the relative importance of each cognitive and affective domain for adherence and stroke risk. As hypothesised, patients’ affective treatment responses explained the greatest unique variance in baseline and six-month adherence reports (8 and 5%, respectively, of the variance in adherence, compared to 1–3% explained by other domains). Counter to hypotheses, patients’ cognitive illness beliefs explained the greatest unique variance in baseline and six-month objective categorised stroke risk (3 and 2%, respectively, compared to 0–1% explained by other domains). Results indicate that domain type (i.e. cognitive and affective) and domain referent (illness and treatment) may be differentially important for providers to assess when treating patients for stroke/TIA. More research is required to further distinguish between these domains and their relative importance for stroke prevention

Longitudinal Impact of Welsh Clinical Leadership Fellowship

Purpose This paper aims to evaluate the longer-term impact of the 12-month Welsh clinical leadership fellowship. Design/methodology/approach Semi-structured interviews with 10 out of 14 trainee doctors who were fellows between 2013-2016, exploring how leadership knowledge and skills were used in clinical practice, impact on patient care and influence on careers. Data, gathered in 2017 when participants had completed the fellowship between 1-3 years, were analysed thematically. Findings All found the fellowship rewarding. The experience was felt to advantage them in consultant interviews. They gained insight into the wider influence on organisations and the complexity of issues facing senior clinicians. Although subtle, the impact was significant, equipping fellows with negotiation skills, enabling them to better influence change. Indirect impact on clinical practice was evidenced by enhanced confidence, teamworking skills and progression of improvement projects. However, the use of skills was limited by lack of seniority within teams, demands of medical training and examinations. The negativity of others towards management and leadership was also noted by some