Board-certified Health Coaches? What Integrative Physicians Need to Know

Abstract

Health and wellness coaching will formally enter the health care system in 2017 through the International Consortium for Health and Wellness Coaching (ICHWC), which successfully established the National Board-certified Health and Wellness Coach (NBC-HWC) credential in partnership with the National Board of Medical Examiners. Surveys suggest close to 20 000 health coaches are qualified for certification. Health coaches “partner with clients seeking self-directed, lasting changes, aligned with their values, which promote health and wellness and, thereby, enhance well-being.” Health coaching involves 3 steps: (1) exploring and building self-awareness, (2) taking action steps, and (3) monitoring and evaluating results. The ICHWC developed a standard of practice published as the job task analysis. As a salutogenic intervention, health coaching offers clients and integrative clinicians a cost-effective approach to supporting ongoing sustaining positive health outcomes.

In September 2017, more than 1000 health professionals will sit for a new certification exam to become Board-Certified Health and Wellness Coaches. They will join the ranks of the integrative health and medicine community by offering a valuable service that complements and augments our holistic approach. Health coaches work with clients to foster healing, optimize health, and enhance well-being. A health coach guides the client to tap into inner resources that leverage strengths to improve weaknesses. Because integrative physicians treat patients using diverse techniques while continuing to maintain more traditional medical structures, such as ordering and reading tests and diagnosing illness, little time remains for behavioral style interventions in the clinical encounter. Thus, the addition of health and wellness coaches to the integrative team is therapeutically beneficial and cost effective for patients and clinicians.

A relatively new health profession, health and wellness coaching has been on the scene for less than 30 years. For simplicity, they will be referred to as health coaches for the remainder of this article. In 2010, the National Consortium for the Credentialing of Health and Wellness Coaches convened (and have recently changed its name to the International Consortium for Health and Wellness Coaching).ⁱ

As part of its effort to establish its profession, the ICHWC took several key steps that included the following:

1. Surveying the field to learn who was considered a health coach.

2. Developing a detailed set of competencies that define the duties of a health coach (the Job Task Analysis).

3. Creating a certification process for practitioners.

4. Developing accreditation for coach training programs.

5. Establishing a strategic relationship within the medical profession through the National Board of Medical Examiners.

The ICHWC research found that between 150 000 and 200 000 individuals identify themselves as health or wellness coaches in the United States. Of these, between 16 000 and 20 000 have completed a training program recognized by the ICHWC as a legitimate training program in health coaching. Specifically, of these 16 000 or so coaches, 11 000 have completed the training from one of the 54 schools approved for provisional accreditation by the ICHWC, whereas 5000 have completed a graduate certificate or a degree from a university that offers formal training in health coaching. Another 20 000 of the 150 000 are self-taught, meaning they learned about healthy lifestyle changes, coaching, nutrition, and fitness enough to have established themselves as a professional health coach. The remainder, approximately 100 000-plus, seem to call themselves health coaches without any recognized credential or training.

A brief look at the bigger picture of the profession provides a useful context. Coaching has been an emerging profession for approximately 50 years, with an initial iteration that found coaches working with corporate executives. Coaches also engage in organizational work, personal life coaching, and, more recently, health and wellness coaching. The largest professional organization devoted to professional coaches is the International Coach Federation (ICF), which has 22 000 certified coaches worldwide, with more than half of these coaches in North America, one quarter in Europe, and the remaining distributed throughout the rest of the world. The ICF requires a minimum of 60 hours of training, 100 hours of coaching, and a certification exam for entry level certification, which is entitled the Associate Certified Coach (ACC). With 125 hours of training and 500 hours of coaching, one can apply to become a Professional Certified Coach (PCC). With 2500 hours of coaching and at least 200 hours of coach training, one can qualify as a Master Certified Coach (MCC).

