Practice Guideline - Working with Indigenous Populations and Communities final.pdf

Working with Indigenous Populations and Communities: A Guide to Culturally Safe Practice and Humility Approved: November 2021 CONTENTS Acknowledgements.......................................................................................3 The College of Alberta Psychologists...........................

Working with Indigenous Populations and Communities: A Guide to Culturally Safe Practice and Humility Approved: November 2021 CONTENTS Acknowledgements.......................................................................................3 The College of Alberta Psychologists.........................................................3 CAP Land Acknowledgement......................................................................3 Use of the Term “Indigenous”......................................................................4 CAP Stands Against Racism and Stands for Equity, Diversity, and Inclusion.................................................4 Role of Practice Guidelines...........................................................................5 Role of Ethical Codes...................................................................................6 Role of Standards of Practice......................................................................8 Cultural Safety for Indigenous Peoples......................................................9 Cultural Safety Checklist...............................................................................10 Resources.......................................................................................................12 Practice Guideline - Working with Indigenous Populations and Communities 2 Acknowledgements The earlier work of the College of Psychologists of British Columbia and the Canadian Psychological Association provided much of the substance for this guideline and their significant contributions are both recognized and greatly appreciated. This is particularly true for the College of Psychologists of British Columbia who graciously provided permission to utilize their cultural safety checklist. The College of Alberta Psychologists would also like to specifically recognize the contributions of the Psychologists’ Association of Alberta and members of the Joint Task Force: Wilma Spear Chief, Loretta McConnell, Janice Minoose, Meagan Farquharson, Karlee Fellner, Judi Malone (PAA), Deena Martin (CAP) and Richard Spelliscy (CAP), as well as elders Francis First Charger, Leroy Little Bear1, Peter Weasel Moccasin, Agnes First Charger, Ira Provost, Catherine Hunt and Shirley Crow Shoe and additionally Lawrence Gervais2. The College of Alberta Psychologists The primary mandate of the College of Alberta Psychologists (CAP) is to protect the public and maintain their confidence by ensuring that all psychologists engage in safe, competent, skilled, and ethical practice. To this end, CAP establishes, adopts, and implements: good character prerequisites; minimum academic criteria (and related) requirements for entry to the profession, standards of practice, and a code of ethics. CAP also closely adheres to the principles of natural justice when receiving and addressing both applications to the profession as well as professional conduct complaints. CAP Land Acknowledgement Responding to the Truth and Reconciliation Commissions’ Calls to Action, it is with respect, and in the spirit of reconciliation and truth, the College of Alberta Psychologists honour and acknowledge that where we are, here in Alberta, are Treaties 4, 6, 7, 8 and 10 – as well as many unsigned treaties – are the traditional and ancestral territory of many diverse Indigenous peoples. Namely, they are: the Kainai, Piikani, Siksika, Cree, Dene, Saulteaux, Nakota Sioux, Stoney Nakoda, Tsuu T’ina Nation, Inuit and the Métis Nation. We acknowledge and give thanks to the many First Nations, Métis Nations and Inuit people who have lived in and cared for these lands for generations and the many others whose histories, languages, and cultures continue to influence our vibrant community. We are dedicated to ensuring the spirit of all Treaties are honoured and respected. We make this acknowledgement as an act of reconciliation and gratitude to those whose territory we reside on or are visiting. 1 Special acknowledgment given to Dr. Leroy Little Bear for providing perspective and feedback on the draft document. Dr. Little Bear is a Blood Tribe member, University of Lethbridge professor and Order of Canada recipient. 2 Special acknowledgment given to Mr. Lawrence Gervais, Metis Nation of Alberta, Region 3. Practice Guideline - Working with Indigenous Populations and Communities 3 Use of the Term “Indigenous” Marie-Céline Charron, a member of the Naskapi Nation of Kawawachikamach, discusses in her March 6, 2019 article No Perfect Answer: Is it First Nations, Aboriginal or Indigenous? the controversy regarding appropriate terminology. She notes “There isn’t a “one size fits all” answer to this question. As there are over 50 different Indigenous Nations in Canada, living in over 600 communities, it can be challenging to find a single, all-encompassing word.” Spear Chief (2021) correctly notes that the legal term in the Canadian Constitution is Aboriginal Peoples. This term is used to identify First Nations, Métis Nation, and Inuit (Personal communication.) “These are three distinct peoples with unique histories, languages, cultural practices and