Starship Play Services: Outpatients

1 Evaluation of Starship Play Services: Outpatients

How well placed is Starship Play Services: Outpatients to contribute to children’s learning and promote their wellbeing?

Starship Play Services: Outpatients is very well placed to promote positive learning outcomes for children.

ERO's findings that support this overall judgement are summarised below.

Background

The Outpatients licence is one of seven services at Starship Hospital. The services operate as part of the Auckland District Health Board (ADHB), the Starship Children's Health Directorate, and Starship Allied Health. A highly qualified clinical team leader has responsibility for the daily operation of the service and leads a team of 31 hospital play specialists (HPS), assisted by an early childhood education curriculum leader.

The Outpatients playroom is used by children and their whānau when attending outpatient appointments. Children may attend once or return for ongoing visits. The service provides for children from New Zealand, the Pacific Islands and other nations. It is licensed for 40 children, and is also used by a number of older children. The Outpatients play service is operated by four qualified and registered early childhood teachers.

The HPS implement Te Whāriki, the early childhood curriculum, and strategies for dealing with hospitalisation through play and support in playrooms, and at children's bedsides. The philosophy for this service references the ADHB Child Health aims of Welcome - Haere Mai, Respect - Manaaki, Together - Tūhono, and Aim High - Angamua.

The vision, strategic direction, and values are clearly articulated. The Children’s Health Directorate promotes the value of play, and provides support and resources to the hospital play services. The service is a contributing, vital component of multidisciplinary teams. The Starship Foundation provides significant additional resourcing.

This review was part of a cluster of seven Starship Play Service reviews. The 2016 cluster review identified a variety of good practices. It noted areas for improvement that have been addressed.

The Review Findings

Children and their whānau are warmly welcomed. They have opportunities to engage in meaningful, self-chosen play, guided by experienced, highly skilled and dedicated HPS practitioners. Respectful, inclusive and caring approaches quickly build close relationships between HPS, children and whānau. The HPS work with children is sensitive and designed to engage whānau in play as a way to help children to build trust and reduce anxiety. Children respond positively to the attention and care they receive from HPS who work in highly collaborative ways.

Children and whānau settle quickly on arrival at the Outpatients clinic playroom and enjoy warm, caring, relationships. HPS engage children in meaningful conversations to encourage them to share their home experiences and to help put them at ease. HPS support children to develop their confidence and understanding about what happens to them in hospital. Their innovative ideas support play and learning. Great sensitivity and a multidisciplinary approach is used around children's transitions into, through and out of the hospital.

Teachers document learning and planning in 'taonga books' that are a shared group programme record in Outpatients. These include photos and stories about children's experiences in the hospital. Children returning to hospital enjoy revisiting these prior experiences.

Planning is highly responsive and often related to children's immediate needs. HPS' evaluation of their work is reflective and often shared to gain insights into effective practices, at regular team meetings and in medical notes. The recently developed clinical coaching team provides expertise, mentoring and support for learning modules towards HPS qualifications.

The service fosters children's resilience and wellbeing. It supports the hospital's community through evidence-based, culturally responsive, holistic play-based learning. All HPS advocate for and empower whānau and children as the experts about their own wellbeing. They support children and whānau to prepare for procedures and treatments and to develop strategies to manage the impact of illness and hospitalisation.

Environments are purposefully designed, inviting and thoughtfully presented. The playroom is print rich and reflects children’s many cultures. The variety of high quality resources ensures that teachers are able to cater for various age groups. A wide range of open-ended resources and activities is skilfully adapted to meet children's individual interests. Healthcare play equipment assists children to engage in medical play. The playroom has an outdoor area that offers musical exploration.

Service leaders are committed to embedding te ao Māori in programmes. Te reo and tikanga Māori are reflected in the programmes and environments. HPS have built their capability and confidence in bicultural practice through targeted professional development and shared evaluation. Feedback from whānau is highly positive. HPS are making a concerted effort to develop their understanding of, and support for, children and families from the Pacific and further afield.

Relationships underpin all aspects of HPS and management practices. A high trust model and strong professional relationships with other staff are evident. HPS are well supported through regular opportunities for professional learning within and outside the hospital, and at overseas conferences. Appraisal processes are thorough. Strategic and annual planning have been developed to align with Starship Child Health Directorate strategic goals and more specific HPS goals. A consistently high level of good practice is evident across the service.

Key Next Steps

Next steps for HPS and management team include:

• continuing to implement and support the ongoing development of programmes that enhance provision for children and families
• documenting procedures for the induction and mentoring of provisionally registered teachers, and specifically linking appraisals to Teaching Council standards.

Management Assurance on Legal Requirements

Before the review, the staff and management of Starship Play Services: Outpatients completed an ERO Hospital-based Education and Care Assurance Statement and Self-Audit Checklist. In these documents they attested that they have taken all reasonable steps to meet their legal obligations related to:

• curriculum

• premises and facilities

• health and safety practices

• governance, management and administration.

