Hide

Error message here!

Lost your password? Please enter your email address. You will receive a link to create a new password.

Error message here!

Back to log-in

Close

Health Coaching Support for Alzheimer’s Patients and Caregivers

Alzheimer Concept.The emotional journey of facing a diagnosis such as Alzheimer’s disease or dementia can be overwhelming for both the patient and their families. Feelings of fear, stress, anxiety and loss can overpower all individuals involved and the ability to have questions answered is essential to easing these emotions.

Although there are a multitude of support groups available through local community organizations, access, availability, and comfort level of participating in a group setting can all be barriers to participation. A health coach can be a crucial lifeline to supporting the needs of both the family and the patient.  Health coaching services can be made available either 1:1 with the patient, loved one or as a family in which everyone is able to process many common issues facing Alzheimer’s patients.

This can include but are not limited to:

  • Understanding and adjusting to the diagnosis
  • Future care plans/options
  • Medical options and support resources
  • Managing symptoms and keeping loved one’s safe
  • Caregiver balance and managing one’s own health needs
  • Financial planning for support and medical management

A health coach does not necessarily need to be an expert in Alzheimer’s disease per se, but rather, have the ability to connect their client to professional, expert resources in their area. Their common goal is to navigate the needs and connect families to trusted experts that can create a network of safety and security throughout the progression of the disease. The supportive ear of a trained health coach can be enough to provide assurance that help is available and neither the patient nor the caregiver(s) are alone in this journey. Often the health coach is available to meet in convenient settings (including in-home or telephonically) as they realize that transportation can be a barrier to accessing resources.

In addition to care navigation, the health coach can connect the family to therapeutic resources such as exercise facilities, memory classes, and social support systems that can contribute to overall quality of life and management of symptoms. Their expert advice can help to remove burdensome details and guide the process in a meaningful, manageable way whereby the caregiver and patient are able to focus on enjoying their time together.


Jaclyn Chadbourne, MA is a Clinical Exercise Physiologist and Principal, Director of Research and Development – ‎Universal Medical Technology, LLC and United Medical Gym, Inc in South Portland, ME. With a passion for sustainable healthy living and desire to advocate for patient-centered care, Jaclyn works to help support community resources for all special populations and to implement and oversee clinical protocols. 

man-counselor

Health & Wellness Coaching for Diabetes

Managing Diabetes can be very complex. How can the diabetes patient be successful at creating a solid lifestyle plan involving healthy nutrition, increased activity and effective medical management? A study published by American Diabetes Association, Clinical Diabetes, state’s “Controlling diabetes to reduce the incidence of its complications rests largely on individual patients and requires vigorous self-management of the disease. Unfortunately, without sustained support, few people achieve their goals or master the tasks that will allow them to live healthfully and reduce their risk of costly complications.”

Diabetes managementAccording to the New England Journal of Medicine, “Type 2 diabetes is increasingly common, primarily because of increases in the prevalence of a sedentary lifestyle and obesity. It was concluded that the reduction in the incidence of diabetes was directly associated with changes in lifestyle and that Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects.”

Diabetes self-management can be very overwhelming for the diabetic patient often leading to a sense of failure but there is help. A Health & Wellness Plan created together with a coach has proven to increase success in achieving healthier lifestyle behaviors and a greater quality of life.

While diabetes management can be overwhelming the Clinical Diabetes study results “revealed broad agreement among participants that their coach helped them figure out what to do to better control diabetes, that their coach’s encouragement was important in controlling diabetes, and that coaching was an important part of the overall program.”

Studies performed by Duke University, published by the New England Journal of Medicine, and the American Journal of Lifestyle Medicine suggest that working with a Health Coach improves medical management, patient engagement, social support, physical activity, diet, decreases stress, and reduces A1C scores. In addition, patient perception indicated positive improvements in overall personal health status, as well as, accomplishment of their goals when working with a health coach.

The Affordable Care Act recognizes that focusing on wellness and prevention is key to improving the health of Americans. The National Prevention Strategy is moving us from a system of sick care to one based on wellness and prevention. Many of the programs and initiatives now being funded include coaching. An example is the YMCA Diabetes Prevention Program that now includes Health Coaches within their team. We are now also finding coaches within insurance companies, such as UnitedHealth Group, Optima Health and Aetna due to success in improving diabetes control for the patient.

health-coaching-wordglobeWhat Can Health & Wellness Coaches Do for You?

