Today the professional lives of nurses demand the highest-ever levels of internal resources and well-being to meet the growing challenges faced by patients, as well as healthcare practices and organizations. ​ As a Nurse Wellcoach® you can become a new force for good - helping your patients, colleagues, and leaders tap into their deepest motivation, draw out their strengths, set their compass on their best selves, and shift their mindsets and behaviors to enable positive, lasting change. ​ All the while, you will be transformed through your own self-coaching journey, rediscovering your deepest values and resources, and rising above the tide of burnout. ​ Why become a Nurse Wellcoach®? Improve your own well-being. Learning about, and applying, key coaching concepts like self-compassion, growth-mindset, and wellness visioning will inevitably have a positive impact on your own life. Increase patient satisfaction and engagement. Your patients will experience you as a more empathetic listener who delivers patient-centered care. Change the culture of your organization. Gain valuable skills for communicating with colleagues and building trusting, and collaborative relationships. Enjoy your professional development and earn CEs. Module 1 of our Core Coach Training is approved for 38.25 CEs. Curious about your own well-being? Wellcoaches has developed a validated inventory to support you in reflecting upon your own well-being in the areas of life, work, body, and mind. Take the Inventory or share it with a patient! Coach with confidence When you use our coaching tools, you can be assured that they work!  The Wellcoaches Protocol of health/well-being coaching is the most thoroughly tested coaching protocol in the healthcare and well-being domains, resulting in positive, statistically significant outcomes in all 22 peer-reviewed studies. 194 coaches, 30,984 patients/clients, 128,076 coaching sessions What you will learn The keys to improving patient well-being (and your own) How to differentiate the coach approach from the educational approach How to establish growth-promoting relationships Ways to display deep coaching presence Expressing compassion through empathy The value of building positive emotions for resilience Strategies for eliciting motivation The process for building self-efficacy The stages of readiness to change The protocol for building powerful visions Inquiries for crafting designs for behavior experiments What it takes to create generative (ah-ha!) moments Meet a Few of our Faculty and Team Members who are Nurses Kim has an extensive history working with medical centres and Primary Health Networks to train medical professionals in behaviour change therapy and chronic disease management. She was awarded the 2015 Australian Best Practice Nurse award in Chronic Disease Management. She is currently training Health Professionals across Australia in chronic disease management, prevention screening, and Quality Improvement strategies. She regularly presents at national conferences as a keynote speaker on Change Management, Teaming, Coaching, Chronic Disease Management, Creating Efficiency in General Practice and Care Co-ordination. With over 25 years of clinical practice, research and teaching background in the healthcare industry, Darlene is an experienced family nurse practitioner, professional coach, consultant, educator, and researcher. Darlene received her academic training at the Universities of Virginia, Washington, North Carolina and Harvard and has many years of clinical, research and faculty appointments at these institutions. Darlene is faculty in multiple ICF-Approved Coaching Programs and graduate university programs, delivers workshops in evidence-based coaching strategies and provides services as a health/well-being coach and consultant to individuals and organizations. Darlene is a guest lecturer for the Science of Coaching courses at Harvard and a contributing team member for NBHWC. Beth is a Certified Professional Health and Wellness Coach, an ICF Professional Certified Coach, and took the first exam offered to become a National Board-Certified Health and Wellness Coach. She has served as a Wellcoaches Practical Skills Assessor and Mentor Coach for many years, wrote Going from Beginner to Brilliant, A Practical Guide to Passing Your Practical, and contributed to our National Board Prep Exam and Lifestyle Medicine for Coaches module. Participating in the 4-day Wellcoaches training & certification process was a rewarding experience. The pace of the program was just what I needed as a busy mom with a demanding career in healthcare. The curriculum was well put together and the instructors were simply amazing. I loved that they offered real life experiences and presented the content in a manner that was easily understood. The self paced modules provided me with an opportunity to review them at my convenience, some of which I reviewed multiple times because the information was so intriguing. At the completion of the Wellcoaches training & certification program, I feel I have learned priceless skills that I can use in my everyday life as a nurse, leader, coach, and entrepreneur. I am thankful to have found such an amazing program that has provided me with a solid foundation to coach clients with confidence. Kai Lang DNP, RN, NEA-BC, CHWC Meet a Few of our Nurse Coach Graduates Christine Buckley, DNP, Certified Health and Well-Being Coach, March 2021 As a Professor of Nursing at  Endicott College, she focuses on integrating mindfulness and resiliency training into the formal education of nursing students as a tool to cultivate resiliency and mitigate burnout. She offers Mindful Wellbeing & Resiliency programs in academic and clinical settings and teaches Mindfulness Based Stress Reduction at the Center for Mindfulness at the University of Massachusetts. Her individual and group Mindfulness Based Health and Wellness Coaching fosters the creation of sustainable, personalized pathways for mindfulness and wellbeing. Elizabeth Peltz, RN, Certified Health and Well-Being Coach, NBC-HWC, December 2021 Elizabeth lives in Wyoming and devotes one to two days per week to coaching. She has a strong interest in collaborating with primary care providers to support patients in making and sustaining lifestyle changes. Elizabeth also does pro bono coaching for www.anisehealth.co, a startup created by a Wellcoaches graduate, Alice Zhang. Linda Mikitish, Certified Health & Well-being Coach, NBC-HWC, August 2018 Linda is the Nurse Health Coach who helped to build and expand the group Lifestyle Medicine Clinic at St. Luke’s in Meridian, Idaho, using the Wellcoaches model of coaching. Linda finds coaching as a nurse “exhilarating.” Cardiac and Pulmonary rehabilitation nurses shadow Linda in the Lifestyle Medicine clinic.

