The Future of Health Coaching, with Lee Ann Webster
In this episode we discuss:
- What is a health trainer?
- Why NBHWC was created
- Partnership between NBHWC and NBME
- Core competencies of health coaching
- Health Training and Behavioral Change
- How the NBHWC statement works for health trainer training programs
- NBC-HWC Credential Benefits
- What's next for health training
Show notes:
Hi everyone, this is Chris Kresser. Welcome to another episode Radio Health RevolutionThis week, I am very pleased to welcome Lee Ann Webster as my guest on the show. Lee Ann is Executive Director National Health and Wellness Coaching CouncilShe has over 20 years of experience in marketing and communications, and is also Certified National Health Council and a certified personal trainer.
She is an active member of the board of directors of the Palomar YMCA family, holds a degree in sociology from the University of California, San Diego, and has received health and wellness coaching from Real Balance and Well Coaches. In her free time, she loves spending time with her family, in nature, running along trails, a triathlon, cooking and traveling. She lives in San Diego, California and is the owner 52 healthy weeks,
So, I look forward to talking with Lee Ann about health training in general, as a profession, that the National Board of Health and Wellness Coaching led to health coaching as a profession, why it started as an organization, why it is important, and what it sees in the future as coaching for health. So let's dive.
Chris Kresser: Lee Ann, I've been looking forward to this for a long time. Welcome to the show.
Lee Ann Webster: Thank you, Chris. I am very happy to be here today. Thank.
What is a health trainer?
Chris Kresser: So, let's start with the absolute basics here. Many people listen to this. They hear the term “health coach,” they probably have some idea of what a health coach is. But perhaps this is not so, we are not all talking about the same thing when we are talking to a health coach. So what is a health trainerfrom your point of view?
Lee Ann Webster: So, I like to look at health trainers as people who help their customers with very customer-oriented behavior change, right? Thus, customer-oriented, customer-driven behavior change. In this way, health trainers really help people identify their innate motivators and discuss their goals, as well as help them understand how to make the changes they seek in their life. As health trainers, we really like to consider the people we work with as experts in our lives.
Chris Kresser: Right. Thus, some people may think that when they hear a trainer, they may actually come up with a vision of some gymnastics teacher with a whistle around his neck or even someone who, as a nutritionist, is extremely The profession is useful, very legitimate and valid in itself and prescribes comprehensive nutrition plans for someone based on their unique individual needs. We have nutritionists in our clinic, I worked with them for years, but the nutritionist is different from the trainer, right?
Lee Ann Webster: Definitely. Therefore, I like to use the example of a nutritionist or even personal trainers. Because many times when people hire nutritionists or personal trainers, they are really looking for education and information, as well as being guided by the recipe for what they can do. And a medical trainer is really the one who comes and helps you. But we really like to see how our customers do their work in terms of, for example, figuring out what will work best for them to own, and then they really make changes in their behavior and succeed.
Therefore, I believe that working with nutritionists and personal trainers is great. I am actually a certified personal trainer. But a health coach really helps bridge the gap between desire and action.
Chris Kresser: Right. And there is a big gap.
Lee Ann Webster: Yeah. Yes exactly.
Chris Kresser: We know, I talked a lot about this in my show. But the CDC believes that only about 6 percent Americans are consistently in the top five health behaviors. And we are not talking about such fashionable things as intermittent post as well as meditations for an hour a day we talk about:
- No smoking
- Do not drink excessively
- Get enough sleep
- Getting enough exercise
- Maintaining a healthy body mass
Yet, only 6 percent of Americans are constantly involved in such behavior.
And this is not because they do not know that these things are good for health. People are confused by some features, such as a healthy diet. But this is not so, no one thinks that smoking cigarettes at this moment is good for health or that overweight is really good. it hard to change, right?
Lee Ann Webster: Right.
Chris Kresser: It is really hard to stick with.
Lee Ann Webster: Yeah.
Chris Kresser: So, I confess that I was very confused about health and coaching trainers a few years ago. And as a practitioner, even in this case, my first encounters with people who called themselves health trainers were not really positive. I had a couple of situations when patients came to me, and they gave me advice from doctors who were completely dangerous from the point of view of the laboratories they did and the recommendations they made based on these laboratory tests.
And I had some situations where people who actually changed what they were doing based on what the medical trainer told them, compared to the one they worked with and their practitioners. Functional medicine Practitioner recommended. And so, when I first began to hear more about coaching in the field of healthcare, I was a little skeptical because of my experience. And I looked around and saw that in reality there are not so many standards for the education and training of health trainers. It was a view of the Wild West. Anyone can call themselves a health coach. Only tomorrow I will print a business card with the words "Coaching Health Worker", and nothing prevented this or any rules regarding it. And then any company or institution can simply say that we have a medical trainer program, here it is. This is a one-day training and now you are a health trainer. And it bothered me as a practitioner.
And this is a kind of good transition to talking about the National Council for Health and Wellness Coaching and why it exists. Because when I first found out about NBHWC, I was really excited, because I was, finally, now a kind of anchor, where we can define these standards and have a way when we say that a health coach, and someone has certification, there is an understanding of what this means. And the level of training that we expect from someone with such certification. Could you tell us about the history of your organization, why it came about, and what is your mission and purpose now?
