Archive for the ‘Motivational Interviewing’ Category

Infographic: How to Make Fitness Resolutions that Stick in the New Year

December 30th, 2016 by Melanie Matthews

The failure rate for New Year’s resolutions is truly shocking. Every year some 64 percent of people will resolve to change for the better. Eating healthy food, losing excess pounds or getting fit are the most common goals, according to a new infographic by Fitness Review.

The infographic examines the key factors which can increase the success rate of these goals.

Infographic: How to Make Fitness Resolutions that Stick in the New Year

Increasing demand for quality-based, pay-for-value healthcare has elevated the health coach’s contribution to chronic care management and population health. From supporting ‘rising risk’ populations telephonically to conducting home visits for recently discharged high-risk, high-cost individuals, health coaching offers an essential care management touch point.

2016 Healthcare Benchmarks: Health Coaching is the fifth comprehensive analysis of the health coaching arena by the Healthcare Intelligence Network, capturing key metrics such as populations, health conditions and health risk levels targeted by health coaching programs; risk stratification criteria; prevalence of embedded coaching within care sites; coaching tools and incentives as well as program outcomes and ROI from more than 100 healthcare organizations.

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Infographic: Motivational Interviewing

November 19th, 2014 by Melanie Matthews

Motivational interviewing (MI) is a standardized, evidence-based approach for facilitating behavior change, according to a new infographic by Health Sciences Institute.

The infographic explores the four key phases of MI and evidence to support MI’s impact.

Evidence-Based Health Coaching: Patient-Centered Competencies for Population HealthTo succeed in a value-driven system, healthcare organizations will need to shift primary responsibility for health management to the individuals it serves. Evidence-based health coaching supports these population health goals by aligning best practice care with patients’ needs and values.

Evidence-Based Health Coaching: Patient-Centered Competencies for Population Health presents a template for evidence-based coaching that emphasizes clinical competencies, along with real-life applications from a health system already utilizing clinical health coaches within its value-based healthcare network.

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NYCHHC Telehealth Success Strategy: One Hand on Heart, the Other on Phone

July 31st, 2014 by Patricia Donovan

"We transform a conversation of chronic disease into something patients can look forward to." Susan Lehrer, RN, CDE, NYCHHC House Calls.

Guided by the philosophy, “Be real to your patients, and let them be real to you,” the New York City Health and Hospitals Corporation (NYCHHC) House Calls telehealth program is as committed to participants’ “life bottom line” as it is to its own program ROI.

In the House Calls telehealth program for diabetics, patients’ blood sugar, blood pressure and weight are transmitted via hand-size wireless modems to a team of specially trained nurses who provide feedback and education during pleasant telephone conversations at scheduled intervals.

“We transform a conversation of chronic disease into something patients can look forward to,” explained Susan Lehrer, RN, CDE, associate executive director of telehealth care management. “If they’re not looking forward to the call, they won’t pick up.”

A digital dashboard provides the telehealth nurses with a quick view of patients’ vitals and individuals who may be alerting. The telehealth technology enables immediate feedback that prevents overcorrection on the part of patients, Ms. Lehrer notes, while facilitating dramatic clinical outcomes.

The telephonic exchanges augment regular patient visits and enhanced by the nurses’ use of motivational interviewing. The telephonic communications are “templated” to avoid long narratives.

“Establishing that trust with patients over the phone is essential, because information received from people they believe care about them, and from people they trust, is information that is remembered,” said Ms. Lehrer. “It’s information that influences behavior.”

Ms. Lehrer presented some of House Calls’ clinical outcomes for the 2,500 patients it has serviced since the program’s inception during a July 2014 webinar, Diabetic Telehealth Monitoring: The Impact of Real-Time Data on High-Risk Patients sponsored by the Healthcare Intelligence Network.

Most House Calls participants are diabetics who spend an average of two years in the program, she explained. Of a random sampling of 769 participants, 76 percent improved their A1C almost every three months. Additionally, of patients in that sampling with A1Cs between 11 and 13, 91 percent improved A1Cs by an average of 2.9 percent.

House Calls, which has experienced a side benefit of fewer appointment cancellations on the part of participants, has been so successful the program already has been rolled out for patients with heart disease; its use for the chronic obstructive pulmonary disorder (COPD) population is being discussed.

