Health Coaching to Improve Health Literacy | Essential Webinar for Counselors

Hello, Low page. Welcome back. Okay, let's go ahead and get started. I know not everybody is here yet, but not everybody really cares about hearing the objectives and I want to make sure I do my best to get through the presentation in the hour allotted you. I'd like to welcome everybody to today's presentation on improving health literacy with health coaching. I'm your host, Dr. Donnelly Snipes. In this presentation, we're going to define health literacy and explain why it's important. We'll identify at least five ways to improve health literacy and then explain how health coaching uses motivational enhancement and adult learning theory to help improve improve health literacy. You have the knowledge got to help people actually implement it. And then we'll describe some different skills that a health coach needs in order to help people become more health literate. Health literacy is the degree to which individuals can obtain, process and understand basic health information to make appropriate decisions. This includes their math skills to manage levels like their, their insulin levels or their blood pressure or anything else that involves numbers. People need to be able to understand. I know cholesterol is a big one right now. You have, well all the time, but you have your HDL and your LDL and figuring out whether you've got a good ratio doctor rarely tells you a ratio and it's important to understand how that impacts you. We need to help people understand their risks for for certain conditions, certain diseases, and a lot of that is online. But most people don't know where to go to find out. What's my risk for diabetes? I don't know. Maybe I'll ask my doctor, maybe I won't. But you can go on and find information online. However, as we all know, the Internet is not always the most reputable place. So it's important that we help people figure out how to discern what a reputable site is versus one that's not so much. Math skills help people measure their medication. If they need to have 1 teaspoon or something and they've only got a half teaspoon handy, then they may be able to figure out how to double that in order to get what they need. I know when I work with animals, when I do animal rescue, a lot of times we're told to give so and so many milliliters of a particular medication. And knowing how to translate between the two can be really helpful. Between milliliters and teaspoons, people also need math skills to understand nutrition labels and figure out how much, how many carbohydrates, what percentage of my diet is coming from carbohydrates, for example, or. Or how many grams of protein do I need? And yes, again, they may be able to ask their doctor, but how many people really ask this question and how many doctors actually give any sort of useful answer? And they need to have math skills to manage their insurance, to understand deductibles and coinsurance and those things so they can choose the best insurance policy for them. Health literacy includes general health information about requirements for good health that include exercise, sleep, nutrition, and regular checkups, as well as ways to prevent or mitigate common risk factors for disease. Okay, these are things that we hope people learned in health class in middle school and high school. But un. Unfortunately, that's probably not the case. Only 12% of adults have proficient health literacy or the skills needed to manage their health and prevent disease. Sorry, y'. All. Hopefully I'll get over this cold pretty soon. Health literacy, which is what a person needs to know and how to help them understand and use that information. And I can have all the knowledge in the world, but if I don't know how to actually implement it, it ain't going to do me any good. So the ability of people to translate knowledge into practice means that is dependent on the communication skills of the laypeople and professionals that teach it to them. A lot of times doctors will talk in doctor speak, and because of white coat syndrome or whatever reason, people may just nod their head and go, huh, okay, fine. And not understand a dagum thing that was said. So it's important that we are able to communicate efficiently and effectively with the populations we serve. If you're working with somebody who's traumatized or who has dementia or who has stressed out and just has a lot of stuff going on, one of those communication skills may be making sure that we write it down. Another thing that affects our ability to provide health information and help people become more health literate is our own level of health literacy. Can't teach what you don't know and the particular demands of the situation in context. And that's really important. When I used to work in community behavioral health, we would do an intake with somebody and we had 90 minutes. 90 minutes to get through 73 pages. This was back before the computers. 90 minutes to get through 73 Pages of material. And so there wasn't a lot of time to provide a lot of information, even though it was important. And one of the things that we did was create some handouts that had bullet points, brief, understandable information that we could hand out to everybody that attended to A lot of the things that a lot of the people we were working with were dealing with. So we were providing them a handout. Is giving them a handout the best course? Heck no. But it was better than nothing. And then when they came back, we could help them figure out how to access those resources if they needed to. Health literacy affects people's ability to find information and services. As I mentioned earlier, if they don't know what a reputable source is, then it's going to be hard to sort through and figure out what's true information and what's hogwash. And to find services. It can be really hard to find services. And I mentioned before this class started, some people will go to United Way 211 or Information and Referral. And that is a good place to start. However, the only people or the only agencies you'll be connected with through 211 are the agencies that are in their