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Delivering The Behavioral Side Of Lifestyle Medicine Through Wellness Coaching

Dr. Michael Arloski/18 May 2018/ All MFN blog/

If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” –Hippocrates 420 B.C – 370 B.C.

Healthcare providers have been prescribing lifestyle improvement for thousands of years. The evidence has been built from the observations of Hippocrates all the way to the neuroscience of today. We know, from mountainous reams of data, that lifestyle affects the course of an illness or health challenge. The challenge for the healthcare provider of today is to see the “lifestyle prescription” translated into lasting lifestyle change. Many well-intentioned healthcare professionals have attempted to educate and admonish their patients into losing weight, ceasing the use of tobacco, managing their stress better, getting more sleep, being medically compliant/adherent, etc. Seeing actual success in behavioral change happening far too seldom, many have abandoned such efforts and just reach for the pharmaceutical prescription pad.

In recent years, however, there has been an exciting movement in the field of medicine that looks at how to use “lifestyle interventions” as first-line treatment.

“Recent clinical research provides a strong evidential basis for the preferential use of lifestyle interventions as first-line therapy. This research is moving lifestyle from prevention only to include treatment–from an intervention used to prevent disease to an intervention used to treat disease.” –The American College Of Lifestyle Medicine

The Lifestyle Medicine Movement has done much to establish an evidence base and it continues to examine research that distinguishes what appears to work for lifestyle improvement. Much of its attention has focused on nutrition, but more and more the field is realizing the importance of health and lifestyle behavior.

Wellness and health coaching has become the delivery mechanism for wellness programs, and its potential for the same vital role is being seen in Lifestyle Medicine. The reality is that the vast majority of clients that most wellness/health coaches see are already health-challenged in some way. They may already have a chronic lifestyle-related illness, or multiple risk factors that set them up for needing serious preventative help. Wellness/health coaches that work for disease management companies, insurance companies and many corporate wellness programs are already working with caseloads populated primarily by lifestyle medicine patients.

At past Lifestyle Medicine conferences, I’ve presented on “Wellness Coaching And Lifestyle Medicine: Covering The Whole Continuum”. and “Delivering The Behavioral Side Of Lifestyle Medicine: Wellness Coaching Skills & Concepts”. Together with other presenters on wellness coaching we have experienced a strong positive response from an audience made up primarily of physicians.

One of the key concepts of my talks that was especially well received was the idea of how the Treatment Plan needs to be integrated with the Wellness Plan.

Co-creating a Wellness Plan with our clients is one of the primary tasks for the wellness coach. Together we work with a structure that insures the client’s plan for lifestyle improvement will lead to success. A key part of that Wellness Plan will always be the “Lifestyle Prescription” that the client’s treatment team is recommending. What is key is that the Wellness Plan supports The Treatment Plan.

I will be talking further about this concept in my forthcoming book on the more advanced skills and methods of wellness coaching, but here is a sketch of the two plans and the way they overlap.

Treatment Plan

Diagnostically Derived
Treatment Provider Devised
Prescriptive
Responsibility on Provider to administer, responsibility on client to follow
Usually does not accommodate patient’s circumstances or abilities, may accommodate patient’s capacities.
Problem solving, solution finding oriented
Purposed for resolution of illness and disease, reduction of symptoms, healing
“Lifestyle Prescription” focuses on recommended behavioral changes leading to Lifestyle Medicine outcomes
Dependent greatly upon medical compliance/adherence

Wellness Plan

Derived through exploration and self-assessment combined with treatment recommendations.
Co-created by “client” and “coach”
Non-prescriptive – client centered
Responsibility on client to follow with coach’s accountability and support
Not only accommodates, but is derived from client’s circumstances, abilities and capacities.
Designed to eliminate barriers and develop additional support
Possibility, growth and self-actualization oriented.
Purposed for behavioral change and lifestyle improvement
Includes assisting client with medical compliance/adherence

