Develop and evaluate cultural safety strategies

A matter of priority for any community service, allied health, aged care or disability organisation that is involved in service delivery for Aboriginal and/or Torres Strait Islander peoples has to be to evaluate their workplace to identify existing cultural safety issues and address any unsafe practices.

Creating cultural safety in the workplace extends to ensuring the well-being of both clients and staff. Specifically, it involves making Aboriginal clients feel secure and valued. Similarly, it requires fostering an environment where Aboriginal and/or Torres Strait Islander staff sense acknowledgment and respect for their individual identities and community connections. To establish a culturally safe workplace, it is essential to accommodate the diverse cultural values and beliefs of all individuals. This includes having policies and procedures that acknowledge and support the cultural needs of each person.

Figure 1 below illustrates some key elements of culturally safe workplaces and services for Aboriginal and Torres Strait Islander peoples. As you can see, the ability to develop self-awareness and work effectively with Aboriginal and Torres Strait Islander peoples (i.e., competency) among staff are essential. As such the organisation must proactively evaluate the extent to which cultural safety practices are integrated in the workplace and practices. Some relevant aspects to consider include (State Government of Victoria, 2019):

• Is cultural safety endorsed by the leadership at all levels? Is it effectively communicated throughout the organisation (e.g., mission, vision, policies)?
• Are Aboriginal and/or Torres Strait Islander staff and/or communities engaged in designing, delivering and evaluating policies and programs?
• Is staff at all levels supported to undertake ongoing cultural safety training and development?
• Are cultural safety practices embedded within recruitment and retention processes? Do the existing policies, programs and procedures reflect cultural safety?
• Do staff consider promotion of cultural safety part of their responsibilities? What are the existing practices and processes in place for individual staff and the organisation to reflect on their competency in cultural safety and seek improvements?

^{(State Government of Victoria, 2019, p. 7)}

In addition, this reading provides a number of additional strategies that disability servicesorganisations can use to support cultural safety (Price-Robertson & McDonald, 2011). These include:

• Working with (rather than working “on”) Aboriginal and Torres Strait Islander communities. Disability services programs for Aboriginal and Torres Strait Islander peoples are most effective when people from their local communities are involved in both program planning and implementation. When possible, workers should try to connect with Elders and/or community members when planning and implementing services.
• Ensuring your service is culturally competent. To be culturally competent, services need to ensure that cultural knowledge shapes the structure of the service, the specific strategies and practices employed by the service, and the selection, training, and actions of individual staff members.
• Focusing on attracting and retaining the right staff. Your organisation should ensure that the staff it employs is representative of the community it works with. If you are working in an organisation that provides services to Aboriginal and/or Torres Strait Islander peoples, you should employ Aboriginal and/or Torres Strait Islander staff with demonstrated skills to do the job.
• Cultivating networks and relationships. Organisations providing service to Aboriginal and Torres Strait Islander peoples are typically more effective when they work in collaboration with Aboriginal and Torres Strait Islander organisations. In that case they are better able to ensure clients are connecting to the relevant culturally appropriate services they may need.
• Adopting an action research approach. Action research, also referred to as participatory evaluation, is “a participatory group process aimed at continual evaluation and improvement of practice” (Price-Robertson & McDonald, 2011, p. 5). This approach is particularly useful in the planning stage of program or service development. Action research is a cyclical process that includes:
  • Planning: workers, other staff and interested parties come together to define goals and ways to achieve these goals.
  • Acting: Going forward with planning program or activity.
  • Reflecting: seeking feedback from all involved in the program or activity.
  • Planning: the cycle begins again, taking into consideration what has been learned.

It is important to remember that cultural safety is not just about clients, it is also important to promote cultural safety in regard to workers.

As a worker, if you are unsure about how to implement a particular policy around cultural safety, or if you are unsure about the appropriateness of a policy with a particular client, talk to your supervisor at a minimum. It would be best to consult with your supervisor, the client and/or a member of their family or extended kin, and a representative or Elder from the local Aboriginal and/or Torres Strait Islander communities. This type of consultation will help promote the cultural safety needs of the client, worker, and organisation.

