For The Victorian Health, Human And Community Services Sector
Part 1:Aboriginal and TorresStrait Islander culturalsafety frameworkFor the Victorian health, humanand community services sector
Acknowledgementof Aboriginal peoplesin VictoriaThe Victorian Government proudly acknowledges Victoria’s Aboriginalcommunities and their rich culture and pays respect to their Elders past andpresent. We acknowledge Aboriginal peoples as Australia’s first peoples andas the Traditional Owners and custodians of the land and water on whichwe live, work and play. We recognise and value the ongoing contribution ofAboriginal people and communities to Victorian life and how this enrichesour society more broadly. We embrace self-determination and reconciliation,working towards equality of outcomes and ensuring an equitable voice.Victorian Aboriginal communities and peoples are culturally diverse, with richand varied heritages and histories both pre- and post-invasion. The impactsof colonisation – while having devastating effects on traditional life – have notdiminished Aboriginal peoples’ connection to Country, culture or community.Aboriginal nations continue to strengthen and grow with the resurgence oflanguage, lore and cultural knowledge. These rich and varied histories needto be understood and acknowledged by all Victorians, to truly understand theresilience and strength of previous generations, as well as the history of thefight for survival, justice and Country that has taken place across Victoriaand around Australia.As we work together to ensure Victorian Aboriginal communities continueto thrive, the government acknowledges the invaluable contributions ofgenerations of Aboriginal warriors that have come before us, who havefought tirelessly for the rights of their people and communities towardsself-determination. We are now honoured to be part of that vision.This document honours the work of Aboriginal and Torres Strait Islandercommunity leaders and staff in the health, human and community servicessector for their tireless work in improving cultural safety and the deliveryof high-quality services over many decades. This framework attempts tostrengthen, reiterate and amplify their wisdom and expertise.Please noteThe department acknowledges the diverse and distinct cultures ofAboriginal peoples and Torres Strait Islanders. This cultural safetyframework is intended for both Aboriginal peoples and TorresStrait Islanders living in Victoria or accessing Victorian health,human or community services. In this framework, ‘Aboriginal’ refersto both Aboriginal and Torres Strait Islander people. ‘Indigenous’ or‘Koorie’ is retained when part of a report, program or quotation.2
Aboriginal and Torres Strait Islander cultural safety framework: Part 1Secretary’s forewordCultural safety is everyone’s businessI am pleased to present theAboriginal and Torres StraitIslander cultural safetyframework.Cultural safety means creatingenvironments where people feelsafe – where there’s no challengeto their identity, and where theirneeds can be met.It’s clear that racism anddiscrimination can significantlyimpact upon an individual’shealth and wellbeing. AboriginalVictorians tell us that a lack ofcultural safety, racism and fearare the main barriers to accessingessential services.As a department, we believethat cultural safety is everyone’sbusiness. We are committedto investing the time, energyand resources to improve thecultural safety of our services – toincrease the life expectancy ofAboriginal Victorians and improvetheir quality of life.This framework marks ourdepartment’s commitment toreform. To achieve this, it guidesVictorian health, human andcommunity services - and thedepartment - to work togetherto deliver more culturally diverseand safe environments, servicesand workplaces.The framework builds on theactions of Korin Korin BalitDjak, our 10-year Aboriginalhealth, wellbeing and safetystrategic plan.It also contributes to the VictorianGovernment’s commitment withinthe Victorian Aboriginal AffairsFramework to advance Aboriginalself-determination and culturalsafety.We will partner with Aboriginalorganisations to lead on thedelivery of training and supportfor all Victorian organisations,helping them to truly deliver onthe intentions of this work.This cultural safety frameworkwas developed in collaborationwith Aboriginal communities,Aboriginal organisations andAboriginal staff across thedepartment.This framework is an importantcatalyst for change – and througha shared commitment from thedepartment, mainstream servicesand Aboriginal organisations– we can together make apositive impact on the health,wellbeing and safety of AboriginalVictorians.We believe that it will help us,and our partners, move beyondcultural awareness by placing astrong importance on reflectinghow one’s own beliefs, valuesand behaviours impact upon thesafety of others.Kym PeakeSecretaryFor the department, theframework offers a new approachto how we can we can deliverand regulate services using acontinuous quality improvementmodel.For our mainstream partnerorganisations, it will support thestrengthening of cultural safetythrough improved accountabilityrequirements included inexisting standards and serviceagreements.The framework is more than acompliance exercise. The key tosuccess is its application in everyservice and every workplace.3
