- Email: [email protected]
A home training service for pre-school developmentally handicapped children
Bchc,,. Ru\. % Pergsmon
&
00057967
Thwcap,. Vol. 17. pp 207 10 ?I4 PICSS Ltd 1979. PrInted an Great Britam
79 0501.0?07SO?.CKlO
A HOME TRAINING SERVICE FOR PRE-SCHOOL DEVELOPMENTALLY HANDICAPPED CHILDREN* SUSANREVILL and ROGERBLUNDEN Mental Ely Hospital,
Handicap Cowbridge
in Wales-Applied Research Unit, Road West, Cardiff, South Wales, U.K.
(Received
20 June
1978)
Summary-The researchers
collaborated with service personnel in developing and evaluating a home training service for pre-school developmentally handicapped children in two areas within South Glamorgan. The service was based on the Portage model of early childhood education, and involved parents as the major teaching resource. A time-series experimental design was used with the 19 subjects acting as their own controls. The data included details of skills taught through the Portage service, monthly scores on the Portage checklist and two-monthly scores on the Griffiths Mental Development Scale. The results showed that 88.2% of tasks taught through the Portage service were learned, 67.3% being learned within one week. In both experimental groups there was an increase in the rate of acquisition of checklist skills coinciding with the introduction of the Portage service. Most of the subjects also showed increased gains on mental development test scores after the introduction of the service.
Parents of severely handicapped children may already encounter serious problems in the years before full-time education commences. Some of these problems are caused by the particular difficulty in teaching these children skills and by the disruptive behaviours which may accompany severe handicap. It is clear that early intervention is essential in the extended task of training severely handicapped children and it has been demonstrated that parent involvement is a major factor in its effectiveness (Bronfenbrenner, 1974). The training of parents as teachers of their own children is a recent development which has emerged from the systematic application of behavioural principles. In the late 1960s several studies (Hawkins et al., 1966; Shah, 1969; Zeilberger et al., 1968) demonstrated that mothers can readily be taught techniques to cope with their young children’s behaviour problems. More recently, behaviourally oriented programmed texts have been produced (for example, Ney and Ney, 1972; Patterson and Gullion, 1968) and ways of directly training parents to teach new skills have been explored, such as The Regional Intervention Program for Preschoolers and Parents (Ora, 1971) and the Portage Project (Shearer and Shearer, 1972). Training facilities for developmentally handicapped children under five years of age vary in the United Kingdom. Some children commence full-time education at a special school as early as 20 months, some attend nursery, playschool or group training sessions, while others, because of shortage of places or transport difficulties, are not able to receive full-time education until they are four or five years of age. There are also dificulties which prevent every eligible child from receiving speech therapy and physiotherapy. Service personnel from the South Glamorgan Area Health Authority agreed to collaborate with the researchers in implementing and evaluating a home training service for pre-school developmentally handicapped children in parts of South Glamorgan, Wales, using the Portage model of service delivery. THE PORTAGE MODEL The Portage model is a precision teaching model which was originally developed by Shearer and Shearer (1972), Wisconsin, U.S.A. It is a home training system which *This research was funded by the DHSS and Welsh Office. The authors wish to acknowledge the cooperation and help received from the Portage project staff, Wisconsin, and all those staff associated with the Home Advisory Service for Pre-school Developmentally Delayed Children in South Glamorgan. 207
208
SUSAN REVILL and ROGER BLLINDEN
directly involves parents in the education of their children. The scheme involves weekly visits by a home adviser who works with the parents in deciding what skills to teach and how to teach them. Parents are also shown how to observe and record behaviour. Weekly staff meetings enable the home advisers to meet with their supervisors for consultation and advice. The basis of the teaching system is the Curriculum Guide (Bluma et al., 1976) which comprises : 1. A developmental checklist which lists behaviour usually exhibited by children from birth to six years of age; 2. A set of curriculum cards to match each of the 580 behaviours on the checklist. Each card includes a behavioural description of a skill and suggests materials and curriculum ideas for teaching it. The checklist and curriculum cards are colour-coded and divided into five developmental areas: self-help, motor, socialization, language and cognitive. In addition, there is a section on infant stimulation which covers all five developmental areas. THE
DEVELOPMENT SOUTH
The development
OF THE PORTAGE
SERVICE
IN
GLAMORGAN
of the service involved:
1. The establishment of criteria for eligibility The following criteria were agreed by researchers and service personnel: (a) the child should not be more than four and a half years of age at the commencement of the service; (b) the child should not be attending a nursery or playschool for more than five half-days per week; (c) the child shoufd score 78 or less on two or more subtests of the Grifliths Mental Development Scale (Griffiths, 1954, 1970); (d) the child should be living within the defined geographical catchment area. 2. A survey In order that the service could be offered to graphical catchment areas, it was necessary to obtained of all pre-school children in South records, were labelled as mentally handicapped,
every eligible child within defined geoconduct a survey. A complete list was Glamorgan who. according to agency retarded or possibly retarded.