database. Their database is minuscule compared to Google. I encourage people, if they're looking for particular resources, to also do an Internet search to find out the resources that are close. Health literacy affects people's ability to communicate their needs and preferences and respond to information and services. If somebody's coming in for treatment and they have no idea about the different types of counseling or ways to address their addiction or their, their depression, they're just walking in going give me, give me whatever you got, doc. And that's not super helpful. Health literacy is, can help people say I prefer a cognitive behavioral approach or I don't want to be on medication or I do want to be on medication, whatever it is. And when the physician or counselor or caseworker proposes different strategies, the health literate person is able to evaluate that and go yeah, that might work for me, or nah, guess again. Health literacy helps people process the meaning and usefulness of the information and services. If people are health literate, then they recognize when they undergo certain things or engage in certain practices that the what they should expect in terms of outcomes, what are they looking for so they can evaluate the usefulness of this information. If I get information about statistics. Oh, people use statistics like crazy. And usually to prove their point, not to be objective. So if I hear that the rate of this particular disease has jumped 100% this year. Oh my gosh, that sounds pretty daggom scary. What are they saying? Was it last year were there two instances of the disease and this year there's four instances of the disease? Well, that's very different than if last year there were 2 million instances and this year, there are 4 million instances. The likelihood of it impacting me as an individual is a lot Greater when it's 4 million people versus 4 people in the world. Health literacy impacts people's ability to understand the choices and consequences of the information and services. If I do this, what are the short term as well as the long term consequences? And it helps them decide which information and services they need to take action. Health literacy is very empowering. It takes the professionals, if you will, out of the driver's seat and puts them both in mutual driver seats. I don't know where I was going with that metaphor. I tell my clients when I start working with them, I have a lot of knowledge about psychology and skills and mental health issues. But you are the expert on you. You know what has worked and why, and you know what hasn't worked and maybe why. And let's talk about that. You need to help me tailor the strategy to meet your needs. Anyone who provides health information and services needs health literacy skills. If you're a teacher, if you are a caseworker, anybody who is providing health education. We need to help people find information and services, effectively communicate information about health promotion and conditions of people of varying ages, cultures, and cognitive abilities. And one of the strategies that's helpful is one that they call teach back, where just like it sounds, you explain something to somebody and then you have them explain it back to you. And it takes a minute to get the verbiage down where you feel comfortable saying it in a way that doesn't feel condescending, but it can be very helpful. For example, if you're trying to help somebody determine how much insulin they need to take based on their, their blood sugar reading, you explain it to them and then you say, let's work together and, you know, go through a couple examples to see, make sure that you feel comfortable with this. It's not to see if you get it, it's to make sure the person feels comfortable. We need to be able to understand what people are explicitly and implicitly asking for. They may come to us and say, I got my lights turned off. Okay, what are they asking for? They're asking for assistance finding somewhere that can help them get their lights turned back on. But maybe, or maybe they have the money, they just don't know how to contact the agency to get the lights turned back on. We need to communicate and ask them exactly what it is that they need help with. And we need to decide which information and services work best for different situations and people so they can act. And I Have asterisks there because deciding for people is very paternalistic. However, as a professional who's been working in this field for a quarter century, I have an idea about what services somebody's going to qualify for versus not. And I'm not going to send them on a wild goose chase trying to access services that I know good and well they're not going to qualify for. So it helps me help them sort through all of the resources, if you will, that they find wherever they find them. A health literate case manager or clinician integrates health literacy into planning, evaluation measures, patient safety and quality improvement. We want to look and make sure that people are developing the skills to keep themselves healthy, not having us constantly telling them what to do. They're learning how to do research on their own. They're learning how to evaluate it. They're learning how to take steps necessary to advocate for themselves. We need to have a high level of health literacy and work with people in the design, implementation and evaluation of their treatment plan. Most of the time, none of these happen, I'll be honest, and that's not okay. We are supposed to work with people in designing their treatment plan or service plan to figure out what it is they're motivated to work on and what steps they're willing to take. The implementation we're supposed to help work, help them access some of these services. If you've dealt with certain agencies, I won't call them out, but it can be a circus trying to actually connect somebody and help them get services at certain agencies. And what I'm referring to right now tend to be more governmental agencies. But when you're talking about a large community, behavioral health, it can also be overwhelming and confusing and everything else. So we want to