Physicians are leaders in addressing the root causes of chronic diseases in primary care and establishing reimbursed Health and Well-being Coaching Services. Physicians who are trained as coaches are pioneers who will shape the future of healthcare. Why become a Physician Coach? Improve your own well-being. Learning about, and applying, key coaching concepts like self-compassion, growth-mindset, and wellness visioning will inevitably have a positive impact on your own life. Increase patient satisfaction and engagement. Your patients will experience you as a more empathetic listener who delivers patient-centered care. Change the culture of your organization. Gain valuable skills for communicating with colleagues and building trusting, collaborative relationships. Where are our Physician Coaches? Wellcoaches has trained and supported hundreds of physicians as coaches through Massachusetts General Hospital, Brigham & Women’s Hospital, Columbia University, Johns Hopkins, Stanford University Hospital, Emory University Hospital, Beth Israel Hospital, and members of the American College of Lifestyle Medicine community. Curious about your own well-being? Wellcoaches has developed a validated inventory to support you in reflecting upon your own well-being in the areas of life, work, body, and mind. Take the Inventory or share it with a patient! Additional Resources on Physician Coaching The American Medical Association's Coaching in Medical Education (contributions by Wellcoaches CEO, Margaret Moore) Foundations in Lifestyle Medicine Board Review Course (contributions by Wellcoaches Chief Coaching Officer, Erika Jackson) Two Randomized Controlled studies of Wellcoaches coaching for physician burnout show robust efficacy Coaching for primary care physician well-being: A randomized trial and follow-up analysis. Journal of Occupational Health Psychology, 2020 Physician Coaching by Professionally Trained Peers for Burnout and Well-Being A Randomized Clinical Trial, JAMA, 2024 AAFP Lifestyle Medicine Course (coaching content developed by Chief Coaching Officer, Erika Jackson and presented by Faculty Member, Charles Inniss) Mayo Clinic Proceeding study defining physician coaching competencies (contributions by Wellcoaches CEO, Margaret Moore)

Recently, the New England Journal of Medicine (NEJM) published an article entitled “Coaching for Better Health: Lessons from Elite Sport.”  (Volpp K, Camplin-Warner A) The paper was published as a NEJM Catalyst article, which is the journal where NEJM presents innovative ideas to improve and transform health care delivery. To understand the importance of this Health Coaching article appearing in the NEJM Catalyst, we must appreciate the standing of the NEJM as the most important medical journal in the United States and probably the world. This is not mere opinion but backed by the objective measure of Impact Factor (IF), calculated by an independent firm and based on frequency of journal citations in a given year.  The IF of the NEJM for 2022 was 158.5.  To put this in context, the IF for Journal of the American Medical Association (JAMA) in 2022 was 120.7.  Another example is the Annals of Family Medicine (AFM) which has an IF of 5.70.  AFM is a good journal, with a high IF compared to most scientific journals whose IF falls below 2.0, with less than 2% achieving IF > 10.0.  The takeaway point is when the NEJM publishes an article it is a huge accomplishment – for health coaching to be recognized as an innovative and potentially transformative health care strategy in NEJM Catalyst is a very big deal for Health Coaching! The purpose of the article was to draw a parallel between Health Coaching and the coaching of elite athletes.  Given both these practices have the objective of improving (health or performance), through the achievement of goals and skill building, it is easy to see the broad foundation for this comparison.   The corollary is furthered by describing the “coach” as someone who cultivates motivation, and helps the individual to learn and grow, while engaging in a supportive and caring relationship.  Within this context, the article goes on to emphasize the following points about coaching: engage the whole person – physically, mentally, and emotionally. purpose-led, personalized goal-setting scenario planning, change management, and resilience training improving self-awareness, expectation management, and learning from setbacks forming better habits and routines, and removal of obstacles that cause friction modifying the choice environment so that defaults favor the desired behavior leveraging technology, social support, and enhancing external accountability focusing on the process, not only outcomes, while celebrating personal growth and progress The authors go on to explain that the U.S. Health care system is not set up to support patients to achieve personal health care goals.  Currently, patients typically have inadequate support and are seen as disengaged.  Well-meaning clinicians do not have the time and likely not the training to effectively guide, or coach, their patients. The authors propose an integration of coaches in an innovative care delivery team. Coaching sessions will allow patients to genuinely feel supported by their extended medical team, encouraging them to try harder to change and improve health.  Moving to this model will require a shift in mindset to a preventative, rather than simply treat or fix, strategy.  Further, a change from fee-for-service to value-based care with reconsidering what success looks like needed.  This new system can then emphasize improved patient choices, sustainable behaviors, and outcomes while improving the trajectory of health care costs. Wow – this is tremendous endorsement of health coaching offered by a prestigious and influential organization.  The newly approved CPT reimbursement codes for health coaching are not mentioned in the article and it is probable this paper was written well before the codes were approved.  Over the coming years, these codes should be a tremendous boon to health coaching once the final protocols and utilizations are fully determined.  It is also curious that the National Board of Health and Wellness Coaching or an outstanding coach training program (e.g., Wellcoaches) was not mentioned in this piece – maybe the authors were trying to remain unbiased in their endorsement of any particular coaching agency.  Finally, the authors could have simply cited “The Coaching Psychology Manual 2nd Edition” for much of the information presented.  This publication is an industry-standard, and fully explains most of the coaching principles presented in the NEJM Catalyst article while delving much further into techniques employed by a masterful health coach. Health and Well-Being Coaching (HWC) is quickly rising in esteem as regarded by the medical community.  This can be no better evidenced then a publication emphasizing HWC by the prestigious NEJM in their journal (i.e., Catalyst) which introduces innovative and contemporary intervention techniques.  This point is further evidenced by the recent AMA and Medicare Services approvals of a temporary CPT codes for the reimbursement of coaching services.  The future for HWC is bright ... and that future is now ! References 1) Volpp K, Camplin-Warner A.  Coaching for Better Health: Lessons from Elite Sport. 2023.  NEJM Catalyst 4:6.  doi:10.1056/CAT.22.0272 2)  Moore M, Jackson E, Tschannen-Moran B, Wellcoaches Corporation. 2016. Coaching Psychology Manual Second ed. Philadelphia: Wolters Kluwer.

