They’re worth 
the journey…

Smoking cessation is a coachable skill, like other behavioral skills like stress management, learning to play the piano, or gaining expertise at a job. Success is supported through support, knowledge, access to the right tools, time to practice and finally experience.

We begin with the assumption that all participants are ready to act toward improving their health. At the same time, participant readiness and motivation to tackle each of the specific components of the program will vary, both among participants and over time. At some point in the program, even the most enthusiastic participant will experience motivational plateaus.

A coach’s role is to keep working with the ongoing (and fluctuating) likelihood that each participant is willing to adhere to the recommended specific behavior change strategies to reach the program goal.

You will need to cultivate a clear sense of purpose, high standards and a respect for the various responses you will encounter from participants.

Coaching and Facilitation Skill

Health coaching philosophy is a holistic one—blending mind, body, and spiritual care components with evidence-based protocols to guide individuals to make lifestyle and behavioral changes that will improve their health status and overall wellbeing. Health coaching goes beyond traditional case management and disease management processes. The goal is to engage individuals differently than has been done in the past. Participants are given tools to help them be successful coupled with motivational interviewing.

Health Coaching is a style of engaging individuals that guides rather than directs the agenda and taps into one’s personal motivation to change unhealthy habits.

Motivational interviewing elicits behavior changes by helping members engage a positive outlook for the future and considers what goals can be achieved. A partnership is developed between the member, the provider and health coach to engage the member on the journey to better health.

Motivational interviewing requires understanding the importance of the member’s self-worth and the member’s perception of the reality of their health and wellness state.

Each member may have different “potentials” such as running their first 5K race, learning to depend less on food as a stress reliever, maintaining a healthy blood pressure through diet and exercise, etc. It is the health coach’s role to accept the member where they are and assist them to achieve their set goals that start with the idea of changing behavior.

Motivational Interviewing

The good life is a process, not a state of being. It is a direction not a destination.
~Carl Rogers

Motivational interviewing strategies do not ask IF the client is motivated, but WHAT motivates him or her.

The goal is to encourage participants to become an active participant in the change process by invoking change from within. Evoking change from within is very different from advice giving and empowers the participant to make choices and changes that are sustainable.

Motivational interviewing aims to encourage the participant’s autonomy in decision making where the coach acts as a guide not an expert, clarifying the participants strengths and goals, listening to their concerns, boosting their confidence in their ability to change, and eventually collaborating with them on a plan for change.

4 Phases of Motivational Interviewing

Engaging

•  Relationship building.
• Goals – Relationship, comfort, safety, and empathy

Focusing

• What process? Finding clear direction and goal.
• Goals – Exploring the target behavior – Targeting behavior – Clarifying the target behavior – Exploring ambivalence – Exploring barriers – Developing discrepancy

Evoking

• Why process? It is better if it is their goal and not yours. Purpose is to evoke a person’s own internal motivation for change.

Planning

• How to process? Work toward resolving ambivalence and choosing to change. Work toward goal setting and developing a specific plan

Coach Roles and Responsibilities
Intervention Strategies

• Open – Ended Questions (allow participant to engage their own ideas)
• Reflective Listening
• Identify motivational statements from member
  • “I don’t know what to do, but something has to change”
  • “I guess this has been affecting me more than I realize”

Other Strategies and Goals

• Avoid alienating or lecturing
• Set attainable goals; may need to set short term goals with an aim to reach longer term goals
• Utilize the member’s own ideas and resources for change
• Determine confidence in ability to make appropriate behavior changes, as well as importance to member
• Use typical day strategy
• If the problem is important, provide the education necessary for support
• If the problem is confidence, discuss solutions
• Be flexible and non- judgmental
• Listen for member’s understanding of information

Listening is also an essential component to effective communication. Here are some common barriers to effective listening

• We think faster than a speaker can talk and jump to conclusions
• We are distracted and we begin to do other things
• We lose patience and decide we are uninterested
• We react emotionally to what is being said
• We interrupt

How to build the relationship?

Express and show empathy

• Acceptance facilitates change
• Skillful reflective listening is fundamental to expressing empathy
• Ambivalence is normal
• Use genuine and specific affirmation and empathy (It sounds like you have not been able to reach your vegetable goal. You must be feeling frustrated. OR You are doing a great job with tracking.)

Develop Awareness

• Developing awareness of consequences helps clients examine their behavior.
• What’s at stake?
• A discrepancy between present behavior and important goals motivates change.
• Amplify the discrepancy between important personal goals and current behavior.
  • “It sounds like you are working very hard to increase your activity, yet it has been a challenge to reach your weekly goal.”

Roll with resistance

• Ambivalence is normal and part of the change process
• Avoid arguing and labeling
  • “Let’s discuss where you are with program goals. Are you satisfied with your success? What needs to happen to reach your goals.”

Support Self Efficacy

• Belief in the possibility of change is an important motivator.
• The participant is responsible for choosing and carrying out personal change.
• Support, encourage and congratulate.
• Build optimism

Developing Autonomy

• Listen as participants develop a list of action steps