Cadetship and Transition to Professional Practice Programs

GUIDING PRINCIPLES AND A FRAMEWORK FOR IMPLEMENTATION

Aboriginal and/or Torres Strait Islander

CADETSHIP AND TRANSITION TO PROFESSIONAL PRACTICE PROGRAMS

A guide to language in the resource These terms are used within the resource with the following meanings:

ABORIGINAL AND/OR TORRES STRAIT ISLANDER

is CATSINaM’s preferred term to be inclusive when referring to individual people or groups of people. A person may identify as Aboriginal only, Torres Strait Islander only, or both Aboriginal and Torres Strait Islander. CATSINaM acknowledges the diversity of the many nations of Aboriginal Peoples and Torres Strait Islander Peoples.

ABORIGINAL AND TORRES STRAIT ISLANDER is commonly used in national health documents; when we are referring to these documents this term will be used.

ORGANISATIONS

© Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, 2018.

Recommended reference: Congress of Aboriginal and Torres Strait Islander Nurses and Midwives 2018, Aboriginal and/or Torres Strait Islander Cadetship and Transition to Professional Practice Programs: guiding principles and a framework for implementation, CATSINaM, Canberra.

Title: Aboriginal and/or Torres Strait Islander Cadetship and Transition to Professional Practice Programs: guiding principles and a framework for implementation

refer to health services and organisations that are managing the program and, in most instances, be the employers of program participants. ‘Employers’ may be used when the focus is specific to the organisation employing the participants.

ACKNOWLEDGEMENTS CATSINaM wishes to thank everyone who contributed to developing this resource:

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ISBN: 978-0-6483208-2-1

ABOUT CATSINaM CATSINaM is the national peak body that represents, advocates and supports Aboriginal and/or Torres Strait Islander nurses and midwives at a national level. We believe that nurses and midwives are the backbone of the Australian health system, and play a pivotal role in providing culturally safe health services to Aboriginal and Torres Strait Islander communities.

More information about CATSINaM and our work is available at: https://www.catsinam.org.au/

CATSINaM Members who participated in the ‘Successful Cadetships Yarning Circle’ at the 2017 CATSINaM National Conference.

Representatives of the jurisdictional health departments who participated in interviews as part of the scoping study undertaken prior to resource development.

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Aboriginal Graduate and Cadetship (Nursing and Midwifery) Program, Victorian Department of Health and Human Services

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Aboriginal Nursing and Midwifery Cadetship Program, NSW Health

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Indigenous Allied Health Australia (IAHA)

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National Aboriginal and Torres Strait Islander Health Worker Association (NATSIHWA)

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Australian Indigenous Doctors Association (AIDA)

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beyond…(Kathleen Stacey & Associates)

PARTICIPANTS refer to Aboriginal and/or Torres Strait Islander participants participating in programs. If ‘cadet’ or ‘graduate’ is used, it is because the focus is specific to Cadetship versus Transition to Professional Practice (TPP) Program participants.

PROGRAM refers to both Cadetship and TPP Programs, unless the focus is specific to a Cadetship versus TPP Program.

VICTORIAN GUIDE refers to the Victorian Department of Health and Human Services 2015 document, Implementing an Aboriginal cadetship program: a guide for public health services.

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CONTENTS 1.

About this resource . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 1.1

What is the focus of the resource?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

1.2

What is in the resource? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

1.3

How can you use the resource? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

1.4

What are cadetship and TPP programs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

2.

Principles underpinning this resource . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

3.

Preparing the workplace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

4.

5.

3.1

A sole or collaborative organisational approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

3.2

Benefits of dedicated programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

3.3

A culturally safe and responsive workplace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

3.4

Workplace supervision and support structures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

3.5

Cultural support and mentoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

3.6

Individual support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

3.7

Peer support and professional development

3.8

Preparedness to address racism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

3.9

Considerations for Aboriginal Community Controlled Heath Services . 22

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Preparing Aboriginal and/or Torres Strait Islander program participants . . . . . 25 4.1

Shared areas of preparation – the participant focus . . . . . . . . . . . . . . . . . . . . . . 25

4.2

Cultural safety and resilience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

4.3

Options beyond the program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

6. Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Appendix A: The brochure templates for organisations and participants . . . . . . 31 Appendix B: The difference between cultural safety and cultural awareness training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

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1.2 WHAT IS IN THE RESOURCE ?

1. About this resource CATSINaM created this national resource to focus on what supports success in Cadetship and Transition to Professional Practice (TPP) Programs that are specifically for Aboriginal and/or Torres Strait Islander participants.

Success means it is a culturally safe experience for participants, they complete the program and stay in the Aboriginal and Torres Strait Islander health workforce.

The resource is inclusive of Aboriginal and/or Torres Strait Islander students involved in a range of health professional training and builds on existing good practice.

The hope is it will: encourage greater uptake of dedicated programs on a national basis encourage the Aboriginal Community Controlled Health sector to be involved in their own or collaborative cadetship and/or graduate programs.

1.1 WHAT IS THE FOCUS OF THE RESOURCE ?

The focus is on how organisations can improve preparation, implementation and participation in Aboriginal and/or Torres Strait Islander Cadetship and TPP Programs, so there is sufficient, effective and culturally safe support in the workplace for participants. It extends on existing information by providing more detail regarding cultural safety and recommended support structures.

While the resource sits in a health sector context, most material is transferable to other sectors in which health professionals work. For example, sectors such as education, early childhood, justice, and family and community services.

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The resource does not include generic organisational information about the operations of specific programs, such as the application process, professional development and/or peer support schedules. If your organisation does not have Cadetship or TPP Programs, then the Victorian Department of Health and Human Services and NSW Health both have current dedicated programs for nursing and midwifery. The Victorian program includes allied health professions. We would encourage you to contact them directly about sharing their generic organisational material.

In writing the resource, CATSINaM acknowledges and thanks the Victorian Department of Health and Human Services for their permission to draw on their 2015 Implementing an Aboriginal cadetship program: a guide for public health services document (Victorian Guide), which is the only available public domain document of a similar nature. Any replication of material from it is clearly identified in this resource; at times we will redirect you to it rather than duplicate the material.

We encourage you to consult the Victorian Guide for additional information. Section 3 on health service preparation is relevant for both cadetship and TPP programs. Section 6 provides useful guidance on recruitment, employment and orientation. There is also a sample cadet job description in Appendix 1 of the Guide.

There are three components to the resource. The first component is this document, which outlines key preparation elements for organisations after identifying the underpinning principles in Section 2.

