Neuro Peds - 03 - Coaching

Question 1

what is the Coaching Model?

Answer 1

a communication style and treatment approach

different than traditional Rx approach of “professional is the expert”
embraces “client as expert”
facilitates continuum between directive and coaching

Question 2

How is coaching different than traditional Rx?

Answer 2

It employs:
collaboration
motivation
role-model
teacher

instead of diirective

Question 3

When is the role of Coaching in best used in Physical Therapy?

Answer 3

especially good in Early Intervention
and
Health and Wellness Promotion

Question 4

How does Collaboration work in the Coaching Model?

Answer 4

• The client and professional work together to come up with a plan
• The client comes up with the strategies.
• The client is embraced as the expert

just a big shift from directive (in which PT just tells what to do)

Question 5

describe Early Intervention

Answer 5

• key principle is Family-Centered Approach - Family is Priority

Top-Down Approach

considers the:

• Environment within which the child lives and functions (Natural Environment).
• Family as a whole unit.
• Cultural and individual values of the family.
• Parent’s priorities and concerns are central. Individualized Family Service Plan (IFSP) is a team plan based on these.

Question 6

Who gets Early Intervention?

Answer 6

children from birth to 3 yo

Question 7

What would be considered the Natural Environment in Early Intervention?

Answer 7

Home
Park
Daycare
* wherever they normally function and have specific routines.

Question 8

describe an example of a Family goal vs the PT goal

Answer 8

Family goal: sit at table for dinner

PT : seeing need for walking, standing, sitting, all that

Question 9

What is a stated competency for pediatric physical therapists?

Answer 9

the Professional will Develop a Partnership with the Parent

• collaborate with client
• not just tell them what is best
• engage them in the process so they will be motivated AND follow through

how do we engage them?
what engages you in learning?

Question 10

discuss ways to use Coaching in Early Intervention

Answer 10

• Explain to parents what coaching is and what they should expect - Therapist and parent to share ideas, then practice together.
• Observe and ask questions
  What does parent already know?
  What have they tried?
  What do they feel is working or not working?
  What ideas do they have they would like to explore?
• Help the family understand their strengths - they may have expectations that PT will just fix the child
• note that Coaching is a style of communication, but does not mean no touching
• Therapist and parent collaborate to come up with a plan for what parent will do between sessions.
• Parent chooses strategies they can use as part of their daily routine.
• Parent and therapist review parent’s priorities each session to see if their plan is working or if the parent would like to change it.

Question 11

what is Motivational Interviewing?

Answer 11

A style of communication for the purpose of changing specific health behaviors.

• used extensively and globally in treatment of health behavior change, including HIV/AIDS, adherence to medication, chronic illness, counseling war veterans, vocational rehabilitation, childhood obesity and any other areas with the goal of behavior change.

Question 12

what is the Goal of Motivational Interviewing?

Answer 12

Behavior Change

Question 13

what is the role of Motivational Interviewing in Physical Therapy?

Answer 13

PT use MI for behavior changes in areas for Health Promotion and Wellness

• Exercise
• Diet
• Stress management
• Life balance
• Home Exercise Program adherence

Question 14

Need the PT be an Expert in the topic to Coach it?

Answer 14

no

Question 15

What are the Core Skills for Motivational Interviewing?

Answer 15

OARS:

• Open-ended questions
• Affirmation
• Reflection
• Summarize

and don’t forget LISTENING
and also PLANNING
LOARPS

Question 16

what are some examples of Open-Ended Questions?

Answer 16

What would you like to focus on today?

What concerns do you have?

What is something you could do now?

After all we did today, what would be a good next step?

Of all the options I’ve mentioned, which one sounds like the best fit?

What would you be willing to try?

What are the main things you would like to focus on?

What would that look like in your daily routine? (How? When? Where? How long?)

What would you like to talk about with regards to this?

Based on what we talked about, what stands out to you?

Question 17

what are some examples of Affirming statements?

Answer 17

It is great that you want to do something about this.

You are really making a great effort to stay committed to this.

You are certainly a resourceful person to have come up with strategies that work these activities into your busy life.

Question 18

what are some examples of Reflecting statements?

Answer 18

So you feel…

It sounds like you….

You’re wondering if….

You….(the operational word is “You”)

Question 19

what are some examples of Planning questions?

Answer 19

How are you going to go about doing this?

So what do you intend to do?

What actions will you take to achieve this goal?

How can you accomplish this in a way that fits with your lifestyle, time constraints, responsibilities, etc?

What will you do if you don’t have time? What would be a good contingency plan?

Question 20

When do you Summarize?

Answer 20

Beginning/Opening - during the initial visit and also to open subsequent sessions

Interim - brief, periodically reinforce ideas and link together what has been discussed

End/Closing - detailed, pull together major ideas and can be long

Question 21

What questions would be helpful to create the Opening or Beginning Summary?

Answer 21

• How did it go this week?
• What went well?
• What would you like to review?
• Is there anything you feel did not work well? Why?

Question 22

describe a generic Closing Summary:

Answer 22

During today’s session, we covered some new things in addition to some review. We have come up with a plan for the week and you have thought of some strategies you feel will work well in with your daily routine. Although last week you felt challenged at times, you now have one new strategy that you believe will work better. Your plan is to commit to that strategy over the next week. How does that sound to you? Did I summarize that correctly? Is there anything else you would like to add or change to our plan for this week?

Question 23

Don’t forget Self Assessment. After a coaching session, what will you be asking yourself?

Answer 23

• Did I create opportunities for dialog?
• What ways did I acknowledge the parent’s strengths and competencies?
• What strategies did I use to seek understanding?
• Did I acknowledge or respond to the feelings or concerns of the parent?

Question 24

discuss the States of Change that may be referenced during any Coaching or Motivational Interviewing session:

Answer 24

• Pre-contemplation - “MD wants me to”, “My life is too busy”, “That is not my problem”.
• Contemplation – “I really need to start exercising”.
• Preparation – Looks at resources, strategizes how and when and what types of exercise classes are offered.
• Action –Joined an exercise class and going 2x wk
• Maintenance - Continues to exercise, and finds buddy for support or has another contingency strategy.
• Relapse – Can jump back in at any stage (don’t have to start over from very beginning)

note which state your patient is in. you may have to revise your planned approach.
try to find what will motivate that patient - find the relevance, think on their level