Child H was referred to KIDS by her Paediatrician when she was a year old. She was first visited by KIDS for Portage Home Learning in July 2013 when Child H was 15 months old. I took her onto my caseload when my colleague left in August 2013 and I have been visiting her on a fortnightly basis. 

Introduction

As a Portage Home Learning Practitioner we are all trained in the principles of Portage and use the three elements of the Portage model: Structured Teaching, Child Led Play and Family Focus.

As part of this training we are also instructed to use a Portage Checklist to establish an accurate baseline of each child’s developmental levels and skills. The checklist is divided into areas of development including: Motor, Communication, Self-Help, Cognition & Socialisation.

Using the initial baseline with parents, we work together to help set aims for children in the identified areas of need. The facilitation of developing the child’s skills in these identified areas of need are implemented through play based activities.

This structured teaching is carried out alongside any family support that may be necessary in order to meet the family’s needs as individuals. Examples of this include: joint working with other professionals; organising Team Around the Child meetings and signposting and referring families to other services.

The Portage service in Southwark is provided by the charity KIDS and is funded by the local authority. The service has been running for 16 years.

We work with children under the age of 5 years who are showing delayed development in at least 2 key areas, before they enter early years provision. When the service starts, the family will receive visits on a weekly or fortnightly basis and where possible we attempt to be as flexible as necessary in order to provide the service at a suitable time for each family and their differing needs.

In addition to the Home Learning service we also run a Developmental Play Session for children under 18 months or pre-walking. This group uses the principles of Portage but it is delivered in a group setting.

Family Background

Child H lives with her parents and 5-year-old brother in a second floor flat in Walworth, Southwark. Child H is 18 months old and has global delay. Her brother also has global delay and attends a special school.

Child H was referred to KIDS by her Paediatrician when she was a year old. She was first visited by KIDS for Portage Home Learning in July 2013 when Child H was 15 months old.

I took her onto my caseload when my colleague left in August 2013 and I have been visiting her on a fortnightly basis. I had visited the family approximately 4 times and had attended a Physiotherapy visit with Child H, when I set her aims for the next three months. These were joint aims with the Physiotherapist.

The Approach

Child H is a friendly little girl who always has a smile for me when I visited her.  She has an undiagnosed condition and is very physically and cognitively delayed and she presented as a much younger child, than her 16 months (Developmentally 6 -7 months); she was not yet sitting without support and was not crawling.

Child H’s movements are jerky and she tends to look up. I noticed this was a particular problem in keeping her attention on the activity in front of her. Her focus is limited and my sessions had to be kept short as after about 10-15 minutes she would get fretful and start to cry.

One of my aims was for her to find a hidden object (object permanence). For this activity I needed shiny beads and a dark cloth and later a flashing torch.

She loved the beads and anything that was shiny. I wanted her to find the shiny beads when she had followed them and I had placed them under the cloth.  Because of her looking up I held the beads above her head until she had reached for them, then I moved them slowly down and under the cloth.

At first, she followed the beads but as soon as I placed them out of view she lost interest and looked up again. I tried this several times but it was not working. Then I remembered a flashing torch that I had with me and she had liked on a previous session.

I repeated the activity with the torch and because she could still see it flashing under the cloth she lifted the cloth and found the torch. This was repeated several times and she was learning to lift the cloth.

I tried the game again with the torch flashing above her head and then off under the cloth and she found it again, even through it was not flashing. I turned the torch on to reward her when she found it.

This was repeated several times. She was getting a little fretful by now and I let her mother comfort her for a while. However, before I left I tried with the cloth and the beads again. This time she lifted the cloth and found the beads!

I was using the elements of Portage to set SMART targets and I broke the task down into small steps using toys that the child was interested in. She achieved an aim that I had lifted from the Portage Check List.

I left the beads and cloth with Child H’s mother to continue the activity during the week and wrote this on an activity chart. I explained that she could use anything that interested the child, i.e. food, small toys etc.

Partnership working

This particular activity was not directly suggested by other professionals working with the child but it is an exercise that is often used by Speech and Language Therapists. I was also working closely with the child’s Physiotherapist and half of each home visit would be spent working on her sitting unaided and getting into a forward crawling position.

Outcomes and Conclusion

Child H had learned how to find a hidden object; due to her global delay she was not learning this skill naturally. Her mother also learned that this was a skill that she could help her daughter achieve by just playing with her, using everyday toys that her daughter liked as strong motivators.