make sure that we are there to help them implement the strategies. And when they start trying, if they have difficulty with implementation or we're there to help, nudge them along the way. Okay, you got this far, great. Let me help you get the rest of the way. And then we want to work with them to evaluate the plan. Have is what you're doing working in your experience, what do you think? What do you feel? It's not for me to say, well, the person has been sober and has had a house for six months. So yeah, it's working just fine. Well, those are my goals. Those are my dashboard things that I've got to measure. But what is their thermometer or measure that they're using to evaluate the effectiveness of what they're doing? Said another way, when they look at what they've been doing, their service plan, how is it helping them work toward their rich and meaningful life? We need to use health literacy strategies and communication and confirm understanding. And that doesn't mean asking. So do you understand what I was I just told you? Because a lot of people are going to say, huh, sometimes they may truly believe that. I remember going to a motivational interviewing seminar and sat through it, watch, watched, participated, whatever, and I thought I had motiv motivational interviewing down. And when it came time to actually implement it, right after the, the conference in, in session, I realized I didn't really know what was going on. I had all the knowledge but I didn't know how to translate that effectively into practice. So we need to make sure that we are confirming that people understand what they need to do and how to do it. We need to provide easy access to health information and services. If there are certain things that y' all encounter with your clients on a regular basis than creating short little videos that can be put on the website, creating handouts, creating things that they can access, ideally 247 when they, when that need comes up. We want to design and distribute print, audio, visual and social media content that's easy to understand and act on bite sized chunks. Even more so than the first time I presented this class several years ago with the advent of tick tock and everything else lately it seems to be more important to keep things bite sized. And this is a tool that you can use, this is how to use it. Let's practice it done and not go into an hour long presentation. And we need to regularly address health literacy in high risk situations, including care transitions and medication changes. When I had clients that would move from residential down to unfortunately most of the time straight up outpatient, that's a big change. And are my clients understanding what they need to do? Are they able to get to their appointments if they're not, do they know how to access services to help them get to those appointments? You see what I'm saying? So when care changes, the person's level of support and the things they need to do often changes as well. We need to evaluate understanding of the condition, treatment options and services available at admission. I mean that's informed consent. But we do need to make sure that they understand what their options are. They don't feel forced or pressured or like there's only one option. We need to evaluate their understanding of general health and wellness behaviors. Do they understand the importance of sleep? Do they understand the importance of nutrition? Do they understand the impact that drinking a fifth of alcohol has on their body. We want to assess their ability to seek out, obtain and use health related information. I know I've said that multiple times, but that's important. That's part of health literacy. Making sure that we're assisting clients in learning how to become more independent, more literate and more self advocating. We want to identify obstacles to client health literacy and set goals for improvement. Some of those obstacles can be unclear. Videos handout with small type I know, especially with my vision these days, I need it in big type. A lack of a clear way to transition knowledge to practice. If we tell somebody it's really important that you get eight hours of sleep a night, they're going to look at us like who? Who says and why? And even if I want to get eight hours of sleep a night, I don't know how because I've got insomnia. Okay? So we need to help people understand how to translate that. And we want promote to promote changes in the health care system that include improved health information communication, informed decision making and access. When we start engaging with our clients and evaluating their health literacy, we're also evaluating their needs and unmet needs in our particular area. And once we do that, then we are more able to go to the powers that be and try to fill gaps in care. We want to support and expand local efforts to provide adult education in especially in English and math so people can be literate. If you can't read about or don't understand what they're writing about, how to prevent diabetes or how to address addiction, you're not going to get very far. And as I mentioned earlier, if you can't do basic math, that also may be a hurdle in implementing a lot of these strategies. And we need to make sure it's culturally and linguistically appropriate in the communities that we serve. If you work in a community that has a lot of people who are Spanish speaking, then we need to make sure that we've got some resources that are presented or translated in Spanish. We want to support efforts to provide services in people's native languages and build partnerships, develop guidance and change policies. Well, that's not just you. We want to advocate for improving health literacy across the board. Schools, churches, community centers, doctors. Helping people understand, just like we're talking a lot about trauma informed care these days, helping people understand what their. Clients, just use that term, generally what their clients need, whether it's their parishioners or their students or whatever, in order to become more health literate and in order to access services necessary for health literacy. And we need to