Indeed, an important strategy to promote cultural safety in an organisation is the partnership and engagement with Aboriginal and/or Torres Strait Islander peoples. It is important that they are involved throughout stages of planning, implementation and evaluation of cultural safety strategies.

KNOWLEDGE CHECK

When developing partnerships between mainstream service organisations and Aboriginal and/or Torres Strait Islander communities and/or organisations, it is important for services to commit to and invest in building trusting relationships (SNAICC, 2020). Considering the history of oppression and maltreatment that First Nation peoples experienced, it is even more important to re-develop trust that is fundamental to effective partnerships. Some key strategies include:

• Taking the time to know and connect with the Aboriginal and/or Torres Strait Islander partner (e.g., Elders, community organisations, or community members).
• Listening and consulting with Aboriginal and Torres Strait Islander peoples and communities.
• Follow through the partnerships with commitment. Trusting partnership is built upon time and meaningful interactions.

It is also important to consider how the partnership will be resourced. Keep in mind that many Aboriginal and Torres Strait Islander communities and organisations operate with limited resources when compared to their mainstream counterparts. However, we must genuinely listen to find out what resources our Aboriginal and Torres Strait Islander counterpart may want or need, without assuming that they will need or want support with resources. Strategies for identifying and utilising resources to promote partnerships include:

• Determine what is needed in terms of human, financial and other resources for the partnership to be successful.
• Aboriginal and/or Torres Strait Islander communities should be consulted to ensure that local needs are being addressed when determining what resources are needed.
• Determine what resources already exist with the organisation (e.g., access to funds, print materials, equipment and other in-kind resources).
• Research government and other funders who are likely to be providing funding or other resources to support your partnership.
• Select staff from the organisation and reach out to Aboriginal and/or Torres Strait Islander communities to determine who will be involved in the partnership. Determine what responsibilities each person will take on.
• Pay attention to the strengths, skills and capacities of the local community in which you would like to partner with.

It is critical that Aboriginal and/or Torres Strait Islander people are consulted and involved in the planning, implementation and evaluation of workplace policies around cultural safety. As mentioned before, cultural safety is an outcome to be determined by recipient of services. It is Aboriginal and/or Torres Strait Islander peoples who will determine if their cultural identity and meanings are being respected, and they are not being subjected to discrimination.

Modes of Service Delivery

When devising ways to support the delivery of services and programs that are culturally safe and encourage increased participation of Aboriginal and/or Torres Strait Islander clients, families and communities, you may want to consider how and where you will deliver the program or service. Rather than running a program through the office of a mainstream disability service organisation, consider other promising approaches for increasing safety and participation. These include:

• Outreach. Outreach programs have been shown to be successful in delivering culturally appropriate services to Aboriginal and Torres Strait Islander communities. Outreach programs tend to be mobile, so they work within the local Aboriginal or Torres Strait Islander community. Some common forms of outreach include a bus or van that travels to communities to offer information and services that goes into communities to conduct home visits with clients and their families. For outreach programs to uphold principles of cultural safety, they must be developed in consultation with community members to ensure programs will be beneficial to the community and not replicate power imbalances. Aboriginal and/or Torres Strait Islander communities must also take an active role in the implementation and evaluation of outreach programs. Some of the benefits of outreach programs include improved access to programs, the ability to better understand and meet the needs of local communities, reduced isolation and the placement of services in a familiar setting for community members, decreased stigma associated with accessing services, reduced barriers such as transportation, and increased opportunity to establish trusting relationships between service providers and Aboriginal and/or Torres Strait Islander communities.
• Satellite services. Satellite services and programs are delivered from a static facility within local Aboriginal and Torres Strait Islander communities. This may be a room in an existing service building such as Aboriginal Land Council, community centre, or Aboriginal Health Centre. Similar to outreach programs, satellite services must be developed, implemented and evaluated in consultation with local Aboriginal and/or Torres Strait Islander community members. Satellite programs have similar benefits to outreach services. Other benefits might include mainstream service providers feeling less isolated and having local Aboriginal and/or Torres Strait Islander staff close by to call on for support if needed, promoting the development of meaningful working relationships and partnerships between mainstream community services organisations and local Aboriginal and/or Torres Strait Islander organisations, and the ability to share resources between mainstream and community programs.
• Partnerships that encourage community control. Partnerships are critical to devising programs that are culturally safe and promote participation and access by Aboriginal and Torres Strait Islander peoples. Partnerships that encourage community control are the most effective strategy for creating culturally safe and culturally relevant programs and services for Aboriginal and Torres Strait Islander clients. Partnerships that promote community control must “extend beyond consultation to provide the resources that genuinely give power to aboriginal and Torres Strait Islander communities to design and implement policy and programs and to make the decisions…” (SNAICC, 2020, p. 5). Community control of services means that Aboriginal and/or Torres Strait Islander people have control over the way that a service is provided in their communities or with members of their communities. The Queensland Government (2011) defines the requisites of community controlled programs as programs and services that are initiated by a local Aboriginal community, based in a local Aboriginal community, governed by an Aboriginal body which is elected by the local community, and delivering holistic and culturally appropriate services to the local community which controls it.

Developing partnerships between mainstream community services organisations and Aboriginal and/or Torres Strait Islander communities must be done with care. Mainstream community services organisations must strive to involve Aboriginal and/or Torres Strait Islander communities at the highest levels of participation. It is also important to recognise that this is process that requires ongoing consultation, time, and patience on behalf of both parties. Importantly, the partnership must be based upon the principle of self-determination, founded upon the ability to reflect on own culture and the impacts of dominant culture on Aboriginal and Torres Strait Islander peoples.

Promoting Self-Determination

Self-determination must be the foundation of all work with Aboriginal and Torres Strait Islander clients. When creating partnerships, organisations should make sure Aboriginal and/or Torres Strait Islander peoples are genuinely involved at the highest levels of participation. The goal is to empower the Aboriginal and Torres Strait Islander communities to lead the effort and build upon their existing strengths and capacity. Self determination is about choice, participation and control. 

Engagement with the communities can only be effective when mechanisms for meaningful participation are in place. Arnstein’s ladder of citizen participation (1969), shown on the next page, is a classic but still useful tool for understanding the various levels of participation when developing collaborative working relationships between mainstream community services organisations and Aboriginal and/or Torres Strait Islander communities.

Participation at the level of manipulation is characterised by community services organisations directing Aboriginal and/or Torres Strait Islander communities, who are not provided with the information they need to make meaningful decisions. At this level, the communities may be asked to support or promote decisions that have already been made by the mainstream community services organisation.

At the therapy level – also sometimes referred to as the decoration level – Aboriginal and/or Torres Strait Islander populations may be indirectly involved in decisions, but are not fully aware of how their involvement and decisions might affect the local community. Participation at the level of informing Aboriginal and/or Torres Strait Islander peoples are informed of what is needed of them, as determined by the mainstream community services organisation; however, their views are not actively sought and they are not involved in any decision-making.

Arnstein’s Ladder of Participation

^{(Arnstein, 1969)}

At the consultation level of participation, Aboriginal and/or Torres Strait Islander communities are fully informed about what may be involved in the partnership and are encouraged to express their opinions; however their opinions have little or no impact on the decision-making process of the community services organisation.

When Aboriginal and/or Torres Strait Islander peoples participate in partnerships at the level of placation, they are consulted and informed about the needs of the community services organisation and what the community partnership can do to benefit them. The communities are listened to in order to inform the decision-making process; however there is no guarantee that the community services organisation will implement any recommendations.

Participation at the partnership level ensures that Aboriginal and/or Torres Strait Islander communities are consulted, informed, and participating in the decision-making processes of the organisation, with some influence over what the partnership looks like. The development of a partnership and the commitments made by both parties are the result of negotiations between mainstream community services organisations and relevant Aboriginal and Torres Strait Islander communities.

