Improve Health Literacy with Health Coaching | Steps to a Healthy Lifestyle

I'd like to welcome everybody to today's presentation on improving health literacy with health coaching. I am your host, Dr. Donnelly Snipes. We're going to briefly define health literacy, explain why it's important, explore health literacy in a recovery oriented system of care. Why is it important? Identify at least five ways to improve health literacy and then move on to explaining what health coaching is which guess what is helping people improve their health literacy? Differentiate it from counseling or medical practice, and explore very briefly some skills that a health coach might need. So we do have a lot to cover, but as always, if you have questions, please feel free to put them in the chat window and I will answer them as quickly as possible. Health literacy is the degree to which individuals can obtain, process and understand basic health information to make appropriate health decisions. And I will tell you, a lot of the websites out there and information out there on the Internet, as well as even some that your physician may give you, is not understandable. It's written above the comprehension of a lot of people. So that's something we have to be really careful about. Health literacy doesn't just include information or knowledge about things like the flu or diabetes, but also includes math skills so you can manage levels like knowing how many calories you can eat and what proportion of fats the carbs you're eating, or managing levels of insulin based on your glucose levels. There are a lot of ways that math is actually used in health literacy, not to mention the fact that you use a lot of math if you do any cooking at all, at least those fractions for the cups and half cups and teaspoons and stuff. It includes understanding risks. You know, you need to use math skills to understand how likely is it? What's the probability that I am going to get this? Is it 1 in 10 or 1 in 100,000 to measure medication, understand nutrition labels, and even manage insurance? If you've ever tried to deal with comprehending deductibles and coinsurance and all that other stuff, that's math. And when you are making health decisions, you're looking at services and going, is this something I can afford? What's the cost benefit to it and how much of it is my insurance going to cover? A lot of that is math, as well as being able to comprehend those forsaken policies. It includes general health information about requirements for good health, including exercise, sleep, nutrition and regular checkups, as well as ways to prevent or mitigate common risk factors for disease. We're going to talk about how to do that in a few Minutes, unfortunately, and I want this to sit with you for a minute. Only 12% of adults have proficient health literacy or the skills needed to manage their health and prevent disease. So just for simplicity sake, we'll round it down to 10%. That's 1 in 10. So just a little bit more than 1 in 10 people have enough health literacy to manage their own health and prevent disease. Think about that next time you go to work. If you work with 15 other people, that means there's a couple of them that are proficient, but the majority of the people that you're working with are not health proficient. And we work in a health profession. Health literacy, what a person needs to know and how to help them understand and use that information is dependent upon both the communication skills of the LAYP people, the people who are receiving the information, and the people who are communicating it, the professionals. We need to make sure we're communicating on the same level, at the same, you know, literacy level and in ways that people can understand. If you've ever worked with somebody who, you know, likes to use flowery language, or if you've ever, oh my gosh, read a journal article and y' all know I love going to PubMed and spending a lot of time in journal articles, but they are written to, you know, a level that most people don't want to have to decipher. Even if they can. They don't want to have to. We need to make sure that the information is presented in an understandable, easy, easily readable, easily comprehensible fashion. And in this culture of microlearning, it's even more important to make sure that we break it down into chunks. You Instagram type chunks. We need to make sure that lay's people and professionals have knowledge of health topics. And that's one thing. If you've attended my classes, a lot of us, when we went through graduate school, if you are in counseling, we learned a lot about counseling. We learned a lot about mental health, but we didn't learn a lot about addiction. We didn't learn a lot about why nutrition is important. We didn't learn a lot about circadian rhythms and endocrine system and how that impacts mental health. It is important for us a range of health topics. It doesn't mean you have to be an expert. There are endocrinologists for endocrine stuff. But it is important to understand things like how blood sugar levels or hormone levels can impact mood. You know, it's important to understand those things. And health literacy is also dependent upon the demands of the situation or context. When somebody is in crisis, you know, they just got a diagnosis of cancer or they just got a diagnosis of diabetes and they're trying to process this, they're trying to process this information. They are going to have difficulty taking in a whole lot of information at that point in time because they are in stress mode, they are in fight or flee mode. It is important in those situations to make sure that information again is clearly understandable. But it is also presented in a way that the person can review it when they are clearer headed, when they're in their wise mind. That can be through handouts, which I highly suggest, as well as little short videos. For example, that may be on your website. If you, you work with survivors of suicide or if you work with people who are undergoing bariatric surgery or people with addictions, you know, having information that is there, that they can peruse in their own time and at a pace that is comfortable for them and they can revisit as many times as they need to to get the understanding is really important. Again, I really encourage, if you're going to do a video, there are a lot of programs out there that are not expensive that you can get the transcript for the video and you can put the transcript on the website with the video. So the transcripts there is a PDF that people can download if they don't like watching videos. Health literacy affects people's ability to find credible, understandable information