However, Ms. Lehrer is quick to point out barriers to telehealth still exist. Physicians who treat a patient with diabetes for years without seeing any real change can develop “clinical inertia,” she says, although this quickly dissipates once the doctor sees a patient engaged in House Calls.

There is also the occasional patient resistant to change, and the frustration of being unable to integrate patient data into an electronic medical record (EMR).

Still, despite the program’s focus on technology and results, the nurses remind themselves that at its core, House Calls is about the person at the other end of the line.

“The staff always talks about keeping our hands on our hearts so that when we speak to people, they don’t become the numbers.”

Listen to an interview with Susan Lehrer here.

Clinical Health Coaching Transforms Care Conversation

May 27th, 2014 by Patricia Donovan

Evidence-based health coaching drives the population health management processes required to succeed in a value-based system—the industry’s quantum shift to ‘Healthcare 3.0,’ advises William Applegate, executive director of the Iowa Chronic Care Consortium.

How do we change to this Healthcare 3.0? One way is to create real patients that are in patient-centered medical homes. NCQA level three medical home recognition is great, but there are still a number of those medical homes that need to add ‘meat and potatoes’ to what they have achieved.

Next, we need to build a true population health capacity. We need to develop differentiated health teams. You can’t really create a robust health coach as a professional in an organization and then not change the position description of others. The trained clinical health coach can actually improve the ability of a physician to operate at the highest level of their license. That’s part of how a health coach fits into a healthcare team. It’s not just an addition. It’s a kind of reformation of how we’re approaching healthcare with patients.

You need to use trained performance health coaches to make this shift. And you need to activate patients towards self-care. And as I say over and over, we really need to inspire their own accountability.

There are two big features in transforming care. One is transforming the conversation, and the other one is transforming the care process. In transforming the conversation, we need to employ a performance-oriented health coaching. That’s more than motivational interviewing.

We need to rely on the science of behavior change. An awful lot of healthcare professionals deep down don’t believe that we can move individual behaviors. I don’t think we can change people’s lives dramatically. But we certainly can change some of their health outcomes, because we know that our chronic diseases are essentially learned; they’re exacerbated by things that we do to ourselves.

Excerpted from: Evidence-Based Health Coaching: Patient-Centered Competencies for Population Health

3 Levels of Health Coaches

April 10th, 2014 by Cheryl Miller

While health coaches address the health risk continuum — keeping the healthy healthy without compromising the clinical support needed for high-risk, high utilization individuals, it is necessary to align individuals with the right coaching service at the right time, say Dennis Richling, MD, chief medical and wellness officer, and Kelly Merriman, vice president of service delivery for HealthFitness. Here they explain the three levels of heath coaches needed to address their clients’ wide-ranging needs.

Our approach engages the individual with the right coach for their need. We use three types of professional coaches: there are health coaches, who are lifestyle coaches, individuals with bachelors, masters and doctoral degrees in health-related fields. There are also advanced practice coaches, skilled senior health coaches who have been trained in clinical conditions in chronic disease management. And then there are nurse coaches, who are registered nurses, who also have been trained in behavior change techniques. We take a look at what happens and who fits into which category.

First, there are those people with no chronic disease but who have health risks. They have issues trying to manage their healthy lifestyle and are seeking help. Those individuals go to health coaches.

Next, there are those individuals with chronic diseases but they’re managing their medication appropriately and complying with the preventive and control measures for their chronic disease. But their underlying lifestyle issues remain, and these individuals go to advanced practice coaches.

Lastly, there are individuals who are not following their care plan, their care is not coordinated, they are seeing multiple doctors, and their medication compliance is poor. They do have underlying lifestyle issues, but their biggest problem right now is managing their chronic disease and these individuals go to the nurse coach.

Excerpted from Integrated Health Coaching: Reducing Risk and Empowering Change across the Health Continuum.

Technology Reshaping Behavior Change Business

February 25th, 2014 by Patricia Donovan

Technology, particularly mobile health, is reshaping the delivery of health coaching, as revealed by these select metrics from the 2013 Health Coaching survey conducted by the Healthcare Intelligence Network.

The prevalence of health coaching has climbed steadily in the last five years—from 60 percent five years ago to 75 percent today. Incentives to participate in health coaching are more plentiful, too, although participants have to do more than just sign up. Today’s trend is to hold the reward until the health goal is attained.

