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Confluence Health PGH

Table of Contents

Mission Statement

About Wellness Coaching

What is Coaching Psychology

The Process of Coaching

Evidence-Based Research

The Client-Coach Relationship

Expectations

Informed Consent

Assessments

Health and Medical Questionnaire

Well-Being Assessment

Fitness Assessment (optional)

Services and Pricing

Consultation

Biometric Screening

Fitness Assessment

Health and Wellness Coaching

Health and Wellness Coaching + Individualized Exercise Program

Credentials, Education, and Professional Experience

Resume

Letter of Recommendation (Hospital Corporation of America)

Client Testimonies

Contact

Mission Statement

I will utilize my passion, education, knowledge, skills, and professional experiences within the field of health and wellness coaching to help people develop an individualized blueprint for well-being and become confident in their abilities to implement it so that they can achieve their ideal level of health.

I saw an angel in the stone and carved to set it free. Michelangelo

About Wellness Coaching

What is Coaching?

Coaching is the art of creating an environment, through conversation and a way of being, that facilitates the process by which a person can move toward desired goals in a fulfilling manner. When those goals have to do with health, fitness, and wellness, coaching becomes a vehicle for assisting people to achieve a higher level of both physical and mental well-being.

Professional wellness coaches help people reach their best health and well-being. Wellness coaches are trained to help clients develop and implement personal wellness plans by:

accepting and meeting us where we are today

asking us to take charge

guiding us in doing the mindful thinking and doing work that builds confidence

helping us define a higher purpose for wellness and uncover our natural impulse to be well

helping us tap into our innate fighting spirit

addressing mental and physical health together

helping us draw a personal wellness blueprint

helping us set realistic goals; small victories lay the foundation for self-efficacy

harnessing the strengths we need to overcome our obstacles

helping us view obstacles as opportunities to learn and grow

helping us build a support team

inspiring and challenging us to go beyond what we would do alone

Wellness coaches are practitioners and life-long students of a vibrant new field: coaching psychology, which integrates more than fifteen other fields. Coaching psychology, in part, is the relational vehicle for implementing the tenets of positive psychology, a field focused on the scientific study of happiness and well-being.

Coaching is NOT an expert approach in which coaches primarily analyze problems, give advice, prescribe solutions, recommend goals, develop strategies, teach new skills, or educate. The expert approach is only used at appropriate times and secondary to the Coach Approach:

The Coach Approach

The goal of coaching is to encourage personal responsibility, deep thinking, self-discovery, and self-efficacy. Clients find their own answers to create their own possibilities rather than to be given answers or direction by the coach. Client-originated goals, visions, and behaviors are the active ingredients to client success. Coaches engage the client by utilizing positive psychology practices to help clients discover strengths, clarify values, increase awareness, set priorities, meet challenges, brainstorm possibilities, and design positive actions. Here the client generates a new self-concept: Who is my best self?.

The Coaching Process

The process of wellness coaching progresses through several stages:

The client provides background information through a well-being assessment so that coach and client are well-informed on the key issues, including medical considerations. Also as a community perk, I will perform a biometric screening at the clients request. I will take the clients blood pressure, blood cholesterol, blood sugar, body fat percentage, body mass index and any additional screenings that the client feels are pertinent to achieving his or her health goals.

During the first 60-90 minute coaching session, the client identifies and sets priorities to develop a personal wellness vision, three month plan, and realistic goals.

In subsequent 30-45 minute coaching sessions, each week, month, or quarter, the client and coach review the progress towards the clients vision and goals, explore and resolve the most pressing issues, learn something new, and then agree on a set of goals for the following week.

By the end of three months, the client can expect to reach more than 70% of his or her three-month goals and feel energized and confident to embark on new areas. By the end of a year the client can count on changing his or her mindset and behavior for indefinitely.

Evidence-Based Research

The protocol for wellness coaching is evidence-based, generating positive health and wellness coaching protocols and outcomes datareported in peer-reviewed scientific journals.

1. Sforzo et al (2014). In press paper for smoking cessation2. Roy, et al (2014). Physician-referred patients with chronic conditions3. Sforzo et al (2013). Ithaca College employees4. Sherman et al (2013). Primary care setting for MGH employees 5. Schwartz (2013). Alternative to bariatric surgery6. Berna (2013). Tribal community healthcare center, diabetes patients7. Galantino & Schmid (2009). Cancer survivors

Wellness Coaching employs a strength-based approach. It is not about fixing what is broken, its nurturing what is best within ourselves. These strength-based approaches are comprised from contributionssuch ascounseling psychology, positive psychology, prevention research, social work, solution-focused therapy and motivational interviewing.

Using a strength-based approach, the Wellness Coach follows the 5 Es:

1) Engage: Builds a trusting relationship with individuals and groups.

2) Explore: Assists clients in identifying their values and desires.

3) Envision: Facilitates a vision for wellness.

4) Experiment: Employs communication strategies to enhance self-efficacy and to transform values and desires into action.

5) Evolve: Supports lasting change.

Global Advances in Health and Medicine features a case report on health coaching. Global Advances in Health and Medicine endorses the reporting guidelines from the Equator Network; supports the International Committee of Medical Journal Editors; and is indexed by the US National Library of Medicine. The journal is a member of the Committee for Publication Ethics and abides by its Code of Conduct and adheres to its Best Practice Guidelines. Editors belong to: the Council of Scientific Editors, the World Association of Medical Editors, and the American Association of Medical Writers.