and services. How many times have you talked to somebody who is complaining, completely stressed out because they have gone online and they have googled their symptom and you know, worst possible case scenarios came up. I saw an interesting meme the other day that is so true. The condition that comes up when you google a symptom is the condition that has the highest search engine optimization. It's the one that brings the search engines the most money. So it's important to be able to ferret through this information and find credible, understandable information and services. I will give you some of those resources. I'll give you a hint in large part if you go to a site that ends in.gov.gov or.edu so like harvardhealth.edu. those tend to be relatively unbiased or relatively helpful sites sometimes like CDC.gov has a lot of information on policy and you really have to dig through it to find anything that the individual person can use. There is some stuff there, but it's important that people aren't going to just any random website and saying, well, you know, so and so XYZ.com said this is what I need to do to treat my depression or my addiction or what have you. It's important that they are relying on, guess what, we've heard it so much lately, the research. Now if they really want to do a deep dive, they can go to PubMed, but that's where they're going to find those hardcore journal articles. So you know, for a lot of my clients, if they have a question and there's not something readily available on online that I can point them to that is written for a layperson, then I will go to PubMed, I will scan the research, I will create a abstract or summary of what I find and then I will put the links for the research articles. So if they really want to go look at them, they can. But that's, you know, really important. The Cochrane Database is another place that people can go to find information. And I'm getting ahead of myself, I know I always do. But the Cochrane Database often has what they call the layperson summary or the general summary that is written, you know, for the average person who has didn't go to college for forever. And Claudia points out, and you have a good point, that family members can also be very misinformed. And a lot of times we will go to family members for information and they may have gotten their information from not a great source on the web or it may be outdated information. When my son was little, for example, you know, when he was an infant, the pediatrician told us no honey and no peanut butter until he is over the age of two. And honey used to be something that my parents gave me whenever I got fussy at all when I was little. And peanut butter. I think I grew up on this stuff. I think I have it coursing through my veins. But policies change as research changes. It is important to, if you have a question about something to find a place where you can verify or clarify that information. There are a lot of places that you can get consultations with doctors. For example, there's Doctors online, Teladoc and those sorts of places. It may be free through your insurance. A lot of insurances you can call like Blue Cross and Blue Shield. I know they have a service where you can call and you can talk to a nurse. So you just go to the 800 number on the back of your insurance card and you can call that number, talk to a nurse for free and get a question answered, you know, such as is it okay to give a one year old peanut butter? And the nurse will give you their best guidance as they can within their scope of practice. So, you know, there are some things that we can do when people are health literate. They can communicate their needs and preferences and respond to information. You don't know what your preferences are if you don't know what your options are. So it's important that people who have a condition or have an issue are aware of all the different options. For example, when you go in to have a baby, do you want to be medicated? Do you want to have an epidural? Do you want to have natural childbirth? What is it that you want? You know, if you've gone through it, you've made a birth plan before. But to make that birth plan, you need to know what your different options are. Process the meaning and usefulness of information and services available. Some stuff is not going to be useful to you or it's not going to be something you want to take part in. Maybe you are adamantly against taking medications, you know, psychotropic medications, or maybe you want to have 100% natural childbirth or something. So information about the different type of opioids you can have or the different types of epidurals you can have would be kind of useless. Same thing is true for mental health services. There are a lot of different treatments out there. A lot of different. There's talk therapy, there's psychopharmacology, there are a lot of different approaches we can use. But some people will find certain approaches off putting. They're like, nah, I'm not going to go there, okay? So they can respond to the usefulness of, of that approach. People who are health literate can understand the choices and consequences of the information and services. They can understand the consequences of. If you continue to smoke, then it increases your risk of these types of cancers. If you don't get enough sleep, it increases your risk of these stress related health problems as well as mood disorders. Once people have the information, then they can make informed decisions for themselves about, okay, what is it that's important to me? Would I rather do this and take the chances or would I rather play it safe? And that goes along with, they can take that information and decide which information and services they need and they want and then take action from there. Anyone who provides health information and services needs health literacy skills. So as clinicians, I saw somebody earlier log in who is a nurse. So you know, I'm going to use the term clinician broadly. You may be a social worker, you may be a nurse, whatever your profession is, we need to be able to help direct people to multidisciplinary information and services. I have recently been working with a patient with postpartum depression and it was really important for me to be able to help direct her to websites and information that helped her learn more about postpartum depression, as well as hormone issues that may be going on in particular with her and things that she might want to talk about with her physician at her next visit. We need to be able to effectively communicate about health promotion and conditions of people of varying ages, cultures, and cognitive abilities. And a lot of that involves