advocate to increase accuracy of health information in all media programming. If you see something that comes up that is just blatantly wrong, it is important to consider contacting that agency that put that out and say, where'd you get this from? Good resources are accurate, accessible and actionable. The three A's accurate, accessible to the person both in a language that they understand and also in a format that is work, works for them and actionable. All right, well, I'm at risk for this particular disease. That's scary. Now what do I do to reduce my risk? I can get better sleep, I can eat better, I can do whatever. But it provides, it may indicate a potential issue, but it also provides one to three actionable steps that a person can take. Now if I say in order to prevent disease, you need to improve nutrition again or fallen short. Because most people have no clue what good nutrition looks like. So we would need to be more specific about what they can do in order to improve their nutrition. We need to use plain language instead of technical jargon or confusing statistics. And talked about numbers earlier. Organize information so that the most important points come first. Even if you're keeping it bite sized, giving people really important information before they start drifting off or getting, getting bored is important. Break complex information into understandable chunks. Instead of doing a 30 minute presentation on improving nutrition, do 152 minute presentations on different strategies to improve nutrition. That way people can take it into bite sized bits. Provide recommendations and explanations of risk and benefits that are clear, concrete and understandable to the person. Risks and benefits. Don't tell somebody about how they're at risk for this, that and the other without providing them tools to address it and benefits to taking particular steps. And there's a focus on translating information from increased awareness to specific steps for action and and behavioral changes. You want to improve your sleep? Great. That's knowledge that it's important. Now let me help you figure out what you need to do to improve your sleep. Use multiple modes of communication, not just text. And I don't mean text messaging, I mean handing out, giving them a handout. A lot of people are too overwhelmed or too intimidated by agencies to to reach out. They're intimidated and have difficulty asking questions. So we can create videos on the importance of nutrition in prevention and recovery. We can provide pictures that help people visualize it. And we can provide experiential activities to help people get more comfortable with actually implementing it. When you give somebody a referral, for example, if they don't follow up with that referral. You want to ask yourself, why not? Did they not see the need for it? Well, you clearly didn't communicate why that was important, or were they overwhelmed? I've had a lot of people be just be completely what I call phone shy about calling and setting up appointments or trying to connect with different agencies because it feels overwhelming. It feels disempowering. A lot of times, a lot of times they come away feeling like a number. So helping people actually do it. And I've had them watch me do it. I've had them do it while they're in my office. So I can help them through it if they start getting flustered and then getting to the point where they feel comfortable. We want to respect cultural preferences and practices. Not everybody wants to go to a traditional western medicine physician. All right, what's going to work for you? And involve members of the target population in planning, developing, implementing, disseminating and evaluating the effectiveness of the information. We're putting this information out there. Is anybody consuming it? And when they do consume it, is it useful to them? If not, what would be more useful? Dissemination strategies. School curricula from daycare to college. And yeah, daycare. Little children 2, 3, 4 years old can understand the importance of hand hygiene, can understand the importance of drinking their water. There are things that we can teach school. Young children can start developing emotional intelligence. They can start developing coping skills and distress tolerance. So we can start as early as daycare. Teaching healthy physical, interpersonal, cognitive, emotional behaviors. YouTube and now TikTok evidently is another area where people do go in order to get information, whether it's about how to change a fan and a refrigerator or how to cope with depression. Social media is another place, and it can be wrought with problems. But some social media sites are actually helpful. One of the ones I like is called patients like me.com and it's where people go in and they log on and they can connect with people who've taken certain medications or had particular diagnoses, other people who are going through similar things and get information about the treatments that they're going through, how well it's worked for them, what the side effects are, whatever. A lot of stuff that you're not going to get from your typical doctor or clinician. And you know, to a certain extent there may be some of this that we see, for example, on Reddit. But anyway, that's one site that I have found really helpful for helping clients find community. Podcasts can be helpful. Handouts can be helpful. And the CDC, the National Institute of Mental Health, SAMSA N4A and NIDA, the National Institute on Drug Abuse are just a few of the governmental agencies that put together handouts on particular issues, particular conditions, and sometimes particular treatment strategies. And it's up to you to evaluate whether that's useful for your clients. News broadcasts. We can start doing this. We used to, back in the day, they would have a minute, they would have some sort of commercial, if you will, where they taught us about a particular issue, or somebody came on and said, hey, I've got depression. This is what it looked like. There's no shame in seeking help. And it did a lot to increase people's health literacy and get them talking about what we need to do in order to have