Coaches work with diabetes patients in a variety of ways. In one example of coaching in a healthcare setting Dr. Heather Bennett and her team (in an American Academy of Family Physicians publication) described Health Coaching for patients as encompassing five principal roles:

  1. Providing self-management support
  2. Bridging the gap between clinician and patient
  3. Helping patients navigate the health care system
  4. Offering emotional support and support resources
  5. Serving as a continuity figure.

In Bennett’s model the role of health educator and the role of health and wellness coach was combined.

Providing self-management support
Self-management support is essential for patients to extend their health care outside the clinic walls and into their real lives. Coaches assist patients in seven domains of self-management support: providing information, teaching disease-specific skills, promoting healthy behaviors, imparting problem-solving skills, assisting with the emotional impact of chronic illness, providing regular follow-up and encouraging people to be active participants in their care. Patients have better health outcomes when provided with disease-specific knowledge and skills.

Bridging the gap between clinician and patient
Throughout the care process, there are plenty of opportunities for disconnects between the clinician and the patient. Prescribing medications is one example. It is a two-part endeavor: 1) writing prescriptions and 2) making sure patients obtain, understand and actually take the medications as prescribed. Physicians perform part one but lack time to address the critical second part. Health coaches can bridge these gaps by following up with patients, asking about needs and obstacles, and addressing health literacy, cultural issues and social-class barriers. Health Coaches help patients navigate the health care system. Many patients, particularly the elderly, disabled and marginalized, need a navigator to help locate, negotiate and engage in services. Coaches can help coordinate care and advocate with patients when their voices are not heard.

Offering emotional support
Coping with illness is emotionally challenging. Well-intentioned but rushed clinicians may fail to address patients’ emotional needs. As trust and familiarity grow, coaches can offer emotional support and help patients cope with their illnesses. They also assist patients in seeking out additional emotional support that will help them achieve and maintain success.

Woman Doing Stretching Exercises In Gym With Trainer

Serving as a continuity figure
Coaches connect with patients not only for office visits but also between visits, creating familiarity and continuity. This is particularly helpful in practices where clinicians work part-time or see one another’s patient. Coaches travel with the patient as an ally and assist them with staying the course while implementing their wellness plan.

Health & Wellness Coaches Can Help

Coaches facilitate a patient-directed process of evaluation and assessment, exploration, tracking and accountability to and assist in co-creating a plan that is tailored to the patient Health & Wellness Coaches work with a patient individually or in small groups. They help create a whole-life integrated wellness plan toward managing diabetes and bringing about the lifestyle changes needed for a healthier life. Coaches serve as an ally to help those challenged with diabetes follow through with their health & wellness plan so they can achieve their goals toward their best life possible.


References

Affordable Care Act – Department of Health & Human Services: www.hhs.gov

Bennett et al, Health Coaching for Patients With Chronic Illness. Fam Pract Manag. 2010 Sep-Oct;17(5):24-29.

MacLean et al, Telephone Coaching to Improve Diabetes Self-Management for Rural Residents. Clinical Diabetes. January 2012 vol. 30 no. 1 13-16.

Melko et al, American Journal of Lifestyle Medicine, March/April 2010; vol. 4, 2: pp. 187-194.

National Prevention Strategy, Clinical and Community Preventive Services, National Prevention Council 2010. www.surgeongeneral.gov/initiatives/prevention/strategy/preventive-services.pdf

National Prevention Council Action Plan: Implementing the National Prevention Strategy
www.surgeongeneral.gov/initiatives/prevention/2012-npc-action-plan.pdf

National Prevention Council, National Prevention, Health promotion, and Public Health Council, 2013 Annual Status Report. June 25, 2012. http://www.cdc.gov/features/PreventionCouncil

Sacco et al, Effect of a brief, regular telephone intervention by paraprofessionals for type 2 diabetes. Journal of Behavorial Medicine. August 2009, Volume 32, Issue 4, 349-359.

Tuomilehto et al, Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance .N Engl J Med 2001; 344:1343-1350.

Wolever et al, Integrative Health Coaching for Patients With Type 2 Diabetes A Randomized Clinical Trial. The Diabetes Educator July/August 2010 vol. 36 no. 4 629-639.

Doctor and patient

A New Code of Ethics For Health And Wellness Coaches: Healthy Boundaries, Part One

The old New England expression that “good fences make good neighbors” applies to the world of professions as well as it does to rows of piled rocks in the old fields and forests of places like Vermont and Maine. The concept of professional boundaries seems to expand the more you look into it. In this and a following post we will look at role definition, ethics and scope of practice, boundary crossings and violations, self-disclosure, and other issues from the unique perspective of the health and wellness coach.