using teach back so we can have people tell us, you know, what is it that we've talked about, all the options here? What is it that you think are the next best three steps for you to take in addressing this issue? Or what are three things that we talked about that you think are going to be useful in the upcoming week? And if they're able to articulate those, then they are comprehending. We need to be able to understand what people are explicitly and implicitly asking for. If they come in and they say, you know, doc, I'm depressed, I need help. Okay, so you don't want to be depressed anymore, and that's great. That's a starting point. But we need to be able to probe a little bit more, understand how to probe in order to figure out what is it that they want from us? Do they want us? You know, sometimes people come in to my office even though I don't have prescribing abilities, and they present with the diagnosis of adhd and ultimately all they want is a prescription. They don't want coping skills, they don't want to talk, they just want a prescription. And I have to be like, well, that's not me. We do need to understand what they're getting at and we need to decide which information and services might work best for different situations and people so we can narrow things down for them so they can act. If you're working with somebody who has a substance use issue and their wanting treatment, it's important that you know about the fact that they, they are probably not going to be able to admit. Be admitted to any treatment until they have detoxed. So the first step is getting them hooked up with a detox program and helping them figure out, okay, what's the next step. A lot of times by the time they come to counseling or go to the doctor, most people put off going to the doctor until it's an emergency or a crisis. They are having difficulty functioning. You know, it's gotten to the point where they can't continue keeping on like they are. And at that point, they are not probably thinking completely in their wise mind because they are in a more urgent situation. So it's important for us to help people narrow down their field of options and make a concrete plan. A health literate case manager or clinician integrates health literacy into planning, evaluation measures, patient safety, and quality improvement. If you're working with a client who has, for example, limited cognitive ability and you determine that in the assessment, then you know that there may be additional steps you need to take in helping this person get their medication or solve particular problems. It is important, you know, you don't think about assessing for math and language literacy as part of an assessment, but it is so important because it affects not only people's ability to understand the information that we're giving them, but to implement the steps that we're asking them to do. If they can't figure out, you know, how to do that, maybe they're supposed to take 150 milligrams of Zoloft every day, and normally they get 50 milligram pills and they take three of those. Well, that's fine. But then one day the pharmacist says, well, we don't have those. So I gave you 100 milligram pills. You take one and a half. And that might throw people who have limited cognitive abilities kind of for a loop because that's not what they're used to doing. And that half may be challenging, especially if they're not. If it's not explained to them. We need to have high levels of health literacy. We need to understand integrative behavioral health. I'm assuming all of you who are in here today do some level of work with behavioral health issues. So, you know, using that broad category, we need to understand integrative behavioral health. How pain, how sleep, how hormones, how age, how nutrition all affect mental health, how all of those things affect neurotransmitter levels, how all of those medications people take side effects that they may have that may mimic or cause symptoms of depression or anxiety. You know, it's important for us to be able to look at the big picture and say, we what is the root cause of this symptom? We need to work with clients in the design, implementation, and evaluation of the service plan, asking them, providing them information and saying, okay, does this sound like something that we want to put in the considerate pile or the not a chance in the world pile and go through it like that? We use health strategies in communications and confirm understanding. We need to make sure a lot of cultures are it's appropriate to not contradict or not challenge the professional. So in a lot of cultures people may nod agreement and tell you that they understand even when they don't get it. So it's important that we confirm understanding again by asking them, for example, you know, we talked about a bunch of different things today in session. What three things or what one thing are you going to start doing tomorrow that is going to help move you towards your goals? Obviously you will find your own phraseology to get people to do a teach back. We need to provide easy access to health information and services. I encourage you. Most people are web. I won't say savvy, but web competent anymore. So if you have it on your website, if you have a resources page on your website, they can go to it, they can click on it. If you have a YouTube channel, they can go go to it, they can click on it. Those are all things that make information easy to access. As far as services, thankfully that has been one benefit of the pandemic. More people have started to learn how to use telehealth services and virtual services. For those people who are not able to get to appointments, the elderly who can't drive anymore, people who've lost their licenses, people who are agoraphobic, there's a lot of people who may not be able to get to an appointment. People who have, you know, children at home and they can't afford to get a sitter for two and a half hours to come to a one hour appointment. There's a lot of different reasons that services may not be easily accessible. We design and distribute print, audio, visual and social media content in ways that are easy to understand and act on. And I talked earlier about micro learning. Something that you can put in a. I make a little square like you understand that I'm talking about Instagram. Something that you can put in an Instagram post. If you go to canva.com and I'm sure there's other ones out there, but I use canva.com it's easy and you can do it with a free account, you don't have to pay for it and you can make little Instagram jpegs with a tip or tool of the day. Something that can be kept in. I usually try to keep it in at least 24 point font, preferably