ArtworkKorin Korin Balit-Djak ArtworkArtist – Dixon PattenThe artwork for the Aboriginal and Torres Strait Islander cultural safetyframework uses a section of the artwork from Korin Korin Balit-Djak,the Aboriginal health, wellbeing and safety strategic plan (2017–2027)and has been adapted with the artist’s permission and depicts theAboriginal community and our connection to culture and each other.Within the detailed circles, the Department of Health and HumanServices and community work together to help with system reformacross the health and human services sector with the ultimate goal ofphysical, social and emotional wellbeing for all Aboriginal people. Theripples represent the positive impact on community that this strategywill have and that Aboriginal culture and community is a priority.The hands represent individuals, couples and families. The whitecircles represent various tribes/families/regions. The various pathswith the footprints depict our life journeys and transference ofknowledge, history and culture.Dixon Patten was commissioned by the Department of Health andHuman Services to produce the artwork for Korin Korin Balit-Djak.Permission to use Korin Korin Balit-Djak for this policy was providedby the Wurundjeri Tribe Land Council.To receive this publication in an accessible formatplease email Aboriginal Strategy and Oversight aboriginalstrategyandoversight@dhhs.vic.gov.au Authorised and published by the Victorian Government, 1 Treasuryplace, Melbourne. State of Victoria, Australia, Department of Healthand Human Services, June 2019. ISBN 978-1-76069-855-3 (print) ISBN978-1-76069-856-0 (PDF/online/MS Word) Available at Aboriginal andTorres Strait Islander Cultural Safety Framework https://dhhs.vic.gov.au/publications/frameworks Printed by Metro Printing, Airport West (1903193).4
Aboriginal and Torres Strait Islander cultural safety framework: Part 1ContentsPart 1: Introduction 6What is Aboriginal and Torres StraitIslander cultural safety? 7The cultural safety framework 71. Vision 82. Principles 93. Domains 104. Cultural safety continuum 10Reflective tool 10References 115
Aboriginal and TorresStrait Islander culturalsafety frameworkIntroductionAboriginal and Torres Strait Islander cultures are the oldest living cultures in the world.Cultural factors, such as identity, language and spirituality, as well as connection to Country,to family and to community, can positively impact on the lives of Aboriginal people.Aboriginal communities areculturally diverse, with rich andvaried heritages and historiesboth pre- and post-colonisation.Aboriginal communities inVictoria were heavily affectedby colonisation and pastdiscriminatory policies suchas the policy of assimilation.Unequal power relationshipsand inequities continue to existbetween Aboriginal peoples andthe dominant non-Aboriginalpopulation.The Victorian Auditor-General’s2014 report Accessibility ofmainstream services forAboriginal Victorians identifiedlack of cultural safety as asignificant barrier to accessingservices. It also highlighted thecritical importance of VictorianAboriginal peoples and theircommunities being authenticallyengaged in the design anddelivery of health and communityservices, policies and programs.Despite concerted efforts toaddress racism and discriminationthrough policies and legislation,both remain systemic issuesacross the health, human andcommunity services sector.Cultural safety is a fundamentalhuman right. Public agencies are6required by legislation to providesafety in the workplace. If we donot invest the time, energy andresources required to improvecultural safety, our health, humanand community services sectorwill not increase life expectancyand improve the quality ofAboriginal people’s lives.The development of the Aboriginaland Torres Strait Islander culturalsafety framework is a keycommitment in the department’sAboriginal employment strategy2016–2021 and in Korin Korin BalitDjak: Aboriginal health, wellbeingand safety strategic plan 2017–2027. The framework will supportKorin Korin Balit-Djak to achievethe Victorian Government’s visionof ‘self-determining, healthy andsafe Aboriginal communities’.This framework has beendeveloped as the first phase ofa continuous quality improvementapproach. Phase 1, 2019: launch theAboriginal and Torres StraitIslander cultural safetyframework – aimed atreflection and planning. Phase 2, 2020: key standardsand measures will bedeveloped to help individualsand organisations tracktheir growth – aimedat improvement anddevelopment. Phase 3, 2021: individualsand organisations will berequired to meet and bemeasured against culturalsafety standards – aimed ataccountability and compliance.The Aboriginal and Torres Strait Islander cultural safety frameworkhas been developed to assist the department and mainstreamVictorian health, human and community services to create culturallysafe environments, services and workplaces.The cultural safety framework is for: every person and every mainstream organisation to takeresponsibility and work together to create culturally safe servicesand workplaces Aboriginal and Torres Strait Islander staff and clients, who havea right to culturally safe workplaces and services.