The National Council for Health and Wellness Coaching (NBHWC) sets the standards for health coaching. Learn how and what will happen next for the profession in this episode of RHR. #changeagent #wellness #chriskresser
Why NBHWC was created
Lee Ann Webster: Sure. And I will start with the fact that I, too, when I decided that I want to become a health coach, and that was in 2007, just like you, I think I thought that I have one thing that was much more education based.
Chris Kresser: Right.
Lee Ann Webster: And then in the first grade I was, like, I love that. There is a lot of psychology, a lot of information about changing behavior. There are a lot of things. And for me it was very different from what I expected, but much better than I expected to receive.
So, this is a good transition to certification of the national council. Because when I became a health trainer, the National Council for Health and Wellness did not exist. I accidentally chose a program with a good education and high quality standards. But our organization was not. So, when I found out that the organization was created, and that they were even looking for someone to work to help them develop it, I jumped on it because I was so excited that we really had standards in this area,
Chris Kresser: Right.
Lee Ann Webster: So, the organization first appeared as an idea, I suppose, like all other things, in 2010. Several members of our council, Margaret Moore, who is the founder of Well Coaches, and Karen Lawson of the University of Minnesota, were in a conference at the National Institute of Health. And they started talking with other leaders in this field who really saw this growth as the Wild West. There was nothing to help standardize the profession or create rules in the field of training and education. And they started talking to each other. It turned into meetings, which then turned into a real non-profit organization.
We were formalized in 2012 with the aim of creating training and education in the field of health and wellness coaching, which would ultimately lead to certification of the national council.Thus, we, the first couple of years, were actually just formalized and made it clear to everyone that this was happening at all. And then we had what is called creation work task analysisAnd this is very common in any new profession. This is when you develop the knowledge, tasks and skills that someone should know in this area as a practicing trainer, in this case. This analysis of work assignments was then confirmed by 1300 trainers who trained, and it told us that we are definitely moving in the right direction. Based on this, we were able to create standards for training and education for the industry.
And we launched what is called program approval in 2015. And just to give you an idea of how large the area is compared to what we thought, at that time we expected about 15-20 programs to be submitted for approval. And we had more than 60 applications for approval that first year.
Chris Kresser: Wow.
Partnership between NBHWC and NBME
Lee Ann Webster: So yes, it’s just a little bit about how we appeared. And then we became a partner with National Council of Medical Experts in 2016 and launched our first certification on national council certification in September 2017.
Chris Kresser: So, yes, let's talk a little about the partnership with NBME, the National Council of Medical Experts. This is for listeners who are not familiar, organization that defines licensing requirements for doctors, And how did this happen, and what triggered this?
Lee Ann Webster: Yes, so, in many ways, it was a bit of luck and a bit, like the one you know. But there was one doctor who performed some contract work for the National Council of Medical Experts, and also worked with some of our experts in this field, who are members of our board of directors. And once he said: “Hey, I think you guys should talk.” So, our organization began to talk with the Board at NBME, and it became clear that there is a clear path to partnership. At the same time, NBME turned 100 years old and was tasked with finding other professions in which they would like to work. And ours was on the list of professions that they wanted to turn to, without our knowledge, when we turned to them.
Chris Kresser: Right.
Lee Ann Webster: And therefore, it was similar to a real positive relationship through many legal negotiations, because, as we all know, this is very, it sounds wonderful, but it is very difficult to create these types of partnerships. But after a lot we were, we like to say that we were engaged for a while, and then we got married.
Therefore, we also consider NBME to be true experts in creating and passing exams. So on our side we had experts on the subject. We had excellent article authors and people who could work together to create exam data. But in fact, we needed help with a good editorial team that could consider all the issues and put everything together into one reliable exam. So we turned to NBME for this.
Chris Kresser: Yes Yes. They have 100 years of experience in this field.
Lee Ann Webster: Yes.
Chris Kresser: As I said, it is this organization that determines what you must do to get a doctor’s degree in medicine in this country. Thus, they have vast experience in creating these powers at the highest level and ensuring consistency of standards. So if, as we have already said, for example, with these powers, then what is phenomenal from my point of view, as a practitioner, and now as the creator of an approved NBHWC program, is that there is only that common language and common language.
What if we say yes, someone has these NBC-HWC credentials, then I can assume that if I’m an employer, if I’m a practitioner who hires a trainer with these credentials, I can have a basic level of assumption that they have the skills and competencies. The fact that they demonstrated these skills both on the official exam and through the assessment of practical skills, where they should record part of their session and evaluate it in the program. And then they also took the extra step of the NBHWC formal exam, or NBC-HWC.
So, for me, this really raises health coaching from an area that has certainly been helpful and has helped many people. And I don’t mean to humiliate health trainers who don’t have these powers, or say that health coaching has not been phenomenally useful for many millions of people around the world, and that I haven’t seen the fantastic health trainers who have I have been in various environments for over 10 years. And I also saw the need, for example, if this is really going to move to the next stage, to become a critical part of solving the problems that we face in the healthcare sector, it will have to be this level of trust and certification.
Lee Ann Webster: Absolutely.
