Prompting
Understanding and applying prompts is an important component of a Safety-Care trainer’s skillset. A prompt is a supplemental stimulus that guides the trainee to the correct response. When teaching any verbal or physical competency, a trainer may apply a variety of prompts, at different times, to promote errorless learning. Additionally, the prompt is a de-escalation strategy that helps an individual exhibit calmer, safer behavior that is different from the challenging behavior, and knowing different ways to prompt may enhance the application of this skill. I will discuss and share examples from both contexts for prompts: training Safety-Care and using The Prompt strategy.
Types of Prompts
There are two major categories for prompts: a response prompt, which acts on the response itself; and a stimulus prompt, which draws attention to the indicator preceding the response. (The indicator lets a person know that responding in a certain manner leads to reinforcement.)
Response Prompts
There are three major types of response prompts: Verbal instruction, Modeling, and Physical Guidance.
Verbal instructions are a common way to prompt the desired behavior by telling the trainee what to do (i.e., In elbow check, a trainer may say “I need you to bring your fingers together and come above the elbow.” While a verbal instruction in the prompt strategy may be, “sit down,” “take a deep breath.”). Sometimes we overutilize verbal instruction. Some individuals may not understand what is being said because they have never learned the instruction in the first place or language processing becomes difficult when escalated. Even in training, it may be easier to try another type of prompt because translating language into behavior can be challenging.
Modeling is best when the learner knows some of the skills. Sometimes we see trainers stand in view of the trainee and model the correct behavior (i.e., in Front Choke Release, when a trainer models bringing elbows up and pushing out, then over…). Modeling prompts can occur during de-escalation by modeling the incompatible or high-probability behavior. For example, if the staff person is trying to prompt deep breathing with a model, they will stay within view of the individual and take loud deep breaths, waiting for imitation. Be aware that for modeling to be an effective prompt, the learner must attend to the model and know how to imitate.
Physical guidance Is the most intrusive prompt. It offers the greatest chance at completing the procedure with the least errors because the trainer is moving the trainee to perform the behavior. A trainer may use physical guidance to gently move a trainee’s hands in the appropriate position for a procedure. Physical guidance can range from a light touch to moving a person/body part. Physical guidance can be used for the prompt strategy as well. For example, if an individual is laying on the ground and is uncooperative to move. A staff person may grab a chair and safely and gently place the individual’s hand on the chair to promote standing/ getting off the ground. However, it is important to note that an individual may become more escalated when touched and some regulating bodies consider physical prompts a restraint. Contact your clinicians or specialists if you are considering physical prompts in de-escalation. Generally, physical prompts may be more effective when the individual is calm and ready to learn.
Stimulus Prompts
There are three types of stimulus prompts: movement, position, redundancy.
A movement-based stimulus prompt occurs when we tap, touch, gesture. For example, when the trainer points to the area above the elbow when teaching the elbow check. We see this in the prompt strategy when a staff person points to a chair then the learner then sits down.
Position prompts increase the chance of responding correctly by using positional cues. For example, when the trainer is playing the individual trying to teach safety during physical management, they may bring their head closer to the trainee’s head to make sure they stay clear of head butts or bring their mouth closer to the trainee’s hand to stay clear of bites. These types of prompts can be highly effective because it highlights what are we trying to avoid, head-butts and bites. An example of a positional prompt for an escalated individual that usually de-escalates when told to squeeze a stress ball would be to place the ball closer to the individual.
Lastly, a redundancy prompt is when one or more response dimensions are paired with the correct response. When training Safety-Care this would be when the trainer is teaching the wait strategy and points out that a trainee should not be talking by spelling out WAIT as, “Why Am I Talking?” This may promote trainees to remember not to talk during this procedure. This prompt type is a little difficult to use in the context of escalation because it may require making materials beforehand (if you have some ideas for this one, please share!).
Prompting is an important tool for a Safety-Care Trainer and staff that work with individuals. To teach effectively, understanding types of prompts is critical because not everyone responds to the same type of prompt. Some learners find verbal instructions and models very effective, while others find physical guidance or positional prompts super helpful. Remember to apply your prompt before or during the response to promote errorless learning and try out these other types of prompts if you are having trouble inspiring independence in a skill.
Sources:
Cooper, J. O., Heron, T. E., & Heward, W. L. (2019). Applied Behavior Analysis (3rd Edition). Hoboken, NJ: Pearson Education.
