Transition Coach Research Articles

Transition to Adulthood through Coaching and Empowerment in Rheumatology (TRACER): A feasibility study protocol.

The transition from pediatric to adult care for patients with chronic disease is a vulnerable period, with risks of disengagement from care and subsequent complications of inadequately managed disease. This period comes at a time when there are many other transitions occurring in the young person's life, including changes to vocation, social supports, and to their physiology. The aim of the TRACER study is to assess the feasibility of conducting a multi-center, randomized-controlled trial of a virtual Transition Coach Intervention in youth transferring from pediatric to adult rheumatology care. Patients are being recruited at their last pediatric rheumatology visit from McMaster Children's Hospital and Children's Hospital, London Health Sciences Centre in Ontario, Canada. Participants are then randomized to standard of care or to eight transition coaching sessions, covering topics around health management, future planning, and self-advocacy. The primary outcomes of the study are to demonstrate protocol feasibility, including optimal recruitment and consent rates, ≥ 90% coaching session completion, and complete data collection with ≤ 5% missing data. Baseline demographics, transition readiness, global functional assessment, disease activity, and self-efficacy will be collected to characterize the study population. Recruitment has begun and is estimated to last 19 months. This study will inform the design of a robust, multi-centered, randomized-controlled study to investigate the impact of a virtual transition coaching program in supporting the physical, mental, and social well-being of youth with rheumatic disease transitioning into adult care. Clinical trial registration: ClinicalTrials.Gov protocol ID: 14499.

Implementation of the Acute Care for Elders Strategy to Improve the Quality of Care Transitions in Quebec and Ontario: a Retrospective Multiple Case Study.

In 2016, two Canadian hospitals participated in a quality improvement (QI) program, the International Acute Care for Elders (ACE) Collaborative, and sought to adapt and implement a transition coach intervention (TCI). Both hospitals were challenged to provide optimal continuity of care for an increasing number of older adults. The two hospitals received initial funding, coaching, educational materials, and tools to adapt the TCI to their local contexts, but the QI project teams achieved different results. We aimed to compare the implementation of the ACE TCI in these two Canadian hospitals to identify the factors influencing the adaptation of the intervention to the local contexts and to understand their different results. We conducted a retrospective multiple case study, including documentary analysis, 21 semi-structured individual interviews, and two focus groups. We performed thematic analysis using a hybrid inductive-deductive approach. Both hospitals met initial organizational goals to varying degrees. Our qualitative analysis highlighted certain factors that were critical to the effective implementation and achievement of the QI project goals: the magnitude of changes and adaptations to the initial intervention; the organizational approaches to the QI project implementation, management, and monitoring; the organizational context; the change management strategies; the ongoing health system reform and organizational restructuring. Our study also identified other key factors for successful care transition QI projects: minimal adaptation to the original evidence-based intervention; use of a collaborative, bottom-up approach; use of a theoretical model to support sustainability; support from clinical and organizational leadership; a strong organizational culture for QI; access to timely quality measures; financial support; use of a knowledge management platform; and involvement of an integrated research team and expert guidance. Many of the lessons learned and strategies identified from our analysis will help clinicians, managers, and policymakers better address the issues and challenges of adapting evidence-based innovations in care transitions for older adults to local contexts.

Interventions for the empowerment of older people and informal caregivers in transitional care decision-making: short report of a systematic review

BackgroundCare transitions across different settings necessitate careful decision-making for all parties involved, yet research indicates that older people and informal caregivers do not have a strong voice in such decisions.ObjectiveTo provide a systematic overview of the literature about interventions designed to empower older people and informal caregivers in transitional care decision-making.DesignA systematic review (Prospero Protocol CRD42020167961; funded by the EU’s Horizon 2020 program).Data sourcesFive databases were searched: PubMed, EMBASE, Web of Science, PsycINFO, and CINAHL.Review methodsThe review included evaluations of empowerment in decision-making interventions for older people and informal caregivers facing care transitions, that were published from the inception of the databases up until April 2022. Data extractions were performed by two independent researchers and the quality of studies was assessed with the relevant JBI-critical appraisal tools. A narrative descriptive analysis of the results was performed.FindingsTen studies, reporting on nine interventions, and including a total of 4642 participants, were included. Interventions included transition preparation tools, support from transition coaches, shared decision-making interventions, and advance care planning. Designs and outcomes assessed were highly diverse and showed a mix of positive and lacking effects.ConclusionsThere is a lack of research on how to empower older people and their informal caregivers in transitional care decision-making. Empowerment in decision-making is usually not central in transitional care interventions, and effects on actual empowerment are mostly not assessed. Conclusions on how to empower older people and informal caregivers in transitional care decision-making cannot be drawn.

