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11/16/2018Whole Health CoachingWhat isWhole Health Coaching?Thoughts on CoachingBecause healing is a process, the metamorphosisof the role of doctor to healer is the change fromdoer to helper, from expert problem solver andfixer to servant and companion, an accompanieron the healing journey.Thomas Egnew, EdDAnnals of Family Medicine, 2009One Sentence Definition of WHCWhole Health CoachingAssisting Veterans (partners) to realizetheir own health goals based on their lives’mission/aspirations/purpose. (MAP)1

11/16/2018Two Distinguishing Features of WHC The belief behind [integrative] healthcoaching is that behavior changes aresustainable when linked to personal valuesand sense of purpose.Caldwell, K., Gray, J. & Wolever, R. (2013). The process of patient empowerment in integrative healthcoaching: How does it happen? Global Advance in Health and Medicine, 2 (3), 48 – 57.Two Distinguishing Features of WHC Patients bring to the coach information andrecommendations from their treatmentproviders and work with the coach to decidewhich ones to enact and most importantlyhow to do so in a way they can sustain givenall they know about their lives.Caldwell, K., Gray, J. & Wolever, R. (2013). The process of patient empowerment in integrative healthcoaching: How does it happen? Global Advance in Health and Medicine, 2 (3), 48 – 57.VIDEOThe American Veteran—Integrative Health Coachinghttps://youtu.be/JSTkaFTO7f82

11/16/2018Characteristics of Health Coaching1. Strength‐focused.2. Views the client as competent (Sharedexpertise).3. Aspiration focused – may be eliminating aproblematic area or enhancing a positivefocus.4. Generally, present and future focused.5. Individual, group, telephonic.What is Whole Health killsUsing the 4 Stage Coaching ProcessHEALTH COACHING PROCESS MODELStage IVExecutetheActionStage IIIPlanforActionTake furtheraction.Re-plan.Learn lessons.Assess action.Create vision.Explore valuesandvalue conflicts.Goals & Actions.Explore barriers.Training &Support.AccountabilityConduct PHIassessment.Define focus.Assessreadiness.Stage IExploreMissionAspirationsPurposeStage IIReflect,Assess &Focus3

11/16/2018Whole Health CoachingQualities of a CoachRespectfulIs PresentMindfulListensUses a Guiding StyleIs a PartnerArticulate &Succinct Willing to Learn Is Open Is Empathic Coaching StrategiesCommunication Skills Uses Inquiry for Open &Close Ended Questions Uses Simple Reflections ofparroting, paraphrasingand summary Uses Complex Reflectionsthat are double‐sided andhave deeper meaning,values Uses Direct Statements toprovide information andguide the process, using Istatements Develops MAP,explores values,guides futurevisioning Assesses componentsof health using PHI,selects a focus area,assesses importanceand confidence Set SMART Goals andAction Steps, explorebarriers, contingencyplans, and resources Explore perspectivesCoach QualitiesRespectful – honors the unique agenda,resources and ‘inner wisdom’ of anotherPresent – fully available for the otherMindful – demonstrates Jon Kabat‐Zinn’s 7Attitudes of MindfulnessBeginner’s Mind Non‐JudgingStriving AcceptancePatienceNon‐Letting Go TrustCoach QualitiesListener – set aside own agendas to fully listen to theother Not a ‘teller’ – not inclined to give advice orinstruct/educate the otherGuiding style – guides the process, but does direct theagenda, outcomes nor strategies Not a directing stylePartner – goes along side the other on their journey Not an ‘expert’4

11/16/2018Coach QualitiesArticulate and succinct – is clear and succinct incommunication styleWilling to learn / OpenEmpathic – seeks to fully understand and bepresent with the experience of anotherInterest in health enhancement and education – isnot necessarily an ‘expert’ in all areas of health butvalues health enhancement and educationCoaching Strategies Develop Mission, Aspirations and Purpose(MAP) Explore values and value conflicts Guide future visioning Assess components of health utilizing PHI Select a focus area Assess importance of focus in light of MAP Assess/enhance confidenceCoaching Strategies Set SMART goals (in light of MAP) Set SMART action steps (in light of goal) Explore strengths Explore barriers and contingency plans Explore resources and support Establish accountability Assess lessons learned5

11/16/2018Coaching Strategies Explore and develop perspectives Reassess/re‐establish action steps, goals, focus area,MAP Utilize elicit, provide, elicit to respectfully provideinformation Conduct brainstorming Guide basic group processes Lead mindfulness activities Direct/redirect coaching processFor Whom is Health Coaching Appropriate? A self‐motivated Veteran who is seeking support. A Veteran referred by clinical team or provider. Motivation may vary; coach may need to assistVeteran in determining motivation. Assessing the coach/client fit and referring theVeteran to another provider.17th Century Nun’s PrayerKeep me from the fatal habit of thinking I mustsay something on every occasion.Release me from craving to straighten outeverybody's affairs.Make me thoughtful but not moody; helpful butnot bossy.(Continued .)6

11/16/201817th Century Nun’s PrayerWith my vast store of wisdom, it seems a pitynot to use it all, but I want a few friends at theend.Keep my mind free from recitals of endlessdetails; give me wings to get to the point.Give me the ability to see good things inunexpected places, and talents in unexpectedpeople. And, give me, the grace to tell them so.Whole Health CoachingParticipant ManualParticipant Manual7

11/16/2018AgendaWelcome and IntroductionThe Manual Does not follow the lectures More like a textbook Designed to complement thecourse8

