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).
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 in 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.
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.
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.