As a health coach, you encounter various scenarios working with clients, but where is the line drawn?
What is the “Scope of Practice?"
The scope of practice refers to the process of coaching and the rules that you follow when you are doing anything related to coaching, whether it be writing a blog, coaching a group or an individual. Why is it important? Like doctors, we vow to “do no harm,” we do not want to act in any way that would harm our clients. For example, since we are not medical doctors, we should not interpret lab results. It could lead to lawsuits or other legal implications. Being an approved training program with the National Board for Health & Wellness Coaches (NB-HWC), the Functional Medicine Coaching Academy teaches you how to coach within the scope of practice abiding by the NB-HWC code of conduct.
According to a study from the American College of Lifestyle Medicine, lifestyle coaching is effective with clients and has shown vast health improvements in cases such as diabetes, obesity, and metabolic syndrome.
You might be wondering what do Health Coaches do? As a Health Coach, we do not diagnose, treat, prescribe, interpret medical results, write food plans, nor recommend supplements. Keeping within the scope of practice simply means we are our client’s accountability partner and educator to help collaborate and navigate through the plans of the professional.
Our founders, Dr. Sandra Scheinbaum and Elyse Wagner go in-depth about what exactly Health Coaches are qualified to do, as well as answering questions from Health Coaches in the community! Watch the full video here:
Updated: May 12, 2020
What Health Coaches Need to Know about Scope of Practice
By Dr. Sandra Scheinbaum
America has some very serious chronic health problems. This report found that in 2014, 60 percent of Americans had at least one chronic condition and 42 percent had multiple chronic conditions and these numbers have steadily increased since 2008. More than 100 million U.S. adults are now living with diabetes or prediabetes, a condition that if not treated often leads to type 2 diabetes within five years. Obesity and heart disease rates continue to skyrocket. That may sound pretty negative but there’s a promising and affordable solution: health and wellness coaching.
A recent article from Mayo Clinic Proceedings stated that “health and wellness coaching is now a respected discipline with the potential to positively change behaviors and health outcomes”. The Compendium of Health and Wellness Coaching: 2019 Addendum found that health and wellness coaching leads to better overall wellness and improves outcomes in a variety of diseases, including obesity, type 2 diabetes, hypertension, and heart disease.
What exactly do health coaches do?
My mentor, Dr. Fredrick Hudson, founder of the Hudson Institute of Coaching, stated that “a coach inspires passion and purpose in others.” According to the National Board of Health & Wellness Coaching (NBHWC):
“Health and wellness coaches work with individuals and groups in a client-centered process to facilitate and empower the client to develop and achieve self-determined goals related to health and wellness. Coaches support clients in mobilizing internal strengths and external resources, and in developing self-management strategies for making sustainable, healthy lifestyle, behavior changes.” Coaches train in behavior change and motivational techniques. Rather than acting as the expert and giving advice, the coach creates an environment that gives the client permission to take the lead. They adhere to what the client wants, not what the coach thinks they should want. The client determines their unique goals through a process of self-discovery and accountability, and the coach facilitates change at a pace set by the client.
The effectiveness of coaching stems from the special nature of coaching; in other words, the coach scope of practice. Rather than limiting and restrictive, it offers unlimited potential for helping people take charge of their health and make profound changes that lead to a better quality of life. That’s why Dr. Jeffrey Bland, referred to as the “father of Functional Medicine,” refers to coaching as “where the rubber meets the road.” I believe that in order to step into the full power of coaching and reap the many rewards that becoming a coach offers, one must rigidly adhere to the coach scope of practice.
What exactly is Scope of Practice?
Scope of practice refers to the specific procedures, actions, and processes that a healthcare provider is allowed to engage in according to the terms of their state-issued professional license. For example, I practiced as a clinical psychologist and was licensed by the state of Illinois for many years. My scope of practice was defined by the terms of this license. It included the administration and interpretation of psychological tests and the ability to offer psychotherapy but did not permit me to prescribe drugs to treat psychiatric conditions. Because my license to practice as a psychologist was issued in Illinois, I would be unable to engage in this practice if I moved to Arizona and wanted to work with Arizona residents. Taking the example a step further, if granted a license to practice by the state of Arizona, it would be my responsibility to learn and abide by the scope of practice regulations for that state. Suppose I remained in Illinois but wanted to work with out-of-state residents by phone or virtually. By doing so, I would be acting as a clinical psychologist without a license in the particular states in which those clients resided. Scope of practice continually fluctuates and also varies on a state-by-state basis. A number of years ago, local psychological associations successfully advocated for psychologists’ right to prescribe medications and won this right in a few states. However, the initiative has been unsuccessful when brought up for a vote in the legislatures of other states, including Illinois. So I could not prescribe in Illinois, but if I moved to New Mexico, applied for licensure, and that state granted me a license to practice, I could prescribe medication provided I met specific qualifications.
