Health and Wellness Coaching and Sustained Gains: A Rapid Systematic Review.

The Transtheoretical Model of Change identifies key stages in behavior change, including a maintenance stage occurring when a behavior has been upheld for at least 6 months. Health and wellness coaching has demonstrated support for health behavior change, but maintenance of gains has received little attention. Our rapid systematic literature review characterizes both the research exploring sustained gains with health and wellness coaching and what is known about sustained gains after the completion of a health and wellness coaching engagement. Guided by The Cochrane Rapid Reviews Methods Group "Interim Guidance," we drew 231 studies from the 2018 and 2020 Sforzo et al "Compendium of the health and wellness coaching literature," and "Addendum…" appendices. Initial screening and coding for inclusion and exclusion criteria yielded 28 studies for data extraction. We examined studies across outcome categories (physiological, behavioral, psychological, and health risk assessment) to determine whether outcome measures were: not sustained; partially sustained; fully sustained; or improved from immediate post-intervention to a later follow-up period. Twenty-five of the 28 studies reviewed demonstrated partially, or fully, sustained or improved outcomes in one or more variables studied, with sustained gains demonstrated across outcome categories, strengthening confidence in HWC as a facilitator of lasting change.

Health and Wellness Coaching and Psychiatric Care Collaboration in a Multimodal Intervention for Attention-Deficit/Hyperactivity Disorder: A Case Report.

INTRODUCTION: Stimulant medications are the most common treatment for attention-deficit/hyperactivity disorder (ADHD). However, a multimodal approach that includes behavioral interventions may yield better outcomes. Coaching is gaining recognition as a client-centered behavioral intervention for the management of ADHD. OBJECTIVE: To examine the collaboration between ADHD-focused health and wellness coaching and psychiatric care to support a client's improved self-management of ADHD. METHODS: Using the internationally developed CARE (CAse REport) guidelines designed to improve transparency and accuracy in health research reporting, this case report is based on a systematic review of data collected from the point of care. RESULTS: An 8-week collaboration between a psychiatrist and a health and wellness coach both expanded what the psychiatrist had been able to achieve alone in working with a client with ADHD and resulted in client improvement in self-efficacy and various functional impairments, including organizational skills and academic achievement. The client achieved her goal of resuming graduate studies and both integrated and maintained her behavioral changes for more than 6 months, successfully graduating from her program. DISCUSSION: This is the first case report, to our knowledge, describing the process of coaching for ADHD and exploring its integration with psychiatric care. It illustrates beneficial outcomes and the promising role of health and wellness coaching in assisting individuals with ADHD in achieving successful behavior change. The client in this case report made progress that was sustained beyond the 6-month mark, an important milestone in the trajectory of behavior change. CONCLUSION: This case report suggests that health and wellness coaching can be effective in supporting beneficial outcomes and can be useful in the multimodal management of ADHD.

Supporting Youth Aging Out of Foster Care.

Over 400,000 children are in foster care in the United States, and more than 100,000 of them are waiting to be adopted. Yet many will age out of foster care into adulthood without an adoptive family. Teens and young adults aging out of foster care, even those with preparation and training for the transition, often do not fare well in young adulthood. Many face challenges in areas of education, employment, homelessness, finances, the criminal justice system, and meeting health and mental healthcare needs. Research demonstrates what only makes sense: teens with tangible support from meaningful adult relationships fare better than those without. This article describes an innovative program that connects teens in foster care with supportive adults through social events that can lead to meaningful long-term teen-adult connections - including friendships, mentoring, and even, in some cases, adoption. Pediatric nurses, aware of the challenges these teens face adjusting to adulthood, can begin to explore referral and support options for such teens in their own locales using the resources herein.

Validation: A Family-Centered Communication Skill.

