Part 2: Children's learning and wellbeing in hospital-based services

Context of hospital-based services

Hospital-based early childhood education and care services operate from hospital premises and provide education and care to children who are patients of that hospital. Aotearoa New Zealand is the only country internationally to have an education curriculum in hospital settings.3

The hospital play specialists’ profession is a niche field, emerging in New Zealand as a professional practice in the 1960s.4 Hospital play specialists (HPS) work as members of interdisciplinary healthcare teams to support children’s development and their emotional wellbeing in hospital settings. They also contribute to wider aspects of paediatric care and provide support for siblings and family members.5

HPS incorporate the principles, strands and goals of Te Whāriki,6 the early childhood curriculum with therapeutic play programmes. This model emphasises the role of play in transforming the potentially psychologically harmful hospital experience into one where the child can learn and grow. Children often regress in hospital due to the uncertainty and stress they face. The role of hospital-based services is therefore very different and learning programmes and outcomes for children will also be different from those in non-hospital settings.7

All licensed hospital-based education and care services are required to meet regulated standards and effectively support HPS to gain the additional knowledge and skills for working within a hospital-based context. ERO’s reviews of hospital-based services respond to the services’ context and evaluate their performance in contributing to children’s learning and promoting their wellbeing.

Regulatory environment

The Education Act 1989 was amended in 2008 to create a revised legislative framework for the operation of early childhood services. All hospital-based services are licensed under the Education (Early Childhood Services) Regulations 2008.8

The key document that forms part of the regulatory framework is the Licensing Criteria for Hospital-based Education and Care Centres 2008 and the Early Childhood Curriculum Framework.9 Hospital-based services must meet the licensing criteria as well as requirements contained in the regulations, in order to gain and maintain a licence to operate.

ERO’s evaluation focuses on the quality of education and care that the hospital-based service provides and how each service meets the regulated standards.

United Nations Convention on the Rights of the Child (UNCRC)

UNCRC10 is a human rights treaty which sets out the civil, political, economic, social, health and cultural rights of children. It places an obligation on governments not just to protect children’s rights but to actively promote them. It also requires governments to allow children to have a voice in decisions that affect them. New Zealand ratified the United Nations Convention on the Rights of the Child (UNCRC) on 6 April 1993.

Leaders and HPS should give consideration to children’s rights in their services’ policies and practices for the provision, protection and participation of children and their families in hospital- based services.

Hospital-based services and Te Whāriki

The curriculum framework is prescribed by the Minister of Education. The Early Childhood Education Curriculum Framework is made up of the English and te reo Māori versions of the principles and strands of the early childhood curriculum Te Whāriki: He Whāriki Mātauranga mō ngā Mokopuna o Aotearoa (Te Whāriki).11 All licensed hospital-based services are required to provide a curriculum that meets the principles and strands of Te Whāriki.

Te Whāriki is based on socio-cultural perspectives. This means that there is an expectation that the curriculum in each hospital-based service will respond to the social and cultural values and beliefs of its community of children, families and HPS. Each hospital-based service, in consultation with its community, determines its own curriculum priorities and emphases.

Hospital-based services and Te Tiriti o Waitangi

Te Tiriti o Waitangi is a foundation document of Aotearoa New Zealand and guides education with regards to participation, power and partnership for Māori, as tangata whenua, and non-Māori as signatories to the Treaty. The Treaty provides a driving force for the revitalisation of Māori language and culture.

Hospital-based services are required to provide a curriculum that acknowledges and reflects the unique place of Māori as tangata whenua. The curriculum must also help children to develop their knowledge and understanding of the cultural heritages of both parties to Te Tiriti o Waitangi.

The principle of partnership in the Treaty needs to be reflected in the practices of the hospital-based service. Working in partnership with Māori requires inclusive and collaborative relationships between the hospital-based service and whānau for the learning and wellbeing of Māori children.

Responding to diversity

Diversity12 encompasses many characteristics including medical needs, ethnicity, socio-economic background, gender and home language.

To understand and respond to this diversity, service leaders and HPS need to have a deep understanding of the identity and experiences of the children attending the service.

