The CBPATSISP uses the following definitions for the key concepts that make up our work. These are described below.

Best Practice refers to the best available evidence to guide treatment, 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
  3. Identified by high quality research/evaluations

Characteristics 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 context 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 are generally best understood, assessed and demonstrated in the community by involving community people who are 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. Efficiency involves comparison of the program’s actual outcomes with the use of resources and the process to achieve these outcomes.

The ATSISEP defined cultural safety as an environment which is safe for Indigenous people with shared respect, shared meaning, shared knowledge, shared 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 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 but how much 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:

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
  • 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 addresses the core knowledge, skills, values and attitudes of competence expected  of mental health practitioners and outlines specific expectations of competence for working with Aboriginal and Torres Straits Islander people, families and communities in Standard 4.  Walker et al (2014) provides a detailed discussion of competence and defines 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.

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 (CRF) 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 CRF aims to provide the Australian public health sector with strategies for culturally respectful services and consists of six domain and focus areas that are the foundation of culturally respectful service delivery with Aboriginal and Torres Strait Islander bodies (Dudgeon et al. 2018; Indigenous Governance Guide). The six domain and focus areas are:

1. Whole of organisation approach and commitment
2. Communication
3. Workforce development and training
4. Consumer participation and engagement
5. Stakeholder partnership and collaboration
6. Data, planning, research and evaluation

The primary audience for the CRF is the Australian public health system. This framework should be used in the government health sector, health departments, hospitals and primary health care settings to guide strategies to improve culturally respectful services. Where your work interacts with health service delivery and design, the CRF should be used as a reference to ensure that the health system is accessible, respectful and safe for Aboriginal and Torres Strait Islander people.

In mental health, evidence-based practice is the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences (APA, 2012).

Evidence-based principles encompass the idea that interventions should not only be based on evidence but also generate evidence (Kelaher, et al, 2018). Evidence-based policy and program approaches are two pronged. First, they involve the incorporation of established evidence into decision making to ensure programs are appropriate and effective and have the best chance of achieving the desired outcomes. Second, an evidence-based approach necessitates a robust process of program evaluation and the integration of evaluation outcomes into policy making and program design.

Framework of Key Values & Principles for Operationalising Aboriginal & Torres Strait Islander Research & Evaluation Goals, Principles & Outcomes