Australian Occupational Therapy Journal (2015) 62, 214–218
Indigenous peoples and human rights: Some considerations for the occupational therapy profession in Australia Chontel Gibson,1 Corrine Butler,2 Christopher Henaway,3 Pat Dudgeon4 and Michael Curtin5 1 School of Community Health, Charles Sturt University, Orange, New South Wales, 2Adult Allied Health Team, Office of Disability, NT Government, Alice Springs, Northern Territory, 3QLD Aboriginal & Islander Health Council, Brisbane, Queensland, 4School of Indigenous Studies, The University of Western Australia (M303), Crawley, Western Australia, and 5School of Community Health, Charles Sturt University, Albury, New South Wales, Australia
KEY WORDS Aboriginal and Torres Strait Islander peoples, cultural competency, health and wellbeing, human rights, Indigenous, occupational therapy, partnerships, self-determination.
Introduction The main purpose of this article is to open a discussion with the occupational therapy profession in Australia relating to the application of human rights, cultural competency and genuine partnerships when working with Aboriginal and Torres Strait Islander peoples.1 This paper begins with an overview of human rights in the context of the United Nations Declaration on the Rights of Indigenous Peoples (the Declaration) (United Nations, 2007) and the Australian Community Guidelines for the United Nations Chontel Gibson MPH, BAppSci (OccThy); Indigenous Academic Fellow. Corrine Butler BOccThy; Occupational Therapist. Christopher Henaway BOccThy; Statewide Outreach Coordinator. Pat Dudgeon FAPS, PhD, Gdip (Psych), BAppSci; Professor and Research Fellow. Michael Curtin EdD, MPhil, BOccThy; Associate Professor, Occupational Therapy. Correspondence: Chontel Gibson, School of Community Health, Charles Sturt University, Leeds Place, Orange, NSW 2800, Australia. Email: [email protected]
Accepted for publication 21 December 2014. © 2015 Occupational Therapy Australia 1
Throughout this paper the term Aboriginal and Torres Strait Islander peoples will be used. This is consistent with the most preferred terms used by the Australian Human Rights Commission (Australian Human Rights Commission, 2012). According to the geographical location and context, the term Aboriginal peoples may be used or Torres Strait Islander peoples. There are other terms that Aboriginal and Torres Strait Islander peoples may prefer, such as Koori, First Australian, Indigenous, etc. Within this paper, the term Indigenous peoples is used when referring to Indigenous communities across the world.
Declaration on the Rights of Indigenous Peoples (the Community Guide) (Australian Human Rights Commission, 2010). The Declaration and the Community Guide are then applied to the occupational therapy profession in relation to the right of self-determination and the concept of cultural competency. Partnerships between Aboriginal and Torres Strait Islander peoples and occupational therapy profession are then recognised as an avenue to facilitate the respectful application of human rights and the concept of cultural competency in practice.2 The Declaration is underpinned by a set of principles, such as: Indigenous peoples’ rights are both collective and individual. Considerations of the equality of people must recognise differences rather than move towards assimilation. Indigenous peoples have been denied opportunities to practice and enjoy the rights to our3 ways of being, knowing, and doing. Human rights should be pursued in the spirit of partnership and mutual respect. The Declaration provides an avenue for governments to implement the rights of Indigenous peoples, and an avenue for developing partnerships between Indigenous peoples and governments. In 2010, the Community Guide was developed in collaboration with 2
To expand on the Aboriginal and Torres Strait Islander peoples’ knowledge and evidence located within the occupational therapy discipline, where possible, we have deliberately drawn on literature written by and/or with Aboriginal and Torres Strait Islander peoples.
This paper was written from the perspective of Aboriginal and Torres Strait Islander peoples (the first 4 authors). Therefore, referring to Aboriginal and Torres Strait Islander peoples the pronouns ‘we’, ‘us’ and ‘ours’ are used (instead of pronouns such as ‘them’ and ‘their’) to reflect the position of these authors. The first three authors and the last author are also occupational therapists, and we have used these same pronouns to position ourselves within the occupational therapy profession.
Aboriginal and Torres Strait Islander peoples to provide information on how the Declaration could be applied in Australia (Australian Human Rights Commission, 2010). This information provided in the Community Guide has relevance to occupational therapists working with Aboriginal and Torres Strait Islander peoples. For the purposes of this paper the right of self-determination and the concept of cultural competency will be described in more detail, along with their application to the occupational therapy profession. This will be followed by a discussion on the importance of applying human rights and cultural competency in the context of developing respectful partnerships between Aboriginal and Torres Strait Islander peoples and occupational therapy professionals.