Technology, particularly mobile health, is reshaping coaching delivery. Telephonic coaching is still the most common coaching modality, but not as common as it was in 2008, when 86 percent of respondents reported the use of telephonic coaching. This year, that figure is 75 percent. Meanwhile, the use of smartphone coaching apps has nearly tripled in the last 12 months, from 4 percent in 2012 to 12 percent this year. Text messaging is up more than 50 percent, too, with 14 percent of respondents incorporating texting in their coaching programs.

health coaching technology
The effect of all of this technology? It remains to be seen. What we do know is that face-to-face coaching interactions are waning, down from 70 percent in 2010 to 59 percent in 2013, as are group coaching visits, which are now conducted by only 28 percent of respondents, versus 40 percent last year.

One constant: motivational interviewing remains the behavior change tool of choice. However, this year’s survey identified a near doubling in use of the Patient Activation Measure® to evaluate participants’ progress, from 10 to 18 percent. Interest in positive psychology has dropped steadily in the last five years, from 48 percent in 2008 to 26 percent this year.

Excerpted from: 57 Population Health Management Metrics: Assessing Risk to Maximize Reimbursement

Case Management, Disease Management Top Skills Sought in Burgeoning Health Coach Field

August 23rd, 2013 by Cheryl Miller

University of Delaware's Health Coaching Certificate recipients' presentation. Mike Peterson, top left, Kathleen Matt, Dean of College of Health Sciences to his left; faculty members, Katherine McCleary, Emily Davis, students.

Motivated by a recurring lament among local physicians and health professionals that patients weren’t following through on certain behaviors, the University of Delaware (UD) launched its first Health Coaching certificate program in 2011, and honored its first two recipients at a ceremony this past May. The 18-credit hour post-baccalaureate program prepares health professionals to work in a clinical setting as part of a team that facilitates behavior change among at-risk patients, decreases demand for healthcare services, and reduces morbidity across the life span.

To create this program, curriculum leaders consulted the Delaware Health Sciences Alliance, which comprises the UD, as well as the Christiana Care Health Systems, Alfred I. DuPont Children’s Hospital, and Thomas Jefferson University, a Philadelphia-based medical school. The school received valuable insight from a team of local physicians and health professionals, including nurses, clinical psychologists, nutritionists, behavioralists, and pharmacologists on perceived needs and deficiencies in the healthcare system, and the kinds of skills and competencies they would like to see in a health coach.

According to the report “Market Demand for Certificate Programs in Health Coaching,” from the Education Advisory Program in Washington, D.C., which stated that employer demand for health coaches has grown 408 percent since 2007, with the number of health coach job openings peaking a year after the ACA was passed.

And the top five skills sets employers are seeking in health coaches? Case management, disease management, motivational interviewing, chronic disease, and clinical experience.

Following is our discussion with Mike Peterson, chair of UD’s Department of Behavioral Health and Nutrition.

HIN: What prompted you to offer this program now?

Mike Peterson: We created it to address the primary determinate of health, which is behavior, which accounts for about 40 percent of morbidity, according to the World Health Organization (WHO). Most doctors, because of the current health system, can only spend from seven to 15 minutes with a patient, which really isn’t a lot more than diagnosis and treatment.

The other thing is that most medical professionals, doctors and nurses don’t get any behavioral change expertise, knowledge or skills. They are trained in diagnostics and prescriptive treatment.

HIN: What insights did you receive from physicians and health professionals regarding skill sets and competencies needed for the certificate?

Mike Peterson: They have to have case management, disease management, and motivational interviewing experiences or knowledge. They have to have a basic understanding of chronic disease, which we provide; a course that covers about 20 of the major, common chronic diseases, their ideology, their treatments, diagnosis, pharmacology. They have to understand how to change people’s behavior, have good communication skills and a good working knowledge of basic health promotion and health education principles.

There’s clearly a skill set that’s currently not being taught in the other health disciplines. How do you extract information? How do you work with an individual? How do you motivate an individual? How do you communicate with them in a way that actually gets them to do the behaviors that are necessary to improve their health?

HIN: What recommendations were made on motivational interviewing techniques?

Mike Peterson: Motivational interviewing is important, but it doesn’t work in all cases. It’s somewhat oversold as a panacea for all problems. It’s a good tool to have but not every problem is a nail. Sometimes you need other tools in your toolbox to facilitate behavior change. So we teach other types of behavior change strategies as well: the use of contracting incentives, things to help facilitate and promote behavior change.