Aboriginal and Torres Strait Islander cultural safety framework: Part 1What is Aboriginal and Torres StraitIslander cultural safety?Professor Gregory Phillips, PhDAboriginal and Torres Strait Islander cultural safety is defined as an environment that issafe for Aboriginal people and Torres Strait Islanders, where there is no assault, challengeor denial of their identity and experience (Williams 2008)Cultural safety is about: shared respect, sharedmeaning and sharedknowledge the experience of learningtogether with dignity andtruly listening strategic and institutionalreform to remove barriersto optimal health, wellbeingand safety outcomes forAboriginal people. This includesaddressing unconscious bias,racism and discrimination, andthe ability to support Aboriginalself-determination individuals, organisations andsystems taking responsibilityfor ensuring their own culturalvalues do not negatively impacton Aboriginal peoples, includinga responsibility to address theirpotential for unconscious bias,racism and discrimination individuals, organisations andsystems taking responsibilityto support self-determinationfor Aboriginal peoples – thisincludes sharing power(decision making andgovernance) and resourceswith Aboriginal communities,and is especially relevant for thedesign, delivery and evaluationof services for Aboriginalpeoples (Phillips 2015).Figure 1 outlines the key featuresof a culturally safe workplace.Figure 1: Key elements of culturally safe workplaces and servicesKnowledge andrespect for selfAwareness of how one's owncultural values, knowledge,skills and attitudes areformed and affect others,including a responsibility toaddress their unconsciousbias, racism anddiscriminationKnowledge ofand respect forAboriginal peopleKnowledge of the diversityof Aboriginal peoples,communities and cultures,and the skills andattitudes to workeffectively with themA commitment toredesigning organisationsand systems to reduceracism and discriminationStrategic and institutionalreform to remove barriers tooptimal health, wellbeing andsafety outcomes forAboriginal peopleCultural safety is an ongoing learning journeyAn ongoing and responsive learning framework that includes the need tounlearn unconscious bias and racism and relearn Aboriginal cultural valuesAdapted from (Phillips 2015).The cultural safety frameworkThe cultural safety framework is designed to improve cultural safety for: Aboriginal employees workingwithin the Victorian health,human and communityservices sector Aboriginal clients accessingservices within the Victorianhealth, human and communityservices sector.The framework aims to assistthe department and mainstreamhealth and community servicesto strengthen their cultural safetyby participating in a process ofcontinuous learning and practiceimprovement. The model isdesigned to guide the departmentand mainstream organisations asthey develop strategies, policies,practices and workplace culturesthat address unconscious bias,discrimination and racism.The cultural safety framework hasbeen informed by evidence andconsultations including: existing government and sectorstandards, policies, proceduresand strategic documents. a series of consultations withAboriginal Victorians, includingstaff and organisations consultation with thedepartment’s AboriginalStrategic Governance Forumand its Koorie Caucus a series of pilots withdepartmental staff to test andvalidate the framework andreflective tool material received in responseto a call for written submissionsfrom the health, human andcommunity services sector a literature review oncultural safetyThis framework does notspecifically address the issue oflateral violence for Aboriginalworkers, but it is acknowledgedthat this is a significant issuerelating to their cultural safety.Addressing lateral violencerequires supervisors andorganisations having advancedcultural safety knowledge, skillsand attitudes. Organisationsmay need to assist Aboriginalemployees to engage specialistexpertise and support to addressissues of lateral violence inthe workplace.7
