Introduction / background Information

I consider myself fortunate to live and work in the beautiful County of Northumberland which is home to approximately 316,000 people. 97% of Northumberland is classed as rural covering an area of 5013 km2. 

Northumberland borders Cumbria to the west, County Durham to the south and the Scottish Borders to the north. 

Northumberland Portage Service

The Northumberland Portage Service is made up of four full time Portage Home Visitors (one of which is Portage Lead), two part time Portage Home Visitors and our Secretary who provides the whole team with administration support for two days per week. 

I joined the Northumberland Portage Service in 2003. We work very much as a team providing support to families across the whole of Northumberland who have children (0-5) with additional needs.

Each family and child is unique and requires an individual programme of support which is planned and implemented by working together in partnership.

This case study is based on a little boy called Vincenzo (known as Enzo to his family) and highlights the importance of multi-agency working during the home/school transition.

The family Background

In August 2010 we received a referral from a local Consultant Paediatrician asking for Portage involvement with a family who had a little boy aged 7 months with a diagnosis of Four Limb Cerebral Palsy.

Whilst on the Portage waiting list, Enzo and his mum accessed a multi-disciplinary group session held weekly at the Children's Centre which was run jointly by the Occupational Therapy and Physiotherapy Services.

Portage are also involved with the groups so we use these sessions to get to know the children and their families prior to home visits.

Enzo's father is Italian and works long and unsociable hours as a chef in a restaurant. Enzo's mum was aware very early on that things did not seem quite right stating "Enzo was very unsettled and crying a lot of the time" feeding was difficult and she reported that his muscle tone appeared very "stiff". She had decided even before his diagnosis that she would not be to returning to work. 

In the village where the family live, there is a small First School which has nursery provision for children to attend the term following their 3rd birthday. There are no toddler groups or support groups locally.

The family were visiting 'Little Miracles' a support group which involved a 10 mile round trip. The family found this worthwhile as they valued the friendship and support they received within the group which was attended by families experiencing similar difficulties.

The staff at the group supported families with any financial concerns i.e. providing advice support for DLA (Disability Living Allowance) and other benefits which they may have been eligible to receive as well as providing an outlet for families to share their experiences and feel that they were not alone.

The Approach

Portage started regular weekly home visits in July 2011 when Enzo was 18 months old. We quickly established a close relationship.

Using Portage assessment resources and through discussions with parents to find out their fears, concerns and their hopes for Enzo, we identified his strengths and highlighted areas for further development. 

A Baseline Assessment was carried out and we agreed Long Term Goals which fit in comfortably with the family daily routines, values etc.

One of the advantages of carrying out joint home visits with other involved professionals meant that we could incorporate their targets into what we were working on i.e. his Physiotherapist was working on supported sitting and Portage target was maintaining grasp of object placed in his hand. His Long Term Goal was that ‘In supported sitting, Enzo will maintain grasp of an object placed in his hand for 1 minute.

As the family were experiencing a high number of hospital/clinic appointments, joint home visits were carried out whenever possible to reduce the number of visits the family had on a weekly basis. I discussed with the family initiating a CAF (Common Assessment Framework) which would enable us to gather everyone involved together on a regular basis to share relevant information and this was set up with Portage taking on the role of Lead Professional.

Over the following months we observed some amazing learning during our visits which highlighted to everyone involved that Enzo's physical difficulties (muscle tone/spasms etc) were the barriers which we needed to address to support his learning.

Working closely with the Physiotherapist and Occupational Therapist specialist equipment was provided to promote weight bearing, posture etc. Enzo is an incredibly bright little boy who picks things up very quickly. He is mischievous and will push the boundaries to the limits - the same as any 2-3 year old! 

As the months passed we started to look at what pre-school provision might be available for Enzo to access the term following his third birthday. Around that time Enzo's parents were delighted to announce that Enzo would have a new baby brother or sister in the New Year (2013).

