In his assessment by a paediatrician, R was described as having ‘classic autism’ and that he was severely delayed in his development of speech and language skills and also in relation to his socialisation and social communication. R was also noted to have learning difficulties as his cognitive skills were delayed.
Introduction
As a Portage Home Learning Practitioner, we are all 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 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. We then use this initial baseline 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 funded by the local authority, which 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
Context
Child R was referred to KIDS following a recent diagnosis of Autism. He is 2 years old and lives at home with Mum, Dad and older sister L who suffers from a severe form of arthritis.
In his assessment by a paediatrician, R was described as having ‘classic autism’ and that he was severely delayed in his development of speech and language skills and also in relation to his socialisation and social communication. R was also noted to have learning difficulties as his cognitive skills were delayed.
The family have expressed a few concerns in relation to R and his behaviour and difficulties he has in a variety of areas. The main concerns from the family were in relation to R’s communication, his sleeping patterns and his ability to be around and play with others.
The Approach
As R has a diagnosis of Autism, in addition to using the Portage checklist to assess his skills, I also used the ‘Venturing into Play’ checklist devised specifically for children with Autism.
Using both of these checklists myself and Mum were able to establish a clearer picture of R’s current skill set and were then able to devise manageable, small step aims for him to work on. These aims were set in partnership with the family around R’s areas of needs.
Intervention
To help R start to work towards and meet his aims I would plan a weekly session that I would carry out with Mum and sometimes Grandma present.
Initially as Mum informed me R does not particularly enjoy playing with others and can sometimes become distressed around new people I asked Mum what were his favourite toys to play with.
I then used these toys to help R become more familiar with me and I would also invite Mum to join us on the floor during the session to put R more at ease.
Following these first few introductory sessions we were able to get to work on the aims set for R. To help R become more tolerant of playing with others in some of my sessions I would use an ‘Identiplay’ approach with Intensive Interaction, this involved sitting directly opposite R and us both having the same toy.
I would copy R’s actions and also occasionally reach out to R’s toy. This approach was very successful with R as he began to reach towards my toy and also would look up at me during these sessions and smile!
In relation to his communication development; as R’s communication is very limited, myself and Mum agreed that we would start with very small steps, and this began with encouraging R to request ‘more’ of an item he enjoyed.
This request would be in any way R expressed. Initially R would request by bringing me an item, then by giving me eye contact following a cue of ‘Ready, Steady’ and R is now making vocalisations to request ‘more’ in addition to eye contact!
In relation to R’s sleep problems; I have given Mum advice based on the ‘Sleep Solutions’ seminar I attended at the Annual National Portage Association Conference that was very informative.
I provided her with some hints and tips around bedtime and also a list of things to consider and foods that can help to induce sleep. We have also planned in the New Year to complete a ‘Sleep Diary’ so we can try and identify patterns in R’s problems with sleeping.
In addition to this, R is displaying sensory seeking behaviours during the intervals when he wakes so I have issued a referral to Occupational Therapy to seek further advice for R.
Partnership Working
I have also carried out joint visits with the Speech and Language therapist and we have been able to share aims and carry out play sessions together, which is something Mum has informed us is very beneficial.
Outcomes
Child R is still receiving weekly Portage sessions and is making good steady progress in the identified areas of need. Myself and the family are working very hard with R to help him meet his aims and he has already met 3 out of the 5 aims set and the other skills appear to be emerging!
R’s Mum has also made an application to the school where his sister attends for a place at nursery when he turns 3. Mum is very pleased with the progress R has made so far and was very happy when I informed her I would be supporting R weekly until he enters provision. She informed me she is finding our sessions very helpful for R.
The Speech and Language Therapist has also reported a good improvement in R’s communication and social communication skills and would like to continue to carry out some further joint working.
Next Steps / Conclusion
R’s Mum has made an application to the school where his sister attends for a place at nursery when he turns 3. Portage sessions will continue and new aims will be set for R every 12 weeks. These will continue to be set in partnership with parents. R will also be supported when he goes into nursery with a handover of all information from Portage being given to nursery so they can have some information about the skills R has developed while receiving Portage.
