Health Coaching & Activation Skills development programme

1. Health Coaching & ActivationSkills development programme Resource guide 2017

2. Important note All intellectual rights in products or materials developed by TPC Health will be the absolute property of TPC Health unless specified in writing. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any other form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of TPC Health.

3. Acknowledgements • We would like to extend our thanks to Blackpool Teaching Hospitals NHS Foundation Trust for commissioning us to undertake this important piece of work. • TPC Health is led by Dr Andrew McDowell who has designed a variety of accredited programmes, short skills programmes and master-classes that focus on helping practitioners from many different health & care professions to use a coaching approach in their work. • Our first Health Coaching Skills Development Programme was developed as part of a wider Primary Care initiative developed with Dr Penny Newman in NHS East of England that involved the provision of health coaching training to support Practice Nurses to coach patients with long term conditions.  The original programme was delivered in NHS Suffolk and funded in part by an East of England Regional Innovation Fund. • We have consistently used the insights shared by the practitioners who have participated in our programmes to update and develop our Health Coaching materials and want to also acknowledge these very helpful contributions. • Our hope is that these programmes will encourage health & care practitioners to adopt a more person centred approach, using coaching to encourage greater awareness, responsibility and ultimately improve self management.

4. Programme Structure

5. Contents Introduction to Coaching 12 Psychological basis of coaching 15 Goal Setting 18 The TGROW Model 22 The Range of Coaching Approaches 27 Introduction to Health Coaching 29 Personalisation and Self-Management 37 Patient Activation 45 Managing Health - Diamond Model 51 Building Trust and Rapport 55 Using Challenge 59 Action planning 64

6. Contents (continued) ABC Health Coaching Model 81 The Inner Game 86 Working with Potential 93 Transactional Analysis 96 Solution-focused coaching 99 Stages of Change Model 102 Motivational Interviewing 107 Coaching Mindset 114

7. EMCC Coaching Competencies

8. Questions • What is my motivation to learn more about a coaching approach? • At this point, how confident do I feel in using a coaching approach?  • What do I expect my strengths as a coach might be? • What do I feel my development areas might be?

9. Your objectives • What would you like to Learn? • What do you intend to Achieve or be able to Dodifferently? • How do you need to Be in order to gain the most benefit from the programme?

10. The learning process 2. Conscious Incompetence 3. Conscious Competence Coaching Withdraw from learning process 1. Unconscious Incompetence 4. Unconscious Competence Practice Feedback Lack of awareness Source: The Learning Curve by A Maslow

11. Zones of awareness Zone of Exposure / Vulnerability Zone of Learning / Discomfort Zone of Comfort / Knowledge Source: TPC Health

12. What do you already know about coaching?

13. What is Coaching? “Coaching can be defined as the facilitation of mobility. It is the art of creating an environment, through conversation and a way of being, that facilitates the process by which a person can move towards desired goals in a fulfilling manner. It requires one essential ingredient that cannot be taught: caring not only for the external result but for the person being coached.” Tim Gallwey, The Inner Game of Work “You cannot teach a man anything. You can only help him discover it within himself.” Galileo “Coaching is the art of facilitating the development, learning and performance of another”. MylesDowney “Unlocking a person’s potential to maximize their own performance” John Whitmore “Coaching involves supporting someone to change their relationship to a problem” Andrew McDowell

14. Different influences on Coaching Source: TPC Health

15. Psychology of the individual A knowledge of some basic psychological principles can help a coach to understand the people they are working with, identify possible opportunities for asking questions and help people raise awareness of their own psychological processes Key areas of psychology of the individual that are directly relevant to coaching: • Personality & individual differences (basis of psychometrics) • Cognition – thinking styles (basis for how people construct their reality) • Information processing & decision making (basis for understanding how people choose to change) • Learning theory (basis of goal setting theory) • Motivation (basis of performance) • Communication & counselling (basis of most coaching skills) • Interpersonal relationships (basis of understanding dynamics) • Social psychology (basis for understanding behaviour in groups/teams)

16. Psychological maps and models Various schools of thought that are used in psychology that have been used as maps to explain the coaching process – and are at the basis of many of the general approaches that are used in coaching: • Psychoanalytic - stages of development, projection, transference • Humanistic – counselling approaches, listening, communication skills • Gestalt – individual responsibility & awareness • Behavioural – focus on behaviour, goal setting • Cognitive – extension of behaviour to mental/emotional events, ways of thinking • Systemic – relationships, interconnection • Archetypal – mythical (Jungian) – journey of discovery & personal development • Transpersonal – values, meaning and purpose • Positive Psychology - happiness and flourishing

17. Coaching techniques and approaches Techniques and approaches with a psychological basis • Coaching is full of many techniques and approaches that are designed to influence the psychology of the coachee • Many were pre-existing therapies or approaches for working with people that have been applied to coaching • Behavioural coaching • Cognitive Behavioural Coaching • Solution Focused Coaching • Integrative Coaching • Transpersonal Coaching (Meaning and Purpose) • NLP Coaching (Neuro-linguistic Programming) • Emotional Intelligence (EQ) • Appreciative Inquiry (AI)

18. Goal setting • What is the value of setting a goal? • In your working environment, who’s goal is it that you are usually working towards? (practitioners, service users/patients, commissioners?) • What factors might influence a persons willingness to set a goal? • What factors might influence a practitioner’s willingness to set a goal with someone?

