NBHWC study guide

Created by Lindsay Killmaster

Open, welcoming and inclusive relationship

Observe, name, and refer to client's belief's values, successes and strengths

Share personal experience only when helpful to client

Recognize limitations of client materials in relation to cultural norms, family history, life events

Strength-based mindset. Focus on person not the problem

Culturally appropriate communication

Repair discord, breaches of trust

Client feels seen and heard

Eliminate distractions

Cultivate growth-enhancing relationship

Facilitate collaborative approach

Build Trust and Safety

Review client materials

Meeting format, onboarding procedures

Respond appropriately to nonverbal cues relevant to unique individual and culture

Establish Logistics

Demonstrate how to locate and evaluate appropriate resources

Mindful and Receptive

Create mindful, calm, receptive state

Ensure clients agenda, needs, pacing drives relationship

Use pronouns/identifiers

Examine potential access issues

Stay up-to-date on emerging research

Curious

Remain open-minded, non-judgemental, curious

Feedback

Invite client feedback

Notice/neutralize power dynamics

Keep Client Needs in mind. Safe confidential environment

Respect Client Boundaries

Session Prep

Seek mentorship and collaboration

Integrity

Demonstrate integrity and follow through on commitments to client

Belief in Client

Convey belief client is resourceful, autonomous, and an expert in their own life and experience

Growth-Enhancing Partnership

Engage in mindful/grounding practice

Build and maintain professional network

Refer clients as appropriate

Presence

Sessions

Ongoing Development

Educate or share information within NBHWC scope of practice when given permission or asked specifically

Attune

Attune to discord, or breaches of trust and rapport (including microaggressions

Develop Ongoing reflective practices to deepen awareness and humility

Assist in developing sustainable pathway forward

Continuing Education

Unconditional positive regard

Identity-affirming

Inclusive, culturally-affirming manner that invites all aspects of client identity

Client reflects progress, insights, growth

Ending the Agreement

Monitor own physical and emotional health

Know and abide by the current NBHWC Scope of Practice

Honor Diversity, demonstrate dignity and respect for all people, practice cultural humility

Early Sessions

Identify and address conflicts of interest (product sales etc)

Coaching Presence, Relationships, and Sessions

Foundation

• Explain coaching process and partnership in plain language
• Explore client's intentions, motivations, and needs for coaching
• Determine if coaching is appropriate
• Mutually determine if good fit
• Establish feedback mechanisms

Explore and summarize support and resources for continued progress

Affirm clients progress and learning

How will successes be celebrated moving forward

Cultivate personal health and wellbeing

Establish focus and/or long-term goals

Maintain and uphold client privacy

Maintain clear professional boundaries with clients

Diversity-related history, marginalization, and trauma

Close session

• invite client to summarize steps
• invite client to reflect on takeaways
• affirm and aknowledge
• set next interaction

Seek consultation or supervision on ethics when needed

Co-create coaching agreement

• Set guidelines (fees, scheduling, inclusion of others)
• Establish format
• Discuss roles, responsibilities and expectations
• Review confidentiality and privacy policies
• Address accessibility issues
• Ensure client understanding of agreement

Follow-up sessions

Ethics and Professional Practice

Attend/attune to yourself

Attend to your own emotions, thoughts, beliefs, values, and non-verbal cues

Explore VIsion, Current vs Desired States

• Have client assess current state of health and well-being
• Explore the importance of the clients vision of desired health and wellbeing
• Identify gaps between current state and desired state

Power and privilage imbalance

Reconnect with client, reflect on how they are showing up

Support client with "how"

Know and abide by NBHWC Code of Ethics

Provide true and accurate representation of training, credentials, expertise

Practice cultural humility

Bias awareness

Recognize that all biases influence the coaching relationship

Invite client to share success and learning related to goals

Self-awareness and Regulation

Identify the "why", what's important

Disclose the use of AI

Awareness of own identities, power, privilege, biases, triggers

Invite client to establish topic "what"

Legal

Give credit for work, contributions

Understand the ethical implications and responsible use of digital health technology and platforms

Restraint

Refrain from directing, advising or problem-solving

Welcome client's full emotional experience

Adhere to relevant laws and regulations

Manage judgement

Manage own emotions and judgement about the client.  Accureately percieve and understand impact of words and actions. Self-monitor verbal and non-verbal communication