The ICF defines coaching as “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.” The core competencies for coaching include setting the foundation, cocreating the relationship, communicating effectively, and facilitating action and results. Health coaches, according to the ICHWC definition:

… partner with clients seeking self-directed, lasting changes, aligned with their values, which promote health and wellness and, thereby, enhance well-being. In the course of their work health and wellness coaches display unconditional positive regard for their clients and a belief in their capacity for change, and honoring that each client is an expert on his or her life, while ensuring that all interactions are respectful and non-judgmental.

A health coach guides the client to access inner resources that allow strengths to be leveraged for positive change. Because health coaches embody diverse personal and educational backgrounds, styles vary, but all effective health coaching is essentially a client-centered process designed to facilitate and empower clients to achieve self-determined goals related to health. To do this, coaches have clearly defined skills and competencies to mobilize internal strengths and identify and enlist external resources that facilitate sustained positive health outcomes. Health coaching, at its best, is salutogenic or health generating, placing little emphasis on the disease process. Rather, health coaching seeks to increase healing resources such that higher levels of health become accessible for each client. By listening and helping clients increase awareness, coaches provide powerful reflective support, monitor progress, identify multiple ways of achieving goals, and celebrate success.

Health coaching is distinct from psychotherapy, health education, disease management, personal training, and nutritional counseling. Health coaches are currently employed in 3 major areas: hospitals, corporate wellness programs, and private health coaching, though coaches are becoming more common in primary care clinics, insurance-based programs, fitness facilities, disease management programs, wellness programs, and academic institutions.

What do health coaches actually do? The coaching process can be described in 3 basic steps. First, explore and build self-awareness, which includes awareness of strengths and weaknesses, plus hopes and dreams for positive health outcomes. Second, take action steps—the ongoing coaching process in which the coach facilitates the client’s regular cycles of learning to strengthen healing resources, increase internal motivation, and overcome obstacles to change. The final element, monitor and evaluate, includes setting an appropriate scale for maximizing change, keeping the program on track, identifying next steps for sustaining growth and development, and recognizing and acknowledging success with the client.

Health coaching is quite different from both conventional and alternative medical models that diagnose and treat. In contrast, health coaching is a development learning model. Whereas conventional and alternative medicine often seeks to fix problems, health coaching orients around realistic, desirable healing goals unique for each client. Whereas doctors, conventional or integrative, are medical experts, health coaches are nonjudgmental partners exploring health priorities. Rather than focusing on causative factors for illness, health coaches begin with present circumstances and work forward toward optimal healing behavior and future-oriented growth. Blending the two, integrative treatment and health coaching offers the best of both perspectives.

The ICHWC created the Job Task Analysis—the competencies for health and wellness coaches (see side bar), which is necessary for establishing an accreditation process. To date, 54 schools have been provisionally approved. Students graduating from these schools qualify for the certification exam once they have met the additional requirement of completing fifty 20-minute paid coaching sessions. Recognizing that some professionals may have alternative backgrounds, with proof of 1000 coaching sessions (not hours), coaches can also qualify to sit for the exam.

The process of creating a certification exam led the ICHWC to form a vibrant and healthy relationship with the National Board of Medical Examiners, the organization that operates the medical licensing examination.ⁱⁱ

With considerable experience providing certification exams, the partnership between the ICHWC and the NBME assures a balanced and respectful presence for the new health coaching profession in the overall health care delivery system.

Considerable opportunity exists for integrative physicians to work with health coaches. Integrative clinics provide an advantageous setting for offering this service for patients, and integrative physicians currently engage several models of incorporating health coaches. A powerful approach has the coach in some of the earlier sessions with the physician and the patient, with follow-up sessions between just patient and coach. This offers patients increased support in a cost-effective style. Clients respond well to regular sessions. Another physician model, which functional prescribers are using, utilizes coaches for the initial intake. With proper protocol rubrics, the coach can order tests which allows patients to begin to make changes, while allowing the clinician to have their initial session once results have been obtained.

