The number of people dwelling in Australia that are foreign-born, have one or both parents born overseas, or use languages apart from English for communication at home has been increasing in recent decades, requiring improvements in Australian child and family health (CFH) professionals’ intercultural competence. One critical issue in addressing diversity refers to the cultural aspect of caring for families from Indigenous Australian backgrounds, such as Aboriginal Australians and Torres Strait Islanders. Despite these population groups’ relatively strong commitment to their native communities, it is not uncommon for them to move to densely populated urban areas for various reasons, ranging from job opportunities to better infrastructures. This essay seeks to discuss the principles of working with this diverse group of clients, issues that may arise within the frame of CFH service provision, and how service providers can support professional development to maximize this population’s positive experiences within the healthcare system.
Guiding Principles When Working with Indigenous Australian Families
A widely versatile client demographic known as families from Indigenous Australian backgrounds is comprised of individuals originating from culturally and linguistically diverse indigenous groups of mainland Australia and its islands. Clients identifying themselves as Aboriginal Australians can originate from a variety of islands, including Tasmania, the Tiwi Islands, Fraser Island, and other territories. Torres Strait Islander people, as the term suggests, come from communities in the Torres Strait Islands, which is a group of a few hundred tiny islands. As of 2016, almost 300,000 Indigenous Australians resided in the main cities of Australia, and this number was projected to grow in the following years (Australian Bureau of Statistics, 2019). These demographic changes add to the significance of child and family health service providers’ understanding of intercultural differences and principles to guide practice.
The first principle to guide CHF practice is the recognition of health inequities in case analysis and decision-making endeavors. The specificity of Indigenous clients’ needs and issues peculiar to CHF services is dependent on a plethora of factors, including English language proficiency, socioeconomic position, and religious and cultural perspectives on health, treatment, pregnancy, and caring for newborns and young children. As per the Australian Institute of Health and Welfare (n.d.), citizens of Indigenous Australian descent display vulnerability when it comes to child health, which finds reflection in Indigenous children’s disproportionately high rates of post-injury hospitalizations, deaths from external causes, and contacts with juvenile justice services. Professionals involved in the provision of CFH services should have a clear understanding of Indigenous families’ continuing disparities peculiar to antenatal care – as per 2018, only 66% of pregnant women from this background had at least one healthcare visit during the first trimester of pregnancy (Lowitja Institute, 2021). Without acknowledging the existing health gap, CFH professionals would not be able to contribute to quality improvement.
Health services’ cultural responsiveness is another critical principle to be observed when working with clients from Indigenous backgrounds. The current national cultural respect framework for healthcare services aimed at Indigenous Australians establishes that these families’ willingness to enter the healthcare system is dependent on providers’ ability to communicate respectfully and display at least some understanding of Indigenous cultures (Australian Health Ministers’ Advisory Council, 2016). As per research, Indigenous Australians may be unwilling to seek health services from white care providers due to a perceived lack of cultural safety (Li, 2017). Taking this into account, all CFH professionals are anticipated to have an understanding of Indigenous clients’ cultural characteristics that might affect health behaviors or demonstrate an ability to interview minority patients without resorting to unethical or ignorant remarks about their cultural identity and traditions.
The next principle of critical significance is creating a healthy psychological climate to promote Indigenous clients’ willingness to be open about their ethnic background. The national framework for promoting cultural respect includes the timely identification of clients having Torres Strait Islander and Aboriginal ancestry by encouraging health professionals to ask questions about clients’ cultural identity (AHMAC, 2016). The disclosure of one’s identity is a voluntary choice made by the patient, but it is the provider’s role to ask for this information in a polite manner and inform the client about healthcare services and programs developed specifically for the said ethnic minority (AHMAC, 2016). Thus, motivating families from the selected minority group to state their identity explicitly is an important practice to improve such clients’ usage of the services that are intended for them, but the desire to refrain from discussing one’s cultural background should also be respected.
Complex Issues and the Role of the Provider’s Culture and Beliefs in Managing Care
Complex issues that may arise when providing CFH services for families of Indigenous Australian descent could be divided into two large categories. Firstly, some possible problems are related to challenges in incorporating these clients’ unique customs and culture-based preferences into care and parenting education. Also, as a particularly vulnerable demographic, Indigenous Australians are greatly affected by various barriers to living a full-fledged life and providing for their children, such as unemployment, limited educational opportunities, poverty, or having to share housing with too many relatives. To support clients with such challenges, a CFH professional is to be proficient at intercultural communication and understand the purpose of the referral process.
For a CFH professional, being perfectly responsive to clients’ needs can be challenging, which is due to a great diversity of Indigenous cultures. As per the New South Wales policy on aboriginal cultural activities, healthcare staff members are expected to promote respect by recognizing each aboriginal culture’s uniqueness and connection to the country (NSW Government, Centre for Aboriginal Health, 2019). Legal frameworks, such as heritage acts, also protect the recognition of diversity. For a CFH service provider who does not also specialize in cultural studies, distinguishing between somewhat similar Aboriginal cultures or languages may be problematic. As an example, assuming that the descendants of Indigenous Australians that now live in urban areas always adhere to their predecessors’ diet and cooking methods, such as the use of underground ovens, will not lead to productive communication. Thus, the lack of an in-depth understanding of a particular Indigenous group’s symbols, language, or eating practices and how they change with the lapse of time might result in the provider’s assumptions that will be found ignorant or disrespectful.