Coaching older adults discharged home from the emergency department: The role of competence and emotion in following up with outpatient clinicians

ObjectiveMotivating older adults to follow up with an outpatient clinician after discharge from emergency departments (ED) is beneficial yet challenging. We aimed to answer whether psychological needs for motivation and discrete emotions observed by care transition coaches would predict this behavioral outcome. MethodsCommunity-dwelling older adults following ED discharge were recruited from three EDs in two U.S. states. We examined home visit notes documented by coaches (N = 725). Retrospective chart reviews of medical records tracked participants’ health care utilization for 30 days. ResultsObserved knowledge-based competence predicted higher likelihood of outpatient follow-up within 30 days, while observed sadness predicted a lower likelihood of follow-up within seven days following discharge. Moreover, participants who demonstrated happiness were marginally more likely to have an in-person follow-up within seven days, and those who demonstrated knowledge-based competence were more likely to have an electronic follow-up within 30 days. ConclusionsKnowledge-based competence and emotions, as observed and documented in coach notes, can predict older adults’ subsequent outpatient follow-up following their ED-discharge. Practice implicationsIntervention programs might encourage coaches to check knowledge-based competence and to observe emotions in addition to delivering the content. Coaches could also customize strategies for patients with different recommended timeframes of follow-up.

An Innovative Workforce Initiative to Support New Graduate Nurses: Clinical Nurse Transition Coaches.

Nursing leaders at Yale New Haven Health System identified a need among new-graduate nurses for further support beyond their accredited new-graduate residency program. The Clinical Nurse Transition Coach (CNTC) program focused on moving from individual tasks to caring for the entire patient, fostered by focused mentoring and education. The CNTC nurses were experienced and worked with a team of 10 new-graduate nurses.

Transition Services Utilization Among US Women Veterans: A Secondary Analysis of a National Survey

The purpose of this study was to explore the military-to-civilian transition experiences among US women veterans. This study used a cross-sectional, mixed-methods survey research study to examine employment and personal well-being outcomes (sense of purpose) among a sample size of 822 women veterans. The survey instrument focused broadly on measuring different aspects of military transition. The quantitative analysis revealed, through the multivariable logistic regression models, a strong sense of purpose associated with belief in the helpfulness of transition services (aOR = 2.03, 95% CI = 1.06–3.90) and the use of a transition coach (3.43, 95% CI = 1.20–9.82). The qualitative analysis revealed, through manual content analysis, that 64% of women veterans used transition services. However, only 12% reported satisfaction with the available services. The study’s findings present important feedback for organizations hoping to reach female veterans, such as many female veterans feel that the current efforts to assist with their transition are ineffective. For this study, women and female will be used interchangeably.

Coaching to prepare students for their school-to-work transition: conceptualizing core coaching competences

PurposeThe present study proposes coaching as a pedagogical intervention to prepare students for transitioning to the labour market. Taking a competence-based approach, the proposed coaching practice aims to enhance students' employability competences to facilitate a smoother school-to-work transition. However, what transition coaching looks like remains largely unclear. Moreover, in competence-based education, teachers are expected to be highly skilled coaches, facilitating students' transition to the labour market. The present study aims to map the core competencies of a transition coach.Design/methodology/approachA qualitative design was adopted to map the core competences of a transition coach. Data were collected from two focus groups, consisting of coaches in higher education and in the workplace.FindingsResults show that, to create the necessary support conditions, a coach creates a safe coaching environment and supports students in setting goals, guide them in the activities they undertake to attain these goals, and asks reflective questions. Moreover, the coach stimulates students' ownership by putting the student in the centre of the decision-making process. Furthermore, the results emphasize the importance of the coach's professional attitude and knowledge about the transition process and the labour market.Practical implicationsThe article concludes with practical implications for novice transition coaches and teachers in higher education.Originality/valueThe present study adds to the agenda of graduate work readiness by proposing a coaching practice aimed at preparing students for their transition to the labour market.