Overlap Of Treatment And Wellness Plans

The Wellness Plan (WP) supports the Treatment Plan (TP)
TP identifies critical areas for recommended lifestyle improvement
Through “client-centered communication” WP aligns with the goals of the TP
Client engages, with coaching support, in lifestyle improvement behaviors that positively affect treatment outcomes
WP helps client with organization, accountability, etc., improving attendance for medical appointments and management of medications, self-testing/self-care
WP helps client make best us of medical appointments (self-advocacy)
WP helps client report more accurately to treatment team about changes in lifestyle behavior (providing more data for treatment decisions)

When clients are operating on a Wellness Plan that they have truly helped co-create with their own buy-in, the opportunity for weaving in Areas of Focus, Goals and Action Steps that support what their treatment team wants to see becomes obvious. Clients then have the structure and support they need to carry out the goals of the Lifestyle Prescription.

Physicians and other healthcare providers can already start making use of wellness and health coaching as a delivery mechanism for the behavioral change they would love to see. Many of their patients already have wellness coaching as an employee benefit. Their company’s wellness program may already provide it, or they may contract with a wellness coaching provider company. More and more employees have wellness/health coaching available through their insurance provider.

Wise medical organizations and practices are hiring wellness coaches to become part of their staff or are outsourcing to them. Healthcare providers are sometime “wearing two hats” and combining their treatment work with coaching. Others are becoming more “coach-like” in their interactions and are then handing the patient off to the wellness coach for the longer process of lifestyle improvement.

The Real Balance Wellness & Health Coach Certification curriculum (http://www.realbalance.com) has included how coaches fit into the Lifestyle Medicine approach for over a decade. Our students come to us as a resource for learning how they can help deliver the lifestyle improvement that their Lifestyle Medicine clients seek.

Wellness Coaching to support Lifestyle Medicine is not just an idea whose time has come, it has already arrived!

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.

Senior woman with help of physiotherapist

The Space Between Fitness and Medicine: Where “the Good You Do For Others” Brings the Reward you Deserve | Part 2

Phil Kaplan/24 April 2018/ All MFN blog/

In our first part of this three-part discussion, in addressing the topic of financial reward, I asked you to ponder the value of restoration. What, I prompted you to consider, is the value of helping someone who has moved along the dis-ease continuum, gradually leaving health in the proverbial rear-view-mirror back toward divine health?

It isn’t an easy question to answer. We can tackle it by considering all of the dollars those who incur inflammatory issues, chronic challenges, and cellular degradation will have to invest in maintaining function and comfort. We might also attempt to place a monetary value upon lost quality of life. We might even consider the simple question, “what would someone pay to rediscover health” considering their fear and apprehension of the alternative, and from that extrapolate the value.

If you are willing to believe that personal trainers with advanced education and the development of a complementary skill set can have immeasurable impact upon “the unwell population,” one perspective becomes clear.

The trainer versed in restoring health commands a far greater value than the personal training mainstream.

That’s important.

STEPPING UP A LEVEL

As in any field, a specialist with enhanced value will serve his or her marketplace best by finding a direct line of contact with those in need of their specialty.

In the sentence above, “need” is the key word.

While it’s oft been said that personal trainers are a luxury or a privilege, with an appropriate adjustment in perspective, those who have slipped into the largest segment of our adult population, the unwell market, might consider any therapeutic resource, if wellness is a goal, a “need.”

Now that I’ve mentioned it a few times, I’ll provide a general description of the market I’m referring to as “unwell.” Then I’ll help you see the opportunity to step up, to meet this population in an arena where they “need” you. I’, to command a value in line with a well-justified fee, and . . . here’s the biggie . . . to provide them the service they will truly benefit from.

WHO ARE THE UNWELL?

Let’s be really clear here. I’m not suggesting the opportunity lies in training “sick people.” I’m suggesting the largest, most opportune market share is made up of many American adults between the ages of 35 and 65. They aren’t “sick” in a clinical sense. They work. They drive their kids to school. They shop in the malls and grocery stores. They eat in the neighborhood restaurants. They pump gas in the same gas stations you do and they frequent Starbuck’s, Chipotle, and the local pizza place.