In 2006, Wellcoaches was a five-year-old school. That year, Margaret Moore, aka Coach Meg, presented wellness coaching to fitness professionals at the IDEA event. Wellcoaches has evolved and grown tremendously since then. However, as you watch this two-hour training, you’ll recognize the foundational elements that remain today: Mount Lasting Change, the intuitive dance of coaching (generative moment), helping clients craft a wellness vision, making actionable goals from a vision, and how to overcome obstacles.

Earlier this year, the Journal of American Medical Association (JAMA) published an article entitled “Effect of Personalized Risk-Reduction Strategies on Cognition and Dementia Risk Profile Among Older Adults." (Yaffe et al. 2024) The purpose of the study in this prestigious medical journal, was to determine if a multi-pronged program featuring health coaching might reduce dementia risk in group of at-risk adults averaging nearly 76 years of age.  In the ever-growing body of research defining health and well-being coaching (HWC), this is one of the first studies to directly address dementia – a debilitating and feared condition associated with old age.  The design of this study was unique in that it targeted a personalized approach to risk reduction and used HWC to deliver the intervention.  Here are some of the details of this important and applicable work. WHO:  Participants in this study were dementia-free but had two or more dementia risk factors which include: 1) physical inactivity, 2) uncontrolled hypertension, 3) poor sleep, 4) prescription meds affecting cognition, 5) high depressive symptoms, 6) uncontrolled diabetes, 7) social isolation, and 8) currently smoking.  These were all independently living older adults who were part of the Kaiser-Permanente Health Care System.  Participants (N = 172) were randomized into the intervention or control group for this two-year randomized and controlled trial (RCT). HOW:  The study was conducted before and during the COVID pandemic making much of the intervention remotely delivery.  Dementia risk was assessed for each participant and health coaches helped them prioritize related goals and then work toward achieving those goals.  Sessions were initially about 45 minutes long every 4-6 weeks, and after three months, were reduced to about 20 minutes every six weeks for the next 15 months.   A nurse was also part of the primary care team meeting every three months with those participants who had uncontrolled diabetes, hypertension, or risky meds. MEASURED: The primary outcome was a neuropsychological test battery measuring attention, memory, language, and global cognition. The authors also measured physical activity using a written scale and a waist-worn accelerometer. Blood pressure and A1C (diabetes indicator) were measured along with quality of life, sleep quality, social isolation, depression, and smoking.  These measures were made every six months. FINDINGS:  When the composite cognitive outcome measure was assessed, the HWC group improved substantially more than the control group.  The intervention participants also had a significantly better dementia risk profile at the end of the study than the control group.  In general, most other outcome measures (quality of life, sleep, social satisfaction, depression) showed the HWC participants to be better off than the control participants who did not receive HWC.  Finally, those who received HWC expressed greater satisfaction with the study protocol than the controls, who were given relevant health education materials to read and apply. WOW:  This study demonstrated that an intervention featuring HWC could very possibly alter the trajectory for the development of dementia in older adults. Alzheimer's and other related dementia diseases are some of the most feared and dreaded conditions associated with aging.  When asked, most people would rather not live than to go on with severe cognitive decline.  This is not the first study to show that risk factor reduction can improve cognition.  What makes this RCT unique is the personalized, or client-centered approach, ……AND the extensive of use of health coaches to deliver the intervention.  According to the authors, this approach appears to be more effective than what is seen in other studies that emphasize a general and directed risk reduction for all participants. The authors go on to say that COVID may have affected some of their outcome measures (e.g., social isolations) and the delivery of the intervention (remote rather than in-person sessions).  BUT …..they guess the HWC treatment effects might have been better if not for this interruption in their protocol. WRAP-UP: The application of HWC continues to grow.  Prolonging a lifespan with effective cognitive function is the hope of just about every aging person.  Doing this without extensive medication and medical intervention is a further goal that may be considered icing on the cake.  This JAMA-published study asks if HWC can be part of the solution to this pressing problem.  What we see is that It appears HWC has the potential to be of great help to older adults, especially those with greater risk for cognitive decline.  This is just another great example of how applying HWC can successfully assist with prevention of a life-threatening medical condition (see diabetes, heart disease, obesity) through lifestyle modification.  As the client base for HWC expands, it becomes clear how important this strategy may be as a global healthcare intervention. References Yaffe K, Vittinghoff E, Dublin S, Peltz CB, Fleckenstein LE, Rosenberg DE, Barnes DE, Balderson BH, Larson EB. Effect of Personalized Risk-Reduction Strategies on Cognition and Dementia Risk Profile Among Older Adults: The SMARRT Randomized Clinical Trial. JAMA Intern Med. 2024 Jan 1;184(1):54-62. doi: 10.1001/jamainternmed.2023.6279.