a little bit larger. Once you get smaller than that, then you're starting to try to cram too much onto an Instagram Image we need to regularly address health literacy in high risk situations, including care transitions and medication changes when somebody's being discharged from the hospital or, or step down to a lower level of care or their medication has changed. Even if you're not the prescribing professional, if your client comes in and they say, yeah, my doctor switched me from Trazodone to something else or switched my dose, making sure that they understand how they're supposed to take it, they aren't having problems with it, they're aware of potential side effects to look for. All of those things are really important. I've had clients before, for example, who've been prescribed Seroquel for sleep and they take it at like 11 o' clock at night, right before they go to bed. And they have to be up at 6am and they can't seem to get out of bed because it is just, it is still heavy in their system. And I encourage them to go back to their doctor and discuss the lethargy to see if it's okay for them to take it earlier in the day. I've had a lot of clients that have had luck, for example, taking their Seroquel around dinner time, around 5 or 6 o', clock, so it has a full 12 hours to get out of their system. They're still going to bed at 10 o' clock or so, but it's out of their system when they need to be up and raring to go. So it is important when anything changes with a client that we regularly assess what's going on and whether they might need new information. When you're working with somebody who's just had a baby, talking with them about whether they feel comfortable with what's going on, if they have support, if they have resources, all of those things are really important. We need to evaluate client understanding of their condition, treatment options and services available. We need to make sure that they're aware of what's going on. A lot of times I start out by, you know, if they say, hey, I've got anxiety, okay, tell me what anxiety means to you. Because it looks different for many, many people. There are a lot of different permutations of it. So tell me what it looks like for you, what you think makes it worse, what you think makes it better, and what interventions, what you hope that I can provide to you that will help you feel better. You know, I start out by empowering them to tell me their perspective so I can get an understanding of what they know or don't know. And I try to use A lot more Socratic questioning than direct telling because I don't want to bore them, giving them a lecture on nutrition or something if they already know that how important it is. So we do talk about different things. We want to evaluate the client's understanding of general health and wellness behaviors. We know that a healthy body contributes to healthy mood and an unhealthy mood also stresses the body. So we need to make sure they understand that mind body connection. We need to assess clients ability to seek out, obtain and use health related information. If they are ask them, you know, where do they get their information from and how do they know if it's good information. We want to identify obstacles to client health literacy and set goals for improvement. For example, if the stuff that we use our videos are unclear, they're at a higher literacy level, for example, than the clients that we're working with. Something that you geared towards a person who's in their 30s is not going to be the same as something that you're gearing towards somebody that's 13, you know, you want to make sure that you're gearing your health information in an appropriate way. Handouts with small type are also problematic. And you know, I've gotten to the point now where I've got to wear glasses all the time and it's really frustrating when I'm at this grocery store and I'm trying to read something and I'm like, you know, can't quite focus on exactly what's going on. And if we're giving people handouts with small type, if they're right on the borderline and they're just digging in, not getting glasses for as long as they can, you know, they may have difficulty reading the information that we give them so they may not read it thoroughly. And we need to make sure that we transition knowledge into practice. We need to do more than say it's important to get enough sleep. Well, great. Why? Number one, when you're working with adults, you need to help them understand why something is important for them. Just because you tell them doesn't mean they're going to care. You got to make them care. And then number two, it's important to get enough sleep is great. But if the person's having problems sleeping and you tell them that, they're going to look at you like well, if I could, I would, doc. We need to transition it by start going through for example, a sleep hygiene checklist with them to identify ways that they may be able to improve their sleep. We need to promote changes in the Healthcare system that improve health information communication, informed decision making and access to health services. A lot of that is going back to prevention and creating a recovery oriented system of care where we identify the needs of the people in our service area. Wherever you're, you know, generally it's your local community what needs are currently being met, what gaps in services are currently existing and try to work with other providers to fill those gaps. We support and expand local efforts to provide adult education, English and math specifically and culturally and linguistically appropriate health information services in the community. I will tell you that if you go to one of the sites like the National Institute of Mental Health or the National Institute of Health, a lot of their publications are in multiple languages. Now I know many, many of them are in English and Spanish, but there are a lot of them. And on the Substance Abuse and Mental Health Services Administration or the SAMHSA website, there's also a lot of the publications that are written in Korean and Chinese and maybe Arabic. I'm thinking there's like five different languages. Now these, all these handouts are free to order, free to download. Your government taxes already paid for them. Use them. You know, somebody has already done the legwork for you. We want to build partnerships, develop guidance and change policies in schools, churches, community centers, and with physicians building these partnerships to figure out what are the messages we, the unified messages we want to communicate and how can we work together to make this happen. For example, physicians can start doing more brief screening and