spiritual beliefs.” (Charron 2019). Charron also highlights that exploring the federal government website underscores the complexity surrounding terminology (see Crown-Indigenous Relations and Northern Affairs). She further states that “the term “Indigenous” is increasingly replacing “Aboriginal”, as the former is recognized internationally, for instance in the United Nations’ Declaration on the Rights of Indigenous Peoples. However, the term Aboriginal is still used and accepted.” Finally, Charron states that understanding, accepting, and respecting preferences in terminology facilitates reconciliation and enhances positive relationships. For ease of reading, this guideline will primarily use the term Indigenous recognizing legitimate alternatives including Aboriginal. CAP Stands Against Racism and Stands for Equity, Diversity, and Inclusion CAP has adopted both a Code of Ethics and Standards of Practice that prohibit discriminatory practices and support respect for the dignity of all communities of people. Like the Canadian Psychological Association’s (CPA) and the Psychologists’ Association of Alberta (PAA), we invite all regulated members to stand up, speak out and work collaboratively to eradicate all forms of racism and discrimination. Leading by example, CAP is committed to identifying regulatory practices to ensure that they reflect equity, diversity, and inclusion. It is also committed to actively encouraging all regulated members to examine their own personal and professional beliefs/actions and work toward equity and justice for all. Practice Guideline - Working with Indigenous Populations and Communities 4 Role of Practice Guidelines As part of their proactive and preventative approach to professional misconduct, CAP provides general ethical and clinical guidance to members which includes guiding members in identifying, interpreting, and applying regulatory resources (e.g., legislation, Standards of Practice, Practice Guidelines/Alerts) to their practice. CAP does not provide legal, business, or practice (client) specific clinical direction. All psychologists are encouraged to seek additional expert subject matter consultations when faced with complex clinical, technical (practice or ethical), legal and/or business issues. Practice guidelines support CAP’s primary public protection role by enhancing the practice of psychologists through the integration of standards of practice and ethical principles to specific subject areas. As a self-regulated profession, psychologists are ultimately responsible and accountable for all decisions and activities they engage in as a regulated member as well as those that link to and reflect upon the profession. Practice guidelines are also significant as they carry regulatory weight like ethical principles and practice standards. The primary purpose of this practice guideline is to enhance cultural safety in the delivery of psychological services to Indigenous peoples and communities. Practice Guideline - Working with Indigenous Populations and Communities 5 Role of Ethical Codes Section 3(1)(d) of the Health Professions Act (HPA) requires CAP Council to develop or adopt a code of ethics. The Canadian Psychological Association’s (CPA) Canadian Code of Ethics for Psychologists (2017) was adopted, and it establishes the foundational ethical principles that underpin the profession of psychology in Alberta. While often considered aspirational in nature, ethical codes may also reflect minimum professional expectations and form the basis of discipline-related allegations/actions. The CPA Code of Ethics encourages all psychologists to engage in deliberate and intentional decisionmaking when faced with complex dilemmas. This is achieved by appealing to a set of decision-making principles and understanding the contextual environment surrounding the presenting dilemma(s). The CPA Code of Ethics Preamble highlights that psychologists operate within a “social contract that is based on attitudes of mutual respect and trust (p.3)” that is organized around four ethical principles arranged in hierarchical order of importance. The one exception is for clear and imminent danger to others or themselves. The four principles have direct relevance for cultural safety in the provision of psychological services to Indigenous populations. Principle I: Respect for the Dignity of Persons and Peoples. “With its emphasis on inherent worth, nondiscrimination, moral rights, distributive, social and natural justice, generally should be given the highest weight (p.4).” Peoples is defined as a distinct group of persons who are linked by a common identity, culture, history, and collective interests. “Psychologists acknowledge that all human beings have a moral right to have their innate worth as human beings appreciated and that this inherent worth is not dependent on a human being’s culture, nationality, ethnicity, colour, race, religion, sex, gender, marital status, sexual orientation, physical or mental abilities, age, social economic status, or any other preference or personal characteristic, condition, or status. As such, psychologists do not engage in unjust discrimination based on such factors and promote non- discrimination in all of their activities (p.11).” In Canada, Indigenous citizens are commonly referred to as “First Peoples” in respect and recognition of their historical status. Principle II: Responsible Caring. This principle typically is awarded the second highest weight. Responsible