The Health Coach newsletter summer 2018

Hennepin County, Minnesota sent this bulletin at 07/25/2018 10:41 AM CDT

July 2018

This quarterly newsletter will provide tips and resources about health coaching to help you keep patients engaged in their care.

Part II — Stages of Change — Meeting the patient where they are

Health coaching is a patient-centered approach to care. Our role as coaches is to help people take steps to improve lifestyle behaviors that impact their health and well-being. Lasting change must be internally motivated. Individuals decide for themselves to change a behavior. People may fluctuate back and forth between the various stages of change for many months or years before they achieve long-lasting change in their behavior. The opportunity for change can increase when the individual and coach work to resolve ambivalence and barriers to progress.

The stages of change are applicable to physical and mental health-related behaviors. The behavior can be smoking, substance abuse, gambling, unsafe sex, unhealthy diet, lack of physical activity, or poor medication adherence. As coaches, you assist people in moving along the stages of change continuum. Being non-judgmental and supportive along this journey of change is important in developing a trusting relationship with your client/patient.

The transtheoretical model (TTM) also known as stages of change was developed in the 1970’s by James Prochaska and Carlo Di Clemente. Originally the model was developed to study how smokers quit. Since then, the model has been applied to many health conditions and to changing high-risk behaviors. The research determined that change is a process of identifiable stages that people pass through.

The five stages to changing lifestyle behavior in order to achieve positive, lasting changes in one’s life are:

Pre-contemplation
Contemplation
Ready for action or preparation
Action
Maintenance

Understanding the stages of change will help coaches know how best to interact with patients and move them along the continuum. The stages are not static, and people can move back and forth between the stages. There is no set length of time for each stage, and the patient can relapse in the decision-making process.

In a previous Health Coach newsletter, pre-contemplation and contemplation were discussed. In this issue of the newsletter, we will discuss ready for action/preparation and action.

Stage 3: Ready for action/preparation

In the preparation stage, people have made a commitment to make a change. Their motivation for changing is reflected by statements such as: “I’ve got to do something about this — this is serious.” “Something has to change. What can I do?” In the preparation stage, people are researching and gaining an understanding of what is involved in making a sincere commitment. People may call their provider to find out what strategies and resources are available to help them in their attempt to change. They are now taking small steps toward behavior change. Too often people skip this stage and try to move directly from contemplation into action. They then fail because they haven’t adequately researched or accepted what it is going to take to make this major lifestyle change.

Stage 4: Action

This is the stage where people believe they have the ability to change their behavior and are actively involved in taking steps to change their behavior by using a variety of different techniques. The amount of time people spend in action varies. It generally lasts about six months, but it can literally be as short as one hour! This is a stage when people most depend on their own willpower. They are making overt efforts to change the behavior and are at greatest risk for relapse.

Mentally, they review their commitment to themselves and develop plans to deal with both personal and external pressures that may lead to slips. They may use short-term rewards to sustain their motivation, and analyze their behavior change efforts in a way that enhances their self-confidence. People in this stage also tend to be open to receiving help and are likely to seek support from others. Health coaches play an important role during this phase by offering support and helping patients identify an action plan for obstacles that surface.

Health coach approach for ready for action/preparation and action

Stage 3: Read for action or preparation

The health coach can:

Assist in identifying potential obstacles to success
Help the patient identify social support(s)
Encourage small steps towards the goal
Confirm that the patient has the skills for behavior change

Stage 4: Action

The health coach can:

Bolster patient confidence for dealing with obstacles
Encourage the patient to focus on restructuring cues that could result in relapse
Promote social support
Help the patient resist feelings of loss and focus on long-term benefits

(Stage descriptions and approaches from Virginia Tech—Continuing and Professional Education)

An example of a conversation with a patient -- preparation stage

Coach: Hello Ms. Johnson. It’s nice to see you again. How are you doing? At your last visit, we talked a little about your smoking. Would you be willing to talk more about that today?

Ms. Johnson: I guess. I haven’t done anything about it, but I’m starting to see how short of breath I get just walking up the stairs. I want to be more active but don’t seem to have the energy. I’m wondering if I should try quitting again, even though I’ve been unsuccessful in my past attempts?

Coach: I’m so glad to hear you are thinking about it again. Just being willing to talk about it is a huge step! Tell me more about your past attempts.

Ms. Johnson: I just stopped smoking, or at least tried. After a few days, I couldn’t resist the urge to smoke.

Coach: Yes, quitting is difficult for everyone. There are some things we can do to help you deal with the urge to smoke. Tell me what you think you need in order to quit?

Ms. Johnson: Well, how do I deal with the urges to smoke? I find I can’t resist these urges.

Coach: Yes, most people can’t quit on their own and need help. There are great medications we can provide you to help deal with the withdrawal symptoms and cravings. Also, let’s talk about the situations when you feel the urge the most. What’s typically going on?

Ms. Johnson: Yes, I think taking some medication will help. The hardest time for me is around dinnertime. After a busy day, I look forward to relaxing with a cigarette. Having one leads to another and then I just give up.

Coach: I appreciate that the end of the day is a challenging time. It’s great that you are able to not smoke during the day. That is an accomplishment. Would you like to start with a plan to cut back?

Ms. Johnson: I haven’t considered quitting on a gradual basis. In the past, when I started smoking after quitting for a few days, I felt I had failed and just went back to my old habits. I like the idea of cutting back.

Coach: Great! Let’s start you on nicotine replacement, develop a plan to cut back, and look at some strategies for you to use at times you feel the urge to smoke. Can I follow up with you to see how things are going?

Ms. Johnson: Sounds good! Thank you for your help.

Ask the health coach

Question

What’s a good approach when the person is discouraged by past attempts that have failed?

Answer

When the person seems discouraged by past attempts, help them identify their strengths and past and current successes. Asking open-ended questions such as, “Tell me about a difficult change that you have been able to make.” Help the patient verbalize their strategies that can lead to success. Then help the patient develop an action plan using those strategies.

Health coach mini-session

The Hennepin County health coach trainers offer a one-hour refresher session to review highlights of the training curriculum and talk about how you and your clinic are using health coaching techniques with your patients. The refresher session is an opportunity to share your successes and challenges and brainstorm solutions to any challenges.

The refresher session can also be an introduction to health coaching. Schedule a refresher with fellow staff to learn about the training curriculum and decide if the full-day training session is something that would be valuable for your clients or patients. Learn how to engage the people you serve, helping them self-manage their health conditions.

The following is the health coach refresher agenda. The agenda can be tailored to meet your needs:

I. Introductions

II. Review health coach principles

Ask-Tell-Ask (includes open-ended questions and the four questions)
Closing the loop
Setting the agenda
Action planning—patient-centered action plans

III. Scenario practice

IV. How to document goals in EPIC

V. Successes and challenges

New venue — stay in your own location, grab your lunch, and join us for a one-hour refresher via Skype for Business or GoToMeeting. Contact Renee Gust at renee.gust@hennepin.us.