intervention in annual exams in order to screen for trauma and mental health issues. Maybe they can start incorporating a mental health practitioner into their practice one day a week. Because a lot of times people feel more comfortable going to an office they've been to before instead of having to find some strange new place. And we need to advocate to increase accuracy of health information in all media programming. Okay, we don't have enough time for me to go on that diatribe right now, but suffice it to say, if you see inaccuracies in information in the media, whether it's on the news, on television, you know, in, you know, sitcoms and things, you can write to the television station or the producers and educate them about the issues that you're seeing. So those things are really important. Good resources are accurate, duh, accessible, okay. And actionable. So accurate and accessible. You know, maybe they're online, maybe you're giving handouts, whatever, but it also has to be actionable. Don't just provide people a whole bunch of statistics, give them specific action steps. What you need to do so this week. Pick one of the things in this list to start doing in order to improve your health and wellbeing. Use plain language instead of technical terminology or confusing statistics. Say 1 in 10 or 1 in 1000 people have this problem versus something like a tenth of a percent. Because when you start using fractions and percentages, it's hard for people to really comprehend how dangerous or how not dangerous, how probable something is. 1 in 10 they can figure, well, if I'm in church with 300 people, you know, there's a bunch of other people, 30 I don't do math in my head very well. 30 other people that have this same issue. We need to organize information so that most the most important points come first because people's attention tends to wane the longer they read. So get the most important points out there first. Break it down microlearning, you know, a minute, a minute and a half, an Instagram. I hate to say that we've come to this, but we have come to what I call 140 character learning. Break complex information into understandable chunks. Don't give somebody an entire lecture on the macronutrients of nutrition. Tell them one time in one sitting about protein, and in the next sitting about carbohydrates, and in the next sitting about fats. You know, you can break things down so they are much more understandable and it gives them a chance to, forgive the pun, digest that information. Provide recommendations and explanations of risk and benefits that are clear, concrete, understandable to the person. When we make a recommendation, if it's for detox or if it's for talk therapy or ketamine infusion therapy, that's a new thing. You know, we want to help educate people about the risks and benefits of these different approaches so they can make the most best informed decision for them. And focus on translating information from increased awareness to specific steps for action and behavioral change. If we want people to start moving more, get more physical activity, well, you can tell them why it's important until the cows come home. But if you don't help them formulate a plan to start moving more, then it's probably not going to get done. So, for example, when the commercials come on, on TV or between episodes, if you're binge watching Netflix, get up and walk for 5 minutes or do 10 sit ups. Small progressive steps that people can build on. Use multiple modes of communication, not just text. And by text, I mean not just handouts. Provide videos on things like the importance of nutrition in prevention and recovery and how to Improve your nutrition. Use pictures such as the food pyramid and help people figure out which foods go in which level of the pyramid. And then experiential for nutrition, help people practice measuring food, reading labels, reading recipes. All those things respect cultural preferences and practices, whoever that is that you're working with in planning, developing, implementing, disseminating and evaluating the effectiveness of information. There are a lot of differences between groups, between different cultures, whether it, you know, different age groups, different ethnicities, different, you know, where they grew up, urban versus rural, you know, there's a lot of differences, socioeconomic statuses. So it's important to involve the people of your target group and say, what is it that you need? How can we best get it to you? And in what? What can we do to make it most meaningful and effective for you? So how do we disseminate it? School curricula. I'm big on this. It hasn't happened, but I think it would be so important. Instead of just teaching health literacy in health class, teach it in all classes. There is so much, especially in the elementary years when they're learning basic addition and subtraction and fractions for cooking and measuring food and, you know, numbers, stuff that is related to health literacy in English, in early reading, children can read books about, you know, other children that are practicing good health behaviors. It's not that outlandish to think that we could integrate these themes into science, math and English. We can disseminate through YouTube videos, of course. Social media, There are other places, you know, social media can be hit or miss. There's one website called Patients Like Me that is very interesting. It is not peer reviewed, but people with different diagnoses will go on there and post their personal experiences with a particular disorder or with a particular medication. They will say, these were the side effects that I had. This worked better for me. They're not prescribing. They're not, you know, condemning anything. They are just stating, you know, for your information, so you know, what other people are experiencing, going through the similar things. This is a great site for normalization and to help people, you know, understand some of the side effects. For example, podcasts for people who like to listen to things can be a great way to get out health information. There are a lot of great health podcasts out there. Handouts from doctors, pharmacists, case managers, counselors, teachers. Those are great. You can get them already pre done from the CDC, the National Institute of Mental Health, SAMHSA N4A NIDA. There are a bunch of different places you can get Pre written information or you can find great resources that you can send people to that are written in understandable, actionable terms. Then your local news can start doing a broadcast minute every newscast and just offer a tip, a tool or some information about a particular issue. For example, you know a news