At the level of delegated power, mainstream community services organisations still inform the agenda of the partnership, but Aboriginal and/or Torres Strait Islander communities are given responsibility for managing aspects of initiatives that result from the partnership. This is typically the level of participation seen by most partnerships between community services organisations and Aboriginal and/or Torres Strait Islander communities.

The highest level of participation, citizen control, is characterised by Aboriginal and/or Torres Strait Islander communities initiating the agenda of the partnership and being given full responsibility and power for management of the partnership and to bring about change within the community services organisation. Power is delegated to the communities, and they are active in designing partnership strategies to improve service outcomes for Aboriginal and/or Torres Strait Islander clients. At this level, full self-determination can be realised. There has been a growing push to implement the highest levels of participation, as can be demonstrated in the following extract:

Strategies that encourage self-determination and community control in services include:

• Engage in discussion about what the partnership means and allow all parties to identify their goals and objectives to ensure all parties are on the same page.
• Engage with Aboriginal and/or Torres Strait Islander peoples who are interested in taking on a leadership role in the partnership.
• Work with Aboriginal and/or Torres Strait Islander peoples to determine how the achievement of their partnership goals can be measured.
• All planning for programs and services for Aboriginal and/or Torres Strait Islander clients should be done with significant input and leadership provided by Aboriginal and/or Torres Strait Islander community stakeholders.
• Implementation of all programs and services for Aboriginal and/or Torres Strait Islander clients should be led by qualified Aboriginal and/or Torres Strait Islander partners.
• Programs and services developed in partnership should be owned by the local Aboriginal and/or Torres Strait Islander community with which they were developed.
• Formalise the partnership (e.g., developing a memorandum of understanding) to clarify the commitment of all parties and the partnership objectives. Particularly, the agreement should recognise the leading role of Aboriginal and Torres Strait Islander organisation/community in partnership.

Self-determination and meaningful collaboration help to uphold the right of Australian Aboriginal and Torres Strait Islander peoples to exercise control over matters that directly affect them, their families, and their communities. Indeed, self-determination and meaningful collaboration result in better service outcomes for Aboriginal and Torres Strait Islander clients.

Developing meaningful and genuine partnerships between community services organisations and Aboriginal and/or Torres Strait Islander communities is a critical component of cultural safety in the workplace.

KNOWLEDGE CHECK

It is recommended that partnerships with Aboriginal and Torres Strait Islander communities to be documented formally (SNAICC, 2020). Whilst this should not replace any relationship building that underpins the agreement, having formal documentation helps to clarify roles and responsibilities of each partner and reduce reliance on particular individuals where there are inevitable changes in staff and leadership. A memorandum of understanding (MoU), for example, is a non-legally binding document often created to record agreement and recognise the leading role of Aboriginal and Torres Strait Islander peoples within the partnership. An example of a brief MoU is shown on the next page. Once again, these documentations should be created in plain English and in collaborative effort with the Aboriginal and Torres Strait Islander partners.

In order to promote cultural safety within the organisation, cultural safety policies and procedures should be formally recognised and documented within the organisation. Most community services organisations have a policies and procedures manual and/or a code of ethics identifying the rules, regulations, and workplace practices that all staff are required to follow. By documenting cultural safety practices of the organisation in the policy and procedure manual and/or code of ethics, workers can better understand what is expected of them in delivering appropriate, culturally safe services to Aboriginal and/or Torres Strait Islander clients. Documented policy and procedures enable workers and organisations to review and evaluate the extent to which cultural safety is integrated in work practices.

Below is an example of a cultural safety policy endorsed by a health service.

Creating a code of ethics or policy and procedure manual to formally document how the organisation will promote workplace cultural safety should always be planned and implemented in consultation with Aboriginal and Torres Strait Islander peoples. They should also be involved in how cultural safety in the workplace is evaluated.