Self-determination: Central to occupational therapy practice The right of self-determination, Article 3 in the Declaration, refers to Aboriginal and Torres Strait Islander peoples having the freedom to live well and live according to our own values and beliefs (Australian Human Rights Commission, 2010). Self-determination forms the basis of all other articles in the Declaration and refers to Aboriginal and Torres Strait Islander peoples: having a choice in determining how our lives are governed; participating in decisions that affect us; being included and being freely able to participate in our own culture, and more broadly within Australian society; and being in control of our lives, including our social, economic, and cultural developments. Since the invasion and colonisation by Europeans, Australia has a long-standing history of policies and events that have denied, and continue to deny, the full participation of Aboriginal and Torres Strait Islander peoples to live the lives we want to live, to practice our cultures, and to decide on which occupations4 we choose to participate in. Zeldenryk and Yalmambirra (2006), along with many other writers, have highlighted examples of policies and events that denied Aboriginal and Torres Strait Islander peoples’ right to self-determination in their descriptions of the forced removal of Aboriginal children from families and communities. These policies and events lead to Aboriginal
children experiencing cultural and spiritual deprivation as they were removed from their families, communities, countries, ancestors and cultural ceremonies. Despite the impacts of colonisation, takeover of lands, the enactment of oppressive policies and subsequently the denial of the right of self-determination, it is important to acknowledge that Aboriginal and Torres Strait Islander peoples and our cultures continue to demonstrate great strength, resilience and survival. One illustration of this is in the way that many Aboriginal and Torres Strait Islander communities have maintained and grown the significant roles, places and spaces of older community members and Elders, who maintain and continue to grow our cultures and connections to culture, as well as our connections to country and kin (Culture is Life Campaign, 2014; NSW Department of Health, 2010). Self-determination needs to be central to the provision of all services with Aboriginal and Torres Strait Islander peoples (Swan & Raphael, 1995).5 Given that a key tenet of the occupational therapy profession is person-centred practice (World Federation of Occupational Therapists, 2011), self determination should be central to both occupation and occupational therapy. When working with Aboriginal and Torres Strait Islander peoples, occupational therapists should explore occupations in the context of individual and community values, beliefs, perspectives, and conceptual frameworks for health, wellbeing and occupations. Yalmambirra (2000) provides a Wiradjuri perspective on this, illustrating how the concept of time not only differs between cultures but also how cultural values and beliefs influence how people prioritise and spend time. Aboriginal and Torres Strait Islander peoples are often required and/or forced to manage our time and occupations across both Indigenous and Western cultures, often dealing with competing priorities. In community, this may be illustrated by a community member spending time with an Elder and prioritising this activity over prior activities that may have been scheduled in, such as a therapy appointment. In Australian society, where the Western culture has enforced its values, beliefs and ‘normative’ processes, professionals need to have an understanding that normative processes can be reflective of discrimination and racism (Kelly, Dudgeon, Gee & Glaskin, 2009).
The World Federation of Occupational Therapists refer to occupations as activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life (World Federation of Occupational Therapists, 2011). Occupations include things people need to, want to and are expected to do. There is limited literature relating to occupations reflecting and promoting Aboriginal and Torres Strait Islander peoples’ perspectives.
Swan and Raphael’s (1995) work was the first extensive consultations with Aboriginal and Torres Strait Islander peoples across Australia in relation to mental health and social and emotional wellbeing. This report continues to inform current policies, services and research delivery. This work is also likely to be the first written recommendations from Aboriginal and Torres Strait Islander peoples to the occupational therapy profession. These recommendations, we believe are still relevant today. © 2015 Occupational Therapy Australia
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TABLE 1: Some self-reflexive questions for considering the application of self-determination in occupational therapy practice
1. How do you define occupation, participation and meaningful engagement? Is it the same way in which Aboriginal and Torres Strait Islander peoples define it? 2. What language do you use to communicate these and other concepts? How could this language be interpreted and/or used by Aboriginal and Torres Strait Islander peoples? 3. How has the Australian history and social contexts shaped your constructs of health and ‘everyday practice’? How does history and everyday practice prevent the acknowledgment, acceptance, or understanding of ‘occupations’ that are important for Aboriginal and Torres Strait Islander peoples? 4. How has Australian history and social context (including the occupational therapy profession) shaped and continue to shape the way in which Aboriginal and Torres Strait Islander peoples participate in meaningful and culturally appropriate ‘occupations’? 5. What awareness and impact do your values and beliefs have on practice and your perceptions of the concepts of occupation, health and wellbeing? Are your concepts of value to and are beneficial when working with Aboriginal and Torres Strait Islander peoples? 6. Do you undertake appropriate and meaningful consultation and engagement processes with Aboriginal and Torres Strait Islander peoples in relation to service delivery, policy development and curriculum review? If perspectives were sought, were interpretations checked, were proposed goals met and did this meet the expectations of the community?
