WHAT IS HEALTH AND WELLNESS COACHING? Meg Jordan, PhD, RN, CWP, ACC ICF Health & Wellness Community of Practice Describe the Learning Objectives: At the end of this expert presentation, you will be able to - Explain why health and wellness coaching is a growing coaching niche - Discuss definitions for health and wellness coaching - Explore contexts where health and wellness coaching is practiced - Discuss how these contexts impact on the coaching process - Describe similiarities and differences between life coaching and health & wellness coaching and competencies Describe the specific content covered in the event that is applicable to ICF Core Competencies Dr Jordan will lead a discussion related to the impact of context on all aspects of the coaching process from Setting the Foundation (including ethical considerations), to Co-Creating the Relationship (as Client-Coach v Expert-Patient), to Communicating Effectively to Facilitating Learning and Results. The discussion around comparing and contrasting 'life coaching' and 'health and wellness coaching' will include discussion around application of core coaching competencies in a health and wellness coaching setting. Building on the foundation of the ICF code of ethics, Dr Jordan will discuss additional ethical considerations relevant to coaching in the health and wellness field (The discussion on the specific content applicable to ICF Core Competencies will be continued in the HWCP facilitated discussion in May.) LEARNING OUTCOMES 1.Explain why health and wellness coaching is a growing coaching niche 2.Discuss definitions for health and wellness coaching 3.Explore contexts where health and wellness coaching is practiced 4.Describe similarities and differences between life coaching and health & wellness coaching 5. Here are the Learning Outcomes for this webinar. At the end, I’ll lead a discussion and hear from all of you about how HWC process still follows an ICF competencies of Setting the Foundation, including ethical consideration, to Co-Creating the Relationship (as Client-Coach v Expert-Patient), to Communicating Effectively to Facilitating Learning and Results. You should join in to compare how those applications compare between life coaching and health and wellness coaching, and then we’ll consider how there are some additional ethical considerations relevant to the practice of HWC. 1. WHY IS HEALTH AND WELLNESS COACHING A GROWING NICHE? • HW COACHING: ANALYZING THE NICHE (USA) •U.S. Estimates: •~150,000 self-identifying as health or wellness coaches in 2017 • •16,000 trained in ICHWC-approved programs •5,000 college degrees or academic certificates •20,000 self-taught •100,000 mislabeled • •Estimated that about 1,000 will take the National Certifying Examination for Health and Wellness Coaches - (Sept 6-18, 2017) Of the approximate 150-200,000 people in the US today self-identifying as a health or wellness coach, the estimates are that about 16-20,000 of them have gone through legitimate training programs, that is ICHWC-transition approved programs, that’s the 11% in blue, another 5,000 have graduate certificates or college degrees (only 4%) ; another 20,000 may be coaches who are self-taught or self-motivated to gain healthy lifestyle knowledge and have moved into the profession through their own motivation to learn and be of service, that’s another 14%, and a great majority -- about 100,000 are calling themselves coaches without any recognized coaching credential or training. HW COACHING: ANALYZING THE NICHE (INTERNATIONAL) •Global. Estimates: •~ 22,000 members of ICF (2014) (approx) • •16,000 trained in ICHWC-approved programs •5,000 college degrees or academic certificates •20,000 self-taught •100,000 mislabeled • •Estimated that about 1,000 will take the National Certifying Examination for Health and Wellness Coaches - (Sept 6-18, 2017) Now when we try to estimate how many are self-identifying as health coaches internationally, we don’t have any centralized data, but I’ve done a brief survey of international associations in countries from A to Z, and found that and ICF membership, which is at 222,000 members as of 2014. THE NEW ERA OF PERSONAL RESPONSIBILITY •The escalating cost of lifestyle-related disease is estimated to comprise approximately 70% our health care dollars •No one can afford it •Not business •Not the government •Not society • • It became apparent that we’ve entered a new era of personal responsibility when research showed that lifestyle-related disease accounts now for 70% of our health care dollars. Lifestyle-related disease, then became the topic of a Summit 2009 at the Institute of Medicine…the US health care advisor. Healthful lifestyles play a vital role in the prevention of chronic disease and mental and physical ailments; and The escalating cost of lifestyle-related disease is estimated to comprise approximately 70% our health care dollars; and The recent debate on health care reform has underscored the need for personal responsibility of individuals to adopt lifestyles which prevent and ameliorate disease, and CHRONIC DISEASE & LIFESTYLE Many people struggle with poor health and vitality because they lack the motivation, skills, knowledge, resources, concerted effort and sustained support needed to succeed in the complex task of transforming multiple health habits. The existing methods of informing, instructing, directing, prescribing, warning, and incenting in health care have so far been unable to achieve significant and sustainable behavior changes for the majority of patients; and FUTURE FORECASTS GRIM FOR GLOBAL DIABETES AND OBESITY • DIABESITY •“The modern epidemic that one of two Americans have…but 90% don’t even know it yet.” •Mark Hyman, MD •Blood Sugar Solution • • • CAUSES OF DEATH (2005, U.S.) •IDENTIFIED •Heart disease •Cancer •Stroke •Chronic respiratory disease •Accidents •Diabetes •ACTUAL •Poor diet •Physical inactivity •Unmanaged stress •Cigarette smoking •Excessive alcohol use •Reckless, high accident-risk • •Source: Mokdad, A, et al. Actual Causes of Death in the United States, 2000. JAMA 2004;291:1238-1245 WITH INDUSTRIALIZATION, MORE DEATHS DUE TO NON-COMMUNICABLE DISEASE (LIFESTYLE) THE ANTIDOTE TO CHRONIC DISEASE IS LIFESTYLE IMPROVEMENT •Regular exercise •Healthful eating •Weight management •Moderate drinking •Non-smoking •Mind-body stress reduction •All evidence-based, safe & effective breakthrough medicines • • • IF KNOWLEDGE ALONE MADE A DIFFERENCE… • •1 in 20 adults engages in all of the six top health behaviors: •Regular exercise •Healthful fat intake •5-9 servings of fruits and vegetables daily •Healthy weight •Moderate drinking •Non-smoking • If knowledge alone made a difference, then we would see more than 1 in 20 adults engage in all of the six top health behaviors: regular exercise, healthful fat intake, 5 servings of fruits and vegetables daily, healthy weight, moderate drinking, and non-smoking. But 1 in 20 barely does. There are over 2000 media messages generated a week on diet and exercise. PEOPLE LACK SKILLS & SUPPORT FOR LIFESTYLE CHANGE •MISSING are skills for autonomous, sustainable lifestyle change: • •Psychological hardiness •Behavioral skills •Capacities for resilience •Process for self efficacy •Tools for new habit formation •Support EXISTING MODELS THAT… —Inform —Instruct —Direct —Prescribe —Warn —Incent —Scold, humiliate, insult, debase, insult… —…so far…are unable to achieve significant and sustainable behavior changes for the majority of patients. — images-2.jpeg In our current delivery model, health care professionals are often denied the time to facilitate lifestyle change for their clients, or may not have received the knowledge or training in motivational or behavioral change; and IF _____ IS GOOD FOR ME, WHY DON’T I DO IT? •(FILL IN THE BLANK) Exercise, Following a Healthy Diet, Not Smoking, •Ask the 80% who don’t do enough to positively impact their health. •1200 responded over 5 years • IN THE CURRENT HEALTHCARE DELIVERY MODEL… Health care professionals are often denied the time to facilitate lifestyle change for their clients, or —May not have received the knowledge or training in motivational or behavioral change; and WHY IS HEALTH COACHING NEEDED? •Current health education in place for over 35 years •Epidemic of obesity and diabetes •Chronic disease requires lifestyle changes •Addiction: fat, salt, sugar •Greater ambivalence from high-jacked motivation centers •Pull out intrinsic motivation • Our most lasting solutions are the ones we happen upon ourselves…our best ideas for behavior change are self-generated. 