What is the Scope of Practice for Health Coaches?
Health and wellness coaching is experiencing rapid growth but remains a relatively new field when compared with healthcare professions such as psychology, nursing, or dietetics. Unlike these fields, health and wellness coaching is currently not licensed by the states, but it’s possible that in the near future, individual states may regulate health coaching. At present, it’s easy to feel “dazed and confused” but it’s incumbent upon the coach to know the regulations for their particular state. The problem is, that’s easier said than done.
- Which state regulatory agency or department should one contact?
- How are regulations to be interpreted?
- What if new laws or regulations come into effect?
As a clinical psychologist, I knew that the Illinois Department of Professional Regulations was the go-to resource but what is the equivalent for coaches? One option involves investigating other professions, such as dietetics. It’s particularly important to note that some states specifically place restrictions on who can dispense dietary advice. Some states allow coaches to provide nutritional advice and even order lab tests, but many others reserve these practices for dietitians or medical doctors. State regulations typically exist for dietetics or nutrition, but the specifics may not be clearly laid out. For example, some states that regulate the practice of nutrition counseling provide exemptions for providing health and wellness information. This latter domain could be interpreted as within the scope of practice of a health coach. Given the challenges of knowing and interpreting guidelines on a state-by-state basis, I recommend that health coaches adhere to a strict scope of practice.
Where can health coaches turn to for guidance?
For the scope of practice standards and guidelines, the best place to turn to is the National Board for Health & Wellness Coaching (NBHWC). NBHWC’s Health & Wellness Coach Scope of Practice is as follows:
“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.”
What if a coach holds multiple credentials?
The scope of practice also highlights that if a coach holds active and nationally recognized credentials they may provide expert guidance related to that topic. At Functional Medicine Coaching Academy, we have graduates who hold licenses as nurses, physicians, psychologists or dietitians, for example. In these instances, the best place to turn for guidance is the state licensing board for each respective profession.
Why should health coaches stay in their own lane?
When clients seek out a coach or are referred to one by their doctor, there’s a good chance they’ll enter the coaching relationship expecting the coach to be the expert. They're going to ask, “What should I eat?,” or “Can you give me a meal plan?” In other words, “Tell me what to do.” Health coaches possess a great deal of knowledge about health and wellness. In some instances, their knowledge may equal or even exceed the knowledge of medical doctors or nutrition professionals. As a result, it’s tempting to step out of the coach lane and advise a client on what to do. Coaches must resist the temptation to drift into the expert lane and thereby violate the coach scope of practice. Let’s discuss two important reasons why.
1. Protection from potential regulatory actions. A recent court case brought the scope of practice for health and wellness coaching to national attention. A health coach living in California moved to Florida, where she proceeded to resume her coaching business, which included asking clients for dietary information for the purpose of providing advice. The Florida regulators found out and issued a “cease and desist” order. She hired a public interest lawyer who claimed that her freedom of speech was being violated. The court ruled against this claim, supporting the opinion that the state of Florida has an interest in the safety and health of its citizens. What was the problem? A health coach who lacked a Florida license that granted her the right to offer such advice, was offering nutritional advice in the state of Florida. Florida, like many other states, requires that if you provide nutritional advice, you must possess a valid and current license that allows you to do so, such as a registered dietician license. The Florida case created quite a stir and many health coaches interpreted the state’s actions and subsequent court decision to imply that health coaching as a profession is under attack and that there’s a movement afoot to discredit or even shut it down. In my opinion, this fear-based conclusion could not be farther from the truth. It is important to note that the individual in question could have worked as a health coach in Florida if she had adhered to the coach scope of practice.
2. Protecting the health and safety of the public. To understand the second, and more important reason why health coaches must abide by the coach scope of practice, consider the reason why the court sided with the State of Florida: states have the right to protect the health and safety of their citizens.
