Health Coaching as an Intervention for Chronic Disease Self-Management

1. Health Coaching as an Intervention for Chronic Disease Self-Management

2. Coaching strives to empowerpeople to enhance their own well-being and healing. Coaching creates a powerful and effective framework which uses the client’s experiences, definitions of health and wellbeing, and unique needs as the starting point for providing EDUCATION, SUPPORT AND PRACTICAL SKILLS to enhance quality of life and re-gain a sense of autonomy and control. What is Coaching?

3. Survivorship of integrity, joy, meaning, dignity and autonomy. (Deena Metzger, Tree)

4. Integration of mind, body and spirit.

5. Facilitation Advocacy Documentation System-level changes Team building Assessing needs Education Access Support Co-ordination KEY AREAS OF PRACTICE

6. Comprehensive Health Care

7. Linden, A., Butterwoth, M.S., Prochaska, J.O. (2009). Motivational interviewing-based health coaching as a chronic care intervention. Journal of Evaluation in Clinical Practice, 16, 166-174. Results: Compared with non-participants, programme participants improved their self-efficacy, patient activation, lifestyle change score, and perceived health status, and more participants decreased their stages of change risk over time than non-participants. Evidence of Health Coaching for Management of Chronic Illness

8. Butterworth, S., Linden, A., McClay, W., & Leo, M.C. (2006). Effect of motivational interviewing-based health coaching on employee’s physical and mental health status. Journal of Occupational Health Psychology, 11, 358-365, 358-365. Results: Health coaching is a relatively new behavioural intervention that has gained popularity in public health because of its ability to address multiple behaviours, health risks, and illness self-management and has been found to be effective in improving both mental and physical health.

9. Increased understanding and knowledge • Emotional, informational and logistical guidance • Improved confidence in their decision making and ability to play an active role in healing • More effective communication with health care providers • Improved coping skills • Improved compliance with treatment • Improved integration of services EVIDENCE AND EXECTED OUTCOMES

10. Severe emotional distress as a response to cancer diagnosis (Andersen, Anderson, & deProsse, 1989), as well as chronic stress reactions to cancer treatments and major life disruptions (Andersen, Kiecolt-Glaser, & Glaser, 1994). Common stressors experienced by cancer patients include fatigue, sexual problems, disruptions in intimate relationships and social support, interrupted life tasks and interpersonal turmoil (Spira & Reed, 2003). Behavioural symptoms related to the distress of coping with cancer include appetite disturbances, sleep problems, and self-medicating with alcohol (Andersen et al., 1994). CONSEQUENCES OF UNMET NEEDS

11. Lack of knowledge • Difficulty communicating with doctors • Difficulty accessing and integrating health care providers and services • Distress • Sense of meaninglessness or hopelessness FACTORS THAT ADVERSELY AFFECT RECOVERY

12. 24 Why health coaching? • Many individuals know that they need to make changes to improve their health and quality of life but don’t know where to start. • Coaching helps to provide information about the possible changes , break them down into “smaller pieces”,and establish desired goals. INDIVIDUAL’S COACHING EXPERIENCE

13. Cancer coaching places the locus of control with the individual. • Their experiences, perceptions, and definitions of health and well-being serve as the starting point for all interaction. • On-going feedback is essential for program adjustments and to facilitate open communication What are the foundations?We fundamentally respect the rights of individuals to make decisions about their treatment and their health.

14. Individual coaching provides one on one personal and private time to deal with often unspoken fears and concerns. It allows for time to deal with unique needs, challenging barriers, and establish individual wellness plans. Group coachingprovides people with the opportunity to find support through common goals and plans. Synergy between members provides a powerful healing modality and members are often inspired by each other to create wellness plans as supported by a community of peers. INDIVIDUAL AND GROUP COACHING

15. Referrals - Members of the centre may self-refer to the coaching program, or may be referred by community programs, hospitals, doctors, complimentary practitioners, community partners or access to our website of outreach media campaigns. Intake and Screening – Preliminary one hour appointment to determine suitability of member and program, to identify needs, and explain limitations, confidentiality and expectations. Pre-Assessment – orientation apt. any assessments required Post-Assessment - ongoing feedback and discussion of needs - any follow-up assessments. System of Implementation

16. Usually 3-6 sessions of approx. 45 min. Phone appts, individual and group. • Individual coaching takes place in private suites/offices that deliberately create a relaxed, non-clinical environment. Lighting, decor, sounds, and smells all contribute to this environment. • Group coaching takes place in either a room with large table and chairs or a more casual living room-like environment. Coaching Environment

17. Coaching clients first talk to a guest services coordinator who walks them through an orientation process that includes: • Phone or personal interview to assess basic information, screen for distress when appropriate, and assess needs as well as explain our services. • This is usually followed by arranging a tour of the centre and a group orientation in which they register (registration form includes health information as well as a needs assessment). “ Triage" or Orientation

18. Coaches are health care professionals who have completed additional training in health coaching (i.e.Health Coaching Australia). • Each professional's expertise forms the foundation of their clinical work, but health coaching functions as a framework for communication, behaviour/perception change, and ongoing feedback and goal adjustment. Who are the coaches?

19. Step 1. Explain role of coach with emphasis on their definitions of health, and your interest in assisting them to identify their needs. Discuss boundaries, confidentiality, termination strategies, if appropriate. • Step 2. Conversation which allows the patient to be heard, and to access their motivation, and challenges. Identify issues. • Step 3. Reiterate and confirm needs and challenges. Active listening. Coaching Model

20. Step 4. Identify priorities - tap into motivation. Step 5. Break desired goals/change, or challenges down into smaller steps based on priorities. Identify and address potential barriers. Step 6. Work with individual to identify pathways to move forward. Step 7. Identify how the coach can assist with this movement - i.e. information, support, practical skills. Reinforce access to personal, medical and community resources and past successes. Step 8. Reiterate plan and motivation and determine next steps - door open for future work.

21. Improved collaboration • Increased appreciation of interdisciplinary cooperation • Improved satisfaction with care provided • Improved communication • Improved productivity of consultation time Potential Benefits to Healthcare Providers

22. Improved patient satisfaction • Enhanced co-ordination between community –based services and hospital • Reduction of service duplication • Improved continuity of care • (Bruce, 2007; Cancer Care Nova Scotia, 2004; Doll et al., 2003; Hohenadel et al., 2007; Psooey et al., 2004; Vargas et al., 2008, Canadian Partnership against Cancer, 2010).

23. Evolving Cancer Care Model by Inspirehealth.ca – Traditional Care

24. Inspirehealth Integrative model.

25. “I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” (Maya Angelou)