Health Coaching Integration Into Primary Care for the Treatment of Obesity, GLOBAL ADVANCES IN HEALTH AND MEDICINE

CASE REPORT

Health Coaching Integration Into Primary Care for the

Treatment of Obesity

Tratamiento de la obesidad mediante la integracin de la formacin de salud en el equipo de atencin primaria

Ryan Sherman, MS, United States; Ben Crocker, MD, United States; Diana Dill, EdD, United States; David Judge, MD,

1

United States

INTRODUCTION

Obesity (and its related comorbidities) is one of the fastest-growing health concerns facing the United States and shows no sign of abating.1 The Centers for Disease Control and Prevention calculated that nearly 36% of American adults were obese in 2010 and estimates that this number will reach 44% by 2018.

The current standard of care for the management of patients with obesity in primary care is often a general recommendation by the physician to lose weight through improved nutrition and increased physical activity. Educational materials may be provided along with a referral to a dietician, nutritionist, or weight management program. Health coaching as an obesity intervention has yet to be fully integrated into primary care practice but has proven to be effective in corporate wellness and behavioral weight loss programs.2-5

The Ambulatory Practice of the Future (APF) at Massachusetts General Hospital (MGH), Boston, puts the patient at the center of a highly collaborative team focusing on wellness and prevention while providing acute and chronic care. A major component of the partnership is the engagement of the patient in setting personal wellness goals and the use of health coaches. Health coaches enable meaningful patient participation and create a context that allows the primary care team to understand wellness and disease from the patients perspective.

THE CASE

A 34-year-old pediatrician who had been overweight since the third grade and obese since high school was referred to health coaching for weight loss. He reached his maximum weight of 265 lbs (body mass index [BMI] 38) at the age of 29 years, during his residency. Despite his own efforts to lose weight by improving his diet and incorporating regular exercise, he often felt hopeless: Even when I worked hard and lost 20 to 30 lbs, I would still feel fat, so I just stopped trying to diet. As a new patient to APF, he was referred for health coaching.

On intake the patients weight was 216 lbs with a calculated BMI of 31. His waist:hip ratio was .96 (107.5 cm waist and 114 cm hip). His blood pressure was 145/77 mmHg, and his resting heart rate was 77 beats per minute. He reported averaging 60 minutes per week of vigorous exercise and ate out often for convenience and for enjoyment on the weekends.

Methods

Over 12 months, the patient participated in 10 health coaching sessions, which included three office visits and seven phone-based (virtual) visits (Figure). Notably, the patient was out of touch with his coach for several weeks after his initial visit until he was reengaged through email. The health coaching approach at APF that is used with all patients is as follows:

Initial health coaching intake (60 min)

Further orientation of the health coaching approach is provided to the patient

A vision of where the patient would ideally like to see himself in a year is created

Three-month goals were made to start working toward this ideal vision

Two-week goals were made to start working toward the patients 3-month goals

Phone-based visits (15 min30 min)

Review short-term goals and assess progress and challenges

Set new short-term goals

Virtual visits incorporate motivational interviewing, appreciative inquiry, self-efficacy, and problem-solving techniques to promote behavioral activation

Follow-up office visits (45 min)

Three-month goals are reviewed

New 3-month goals are made based on progress and the patients experience including reflection on adjusting initial goals and strategies to achieve success

Follow-up

After 9 months in the APF program, the patient weighed 166 lbs (23% total body weight loss) and had lowered his BMI to 24; his waist:hip ratio was .87 (84 cm waist and 96.5 cm hip)an almost 10% reduction. The patients blood pressure was 121/76 mmHg, and his resting heart rate was 58 beats per minute (Table).

The patient reported an average of 210 minutes of moderate to vigorous exercise each week and noted significant improvements in his eating and exercise habits:

I think diet was more important in the first 6 months, but once I lost some weight I felt like my exercise tolerance improved a lot faster. About 6 months in, my weight loss started to flatten out, but then I increased my exercise by running and starting a regular weight training routine at the gym. At that point I was really feeling the payoff from the hard work, which made it easier to keep pushing forward. Having sessions with a coach helped me come up with ideas on how to reach my goals, and the followup sessions gave me pressure to stay on track.

I dont have to try to eat healthy now or worry

about what the scale shows; healthy eating and

exercise are just part of my routine, which makes

weight maintenance much easier. Im at a

healthy weight for the first time in my life, and

nearly every aspect of my life has improved.

Achieving my weight loss goal was a great boost

to my self-confidence, and that confidence has

helped me at work and in my personal life.

DISCUSSION

Health coaching influenced how this pediatrician

approaches both his own and his patients wellness: I

used to provide education and guidelines to patients as

a solution to their health problems and it never worked;

telling patients they need to change isnt enough.

Although having longer visits to connect with patients

isnt an option, he has made more frequent follow-up

visits part of his practice:

/25/

12

9

In-person

follow-up

6

/2/

12

Virtual visit

12

/29/

2

Virtual visit

12

11

/21/

Initial intake

1/2012

Email sent to

reengage patient

/21/

3

12

Virtual visit

12

/5/

4

Virtual visit

/18/

4

12

Virtual visit

/9/

5

12

Virtual visit

5

12

/24/

In-person visit

Figure

Timeline of in-person visits and virtual visits.

Table

Comparison of Baseline Data and Outcomes After 9 Months

Intake

After 9 Mo of Coaching

Weight

216

lbs

165

lbs

Body mass index

31

24

Waist circumference

cm

107.5

84

cm

Hip circumference

cm

114

cm

96.5

Hip:waist ratio

.96

.87

Blood pressure

145/77

120/80

Resting heart rate

77

BPM

58 BPM

Abbreviation: BPM, beats per minute.