Maintain confidentiality of data

• Documented consent from client to collect and store data
• Provide data security through access controls
• Ensure data privacy, confidentiality and storage through password, secure devices, physical files
• Know secure vs non-secure sites and platforms
• If using generative AI, do not involve client data

HIPAA

Invite client to articulate strengths and abilities and plan to leverage them

Support client to build confidence through reflection, self-assesment and naming of insights and progress

Offer affirmations to support client's positive efforts, qualities and skills

Connect focus to multiple dimensions of clients life

Support client to build self-efficacy through achievable, realistic steps

Explote broader perspectives and inspire interest in new possibilities

Skillfully interupt and redirect

Social Learning Theory

Use bottom-lining

Identify positive role models for behavior change

• vicarious learning experiences for self-regulation, acceptance and active engagement

Invite client to problem-solve and evaluate options, considering short and long-term

NBHWC Core Competencies

1. Coaching Presence Relationships and sessions
2. Theories, models and approaches to behavior change
3. Skills, tools, and strategies
4. Ethics and professional practice
5. Health and Wellness

Recall previous information and experiences of client

Expanding the Conversation

Narrowing the Conversation

Client Self-efficacy

Use metaphors based on client language and interests

Social Cognitive Theory

Ask client to summarize

Recognize and highlight client's identity and lived experience as integral to making informed decisions

Neuroplasticity, basics of behavior change

Positive Psychology Approach

Draw out client's positive emotions

Evocative, powerful questions

Self-Efficacy Theory

Appreciative Inquiry

Ensure appropriate time management

Personal Health Inventory

Open-ended appreciative questions

Support client to recognize, name and descrbe emotions

Invite and amplify client insights

Nurture optimism, persistence, and resilience

Wellness Wheel

Wellness Exploration

DIgital Health Platforms and Apps

Invite and support client to engage in reframing and shifting perspective

Tests Available

• Dutch
• Organic Acids

ENcourage client to foster self-compassion and acceptance

Client Awareness, perspective shifts, insights

Transtheoretical Model

Growth vs Fixed Mindset

Health Information

• Healthcare providers
• Provider recommendations
• Biometric data
• RIsk assessment results

Facilitation Tools

Acknowledge self-defeating thoughts, perceptions and limiting beliefs

Explore patterns related to client behaviors and decision tendencies

• triggers, thoughts, emotions, physical sensations, environment, and culture

Theories, Models and Approaches to Behavior Change

Values Exploration (surveys)

Strengths-based exploration

Skills, Tools, and Strategies

Motivational Interviewing 4.0

Self-Determination Theory

Scaling questions

Help Client envision their optimal health and wellbeing

Elicit awareness of self-talk and adjustment as appropriate

Spirit of Motivational Interviewing

Guiding Style

Reflective and Self-awareness Practices

• journaling
• meditation
• guided imagery
• visualization
• mindfulness

Wellness, Wellbeing Visioning

Brainstorming

Change Talk vs Sustain Talk

Goal Setting Theories and Approaches

Clients autonomy and intrinsic motivation

The Four Tasks

DUMB

Anticipate and plan for potential barriers or challenges

Help clients explore and articulate values, sense of meaning, and purpose

Discuss and honor without judgement client's preferences for self-monitoring, accountability, and mode of connecting

Recognize that there are strategies and resources to promote equity, dismantle power dynamics, address sterotyping, reduce discrimination

SMART

Guide client to commit to action

Elicit Client Perspective

• reasons for change
• solutions, ideas, experiments, desires, reactions, desired outcomes, rewards/incentives, cultural identity, and lived experiences

Identify and build supportive relationships (family, social, professional)

Improving Support

Definitions

• Health disparities
• Health equity and inequity
• Healthcare equity and inequity

Health and Healthcare Disparaties

Health Literacy and Numeracy

Establish and Refine specific long-term goals that lead to vision/desired outcome

Defining Goals and Implementing Action

Utilize Motivational Interviewing

• Cultivate change talk
• Soften sustain talk
• Respond to discord
• Use ask-offer-ask

Recognize non-modifiable systematic barriers to inform support

Summarize

Identify and build community resources and networks

Identify Short-term goals and action plans

• Align with clients pace, interests, needs values
• specific, realistic, time-bound
• consider thought goals or mindset changes as well as tangible actions