station in your local area right now may do a one to three minute segment on the impact of stress on maintaining blood sugar levels. That's really important for people with diabetes. For example, you can write local magazine columns which can be a source of, if you want to call it free publicity, you write it for free, but then you get publicity because you get the byline. So that can be great for increasing the visibility of your practice. There are good mobile apps out there. There are really awful mobile apps out there. So you have to screen for the ones that are most effective that you're going to recommend to your clients. Health fairs at businesses, health fairs at local like art fairs and street festivals. And I assume we're eventually going to get back to those things. Those are great places where you can set up a table and provide general health information to people. It increases your visibility for your practice or your organization. It makes a good first contact with them in a non threatening way and it starts getting that information out there. Church circulars. You know, I don't know about your church, but at my church a lot of times about halfway through, of course I have the attention span of a gnat. I'm flipping through the circular looking at what's going on. But you know, church, synagogue, you know, place of worship, anywhere that has some sort of a circular where people are have to stay for 30 minutes or an hour where they may get bored and want to start reading something. A great place to put information. Libraries. Create tables in the libraries that provide health information. Change it once a month or once a week if you're really into it. So you go in and you change out the information. People coming into the library can get that. You can even do presentations maybe once a month, get on the calendar at the library. I used to do that a lot when I worked for the nonprofit in in Florida. T shirts. This is one of my favorite. When I'm at the gym, I read people's T shirts because I'm bored and I don't want to think about how uncomfortable I am. This is a T shirt that I made a while ago. 12 tips to improve mental health. And then I'm not going to read each one because we're short on time. But you know, I put 12 tips there and then the Counselortoolbox podcast, because obviously I was promoting my podcast. But you know, anybody who was behind me at the gym had the ability, or at the store or wherever else I was wearing that T shirt had the ability to read that and they might be interested or they might say, okay, you know, that makes sense. Or like practice mindfulness, they may say, hmm, I wonder what that is. And then they go home and they Google it. You know, there are a lot of ways to get information out. Peer facilitated education is great to do if you can get people who've been there to provide support groups, information groups, what have you. Just think about where your population frequents, where do they spend the most time? What do people need to know? They need to know basic health promotion behaviors and how to implement them. How do we stay healthy? Why is sunlight important? Why is vitamin D important? Why is nutrition and sleep important? Why is hand washing important? All of those basic things that contribute to a healthy body, that will contribute to good mental health, basic health and mental health needs by developmental age, parenting and self parenting skills. Not everybody had a great childhood growing up. It doesn't mean that all is lost. It's important for them to learn how to re parent themselves. Providing themselves that unconditional positive regard, that support and nurturance that you would hope to get from a secure attachment. Basic coping and distress tolerance skills. Basic math and reading skills to manage nutrition, weight, blood sugar medication. Basic reading skills to manage and learn about health and problems when they arise. So you know, if they want to start taking this supplement, how can they make sure that taking that is not going to be contraindicated with the medications that they're on? You know, do they talk to the pharmacist? Do they call the nurse that's associated with their health plan? Do they, do they go online? Where do they find this information? Time management skills and communication and assertiveness skills, including self advocacy. A lot of people are not health literate because they sit passively in the doctor's office or the counselor's office and just say, okay, I'll do whatever you say. Instead of saying why? Or instead of saying no, I don't think that's going to work for me. Let's talk about something else. So it's important that we encourage people to be assertive and advocate for themselves. If there are unacceptable side effects to the meds that they're taking, if they start feeling weird after they start taking a medication, or if the counseling process that you're using isn't working for them, it's important for them to be able to speak up and go, you know what, I'm just not feeling like we're making progress. People need to know how to identify and mitigate risk and enhance protective factors for the development of mood disorders, addictive behaviors and stress related health conditions, including adverse childhood experiences. Now obviously if they already had the adverse experiences, they need to know how to be able to mitigate that trauma. They need to know how to access accurate, understandable health related information to identify wellness behaviors as well as early symptoms of mental health, addictive or physical health problems, not wait until it's a huge crisis or they're for sure they've got it, you know, when they start having symptoms. Early intervention is a whole lot more effective. They need to know how to identify community based resources such as support groups, housing, resources for medical care, transportation, child care, respite services, and I'll give you a Hint, United Way 211 is a great place to start. They may not have everything, but if what they don't have, they may know another agency in your local, in your county that has more specific local information for you. So United Way 211 is always a great place to start. People also need to know the risks and effects of use of pornography, gambling, Internet gaming and substances. So that's great, but how do we make this happen? Health coaches are a great way to transition. And health coaches can be behavioral health techs, for example. They don't have to be licensed clinicians because they provide self management support. They're helping people implement the treatment plan that they developed with a professional. They may educate clients, you know, they may have knowledge