I thought I’d do a quick search through the internet to locate resources and worksheets for health coaching – and what a wealth there is! I’m not sure about the grammar of that last sentence, but I am sure of the amazing amount of material there is online.
First up, a link back to Health Coaching Australia, with a very good series of worksheets in pdf format on topics like a healthy goal action plan, a weekly goal checklist, a ‘change your mind’ worksheet (decisional balance), and an ‘activity pyramid’ for the elderly. All work looking at and perhaps modifying if you need to.
University of Iowa provides a health coaching service – and has several worksheets that could be used as an initial screening or record tool, and one that I liked especially, a ‘roles and responsibilities’ sheet listing the expectations from each person in the coaching relationship. If you head to the ‘Resources’ section you can find further tools mainly for more general health situations such as a food diary, and a headache diary with some helpful ideas for what to record.
If you’re curious about the various self management programmes available, this summary outlines some of the more popular generic programmes that have been used around the world. It does give some dollar figures, but I can’t be certain whether these are up-to-date, so it would pay to make contact with the providers before saving your pennies!
A very helpful bibliography for anyone thinking about chronic conditions self management is available here, while this page lists a huge number of tools for developing chronic care management within a clinical practice setting. I really liked the ‘Patient Assessment’ tool, but it’s certainly not the only one you could use. Also available at The Robert Wood Johnson Foundation website, is a very practical booklet called ‘Partnering in Self Management Support: A toolkit for clinicians’. This includes some really great steps you can include to ensure your patients really do understand what their health problem is, and what they can do to help themselves.
Before, During, and After the Visit
- Help patients understand their central role in managing their conditions and that the entire health care team is there to help.
Before the Visit
- Make time for self-management by gathering clinical and patient experience data in the chart.
- Ask patients to bring questions and concerns and health monitoring information.
During the Visit
- Collaboratively develop a visit agenda with the patient and family, handling as many concerns as possible, and plan return visits as appropriate.
- Engage the entire practice team in supporting patients, use “warm handoff” introductions, and explain team member roles to patients.
- Ask about patient goals to improve their health and help them make action plans that build confidence in their ability to reach these goals.
- Use “ask-tell-ask” to provide just the right information at just the right time and “close the loop” to ensure patients know how to use the information.
- Prepare a written care plan or visit summary that includes goals and action plans to ensure patients and families know what to do when they leave the visit.
- Use group medical appointments, peer-led support groups, or patient education classes to provide opportunities for patients to share experiences and support.
After the Visit
- Organize follow-up support to help patients sustain healthy behaviors between visits.
- Extend care into the community by linking patients to community programs.
Build a Team
- Designate and train a lead coach for self-management support who will support ongoing staff development of skills.
- Assign responsibility for self-management tasks to all team members, extending the work out from the physician.
- Use daily team huddles to review the schedule of patient charts, anticipate care needs, and enhance the flow of care.
While pondering the idea of self management, and all the wonderful resources available to do this, I had to pause and consider the differences between chronic disease management like diabetes and obesity or chronic respiratory disease. I see one of the main differences is that many people with chronic pain are still searching for ‘the cure’ or for pain reduction through medical or pharmacological management.
Unlike people with diabetes, for example, who are clearly aware that their disorder cannot be ‘fixed’, people with chronic pain often continue to hope (and at times be promised) that their pain will be completely abolished. The mixed messages that people with chronic pain often receive, both from those unscrupulous purveyors of lotions, potions and magnetic devices – as well as well-meaning but also misguided individuals who believe they have ‘the answer’ and that pain reduction should be the only focus – can lead people with chronic pain to fruitlessly pursue pain reduction instead of learning to live good and healthy lives despite their pain.
Self management doesn’t seem to work well when the promise of removing pain remains the focus.
This makes the work of helping people look to developing self management of their chronic pain so much more challenging that working with people with other health conditions. So many of the messages that we need to convey to people with chronic pain run counter to popular belief – like being active despite pain, taking medication on a regular basis even when pain isn’t high, doing no more on good days than on bad, no less on bad days than good, that X-rays aren’t helpful in most low back pain – the list goes on.
I applaud the idea of self management and health coaching. I hope that it becomes a standard approach to managing chronic conditions – and maybe the idea that much of health comes from what you and I actually do for ourselves might rub off in the management of chronic pain.