11/16/2018Additional Course Material Beginning on pg. 73 – find the OPCC&CTlink to the SharePoint site to downloadPowerPoint slides Information about the Office of PatientCentered Care & Cultural Transformation Links to course videos and more thatmight be helpfulResources and References OPCC&CT – pg. 76‐77 Resources to support your WholeHealth journey – pg. 78 Other VHA resources and suggestedwebsites pg. 78‐79Handout SectionPgs. 1-11 ThePersonal ARE/about.aspResources – My Story9

11/16/2018OPCC&CTOffice of Patient Centered Care and Cultural e/index.aspWhole Health CoachingIntroduction toMindful AwarenessMindful AwarenessWhat does being presentmean to you?10

11/16/2018Mindful Awareness“Paying attention on purpose,in the present moment,non-judgmentally.”Jon Kabat-Zinn, PhDMindful Awareness“The intention to pay attention,in the present moment, with afriendly and open orientation.”Jeff Brantley, M.D.11

11/16/2018Mindful AwarenessWe all have it . . .the natural capacity topay attention with curiosityand openness.Mindful AwarenessWe also have the capacityfor mindlessness,in-attention, or going onauto-pilot.Mindful Awareness“Mr. Duffylived a shortdistance fromhis body.”James Joyce12

11/16/2018Mental Benefits of Mindful AwarenessLess emotional distress and ruminationDecreased anxiety, worry, anger,depressionIncreased concentration, emotionalintelligence, creativity and problemsolvingPhysical Benefits of Mindful AwarenessDecrease in stress hormonesDecrease in heart rate, blood pressure,and hypertensionDecrease in inflammatory moleculesDecrease in chronic painIncrease in immune functionBehavioral Benefits of Mindful AwarenessIncrease in non-reactivitySmoking cessationDecrease in binge eatingDecrease in sleep disturbanceReduction in alcohol use and illicitsubstance use13

11/16/20187 Attitudes of Mindful JudgingLettingGoAcceptanceTrustPractice of Mindful Awareness Find a comfortable positionAllow your eyes to close if you likeRemember the 7 attitudesLet go of busy-ness or life concernsPay attention to your breathWhen attention wanders to thought, sensation,emotion, etc. . . . simply notice Gently return focus to your breath Practice as long as you wishMindful Awareness“We shall not cease fromexploration. And the end of all ourexploring will be to arrive wherewe started and know the place forthe first time.”T.S. Eliot14

11/16/2018Mindful Awareness“Life moves pretty fast. If youdon't stop and look around once ina while, you could miss it.”Ferris BuellerWhole Health CoachingWhole Health andPatient Centered CareVHA Strategic GoalsObjectives for 2013‐2018Provide Veterans personalized,proactive, patient‐driven health careand support to successfully implementtheir personal health plans.15

11/16/2018VIDEOVIDEO: Tracy Gaudet—Personalized,Proactive, Patient‐Driven Care(Video link available on Sharepoint)Personalized, Proactive, Patient‐DrivenPERSONALIZEDA dynamic adaptation or customization of recommended education,“Tailorcare relevant to the individual user,prevention and treatmentthat is myspecificallybased on the user’s history,presentation, lifestyle, behavior andto meclinicalas a person”preferences.PROACTIVEActing in advanceof a preventlikely futuresituation, rather than just reacting; taking“Help mefutureinitiative to make things happen rather than just adjusting to a situation orandtopreparefor anywaitingproblemsfor somethinghappen. Usingstrategies that strengthen theperson’scapacityfor healthandhealing,such as mind‐body approacheshealthproblemthatcomesup”prior to surgery.PATIENT‐DRIVENAn engagement between a patient and a health care system where thewhathealth care is based in theirpatient is the source“Supportof controlmesuchwiththat theirneeds, values, and howthe patientto live. This requires that wemattersmostwantsto me”change the conversation and start from a different place.Mentalhealth.va.govQuestions for PCC Consideration1. Think of a time when you or a loved one receivedwhat you believe was ‘patient‐centered’ care.2. What did the provider say or do that made it amemorable patient‐centered experience?3. How was it either:a. Patient‐driven?b. Personalized?c. Pro‐active?16

11/16/2018Whole Health CoachingListeningMindful CommunicationPractice #1Mindful Speaking & Listening Speaker: Share a decision you are currentlymaking, or have made in the past. Listener: Bring your attention to your partner’swords.17

11/16/2018Practice #2Mindful Speaking & Listening Speaker: Talk about an area of your life whereyou’re considering making a change. Listener: As you listen, notice your own innerexperience (body sensations, thoughts,emotions)Practice #1 and #2 DebriefWhat did you notice?Listening Being present allows us to listen Listening involves paying attention towhat our client/partner is saying or notsaying, both verbally and non‐verbally,the feeling and meaning behind thewords.18

11/16/2018Coaching Quality: Listening/EmpathyAs you watch the video Bring a mindful attention toyour thoughts, feelings,reactionsVIDEOEmpathy—The Human Connection toPatient Care (Cleveland Clinic)https://youtu.be/cDDWvj q‐o819

11/16/2018Partner ActivityBased on the video you just watched: Each person will share a response to thevideo. The speaker will have 2 minutes. The role of the listener is to be present andlisten without responding. Simply ‘hold thespace’ for your partner to share.Listening/Empathy Activity Questions1. What was it like just to listen?2. What was your experience beinglistened to without interruption?3. How does listening relate toempathy?Listening How can you tell if someone is reallypaying attention and listening to you? When are times when you don’t listenwell? What gets in your way of listeningwell?20

11/16/2018Two Types of Listening Primarily Self‐focused Primarily Other‐focusedSelf‐Focused Listening Multi‐task, distracted Formulate responses Filter through past experiences, history,assumptions Personal stories, agenda, advice21