Introduction

Torbay is a small unitary authority in South West England.  The Portage Service is made up of 4 home visitors (2 part time, 1 full time and the Portage Manager who is seconded for 2 days a week).  We sit as part of the SEN team within the local authority. 

I have been a Portage Home Visitor for about 13 years.  I started as a sessional worker and was then lucky enough to secure a full time position in Torbay.  In 2004 Torbay became a pathfinder for Early Support and so key working was part of our contract, 2 full time designated keyworkers were also employed at this time – 1 is still in position today.

Torbay Portage including the designated keyworker is currently visiting 51 children in the bay.  We offer a service to preschool children who have a developmental delay in 2 or more areas.  We are able to offer a service that is unique, focusing on the individual needs of each family working in a multiagency approach. 

Family Background

This case study is based on a little boy called Jeydan who has Down Syndrome; he has had significant medical needs due to heart defects chronic lung disease and is peg fed. He spent the majority of his first 18 months in and out of hospital.  Jeydan also has a significant hearing loss and low muscle tone.

A referral was made to the inclusion service soon after Jeydan was born. 

The designated keyworker started the service and was able to start co-ordinating joint visits with health professionals and ensuring benefits were up to date and reflected Jeydan’s needs.  Dad reduced his working hours to give support to mum and to care for Jeydan’s older siblings who were not yet school age.

Jeydan’s family had access to the Special Needs Parent support group run by the designated keyworker which is held at local Children’s Centres across the bay.  Mum and Dad accessed these sessions occasionally when Jeydan was well enough.

The Approach

The designated keyworker started to transition Jeydan to Portage soon after his first birthday (Sept 2013), however weekly visiting was not established until the Spring of 2014 due to continual hospitalisation.  Jeydan left hospital fully dependant on oxygen.

Initially visits were more family focused; getting to know them and understanding the impact of Jeydan’s medical and developmental needs were having on the whole family.  I was able to update DLA adding oxygen dependency on to his care needs. 

What was very clear from the beginning was that even though Jeydan did have a number of medical needs Mum and Dad wanted Jeydan to experience as normal life as possible and were keen to explore mainstream nursery provision.

As Jeydan began to get stronger so the emphasis started to change from family focus to child led play and then eventually I was able to introduce the structured teaching element to the home visit.

At this point Jeydan was unable to sit independently, used crying as his functional communication but was developing some single sounds, he was able to roll to his right and he was really responsive to music.

We worked on completing a baseline assessment using the most appropriate tools (Derbyshire profile, Early Support Developmental journal) which then informed us of short term targets and the priorities of Mum and Dad.

Targets at this point were;

Communication:

Jeydan will restart a song by looking or smiling at the adult when a pause is introduced at a motivating point of the song.
Jeydan will imitate consonant sounds in imitation of the adult.

Physical;

Jeydan will sit in long sitting with minimal support from the adult and manipulate a toy.
Jeydan will prop on his elbows whilst on his tummy and reach for toys alternating between his hands.

Fine motor;

Jeydan will manipulate his toys bringing both of his hands into a midline position.
Jeydan will reach across his body whilst in long sitting to retrieve a toy.

Physiotherapy, Occupational Therapy and the Advisory teacher for the hearing impaired were all involved in setting these targets, it was important to me that the targets were linked, for example in long sitting the communication targets and the fine motor targets could all be worked on simultaneously.

During this time we had visited the families’ local non maintained nursery and I was starting to liaise with the staff and organising a transition in preparation for starting in September 2014.  To give Mum and Dad a complete over view of education provision available I accompanied them to the local specialist educational provision.  They were clear that they wanted Jeydan to attend mainstream education.

Partnership Working

The transition meeting was held at the end of June 2014.  All health professionals and therapists were invited and all but the Paediatrician attended. From education the advisory teacher for the hearing impaired attended as did the designated keyworker.  The Early Support Family Service plan was used to record the minutes.

The nursery were very anxious about having Jeydan attending, so that they could safely accommodate him the oxygen needed to be stored securely, his feeding equipment had to be stored and training was needed for all key members of staff with regards to feeding, the use of oxygen and care of the hearing aids. Manual handling, structured teaching and child led play activities also needed to be discussed and considered.

Every professional who attended the transition meeting had responsibilities for training and supporting the staff to make Jeydan’s start in the September a success.

The key nursery staff attended Portage sessions so that they could start feeling comfortable in handling Jeydan. We worked together building up resources that complimented what Jeydan was achieving at home.

I attended the full staff meeting at the beginning of term just to answer any questions about Jeydan’s care and to be clear that all actions from the transition meeting had been achieved.

Following further surgery at the beginning of the September Jeydan started nursery at the end of September 2014.

Outcomes

Jeydan has just completed his first year in nursery and is moving to the preschool room September 2015.  Multi agency Individual Learning and Development Plan meetings have been held every 6 – 8 weeks so that communication remains open and issues can be resolved quickly.  The nursery is supported by the therapists, dietician, and Advisory teacher and have regular contact with me to problem solve teaching activities that are not working and the ones that are.  Jeydan has achieved all his targets set at the meetings which illustrate the Portage Principles of achievable small steps to learning.

Following regular supervision it was decided that an Education Health and Care plan should be requested due to Jeydan’s high level of need.  This has been finalised and can be reviewed regularly to address Jeydan’s changing needs and preparation can start in planning the transition to the local mainstream primary school.

Jeydan is now off his oxygen and is starting to take foods orally.  He can sign up to 20 words and is starting to put words and sounds to a lot of them.  He is still very motivated by songs and can request his favourites using actions and sounds.  Jeydan is standing at furniture whilst supported by an adult.

This has been achieved from the determination of his parents to send Jeydan to a mainstream setting and the professionals working in a multi agency approach to make his attendance in a main stream nursery successful.

Next Steps

Jeydan and his family will now be moving on to the children’s disability social work team for ongoing support and Portage will support Jeydan into his primary school setting.

Jeydan and his family have been supported by a multi-agency team which has worked towards Jeydan continuing his education in a main stream setting.