19. Locke and Latham’s Goal Setting Theory 1990 - Locke and Latham publish “A Theory of Goal Setting and Task Performance” • Goals narrow attention and direct efforts to goal-relevant activities and away from perceived undesirable and goal-irrelevant actions • Goals can lead to more effort • Goals influence persistence A series of factors influence goal-directed efforts • Goal difficulty is the level of perceived difficulty in achieving the goal • Goal Commitment is the extent to which a person is interested in reaching the goal • Goal specificity means the level of clarity I have around what is required or needed • Goal acceptance means the levels to which a person adopts a goal as their her own

20. Goal setting There are several advantages in setting goals: • Emphasises the possibility of change • Focuses on an outcome • Focuses on the program of activity • A goal should be SMART

21. Notes

22. The TGROW Model Source: John Whitmore

23. The TGROW Model

24. Brief Coaching Dialogue What do you want to talk about? What do you want from this conversation? What is happening now? What could you do? What will you do? T G R O W Topic Goal Reality Options Will

25. When to use a coaching approach In your role, when do you think you could use a coaching approach? • Consider: • Types of situations • Types of service users • Types of health & social conditions • Types of team and staff related situations

26. Coaching Applications Coaching can be used in the following ways: • A formal one to one process • A team process • A meeting process • A brief intervention tool • An approach to having a conversation

27. The Range of Coaching Approaches NON-DIRECTIVE SILENCE/WITNESS REFLECTING PULL SUMMARISING Enabling person to solve their own problem - Accessing theperson’s resources & experiences PARAPHRASING PUSH CLARIFYING UNDERSTANDING Solving person’s problem for them -Offering the practitioner’s resources & experiences LISTENING TO UNDERSTAND ASKING QUESTIONS THAT RAISE AWARENESS Telling GIVING FEEDBACK MAKING SUGGESTIONS OFFERING GUIDANCE GIVING ADVICE TELLING / TRAINING DIRECTIVE Asking Source: TPC Health

28. Listen Discovery and Informing Empathise NONDIRECTIVE Clarify Discovery Ask questions Share opinions Inform Provide guidance Give advice Tell Informing DIRECTIVE

29. Introduction to Health Coaching In a health & social care context, performance = self management • Health coaching aims to raise awareness and increase responsibility for self management “A behavioural intervention that facilitates participants in establishing and attaining health-promoting goals in order to change lifestyle-related behaviours, with the intent of reducing health risks, improving self-management of chronic conditions, and increasing health-related quality of life” Van Ryn & Heaney (1997)

30. Traditional approach: A culture of “telling people what they need to do” • Practitioner is viewed as expert • Decisions often made by practitioner • Person believes it is the practitioner’s role to fix them • Goals are often suggested by the practitioner • Focus on extrinsic motivators • Psychological factors in change unlikely to be addressed Person Practitioner Source: Andrew McDowell, TPC Health

31. Different kind of conversation “Instead of treating patients as passive recipients of care, they must be viewed as partners in the business of healing, players in the promotion of health, managers of healthcare resources, and experts on their own circumstances, needs, preferences and capabilities.” Coulter (2011)

32. New skills for a new kind of relationship? Role of practitioner The coach is a healthcare professional trained in behaviour change theory, motivational strategies, and communication techniques, which are used to assist patients to develop intrinsic motivation and obtain skills to create sustainable change for improved health and wellbeing. Role of person A person centred approach wherein people at least partially determine their goals, use self-discovery and active learning processes together with content education to work towards their goals, and self-monitor behaviours to increase accountability all within the context of an interpersonal relationship with a coach. Practitioner Person Source: Ruth Wolever 2013

33. Health Coaching approach: A culture of “encouraging people to be resourceful” • Person is viewed as the expert in their own life • Person contributes to generating their own solutions • Decisions made in partnership • Person believes that they have an active role in their health • Person is supported to define & measure their own goals • Focus on intrinsic and extrinsic motivators • Psychological factors in change are addressed Person Practitioner Source: Andrew McDowell, TPC Health

