Health Coaching in Case Management

004 -Health Coaching in Case Management
Health Coaching
Case Management Toolbox Podcast
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs Continuing Education
Host: Case Management Toolbox Podcast & Counselor Toolbox Podcast

CEUs can be earned for this podcast here: https://allceus.com/member/cart/index/product/id/1125/c/

Objectives
– Explain what health coaching is
– Differentiate it from counseling or medical practice
– Describe different skills a health coach needs
– Discuss how to develop an individualized service plan

Give a man a fish, he eats for a day.
Teach a man to fish, he eats for a lifetime.

Overview of Health Coaching
– Health coaches:
– Providing self-management support
– Educate clients
– Bridge the gap between clinician and patient
– Help patients navigate the health care system
– Offering support and encouragement
Health Coaching Research
– Significant improvements in one or more of the following
– Nutrition
– Physical activity
– Weight management
– Exercise frequency
– Perceived social support
– Patient engagement and “activation”
– Medication adherence
– Common features of effective programs are goal setting, motivational interviewing, and collaboration with health care providers

– The Care Transitions Intervention is a widely-used coaching method that imparts skills, tools and confidence to patients and family caregivers as they move from hospital to home.13 It is focused on “four pillars”:
– Having an effective, understandable management strategy
– Overcoming barriers to follow-up appointments,
– Knowing how to recognize and respond to worsening signs and symptoms
– Using a personal health record to identify and record 30-day goals, health information and key questions to be shared with the physician at upcoming health care encounters.

Goal Attainment Scaling
Educate Clients
– Help clients learn where to find reliable, valid information about their concerns or conditions
– Help clients learn how to evaluate that information
– Educate clients about the impact of nutrition, sleep, exercise, sunlight, relaxation, thoughts and mood on their condition and their goals
– Teach clients about SMART Goals
– Teach clients about motivational enhancement
Patient Centered Care: Engagement & Rapport
– Employ a person centered model
– Respect for client as an individual (UPR)
– Respect for client’s preferences for goals and interventions
– Collaborative approach providing choice and self-determination
– Coordination and integration of care
– Validation, support, encouragement, empathy
– Involvement of social supports
Enhancing Motivation
– Emotional (How will this help client be happier-)
– Mental (How does this make sense to the client-)
– Physical (How can this improve the client’s health and energy-)
– Social (How will it enhance important relationships- Who is supportive of this change-)
– Environmental (What things can be placed in the environment to enhance motivation)
– Spiritual (In what ways does this change help the client live more in harmony with personal values and feel a greater sense of connection-)
Motivational Techniques (ROADS)
– Reflective Listening
– Open Questions
– Affirmations of Self-efficacy and Optimism
– Develop Discrepancy
– Summarizing
Adult Learning Theory
– Provide explanations of why specific concepts are being taught
– Ensure learning that is connected to their health goals (make room for meaning)
– Use self-assessments to assess different levels of prior experience and education
– Remember prior learning will be the filter with which they conceptualize new information
– Use multiple methods of instruction (auditory, visual, kinesthetic)
– Ensure access to sufficient resources
– Adult students prefer a self-directed approach that allows for discovery on their own.

Behavior Change Theory
– When presented with a need to act (behave) people choose the most rewarding
– One issue many people have is delay of gratification. They choose what is most rewarding in the moment instead of overall.
– Rewards (reinforcers) encourage a behavior to be repeated
– Consequences (punishments) discourage a behavior
– Stimuli prompt a person to engage in a behavior
Behavior Change Examples
– Emotional Eating
– Food is associated with pleasure and happy times
– Food is readily available (stimulus)
– When people are stressed or bored the sight or smell of food IRL or in the media can prompt eating behaviors
– Habit
– Sally smokes a cigarette when she is driving to work, after lunch, on the way home from work, after dinner and before bed “to relax”
– Smoking strongly activates pleasure centers in the brain
– Triggers: Car, meal time, when she needs to relax
– Goal: Make not smoking more rewarding and less punishing
Readiness for Change
– Precontemplation
– I don’t have a problem with my blood sugar. The test must be wrong
– Contemplation
– My symptoms are not that bad. I can control it by eating healthier.
– Preparation
– I am having difficulty controlling my blood sugar and I don’t want it to get worse. Let me evaluate my treatment options.
– Action
– I need information and tools to help me manage my blood sugar and make better lifestyle choices
– Maintenance
– I know what I need to do. I just need to maintain the motivation and willingness to do it.
– Relapse*
– I am starting to fall back into old habits or “cheat” on my plan.
Creating a Wellness Vision
– Describe your body and mind in their ideal state
– What would you look and feel like-
– What types of things would you be doing (or not doing)-
– What are the most important elements in your vision-
– Why are these elements important- (i.e. How will they improve your life-)
– Which one do you want to work on first-
– On a scale of 1-5 what is your level of confidence you can achieve this-
– What types of assistance might you need in achieving it-
– What obstacles do you anticipate and how can you deal with them-
– What strengths and resources do you have that will help you accomplish these goals
Visualize Goals
– Pictures/collages/scrapbooks
– Push notifications
– Narratives
– Charts
– Mental Imagery
Goal Setting
– KSAs
– Knowledge of
– Physical, emotional, cognitive, behavioral factors that exacerbate and mitigate the problem
– Physical, emotional, cognitive, behavioral factors that enhance goal attainment
– Skills
– Abilities

Goal Setting
– SMART
– Specific
– Measurable
– Achievable
– Relevant
– Time Limited
Scaffolding (GROW-ME)
– Goals are specific and shared
– Rescue (Help) is immediately available
– Optimal level of help
– Encourage self-efficacy
– Concrete prompts
– Use prior knowledge
– Use preferred learning method
– Whole-task, holistic approach
– Cognitive: What is the goal-
– Emotional: What are your concerns- Elicit confidence.
– Behavioral: What do you need to do-
– Model desired behaviors
– Empower to take chances

Behavioral Health & Chronic Conditions
– Treatment plan developed by a clinician OR by an individual for wellness enhancement
– Overcoming barriers to participation: Follow-up appointments, homework assignments
– Knowing how to recognize and respond to worsening signs and symptoms
– Using a personal health record to
– Identify 30-day goals and record progress
– Journal health information (nutrition, sleep, mood, etc)
– Key questions to be shared with the physician/therapist at upcoming health care encounters(including annual exam),

Health Coaching: Self-Improvement
– Help client identify goals for 30, 60, 90 days
– Develop an effective, understandable management strategy based on SMART goals
– Overcoming barriers to achievement including prior failures
– Identify triggers for and signs and symptoms of backsliding/relapse and develop a prevention/ intervention plan
– Have client record
– progress toward 30-day goals daily
– health information
– key questions to be shared with the physician at upcoming health care encounters.

Sample Wellness Plan
– Wellness Vision: Have good energy, maintain mental functioning, stay physically healthy (sleep, nutrition, exercise, stress management, smoking cessation)
– Six month goals
– Three month goals
– One month goals
– This weeks goals: Do what, how often, how much
– Log
– What I did for each of my goals
– My energy 1-5
– My ability to concentrate and remember 1-5
– My weight
– My blood pressure

Summary
– Health coaching is a valuable resource to improve client retention and success
– Health coaches can help with treatment plan implementation, relapse prevention
– Health coaches have the opportunity to
– Increase people’s health literacy
– Teach people how to enhance motivation
– Teach people how to set SMART goals
– Help people attain those goals