Culturally Safe. Mapping Evaluation of Community- based FASD Prevention and FASD Support Programs. evaluation.ca

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1 Culturally Safe Short Definition: Cultural safety is based on the notion that people seeking help from services need to feel safe, respected, and valued as an individual and for their cultural identity. Key to cultural safety is appreciation that the worker, the organization, and the program client are all bearers of culture; health and social service providers must embrace the skill of self- reflection and provide care that is congruent with the cultural values and norms of the person being served.

2 Definition: Cultural safety is based on the notion that people seeking help from services need to feel safe, respected, and valued as an individual and for their cultural identity. First developed in the 1980s by a Maori nurse leader in New Zealand, the concept of cultural safety goes beyond cultural sensitivity (i.e. appreciating that there are differences among cultures) and calls attention to ways in which colonization affected the health of Maori people historically and to ways in which colonizing processes continue to impact Indigenous people s health and well- being. Cultural safety emphasizes the importance of reflecting on the social, economic, and political position of different groups within society - in particular indigenous peoples across the globe and on the ways in which current policies, practices, education and research may oppress and be re- traumatizing for Aboriginal peoples. Key to cultural safety is appreciation that the worker, the organization or agency, and the program client are all bearers of culture; in order to provide quality care to people who are not part of the dominant culture, health and social service providers must embrace the skill of self- reflection and provide care that is congruent with the cultural values and norms of the person being served. In this regard, culturally safe practice moves beyond accepting differences to analyzing power imbalances, institutional discrimination, colonization and relationships with colonizers (NAHO, 2006). Cultural safety also has been defined as the outcome of interactions where individuals experience their cultural identity and way of being as having been respected or, at least, not challenged or harmed (Ball, 2008, emphasis added). Similarly, cultural safety is respectful engagement that supports and protects many paths to well- being (Ball, 2008). Culturally Safe Approach - Key Elements Although the notion of cultural safety originated in relation to health care, it is increasingly evident within other service systems, including the education and criminal justice systems (Bernal & Sáez- Santiago, 2006; Brascoupé & Waters, 2009; scc.gc.ca/text/pblct/forum/e121/e121j- eng.shtml.; Tait, 2008). Cultural safety is ultimately about social justice, personal empowerment and self- determination where the Indigenous client is part of his or her own healing journey and wellness plan, and linkages between health, well- being, and community wellness are recognized. In relation to Indigenous people, a culturally safe approach recognizes the centrality of an integrated, wholistic approach to health and well- being and incorporates traditional knowledge

3 and practice as part of the service or program. In this regard, culturally safe practice is increasingly understood as a protective factor that positively influences both Aboriginal communities and individuals (McIvor, Napoleon, Dickie, 2009; Hill, 2009; Brascoupe & Waters, 2009). As described by the Native Mental Health Association of Canada, (2010, p. 1): For Aboriginal people, the concept of cultural safety is central to developing effective models of holistic care and relational practice. As described by Rosella Konishameg in It Takes A Community (Health Canada, 1997, p.10):...the creator has given us the circle and medicine wheel so that we can view life in a wholistic manner. The circle symbolizes completeness and interdependency that gives unity and strength. Health is the power and energy to exist in balance of the body, mind, ad spirit and to function in harmony with the environment. All things are in relationship. We have only to look at the web of life Chief Seattle Following are key elements in culturally safe practice (Chansonneuve, 2010; Waldram, 2008; Crooks, Chiodo, & Thomas, 2009; Aboriginal Healing Foundation, 2003; Health Canada, 1997; NAHO, 2006; Maar & Shawande, 2010): 1. Working from a wholistic perspective: The program acknowledges that the physical, mental, social, spiritual and emotional needs of individuals are inseparable and inclusive of their network of family and community relationships. 2. Understanding the role of colonization, racism, and oppression in the emergence of health and social determinants and current health conditions of Indigenous peoples. 3. Culture as healing: The program incorporates traditional knowledge and practice such as the use of stories, ceremonies, and other traditional and land- based activities. Elders and other traditional knowledge holders are integral to development and implementation of any culturally based programming. Cultural programming builds on a strength- based approach to wellness. 4. Recognizing we are all bearers of culture: The practitioner considers not only the culture of the people but also the culture of the practitioner him/herself and his/her place of work. Whether in an office, a clinic, a hospital or as part of a particular discipline, each carries its own unique culture. The practitioner is respectful of the person s nationality, culture, age, sex, gender, political and/or religious views, and does not practice in a manner that ignores or denies that differences may exist.