3. The pilot phase In order to test the service and research components, a pilot phase was implemented in a small area of South Glamorgan. Eight eligible families in that area were identified and accepted the Portage service for a six-month pilot period. 4. The establishment of the service In order to establish the service, a wide range of activities were undertaken personnel and researchers. These included :
by service
(a) the supervisors agreeing to allocate a portion of their time to the service; (b) recruiting the home advisers who allocated a major part of their time to the service; (c) training the home advisers and supervisors in Portage methods; (d) producing the d~umentation for the service (forms, letters, etc.); (e) identifying potential clients and offering them. the service; (f) delivering the service on a regular weekly basis to clients; (g) conducting weekly staff meetings.
A home traming
AIMS
service for handicapped
OF THE
children
209
EVALUATION
,4 major aim of the project was to evaluate the use of the Portage model with a view to establishing a home training service for pre-school deuelopmentally handicapped children. Previous evaluation of the Portage scheme in Wisconsin (Shearer and Shearer, 1972) involved 75 multiply handicapped children. Their ages ranged from birth to six years and their average I.Q. score was 75 as determined by the Cattell Infant Test (Cattell, 1940) and the Standford-Binet Intelligence Test (Terman and Merrill, 1960). It was found that these children gained an average of 13 mental age months in an eight-month period of Portage service. Though these results from the American study suggested that the service was of benefit to pre-school retarded children, more specific questions concerning the implementation of the service in the United Kingdom needed to be investigated. The main questions asked in the present evaluation were:
1. Can, pre-school developmentally handicapped children successfully be taught new skills, using the Portage model of service delivery? 2. Does the child’s rate of acquisition of skills increase while receiving the Portage service? 3. Does the child’s acquisition of skills other than those taught through Portage increase more rapidly after the introduction of the service? METHOD
The project was conducted in two defined geographical catchment areas in South Glamorgan. Area A had a population of about 51,000 and Area B about 52,000, such that approximately 10 eligible subjects could be expected from each. The home advisers The two part-time home advisers were qualified nursery nurses who had also received specific training in the Portage methods. They were based at the Child Psychology Unit, Department of Child Health, University Hospital of Wales. The supervisors The two part-time supervisors were senior clinical psychologists in the South Glamorgan Clinical Psychology Department. Both had received specific training in the Portage methods and had previous experience in the use of behavioural techniques with developmentally delayed children. The subjects The 19 eligible families in the two areas had been identified from the preliminary survey and from contact with local professionals. Although no formal data were taken concerning the socio-economic status of the families in the study, a wide range of parental occupations were, in fact, represented. The ages of the children ranged from eight months to four years. Their initial overall scores on the Griffiths Mental Development Scale ranged from 8 to 89. The home training procedure During the first of the regular visits, the home adviser, with the parent’s help, completed the Portage checklist of behaviours which established the child’s present performance in the five developmental areas. After completing the checklist, the home adviser had enough information to select, in collaboration with the parent, a suitable task for the parent to teach her child during the coming week. The home adviser first took a baseline for that task, then completed an activity chart. This chart contained a behavioural description of the skill to be taught and instructions specifying how often the skill was to be practised and details of the teaching procedure.
210
SUSAN REVILL and RCKZERBLUNDEN
The teaching of the task was first demonstrated by the home adviser, who then supervised the parent working with the child on that task. The activity chart was left with the parent, who worked with her child throughout the following week, recording daily progress on the activity chart. At the beginning of the next weekly visit, the home adviser recorded post-baseline data on the previous week’s activities. This enabled the home adviser to validate the parent’s recording. If the child had learned the task to criterion, the home adviser recorded a ‘success’ on the chart. If the child had almost learned the task, or the child or parent had been ill during the week, then the home adviser usually suggested to the parent that she continued with the task for another week, and the home adviser recorded ‘continued’ on the activity chart. However, if it was clear that the task needed to be broken down into smaller steps, or taught in a different way, the home adviser recorded ‘changed and continued’ and wrote a new chart. If the decision was made to abandon the task, this was also recorded. Each weekly visit lasted approximately one and a quarter hours. The staff meeting The staff meeting was held weekly and was attended by the two supervisors, two home advisers, the researcher and others concerned with the service. The agenda of a staff meeting typically included the following: 1. 2. 3. 4. 5. 6.
the
A review of any problems concerning the goals to be set the following week; A review of any problems encountered with current tasks; Presentation of any new materials (e.g. revised cards); Discussion of any referrals to other agencies; Discussion of any other problems; A review of successes.
