What is a health and wellness coach?

May 2015
BY Victor S. Sierpina, MD, ABFM, ABIHM, Director, Medical Student Education Program, WD and Laura Nell Nicholson Family Professor of Integrative Medicine, Professor, Family Medicine University of Texas Distinguished Teaching Professor

Are you having trouble helping patients make changes in their lifestyle? Have they tried time and again to improve diet, exercise, fitness, or sustain motivation to change only to fall short? If so, they may benefit from a Health and Wellness Coach. What is that you may ask?

According to a recent expert panel consensus:

“Health and Wellness Coaches are professionals from diverse backgrounds and education who work with individuals and groups in a client-centered process to facilitate and empower the client to achieve self-determined goals related to health and wellness. Successful coaching takes place when coaches apply clearly defined knowledge and skills so that clients mobilize internal strengths and external resources for sustainable change.”

That’s a long definition, and you might be asking who needs a health coach and what can they do?

First be aware that coaching is a burgeoning and largely unregulated new health care service area. When the Affordable Care Act shifted responsibility and incentives for patient outcomes onto health care providers, hospitals, and clinics, these entities created a spike in demand for health coaches. They realized that existing systems of care, such as a 15-minute doctor’s office visit every few months, wasn’t doing the job for many patients - particularly the underserved and under-insured. Many patients need someone specifically trained in motivation and change processes who can also spend more time with them through the entire process of change. They looked to coaches to help improve self-management and wellness, particularly in high-risk patients such as those with poorly controlled diabetes, asthma, obesity, and other chronic conditions.

I just read an article in Global Advances in Health and Medicine by my colleagues, Meg Jordan, Ruth Wolever, Karen Lawson, and Margaret Moore. (1) They reported on a 5-year effort to create national training and education standards and to create a pathway to certification and eventual licensure for Health and Wellness Coaches. This is becoming a pressing issue since currently there are no federally, state, or locally mandated requirement for licensure, certification, or registration of health and wellness coaches.

In other words, anyone can hang out a shingle with little or no training or experience and can say, “I am a health coach.”

Many skills go into being an effective health coach. Since coaches most typically work with those who are struggling unsuccessfully to self-manage a chronic condition, the health and wellness coach must be highly adept at communication, motivation, relationships, empathy, and goal setting. Additionally helping to build self-efficacy, positivity, empowerment, stress management skills, and the psychology of overcoming resistance to change is only part of the tall order expected of professional health coaches.

Of course, many types of licensed health care providers such as physicians, nurses, exercise physiologists, psychologists, nutritionists, chiropractors, acupuncturists, and other healers may also employ coaching strategies. Most of these professionals, however, will not spend the majority of their time in a health-coaching role as essential as it might be to facilitating health-related behavioral change. Additionally, it can be confusing to patients for their providers to switch back and forth between the expert professional role and the more facilitative, partner role of a coach where the stance is not directive or advice-giving. Rather, through specific techniques a coach empowers clients to see themselves as the best experts in their own lives – not their health conditions, but in their lives – so that individual clients are best able to figure out not only which solutions recommended by healthcare teams can best fit into their lives, but also, when and how.

A well-trained health and wellness coach can work with individuals, groups, in person, on line, on the phone, in the gym, in the home, in community centers, clinics, and hospitals to help people achieve healthier lives. They also can do this at a fraction of the cost of other more highly trained health professionals whose time might be better spent in overseeing and monitoring teams, the diagnosis and care of complex patients, medications, and handling acute illness, pain, or life-threatening problems. Both groups can partner and collaborate to help patients navigate the increasingly our complex, confusing, expensive, and often inefficient, depersonalized health care system.

The National Consortium for Credentialing Health and Wellness Coaches (NCCHWC) is proposing that those without another professional degree should have at a minimum a Bachelor’s degree in a health related field or significant experience in allied health or a helping field (2000 hours) such as fitness, ministry, hospice, counseling, teaching, or nutrition. NCCHWC also is working on defining the scope and depth, hours of study, clinical experience, and testing requirements to help establish a baseline of competency and training for the health and wellness coaches of the future. This is a landmark effort. It is the product of an extensive dialogue among numerous health care professionals, organizations, coaches, and other stakeholders to bring some coherence to an increasingly important component of value-based, effectiveness-driven health care.

So if your patients have a health challenge, need some support in building confidence in their ability to change or just want someone on your team to guide and encourage them to improved health and wellness, consider recommending a health coach. Just be sure to ask the coach about their training and experience. The national certification process, while now well underway, is still a work in progress, and won’t be a credential providers can acquire until 2016.