Coach: Asking permission is a great way to start a sensitive conversation. When parents and clients feel like they have control of the conversation, they're more willing to listen to what you say.
Health Coach: We measured Ethan's height and weight today, and I have some information about where he is relative to other kids his age. Would you be interested in hearing about that?
Heather: Okay, sure.
Health Coach: Great. Well, with his height and weight, we calculated what's called a body mass index, or BMI. Basically this is just comparing his weight to other kids that are his age and height, and he's in the 95th percentile.
That means that if you looked at 100 kids his age and height, he'd be heavier than about 95 of them.
What do you make of that?
Heather: Wow. Well, I, I didn't realize he was quite that big for his age. I just assumed it was fine, but maybe I should be concerned?
Ethan’s Thought: The only kid I know bigger than me is Louis Donnelly. He's in sixth grade and he got held back.
Coach: Notice how the elicit-provide-elicit technique got Heather engaged in the conversation. Asking for her permission to discuss Ethan's height and weight lowered her resistance and allowing her to come to her own conclusions helped her internalize the need for change.
Health Coach: Tell me what concerns you might have, if any, about Ethan's weight.
Heather: Well, I want him to be healthy, of course, which he is. He's healthy. But I also, um, my dad has diabetes. And my doctor said that I'm prediabetic. Should I be worried about Ethan?
Health Coach: Well, it is common for diabetes to run in families, especially Type 2 diabetes.
Heather: That's the kind my dad has.
Health Coach: But it's not just about genetics. When children stay at this BMI, it significantly increases their risk of developing diabetes. Even small improvements in weight can help reduce that risk. So what are your thoughts about that?
Heather: Well, I know I don't want that for him. My dad has been having a, a really tough time, and he, it's, it's been rough for him. It's rough for all of us.
Health Coach: Yeah. You want to make sure Ethan's weight doesn't put him at risk for developing diabetes.
Heather: Yeah. I don't care if he's large for his age, but I do want him to be healthy.
Health Coach: Ethan, what do you think about this?
Ethan: I, I don't want to get sick.
Heather’s Thought: My dad wouldn't want that for Ethan, either.
Coach: The health coach did a good job here. Instead of telling Heather why she should be concerned, she asked for her thoughts, and Heather volunteered a powerful reason for change. Then the health coach reflected that change talk back to her, which elicited even stronger change talk.
Coach: The health coach is entering the focus stage of the conversation. Her goal is to use the information and concerns she hears from the family to find one area where they want to improve Ethan’s habits.
Health Coach: It sounds like this is a concern for you, and you'd consider taking action.
Heather: Yes. Yeah, I think we need to do something.
Coach: When clients come to their own conclusions and say them out loud, that is a powerful experience that pushes them closer to making lasting changes. Wherever possible, use open-ended questions and reflections to evoke and strengthen that change talk.
Health Coach: In the questionnaire you filled out, it looks like we could talk about a few different areas where small changes could help Ethan get to a healthy weight. We could talk about screen time, physical activity, or soda intake. So which of those topics would you prefer for us to discuss?
Heather: Well, I think it would be tough to get him away from the computer and the video games, and I think the physical activity would be hard, too. So I guess let's talk about the soda. Maybe we could make some changes there.
Health Coach: Okay.
Coach: By asking Heather to choose the topic of discussion, the health coach is saving herself time and effort. Heather will be likely choose the area that she is most open to changing. And the health coach is maintaining the collaborative spirit!
Coach: The health coach is entering the evoke stage of the conversation. Her goal is to elicit change talk, or speech in favor of change. It’s empowering for the family to voice their own reasons for change, and it can help guide the conversation.
Health Coach: So talk to me about soda. Ethan, what do you like about it?
Ethan: Root beer's my favorite!
Health Coach: What do you like about root beer, then?
Ethan: I don't know. It's, it tastes really good!
Health Coach: Okay and what else do you like about soda? Nothing? Heather, how about you?
Heather: Well, Ethan loves it, and root beer floats are a special treat. And, well, I like to have one now and then. The kind we get has caffeine too, so I guess sometimes I drink it when I need some energy to get things done.
Health Coach: Okay, so it seems like there are a few different things you both like about soda. What are some things that are not so good about soda?
Heather: I guess I hear about, uh, you know, all the sugar and corn syrup. I, ah, I really don't want Ethan drinking too much of that stuff. And sometimes if Ethan has one too late in the day, he gets very hyper and has trouble falling asleep.
Health Coach: Okay. And what about you, Ethan?
Ethan: Um, well, a while ago, I went to the dentist and I had a cavity. She said it might have been from the soda.
Heather: You didn't like that very much, did you?
Ethan: No.
Coach: Exploring pros and cons is a great way to generate change talk. This is also an opportunity for the health coach to follow up with a double-sided reflection.
Health Coach: I'm hearing a few different things here. On one hand, you and Ethan like soda, and, Heather, you like that it can give you an energy boost. On the other hand, you don't like all the corn syrup and sugar in soda and how it might affect Ethan's health. Also, sometimes it makes Ethan hyper and keeps him up at night and it could even cause cavities.
Heather: Right. We do like it, but maybe we could find something else to drink that's a little healthier.
Heather’s Thought: Though I don't know what else he'll drink.
Coach: This was a nice use of a double-sided reflection to sum up the pros and cons of soda. You can see that this is already helping them to resolve their ambivalence!
Coach: The health coach is now in the plan stage of the conversation. Her goal is to collaborate with the family to plan one realistic change to Ethan’s soda-drinking habits.
Health Coach: So it sounds like you are interested in cutting down on the soda. What do you think would be a reasonable goal?
Heather: Well, I guess no more root beer.
Ethan: Mom! That's my favorite! I know it is, honey, but it's bad for you.
Ethan: Even a little bit would be bad for me?
Heather: Yes.
Ethan’s Thought: This is the worst day of my life.
Coach: It's great that Heather is so enthusiastic about reducing how much soda Ethan drinks, but it doesn't sound like Ethan is ready to make so large a change. To increase adherence, the health coach might want to steer them toward a more moderate change.
Health Coach: Cutting out all the soda is one possibility, but it sounds like that might be really difficult for both of you. And we don't have to do this all at once, you know.
Is there another goal you might want to work towards?
Ethan: Maybe.