Chris Kresser: So, you think, for example, if I, for example, an insurance company, and I think about whether I’m going to cover the session with a health coach at some point, I’m probably not going to cover the session of anyone who calls himself a health coach . Just as I would not refund the session to someone who calls himself a doctor who does not have a doctor of medicine or the appropriate qualifications for this. And so for me it just really opens up opportunities for health coaching to start integrating into the ordinary medical worldfurther integrated into the world of functional and integrative medicine and provide legal and recognized career path for people who want to engage in this profession.
Lee Ann Webster: Right, yes.
Core competencies of health coaching
Chris Kresser: So, let's talk a little more about these core competencies of a health trainer.
Lee Ann Webster: Good.
Chris Kresser: You outlined, I forgot the exact number, I need to know, because we are an approved school. Is it 17? It's close?
Lee Ann Webster: Oh, core competency? Oh, that, in … Yes, in the analysis of work tasks, I believe that this is 22.
Chris Kresser: Good. Thus, there are a number of competencies that you need to demonstrate to show that you are working as a health trainer. And we're obviously not going to discuss all 22. But what are some of them, just so that people who listen, who may not be so familiar with health coaching, have an idea?
Lee Ann Webster: I think the best way to talk about this is actually through what is called our plan content, So, we have an analysis of work tasks, and then it grew into the content of the plan. And this is indeed a very interesting resource. Because they, like experts in this field, basically took an analysis of work assignments, and then expanded it. And they broke it into four different areas. So coaching structure, right? So how do you organize your training?
Chris Kresser: Right. What do you do first, what do you do next? What do you do in the end? How do you just logistically make it work?
Lee Ann Webster: Right, right. And why I, I, as it were, completely disconnect … the coaching process, the coaching structure, learning process, right? So what process are you going to go through, right? Are you going to ask a lot of open questions? Собираетесь ли вы показать сочувствие? Как вы собираетесь подойти к этому?
И затем здоровый образ жизни, который на самом деле является ключевым моментом, потому что он как бы связывает начало нашего разговора, в котором мы говорим, мы немного поговорим об образовании, диетологах и личных тренерах.
И это не часть тренинга по здоровью, или, я должен сказать, часть того, что должен знать тренер по здравоохранению, который очень должен соответствовать некоторым стандартам в медицине, верно? Итак, нам нужно знать о кровяном давлении, нам нужно знать о холестерине, нам нужно понимать язык, чтобы, если врач отсылает своего пациента к нам в качестве тренера по вопросам здравоохранения, мы могли на самом деле интерпретировать, в чем заключаются проблемы и что необходимо сделанный.
Крис Крессер: Да уж.
Ли-Энн Вебстер: Так что это третья часть плана содержания, здоровый образ жизни, И тогда четвертый кусок будет этика, правильно? Таким образом, вы определенно хотите убедиться, что вы вступаете в любой тренерский разговор с вашей этикой на месте.
Крис Крессер: Честность, мораль, да.
Ли-Энн Вебстер: Абсолютно.
Крис Крессер: Вы понимаете свою сферу практики.
Ли-Энн Вебстер: Именно так.
Крис Крессер: Вы знаете, что вы должны делать, а не делать. Что за красные флажки могут привести вашего клиента к другому профессионалу? Да уж.
Ли-Энн Вебстер: Ага.
Крис Крессер: Это очень важный момент, и мы часто говорим об этом и нашим студентам и будущим студентам, что, с одной стороны, я думаю, что история коучинга в области здравоохранения заключалась в том, что многие люди, которые изначально были подготовлены в качестве тренера по вопросам здравоохранения, возможно, имели какой-то хороший результат. основа в питании и изменении образа жизни. Но они просто говорили своим клиентам, что делать, и предоставляли информацию и образование. И мы знаем, что сейчас благодаря обширным исследованиям, и большинство из нас просто знают по собственному опыту, что говорить людям, что делать, не работает,
Ли-Энн Вебстер: Верно-верно.
Крис Крессер: Если у вас есть ребенок, партнер или что-то еще, вы, наверное, поняли это. Мы даже не хотим говорить себе, что делать. У нас этот внутренний диалог ведется постоянно. Таким образом, казалось, что часть пищи и хорошего самочувствия была исторически там. И чего не хватало, так это основных тренерских навыков и компетенций, о которых мы говорим. Мотивационное интервьюирование и этапы изменений и позитивная психологияСочувствие, создание доверия и взаимопонимания, все эти вещи. С другой стороны, то, о чем вы говорите, и я согласен с этим, заключается в том, что основных навыков коучинга недостаточно сами по себе –
Ли-Энн Вебстер: Правильно.
Крис Крессер: Если вы планируете быть тренером здоровья. И в этом может быть разница между, например, тренером по здоровью и тренером по жизни, или исполнительным тренером, или кем-то в этом роде, верно?
Ли-Энн Вебстер: Ага-ага.
Крис Крессер: У них будут те же основные тренерские навыки –
Ли-Энн Вебстер: Правильно.
Крис Крессер: Это они могли бы использовать, но они применяют их в действительно другой среде.
Ли-Энн Вебстер: Абсолютно.
