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Moving to an Evidence-Based Health Coaching Practice

Various health coaching approaches are being used in employer, primary care, community, health plan and population health improvement settings to support individual lifestyle change, treatment adherence, and self-care. Yet while health coaching is a frequently used term, it is often a poorly defined, informal practice. Some clinicians refer to any patient education or advice-giving encounter as “health coaching.” And many non-clinician and clinician health coaches use a variety of life coaching approaches that are based more on popular psychology than behavioral science research. These facts raise a number of questions: What is coaching? Can coaching approaches from the business and sports worlds be applied by clinicians in health care settings? Which health coaching approaches are most effective? How can health coaching be patient-centered and deliver best value to patients and health care payers and purchasers?

What is “Coaching?”

The International Coach Federation (ICF) defines coaching as “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.”1 Life coaches help clients “clarify their mission, purpose and goals, and help them achieve that outcome.” Life coaching borrows from executive coaching methods that companies use to support employee career growth, learning and performance.

The modern coaching movement can also be traced to Benjamin Karter, a college football coach who became a motivational speaker in the late 1970s. Kanter and others from the sports world have popularized what is known as “personal performance” oriented models of coaching. Most wellness and health coaching models and training programs have been developed by motivational speakers or coaches from the business world. These programs are loosely based on sociology, counseling and positive psychology concepts such as “self-efficacy.”

The ICF is the primary global body that credentials coaches and accredits coach training programs. ICF certifies coaches at three levels: Associate Certified Coach (ACC), Professional Certified Coach (PCC), and Master Certified Coach (MCC). While no professional training or license is required for ICF certification, applicants must complete an ICF-accredited or other coach training program(s), receive mentoring by a coach, fulfill experience requirements and pass an examination. While the ICF does not specifically accredit wellness or health coach training or certification programs, these programs may be recognized as Continuing Coach Education Programs for existing ICF-certified coaches. The ICF has developed the following competency model3 for coaches:

    Eleven Core Coaching Competencies
    Setting the Foundation
    Meeting ethical guidelines and professional standards
    Establishing the coaching relationship
    Co-Creating the Relationship
    Establishing trust and intimacy with the client
    Coaching presence
    Communicating Effectively
    Active listening
    Powerful questioning
    Direct communication
    Facilitating Learning and Results
    Creating awareness
    Designing actions
    Planning and goal setting
    Managing progress and accountability
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