Developing Culturally Safe Healthcare Policies for Indigenous Australians

To ensure cultural safety for indigenous people in Australia, it is essential to involve all parties, including indigenous organizations and service providers. This can be achieved by developing a permanent advisory group with the indigenous people, having a well-defined framework for indigenous engagement, and ensuring greater accountability from funding bodies, government agencies, and health service providers. Additionally, implementing awareness on Aboriginal and Torres Strait Islander history and cultures into work practices, providing community control and ownership of decision-making, and working in partnership with community people are crucial steps towards creating culturally safe healthcare policies and increasing accessibility among indigenous people.

PROMOTE ABORIGINAL AND/OR
TORRES STRAIT ISLANDER CULTURAL
SAFETY
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Formative assessment
Activity 1
Question 2
The twelve basic strategies for addressing cultural diversity are—
1. Development of understanding on the culture- appropriate work practices among all the staffs
2. Developing an environment which ensures cultural and psychological safety for all the
stakeholders (Sala & Baldassar, 2017)
3. Reviewing the work practices regularly and modifying the practices accordingly
4. Making all the members able to develop strong relationship with the culturally diverse
population
5. Enabling the staffs to show respect to cultural diversity while interacting with the stakeholders
6. Development of strategies to deal with bias
7. Promoting effective communication for developing the mutual trust and confidence
8. Use of interpreters to eliminate the language barriers
9. Identification of the issues that can cause conflict in advance
10. Using mediation to deal with the cross-cultural misunderstandings
11. Addressing the issues associated with cultural differences
12. Involving the community members to deal with the cultural issues
References:
Sala, E., & Baldassar, L. (2017). Ageing between Cultures: the Experiences and Challenges of Italian
Migrants in South Australia, edited by Daniela Cosmini-Rose, Leicester, Troubador, 2015, 200 pp.,£ 24.99
(paperback), ISBN 978-16-846-2468-2. Modern Italy, 22(3), 342-343.
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Activity 5
In 200-300 words explain how it is possible to identify communication issues and ensure they are
addressed?
Effective communication leads to development of better understanding on a particular topic. The
effectiveness of communication can be understood by analyzing the extent to which the involved parties
are demonstrated and comprehended the information being shared (Rychlowska et al., 2015).
Difficulties faced by the involved parties to understand the information being shared indicates that there
are issues in the existing communication process.
Issues can arise while communicating with the Aboriginals and the Torres Strait Islanders because of the
lack of knowledge on their culture and the communication style. The language barrier is another
problem that can arise while communicating with the Aboriginals. The issues can be mitigated in the
following ways—
 Eliminating the use of jargons and complex words (Rychlowska et al., 2015)
 If asking question is necessary, the person involved should be explained the purpose
 It should be checked continuously whether the people involved have understood all the terms in
the communication
 The visual interpretation such as the diagram, image and models for explaining the concepts and
terms
 The use of traditional languages should be avoided unless the speaker does not have excellent
understanding on the terms
 Aboriginal and Torres Strait Islander staffs need to be involved in the communication when
necessary
References:
Rychlowska, M., Miyamoto, Y., Matsumoto, D., Hess, U., Gilboa-Schechtman, E., Kamble, S., ... &
Niedenthal, P. M. (2015). Heterogeneity of long-history migration explains cultural differences in reports
of emotional expressivity and the functions of smiles. Proceedings of the National Academy of Sciences,
201413661.
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Activity 9
Question 1
What does it mean to say that Indigenous people need to be self-determining and to have some
control over community services and programs? What stages might be implemented to support this?
(375-400 words)
The indigenous people should be provided with the control over the community services and the
programs. It indicates that the indigenous people need to be able to take part in the community services
actively. The services offered to the indigenous people should align with their cultural and social values
(Banks, 2015). Therefore, it is necessary to develop an in-depth understanding on the culture of the
indigenous people. It can be done by seeking input from the indigenous community while service design
and obtaining feedback from them on the services. The control of community services and programs can
be passed to the indigenous people in the following ways—
 Providing the Indigenous community with options to choose from can be an effective way to
promote autonomy. For instance, while offering the health services to the users, the different
options for administering medications such as oral medication or injection should be explained
(Gara, 2017). The recipient can choose the suitable one as per his/her preferences. When the
individuals are provided with options to choose own course of actions, the likeliness to the
compliance increases. So, offering autonomy to the Indigenous community is expected to bring
better outcomes from the community services.