I have been having my patients set short-term goals and have been following up with them a on weight loss helps to improve their health and

reduce future costs. Promoting weight loss now is much more cost-effective than paying for diabetes care in the future. This case illustrates the use of health coaching to support sustained weight loss. To further demonstrate the efficacy of health coaching as a sustainable weight loss intervention in a larger population, we have conducted a study with a sample size of 60 patients. The preliminary analyses show an average BMI reduction from 31 to 26 over 12 months. This result will be compared to a control group, and a cost and scalability analysis will be calculated. The APF program is a practice caring primarily for employees and their adult dependents insured via MGH.

Case Reportwww.gahmj.com July 2013 Volume 2, Number 42

GLOBAL ADVANCES IN HEALTH AND MEDICINE

We believe that health coaching will become increasingly integrated into primary care practice and offers the promise to provide effective tools for engaging patients in health outcomes across a broad range of chronic health issues. The challenge will to be to create increased awareness and understanding within primary care of the health coaching model and create reimbursement mechanisms that support this approach. Health coaching shows promise in lowering future healthcare costs and productivity loss for employers.6

REFEREnCES

1. Centers for Disease Control and Prevention. Adult obesity facts. http://www.cdc.gov/obesity/data/adult.html. Accessed May 24, 2013.

2. Appel LJ, Clark JM, Yeh HC, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011 Nov 24;365(21):1959-68.

3. Kumanyika SK, Fassbender JE, Sarwer DB, et al. One-year results of the Think Health! study of weight management in primary care practices. Obesity (Silver Spring). 2012 Jun;20(6):1249-57.

The Client-Coach Relationship

Expectations

What clients can expect from me:

Professionalism. I will offer my services with complete professionalism. This includes:

Punctuality

I will be at the clients appointment 15 minutes before the scheduled time.

Expertise

I will use my knowledge, skills, and experience to help the client achieve his or her health goals.

I will remain within my scope of practice and refer clients to resources and other professionals when the client needs assistance outside of my scope of practice.

Confidentiality

I will accurately create, maintain, store, and dispose of any records of work done in relation to the practice of coaching in a way that promotes confidentiality and complies with applicable laws.

I will take all responsible steps to notify the appropriate authorities in the event a client discloses an intention to endanger self or others.

Non-Judgment

I present a non-judgment, safe environment for clients. I view coaching matter objectively and unbiasedly to help clients overcome challenges.

My Full Attention and A Genuine Style of Coaching

You will receive all my attention when we talk about your health and wellness goals. I can promise you that I actually care about your health, and that I want to help you as much as you want to help yourself.

I am very passionate about my career as a coach, as well as health and wellness. My passion in combination with my genuineness are evident in my coaching.

What I expect from my clients:

Punctuality

Clients will be meet with me at the appointed time. I ask that if a client cannot make a scheduled appointment to please let me know 24 hours in advance of the appointed time.

Honesty

Clients who are the most honest with themselves and me are the most successful ones in achieving their goals. Clients must be able to answer questions regarding strengths and weaknesses, obstacles, and fears. Once established, we are able to work through any challenges to reach success.

What is expected from health coaching:

Results: Client will achieve outcome-based goals and leave coaching with increased self-efficacy.

INFORMED CONSENT FOR PARTICIPATION

HEALTH AND WELLNESS COACHING

NAME: ____________________________________ DATE: ____________________

1. PURPOSE AND EXPLANATION OF PROCEDURE

I hereby consent to voluntarily engage in an acceptable plan of personal health and wellness coaching. I also give consent to be placed in personal fitness training program activities which are recommended to me for improvement of dietary counseling, stress management, and health/fitness education activities. The levels of exercise I perform will be based upon my cardiorespiratory (heart and lungs) and muscular fitness. I understand that I may be required to undergo a graded exercise test prior to the start of my personal fitness training program in order to evaluate and assess my present level of fitness.

I will be given exact personal instructions regarding the amount and kind of exercise I should do. A professionally trained personal fitness trainer will provide leadership to direct my activities, monitor my performance, and otherwise evaluate my effort. Depending upon my health status, I may or may not be required to have my blood pressure and heart rate evaluated during these sessions to regulate my exercise within desired limits. I understand that I am expected to attend every session and to follow staff instructions with regard to exercise, stress management, and other health and fitness regarded programs. If I am taking prescribed medications, I have already so informed the program staff and further agree to so inform them promptly of any changes which my doctor or I have made with regard to use of these. I will be given the opportunity for periodic assessment and evaluation at regular intervals after the start of the program.

I have been informed that during my participation in the above described health coaching program, I will be asked to complete the physical activities unless symptoms such as fatigue, shortness of breath, chest discomfort or similar occurrences appear. At this point, I have been advised that it is my complete right to decrease or stop exercise and that it is my obligation to inform the personal fitness training program personnel of my symptoms, should any develop.

I understand that during the performance of exercise, a personal fitness trainer will periodically monitor my performance and, perhaps measuring my pulse, blood pressure, or assess my feelings of effort for the purposes of monitoring my progress. I also understand that the personal fitness trainer may reduce or stop my exercise program when any of these findings so indicate that this should be done for my safety and benefit.

I also understand that during the performance of my personal fitness training program physical touching and positioning of my body may be necessary to assess my muscular and bodily reactions to specific exercises, as well as to ensure that I am using proper technique and body alignment. I expressly consent to the physical contact for the stated reasons above.

2. RISKS

It is my understanding and I have been informed that there exists the remote possibility during exercise of adverse changes including, but not limited to, abnormal blood pressure, fainting, dizziness, disorders of heart rhythm, and in very rare instances heart attack, stroke, or even death. I further understand and I have been informed that there exists the risk of bodily injury including, but not limited to, injuries to the muscles, ligaments, tendons, and joints of the body. Every effort, I have been told, will be made to minimize these occurrences by proper staff assessments of my condition before each personal fitness training session, staff supervision during exercise and by my own careful control of exercise efforts. I fully understand the risks associated with exercise, including the risk of bodily injury, heart attack, stroke or even death, but knowing these risks, it is my desire to participate as herein indicated.