KNOWLEDGE CHECK

Promoting cultural safety is an ongoing commitment and learning process. As such, it is important to conduct evaluations to find out if strategies implemented are effective and seek improvement. It is critical that Aboriginal and/or Torres Strait Islander peoples participate in the development and evaluation of indictors for which cultural safety in the workplace is to be measured as well as in the process of evaluation.

Agreeing on the outcomes against which cultural safety can be measured may not be a straightforward process. There may be different understanding among stakeholders on what a successful outcome looks like, and what the goal of evaluation is. For example, for a support services program based within the health care setting, indicators may include rate of service use, drop-out of programs, or withdrawal from service against advice. Additionally, some evaluation methods may not be feasible due to limitation in capacity or resources. Therefore mainstream organisation will need to work collaboratively with their counterparts to determine what is the most appropriate way to evaluate cultural safety strategies, within each specific context. Other important considerations include:

• Learn to share power and work collaboratively.
• Agree on principles to guide relationships between mainstream community services organisations and Aboriginal and/or Torres Strait Islander communities.
• Clarify roles and responsibilities.
• Allow Aboriginal and/or Torres Strait Islander peoples to set targets that highlight their understanding of cultural safety.
• Be flexible and adaptable to work toward outcomes identified by Aboriginal and/or Torres Strait Islander partners.
• Provide training to support non-Indigenous staff to better understand the protocols of culturally respectful communication. Recognise that English may be a second or third language, and allow for planning and goal setting with Aboriginal and/or Torres Strait Islander communities to occur in their own language. Use interpreters and/or translators when required.
• Avoid jargon or overly professional language when engaging with Aboriginal and/or Torres Strait Islander communities to set indicators of workplace cultural safety.
• Demonstrate genuine respect and interest in learning from Aboriginal and/or Torres Strait Islander peoples.
• Invest in capacity building initiatives to ensure more vulnerable groups are able to participate in setting targets to measure cultural safety.
• Allow flexibility for Aboriginal and/or Torres Strait Islander communities to participate on their own terms.

A Participatory Approach to Evaluation

Participatory evaluation is a partnership approach in which local Aboriginal and/or Torres Strait Islander communities actively participate in the evaluation at all phases of its implementation. The local Aboriginal and/or Torres Strait Islander community is engaged in program evaluation processes including:

• Identifying relevant questions.
• Planning and evaluation design.
• Selecting appropriate measures and data collection methods.
• Gathering and analysing evaluation data.
• Reaching consensus about findings, conclusions and recommendations.
• Determining to who and how to disseminate evaluation findings.
• Preparing an action plan to improve program performance.

Participatory program/service evaluation is both inclusive and sensitive to the particular Aboriginal and/or Torres Strait Islander community that a program or service in engaged with. According to Jordan, Stocek and Mark (2010), participatory program evaluation is best suited to small-scale local programs, which are accessible to participation by the communities in which the program is operating. As such, they are less susceptible to colonisation by outside ‘experts’.

Participatory program evaluation emphasises the importance of Aboriginal and/or Torres Strait Islander peoples’ participation in the design, planning, implementation and evaluation processes, viewing all as interconnected. By demanding involvement at all levels of service planning, delivery and evaluation, participatory program evaluation is accountable to the Aboriginal and/or Torres Strait Islander community with which the program or service is engaged. The local community partners have control over the evaluation and the outcomes to be measured to determine the success of the program.

Strategies for participatory program evaluation include:

• All evaluation materials must take into account the varying degree of literacy and educational experiences of Aboriginal and/or Torres Strait Islander peoples working on the program.
• The local language of the community should be the dominant language of the evaluation process if the community desires. Translators can be hired to convert evaluation data to English for the mainstream service organisation if needed.
• Avoid reliance of written evaluation data collection methods (e.g., long surveys/questionnaires, journal entries). Rather, try to use visual or narrative materials and methods.
• Create a strong sense of solidarity and teamwork.
• Intended outcomes and indicators should be developed by the local Aboriginal and/or Torres Strait Islander communities, allowing for historical and qualitative indicators that are able to capture the reality of their life.
• Understand evaluation as an on-going cyclical process: planning, implementation, evaluation, and planning and revising taking into consideration what has been learned in evaluation, repeat.