Partnership Working

Due to Enzo's physical, learning and medical difficulties it was essential to adopt a multi-agency approach so that everyone was kept up to date with any changes in circumstances.

Regular 'Team around the Child' meetings had been established as part of the CAF and we also had opportunities to share information during multi-disciplinary feeding clinics held by the Consultant Paediatrician and Speech Therapist. Joint home visits were also now well established.

As Enzo was now approaching school age it was imperative that we started planning early in preparation for his transition and everyone involved was aware of the role they had to play. Enzo was accessing some pre-school provision at a private day care nursery with funding we had accessed from the Children's Disability Team in Northumberland for one full day per week.

His mother was now well into her pregnancy and was feeling tired so it was important to provide her with some respite to maintain her health and wellbeing.

Enzo's parents stated that they very much wanted Enzo to attend his local First School nursery so that he could get to know and develop friendships with children in his community. In February 2013, we initiated a request for Statutory Assessment with the Local Education Authority.

CAF meeting notes and action plans were reviewed and drawn up for use at every meeting. 

The action plans were an essential tool to recording and ensured that all actions were carried out. They also meant that new people invited to the meetings i.e. School SENCO and Head Teacher could quickly be brought up to speed with past actions and enabled them to contribute and share information. 

Enzo’s school highlighted the importance of accessing relevant training for all of their staff prior to Enzo starting nursery in the September. A list of training and appropriate training providers was drawn up between all agencies involved.

The following key areas were highlighted for training.

• Feeding - Enzo was gastrostomy fed and would require either being put on or taken off a feed during his morning session. The Community Nursing Team liaised closely with the school to provide training.
• Lifting and handling - generally moving Enzo around the nursery to access a range of activities at varying heights/areas etc. The Occupational Therapist and Physiotherapist liaised closely with nursery staff to provide training with specialist equipment i.e. standing frames, seating and access to areas around the school. 
• School access - The Head Teacher liaised with the Local Education Authority who carried out essential work during the summer holiday period to widen doors and provide ramps etc for Enzo's wheelchair access.

Leading up to and over the summer holiday period both the Day Care Nursery Manager and Head Teacher worked together to draw up a rota to release staff.

Both support assistants were able to spend time in each other's settings observing and sharing information about how Enzo's needs could be best met and how they could provide a smooth transition for Enzo and his family into his new learning environment.

All resources for activities being used with Enzo were duplicated so there was clear continuity in activities and approaches across both settings as well as at home.

As part of the Statutory Assessment process, the LEA Educational Psychologist visited Enzo at home and linked into the Team around the Child meetings to gather information and liaise with others involved in Enzo's care. She stated that she found this invaluable and was able to provide a detailed report which highlighted parent’s concerns and wishes and identified close working relationships between all professionals involved.

Outcomes

In September 2013 Enzo started attending his local mainstream nursery. The planned activities i.e. matching games (photographs of new staff/activity areas) carried out over the summer holidays and opportunities to visit his new 

nursery meant that he was familiar with the environment and nursery staff.

Planning early for his transition has enabled him to settle quickly. His parents report that he loves going to nursery and that he is developing lots of new friendships.

His parents are confident that they are leaving him in a safe and very inclusive environment with staff who are all trained to meet his individual needs. They have opportunities daily to share information/raise concerns and feel that staff kept them fully informed of Enzo's progress.

The Disabled Children's Team continue to fund 1 day per week over the holidays so contact has been maintained with his key worker at the Private Day Care Nursery who visits Enzo at school before any holiday placement.

Conclusion

Portage has now withdrawn following Enzo's successful transition into his mainstream nursery. For me, this case study highlights the positive outcomes when all services work together in partnership with families, share relevant information and plan ahead. 

I use this example to highlight good practice whenever possible when supporting families through transition. It shows what can be achieved with positive attitudes to inclusion and incorporates all of the Portage principles that 

Home Visitors strive to achieve when working with families.