Section 3 is about preparing the workplace to: appreciate the benefits of a dedicated Aboriginal and Torres Strait Islander program know what to expect in the program clarify responsibilities and expectations in the workplace be a culturally safe environment with good support structures be clear about what the role of program participants does and does not involve.

Section 4 is about preparing Aboriginal and/or Torres Strait Islander participants to know: what to expect in the program what types of support they can access and how what their options may be after the program.

Brochure templates for organisations are the second component – there is a template for a cadetship and another for a TPP program. Brochure templates for participants is the third component; there is one each for cadets and graduates. All brochure templates are provided in separate Word documents. An explanation of these templates is in Appendix A.

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1.3 HOW CAN YOU USE THE RESOURCE ?

Your approach to using this resource will depend on your context. CATSINaM is happy for material in the three components of this resource to be replicated or adapted depending on your context but we expect our intellectual property to be recognised through full acknowledgement within your resources that the material was originally created by CATSINaM. Jurisdictions and/or organisations that DO NOT have programs specifically designed to support Aboriginal and/or Torres Strait Islander people: You can use the three components as a starting point for developing your own comprehensive set of resources – both public domain and internal organisational resources and documents.

Jurisdictions and/or organisations that DO have dedicated programs for Aboriginal and/or Torres Strait Islander people: You may find material within the national resource that you would like to incorporate into your existing set of resources.

1.4 WHAT ARE CADETSHIP AND TPP PROGRAMS ?

A Cadetship Program is for people who have enrolled in and are studying a health profession at university or an RTO. Programs vary as to whether cadets can start in Year 1 or Year 2 of their qualification. Cadets are employed by a health service, released to meet study commitments and apply their learning directly to the workplace within a scope of practice as defined in the non-registered health staff.

Cadets may remain in the program for the duration of their course. Funding to support Cadetship Programs can be accessed through the Australian Government, but it is advisable to supplement this funding at an organisational level to ensure that all elements of the program are appropriately resourced.

A Transition to Professional Practice (TPP) Program is for people who have completed their course of study and are eligible for registration as a fully qualified health professional. Graduates need to have gained their registration as they commence a TPP Program. It is usually a structured one-year program supporting new health professionals in their first year of registered practice. TPP Programs are generally funded on a jurisdictional basis. Each jurisdiction’s health department allocates funding on an annual basis to support TPP Programs across a number of professions.

2. Principles underpinning this resource CATSINaM, AIDA, IAHA and NATSIHWA have played a key role in articulating the vision and principles of recent national Aboriginal and/ or Torres Strait Islander health documents through their membership of the National Health Leadership Forum.

The centrality of culture to health and wellbeing is a principle that Aboriginal and/ or Torres Strait Islander peoples have lived for thousands of years. Due to colonisation and its impact, other principles have become important in order for Aboriginal and/or Torres Strait Islander Australians to enjoy the same level of health and wellbeing as non-Indigenous Australians, and culturally safe and responsive health care.

The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (Department of Health 2013) identifies the following four principles: 1. health equality and a human rights approach, 2. Aboriginal and/or Torres Strait Islander community control and engagement, 3. partnership and 4. accountability.

The National Aboriginal and/or Torres Strait Islander Health Workforce Strategic Framework (Australian Health Ministers’ Advisory Council’s Aboriginal and Torres Strait Islander Health Workforce Working Group 2016) is aimed at creating a health system comprised of a larger Aboriginal and Torres Strait Islander health workforce delivering culturally safe and

responsive health care. It lists the following principles: 1.

centrality of culture,

2. health system effectiveness, 3. partnership and collaboration, 4. leadership and accountability, and 5. evidence and data.

Aboriginal and/or Torres Strait Islander health staff make a positive difference to the cultural safety of health service experiences for Aboriginal and/or Torres Strait Islander Australians. Australia needs a larger Aboriginal and/or Torres Strait Islander health workforce.

Currently, the workforce is well below population parity - a minimum benchmark to achieve. As the burden of disease for Aboriginal and/or Torres Strait Islander Australians is 2.3 times that of other Australians (Australian Health Ministers’ Advisory Council 2017), the preferred benchmark is closer to 6% of the health workforce. While the workforce is growing, the current rate of growth is not fast enough to make a substantial change in this situation.

CATSINaM, along with their colleagues in IAHA, NATSIHWA and AIDA, know a long-term commitment to implementing appropriately resourced dedicated strategies is required to build the Aboriginal and/or Torres Strait Islander health workforce. This resource is designed to support such strategies. It is consistent with the above principles and provides a practical guide for realising them.

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3.2 BENEFITS OF DEDICATED PROGRAMS

3. Preparing the workplace 3.1 A SOLE OR COLLABORATIVE ORGANISATIONAL APPROACH The first workplace preparation step that employers should take is preparing to manage and support the program as a whole. The initial decision to make is:

There are multiple benefits for both participants and employers of a well-run, culturally safe and successful program. They are listed in Figure 1. 1 Appreciating and promoting the benefits of dedicated Aboriginal and/or Torres Strait Islander programs creates an important platform for participants to be successful, as employers and their staff will be motivated

FIGURE 1: BENEFITS OF PROGRAMS FOR PARTICIPANTS AND ORGANISATIONS

BENEFITS FOR CADETSHIP PROGRAM PARTICIPANTS

BENEFITS FOR TPP PROGRAM PARTICIPANTS

BENEFITS FOR ORGANISATIONS

• Can earn while learning • Offer a supportive study environment

• Structured support to develop personal, professional and leadership skills

• Support pathways into health careers for Aboriginal and/or Torres Strait Islander Australians

• Directly apply learning in the workplace

• Consolidate employability skills and knowledge

• Attract Aboriginal and Torres Strait Islander employees

• Gain exposure to health sector and interprofessional context

• Strengthen interprofessional experience

• Retain participants as employees

• Advance clinical skills and knowledge

• Increase representation of Aboriginal and/or Torres Strait Islander Australians in the workforce

Will a single organisation run the program?

Alternatively, will the program be run as a collaborative cluster arrangement involving several organisations with central coordination hosted by one organisation?

The latter approach may be a more effective use of resources, as it offers additional benefits through having a larger cohort of cadets/graduates participating together as part of the support structures (see Section 3.4) and greater opportunities for participants to a diverse range of work contexts. However, a condition for success is appropriately resourcing the program coordination function.

The learning from existing dedicated Aboriginal and/or Torres Strait Islander programs is that regardless of whether the program is run by a single organisation or through a collaborative cluster arrangement, it is important there is consistency in how participants are recruited and supported, while allowing for flexibility to reflect the unique aspects of individual organisations.

to support them. This information should be shared widely across organisations prior to the program launch as they prepare the workplace for staff and participant roles within the program. An example of how this can occur is provided in the ‘Brochure template for organisations’, a separate document within this resource.

