As a health and exercise professional, it’s not surprising that your clients may come to view you as a trusted confidant. After all, you help guide them in their quest for lifestyle change, support their intentions and goals, and meet them where they are. As a result, some clients may feel compelled to share more information (unrelated to their health) than you might expect or know how to handle with confidence. When this happens, it can create significant challenges, as you may feel equally compelled to empathize, guide, reassure and comfort.

But what happens when the information a client shares goes beyond the definition of unexpected? Do you know how to manage information that is considered sensitive, dangerous or inappropriate? This is a question health coaches and other health and exercise professionals grapple with, so we asked three industry professionals to weigh in on how to best handle these types of situations, should they arise.

Begin With Boundaries and a Plan

Just as health and exercise professionals have an emergency management plan in the case of adverse events or situations, creating a set of boundaries as well as a “just in case” plan for these types of situations is crucial. Take the time to outline those boundaries and design a management plan that best suits the environments within which you work: face-to-face, hybrid and/or online. 

Part of developing an effective “just in case” plan involves what is sometimes called "front door communication," which is information that can be verbally delivered to clients in person or in a client onboarding or welcome packet. Chris Gagliardi, ACE’s Scientific Education Content Manager, emphasizes the importance of client communication.

“Let clients know up front at the beginning of the coaching or personal training program that there are certain topics that, if mentioned, will require you to take further action,” explains Gagliardi. For example, you, as the professional, might share with your clients that if the conversation diverges from the intended agenda, you will redirect accordingly. Such a statement might take a more direct route and include you telling your client that they have a duty to report to proper authorities if something such as child abuse or violence are mentioned.

“The key is to make your clients aware that this is a professional relationship with boundaries,” continues Gagliardi. “It is important to remain in a state of unconditional positive regard and to honor and respect the relationship you are building with your clients, while at the same time recognizing the responsibility you have as a professional in a helping profession who may encounter certain topics that require follow-up.”

Erin Litton, MCHES, ACSM-CEP, NBC-HWC, internship director and lecturer at the University of Iowa, echoes Gagliardi’s recommendations. “Your role is to support clients through change. When they share information that is sensitive, dangerous or inappropriate, the best thing you can do is have your systems in place to protect both you and the client.” Litton suggests addressing your role and scope related to concerning information as part of your coaching contract. For example, in your contract it may be helpful to identify what you will do and to what type of information you will respond.

“Collect information you can use to support a client up front, such as  an emergency contact, their local address where you can connect to law enforcement, and the phone numbers for crisis management services (such as the National Suicide Prevention Lifeline through the National Institute of Mental Health),” recommends Litton. “Whatever resources you engage, it should not be a surprise to your client that you will engage with those resources when they share harmful information.”

It is best practice to openly and clearly communicate with your clients that any concerning information they share could require you to engage with supportive resources outside of your client-coach relationship. Litton stresses that if a client does share dangerous or concerning information, you need to activate your plan. “When appropriate, engage your client in the process, but it should not be a surprise.”

It is impossible to predict the information your clients will share with you. Planning for the unexpected topics and situations will allow you to elevate your service to clients, keep them (and yourself) safe and remain within your scope of practice. 

Lessons From the Field

Two veteran health and exercise professionals share insights they gained only after encountering situations they each perceived to be sensitive or concerning.

Chris Gagliardi’s Story

Gagliardi previously worked as a telephonic health coach, speaking to as many as 50 clients per week. “It’s no wonder,” he says, “that I occasionally encountered sensitive and sometimes dangerous situations. Imagine, for example, following up with a client who had missed their last two sessions and they disclose that they’re not able to attend because they’re embarrassed to be seen with the bruising on their face.” Situations like this may or may not mean someone is in danger or indirectly asking for help, but, as Gagliardi explains, it’s worth asking the client if they need help.

“Explore the topic further to see if more direct steps are needed,” urges Gagliardi. “Depending on how the conversation goes, you may end up asking if the person needs help or if they are safe. Sometimes asking these questions takes courage and can be uncomfortable, but it is the right thing to do.”

If a client discloses that they are in an abusive relationship and are afraid for their safety, their most pressing concern is to find a safe location and you can help guide them toward the appropriate resources. “Always have resources available for a variety of situations,” recommends Gagliardi. “One resource I appreciate and rely on is 2-1-1, which I believe is specific to my location, but it is a one-stop shop for resources related to transportation, housing/shelter, income support, mental health, substance abuse and healthcare.” Check your local area for a similar clearinghouse of resources.