Let’s chat for a sec about authenticity, Merriam-Webster's word of the year. It makes sense that authenticity is in demand as we’ve had to work harder and harder to separate genuineness from falsity in the news, in marketing, and in technology. And, amidst the noise of pundits, influencers, and conflicting data, many of us grapple with having a clear point of view about life and about ourself. The value of living authentically is that it yields personal freedom and power. Practically speaking, when we live and lead authentically, we communicate and relate more easily, make decisions with less turbulence, and fall asleep more quickly because there’s less mental buzz of conflicting thoughts and stress. And while the pursuit of authenticity is a mainstay for spiritual seekers and personal growth devotees, leaders and the world at large are increasingly focused on authenticity because deceit and confusion has become perfected and machine-driven, and followers take solace in having authentic leaders. I've been exploring what it means to live and lead authentically for close to 40 years, and want to share just one important aspect to make your efforts in this path more fruitful. I've found that typical education and cultural notions about being authentic and finding our authentic self, range from naïve to misleading to bamboozling. At the heart of this mess is a collective agreement – a mistaken assumption – that hidden somewhere deep within us is an authentic self. Typical pursuit of authenticity implicitly assumes that we have a static and stable (read, authentic) Self that, with enough effort and skill, can be chiseled out and released. Unfortunately, this isn’t helpful as it flies in the face of science, philosophy, and spirituality. All of our wisdom fields  agree that everything in life fluxes and changes. From galaxies to molecules, and from markets to moods, everything is impermanent – constantly shifting and changing. Impermanence is a universal fact that touches every aspect of life, including authenticity. It is not possible, therefore, to locate a static and unchanging self, is it? We, too, are subject to change and flux. So, to clean up this limiting idea, embrace the fact of impermanence. Then you can replace your search for an “authentic self” with a notion of “authentic expression.” An expression is dynamic. An expression honors change and flux. An expression grasps that from our birth to our (hopefully) ripe old age, we continuously unfold and grow in a myriad of domains—mental, emotional, physical, interpersonal, and spiritual. An expression acknowledges that there’s no end to learning and evolving; we are constantly unfolding. It’s natural. When we embrace our authentic expression, we honor our past selves, and welcome our emerging self. We accept that changing our mind and values is a feature of evolving and maturing. We can gracefully let go of the versions of self that were sculpted by others, and make room for our unique expression of creativity and care. We bow deeply to the Universal inevitability of impermanence. When we embrace authentic expression, we attune our awareness to an unfolding self-expression. Why not do the work of authenticity in 2024? It is personally gratifying, and it is a leadership magnet to other people of depth and substance. Clarify your values. Identify child-aged beliefs and let them go. Set boundaries with people. Share your creativity and perspective more often. And as you do all this, be deeply curious about what’s emerging. This isn’t the kind of work that just end – there’s no certificate that declares that you are complete. Your authentic expression is a flow, not a pool. This work is good for your team and for your company. This work is good for your loved ones and community. And this work is ancient spiritual practice. Wishing you an amazing 2024. Happy New Year. Eric

The journal Patient Education and Counseling recently published an exciting study entitled “The Impact of Health and Wellness Coaching (HWC) on Patient-Important Outcomes in Chronic Illness: A Systematic Review and Meta-Analysis." The study was conducted by a Mayo Clinic team. Meta-analysis allows for statistically combining results of many unifocal (e.g., HWC) experimental studies to provide broad conclusions and recommendations. Meta-analysis is often the most trusted form of evidence in policy decision-making and is typically considered the pinnacle of scientific topic review. WHAT and HOW: The study’s purpose was to determine the effects of HWC programs on quality of life (QoL), self-efficacy (SE), depression, and anxiety in chronically ill patients. Chronically ill was defined as any condition limiting self-care for more than 12 months. The authors only used randomized and controlled trials (RCTs), which are considered the most rigorous and powerfully designed experimental studies. Keep in mind, to be included in this review, a study had to be an HWC RCT in chronically ill patients measuring QoL, SE, depression, and/or anxiety. In the end, they selected and analyzed 30 RCTs from the 1337 HWC articles returned by their electronic search of the literature from 2005 – 2023. The 30 retained studies had over 8600 participants that were included in the meta-analysis. FINDINGS: The meta-analyses revealed that HWC had a beneficial impact on QoL, SE, and depression. Each outcome improved at a different time point (e.g., at 3, 6, or 12 months) relative to starting a coaching intervention. Only anxiety was not found to improve after coaching. QoL, SE, and depression were measured in 14, 13, and 15 studies, respectively, while anxiety was measured in only 7 studies. MAIN POINTS: HWC intervention is beneficial for chronically ill patients and can likely improve QoL, SE, and depressive symptoms. It was difficult to determine how long the HWC effects persisted and whether booster sessions were needed because reviewed studies generally did not have adequate follow-up measures after HWC sessions stopped. Successful coaching programs attended to aspects of the Theory of Patient Capacity (TPC). Typically, three TPC constructs were addressed in HWC studies that reported beneficial findings – more on TPC below. CONCLUDING CONSIDERATIONS: The authors cited many limitations in the literature they reviewed. They called for stronger study designs, standardization of outcome measures, and longer follow-up periods. OUR COMMENTARY: Given the design of this review and meta-analysis, it is difficult to say anything about the sustainability of HWC intervention. This study specifically used papers that measured QoL, SE, depression, and anxiety but did not seek to find papers that emphasized long-term follow-up outcome