Крис Крессер: Им не нужно знать об этих вещах. И так, вроде бы, в наша программамы обучаем людей не только здоровью и базовым медицинским знаниям, но и функциональному здоровью и медицинским знаниям, потому что, конечно, это мой объектив и откуда я родом. Как сам практикующий, я просто думал, думал о том, что бы я хотел, чтобы тренер, наши тренеры, знали, когда я направляю пациентов. Мне не нужно, чтобы они знали как интерпретировать лаборатории и назначать лечение на основе этого, потому что это то, что я делаю. И это выходит за рамки их практики. Но я делаю, если я предписываю определенный протокол лечения, который включает изменения диеты и изменения образа жизни, я хочу, чтобы они знали, о чем я говорю.
Ли-Энн Вебстер: Абсолютно.
Крис Крессер: Не просто быть, как «Что? Что это за штука? »И даже просто для того, чтобы понять лаборатории и почему я их использую и что они значат, не переводя. И это другое, это важная линия для меня. Так это звучит так: это сочетание функциональности или питания, медицинских знаний, а также основных тренерских навыков.,
Ли-Энн Вебстер: Абсолютно. Я имею в виду, я думаю, что вам действительно нужно иметь возможность войти в кабинет врача или даже в корпоративную среду и помочь людям интерпретировать информацию, которую им предоставили, верно? Потому что много раз, когда люди находятся в кабинете своего врача, они нервничают.
Крис Крессер: Правильно.
Ли-Энн Вебстер: Они не обязательно сохраняют информацию. И они не обязательно понимают это. Я просто думал об этом сегодня утром, это очень легко для нас в здравоохранении, и я имею в виду, что наш народный язык каждый день – это все, верно? И, конечно же, мы будем осознавать физические упражнения и мышечную массу, потому что это то, чем мы увлечены. Но я думаю, что когда тренер входит в комнату, они должны войти, в первую очередь, без суждений, верно? Готовый действительно помочь кому-то почувствовать, что он может что-то сделать и интерпретировать информацию, которую он получил. Так что я считаю, что здоровый образ жизни – это очень важно.
Крис Крессер: Да, это такой хороший момент. Я имею в виду, мы знаем среднее время в обычная модель время, которое пациент проводит с врачом, составляет от 10 до 12 минут. Таким образом, у нас нет времени на обучение пациентов и на самом деле полное объяснение того, почему было назначено лекарство, почему была сделана рекомендация или что-то из этого. Таким образом, тренер здравоохранения в этой ситуации может стать важной связью между врачом или практикующей медсестрой и пациентом. И в Модель функциональной медицины, у нас почти противоположная проблема, когда слишком много информации предоставлено.
Пациент со мной в течение часа просматривает историю болезни, он может уйти с 15 страницами, может быть, это преувеличение, но огромное количество рекомендаций. Все, от добавок, которые они будут принимать в рамках своего протокола SIBO, до специальной диеты, которую мы хотим, чтобы они соблюдали, до лабораторных наборов для последующих тестов, которые они должны делать определенным образом и принимать в определенное время. И это невероятно сложно, и в нем так много движущихся частей, и люди сильно перегружены. И это часто очень острые, высоко функционирующие люди. И так в нашей ситуации, тренер по вопросам здравоохранения, опять же, служит связующим звеном между мной и другими практикующими, Помогает пациентам пройти через все различные шаги, которые им необходимо предпринять. И затем, если они столкнутся с какими-то трудностями, вызовами или амбивалентностью в будущем, то тренер по вопросам здравоохранения может стать невероятным ресурсом в этой ситуации.
Ли-Энн Вебстер: Определенно.
Тренировка здоровья и изменение поведения
Крис Крессер: Давайте поговорим немного больше об этом. Я имею в виду, что амбивалентность – это термин, и я думаю, что мое понимание амбивалентности имеет одинаковые причины для изменения, а не изменения. И поэтому вы можете иметь пациента, скажем, большинство моих пациентов действительно мотивированы, которые приходят ко мне. Но даже там, на днях у нас был пациент, которого у меня не было, я прописал протокол, он был очень рад этому. Я не видел его в течение года. И на этой неделе он вернулся в офис и сказал: «Я действительно взволнован. Я думаю, что это поможет мне, но я просто не могу преодолеть горб. Я не могу сделать шаг. Я не знаю, что делать ». Так что это был идеальный сценарий для тренера.
Ли-Энн Вебстер: О, абсолютно.
Крис Крессер: Да уж. Так как же тренер здравоохранения подойдет к такой ситуации?
Ли-Энн Вебстер: Я имею в виду, это интересно, потому что первое, о чем я думаю, это Транстеоретическая модель для изменения, правильно? Итак, вывести кого-то из предубеждения в действие и в конце концов овладеть им, по крайней мере, в этом и заключается цель. Я думаю, что это одно из лучших мест для начала, и, конечно, я собираюсь рассказать о том, как я это сделаю.
Крис Крессер: Да.
Ли-Энн Вебстер: И я думаю, что все, я хотел бы сказать, что у всех нас есть свой вкус, как мы это делаем. Но я думаю, что одна из лучших вещей, которую может сделать тренер здравоохранения, – это действительно глубже погрузиться в жизнь человека и выяснить, каковы его внутренние мотивы и что действительно является основой того, чего они хотят для себя, И что для этого нужно, например, иметь возможность задавать эти сложные вопросы? Я думаю, что это одна вещь, в которой медицинские тренеры становятся очень хорошими, это чувствовать себя комфортно в некомфортных ситуациях.