HIN: You would like to see health coaches affiliated with doctors’ offices and clinics. Should they be embedded or co-located in the practice or clinic?

Mike Peterson: Yes. We’re trying to get them placed right in the clinical office and become part of the healthcare team, for example, the medical home model where the doctor is in charge and the health coach is part of that team. We see health coaches not necessarily dealing with every patient a doctor has, but the primary, high-risk patients, or people of moderate risk who could have potential for high risk.

HIN: What about reimbursement for them?

Mike Peterson: That’s a good question and the one we’re all wrestling with right now. There’s been a shift in the demand for health coaches from payors to providers; we are seeing health coaches paid right from the insurance industry or hospital; they see that the coach is a good idea and so they decide to fund them privately within their own coffers. And under the new healthcare bill doctors are paid for outcomes. If they get better outcomes with patients they get a percentage of the potential savings reimbursed back to them. Some of those funds could be used to fund a health coach.

HIN: What insights did you receive on recommended caseloads for health coaches?

Mike Peterson: Ideally, if you have a 40-hour work week, about 25 hours could be engaged in client time, one-on-one face time. The other 15 hours would have to be a record keeping and perhaps telephonic communications with previous patients or communications with the medical staff about what’s going on with specific patients. So we figure in any week you could see 25 individuals.

HIN: How can health coaches help to improve care transitions, from hospital to home?

Mike Peterson: Again, going back to their primary role, which is helping people deal with behavior changes, their role in terms of transitions from hospital to home would be to follow up with some of the behaviors that they would need to do, such as out-clinic or out-patient activities. For example, if they just had physical therapy following a knee replacement, it could most likely be due to their being overweight. Health coaches could help them maintain a physical therapy program, and also help them with strategies to lose weight. They would work in tandem with the patient and healthcare professional.

HIN: Where do you see the profession of health coaches in the future?

Mike Peterson: Ultimately, we would like to see health coaches licensed, because too many people now are calling themselves health coaches and not anyone knows what it is. Someone says they’re a health coach and they deal with ADHD and another person says they’re a health coach and they deal with personal training, so they’re basically a glorified personal trainer.

Meet Health Coach Alexis Koutlas: Natural Progression from Nurse to Case Manager to Coach

February 18th, 2013 by Cheryl Miller

This month’s inside look at a health coach, the choices she made on the road to success, and the challenges ahead.

Alexis Koutlas, BSN, CCM, CHC, specializing in women’s, children’s and health professionals’ wellness

HIN: Tell us a little about yourself and your credentials.

(Alexis Koutlas) After graduating with my BSN, I started my professional career in women’s and children’s services. Over time I shifted roles from the bedside to referral and case management for high-risk obstetric patients and pre-term infants. Wanting to understand how these children progressed and what their needs were, I then transitioned to the outpatient arena in pediatric medicine. Once there, my interest led me to preventative medicine, which led me to the discovery of health coaching. Since receiving my Certified Health and Wellness Coaching certification from Vera Whole Health, I look at my nursing role as promoting and supporting wellness, rather than treating just the illness. I’m passionate about supporting children and colleagues, helping them to engage in their own health and well-being, and learning to be the best selves they can be.

What was your first job out of college and how did you get into case management?

Out of school I jumpstarted my career in a neonatal intensive care unit (ICU). What a fantastic opportunity that was! I worked in an academic care facility and had the opportunity to work with some very well-respected practitioners. To keep up with changes in the environment of care, the medical leadership created a position for a case manager, which I accepted, working directly for the physicians who were part of the Division of Perinatal and Neonatal Medicine. It wasn’t a traditional case management position; actually, our approach was quite unique. Rather than try and cut length of stay, we looked at the positives for increasing the length of stay of the mom, to decrease the infant’s length of stay and morbidities that occur from prematurity. There was no certification for this at the time. Working together for the best outcome for high-risk obstetric patients, we were able to expand the role to include referral management, supporting patients across the Pacific Northwest, Montana and Alaska.

When did you decide you wanted to go into health coaching?

The transition from treating illness to preventing illness was an entirely new concept that I discovered as I moved into the outpatient arena. Along with focusing on patient wellness, the care environment supports nurses’ own self-care. Better work hours and shorter shifts allow nurses to balance a personal life. My newfound schedule allowed me to engage with my own fitness and health regimens. And along the way, I met such fantastic, energetic experts who see and support the movement of wellness, and I am excited to return that gift to others.