1. VisionThe Victorian health, human and community services sector provides culturally safepractices and service provision that enable optimal health, wellbeing and safetyoutcomes for Aboriginal and Torres Strait Islanders (Figure 2).Figure 2: Cultural safety frameworkVISIONThe Victorian health, human and community service sector provides culturally safe practices andservice provision that enables optimal health, wellbeing and safety outcomes for Aboriginal people.PRINCIPLESLeadershipRespectand sparency1Creating a culturallysafe workplace rship andaccountabilityHuman rightsapproachSupport emsREFLECTION TOOLThe fourstages oflearningOverallreflection8TOWARDS CULTURAL SAFETY1ST STAGE: UNAWARE2ND STAGE: EMERGING3RD STAGE: CAPABLE 4TH STAGE: PROFICIENT‘Unconsciously incompetent’learning stage‘Consciously incompetent’learning stage‘Consciously competent’learning stage‘Unconsciously competent’learning stageI am unaware of how myunconscious biases andbehaviours affect thecultural safety of theworkplace and servicesdeliveredI recognise the need tounlearn and build my skillsand knowledge to improvecultural safetyI consciously apply mylearnings and improvecultural safety practiceMy work practices areculturally safe and do notrequire a consciouscorrection. I am open to andenact ongoing learning andimprovement
Aboriginal and Torres Strait Islander cultural safety framework: Part 12. PrinciplesThe cultural safety framework is supported by an agreed set of guidingprinciples. Table 1 outlines the principles to be applied across the three domainsof the framework.Table 1: Cultural safety framework ons provide meaningful leadership opportunities to design, deliverand evaluate culturally safe policies, programs, initiatives and services.Organisations have leadership at all levels that understand and championthe organisation’s role in cultural safety.Self-determinationAboriginal staff, people and communities have meaningful leadershipand decision-making roles, and are involved in designing, delivering andevaluating Aboriginal health, wellbeing and safety policies, programs andinitiatives.Human rightsapproachThe rights-based approach that drives this framework is an essential partof Victorian Aboriginal service delivery and sector development.The United Nations Declaration on the Rights of Indigenous Peoplesrecognises both the principle of self-determination (Article 3) and the rightto culture (Articles 11 and 31). The Victorian Charter of Human Rights andResponsibilities Act 2006 also recognises culture as a right.Support andsustainabilityStaff at all organisational levels are supported to undertake ongoingcultural safety professional and personal development.Workplaces have processes to build individual and organisational capacity,provide mentoring opportunities and establish culturally safe spaces forAboriginal staff and clients.Culturally safesystemsEmbed culturally safe practice into recruitment and retention processes,as well as into existing policies, programs, procedures, procurementand services.OngoinglearningA continuous process of reflection and quality improvement to identifyand reflect on individual and organisational practice, and implement theactions required for ongoing learning and self-reflection at all levels ofthe organisation.Accountabilityand transparencyIndividuals reflect on their own level of competency in cultural safety andidentify required improvements.Organisations reflect on their current policies, practices and proceduresand reflect on their organisational competency. Organisations demonstrateaccountability by implementing key performance indicators.Respectand trustIndividuals and organisations establish a relationship of trust and respectwith Aboriginal staff, clients and local Aboriginal communities.9
3. DomainsThe cultural safety framework has three key domains for action:1Creating a culturally safeworkplace and organisationThis domain focuses on changingworkplaces and organisations tobe culturally safe by reformingstrategies, policies, procedures andaccountabilities. It helps individualsand organisations build on theircultural safety through professionaldevelopment, reforminggovernance, policies, proceduresand evaluation measures.23Aboriginalself-determinationLeadership andaccountabilityThis domain highlights theimportance of leaders beingaccountable for drivingquality improvement to affectbehavioural and systemicchanges so that culturalsafety becomes embeddedin everyday practice.This domain is closely alignedto changing workforce andorganisational practice.It focuses on building ourability to hear the Aboriginalclient and community voiceand support the decisions ofAboriginal people, familiesand