The role of the portage home worker has been in the media spotlight this year after the Princess of Wales attended a sensory play session run by Kent County Council (KKC)’s portage team. While the Princess got down on the floor with the children, plunging farmyard animals into shaving foam and throwing shredded paper into the air, parents spoke to her about the ‘invaluable support’ they receive from the service.
‘The visit has helped raise the profile of portage services and the vital support we provide for families and children with complex and specialist needs,’ explains Janet Rickman, chair of the National Portage Association (NPA), the charity that supports portage services, families and professionals.
‘The next five years are crucial to the NPA and portage services,’ she adds. ‘We want portage to be a better-known household name so that no families are missing out on vital support.
‘And we want more early years professionals to undergo portage training to support them with the unprecedented number of children with SEND.’
What is portage?
Portage is a home-visiting, pre-school educational service that supports children with the ‘highest level’ of additional needs and their families.
Most portage services offer group sessions, connecting parents on similar pathways and helping to reduce isolation. During the past year, 110 local authorities have delivered NPA’s quality approved portage services to 15,300 children across England and Wales.
Children who fit the criteria for assessment must have a delay or difficulty in two or more areas of development, which accounts for ‘around two per cent’ of the school-age population, Rickman says. Referrals come from multi-agency health teams, early years settings, or parents can self-refer online.
Each local offer differs, but councils usually stop funding portage at age three, when children have access to the ‘free’ 15- or 30-hours nursery entitlement.
Although portage has been around since 1983, not everyone is familiar with the service.
‘Historically, more children would have gone straight from portage into special educational provision. But over the last decade, there has been a huge increase in early referrals for children with social and communication difficulties, many of whom are going into mainstream provision, often without a full assessment and appropriate support,’ Rickman adds.
The portage model has developed and evolved over the years to become a respected model of good practice and support for families. The principles can be applied to early years settings, and the NPA has devised a training workshop and a Stamp of Approval scheme for participating nurseries (see Further information).
Based on a set of principles which underpin service delivery, portage focuses on what children ‘can do’, celebrating their successes, no matter how small.
‘It can be a bleak time for parents when their child isn’t responding to their name or joining in with games,’ Rickman explains. ‘Our model is simple and effective. It focuses on what the child can do based on their developmental stage and not their chronological age.
‘We work in partnership with the parents to set goals that are then broken down into achievable targets using a “small steps” approach. These targets are agreed with parents and communicated in clear, concise language and they become the benchmarks on which to celebrate their success.’
Small steps
‘We work with children with the highest level of need,’ says NPA vice chair Pam Fry, who also manages PlayWise, which is commissioned by Sutton Council to deliver portage services. This includes children with cerebral palsy, autism, complex health needs, learning difficulties and global developmental delay.
During the home portage sessions, practitioners plan fun, play-based activities, focusing on the senses. They have a ‘bag of tricks’ (see Case study, page 18) containing everyday items that are tactile and stimulating: a space blanket for its rewarding ‘crinkly’ nature; flashing spinning tops; feathers for tickling – and lots of bubbles.
‘We carry out holistic assessments of the child’s needs and plan successful outcomes based on the family’s priorities. This ranges from helping them learn to dress or feed themselves to sitting on a chair or posting shapes into a shape sorter,’ Rickman says.
Once the goal has been set, it is broken down into small steps, or targets. For example, Billy’s goal is to sit on a chair unsupported. To reach this point, practitioners might use a peanut-shaped ball, similar to a gym ball, for the time it takes to sing The Grand Old Duke of York – around five seconds. The first target for his parents is to do this twice a day, holding his hands, bouncing Billy on the ball, while singing. The second target might be to do this to the song, twice. They will then move on to singing the song while holding just one hand. All the while, he is building up his balance and getting a better sense of where his body is in relation to the world – his proprioception.
‘We work in partnership with paediatricians, speech therapists, physiotherapists and occupational therapists and incorporate their targets into our goals, through play,’ Fry says.
The trick is to use ‘simple language, repeated over’, explains Tracy Harvey, KKC’s portage county manager and training trustee for the NPA.
‘If parents embrace our way of working and think about how they can make things achievable for the child, the benefits are lifelong,’ she adds.
Training for early years professionals
Part of the portage practitioner’s role is to support children in their transition to nursery or school, an intervention which has been described as ‘game-changing’ by early years professionals, Fry says.
‘The child might be three years old but is functioning at 18 months [development]. It gives them the validation that it’s ok to go back to bubble blowing or introducing the small steps approach to posting. With this approach, the meltdowns fade and everyone is happier,’ she adds.
Research by University Northumbria and Elizabeth Fawcett, early development specialist teacher for North Yorkshire County Council, emphasises the value of ‘emotional support’ the service provides for parents, alongside education (see Further information).
The principles that underpin portage have been developed into a two-day, accredited Portage Workshop training for early years practitioners and teachers. Hayley Walker, manager of 59-place Blackthorn Good Neighbours Nursery in Northampton, an Outstanding local-authority-run nursery for deprived two- to four-year-olds, recommends that all nurseries receive the training, particularly those ‘less experienced’ in working with SEND.
