Towards Culturally Safe practice: Taking the field on the journey too ANZSWWER Symposium 2018 DEB DUTHIE - FOTINA HARDY - ROS DARRACOTT

Transcription

1 Towards Culturally Safe practice: Taking the field on the journey too ANZSWWER Symposium 2018 DEB DUTHIE - FOTINA HARDY - ROS DARRACOTT

2 Acknowledgement of Traditional Custodians We respectfully acknowledge the Kaurna people as the custodians of the lands and waters of the Adelaide region, on which we meet today. We pay respect to Elders both past and present. We acknowledge and respect the Kaurna people s cultural, spiritual, physical and emotional connection with their land, waters and community. We thank you for allowing us to meet on your lands as visitors from Queensland QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 2

3 The central discussion SW&HS at QUT has embarked on a journey to prepare students in fostering a sense of cultural safety with people they work with as opposed to a focus on the dominant cultural competence approach. This presentation will: ** Discuss our move to culturally safe practice and ** Showcase some of the tools we have developed to encourage the SWHS field to come on the journey towards cultural safety with us QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 3

4 Cultural competency defined A set of congruent behaviours, attitudes, and policies that come together in a system, agency, or amongst professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations a culturally competent system of care acknowledges and incorporates at all levels the importance of culture, the assessment of cross-cultural relations, vigilance towards the dynamics that result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to meet culturally-unique needs (Cross et al. 1989:iv/7 cited Bainbridge, McCalman, Clifford & Tsey, 2015) Cultural competency teachings attempt to recognize how culture, race, and identity define health among minority groups (Tsai, 2016) HOWEVER QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 4

5 Critique of cultural competency Assumes culture is static Takes a narrow view of what is culture Assumes culture can be mastered by reducing culture to a technical skill for which practitioners can be trained to develop expertise (Kleinman & Benson, 2006) Relies on cultural stereotypes Essentially a very Western modernistic way of thinking Does not take into consideration the culture of the profession, the culture of the sector nor the culture of the practititioner (Thackrah & Thompson, 2013) Reiterates mastering the Other, rather than examining the internal cultures, prejudices, fears, or identifications of the Self (Tsai, 2016). QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 5

6 Critique of cultural competence Fails to acknowledge how members of dominant cultural groups are influenced by: Their own culture, the culture of the workplace, the culture of programs in the social services sector, the culture of institutional paradigms, by the culture of the social work and human services professions themselves QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 6

7 The history of Cultural Safety Grew from a nursing context the experience of Maori s in the health system Focus is on individuals interacting is not a macro approach BUT Is fully cognisant of macro issues particularly: The power differentials between a practitioner whose overt identities are from the dominant culture, and the client/colleague from a subjugated culture Very relevant to the experience of colonisation, but has application in all cross-cultural encounters (which is every single encounter you will ever have) QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 7

8 Journeying towards cultural safety: An Indigenous Knowledge Recognises that: Culture is fluid, is complex & is individual Focuses on cultural self-awareness rather than mastery of the other Privileges relationships as central to culturally safe practice Groups in society will have common experiences, worldviews & practices, BUT Because we each come with a mix of cultural positionings, every interaction between two people is two different cultures coming together; two different ways of making sense of the world & trying to come to a common understanding It is an Indigenous knowledge helping to decentre the Eurocentric nature of knowledge QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 8

9 The Cultural Safety Continuum Cultural Safety: is an outcome of education that enables safe service to be defined by those who receive the service. Cultural Sensitivity: alerts people to the legitimacy of difference and begins a process of self-exploration as the powerful bearers of their own life experience and realities and the effect this have on others. Cultural Awareness: is a beginning step towards understanding that there is difference. Many people undergo courses designed to sensitise them to formal ritual rather than the emotional, social, economic and political context in which people exist. Figure 1: Process of Cultural Safety (Ramsden, 2002) QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 9

10 Cultural safety is based on a definition of culture congruent with the social work perspective Learned yet dynamic ways of being in everyday life, informed by attributes such as age, class, ability, ethnicity, gender and sexual orientation, which influence beliefs, values and attitudes and how humans explain and respond to life s context and circumstances (Cox, 2013, p. 13). It is not only relevant to working with Aboriginal and Torres Strait Islander peoples and communities, and/or refugee or migrant communities it is about working with all people no matter the attributes named above QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 10

11 The challenge SW Education in the context of field experiences University exposes students to the critiques of cultural competence with cultural safety emerging as a contemporary and valuable practice approach HOWEVER Cultural competence still embedded in the discourse of social service organisations / policies and the professional discourse of social work On placement students are likely to be measured against the concept of cultural competence as opposed to cultural safety Power dynamics - Issues of powerless of students to speak up, feeling the need to conform, fear of passing or failing The AASW Code of Ethics (2010) and ASWEAS Accreditation standards (2015) refer throughout to culturally competent, safe and sensitive practice. ACWA Practice Guidelines (2017) refers to understanding and sensitivity to diversity and compliance with legislation It is not possible to work from a culturally safe approach whilst trying to be culturally competent QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 11

12 So how do we address the challenges? Issues: Recognition that Field Educators are busy with limited opportunity to engage in additional training AND are voluntarily educating our students on top of their workload Requires a shift in the dominant discourse about culture among a diverse range of educators and organisations i.e. cultural safety is a positioning that should inform all interpersonal encounters. This is a journey that requires a joint commitment and shared understanding Also need to consider the diversity of field educators Requires a innovative approach that is easily accessible to a range of Field Educators in a range of locations Decided to use the SWISS website as a starting point for providing information about cultural safety as our key positioning for field educators in particular SWISS is a website specifically designed for and available to all QUT Field Educators and more broadly QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 12

13 A work in progress: The vision QUT SWISS website is being structured to: Provide field education information for students and Field Educators General information about cultural safety at an interpersonal level Links to resources are being developed that discuss cultural safety in the context of working with specific groups, and these will be included in topicspecific folders. QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 13

14 The vision cont d A series of relatively quick access video and written resources that can be accessed by field educators and students For example, resources being developed will include: Interviews with students & academics about practising cultural safety Direct practice case studies looking at a range of interpersonal encounters Practising cultural safety within research contexts Links to international research and literature QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 14

15 The vision Emphasis is on a joint learning journey and the role of our university to provide the tools Watch this space! Thank you! QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 15

16 References Bainbridge, R., McCalman, J., Clifford, A & Tsey, K. (2015). Cultural competency in the delivery of health services for Indigenous people. Issues paper no. 13. Closing the Gap Clearinghouse, Accessed from Kleinman, A. & Benson, P. (2006). Anthropology in the clinic: The problem of cultural competency and how to fix it. Malat, J. (2013). The ApPeal and problems of a cultural competence approach to reducing racial disparities. J General Intern Medicine, 28(5): DOI: /s y Thackrah, R. & Thompson, S. (2013). Refining the concept of cultural competence: Building on decades of progress. Medical Journal of Australia, 199(1), doi: /mja Tsai, J. (2016). The problem with cultural competency in medical education. Retrieved from QUT SCHOOL OF PUBLIC HEALTH AND SOCIAL WORK 16