Peer Health Care Coaching

A 2006 report by the National Association of State Mental Hygiene Program Directors concluded that "persons with serious mental illness are now dying 25 years earlier than the general population" and that "their increased morbidity and mortality are largely due to treatable medical conditions that are caused by modifiable risk factors such as smoking, obesity, substance abuse, and inadequate access to medical care." In 2008, the NYS Department of Health found that 20% of NYS Medicaid beneficiaries account for 75% of the program's expenditures and that those individuals shared multiple medically complicated conditions for which they currently received fragmented, uncoordinated and duplicative care. A significant number were found to have "chronic conditions" including psychiatric disabilities and substance abuse disorders.

In response, NYAPRS has developed a Peer Health Care Coaching initiative that builds on our successful Peer Bridger model and incorporates innovations from several nationally recognized approaches, to direct our collaborative efforts with Optum Health's Chronic Illness Demonstration Program.

Background

Health coaching is becoming recognized as a new way to help individuals "manage" their illnesses and conditions, especially those of a chronic nature. Health coaching is a method of guiding another to "discover" and address their own ambivalence to health behavior change. Health coaching gives health care providers a framework by which they can assist someone to identify issues, beliefs, and concerns that may hinder or support his/her lifestyle change or responsibility for health that lies ahead for the individual. Like traditional coaching, health coaches utilize goal setting, identification of obstacles, and use of personal support systems. The relationship between the coach and coachee is an accountability partnership focused on the overall health outcome goals as defined by healthcare practitioners and the patient/coachee. Health coaching differs from traditional patient education in that the traditional approach to patient teaching and education is one that directs information "at" the patient. In essence, the goal is to have the patient do the things prescribed for them to do. Health coaching, by contrast, guides patients to talk about what is most troubling to them about their conditions, what they most want to change, what support they have to foster change, and what obstacles or difficulties must be removed or minimized to advance healthy behaviors. It is not the main role of the health coach to teach, advise or counsel the patient. Health coaching focuses on the special issues and concerns unique to the individual patient that fit into the context of the patient's life (Wikipedia).

Health Care Coaching's Impact on Patients
(Source: 2008 HIN Health & Wellness Coaching survey)

  • Improved participation in treatment

  • Significant changes in wellness attitudes, weight loss, being more physically fit, becoming program ambassadors throughout the company

  • Measured increase in quality of life scores

  • Decreased claims

  • Improved healthy status

  • Improved cost savings

  • Reduced risks in all HRA lifestyle risks including biometrics.

Peer Health Care Coaching By/For People with Psychiatric Disabilities with Co-Occurring Complex Medical Conditions

"There is a substantial future role for certified peer specialists in health and wellness promotion, especially in the specialty MH/SU sector. Peer-led disease self-management interventions have been demonstrated to be feasible, effective, in health and health behaviors in populations with a range of chronic medical conditions. Lay people with chronic conditions, with appropriate training, can teach the Chronic Disease Self Management Program* as effectively, if not more effectively, than health professionals." -Mind and Body Reunited: Improving Care at the Behavioral and Primary Healthcare Interface Mauer, Druss March 2007

Key Elements of NYAPRS Peer Health Care Coaching Initiative

Through a partnership with Optum Health, NYAPRS is building on some of the key elements of our Peer Bridger Project (individualized relational peer support and peer support groups) and incorporating within these health care educational and support services that borrow from the best of the New Jersey, Georgia and Clubhouse of Suffolk approaches.

RELATIONSHIP

NYAPRS Peer Health Care Coaches' ability to form unique trusted relationships are an essential aid to helping to find, enroll and engage identified CID beneficiaries. Prospective CID enrollees are, by definition, likely to demonstrate a past history and current reluctance or difficulty to engage in a health care relationship, adhere to a treatment plan, follow through with various treatments and new behaviors and anticipate and/or reach out in times of crisis that have historically led to avoidable visits to the emergency room or hospital. A key to turning this around is in the development of accepting, appealing, flexible, familiar and reliable relationships with members of the health care team: peer relationships score uniquely high in their capacity to engage and serve "at risk" individuals with psychiatric disabilities with complex medication conditions.

HOPE

Hope is an essential element to engagement and to foster motivation and follow through: peer support is steeped in a hope for recovery, dignity, meaningful roles and a return to wellness. Our ability to foster hope for positive change and personal empowerment has been critical to our success in the Peer Bridger Project and is a critical element to our Peer Health Care Coaching initiative as well.

HEALTH CARE EDUCATION

NYAPRS Peer Health Care Coaches are able to support enrollees on a broad range of topics including lifestyle factors for health & wellness, metabolic syndrome, smoking cessation, nutrition, exercise, oral health and medication side effects. Accordingly, they have all undergone substantive training in a variety of areas to help them best inform and support CID enrollees.

Our training has come from two primary sources:

  • coaches were trained at the University of Medicine and Dentistry of New Jersey (UMDNJ), in collaboration with the Institute of Wellness and Recovery Initiatives (CSP-NJ, where they received an extensive 2 days a week six week long training program that yielded 6 undergraduate credits and UMDNJ certification as a Peer Wellness Coach. The program focused on helping coaches to have a capable knowledge of health and wellness and to learn specific coaching and coordination skills to enhance their work with enrollees.

  • In addition, we supplemented their training with material related to how to help individuals improve personal stress management and avoid unhealthy stress-driven responses like poor sugar-based nutrition, alcohol and drug abuse, smoking and idle avoidance. This included training on progressive relaxation methods that have been shown to decrease metabolism, heart rates, blood pressure, breathing, muscle tension, the release of adrenaline and cortisol.

PERSONAL SUPPORT FOR HEALTHY BEHAVIORS

NYAPRS Peer Health Care Coaches also help to encourage and reinforce improved self health management via a variety of strategies in arrangement with Optum, including motivational rewards, group health education/motivational celebrations, healthy food or nicotine patch vouchers, exercise club vouchers and the like.

RELAPSE PREVENTION AND TRIAGING

NYAPRS Peer Health Care Coaches encourage each identified enrollee to complete a Wellness Recovery Action Plan that will help them anticipate difficult times, red flags and warning signs leading to possible relapse of either health, mental health or substance abuse recovery and develop personal strategies to take effective action, including reaching out to the coach or the Optum team for assistance, before a visit to the emergency room or hospital.

LINKAGE TO COMMUNITY SERVICES AND SUPPORTS

NYAPRS Peer Health Care Coaches help enrollees self-identify and engage with a broad range of valuable supports, including family and friends, religious institutions, support and 12 step groups and social, health or mental health service organizations.

TREATMENT TEAM PLANNING ASSISTANCE

NYAPRS Peer Health Care Coaches sometimes play a uniquely valuable role in providing input to the treatment team that reflects an up to date and person knowledge of enrollees' current status and motivations.

ADVOCACY

NYAPRS Peer Health Care Coaches help support enrollees to advocate for themselves with various systems of care, support or entitlements.