Professional women and maternity transition: Guidelines for maternity coaching in organisations

Orientation and research purpose: There is a need to explore the role of maternity coaching in supporting and retaining professional women in South African organisations. Therefore, this study investigated the experiences of professional women during their maternity transition into working mothers and explored how maternity coaching can be used as a strategic intervention to support these women.Research design, approach and methodology: A qualitative inductive methodological approach was followed to gain an in-depth understanding of maternity coaching. The research strategy was cross-sectional and multi-perspective, consisting of 13 participants from 4 professional groups.Main findings: The findings emphasise that maternity coaching can play a positive role in assisting both working women and organisations to successfully navigate the maternity transition phase. Through the findings, it was established why maternity coaching is needed as a mechanism of support, how maternity coaching should be implemented and what should be included in the coaching conversations.Practical managerial implications: This article provides a Maternity Transition Coaching Model with guidelines and recommendations for different professional groups in any organisation where maternity transition is experienced. The implications of this study are how maternity coaching can be implemented as a tool in dealing with retention of professional women during maternity transition and to increase gender diversity at the senior organisational level.Contribution: The body of knowledge contributes to understanding the role of maternity coaching as an emerging form of transition coaching in organisations. A Maternity Transition Coaching model was designed that is complemented by guidelines for implementing a maternity coaching programme that can be utilised by human resources personnel, senior management and coaches who are exposed to the adverse consequences of senior women leaving the organisations because of the challenges they face during maternity transition.

Person-centred communication with cancer survivors: Exploring the meaning of follow-up coaching conversations.

The aim of this study was to explore the meaning of a coaching intervention for cancer survivors. Cancer survivors often experience existential concerns and worries after adjuvant treatment. A number of "care transition interventions" have been developed to improve person-centred care by empowering patients. Several of these interventions include a "care transition coach". A coaching approach to communication used in health care communication have among others shown to assists in establishing confidential relationships between health professionals, increase the patient's well-being and support the patient's experience of being met and viewed as a whole person. This is a qualitative study using semi-structured interviews to explore the meaning of a coaching intervention. In analyzing and interpreting the qualitative interviews Ricoeur's theory of interpretation was applied. The intervention consisted of two parts: (1) a two-day training program in coaching for nurses and (2) a specially developed communication intervention for cancer survivors. The analysis of the transcribed interview material led to the development of two themes: (1) Support in moving forward in life, and (2) An opportunity to talk about existential thoughts and worries. Our results show how the experience of cancer, even when cured, leaves the survivors with profound existential worries. The cancer survivors described how coaching conversations allowed them to express their current concerns and provided them with an opportunity to discuss wider issues than treatment, symptoms, and after-effects, which had been the main focus during treatment. The time immediately after the end of adjuvant treatment can be challenging, with many existential concerns and opposing emotions. We found that the follow-up coaching conversations performed helped the cancer survivors to process many of these difficult thoughts and feelings.

Using a Social Worker Transition Coach to Improve Hospital-to-Home Transitions for High-Risk Nonelderly Patients.

High-risk hospitalized younger adults (age ≤60) have 30-day readmission rates comparable to Medicare fee-for-service patients. This younger cohort has a high incidence of comorbid mental health and substance use disorders, which increases the complexity of their postdischarge care. Although few care transition studies have enrolled younger adult patients, findings from our previous work suggest that these patients have postdischarge needs requiring different approaches than those serving elderly patients. Our current pilot study, situated in a safety-net system, targets this younger population, employing a social worker as the Transition Coach (TC). Social workers are explicitly trained to address psychosocial complexities, and we evaluated whether our TC intervention could improve hospital-to-home transitions by assisting patients with medication management, attending follow-up appointments, and addressing medical, psychiatric, and psychosocial needs. Primary outcomes were Patient Activation Measure scores on admission and 30-days postdischarge; outpatient follow-up at 7 and 30 days; and all-cause, in-network 30-, 60-, and 90-day readmissions. At 30 and 60 days, no differences were observed in the primary outcomes; at 90 days, intervention patients demonstrated a trend toward readmission reduction. A social worker-led transitional care program shows promise in reducing readmissions over 90 days among high-risk, lower socioeconomic, nonelderly adult patients.