of certain areas and help, you know, educate them about, you know, walk them through the nutrition guidelines or something. They bridge the gap between the clinician and the patient. They help patients navigate the health healthcare system, and they can offer support and encouragement. The health coach is there to lead or facilitate the person in achieving their highest level of health and wellness. Health coaching has shown significant improvements in, depending on what we are talking about, one or more of the following nutrition, physical activity, weight management, exercise frequency, perceived social support, patient engagement, and activation, which means treatment compliance and medication adherence. Common features of effective health coaching programs are goal setting, motivational interviewing and a collaborative relationship with healthcare providers. And because our culture in large part has conditioned people to be passive with healthcare providers, it's important for health coaches and for us, even if we're not acting as a health coach, to encourage people to stand up for themselves, encourage people to ask questions, encourage people to Communicate what their thoughts are to enhance motivation. There are multiple ways we can do this. Emotional motivation. How is this going to help the client be happier? So you're going to talk with them if you want to get them to start doing something, maybe journaling or doing mindfulness activities three times a day. How will doing this help them be happier? Most people want to be happier. How will it make sense to the client? How is it logical that doing this could be helpful? How is doing this. We'll stick with mindfulness for right now. How could mindfulness activities help the client improve their health and energy levels? Most people, that's one of their goals. How can it enhance important relationships? How can it help them be more emotionally available or energetic and physically available to really nurture the relationships that are important to them? Who is supportive of this change? Who could they get that could be their cheerleader? Environmentally? What things can be placed in the environment to help the person enhance their motivation? Maybe pictures, maybe push notifications to remind them to do things. What is it that they can do in their environment to enhance their motivation and potentially spiritually? In what ways might this change help the person live more in harmony with their personal values and feel a greater sense of connection to themselves as well as others? Motivational techniques we can use and Rhodes is the acronym Reflective Listening. We need to paraphrase what we're hearing and help people identify their thoughts and feelings and articulate them. Because sometimes you know that there's something down there. You get a. You can sense that there's a yes, but however the person's not saying it, so you may paraphrase and then say something like however I'm getting the sense that you're apprehensive about that. Use open questions. Obviously open ended questions, not yes or no, are going to get you more information. Encourage affirmations of self efficacy and optimism. When you're going through those motivations, those are meant to help the person identify optimism. Sources of optimism. If I do this, these are all the reasons that doing this is going to help me move towards my goals. Develop discrepancy, help them see the difference between what they're doing right now and what they want. You know, what they're doing right now isn't getting them there and it doesn't seem to be getting them there. So they need a change. So if they want to get there, they need to change their behavior. And then summarize regularly summarize what you're talking about, what their impressions are. And like I've said multiple times in this presentation, I often put it on the client to summarize, and I say, okay, we've talked about multiple things that you can do. For example, to improve your sleep. What are two things that you think that we talked about that you think might be helpful that you're willing to try in the upcoming week? So I have them kind of summarize what they heard or two important points. When you're working with adults, and I really believe this is true with children too. But this falls under the rubric of adult learning theory. We need to provide explanations of why specific concepts are being taught. If you are teaching Nutrition 101 in a residential addiction recovery program, people may be going, what does this have to do with addiction recovery? So you need to connect the dots and help them see why that's important. We need to ensure learning that is connected to their health goals. People will remember things that are meaningful to them. Things that aren't meaningful go in one ear and out the other. We need to encourage people to look at those motivations and figure out why is this topic, why is this concept important to me and how is it going to help me achieve my goals? We need to use self assessments to assess different levels of prior learning experience and education. You know, when I used to work in residential, a lot of times we'd have people who'd come through the program before and we'd have people who'd never been through any program before and they obviously had vastly different levels of knowledge of different concepts. It's important to know where the people that you're working with are in terms of their knowledge and understanding of the issue. Remember, prior learning is often the filter with which they conceptualize new information. So for example, if a patient is, you're talking with a patient about. TMS or ECT because ECT is still used, you know, they may think back to the media and, and you know, old fashioned depictions of electroconvulsive therapy. And you start talking to them about that and their eyes may get super wide and they may go, oh heck to the no. And that's okay. They are taking in the information that you're giving them, but they're relating it to the only thing they know about that. And it's important to maybe start out with things like, okay, you know, this is not what you saw in that movie is not what actually happens. Now I do the same thing with group therapy. I talk to people about the difference between, for example, a you know, roundtable support group versus psycho educational groups. Because some people automatically, when you Say group therapy, think, you know, 10 people sitting in a circle and sharing. And that's not always the way it is. We do need to make sure that we help people understand what we're talking about. So if they didn't like what they knew, they're willing to consider the new information