Health and wellness coaching is a quickly expanding field. Most health coaching focuses on enhancing fitness and nutrition among adults. Less attention has been paid to the need for coaching adolescents to engage in healthy habits like physical activity, eating healthy foods, and getting adequate sleep, while also avoiding health damaging behaviors like using alcohol, tobacco and drugs.

I will discuss the later area of health coaching in this article. In particular, I describe a proven model for planning and the steps for implementing integrated health and prevention coaching for adolescents and young adults.

The Behavior-Image Model: An Evidence-based Framework for Planning Integrated Youth Coaching

The Behavior-Image Model (BIM) is an emerging theoretical framework for planning integrated health and prevention motivational strategies like coaching. BIM is an evidence-based model shown to be effective in creating a number of integrated programs for youth, several of which have been found efficacious in influencing both health risk and health enhancing behaviors in rigorous evaluation trials.

While BIM can be used to develop a number of different types of motivational programs and materials, it has been used primarily to create brief structured coaching sessions with individual young people. These standardized coaching sessions are designed to provide personalized and positive motivational feedback to youth regarding increasing healthy behaviors, avoiding risk behaviors, and adopting positive self-image and goal setting skills.

Below are key steps for implementing integrated prevention and health coaching with young people based on BIM.

Step One: Screen Youth for Their Current Health Habits

The first step in coaching youth to adopt health promoting behaviors while avoiding risk habits is to collect baseline data on their current health behaviors. Screening in this model has two goals. First, to cue desired behaviors and related positive images of participants, and second, to provide data for tailoring feedback on both health enhancing and risk habits.

In its simplest form, the screening survey should measure each of the key health promoting and risk behaviors you wish to address in your coaching session. Screening items should emphasize easy to answer yes/no responses to reduce screening time. For example, a screening measure of a health promoting behavior could be: “Do you participate in any physical activity for at least 30 minutes four or five times a week?” In addition, a dichotomous response risk behavior screening item might include: “During the past 30 days, have you smoked one or more cigarettes?”

Step Two: Provide Tailored Coaching Targeting Positive Images and Behaviors

The second step in providing integrated prevention and health coaching for youth includes presenting tailored feedback, and positive image and behavior comments and recommendations. First, positive feedback is provided to participants for engaging in each of the targeted health promoting habits and avoiding each risk behavior, based on screening responses. In addition, feedback given regarding unhealthy habits should also be encouraging and non-negative. For example, “It seems you might not be exercising regularly. You can really improve your fitness level and your amount of energy by participating in physical activity each week.”

Next, positive images are cued by describing how those who regularly participate in each of the health enhancing behaviors experience positive image effects, and how improving these habits can help participants achieve the same positive image outcomes. For example, “Young adults who exercise regularly are fit, active and confident. Getting additional exercise can help make you look and feel more fit and lead an active lifestyle.”

Then, to the extent possible, each risk behavior is linked to each healthy behavior by discussing how engaging in the risk behaviors interferes with achievement of the positive behaviors and images, and produces opposing behavior and image effects. For example, “Alcohol can sap your energy, making it hard to exercise and play sports at your best. It also adds empty calories making it difficult to maintain a fit and lean body.”

Lastly, specific recommendations are provided which again link engaging in each of the health promoting behaviors and avoiding each of the risk behaviors with resulting key positive image outcomes. For example, “As your personal fitness coach, I recommend you avoid alcohol use to help you stay fit and live an active high energy lifestyle.”

Step Three: Implement a Multiple Behavior Goal Plan and Contract

After motivating the participant with tailored feedback and positive image coaching, the third step in the model is to provide youth with a goal setting exercise. The goal plan should allow for setting concrete goals related to each of the target health behaviors and thereby experience linked positive images in the future. In addition, providing an opportunity to make a public commitment by signing a contract to change multiple health habits solidifies motivation to work toward and monitor goals set.

Step Four: Repeat the Coaching Session

The fourth and final step in the model is to repeat the coaching session. Our research suggests that a single brief coaching session can result in positively influencing both health promoting and risk habits among adolescents and young adults for up to three months, with some effects sustained even a year later.

Because certain effects appear to weaken over time, however, I recommend providing a follow-up coaching session at least annually, if not every 3-6 months. In addition, you might wish to experiment with providing weekly or monthly coaching sessions, to determine the best dosing schedule for obtaining and maintaining maximal health behavior outcomes for your situation and youth population.


In conclusion, while the evidence-based Behavior-Image Model can be used to plan and implement a range of integrated health and prevention motivational interventions and materials, it is ideal for providing brief personalized yet structured coaching sessions with individual young people. BIM has been used to create a number of existing one-on-one coaching programs shown to be effective in preventing risk habits like alcohol, tobacco and drug use, while promoting healthy behaviors like physical activity and healthy eating among adolescents and college aged young adults.

To learn more about these brief integrated health and prevention coaching programs, go to our website at: www.preventionpluswellness.com.

You can also read a recently published paper describing an evidence-based coaching program shown to promote positive behaviors and self-image among adolescents here.


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