Learning Integrated Health System to Mobilize Context-Adapted Knowledge With a Wiki Platform to Improve the Transitions of Frail Seniors From Hospitals and Emergency Departments to the Community (LEARNING WISDOM): Protocol for a Mixed-Methods Implementation Study.

BackgroundElderly patients discharged from hospital experience fragmented care, repeated and lengthy emergency department (ED) visits, relapse into their earlier condition, and rapid cognitive and functional decline. The Acute Care for Elders (ACE) program at Mount Sinai Hospital in Toronto, Canada uses innovative strategies, such as transition coaches, to improve the care transition experiences of frail elderly patients. The ACE program reduced the lengths of hospital stay and readmission for elderly patients, increased patient satisfaction, and saved the health care system over Can $4.2 million (US $2.6 million) in 2014. In 2016, a context-adapted ACE program was implemented at one hospital in the Centre intégré de santé et de services sociaux de Chaudière-Appalaches (CISSS-CA) with a focus on improving transitions between hospitals and the community. The quality improvement project used an intervention strategy based on iterative user-centered design prototyping and a “Wiki-suite” (free web-based database containing evidence-based knowledge tools) to engage multiple stakeholders.ObjectiveThe objectives of this study are to (1) implement a context-adapted CISSS-CA ACE program in four hospitals in the CISSS-CA and measure its impact on patient-, caregiver-, clinical-, and hospital-level outcomes; (2) identify underlying mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly; and (3) identify underlying mechanisms by which the Wiki-suite contributes to context-adaptation and local uptake of knowledge tools.MethodsObjective 1 will involve staggered implementation of the context-adapted CISSS-CA ACE program across the four CISSS-CA sites and interrupted time series to measure the impact on hospital-, patient-, and caregiver-level outcomes. Objectives 2 and 3 will involve a parallel mixed-methods process evaluation study to understand the mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly and by which our Wiki-suite contributes to adaptation, implementation, and scaling up of geriatric knowledge tools.ResultsData collection started in January 2019. As of January 2020, we enrolled 1635 patients and 529 caregivers from the four participating hospitals. Data collection is projected to be completed in January 2022. Data analysis has not yet begun. Results are expected to be published in 2022. Expected results will be presented to different key internal stakeholders to better support the effort and resources deployed in the transition of seniors. Through key interventions focused on seniors, we are expecting to increase patient satisfaction and quality of care and reduce readmission and ED revisit.ConclusionsThis study will provide evidence on effective knowledge translation strategies to adapt best practices to the local context in the transition of care for elderly people. The knowledge generated through this project will support future scale-up of the ACE program and our wiki methodology in other settings in Canada.Trial RegistrationClinicalTrials.gov NCT04093245; https://clinicaltrials.gov/ct2/show/NCT04093245.International Registered Report Identifier (IRRID)DERR1-10.2196/17363

Coaching techniques for sustained individual change during career transitions

AbstractCareer development and transitions are forms of learning integral to human resource development (HRD). Understanding these phenomena is becoming critical due to the changing nature of work. Transition coaching, an individualized HRD learning intervention, is gaining traction as a career support mechanism, yet the details of how this type of coaching works are not clear. To investigate the potential role of transition coaching as an HRD intervention that facilitates learning beyond the acquisition of knowledge and skills, this study examined which coaching techniques, from the perspective of the transitioning manager (coachee), are likely to contribute to transformative individual learning during transition coaching. Perceptions of these coaching techniques were identified through deductive and summative content analyses of interview transcripts of 20 coached transitioning managers. Of the 13 coaching techniques identified, five were perceived to be experienced substantially more than the others: active experimentation, questioning, reflection, challenging views and assumptions, and using theories and frameworks. The findings suggest empirically that transition coaching could facilitate transformative individual learning during career transitions. The findings also indicate that, unlike what is generally professed during coaching, transitioning managers value a directive, knowledge‐imparting coach and confirm that reflection and experiential learning are key to succeed in a new role. This study advances HRD, transformative learning, and coaching theory and practice through the operationalization of coaching in the specific HRD context of career development and transitions aimed at transformative learning.

