Definitions

Considerations2018-09-10T10:02:04+00:00

There are a number of considerations and an evidence base that support the proposition that Indigenous governance is non-negotiable in designing and implementing suicide prevention activity in Aboriginal and Torres Strait Islander communities.

This illustrates the connection between contemporary Aboriginal and Torres Strait Islander suicide rates and the unresolved legacies of
colonisation. It starts with culture.

Best Practice refers to the best available evidence to guide treatment and prevention approaches and practices. The CBPATSISP views best practice through an Indigenous community lens. It indicates activities:

  1. With the highest degree of proven effectiveness in Indigenous community/ cultural contexts;
  2. With transferability across urban, rural and remote settings, and
  3. Identified by high quality research/evaluations.

Charcteristics that need to be considered when developing and delivering programs and services include effectiveness and efficacy. These two concepts are distinguished below:.

Effectiveness addresses the question: Does the program, service or initiative work in Indigenous contexts. Effectiveness is the real world impact of the prevention activity – that is the extent to which the level of care; intervention or action achieves the desired outcome/s. It is the efficacy of a strategy taking into account the specific challenges, constraints and opportunities within the specific contexts and communities. For example, a theoretically sound program may have to address a range of local issues that act as a barrier to participation.

The effectiveness of programs, services and initiatives is generally best understood and assessed and demonstrated in the community by involving community people who were intended to benefit.

Efficiency addresses the question: Does the program, service or initiative deliver cost and resource effective outcomes? Efficiency is the extent to which a program’s activities are being produced with appropriate use of resources such as budget and staff time. Efficency involves comparison of the program’s actual outcomes with the use of resources and the process to achieve these outcomes.

There is general agreement on the importance of ensuring that programs and services for Aboriginal and Torres Strait Islander people need to be culturally responsive and safe. The concepts of cultural responsiveness, safety, competence and respect are complex, interwoven and have been used interchangeably. These concepts apply both to programs and services and the individual practitioners working with Aboriginal and Torres Strait Islander people. The importance of cultural safety is also increasingly recognised by the regulators of health professions (see the Australian Health Practitioner Registration Authority (AHPRA) Statement of Intent to ensure culturally safe health services and workforces).

Cultural Safety

The ATSISEP defined cultural safety as an environment which is safe for Indigenous people with shared respect, shared meaning, shared knowledge and experience, and dignity (ATSISPEP, 2016).

Culturally safe service environments are welcoming for Indigenous people. It is a model of practice which respects and supports patients’ identities. Markers of culturally safe environments include Indigenous staff working at all positions of an organisation, and artwork and posters celebrating Indigenous life and culture. Cultural safety is also important for Indigenous health workers to work effectively in mainstream health services – free from discrimination, where their Indigeneity is valued, and that at an individual level they feel secure, safe and respected (Williams, 1999).

Cultural safety can be seen as a higher order concept that includes cultural awareness, responsiveness and competence. This is reflected in definitions such as the Congress of Aboriginal and Torres Strait Islander Nurses and Midwifes (CATSINaM) which describes cultural safety as a “philosophy of practice” that informs not only what health professionals do much how they work. Others as Walker, Schultz and Sonn (2014) have included the concept of critically reflective practice in their definition of cultural competence. A link to their work Cultural Competence – Transforming Policy, Services, Programs and Practice (2014) is here: https://www.telethonkids.org.au/globalassets/media/documents/aboriginal-health/working-together-second-edition/wt-part-3-chapt-12-final.pdf

Cultural Responsiveness

The Indigenous Allied Health Association (IAHA, 2015) definition of cultural responsiveness includes six capabilities: the service provider “holds culture as central to Aboriginal and Torres Strait Islander health and wellbeing, involves ongoing reflective practice and life-long learning, is relationship focussed, is person and community centred, appreciates diversity between groups, families and communities, and requires access to knowledge about Aboriginal and Torres Strait Islander histories, peoples and cultures.

Cultural Competence

The National Practice Standards for the Mental Health Workforce (2013) which address the core knowledge, skills, values and attitudes expected of competence mental health practitioners and outline specific expectations of competence for working with Aboriginal and Torres Straits Islander people, families and communities in standard 4. Walker et al (2014) provide a detailed discussion of competence and define the concept as involving the “skills, knowledge, attitudes and values necessary for effective intercultural transactions within diverse social, cultural and organisational contexts. Cultural competence is seen as a dynamic process that involves reflective practice as a key element.