caring requires competence maximization of benefit and minimization of harm and should be carried out only in ways that respect the dignity of persons and peoples. Psychologists are concerned about community relationships, personal and cultural identities, and engage in personal and professional self-reflection regarding their own values, attitudes, biases, both conscious and unconscious (e.g., culture, ethnicity, racial, religion etc.,) and systemic and structural influences/barriers (economic, geographic and historical trauma) with the intent of increasing the probability that their professional services will benefit and not harm those they are offering services to in their role as psychologist (e.g., individuals, families, communities, peoples). Principle III: Integrity in Relationships. Subordinate to the principles of respect for the dignity of persons and peoples and responsible caring, psychologists are expected to demonstrate the highest degree of integrity in all relationships. “These expectations involve a commitment to Practice Guideline - Working with Indigenous Populations and Communities 6 truthfulness and include: accuracy and honesty, straightforwardness and openness; maximization of objectivity and minimization of bias, and avoidance of conflicts of interests (p.25).” Integrity in relationships means that psychologists must be aware of “how their own experiences, attitudes, culture, beliefs , values, individual differences, specific training, external pressures, personal needs, and historical, economic and political context might influence their activities and thinking integrating this awareness into their own attempts to be objective and unbiased as possible in their research, service, teaching, supervision, employment, evaluation, adjudication, editorial and peer review articles or activities (p.27).” Principle IV: Responsibility to Society. While it is important to consider that responsibility to society; the dignity, well-being and best interests of person and peoples and integrity in relationships should not be sacrificed for a vision of the greater good of society. The latter includes acquiring “an adequate knowledge of the culture, social structure, history, customs, and laws or policies of organizations, communities and peoples before beginning any major work there, obtaining guidance from appropriate members of the organization, community or people as needed…” If their work is related to societal issues, be especially careful to keep well informed of social, cultural, historical, economic, institutional, legal and political context issues through relevant reading, peer consultation and continuing education. (pp.33-34).” This includes not promoting, contributing, or engaging in any professional activity that contravenes international humanitarian law (e.g., declarations, treaties or conventions regarding human rights of Indigenous peoples). These four principles were expanded upon in the Canadian Psychological Association (2018) report “Psychology’s Response to the Truth and Reconciliation Commission of Canada‘s Report”. Building upon a statement of accountability that acknowledges and apologizes for the harms done to Indigenous peoples in Canada by the profession of psychology, a position statement on how to move closer to reconciliation was proposed. This includes adopting the guiding principles of cultural allyship, humility, collaboration, critical reflection, respect and social justice in all work with Indigenous communities. Psychologists working with Indigenous peoples should read the full CPA report. Practice Guideline - Working with Indigenous Populations and Communities 7 Role of Standards of Practice The Health Professions Act Section 3(1)(c) requires CAP Council to develop, implement and enforce standards of practice that outline the minimum expectations of the profession. Compliance is obligatory. Failure to adhere to practice standards may constitute unprofessional conduct. In October 2019, and in recognition of recent changes in the CPA Code of Ethics, CAP expanded its definition of client to include communities, peoples, or persons. A community means a group of individuals sharing a common identity, values and/or interests which may or may not include a common geographical locale. Peoples are a distinct group of, or groups who, share a common identity, culture, language, history, beliefs and/or collective interests (p.4).” Additional enhancements to the Standards of Practice (2019) included the expansion of the definition of harassment to include criteria from both the Criminal Code of Canada and the Alberta Human Rights Act prohibiting discrimination on the grounds of ancestry, race, and colour. Finally, a specific practice standard recognizes the injustices suffered by Indigenous peoples and the need for special consideration when delivering professional psychological services. Truth and Reconciliation 18.1 A psychologist shall take reasonable steps to familiarize themselves with the current and historical injustices suffered by Indigenous peoples prior to providing services, and ensure all professional activities are performed in a culturally sensitive, safe, and competent practice This guideline was also developed to support psychologists in their efforts to ensure their practices are aligned with the Truth and Reconciliation Commission of Canada’s Calls to Action (2015). It also integrates learnings from the College of Alberta Psychologists’ and Psychologists’ Association