• Strengthen work readiness skills • Develop clinical skills through observation • Build self-confidence in skills and abilities • Build confidence in career choice

• Build self-confidence in skills and abilities • Gain exposure to specific health areas • Security of employment for length of the program

• Exposure to career opportunities

• Provide a pathway to career opportunities and specialisations

• Increase employment opportunities

• Increase employment opportunities

• Strengthen credibility and relationships with the wider Aboriginal and/or Torres Strait Islander community • Act on responsibility to close the gap in health, education and employment inequities • Strengthen Aboriginal and Torres Strait Islander client outcomes • Shared recognition and engagement in cultural safety principles across all organisational levels

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These benefits were informed by three activities: 1) CATSINaM’s consultation with Aboriginal and Torres Strait Islander nursing and midwifery students and graduates who have participated in programs, 2) interviews with representatives of organisations that currently run programs - part of a scoping study on available programs undertaken during the resource development stage, and 3) a stakeholder roundtable with experienced Aboriginal and/or Torres Strait Islander health professionals that was held to review the draft resource.

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3.3 A CULTURALLY SAFE AND RESPONSIVE WORKPLACE It is important to discuss these benefits with staff who are involved in some capacity: coordinators, supervisors, mentors, cultural mentors, and colleagues – including professional, operational and administrative staff.

The critical organisational enablers required for realising these benefits are illustrated in Figure 2. Leadership commitment is vital and needs to be demonstrated through how leaders promote and support the program. This includes how the program is identified within core organisational documents, such as: strategic and business plans,

Leadership engagement must be evident at the top of organisations and replicated through to middle management and unit management.

Long-term and adequate funding support is vital. This was a feature of existing dedicated Aboriginal and/or Torres Strait Islander programs identified in the scoping study during the resource development phase. The Program Coordinator position must be resourced to adequately undertake all involved tasks, and funds be allocated to meet participant needs over and above base per participant funding.

Internal advocates who can promote the benefits of the program, particularly those who can testify from their own involvement in support roles, are also valuable enablers.

Aboriginal and/or Torres Strait Islander employment strategies, codes of conduct, and potentially, Reconciliation Action Plans.

A range of high level national documents emphasise the necessity of health services providing a culturally safe workplace for Aboriginal and/or Torres Strait Islander clients, family members and staff (e.g. Australian Commission on Safety and Quality in Health Care 2017; Department of Health 2013) and accreditation standards for many health professional courses. Cultural safety is within health professional practice standards, codes of conduct and registration standards (e.g. Australian Association of Social Workers 2013; Nursing and Midwifery Board of Australia 2018a and 2018b; Occupational Therapy Australia 2010).

Cultural safety is also addressed in the Cultural Respect Framework 2016-2026 for Aboriginal and Torres Strait Islander Health (Australian Health Ministers Advisory Council 2016).

Several jurisdictional health departments are operationalising this document by resourcing cultural safety training in their organisations. It would be useful to ascertain what is possible within your jurisdiction for accessing this training.

CATSINaM (2017b) defines cultural safety in this way.

FIGURE 2: CRITICAL ORGANISATIONAL ENABLERS FOR REALISING THESE BENEFITS

Cultural safety has its roots in nursing education and health care in Aotearoa based on the work of Ramsden (2002) and others, but has since become more broadly theorised and accepted in Australia as a means to work towards social justice and better health outcomes for those experiencing health inequity.

Cultural safety is a philosophy of practice that is about how a health professional does something, not what they do, in order to not engage in unsafe cultural practice that ‘… diminishes, demeans or disempowers the cultural identity and wellbeing of an individual’ (Nursing Council of New Zealand 2011, p 7). It is about how people are treated in society, not about their diversity as such, so its focus is on systemic and structural issues and on the social determinants of health.

Cultural safety represents a key philosophical shift from providing care regardless of difference to care that takes account of peoples’ unique needs. It requires nurses and midwives to undertake an ongoing process of self-reflection and cultural self-awareness, and an acknowledgement of how a nurse’s/midwife’s personal culture impacts on care.

Cultural safety uses a broad definition of culture that does not reduce it to ethnicity, but includes age/generation, sexual orientation, socio-economic status, religious or spiritual belief, ethnic origin, gender and ability. It also recognises that professions and work places have cultures, and cultural safety is as applicable to working with colleagues in providing health care as it is to working with health service users. (p. 11)

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3.4 WORKPLACE SUPERVISION AND SUPPORT STRUCTURES Further resources are available from CATSINaM on cultural safety (2014, 2016, 2017a). Two other resources are the NATSIHWA (2016) Cultural Safety Framework and the IAHA (2015) Cultural Responsiveness in Action: An IAHA Framework. The IAHA document focuses on translating cultural safety concepts and knowledge into practice once initial cultural safety training is undertaken.

STEPS THAT ORGANISATIONS CAN TAKE A culturally safe and responsive workplace is an essential foundation for an effective cadetship and/or graduate/TPP program. Creating and maintaining a culturally safe and responsive workplace is also an ongoing commitment. The types of steps that organisations are strongly encouraged to take include: cultural safety professional development training for all staff, beginning with the leadership, followed by middle management and frontline staff positions inclusive of clinical, operational and administrative staff – this is considered essential ensuring staff are aware of key national documents and how they relate to the organisation ensuring the organisation has policies and codes of conduct that highlight cultural safety, cultural responsiveness and zero tolerance for racism

signing up to the ‘Racism. It stops with me!’ campaign designing and implementing dedicated Aboriginal and/or Torres Strait Islander employment strategies across all work areas and levels of seniority having a visual presence of Aboriginal and/ or Torres Strait Islander cultural groups who utilise the organisation’s services (such as posters, marketing material, displays and art), including traditional custodians of country on which the organisation is situated, and nationally recognised symbols, such as the Aboriginal flag and Torres Strait Islander flag cultural and peer support strategies for Aboriginal and/or Torres Strait Islander staff (see Section 3.3, 3.4 and 3.5) inclusion of Aboriginal and/or Torres Strait Islander people in governance, decisionmaking and advisory structures, including traditional custodians of country on which the organisation is situated recognition and respect for Indigenous ways of knowing, being and doing recognition and respect for a human rights approach and self-determination consistent with the United Nations Declaration on the Rights of Indigenous Peoples (Australian Human Rights Commission 2010)

2.