a healthier life. Or if I'm depressed, it helps me know a tool or a few tools that I can use in order to start addressing it. Local magazine columns are another place. There's a lot of local magazines, you know, in a. Where I live, it's the Lebanon Magazine, the Mount Juliet Magazine, the Nashville Magazine. But having columns that are written by health educators can be another way to disseminate information. Mobile apps, health fairs, another one, church circulars. There are still a lot of people who go to church and there's a lot of people who read the circular during the sermon. So having information about health literacy in church circulars can be really helpful. Libraries. Having certain sections set aside in libraries that are dedicated, dedicated to particular topics and highlighting those topics can be helpful. T shirts, you know, wear around a shirt that says, this is how to deal with depression. I have one T shirt that I made that was 12 tips to improve Happiness and Cognitive Behavioral Strategies. But it's there. Do people read it? I don't know, but it's another way of just literally getting the word out. And peer facilitated education, thinking about how we can help peers, educate peers about what's going on. And that was one of the things that really surged over the past three, four years is peer support. And it is really helpful for a lot of people. Just like I said with patients like me, when you have people who've gone through the same thing or who are going through the same thing, who can help educate one another, because a lot of times they're speaking the same language. If you've ever been at a class in which you were being taught by the professor who wrote the book, too often the professor is talking up here because everything down here seems just too elementary. They're like, why would you need to know that? And so students can Talk among themselves and educate themselves unfortunately, but that's what it's like. A lot of times when physicians or other people communicate with their clients, we assume knowledge that they don't have. What do people need to know? Basic health promotion behaviors and how to implement them. Basic health needs by developmental stage what does a 2 year old need versus a 22 year old? Parenting and self parenting skills A lot of people had really crappy parents and really crappy childhoods. Let's just call it what it is. And they still want to live a rich and meaningful life, which means they need to develop all the skills that their parents didn't teach them and learn how to self manage basic coping and distress tolerance. Basic math and reading skills to help them manage their nutrition, their weight, their blood sugar, their medications. Basic reading skills to manage and help them learn about health problems when they arise. Time management skills and communication and assertiveness skills including self advocacy. If you're working with somebody, you may be great at providing health literacy information, but the six other providers they're working with, not so much. So helping them learn how to be communicate assertively what they need advocate for themselves with those other providers goes a long way. You can't teach everything and you don't know everything. People need to know how to identify and mitigate risk and enhance protective factors for the development of mood disorders, addictive behaviors, stress related health conditions, including adverse childhood experiences. They need to know how to access accurate, understandable health related information to identify wellness behaviors as well as symptoms of mental health, addictive or physical health problems. So people can identify early on that hey, I may be starting to develop depression, I may be starting to develop an addiction. What do I do instead of waiting until this is this full blown thing that's going to be a lot harder to address and treat. People need to know how to identify community based resources like support groups, housing, medical care, dental care, transportation, child care, respit services, etc, and some of these things you can easily search for online. But others of these things are a little bit more difficult to find out. Like respit services. You put in respite services in Google a lot of times you're not going to come up with a lot. So having a database as a clinician, having a database of community centers and churches and drop in daycares or whatever that may help provide respit services can be really helpful. And that's where we start identifying where are the gaps that keep people from being able to access the knowledge and services they need. Translating knowledge to Practice Health coaches have that knowledge, that's great, but now we need to help people learn it and use it. So we want to provide self management support. No change happens like that. If somebody says, okay, I need to improve my sleep or my nutrition or address my cognitive distortions, well, that's wonderful, but it's not going to suddenly flip a switch and be different. We need to help them in their learning process. We need to educate clients about the steps in that learning process and that change is not going to happen like a light switch. That's okay. We want to look for progress, not perfection. Health coaches can bridge the gaps between clinicians and patients. If they go into their endocrinologist and get a whole bunch of gobbledygook back, the health coach can look at the treatment plan and say, okay, let me break it down for you. I mean, ideally the endocrinologist would have broken it down, but we can help patients navigate the health care system and offer support and encouragement. A lot of nurses, while I'm on this topic, a lot of nurses are also health coaches because they pick up where the doctor left off with jargon. Significant improvements in one or more of the following have been seen with health coaching. Nutrition, physical activity, weight management, exercise frequency, perceived social support. This is really important because loneliness is a huge issue these days. Patient engagement and activation. That means their motivation and actually implementing stuff and medication