measures. If you are interested in the potential long-term effects of coaching, then check out a study that was designed to address this question (Ahmann 2023). We recently reviewed Ahmann et al. 2 in this column and concluded there are sustained beneficial effects of HWC beyond the coaching period. An interesting concept discussed by authors of this study involved framing HWC treatments in terms of the TPC constructs (Biography, Resources, Environment, Work, and Social Functioning – BREWS). According to this theory, patients draw on these capacities they may possess to deal with the challenges of their treatment. It may be beneficial to plan HWC programs to address these capacities. The figure below provides a graphic of patient capacities. If you want to learn more about the TPC, then start with the reference cited below3. CONCLUSIONS: We now have further evidence of a beneficial effect of HWC on psychometric outcomes such as life quality and self-efficacy in a patient population. These are such important self-reported constructs. Consider, now, that we can be comfortable saying that participation in several months of coaching can positively impact the quality of one’s life – a strong statement even when taken in isolation from the other beneficial HWC effects reported here. The meta-analysis described here also verifies the effectiveness of HWC for addressing depressive symptoms, though, surprisingly, the papers analyzed did not support a similar impact on anxiety. A concept like the Theory of Patient Capacity might inform your coaching. Consider looking into it, especially if you work with patients with self-treatment limitations. REFERENCES Boehmer KR, Álvarez-Villalobos NA, Barakat S, de Leon-Gutierrez H, Ruiz-Hernandez FG, Elizondo-Omaña GG, Vaquera-Alfaro H, Ahn S, Spencer-Bonilla G, Gionfriddo MR, Millan-Alanis JM, Abdelrahim M, Prokop LJ, Murad MH, Wang Z. The impact of health and wellness coaching on patient-important outcomes in chronic illness care: A systematic review and meta-analysis. Patient Educ Couns. 2023 Sep 15;117:107975. doi: 10.1016/j.pec.2023.107975. Ahmann E, Saviet M, Conboy L, Smith K, Iachini B, DeMartin R. Health and Wellness Coaching and Sustained Gains: A Rapid Systematic Review. American Journal of Lifestyle Medicine. 2023;0(0). Boehmer, K.R., Gionfriddo, M.R., Rodriguez-Gutierrez, R. et al. Patient capacity and constraints in the experience of chronic disease: a qualitative systematic review and thematic synthesis. BMC Fam Pract 17, 127 (2016). https://doi.org/10.1186/s12875-016-0525-9

On November 2, the US Centers for Medicare and Medicaid Services (CMS) announced that Health & Well-being Coaching (HWC) Services will be added to the Medicare Telehealth List in 2024 in a temporary phase to study outcomes. Let's share an abundance of gratitude for everyone's amazing contributions. First, the pioneering souls who co-founded the national standards as early board members of what became the National Board for Health & Wellness Coaching: Richard Cotton, ACSM - enabled the HWC job task analysis Cindy Schultz - the first NBHWC Chair, led the project for CDC DPP group coaching standards Karen Lawson, MD - secured funding for the 2010 retreat, which enabled NBHWC formation Linda Bark PhD, RN, MCC, NC-BC, NBC-HWC - first integrative health coach, brought nurse coaches together with NBHWC Leigh-Ann Webster, NBC-HWC - built operational and marketing foundation Meg Jordan, PhD, RN, NBC-HWC - developed coaching skills standards Ruth Q. Wolever, PhD - first HWC researcher, led a systematic review that defined HWC Michael Arloski, PhD - first wellness coach, coaching standards leader Tim Cline, PhD - built a group coaching curriculum for the CDC DPP program and NBHWC Francis "Frank" Ardito, EdD - developed the NBHWC program approval system Linda Smith, PA - coaching standards leader Pamela Peeke, MD – steering board and advocacy Margaret Moore, MBA – co-leader of national standards, certification development, NBHWC formation Second, NBME leaders who believed in our co-founders' passion: David Eisenberg, MD, introduced NBME to co-founders Donald Melnick, MD, NBME past President Peter Katsufrakis, MD, NBME CEO Agata Butler - enabled HWC certification examination Craig Mills - negotiating lead of NBME/NBHWC agreement Jack Hinke - helped NBHWC establish a viable financial path Lisa Rawding - helped NBHWC establish a viable strategic path Third - Dr. Kavitha Reddy, Veteran’s Health Administration, who led the 2019 approval of CPT codes for health and well-being coaching services with our help at NBHWC. Fourth, our team who met with CMS twice in 2019 to discuss HWC services in Medicare: Brian Carey, JD, Foley Hoag Ross Margulies, JD, Foley Hoag Linda Lysoby, NCHEC Francis "Frank" Ardito, NBHWC Thomas Rebbecchi, M.D., NBME Ben Crocker, MD, MGH George Guthrie, MD, ACLM Fifth, our team that prepared and advocated for the HWC codes at the AMA CPT Panel in May 2023 and the CMS decision in November 2023: Kavitha Reddy, MD, VHA Moain Abu Dabrh, MBBCh, MS, NBC-HWC, Mayo Clinic Janet Clark, MD, VHA Melissa Opp, NCHEC Beth Frates, MD FACLM DipABLM, ACLM Michael Parkinson, MD, MPH, FACPM, ACPM Angela Fitch MD, FACP, FOMA, Dipl. ABOM, OMA Jacob Mirsky, MD, MA, DipABLM, MGH Monte Ward, ACSM Karen Avino EdD, RN, AHN-BC, HWNC-BC, SGAHN, AHNCC Leigh-Ann Webster, NBC-HWC, NBHWC Jessica Matthews, DBH, MS, NBC-HWC, DipACLM, FACLM, UCSD database Gene Kallenberg, MD, UCSD Scott Morcott, MD, NBHWC Jennifer Lundman, LCSW, NBHWC Steven Stranne, MD, JD, Foley Hoag John McInnes, MD, JD, Consultant Katy Goodell, Outreach and utilization data management Gary Sforzo, PhD, Evidence review Bettina Beech, Dr.P.H., CPT submission Jocelyn Weiss, PhD, Evidence review Margaret Moore, MBA, Team Lead What a transformational accomplishment, a milestone we will long celebrate. After 14 intense years (starting in late 2009) and 10,000 volunteer hours, I resigned from my NBHWC board and policy leadership roles in October 2023. In our next phase, I am focused on fully supporting the Wellcoaches community on our collaborative journey together. Onward & upward! Here’s to our next big milestone. Coach Meg