of Alberta’s Truth and Reconciliation Joint Task Force and statements reflected in the Psychology’s Response to the Truth and Reconciliation Commission of Canada’s Report (Canadian Psychological Association and the Psychology Foundation of Canada, 2018). While this document reflects the profession’s commitment to culturally safe care, practices, and relationships with Indigenous peoples, it is not a substitute for thorough training in the values, practices, and views of health held by the Indigenous individuals and communities served. Like other regions, in Alberta there is significant diversity among the different Indigenous communities. As such, these guidelines are intended to provide general guidance and broad information and it is the responsibility of the psychologists to seek additional knowledge including, when possible and practical, the guidance and knowledge of elders for insight into local customs, healing practices and traditions. This perspective is best summarized by Métis aviator and Iskwew Air founder Teara Fraser: “I believe that when you’re operating from an Indigenous worldview, there is a feeling you’re not alone. Like you are part of something more than just yourself. There is a sense of connection to all your relations, to your ancestors, to future generations - and most of all, to the land. I refer to this as a relational worldview because it is all about interdependence of relationships and the foundational understanding that we are all connected. While this worldview manifests itself differently across nations and communities, I believe it is something that many Indigenous peoples share because it is based on thousands and thousands of years of traditional wisdom. But let me be clear, while I am Indigenous, I do not speak for all Indigenous peoples. I can only speak from own experience and I cannot speak on behalf of anyone other than myself. I believe it is important to clarify this when engaging with and speaking about the diverse Indigenous nations and peoples of this land (Globe and Mail, 2021 p.B5).” Practice Guideline - Working with Indigenous Populations and Communities 8 Cultural Safety for Indigenous Peoples Both the Canadian Psychological Association’s Canadian Code of Ethics for Psychologists and the College of Alberta Psychologists’ Standards of Practice (Section 19) address the importance of facilitating culturally safe psychological services. Ethically, psychologists strive to ‘do no harm’ and are explicitly cautioned to avoid unjust discrimination. CAP and its members will always attempt, to the best of its ability, to interpret legislation, regulations, and policies from an Indigenous perspective when providing services to an Indigenous person. This would bring about greater knowledge on the part of psychologists regarding Indigenous cultures. This, is turn, will mean that psychologists can better serve Indigenous clients. The concept of cultural safety moves beyond cultural competence (i.e., knowledge, skills, judgement, and diligence) required by psychologists and makes explicit the role of understanding and reflecting on the power differentials in health services. Cultural safety is in fact, determined by those who are receiving services. As a result, psychologists must continually seek guidance and listen to respected elders/leaders, community members and the people we serve. Psychologists are also encouraged to be cognizant that cultural safety is a shared responsibility with the organizational structures they work within (e.g., healthcare, education, justice). For example, psychologists are to be mindful of and to work to address institutional policies that may be contributing to inequitable access to services and/or care. This is also true for unjust systemic practices that invariably and disproportionately impact Indigenous communities. Psychologists should demonstrate epistemological pluralism when working with Indigenous populations. This also requires accountability and acknowledgment of the ongoing adverse impact of colonialism, white supremacy and privilege on Indigenous peoples. Psychologists should also demonstrate both cultural agility and humility by recognizing the special status Indigenous peoples possess as being the original inhabitants of the land. Practice Guideline - Working Medications withand Indigenous Psychologists Populations and Communities 9 Cultural Safety Checklist Introduction This checklist is intended to assist registrants in considering relevant issues when contemplating providing services to Indigenous individuals/ communities, to ensure those services are provided consistent with requirements of the College of Alberta Psychologists Standards of Practice and that all services are provided in a culturally safe manner. This checklist is also intended to be consistent with the Truth and Reconciliation Commission of Canada’s Calls to Action and the United Nations Declaration on the Rights of Indigenous Peoples. This checklist is also designed to support professional self-reflection and judgement required as a part of competent practice. Knowledge † I recognize that many formal education and training programs have not adequately prepared psychologists to provide professional services to Indigenous individuals/communities. † I have read and understand Section 35 of the Canadian Constitution, which recognizes and affirms the existing treaty rights of the Indigenous peoples of Canada. † I am familiar with relevant Federal legislation