Level of help: a simple way to score sensory integration
In a sensory integration session, many tasks do not have a correct or incorrect answer in the usual sense. The child climbs the climbing wall, crosses the balance beam, or sits down in the swing by themselves. Asked "did they manage it?", the answer is often "yes". What changes from one month to the next is how much help they needed to manage it.
Level of help is a simple way to record exactly that, attempt by attempt.
Why correct or incorrect is not enough
Take an invented example. A 6-year-old girl is working on an obstacle course: she climbs a ramp, crawls through a tunnel, and jumps from a low platform onto a mat. At first, she is held by the hand the whole way through. Two months later, she goes through it alone, with just a single touch on the shoulder at the platform.
In a table with "correct" and "incorrect", the start and the end look the same: the task was completed. The most important difference, between being carried through the course and going through it almost alone, disappears.
Scoring with just two options pushes the therapist towards one of two traps. Either every assisted attempt is marked "incorrect", and the child seems to make no progress for months on end. Or every completed attempt is marked "correct", and progress looks complete from the very first week.
The four levels
For each attempt, you choose the level of help the child needed:
- Full help: you do most of the movement. You hold their hands the whole way, lift them onto the platform, guide every step on the beam.
- Moderate help: the child does part of the movement, you complete the rest. You support them at the hip as they climb the wall, or hold the swing steady until they sit down.
- Minimal help: the child does almost everything alone. You only need a light touch, a gesture towards the next spot, or a short word: "foot here".
- Independent: the child does the task from start to finish, without any help from you.
It matters that the whole team uses the same definitions. If one therapist scores a gesture as minimal help and another as independent, their data can no longer be compared. It is worth writing down together, for each programme, what each level means in concrete terms.
Withdrawing help gradually
The goal is not just for the child to succeed, but to succeed with less and less help. That is why many teams plan in advance how they will withdraw support: from full physical guidance, to a touch, then a gesture, and finally nothing. Others start the other way round: they let the child try alone and add only as much help as needed. The choice depends on the child and the task.
A few things worth watching:
- One step at a time: withdraw help gradually. Jumping straight from full help to independent can suddenly make the task too hard, and the child may avoid it next time.
- Help given at the right moment: step in before the attempt becomes frustrating, not after the child has given up.
- Help the child starts to depend on: some children end up waiting for your touch before they start. If you notice this, discuss as a team how to withdraw the support.
What help you use and at what pace you withdraw it remain decisions for the therapist and the child's team. Scoring only makes them visible.
What progress means
Progress is read in the proportion of attempts that shift towards Independent. A session might have five attempts: two with moderate help, two with minimal help, and one independent. A few weeks later, the same task might show one attempt with moderate help, two with minimal help, and two independent.
Neither session has every attempt independent, but the direction is clear. This is exactly the information that gets lost when you only score "correct" or "incorrect".
Watch out for hard days. A tired child, after a bad night or on a noisy day, may need more help. A single session does not change the overall picture. Look at the trend across several weeks, and note down in a few words what happened on that particular day.
What a session looks like
- You choose the task and remind yourself what each level means for it.
- For each attempt, you score one of the four levels.
- At the end, you add a short note: what help worked, what the child avoided, what you will change next time.
It takes a few seconds per attempt, and after a month you can see clearly how much the help has been withdrawn.
What you show parents
For parents, level of help is easy to understand. "They now climb the wall with a light touch on the back, instead of being held by the hand" says more than "they succeeded five times out of five". It helps them at home too: they know how much to step in, and when to let the child try alone.
In TempoApp
In TempoApp, the Level of help method scores each attempt as Full help, Moderate help, Minimal help or Independent. Each session becomes an independence score from 0 to 100, from the average of the attempts: Full help counts as 0, Moderate help as 33, Minimal help as 67, and Independent as 100.