Since its inception just over twenty years ago the ICF (International Coaching Federation) has developed a Code of Ethics which it revises on a regular basis. The ICF also maintains an Ethics Community of Practice where you can bring ethics questions and learn from presentations.

Law & Ethics in Coaching: How To Solve And Avoid Difficult Problems In Your Practice (2006) by Patrick Williams and Sharon K. Anderson houses considerably valuable information from the chief authors and other contributors.

With the development and growth of the field of health and wellness coaching, the question of ethics and scope of practice emerged with the realization that such coaches often face unique situations, sometimes interacting with the medical world, that require a fresh look. While the ICF Code of Ethics is to be embraced by all coaches, the need for something more became evident.

As an Executive Team member of The National Consortium for Credentialing Health and Wellness Coaches, I was honored to chair a committee last summer of extraordinary coaches who are part of our NCCHWC Council of Advisors.

Through our efforts “in August 2016, the NCCHWC created the Code of Ethics and Health & Wellness Coach Scope of Practice to serve as a reference for health & wellness coaches and faculty. The NCCHWC expects all credentialed health and wellness coaches (coaches, coach faculty and mentors, and students) to adhere to the elements and Principles and ethical conduct: to be competent and integrate NCCHWC Health and Wellness Coach Competencies effectively in their work.”

Please download the NCCHWC Code of Ethics and Health & Wellness Coach Scope of Practice here: NCCHWC Code of Ethics; NCCHWC Health & Wellness Coach Scope of Practice. You can also find copies of both documents in the Wellness Resources section of the Real Balance website.

Codes of ethics such as these serve as the primary guides to help form professional boundaries that we can adhere to. In Section Three of the NCCHWC Code of Ethics we find most of the references to boundaries. The most obvious boundary here is #23 – to avoid any sexual or romantic relationship with current clients, sponsor(s), students, mentees or supervisees. But, we also see in other items in this section, that much of the issue of boundaries also refers to creating clear agreements with our clients about the nature of coaching, how it works, confidentiality, financial agreements, etc. The client-centered nature of coaching is emphasized along with complete transparency, spelling out the rights, roles and responsibilities for all involved.

The issue of boundaries is more directly addressed in item #22. Hold responsibility for being aware of and setting clear, appropriate and culturally sensitive boundaries that govern interactions, physical or otherwise, I may have with my clients or sponsor(s). Here we are looking at how we create a safe environment for our client where they feel respected, comfortable and safe. While most individuals are at least somewhat sensitive to this in most social interactions, the coach must be especially sensitive about it because of the trusting nature of the coaching relationship. While not on the same level as clinical relationships, coaching clients must feel free to express themselves at a trusting level. The health and wellness coaching client who is attempting to gain insight about how they hold themselves back from being successful at weight loss, for example, needs to feel that they can reveal information about relevant feelings and experiences without feeling vulnerable. This shows up mostly in two areas, the appropriateness of touch, and self-disclosure.

While not inherently wrong, behaviors such as giving/receiving a hug from/with a client after a triumphant moment in coaching, may be misconstrued in its intention. For one client it may, according to some authors, “engender healthier relationships”, while for another it may feel like a boundary crossing, which other authors would argue, might “pave the way to a boundary violation.”  Coaches learn early on in their training to ask permission. Seeking permission first and respecting our client’s wishes can avoid such boundary crossings/violations. We avoid the pitfalls of assumptions and honor our client’s personal and cultural boundaries in this way.

Self-disclosure also has different boundaries in different cultures and with different individuals. We looked closely at this topic in a previous blog post “Self-Disclosure in Coaching – When Sharing Helps and Hinders“. We can remember from that post that coaches who do not self-disclose at all are not trusted, while those who disclose “too much” are thought to be incompetent. Our own self-disclosure, should never put undue pressure on our client to also self-disclose. Differences in culture, social class, family upbringing, etc. all can set very different boundaries around the issue of appropriate self-disclosure.

Originally published on Real Balance blog. Reprinted with permission.


