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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Tier Two health-based coaching is especially valuable with regard to medication compliance, identification of healthy habits (nutrition, exercise, sleep) and identification of potential household hazards. Health-based coaches can often offer their clients tools and strategies for the effective management of stress. They can also help their clients assess environmental conditions that are conducive or detrimental to health (an assessment that sadly is becoming increasingly important in many communities throughout the world).

I have worked very closely with a colleague for many years who has recently taken on the job of providing Tier Two coaching. He recently recovered himself from a stroke and is involved in his own ongoing rehabilitation (while also changing many of his health habits). While spending time with other stroke survivors in a nearby health care facility, my colleague came to recognize that there was great need for (and strong interest in) health-based coaching that focuses on this recovery process. He began meeting with new clients who are similarly in recovery from strokes. He helps them identify ways to sustain their new healthy habits, while also helping them build new relationships with family members (who are suddenly concerned about his client’s disabilities and even his client’s mortality). As noted by Atul Gawande in his remarkable book, Being Mortal, this is certainly the right time for his clients to engage in critical conversations with significant others regarding the near and distant future.

Tier Three: First-Order Prevention

A health psychologist can engage prevention strategies that discourage or block behaviors leading to illness or injury. The Tier Three health-based coach is helping her client who is standing at the edge of the cliff to avoid falling off the client. She helps her client to identify and engage healthy practices that reduce the chance of injury or illness. As in the case of Tier Two coaching, the Tier Three coach often engages in some tough questioning (“why do you think you are hesitating to start up this new health-based practice?”), some monitoring (“your blood pressure seems to still be quite high”) and some encouragement (you have taken an important first step!).

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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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