Introduction

• I currently work as an Early Years Specialist Support Teacher in Fenland in Cambridgeshire. My previous role as a Portage Home Visitor was also based in the same area (during which time I completed the Portage Workshop training).
• In June 2014 we began a new way of working with children who were accepted into Early Support and accessed an early years setting for less than nine hours. These children were invited to a group session based on Portage principles, prior to this we had long waiting lists for home visiting. 

The Family Background

• Single parent family, child aged 20 months. One older sister also known to the Support for Learning team before entering school.
• Referred to Early Support by specialist health visitor in November 2014, case was presented at Early Support mid- December where it was agreed he met criteria and that he should see a Speech and Language Therapist and be referred to the Support for Learning team. He was already known to a paediatrician.
• The child was seen by the Community Paediatrician and Speech and Language Therapist in March 2015 for a joint assessment where subdural effusion with macrocephaly and mild global delay with significant expressive language delay was confirmed. He began attending a support for learning group in January 2015 and is still attending in May 2015 although will be allocated to specialist support worker for fortnightly home visiting from the end of May.
• Family’s initial concerns were around supporting speech, behavior and having the right diagnosis.

The Approach

• From June 2014 we began to invite all children not attending a setting for more than nine hours to a specialist invite only group at their local Children’s Centre where we would run a session based on key Portage principles for all the children in the group. This group is jointly run with support from learning staff and a member of the Children’s Centre staff.
• Prior to the group starting the family were visited at home to establish priorities, concerns and ensure they understand the purpose of the group. Information is also gathered from other agencies involved and used to begin the Early Support Developmental Journal.
• Week 1 of the group Mum and Dad attended and met the person who visited them at home in the group along with other group staff and myself. I talked to parents about information gathered and what next steps were important for them as a family. Together we made these into small steps and recorded these as the targets for the next six weeks.
• Together we planned three targets, one around cognition, one around language and one around fine motor. Each of these targets, as well as a description of baseline behaviour were agreed with the family. The baseline, the expected behaviour after 6 weeks and the level that is achieved are all converted into a number between 1 and 10 to enable comparisons to be made and progress to be recorded.

Targets were as follows;

• ‘P’ will use the sign or make a sound for “more” after watching/ listening to an adult model 50% of the time.
• ‘P’ will remain within the small group during group time for one song and will use actions within one known song e.g. row row or pat a cake
• ‘P’ to thread three beads onto the string with a wooden rod handle 100% of the time. ‘P’ to use both hands to complete this. Adult to support using hand over hand initially and give lots of verbal praise.
• We also set a parental confidence/ involvement target; Mum and Dad will feel confident about reducing their language in order to help ‘P’ understand what is happening and to help him gain new words.

• Week 2 staff modelled to Mum and Dad how to support their child to work towards the targets and demonstrated different activities that they could use. They also gave time for child led play and joined him at his own activities. There was also opportunity to be around children of a similar age or development level.
• Week 3-6 staff discussed with parents/carers attending with the child how they have been getting on with the targets and have the opportunity to demonstrate to staff how much progress has been made. Lots of praise and positive language is used when a child achieves something new or moves towards their target.
• Week 6 staff talk with parents about how they have got on with targets including the parental confidence target and a description of achievement is recorded and celebrated.
• Activities used for target 1 included bubbles, blowing some and waiting for an indication from the child that he would like “more”. When he started attending he would make eye contact to make a request but did not yet say or sign “more”. He was using some single words.
• Each week parents would use bubbles as this was the child’s favourite activity. They would blow some and then wait for him to look, as soon as he looked they would say and sign more and then immediately blow more bubbles.
• At the review week it was noted that the child consistently looked towards the appropriate adult and watched them sign more, he also tolerated someone using hand over hand support to help him sign more. He had occasionally made a noise when the bubbles stopped but not consistently enough to be sure the noise was a request.
• After around 8 weeks of working towards this target new motivators were emerging and we used this as a time to generalise the skill of requesting to other items, this was explained to parents and items including building bricks (for a tower) and tickling games were used.
• The family saw a speech and language therapist at their initial assessment and were discharged with advice about developing early communication and language. All staff at the group worked closely with the speech and language therapist and targets were shared with her to check they were appropriate.

This case reflects the following Portage principles;

Partnership (with health, children’s centres, and family), inclusion (the family and child were part of a wider group, where small steps are celebrated, there is also significant effort made to ensure that the family are signposted to other relevant support groups, networks and groups).

Generalising skills (generalising communication skill and also fine motor following the initial six weeks).

Enabling (we enabled the child and family to succeed), looking forward (the goals support this and when longer term goals are identified by the family we use to ensure that we are looking forward to when they are able to achieve these by using small steps).

Practical, immediate and relevant (the group allows us to support families in a time efficient manner which we wouldn’t have been able to do before, the activities we identify are always practical and immediate often without specialist equipment, where a specific piece of equipment is needed e.g. threading rod, then this is loaned to the family),.

Supporting (families say that the group is supportive and recognises individual and family needs; they like the emotional support as well as practical developmental support)

Whole child, family and community (by running the group within the families local children centre we are able to support the family by making those local community links with them, the whole child and family’s needs are considered when offered a place at the group, when targets are set and when activities are chosen).

Being positive (all staff support parents to be positive and celebrate the small steps of progress their child is making.

Partnership Working

• Also involved; Paediatrician and Speech and Language Therapist.
• Parents were shown how to put in place the recommendations of the Speech and Language Therapist during child led play. Parents were less upset about being discharged from speech and language therapy because they felt that the group and staff at the group were supporting him to make progress with his communication).
• From March 2015 (‘P’ has now had two sets of targets) it was felt that the family and child would 
• benefit from home visiting to continue to support development and eventually accessing an early years setting. There was at the time no space with a home visitor so the child continued to attend the group and targets were reviewed and set to ensure progress was being made.
• Further opportunity will come for partnership working at the Family Service Plan when the family meet with all professionals involved, where possible, and talk about their child’s needs and who and how we can support this need along with SMART outcomes which are reviewed in 6 months’ time.

Outcomes

• Since January 2015 the child is now knowingly playing alongside other children and occasionally initiating interactions with them, he is using more single words and sounds as representations, he is able to use two hands to thread beads, he is able to follow motivating parts of the group routine such as snack time and joins in group singing time for his favourite songs, he independently uses actions for his favourite song.
• Clear developmental progress within an age band is evident on the child’s developmental journal. Developmental progress against each goal can also be seen within descriptions of behaviour and scoring of achievement.
• Parental confidence has increased and descriptions of achievement have been incredibly positive as well as the scoring against these.

Conclusion

• The family will receive fortnightly home visiting from the end of May 2015. This will continue to work on the goals set at the group and at the Family Support Plan.
• At the Family Support plan the whole family’s needs will be considered including finances where appropriate, housing, emotional needs of parents and impact on older sibling and her needs.
• Longer term the family have identified an early years setting they would like the child to attend and support for the family to begin this next step as well as work with the setting will begin in the near future.