3. BENEFITS TO BE EXPECTED AND ALTERNATIVES AVAILABLE TO EXERCISE

I understand that this program may or may not benefit my physical fitness or general health. I recognize that involvement in the personal fitness training sessions will allow me to learn proper ways to perform conditioning exercises, use fitness equipment and regulate physical effort. These experiences should benefit me by indicating how my physical limitations may affect my ability to perform various physical activities. I further understand that if I closely follow the program instructions, that I will likely improve my exercise capacity and fitness level after a period of 3-6 months.

4. CONFIDENTIALITY AND USE OF INFORMATION

I have been informed that the information which is obtained in this health coaching program will be treated as privileged and confidential and will consequently not be released or revealed to any person, to the use of any information which is not personally identifiable with me for research and statistical purposes so long as same does not identify my person or provide facts which could lead to my identification. Any other information obtained, however, will be used only by the program staff to evaluate my exercise status or needs.

5. INQUIRIES AND FREEDOM OF CONSENT

I have been given an opportunity to ask questions as to the procedures.

I have read this Informed Consent form, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily, without inducement.

Participants Signature _____________________________________________________________

Participants Name (Printed) _____________________________________________________________

Witnesss Signature ______________________________ Date: ______________

HEALTH & MEDICAL QUESTIONNAIRE

Name: _________________________Date of birth: _____________________

Date: ________________

Address:________________________________________________________________

StreetCityStateZip

Phone (Cell): __________________(Work): _________________

Email address: ___________________

In case of emergency, whom may we contact?

Name: _________________________Relationship: _______________________

Phone (Cell):_________________________ (Home):___________________________

Personal physician

Name: _________________________ Phone: _______________________

Fax: __________________

Present/Past History

Have you had or do you presently have any of the following? (Check if yes.)

______ Rheumatic fever

______ Recent operation

______ Edema (swelling of ankles)

______ High blood pressure

______ Low blood pressure

______ Injury to back or knees

______ Seizures

______ Lung disease

______ Heart attack or known heart disease

______ Fainting or dizziness

______ Diabetes

______ High Cholesterol

______ Orthopnea (the need to sit up to breathe comfortably) or paroxysmal (sudden,

unexpected attack) or nocturnal dyspnea (shortness of breath at night)

______ Shortness of breath at rest or with mild exertion

______ Chest pains

______ Palpitations or tachycardia (unusually strong or rapid beat)

______ Intermittent claudication (calf cramping)

______ Pain, discomfort in the chest, neck, jaw, arms, or other areas

______ Known heart murmur

______ Unusual fatigue or shortness of breath with usual activities

______ Temporary loss of visual acuity or speech, or short-term numbness or weakness

in one side, arm, or

leg of your body

Cancer

______ Other (please describe): __________________________________________

Family History

Have any of your first-degree relatives (parent, sibling, or child) experienced the following conditions? (Check if yes.) In addition, please identify at what age the condition occurred.

______ Heart attack

______ Heart operation (Bypass surgery, Angioplasty, Coronary Stent placement)

______ Congenital heart disease

______ High blood pressure

______ High cholesterol

______ Diabetes

______ Other major illness: _____________________________________

CONFLUENCE HEALTH PGH

Explain checked items : ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Activity History

1. How were you referred to this program? (Please be specific.) __________________________________________________________________

2. Why are you enrolling in this program? (Please be specific.)

_________________________________________________________________

3. Have you ever worked with a personal trainer before? Yes _____No _____

4. Date of your last physical examination performed by a physician: ____________________________

5. Do you participate in a regular exercise program at this time?

Yes _____ No ______ If yes, briefly describe: ____________________________________________________________________________________________________________________________________

5. Can you currently walk 4 miles briskly without fatigue? Yes ______ No ______

6. Have you ever performed resistance training exercises in the past?

Yes ______ No _______

7. Do you have injuries (bone or muscle disabilities) that may interfere with exercising? Yes ______No ______ If yes, briefly describe: __________________________________________________________________

8. Do you smoke? Yes ______ No ______ If yes, how much per day and what was your age when you started? Amount per day _______ Age _______

9. What is your body weight now? _______What was it one year ago? ________

At age 21? _______

10.How tall are you?

11. Do you follow or have you recently followed any specific dietary intake plan and, in general, how do you feel about your nutritional habits?

______________________________________________________________________________________________________________________________________________________________________________________________________

12. List the medications you are presently taking.

______________________________________________________________________________________________________________________________________________________________________________________________________

CONFELUENCE HEALTH PGH

13. List in order your personal health and fitness objectives.

a. ____________________________________________________________

b. ____________________________________________________________

c. ____________________________________________________________

d. ____________________________________________________________

Thank you.

Well-Being Assessment

MY AGREEMENT OF RELEASE OF LIABILITY

In consideration of my being allowed to receive coaching services from a certified wellness coach, and, in that process, to be coached in fitness, nutrition, weight management, stress management, mental health, and/or health risk management, I do hereby waive, release, and forever discharge my coach and Wellcoaches Corporation and its officers, agents, independent contractors, employees, representatives, executors, and all others from any and all responsibility or liability for injuries or damages resulting from my participation in any activities or my use of fitness equipment arising out of my participation in any activities under such coaching.

I do also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury or damage to myself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any activities of wellness coaching.

I understand that as a part of my wellness coaching program, I may be coached to, or it may be suggested that I, participate in exercise activities, e.g., exercise, aerobic training, strength training, flexibility training, etc., that could be potentially hazardous. I also understand that such activities involve risks of injury and even death, and that I am voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury or death.