 Making realistic promises is another factor that promotes the trust with Indigenous people. The
realistic promises help the Indigenous people to build confidence. It, in turn, helps them to take
charge of the community services.
 Fostering effective communication and seeking feedback is necessary to enhance control of the
Indigenous community over the services. Seeking feedback from the recipients is effective to
understand to what extent the services are benefitting them. As the positive and negative
aspects of the services are identified, modifying the services and making those more effective
for the community becomes easier.
 Promoting shared decision-making is another important aspect of offering control to the
Indigenous community over the services. The family-based model is at the center of Indigenous
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society. Often the decisions taken by the Indigenous people need to be approved by the family.
Development of a decision-making model where the policy makers and the Indigenous society
can participate and contribute equally. When the family based decision making model is
incorporated in the community service, the Indigenous people can be more encouraged to
participate in the process. It, in turn, can enhance their control over the community services.
References:
Banks, J. A. (2015). Cultural diversity and education. Routledge.
Activity 10
Importance of identifying outcomes and metrics in community service—
Identifying the metrics and measuring the outcomes is important for the following reasons:
 The metrics and the outcomes are useful to analyze the effectiveness of the community
services. The metrics enable the service providers to understand actual benefits obtained from
the community services (Williams & Elmore, 2014). There are several aspects associated with
the services. Use of the metrics and the outcomes is necessary to determine the
underperforming aspects of the community programs.
 The metrics are also important for benchmarking the services. By using the metrics, the service-
providers can understand whether they are meeting the standards or not (Frieden, 2014). It,
indicates that the metrics provide the ground for in-depth analysis on the services and facilitate
them to make the services more efficient.
 Identification of the effective practices is another benefit of using the metrics and outcomes.
From the metrics, the practices that are giving benefits to the society are identified and are used
to improve overall effectiveness of the program.
Participants in strategy and outcome evaluation process—
The strategy and outcome evaluation process needs to be participatory in nature. The process provides
the optimum benefits when it is evaluated by involving all the stakeholders. The evaluation process can
involve the below participants—
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 The program directors—the program directors play a key role in strategy development. So, their
involvement is necessary to assess the strategies and decide the future course of actions.
 Front-line staffs-- the front line staffs play a key role in service delivery. So, the front line staffs
have adequate knowledge on how the services are performing and what are the difficulties they
are experiencing while delivering the services to beneficiaries (Abrishambaf et al., 2016). The
information obtained from the beneficiaries is valuable to identify the effectiveness of
community services.
 Recipients of the services-- the recipients can provide valuable information on the actual
performance of the services. From the recipients, it can be understood whether the services are
meeting their expectations or not. So, from the information obtained from recipients, the
positive and negative aspects of the services can be understood. The suggestions also can be
obtained from the services to make those easily accessible to the recipients.
 External researchers, volunteers-- The external researchers and volunteers often participate in
the service delivery. So, they can have important information on the performance of the
services and the other difficulties to deliver the services to the community. The participation of
external volunteers is important to make the services more effective.
Implications of metrics identification and outcome evaluation—
The metrics identification and the outcome evaluation can be effective to achieve the following goals—
 Identifying the factors that trigger success for a program
 Identifying the processes that make the program successful
 Better program design with the success factors
 To identify whether right strategies are being used for program implementation
 To identify the performance metrics to evaluate impacts of the program
 To identify whether the program needs to be continued or not
 To prioritize different services within the program
Reference:
Abrishambaf, O., Ghazvini, M. A. F., Gomes, L., Faria, P., Vale, Z., & Corchado, J. M. (2016, September).
Application of a home energy management system for incentive-based demand response program
implementation. In 2016 27th International Workshop on Database and Expert Systems Applications
(DEXA) (pp. 153-157). IEEE.