The following case study demonstrates an example of an evaluation process that involves relevant Aboriginal staff and community from design to implementation stage.

The concepts of self-determination, capacity building, mutual trust and respect have been frequent themes throughout this module and are critical for ensuring cultural safety in the workplace. Participatory evaluation has self-determination and capacity building at the heart of its methodology, and is not possible without respectful and trusting relationships between Aboriginal and/or Torres Strait Islander communities and mainstream community services organisations. Capacity building is realised because, through participatory evaluation, Aboriginal and/or Torres Strait Islander partners are able to learn and practice evaluation and partnership skills that are transferrable to other work they are involved in with their communities. Capacity building is realised in the form of increased cultural awareness and cultural competency results for mainstream service partners. Self-determination is realised as Aboriginal and/or Torres Strait Islander peoples are involved in naming and framing the issue, planning and implementing a program, identifying the evaluation questions that will be asked, collecting evaluation data, analysing that data, and assessing what to celebrate or to do differently – promoting participation and community control in all stages of the program. When done effectively and genuinely, participatory practice supports the building of trusting relationships and leads to increased partnership opportunities.

Participatory program evaluation is a powerful alternative to traditional methods of evaluation. This approach is best suited to meet the unique needs of Aboriginal and/or Torres Strait Islander communities and promotes the processes of decolonisation and self-determination.

KNOWLEDGE CHECK

In this topic you learned the importance of developing genuine partnerships with Aboriginal and/or Torres Strait Islander communities and/or organisations in the efforts of planning, implementing and evaluating cultural safety strategies. Remember that promoting cultural safety is an ongoing learning journey for practitioners as well as non-Indigenous organisations that requires a lot of patience and understanding. Nevertheless, it is everyone’s responsibility to support the rights of Aboriginal and Torres Strait Islander clients and colleagues to access a safe and culturally appropriate service or workplace.

Arnstein, S.R. (1969). A Ladder of Citizen Participation. Journal of the American Institute of Planners, Vol. 35, No. 4, July 1969, pp. 216-224. Boston: American Institute of Planners. Retrieved from https://lithgow-schmidt.dk/sherry-arnstein/ladder-of-citizen-participation_en.pdf

Bega Garnbirringu Health Service. (2018). ORGPN01 - Cultural Safety Policy. https://bega.org.au/bewp/wp-content/uploads/2018/08/ORGPN01-Cultural-Safety-Policy.pdf

Department of Health. (2016). National framework for health services for Aboriginal and Torres Strait Islander children and families. Australian Government, Canberra.

Jordan, S., Stocek, C., & Mark, R. (2010). Nigawchisuun: Participatory evaluation as indigenous methodology. Participatory Action Research and Action Learning. Melbourne, VIC: 8th World Congress 2010.

Muir, S., & Dean, A. (2017). Evaluating the outcomes of programs for Indigenous families and communities. CFCA Practice Resource – February 2017. https://aifs.gov.au/cfca/sites/default/files/publication-documents/evaluating-outcomes-porgrams-indigenous.pdf

Queensland Government. (2011). Information Sheet – Transition to Aboriginal and Torres Strait Islander Community Control of Health in Queensland: A draft strategic policy framework. Brisbane, QLD: Queensland Government.

SNAICC – National Voice for our Children. (2020). Creating change through partnerships: An introductory guide to partnerships between Aboriginal and Torres Strait Islander and non-Indigenous organisations in child and family services. https://www.snaicc.org.au/policy-and-research/genuine-partnerships/

State Government of Victoria. (2019). Part 1: Aborginal and Torres Strait Islander cultural safety framework. https://www.health.vic.gov.au/health-strategies/aboriginal-and-torres-strait-islander-cultural-safety