Name: L. Cindy Carra, MPH, CHES®, CPT
Job Title: SME/Instructor of Health & Wellness Programs
Career Sector: Healthcare
NCHEC: What is your current job title and sector?
Cindy: I am currently a curriculum designer and instructor for an online learning institution. It is extremely rewarding to help prepare the next cohort of health, fitness, and nutrition coaches that will make an impact on people’s lives and in the healthcare field.
Designing and writing curriculums has driven me to take a very close look at what it means to be a health coach. It is much more than being an expert in a particular area of well-being. For example, a person can be an expert basketball player, but not a great basketball coach. I believe we have designed courses with the defining skills to build a career as a great coach and educator.
NCHEC: What sort of duties do you complete during the course of your daily work?
Cindy: In my current role, I constantly lean on my healthcare coursework, certification knowledge, and field experience. As a practicing health coach, a normal day of work will involve calling scheduled clients for coaching appointments. On particularly busy days when carrying a high caseload, these calls may be back-to-back all day, so it is important to be prepared between calls. There is also documentation to record for each client, typically in an electronic health record. When working within an interdisciplinary client/patient care team, there is communication with other healthcare practitioners, such as physicians, dietitians, or physical therapists.
NCHEC: How did your career path trajectory lead you to becoming a health coach?
Cindy: Prior to returning to graduate school for my Public Health-Nutrition degree, I had a passion for wellness born out of the realization that many of the health problems my loved ones or I encountered were largely preventable with proper diet, exercise, sleep, and stress management. Around the same time, I saw the growth trend that the health coaching field was experiencing. Health coaches have gained legitimacy and respect as a valuable member of the collaborative patient care team and not just something social media influencers do.
I looked at the ‘people skills’ I had acquired within my former sales and marketing career where building relationships and trust with clients is so important. I also had a great deal of account management experience, which is useful when managing a large coaching caseload. I decided to undertake this career transition into health care and it has been an excellent decision. Today, I am focused on the curriculum and training side -- helping those with the same motivation I had to enter the rewarding field of health and wellness coaching.
NCHEC: Could you speak to cultural competence and its importance in the work that you do, and how being bilingual assists you in your career?
Cindy: Cultural competence is the awareness that people are different in a variety of ways – cultural heritage, upbringing, life experiences, opportunities, values, and beliefs…to name a few. As a health educator, it is important to recognize how these differences impact health.
Cultural competence also means being aware of any biases you may have and putting them aside in favor of getting to know a person’s unique situation. Some of these elements that are unique to a client often shed light on the root causes of health and wellness concerns. For example, public health data historically shows health disparities across race, gender, and socioeconomic groups. As a health coach, you should know this, but also should evaluate the client’s individual knowledge, habits, and beliefs. This takes time and a genuine desire to form a relationship and not take shortcuts, but instead take a “whole person” approach to coaching. Clients/patients are individuals and deserve that their cases be treated as such.
Making health care accessible to all people groups means understanding there is a segment of our population who cannot be reached if there are language barriers. My ability to communicate in Spanish with clients whose primary language is Spanish has been an incredible experience. I have been told by my Spanish-speaking clients that they appreciate it and that coaching through an interpreter is not quite the same.
NCHEC: Do you do any consulting outside of your regular employment? Is this q difficult sector to break into?
Cindy: I worked in managed care with a high caseload and hundreds of billable hours per month, but this was difficult to achieve while self-employed with self-pay clients. Since there are now codes for health and well-being coaching, billing for services will become easier for health coaching businesses or medical practices (i.e. - under the leadership of a doctor). There still seems to be issues with reimbursement for many self-employed health coaches. Some states are working on offering self-employed health coaches the ability to band together to be part of a larger group that seeks reimbursement on behalf of its members.
I believe the efforts of credentialing bodies, like NCHEC, who standardize what it means to be a highly skilled health education specialist, will result in more successful reimbursement endeavors. We can then hope to see this trickle down to self-employed health coaches.
NCHEC: How has your workload shifted since the onset of the COVID-19 pandemic?
Cindy: Health coaching has always provided a remote-friendly work environment…even before COVID-19. Coaching is typically conducted via video conference, phone, or app. Like all forms of telemedicine, the demand for health coaching has grown exponentially throughout the pandemic. People are focused on overall better health more than ever – and working with a coach can improve nutrition, exercise, stress levels, immune health, and even mental health.
NCHEC: Do you have any advice for certified health education specialists looking to enter the health coaching job sector?
Cindy: Coaching is a rewarding field where you can make an impact on the health of individuals, as well as population health. As a health coach, you will help close the gap where client/patient adherence to healthy behaviors and habits will equate to the success or failure of a treatment care plan. You have the important job of ensuring that the prescribed advice of a healthcare provider is easily translated and assimilated into the unique lifestyle of the patient/client. Doctors and other providers often do not have the time in their busy schedules to follow up with a patient/client on the behavioral aspects of the care plan. That is where health educators and coaches step into the gap.
The field of health coaching is growing and becoming more specialized in a variety of subfields, like nutrition or sleep coaching, for example. The field can be competitive and a certification, like CHES®, can set you apart from other health coaches. My advice is do not only focus on coursework in a particular area of health or well-being – concentrate on coaching coursework that will help you relate with and motivate clients. This is truly at the heart of what it means to be a coach.
Lastly, practice what you preach. As a caregiver, it is important to extend that same compassion to yourself in the form of self-care. Refreshing and recharging yourself with healthful nutrition, physical activity, and stress management techniques will also make you a better coach for your clients or patients.