The Coaching Relationship

1. Presentation: The Coaching Relationship Shandiin Begay The Coaching Relationship Lessons from the Diabetes Prevention Program ShandiinBegay, MPH Denver, CO

2. Health Coaching Model • The health coaching model uses a team of health professionals to assist patients in making behavior changes to improve their health. • An assigned health coach works with the patient and multi-disciplinary team to work collaboratively with the patient to create a health plan by helping them to identify barriers and establish goals to change health related behaviors.

3. Health Coaching Model Physician Centric RN Directed Multi Disciplinary Health Coaching Constraints on physician time and resources do not allow for the in-depth counseling and assistance necessary for the effective treatment of chronic illnesses RN gives didactic Telephonic education Without assessing Member motivation or underlying barriers to change Health coaching is a Multi-disciplinary, Facilitative approach To enhance members’ Ability to self-manage conditions

4. The Health Coaching Model uses the team to coach participants in making difficult behavior changes to improve their health. An assigned health coach works with the participant and team to identify barriers, establish goals, and work together to develop a plan.

5. What is a coach? • “A coach is someone who motivates you, provides unconditional support, identifies your strengths and helps you build upon them, shines a light on what's holding you back and helps you see your way clear, and partners with you to discover the creative solutions you need to achieve your goals.”

6. Coaching Concept • Participant • Actively involved in their care • Verbalizes reasons for change • “Co-Healers” Coach • The professional doesn’t carry all the responsibility • A collaborative relationship, not adversarial • A way of being; not a series of techniques • Behavior change • Discussed in safe way • Uses an interpersonal context • Promotes and reinforces individual capabilities

7. Who can be a coach? • Professionals were used in the DPP • Paraprofessional helped support • Translation in American Indian communities have used both • The coach needs to be supported by a team

8. How much work is it? • One-on-One contact with coach • DPP Research generally a 1:20 ratio • Groups: estimate 8-10 hours per class • Travel time not included

9. What to look for in a Coachprofessional or paraprofessional • Be friendly and accepting • Be optimistic • Model healthy behaviors • Follow through with what you say you’ll do • Hold accountable in a non-threatening way • Be able to work with a team • Be willing to persevere and endure • Believe people can lose weight • Believe that those you work with can change

10. Coaching in a Variety of Settings

11. “How’s that workin’ for ya?” - Dr. Phil

12. Characteristics of a Health Coach and Participant Relationship • Building Trust • Facilitating Change • Valuing Diversity • Communication • Gaining Commitment • Problem Solving • Revisiting and Adjusting • Building on Success

13. Building Trust

15. Establishing The Norms • Establish a good rapport • Ex. - Greeting, snacks, • Review group guidelines and appropriate group behavior • Caring, safe supportive atmosphere • Reinforce need for confidentiality • Attendance, punctuality, referring to contract

16. Facilitating Change

17. Coaching Class • Interactive • Utilize the skills of Motivational Interviewing (MI) & Problem Solving • Build on what was already learned from the previous session(s) • Change seating arrangements, if necessary, to accommodate lesson plan • Identify and discuss individual roadblocks from previous week • Use tools – Keeping Track books

18. Valuing Diversity

19. Communication

20. We know “What”, we don’t know “Why.” Stories offer Meaning.

22. Delivering the message • 7% Words we use • 38% Tone of voice • 55% Body language

23. Communi-coaching • Communicating styles • Verbal/Nonverbal • Listening for the sake of listening

24. Opening Strategies • Ask open ended questions • Listen reflectively • Summarize-reflect what you heard • Affirm • Elicit self motivating statements

25. Eliciting Self-Motivating Statements • Ask probing questions • Explore pro’s and con’s • Ask for elaboration • Imagine extremes • Look forward • Look back

26. Basic Listening Skills Problem Solving Confrontation Genuiness Questions Summarization Empathizing Attending

27. Gaining Commitment

28. Problem Solving

29. Lifestyle Core Session #9:Problem Solving The five steps to solving a problem: • Describe the problem in detail. • Brainstorm your options. • Pick one option to try. • Make a positive action plan. • Try it. See how it goes.

30. Problem SolvingSusie’s Action Chain • Works at home alone all week • Friend invites to weekly casino outing • Didn’t eat before she left home • Chose buffet over other choices (better deal) • Saw friend’s big plate of everything • Over ate • Gave up

31. Building on Success

32. Revisit and Adjusting Plan

33. Additional Ideas to Consider

34. Provide Tools to Achieve Goals • Home weight scales, measuring cups and spoons and food scales • Visual weight loss and exercise graphs • Monthly exercise calendars • Weekly Menu planners • Pedometers • Books for keeping track, fat counters, & fast food values

35. Keeping People Motivated • Reinforce the “process” of weight loss • Never give up on people • Take breaks • Remember life happens and is dynamic • For missed visits deal with ASAP

36. Lifestyle Maintenance • Continued self-monitoring and other behavioral strategies • Frequent contact • Group classes and motivational campaigns • Tool box strategies

37. “When advice alone is not enough”

38. QUESTIONS??

39. SMALL STEPSBIG REWARDS

40. The risk is great.

41. The goals are important.

42. The changes are modest.

43. The action steps are clear.

44. That doesn’t make it easy for you, but the DPP demonstrated that it can be done. NIH Pub. No. 03-5335 Feb 2003

45. Ongoing thanks to the DPP participants and tribal community partners for their commitment and dedication to the goal of diabetes prevention.