Their systems and practices should be responsive to all children’s needs, capabilities and circumstances.

Māori children

Ka Hikitia,13 the Government’s Māori Education Strategy, proposes that the language, culture and identity of Māori children be acknowledged and a productive partnership forged by the sharing of power between Māori children, whānau, iwi, HPS and leaders.

Penetito14 states that there is no such thing as the Māori identity, there are only Māori identities. In addition, Māori children live in and between at least two worlds. While they may position themselves differently in these worlds they are Māori, by virtue of descent and whakapapa.15

The wellbeing and learning of Māori children is located in their culture, language and identity. A child’s culture, language and identity are where concepts of mana, wairua and mauri exist. Mana is the power and potential the Māori child brings with them.16 Wairua is a concept linked to the child’s spirit and emotional stability. Mauri is observable. It is the life force and energy of the child which enables energy to be expended; the mind to think and have some control over how the body behaves. It enables the child to be vibrant, expressive and impressive.17

Children of Pacific heritage

The Pasifika Education Plan,18 the Government’s strategic direction for improving Pacific education, includes a focus on how well early childhood services engage Pacific children, parents, families and communities.

Children with a Pacific heritage are not a homogeneous group. Pacific children come from diverse groups with different cultures and languages. While some Pacific children are born in New Zealand, others may be new arrivals to the country or may have come to New Zealand specifically for specialised medical treatment.

Understanding the diversity of Pacific children is integral to understanding each child as an individual. HPS cannot simply create broad strategies or approaches for Pacific children in hospital-based services. They need to use their knowledge and understanding of Pacific children, their families and communities to design a meaningful curriculum for each Pacific child.

3     Kayes, M. (2005). The Experience of Novice Play Specialists in their Early Months of Employment. (Master of Health Science thesis), Auckland University of Technology, Auckland.

4     Hospital Play Specialists Association. (2014). History: Background information on the development of play and recreation services in New Zealand hospitals. Retrieved from

5     Rollins, Judy A., Bolig, Rosemary and Mahan, Carmel C. (Eds). (2005). Meeting children’s psychosocial needs across the health-care continuum. Pro-Ed. Austin, Texas.

6    Ministry of Education (1996). Te Whāriki: He Whāriki Mātauranga mō ngā Mokopuna o Aotearoa; Early Childhood Curriculum. Wellington.

7     Matthews, B. (1991). A therapeutic play programme for young hospitalised children. Paper presented at the ‘The Impact of Policy Change’. Fifth Early Childhood Convention (September 8-12. 1991). Dunedin.

8     Ministry of Education. (2008). Education (Early Childhood Services) Regulations 2008. Wellington.

9     Ministry of Education. (2008). Licensing Criteria for Hospital-based Education and Care Centres 2008. Wellington.

10    Ministry of Justice. (May 2015). United Nations Convention on the Rights of the Child. 1989.

11   Ministry of Education. (1996). Te Whāriki: He Whāriki Mātauranga mō ngā Mokopuna o Aotearoa; Early Childhood Curriculum. Wellington.

12    Ministry of Education. (2003) Quality Teaching for Diverse Students in Schooling: Best Evidence Synthesis Iteration (BES).

13    Ministry of Education. (2013). Ka Hikitia – Accelerating Success 2013-2017.  Wellington.

14     Penetito, W. (2001). ‘If We Only Knew … Contextualising Māori Knowledge’. Paper presented at Earl Childhood Education for a Democratic Society 2001. New Zealand Council for Educational Research. Wellington.

15     Rameka, L. (2011) Being Māori: Culturally relevant assessment in hospital-based education. Early Years 31, (3): 245–256. Retrieved  from

16     Walker, R. (2008) The Philosophy of Te Whatu Pōkeka: Kaupapa Māori assessment and learning exemplars. The First Years: Ngā Tau Tuatahi, New Zealand Journal of Infant and Toddler Education 11 (1): 5-9.

17    Mead, H., and Mead, S. (2003). Tikanga Māori: Living by Māori Values. New Zealand. Huia Publishers.

18   Ministry of Education. (2013). Pasifika Education Plan 2013-2017.