Health coaching strategies in a global pandemic

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Any time we are going to talk about any type of health coach subject it's important to be embodied first, said Meg Jordan, PhD, RN, NBC-HWC, at the 2022 Integrative Healthcare Symposium in New York City.

Jordan, who is professor and chair of Integrative Health at the California Institute of Integral Studies, led a brief exercise to get audience members moving. “Oh, you look so good. Bring this home to your family and friends. It just lets us know we have so much in our heads,” she said.

“I love looking at emergent professions and the interplay of the hierarchy we look at all the time,” she said. “Health coaches occupy the lowest rung but deal with the toughest challenges.”

She added that coaches often sit with their patients and clients in heavy duty existential conversations.

Jordan said that coaching did not evolve in the medical industry, it came from business.

“When an executive coach is hired by a company to talk to a CEO, you better believe they don’t talk down to them,” she said. Early on when Jordan collaborated with colleagues at the integrative schools at the time, they decided to borrow a model that was developed in the business world.

She said today there’s a new challenge for health coaches to rethink their roles, broaden skills, explore possibilities, and make a difference.

Jordan used the word “syndemic,” and pointed to a confluence of critical problems a such as the rate of chronic disease in Black, Indigenous, People of Color (BIPOC); health and structural inequalities; a politically divisive anti-science environment; and the novel coronavirus (COVID-19).

“When it started out, health coaches were making the well, weller,” she said. Much of that wellness was for whiteness, according to Jordan. This was before two years ago, where there was a general moral reckoning regarding matters about wealth, health, and inequalities.

“You are speaking into that political, social, spiritual reality,” she said.

Between the rate of chronic disease, inequity, mistrust and divisiveness, and the COVID-19 pandemic, a perfect storm has been created, according to Jordan. In addition, coaches are also having to deal with the disinformation on social media, or what she described as “click bait garbage” in their conversations with clients and patients.

One in four adults in the United States have a chronic disease, she said.

When it comes to health inequality in the U.S., there is a disproportionate risk to racial and ethnic minorities according to Jordan, in both urban and rural areas among non-English speaking and minority groups. This increased burden of chronic disease is compounded by effects of structural discrimination.

Jordan said all of this is an opportunity for health coaches to embrace a new expanded skill set and adopt a wider perspective to reverse longstanding health inequities.

According to the National Board for Health and Wellness Coaching (NBHWC), a health coach’s scope of practice is to facilitate and empower the client to develop and achieve self-determined goals related to health and wellness. They support clients in mobilizing internal strengths and external resources, and in developing self-management strategies. In addition, their role is to provide support in making sustainable, healthy lifestyle, behavior changes. Coaches do not diagnose, prescribe, treat, manage care, or provide therapy.

This scope was developed in 2012 and Jordan questioned if this scope is still working and relevant.  

Jordan talked about a health coach’s strategies to address COVID-19 risk factors such as older age, obesity, lower respiratory conditions, and chronic immune dysfunction.

There are coaching strategies for every one of these situations, she said. You can only coach to the level of your license. If you are a health coach and a MD, you are held liable to the level of your MD license. If you are a health coach and fitness trainer, you are liable to the level of your health coach certification, she said.

Adopting next generation cultural competence is essential for health coaches, she said. Conventional cultural competence includes tokenism, stereotypes, color blindness, othering, and marginalizing. Repositioning cultural humility includes being respectful, affirming, embracing cultural sensitivity awareness, centering voices, and eliminating structural barriers.

She also said it’s important to have those uncomfortable conversations with patients and clients who are committing racially charged microaggressions all the time, she said.

Next generational cultural sensitivity means coaches need to assess their own cultural effectiveness, unconscious bias, and keep practicing for more inclusivity. She said it’s important to be opened to continually learning, check judgmental assumptions, audit personal privileges, and expand vocabulary. She also encouraged coaches to keep practicing these new strategies.

She said it’s also essential to be able to hear feedback nondefensively. Jordan also talked about allyship as a non-person of color. She said it’s not just about identifying as an ally, but it’s a continuous lifelong process.

Jordan also talked about building a more comprehensive coaching program that includes non-medical Social Determinants of Health (SDoH) factors. SDoH include hunger, access to care, housing, mental health, transportation, education, income and jobs, isolation, environment, and safety. It’s also important to understand the wellness wheel, which incorporates occupational, spiritual, intellectual, physical, emotional, environmental, and social aspects of an individual’s life.

“When you are having that deep seated coaching conversation you are in an interpsychic field. If you dive in deep enough you are heightening your sense of empathy, sensitivity, and vicarious trauma. You have to learn to have another coach to debrief these sessions,” she said.

Jordan said coaches are working too hard when they are trying to solve problems for the client or patient.

“You move the conversation over to them,” she said. “You ask them that powerful, provocative coaching question: ‘where do you want to start?’” She added, “You go where they want to go. That’s it because we are developing trust and rapport in such a beautiful and concrete way.”

The beauty of a coaching conversation at a peer level is that patients or clients may not have any instances of that in their life, as they may be talked down to, Jordan said. It's so rare to have a conversation with somebody that is open-ended, non-judgmental and totally curious, according to Jordan.

“That curious mindset, that is the coach mindset,” Jordan said. “It’s so powerful and sweet. When you start mainlining it, you don’t want to do anything else.”