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Frieden, T. R. (2014). Six components necessary for effective public health program
implementation. American journal of public health, 104(1), 17-22.
Williams, W., & Elmore, R. F. (Eds.). (2014). Social Program Implementation: Quantitative Studies in
Social Relations. Academic Press.
Activity 11
 Why is it necessary to evaluate programs and services against desired outcomes? (200
words)
Measurement of the outcomes and evaluating the programs is necessary for the following reasons—
 While running a program, it is necessary to identify its effectiveness to meet the expectations
of the community. Evaluation of the program against the key metrics is necessary to get an idea
on the actual effectiveness of the program.
 Identifying the areas of improvement is necessary to make the programs more beneficial to the
community (Riall et al., 2018). Evaluation of the services is necessary to know which aspects of
the services are performing effectively.
 Identifying the capacity building needs is another reason for evaluating the programs and
making changes accordingly. The program evaluation enables the service providers to know
whether the existing capacity is effective to deliver the services or not. The requirement for
developing additional capacity is also identified in the program evaluation process.
 The evaluation is necessary to know the actual value of the services. Realizing the actual value
of the services is effective to attract the investors. It, in turn, enables the service providers to
continue the programs.
 Maintaining transparency on the services is necessary while running the community programs.
The program evaluation gives the stakeholders with an idea on how the programs are
performing and how the resources are being utilized. The program evaluation gives the
stakeholders with a holistic idea on the services.
References:
Riall, T. S., Teiman, J., Chang, M., Cole, D., Leighn, T., McClafferty, H., & Nfonsam, V. N. (2018).
Maintaining the fire but avoiding burnout: implementation and evaluation of a resident well-being
program. Journal of the American College of Surgeons, 226(4), 369-379.
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The Indigenous population constitutes a significant portion of the total population in the country. In
2016, the number of indigenous people was approximately 649,171. In 2016, about 35% of the
indigenous population leaves in the capital cities (Harding, 2018). Although the participation of
indigenous people in the mainstream Australian society is increasing, their access to health services is
still low. The current research deals with analysis on the issues faced by Indigenous people while
accessing the healthcare services. The research also includes discussion on the strategies that can be
used to improve accessibility to the health services among the indigenous people.
Cultural issues affecting the health and community services for Indigenous people:
The people of indigenous community have unique culture. The cultural gap between the indigenous and
non-indigenous Australians is really wide. Therefore, developing the culturally competent health policies
and mitigating the accessibility issues for the indigenous community is difficult. The social factors play a
key role in influencing accessibility of the healthcare services for the indigenous people (Malaspinas et
al., 2016). In addition to the social factors, the human rights rules and regulations are the other issues
that need to be considered at the time of implementing health policies for the indigenous people. The
cultural factors that shape the health and community service accessibility among the indigenous people.
The perceptions of control are one of the key factors that affect accessibility of the community and
healthcare services. The health status of indigenous people is linked to their control over the dignity,
physical environment, justice and self-esteem (O'Connor, 2017). So, the health services to the
indigenous people are more than the provision of hospitals, doctors, medicines and the lack of disease.
The perceived lack of control over life among the individuals can lead to chronic and unhealthy stress. It,
in turn, can contribute to the mental health issues, tendency of substance abuse and getting involved
into the violent activities.
The traditional ownership of land is another factor that influences the mental health status of the
Indigenous people. The self-determination right helps the people from Indigenous community is
effective to enable them to dispose the natural resources and wealth (Gray & Tesfaghiorghis, 2018). It
helps them to achieve better health. The communally owned land and the naïve title is considered as
the natural wealth and resources for the Indigenous people. Recognizing the traditional ownership of
the Indigenous people helps them to maintain the customary law and the governance structures. When
the Indigenous people are provided with the access to land, they show the signs of improved diet,
traditional economic bases and exercise.
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Historical and contemporary issues:
Mental stress related issues are a crucial health problem in the indigenous community. The rate of
getting involved into the high-risk health behaviour such as substance abuse is quite high among the
indigenous community. The rate of hospitalization due to the mental stress related problem is also high
among the indigenous people. The cases of hospitalization mostly occur due to intentional self-harm
which is an indication of the mental stress.