These types of steps are similar to the domains identified in an organisational cultural safety self-assessment tool that has been designed to help organisations monitor improvement in how they are implementing cultural safety strategies at the organisational level (beyond…(Kathleen Stacy & Associates) Pty Ltd & Sharon Gollan & Associates 2018).

Some but not all of these types of steps are identified in the Reconciliation Action Plan templates developed by Reconciliation Australia: https://www.reconciliation.org.au/reconciliation-action-plans/

supporting staff involvement (Aboriginal and/or Torres Strait Islander and nonIndigenous staff) in activities and events of significance to Aboriginal and/or Torres Strait Islander people, such as: local cultural programs, activities, events and festivals; Close the Gap day; the anniversary of the National Apology to the Stolen Generations; NAIDOC week and/or Reconciliation Week developing and implementing Reconciliation Action Plans and/or overall organisational cultural change strategies to strengthen cultural safety and responsiveness that are inclusive of the above steps.2 As cultural safety professional development training is essential, it is also important to know the difference between cultural safety and cultural awareness training. An explanation is provided in Appendix B. Cultural safety training opportunities exist in most jurisdictions; however, additional or other training to consider include: CATSINaM: ‘A brief introduction to enabling culturally safe health care’ is a half-day workshop as an entry point to comprehensive (two-day) cultural safety training.

IAHA: ‘Cultural responsiveness training’, which builds on cultural safety training, can be requested to support implementation of the Cultural Responsiveness in Action: An IAHA Framework.

Available cultural safety and cultural responsiveness resources may also be helpful (for example, CATSINaM 2014, 2016 and 2017a; IAHA 2015, NATSIHWA 2016).

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Three distinct but interrelated roles are required within the program: the Program Coordinator, Clinical Supervisor and Cultural Mentor (more information on mentoring is in Section 3.5).

Although it is possible that one person may play more than one role, it is more likely these roles will be undertaken by different people. Both the Program Coordinator and Clinical Supervisors need to undertake cultural safety training, and Clinical Supervisors should undertake basic clinical supervision or preceptorship training prior to supporting participants. Wherever possible, Clinical Supervisors need to share the same health profession with the cadet or graduate. The Cultural Mentor may be an Aboriginal and/or Torres Strait Islander staff member in the health service or a member of the local community who is formally engaged to undertake this role.

CLARITY ON PROGRAM COORDINATION, SUPERVISION AND MENTOR ROLES It is important there is clear understanding of the difference between the roles by the people undertaking them, as well as participants, and how they need to relate to each other. Figure 3 provides a summary of the roles that each position would perform.

We also recommend consulting Section 5 of the Victorian Guide on establishing workplace and supervision structures, which can apply to both program types even though it is focused on cadetship programs. It emphasises how these three roles must interact with each other in support of the participant – see Figure 4.

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FIGURE 4: RELATIONSHIP BETWEEN THE SUPERVISION AND SUPPORT ROLES

ENSURING WIDER STAFF UNDERSTANDING : PROMOTION During program establishment, and at the beginning of each intake, the organisation should promote the program across all units and sites as part of the program’s communication strategy. The brochure templates that form part of this resource, and are explained in Appendix A, are one mechanism that can be used.

It is also helpful to identify ‘internal advocates’ as a critical enabler (see Section 3.2). These staff can maintain this promotion and messaging at a local level. They can help ensure staff with whom participants may interact, even briefly or intermittently, are familiar with the purpose of the program and the role of the participants.

Internal advocates can include program ambassadors or alumni who have continued with the organisation upon completion of the program.

ENSURING WIDER STAFF UNDERSTANDING : INDUCTION WORKSHOPS It is highly recommended to hold a half or oneday induction workshop for all staff centrally involved in the program; noting that several staff may undertake the clinical supervisor roles for each participant. We encourage you to utilise material in this resource, along with the Victorian document, in designing the agenda and content of induction workshops.

Topics to cover are: who the participants are why participants are there what participants roles are how they can support participants how they can apply what they learned in cultural safety training to providing a culturally safe work environment.

If a decision is taken for participants to wear uniforms or other identifiers (i.e. a badge) so they can be distinguished from other staff with professional or different responsibilities, ensure this is explained. This will avoid unfair or inappropriate expectations being placed on participants by other staff, which may be more critical in cadetship programs.

It is also vital that clinical supervisors and other staff know that participants are not there to be cultural consultants to staff who are working with Aboriginal and/or Torres Strait Islander clients and families. This is not part of the participant’s position description and they are still learning in their role. Where cultural support and advice is required to ensure nonIndigenous staff provide a quality and culturally safe service for Aboriginal and/or Torres Strait Islander clients and families, this should be sought through existing resources and structures the organisation has in place. Even if the Aboriginal and/or Torres Strait Islander participant works with the client and family in some capacity, cultural support and advice should be accessed or at least offered.

© Victorian Department of Health and Human Services 2015, p. 12

FIGURE 3: ROLES WITHIN THE PROGRAM

PROGRAM COORDINATOR

CLINICAL SUPERVISOR

CULTURAL MENTOR

• Program management

• Organise shifts for participants

• Ensure participant feels culturally safe

• Delegate tasks in line with participant position descriptions

• Support participant to address cultural safety issues with relevant parties

• Provide advice about aspects of these tasks

• Provide cultural and personal support

• Performance review of participants

• Ensure work team understand role and scope of participants

• Provide advice on cultural considerations in working with clients

• Approve and coordinate leave requests and other entitlements

• Ensure work team provide appropriate support to participants

• Coordinate peer support structures

• Model and foster a culturally safe work environment

• Help participant access other cultural support structures and links within the health service and community

• Coordinate training and development

• Identify and address issues that prevent cultural safety

• Coordinate placements • Liaise with clinical supervisors, cultural mentors and universities • Promote culturally safe work environments

• Support the welfare of participants and develop strategies to balance their work with personal obligations or challenges

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3.5 CULTURAL SUPPORT AND MENTORING A specific aspect of creating a culturally safe workplace is ensuring participants have consistent access to cultural support. Being connected to culture is a ‘cultural determinant of health’ and fosters resilience in Aboriginal and/or Torres Strait Islander participants. This can be provided in several ways. In fact, it is recommended to utilise all the options described.

A CULTURAL MENTOR Mentoring is a developmental, caring, sharing and supportive relationship where a more experienced person (Mentor) invests time, know-how and effort in enhancing the personal and professional growth, knowledge and skills of a less experienced person (Mentee). It is a distinctive and meaningful relationship where the two parties consider each other with positive regard, develop respectful boundaries – including confidentiality, paying close attention to cultural safety and committing to working with each other over an agreed timeframe. (CATSINaM 2017, p. 7) Mentoring involves linking participants to a more experienced Aboriginal and/or Torres Strait Islander person as a cultural mentor. He/ she may work with the organisation, but if this is not a viable strategy, mentors could be sought through local Aboriginal organisations or from the wider community. Good practice would involve: establishing these relationships during program orientation providing interested staff, colleagues or community members with formal mentor training

considering how well mentors and mentees are matched (same sex mentors may be more appropriate but gain local advice) being clear on the mentoring role (see Section 3.4).