Потому что много раз клиенту приходится действительно задумываться о том, что происходит, и действительно исследовать свою жизнь, верно? Таким образом, помогая кому-то проанализировать свою жизнь, а затем выяснить, почему он заинтересован в переменах, и помочь им понять это в себе и подумать, помочь им подумать о том, какие проблемы встанут у них на пути, как только они покинут офис ,
Крис Крессер: Правильно, готовимся к провалу.
Ли-Энн Вебстер: В ту минуту, когда они покидают ваш офис, что-то пытается сбить их с толку.
Крис Крессер: Да, абсолютно.
Ли-Энн Вебстер: И поэтому помогая им понять, как: «Хорошо, я обдумываю. Мне сказали, что это проблема. Теперь я думаю об этом. Хорошо. Я хочу измениться, я делаю. Хорошо. Хорошо. Да, я собираюсь начать делать это, я собираюсь начать тренироваться, я собираюсь попробовать что-нибудь, ходить три раза в неделю в течение 30 минут ». И опираясь, как, что это? Что вам понадобится, чтобы действительно добраться туда и сделать это?
Крис Крессер: Да, да, это такой замечательный момент. И я имею в виду, я думаю, я написал об этом пациенте, которого я имел в моей последней книге, Нетрадиционная медицинагде она была женщиной средних лет, до диабета, на грани полного диабета сахара в крови. На самом деле, она бы ходила взад и вперед. И ее врач, и ее практикующая медсестра годами говорили ей, чтобы она придерживалась более здоровой диеты, делала больше упражнений, чтобы решить эту проблему. И она просто не могла и не могла найти, просто от того, что ей сказали сделать это, этого было недостаточно. Вы не будете удивлены этим.
Но мне интересно, что это по-прежнему подход по умолчанию, несмотря на все наши исследования и исследования. Это другая тема. В итоге она работала с тренером по вопросам здравоохранения, который обучался этим методам и благодаря этому смог внести изменения. И для нее это было действительно связано с ее глубоким желанием увидеть ее внука, который недавно родился, окончив колледж, и по-настоящему связать это. Ее любовь к внучке и ее желание быть частью ее жизни и иметь возможность играть с ней, чувствовать себя хорошо и присутствовать в ее детстве и ее окончании колледжа.
Это была цель, которую она чувствовала, как будто она могла действительно отстать. И как только она соединилась с этой мотивацией, открылись шлюзы, и она полностью смогла придерживаться программы.
Ли-Энн Вебстер: Это классно. Замечательно.
Крис Крессер: Я имею в виду, для меня это такой хороший пример того, о чем мы говорим здесь, где мы могли бы пойти дальше, я, ее другие доктора, что угодно, могли бы сказать ей, чтобы она ела здоровую пищу и больше занималась годами без изменений. Но на самом деле это был просто процесс, когда кто-то задавал ей правильные вопросы, что в итоге и помогло ей.
Ли-Энн Вебстер: Да, и я думаю, что много раз люди смущались, верно? Потому что они терпели неудачу. Они не смогли достичь своих целей, возможно, они продолжают прибавлять в весе, или они не теряют вес, что бы это ни было. И поэтому они смущены перед своим врачом. И действительно, когда они встречаются со своим тренером по здоровью и начинают работать со своим тренером по здоровью, им нужно чувствовать, что это такое безопасное место.
Крис Крессер: Правильно.
Ли-Энн Вебстер: Это несправедливо, и что бы вы ни говорили, я все равно буду относиться к вам с большим уважением и делать все, что могу, как тренер по вопросам здравоохранения, чтобы помочь вам добиться успеха.
Крис Крессер: Это так сильно. Я имею в виду, и, конечно, именно поэтому эмпатия и построение доверия и взаимопонимания относятся к тем компетенциям, которые вы должны продемонстрировать как тренер. Потому что без этого вы не сможете построить это доверие и отношения и создать это безопасное пространство. И я думаю, что для некоторых людей такое взаимодействие с тренером по вопросам здравоохранения может быть первым и единственным, что у них когда-либо было, когда они это чувствовали.
Ли-Энн Вебстер: Я согласен.
Крис Крессер: Какой невероятный подарок предложить кому-то. Особенно, когда у них нет этого в любой другой области их жизни.
Ли-Энн Вебстер: Ага. Ага, я согласен. И это тоже требует практики. Я имею в виду, я думаю, что у всех нас есть преимущество. И именно поэтому я люблю разговаривать с тренерами по вопросам здравоохранения, и мне нравится быть тренером по вопросам здравоохранения, особенно в качестве родителя.
Крис Крессер: Да уж.
Ли-Энн Вебстер: Потому что это требует практики, это требует времени. И именно поэтому, как и оценка практических навыков, а также тренировка и наставничество, это важно. Потому что вы, как тренер, вы также прогрессируете как человек.
Крис Крессер: Да уж.
Ли-Энн Вебстер: И вы становитесь менее осуждающим и гораздо более открытым для того, чтобы выслушать чью-то историю и реально помочь им.
