Application for Transition Health and Wellness Coach Training & Education Program

Transcription

1 Application for Transition Health and Wellness Coach Training & Education Program Thank you for requesting an application for an NCCHWC-Approved Transition Program. Programs may seek approval as an Approved Transition Program between July 1, 2015 and September 30, Transition Program approval will expire June 30, 2016, i.e. transition programs will need to start before June 30, 2016 to enable coaches seeking NCCHWC certification to complete programs and apply for coach certification before the Transition Phase closes at the end of Approval of Transition Programs will be notified by . Approved Transition Programs will be listed on the NCCHWC website by October 1, Once your organization has submitted its application and fee, the NCCHWC will review your materials and determine your program s eligibility. Programs will be approved for the Transition Phase if they have demonstrated the following: Students are required to learn and practice coaching tasks in all four domains of the Job Task Analysis (JTA) in a minimum of 30 real-time, synchronous contact hours of training and education classes or sessions. Details on the four domains of the Job Task Analysis are available at Programs deliver a graded assessment of a student s demonstration of practical skills. Submitting the NCCHWC-Approved Transition Program Application: When you have completed the Transition Program Application, please prepare a single PDF format file of the application and any additional paperwork. If you have more than five faculty members, info@ncchwc.org to request a customized application form. Send the application to: info@ncchwc.org. Send a nonrefundable application fee of $225 by mailing a check to: NCCHWC, PO Box San Diego, CA The application fee covers the administrative costs of program evaluation and is due within 30 days after your organization submits an application.

2 Program Information Organization, School or Business name: Address: City: State: Name of contact person: Phone number: Website: Program Name: Describe the program (you may also include a copy or link for a brochure or web page):

3 What is the time frame of the program? How many live contact hours of coach training and education are delivered in this program? How many students complete this program per year? Please describe any prerequisites required for entry into your program (you may also provide a copy or link to a brochure or web page):

4 Faculty Credentials (Please include information for each faculty member on the following pages.) Completing the following form for each program faculty member is optional, and will help us determine the national standards. In addition, you may also include faculty bios or CV s with your application. Faculty Member Name: Address: What is the highest degree obtained? What health related education, credentials, and work experience have been completed? What coach training programs has the faculty member completed? Please also list coaching credentials. How many years of coaching experience does the faculty member have? Please describe coaching experience.

5 Please list the coaching-related courses and programs that the faculty member has taught, including the number of years they have been teaching: Please describe other work experience:

6 Faculty Member 2 NCCHWC is setting national standards for faculty responsible for the training and education of health and wellness coaches in the Permanent Phase. To inform the standards, please complete the following for each program faculty member. Faculty Member Name: Address: What is the highest degree obtained? What health related education, credentials, and work experience have been completed? What coach training programs has the faculty member completed? Please also list coaching credentials. How many years of coaching experience does the faculty member have? Please describe coaching experience.

7 Please list the coaching-related courses and programs that the faculty member has taught, including the number of years they have been teaching: Please describe other work experience:

8 Faculty Member 3 NCCHWC is setting national standards for faculty responsible for the training and education of health and wellness coaches in the Permanent Phase. To inform the standards, please complete the following for each program faculty member. Faculty Member Name: Address: What is the highest degree obtained? What health related education, credentials, and work experience have been completed? What coach training programs has the faculty member completed? Please also list coaching credentials. How many years of coaching experience does the faculty member have? Please describe coaching experience.

9 Please list the coaching-related courses and programs that the faculty member has taught, including the number of years they have been teaching: Please describe other work experience:

10 Faculty Member 4 NCCHWC is setting national standards for faculty responsible for the training and education of health and wellness coaches in the Permanent Phase. To inform the standards, please complete the following for each program faculty member. Faculty Member Name: Address: What is the highest degree obtained? What health related education, credentials, and work experience have been completed? What coach training programs has the faculty member completed? Please also list coaching credentials. How many years of coaching experience does the faculty member have? Please describe coaching experience.