Three of the national Aboriginal and/or Torres Strait Islander health professional organisations have mentoring programs that may be helpful.

CATSINaM partners with organisations to deliver a Mentoring Training Program and support implementation of a mentoring program.

CATSINaM offers an Introduction to Mentoring half-day workshop to provide a clear understanding of what mentoring involves and what mentors and mentees should expect from the experience.

IAHA runs a Mentoring Program for Aboriginal and/or Torres Strait Islander allied health students and early career professionals.

AIDA runs a Mentoring Program for Aboriginal and/or Torres Strait Islander medical students and early career professionals.

CULTURAL PEER SUPPORT INTERNAL TO THE ORGANISATION

NATIONAL ABORIGINAL AND / OR TORRES STRAIT ISLANDER HEALTH PROFESSIONAL ASSOCIATIONS

This can occur by linking participants into any existing Aboriginal and/or Torres Strait Islander staff forums. For example, forums that are held on a regular basis for Aboriginal and/ or Torres Strait Islander staff in any position across the organisation. If they do not yet exist, organisations are encouraged to establish them.

A core purpose of the national Aboriginal and/ or Torres Strait Islander health professional associations is to provide culturally grounded peer support, information, networking and informal mentoring in a culturally safe environment. Participants should be encouraged to join an association relevant to their health profession where they can access a range of opportunities to participate in jurisdictional and national activities.

CULTURAL PEER SUPPORT EXTERNAL TO THE ORGANISATION An additional option is linking participants into any existing Aboriginal and/or Torres Strait Islander forums run by organisations in the local area, including Aboriginal and/or Torres Strait Islander organisations.

LOCAL CULTURAL ACTIVITIES AND EVENTS It is highly recommended that organisations encourage participants to be involved in local cultural activities and events. This includes those in which the organisation is involved and may even support, and those led by Aboriginal and/or Torres Strait Islander community organisations and groups in the local area or jurisdiction.

Here are the membership information links: CATSINaM membership information for nurses and midwives.

IAHA membership information for allied health professions.

AIDA membership information for medical doctors.

NATSIHWA membership information for Aboriginal and Torres Strait Islander Health Workers and Health Practitioners.

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3.6 INDIVIDUAL SUPPORT Each participant should have access to individualised support where they can discuss and evaluate their progress in the program and their studies (if relevant), and their level of cultural safety. They can plan and make decisions about steps that will support their ongoing involvement in the program and their career pathway, as well as discuss any flexibilities that would be helpful.

Each of the three core staff roles in the program would play a part according to their specific focus (see Section 3.4 and Figure 3). It is through this that participants will establish a foundation for their relationship with the people working in each of these roles.

3.7 PEER SUPPORT AND PROFESSIONAL DEVELOPMENT Strategies that enable peer support between participants should be a core component of the program. Two strategies to implement from the start are an induction workshop and co- placements.

CO-PLACEMENTS : Wherever possible, more

than one Aboriginal and/or Torres Strait Islander participant should be placed in an organisation or unit to reduce isolation and strengthen peer support on an everyday basis.

INDUCTION WORKSHOP : Upon formal

commencement of each intake, hold a half or one-day induction workshop for participants to orient them to the specific features of the program, and introduce them to key people they need to know: the Program Coordinator, potential Cultural Mentors and Clinical Supervisors, and, if possible, the Executive or Senior Management sponsor of the program.

We encourage you to utilise material in this resource in designing the agenda and content of induction workshops.

Other recommended strategies to implement during the program include: provide regular opportunities for all participants to come together for both formal and informal peer support, reflect on their progress and identify specific support needs if different shift times make it difficult for all participants to meet at the one time, then it is wise to organise two or three options on a regular basis to offer flexibility while enabling full participation offer professional development during these gatherings on topics complementary to the program that support personal and professional growth

consider formal ‘buddy’ arrangements between participants to encourage stronger peer support create program ambassadors or alumni who can attend peer support forums and may formally present at these forums as part of the professional development options.

The national Aboriginal and/or Torres Strait Islander health professional associations can contribute to professional development opportunities for participants. Organisations should also consider how they can sponsor participants to attend jurisdictional and national peer support and professional development events that associations hold. Both existing dedicated Aboriginal and/or Torres Strait Islander programs in Victoria and NSW do this and recommend this as an effective cultural and peer support strategy.

Regardless of whether the program is run by a single organisation or as a collaborative cluster arrangement, the Program Coordinator role needs to be appropriately resourced to plan and implement the peer support and professional development strategies.

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3.8 PREPAREDNESS TO ADDRESS RACISM A role for the Program Coordinator in Table 2 was to promote a culturally safe and responsive work environment. A role for Clinical Supervisors was to address issues that prevent cultural safety. The most likely issue to prevent cultural safety is racism.

Racism can be broadly defined as the types of behaviours, practices, beliefs and prejudices that underlie avoidable and unfair inequalities across groups in society based on race, ethnicity, culture or religion. Racebased discrimination is those behaviours and practices that result in avoidable and unfair inequalities across groups in society. This definition encompasses not only racial violence or illegal forms of discrimination, but subtle forms of exclusion as well.

Racism can occur at three conceptual levels, which overlap in practice: interpersonal racism (i.e. racist interactions between people); internalised racism (i.e. the incorporation of ideologies within the worldview of an individual who experiences racism which results in the unequal distribution of power between racial, ethnic, cultural or religious groups); and systemic or institutional racism (i.e. formal policies, practices, processes and conditions that serve to increase power differentials between racial, ethnic, cultural or religious groups). (Ferdinand, Paradies & Kelaher 2013, p. 3)

The vision of the National Aboriginal and Torres Strait Islander Heath Plan (Department of Health 2013) states the “Australian health system is free of racism and inequality and all Aboriginal and Torres Strait Islander people have access to health services that are effective, high quality, appropriate and affordable” (p. 7). This applies to health staff in any capacity in any organisation and is consistent with national safety and quality health standards (Australian Commission on Safety and Quality in Health Care 2017).

This requires organisations to be prepared to address racism when it occurs, whether directed at Aboriginal and/or Torres Strait Islander participants, staff, clients and/or family members. All organisations should have policies and/or codes of conduct that state there is zero tolerance for racism. If not, this should be addressed during the program establishment stage or as soon as possible once identified as an absence. For example, this may be an outcome from the initial cultural safety training with health service management.