Cultural Competence and Responsiveness
With reflective practice seen as a critical component for culturally safe practice, some authors have suggested that responsiveness is a better term than cultural competencies or capabilities (Dudgeon et al, 2016). Although intended as a dynamic concept, the word competence implies that knowledge and skills acquired during a course of training could finite. The concept of cultural responsiveness includes competence but goes beyond it by recognising life-long learning, or the need for ongoing evolution of skills and abilities over time. The concept of cultural responsiveness also acknowledges the complexities and divergence within and between different cultural groups and allows for flexibility in working respectfully with cultural differences.

Cultural Respect

The Cultural Respect Framework 2016-2026 defines cultural respect as: “Recognition, protection and continued advancement of the inherent rights, cultures and traditions of Aboriginal and Torres Strait Islander people.” The framework provides a set of cultural respect indicators for health services when working in partnership. The CBPATSISP has developed an Indigenous Governance guide which suggests that a culturally respectful partnership supports and works to the leadership and direction of Aboriginal and Torres Strait Islander governing bodies.
The text box below provides selected extracts from the six domains of the Cultural Respect Framework function as indicators describing what would be culturally respectful partnerships with Aboriginal and Torres Strait Islander bodies (Dudgeon et al. 2018; link to Indigenous Governance Guide).

Text Box: The Cultural Respect Framework on Cultural Governance (selected extracts)
• Aboriginal and Torres Strait Islander leadership and participation in decision-making and governance at all levels of the Australian health care system, both within Aboriginal and Torres Strait Islander-specific and mainstream roles and positions.

• Cultural safety and responsiveness efforts are directed and guided by Aboriginal and Torres Strait Islander health professionals and/or Aboriginal and Torres Strait Islander people with cultural expertise and/or authority.

• Cultural knowledge, expertise and skills of Aboriginal and Torres Strait Islander health professionals are reflected in health service models and practice.

• Mechanisms are utilised to facilitate community involvement in developing and implementing cultural safety and responsiveness related activities.

• Governance structures support membership of, and partnerships with, Aboriginal and Torres Strait Islander communities, consumers and carers.

The ATSISEP defined cultural safety as an environment which is safe for Indigenous people with shared respect, shared meaning, shared knowledge and experience, and dignity  (ATSISPEP, 2016).

Culturally safe service environments are welcoming for Indigenous people. It is a model of practice which respects and supports patients’ identities. Markers of culturally safe environments include Indigenous staff working at all positions of an organisation, and artwork and posters celebrating Indigenous life and culture. Cultural safety is also important for Indigenous health workers to work effectively in mainstream health services – free from discrimination, where their Indigeneity is valued, and that at an individual level they feel secure, safe and respected (Williams, 1999).

Cultural safety can be seen as a higher order concept that includes cultural awareness, responsiveness and competence. This is reflected in definitions such as the Congress of Aboriginal and Torres Strait Islander Nurses and Midwifes (CATSINaM) which describes cultural safety as a “philosophy of practice” that informs not only what health professionals do much how they work.  Others as  Walker, Schultz and Sonn (2014) have included the concept of critically reflective practice in their definition of cultural competence. A link to their work Cultural Competence – Transforming Policy, Services, Programs and Practice (2014) is here: https://www.telethonkids.org.au/globalassets/media/documents/aboriginal-health/working-together-second-edition/wt-part-3-chapt-12-final.pdf

The Indigenous Allied Health Association (IAHA, 2015) definition of cultural responsiveness includes six capabilities: the service provider “holds culture as central to Aboriginal and Torres Strait Islander health and wellbeing, involves ongoing reflective practice and life-long learning, is relationship focussed, is person and community centred, appreciates diversity between groups, families and communities, and requires access to knowledge about Aboriginal and Torres Strait Islander histories, peoples and cultures.

The National Practice Standards for the Mental Health Workforce (2013) which address the core knowledge, skills, values and attitudes expected of competence mental health practitioners and outline specific expectations of competence for working with Aboriginal and Torres Straits Islander people, families and communities in standard 4.  Walker et al (2014) provide a detailed discussion of competence and define the concept as involving the “skills, knowledge, attitudes and values necessary for effective intercultural transactions within diverse social, cultural and organisational contexts. Cultural competence is seen as a dynamic process that involves reflective practice as a key element.

Self-determination is a recognised human right of all peoples, including Indigenous peoples, as set out in the United Nations Declaration on the Rights of Indigenous Peoples (Declaration).