11 Please list the coaching-related courses and programs that the faculty member has taught, including the number of years they have been teaching: Please describe other work experience:

12 Faculty Member 5 NCCHWC is setting national standards for faculty responsible for the training and education of health and wellness coaches in the Permanent Phase. To inform the standards, please complete the following for each program faculty member. Faculty Member Name: Address: What is the highest degree obtained? What health related education, credentials, and work experience have been completed? What coach training programs has the faculty member completed? Please also list coaching credentials. How many years of coaching experience does the faculty member have? Please describe coaching experience.

13 Please list the coaching-related courses and programs that the faculty member has taught, including the number of years they have been teaching: Please describe other work experience:

14 Job Task Analysis Coverage/Live Contact Hours Domain 1 Tasks Course/Class/Lesson Time in Live Contact Hours Time in Non-Live Contact Hours Training & Education Methods T-1 Explain the coaching process. T-2 Obtain information about why coaching is sought, desired outcomes, priorities, personal strengths and challenges. T-3 Determine if the individual is a candidate for health and wellness coaching. T-4 Explore motivation and assess readiness for change. T-5 Jointly create a coaching agreement that includes roles, expectations, practice-specific processes, fees, and frequency, mode and length of sessions.

15 Domain 2 Tasks Course/Class/Lesson Time in Live Contact Hours Time in Non-Live Contact Hours Training & Education Methods T-6 Assist the client in creating a description of their ideal vision of the future. T-7 Establish or identify the present situation, past history, previous successes and challenges, resources, etc. associated with the client s vision. T-8 Explore and evaluate the client s readiness to progress toward the vision. T-9 Invite the client to identify and explore patterns, perspectives, and beliefs that may be limiting lasting change. T-10 Work with the client to establish goals that will lead to the vision. T-11 Work with the client to develop a series of steps that will lead to the achievement of client-selected goals. T-12 Elicit the client s commitment to and accountability for specific steps.

16 Domain 3 Tasks Course/Class/Lesson Time in Live Contact Hours Time in Non-Live Contact Hours Training & Education Methods T-13 Collaborate as the client evaluates success in taking steps and achieving goals. T-14 Work with the client to maintain progress and changes. T-15 Collaborate as the client re-assesses goals and makes modifications based on personal decisions and progress made. T-16 Assist the client in articulating learning and insights gained in the change process. T-17 Work with the client to develop a post-coaching plan to sustain changes that promotes health and wellness.

17 Domain 4 Tasks Course/Class/Lesson Time in Live Contact Hours Time in Non-Live Contact Hours Training & Education Methods T-18 Health and Wellness Coaches practice in accordance with applicable laws and regulations. T-19 Health and Wellness Coaches practice in accordance with accepted professional standards and within the limits of their scope of practice. T-20 Health and Wellness Coaches practice in accordance with the accepted standards of professional ethics. T-21 Health and Wellness coaches engage in a continuous process of training and education to become more proficient in their practice and to ensure that their practice-related knowledge and skills remain current. Total Live Contact Hours Focused on JTA Tasks:

18 Describe other coaching tasks/knowledge/skills covered in your program, including the time in live and non-live contact hours:

19 Practical Coaching Skills Assessment Please describe your process for evaluating student learning and application of practical coaching skills: Describe how the Practical Coaching Skills Assessment is delivered (e.g. Live in-person, live phone/video conference, recorded submission - mp3 or digital file):

20 Describe credentials and experience of practical coaching skills assessors: Please include a PDF file of your assessment description and scoresheet with your application, or complete the questions below: TASKS, SKILLS AND BEHAVIORS List the tasks, skills and behaviors that are assessed by your program s Practical Coaching Skills Assessment: SCORING Describe the process for scoring the Practical Coaching Skills Assessment. What is the highest possible score? What is a passing score? How is a non-passing score handled?:

21 Thank you for completing the application to become an NCCHWC-Approved Transition Program. Throughout the approval process, please feel free to contact the NCCHWC office at or with any questions regarding the approval process.