She says, ‘We first received the NPA Stamp of Approval five years ago, after attending the workshop training.
‘Each year we provide evidence of how the principles are being embedded in practice. It’s a great approach that helps you reflect on your practice and realise the importance of looking at the child’s development age. The award is a recognition of the extra work that we put in to supporting our families and we’re proud of it – the sticker is displayed on our door.’
KKC’s Harvey, who developed the training along with a Best Practice Assessment Checklist, which relates the portage principles back to the EYFS, says, ‘We have a specific way of writing targets that focuses on breaking them down into small steps that we communicate through clear language. This is highly valued in the sector, and nurseries, schools and special schools come to us for training.’ (see Case study, page 19).
But with more children on the waiting list for portage services, coupled with diminishing local authority budgets, this non-statutory service is ‘at risk’, Rickman says. ‘Some local authorities are offering a watered-down version of portage, which is home learning for children with SEND, but this is not quality-assured and does not meet our criteria.’
CASE STUDY: The Redway School, Milton Keynes
‘We got involved with portage during Covid, in an attempt to formalise and structure our home visiting induction and play sessions for new children,’ explains Sam Lazard, EYFS home link liaison teacher at the 173-place special school for two- to 19-year-olds.
‘One of the main things we took away from the in-house Portage Workshop is the need to set clear goals for our children, making sure the language we use is not cloudy.
‘I usually take my sensory “bag of tricks” which contains a space blanket, a parachute and a “story massage” where the children get an on-body experience alongside a story, with the parents’ permission. For example, we use actions and touch, such as a squeeze on the shoulders to accompany Twinkle Twinkle Little Star. For children with multi-sensory impairments, who perhaps can’t hear well, the touch brings the sensory element to the story, which is great for communication, as we look for signs that the child is happy or wants more.
‘We also use Tak-Pac, where we use objects on a child’s body, to music. This could be a frozen shower puff or feathers for tickling. We’ve always used these activities, but the training made us think more carefully about the developmental needs of each child, what activities to provide and what we want to gain from it.’
CASE STUDY: group portage sessions
KCC’s team of 24 portage practitioners work with over 900 children a year in its 12 districts. Unlike many portage services, children can be referred after the age of three.
‘We offer families home learning and focused group sessions as part of our bespoke blended offer,’ explains Tracy Harvey, KKC’s county portage manager. ‘There’s a sensory group for children with the most complex and profound learning difficulties. In these sessions, we use sensory stories and music to help find ways for children to respond to different stimulus, which will help them with their daily routines.’
One child who had a brain bleed at birth was severely visually impaired and had limited movement, apart from being able to move her eyes and hands slightly. She has had a comfort teddy, but if she lost it at night, she would become distressed.
‘We discovered that she was responsive to the smell of limes, so we sprayed her teddy with a lime smell, and as long as she could smell it, she wasn’t distressed,’ Harvey says. ‘She went on to have different smells for different markers throughout her day.’
KKC also runs a group supporting children going into early years settings and a group for children with delayed social communication and interaction, which account for about 80 per cent of referrals.
CASE STUDY: portage home worker
‘A key element of our role is to support the family, with the child at the centre,’ explains Teresa Lyons, portage manager for Playwise, the charity that runs the London Borough of Sutton’s portage service. Under-threes receive portage sessions up until the age of three, or until they start nursery and are in receipt of funding. Three- to five-year-olds can apply for funding or pay for Portage Intervention Plus.
‘It takes time to build up trust and for parents to speak to us about their children’s diagnoses or their concerns about upcoming appointments,’ Lyons says. ‘We do hands-on work with the child and set targets for the parents to carry out before the next fortnightly session. Each session starts with the Big Mac, a large recordable electronic button that every child, whether they are verbal or non-verbal, presses to say hello.
‘We use bubbles and attention buckets for children with social communication needs. These include exciting and motivating toys that light up or spin. The idea is to hold the toy and say “Ready, steady, go”, building the anticipation until the toy lights up. We model what we want them to say, but they might use body language to convey this. We also use signing to convey words like “more”.
‘Two-year-old Tony* [name changed] has epilepsy and global development delay. He’s working at the development age of an eight-month-old. He loves bubbles, but because he’s visually impaired, by the time he’s seen the bubble, it has popped. So I make him a bubble sock by placing a sock around a plastic bottle with the end cut off. This way, he has a stream of bubbles in front of him that he can easily track.
‘Giving parents these tailored strategies to help their child develop helps them feel empowered. Parents can also meet others in similar situations to them at our community group sessions for children aged five and under.’
FURTHER INFORMATION
- NPA Stamp of Approval Scheme: https://bit.ly/3Nlbmx1
- Best Practice Assessment Checklist: https://bit.ly/3ReO90M
- NPA Portage Workshop training: https://bit.ly/47MqSKr
- Free online training: https://www.portage.org.uk/news/picture
- ‘Experience of the Portage programme: a reflexive thematic analysis’ by Elizabeth Fawcett
- ‘Princess of Wales joins sensory play session to raise awareness of importance of support for children with SEND’, www.nurseryworld.co.uk
- Ava the Mermaid by Eleanor Baggaley and Jenn Garside