COACH: A framework for empowering patients, and students too

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COACH is a method for developing authentic healing relationships with patients, encompassing the Camden Coalition’s tools, philosophies, and techniques for supporting patients with complex health and social needs in managing their health. Recently, we published our COACH framework as a manual with the help of our friends at the PolicyLab of the Children’s Hospital of Philadelphia. COACH is proving useful for not just health care providers: In Camden, the city’s school district is learning COACH to engage students and families struggling with chronic absenteeism.

“What we have traditionally done is have uniformed attendance officers knock on the doors of students who are at risk of becoming chronically absent,” said Joanna Lack, Chief Performance Officer at the Camden City School District. “By state law we are mandated to take students who are defined as chronically absent to truancy court.”

When Joanna read about the Camden Coalition’s healthcare hotspotting model in the 2011 New Yorker article “The Hot Spotters,” she started thinking about what an analogous “outlier” population might be within the city’s school district. She realized that chronically absent students are much like our patients with high ED and hospital utilization: both of these outlier groups constitute a small subset of the population, and for both, the same drivers— unmet complex social needs— are at play. These unmet needs are the reasons why this small percentage of students miss so many of days of school and also why this small cohort of patients so heavily frequent hospitals and EDs.

Joanna took the idea to the superintendent. With the help of the Camden Coalition they launched a pilot program last year to augment traditional visits from attendance officers with Camden Coalition-style home visits by school and central district office staff. This year they’re expanding the pilot and adding in training on our COACH framework for staff from eight randomly selected schools.

The COACH model asks providers to observe a patient or client’s normal routine to understand and build on their strengths, to work with a patient or client to figure out their needs and priorities, and to coach them incrementally towards empowerment and long-term social support.

“The most important thing I’ve learned [from using the COACH framework] is to not take away power from patients,” said Jeneen Skinner, Clinical Manager of Care Management Initiatives at the Camden Coalition. “We observe what the patient does well, and if there’s something we can do to enhance that, we can do that. We should work together as a team, bring those ideas to the patient, and help empower them. Because once we’re out of the picture, I want the patients to be able to advocate for themselves, and someday share that knowledge with someone else.”

Jeneen and colleague Maritza Gomez, Senior Community Health Worker at the Camden Coalition, have been training school district staff on the COACH framework. “When you have people who do this on a daily basis teach the model it’s a more meaningful experience for everyone,” said Victoria Sale, Chief Learning Officer at the Camden Coalition.

Jeneen said that the challenges faced by struggling families in the school district mirror those faced by the patients enrolled into our care management intervention, and that this is an opportunity for the school district to connect families to the resources they need.

For her part, Joanna said that the biggest challenge faced by school staff being trained in the COACH model is learning the patience it requires— taking the time to observe the normal routine and build on the family’s strengths instead of jumping straight to solutions. “We have this real problem [chronic absenteeism] that we haven’t been able to make enough of a dent in,” she said. “We realized we need to better understand our most chronically absent students and families. Our work with the Coalition has helped push us to listen longer.”

“It’s been a challenging conversation, because it’s pushing against all of our best instincts to jump in and fix urgently. It’s a mindset shift that we’re just in the beginning stages of, but I’m hopeful that it will lead us to more effective and sustainable solutions.”

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