The stress among the indigenous community is also triggered by the factors like poverty and racism
(Tobler et al., 2017). The people from indigenous community have long history of experiencing racism
and poverty related issues. Long exposure to poverty and racism can impact the circulatory system. In
case of people from the indigenous community also, poverty has impacted the health status
significantly.
The indigenous people in Australia are not only the disadvantaged citizens but the key reasons behind
the poverty and inequality is the historical treatment received by them. Racism can be considered as a
stressor and cause several negative impacts behind the physical and mental health (D’Aprano et al.,
2016). The issues associated with stolen generations are also considered to have negative impacts on
the health status of Indigenous people. When the children were isolated from their families, the parents
were subject to high level of stress. It, in turn, increased the tendency of substance abuse and degraded
the health status.
Strategies to increase community engagement:
Isolation is an effective strategy for improving the mental health status of the indigenous community.
The studies indicate that the individuals in the indigenous community show the signs of better mental
health when they live in the remote areas along with their community.
Recognizing the rights of indigenous people is another effective strategy for improving the mental health
status. When the right of indigenous people to self-determination is recognized, they can regain the
control of their lives (Tobler et al., 2017). In other words, recognition of the self-determination rights of
the individuals enables them to maintain the traditional culture. As the indigenous people gain the
control over their rights, their mental health status improves. Recognition of the self-determination right
is also effective to improve the social and economic equality status among the Indigenous people.
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The other strategies that be effective to develop the culturally competent healthcare policies are as
follow—
 Maintaining and developing the traditional knowledge is important to develop suitable
healthcare policies for the Indigenous people. While developing and implementing the policies,
the policy-makers should focus on maintaining the cultural expressions and the practices.
 The people in the indigenous community communicate in their own language. Use of the
language of the indigenous community is effective to demonstrate the healthcare policies.
 Development of bilingual and culturally competent education can be useful to promote health
related awareness among the Indigenous people. The increased awareness on health issues can
be effective to improve accessibility of the services.
 The ownership of the lands, territory and natural resources is effective for developing the
culturally appropriate health infrastructure (Harding, 2018). It also increases the access to
healthcare system among the people of indigenous community.
 The Indigenous people have their own management and governance system. The own
management system of the community need to be incorporated in the healthcare management
as well.
 While offering the healthcare services, the indigenous people should be provided with the
control. The control can be offered in several ways -- such as by providing the prior consent and
encouraging the full participation of the Indigenous people in the healthcare service delivery.
 The service implementation for the indigenous people should comply with the international
standards and incorporate the rights of community.
Consultation and negotiation procedures to identify the cultural safety requirements:
The meaningful consultation with the Indigenous people is necessary for developing the trust and
enabling the community to gain control over the services. The policy makers need to ensure that the
policies reflect the requirements of the local aboriginal community. While implementing the policies, the
local governments need to recognize the significant contributions of the indigenous people to the
country. The local government also requires acknowledging the importance of strengthening the
position of Indigenous people in the local decision making. The local government also needs to give
importance on the engagement of the youth in the community decision-making. The engagement
policies and the protocols also require respecting the role of different community group s and define the
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relationship between different groups. The consultative processes can be used as the mechanisms for
establishing engagement with the advisory committee to the council.
Developing appropriate strategies for cultural safety:
The cultural safety in the healthcare policies can be ensured when the indigenous people take part fully
in the policy development and the implementation process. While developing and implementing the
healthcare policies for the indigenous people, the Indigenous organizations require taking part in the
council forums. The indigenous organizations need to be encouraged to provide consultation regarding
the development of strategies, plans and policies of the council. Developing a permanent advisory group
with the indigenous people is also an effective strategy to enhance the participation of the community
and create the culturally safe community policies. The policy makers can also have a well-defined
framework for indigenous engagement to ensure cultural safety for the programs.