communities.4. Cultural safety continuum reflective toolThe framework includesa continuous qualityimprovement approachand uses the ‘Johariwindow’ approach to thefour stages of learning anew skill (Figure 3).Competence continuum modelThe competence continuum model describes the four stages ofcompetency in cultural safety as:1. unaware – unconsciously incompetent2. emerging – consciously incompetent3. capable – consciously competent4. proficient – u nconsciously competent and open to continuallearning and improvementThe continuum acknowledges coming into consciousness along thelearning journey (Getha-Taylor et al. 2013; Luft & Ingham 1955; Pateros2001). These terms relate to the competency level of learning a new skill,rather than the competency of an individual.Figure 3: The four stages of learning a new apted from Getha-Taylor et al. 2013.10
Aboriginal and Torres Strait Islander cultural safety framework: Part 1Continuous learning and improvementImproving cultural safety is an ongoing learning process. Proficiency will beachieved when individuals and organisations commit to improving their knowledgeof cultural safety and changing their attitudes, beliefs and behaviours.The cultural safety continuum reflective tool intends to support a continuous quality and practiceimprovement approach. Figure 4 outlines the continual learning journey from ‘unlearn’ to ‘embed’.Figure 4: Continual learning journeyUnlearn – Challenge what is established as ‘thenorm’ and question what is accepted so a nonbiased and more balanced set of shared valuesand ways of doing things can be learnt.UnlearnEmbedLearnLearn – Understand why ‘established’ or ‘usual’practice is not always the best way to learn. Learnother, more balanced ways to learn as part ofeveryday practice.Apply – Implement what is learnt to create positiveinteractions and environments.Reflect – Continually challenge assumptions,which may require returning to the unlearning andlearning stages to gain more knowledge.ReflectApplyEmbed – Implement continuous qualityimprovement to reform systems, procedures,policies, strategies, programs, procurement,workplace culture, accountability and monitoring.The aim is for individuals and organisations in the Victorian health, human and community services sectorto continuously improve cultural safety proficiency by adopting the Aboriginal and Torres Strait Islandercultural safety framework.ReferencesDepartment of Health and Human Services 2017, KorinKorin Balit-Djak: Aboriginal health, wellbeing and safetystrategic plan 2017–2027, State Government of Victoria,Melbourne.Getha-Taylor H, Hummert R, Nalbandian J and SilviaC 2013, ‘Competency model design and assessment:findings and future directions’, Journal of Public AffairsEducation, vol. 19, no. 1, pp. 141–171.Luft J and Ingham H 1955, The Johari window, a graphicmodel of interpersonal awareness: Proceedings of thewestern training laboratory in group development,University of California, Los Angeles.Pateros J 2001, The four stages of learning, ProcessCoaching Centre, San Rafael, viewed 22 February 2019, https://www.processcoaching.com/fourstages .Phillips G 2015, Dancing with power: Aboriginal health,cultural safety and medical education, PhD thesis, Schoolof Psychological Sciences, Monash University, Clayton.Williams R 2008, ‘Cultural safety: what does it mean forour work practice?’ Australian and New Zealand Journalof Public Health, vol. 23, no. 2, pp. 213–214.Victorian Auditor-General 2014, Accessibility ofmainstream services for Aboriginal Victorians, StateGovernment of Victoria, Melbourne.Victorian Government 2006, Charter of Human Rightsand Responsibilities Act 2006, no. 43 of 2006, VictorianGovernment, Melbourne, http://www.legislation.vic.gov.au/ Domino/Web Notes/LDMS/ LTObject Store/LTObjSt8.nsf/DD 57D07 00052646/ FILE/0643aa013%20 authorised.pdf .United Nations (UN) 2008, United Nations Declarationon the Rights of Indigenous Peoples, UN, Geneva, PS en.pdf .11
safety in the workplace. If we do not invest the time, energy and resources required to improve cultural safety, our health, human and community services sector will not increase life expectancy and improve the quality of Aboriginal people's lives. The development of the Aboriginal and Torres Strait Islander cultural safety framework is a key
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