Lowest Level of Intervention

The following is a guide for assisting children and adults to work as independently as possible in arts and educational settings.

When developing strategies for providing assistance, it is first important to determine what level of input is needed.  This will be based upon the current level of independent functioning, the nature of the activity and how well the day is going!  It is not a “formula” but is designed to remind teaching artists, aides, workshop leaders and caregivers that we need to take our time and allow as much independence and choice as we possibly can.  In order to illustrate we’ll take the example of a young person taking part in a painting activity.

- Start with a verbal prompt for the first step. “Pick up your paintbrush so you can begin” or “Can you reach down and pick up the brush now?”

- If there isn’t a response after a pause, repeat the prompt and add pointing.  “Here’s the brush; let’s pick it up so you can begin to paint.”

***Note:  Give these first steps plenty of time, unless you know that the next level is going to be necessary.

- If the child doesn’t respond, add a light touch.  How you do this will depend on the physical functioning level of the child.  If you know they can do this action independently, you might touch the child’s arm or hand and say, “OK, use your hand and reach down for the brush so you can begin your painting.”

- If you know physical assistance is necessary, again make your assist as minimal as possible.  Some children may respond to simple pressure on the shoulder or may need you to put a hand under their forearm and guide them to the brush.  You can get input from therapists or family members about what works best, or you may want to work this out for yourself.  While you are doing this talk to the child, saying something like, “I’m going to support your arm and let’s see if that makes it easier for you to reach the brush” or “Let’s try having me put my hand under your wrist so your hand is steadier.”  Watch and listen for cues that the child thinks this is working well, particularly with non-verbal youngsters.

*** Note: The advantage to working this through by yourself is, of course, that you can move through the levels of intervention and thus not accept a low estimation of what the child can do.  You may find success where others have not!

- If more assistance is needed try supporting forearm or elbow or wrist.  One tip to keep assistance at a low level is to keep your hand open flat and use your palm. This often means you do not have to actually do “hand over hand”.  It is very effective in keeping us from being more directive than we need to be.

- If you do need to use hand-over-hand, again be as non directive as possible.  Grabbing a child’s hand and forcing movement is very invasive and certainly does not allow the work being done to be reflective of the child’s creative choices.  If you are doing this, talk with the student saying something like, “I’m going to put my hand on yours and we’ll work together but I’ll be watching to see what I think you’d like to do and I’ll follow you as much as I can.”

This same principal applies to all activities.  The assists will be different, but the protocol is identical – the lowest level of intervention is what we’re after.

Here are some other examples:

• A dancer working with a person with mobility disabilities might find ways to touch shoulders or spine to help with centering or might use the open hand on the small of the back to help with forward motion.

• A musician working with a student with muscle rigidity might work to find ways to assist the student to first open fingers and then to grasp an instrument by stroking the hand to open it and then gently helping fingers to grasp by lightly touching them.

There is no one right way to do this.  It is dependent on respectful observation, getting to know the individual’s needs and capabilities, by communication with the child and by striving for the highest degree of independence possible.  We need to intervene with the consent of the child.  We need to never pretend that our choices are their choices simply because it’s easier or we think they aren’t capable of making choices.  If push comes to shove and we need to take initiative we say so.  “You know what…I’m not sure what direction you’d like to go, so this time I’ll take a turn choosing and we’ll be partners.  Next time I’ll ask you again if you want to choose.”

Our goal is as much independence as possible.  We move through these levels each time, even if quickly, and are alert for growth and progress.  We put the child first and rejoice as new activities are mastered. 

© Deborah Stuart, VSA arts