Collaborative Family Healthcare Association 17 th Annual Conference

1. Session # F2A Friday, October 16, 2015 – Period 2 –1:30 PM More than Enough Work to go Around: Adding a Health Coaching Program into an Integrated Primary Care Clinic Shandra M. Brown Levey, PhD, Department of Family Medicine , University of Colorado School of Medicine Kaile Ross, MA, Clinical Health Psychology University of Colorado Denver Lacey Clement, MA, Clinical Health Psychology University of Colorado Denver Kevin S. Masters, PhD, Clinical Health Psychology Department of Psychology University of Colorado Denver Corey Lyon, DO, FAAFP, AF Williams Family Medicine University of Colorado School of Medicine Collaborative Family Healthcare Association 17thAnnual Conference October 15-17, 2015 Portland, Oregon U.S.A.

2. Faculty Disclosure The presenters of this session • have NOT had any relevant financial relationships during the past 12 months.

3. Learning ObjectivesAt the conclusion of this session, the participant will be able to: • Describe the complexities of integrating health coaches into an existing clinical team. • Discuss the importance of a targeted intervention to assist patients who want to make health changes but lack the traditional support and resources to do so. • Develop ideas for better integrating this form of support into other clinical settings.

4. Bibliography / Reference Leung, L. B., Busch, A. M., Nottage, S. L., Arellano, N., Glieberman, E., Busch, N. J., & Smith, S. R. (2012). Approach to antihypertensive adherence: a feasibility study on the use of student health coaches for uninsured hypertensive adults. Behavioral Medicine (Washington, D.C.), 38, 19–27. doi:10.1080/08964289.2011.651174 Adams, S. R., Goler, N. C., Sanna, R. S., Boccio, M., Bellamy, D. J., Brown, S. D., … Schmittdiel, J. A. (2013). Patient satisfaction and perceived success with a telephonic health coaching program: the Natural Experiments for Translation in Diabetes (NEXT-D) Study, Northern California, 2011. Preventing Chronic Disease, 10, E179. doi:10.5888/pcd10.13011 Appel, L. J., Clark, J. M., Hsin-Chieh, Y., Wang, N.-Y., Coughlin, J. W., Daumit, G., … Brancati, F. L. (2011). Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice. New England Journal of Medicne, 365(21), 1959–1968. Frosch, D. L., Uy, V., Ochoa, S., & Mangione, C. M. (2011). Evaluation of a behavior support intervention for patients with poorly controlled diabetes. Archives of Internal Medicine, 171(22), 2011–7. doi:10.1001/archinternmed.2011.497 Patja, K., Absetz, P., Auvinen, A., Tokola, K., Kytö, J., Oksman, E., … Talja, M. (2012). Health coaching by telephony to support self-care in chronic diseases: clinical outcomes from The TERVA randomized controlled trial. BMC Health Services Research, 12, 147. doi:10.1186/1472-6963-12-147

5. Learning Assessment • A learning assessment is required for CE credit. • A question and answer period will be conducted at the end of this presentation.

6. You can begin your slides here and REMOVE THIS SLIDE

7. Overview • Every clinic is challenged to help patients who struggle to make needed behavioral health changes. • Even in a level 3 PCMH with behavioral health integration, our reach was limited. • In this presentation, we will describe the implementation and early findings related to a health coaching program which provides an extra layer of support to both patients and clinic staff. • Understanding and addressing these complexities can help medical homes manage and treat patients in a more holistic manner.

8. What is health coaching? • A behavioral health intervention that helps pts. establish and attain health-related goals to increase quality of life and improve self-management of chronic diseases. • Aid patients in making and progressing toward health-related goals. • improved medication adherence • weight loss • healthful eating • increasing physical activity • smoking cessation • stress reduction. • Many health coaching programs report helping patients identify appropriate health behavior goals and develop an action plan to reach the goal(s).

9. Lit Review: What is health coaching? • Variable education and training • Utilization varies by site • Method of health coaching • Interventions

10. What is health coaching? • Due to the variety of educational backgrounds of health coaches, the variety of patient contact schedules, and the differences in contact modality reported, it is difficult to compare one health coaching program to another. • Some components, however, that appear repeatedly in effective health coaching programs are: • 1) multiple structured contacts with the patient, • 2) patient education, • 3) goal setting, • 4) health coach follow-up on goal progress, and • 5) utilization of motivational interviewing techniques and patient empowerment.

11. Provider Responses Pre-Implementation • “I know we need them (health coaches) for sure.” • “I think this would be a great resource to be able to offer patients.” • “Patient needs more teaching than I can provide in the context of a visit.”

12. Staff and Provider Input • Online survey • Clinic Presentation • Flyers in clinic

13. How is health coaching integrated into the team? • Delivered by doctoral graduate students, who have extensive training and experience in health-focused clinical and behavioral strategies. • High level training in health psychology and can complete health coaching role under the supervision of a licensed psychologist without the need of additional training. • motivational interviewing • health psychology education and training • health behavioral change counseling • Health Coaches work as part of the Behavioral Health team and act as a member of the medical team for the patient.

14. How do patients participate in health coaching? • Warm hand off • Follow-ups by telephone or in person as a one-on-one appointment or a co-consult • In-basket messages

15. Action Plans and Resources • Actions plans were created to aid health coaches in the educational piece of their intervention. • included brief educational points regarding the respective topic and a place to write down short-term goals, along with importance and confidence ratings of those goals. • Sleeping Well • Weight Loss (diet and exercise) • Smoking Cessation • Chronic Disease Management • Resource List – to identify and contact various resources such as mental health referrals, emergency housing and shelters, support groups, and crisis lines.

16. Sleep Action Plan Example

17. Sleep Action Plan Example

18. Health Coaching in Action • Number of referrals (N=) • Reason for referral • Weight loss (N= ) • Exercise (N= ) • Healthy Eating (N= ) • Sleep (N= ) • Stress management (N= ) • Disease management (N= ) • Patient outcomes- • “I haven’t changed my diet yet, but I have met with a trainer and I’m working out 5-6 times per week a the gym.” • “I’ve completely quit drinking soda and I’ve lost 3 pounds.” • “I’ve been getting off one bus stop early so that I can get extra steps in my day.”

19. Preliminary Conclusions • Accountability • Motivational Interviewing • Goal Setting (creativity; ideas coming from pt) • Problem Solving • Qualitative Feedback from Patients/Medical Providers

20. Next Steps • Continuation of health coaching program • Sustainability (graduate students) • Tracking longitudinal data in clinic • Other outcomes (ED visits, hospital stays, etc.)

21. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!