The Coaching Relationship Lessons from the Diabetes Prevention Program Shandiin Begay, MPH Denver, CO

Health Coaching Model  The health coaching model uses a team of health professionals to assist patients in making behavior changes to improve their health.  An assigned health coach works with the patient and multi-disciplinary team to work collaboratively with the patient to create a health plan by helping them to identify barriers and establish goals to change health related behaviors.

Health Coaching Model 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 assessing Member motivation or underlying barriers to change Health coaching is a Multi-disciplinary, Facilitative approach To enhance members’ Ability to self-manage conditions

The Health Coaching Model uses the team to coach participants in making difficult behavior changes to improve their health. An assigned health coach works with the participant and team to identify barriers, establish goals, and work together to develop a plan.

What is a coach? “A coach is someone who motivates you, provides unconditional support, identifies your strengths and helps you build upon them, shines a light on what's holding you back and helps you see your way clear, and partners with you to discover the creative solutions you need to achieve your goals.” “A coach is someone who motivates you, provides unconditional support, identifies your strengths and helps you build upon them, shines a light on what's holding you back and helps you see your way clear, and partners with you to discover the creative solutions you need to achieve your goals.”

Coaching Concept Participant Participant –Actively involved in their care –Verbalizes reasons for change “Co-Healers” Coach “Co-Healers” Coach –The professional doesn’t carry all the responsibility –A collaborative relationship, not adversarial –A way of being; not a series of techniques Behavior change Behavior change –Discussed in safe way –Uses an interpersonal context Promotes and reinforces individual capabilities Promotes and reinforces individual capabilities

Who can be a coach?  Professionals were used in the DPP  Paraprofessional helped support  Translation in American Indian communities have used both  The coach needs to be supported by a team

How much work is it?  One-on-One contact with coach  DPP Research generally a 1:20 ratio  Groups: estimate 8-10 hours per class  Travel time not included

What to look for in a Coach professional or paraprofessional  Be friendly and accepting  Be optimistic  Model healthy behaviors  Follow through with what you say you’ll do  Hold accountable in a non-threatening way  Be able to work with a team  Be willing to persevere and endure  Believe people can lose weight  Believe that those you work with can change

Coaching in a Variety of Settings

“How’s that workin’ for ya?” - Dr. Phil - Dr. Phil

Characteristics of a Health Coach and Participant Relationship  Building Trust  Facilitating Change  Valuing Diversity  Communication  Gaining Commitment  Problem Solving  Revisiting and Adjusting  Building on Success

Building Trust

Establishing The Norms Establish a good rapport Establish a good rapport –Ex. - Greeting, snacks, Review group guidelines and appropriate group behavior Review group guidelines and appropriate group behavior Caring, safe supportive atmosphere Caring, safe supportive atmosphere Reinforce need for confidentiality Reinforce need for confidentiality Attendance, punctuality, referring to contract Attendance, punctuality, referring to contract

Facilitating Change

Coaching Class Interactive Interactive Utilize the skills of Motivational Interviewing (MI) & Problem Solving Utilize the skills of Motivational Interviewing (MI) & Problem Solving Build on what was already learned from the previous session(s) Build on what was already learned from the previous session(s) Change seating arrangements, if necessary, to accommodate lesson plan Change seating arrangements, if necessary, to accommodate lesson plan Identify and discuss individual roadblocks from previous week Identify and discuss individual roadblocks from previous week Use tools – Keeping Track books Use tools – Keeping Track books

Valuing Diversity

Communication

We know “What”, we don’t know “Why.” Stories offer Meaning.

Delivering the message 7% Words we use 7% Words we use 38% Tone of voice 38% Tone of voice 55% Body language 55% Body language

Communi-coaching Communicating styles Verbal/Nonverbal Listening for the sake of listening

Opening Strategies Ask open ended questions Ask open ended questions Listen reflectively Listen reflectively Summarize-reflect what you heard Summarize-reflect what you heard Affirm Affirm Elicit self motivating statements Elicit self motivating statements

Eliciting Self-Motivating Statements Ask probing questions Ask probing questions Explore pro’s and con’s Explore pro’s and con’s Ask for elaboration Ask for elaboration Imagine extremes Imagine extremes Look forward Look forward Look back Look back

Attending Empathizing Summarization Questions Genuiness Confrontation Problem Solving Basic Listening Skills

Gaining Commitment

Problem Solving

Lifestyle Core Session #9: Problem Solving The five steps to solving a problem: 1.Describe the problem in detail. 2.Brainstorm your options. 3.Pick one option to try. 4.Make a positive action plan. 5.Try it. See how it goes.

Problem Solving Susie’s Action Chain  Works at home alone all week  Friend invites to weekly casino outing  Didn’t eat before she left home  Chose buffet over other choices (better deal)  Saw friend’s big plate of everything  Over ate  Gave up

Building on Success

Revisit and Adjusting Plan

Additional Ideas to Consider

Provide Tools to Achieve Goals  Home weight scales, measuring cups and spoons and food scales  Visual weight loss and exercise graphs  Monthly exercise calendars  Weekly Menu planners  Pedometers  Keeping Track books and fat counter books and nutrition in the Fast Lane

Keeping People Motivated Reinforce the “process” of weight loss Reinforce the “process” of weight loss Never give up on people Never give up on people Take breaks Take breaks Remember life happens and is dynamic Remember life happens and is dynamic For missed visits deal with ASAP For missed visits deal with ASAP

Lifestyle Maintenance  Continued self-monitoring and other behavioral strategies  Frequent contact  Group classes and motivational campaigns  Tool box strategies

“When advice alone is not enough”

QUESTIONS??

SMALL STEPS BIG REWARDS

The risk is great.

The goals are important.

The changes are modest.

The action steps are clear.

That doesn’t make it easy for you, but the DPP demonstrated that it can be done. NIH Pub. No Feb 2003

Ongoing thanks to the DPP participants and tribal community partners for their commitment and dedication to the goal of diabetes prevention. Ongoing thanks to the DPP participants and tribal community partners for their commitment and dedication to the goal of diabetes prevention.