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Health Coaching in Case Management

Health Coaching in Case Management

Update: 2019-07-05
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004 -Health Coaching in Case Management

Health Coaching

Case Management Toolbox Podcast

Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC

Executive Director: AllCEUs Continuing Education

Host: Case Management Toolbox Podcast & Counselor Toolbox Podcast


CEUs can be earned for this podcast here: https://www.allceus.com/member/cart/index/product/id/1125/c/


Objectives

– Explain what health coaching is

– Differentiate it from counseling or medical practice

– Describe different skills a health coach needs

– Discuss how to develop an individualized service plan


Give a man a fish, he eats for a day.

Teach a man to fish, he eats for a lifetime.


Overview of Health Coaching

– Health coaches:

– Providing self-management support

– Educate clients

– Bridge the gap between clinician and patient

– Help patients navigate the health care system

– Offering support and encouragement

Health Coaching Research

– Significant improvements in one or more of the following

– Nutrition

– Physical activity

– Weight management

– Exercise frequency

– Perceived social support

– Patient engagement and “activation”

– Medication adherence

– Common features of effective programs are goal setting, motivational interviewing, and collaboration with health care providers


– The Care Transitions Intervention is a widely-used coaching method that imparts skills, tools and confidence to patients and family caregivers as they move from hospital to home.13 It is focused on “four pillars”:

– Having an effective, understandable management strategy

– Overcoming barriers to follow-up appointments,

– Knowing how to recognize and respond to worsening signs and symptoms

– Using a personal health record to identify and record 30-day goals, health information and key questions to be shared with the physician at upcoming health care encounters.


Goal Attainment Scaling

Educate Clients

– Help clients learn where to find reliable, valid information about their concerns or conditions

– Help clients learn how to evaluate that information

– Educate clients about the impact of nutrition, sleep, exercise, sunlight, relaxation, thoughts and mood on their condition and their goals

– Teach clients about SMART Goals

– Teach clients about motivational enhancement

Patient Centered Care: Engagement & Rapport

– Employ a person centered model

– Respect for client as an individual (UPR)

– Respect for client’s preferences for goals and interventions

– Collaborative approach providing choice and self-determination

– Coordination and integration of care

– Validation, support, encouragement, empathy

– Involvement of social supports

Enhancing Motivation

– Emotional (How will this help client be happier-)

– Mental (How does this make sense to the client-)

– Physical (How can this improve the client’s health and energy-)

– Social (How will it enhance important relationships- Who is supportive of this change-)

– Environmental (What things can be placed in the environment to enhance motivation)

– Spiritual (In what ways does this change help the client live more in harmony with personal values and feel a greater sense of connection-)

Motivational Techniques (ROADS)

– Reflective Listening

– Open Questions

– Affirmations of Self-efficacy and Optimism

– Develop Discrepancy

– Summarizing

Adult Learning Theory

– Provide explanations of why specific concepts are being taught

– Ensure learning that is connected to their health goals (make room for meaning)

– Use self-assessments to assess different levels of prior experience and education

– Remember prior learning will be the filter with which they conceptualize new information

– Use multiple methods of instruction (auditory, visual, kinesthetic)

– Ensure access to sufficient resources

– Adult students prefer a self-directed approach that allows for discovery on their own.


Behavior Change Theory

– When presented with a need to act (behave) people choose the most rewarding

– One issue many people have is delay of gratification. They choose what is most rewarding in the moment instead of overall.

– Rewards (reinforcers) encourage a behavior to be repeated

– Consequences (punishments) discourage a behavior

– Stimuli prompt a person to engage in a behavior

Behavior Change Examples

– Emotional Eating

– Food is associated with pleasure and happy times

– Food is readily available (stimulus)

– When people are stressed or bored the sight or smell of food IRL or in the media can prompt eating behaviors

– Habit

– Sally smokes a cigarette when she is driving to work, after lunch, on the way home from work, after dinner and before bed “to relax”

– Smoking strongly activates pleasure centers in the brain

– Triggers: Car, meal time, when she needs to relax

– Goal: Make not smoking more rewarding and less punishing

Readiness for Change

– Precontemplation

– I don’t have a problem with my blood sugar. The test must be wrong

– Contemplation

– My symptoms are not that bad. I can control it by eating healthier.

– Preparation

– I am having difficulty controlling my blood sugar and I don’t want it to get worse. Let me evaluate my treatment options.

– Action

– I need information and tools to help me manage my blood sugar and make better lifestyle choices

– Maintenance

– I know what I need to do. I just need to maintain the motivation and willingness to do it.

– Relapse*

– I am starting to fall back into old habits or “cheat” on my plan.

Creating a Wellness Vision

– Describe your body and mind in their ideal state

– What would you look and feel like-

– What types of things would you be doing (or not doing)-

– What are the most important elements in your vision-

– Why are these elements important- (i.e. How will they improve your life-)

– Which one do you want to work on first-

– On a scale of 1-5 what is your level of confidence you can achieve this-

– What types of assistance might you need in achieving it-

– What obstacles do you anticipate and how can you deal with them-

– What strengths and resources do you have that will help you accomplish these goals

Visualize Goals

– Pictures/collages/scrapbooks

– Push notifications

– Narratives

– Charts

– Mental Imagery

Goal Setting

– KSAs

– Knowledge of

– Physical, emotional, cognitive, behavioral factors that exacerbate and mitigate the problem

– Physical, emotional, cognitive, behavioral factors that enhance goal attainment

– Skills

– Abilities


Goal Setting

– SMART

– Specific

– Measurable

– Achievable

– Relevant

– Time Limited

Scaffolding (GROW-ME)

– Goals are specific and shared

– Rescue (Help) is immediately available

– Optimal level of help

– Encourage self-efficacy

– Concrete prompts

– Use prior knowledge

– Use preferred learning method

– Whole-task, holistic approach

– Cognitive: What is the goal-

– Emotional: What are your concerns- Elicit confidence.

– Behavioral: What do you need to do-

– Model desired behaviors

– Empower to take chances


Behavioral Health & Chronic Conditions

– Treatment plan developed by a clinician OR by an individual for wellness enhancement

– Overcoming barriers to participation: Follow-up appointments, homework assignments

– Knowing how to recognize and respond to worsening signs and symptoms

– Using a personal health record to

– Identify 30-day goals and record progress

– Journal health information (nutrition, sleep, mood, etc)

– Key questions to be shared with the physician/therapist at upcoming health care encounters(including annual exam),


Health Coaching: Self-Improvement

– Help client identify goals for 30, 60, 90 days

– Develop an effective, understandable management strategy based on SMART goals

– Overcoming barriers to achievement including prior failures

– Identify triggers for and signs and symptoms of backsliding/relapse and develop a prevention/ intervention plan

– Have client record

– progress toward 30-day goals daily

– health information

– key questions to be shared with the physician at upcoming health care encounters.


Sample Wellness Plan

– Wellness Vision: Have good energy, maintain mental functioning, stay physically healthy (sleep, nutrition, exercise, stress management, smoking cessation)

– Six month goals

– Three month goals

– One month goals

– This weeks goals: Do what, how often, how much

– Log

– What I did for each of my goals

– My energy 1-5

– My ability to concentrate and remember 1-5

– My weight

– My blood pressure


Summary

– Health coaching is a valuable resource to improve client retention and success

– Health coaches can help with treatment plan implementation, relapse prevention

– Health coaches have the opportunity to

– Increase people’s health literacy

– Teach people how to enhance motivation

– Teach people how to set SMART goals

– Help people attain those goals

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Health Coaching in Case Management

Health Coaching in Case Management

Charles Snipes