They don’t have need for hospitalization or chronic care . . . but they’ve slipped, moved along what I’m calling the dis-ease continuum. They’ve begun a process of maladaptation, a movement away from healthful homeostasis, and while many haven’t yet been diagnosed (many have), their bodies have become imbalanced. Whether it’s a hormonal imbalance, thyroid irregularity, blood sugar elevation, hypertensive condition, hypercholesterolemia, or chronic inflammation of one or several bodily systems, they have moved into a place where innate homeostasis is no longer their “norm.”

Not sick, at least not clinically, but not well. What’s alarming is, I’m describing near 65% of the adult population over the age of 45. Yes, the market is vast.

If the unwell were being cured of their ailments or remedied by the conventions of medicine, I wouldn’t see the “need” as being this opportune. All I need to share is a single statement to help you see why there’s a desperate need for a new type of health practitioner, one who masters the exercise and eating intervention. Here’s that statement.

In a society where chronic disease is most treated with pharmaceutical intervention, there isn’t a single medication that will cure any chronic disease.

Read that again. While there exists a wild array of meds to manage conditions and change biomarkers, there isn’t one that will cure the plight of the unwell.

Conversely, there is an extensive body of evidence to demonstrate the power we have over shifts in blood sugar, blood pressure, and hormonal disruption when we strategically employ a variety of exercise modalities and guidance in the realm of supportive nutrition.

If the demand is great, the “need” remains unfulfilled, and the greatest potential lies in the skill set we, as fitness professionals, have access to . . . our value escalates above virtually any conventional yet impotent “cures.”

THE LEVEL 2 TRAINER AS A CORRECTIVE HEALTH SPECIALIST

If we consider a “Level 1” trainer someone who is qualified, credentialed, and able to provide safe and effective exercise prescription to a healthy population, let’s consider a “Level 2” someone who can effectively target this Unwell niche and deliver improvements in biomarkers, condition, and quality of life.

The Level 2 trainer can identify his or her “ideal client avatar.” Moving forward I’ll refer to the Ideal Client Avatar as an “ICA.”

In establishing a presence and a track record with the Unwell, the enhanced personal trainer (enhanced with a higher level of education than the standard and an ability to implement positive change in the unwell) can justifiably command fees in line with other health practitioners, medical practitioners, and specialists.

In setting a fee structure, there should be a professional standard, a relationship-based fee that is consistent, one that exceeds “an industry standard.” Remember, if you deliver above the standard, you deserve reward above the usual.

HOW DO YOU STEP UP AND CREATE AN AUDIENCE?

Marketing, for the Level 2 trainer targeting this niche is not as haphazard as “pass out cards, talk it up in the gym, and talk to everyone about what you do.”

In order to establish your position, you’ll want to have four. Four strong successes. Four living examples of the value you deliver, and finding those four requires a bit of front-end work. Once you have your four you have a sound foundation upon which to build. The question, therefore, that merits consideration is . . . how do you “break in.” Where do your “four” come from.

I’ll make it step by step.

Note that everything that follows is based upon the assumption that you have received extraordinary training, that you’ve established a level of education complementary to your base credential, and that you’re positioned to initiate and maintain a practice with a revised focus on empowering clients to reverse the imbalances inherent in chronic disease. This is a prerequisite of paramount importance and although I won’t invest any more time in addressing it here, don’t allow my failure to repeat and reiterate this point as an indication its any less than vital.

STEP ONE: Define your Ideal Client Avatar. If you have a personal connection to a given condition or population (i.e. a relative with diabetes, a personal history with thyroid issues, etc.) and you have a passion for helping others who you feel are kindred spirits, that’s where you should best direct your marketing. You can’t “market well” until you define your ICA. This is a “must” in turning your ambition into financial security (and it’s the step most who seek to elevate their careers miss or ignore). Your ICA may not be based on your personal experience, but rather on where you see the greatest opportunity or where you have the greatest inroads. Devote time to getting clear on your ICA. It’s the true key to successfully “Stepping up to Level 2.”