Крис Крессер: Да, мы так часто слышим от наших учеников, и у нас даже есть внутренняя поговорка: лучший тренер, лучший человек. Это просто навыки, которые вы изучаете, когда тренируетесь в качестве тренера, это навыки, которые являются просто жизненными навыками. Умение эффективно общаться, быть хорошим слушателем, быть способным отражать и поддерживать то, что кто-то говорит, таким образом, чтобы он чувствовал себя услышанным и понятым. И помогать людям в достижении их целей. Я имею в виду, что в какой профессии или отношениях эти навыки не помогут?
Являетесь ли вы родителем, или вы работаете в совершенно другой области, или вы учитель, педагог, это просто, это вроде, я имею в виду, вроде, я часто чувствую, что это должно быть просто часть общего образования. Это должно быть частью школы, точка. Начиная с начальной школы и заканчивая среднюю школу и колледж.
Ли-Энн Вебстер: Я очень согласен. Да.
Как утверждение NBHWC работает для программ обучения тренеров здравоохранения
Крис Крессер: Ага-ага. Итак, давайте немного поговорим о требованиях к школам.
Ли-Энн Вебстер: Хорошо.
Крис Крессер: Я имею в виду, я, конечно, знаком с ними, так как сейчас мы являемся утвержденной школой, но для слушателей, которые не знакомы, что должна продемонстрировать школа, только начиная с высоты 30 000 футов, чтобы стать утвержденным? Because it’s quite a rigorous process, in order to get this approval.
Leigh-Ann Webster: It is, it is. So I think the biggest thing that people are surprised by is that a school needs to show that they have a certain number of hours. And I believe it’s 40 hours of synchronous training, So a lot of people don’t even know what the word synchronous means. And I like to describe it as live and interactive. What you and I are doing right now is synchronous. If I was reading what you wrote online, by myself, that is not synchronous. That’s asynchronous.
Chris Kresser: Watching a recording of this conversation on your own time is asynchronous.
Leigh-Ann Webster: Yeah. We’re learning from each other right now. We’re talking. It’s back and forth. So that’s probably the biggest piece, obviously. And, of course, the biggest piece is teaching in terms of the content outline, right? But the part that a lot of people don’t necessarily get when they call us is the synchronous component. So it’s 40 hours of live, synchronous training. And then there’s an asynchronous component, which is 20 hours.
So that can be self-paced, reading on your own, listening to a recording. And then another piece would be the minimum of 15 hours of healthy, what we call healthy lifestyle basics, And that’s like what we were talking about earlier, just knowing about cholesterol, blood pressure, just some basic terms. And then another big piece that we often have to go into detail with people about is the practical skills assessment, Because we really believe that you learn by doing. And you, there’s a lot of parts about coaching that you don’t get until you’re actually doing it, like how to sit in the room when someone is crying across the table from you, and how to sit there comfortably, but still with a lot of empathy. So like, we really believe in the practical skills assessment and in coaching practice before you actually are assessed.
Chris Kresser: Yeah.
Leigh-Ann Webster: So those are the biggest pieces of what we’re looking for when a program comes to us for approval. Now, of course, there’s many, many more details in there.
Chris Kresser: Oh yeah, yeah.
Leigh-Ann Webster: But we don’t want to get into that, because let me tell you, I don’t even want to get into it.
Chris Kresser: I think our application was 325 pages, if I recall.
Leigh-Ann Webster: Oh my gosh.
Chris Kresser: Something like that.
Leigh-Ann Webster: Well, let’s not scare people. It’s not that bad.
Chris Kresser: No. But it was well worth it.
Leigh-Ann Webster: Yeah.
Chris Kresser: And I just feel strongly, as you know, I mean we’ve talked about this before, in the vision here and what we need to do in order to advance coaching as a profession. I put my stake in the ground in my book saying that health coaching is critical to the future of medicine, And in fact, we can’t, I don’t think we have a hope of preventing and reversing chronic disease without health coaches playing a much more significant role. Because we already have a shortage of primary care doctors that’s expected to get worse by 2030. There’ll be a shortage of 50,000.
The visits even now are 10 to 12 minutes per patient, they’re getting shorter. Doctors don’t have time to talk about the important diet, lifestyle, and behavior change. And as we’ve been talking about the whole show, they don’t have the training that’s actually required to support people in making those successful changes, motivational interviewing, stages of change, etc. They have incredible training and doctory kind of things that we need them to focus on. And so, and also it takes seven years and tens of thousands, hundreds of thousands of dollars to train a new physician. Whereas someone can earn a health coach certification from a program like ours in one year.
Leigh-Ann Webster: Yeah.
Chris Kresser: And be already ready to make a big difference and help people. So, I’m a huge believer in that. And it just, I know you have recently moved. When you first started, there was some transitional process for approving programs. And then you’ve recently updated the process now for new programs. So tell us a little bit about the shift that happened there and what the differences are. Because I know some people have been confused about that as well.
Leigh-Ann Webster: And it is confusing unless you’ve been there since the beginning, which I have. So anytime, if you’re taking the proper steps, when a profession is trying to advance, you usually have to do it in stages. Because you have to have time for the people practicing in that profession to catch up and for the educators in the profession to essentially catch up to where you ideally would like to end up, right? So when we launched what we call “program approval” in 2015, we started with the very, very basic core competencies. And at the time, I believe that was 30 hours of training and education. So we essentially then stayed dormant in terms of program approval for two years, actually, while all the programs, including the programs that applied for approval, back in the transition phase in 2015, all of them had to catch up.