How has your medical and case management background impacted your career as a health coach?

Understanding the physiologic ramifications (medicine) of the lack of wellness — the mental, physical and emotional components — is like the slab of foundation for a home. Understanding the financial ramifications and the necessity for conscious spending (case management) is that budget we maintain to build that home. Health coaching, however, is the covering; the roof, walls, windows and doors. If the roof leaks, the budget will be affected by the cost of repairs and your foundation will be destroyed from mold. Health coaching is the natural progression. Having a background in disease management enables me to help clients explore their own processes and circumstances with a deeper level of understanding.

In brief, describe your organization.

I’m an independent practitioner and specialize in two dynamic groups.

  • The first: families affected by pediatric obesity. Pediatric obesity is not just a child’s problem. It’s a family’s problem, and working with getting these children to engage in their health takes more than working with them independently.
  • My second area of focus: healthcare professionals. I work to get them to explore their own health needs and their role and responsibility as representatives of health, not just disease management.

What are two or three important concepts or rules that you follow in health coaching?

  • Never have a road map for your client.
  • The client has the answers, the client has the answers, the client has the answers. My job is to coach them, weed through all the mush to get to the answers that only they have and know are best for them.
  • I cannot successfully coach someone else if I am not working to care for myself.

What is the single most successful thing that your organization is doing now?

Health coaching is new. Independent practice is newer. The greatest most effective thing I can do at this time is promote the movement, help people understand why it’s important, and get them to engage in it in a different way. This is trailblazing and so with the weed eater in hand, I keep moving forward.

Do you see a trend or path that you have to lock onto for 2013?
Recognition of the wellness movement. On the West Coast, we are last to catch up to other parts of the country. Defining wellness, making it a household term, is progress in itself. Taking it into western medicine and proving its worth is monumental and will continue to be a work in progress backed by data acquired over time. Unfortunately, automated health coaching set us back from this goal. Two steps forward, one step back.

What do you mean by automated health coaching?

Automated, or scripted coaching from computer generated scripts. For example, you have this diagnosis, and the script encourages such and such questions. Hospitals have purchased the automated heath coaching for their employees. All the employee has to do is click here that they are getting their BP checked, and click there that they walked three times this week. For this, they receive a nominal bonus. The incentive is the bonus. Many employees participate. Many employess punch the buttons. Many employees do not make the changes that are necessary. I had the fortunate opportunity to have an informational interview with the person who has championed getting this service into a local hospital facility for their employees. She agrees, the true success behind this method will be to engage employees without significant issues or the ‘low hanging fruit’. The fact is, nothing replaces one-on-one personal coaching. But for right now, it isn’t a covered benefit, and if it was, would people value it the same way? I liken it to paying for a fitness trainer. The fact is, it’s personal service. It’s expensive. But when I pay for it, I am engaged with it. If someone else was paying the bill, I may show up, but would I engage?

What is the most satisfying thing about being a health coach? How is it different from case management?

As a coach, when the client discovers their sense of direction, that sense of self, that “aha” moment that is life changing, it reaffirms what I love about healthcare. It supports the notion of supporting health and allows the patient to design, dream and discover for themselves. Case management sets up a series of rules, set by a governing body with a focus on finances and limits the patient’s ability to be independent in their choices for improving their care. Although the goals are similar, i.e. patients who are not dependent upon the healthcare system, the methods to acquire the goals are in opposition.

What is the greatest challenge of health coaching and how are you working to overcome this challenge?

Understanding and engagement. People are naturally skeptical. They are unsure what they are getting with health coaching. It’s new. For those who have had exposure, they get it. They understand they have been beneficiaries of the inherited ‘wealth of health’ through their hard work. For others, it is an unknown. The most effective health coaching happens when the person is invested. Not only emotionally, but financially. Since this is not a covered service by insurance, it requires private funding. That can be costly, but the return on the investment is ten-fold. In short, people NEED to pay for the service, for their own sake, to reach success and stay motivated. But by the same token, it’s a cost that many are unwilling to pay if they are unsure of what it can do for them.

What is the single most effective workflow, process, tool or form health coaches are using today?

  • For the client: Getting them to a state of awareness at the beginning of each meeting. We so often go through our days as robots. We eat because it’s time to eat. We make lists and try and accomplish the items on the list. But are we ‘present’ with ourselves? Getting the client to ‘be’ for the coaching time allows them to process on a deeper level.
  • Processes for me as a coach: Working with clients to clearly define, describe, dream and design their goals and utilize both motivational interviewing as well as appreciative inquiry as tools to help clients separate out the mush and reach their own personal levels of success.