STEP TWO: Determine your fee structure, your promise, and your offer. You don’t want to approach each prospective client with an open negotiation, nor do you want to exhibit uncertainty. As any business owner, design your foundation. What, precisely, are you promising each client? How are you compensated for that? What, precisely, is the person considering retaining you, supposed to do now, as a point of commitment.

STEP THREE: Choose a location, an affiliation, a network, and a social media platform where you can “meet” your ICA and spread the word. This is far simpler than it sounds. In outlining your ICA, simply as the question, “where do I find him (her)?” This is marketing at its core. Don’t think “medical.” Think real life. Where can you do a talk, a workshop, a presentation, knowing your ICA sits in the audience. I realize this is the intimidating step . . . but it’s also the one that brings you to human connection, and ultimately to commitment and money exchange. Perhaps in the future I’ll share an entire article devoted to “finding your ICA in the real world.” For now, accept that you have the answer to the question, you have the ability, and all it takes is a bit of courage and determination.

STEP FOUR: Create your Four. Do your thing. Work your magic. Use your skill set. Bring about change. Documentable change. Once you have your first four successes, you begin to build what I call an Arsenal of Evidence, and from that point on, the marketing challenge is replaced by magnetic appeal.

STEP FIVE: Build your business confidently, massively, professionally, and without limit.

This 3-part piece is intended, not to be a complete primer for business building, but to give you a sense of both the opportunity and your ability.

In creating a distinction between the progressive trainer willing to study, learn, and elevate, I’ve used the term “Level 2,” not to suggest any elite status, but to demonstrate a clear escalation in earning potential. Before I conclude this second part of the piece, I’ll outline a few elements of what I’m calling The Level 2 Trainer.

FIVE DISTINCTIVE ELEMENTS OF THE LEVEL 2 TRAINER

You are a specialist among a given population
You command fees above the norm
You have a consistent promise and offer
You have a track record and consistently grow a marketing / referral base
You understand and recognize the value in the potential you have as a guide to empower others to move away from chronic disease and back toward divine health

Is there a level above the Level 2 trainer? Yes. And the sky’s the limit. Literally. More to come in Part 3!

This is 3 part series. Read part 1 here, and part 3 here

Phil Kaplan has been a fitness leader and Personal Trainer for over 30 years having traveled the world sharing strategies for human betterment. He has pioneered exercise and eating interventions documented as having consistent and massive impact in battling chronic disease. His dual passion combines helping those who desire betterment and helping health professionals discover their potential. Email him at phil@philkaplan.com

You Need a Coach

Maurice D. Williams, MS/11 April 2018/ All MFN blog/

You Need a Coach.

This is a subject I am REALLY passionate about.

As most of my readers know, I’m writing to you from the perspective of a weight loss, nutrition, and fitness coach.

I own my own facility coaching others like you.

And I have a coach.

You need a coach.

You see, despite being a highly qualified coach myself across multiple areas, I hold a deep belief that everyone needs a coach in their life.

I have a business coach that I speak to 2 times a month, and it’s been a powerful investment I’ve made in myself. I love the personal growth that comes from it. There is tremendous value in being coached. She tells me yes when I say no and vice versa.

So what area of life should you look for a coach in?

Anywhere you are struggling, really. Struggling with weight loss? You need a coach. Struggling to make major decisions in life? You need a coach. Struggling to transition careers? Hire a coach. Looking to improve athletic performance? Hire a coach.

Think about it…there are not many people (if any) who reach high levels of success in life without a coach. It’s too hard to go it alone, to know what to do, to see things in life objectively.

The number one reason I hear from people for not hiring a coach is cost.

How many times have we tried to “do it on our own” and failed? Here’s the thing…we can’t afford not to. We need accountability, support, guidance, advice, etc.

I’ve been there and fallen off the wagon. I’ve given up and stopped believing in myself.

But, the difference is that when you’ve got someone to bring you back to reality and pick you back up, life just gets easier and less lonely. We all need an objective eye on our lives, someone who sees things entirely from an outside perspective.

