Michael Peterson, EdD
Professor & Chair, Department of Behavioral Health and Nutrition
University of Delaware
The etiology of many current chronic diseases (e.g., cardiovascular disease, diabetes, obesity, hypertension) is heavily weighted towards individual behavior (e.g. exercise, diet, stress management, sleep) (U.S. Centers for Disease Control and Prevention, 2014; U.S. Department of Health and Human Services, 2014), as well as social and ecological constructs (e.g. work, family, social support, living conditions) (U.S. Department of Health and Human Services, 2010). Despite the plethora of health information available, transferring knowledge into behavioral change or treatment adherence has been challenging. Thus, a need has developed to create a health professional role devoted to addressing the behavioral causes and contributors to chronic disease risk and helping patients develop healthier ways to function. As a result health coaching has emerged as a patient-friendly profession that provides health behavior change assistance to help prevent or better manage chronic disease.
Despite the demand and rapid growth of health coaching, there are few academically-based health coaching certification programs, and a standardized training curriculum has yet to be widely adopted. Typically, non-academic training programs are web-based, last approximately 10-12 weeks, and offer little practical application of the skills taught. In these programs, the certifying agent is often the same party providing the instruction. In response to inconsistencies across training programs, physicians and health professionals across the country have voiced concern that many health coaching certification programs lack the academic rigor and preparation to meet the demands of the health care system. Simply stated, they would not trust their patients to many “certified” health coaches.
A New Standard of Training
In response to this growing health care challenge, and the need to create a rigorous program that meets the needs of health care professionals, the University of Delaware formed a collaborative team representing physicians, nurses, psychologists, behaviorists, nutritionists, and pharmacists to create a post-baccalaureate certificate program in health coaching. The interdisciplinary team identified the following 10 competencies required of health coaches to best serve the current health needs of the population:
Patient chronic disease risk and behavior change assessment
- Behavior change strategy skills
- Motivational Interviewing
- Case management and patient progress monitoring skills
- Chronic disease etiology, treatment, and pharmacological knowledge
- Track and assess patient progress in behavior change
- Interpersonal and group facilitation skills
- Integrative health knowledge
- Ability to work as part of an interdisciplinary team of health professionals within chronic disease prevention, early intervention, rehabilitation, and other chronic condition self-management programs.
- Utilize information technology to monitor, motivate, and improve patient adherence to program plans
Our university-based program consists of five 3-credit didactic courses and a 3-credit practicum consisting of 120 clinical hours. The practicum allows every student to have a supervised clinical experience to further develop his or her skills. The five didactic graduate level courses are:
- Health Behavior Theory and Models
- Behavior Change Strategies and Tactics
- Concepts in Chronic Disease Management
- Integrative Health
- Health Coaching
All competencies identified by the program team are covered within these 15 credit hours. Students must demonstrate these specific competencies before being approved for their practicum experience. Preceptors have been identified and practicum sites established so that students can be easily placed within their program of study. Practicums require students to videotape three patient sessions for educational review and critique with an assigned faculty member.
Upon completion of the 15 credit hours of didactic course work and the practicum, students must take a final qualifying exam to receive a certificate of completion. The exam format involves two 45- to 60-minute coaching sessions with a standardized patient under the observation of a minimum of two health coaching program faculty members. Patients are professional actors from the university theater program who are hired to play a character designed to address areas of weakness a student may have exhibited during their practicum experience. Students are assessed based on the competencies outlined for the program for individual coaching sessions.
To be eligible for the program, prospective students must have a health-related undergraduate degree from an accredited institute of higher education (e.g. behavioral health, nutrition, exercise science, nursing, or related discipline(s), or commensurate and demonstrable experience in behavioral health and/or health care). This requirement allows the program to focus on the skills required to be a health coach. If deficiencies are identified in the undergraduate program, students may be required to fulfill those via co- or pre-requisites as part of their program of study.
Upon completion of the Graduate Certificate in Health Coaching program the student is ready to:
- Help people clarify their health goals and implement and sustain behaviors, lifestyles, and attitudes that are conducive to optimal health
- Guide people in their self care and health-maintenance activities
- Assist people in reducing the negative impact made on their lives by chronic conditions such as cardiovascular disease, cancer, and diabetes
Program graduates are prepared to be an integral part of public or private inter-disciplinary teams of health professionals within chronic disease prevention, early intervention, rehabilitation, and other chronic condition self-management programs. They are also prepared to function independently as health behavior change entities to help meet the growing need for health coaching consultations as part of chronic disease management programs. Additionally, health coaches are taught when to refer patients to other health professionals. For example, intervention with a patient suffering from depression, anxiety, or an eating disorder is not within the scope of a health coach’s activities. Such patients should be referred to a qualified member of the health care team or to an outside professional.
Future of Health Coaching
Based on a study conducted by the Education Advisory Board (Qing & Geraci, 2012), health coaches will be in greater demand as accountable care incentives shift responsibility for patient outcomes onto health care providers. Initial evidence indicates that even with minimal training, health coaches are playing an important role (Wolever et al., 2013); however, the ability and success of health coaches to consistently motivate high-risk patients to self-manage their conditions, as well as prevent low-moderate risk patients from becoming high-risk, will ultimately determine their role in the future of health care.
As with most new professions, there will be “growing pains” as training and professional standards for health coaches evolve. Eventually, health coaches may have to be licensed to protect the integrity of the profession as well as the health and wellbeing of patients. Until that happens, it is recommended that health coaches from formal academic programs within accredited institutions of higher education be the standard.
Finally, as health coaches become more common and their value recognized, health insurance carriers and other third party payers may begin to reimburse them for their work. Until then, health coaches work primarily on a fee-for-service basis in salaried positions within a given practice, where payment is absorbed as part of their service/administrative overhead, or they assume the role under another third party payer fundable credential (e.g., RN, RD).
Institute of Medicine (2001). Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences. Washington, DC: National Academies Press.
Qing L, Geraci L (2012). Market demand for certificate programs in health coaching. Education Advisory Board, 2445 M Street NW, Washington DC. 20037. Available at: www.educationadvisoryboard.com
U.S. Centers for Disease Control and Prevention (2014). National Health Report: Leading Causes of Morbidity and Mortality and Associated Behavioral Risk and Protective Factors—United States, 2005-2013. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/su6304a2.htm.
U.S. Department of Health and Human Services. Healthy people 2020. Leading health indicators. Available at: http://www.healthypeople.gov/2020/LHI/default.aspx
Wolever, R. Q., Simmons, L. A., Sforzo, G. A., Dill, D., Kaye, M., Bechard, E. M., Southard, M. E., Kennedy, M., Vosloo, J., & Yang, N. (2013). A systematic review of the literature on health and wellness coaching: Defining a key behavioral intervention in health care. Global Advances in Health and Medicine, 2(4), July 2013. Available at: http://www.gahmj.com.