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.