adherence. So health coaching can be super useful and serves as what we may call a therapist or clinician extension. So the doctor or the therapist isn't constantly having to check in with people and there's somebody that they can reach out to between appointments. Common features of effective programs are goal setting, motivational interviewing and collaboration. If you are the health coach, then you may be serving as the case manager or single point of contact. So you want to know what are the treatment plans from all these different providers and help communicate with them. Hey, I know you want Sally to be doing this. She's not understanding how to make that happen. So what do we need to do in order to help her translate it? Adult learning theory. Now if you work with kids, that's slightly different, but in adult learning theory, we figure out how to communicate this information in a way that is received and processed. We provide explanations of why specific concepts are being taught. Why do I care about nutrition? Why do I care about health literacy? We ensure that learning is connected to their health goals. We want to make what they say make room for meaning. We want to say nutrition is important and this is why it's important to you. Based on Your goals for your rich and meaningful life. We want to use self assessments to assess different levels of prior experience and education. If somebody is a registered dietitian, you don't want to start telling them about what a serving size is. That's annoying and condescending. So we do want to make sure we're meeting the person where they are in terms of knowledge, skills and abilities. Remember, prior learning will be the filter with which they conceptualize new information. If they've been told that this particular condition is manageable but not ever curable, then that's how they're perceiving what you're talking with them about. And maybe that's accurate, maybe that's not. For example, personality disorders have long been seen as being incurable, and I vehemently disagree with that. But people who've been told that their condition is incurable may have a much greater sense of hopelessness and need more motivation and more scaffolding in order to help them get engaged. Use multiple methods of instruction, talk about it with them, give them written instructions and help them practice it. Ensure access to sufficient resources as possible. And remember that adult students often prefer a self directed approach that allows for discovery on their own. They don't want to be spoon fed everything most of the time. They want to be able to research the information when it's practical. In order to help people implement this, we need to enhance their motivation. And I have lots of videos on motivational enhancement and goal setting, so I'm only going to kind of skim over these things. But it's important to understand the more areas, the more pieces of their life that you're improving their motivation, the more motivated they're going to be. Physical motivation, how is this going to help the person feel better? How's it going to improve their health, their energy, their pain levels? That's pretty motivating for most people. Interpersonally, how will making these this change? Whatever you're hoping they're going to make or how will this knowledge enhance their important relationships? They may not care about their neighbor two doors down, but they care about their relationship with their kids or their spouse or their parents. And who is supportive of this change? All need support. Emotionally, how will this help the person be happier? Cognitively, how does this make sense to the client? Do they understand the why? Why is getting more sleep going to help you deal with your ruminations? You know it doesn't. Those two things don't seem connected. But research has shown that people who are sleep deprived tend to have more ruminations and More difficulty controlling their thoughts. We want to help them see the whys behind this and how does it help them with brain fog. And a lot of people use that term to refer to slow processing, difficulty with attention and concentration. Environmentally, what things can be placed in the environment to enhance motivation and in what ways does this change, help the person live more in harmony with their personal values and feel a greater sense of connection? Motivational techniques to help, you know, we see all these different ways that we can. Dimensions in which we can increase motivation. But how do we do it? Well, reflective listening. If I hear somebody saying they're exhausted all the time, then I'm going to reflect that back. And I can also talk about how getting better sleep can help or improving their diet. Open ended questions about the benefits and drawbacks to staying the same. And I know you're like, excuse me. People do things that have the most benefit. So what are the benefits to what they're doing right now and, and the benefits to staying the same? And what are the benefits to change so they can wave for themselves. We want to encourage affirmations of self efficacy or their ability to do it and optimism. What is it that you think you can do? Recovery looks huge. That can be overwhelming. What is one thing that you know you can start doing today? Helping people recognize the importance and, and the practicality of baby steps. Every baby step you make one baby step for 365 days. That's 365 steps. We want to develop discrepancy between what they're doing and their rich and meaningful life. How is what they're, what you're doing right now keeping you from, from moving toward your rich and meaningful life? And then once we've kind of established that, then summarize. So what I'm hearing you say is this is what you want out of life. This is what's keeping you from achieving your goals. And you're willing to try doing this, that and the other in order to address it. Behavior change theory. All right, so they're motivated. That's great. Now they have to be able to actually change that behavior. And, and we need to help them. When presented with a need to act or behave, people choose what's most rewarding. Well, duh, I'm