2. DEFINITIONS FOR HEALTH AND WELLNESS COACHING • DEFINITION OF HEALTH AND WELLNESS COACHING •Health and Wellness Coaches partner with clients seeking self-directed, lasting changes, aligned with their values, which promote health and wellness and, thereby, enhance well-being. •In the course of their work health and wellness coaches display unconditional positive regard for their clients and a belief in their capacity for change, and honoring that each client is an expert on his or her life, while ensuring that all interactions are respectful and non-judgmental. • •Source: International Consortium for Health and Wellness Coaching (ICHWC) ICHWC is committed to developing practice standards for education and training of professional healthand wellness coaches, supporting the intergration of health and wellness coaching into the health care systems globally, supporting collaborative research, and offering the first national certification, launching this year. More on that later. ANOTHER DEFINITION OF HW COACHING •A health coach employs the art and science of the coaching relationship to optimize health, well-being for the client • •HW Coaches are professionals from diverse backgrounds and education who work with individuals and groups in a client-centered process to facilitate and empower the client to achieve self-determined goals related to health and wellness. • •Successful coaching takes place when coaches apply clearly defined knowledge and skills so that clients mobilize internal strengths and external resources for sustainable change. •(Source: NCCHWC Presentation to National Wellness Institute 2015) MILESTONE EVENTS (USA) •1970 Humanistic psychology altering health-related dialogs for change •1980 Rising rates of chronic disease lifestyle related •1990 Universal call for health care reform •2000 First real growth of health and wellness coach training programs •2010 First Summit of health and wellness coaches (80 stakeholder groups) •2017 First National Certification of health and wellness coaches Leaders at a 2009 Institute of Medicine Summit on Integrative Health called for a new profession of health and wellness coaches to assist the medical and public health professions in addressing this need for lifestyle turnaround; and GROWING RESEARCH BASE •Among other frameworks, health and wellness coaching has been variously defined in the context of health education, nursing, medicine, life coaching, and behavioral health and psychology. • •Multiple disciplines have tried to claim health and wellness coaching as their own. Multiple training programs have tried to claim that their way is the best way. • •Wolever, R (2013). Collaboration and Synergy in the Field of Health and Wellness Coaching: Naïve or Necessary? GLOBAL ADVANCES IN HEALTH AND MEDICINE, Volume 2, Number 4 • 3. EXPLORE CONTEXTS WHERE HEALTH AND WELLNESS COACHING IS PRACTICED • WHERE DO HC COACHES WORK? •Healthcare organizations, hospitals and clinics; insurance third-party payers, •Employee Benefits companies; disease management companies •Fitness facilities •Community Wellness Centers •On-Site employee wellness programs for corporations; Human Resources departments •Private coaching practitioners •Health and wellness coach educational and training programs •Academic institutions; schools • HC Coaches work in a variety of settings ICHWC SURVEY 2015 (USA) Most HC coaches survey by NCCHWC in 2015 work in private practice. A growing number are health care professionals who are adding health coaching to their practice – but that’s only 10% of the total, Another 10% work for benefits companies, and a small portion work in wellness promotion. SOUNDS A LOT LIKE LIFE COACHING, RIGHT? •So what’s the difference? ICF DEFINITION OF COACHING •ICF defines coaching as partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential, which is particularly important in today's uncertain and complex environment. COACHING •Facilitate a process of discovery for the client, where insights and strengths are built, and values are clarified, while progress is made and sustained toward client’s goals. • The coach then is more of a guide, pointing out the signposts that may or may not be visible to the client. COACHING ROLES •EXECUTIVE COACH • •LIFE COACH • •HEALTH /WELLNESS COACHES • • “Health and Wellness Coaches are professionals from diverse backgrounds and education who work with individuals and groups in a client-centered process to facilitate and empower the client to achieve self-determined goals related to health and wellness. Successful coaching takes place when coaches apply clearly defined knowledge and skills so that clients mobilize internal strengths and external resources for sustainable change.” THE COACHING PROCESS ICF CORE COMPETENCIES •a. Setting the foundation