Resources required for addressing cultural issues:
The indigenous people live in different areas. While developing the healthcare and community services
for a particular area, it is necessary to be aware of the geographical location and the language group
living in the location. Along with it, the policy makers should also be aware of the history of the language
group to obtain detailed information on the local culture. The local land councils, indigenous
organizations and other service providers should also be encouraged to work in partnership. The
assistance from indigenous staffs is also needed to collect and organize the information sessions to
obtain in depth knowledge on the dynamics and history of the community.
Importance of achieving greater accountability for funding bodies, government agencies and health
service providers:
Ensuring cultural safety for the indigenous people in Australia is a challenging task. The cultural safety
needs to be ensured by involving all the parties. While implementing the community and healthcare
services, the service providers require dealing with the Indigenous people extensively. Greater
accountability of the heath service providers ensures that the services are delivered in culturally
competent way. Delivering the services in culturally competent manner is effective for building trust
with the Indigenous community. It, in turn, encourages the community to access the health services
more. The government agencies play another key role in developing the policy. The greater
accountability of the government agencies also ensure that the developed policies comply with the
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norms of the Indigenous community. Development of the culturally safe healthcare policies increases
the accessibility among the Indigenous people. Finally, greater accountability needs to be achieved on
part of the funding agencies as well. The greater accountability on part of the funding bodies ensures
that the initiatives to protect cultural integrity of the Indigenous community are being supported
financially.
Implementing awareness on Aboriginal and Torres Strait Islander history and cultures into work
practices:
The people from Aboriginal and Torres Strait Islander community experienced racism, poverty and
other cultural biases for long time. The long history of inequality and injustice is still a sensitive issue for
the indigenous people. The health service providers should focus on dealing with such issues with
respect and empathy.
Implementing awareness on own cultural realities in work:
While working with the community people, the awareness and the cultural realities of the Indigenous
community can be implemented in the following way—
 Providing the community with the control and ownership of decision-making-- While executing
the programs, the culture should be kept at the center. The service providers should focus on
analyzing the history and local context (Harding, 2018). The service providers should also give
importance on discussing with the community leaders for designing and development of the
programs.
 Presence of the good corporate governance is another factor that can lead to successful
program execution. The corporate governance system is effective to monitor whether the
cultural safety is being maintained at all levels of program delivery.
Implementing effective communication:
The knowledge on Indigenous language is necessary for communicating effectively with the Indigenous
people (D’Aprano et al., 2016). The service providers need to know the terms used by Indigenous
community and incorporate those in the communication. The service providers also require paying
attention to the non-verbal communication for enhancing the effectiveness.
Working in partnership with community people:
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While delivering services to the people from indigenous community, an indigenous staff can be
involved. The indigenous staff can have better knowledge on the community norms. So, developing
trusted relationship will be easier with the Indigenous staff. Finally, the community should be provided
with power to manage the programs for obtaining better outcomes.
References:
Harding, M. (2018). Colonialism and its aftermath: A history of Aboriginal South Australia [Book
Review]. Journal of the Historical Society of South Australia, (46), 135.
Gara, T. (2017). Colonialism and its aftermath: a history of Aboriginal South Australia.
Malaspinas, A. S., Westaway, M. C., Muller, C., Sousa, V. C., Lao, O., Alves, I., ... & Heupink, T. H. (2016).
A genomic history of Aboriginal Australia. Nature, 538(7624), 207.
O'Connor, S. (2017). 30,000 Years of Aboriginal Occupation: Kimberley, North West Australia. Canberra,
ACT: Dept. of Archaeology and Natural History, The Australian National University..
Gray, A., & Tesfaghiorghis, H. (2018). Social indicators of the Aboriginal population of Australia.
Tobler, R., Rohrlach, A., Soubrier, J., Bover, P., Llamas, B., Tuke, J., ... & O’Loughlin, I. (2017). Aboriginal
mitogenomes reveal 50,000 years of regionalism in Australia. Nature, 544(7649), 180.
D’Aprano, A., Silburn, S., Johnston, V., Robinson, G., Oberklaid, F., & Squires, J. (2016). Adaptation of the
ages and stages questionnaire for remote aboriginal Australia. Qualitative health research, 26(5), 613-
625.
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