I further understand that my certified wellness coach, as applicable, is an independent contractor and not an agent of Wellcoaches Corporation.

I do hereby further acknowledge that I have either had a physical examination and have been given a physician's permission to participate or that I have decided to participate in activity and or use of equipment and machinery without the approval of my physician and do hereby assume all responsibility and risks of injury or death from such participation and activity.

I accept the above agreement of release of liability and the terms of the well-being assessment.

Date

Client Name

Signature

WELL-BEING ASSESSMENTContact Information

*

First Name

*

Last Name

*

Birth Date

(

)

mm/dd/yyyy

Sex

Female

Male

Relationship

Single

Married

Separated

Divorced

Committed

Children# and ages

Occupation

Address

City

State/Province

ZIP/Postal

*

Email

*

Phone

Select username/password for my secure coaching client website:

*Username*Password

Indicate coach name if you have already selected your coach:

FirstLast

Indicate your coach's ID number if known:

If you haven't selected your coach please indicate your preference

If you haven't selected your wellness coach please indicate your preferred speciality:

Priorities for Coaching

I want to address the following areas with my coach (check up to five areas):

TO AVOID POTENTIAL LOSS OF DATA PLEASE SAVE YOUR WORK AT THE END OF EACH PAGE Page 1 of 19

Wellcoaches Corporation 2009

Overall

Improve well-being (health and happiness)

Improve family well-being Improve energy

Improve productivity

Physical

Increase physical activity

Manage or prevent injury

Lose weight

Manage or maintain current weight

Improve eating habits

Improve health risks or medical conditions Reduce need for medication

Mental and Emotional

Improve work/life balance

Improve sleep

Manage stress better or reduce stress

Reduce or quit smoking

Improve finances Improve personal relationships

Manage drug or alcohol issues

Spiritual

Improve job satisfaction

Improve life satisfaction

Life Satisfaction

*Sense of Purpose - I feel a strong sense of purpose in life:*Joy - I feel a deep satisfaction or joy in my life:

*Gratitude - I feel grateful and appreciative for what I have:*Work satisfaction - indicate level of satisfaction:

*Personal relationship satisfaction - indicate level of satisfaction:

My Readiness to Change

My readiness to make changes or improvements in my life satisfaction

1. I am already maintaining good life satisfaction consistently (6 mos. +)

2. I recently started working on this

3. I am planning a change this month

4. I am planning a change to start in the next 6 months

5. I have no present interest in making a change

My Importance

Rate the importance to me of having a high level of life satisfaction: 1 - 10 (highest level)

1. Not important at all

5. About as important as most of the other things I would like to achieve now

2.

3.

4.

6.

7.

8.

9.

10. Most important thing in my life now

My Confidence

My confidence level in my ability to reach and sustain a high level of life satisfaction is

1 - 10 (highest level)

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Energy

In a typical work-day what percentage of the time are you at (all three add up to 100% various levels of energy (physical and mental vigor or vitality):

Best: My energy is high, I am vigorous, and I am able to perform at my best

Average: My energy is good and I am able to accomplish what needs to get done

Low: My energy is low and it's hard to accomplish what needs to get done

1. Best energy

2. Average energy

3. Low energy

When you are not working what percentage of the time are you at (all three add up to 100%)

1. Best energy

2. Average energy

3. Low energy

Energy drains - Select the top three things that drain your energy.

a. Poor or insufficient sleep

b. Too little exercise

c. Unhealthy eating habits

d. Stress

e. Weight management issues

f. Physical health issues

g. Pessimism or emotional issues

h. Work issues

i. Family or relationship issues

j. Financial issues

k. Other - describeEnergy boosters - Select the top three things that boost your energy.

a. Healthy sleep

b. Regular exercise

c. Healthy eating habits

d. Stress management, relaxation, or fun activities

e. Healthy mindset

f. Healthy family and personal relationships

g. Healthy work relationships

h. Maintaining healthy weight

i. Maintaining good physical health

j. Job satisfaction

k. Spiritual activities

l. Healthy finances

m. Other - describe

EnergyMy Importance

Rate the importance to me of being a my best energy level at least 50% of the time: 1 - 10 (highest level)



2.

3.

4.

6.

7.

8.

9.



My readiness to make changes or improvements in my energy levels:

1. I am already maintaining good energy levels consistently (6 mos. +)





My Confidence

My confidence level in my ability to reach and sustain my best energy levels at least 50% of the time is:


1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Weight

Body Mass Index

*Height in inches (without shoes)

Describe any weight-management program pursued in

the last 10 years:

*Waist Measurement in inches:

*Current weight in pounds (without shoes)

Weight in pounds one year ago

Weight in pounds two years ago

Weight in pounds five years ago

Weight in pounds ten years ago

My Importance

Rate the importance to me of reaching and sustaining a healthy weight: 1 - 10 (highest level)



2.

3.

4.

6.

7.

8.

9.



My readiness to make changes or improvements to reach and sustain a healthy weight

1. I am already maintaining a healthy weight (6 mos. +)





My Confidence

My confidence level in my ability to reach and sustain a healthy weight:


1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Exercise

Regular physical activity - Do you currently participate in regular physical activity?

* Regular physical activity is defined as:

A. At least 20 minutes of vigorous activity 3 or more days per week (hard enough to make you breath heavily or make your heart beat faster) or

B. At least 30 minutes of moderate intensity activity 5 or more days per week.

*Other physical activity minutes - How many minutes in an average day are you physically active (gardening, physical labor, use stairs not elevator, walk not drive, etc):

Current limitations on physical activity (e.g. injuries, illness, medical conditions):

Previous limitations on physical activity (over the last 5 years):

*Aerobic exercise - How many days per week do you engage in aerobic exercise of at least 20 minutes duration (fitness walking, cycling, jogging, swimming, aerobic dance, active sports)?