During the review, ERO looked at the service’s systems for managing the following areas that have a potentially high impact on children's wellbeing:

• emotional safety (including positive guidance and child protection)

• physical safety (including supervision; sleep procedures; accidents; medication; hygiene; excursion policies and procedures)

• suitable staffing (including qualification levels; police vetting; teacher registration; ratios)

• evacuation procedures and practices for fire and earthquake.

All early childhood services are required to promote children's health and safety and to regularly review their compliance with legal requirements.

Steve Tanner

Director Review and Improvement Services Northern

Northern Region

11 July 2019

The Purpose of ERO Reports

The Education Review Office (ERO) is the government department that, as part of its work, reviews early childhood services throughout Aotearoa New Zealand. ERO’s reports provide information for parents and communities about each service’s strengths and next steps for development. ERO’s bicultural evaluation framework Ngā Pou Here is described in SECTION 3 of this report. Early childhood services are partners in the review process and are expected to make use of the review findings to enhance children's wellbeing and learning.

2 Information about the Early Childhood Service

3 General Information about Hospital-based Service Reviews

ERO’s Evaluation Framework

ERO’s overarching question for a hospital-based service education review is ‘How well placed is this service to contribute to children’s learning and promote their wellbeing?’

ERO focuses on the following factors as described in the bicultural framework Ngā Pou Here:

Pou Whakahaere– how the service determines its vision, philosophy and direction to contribute to children’s learning and promote their wellbeing

Pou Ārahi– how leadership is enacted to contribute to children’s learning and promote their wellbeing

Mātauranga– whose knowledge is valued and how the curriculum is designed to contribute to children’s learning and promote their wellbeing

Tikanga whakaako– how approaches to teaching and learning respond to diversity, contribute to children’s learning and promote their wellbeing

Within these areas ERO considers the effectiveness ofarotake– self review and ofwhanaungatanga– partnerships with parents and whānau.

ERO evaluates how well placed a service is to sustain good practice and make ongoing improvements for the benefit of all children at the service.

A focus for the government is that all children have an opportunity to benefit from quality early childhood education. ERO will report on how well each service responds to children who are Māori, Pacific, have diverse needs, and are up to two years of age.

For more information about the framework and Ngā Pou Here refer to the methodology for ERO reviews in Hospital-based Education and Care Services.

ERO’s Overall Judgement

The overall judgement that ERO makes will depend on how well the service promotes positive learning outcomes for children. The categories are:

• Very well placed

• Well placed

• Requires further development

• Not well placed

ERO has developed criteria for each category. These are available on ERO’s website.

Review Coverage

ERO reviews are tailored to each service’s context and performance, within the overarching review framework. The aim is to provide information on aspects that contribute to children’s learning and wellbeing and are useful to the service.

1 Evaluation of Outpatients Playroom

How well placed is Outpatients Playroom to contribute to children’s learning and promote their wellbeing?

ERO's findings that support this overall judgement are summarised below.

Background

The Outpatients Playroom is part of Starship Children's Health. It is located in Auckland City Hospital and governed by Allied Health Auckland. The playroom is mostly used by children and their whānau when attending outpatient appointments. It is licensed for 20 children and provides morning and afternoon sessions. A high number of older children and teenagers also use this service. Children may attend only once or come for return visits. The playroom has an outdoor area that is supervised at all times.

The playroom is staffed by two qualified early childhood teachers. They work with children in the playroom to implement Te Whāriki, the early childhood curriculum, and provides planned and responsive learning experiences. The HPS' mission is to support children, siblings and whānau with coping strategies to minimise the impact of hospitalisation and illness.

A team leader from Allied Health and a practice supervisor, who is a qualified early childhood teacher and a qualified play specialist, have responsibility for the daily management of the service. HPS are also part of a multi-disciplinary team which is made up of a range of healthcare professionals.

Since ERO's review in 2012, HPS have been involved in ongoing professional learning and development. Internal evaluation processes have been established to monitor and evaluate the effectiveness of service operations and teaching programmes for children.

The Review Findings

Skilled HPS quickly establish respectful, caring and trusting relationships with children and families/whānau. These positive interactions foster a sense of wellbeing and belonging for children and families. The HPS support children to develop their confidence to understand and contribute to decisions about their learning and what happens to them in hospital.

The HPS provide responsive and sensitive support. They respect and value the languages and cultures of children and families. They plan to continue improving how well programmes, resources and practices reflect cultural diversity. HPS are strong advocates for the rights of children, their whānau and siblings and are dedicated to reducing stress during their time within the hospital environment.

Children experience an inclusive, welcoming environment in the playroom. It is well resourced and attractively prepared to cater for children's diverse interests and needs. Children enjoy playing with a wide range of accessible resources. Activities are skilfully adapted so they are meaningful for all ages of children. Healthcare play equipment assists children to engage in medical play. HPS expertise in therapeutic play supports children to prepare for procedures and treatments.

HPS are knowledgeable about Te Whāriki, the early childhood curriculum, and use a wide range of effective teaching strategies to respond to children's interests. HPS ask good questions to encourage children to share their ideas and home experiences. Assessment of children's learning is high quality. Group programme records (taonga books) include photographs and stories about children's experiences and learning in the hospital-based setting. Children who return frequently to the hospital are able to revisit prior experiences in the taonga books.