Chris Kresser: Правильно.
Leigh-Ann Webster: And it’s still quite an effort for programs because we have advanced so much in terms of what we’re asking for. But everybody is catching up. And so in September of 2018, so actually it was a year ago, because it was September first of last year, we launched program approval now in this new phase, and we call that the 2018 standards. Personally, I’d like to have a different name, but we haven’t had a chance to develop that yet, because we’ve been so busy. But now programs are applying under those standards. So people who attended one of the programs under the first phase, they’re still eligible to sit for the exam through February of 2021. Because like I said, we’re catching up education and training. And then anybody who’s sitting for any of the newly approved programs is in a good spot because they have that much more education.
Benefits of the NBC-HWC Credential
Chris Kresser: Yeah, yeah, that’s great. And yeah, I’m very familiar with the need to do that when you are starting off a new, you’re really advancing a new profession and credibility there. On that note, I know that the National Board has been involved in a number of kind of advocacy efforts for advancing the profession of health coaching and the recognition of health coaching within the conventional medical world and the entire medical world in general. Including, exploring the potential for future insurance reimbursement and things like that. So what can you tell us, just in broad terms about your goals and vision there and what’s going on?
Leigh-Ann Webster: Well, we would love to get to a place where health and wellness coaching has what’s called a Category I CPT code so that it’s an automatic in healthcare that a physician could prescribe health and wellness coaching. And that there was a reimbursable code for it. As of today, we do have what’s called a Category III CPT code. CPT codes are provided by the American Medical Association after you complete an application and then go in front of a review board and really present all of the information.
So on July 1st of this year, 2019, we were granted a Category III code. And it’s technically for health and well-being coaching. And that code will become effective January 1, 2020. The Category III codes are not generally reimbursed. They’re generally used for data collection. And that data collection, or the data is then, the hope is that you collect enough data across all demographics, across all regions in the country, so that you then can present that information to the American Medical Association within a couple years. That’s the goal. So that you can move to Category I CPT code.
Chris Kresser: So yeah, it sounds like it’s a stepping stone on the process to hopefully getting insurance reimbursement for health coaching sessions at some point.
Leigh-Ann Webster: It’s huge, actually. It’s huge. We’ve been working on this, it’s been a big topic of conversation. It’s probably one of my number one questions.
Chris Kresser: Yeah.
Leigh-Ann Webster: And it’s huge that we have this. It might not feel huge, because it’s not reimbursed yet. But it is huge. And we will get there.
Chris Kresser: It’s huge and it’s a game changer. I mean, that’s going to open up so many opportunities for health coaches. If insurance reimbursement is available, it’ll increase its accessibility, and that’s when it really gets exciting. Because it does then start to fulfill its promise of being able to scale up and really reinvent medicine and prevent and reverse chronic disease. Because if you’re a physician, you’re working in a conventional primary care practice, again, you only have 10, 12 minutes. You know that your patient needs to work, change their diet, exercise, and work on their lifestyle.
Almost every doctor I know wants to provide that support, but they just don’t have the infrastructure to do it. And in many cases, they’re not going to, referring their patients who might be low income to a private health coach, is not even feasible for their patient populations. But if they can refer, if they’re on Medicare and they can refer them and Medicare will pay or a private insurer will pay, that’s a completely different story. And really, really exciting development. Do I understand that, I read a little bit of information that you sent me, in the way that a health coach is defined in this, what do we call it, in the CPT code approval process, as someone who has the National Board credential?
Leigh-Ann Webster: Yes, yes. So in the actual language written by the AMA, it states that the health and well-being coach needs to either be a National Board Certified Health & Wellness Coach or CHES certified, which would be a health educator.
Chris Kresser: Правильно. Okay, so the AMA is actually defining a health coach as someone that has one of those two certifications. So someone who does not have one of those two certifications will not be eligible for their clients to get reimbursement for health coach sessions. Is that right?
Leigh-Ann Webster: Well, given that there’s no reimbursement yet, I would say that they wouldn’t be eligible to provide the data as a result of that Category III CPT code.
Chris Kresser: Правильно. And then we don’t know yet what the definition will be if it progresses to Category III, or will it probably stay the same?
Leigh-Ann Webster: Well, I would imagine that since the original language is for the stage three, Category III, with the eventual goal to move to Category I, which would be reimbursed, that I would assume that the language would remain the same.
Chris Kresser: It would have to be the same.
Leigh-Ann Webster: Yeah, because the data.
Chris Kresser: The data would change.
Leigh-Ann Webster: Exactly, exactly.
Chris Kresser: You would have to be sure that someone who doesn’t have one of those credentials will get the same or similar results, which is the whole point of the credential in the first place.
Leigh-Ann Webster: Right, exactly. And I think actually, our conversation right now is a perfect example of the complexity of the system. Because we’re figuring it out too, right? And you can tell just by our conversation, that it’s like Category I, Category III, I mean, we’re just like, wow, this is complicated. But we’re getting there.
