week 4 developing cultural competence

Question 1

Examine the nature of cultural competence skills required to work respectfully with Indigenous peoples.
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Answer 1

Mental health workers, counsellors, and other health professionals need to work in accordance with the guiding principles contained in the Ways Forward National Aboriginal and Islander Mental Health Policy Report3 which suggested all mental health practitioners to ‘take on board’ the understanding that:
The Aboriginal concept of health is holistic.
Self-determination is central to the provision of Aboriginal health services.
Culturally valid understanding must shape provision of Aboriginal health (and mental health) care.
The experience of trauma and loss contribute to the impairment of Aboriginal culture and mental health well-being.
The human rights of Aboriginal people must be recognised and enforced (emphasis added).
Racism, stigma, adversity and social disadvantage must be addressed in strategies aimed at improving Aboriginal mental health.
The strength and centrality of Aboriginal family and kinship must be understood and accepted.
Diversity of groups needs to be recognised.

Question 2

Identify the components of cultural safety: working with Aboriginal and Torres Strait Islander people in a health context

Answer 2

cultural safety is: Shared respect, shared meaning and shared knowledge
The experience of learning together with dignity and truly listening
Strategic and institutional reform to remove barriers to the optimal health, wellbeing and safety of Aboriginal people. This includes addressing unconscious bias, racism and discrimination, and supporting Aboriginal self-determination
Individuals, organisations and systems ensuring their cultural values do not negatively impact on Aboriginal peoples, including addressing the potential for unconscious bias, racism and discrimination
Individuals, organisations and systems ensuring self-determination for Aboriginal people. This includes sharing power (decision-making and governance) and resources with Aboriginal communities. It’s especially relevant for the design, delivery and evaluation of services for Aboriginal people.

Cultural competence starts with being a “decent human being”
One needs to have a genuine interest with the individual and/or family
Aboriginal and Torres Strait Islander people are careful about the language they use
Let them use their words
Pause and give them time to reflect on the questions you pose
Note that health is holistic in the Indigenous culture
Be respectful
Be authentic
Note that trust builds over time
Be cautious of the bias in the English language
Note the impact of intergenerational trauma on First Nations peoples’ mental health.

Question 3

Examine the protocol for treating Indigenous people with a mental illness.

Answer 3

Vicary and Bishop’s (2005) ten-step model of engagement with Indigenous communities.

1. Self-reflection Reflecting on your own motives and assumptions
2. Formative preparation
   Developing an understanding of the culture and history of the community you are engaging with. Reviewing and modifying your micro-counselling skills
3. Networking and supervision Establishing networks; identifying and forming relationships with cultural consultant(s); obtaining cultural supervision or mentoring; setting up a reference group (depending on what you aim to do)
4. Referral Understanding the referral process; understanding the client’s perceptions/wishes
5. Research Researching the client’s personal history
6. Potential limiting factors Negotiating possible barriers with your client - gender, age, sexuality, cultural beliefs etc.; working out an an appropriate location; identifying who should attend
7. Contact Structuring the initial contact carefully, based on research into limiting factors
8. Therapeutic options Exploring what therapeutic options are available and appropriate
9. Follow-up Determining how to obtain feedback on the effectiveness of the engagement
10. Evaluation Determining strategies to evaluate the effectiveness of the engagement