The HPS are reviewing how well programmes and practices reflect the bicultural heritage of Aotearoa New Zealand. Their emphasis has been on improving resources and equipment. Increasing their use of te reo Māori in spontaneous play situations and in written learning assessments could help HPS to improve their bicultural practice. Developing a long-term goal to reflect this service-wide focus would support planned, deliberate improvements over time.

The HPS team continues to develop shared understandings about effective practice. They regularly participate in team meetings and engage in professional discussions focused on fostering positive outcomes for children and their whānau. Individual skills contribute to team development and professional learning opportunities have added to HPS knowledge.

The team leader works collaboratively with the practice supervisor to promote improvement. Performance appraisals provide opportunities for HPS to reflect on and develop their practices. Leaders plan to strengthen appraisal by making clearer links to new Education Council requirements.

Good systems have been established for internal evaluation. HPS seek the views of families to inform improvements. The team leader and practice supervisor have identified ways to build on the significant progress that has been made in this area of practice since the 2012 ERO report.

Key Next Steps

The team leader and practice supervisor agree that key next steps include:

• developing annual and long-term educational goals to guide ongoing improvement
• improving practices to promote success for Māori and Pacific learners
• continuing to improve processes for internal evaluation
• seeking professional development support to strengthen assessment and evaluation practices.

Management Assurance on Legal Requirements

Before the review, the staff and management of Outpatients Playroom completed an ERO Hospital-based Education and Care Assurance Statement and Self-Audit Checklist. In these documents they attested that they have taken all reasonable steps to meet their legal obligations related to:

• curriculum
• premises and facilities
• health and safety practices
• governance, management and administration.

During the review, ERO looked at the service’s systems for managing the following areas that have a potentially high impact on children's wellbeing:

• emotional safety (including positive guidance and child protection)
• physical safety (including supervision; sleep procedures; accidents; medication; hygiene; excursion policies and procedures)
• suitable staffing (including qualification levels; police vetting; teacher registration; ratios)
• evacuation procedures and practices for fire and earthquake.

All early childhood services are required to promote children's health and safety and to regularly review their compliance with legal requirements.

In order to improve current practices, the employer and team leader should ensure that:

• as identified in ERO's 2012 report, an annual plan is developed to guide continual improvements and provision for children's education
• budgets and use of government funding are transparent to staff and families.

Next ERO Review

When is ERO likely to review the service again?

The next ERO review of Outpatients Playroom will be in three years.

Graham Randell

Deputy Chief Review Officer Northern

22 January 2016

The Purpose of ERO Reports

The Education Review Office (ERO) is the government department that, as part of its work, reviews early childhood services throughout Aotearoa New Zealand. ERO’s reports provide information for parents and communities about each service’s strengths and next steps for development. ERO’s bicultural evaluation framework Ngā Pou Here is described in SECTION 3 of this report. Early childhood services are partners in the review process and are expected to make use of the review findings to enhance children's wellbeing and learning.

2 Information about the Hospital-based Education and Care Service

3 General Information about Hospital-based Service Reviews

ERO’s Evaluation Framework

ERO’s overarching question for a hospital-based service education review is ‘How well placed is this service to contribute to children’s learning and promote their wellbeing?’ ERO focuses on the following factors as described in the bicultural framework Ngā Pou Here:

Pou Whakahaere– how the service determines its vision, philosophy and direction to contribute to children’s learning and promote their wellbeing

Pou Ārahi– how leadership is enacted to contribute to children’s learning and promote their wellbeing

Mātauranga– whose knowledge is valued and how the curriculum is designed to contribute to children’s learning and promote their wellbeing

Tikanga whakaako– how approaches to teaching and learning respond to diversity, contribute to children’s learning and promote their wellbeing

Within these areas ERO considers the effectiveness ofarotake– self review and ofwhanaungatanga– partnerships with parents and whānau.

ERO evaluates how well placed a service is to sustain good practice and make ongoing improvements for the benefit of all children at the service.

A focus for the government is that all children have an opportunity to benefit from quality early childhood education. ERO will report on how well each service responds to children who are Māori, Pacific, have diverse needs, and are up to the age of two.

For more information about the framework and Ngā Pou Here refer to the methodology for ERO reviews in Hospital-based Education and Care Services.

ERO’s Overall Judgement and Next Review

The overall judgement that ERO makes and the timing of the next review will depend on how well placed a service is to contribute to children’s learning and promote their wellbeing. The categories are:

• Very well placed – The next ERO review in four years
• Well placed – The next ERO review in three years
• Requires further development – The next ERO review within two years
• Not well placed - The next ERO review in consultation with the Ministry of Education

ERO has developed criteria for each category. These are available on ERO’s website.

Review Coverage

ERO reviews are tailored to each service’s context and performance, within the overarching review framework. The aim is to provide information on aspects that contribute to children’s learning and wellbeing and are useful to the service.