Chris Kresser: Yeah, I mean, it is and it isn’t. It goes back to what we were talking about before. If you’re the AMA, now I certainly don’t agree with the AMA on everything. But put yourself in the shoes of a policymaker or someone who makes these kind of decisions at the AMA or at Medicare or a private insurer. You’re not going to pay for a session that happens with someone who has no, without knowing what their credentials are and their training is.
Leigh-Ann Webster: Правильно.
Chris Kresser: That just doesn’t make sense, so they don’t want to spend taxpayer money to, even if the person is very skilled and competent, if they’ve just done that learning on their own, there’s no way of demonstrating that. And so it makes total sense to me that the AMA would define a health coach as someone who has the national board credential. Because that is currently nationally, and even internationally, as far as I understand right now, the highest level of training and education that a health coach can get.
Leigh-Ann Webster: Да. That’s right.
Chris Kresser: And so if you’re the AMA and you want to study health coaching and its effectiveness, which is what this Category III CPT code is about, with an eye towards potentially providing reimbursement later, then yeah, you’re going to define a health coach as someone who has evidence-based training and shares a certain basic level of skills, which is why credentials exist in every single profession, not just in medicine.
Leigh-Ann Webster: Yeah, exactly.
Chris Kresser: So kudos to you and the organization. I have had a little bit of interaction with the, with that system, and it’s a large bureaucratic organization, and nothing happens quickly. And I think it’s quite an accomplishment and I’m super excited about it.
Leigh-Ann Webster: Yeah. And from what I’ve been told, too—I wasn’t personally at the meetings in Chicago—but from what I’ve been told, they’re very excited too.
Chris Kresser: That’s great.
Leigh-Ann Webster: And receptive.
Chris Kresser: That doesn’t surprise me.
Leigh-Ann Webster: That’s good.
What’s Next for Health Coaching
Chris Kresser: Like, the CDC has endorsed health coaching. This is not something that’s just like integrative and Functional Medicine. These mainstream conventional health organizations have seen the writing on the wall. They know as well as anybody that the current system is not working. I mean, that’s not a news flash. Like, it’s a major issue in political campaigns. Congressional Budget Office has predicted that if we don’t get healthcare spending under control, the U.S. could be bankrupt by the year 2040.
This is a big deal. And everybody, I think, everybody recognizes that diet and lifestyle change are critical and they’re the missing piece. Like, we spent 90 percent of our healthcare dollars on treating chronic disease and 3 percent on public policy and education and things that might fall under, like where health coaching might fall under that. And if we spent even 20 percent on paying for health coaches for people, I’m convinced that we would have a dramatic impact on the burden of chronic disease. And I think everybody knows that and agrees with that at this point.
Leigh-Ann Webster: Yeah, and I think if health coaches became more mainstream, then we would reach a tipping point where people working with health coaches would start talking about their experience. People in healthcare would start relying more on health coaches to bridge the gap. And I think it would really help us get to a place where it tips and it’s just part of the healthcare system.
Chris Kresser: Yeah, that’s what I’m looking forward to. And also, as the awareness grows in all different environments, people will get exposed to health coaches in many different ways. Like maybe through their corporate wellness program, for example. And maybe through their Functional Medicine practitioner, or maybe they sign up for, there’s a growing number of companies, like, we call them doc-in-the-box companies, like Vida Health, that do individual wellness programs and utilize health coaching.
Or Noom, which is a weight loss coaching app that offers, it does health coaching. And actually one of our students was hired by Noom even before she finished the program and is still working with them. And so there’s a growing, I just think, like, health coaching awareness in the public sphere is growing in part due to your efforts. And just because out of necessity.
Leigh-Ann Webster: Right, right. Yeah, in fact, today we just did a big session with, we actually had 900 people on the Zoom session today and we had people from Vida Health and people from Noom.
Chris Kresser: There you go. Yeah, yeah. So it’s definitely an exciting time to be a health coach, to be considering a health coaching career, to be a practitioner that benefits from working with health coaches, like myself. And I definitely want to thank you and your colleagues at the National Board for all the hard work that you’re doing. And excited that we’re now a fully approved school. That was definitely a worthwhile process to go through. And I feel so confident in our program and its ability to prepare people for a successful career, and having that NBC credential is a big part of that.
Leigh-Ann Webster: Yeah, we’re happy that you’re now an approved program. And I’ve had a lot of fun talking to your coaches, who are reaching out all the time. So yeah, thank you.
Chris Kresser: Потрясающие. Okay, so where can people learn more about the national board and learn about the exam process and all that stuff? What’s the website?
Leigh-Ann Webster: So the website is N as in Nancy, B as in boy, HWC, so NBHWC.org,
Chris Kresser: Great, yeah. Lots of useful resources there. And then for those of you who are thinking of a career as a health coach, at the time of this recording, we’re in an enrollment for our fall program. And if you want to learn more, the best way to do that is go to Kresser.co/info and there you can download our full info packet, 47-page guide with everything you ever wanted to know about the program and how to schedule a call with an enrollment advisor to talk about whether it might be the right fit for you.
So thanks, again, everyone for listening. Thank you, Leigh-Ann, for being here today. It was a pleasure.
Leigh-Ann Webster: Anytime.
Chris Kresser: And keep sending your questions in at ChrisKresser.com/podcastquestion, It helps me to understand what’s on your mind and choose guests and topics for the show. And we’ll talk to you next time.