- What could possibly be the harm in telling people to eat fruits and vegetables, for example? Health coaching is all about helping people to become healthier, so why should they be restricted from providing advice?
- What’s the concern? It has to do with how dietitians, nutritionists, medical doctors, and others with specialized licenses are trained. They graduated from degree programs that entailed many years of education, and then met rigorous internship and supervision requirements. During this training, they learned to spot those extremely rare and potentially life-threatening medical conditions for which seemingly benign dietary recommendations could result in serious, or even fatal consequences.
The best coaching programs train students in the powerful client-centered approach that empowers people to make difficult changes. They do not duplicate the training one would receive in medical school or a graduate degree program in nutrition because the emphasis must be on learning crucial behavior change and motivational interviewing principles important for the coaching process. Often coaches work on medical collaborative care teams, and in that capacity, help the practitioners’ patients understand the root causes of their condition and ensure that treatment recommendations are aligned with the individual’s readiness for behavior change. Providing this type of education and support is an ideally-suited role for coaches. In this context, they would not be violating the scope of practice, as they are not providing advice, but explaining “doctor’s orders.”
At the Functional Medicine Coaching Academy, we teach principles of Functional Medicine so that graduates can work effectively with Functional Medicine practitioners, whether by accepting referrals if they run their own business, or directly working for medical practices. In either case, the practitioner develops the plan of care. Coaches come from a wide range of previous careers and educational backgrounds. Some have healthcare experience, but many do not. It should be noted that those in the later category become some of the best health coaches! And to reiterate, effective coaches know that it’s by strictly adhering to the coach scope of practice that “the magic happens.”
6 Action Steps to Adhere to the Coach Scope of Practice and Leverage It to Your Advantage
1. Ensure that clients understand the nature of health coaching by providing a “scope of practice” statement that they sign prior to the initiation of coaching. Referred to as
“informed consent,” this written agreement provides information about the coach’s credentials and sets clear expectations about the coaching process and what it does and does not include.
2. Educate yourself about what you can and can't do in the state in which you work as a coach, as well as the state where your client may reside if you coach virtually or by phone.
3. For all written and electronic communication, including progress notes, always include a disclaimer that clearly states that you are not diagnosing or treating any medical or psychiatric condition or offering medical or dietary advice. An attorney can provide the appropriate wording for your particular circumstances.
4. When clients seek specific advice, point them to evidence-based sources, such as books written by experts, research studies, or reputable websites.
5. Rather than giving clients personal advice, share your knowledge and voice your opinion in other ways. Some possibilities include writing books, articles and blogs, appearing on podcasts and online summits, or giving talks, either live or as webinars.
6. Appreciate the incredible power of collaboration. Getting healthy is a team sport and when coaches partner with doctors, dietitians, nutritionists, and therapists, you’re not only meeting the needs of your clients but advancing your own career as well.
How can strictly adhering to the coach scope of practice actually elevate my business?
Although clients may expect a coach to give advice and provide information, experienced coaches who adhere to the coach scope of practice will tell you that veering out of your lane and providing advice cheats the client out of the value of self-determination. When you help clients find the information themselves and draw their own conclusions, their confidence and sense of empowerment increases. They’re truly becoming the CEOs of their own health, and isn’t that the ultimate objective? When you step out of that powerful coaching lane and give in to the temptation to act as an expert by telling clients what to do, you’re now just one more consultant in what was most likely a long list of experts who they sought out before you. Is telling someone what to do working? If people actually followed the well-intentioned advice of the health experts and made lasting changes, then wouldn’t we have solved the epidemic of obesity, diabetes, and other chronic diseases? The power of a coach lies in the coaching lane. Be a genuine coach. Embrace your role, own it, and experience the profound transformations that will take place, both personally and for the health and well-being of clients.
Multiple Chronic Conditions in the United States - fightchronicdisease.org
New CDC report: More than 100 million Americans have diabetes or prediabetes - cdc.gov
Capacity Coaching: A New Strategy for Coaching Patients - mayoclinicproceedings.org
Compendium of Health and Wellness Coaching: 2019 Addendum- American Journal of Lifestyle Medicine
NBHWC’s Health & Wellness Coach Scope of Practice - nbhwc.org
Who gets to give dietary advice? Health coach fights law - apnews.com