*Strength exercises - How many times per week do you do strength building exercises for ten minutes or more, such as sit-ups, pushups, or use strength training equipment?

*Flexibility or stretching exercises - How many times per week do you do stretching exercises for five minutes or more to improve flexibility of your back, neck, shoulders, and legs?

ExerciseMy Importance

Rate the importance to me of regular physical activity:




2.

3.

4.

6.

7.

8.

9.



My readiness to make changes or improvements to reach or sustain regular physical activity:






My Confidence

My confidence level in my ability to reach and sustain regular physical activity:


1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Breakfast and Snacks

*Breakfast - How often do you eat breakfast, more than just a roll and a cup of coffee? a. Eat breakfast every day

b. Eat breakfast most mornings

c. Eat breakfast two to three times per week

d. Seldom or never eat breakfast

*Snacks - How often do you eat "junk" snack foods bewteen meals (e.g. chips, pastries, candy, ice cream, cookies)? a. Three or more times per day

b. Once or twice per day

c. Few times per week

d. Seldom or never eat "junk" snack foods

Fats

*Fat intake - Indicate the kinds of food you usually eat

A. High fat examples: hamburgers, hot dogs, bologna, steaks, sour cream, cheese, whole milk, eggs, butter, cake, pastry, ice cream, chocolate, fried foods, and many fast foods

B. Low fat examples: lean meats, skinless poultry, fish, skim milk, low fat dairy products, fruit desserts, vegetables, pasta, legumes (peas and beans)

1. Nearly always eat the high fat foods

2. Eat mostly the high fat food, some low fat

3. Eat both about the same

4. Eat mostly low fat foods, some high fat

5. Eat only low fat foods

*Trans fats - are commonly listed as "partially hydrogenated vegetable oil" on food labels. These processed fats increase your risk of developing heart disease. Many snacks, baked goods, and even healthy-appearing breakfast cereals contain trans fat or partially hydrogenated vegetable oil. How often do you eat foods containing trans fats or partially hydrogenated oil?

a. Many times each day

b. At least once a day

c. Occasionally

d. Rarely, if ever

e. I haven't paid attention to trans fats or partially hydrogenated vegetable oils before

Breads, Grains, Fruits, Vegetables

*Breads and grains - Indicate the kinds of breads and grains you usually eat

A. Refined grain examples: white bread, rolls, regular pancakes and waffles, white rice, typical breakfast cereals, typical baked goods

B. Whole grain examples: whole grain breads, brown rice, oatmeal, whole grain or high fiber cereals

1. Nearly always eat refined grain products 4. Eat primarily whole grain products

2. Eat mostly refined grain products 5. Eat only whole grain products

3. Eat both about the same 6. I have gluten intolerance or allergies to certain grains

*Fruits and vegetables - How many servings of fruits and vegetables do you eat daily? (A serving is: 1 cup fresh, 1/2 cup cooked, 1 medium size fruit, or 3/4 cup juice)

1. one or less 2. two daily 3. three daily 4. four daily 5. five or more

Fluids

*Water intake - How many eight ounce glasses of water do you drink on average per day?

*Number of drinks - How many alcoholic drinks do you usually have per weekday (one ounce liquor, 12 ounces beer, or 4 ounces of wine)?

a. None a. 6 - 8 glasses

b. 1 -2 glasses b. 3 - 5 glasses

c. 3 - 5 glasses c. 1 - 2 glasses

d. 6 - 8 glasses d. Seldom or never

*Soft drink intake - How many eight ounce glasses of non-diet soft drinksdo you drink on average per day?

*Number of drinks - How many alcoholic drinks do you usually have per weekend (one ounce liquor, 12 ounces beer, or 4 ounces of wine)?

a. 6 - 8 glasses a. 6 - 8 glasses

b. 3 - 5 glasses b. 3 - 5 glasses

c. 1 - 2 glasses c. 1 - 2 glasses

d. Seldom or never d. Seldom or never

My Importance

Rate the importance to me of consuming healthy food and drinks most of the time: 1 - 10 (highest level)



2.

3.

4.

6.

7.

8.

9.



My readiness to make changes or improvements to consume healthy food and drinks:






My Confidence

My confidence level in my ability to consume healthy food and drinks most of the time:


1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Nutrition

Nutrition

Nutrition







General Health

*Complete the following statement.

In general, my overall health is ...

1. Poor

2. Fair

3. Good

4. Very good

5. Excellent

What is your blood pressure:My numbers Don't Know

Systolic (high number)

Diastolic (low number)

What is your total cholesterol:

What is your HDL (good cholesterol)

What is your fasting Triglyceride level

What is your fasting glucose level

*Physician relationship. Do you have a primary care doctor who you trust and see regularly?

*Physical Exam. When was your last physical examination? Within the last ...

1. No a. Five or more years

2. Somewhat b. 3 - 4 years

3. Yes c. 2 years

d. Year

Health Issues

Women's health issues - Mark all that apply. Men skip to next question.

Men's health issues - Mark all that apply. Women skip to next question.

Currently pregnant. Had prostate exam within last 12 months

Had PAP smear within last 13 monthsPractice monthly testicle self exam for lumps

Had mammogram within last 12 months

Practice monthly breast self exam

Sick days - How many days did you miss from work due to illness or injury during the last 6

What is your LDL (bad cholesterol)

Health

Health

Health







Medications - How often do you use drugs or medicines (include prescription and nonprescription) that treat depression, affect your mood, help you relax, or help you sleep?

a. Frequently

b. Sometimes

c. Rarely

d. Never

months?