There should be an anti-racism policy or a policy with an identifiable section on the organisation’s anti-racism position. There should be existing processes through which participants can report instances of racism they directly experience and those they witness, so the organisation addresses it. Both instances are highly impactful on participant wellbeing and cultural safety.

Identifying the different forms of racism and how they are evident in the organisation should be a core component of cultural safety training that management, clinical and administrative staff attend. If this is not covered, the organisation is not accessing the right form of training (see Appendix B). Through cultural safety training, all staff involved in the program should be better equipped to not engage in racism, identify racism when they witness it and believe it has occurred if a participant talks to them about it. What does this mean in straightforward terms?

ADDRESSING RACISM MEANS TO : not participate in racism in any form call racism out when you hear and see it, and address it promptly if it happens by other… health professionals, health services staff or non-Indigenous clients be mindful that the many experiences of racism that Aboriginal and/or Torres Strait Islander Australians have and still experience, including in health services, can negatively affect their trust of health services as a safe place and health professionals as people who have their best interests at heart provide immediate and empathic support for Aboriginal and/or Torres Strait Islander clients or colleagues who experience racism and choose to talk to about it respect that Aboriginal and/or Torres Strait Islander people determine if they experience racism – the person or people who spoke or acted in a racist manner cannot decide this

recognise that, if they are white people, their experience of the world is very different from Aboriginal and/or Torres Strait Islander people – as white people, life may sometimes be hard, but it is not hard because you are white think about how to make the experience of their health service as safe and comfortable as possible for Aboriginal and/or Torres Strait Islander people. (CATSINaM 2018, p. 93) It must be understood that participants may be very anxious about discussing experiences of racism with non-Indigenous people, as this involves significant personal and professional risks. The all too common experience is not being believed - in fact, being minimised, ridiculed and blamed. Believing an Aboriginal and/or Torres Strait Islander person when they share an experience of racism and having an empathic response is an important part of creating cultural safety. The Aboriginal and/or Torres Strait Islander person decides if racism occurs, not non-Indigenous people.

If a culturally safe work environment has been created, it will be more possible for participants to not only share this with their Cultural Mentor, but also their Clinical Supervisor and the Program Coordinator. It will be vital to provide strong support to the participant and clarify how far they want to take the matter.

Program staff will also need to work through what action may need to be taken if the racist incident breached professional duty of care, the code of conduct or organisational policy, and if it resulted in an adverse health outcome.

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3.9 CONSIDERATIONS FOR ABORIGINAL COMMUNITY CONTROLLED HEALTH SERVICES Currently, dedicated Aboriginal and/or Torres Strait Islander cadetship and TPP programs are rare in Aboriginal Community Controlled Heath Services (ACCHS). There are a range of reasons why this is the case. Yet these are excellent health contexts for such programs.

Advantages include that participants would have regular opportunities to work directly with Aboriginal and/or Torres Strait Islander Australians. Due to the higher proportion of Aboriginal and/or Torres Strait Islander people employed in ACCHS, participants would also have better access to Aboriginal and/or Torres Strait Islander supervisors, role models and cultural mentors in their own and other professions, as well as a range of work roles.

This exposure could encourage Aboriginal and/ or Torres Strait Islander participants to pursue or consider pursuing a career in the ACCH sector upon achieving professional registration or after the TPP Program.

All areas in Section 3 and 4 are relevant for ACCHSs if they decide to establish programs or partner with non-Indigenous organisations to provide program placements in their setting.

Here are other considerations that are particularly relevant to ACCHSs seeking to do this.

WHAT IN-KIND RESOURCES COULD THE ACCHS OFFER IF : partnering with a mainstream organisation that funds the Program Coordination position and participant salaries, and participants can have placements in both locations? the jurisdictional ACCH peak body accesses funding for the Program Coordination position and participant salaries, and the program operates completely or primarily in the ACCH sector?

WHAT INTERNAL CAPACITY EXISTS FOR KEY PROGRAM ROLES :

IN WHAT AREAS COULD PARTICIPANTS WORK WITHIN THEIR SCOPE OF PRACTICE ? 3 A very important conversation for ACCHS to have is to explore how to promote the program as a benefit to participants, the ACCHS, clients and the community. Here are some possible benefits that may apply in the ACCHS context that will be helpful in these conversations: offering participants good exposure to the primary health care environment and a social determinants of health approach creating interprofessional opportunities by taking a team approach to clinical supervision

who are suitable people to provide clinical supervision who may or may not be from the same health profession?

creating more employment opportunities in their community

who are suitable people to be cultural mentors (they do not need to be from the same heath profession)?

increasing the Aboriginal and/or Torres Strait Islander workforce in primary health care

WHAT EXTERNAL CAPACITY COULD BE DRAWN UPON FOR KEY PROGRAM ROLES ? are there clinical supervision or cultural mentor options external to the organisation? how can this be resourced?

3.

For cadets, see Appendix 1 of the Victorian Department of Health and Human Services (2015) document as an example of scope of practice.

providing an opportunity for participants to give back to their communities.

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4. Preparing Aboriginal and/or torres strait islander program participants 4.1 SHARED AREAS OF PREPARATION - THE PARICIPANT FOCUS Several areas of preparation for Aboriginal and/or Torres Strait Islander program participants overlap with the preparation required in the workplace, so are not repeated here. The areas of shared preparation and information for participants are:

BENEFITS OF DEDICATED PROGRAMS (Section 3.2): Participants need to consider and appreciate what the benefits are for them in order to both apply and then remain within the program.

WORKPLACE SUPERVISION AND SUPPORT STRUCTURES (Section 3.4): Who will undertake each of the three roles and clarity on the distinctions between them? What does the wider staff group know about the program and who are the people who can provide more information to staff if needed?

CULTURAL SUPPORT AND MENTORING (Section 3.5): What options has the organisation made available? What is required and what is optional although encouraged?

INDIVIDUAL SUPPORT (Section 3.6): What options has the organisation made available? What is required and what is optional although encouraged?

PEER SUPPORT AND PROFESSIONAL DEVELOPMENT (Section 3.7): What options has the organisation made available? What is required and what is optional although encouraged?

PREPAREDNESS TO ADDRESS RACISM (Section 3.8): How is zero tolerance to racism identified in the organisation’s policies and code of conduct?

What are their options for sharing and seeking support if they experience or witness racism? What is the process for reporting racism formally if they choose that path or it may be required due to the consequence of the racist experience?