Where did you grow up?

I grew up in a little town just north of Seattle, Washington.

What college did you attend? Is there a moment from that time that stands out?

I attended college at Marquette University in Milwaukee, Wisconsin. It’s hard to pick one moment that stands out because there are so many memorable events in college. However, if I have to pick one, I’ll choose the moment I arrived at the school of nursing. Growing up in the country, arriving at an inner city university was culture shock. Add to that the moment when I sat in nursing orientation and heard the dean speak. “Look to your left and look to your right. One of you won’t be here when you graduate.” I remember thinking – “what am I going to do to be here? What qualities do I have to help me get through this?”

Are you married? Do you have children?

Unfortunately I have never married and do not have children. I believe that this is in part one of the reasons I have always enjoyed working in pediatric medicine. I like to say “even when I’m in a bad mood, somewhere during the day, some child will make me smile.”

What is your favorite hobby and how did it develop in your life?

Designing my own fitness routines and attending fitness classes with my favorite trainers. After years of being a couch potato, when I took stock in my own health, I realized that I needed to make changes to not only be a healthier person, but a better person, a happier person, a better employee and health coach. Throughout my learning, I found great trainers, and have met great friends. I’ve learned what motivates me and what keeps me engaged. I now look forward to creating my workouts and challenges.

Is there a book you recently read or movie you saw that you would recommend?

Ok, this is not a good movie. Not noteworthy in the sense that anyone with great intellect would feel compelled to watch. But for me, I loved “Step Up” – the original with Channing Tatum. Why? Pure and simple, the dance. I am both inspired and enamored with the physical strength, endurance and flexibility of dancers. To me, their movement is its own form of expressive art. I’ve worked with dancers in some of my personal training modalities. Those experiences have led me to appreciate the true talent and physical discipline that each and every move requires. However, buyer beware, this really is a B movie at best. If you choose to enjoy it, think about it from the perspective I’ve shared and see if it doesn’t improve the enjoyment factor.

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Meet Health Coach Shelley Wroth, M.D. – “Health Happens Mostly Outside the Doctor’s Office”

February 8th, 2013 by Cheryl Miller

This month’s inside look at a health coach, the choices she made on the road to success, and the challenges ahead.

Shelley Wroth, MD, Instructor for the Integrative Health Coach Professional Training at Duke Integrative Medicine

HIN: Can you tell us a little about your first job after college and how you got into health coaching?

(Shelley Wroth, M.D.) My first job after college was working for a company writing grant proposals for a non-profit agency, Helen Keller International, that does blindness prevention and rehabilitation work globally. Just writing about this life-changing work became frustrating; I wanted to be doing it! I returned to school to finish medical school requirements and began medical school at Columbia University College of Physicians and Surgeons. I became a health coach after practicing first as a general OB/GYN for seven years, then completing a fellowship in integrative medicine through the University of Arizona and shifting my practice to integrative women’s care.

Even with a much broader approach to treatment options after my integrative training, people still didn’t always do what I told them to do! I realized I was missing the tools to find out what people actually wanted for their lives and health, and to partner with them first to create a customized health plan to meet that big picture, and next break it down into concrete steps to put into place. Health coaching training provided me those skills and radically changed my practice and view of truly patient-centered care.

Have you received any health coaching certifications? If so, please list them.

I received my health coaching training through the Duke Integrative Health Coach Professional Training.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

I think the defining moment was when I was reminded in both my integrative medicine training and health coaching training that people’s health is their own, and happens mostly outside of the doctor’s office. People’s bodies heal themselves, even after a needed surgery or medication, and people decide how they want to approach their health based on their personal goals and values, and the most important things that support their health happen through their food, movement and relationships. In my medical training, I had truly forgotten that. To not only be reminded, but to learn a process, skills and strategies to work skillfully with people to discover what makes sense for them for their health, changed everything and let me know I was on the right path.

In brief, describe your organization.

Duke Integrative Medicine has a mission to transform medicine in the 21st century. Our professional training in integrative health coaching is a primary pillar of this mission, in addition to our clinical and research work. In order to transform medicine into a care system that is focused on supporting health, preventing disease and treating it at the earliest signs, and that supports each person to create and implement a plan that is based on best practices and is customized to their values and needs, we need providers with new skills in effective health behavior change. Our Integrative Health Coach Professional Training is designed to train a new professional on the healthcare to meet this need.