and decide whether it's still off putting or whether they're willing to consider the treatment. Use multiple methods of instruction with adults. Get as many senses involved as possible. Talk about that, talk about it. Encourage them to talk about it. Engage in discussion. Use visual aids when possible. Provide handouts, bullet points, but also, you know, graphs. Anything you can do that's visual and kinesthetic. You can have people, for example, break your group, your big group into smaller groups and have each smaller group do a skit or teach a concept relating to, you know, what you learned that day. Ensure access to sufficient resources. And remember that adult students prefer a self directed approach that allows for discovery on their own. And yes, there are a lot of people who don't have a lot of access because of their socioeconomic status, to holistic resources. And that's one of those issues in a recovery oriented system of care that we need to evaluate. For example, acupuncture is generally not covered by most insurances and a lot of people can't afford it. But if you think acupuncture is an important service to have available, approaching the different professionals in your community that do acupuncture to see if maybe they would be willing to participate. Most communities have a free clinic that happens once a week or you know, a couple of times a week. See if they would be willing to volunteer their time and services there for the people who can't afford to access it otherwise. Encourage people to create a wellness vision. Have them describe their body and mind in the ideal state. What would you look and feel like? What types of things would you be doing or not doing? What are the most important elements in your vision and why are these elements important? How will this improve your life? Maybe they say improved health or an improved relationship with my spouse. Okay, why is this important? 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 and why? And you know, encourage them. Ideally they will have at least a confidence level of a 3. If not, you're going to need to do some motivation and self efficacy work. What types of assistance might you need in achieving your goal? What obstacles do you anticipate and how can you deal with them and what Strengths and resources do you have that will help you accomplish these goals? When you're working with people to set their goals, remember the KSA format? And I had an auditor share this with me one time and I've used it henceforth and forevermore. Knowledge, skills and abilities first, people need to understand the problem in general. What is depression? Then they need to understand the problem specifically as it relates to them. What does my depression look like? What does my diabetes look like? Then they need to understand general interventions. What are the possible things that I could do. From there, they're going to narrow it down to interventions that they think would work for. So there's a lot of knowledge here. Skills means demonstrating an awareness and effective use of the knowledge and skills at appropriate times. And then abilities means the ability to generalize awareness and skills to other life areas. For example, if they learn how to do research on depression management, then they've learned how to do this health information research and they can apply it, for example, when their child starts having a problem. Scaffolding means helping people develop their goals and being there to support them, but not until they need that support. I always give the example of when my son was learning to tie his shoes. You know, we started out with Velcro and then we finally went to laces and he got the, you know, the first tie really quickly. That was easy. And then he got the make the bunny ear. He got that really easy. But then, you know, going around the tree and, you know, I don't, I'm mixing my metaphors here. It's been 20 years since I did that. But it was important for me to let him do it as far as he could. And then we, when he got stuck, prompt him with. First I would prompt him with words. I wouldn't just take it over, I would prompt him with words to help walk him through the rest of the way. So in scaffolding, we're helping people develop skills and the acronym is grow me. Goals are shared in specific rescue or help is immediately available. We provide the optimal level of help that encourages self efficacy by using concrete practice prompts, prior knowledge, and the person's preferred learning method. We use a whole task holistic approach by identifying what is the goal cognitively, what are your concerns about this and how can we increase your confidence and what specifically do you need to do? We want to model desired behaviors and empower the person to take chances. So always think back to learning how to tie your shoes. And because, you know, teaching someone to tie their shoes can use all of these prompts in scaffolding. Health literacy is imperative to empower people to take charge of their health and well being. We need to ensure clients understand their current condition, the causes of it, treatment options, and use information to make an informed choice about what to do next. We need to advocate with other professionals as well as the lay community to enhance health literacy from birth. Health coaching improves client retention and success. And health coaches have the opportunity to increase people's health literacy, teach them how to enhance their motivation, how to set smart goals and attain those goals. All right, I know I went over a little bit. I apologize for that. Thank you for being with me today. It is important to also, you know, as you guys were discussing, understand what issues that your clients may be struggling with, advocating for themselves about. I think I said that right. Whether it has to do with bmi, weight management, medication management. Important for them to know, for us to know where they feel they're not getting support. So we can maybe help them role play, for example, how they might advocate for themselves with the other professional or even with us. We need to make sure that we're encouraging them to advocate for themselves with us. And you know, that can mean regularly asking them, what are we doing right now that is working? And what is one thing that you might change, if anything, in the way we're approaching this situation and that gives the person the opportunity to share things with you. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand CEUs for this podcast is@allce.com podcastceus that's allceus.com podcastceus to sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week, go to allce.com sponsor thank you.