Experimental design A time-series design was used, with the subjects acting as their own controls (Risley and Wolf, 1972). Two geographical areas of comparable populations were identified within South Glamorgan. Area A contained nine subjects and Area B, 10 subjects. Baseline measures commenced in both experimental areas at the beginning of July, 1976. After two months the Portage service was introduced into Area A and, after a further two months, into Area B. Measurement continued in both areas for four months. The Portage service was introduced as an addition to any other services being received by the families. In practice, none of the families was receiving regular advice on teaching their children skills. Measuremen r 1. The data on the activity charts were recorded by the parents during the week, between home visits. The home adviser conducted baseline measures on each skill before it was taught, to determine that the child could not perform the skill to criterion. Post-baseline measures were conducted at the next visit to determine whether or not the child had learned the skill. 2 The Portage checklist was completed for each child at monthly intervals throughout the study. For each group the checklists were completed by the same person on each occasion.* Each check was carried out in the child’s home. 3. Each child was assessed on the Griffiths Mental Development Scale at two-monthly intervals throughout the study. The Griffiths tests for Group A were administered *Because the the researcher
home adviser for Group B had not completed her training by the beginning completed the Portage checklists for this group throughout the study.
of baseline,
211
A home training service for handicapped children
occasion by the home adviser and, for Group B, by a clinical psychologist. Each test was conducted in the child’s home.
on each
Reliability
Reliability checks on the Portage checklist and the Griffiths Mental Development Scale were conducted by two clinical psychologists who independently scored the Ss performances simultaneously with the primary testers. For each set of scores the difference between the scores was calculated and expressed as a percentage of the primary tester’s score. The mean percentage agreement was then calculated over all reliability checks. The mean percentage agreement on the Griffiths scores was 95.7 (range 81.2-100%) and on the Portage checklist 93.9 (range 89.1-97.7x). RESULTS
1. The analysis of the tasks set during the study is shown in Table 1. An average of 1.08 tasks per week per child were set with individual means varying from 0.33 to 1.35 tasks per week. 2. The mean number per group of Portage checklist skills gained per month during baseline and the Portage service are compared in Table 2. 3. Figures 1 and 2 show the total number of checklist items credited each month for each child. 4. Table 3 shows the mean number of points on the Griffiths Mental Development Scale gained per two months during baseline and the Portage service. Though the mean number of points gained per two months was greater during the Portage service than during the baseline period, the scores on the Griffiths Mental Development Scale were variable, and not all children showed consistent gains. Sixteen of the 19 children showed overall gains in Griffiths test scores, with individual gains ranging from 2 to 27 points during the period when they received the service. 5. Table 4 shows the rate of acquisition of Portage checklist skills during baseline and the Portage service, and compares the mean number of tasks taught per month during the service with the mean number of skills learned per month which were not taught through the service.
Table 1. Analysis of the tasks set during the study Group A
Group B
150
Total no. of tasks set __._._~ No. of these which were reanaiysed ---__ _____ No. of tasks learned to criterion
156
9 (6%) 138 (92%)
No. of tasks abandoned No. of tasks continued at end of study
Total
5 (3.3%) 7
306
13 (4.2%) 4 (2.6%) -___~~ 132 (84.6%) 270 (88.2%) 10 (6.4%) 15 (4.9%) 14 21
Table 2. Mean number of Portage checklist skills gained per month Months of baseline 1 3.7
2 5.8
1 9.7
Months of baseline 1 4.8
2 5.1
3 2.6
Group A Months of Portage service
4 3.0
2 4.1
3 9.8
4 11.8
5 10.4
6 21.5
Group B Months of Portage service. 1 6.0
2 8.4
3 9.9
4 14.1
212
SUSAN REVILL and ROGER BLUNDEN
GroupA
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160
B f 1
210 -
P”‘“” Ana
150 120 so
k-/
*Ob
Len
60 30
f
01
’
01
’
’ ’ 2345676
1. Total
number
’
f
Months --_--_&&age
I Baseline--c)
Fig.
’
of Portage checklist Group A. The names
’ -___
’ *
items credited each month of the clients are fictitious.
for
each
client
in
Group B
g 240 .z g
210 t
60 30
L
I
I
I
I 5
I
I
II
6
7
6
Months *
Fig.
2. Total
number
- - -Boselme - - - - CI*
of Portage checklist Group B. The names
- - Portage _ _ e
items credited each month of the clients are fictitious.
