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The Coaching The Coaching RelationshipRelationship
Lessons from the Diabetes Prevention Lessons from the Diabetes Prevention ProgramProgram
Shandiin Begay, MPHShandiin Begay, MPH
Denver, CO Denver, CO
Health Coaching ModelHealth Coaching Model The health coaching model uses a team The health coaching model uses a team
of health professionals to assist patients of health professionals to assist patients in making behavior changes to improve in making behavior changes to improve their health.their health.
An assigned health coach works with the An assigned health coach works with the patient and multi-disciplinary team to patient and multi-disciplinary team to work collaboratively with the patient to work collaboratively with the patient to create a health plan by helping them to create a health plan by helping them to identify barriers and establish goals to identify barriers and establish goals to change health related behaviors. change health related behaviors.
Health Coaching Health Coaching ModelModel
RN Directed Physician Centric Multi Disciplinary Health Coaching
Constraints on physician time and resources do
not allow for the in-depth counseling and assistance
necessary for the effective treatment of chronic illnesses
RN gives didactic Telephonic education
Without assessingMember motivation or underlying barriers to
change
Health coaching is aMulti-disciplinary,
Facilitative approachTo enhance members’Ability to self-manage
conditions
The Health Coaching Model The Health Coaching Model uses the team to coach uses the team to coach
participants in making difficult participants in making difficult behavior changes to improve behavior changes to improve
their health.their health.
An assigned health coach works An assigned health coach works with the participant and team to with the participant and team to identify barriers, establish goals, identify barriers, establish goals, and work together to develop a and work together to develop a
plan.plan.
What is a coach?What is a coach?
““A coach is someone who motivates A coach is someone who motivates you, provides unconditional support, you, provides unconditional support, identifies your strengths and helps identifies your strengths and helps you build upon them, shines a light you build upon them, shines a light on what's holding you back and helps on what's holding you back and helps you see your way clear, and partners you see your way clear, and partners with you to discover the creative with you to discover the creative solutions you need to achieve your solutions you need to achieve your goals.”goals.”
Coaching ConceptCoaching Concept
ParticipantParticipant– Actively involved in their careActively involved in their care– Verbalizes reasons for changeVerbalizes reasons for change
““Co-Healers” CoachCo-Healers” Coach– The professional doesn’t carry all the The professional doesn’t carry all the
responsibilityresponsibility– A collaborative relationship, not adversarialA collaborative relationship, not adversarial– A way of being; not a series of techniquesA way of being; not a series of techniques
Behavior changeBehavior change– Discussed in safe wayDiscussed in safe way– Uses an interpersonal contextUses an interpersonal context
Promotes and reinforces individual Promotes and reinforces individual capabilitiescapabilities
Who can be a coach?Who can be a coach?
Professionals were used in the DPPProfessionals were used in the DPP Paraprofessional helped supportParaprofessional helped support Translation in American Indian Translation in American Indian
communities have used bothcommunities have used both The coach needs to be supported by The coach needs to be supported by
a teama team
How much work is it?How much work is it?
One-on-One contact with coachOne-on-One contact with coach DPP Research generally a 1:20 ratioDPP Research generally a 1:20 ratio Groups: estimate 8-10 hours per Groups: estimate 8-10 hours per
classclass Travel time not includedTravel time not included
What to look for in a CoachWhat to look for in a Coachprofessional or paraprofessionalprofessional or paraprofessional
Be friendly and acceptingBe friendly and accepting Be optimisticBe optimistic Model healthy behaviorsModel healthy behaviors Follow through with what you say you’ll doFollow through with what you say you’ll do Hold accountable in a non-threatening wayHold accountable in a non-threatening way Be able to work with a teamBe able to work with a team Be willing to persevere and endureBe willing to persevere and endure Believe people can lose weightBelieve people can lose weight Believe that those you work with can Believe that those you work with can
changechange
Coaching in a Variety of Coaching in a Variety of SettingsSettings
““How’s that workin’ for How’s that workin’ for ya?”ya?”
- Dr. Phil- Dr. Phil
Characteristics of a Health Characteristics of a Health Coach and Participant Coach and Participant
RelationshipRelationship Building TrustBuilding Trust Facilitating ChangeFacilitating Change Valuing DiversityValuing Diversity CommunicationCommunication Gaining CommitmentGaining Commitment Problem SolvingProblem Solving Revisiting and AdjustingRevisiting and Adjusting Building on SuccessBuilding on Success
Building TrustBuilding Trust
Establishing The NormsEstablishing The Norms
Establish a good rapport Establish a good rapport – Ex. - Greeting, snacks, Ex. - Greeting, snacks,
Review group guidelines and Review group guidelines and appropriate group behaviorappropriate group behavior
Caring, safe supportive atmosphereCaring, safe supportive atmosphere Reinforce need for confidentialityReinforce need for confidentiality Attendance, punctuality, referring to Attendance, punctuality, referring to
contractcontract
Facilitating ChangeFacilitating Change
Coaching ClassCoaching Class Interactive Interactive Utilize the skills of Motivational Utilize the skills of Motivational
Interviewing (MI) & Problem SolvingInterviewing (MI) & Problem Solving Build on what was already learned from Build on what was already learned from
the previous session(s)the previous session(s) Change seating arrangements, if Change seating arrangements, if
necessary, to accommodate lesson plannecessary, to accommodate lesson plan Identify and discuss individual roadblocks Identify and discuss individual roadblocks
from previous weekfrom previous week Use tools – Keeping Track booksUse tools – Keeping Track books
Valuing DiversityValuing Diversity
CommunicationCommunication
We know “What”, we don’t We know “What”, we don’t know “Why.”know “Why.”