not going to look at something and go, yeah, let me choose the most painful or costly thing. No, that's just not how we're wired. One issue many people have is delay of gratification. They choose what's most rewarding in the moment instead of overall and helping people Be able to step back and make a informed decision about what's the best course of action to help me move toward my rich and meaningful life. It may be great right now or it may suck right now, but in the big scheme of things, what's the best course of action in order to do that? People need distress tolerance skills. They need to be able to unhook from their feelings and thoughts and say, all right, I'm having a feeling that I'm anxious or I'm, you know, having all these thoughts that something's going wrong with me physically. Okay, well you're having these feelings or thoughts now. What do you do with them? They're not part of you. You can figure out what to do with them. And I talk a lot about that in my video on acceptance and commitment therapy, redirection. Sometimes things just suck. And that's going to be the way it is right now. And helping people turn their attention if they're having cravings or if they're feeling really anxious right now, unhooking from that thought, recognizing it's a thought or a feeling, and then redirecting their attention to something else, not forever, but for a minute so they can get out of their fight or flight stage and into their wise mind and using distress tolerant thoughts instead of saying, I have to do this or I can't tolerate this. Helping them develop thoughts that even maybe, this is awful right now and it will be over soon enough. This is awful right now and I can get through it. We want to reduce or increase access to the target. If we want somebody to stop drinking, then reducing access to alcohol, you know, get it out of the house, is going to be a step. If they continue to have it around the house, it's going to be very triggering. We can also increase access to the target. When we're trying to increase a behavior like exercise or healthy food, not everybody wants to go to the gym. Not everybody has a place where they can go out and easily exercise, walk. So what can they do if they want to exercise? Can they watch videos on YouTube or on Netflix or something of exercise? Helping them figure that out and then add stimuli to the environment, things that are going to remind them to engage in the new behavior. Rewards or reinforcers encourage a behavior to be repeated. Positive rewards mean you're giving me something, I do it and I get a reward. I go to work, I get a paycheck. Negative rewards. Negative reinforcement is not negative at all. Negative reinforcement means I'm taking away something unpleasant. If you clean your room, you don't have to eat your broccoli at dinner tonight. Woohoo. You know, kid's gonna clean his room. And it's important to understand that rewards can come from getting something or getting rid of something unpleasant. Consequences or punishments discourage a behavior. And it's easier to change behaviors with rewards because people move towards what's rewarding than to completely rule with consequences. Because if there's a consequence for it, okay, I may stop doing it, but what am I going to do instead? That and stimuli prompt a person to engage in a behavior. Remove unhelpful stimuli like the alcohol, get it out of the environment if, and then add helpful and motivating stimuli. If I have a, an urge to drink, if I'm having a craving to use, it's not in the environment, okay, that's good. And what can I do to get through this urge, this craving? Some people have a big book, some people have a bible, some people call a friend. What is it that you're going to put in your environment that's going to help you help people define their rich and meaningful life? Who and what things and experiences are important to you? If things were changed, if you were healthy, what types of things would you be doing or not doing? What are the most important elements in your vision? Why are these elements important to you? How are they actually going to improve your life? Which one do you want to work on first? On a scale of 1 to 5, what is your level of confidence you can achieve this? If they say it's a five, great, tell me why. If they say it's a one, okay, tell me why and let's see how. What would need to change in order to help you feel like you're at least a 3? What types of assistance might you need in achieving your goal? KSA stands for knowledge, skills and abilities. Knowledge of the issue, the skills to address the issue, and the ability to translate that those skills into actual, practical, useful stuff. What obstacles do you anticipate and how can you deal with them? There's going to be obstacles and the only obstacle may be I don't wanna. Okay, there are gonna be days you don't wanna. How do you deal with it? So you do it anyway? And what strengths and resources do you have that will help you accomplish these goals? People can visualize goals using pictures, collages, scrapbooks to help them see, you know, their destination, where they're going. They can use push notifications to give them, give themselves encouragement and to remind them why they're doing this. They can use Narratives or journaling with narratives. I say write the chapter. Okay, you're closing this chapter. You are no longer going to be drinking alcohol or you are going to start in this next chapter. You're going to start addressing your depression. All right, Write that chapter for me. What does this chapter hold for you? What are you giving up? What are you using? And. And that help helps some people get a more concrete idea about what they're going to do and then encourage people to reflect on the day, every day. What went well? What didn't go so well, what helped you move towards your goals, what might need to be improved on a little bit. Some people are not down with the whole narratives and journaling, that's okay. I'm not either. Charting can be super helpful. Making hash marks of their progress. Did you do this? I had cravings today. All right, well, it happens. How many cravings did