for
each
client
in
A home training Table
service for handicapped
213
children
3. Mean number of points on the Griffiths Mental opment Scale gained per two months
Experimental
condition
Group
Baseline period Portage service
A
Group
1.0 4.1
Table 4. Rate of acquisition
Devel-
B
0.4 2.1
of Portage
checklist
skills Group
Mean number
of Portage
Mean
of Portage
number
Mean number
checklist checklist
skills gained
of tasks toughr per month
Mean number of Portage month during Portage
checklist
per month
skills gained through
during
per month Portage
skills nor taught
the baseline
during
Portage
Portage
Group
period
4.3
3.7
service
11.1
9.5
service
through
A
gained
per
2.6
3.3
8.6
6.1
B
DXSC’lJSSI[ON
The study demonstrated that the service was of benefit to every child, regardless of the degree of handicap. The Portage service was offered to all eligible families in the defined catchment areas. Consequently, there was a large variation in the nature and degree of the children’s handicaps. Initial scores on the Griffiths Mental Development Scale ranged from 8 to 89. During the evaluation period of the project, 306 tasks were set. Of these, 270 (88.2%) were learned, 206 (67.3%) of them being learned within one week. Only 13 (4.2%) of the tasks needed to be reanalysed, and only 15 (4.9”/,) were abandoned. With one exception, the rate of acquisition of Portage checklist skills increased faster after the introduction of the service, though greater increases were made by the less handicapped children. However, not all children showed consistent gains in their Griffiths test scores even though care had been taken to ensure that, for each group, every test was administered by the same tester and every test was conducted in the child’s home. Clearly, there are problems in the repeated use of standard tests as a measure of progress. The study also showed that the children not only gained more checklist skills during the Portage service than during the baseline period, but that the majority of these skills were not directly taught through the Portage system. There are at least two possible explanations for these results. First, as a result of the advice received from the home advisers, the parents in the study may have become more skilled at teaching appropriate skills to their children. Secondly, the repeated monthly tests may have helped the chiidren acquire new skills, that is, the test situation itself may provide opportunities for learning. The measurement of acquistion of skills using standardized checklists presents a problem to researchers, and alternative and more precise ways of describing the impact of a service are being sought. It is clear that administering standard tests at regular intervals simply gives a measure of the child’s performance in this test situation, and this may be unrelated to his use of these skills outside the test situation (Blunden, 1978). The home training scheme was shown to be a very effective way of teaching retarded children new skills, with parents playing the major part in the teaching process. By tailoring weekly training goals to the individual parent and child a very high proportion (88%) of these were learned to criterion, most within one week. Furthermore, unlike some schemes the Portage scheme involved comparatively little parent time each day.
214
SUSANREVJLLand ROGERBLUNDEN
The present study has therefore shown that the Portage system of home training can be operated successfully as a service from which pre-school children of all degrees and types of developmental handicap can benefit.
REFERENCES BLUMA S. M., SHEARERM. S., FROHMANA. H. and HILLJARDJ. M. (1976) Porrage Guide to Early Educafion. Cooperative Educational Service Agency 12. Wisconsin. BLUNDENR. M. (1978) The repeated use of standard skill checklists to evaluate services for developmentally retarded people: problems and some possible solutions. Unpublished paper read at a Symposium on the Evaluation of Behaviour Change, British Psychological Society Annual Conference, University of York, April, 1978. BRONFENBRENNER U. (1974) A report on longitudinal evaluations of pre-school programs. Vol. 11, 1s Earl] Intervention Efictiue? p. 55. DHEW Publications. CATTELLP. (1940) Cartel/ Infanr Scale. The Psvcholoaical Cornoration New York. GRIFFITHSR: (1954) The M&es of Babies. University of Lonhon Press, London. GRIFFITH~R. (1970) The Abilities of Young Children. Child Development Research Centre, London, HAWKINSR. P., PETERSON R. F., S~HWEI; E. and BIJOUS. W. (1966) Behavior therapy in the home: amelioration of problem parent-child relations with the parent in a therapeutic role. J. exp. Child Psycho/. 4, 99-107. NEY P. and NEY M. (1972) How ro Raise a Family. Pioneer Publishing, Victoria, British Columbia. ORA J. P. (1971) Instructional pamphlet for parents of oppositional children. Unpublished pamphlet. George Peabody College, Nashville, Tenn. PATTERSONG. R. and GULLJONM. E. (1968) Living With Children. Research Press, Champaign, Illinois. RJSLEYR. T. and WOLF M. M. (1972) Strategies for analyzing behavioral change over time. In Li&Span Development Psychology: tiethodological Issues (Edited by J. NE~~ELROADES and H. REESE).Academic Press, New York. SHAHS. A. (1969) Training and utilising a mother as the therapist for her child. In Psychotherapeutic Agents: New Roles for Non-Professionals, Parents and Teachers (Edited by B. G. GUERNEY),pp. 40-7. Rinehart & Winston. New York. SHEARERM. and SHEARERD. E. (1972) The Portage project: a model for early childhood education. Exceptional Children, 36, p. 217. TERMANL. and MERRILLM. (1960) Stand’ord-Binet Intelligence Scale (3rd rev.), Form L-M, Houghton Mifflin. New York. ZEILBERGER J., SAMPENS. E. and SLOANE H. N. JR. (1968) Modification of a child’s problem behaviors in the home with the mother as therapist. J. appl. Behac. Anal. 1, 47-53.