Consider how health literacy and numeracy impact client's health and adjust

Translate outcome goals into behavior goals

Open-ended vs Closed-ended questions

Core Communication Skills

Governance

Values, beliefs, norms

Structural Determinants of Health are the "root cause" of health inequities

StructDOH shape the quality of the Social Determinations of Health experienced by people in their neighborhoods and communities

Use Silence and Pauses Appropriately

HIgh-kevel wellness

Illness-wellness continuum

Identify relevant structural determinants and how they impact clients

Identify and leverage types of support to facilitate and sustain change

Establish client's own method for accountability, tracking progress moving toward self-management

Employ Active Listening

• Listen with curiosity for what is said and how
• Observe non-verbal communication
• What is not being said

Laws and policies

Incorporate cultural considerations into goals

Affirm/aknowledge/validate

Structural Determinants of Health

Describe health, wellness, and well-being

Whole person health

Adapt goals and plans to address the impact of social determinants of health

Reflect

Institutional practices and Hierarchical patterns of advantage

Power Relations

Health and Wellness

SImple reflection

Complex Reflection, Double metaphors

Health promotion and wellnes

StructDOH affect whether resources necessary for health are distributed equally in society

Consider how StructDOH affect the client's health, well-being, behavior and medical conditions

Describe dimensions of health and inter-connectedness

social, physical, intellectual, occupational, financial, emotional, environmental, spiritual

Structural determinants of health create and impact SDOH

BMI, waist circumference

Modifiable risk factors

Modifiable risk factors

Definition and Description

Modifiable risk factors

Definitions and descriptions

Definition, Criteria

Having three or more of the following:

• high blood pressure
• high blood sugar
• excess belly fat
• high cholesterol
• high triglycerides

Obesity

SDOH: The conditions under which people are born, grow, live, work, and age, which are shaped by forces beyond the control of the individual.

Metabolic Syndrome

Dementia and Alzheimers

Impact of thoughts, beliefs, and mindset on behavior as well as physical and mental health

Fasting Blood Glucose

• normal <100 mg/dL
• prediabetes 100-125
• diabetes >125

Modifiable Risk Factors

Sleep, rest

• basic sleep needs
• impact of sleep on optimal functioning, including chronic diseases and conditions
• sleep hygiene

US Surgeon General guidelines

Intermediate determinants of health. Downstream of structural determinants.

Social Determinations of Health

Changes in mind impact the body and vice-versa

Impact of mindset shifts on moving toward health and well-being-EVEN in presence of disability

USDA MyPlate

Diabetes

Physical Activity, Exercise, Movement

Activity tracking options, mobile devices, wearables

Consider how SDOH impact client's health, well-being, behavior, and medical conditions

Oral Glucose Tolerance test

• normal <140 mg/dL
• prediabetes 140-199
• diabetes >200

Mind-Body Connection

Healthy Diet Recommendations

• unprocessed, minimally processed whole foods
• whole grains
• lean proteins
• adequate fiber
• healthy fats 
• fruits and vegetables

Harvard Healthy Eating

Identify relevant SD and how they impact client

• Education access and quality
• Economic stability
• Healthcare access and quality
• Neighborhood and built environment
• Social and community context
• mine: access to technology

AbA1C

• normal : <5.7% eAG estimated average glucose
• prediabetes: 5.7-6.5%
• diabetes: >6.5
• <7% is goal for those with diabetes

Definitions and Descriptions

body can't process sugar appropriately

symptoms include:

• excessive thirst
• excessive urination
• blurry vision
• dry skin
• numbness, tingling hands/feet
• slow wound healing
• frequent infections

Anxiety

Depression

Impact of mind-body practices to support behavior change, personal growth and overall health and well-being

Food and Water

Modifiable risk factors

• diet
• diabetes
• exercise
• low estrogen

Mental Health

DASH diet

Lipid Abnormalities

Evidence-based Nutrition interventions for chronic health conditions

Prevention and Self-Management of Chronic Disease

Lifestyle influences

Components of Proactive Health and Wellbeing

Water Intake basics

ADA plate Method

Trig

• normal <150
• borderline 150-199
• high 200-499
• very high >500

Lipid Profiles

Definition Mental Health

Personal and Professional Development

• Impact of investing in personal and professional growth

Mediterranean Diet

Total Chol

Definitions and Descriptions

Surroundings and Environment

Anti-inflammatory Diet

HDL

• normal >40
• optimal >60

LDL

• optimal <100 mg/dL
  • goal for heart disease, diabetes
• near optimal: 100-129
• borderline: 130-159
• high: 160-189
• very high: >190