Lee Jordan’s Story

Lee Jordan, MS, NBC-HWC, SHRM-SCP, is an ACE Master Coach and national presenter. He shared with me a story from his time in the corporate wellness realm. As is common, Jordan was talking with a new employee who shared that he had just moved to the area. Through that casual conversation, Jordan learned that this individual smoked tobacco products, was largely sedentary and in the precontemplation stage of change. Curious about how he was settling into his new home and location, Jordan asked the man if he had identified a primary care physician. He had not at the time and Jordan offered to assist in locating a resource. The employee’s response: “Maybe next week. I’m crazy busy.”

This conversation continued the following week, where Jordan learned this individual had been experiencing pain and cramping in his calf. Using clarifying questions to dig deeper and open the conversation, Jordan suggested that the type of pain the man was experiencing may be vascular in nature, and that he should consider seeing a physician. However, the individual remained hesitant, citing a myriad of reasons why he didn’t have the time. Jordan was unable to shake the nagging feeling that something serious might be going on.  

Given that the new employee smoked cigarettes, had obesity and was largely sedentary, Jordan recognized that the type of pain the man had described was consistent with a blood clot in the leg, which could lead to a pulmonary embolism if it were to break off and become lodged in the lungs. Jordan called a physician he works with for his input. After hearing the man’s symptoms, the physician suggested that the man could be tested if and when he would see a physician, but that he wasn’t exhibiting stroke symptoms (FAST), which would require immediate action.

Sadly, this story did not have a happy outcome. The next week, Jordan learned that the new employee had experienced a pulmonary embolism two days earlier while at work and passed away in transit to the hospital.

“I have to live with this and be O.K., that I followed a reasonable path,” explains Jordan. “We cannot change people—we can only love and accept them. This is not a game and for me that means I prepare myself with the best evidence-based approach, I keep learning and serving, knowing lives and families are at stake. Following this sad event, this corporation chose to invest (even more) and launch programs and opportunities for employees to be more intentional about heart health.”

While this information was not necessarily sensitive or obviously dangerous, it presented medical red flags that, sadly, ended with the loss of life. The lesson here is that the health coach, Jordan, followed a reasonable path and met the client where he was at by opening the door for a conversation, asking open-ended clarifying questions and seeking input from a medical professional. Unfortunately, the condition worsened before corrective or preventive action could be taken by the employee.

Recommended Action Steps

It is not within the scope of practice of a health and exercise professional to intervene with specific directives or action steps to correct a client’s sensitive, dangerous or harmful situation. However, you can commit to planning ahead, communicating that plan to clients and those you serve, as well as sharpening your skill set around identifying the type of information or scenario that may threaten a client’s safety or health to a degree that requires further support. Below, Gagliardi and Litton share some necessary steps you can take to be prepared and aware.

Education and Training

“Professionals should engage in training to support your ability to recognize and navigate concerning conversations,” says Litton. “The  National Institute of Mental Health and the American Psychological Association haves many resources for building understanding and skills.

Gagliardi recommends a suicide-prevention training course called Question, Persuade, and Refer, which he says has benefitted his work with clients on numerous occasions. “This is a course I was required to take and, initially, I didn’t appreciate how important it was. However, there have been a handful of times throughout my career, both before and during my time at ACE, where I was able to use skills learned from this course.”

Communicate Effectively

There may be times when clients share sensitive, dangerous or inappropriate information in a joking or off-the-cuff manner, which can make it difficult to discern the seriousness of the comments. Gagliardi offers this example: “Imagine your client says something like, ‘I am so frustrated right now about my lack of progress that I am tempted to go to my safe to get my gun.’ This could be a joke or a harmless way of expressing frustration, but in my experience, it is best to confront these words and to let your client know that you take this type of language very seriously.”

Emergency Medical Services

In today’s world of online coaching and training, it is critical that health and exercise professionals research and learn how to activate EMS in other countries, states and cities. Gagliardi recommends researching this ahead of time based on the location of each of your clients. “This information could be added to your client's file as an emergency contact. Again, when doing telephonic health coaching, I worked with clients all over the United States. On more than one occasion, I had to activate EMS in another state and had to figure out how to do so in the moment while precious time was wasting away. Had I been more prepared, I could have saved that time.”

Follow-up

As part of planning ahead for these types of situations, ensure that you have an additional step of how and when to follow-up. This demonstrates to the client that you care and are invested in their health and safety.

Additional Resources

Handling these situations and responding effectively and appropriately to whatever information a client shares is not an easy or small task. Take the time to become familiar with and bookmark a variety of resources to have on hand and use when or if it becomes necessary.

Resources - 211

National Suicide Prevention Lifeline through the National Institute of Mental Health

National Eating Disorders Association

Child Protective Services

National Domestic Violence Hotline

Substance Abuse and Mental Health Services Administration

Finally, be sure to build your professional network to include a variety of helping profession members so that you have a solid referral base to further support and serve your clients. Keeping these and other resources readily available will elevate your practice and, potentially, save a client’s life.