&
00057967
Thwcap,. Vol. 17. pp 207 10 ?I4 PICSS Ltd 1979. PrInted an Great Britam
79 0501.0?07SO?.CKlO
A HOME TRAINING SERVICE FOR PRE-SCHOOL DEVELOPMENTALLY HANDICAPPED CHILDREN* SUSANREVILL and ROGERBLUNDEN Mental Ely Hospital,
Handicap Cowbridge
in Wales-Applied Research Unit, Road West, Cardiff, South Wales, U.K.
(Received
20 June
1978)
Summary-The researchers
collaborated with service personnel in developing and evaluating a home training service for pre-school developmentally handicapped children in two areas within South Glamorgan. The service was based on the Portage model of early childhood education, and involved parents as the major teaching resource. A time-series experimental design was used with the 19 subjects acting as their own controls. The data included details of skills taught through the Portage service, monthly scores on the Portage checklist and two-monthly scores on the Griffiths Mental Development Scale. The results showed that 88.2% of tasks taught through the Portage service were learned, 67.3% being learned within one week. In both experimental groups there was an increase in the rate of acquisition of checklist skills coinciding with the introduction of the Portage service. Most of the subjects also showed increased gains on mental development test scores after the introduction of the service.
Parents of severely handicapped children may already encounter serious problems in the years before full-time education commences. Some of these problems are caused by the particular difficulty in teaching these children skills and by the disruptive behaviours which may accompany severe handicap. It is clear that early intervention is essential in the extended task of training severely handicapped children and it has been demonstrated that parent involvement is a major factor in its effectiveness (Bronfenbrenner, 1974). The training of parents as teachers of their own children is a recent development which has emerged from the systematic application of behavioural principles. In the late 1960s several studies (Hawkins et al., 1966; Shah, 1969; Zeilberger et al., 1968) demonstrated that mothers can readily be taught techniques to cope with their young children’s behaviour problems. More recently, behaviourally oriented programmed texts have been produced (for example, Ney and Ney, 1972; Patterson and Gullion, 1968) and ways of directly training parents to teach new skills have been explored, such as The Regional Intervention Program for Preschoolers and Parents (Ora, 1971) and the Portage Project (Shearer and Shearer, 1972). Training facilities for developmentally handicapped children under five years of age vary in the United Kingdom. Some children commence full-time education at a special school as early as 20 months, some attend nursery, playschool or group training sessions, while others, because of shortage of places or transport difficulties, are not able to receive full-time education until they are four or five years of age. There are also dificulties which prevent every eligible child from receiving speech therapy and physiotherapy. Service personnel from the South Glamorgan Area Health Authority agreed to collaborate with the researchers in implementing and evaluating a home training service for pre-school developmentally handicapped children in parts of South Glamorgan, Wales, using the Portage model of service delivery. THE PORTAGE MODEL The Portage model is a precision teaching model which was originally developed by Shearer and Shearer (1972), Wisconsin, U.S.A. It is a home training system which *This research was funded by the DHSS and Welsh Office. The authors wish to acknowledge the cooperation and help received from the Portage project staff, Wisconsin, and all those staff associated with the Home Advisory Service for Pre-school Developmentally Delayed Children in South Glamorgan. 207
208
SUSAN REVILL and ROGER BLLINDEN
directly involves parents in the education of their children. The scheme involves weekly visits by a home adviser who works with the parents in deciding what skills to teach and how to teach them. Parents are also shown how to observe and record behaviour. Weekly staff meetings enable the home advisers to meet with their supervisors for consultation and advice. The basis of the teaching system is the Curriculum Guide (Bluma et al., 1976) which comprises : 1. A developmental checklist which lists behaviour usually exhibited by children from birth to six years of age; 2. A set of curriculum cards to match each of the 580 behaviours on the checklist. Each card includes a behavioural description of a skill and suggests materials and curriculum ideas for teaching it. The checklist and curriculum cards are colour-coded and divided into five developmental areas: self-help, motor, socialization, language and cognitive. In addition, there is a section on infant stimulation which covers all five developmental areas. THE
DEVELOPMENT SOUTH
The development
OF THE PORTAGE
SERVICE
IN
GLAMORGAN
of the service involved:
1. The establishment of criteria for eligibility The following criteria were agreed by researchers and service personnel: (a) the child should not be more than four and a half years of age at the commencement of the service; (b) the child should not be attending a nursery or playschool for more than five half-days per week; (c) the child shoufd score 78 or less on two or more subtests of the Grifliths Mental Development Scale (Griffiths, 1954, 1970); (d) the child should be living within the defined geographical catchment area. 2. A survey In order that the service could be offered to graphical catchment areas, it was necessary to obtained of all pre-school children in South records, were labelled as mentally handicapped,
every eligible child within defined geoconduct a survey. A complete list was Glamorgan who. according to agency retarded or possibly retarded.