Tobacco status - Mark the appropriate response:

a. Use chewing tobacco regularly

b. Currently smoke ten or more cigarettes daily

c. Currently smoke less than ten cigarettes daily

d. Smoke pipe or cigar only

e. Quit smoking less than two years ago

f. Quit smoking two or more years ago

g. Have never smoked (or used tobacco)

Family Health History

Family health history Mark any of the following health problems found in your family (parent, brother, sister).

1. Colorectal cancer

2. Breast Cancer

3. Depression

4. Diabetes

5. Coronary heart disease, heart attack, or coronary surgery before age 55 in men, before age 65 in women

6. High blood pressure

7. High blood cholesterol

8. Suicide

9. None

Personal Health History

Has a doctor informed you that you currently have any of the following health problems?

If yes, mark either "Yes and is not under control" or "yes and taking medication or is under control", otherwise please select N/A

Yes and is not under control

Yes and taking medication or is under control

N/A

Asthma or lung disorder

Current Symptoms

Mark any of the following symptoms you have experienced within the last four weeks.

a. Chest pain or discomfort, frequent palpitations or fluttering in the heart

b. Unusual shortness of breath

c. Unexplained dizziness or fainting

d. Temporary sensation of numbness or tingling, paralysis, vision problem, or lightheadedness e. Frequent urination and unusual thirst

f. Frequent back pain

g. Have trouble sleeping lately

h. None

Bodily Pain

How much bodily pain have you had during the past four weeks.

1. Very severe

2. Severe

3. Moderate

4. Mild

5. Very mild

6. None

Health Limitations

During the past four weeks, how much difficulty did you have doing your work or other regular activities as a result of your physical health.

a. Could not do daily work

b. Quite a bit

c. Some

d. A little bit

e. None

Health

My Importance

Rate the importance to me of managing my health:




2.

3.

4.

6.

7.

8.

9.



My readiness to make changes or improvements in managing my health






My Confidence

My confidence level to make changes or improvements in managing my health:


1. 2. 3. 4. 5. 6. 7. 8. 9. 10.





Stress and Mental Health

Coping, Sleep, Stress and Emotional Issues

*Coping. How well do you feel you are coping with your current stress load?

a. Feeling unable to cope any more

b. Often have trouble coping

c. Have trouble coping at times

d. Coping fairly well

e. Coping very well

*Stress - Mark any symptoms below that apply to you.

1. Minor problems throw me for a loop.

2. I find it difficult to get along with people I used to enjoy.

3. Nothing seems to give me pleasure anymore

4. I am unable to stop thinking about my problems.

5. I feel frustrated, impatient, or angry much of the time.

6. I feel tense or anxious much of the time.

7. None of the above

Social Activity, Personal Loss and Social Support

*Sleep. How many hours of sleep do you get on average?

a. Less than 6

b. 6 - 7

c. 7 - 8

d. 8 - 9 or more

*Emotional issues - During the past four weeks, to what extent have you accomplished less than you would like in your work or other daily activities as a result of emotional issues, such as feeling depressed or anxious

1. Extremely

2. Quite a bit

3. Moderately

4. Slightly

5. None at all

Social Activity - During the past four weeks, to what extent has your physical health or emotional issues interfered with your normal social activities with family, friends, neighbors, or groups?

1. Extremely

2. Quite a bit

3. Moderately

4. Slightly

5. None at all

Personal loss - Have you suffered a personal loss or misfortune in the past year? (For example: a job loss, disability, divorce, separation, or the death of someone close to you) a. No

b. Yes - one loss

c. Yes - two or more serious losses

Social support - Do you have friends/family with whom you can share problems/get help if needed? a. No

b. Yes

Stress and Mental Health

Feelings

* The next questions are about how you feel things have been with you during the

past four weeks. For each question, please give the one answer that comes the closest to the way you have been feeling. How much of the time during the past four weeks ...

1. None of the time

2. A little of the time

3. Some of the time

4. A good bit of the time

5. All of the time

1 2 3 4 5

a. Have you felt calm and peaceful?

c. Have you been a happy person?

b. Did you have a lot of energy?

d. did you take the time to relax and have fun daily?

e. Have you felt downhearted or blue? (If you answer 3 or higher, please complete the depression evaluation)

f. Have you felt worthless, inadequate, or unimportant?

(If you answer 3 or higher, please complete the depression evaluation)

Depression Evaluation

If you answered 3 or higher for the previous section "Feelings e. and f.", please complete the following:

A. None or little of the time.

B. Some of the time.

C. Most of the time.

D. All of the time.

A B C D

Been feeling low in energy, slowed down?

Had a poor appetite?

Been feeling hopeless about the future?

Been feeling no interest in things?

Thought about or wanted to commit suicide?

Been blaming yourself for things?

Had difficulty falling asleep, staying asleep?

Been feeling blue?

Had feelings of worthlessness?

Had difficulty concentrating or making decisions?

Mental & Emotional Fitness

My Importance

Rate the importance to me of reaching and sustaining optimal mental and emotional fitness (managing stress and emotions well and maintaining a positive mindset): 1 - 10 (highest level)



2.

3.

4.

6.

7.

8.

9.



My readiness to make changes or improvements to reach and sustain optimal mental and emotional fitness is:






My Confidence

My confidence level in my ability to reach and sustain optimal mental and emotional fitness (managing stress and emotions well and maintaining a positive mindset):


1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Thank you for completing this Well-Being Assessment.