Stories offer Meaning.Stories offer Meaning.
Delivering the messageDelivering the message
7% Words we use7% Words we use38% Tone of voice38% Tone of voice55% Body language55% Body language
Communi-coaching
•Communicating styles
•Verbal/Nonverbal
•Listening for the sake of listening
Opening StrategiesOpening Strategies
Ask open ended questionsAsk open ended questions Listen reflectivelyListen reflectively Summarize-reflect what you heardSummarize-reflect what you heard AffirmAffirm Elicit self motivating statementsElicit self motivating statements
Eliciting Eliciting Self-Motivating StatementsSelf-Motivating Statements
Ask probing questionsAsk probing questions Explore pro’s and con’sExplore pro’s and con’s Ask for elaborationAsk for elaboration Imagine extremesImagine extremes Look forwardLook forward Look backLook back
Attending Empathizing Summarization
Questions
Genuiness
Confrontation
Problem Solving
Basic Listening Skills
Gaining CommitmentGaining Commitment
Problem SolvingProblem Solving
Lifestyle Core Session #9:Lifestyle Core Session #9:Problem SolvingProblem Solving
The five steps to solving a problem:The five steps to solving a problem:
1.1.Describe the problem in detail.Describe the problem in detail.
2.2.Brainstorm your options.Brainstorm your options.
3.3.Pick one option to try.Pick one option to try.
4.4.Make a positive action plan.Make a positive action plan.
5.5.Try it. See how it goes. Try it. See how it goes.
Problem SolvingProblem SolvingSusie’s Action ChainSusie’s Action Chain
Works at home alone Works at home alone all weekall week
Friend invites to weekly Friend invites to weekly casino outingcasino outing
Didn’t eat before she Didn’t eat before she left homeleft home
Chose buffet over other Chose buffet over other choices (better deal)choices (better deal)
Saw friend’s big plate Saw friend’s big plate of everythingof everything
Over ate Over ate Gave up Gave up
Building on SuccessBuilding on Success
Revisit and Adjusting PlanRevisit and Adjusting Plan
Additional Ideas to ConsiderAdditional Ideas to Consider
Provide Tools to Achieve Provide Tools to Achieve GoalsGoals
Home weight scales, measuring cups Home weight scales, measuring cups and spoons and food scalesand spoons and food scales
Visual weight loss and exercise graphsVisual weight loss and exercise graphs Monthly exercise calendarsMonthly exercise calendars Weekly Menu plannersWeekly Menu planners PedometersPedometers Keeping Track books and fat counter Keeping Track books and fat counter
books and nutrition in the Fast Lanebooks and nutrition in the Fast Lane
Keeping People MotivatedKeeping People Motivated
Reinforce the “process” of weight Reinforce the “process” of weight lossloss
Never give up on peopleNever give up on people Take breaksTake breaks Remember life happens and is Remember life happens and is
dynamicdynamic For missed visits deal with ASAPFor missed visits deal with ASAP
Lifestyle MaintenanceLifestyle Maintenance
Continued self-monitoring and other Continued self-monitoring and other behavioral strategiesbehavioral strategies
Frequent contactFrequent contact
Group classes and motivational Group classes and motivational
campaignscampaigns
Tool box strategiesTool box strategies
““When advice alone is not When advice alone is not enough”enough”
QUESTIONS??QUESTIONS??
SMALL STEPSSMALL STEPSBIG REWARDSBIG REWARDS
The risk is The risk is great.great.
The goals are The goals are important.important.
The changes are The changes are modest.modest.
The action steps The action steps are clear.are clear.
That doesn’t That doesn’t make it easy for make it easy for you, but the DPP you, but the DPP
demonstrated demonstrated that it can be that it can be
done.done.NIH Pub. No. 03-5335 Feb NIH Pub. No. 03-5335 Feb
20032003
Ongoing thanks to Ongoing thanks to the DPP participants the DPP participants and tribal community and tribal community partners for their partners for their commitment and commitment and dedication to the dedication to the goal of diabetes goal of diabetes prevention.prevention.