Clinicians also utilize health coaches for group classes that focus on disease-specific support such as diabetes, heart disease, or smoking cessation, to name a few. The cost benefit of health-coach-led classes over physician-led classes is considerable. Other integrative physicians incorporate coaching methods into their own treatment delivery protocols. Shifting the emphasis from fee for service individual sessions to ongoing investment in a coaching program with advance payment or monthly fee schedule offers clinicians an opportunity to diversify their income stream and also improves outcomes, because patients who make such investments in their health tend to be more compliant. Hospital systems offer coaching services for various lifestyle support issues such as healthy heart programs, pain management, and weight loss.

Considerable research continues to establish the effectiveness of health coaching. Board-certified health coaches will fill a vital role in health care delivery. With the new board certification, this is a good time to explore the skills and services health coaches can provide. To become familiar with coaching skills and the opportunities of the profession, introductory webinars, continuing education classes, and coaching certification programs are readily available. To become a board-certified health coach, the ICHWC requirement is completion of a certification program with a minimum of 78 hours of training and 50 paid sessions working with a client. The first certification exam is scheduled for September 2017.

Health coaches and integrative clinicians offer a powerful combination for increasing positive health outcomes for patients. Given the clarity and the strength of the ICHWC, health coaches will continue to become increasingly visible in the integrative health movement, and patients will become more reliant on them, due to the positive effect of the coaching relationship. This is a win/win for all parties.

The specific domains for health coaching, developed by the ICHWC, are as follows:

1. The tasks that take place in the initial stages of the coaching process including:

   • Explaining the process.
   • Understanding why the client wants to be coached.
   • Exploring motivation and readiness to change.
   • Co-creating a coaching agreement.
2. The tasks that focus on the coaching relationship and the coaching process:

   • Helping create a healing vision.
   • Assessing current resources.
   • Exploring readiness to change.
   • Creating a series of steps that will allow the client to reach his or her healing goals.
3. The activities that address the clients evaluation and integration of progress:

   • Working with the client to maintain progress and effect change.
   • Collaborating with the client to self-assess goals and make modifications that enhance the outcome.
   • Assisting the client in articulating the learning and insight gained from the change process.
   • Working with the client to develop a sustainable plan beyond the coaching.
4. The tasks that underlie all Health and Wellness Coaching practice and the professional behavior of coaches:

   • Practice in accordance with the laws and regulations.
   • Practice with professional standards within the scope of practice.
   • Practice with accepted standards of professional ethics.
   • Engage in continuous training and education to become more proficient and maintain current knowledge of the field.

Biographies

Joel Kreisberg, DC, PCC, is the founder and executive director of the Teleosis Institute, a not-for-profit institution devoted to Narrative Health Coaching. Dr Kreisberg brings 29 years of leadership to his work as an integrative physician, teacher, coach, and change agent. After becoming an Integral Master Coach, Dr Kreisberg integrated this coaching into his clinical practice in homeopathy, nutritional medicine, and Narrative Health Coaching. He is the program developer for the new Health Coaching for Healthcare Professionals program at Southern California University of Health Sciences.

Reggie Marra, MA, PCC, is the creative director at Teleosis Institute. He serves on the faculty of Integral Coaching Canada, with previous positions as adjunct faculty at Maryland University of Integrative Health and The Graduate Institute. Author of 4 books of nonfiction and 3 volumes of poetry, Reggie’s most recent publication is And Now, Still: Grave and Goofy Poems (2016).

Teleosis Institute (http://www.teleosis.org) offers the Certificate Program in Narrative Health Coaching and continuing education classes for health professionals. Narrative Health Coaching is a comprehensive framework that identifies and nourishes the healing capacity of those seeking to reduce pain and illness as well as those seeking to increase overall health and vitality. Kreisberg, Marra, et al recently coauthored Coaching and Healing: Transforming the Illness Narrative (2016).