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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Everett Rogers’ (2003) model of innovation diffusion can be a valuable guide in the promotion of ideas and practices related to healthy habits and environments, as well as health-related public policies. The Tier Four coaching can help her client find ways to support those involved in the early implementation of healthy community policies and practices (Rogers’ early adopters). A Tier Four coach can also assist her client in the gathering and presentation of persuasive information regarding the effectiveness of healthy community policies and practices (Rogers’ early majority). Finally, the Tier Four coach can help her client or client system in devising ways (e.g. social media) of persuasively informing the general public about specific healthy community policies and practices that are now commonly in place and are the “norm” (Roger’s late majority).

You will notice that the Tier Four coach usually ceases to be a neutral party. She is committed to health and to the initiation of health-oriented public policies. Furthermore, her clients are often not individuals or even families or community groups. The coaching client is often an entire health care system, public agency or government office. Tier Four coaching is “big picture” – and not for the faint of heart—but it is essential.

I have recently helped to found an inter-community service agency—called “Communities Collaborating”—that is helping to set up programs that offer Tier Four (as well as Tier One, Two and Tree) health-based coaching in isolated communities (“islands” that might not be surrounded by water but are just as separated from major population centers). These communities are frequently populated by senior citizens who are “caught” in their homes (either be choice or because of economic exigencies). They are also often “caught” in a life style that is not conducive to sustained health (though they have managed to live many years without a major concern for nutrition and finish each day with a shot of whiskey or a smoke!!). Communities Collaborating is in the business of advocating for healthy practices (nutrition, exercise, sleep), while also helping to set up transportation for the elderly to health-care appointments, and providing the elderly with knowledge and assistance regarding health-related financial matters (e.g. government assistance programs, appropriate insurance plans).

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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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