Introduction

As a Portage Home Learning Practitioner I am 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 I am 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, Cognitive & Socialisation.

I then use this initial baseline with parents to 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.

Background / Context

J is a two year old little boy with a diagnosis of cerebral palsy.

Across the week, J has appointments with a speech and language therapist , a feeding specialist, an occupational therapist, a physiotherapist and the visual impairment team.

J has had frequent visits to his GP and is often diagnosed with chest infections. On a few occasions, J’s mother has had to take J to the local Accident and Emergency when concerned about his breathing.

J needs support in all areas of self-help, including full support when moving from one position into another. J can become quite frustrated when he is unable to do something without support or if he has difficulty communicating what he wants.

However, this behaviour is very appropriate for J’s stage of development.

The Approach

J began by attending the developmental play sessions, a weekly group established using the principles of Portage, with the added extra of socialisation for both children and parents. When attending the group, we worked on J’s positioning when engaging in activities as his increased tone in his four limbs means that he has to work hard to develop his motor skills.

It was clear that once J approached 2 years of age, he was keen to work on activities that were more challenging. We then began weekly home visits.

The three elements of the Portage model; structured teaching, child led play and family support are the fundamental basis of each home visit.

To begin, the use of the Portage checklist can highlight baseline skills and help to plan future activities and targets, taking the nature of J’s individual needs into consideration.

It was also important to discuss what was important to J’s mum, to help shape the work to be carried out. In this particular case, we decided it was important to ease J’s frustrations and help J to develop a way to communicate his own decisions in partnership with his speech and language therapist.

Structured Teaching

The speech and language therapist provided an A3 frame for picture cards to be placed on, alongside a physical object, the spoken word and Makaton sign.

This would allow for many opportunities for J to understand what is being offered and to allow him to make an informed decision. The use of the frame and picture cards meant that J could choose an activity by looking at the picture (eye pointing).

To begin, singing was highlighted as a motivator for J, so this was added to the functional activities: cup, drink and singing.

After practice, the number of options given increased to allow for ‘drawing’ and ‘toys’. This then led to taking photos of favourite toys so that the physical object did not need to be shown alongside the picture card.

During each home visit, I used clear language, modelling to parents how activities should be carried out to ensure continuity and optimum results. For example, using the same phrase; ‘J, it is time to choose’ and ‘You’ve chosen singing! Good choosing!’

I also modelled leaving plenty of reaction time, to allow J to process information and make his response.

Encouraging parents to monitor activities throughout the week, using a bubble chart for example, was a good way to show the benefit of practicing structured learning as part of every day play. Working in partnership with parents is key to the success of Portage intervention.

Child Led Play

Using J’s likes and dislikes for different toys and activities was fundamental to the success of his choosing activities. We could build on J’s abilities and strengths by observing J’s initiatives during child led play and then using this as a platform for introducing new play ideas, for example; choosing individual songs using song cards.

Family Focus / Partnership Working

The Portage approach allows for flexibility, taking into account the needs of the family as well as the child. Alongside J’s needs, there were some things that J’s mother needed support with.

J’s mother had done an incredible job attending all of J’s appointments, taking in the information regarding his diagnosis as well as coming to terms with the issues that the future may hold. However, she was coming to a point where she needed more support to cope with all of this and to feel confident that the professionals around her were there to support her.

It is always important to gain a holistic assessment of the family and understand that if the parents are feeling unhappy then the work carried out with the child may not always be successful. Therefore, to support mum to feel confident in herself and the work being done with her child would allow her to move forward with the objectives created to help move J forward.

As well as working in partnership with the parents, a good relationship with the other professionals in the team around the family is also very important. In this particular case, working in partnership with the speech and language therapist was key to successfully achieving the aims set.

Meetings involving all professionals working with the family were essential to ensure that everyone is working with the same techniques in mind. This also helped J’s mother to feel confident in the work being carried out and also feel part of that team. With so many people being involved in her routine, she was at risk of feeling like others were taking charge.

It is difficult to share feelings amongst a group of professionals, therefore it was important to allow for J’s mum to feel comfortable with the lead professional acting as a voice in times of difficulty.

Having the knowledge from each professional working with a child allows for a well-structured approach to Portage intervention. From gaining this information, an ‘All About Me’ book was created with J and his mum to bring together all of the information that would be required to help other professionals to understand what J likes/dislikes, how he communicates, what positions are best for him to access. This further ensured that the appropriate information was being shared with those looking after or working with J. 

In addition, working together and using information from J’s mum, highlighted that she is the expert on her child and was empowering. Providing a flexible service and acknowledging the changing needs of the child and family also helped J’s mum to trust Portage and the service it could offer.

The positive approach of Portage, which focuses on what a child can do, rather than what he can’t, also helped this family to cope with the multiple appointments that often highlighted all of the areas of development in which J was delayed.

Conclusion

In conclusion, it was a combination of all the elements above that allowed for J to progress to a stage where he was able to make more of his own decisions regarding his routine and play, by creating a form of communication that was adapted to his own needs.

J has made such a lot of progress in this time, with the help of the team around him and especially highlighting the dedication of his Mum and family which was shared with all of those who are working with him. J is now able to communicate what he wants with less frustration. This has been achieved by breaking down the process into small steps, across a period of time of practice, alongside working in partnership with all of the professionals to ensure everyone was using the same approach.