The Portage Home-Based Model of Early Intervention, has had documented success as implemented in Portage, Wisconsin and throughout the nation leading to its unanimous approval by the Joint Dissemination and Review Panel of the U.S. Office of Education in 1975 and its recertification in 1985 and 1992. The original model has been modified to reflect current research and best practices in early intervention.
The model continues to adhere to the sound theoretical principles upon which it was founded, namely: parent/primary caretaker involvement is critical to successful early intervention; the home or other least restrictive environments are natural and significant learning environments; intervention objectives and strategies must be individualized for each child and family based on their concerns, priorities and resources; data collection is important to reinforce positive change and to make ongoing intervention decisions.
These principles are rooted in current research and theory. Research emphasizes the need for processes that: provide support for the family systems (Foster, Berger, and McLean, 1981; Dunst and Trivette, 1987); incorporate a family focused approach to intervention as it is delivered within a variety of least restrictive settings appropriate for children ages birth to five years (Foster, Berger, and McLean, 1981; Turnbull and Turnbull; 1986; Smith, B., 1988); enhance child interactions within their social and physical environments, increasing independence and self initiations, and thereby increasing developmental competency (Brinker and Lewis, 1982; Bromwich, 1981).
Portage views families as operating within a societal, political and economic system which mediates the style of interactions they use with their young children, and makes parents central in deciding the appropriate intervention for their child and family.
Promoting a Family Focus
From the point of referral, the Portage Model establishes a relationship with the family that is based on building mutual trust and rapport. A parent-professional partnership is initiated in order to best meet the priorities, concerns, and desired resources of child and family members. From the first home visit, parents are looked to as experts regarding their child's behavior and level of skill development. They are involved at the level they feel comfortable in planning the child assessments and assembling the appropriate team to do this assessment. Parents are also encouraged to invite any other family, relatives or friends to the assessment to provide additional support, input or insight into the team's findings. From the onset, the parents are emphasized as the decision makers, lifelong managers and advocates for their child.
The Portage Model components encompass a wide range of parent/caregiver involvement options, from full participation in the home visit to observer; and from volunteer or policymaker in a preschool or child care program to consumer of services. It is realized that the parent will likely fluctuate along a spectrum of involvement, depending on the circumstances in his/her life at the time. This variability is accepted by the interventionist without judgement, and every opportunity is provided for the parent to become involved at his/her desired level.
Effective communication is emphasized during all interactions between the early interventionist and the family, including utilizing open interviewing and active listening techniques to facilitate the family's identification of the types of services and support systems they or their child may need, the priorities they have at this point regarding their child and family, and the strengths or resources they bring as a family to achieve positive outcomes from these identified needs and priorities. Although formal questionnaires are sometimes used to structure such conversation for informal or formal interview, the model emphasizes that it is the personal rapport building which takes place through ongoing home visits that provide the context for identifying child and family strengths and needs. The open and honest exchange of ideas and concerns between home visitors and the family is what truly facilitates the interventionist's knowledge of the family and its systems including formal and informal support networks. In this way the interventionist learns how he or she could be most useful to the family in achieving positive outcomes and meeting family goals.
Program Planning
Child assessment for the purposes of program planning has always been a strong component of the Portage Model. However, as the model began to serve younger infants and more medically fragile children it became evident that child assessment must include more than standardized and curriculum based assessments. Instruments such as the Bayley or Battelle, and developmental checklists like the Portage, the Carolina, or the Hawaii, are currently utilized as part of the Portage Model. Significant time is spent in developing an atmosphere during the assessment which is play-based and encourages the child's optimum performance in as relaxed and playful an environment as possible. However, assessment techniques such as parent interview, child observation, and assessment data from other disciplines such as therapists, doctors, and public health nurses are also employed within the model in order to gather an accurate picture of the child.
Child assessment includes systematic observation of the child in his/her home setting in a variety of play and daily routine situations. Because Portage wishes to maintain a family focus throughout the intervention process, it is essential that the opportunity is taken to observe the child with the primary caregiver, and other family members in order to gain an accurate picture of the developmental strengths and needs of the child and the interaction patterns that typically occur within the home setting. Furthermore, since parents live with their youngsters on a daily basis and see many behaviors that an interventionist does not when observing a child for an hour or two, it becomes imperative to use parent report as a means for gathering information pertinent to program planning.
