Southwark Portage Worker - Case study one

I have recently started visiting a little boy (X) who is 2 years and 8 months. He lives in a high rise 2 bedroom flat with his mother, father and 3 older brothers. The family have lived in the UK for a few years, and previously lived in Afghanistan.


As a Portage Home Learning Practitioner, I am trained in the principles of Portage, these key principles are; Structured Teaching, Child Led Play and Family support. As part of this training we are also instructed to use a Portage Checklist to establish a baseline of development of skills a child has.

The checklist is divided into areas of development including: Motor, Communication, Self-Help, Cognitive & Socialisation. We then use this initial baseline to help set aims for children in the identified areas of need.

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

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

We work with children under 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.

Family Background

General information

I have recently started visiting a little boy (X) who is 2 years and 8 months. He lives in a high rise 2 bedroom flat with his mother, father and 3 older brothers.

The family have lived in the UK for a few years, and previously lived in Afghanistan. English is an additional language for the family, their first language being Dari. I deliver home learning with the help of one of X’s brothers as his mother doesn’t speak English and his father is at work when I visit.

Referral details

X was referred to KIDS by a speciality doctor in community paediatrics.  Main concerns reported were:

1 – Possible social communication disorder

2 – Severe speech and language delay

3 – Moderate delay in personal/social skills

4 – Mild delay in gross motor skills and performance skills (puzzles).

Five months after the initial referral, X was diagnosed with Autism. I started visiting X two days after the family had received X’s diagnosis. At the time of writing this case study, X has had 4 Portage home learning sessions.

The Approach

My 1st few visits were focused on making sure X felt comfortable in my presence, giving him opportunities to explore different toys and for me to follow his lead.

He quickly settled into the routine and seemed happy to engage with me. It soon became apparent that learning priorities for X were supporting his attention, listening and looking, following instructions/understanding, verbal and non verbal language e.g. gestures and sounds/words.

To support X with the learning objectives I implemented ‘what’s in the box’. This is an activity where a selection of toys are placed in a box e.g. bubbles, ball, and a wind -up chicken.

The box is presented to X and I sing a repetitive tune and tap the box before opening it and offering the choice to X. This part of the activity supports X to listen, wait/anticipate and offers an opportunity for X to imitate my gestures (tapping) and to vocalise (sing). All of the objects in the box are motivating and support X to engage and extend his attention.

Bubbles – This supports X to attend, give eye contact /vocalise/sign for more. Link language to objects and vocalise ‘pop’ or ‘bubbles’.

Ball – This supports X to follow instructions - to roll the ball and to give the ball back on request and to take turns.

Wind -up toy – This supports X to request more if he enjoys it, to make an animal sound or say ‘chicken’ linking language to objects, and give it back on request (with gesture).

I have also implemented a visual timetable, so that X knows what to expect and what is going to happen next e.g. a photo of the box is followed by a photo of a book. This also helps X to understand when an activity has finished and when it is time to change to something else.

Elements of Portage principles

  • Small steps to learning.
  • Supporting X’s development through structured play and motivating activities in a familiar environment.
  • X’s mother and brother play a vital role in my home visits. X’s mother sits with us during the session and supports X to engage appropriately. X’s brother translates for me and implements any activity left with the family for the following week on a daily basis.
  • Aims have been implemented in conjunction with X’s family and are based on their priorities, supported by the Portage check list.
  • X’s family are interested in accessing a local stay and play group with me.

Partnership Working

I am going to be working in partnership with the Autism Support Worker based at the child development centre. One of the challenges is that the family understandably are finding it difficult to come to terms with their son’s diagnosis. 

This became apparent when X’s older brother returned from university and explained that he is concerned about the diagnosis being accurate.

I explained that it wasn’t for me to question the diagnosis and discussed elements of X’s development and behaviour which suggests X would require substantial support.  I recommended being careful with information read online and discussed Autism as a spectrum disorder.

I offered the family a joint visit with myself and the Autism Support Worker which they were very thankful for.

I will also work in conjunction with any therapists involved. A referral for Speech and Language Therapy has been made and I will hope to carry out a joint visit for consistency.


It is still early days with this family, so it’s hard to draw on any outcomes as yet. What is apparent is that X is making progress and is demonstrating some good attention, listening and imitation e.g. actions, sounds and attempting words. X is also responding well to routine and consistency.                                                       

Next steps

1 – Joint visit with Autism Support Worker

2 – Support family through the post diagnosis process

3 – Continue with aims and review in 3months

4 – Support family to attend children centre sessions