Family-centered care can seem challenging when family member behavior, choices, attitudes, or emotions are "difficult" or "challenging" to deal with. Yet nurses can develop skills to effectively interact with families in a wide variety of circumstances and then become able to practice family-centered care in any situation that might arise. One particularly useful skill is "validation," which means accepting what the family member says or does as a valid expression of thoughts and feelings in that particular circumstance at that particular time. Validation does not mean there is agreement or acceptance of unsafe behaviors, only that the nurse acknowledges that the family member's concerns and feelings are important and should be listened to and taken seriously, even in the presence of disagreement. Validation, which should be individualized, can take many forms, ranging from providing complete attention to reflection of statements, identification of possible unexpressed emotions, normalization, and finally, a full and genuine sense of connection. Understanding and practicing validation can empower nurses and family members, as well as support effectivefamily-centered communication and problem solving even in challenging circumstances.

Family Presence and Participation: Pediatrics Leading the Way ... And Still Evolving.

Patient- and family-centered care began in pediatrics more than two decades ago, and pediatric care has continued to lead the way in acknowledging and supporting family presence and participation in patient care and decision-making. However, many adult hospitals still have "visiting" policies that restrict the potential for true partnerships with families and other care partners. A national campaign, Better Together: Partnering with Families, developed by the Institute for Patient- and Families-Centered Care (IPFCC), urges all hospitals--pediatric and adult--to welcome families 24/7. Despite the leadership of pediatrics in family-centered care, even in children's hospitals, policy and practice must continue to evolve to strengthen partnerships with families, as described in a profile of C.S. Mott Children's Hospital and the University of Michigan Health System.

Transitions from Pediatric to Adult Care: Programs and Resources.

This third article in a series on the critical issue of the transition from pediatric to adult care for young adults with complex chronic conditions offers resources, including information about exemplary programs, to pediatric nurses. Three hospital-based programs are highlighted, four key Internet resources are identified, and five relevant articles are annotated. This information can support pediatric nurses in considering transition support options for individual teens and their families as well as in developing resources and designing programs in their own settings.

Validation: a family-centered communication skill.

Family-centered care can seem challenging when family member behavior, choices, attitudes, or emotions are "difficult" or "challenging" to deal with. Yet nurses can develop skills to effectively interact with families in a wide variety of circumstances and then become able to practice family-centered care in any situation that might arise. One particularly useful skill is "validation," which means accepting what the family member says or does as a valid expression of thoughts and feelings in that particular circumstance at that particular time. Validation does not mean there is agreement or acceptance of unsafe behaviors, only that the nurse acknowledges that the family member's concerns and feelings are important and should be listened to and taken seriously, even in the presence of disagreement. Validation, which should be individualized, can take many forms, ranging from providing complete attention to reflection of statements, identification of possible unexpressed emotions, normalization, and finally, a full and genuine sense of connection. Understanding and practicing validation can empower nurses and family members, as well as support effective family-centered communication and problem solving, even in challenging circumstances.

Encouraging positive behavior in 'challenging' children: the Nurtured Heart Approach.

Conventional parenting approaches often fall short of the mark for children who exhibit difficult behavior, sometimes inadvertently leading to increased oppositionality and poor self-esteem. As a result, parents of children with intense personalities and challenging behaviors need strategies that work very differently. The Nurtured Heart Approach is a philosophy/technique developed to help parents rewrite the often negative parenting scripts used with these children by limiting the amount of attention given to negative or undesirable behaviors while noticing and acknowledging even small positive behaviors, naming them, "energizing" attention given to them, and valuing their occurrence. Although there has been very limited empirical study of the Nurtured Heart Approach to date, it has been used, with anecdotal reports of success, in a variety of settings, including Head Start programs, schools, foster care agencies, a treatment center, and a pre-adolescent diversion program (Glasser, 2000).

Transitioning from pediatric to adult health care: the experience of patients and families.

Due to advances in medicine, many young adults with complex chronic conditions are now able.to reach the age when they must transition from pediatric to adult care. But preparation for these transitions is often inadequate--for patients and their families, as well as for adult providers. As a result, many needs (clinical, psychosocial, and educational) may not be met, and patients and their families may feel uncertain about the quality of care. This article is the first in a series addressing this critical issue by providing insights from patients and families who have experienced transitions, as well as information about programs and available resources. In this article two parents and one young adult patient share their stories of transitioning, identify the numerous challenges they faced, and suggest strategies to improve the health care system for other patients and families.