34. Person Centred Coaching Skills Development • Behaviour Change theory • Social Cognition theory • Patient Activation • Motivational Interviewing • Stages of Change • Positive Psychology • Mindful awareness • Cognitive Behaviour Therapy Principles & models from Psychology and Behaviour Change Science • Knowledge • Recommendations • Diagnostic skills • Consultation skills • Questioning skills • Listening skills • Problem solving skills • Person-practitioner relationship Knowledge, skills & expertise of Practitioners Skills & techniques from Performance & Development Coaching • Goal setting • Coaching models • Coaching competencies • Range of approaches • Awareness & Responsibility • Focus on potential & emergence • Using Challenge & Rapport • Scaling Source: Andrew McDowell, TPC Health

35. Health Coaching integrates Source: Andrew McDowell and Dr Penny Newman

36. Health Coaching is an enabler of…

37. Self care support and self care Source: Department of Health

38. The four principles of Person Centred Care Being person-centred means affording people dignity, respect and compassion • Whenever someone interacts with health services, they should always be treated with dignity, respect and compassion. These ‘experience standards’ are basic human rights that are enshrined in the NHS Constitution Being person-centred means offering coordinated care, support or treatment • It’s not just individual encounters that matter – services should offer coordinated care, support or treatment across multiple episodes and over time Being person-centred means offering personalised care, support or treatment • Because we are all different, person-centred care is care that is tailored to the needs and aspirations of each individual, not standardised to their condition    Being person-centred means being enabling • The starting point for being enabling is seeing patients as assets not burdens and seeking to support them to recognise, engage with and develop their own sense of resourcefulness, and to build on their own unique range of capabilities Source: The Health Foundation

39. Shared Decision Making • Two sources of expertise … • Shared decision-making may involve negotiation and compromise, but at its heart is the recognition that clinicians and patients bring different but equally important forms of expertise to the decision-making process Source: Coulter & Collins (2011) Making Shared Decision Making a Reality, The King’s Fund

40. An asset based approach ‘Deficit’ oriented approaches: • Focus on the problems, needs and deficiencies in a community such as deprivation, illness and health-damaging behaviours • Designs services to fill the gaps and fix the problems • As a result, a community can feel disempowered and dependent; people can become passive recipients of services rather than active agents in their own and their families’ lives Asset oriented approaches: • Value the capacity, skills, knowledge, connections & potential in a community • … the glass is half-full rather than half empty An asset approach starts by asking questions and reflecting on what is already present: • What makes us strong? • What makes us healthy? • What factors make us more able to cope in times of stress? • What makes this a good place to be? • What does the community do to improve health? Source: Jane Foot, with Trevor Hopkins, A glass half-full: how an asset approach can improve community health and well-being Improvement and Development Agency: Healthy Communities Team

41. What are assets? Assets can be grouped into three levels: • Individual assets • e.g. resilience, commitment to learning, self-esteem, sense of purpose • Community assets • e.g. family and friendship networks, social capital, community cohesion, religious tolerance, intergenerational solidarity • Organisational or institutional assets • e.g. environmental resources for promoting physical health, employment security and opportunities for volunteering, safe housing, political democracy and participation Source: Morgan A, Davies M, Ziglio E. Health assets in a global context: theory, Methods, Action: Investing in assets of individuals, communities and organisations. London: Springer; 2010

42. Personalised care and support planning in … Source: adapted from TLAP (think local act personal)

43. TLAP Personalised care and support planning tool Source: adapted from TLAP (think local act personal) http://www.thinklocalactpersonal.org.uk/personalised-care-and-support-planning-tool/

44. Awareness and Responsibility Health Coaching aims to: Raise Awareness and Increase Responsibility for health Source: Andrew McDowell, TPC Health

45. Patient Activation level is predictive of behaviours • Patient Activation is…. • ‘an individual’s knowledge, skill, and confidence for managing their health and health care’ (Hibbard et al 2005) • Research consistently finds that those who are more activated are engaged in more: • preventive behaviours (e.g., attend screenings) • healthy behaviours (e.g., diet, exercise) • disease specific self-management behaviours and are more likely to have clinical indicators in the normal range (e.g., BMI, HbA1c) • health information-seeking behaviours (e.g., finding out more) • Tailoring service delivery according to patient activation levels can maximise productivity and efficiency by ensuring that the level of support provided is appropriate to the needs of the individual

46. Building Activation Source: Prof Judy Hibbard, University of Oregon (2008)

47. Low activation signals problems (& opportunities)

48. Tailoring support to activation measures Source: Prof Judy Hibbard, University of Oregon (2008)

49. Notes

50. Components of High Performance Achievement Sustained High Performance Enjoyment Learning Meaning Source: TPC Health