you have? How many cravings did you give into? And people can start keeping a hash mark chart so they can see their progress. Even if it's only going down a little bit every day, it's still going down. And mental imagery. I encourage people to use mental imagery when they are going to bed because right before you fall asleep is actually when your brain is most primed to learn new information. Envisioning their rich and meaningful life. Envisioning whatever it is they're working on and doing it successfully tomorrow can actually help. Start priming and pre programming the brain. As I mentioned with goal setting. KSAs are your knowledge, skills and abilities. The knowledge of the problem in general. Depression. What is it? What causes it? The problem for them. What does depression look like for me and what causes it for me? General interventions to address depression and what interventions might work for me. Maybe I don't want to be on medication. Maybe I don't like cognitive, behavioral. What other options are available? Skills. Help the person demonstrate awareness and effective use of skills at appropriate times. And this is more of sort of rehearsal and practicing. And then abilities is the person's ability to generalize awareness and skills to other life areas. If I'm using distress tolerance when I get angry, well that's great. And then if I can start using distress tolerance when I feel anxious, when I'm in pain, when I'm doing having these other things, that's generalizing, making it more abilities. Behavior change. Examples Emotional eating. A lot of people have it. Food is associated with pleasure and happy times or sometimes just emotional numbing. Food is readily available. So that's the stimulus. You're not just going to get rid of all the food in your house so you have this stimulus around when people are stressed or bored. The sight or smell of food in real life or in the media, seeing a commercial for pizza or something can prompt eating behaviors due to the hormone and neurotransmitter surge caused by memories associated with the food and sometimes the food itself. Once they start eating, they know it's going to trigger the release of some pleasure chemicals. Our goal is to develop alternative strategies to deal with those emotions and help them learn what those strategies are. Implement those strategies and when they don't, aren't 100% effective at implementing them. That's fine. Let's take a look at why and modify. We need to help people learn the process. Habit is another thing that a lot of people want to change. Sally smokes a cigarette when she's driving to work. After lunch, on the way home from work, after dinner and before bed to relax. She is not necessarily self medicating all the time. She's not necessarily responding to withdrawal symptoms. She's just, that's when she does it. My mother used to roll out of bed and before her feet hit the floor, she'd light up a cigarette. Smoking strongly activates the pleasure centers in the brain. So for this person, triggers may be being in the car, meal time, or when she needs to relax. Okay, so now we know what stimuli that behavior is associated with. We can help her develop alternative strategies to help her relax and figure out how to make smoking more. Make not smoking more rewarding and less punishing like through nicotine replacement patches. Finally, with scaffolding, the mnemonic is grow me. Goals between the client and the coach are specific and shared rescue or help is immediately available. The optimal level of help is provided. Not too much, not too little. We want to encourage self efficacy, self effectiveness, concrete use, concrete prompts help them use call on prior knowledge and we want to prevent pre present it. Using their preferred learn learning method. We want to use a whole task holistic approach. Cognitively, what is their ultimate goal? Emotionally, what are their concerns about their ability to meet that goal? And then we help elicit confidence. And then behaviorally, what do you need to do in order to make this happen? Finally, model desired behaviors and empower people to take care of chances. Scaffolding is something we use when we teach our kids how to tie their shoes. And that's the best analogy I can make because when kids are learning to tie their shoes, first they start figuring out, okay, how do I cross the laces over? And then a lot of times they get stuck. It's like, what do I do next? Okay, well, I'll let you get to the point where you don't know what to do next and I'll help you out. And then after they've done it a few times, they tie their laces and they make the bow and then they can't remember what to do next. And I might be like, okay, remember, what do you do now that you've got the rabbit ear? What happens next? And then walk them through it. So they're calling on that knowledge. You're not telling them what to do. You're prompting them to retrieve that knowledge that they have so it's more easily accessible the next time. Health literacy is imperative to empower people to take charge of their health and well being. Ensure clients understand their current condition, the causes of their current condition for them, and treatment options, and use that information to help them make informed choices about what to do next. Advocate in your communities, in your professions to start enhancing health literacy from birth. And I know an infant ain't going to get much, but preschool and on, definitely ripe for learning. Health coaching improves client retention and success. And health coaches have the opportunity to increase people's health literacy. Teach people how to enhance motivation, teach them how to set smart goals and how to attain those goals. Are there any questions? Hey Rookie J. Glad to see you. Alrighty. I know this was a long one but hopefully it provided you a lot of resources and as always, if you are taking this for CEUs in your class, you are able to download the PDF of the PowerPoint so you have access to the research that those links went to and you also can peruse everything that we went through because I know I went through a lot in this past hour. Everybody have a great day.