“To experience peace does not mean that your life is always blissful. It means that you are capable of tapping into a blissful state of mind amidst the normal chaos of a hectic life.” ―Jill Bolte Taylor Note: This was previously published as an IOC Research Dose Introduction In today’s turbulent world, dealing with constant and ever-changing stressors is the norm. Although these are typically not large-scale stressors like death of a spouse or child, or a major trauma, chronic stressors cumulatively over time harm physical and mental health and well-being. Ongoing stress impairs the immune system, cognitive functioning, engagement at work, and makes us more prone to burnout. It has been difficult to study the cumulative effects of everyday stressors and how to prevent them without a tool for measuring them. The new Personal Sustainability Index (PSI) described and validated in a 2021 article by Boyatzis et al in Consulting Psychology Journal: Practice and Research titled “Thrive and Survive: Assessing Personal Sustainability” can provide that measurement. The authors note: “there are four types of experiences that activate and exaggerate stress: (a) the degree to which an activity is important to a person; (b) the degree of uncertainty the person is experiencing; (c) the degree to which others are watching or evaluating; and (d) the anticipation of any of these experiences.” The PSI tracks not only the frequency and variety of everyday stress events but also “renewal” events, such as walking in nature, playing with a child, or meditating, that help to counteract stress events. The article’s authors explain that reducing stress only helps us to survive, while increasing renewal instead helps us to thrive, and that the PSI is a critical tool for helping us get there. The Stress Response Boyatzis et al provide practical definitions of both stress and renewal. Stress activates the sympathetic nervous system (SNS), while renewal activates the parasympathetic nervous system (PNS). The SNS is a network of nerves important in the “fight-or-flight” response and is more active when a person is stressed or in danger. The body secretes adrenaline in response to danger, which increases heart rate, breathing capacity and the availability of energy stores. If the threat continues, the body releases cortisol, the primary stress hormone, to increase sugars in the bloodstream and keep the body primed for action. The PNS, associated with hormones like oxytocin and vasopressin, is the brake that shuts down the stress response. The fight-or-flight response was very effective at helping early humans evade predators. Once the sudden threat passed, the PNS shut the stress response down. However, in today’s hectic world, where low-level stress awaits at every busy corner or failed internet connection, the stress response remains switched on, with serious consequences for physical and mental health. For example, such chronic stress can increase the likelihood of heart disease, heart attack and stroke, cause sleep problems or weight gain and lead to anxiety and depression. Because we are so accustomed to these low-level stressors, such chronic stress can fly under the radar. Boyatzis et al describe the problem: “Adapting to life can enable us to adjust to dangerous or dysfunctional levels of stress. The ordinariness of many episodes may deceive us into tolerating stress and not acknowledging or even noticing the strain from the cumulative impact.” The Importance of Renewal The authors summarize the current theories on the need for a balance of stress events and renewal events: “…the degree of renewal (parasympathetic nervous system) needed is determined by the degree of stress (sympathetic nervous system) activated in the person during the recent past. The renewal experiences, if sufficient in arousal, can help to return the body to its prestress levels. The result is that the person has resources and energy in relationships, work, and life to feel more engaged, excited, and satisfied.” Many of the previous measures of stress have heavily weighted major life events like death of a loved one (e.g., Social Adjustment Rating Scale) or focused on posttraumatic stress (e.g., Impact of Events Scale). Other scales were meant to measure recovery from stress, such as unwinding after work (Recovery Experience Questionnaire), or coping with it, as for example by venting of emotions or seeking emotional support (Multidimensional Coping Inventory). Unlike these scales, the PSI focuses on the cumulative impact of everyday stressors and measures the events that not just reduce stress but that activate the PNS to shut it down. It inventories 16 renewal and 17 stressful everyday events, which were gleaned from the psychological and medical literature on chronic stress. In the words of Boyatzis et al, “Renewal is not assessed as low stress but as actual experiences that invoke the PNS.” By measuring not just everyday stressors but also renewal events, the PSI provides an important tool for better understanding and managing chronic stress. What the researchers found Using structural equation modeling to analyze the survey results, investigators found that depressed or anxious people may be less likely to engage in a variety of renewal activities. Subjective well-being, work engagement and career satisfaction were all significant positive consequences. Variety was a stronger determinant of these relationships than frequency, though frequency often but not always moderated variety’s effects. Boyatzis et al summarize the findings as follows: “To use the analogy of dosage from the pharmaceutical industry, a person would feel and function better if they had more episodes of renewal each week than stress, as well as a greater variety of types of renewal experiences each week.” Conclusion The PSI is an innovative tool for measuring everyday stress and renewal events. It helps us appreciate how low-grade stressors contribute to chronic stress and how renewal events can build resources and resilience. The PSI can be an informative tool for measuring how well a client is managing stress. It could also support the optimizing of stress management and improving the coaching experience. Takeaways for Coaches Using the PSI directly or being inspired by its principles, coaches can: Develop a list of renewal events (e.g., coaching, volunteering, showing compassion, exercise, nature, yoga, breathing, reflection, meditation, prayer, play, laughter, enjoyable meal) building on those inventoried in the PSI. Brainstorm on renewal activities with clients to counter their stress. Suggest that clients do a renewal activity just before or at the beginning of a coaching session to help them engage more in the growth process. Incorporate renewal activities into the coaching session to help clients integrate the skills learned. Encourage clients to track and manage their everyday stress and renewal activities. Help clients understand the importance of renewal activities not only for themselves but also for others at their organization. Citation: Boyatzis, R. E., Goleman, D., Dhar, U., & Osiri, J. K. (2021). Thrive and survive: Assessing personal sustainability. Consulting Psychology Journal: Practice and Research, 73(1), 27.