Making meaning when a child has mental illness: four mothers share their experiences.

Approximately 15 million children in the United States can currently be diagnosed with a mental health disorder (APA, 2013). Families of these children experience not only grief and the challenge of managing the disorder, but also stigma, including rejection, misunderstanding, and a feeling of isolation. Nonetheless, some parents find or develop approaches for "making meaning" from the experience. Interviews of four mothers of children with mental illness demonstrate "making meaning" in ways that provide for personal growth, fulfillment, and support, while engaging in efforts that ease the journey for others in similar circumstances.

Strategies for encouraging patient/family member partnerships with the health care team.

The 5th International Conference of the Institute for Patient- and Family-Centered Care (IPFCC), held in Washington, DC, from June 4-6, 2012, offered an opportunity for almost 1,000 conference participants to share and learn about exciting new patient- and family-centered initiatives occurring across the U.S. and in many other countries. One focus addressed by keynote and plenary speakers, as well as numerous conference sessions and poster presentations, was how nurses and other health care professionals can encourage patients and family members to become partners with their health care teams. Various presenters shared strategies ranging from initial approaches to acknowledging family members as part of the team and offering simple, non-threatening roles in care provision, to policies and approaches inviting increased participation in health care encounters, to higher level involvement in the care planning process, and to partnership roles extending beyond care of the individual child and family. A wealth of ideas can be implemented at various levels by individual nurses, units, and health care institutions.

Great summer reads and family-centered care, all in one!

Award-winning author Jodi Picoult has written several novels that dramatically portray families caught in personal, financial, medical, legal, and ethical dilemmas related to their children having medical or developmental challenges. At times drawing on personal experience but always conducting extensive background research, Picoult's work is very realistic in its depiction of varied child and family scenarios. These gripping stories, while fiction, point clearly to real issues and highlight the need for and importance of a family-centered approach in pediatric care. Pediatric nurses can confidently pick up a Picoult novel for an entertaining and thought-provoking summer read.

New Year's resolutions for family-centered care!

Consider a New Year's resolution to implement at lease one family-centered change in your practice in the upcoming year. New Health Partnerships, the Institute for Family-Centered Care, and the Initiative for Pediatric palliative care are among organizations whose websites offer information, guidance, curriculum materials, and tools related to implementing family-centered care. Nurses in any setting will find material here to inspire, encourage, and facilitate turning this New Year's resolution into reality. May the coming year be a good year for you ... and for the advancement of family-centered care. We'd love to hear back about the successes you have!

Supporting fathers' involvement in children's health care.

Although mothers are generally more likely than fathers to be involved with their child's health care needs, incorporating fathers is important as well. Some research suggests that factors interfering with paternal involvement include work conflicts and greater convenience for mothers accompanying the child to health care visits. One factor fathers have identified as a positive motivator is a health care provider's specific invitation or encouragement to attend the child's appointments. Fathers and mothers may cope differently with a child's illness or disability, and the type of support each parent needs may vary. Health care providers can increase their own awareness of paternal concerns and needs to best encourage paternal involvement.

The many roles of family members in "family-centered care"--part I.

This article is the first in a series highlighting parental roles in family-centered care. A brief history of family-centered care from the 1960s to the present provides the context for the development of numerous roles parents have begun to play in the health care system. This background is followed by a mother's description of the steps in her own evolution as a "parent advocate." Deborah Dokken first developed her voice in the health care system as a parent to three premature infants, one of whom survived. Dokken used the skills she developed as a NICU parent to help other families through a peer-support program. She was subsequently invited to serve on a hospital's Ethics Committee; later to participate as a co-investigator and consultant on a palliative care education project; and most recently to be a member of several federal level health care advisory committees. Several themes in her development as a parent advocate included: readiness and commitment to assume new roles; the open support of at least one care professional in each setting; the identification of roles that matched her interest, background, and skills; and a growing conviction of her ability to contribute in a holistic way. Subsequent articles in this series will introduce other parents as they describe a variety of parental roles in family-centered care. We hope that illustration of these roles will inspire further involvement of parents in the pediatric health care system, at all levels.