4 5. Diversity: Indigenous culture is diverse and adherence to traditional practices and connection to culture, spiritual beliefs, and knowledge of traditional language is varied and cannot be presumed to be universal. Consequently, culturally safe programs are flexible and typically include the practices of many Nations, depending on location and context (e.g. urban setting; provincial program), as well as westernized practices/activities so as to offer a full spectrum of modalities for clients. 6. Relational: The helper and the helped have something to contribute to the problem- solving and all play into the goal of a respectful relationship where each can share their own information to create equality and trust, knowing that each person s knowledge and perspective is validated. Part of relational approach is person first language. 7. Empowerment: The program and practitioner recognize individual strengths and challenges and acknowledges that not all Indigenous people are the same. The focus is on working with people where they are at rather than where staff or others want them to be. An eclectic grouping of traditional and westernized practices and activities are often used to meet the complex needs of clients, and promote self- determination. Potential Indicators of activities and practice, program and community outcomes informed by Culturally Safe approach: Programs intended for Aboriginal program participants: o include an active role for Elders/ traditional knowledge keepers; o address participants spiritual needs; o offer both Indigenous and westernized activities/approaches; o ensure that program staff are culturally aware and knowledgeable about the impacts of colonization including of trauma (see Trauma- Informed definition and indicators); o adapt to local Aboriginal culture/traditions/practices as required, even if the program is provincial or federal in scope; o include land- based activities where feasible; o pay attention to the community context and significant events in the community that might affect participation (e.g. death of a leader, elder, young person). Participants experience the program, facility, and staff as being welcoming, inclusive, knowledgeable about and respectful of the importance of cultural connections and traditions. The program uses multiple strategies to engage and include parents, extended family and social networks and key community members (where feasible).

5 In addition, evaluation of culturally safe FASD programs also should incorporate culturally appropriate methodologies in terms of design, purpose, and process. For these reasons, a linear approach such as a program logic model may not work well in a culturally centred program or setting (Desai, et al, 2009).

6 References/citations of cultural safety Aboriginal Healing Foundation (2003). Third Interim Evaluation Report of Aboriginal Healing Foundation Program Activity. Author. Ottawa, Ontario. Atlantic Council for International Cooperation (nd). Medicine Wheel Evaluation Framework. Ball, J. (2008). Cultural Safety in Practice for Children, Families and Communities. In Early Childhood Development Intercultural Partnerships. University of Victoria. Bernal, G., & Sáez- Santiago, E. (2006). Culturally Centred Psychosocial Interventions. Journal of Community Psychology. 34, (2) Brascoupé, S. & Waters, C. (2009). Exploring the Applicability of the Concept of Cultural Safety to Aboriginal Health and Community Wellness. Journal of Aboriginal Health. 5(2) Chansonneuve, D. (2011). Submission to the Office of the High Commissioner for Human Rights. Minwaashin Lodge/Aboriginal Women s Support Centre. Best Practices from the Front Line: A Lifecycle Service Model for Prevention of Violence Against Indigenous Women and Girls. Crooks, C., Chiodo, D., & Thomas, D. (2009) Engaging and Empowering Aboriginal Youth: A Toolkit for service providers. CAMH Centre for Prevention Science and the University of Western Ontario. Desai, N., Saadati, A., Belcher, J., Mong, A., Chan, J., Alisch, M., Hermiston, L. (2009). Evaluation of the Indigenous Early Childhood Development Training Program. Canadian Mothercraft Society. Toronto. Hill, D. M. (2009). Traditional Medicine and Restoration of Wellness Strategies. Journal of Abopriginal Health. 5 (1) Maar, M & Shawande, M. (2010). Traditional Anishinabe Healing in a Clinical Setting: The Development of an Aboriginal Interdisciplinary Approach to Community- based Aboriginal Mental Health Care. Journal of Aboriginal Health. 6 (1) McIvor, O., Napoleon, A., & Dickie, K. (2009). Language and Culture as Protective Factors for At- Risk Communities. Journal of Aboriginal Health. 5 (1) National Aboriginal Health Organization. (2006). Fact Sheet: Cultural Safety. Accessed on- line May 13, 2012 via:

7 Native Mental Health Association of Canada (2010). Building Bridges 2: A Pathway to Cultural Safety, Relational Practice and Social Inclusion. Final Report. Mood Disorders Society of Canada. Tait, C. (2008). Ethical Programming: Towards a Community Centred Approach to Mental Health and Addiction Programming in Aboriginal Communities. Journal of Aboriginal and Indigenous Community Health 6 (1) Van Bibber M,(1997) It Takes a Community. A Resource Manual for Community- based Prevention of Fetal Alcohol Syndrome and Fetal Alcohol Effects Published by Aboriginal Nurses Association of Canada. (Republished by Health Canada) Waldram, J. (2008) Aboriginal Healing in Canada: Studies in Therapeutic Meaning and Practice. Aboriginal Health Foundation Research Series.