3. The pilot phase In order to test the service and research components, a pilot phase was implemented in a small area of South Glamorgan. Eight eligible families in that area were identified and accepted the Portage service for a six-month pilot period. 4. The establishment of the service In order to establish the service, a wide range of activities were undertaken personnel and researchers. These included :
by service
(a) the supervisors agreeing to allocate a portion of their time to the service; (b) recruiting the home advisers who allocated a major part of their time to the service; (c) training the home advisers and supervisors in Portage methods; (d) producing the d~umentation for the service (forms, letters, etc.); (e) identifying potential clients and offering them. the service; (f) delivering the service on a regular weekly basis to clients; (g) conducting weekly staff meetings.
A home traming
AIMS
service for handicapped
OF THE
children
209
EVALUATION
,4 major aim of the project was to evaluate the use of the Portage model with a view to establishing a home training service for pre-school deuelopmentally handicapped children. Previous evaluation of the Portage scheme in Wisconsin (Shearer and Shearer, 1972) involved 75 multiply handicapped children. Their ages ranged from birth to six years and their average I.Q. score was 75 as determined by the Cattell Infant Test (Cattell, 1940) and the Standford-Binet Intelligence Test (Terman and Merrill, 1960). It was found that these children gained an average of 13 mental age months in an eight-month period of Portage service. Though these results from the American study suggested that the service was of benefit to pre-school retarded children, more specific questions concerning the implementation of the service in the United Kingdom needed to be investigated. The main questions asked in the present evaluation were:
1. Can, pre-school developmentally handicapped children successfully be taught new skills, using the Portage model of service delivery? 2. Does the child’s rate of acquisition of skills increase while receiving the Portage service? 3. Does the child’s acquisition of skills other than those taught through Portage increase more rapidly after the introduction of the service? METHOD
The project was conducted in two defined geographical catchment areas in South Glamorgan. Area A had a population of about 51,000 and Area B about 52,000, such that approximately 10 eligible subjects could be expected from each. The home advisers The two part-time home advisers were qualified nursery nurses who had also received specific training in the Portage methods. They were based at the Child Psychology Unit, Department of Child Health, University Hospital of Wales. The supervisors The two part-time supervisors were senior clinical psychologists in the South Glamorgan Clinical Psychology Department. Both had received specific training in the Portage methods and had previous experience in the use of behavioural techniques with developmentally delayed children. The subjects The 19 eligible families in the two areas had been identified from the preliminary survey and from contact with local professionals. Although no formal data were taken concerning the socio-economic status of the families in the study, a wide range of parental occupations were, in fact, represented. The ages of the children ranged from eight months to four years. Their initial overall scores on the Griffiths Mental Development Scale ranged from 8 to 89. The home training procedure During the first of the regular visits, the home adviser, with the parent’s help, completed the Portage checklist of behaviours which established the child’s present performance in the five developmental areas. After completing the checklist, the home adviser had enough information to select, in collaboration with the parent, a suitable task for the parent to teach her child during the coming week. The home adviser first took a baseline for that task, then completed an activity chart. This chart contained a behavioural description of the skill to be taught and instructions specifying how often the skill was to be practised and details of the teaching procedure.
210
SUSAN REVILL and RCKZERBLUNDEN
The teaching of the task was first demonstrated by the home adviser, who then supervised the parent working with the child on that task. The activity chart was left with the parent, who worked with her child throughout the following week, recording daily progress on the activity chart. At the beginning of the next weekly visit, the home adviser recorded post-baseline data on the previous week’s activities. This enabled the home adviser to validate the parent’s recording. If the child had learned the task to criterion, the home adviser recorded a ‘success’ on the chart. If the child had almost learned the task, or the child or parent had been ill during the week, then the home adviser usually suggested to the parent that she continued with the task for another week, and the home adviser recorded ‘continued’ on the activity chart. However, if it was clear that the task needed to be broken down into smaller steps, or taught in a different way, the home adviser recorded ‘changed and continued’ and wrote a new chart. If the decision was made to abandon the task, this was also recorded. Each weekly visit lasted approximately one and a quarter hours. The staff meeting The staff meeting was held weekly and was attended by the two supervisors, two home advisers, the researcher and others concerned with the service. The agenda of a staff meeting typically included the following: 1. 2. 3. 4. 5. 6.
the
A review of any problems concerning the goals to be set the following week; A review of any problems encountered with current tasks; Presentation of any new materials (e.g. revised cards); Discussion of any referrals to other agencies; Discussion of any other problems; A review of successes.