 •1. meeting ethical guidelines and professional standards •2. establishing the coaching agreement • •b. Co-creating the relationship
 •3. establishing trust and intimacy with the client •4. coaching presence • •c. Communicating effectively •5. active listening
 •6. powerful questioning •7. direct communication • •d. Facilitating learning and results •8. creating awareness
 •9. designing actions
 •10. planning and goal setting
 •11. managing progress and accountability • •NUTRITION •SOCIAL RELATIONS •SPIRIT & BELONGING •EMOTIONAL •INTELLECTUAL •EXERCISE •RECREATION •OCCUPATION • •© 2013 Global Medicine Enterprises, Inc. •10 9 8 7 6 5 4 3 2 1 •1 2 3 4 5 •6 7 8 9 10 •1 2 3 4 5 6 7 8 9 10 •10 9 8 7 6 5 4 3 2 1 •COUNSELING IN MEDICINE •Medical model •Diagnosable illness in paradigm of pathology •Focus on fixing a problem •Expert provides information •“Why” questions, with past/present focus •Restore to level of functioning •Learning/development model •Desirable goals & achievement in paradigm of possibility •Focus on optimal performance •Non-judgmental partner supports exploration of health priorities •“How” questions with present/future focus •Move to optimal behavior •HEALTH COACHING HEALTH COACHING IS NOT HEALTH EDUCATION OR COUNSELING LEVELS OF PRACTICE •BASIC COACHING •Training ranges from 24 hours to 18 months •Private firms •University certificates •Online courses • •ADVANCED SKILLS •Requires health-related college degrees or health profession •CIIS Certificate for Integrative Wellness Coaching – within M.A. in Integrative Health Studies The best practices of well-trained professional health coaches and wellness coaches are based upon the translation and integration of evidence-based psychological processes of change combined with evidence-based lifestyle interventions into coaching models designed to enable people to outgrow their old ways of thinking, feeling, and behaving, and change lifestyles for good. On a small but growing scale, health professionals, including physicians, nurses, case managers, physical therapists, occupational therapists, psychotherapists, and exercise physiologists, are also being taught to integrate basic skills in coaching and motivational interviewing in current practices, a highly promising development. The goal is to improve health outcomes by helping patients get engaged in changing lifestyles to improve health, moving away from sole reliance on medicines and quick fix programs, and ultimately support the referral to health and wellness coaches. HEALTH COACHING DEFINED •A health coach employs the art and science of the coaching relationship to optimize health, well-being for the client • •Health coaches engage in a process that allows the client to: •Tap into inner resources •Develop strengths, identify and clarify values •Discover external allies •Set goals and achieve them •Monitor progress and celebrate outcomes • EXECUTIVE COACHING DEFINED • •The aim of executive or life coaching is sustained cognitive, emotional, and behavioral changes that facilitate goal attainment and performance enhancement, either in one’s work or in one’s personal life. •(Source: Stober & Grant, 2006) • • SO WHAT IS HEALTH AND WELLNESS COACHING, AGAIN? •A specific methodology for changing behavior and attitudes to improve your lifestyle choices, habits and actions for the long haul. • •HOW? •By building growth-promoting relationships •Eliciting self-motivation •Increasing capacity to change •Facilitating process of change • • • WHY COACHING WORKS SO WELL FOR LIFESTYLE IMPROVEMENT…. •• TREATMENT MODEL •Top down, unilateral, authoritarian •Imposes correct information •Normative, information-driven •Applies rules of behavior •Focus on relief, fixing, cure • • •PARTNERSHIP MODEL •Egalitarian •Collaborative •Elicits goals •Evokes change from within •Holds client as capable, no need to “fix” •Focus on process •HEALTH / MEDICINE •COACHING WHAT HW COACHING IS NOT •Coaching is also distinct from the following: •NOT psychotherapy, •NOT health education, •NOT case or disease management; •NOT personal training, and •NOT nutritional counseling •