Dr. Michael Arloski is the CEO and Founder of Real Balance Global Wellness Services, Inc. (www.realbalance.com). Real Balance has trained thousands of wellness coaches worldwide. Dr. Arloski is a board member of The National Wellness Institute, and a founding member of the executive team of The National Consortium For Credentialing Health and Wellness Coaches. He is author of the leading book in the field of wellness coaching: Wellness Coaching For Lasting Lifestyle Change, 2nd Ed.

finger-touch

Success in Life & Business… It’s a Matter of Touch

I am sure you would agree that effective communication plays a significant role in relationships with clients, customers, patients, partners, family members, colleagues, friends, etc. But what about when those individuals are away from you? Do you fill that void effectively and systematically or do you leave it to chance?

Maximizing success in life and in business is dependent upon a complete relationship. To optimize your success you must see your time away from others just as important as the time you spend with them.

Let me explain. Your spheres of relationships are continually changing from both your perspective and from the perspective of others. As a result of these shifting viewpoints, the strengths or weaknesses of these bonds fluctuate and unless you systematically inject yourself into the relationship, you leave success and happiness to chance.

So how do you step-up and make sure you are not rolling the dice when it comes to your success? Simply put, by implementing real, honest, and effective “touches” you can maintain your presence the way that you want it to be. These “touches” are small, short, targeted, and balanced communications that fill the relationship gap that will maintain and even grow trust, loyalty and commitment. Found in various forms, these individualized gems can be phone calls, text messages, video calls, written letters, cards, etc. And the frequency? This depends on each situation but I recommend 14 to 21 days as the sweet spot to offer the best balance.

Remember, to maximize your success, “touch” everyone regularly in a way that will positively inject your influence and not allow chance to control of the outcome.

Reprinted with permission from Dr. Steve Feyrer-Melk.


Steve Feyrer-Melk, MEd, PhD, is a powerful, passionate, and trusted authority in Lifestyle Medicine who is bringing an innovative, refreshing, and successful approach to proactive health care. Dr. Steve co-founded the Optimal Heart Attack & Stroke Prevention Center where he crafts and hones real-world programs for immediate impact. Dr. Steve also serves as the Chief Science Officer of Nudge, LLC, a lifestyle medical technology company.

pearl-z1

Member Spotlight: Functional and Integrative Medicine Physician Pearl Zimmerman, MD, MPH

Dr. Zimmerman specializes in patients with multiple medical problems that haven’t found help through Conventional Medicine. She uses the Functional Medicine Systems approach to address genetic variations and nutritional deficiencies, balance the immune system, hormones, and brain neurotransmitters, plus diagnose undetected Infectious Diseases, GI health, and Cardiovascular/Metabolic issues, instead of just treating symptoms.

Home care

From Couch to Coach: The Benefits of Health Coaching for Improving Physical Activity in Parkinson’s Disease Patients

The benefits of health coaching for managing chronic diseases has been growing in popularity for the past decade and contrary to popular belief, a health coach is not someone who is just providing guidance on weight loss. The concept of activation is a crucial component to managing healthy behaviors and for those diagnosed with Parkinson’s Disease (PD) or other neurological conditions, the ability to adhere to exercise programs can be a challenge.

According to Terry Ellis, assistant professor at Sargent College and Director of the Center for Neurorehabilitation, a virtual coach was effective in helping individuals diagnosed with PD adhere to a daily walking regimen. After one month of coaching, Ellis’ study demonstrated a 100 percent retention rate among participants due to the ability of the coach to build social and emotional relationships.

For those living with neurological conditions, both the availability and accessibility to exercise programs for this population can be a limiting factor. For those with advanced symptoms, driving themselves to an exercise class is not possible and can place an added strain on their caregiver to coordinate such processes. A health coach can be just what is needed to link the patient to the outside world by which they feel connected socially and emotionally. This can provide enough motivation for them to engage in the necessary level of exercise the can significantly reduce symptoms related to PD or other neurological conditions.

Health coaching for this population should focus primarily on:

  • Managing the severity and variability of symptoms through a day, week or month and counsel the patient on how to stay on track with healthy behaviors
  • Ensuring adequate social and emotional support and possibly connecting them to community resources such as respite programs, support groups, or educational classes
  • Connecting them to experts that can help them remain physically active while avoiding injury or falls
  • Support the needs of the caregiver through the progression of the disease and guide additional services that may be required should symptoms worsen
  • Health coaches are not expected to be experts in the disease itself, but rather an outlet for the patient to express their needs and ensure the highest quality of life possible.

 

Resources

Ellis, T. (2013). Feasibility of a virtual exercise coach to promote walking in community dwelling persons with Parkinson Disease. American Journal of Physical Medicine and Rehabilitation. Vol. 92, Issue 6, pp. 472-485. Doi: 10.1097/PHM.0b013e31828cd466.