Experimental design A time-series design was used, with the subjects acting as their own controls (Risley and Wolf, 1972). Two geographical areas of comparable populations were identified within South Glamorgan. Area A contained nine subjects and Area B, 10 subjects. Baseline measures commenced in both experimental areas at the beginning of July, 1976. After two months the Portage service was introduced into Area A and, after a further two months, into Area B. Measurement continued in both areas for four months. The Portage service was introduced as an addition to any other services being received by the families. In practice, none of the families was receiving regular advice on teaching their children skills. Measuremen r 1. The data on the activity charts were recorded by the parents during the week, between home visits. The home adviser conducted baseline measures on each skill before it was taught, to determine that the child could not perform the skill to criterion. Post-baseline measures were conducted at the next visit to determine whether or not the child had learned the skill. 2 The Portage checklist was completed for each child at monthly intervals throughout the study. For each group the checklists were completed by the same person on each occasion.* Each check was carried out in the child’s home. 3. Each child was assessed on the Griffiths Mental Development Scale at two-monthly intervals throughout the study. The Griffiths tests for Group A were administered *Because the the researcher
home adviser for Group B had not completed her training by the beginning completed the Portage checklists for this group throughout the study.
of baseline,
211
A home training service for handicapped children
occasion by the home adviser and, for Group B, by a clinical psychologist. Each test was conducted in the child’s home.
on each
Reliability
Reliability checks on the Portage checklist and the Griffiths Mental Development Scale were conducted by two clinical psychologists who independently scored the Ss performances simultaneously with the primary testers. For each set of scores the difference between the scores was calculated and expressed as a percentage of the primary tester’s score. The mean percentage agreement was then calculated over all reliability checks. The mean percentage agreement on the Griffiths scores was 95.7 (range 81.2-100%) and on the Portage checklist 93.9 (range 89.1-97.7x). RESULTS
1. The analysis of the tasks set during the study is shown in Table 1. An average of 1.08 tasks per week per child were set with individual means varying from 0.33 to 1.35 tasks per week. 2. The mean number per group of Portage checklist skills gained per month during baseline and the Portage service are compared in Table 2. 3. Figures 1 and 2 show the total number of checklist items credited each month for each child. 4. Table 3 shows the mean number of points on the Griffiths Mental Development Scale gained per two months during baseline and the Portage service. Though the mean number of points gained per two months was greater during the Portage service than during the baseline period, the scores on the Griffiths Mental Development Scale were variable, and not all children showed consistent gains. Sixteen of the 19 children showed overall gains in Griffiths test scores, with individual gains ranging from 2 to 27 points during the period when they received the service. 5. Table 4 shows the rate of acquisition of Portage checklist skills during baseline and the Portage service, and compares the mean number of tasks taught per month during the service with the mean number of skills learned per month which were not taught through the service.
Table 1. Analysis of the tasks set during the study Group A
Group B
150
Total no. of tasks set __._._~ No. of these which were reanaiysed ---__ _____ No. of tasks learned to criterion
156
9 (6%) 138 (92%)
No. of tasks abandoned No. of tasks continued at end of study
Total
5 (3.3%) 7
306
13 (4.2%) 4 (2.6%) -___~~ 132 (84.6%) 270 (88.2%) 10 (6.4%) 15 (4.9%) 14 21
Table 2. Mean number of Portage checklist skills gained per month Months of baseline 1 3.7
2 5.8
1 9.7
Months of baseline 1 4.8
2 5.1
3 2.6
Group A Months of Portage service
4 3.0
2 4.1
3 9.8
4 11.8
5 10.4
6 21.5
Group B Months of Portage service. 1 6.0
2 8.4
3 9.9
4 14.1
212
SUSAN REVILL and ROGER BLUNDEN
GroupA
330 300 270 p c $ 5
240-
i t_ 6
160
B f 1
210 -
P”‘“” Ana
150 120 so
k-/
*Ob
Len
60 30
f
01
’
01
’
’ ’ 2345676
1. Total
number
’
f
Months --_--_&&age
I Baseline--c)
Fig.
’
of Portage checklist Group A. The names
’ -___
’ *
items credited each month of the clients are fictitious.
for
each
client
in
Group B
g 240 .z g
210 t
60 30
L
I
I
I
I 5
I
I
II
6
7
6
Months *
Fig.
2. Total
number
- - -Boselme - - - - CI*
of Portage checklist Group B. The names
- - Portage _ _ e
items credited each month of the clients are fictitious.