The outcome of self-determination is inseparable to the process, and therefore the process to achieve selfdetermination is just as important as the outcome (Australian Human Rights Commission, 2010). The selfdetermination process will vary depending on the type of work and which key partners are involved. Many authors in this area such as Kantartzis and Molineux (2012), have illustrated that occupational therapy is a Western socially and culturally constructed profession that influences communication, understandings, world views and concepts and frameworks. Understanding personal and professional perspectives of social and cultural constructs will assist in understanding and facilitating the occupational therapy role in the selfdetermination process. A number of self-reflexive questions have been developed for occupational therapists to consider how our socially and culturally constructed profession influences ‘everyday practice’, including the capacity to incorporate the right of self-determination when working with Aboriginal and Torres Strait Islander peoples. These questions are provided in Table 1.
Cultural competency: Human rights matter There are numerous articles in the Declaration that relate to culturally competent service delivery. Some of these include: Indigenous peoples have a right to practice and keep our culture and spirituality safe, passing this onto future generations (Article 12 and 13). Education (including higher education) and public information (including health promotion, policy and research) should reflect the dignity and diversity of our peoples’ cultures, histories, experiences, and hopes (Article 15). © 2015 Occupational Therapy Australia
Indigenous peoples have a right to participate in decisions that have an impact on our lives (Article 2 and 18). Indigenous peoples have the right to care for country (Article 29). A widely accepted definition of cultural competency6 includes: A set of congruent behaviours, attitudes and policies that come together in a system, agency or among professionals and enable that system, agency or those professionals to work effectively in cross-cultural situations. (Cross, Bazron, Dennis and Isaac (1989), cited in Walker, Schultz and Sonn (2014), p. 200)
For the purposes of this viewpoint article, the term cultural competency is used as it provides a comprehensive framework for discussions. The Universities Australia & Indigenous Higher Education Advisory Council (2011) in the National Best Practice Framework for Indigenous Cultural Competencies in Australian Universities highlights that there is not a single definition for cultural competency. This Framework illustrates that professional cultural competency includes a ‘number of common elements or measurable human capabilities’ involving knowledge, skills, values and attributes which are orchestrated in our professional practice (p. 41) Health Workforce Australia (2014), prefers the terminology cultural capabilities when referring to student learning outcomes in higher education facilities based on the belief that this terminology offers a more holistic approach to identifying and assessing behaviours and understandings that extend beyond particular knowledge and skills. For this viewpoint article, the authors believe regardless of terminology preferences, that all professionals should execute professional behaviours, attitudes, beliefs, values, communication, practices, processes, frameworks and so on, that benefit Aboriginal and Torres Strait Islander peoples, and that are aligned with both a human-rights based approach and a strength-based approach.
Cultural competency encompasses and extends beyond the elements of cultural respect, cultural awareness and cultural safety7 (Walker et al., 2014). Cultural competency refers to continually learning and executing professional and personal skills that allow services to be developed and delivered in a manner that considers and values the culture and social context of the person and community receiving services. The execution of these professional and personal skills means that cultural competency informs and is embedded in the clinical reasoning process, and should enhance the quality of occupational therapy practice. We believe that the cultural competency of occupational therapy can be informed and developed through the involvement of Aboriginal and Torres Strait Islander peoples in the design, development, implementation, monitoring, and evaluation of all practice. This is reflective of a human rights approach. This type of involvement allows occupational therapists to work with individuals and communities to develop services that respect and cater for the experiences, knowledge and expressions of Aboriginal and Torres Strait Islander peoples. For example, the occupational therapist may work with a community to develop, implement and evaluate a falls prevention program that is reflective of local communication protocols, understanding of health and wellbeing, as well as aligned with community priorities. It is through this process that occupational therapists may learn how to provide services that are truly reflective of a person’s and/or community’s need.
