Home Concepts Managing Stress & Challenges  On the Cliff’s Edge: Four Tiers of Health-Based Coaching

 On the Cliff’s Edge: Four Tiers of Health-Based Coaching

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A new domain of professional coaching is emerging. The domain is health. The challenges to be found in this domain are many—and quite diverse. In seeking to identify coaching opportunities in the domain of health, we turn to a metaphor offered by Dr. Camara Phyllis Jones of the American Public Health Organization. Her provocative metaphor sets the stage for what I believe is the future of health-based coaching. Dr. Jones describes the situation where a cluster of people stand on the edge of a cliff. Some of the people fall off the cliff; fortunately, there are ambulances waiting at the bottom of the cliff to pick up the hurt people and take them to a hospital for treatment. This is Tier One (Treatment). Alternatively, nets and trampolines are placed half way down the cliff which will catch the people as they fall off the cliff. This is Tier Two (Amelioration). A third alternative is for a fence to be built at the top of the cliff which prevents people from falling off the cliff. This Third Tier (First Order Prevention) leads to fewer casualties. Jones suggests that there is a Fourth Tier: people can be encouraged to move away from the edge of cliff. This Second Order Prevention strategy eliminates the need for a fence, net or ambulance. Practitioners of health-based coaching can engage in one or more of the coaching strategies associated with each of these four tiers.

Tier One: Treatment

At Tier One, the Health-Based Coach, in essence, helps an “injured” or “ill” person (who fell to the bottom of a cliff) with identifying and articulating the nature of the injury/illness, while identifying and contacting appropriate treatment professionals. A health-based coach usually cannot provide direct treatment strategies (unless a licensed professional), but can provide valuable advice, information and assistance to someone who is injured or (more frequently) in need of medical health for a lingering disease. The health-based coach can also offer assistance (Tier One, strategies) that reduces the impact of injury or illness (such as identifying appropriate and competent health care assistance—be it a home-care professional or rehabilitation facility).

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  1. Rey Carr

    January 9, 2019 at 8:12 pm

    I like the modernizing of prevention and its application to health coaching. When I was working as a school psychologist in a community mental health center in San Francisco in the early 1960s, this prevention approach was our mandate and mantra. Originally developed by Gerald Caplan (1917-2008), a child and community psychiatrist who wrote the prevention “bible”: Principles of Preventive Psychiatry. He founded the idea of mental health consultation and I was fortunate to be in one of his workshops on how to implement the three-tier model of prevention, simply known as primary prevention, secondary prevention and tertiary prevention (which correspond to your model). I was able with Dr. Caplan’s guidance to complete a research study in 1976 on the power of the “preventive consultation” model: “The effects of preventive consultation with elementary school principals on changing teacher staff meeting behaviours. “Canadian Counsellor, 10(4), 157-166.


  2. Rey Carr

    March 25, 2020 at 6:09 pm

    In my recent research I found out that the International Association of Health Coaches has 80,000 members; and the National Society of Health Coaches has 5,600 members. This significant increase in membership parallels the points that Bill is making in this article.

    One other point that I’d like to add. There could be another level of prevention: the training of health coaches to provide services at the other levels.


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