Transformative transition coaching: a framework to facilitate transformative learning during career transitions

Corporate leaders are frequently promoted into senior positions without the requisite capabilities to be successful in such career transitions. A significant proportion fails with substantial negative personal and organisational implications. Incumbents need to adapt through a flexible learning process that transcends superficial change. Transformative learning alters deeply held perspectives and world views and has long-term efficacy, while transition coaching, used sporadically at present, is a personalised learning process. This research created a novel synergy between transformative learning theory and transition coaching using a combination of grounded theory principles (16 participants) and canonical action research (6 participants). The findings yielded two results: the transformative transition coaching framework that appears to facilitates deep, lasting changes in an individual’s perspectives and world views during senior career transitions; and a novel coaching state transition notation that could help coaches to graphically track coachees’ transition progress. By undergoing transformative learning through coaching, transitioning leaders may increase their chances of success in their current and future roles.

A FRAMEWORK FOR CARE TRANSITIONS FOR OLDER ADULTS WITH COMPLEX HEALTH CONDITIONS

For older adults with complex health conditions, transitions between care settings are common and a major risk to quality of care and patient safety. Care transition interventions have shown positive impacts on continuity of care and health service use, however, most require additional human resources (e.g., transition coach), focus on one transition or “handoff”, and provide support for individual patients without addressing underlying challenges of health system integration. We sought to develop a framework for system-level enhancements to care transitions for older adults. We report a secondary framework analysis of an ethnographic investigation (the “InfoRehab” project) of care transitions for older persons who had experienced a hip fracture. The ethnographic study involved interviews, observations, and document reviews for 23 patients, 19 family caregivers, and 92 health care providers. Data were collected at each transition point (1-4/patient) along the care continuum, at three Canadian sites (large urban, mid-size urban, rural). Our framework analysis followed the approach described by Gale et al. (2013), using as cases 12 peer-reviewed papers which had reported InfoRehab results. Two researchers coded findings from each paper, then developed an analytical framework of eight themes by consensus; these include: patient involvement and choice, family caregiver involvement, patient complexity, health care provider coordination, information sharing, documentation, system constraints, and relationships. NVivo 11 was used to index findings into these themes and to generate a matrix. We are working with system stakeholders, including patients and caregivers, to apply this framework in the development of improved systems for care transitions.

EMERGING MODELS OF CARE: THE IMPACT OF PHARMACIST-LED MEDICATION MANAGEMENT IN A TRANSITIONAL CARE PROGRAM

Transitional care programs have emerged as successful models of care in which to reduce cost and improve health outcomes. However, few transitional care models have directly incorporated the expertise of the pharmacist as an integral member of the care coordination team. Therein lies an inherent limitation of many community-based transitional care programs, the underutilization of pharmacist during all stages of the care transition process. In 2013, the Hampton Roads Care Transitions Project (HRCTP), a partnership between Senior Services of Southeastern Virginia Area Agency on Aging in Norfolk, VA and Hampton University School of Pharmacy, was established. The goal of the HRCTP is to provide medication management services to reduce preventable hospital readmissions for adults 60 years of age and older with targeted diagnoses. Pharmacists work in collaboration with social workers who act as HRCTP care transition coaches. Between May 2017- October 2018, 678 patients were enrolled in the HRCTP. The hospital readmission rate among patients with targeted diagnoses was reduced by 55.3% with an absolute percentage point reduction of 9.9% and estimated savings amount per avoided readmission of $14,400. Patients who participated in the HRCTP showed a 14% increase in the Patient Activation Assessment indicating an improvement in self-managing efficacy. 93% of patients/caregivers indicated they felt more confident in their ability to manage their health, and 91% expressed satisfaction with the program. The program has proven effective in assisting seniors to remain in their home, reducing hospitalizations, promoting health, increasing patient satisfaction, and reducing healthcare cost.

Developing Healthy Habits:: A Faith-Based Interdisciplinary Action Framework

This interdisciplinary action framework to influence health and well-being enables wholeness within a faith-based community. The framework provides health care professionals and practicum students the opportunity to serve while reducing negative health outcomes and social inequities, by integrating the elements of what is important to individuals. This article illustrates how innovative methods and collaborations are instrumental in stimulating one faith-based bilingual community to engage in healthy habits such as walking, developing a vegetable garden, and using a self-care transition coach.