All the above areas need to be covered in the induction workshop for participants described in Section 3.7. They must also be given attention during the orientation process as they become familiar with the organisational environment and staff with whom they will regularly interact.

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4.2 CULTURAL SAFETY AND RESILIENCE Assumptions are often made that Aboriginal and/or Torres Strait Islander people automatically know about racism and cultural safety. However, participants may not be familiar with all the language and concepts involved, although they would be familiar with recognising a culturally safe situation at a personal level. Understanding cultural safety is a lifelong learning journey for Aboriginal and/or Torres Strait Islander participants, just as it is for non-Indigenous people.

One way in which participants can strengthen their resilience is to be familiar with the language of racism, understand the different levels at which it operates and know how to articulate what cultural safety means for them.

They also need to be familiar with what will support the cultural safety of Aboriginal and/or Torres Strait Islander staff, clients and families with whom they may work.

The cultural safety and cultural responsiveness training that Program Coordinators, Clinical Supervisors and Cultural Mentors undertake should equip them to support participants with this process. Their roles include discussing racism and cultural safety with participants, and supporting them to address issues that compromise their cultural safety (see Figure 3 in Section 3.4). There are different opportunities for this to occur:

emphasising the importance of cultural safety during the induction workshop and orientation process, and the organisation’s position on zero tolerance for racism during individualised support and peer support sessions - e.g. regularly explore how culturally safe participants feel, if they have noticed instances of racism, how they are addressed, and, critically, examples of good practice in cultural safety they are witnessing in their placements as topics for professional development.

For example, an existing cadetship program offered CATSINaM’s Cultural safety and resilience half-day workshop to participants as part of a peer support and professional development gathering. Similar options may be accessible in different jurisdictions, along with cultural safety and cultural responsiveness training designed for Aboriginal and/or Torres Strait Islander participants.

The resources on cultural safety and cultural responsiveness listed in Section 3.3 will also be valuable to share with participants (CATSINaM 2014, 2016 and 2017a; IAHA 2015; NATSIHWA 2016).

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4.3 OPTIONS BEYOND THE PROGRAM Each program will have different features. For example, the overall length of the program, what year of study a cadetship is first available (e.g. first year or second year of pre-registration training), the minimum number of clinical hours required and the minimum number of rotations (placements) required. This may affect options beyond the program.

Organisations need to explore and determine the following matters during program preparation and explain what expectations they hold of participants and what options are available to them upon successful completion of the program: The involvement of existing and previous participants in informal and/or formal evaluation of the program.

The provision of a formal reference that participants can use to assist them in finding a position once they complete the program.

What career development support the organisation is willing to offer participants as they plan what they will do after they complete the program.

The ongoing positions that will be available for participants once they complete the program.

If available positions will be specific to a health profession or involve a different role in health - this is relevant for cadetship programs that do not support cadets through to the end of their pre-registration qualification.

Whether opportunities will be created for participants to become program alumni or ambassadors once they complete the program, so they can play a role with supporting participants in later program intakes.

The opportunities that exist for cadetship program participants to move into a graduate/TPP program offered by either the same or a different organisation.

Whether to have ‘conditions’ for gaining a place in the graduate program that participants must meet upon completion of the program, e.g. work for a specified period of time in an area of the organisation’s or participants’ choosing.

Rather than set these decisions in concrete, they should be open to review on an annual basis as part of the program evaluation strategy. Opportunities may present themselves or be deliberately pursued by the organisation to improve the nature of and/ or number of options available beyond the program as it becomes established as an annual and standard program.

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5. references Australian Association of Social Workers 2013, Practice standards, Australian Association of Social Workers, Canberra, viewed 4 May 2018, https://www.aasw.asn.au/document/item/4551 Australian Commission on Safety and Quality in Health Care 2017, National Safety and Quality Health Service Standards (2nd edition), Sydney, Australian Commission on Safety and Quality in Health Care, viewed 1 April 2018, https://www.safetyandquality.gov.au/wp-content/ uploads/2017/12/National-Safety-and-Quality-HealthService-Standards-second-edition.pdf Australian Health Ministers’ Advisory Council 2017, Aboriginal and Torres Strait Islander Health Performance Framework 2017 Report, AHMAC, Canberra, viewed 25 April 2018, https://www.pmc.gov.au/sites/default/files/ publications/2017-health-performance-framework-report. pdf Australian Health Ministers’ Advisory Council’s Aboriginal and Torres Strait Islander Health Workforce Working Group 2016, National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework, Canberra, Australian Health Ministers Advisory Council, viewed 25 April 2018, https://www.health.gov.au/internet/main/publishing.nsf/ Content/4A716747859075FFCA257BF0001C9608/$File/ National-Aboriginal-and-Torres-Strait-Islander-HealthWorkforce-Strategic-Framework.pdf Australian Health Ministers’ Advisory Council’s National Aboriginal and Torres Strait Islander Health Standing Committee 2016, Cultural Respect Framework 2016-2026 for Aboriginal and Torres Strait Islander Health, Canberra, Australian Health Ministers Advisory Council, viewed 25 March 2018, http://www.coaghealthcouncil.gov.au/Portals/0/ National%20Cultural%20Respect%20Framework%20for%20 Aboriginal%20and%20Torres%20Strait%20Islander%20 Health%202016_2026_2.pdf

Australian Human Rights Commission 2010, The community guide to the UN Declaration on the Rights of Indigenous Peoples, Australian Human Rights Commission, Sydney, viewed 4 May 2018,

CATSINaM 2017b, The Nursing and Midwifery Aboriginal and Torres Strait Islander Health Curriculum Framework (Version 1.0), Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, Canberra, viewed 27 March 2018,

https://www.humanrights.gov.au/our-work/ aboriginal-and-torres-strait-islander-socialjustice/publications/community-guide-un

http://catsinam.org.au/static/uploads/ files/nursing-midwifery-health-curriculumframework-final-version-1-0-wfxusnoufjil.pdf

beyond…(Kathleen Stacy & Associates) Pty Ltd & Sharon Gollan & Associates 2018, Cultural safety in practice: an organisational self-assessment guide, Adelaide, beyond…

(Kathleen Stacy & Associates) Pty Ltd.

CATSINaM 2018, CHCDIV002 - Promote Aboriginal and/or Torres Strait Islander Cultural Safety: Learner Guide, Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, Canberra.