Welcome to Wellcoaches' On-Demand Learning Offerings. We invite you to take advantage of these opportunities to earn continuing education for further professional development and/or credential renewals. Coaching Specialty Collection I This collection of five continuing education classes will help you hone your coaching skills. The Collection I series covers affirmations, open-ended questions, systemic coaching, how contracts play a role in coaching, and more. Four sessions offer coaching demonstrations, and the fifth class provides a thoughtful conversation about many coaching challenges that may, directly or indirectly, result from unclear contract parameters. (This collection of classes was initially hosted in our Wellcoaches Membership program.) In this offering, you will learn how to: * Describe how close-ended questions can sometimes come from an expert mindset and transcribe them into open-ended, though-provoking inquiries * Shift from praising to truly affirming * Replace repeating with perceptive and other types of reflections * Define Systemic Coaching * See the value of coaching from a systems perspective * Recognize the steps to setting up the dialogue with a symptom exercise * Observe a coaching demonstration that supports a client to explore, grow, and learn from the written dialogue * Discuss lessons learned following the demonstration * Consider where/how you might use this tool CEUs: Wellcoaches 5, NBHWC 5, ACSM 5, NCHEC 4 ADD TO CART $125 Coaching Clients to a Healthy Weight: Clearing a Path to Healthier Lives in Diet Culture with Greg Hottinger and Michael Scholtz There are many mixed messages to consider when coaching clients toward their weight loss goal. There is pressure from society to achieve a specific body weight or shape. And when a client’s weight is considered a health risk there is also pressure from the healthcare field. As a result, many overweight clients have unrealistic expectations and low self-acceptance and feel defeated by efforts to lose weight. And, for those who are overweight but active and healthy, research shows that losing as little as 5% of body weight can make a positive health difference, including the prevention of Type II diabetes. Navigating this world of confusing information and often conflicting standards and expectations is difficult. With the increasing prevalence of our population dealing with issues related to overweight and obesity, coaches need to be appropriately skilled to assist their clients in working toward a healthier life. Participation in this course will provide coaches with: an understanding of the evidence of how people lose weight an in-depth look at seven key obstacles to weight loss an exploration of dozens of practical tools designed to help your clients approach weight loss or weight maintenance in a compassionate way CEUs: Wellcoaches 9, ACSM 9, NBHWC 9, NCHEC 9 ADD TO CART $250 Coaching Specialty Collection II This collection of five continuing education classes will help you grow and expand your coaching skills. The Collection II series covers A Coach Approach to Mental Health, Coaching Clients with Burnout Symptoms, Coaching Skills in Action: Words Create Worlds, Coaching Skills in Action: Honoring the Integrity of the Generative Moment, and Reflections. The first class in the series provides an essential structure for how a coach can approach mental health issues that may show up in the course of a coaching relationship. Three sessions offer coaching demonstrations focusing on issues of today like burnout, appreciative inquiry, and the deep value of the generative moment. Lastly, the fifth session covers reflections, the different kinds that can be used in a coaching session, and how to use them effectively. (This collection of classes was initially hosted in our Wellcoaches Membership program.) Through this collection, you will learn how to: * Name indicators of declining mental health in a person * Identify and follow a referral process for further investigation/treatment * Identify red flags in mental health and take appropriate action * Employ the 5 stages of AI in a coaching context * Appraise the value of the 5 AI principles as a systemic rather than linear model * Evaluate the impact of AI inquiries focussed on perceived negative experiences address key facets of burnout * Identify coaching approaches for dealing with burnout among clients, including other coaches * Demonstrate how the coach honors the client’s agenda * Demonstrate relational flow between coach and client * Explain how to stay grounded and focused as a coach during a generative moment. * Describe the main types of reflections and the circumstances in which they may be used for the best effect. * Practice making reflections using a variety of linguistic styles. CEUs: Wellcoaches 5, NBHWC 5, ACSM 5, NCHEC 3 ADD TO CART $125 Cut Through the Noise: The Stark Truth About What it Takes to Make a Living at Coaching With Mary Cravets To earn enough money to support a life you love, you must master two skill sets: coaching skills and business development skills. Wellcoaches has equipped you fully for the first, but so often, new coaches' businesses fail because they either… 1. Avoid the business development skills altogether- and their business goes nowhere. OR 2. Get overwhelmed by conflicting advice from marketing “gurus” who leave you feeling lost, turned off by icky sales tactics, and paralyzed with confusion. It’s time to cut through the noise, simplify, and ensure you’re doing the right things to grow your business. This workshop is not for the faint of heart! It provides hard truths and straightforward advice so you will: Understand how to use three simple questions to create your own unique strategy to get more clients and become profitable faster. Uncover mindset roadblocks about sales and marketing, so you put yourself out there in ways you actually enjoy! Learn the easy-to-overlook myths, mistakes and missteps that significantly slow your ability to get paying clients Figure out the best use of your time as you get started (especially if you have a full-time job you want to escape!) CEUs: Wellcoaches 3, NBHWC 3 ADD TO CART $300