Modifiable risk factors

Hypertension

Cardiovascular Disease

Health Effects

Indoors/out, where we live, work, play, learn, worship

Definitions and Descriptions

Tobacco

Support Networks

Relationships and communication

• Influence and role of relationships and communication in health and well-being
• Impact of relationships and communication in shaping how client percieves themselves and world around them

Incremental changes to improve environment

Blood Pressure ranges, Red Flags

Red Flags

Definitions and Descriptions

A general term to describe disease of the heart and circulatory system. Including :

• coronary heart disease
• heart failure
• stroke
• arrythmia
• congenital heart disease

Substance Use Rx and non

Overview of tobacco use

Surroundings influence behavior positve and negative

Men

• nausea/vomiting
• jaw, neck, back pain
• squeezing pain or pressure in chest or arm
• shortness of breath

Heart Attack SIgns

FAST

F-Face drooping

A-arm weakness

S-SPeech difficulty

T- Time to call emergency services

Alcohol

Overview of Use

Modifiable Risk Factors

• smoking
• alcohol use
• high stress
• high cholesterol
• atherosclerosis
• obesity/diet

Women

• nausea, vomiting
• pain in jaw, upper back
• shortness of breath
• extreme fatigue
• fainting
• indigestion
• sometimes pain in chest

Substance Use and Abuse Overview, Definitions, When to refer

Health Effects

Support Networks

Community and Belonging

Influence of the community on health and well-being

• connections to others
• environments
• social systems
• culture
• history
• geography
• access

Sleep disorders

Spititual Meaning and Purpose

• influence of connecting with something greater than oneself and how this can improve a sense of meaning, purpose, direction, peace and comfort
• Importance of exploring personal meaning under desires and needs; what gives a person meaning and purpose

Evidence-based strategies to reduce stress, relaxation, parasympathetic activation

• breathing techniques
• yoga, tai qi, qi gong
• meditation
• massage therapy
• other components covered elsewhere (prayer, exercise, sleep, nature, friends)

Atrial fibrillation

• quivering, fast irregular heartbeat
• atria-not pumping regularly-blood can pool in chamber causing clots
• Symptoms: racing heart, fast/quivering beats, light-headedness, palpitations, short of breath, fatigue
• Treatment
  • medications to slow heart rate (digoxin, beta-blockers, calcium-channel blockers)
  • medications to restore normal rhythm (beta-blockers, arrhythmia meds)
  • control the electrical pulses (cardiac ablation, electrocardioversion, pacemaker)

Symptoms

• angina pectoris (Chest pain)
• shortness of breath
• fatigue
• dizziness
• heartburn/reflux

Coronary Heart DIsease

atherosclerosis

buildup of plaque in arteries, narrows vessels impeding blood flow, hardens arteries making them brittle

can cause stroke, heart attach, heart failure

Stress Management, Recovery and Recharge

AHA Heart Failure

Heart Failure

Most often caused by coronary heart/artery/ disease. Muscles in the heart wall slowly weaken and thin

Usually results in enlarged heart

4 types

Left-sided: Left ventricle can not pump effectively, build-up of fluid in lungs

• systolic-doesn't contract normally 
  • HFrEF heart failure w/reduced ejection fraction (<=40%)
• diastolic-doesn't relax normally
  • HFpEF heart failure w/preserved ejection fraction (>=50%)
  • HFmEF mildly reduced EF (41-49%)

Right-sided: right ventricle, fluid build-up in legs, abdomen

Low-output

HIgh-output

Congestive heart failure is type of failure that involves fluid buildup in the body, can't pump enough to meet body's needs

Insomnia, Apnea descriptions and definitions

Modifiable risk factors

Symptoms

Fluid retention

Shortness of breath

Fatigue

Edema

Stroke

affects arteries leading to and in the brain

blood vessel blocked or bursts

brain cells die from lack of oxygen

50% of stroke patients also have sleep apnea

atrial fibrillation 5X higher risk of stroke

Recharging Involves activities that replenish mental and physical energy

Ischemic stroke

caused by blood clot

TIA transient ischemic attack-temporary blood clot

Hemorrhagic stroke

blood vessel rupture

Role of Unmanaged Stress in chronic diseases

Impact of Stress on Body and Mind