So, if you have a goal that you want to achieve, stick to for the long run, and you believe investing in yourself is a top priority, hire a coach. Go on that journey. Change your life, in whatever aspect you seek change.

You’ll gain more than you ever expected.

Originally published on MoveWell Fitness. Reprinted with permission from Maurice Williams

Maurice D. Williams is a personal trainer and owner of Move Well Fitness in Bethesda, MD.

senior man having a massage in a spa center

What is an Allied Healthcare Professional?

Jaclyn Chadbourne/20 March 2018/ All MFN blog/

Whether it’s exercise, nutrition, or massage therapy you are seeking, finding the right person to do the job can be incredibly challenging. The area known as allied healthcare professionals can be a challenging one to navigate.

The professions that require a state or national licensures, such as physicians, nurses, or physical therapists, help to provide checks and balances on who should and should not be providing a service to any individual. However, there are many professions within our healthcare community that are poorly understood and many times misrepresented by individuals with minimal certifications or credentials.

Allied healthcare professionals are thought to make up roughly 60% of the healthcare workforce by providing a range of diagnstic, technical, therapeutic and direct patient care and support services that are critical to the other health professionals they work with and the patients they serve. All categories of allied healthcare require either registration by law to practice or post secondary degree or higher education. Click here for more information about allied healthcare professions.

Is it time to re-assess who you trust with your healthcare needs?

It is essential to know the credentials and education of anyone you are trusting for information or advice whether it be an accountant, lawyer, dentist or teacher. Healthcare is no different, but there are many misunderstood healthcare professions.

Distinct from nursing, dentistry or medicine, allied healthcare professionals make up approximately 60% of the health workforce. Examples include athletic trainer, exercise physiologist, paramedic, and massage therapist. Many times, these professionals are those you are referred to by your physicians to help manage your healthcare needs daily, weekly, and monthly. National and state licensures ensure that certain healthcare professionals uphold the standards and scope of pratice that is pertinent to their level of education.

Multiple allied professions remain to establish this key aspect of standardized care which simply means that certain professions are more susceptible to individuals claiming a level of expertise or knowledge that can be misleading or confusing to the general population. For example, as a Clinical Exercise Physiologist, I clearly understand the difference between my skillset and that of a personal trainer; however, to the general public, both professions provide guidance with exercise. Due to lack of established licensure exams, it is unclear to many people that some Exercise Physiologists (like myself) have a Master’s Degree, while others may have earned a weekend certification. It is incredibly important for you to understand the roll of any healthcare professional from which you seek treatment and advice as well as their experience and background in relation to your particular healthcare needs. Accessing information about these resources from a knowledgeable professional can help to ensure proper connection to an individual that is appropriately educated to effectively meet your needs.

Jaclyn Chadbourne, MA, CES has worked within the allied health profession as a Clinical Exercise Physiologist for 15 years. She is currently the Director of Research and Development at Universal Medical Technology, and serves as Adjunct Faculty at University of New England DPT Program

Cancer, Lifestyle and Health Coaching

Linda Gogl/15 January 2018/ All MFN blog/

A cancer diagnosis is tremendously overwhelming and often takes away the feelings of control over one’s life. After diagnosis comes the whirlwind of information and new decisions that revolve around living with cancer. Health & Wellness Coaches work with clients in a variety of ways to help them navigate through the healthcare system and develop a self-created plan for treatment and lifestyle that supports the client in managing and re-gaining control over their lives.

Health Coaching Support for Alzheimer’s Patients and Caregivers

Jaclyn Chadbourne/6 December 2017/ All MFN blog/

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.

Health & Wellness Coaching for Diabetes

Linda Gogl/28 September 2017/ All MFN blog, Conditions/

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 management According 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.

What 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:

Providing self-management support
Bridging the gap between clinician and patient
Helping patients navigate the health care system
Offering emotional support and support resources
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.

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.

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

Dr. Michael Arloski/22 August 2017/ All MFN blog/

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.

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

Dr. Steve Feyrer-Melk/3 August 2017/ All MFN blog/

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.