What are two or three important concepts or rules you follow in health coaching?

  • Start and stay curious. I may have a lot of information and even passion about different options to support health for my clients. However, I know nothing about what they already know about their health, how they work best, what is most important to them, and most realistic to put in place unless I ask. My favorite question is: What else? There is always more for a client to discover to increase learning and enact successful action.
  • Mindful awareness. At Duke, we view cultivating mindful awareness as a foundation to effective coaching and partnership. With mindful awareness, I am paying attention to the present moment, just as it is. This supports my ability to hear my client, be aware of my own thoughts without needing to automatically react to them, and notice changes in voice tone, or energy level, or emotion with my client, and follow up on them to see where it might expand client learning.
  • Work from research and neuroscience-based models. No one has cornered the market on effective behavior change; if they had, our country would not be in the healthcare crisis due to preventable chronic diseases that it currently is. However, we are learning more and more about how the brain prioritizes information and builds new neural pathways that are required for change. I believe in using health coaching strategies that take advantage of the amazing plasticity of the brain for sustainable behavior change.

What is the single most successful thing that your company is doing now?

We are focused on increasing the accessibility of integrative health coaching training to interested providers through the healthcare system, including nurses, nurse practitioners, physician assistants, physicians, psychologists, massage therapists, nutritionists, and exercise physiologists, in order to more effectively engage people in planning for their own health and making sustainable health behavior changes.

What is the single most effective workflow, process, tool or form that you are using in coaching today?

I believe there is no single most effective process or tool in coaching, as every person’s brain is unique based on their own experiences and decisions. Therefore the most effective process or tool will be unique for each client. The key is to listen to the client, have established a trusting working relationship, and as a coach be familiar with a clear process for exploring change that offers multiple strategies to try and see what helps the client make the greatest insight and implement new action.

Do you see a trend or path that you have to lock onto for 2013?

The questions about whether or not we will implement healthcare reform have been answered with the presidential election. It is now time for action. The old system will not work to provide the truly patient-centered, preventive care needed for reform. Integrative health coaches will be at the forefront of new systems and delivery methods for healthcare that make sense to promote and incentivize health.

What is the most satisfying thing about being a health coach?

For me it is when I am teaching health coaching and a coaching student sees the impact of asking the client a question that elicits the client’s own knowledge and solution instead of the coach offering advice. That is when everything changes in the neurochemistry of possibilities for the client and coach.

What is the greatest challenge of health coaching, and how are you working to overcome this challenge?

My greatest challenge is patience as the healthcare system moves to incorporate the position of health coaching. The need for expertise in health behavior change is so great and immediate, it is both an amazing opportunity and a personal source of great frustration with the gap in our current care.

Where did you grow up?

I grew up in Santa Barbara, Calif., though I have lived longer in my current home of Durham, N.C. I feel lucky to have lived in such beautiful university towns, with amazing resources for outdoor activities, music, food and arts.

What college did you attend? Is there a moment from that time that stands out?

I went to Yale University as an undergraduate. I loved being on the women’s rowing team and spending a junior semester living in London, studying and going to plays.

Are you married? Do you have children?

I have a partner who is an acupuncturist. I have learned a great deal from her about Chinese medicine’s approach to whole person care and healing. I have two children, one getting ready to drive and the other busy with Ultimate Frisbee. Life is full and always interesting!

What is your favorite hobby and how did it develop in your life?

My favorite hobby is yoga. I discovered yoga during my integrative medicine training about eight years ago. It has been part of my life ever since, supporting my physical and mental flexibility, stamina and strength.

Is there a book you recently read or a movie you saw that you would recommend?

Two books that I recently read and loved were The Power of Habit by Charles Duhigg and Escape Fire: Designs for the Future of Health Care by Donald Berwick. The Power of Habit has a great discussion of how we set behavior patterns as individuals, businesses, and societies, as well as how we can recognize those patterns and change them. Escape Fire: Designs for the Future of Health Care is an inspirational series of talks given by Don Berwick, the founder of the Institute for Healthcare Improvement, over 10 years, detailing the gaps in the current healthcare system and outlining the framework of the solution and what our future healthcare system will evolve into. Absolutely masterful.