In July 2023, Medicare shared their laudable mission informing proposed changes for 2024: “If finalized, the proposals in this rule ensure the people we serve experience coordinated care focused on treating the whole person, considering each person’s unique story and individualized needs — physical health, behavioral health, oral health, social determinants of health, and are inclusive of caregivers, which are all so important to providing the care that people with Medicare deserve.” What Moves is Medicare proposing? 1. Coding and payment for social determinants of health risk assessments. 2. Separate coding and payment for community health integration services (supporting SDOH), including person-centered planning, health system coordination, promoting patient self-advocacy, and facilitating access to community-based resources to address unmet social needs. 3. Improve access to behavioral health in Medicare by allowing marriage and family therapists and mental health counselors, including addiction counselors, to enroll in Medicare and bill for their services for the first time. Increase payment for crisis care, substance use disorder treatment, and psychotherapy. 4. Payment for Principal Illness Navigation services to help patients navigate cancer treatment and treatment for other serious illnesses. These services are also designed to include care involving other peer support specialists, such as peer recovery coaches for individuals with substance use disorder. 5. Pay for certain caregiver training services in specified circumstances, so that practitioners are appropriately paid for engaging with caregivers to support people in carrying out their treatment plans. 6. Relevant to coaches – add health and well-being coaching services using the Category III coaching CPT codes, to the Medicare Telehealth Services List on a temporary basis for CY 2024. While temporary, Medicare’s proposal to open the door to 2024 payment for health and well-being coaching services is a pivotal and promising move for our field, particularly in the context of better addressing health equity and SDOH. It’s time, time for more and more people to grow and thrive with our help as the best health and well-being coaches! The Excited Wellcoaches Team

Last month the American Journal of Lifestyle Medicine published an article entitled “Health and Wellness Coaching and Sustained Gains: A Systematic Review" (Ahmann et al., 2023). Three of the six authors of this paper were Wellcoaches trained! The study’s purpose was to determine what is known about long-lasting effects for coaching clients after completing a health and wellness coaching program. To make this determination, the authors reviewed 231 HWC data-based research studies housed in the Compendium of Health and Wellness Coaching (Sforzo et al., 2020). They ultimately selected 28 articles of sufficient quality to examine the sustainability of a coaching effect post-intervention. Physiological, psychological, behavioral, and health risk outcomes were measured in these studies. It was essential that clients received NO additional coaching before the follow-up measurements, which usually occurred 3-12 months after the initial coaching period. The authors rated the results of each of the 28 retained studies as gains not sustained, gains partially sustained, gains fully sustained, or gains improved at follow-up compared to post-intervention. The average length of coaching intervention for the 28 studies was 6.4 months with about 8 coaching sessions over this time. The time for follow-up measures averaged nearly seven months after the completion of the coaching intervention. So, in essence, the question being addressed in this paper was, are beneficial coaching changes still evident more than six months after the cessation of a six-month coaching program. The authors found that coaching effects were sustained in 25 of the 28 studies examined (nearly 90%). This finding is supported by a large JAMA-published cluster RCT that found blood pressure changes after coaching were sustainable for up to four years (Nguyen-Huynh et al., 2020)! Sustainability of treatment benefits is a robust achievement for health and wellness coaching. Consider that, short of surgery, the effects of most other health interventions are not maintained long after halting treatment. For example, medications must be taken regularly, or the effect quickly fades away – cholesterol will go up if the patient stops taking daily doses of a statin. Take rehab programs (e.g., cardiac rehab or PT for orthopedic reasons) that typically last 2-4 months. After these programs, patients will show a loss of gains made after 2-4 weeks of detraining, with all benefits likely lost within 3-6 months if treatment is fully halted. And we are all acutely aware of what happens when a client falls off a successful diet plan and returns to old eating habits – they will certainly regain most, if not all, of whatever weight was lost. Long-lasting Effects of Coaching – I’ll have mine in BRICK, please! The present study demonstrated that a coaching program, supporting and encouraging behavior change, can have long-lasting benefits. In fact, in nine studies examined outcomes of interest (e.g., physiological and psychological) actually improved months after ceasing the coaching process. This likely indicates that healthy behaviors habits, newly formed during the coaching process, yielded enhanced benefits months after the last coaching session. Health and well-being coaching appears to be a unique form of health intervention that keeps on giving well after the process stops. In the 3 studies where outcomes were not sustained, it was likely to be physiological outcomes (e.g., BMI, A1C, or BP) that reverted to baseline. Improved psychological (e.g., stress or anxiety) or behavioral outcomes (e.g., exercise or eating habits) were more stable than physiological outcomes, typically being maintained for months of follow-up after coaching ended. These physiological parameters matter greatly in healthcare, and we do not want our clients to revert to baseline on these outcomes. Practically applied, this finding might lead coaches to discuss with their client how to best follow-up after completing the initial coaching intervention. As with all coaching, this would be a client-centered discussion and would consider that maintaining beneficial physiological changes might take careful attention and may require a maintenance strategy. That strategy might include using new resources or on occasional coaching booster at a lesser frequency than initially prescribed. As part of their coaching competencies, the National Board of Health and Wellness Coaches clearly and formally encourages coaches to assist clients in finding a sustainable pathway forward. The authors of this rapid systematic review strongly conclude that they provide “…evidence for the efficacy of sustaining gains beyond the active coaching period.” They continue, “…the unique value and important contribution HWC can make for varied health conditions….” It is hard not to agree with their conclusions! A well-delivered program of health and wellness coaching not only helps a client during the process but also for a substantial period after the intervention is stopped. With careful attention to follow-up management, our patients and clients can expect gains made during a coaching program to stick with them for an indefinite length of time. Not too many health or medical interventions can make that claim. Viva health and well-being coaching …. and the clients who benefit! References Ahmann E, Saviet M, Conboy L, Smith K, Iachini B, DeMartin R. Health and Wellness Coaching and Sustained Gains: A Rapid Systematic Review. American Journal of Lifestyle Medicine. 2023;0(0). Sforzo GA, Kaye MP, Harenberg S, et al. Compendium of Health and Wellness Coaching: 2019 Addendum. American Journal of Lifestyle Medicine. 2020;14(2):155-168. doi:10.1177/1559827619850489 Nguyen-Huynh MN, Young JD, Ovbiagele B, Alexander JG, Alexeeff S, Lee C, Blick N, Caan BJ, Go AS, Sidney S. Effect of Lifestyle Coaching or Enhanced Pharmacotherapy on Blood Pressure Control Among Black Adults With Persistent Uncontrolled Hypertension: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2022 May 2;5(5):e2212397. doi: 10.1001/jamanetworkopen.2022.12397