For Aboriginal and Torres Strait Islander peoples in Australia, self-determination in a post-colonial context essentially means a right to self-governance and decision-making power in all matters that affect them. The Declaration is now referenced in a range of Australian Government documents,
including the Fifth Plan as an implementation guidance document.It is discussed in greater detail in Implementing Integrated Suicide Prevention in Aboriginal and Torres Strait Islander Communities: A Guide for Primary Health Networks.

The Fifth National Mental Health and Suicide Prevention Plan (Fifth Plan) approaches Aboriginal and Torres Strait Islander people as both consumers of mental health and suicide prevention services as well as peoples with collective human rights. As consumers, the Fifth Plan provides clear guidance to
ensure that:
Governance and implementation of the Fifth Plan reflect the intent of the National Mental Health
Policy regarding consumer and carer participation—that is, ‘Nothing about us, without us’.

Further, the Fifth Plan defines consumers and carers as
people with lived experience… who identify either as someone who is living with (or has lived
with) mental illness or someone who is caring for or otherwise supporting (or has cared for or
otherwise supported) a person who is living with (or has lived with) mental illness…48
For Aboriginal and Torres Strait Islander consumers, lived experience includes of the cultural,
historical and social context in which Aboriginal and Torres Strait Islander mental health difficulties
and suicide are occurring, in addition to a range of cultural and other barriers for engaging in effective
treatment.
Indigenous Governance for Suicide Prevention in Aboriginal and Torres Strait Islander Communities
A Guide for Primary Health Networks
12
The value the Fifth Plan places on lived experience provides a
further rationale for ensuring Indigenous governance of suicide
prevention activity in communities and the full involvement of
Aboriginal and Torres Strait Islander consumers with lived
experience of the mental health system and of suicide in suicide
prevention design and implementation processes. This should
also be considered as a contributor to risk management by
helping PHNs avoid common pitfalls that have the potential to
result in harm, such as assuming that what works in one
Aboriginal and Torres Strait Islander community will work in
another, or by imposing integrated approaches, elements or interventions intended for nonIndigenous
settings.

The Cultural Respect Framework 2016-2026 defines cultural respect as: “Recognition, protection and continued advancement of  the inherent rights, cultures and traditions of Aboriginal  and Torres Strait Islander people.” The framework provides a set of cultural respect indicators for health services when working in partnership. The CBPATSISP has developed an Indigenous Governance guide which suggests that a culturally respectful partnership supports and works to the leadership and direction of Aboriginal and Torres Strait Islander governing bodies.

The text box below provides selected extracts from the six domains of the Cultural Respect Framework function as indicators describing what would be culturally respectful partnerships with Aboriginal and Torres Strait Islander bodies (Dudgeon et al. 2018; link to Indigenous Governance Guide).

The Cultural Respect Framework on Cultural Governance (selected extracts)

  • Aboriginal and Torres Strait Islander leadership and participation in decision-making and governance at all levels of the Australian health care system, both within Aboriginal and Torres Strait Islander-specific and mainstream roles and positions.
  • Cultural safety and responsiveness efforts are directed and guided by Aboriginal and Torres Strait Islander health professionals and/or Aboriginal and Torres Strait Islander people with cultural expertise and/or authority.
  • Cultural knowledge, expertise and skills of Aboriginal and Torres Strait Islander health professionals are reflected in health service models and practice.
    >Mechanisms are utilised to facilitate community involvement in developing and implementing cultural safety and responsiveness related activities.
  • Governance structures support membership of, and partnerships with, Aboriginal and Torres Strait Islander communities, consumers and carers.

Contact Us

School of Indigenous Studies, University of Western Australia

39 Fairway, Nedlands, WA 6009.

cbp.clearinghouse@uwa.edu.au 

+61 8 6488 1570

Acknowledgement of Country:

We acknowledge and pay our respects to the traditional custodians of the land we live and work on, the Wadjuk people of the Noongar nation, and their Elders past, present and emerging. We also wish to acknowledge and respect the continuing culture, strength, and resilience of all Aboriginal and Torres Strait Islander peoples and communities as well as our Indigenous members from other parts of the world.

Disclaimer:

“The terms ‘Aboriginal’, ‘Aboriginal and Torres Strait Islander’ and ‘Indigenous’ are used interchangeably. It is acknowledged that there are many cultural differences between and within Aboriginal and Torres Strait Islander communities and the use of differing terms does not intend to disregard such differences.” © Copyright 2018