Partnerships: Facilitating human-rights based practice Partnerships between Aboriginal and Torres Strait Islander peoples and service providers are a significant way in which professionals and institutions can implement human-rights based practice leading to the empowerment and engagement with individuals and communities. Partnerships are relationships that are mutually beneficial and well defined, and which have the aim of achieving common goals (Taylor & Thompson, 2011). The structures of the partnership should be developed collegially, with mutual authority, shared responsibility
A brief definition of these concepts as defined by Walker et al. (2014): Cultural respect is the recognition, protection and continued advancement of inherent rights and cultures. Cultural awareness is where practitioners take responsibility for their own biases, stereotypes, values and assumptions and understand that this may be different to other people. Understanding Australian history facilitates cultural awareness. Cultural safety focuses on the person’s experiences of intervention provided, and whether the person felt culturally safe during the intervention.
217 and shared accountability. Partnerships include the sharing of resources, successes and failures. Taylor and Thompson (2011) conducted a literature review, identifying six factors that underpinned the development of effective partnerships: 1. An understanding of the environment, including the local communities and any past partnership attempts; 2. A consideration of the traits of the various members of the partnership and ensuring the equitable treatment of all members; 3. An implementation of processes and structures that are built together and that are inclusive of communities, professionals and managers; 4. The establishment of inclusive, appropriate and flexible communication strategies, both formal and informal; 5. The development of a shared purpose that is meaningful to all partners; and 6. The availability of partnership resources within organisations. Partnerships will inevitably shape the way occupational therapists work with Aboriginal and Torres Strait Islander peoples. Importantly, part of the partnership building process needs to acknowledge power differences between groups and be cognisant that these power differences are a reflection of the imposed colonisation of Australia, including the historical, social and political contexts. Furthermore, it needs to be understood that within partnerships there will be points of feeling uncomfortable and some of this is related to clashes of differences in values and beliefs. It is important to move through being uncomfortable by a process of critical self reflection. Partnerships between Aboriginal and Torres Strait Islander peoples and health service providers (such as occupational therapists) should create opportunities to increase service capacity, improve service access, increase problem solving, enhance cultural competency, and encompass a holistic view of health (Taylor & Thompson, 2011). Depending on the purpose of the partnership, members may include national, state and/or local Aboriginal and Torres Strait Islander community members, organisations and networks. At a professional and service level, partnerships should function to maintain long-term relationships with a number of Aboriginal and Torres Strait Islander partner organisations and networks, which reflect the partnership goals and functions. At a clinical level, partnerships can also be developed between the individuals and communities accessing services. There are infinite ways in which occupational therapists can develop partnerships that reflect a humanrights approach. Such examples include: An occupational therapy association partnering with Aboriginal and Torres Strait Islander occupational therapists to facilitate cultural competent professional activities and this may include using these partnerships to influence the national occupational © 2015 Occupational Therapy Australia
218 therapy research agenda or to enhance the capacity of the occupational therapy profession to address issues such as social justice, reconciliation and equity. Higher education facilities working with a predominately Aboriginal and Torres Strait Islander governed body to review, develop and monitor the cultural competency components of the curriculum Occupational therapists partnering with Aboriginal service providers to facilitate connections with communities and provide services that support the priorities of the communities’, as well as services that reflect the communities’ concepts of health, wellbeing and occupations. Importantly, partnerships are more than gaining Aboriginal and Torres Strait Islander perspectives and knowledge; partnerships are about creating connections and relationships that allow professionals to cross and broker cultural borders (Dudgeon & Fielder, 2006).
Conclusion Aboriginal and Torres Strait Islander peoples are not just recipients of occupational therapy services; we are active and self-determining partners in the development and delivery of practice, policies and projects that affect our health, wellbeing and occupations. The application and implementation of human rights principles in everyday occupational therapy practice is both practical and achievable. To build partnerships that support a rights-based practice, occupational therapist and the occupational therapy profession can commence by addressing the questions in Table 1. Addressing these questions may facilitate the therapists’ and the profession’s capacity to acknowledge, respect and cater for diverse voices, experiences, knowledge and cultural expressions of Aboriginal and Torres Strait Islander peoples. Building and maintaining collaborative and collegiate partnerships will enhance the development of the occupational therapy profession that can provide culturally competent services, encompassing a rightsbased approach.
Acknowledgements Chontel, Corrine and Christopher are members of the National Aboriginal and Torres Strait Islander Occupational Therapy Network. We like to acknowledge Tom Brideson (Statewide Coordinator, Aboriginal Mental Health Workforce) who has provided guidance and advice along the way.
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