CATSINaM 2014, Towards a shared understanding of terms and concepts: strengthening nursing and midwifery care of Aboriginal and Torres Strait Islander peoples, Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, Canberra, viewed 27 March 2018,

Department of Health 2013, National Aboriginal and Torres Strait Islander Health Plan 2013-2023, Commonwealth of Australia, Canberra, viewed 23 March 2018,

http://catsinam.org.au/static/uploads/files/ catsinam-cultural-terms-2014-wfwxifyfbvdf.pdf CATSINaM 2016, Cultural Safety in Policy and Practice Seminar: summary and implications, Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, Canberra, viewed 27 March 2018, http://catsinam.org.au/static/uploads/files/ cultural-safety-in-policy-and-practice-seminar27-april-2016-report-wfwxsnrkyzyh.pdf CATSINaM 2017a, Position statement: embedding cultural safety across Australian nursing and midwifery, Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, Canberra, viewed 27 March 2018, http://catsinam.org.au/static/uploads/files/ embedding-cultural-safety-accross-australiannursing-and-midwifery-may-2017-wfca.pdf

http://www.health.gov.au/internet/ main/publishing.nsf/content/ B92E980680486C3BCA257BF0001BAF01/$File/ health-plan.pdf Ferdinand, A, Paradies Y & Kelaher M 2013, Mental health impacts of racial discrimination in Victorian Aboriginal communities: the localities embracing and accepting diversity (LEAD) experiences of racism survey, The Lowitja Institute, Melbourne, viewed 4 May 2018, https://www.lowitja.org.au/lowitja-publishing/ L023 IAHA 2015, Cultural responsiveness in action: an IAHA framework, Indigenous Allied Health Australia, Canberra, viewed 30 March 2018, http://iaha.com.au/policy/culturalresponsiveness/

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6. appendices Indigenous Nurses Working Group, 2002, gettin em n keepin em: report of the Indigenous Nursing Education Working Group, Department of Health and Ageing, Canberra.

NACCHO 2011, Creating the NACCHO Cultural Safety Training Standards and Assessment Process: a background paper, National Aboriginal Community Controlled Heath Organisation, Canberra.

NATSIHWA 2016, Cultural Safety Framework, National Aboriginal and Torres Strait Islander Health Workers’ Association, Canberra, viewed 30 March 2018, http://www.natsihwa.org.au/sites/default/files/ natsihwa-cultural_safety-framework_summary. pdf Nursing and Midwifery Board of Australia 2018a, Code of conduct for midwives, Nursing and Midwifery Board of Australia, Melbourne, viewed 6 April 2018, http://www.nursingmidwiferyboard.gov.au/ Codes-Guidelines-Statements/Professionalstandards.aspx Nursing and Midwifery Board of Australia 2018b, Code of conduct for nurses, Nursing and Midwifery Board of Australia, Melbourne, viewed 6 April 2018, http://www.nursingmidwiferyboard.gov.au/ Codes-Guidelines-Statements/Professionalstandards.aspx

Occupational Therapy Australia 2010, Australian minimum competency standards for new graduate Occupational Therapists, Occupational Therapy Australia, Fitzroy VIC, viewed 4 May 2-18, https://www.otaus.com.au/sitebuilder/aboutus/ knowledge/asset/files/16/australian_minimum_ competency_standards_for_new_grad_ occupational_therapists.pdf Victorian Department of Health and Human Services 2015, Implementing an Aboriginal cadetship program: a guide for public health services, Melbourne, State of Victoria, viewed 28 February 2018, http://www.health.vic.gov.au/__data/assets/ pdf_file/0010/922663/Implementing-anAboriginal-cadetship-program.pdf

APPENDIX A: THE BROCHURE TEMPLATES FOR ORGANISATIONS & PARTICIPANTS These two templates provide material that organisations may wish to copy and use in a brochure for employers or health units within an organisation to engage them with the cadetship or graduate/TPP program and for potential program participants. The employer template can be adapted to promote the program more generally to staff and explain why the organisation is supporting it.

Language will need to be customised based on: what type of program is being promoted (organisations may run both types) the terminology used for the program geographical location, e.g. whether to use the term Aboriginal, Torres Strait Islander Aboriginal and/or Torres Strait Islander, or another regional term that is preferred by Aboriginal and/or Torres Strait Islander people.

Italics is used to identify where to customise the text, but there may be other language you wish to customise. There is a cadetship and graduate/ TPP program version for both employers/staff and potential program participants.

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APPENDIX B: THE DIFFERENCE BETWEEN CULTURAL SAFETY & CULTURAL AWARENESS TRAINING Cultural safety training is often an early strategy that organisations undertake and would be very important to do prior to implementing a cadetship or TTP program. As a minimum, this should include the organisational leadership and all involved staff. Preferably, this training should be offered to staff across the organisation but should certainly include all staff who will have a core role in the program.

Organisations do not always understand the differences between cultural safety and cultural awareness, as two different forms of cultural training. While staff should have access to both forms of training, cultural safety training is a priority for helping them understand what is involved in fostering cultural safety in the workplace and in health service delivery.

The following areas should be reflected in cultural safety training: An understanding of one’s own culture.

An acknowledgement of difference, and a requirement that caregivers are actively mindful and respectful of difference(s).

It is informed by the theory of power relations - any attempt to depoliticise cultural safety is to miss the point.

An appreciation of the historical context of colonisation, the practices of racism at individual and institutional levels, and their impact on First Nations People’s lives and wellbeing – both in the past and the present.

Its presence or absence is determined by the experience of the recipient of care – it is not defined by the caregiver. (CATSINaM 2014, pp. 8-9).

Cultural safety training explores the values and beliefs of the dominant culture in Australia, and the concept of white privilege.

It examines why it is important for each of us to understand how white privilege relates to us – as white Australians, Aboriginal and/or Torres Strait Islander Australians, or non-white non-Indigenous Australians. White privilege refers to the “unearned benefits that people gain simply by being born white…which is [an] uncomfortable but critically important conversation” (CATSINaM 2018, p. 14). These conversations help us understand how to create culturally safe health services and workplaces.

Cultural awareness training has a different focus, which is on: …raising the awareness and knowledge of participants about the experiences of cultures different from their own - in particular, different from the dominant culture. Therefore, cultural awareness training maintains an ‘other’ rather than clear selffocus for participants. It…tends to have an individual/personal rather than systemic focus. Even if racism is named the focus is on individual acts of racial prejudice and racial discrimination. While historical overviews may be provided, the focus is again on the individual impact of colonisation in this country, rather than the inherent embedding of colonising practices in contemporary health and human services institutions. (NACCHO 2011, p. 9) Cultural awareness is specific to the locations in which organisations operate; in particular, the Aboriginal and/or Torres Strait Islander nation(s) on which it is based, as well as the diversity of other Aboriginal and Torres Strait Islander peoples who may now live and work there.