Collaborative Value in Public and Nonprofit Strategic Alliances: Evidence From Transition Coaching

The value created by public–nonprofit (PNP) alliances often emphasizes public sector service delegation to nonprofits, but public and nonprofit organizations often seek to create shared social value with alliances, particularly in sectors where there is coproduction. To better understand shared social value, we apply the Collaborative Value Creation (CVC) framework to investigate value creation in the Transition Coaching sector—nonprofit organizations that provide support to high school students as they transition to college. We interview public and nonprofit executives and staff and find that nonprofits seek resources to help navigate complex bureaucratic public structures related to private client information and centralizing bureaucratic information. We also find shared public and nonprofit value in improving client navigation, knowledge sharing within public bureaucratic structures, and capacity building. Future scholarship should develop the potential for reduced bureaucratic frictions as a point of shared value in PNP alliances.

Using transformative transition coaching to support leaders during career transitions

Senior leadership transitions present daunting challenges. To promote inclusive development and comply with equal opportunity legislation, South African companies often fast-track careers of high-potential previously disadvantaged individuals. Organisations typically do not sufficiently support transitioning leaders, possibly acting unethically. The rate of failure is high with devastating effects for the individual and their organisation. The novel, empirically researched Transformative Transition Coaching (TTC) framework, helps facilitate deep and lasting changes in meaning perspectives of transitioning leaders through coaching. The ability of the TTC framework to support transitioning leaders is presented in this article

The junior to senior transition: a narrative analysis of the pathways of two Swedish athletes

There are as many careers with various pathways as there are athletes, and the interest in the junior-to-senior transition (JST) stems from its particular importance for athletes’ lives when aiming for the senior elite levels of their sports. This study is a follow-up of the quantitative longitudinal study that investigated the JST process in Swedish sport club athletes. The aim of this study was to explore two athletes’ (pseudonyms Erik, the swimmer, and Jessika, the tennis player) JST transition pathways, emphasising psychosocial factors that were perceived as facilitating and debilitating the transition process. Narrative-type interviews were conducted, and the stories were analysed using the holistic-form structural analysis. The analysis provided a central storyline (performance narrative) that is similar for both athletes, and two side storylines: Erik’s effort and relationship narrative and Jessika’s injury and reorientation narrative. They shared psychosocial factors that were perceived as facilitating the transition process, including family, coaches and sport club environment. For Erik, the debilitating factors were the negative changes in the group and a poor relationship with the new coach. The debilitating factors that influenced Jessika’s JST were the decrease/loss of financial support and the challenge of facing younger opponents against whom she felt she shouldn’t lose when making a comeback after an injury. After the JST, both Erik and Jessika changed their tracks in life, terminated their athletic careers and focused on pursuing higher education qualifications.

A Person‐Centered Approach to Poststroke Care: The COMprehensive Post‐Acute Stroke Services Model

Many individuals who have had a stroke leave the hospital without postacute care services in place. Despite high risks of complications and readmission, there is no standard in the United States for postacute stroke care after discharge home. We describe the rationale and methods for the development of the COMprehensive Post-Acute Stroke Services (COMPASS) care model and the structure and quality metrics used for implementation. COMPASS, an innovative, comprehensive extension of the TRAnsition Coaching for Stroke (TRACS) program, is a clinician-led quality improvement model providing early supported discharge and transitional care for individuals who have had a stroke and have been discharged home. The effectiveness of the COMPASS model is being assessed in a cluster-randomized pragmatic trial in 41 sites across North Carolina, with a recruitment goal of 6,000 participants. The COMPASS model is evidence based, person centered, and stakeholder driven. It involves identification and education of eligible individuals in the hospital; telephone follow-up 2, 30, and 60 days after discharge; and a clinic visit within 14 days conducted by a nurse and advanced practice provider. Patient and caregiver self-reported assessments of functional and social determinants of health are captured during the clinic visit using a web-based application. Embedded algorithms immediately construct an individualized care plan. The COMPASS model's pragmatic design and quality metrics may support measurable best practices for postacute stroke care.