Fitness Assessment Data Sheets

Name: _________________________ Date: ___________________

Phone number (Cell, work, home): ________________________________________________________________

Date of birth:_________________Age: ____________ Height: _______________

Resting heart rate: ______________ Resting BP: Weight: _________

Circumference Measurements

Neck: ________________ Abdominal: ______________ Waist: _________________

Shoulder: _______________ Hip: _________________ Chest: ___________________

Thigh (Mid): ________________ Arm: (L) _______________(R ): _____________

Body Composition

Percent body fat: _____________ Pounds of fat: _________ Rating: _________

Muscular Endurance

Number of push-ups: ___________________Rating: _________________

Number of curl-ups: __________________ Rating: _________________

Flexibility (Modified Sit and Reach test) Best of three trials

Best Trial (inches): __________________Rating: __________________

General Screening: Biometric Screening

Total Cholesterol: ________

LDL:_________________

HDL:_________________

A1C:_____________________

Fasting Glucose: ____________

Services and Pricing

Consultation (Free)

I will meet you in person, over the phone, or over your webcam for your free consultation.

Your free consultation includes generating your wellness vision and a free biometric screening (in-person) in which I will take your blood pressure, total cholesterol, Body Mass Index, and fitness assessment (FA is $10See below). Find out what your numbers are and how you can improve themall for no charge.

Health and Wellness Coaching

Your health and wellness coaching sessions begin with your wellness vision, whichis the outcome-based goal we outlined in your free consultation. From there, we form very specific weekly behavioral goals to help you achieve your wellness vision. I provide accountability, motivation, expertise, resources, and experienced problem-solving skills regarding specific challenges and obstacles, improving your self-efficacy, and getting your health towhere you want itto be. You choose how long you want to receive wellness coaching. (See below)

Health and Wellness Coaching + Individualized Exercise Program

This package includes everything you would receive through health and wellness coaching plus my expertise in exercise. I will meet you at your house, your gym, or the great outdoors as your personal exercise specialist to help you get fit. Enjoy this perk at a low rate of $20/session, which you can schedule along with your coaching session or at a separate time.

Fitness Assessments

I will perform a fitness assessment at your request. The cost is an additional $10. I will perform the assessment before we begin your coaching and at the conclusion of your program. Your fitness assessment includes V02 Max, Muscular Strength, Muscular Endurance, and Body Composition.

Pricing

Price

One session of health coaching equals $40 You Save:

One month:4 sessions$150$10

Three Months:12 Sessions=$425$55

*Six Months:24-26 Sessions=$850 You Save: $110-$190

*One year:48-52 Sessions=$1,700 You Save: $220-$380

*You will pay the lower price if, at that time, you are achieving your goals and have significant results. So basically, the more you achieve, the less money you pay for coaching sessionsa win-win for you.

Professional Experience

BRIT

T

NI

G

EI

B

EL

12/2013-Present

Hospital Corporation of America, Health to You Nashville, TN

Telephonic Remote Health and Wellness Coach

Manage Caseload of 200 high and moderate risk participants

Successfully coach participants (Web and phone-based) to establish a personal wellness and

accountability plan including weight loss, movement, nutrition, tobacco cessation, stress management,

diabetes or other areas while providing excellent customer service.

Create clinical documentation using electronic systems (i.e., EMR, charting, etc.)

for each interaction in DiaWeb.

02/2012 12/2013

Health Solutions, Summit Health Inc. Pittsburgh, PA

Health Screening Technician/Wellness Coach

Biometric Screenings- Take cholesterol and glucose blood levels, blood pressure,

height and weight, BMI

Wellness coaching- Promoted healthy behaviors based on results

Education and Training

December 2011 Slippery Rock University, Slippery Rock, PA

BS Professional Studies -Exercise Science (ACSM accredited program)

Nutrition and Health, Nutrition and Exercise, Stress Management, Group Fitness,

Strength and Conditioning, Personal Fitness, Wellness Through Movement, Biomechanics, Anatomy and Physiology, Measurements and Statistics in Exercise Science, Personal Health, International Health.

March 2012

Wellcoaches School of Coaching

Learned science-based coaching competencies in Wellcoaches three-month training program, which is endorsed by the American College of Sports Medicine (ACSM)

July 9, 2014

Wendy Downey, RN

1021 NW 42nd Drive

Gainesville, FL 32605

352-225-3363

Employer: North Florida Regional Medical Center, HCA

RE: Testimony for H2U Coach Brittni Geibel

To whom it may concern,

I have had a wonderful experience working with Brittni Geibel as my Health Coach with H2U provided by my employer and HCA, our parent company. Brittni was professional and encouraging when speaking with me. She always sent reminders and called on time for our coaching sessions. Brittni was forced to reschedule my sessions several times due to my fluctuating work schedule. She was always pleasant and very helpful in confirming the goals I set for myself. When I did not fully meet my goal, she gently, with compassion, encouraged me to press onward. She helped me focus on the end result that I desired. Something about the way she spoke to me left me with challenging myself to reach deeper into my desires and work harder to achieve success. I shared my personal goals with her and she helped me fashion them into a reasonable and achievable plan. Brittnis smile was evident even though I never saw her face. I could tell she was genuinely concerned about me as a person and that I was successful in my health endeavors and goals. I feel fortunate to have the privilege to have Brittni as my coach. I am sure those who experience her help in the future will benefit greatly. My blood pressure is now within normal limits without medication and my weight loss is continuing to move down slowly. I know that this was possible because Brittni Geibel believes in me.

I commend Brittni Geibel for helping and encouraging me on my path to success.

Respectfully,

Wendy Downey, RN

Wendy was featured in H2Us summer Health Magazine

CONTACT

Brittni Geibel

250 Hazelnut Road

Chicora, PA 16025

EMAIL

[email protected]

PHONE

(724)504-3856

WEBSITE

http://confluencehealthpgh.com

FACEBOOK

https://www.facebook.com/confluencehealthpgh

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