Another emphasis of the Portage Model is also team building with other professionals and interagency collaboration. The assessment process is enhanced by the cooperation, information, and insights of other professionals who have also worked with the child or who currently are gathering information as part of the multi-disciplinary assessment team.
As this information is compiled, it, along with the information regarding family priorities, resources and concerns, is discussed in a meeting between the family and the multidisciplinary team to develop an Individual Family Service Plan (IFSP). This plan lists family and child goals or outcomes, the strategies and resources needed to achieve these outcomes, and the person(s) responsible for achieving these outcomes. These are generated from a discussion with the family, and through analysis of the information gathered during informal interviews, observation, and assessment.
Another important aspect of the IFSP is the transition plan, which is created at least 3 to 6 months prior to the child's entry into a different program. This plan is developed at a meeting with the parent, the interventionist, and ideally, a representative of the receiving agency. They discuss the family's priorities and concerns regarding the transition process, develop a plan to identify the steps which need to be taken, timelines, who will be involved, and who will be responsible for initiating each step. This facilitates smooth transitioning for both child and family and encourages team and interagency cooperation and collaboration in meeting the child and family needs at a very critical time.
Implementing Family Focused Curriculum
The Portage program utilizes the Portage Guide to Early Education curriculum and other developmentally appropriate curriculum designed for young children. Portage also makes use of several other strategies and techniques to implement a home curriculum which is family-centered and individualized for each child's unique abilities and needs. Specific functional skills are targeted and opportunities are identified to practice these skills through daily routines. For example, motor exercises are often practiced during diapering or before or after bathing; language activities may take place during feeding or before bedtime. Not only does this practice assist families in incorporating skill development and maintenance into their already hectic and busy daily schedules, it also gives the child the chance to practice skills in a more normalized environmental context.
Another important consideration is skill building within the context of responsive play. Young children learn best through play-based activities that allow them to respond to materials and activities in a contingent responsive continuum and give opportunities for exploration, experimentation, and creativity. Activities planned within this model reflect adaptation of materials, parent or interventionist support, and child expectations in order to offer a play environment that fits the child's needs and abilities and provide opportunities for the child to participate regardless of developmental level or current abilities.
In addition, activities reflect the level at which the parent or other family members wish to be involved and the goals of the IFSP. Activities are designed to promote and enable positive adult/child interactions. Activities are set up to give parent and child opportunities in positive interactions with one another and to assist the child to take action that is responsive to or engages the caregiver or family member whenever appropriate.
Interventionists encourage the family to be involved in planning and carrying out activities at their level of comfort. Time is spent each week discussing activities for the following home visit, and ways in which siblings or other family members could be involved during the home visits or during the week. When siblings are present during the home visit, every effort is made to develop and implement activities which include them, either at the teaching or participation level. The interventionist recognizes that siblings also need positive attention; acknowledgement of their unique contribution to the success of the home visit is vital.
Implementing a family centered curriculum includes providing methods and strategies that enable family issues to be recognized and discussed during the home visit, as well as providing activities for developing child skills. The model provides for an early interventionist to serve as service coordinator. The service coordinator works with the caregiver and other family members to develop and strengthen their support network, develop action plans for addressing family priorities and concerns, and access resources as required. The model emphasizes the interventionist as a consultant to the family, assisting the family to "do for themselves" and supporting them, rather than "doing for" the family.
Data-Based Curriculum Decisions
A feature of the original model which remains constant is the data-based decision making. Observation of child behavior and recording systems are designed to meet the demands of the environment. Caregivers in partnership with home visitors develop strategies to determine progress toward identified goals and objectives and make decisions to modify materials, stimuli, and activities based on their knowledge and observations of the child and the environment. Along with objective child data, an anecdotal record is written by the home visitor and/or parent at the conclusion of each home visit to record pertinent observations, parent concerns or issues, child and family successes. A copy is given to the parents to put in their own notebook and the home visitor keeps one for his/her file.
Data from the direct service site in Portage and model implementation sites nationwide indicate that children in Portage-trained programs make "significant progress in diminishing their developmental delay over the program year... Children's post-test scores were found to be significantly higher than their expected scores. Expected scores were calculated based on their pre-test performance. (Re-validation Report, 1985). Parents were shown to be successful mediators of skill development. Data from model implementation sites showed that an average of 43 short-term developmental goals were devised for each child and an average of 82% were achieved through parent efforts. Children were not only maintaining a normal developmental rate, but were also diminishing their delay over the program year, and parents were contributing significantly to the gains.