for
each
client
in
A home training Table
service for handicapped
213
children
3. Mean number of points on the Griffiths Mental opment Scale gained per two months
Experimental
condition
Group
Baseline period Portage service
A
Group
1.0 4.1
Table 4. Rate of acquisition
Devel-
B
0.4 2.1
of Portage
checklist
skills Group
Mean number
of Portage
Mean
of Portage
number
Mean number
checklist checklist
skills gained
of tasks toughr per month
Mean number of Portage month during Portage
checklist
per month
skills gained through
during
per month Portage
skills nor taught
the baseline
during
Portage
Portage
Group
period
4.3
3.7
service
11.1
9.5
service
through
A
gained
per
2.6
3.3
8.6
6.1
B
DXSC’lJSSI[ON
The study demonstrated that the service was of benefit to every child, regardless of the degree of handicap. The Portage service was offered to all eligible families in the defined catchment areas. Consequently, there was a large variation in the nature and degree of the children’s handicaps. Initial scores on the Griffiths Mental Development Scale ranged from 8 to 89. During the evaluation period of the project, 306 tasks were set. Of these, 270 (88.2%) were learned, 206 (67.3%) of them being learned within one week. Only 13 (4.2%) of the tasks needed to be reanalysed, and only 15 (4.9”/,) were abandoned. With one exception, the rate of acquisition of Portage checklist skills increased faster after the introduction of the service, though greater increases were made by the less handicapped children. However, not all children showed consistent gains in their Griffiths test scores even though care had been taken to ensure that, for each group, every test was administered by the same tester and every test was conducted in the child’s home. Clearly, there are problems in the repeated use of standard tests as a measure of progress. The study also showed that the children not only gained more checklist skills during the Portage service than during the baseline period, but that the majority of these skills were not directly taught through the Portage system. There are at least two possible explanations for these results. First, as a result of the advice received from the home advisers, the parents in the study may have become more skilled at teaching appropriate skills to their children. Secondly, the repeated monthly tests may have helped the chiidren acquire new skills, that is, the test situation itself may provide opportunities for learning. The measurement of acquistion of skills using standardized checklists presents a problem to researchers, and alternative and more precise ways of describing the impact of a service are being sought. It is clear that administering standard tests at regular intervals simply gives a measure of the child’s performance in this test situation, and this may be unrelated to his use of these skills outside the test situation (Blunden, 1978). The home training scheme was shown to be a very effective way of teaching retarded children new skills, with parents playing the major part in the teaching process. By tailoring weekly training goals to the individual parent and child a very high proportion (88%) of these were learned to criterion, most within one week. Furthermore, unlike some schemes the Portage scheme involved comparatively little parent time each day.
214
SUSANREVJLLand ROGERBLUNDEN
The present study has therefore shown that the Portage system of home training can be operated successfully as a service from which pre-school children of all degrees and types of developmental handicap can benefit.
REFERENCES BLUMA S. M., SHEARERM. S., FROHMANA. H. and HILLJARDJ. M. (1976) Porrage Guide to Early Educafion. Cooperative Educational Service Agency 12. Wisconsin. BLUNDENR. M. (1978) The repeated use of standard skill checklists to evaluate services for developmentally retarded people: problems and some possible solutions. Unpublished paper read at a Symposium on the Evaluation of Behaviour Change, British Psychological Society Annual Conference, University of York, April, 1978. BRONFENBRENNER U. (1974) A report on longitudinal evaluations of pre-school programs. Vol. 11, 1s Earl] Intervention Efictiue? p. 55. DHEW Publications. CATTELLP. (1940) Cartel/ Infanr Scale. The Psvcholoaical Cornoration New York. GRIFFITHSR: (1954) The M&es of Babies. University of Lonhon Press, London. GRIFFITH~R. (1970) The Abilities of Young Children. Child Development Research Centre, London, HAWKINSR. P., PETERSON R. F., S~HWEI; E. and BIJOUS. W. (1966) Behavior therapy in the home: amelioration of problem parent-child relations with the parent in a therapeutic role. J. exp. Child Psycho/. 4, 99-107. NEY P. and NEY M. (1972) How ro Raise a Family. Pioneer Publishing, Victoria, British Columbia. ORA J. P. (1971) Instructional pamphlet for parents of oppositional children. Unpublished pamphlet. George Peabody College, Nashville, Tenn. PATTERSONG. R. and GULLJONM. E. (1968) Living With Children. Research Press, Champaign, Illinois. RJSLEYR. T. and WOLF M. M. (1972) Strategies for analyzing behavioral change over time. In Li&Span Development Psychology: tiethodological Issues (Edited by J. NE~~ELROADES and H. REESE).Academic Press, New York. SHAHS. A. (1969) Training and utilising a mother as the therapist for her child. In Psychotherapeutic Agents: New Roles for Non-Professionals, Parents and Teachers (Edited by B. G. GUERNEY),pp. 40-7. Rinehart & Winston. New York. SHEARERM. and SHEARERD. E. (1972) The Portage project: a model for early childhood education. Exceptional Children, 36, p. 217. TERMANL. and MERRILLM. (1960) Stand’ord-Binet Intelligence Scale (3rd rev.), Form L-M, Houghton Mifflin. New York. ZEILBERGER J., SAMPENS. E. and SLOANE H. N. JR. (1968) Modification of a child’s problem behaviors in the home with the mother as therapist. J. appl. Behac. Anal. 1, 47-53.