Prompting

General Guidelines

  1. Always behave in a consistent fashion when working with clients, letting them know what is expected of them.
  2. Always give a client the opportunity to accomplish a task, or step involved in a task Independently.
  3. Only provide prompting if it is necessary.
  4. When prompting, always "work down" the prompting hierarchy: Independent > Verbal > Model > Physical > Hand Over Hand, Etc., all the way down to resistive.
  5. Repeat prompts 2 or 3 times before proceeding to the next lower independence level.
  6. Allow a reasonable amount of time for a client to respond before repeating the prompts.
  7. Always reinforce a client for successful performance of a task as indicated in their program plan.
  8. Never force a client through a task.
  9. Never say anything negative to them even if they refuse to cooperate with the program. Just stop and thank them for any signs of recognition or cooperation at all.

Always behave in a consistent fashion when working with the Intellectually Disabled. Repetition, over and over and over and over the same way and approximate time each day is the easiest and most effective way of learning.  Set schedules and a lot of consistency help them to feel safe and secure in a world that moves way to fast for them.  Things like the same snack time, dinner time, shower time make transition times between activities smother.  When implementing a training program also do it at the same time each day and the same way. They learn to expect and anticipate events of the day. 

The facility needs to be sure that all the trainers know the program from memory and use the same methods each time.   It doesn’t help if only one trainer can get the trainee to do something.  Sure that trainer feels good and important However, what happens of different days or shifts when that trainer is not there?  And worse what if that trainer moves on to another job which will happen some day?

When working on a formal training program it is important to let them know that it is time to change from what they were doing to the activity that you want them to focus on.  It is also important to let them know exactly what is expected of them.
For example: “OK Shannon, its time to put away the connect four” You help them put away the connect four and remember to give them praise. “Very Good Shannon, now lets take out your matching cards”.

Only provide prompting when and if it is necessary.  Always give a trainee the opportunity to accomplish a task independently by waiting a few seconds (or minutes depending on the person) to respond. 

When prompting, always  "step down".  Starting with least invasive prompting to physically guiding them or doing for them.  The prompting hierarchy is usually like this:  Independent   > Verbal   > Model   > Physical  > Hand Over Hand, Etc.. ..all the way down to resistive.
Each consultant writes their plans a little differently where as they may use alternative terms.  For example one plan may ask for modeling and another may ask for gesture prompts.  If not sure ask your QIDP for clarification.

This model of step down prompts works well for most all situations.  The most frequent exceptions are behavioral programs where the trainer should have specific written guidelines given that are different than the standard step down prompts.

Repeat prompts 2 or 3 times before proceeding to the next lower independence level.  When giving prompts be care full not nag the trainee.  This is particularly true with repeating prompts.  For Example: Don’t say “Margie pick up the card 10 times.” If she dose it the first few times great.  If not move on to the next level of prompting.  Again allow a reasonable amount of time for a trainee to respond
before repeating the prompts.

When encouraging a trainee always reinforce a trainee for successful (or close) performance of a task as indicated in their program plan. Be sure to add at least a “please” when asking them to do something and a “thank you” when they at least tried to cooperate.

Never! Never! Never! Never! push or force a trainee through a task.  If they are resistive or this is new for them you can try again later.  If each trainer at the appropriate opportunity works with that person on that task every day eventually they will learn it.  There is nothing so important that they learn today to warrant making them upset, frustrated, or angry.  Also try not say anything negative to them even if they refuse to
cooperate with the program.  Just stop and thank them for any signs of recognition or cooperation at all.  Try to make training as fun as possible.

Sometimes prompts in a plan are very strait forward and sometimes just not.  For the most part prompts go as follows:

1. Independent prompt: An independent prompt lets the person you are training know that it is time to do the task.  For Example: Trainer says “Sally, time for dinner” Then if Sally sits down at the dining table, and starts to eat, she did it independently.

2. Verbal Cue: A verbal cue helps remind the person you are training of what task to do next. For example: Sally sat down at the dinning table.  The food has been served onto her plate and she is not moving.  Say may say: “Now Sally what do you now?” If she picks up her utensils to eat, She did it with verbal cue.

3. Verbal Prompt: a Verbal prompt is simply asking the trainee to do a task.  For example: Trainer may say “Sally please pick up your spoon” or “Please take another bite”.
If she completes the task, she did it with verbal prompts.  (remember, don’t nag).

4. Modeling Prompt: A modeling prompt is when the trainer models the motion of the task.  For example: Sally if holding her spoon with food on it and as trainer asks her to bring it to her mouth trainer also model the motion of holding a spoon and bring it to their mouth. 

5. Gesture Prompt:  A gesture prompt is when the trainer uses their hands to non-verbally assist the trainee to understand what they are saying verbally (Also used often with deaf persons).  For example: Sally is holding her spoon in her mouth after taking a bite.  Say may say “Sally bring your spoon down” and at the same time Trainer will use a flat hand open palm facing downward and gesture her to bring her hand down.  Gesture prompts are universal, they are used by people every day to get their messages across easier.  A flat hand facing upward in from of a person usually mean stop.  A wave of a hand is usually either come here or go away.

6. Physical Prompt: A physical prompt is when the trainer gently guides the trainee to complete a task physically.  For example: Sally eats too fast and trainer want her to put her spoon down between bites of food.  Trainer may gently touch her hand (not the spoon) and guide her hand down toward the table.

7. Hand Over Hand Assistance: A hand over hand prompt is when the trainee actually places (again gently) on the top of the trainee’s hand a guide them through the motion of the task.

8.  Manual Prompts or Manual Guidance: Manual guidance is when the trainer will touch the trainee’s arms, legs, shoulders etc. to guide the trainee in the appropriate motion for the task.  For example: Range of motion, or exercise objectives.  Here the trainer needs to be extremely careful not to force the trainee in the movements.  Also, a trainer needs to remember to use an open palm when guiding another person’s motions.  A curled hand may cause bruising to the skin or be misinterpreted as grabbing the person in a forced manor. 

Again if as a trainer you are not sure what a prompting level means for a specific plan, ask your QIDP to explain it in detail.  It is important that the plans are carried out in a consistent manor for the trainee to learn.