including the Canadian Human Rights Act, Charter of Rights and Freedoms, Provincial legislation including the Alberta Human Rights Act and legal rulings such as the Jordan's Principle. † I have read the Truth and Reconciliation Commission of Canada’s Calls to Action and the Canadian Psychological Association’s Response to the Truth and Reconciliation Commission of Canada’s Report. † I acknowledge the adverse impact of the significantly misguided and unjust assimilation efforts including the effects of intergenera ational trauma. † I have taken steps including continuous professional development to obtain a working knowledge of the historical and social context including culture, language, and lifestyle considerations (including health beliefs) of the individual/community accessing psychological services. † I am aware of the relevant local, cultural views of mental health including both origins and traditional healing practices of the individual/ community accessing services. † I understand the inherent diversity of languages, traditions, cultural and spiritual beliefs, among Indigenous, Inuit and Métis communities, both rural and urban, and that not all individuals within communities may share the same belief systems with respect to traditional and nontraditional healing practices. † I am aware that cultural safety is defined by the recipient of the professional service. † I am aware of and recognize that the inherent power differential in all professional relationships especially with those who may not have had their voice previously recognized necessitating the ongoing review of the informed consent process throughout the provision of services. † I understand that respect for the dignity of all individuals must guide my professional activities. Practice Guideline - Working with Indigenous Populations and Communities 10 Skills † I have taken steps to learn, develop, practice, and evaluate my trauma informed practices. † I have taken steps to learn, develop, practice, and evaluate my cultural safety skills. Judgment, Diligence and Professional Reflective Practices † I am aware/sensitive to possible conscious and unconscious personal/professional biases, attitudes, assumptions, prejudices, and stereotypes and/or the individual/community receiving services may hold. † I can incorporate appropriate cultural knowledge into all aspects of psychological services. † I am aware of the importance of cultural awareness, humility, and respect in the provision of psychological services and integrate these values into my practice. † I am aware of and can access community opportunities, experiences, and resources (including elders and/or knowledge holders) to enhance my professional knowledge, awareness, and skills in working with Indigenous peoples. † I am aware of and work to alleviate the historical and current power differentials and inequities that arise in the provision of healthcare services, especially mental healthcare, to Indigenous communities. † I recognize and respect the diversity amongst Indigenous individuals and within communities, not assuming their preferences prior to and during professional services. † I understand the historical and ongoing impact of colonialism on the discipline of psychology and mainstream organizations (e.g., education institutions, government structures, the justice system). † I am aware and sensitive to the potential effects both positive and negative of each professional interaction and strive to ensure that I do no harm culturally or otherwise. † I am open to feedback from both service recipients and colleagues to ensure that all my activities are culturally safe and meet the expectations of the profession. † I recognize the importance of speaking out and providing respectful feedback to colleagues and program officials when systemic barriers affect access and/or quality of services. Practice Guideline - Working with Indigenous Populations and Communities 11 Resources College of Psychologists of British Columbia. (2018). Indigenous Cultural Safety Checklist. http:// collegeofpsychologists.bc.ca/docs/psc/PS12%20-%20Indigenous%20Cultural%20Safety%20Checklist. pdf Canadian Psychological Association. (2017). Canadian Code of Ethics for Psychologists. https://www.cap. ab.ca/regulatory-information Canadian Psychological Association. (2018) Psychology’s Response to the Truth and Reconciliation Commission of Canada’s Report. https://cpa.ca/docs/File/Task_Forces/TRC%20Task%20Force%20 Report_FINAL.pdf College of Alberta Psychologists. Standards of Practice. (2019). https://www.cap.ab.ca/regulatoryinformation Charron, Marie-Céline. (2019). National Post. No Perfect Answer: Is it First Nations, Aboriginal or Indigenous? Gervais, L. (2021). Use of the term Métis. Personal Communication. Little Bear, L. (unknown date). Traditional Knowledge and Humanities: A Perspective by a Blackfoot. University of Lethbridge Psychologists Association of Alberta. Education Report. https://psychologistsassociation.ab.ca Spear Chief, W. (2021). Use of the term Indigenous Peoples. Personal Communication. Truth and Reconciliation Commission of Canada. (2015). Truth and Reconciliation Commission of Canada: Calls to Action. http://www.trc.ca/assets/pdf/Calls_to_Action_English2.pdf University of Alberta. Indigenous Canada (online course that addresses Indigenous historical and contemporary issues) https://www.coursera.org/learn/indigenous-canada Practice Guideline - Working with Indigenous Populations and Communities 12