Health and wellness coaches are rapidly earning recognition as indispensable healthcare allies. Until recently, however, there was no clear gold standard for choosing a quality health coach with adequate training and expertise. But a new national coaching credential could set some coaches above the rest.
Last September, in a major landmark for the field of health and wellness coaching, over 1,000 individuals passed the recently developed Health & Wellness Coach Certifying Examination. They became the first-ever health professionals to earn the National Board Certified Health & Wellness Coach (NBC-HWC) credential, an optional certification for practitioners who have also completed an approved health and wellness coaching education program.
Creating a National Credential
Culminating an eight-year planning process involving more than 70 stakeholder groups, the International Consortium for Health & Wellness Coaching (ICHWC), debuted the national certification exam and NBC-HWC credential in 2017. The organization aimed to establish clear minimum standards for the health coaching profession, as well as a reliable measure of foundational coaching competencies, including the knowledge, tasks, and skills essential to the coaching practice.
Prior to releasing its certification exam, the ICHWC worked for years to advance health and wellness coaching as a bonafide profession. The organization conducted an extensive job task analysis, from which it created a set of national training and education standards. In a widely distributed 2015 paper, members of ICHWC's Board of Directors published the findings of their health coach job task analysis and proposed national standards, establishing for the first time a clear list of key competencies, training requirements, fundamental education, and methods to evaluate health and wellness coaches (Jordan, M. et al. Global Adv Health & Med. 2015; 4(3): 46-56).
ICHWC's definition of a coach's role states that "Health and Wellness Coaches partner with clients seeking self-directed, lasting changes, aligned with their values, which promote health and wellness and, thereby, enhance well-being. In the course of their work, health and wellness coaches display unconditional positive regard for their clients and a belief in their capacity for change, and honoring that each client is an expert on his or her life, while ensuring that all interactions are respectful and non-judgmental." These core principles guided the organization's development of the NBC-HWC credential and exam.
The ICHWC team's goal was "to roll out a national certification that would garner the respect of the most conventional medical professionals, the government, and institutions like the American Medical Association"--Meg Jordan, PhD, ICHWC Board of Directors
When writing the examination, the ICHWC team's goal was "to roll out a national certification that would garner the respect of the most conventional medical professionals, the government, and institutions like the American Medical Association," explained ICHWC Board of Directors member Meg Jordan, PhD, RN, CWP.
Jordan, who is also Professor and Chair of the Integrative Health Studies program at the California Institute of Integral Studies, holds that mainstream medicine is waking up and realizing the value that well-trained, credentialed coaches can bring to the patient care equation.
Recently, officials from the Centers for Disease Control and Prevention entered into discussions with ICHWC regarding CDC's evidence-based Diabetes Prevention Plan. ICHWC intends to develop standards for group coaching and updates to the Lifestyle Coach Training that the CDC currently administers.
Research shows that including professional health and wellness coaches can really move the needle on patient engagement in diabetes management programs. According to a 2017 paper in the American Journal of Lifestyle Medicine, health and wellness coaching favorably impacts patients' A1C levels (Sforzo, G. et al. Amer J Lifestyle Med. 2017. doi: 10.1177/1559827617708562).
To dispense its national certification, ICHWC formed a partnership with the National Board of Medical Examiners (NBME), a non-profit founded in 1915 to conduct high-quality assessments of healthcare professionals. The NBME and the Federation of State Medical Boards co-sponsor the US Medical Licensing Examination (USMLE) in all 50 states and Puerto Rico.
At present, the NBC-HWC is a voluntary credential. Its recipients are not currently subject to any state licensing regulations, as the self-regulated field of health and wellness coaching is not yet a licensed profession. However, some view the national certification as a potential first step towards future licensing.
To sit for the NBC-HWC exam, a coach must have first graduated from one of the more than 50 training programs approved by ICHWC. The Consortium carefully vets schools and training programs to ensure that they provide an adequate level of education, sufficient coach trainee hours, and faculty expertise.
ICHWC maintains strict standards, and has declined some schools whose programs did not meet the Consortium's criteria. A list of approved programs, as well as detailed information on the content of the coaching examination, are posted on ICHWC's website.
Coaches wishing to sit for the exam must apply directly to the NBME to take the exam and then await confirmation that they have met all requirements needed to complete it. The 150-question multiple choice exam tests theoretical knowledge and includes scenarios in which candidates must make accurate decisions about how to best support clients.
The exam does not include a live demonstration of coaching skills, as evaluations of in-person coaching skills are among the criteria required of all ICHWC-approved schools.
The Health & Wellness Coach Certifying Examination is currently offered twice a year at proctored sites across the country. The application window for the next exam in June 2018 closes on March 15, 2018, with the following application window scheduled to open May 1, 2018, for the November 2018 exam.
Choosing a Health Coach
A growing number of healthcare practitioners and medical institutions are seeking ways to collaborate with coaches to support their work with patients. A recent Holistic Primary Care piece by Sandra Scheinbaum, PhD provides a thorough description of health coaching and how to choose an appropriate coach.
At present, because the NBC-HWC credential is still so new, many physicians who want to work with coaches will find it challenging to find local credentialed coaches until more pass the certification exam. To guide their coaching decisions, practitioners and patients alike might consider using ICHWC’s directory of National Board Certified Health & Wellness Coaches. ICHWC's list of approved schools and training programs offers another source of guidance for selecting a trained coach.
The Future of Health Coaching
What well-trained coaches do best is support patients in making sustainable day-to-day health habit changes.
In a hurried medical environment, promoting long-term healthy behavior change -- a major undertaking -- is nearly impossible, even for the most caring of integrative practitioners. For most individuals, learning to change health habits requires a significant change of mindset. Lifestyle change is easy to say but difficult to implement becaues it requires someone to stop and make conscious choices in the moment about many aspects of life that were once habitual.
Coaches offer the vital partnership and accountability that patients often need to build habit changes that will really stick.
"Healthcare leaders are really beginning to recognize the value of the supportive coaching alliance, either through one-on-one or group coaching, as a powerful intervention," ICHWC's Jordan said. "Coaches can really help people when they feel isolated in their decision-making, when they don't have self-efficacy, when they don't know how to overcome certain obstacles, and are left hitting their heads against the wall, struggling again and again with the same frustrations" around their health.
The NBC-HWC credential is still young, and it is certainly not the only certification available for health coaches. In 2014, the Institute for Functional Medicine opened a coaching academy, the Functional Medicine Coaching Academy. Similarly, another pioneer in the holistic medical field, the University of Arizona's Center for Integrative Medicine, now offers an Integrative Health Coaching certification program. Both the IFM and UACIM's coaching programs are ICHWC-approved transition programs.
As the coaching field continues to grow, Jordan predicts that in the future, we will begin to see the development of specialty coaching areas. Some coaches might, for instance, specialize in working in hospital environments or rehabilitation facilities, collaborating with medical teams, while others may offer coaching tailored to patients receiving prenatal/perinatal or diabetes care. Some ICHWC board members dream that eventually, health coaching will become a reimbursed medical service.
That's not likely any time soon, but as the "pill-for-ill" reactive approach to disease management becomes more and more unsustainable, payors may start to look more seriously at coaches--and the medical practices that hire them. Health coaches may help bring about the sea change so deeply needed in our modern medical landscape.