A lack of resources to make parenting education more aligned with the family’s customs is another issue that may arise. The New South Wales cultural activities policy motivates health professionals to respect Indigenous Australians’ family-oriented mindset and collectivistic traditions and offer access to facilities for family gatherings (NSW Government, CAH, 2019). As members of multi-generational extended families that emphasize collectivism in caring for children, some expecting or new mothers of Indigenous descent may wish to attend developmental assessments or education sessions with multiple older female relatives to make them more included in child-rearing. This expectation, however, is not always easy to meet, especially in settings where care is provided for diverse cultural subgroups, not only Indigenous Australians. In this and similar cases, healthcare providers may need to analyze the situation with reference to available resources, ethical frameworks, and patients’ preferences to come up with an optimal solution.
As a professional, I am committed to reducing the impact of my culture-specific values and beliefs on patient education and care management decisions. Instead, I make sure to give the pride of place to universal healthcare values, such as respecting the client’s autonomy, human dignity, and self-determination. Whenever possible, I consider the patient’s preferences and beliefs regarding parenting styles and practices instead of recommending strategies and attitudes that are typical for my family and community. However, some of my personal beliefs are closely aligned with the requirements of cultural responsiveness and evidence-based care, so they find reflection in care management decisions. For instance, I am convinced that English language proficiency should not be the only indicator of the need for the individualization of patient education. Based on qualitative research in health provider populations, this misconception is often manifested when it comes to caring for patients from Indigenous Australian backgrounds (Berger et al., 2014). This belief informs my practice during patient teaching and is reflected in encouraging new mothers from any linguistic backgrounds to be explicit about concerns and health beliefs that might interfere with the implementation of recommendations.
Supporting One’s Professional Development and Practice
Embarking on the path of self-improvement and knowledge development is a critical step to acquire an ability to recognize Indigenous Australians’ unobvious needs and complex concerns related to CFH services. As per NSW policies that outline culture competency requirements for diverse professionals in the healthcare system, NSW health employees are required to complete the Respecting the Difference online training that is aimed at eliminating racism, poor cultural respect, and inaccurate assumptions about Aboriginal families’ needs and attitudes to health and treatment (NSW Ministry of Health, 2011). Taking the e-learning component of the course will enable me to develop more sensitivity to contemporary Aboriginal culture and health disparities, which will be instrumental in caring for Aboriginal families with complex issues, such as expecting or new parents experiencing financial or housing-related distress. Particularly, the online learning part of the course includes modules on this population’s barriers to adequate healthcare services, including socioeconomic variables and employment situation (NSW Ministry of Health, 2011). This information will prepare me for responding to Aboriginal Australians’ complex needs without resorting to fragmentary knowledge about this diverse ethnic group.
Another way to support professional growth and practice when encountering clients from Indigenous Australian backgrounds will be to engage in self-initiated learning to master the art of preventing misunderstanding related to the influence of such families’ first language and communication practices. The Department of the Prime Minister and Cabinet (2016) recommends those communicating with the said demographic to minimize the use of professional jargon/abbreviations and consider semantic differences between Australian English and Australian Aboriginal English during message formulation. To prevent the misinterpretation of clients’ seemingly limited verbal participation during patient education sessions, I will use the mentioned document to explore the meaning of silence as a communication style in multiple Indigenous Australian communities. As the report explains, Indigenous Australians’ silence is often misinterpreted as a sign of misunderstanding, whereas its actual culture-specific meanings may involve the demonstration of deep respect for the speaker, disagreement, or waiting for extra assistance (Department of the Prime Minister and Cabinet, 2016). An improved understanding of linguistic differences and peculiar communication styles will enable me to increase the effectiveness of family education sessions by selecting an appropriate information delivery rate and linguistic means.
The outcomes of working with families from Indigenous Australian backgrounds may depend on the provider’s understanding of non-verbal communication and word choices when referring to minority groups. Aside from aligning the referral process with these families’ complex needs and barriers to optimal health, I will implement regional guides to communication and Aboriginal terminology to maximize collaboration and mutual trust. The NSW Ministry of Health (2019) has developed a guide for all health professions in the NSW area that offers comprehensive information on word choices that hinder communication. Aside from explicitly racist and disrespectful terms, such as “savage” or “coconut,” the guide specifies less obvious unwanted lexical means, including “25%, 50% Aboriginal,” “half-caste,” “quarter-caste,” and so on (NSW Ministry of Health, 2019, p. 16). The document also offers guidance on the use of the so-called loaded words and non-verbal cues, including the meaning of clients’ avoidance of direct eye contact (NSW Ministry of Health, 2019). The adoption of these recommendations will support me in preventing misunderstanding when offering CFH services and education.
Finally, it is pivotal for the providers of CFH services in Australia to be aware of the population’s ethnic, cultural, and linguistic diversity and develop sound intercultural communication skills to serve clients from Indigenous Australian backgrounds. Working with these families requires observing a series of principles, including cultural responsiveness, the recognition of health disparities, and respecting clients’ decisions regarding reporting their cultural identity. To address complex issues, including clients’ unfavorable life circumstances, unique and rare cultural or religious characteristics, and the willingness to have their traditions incorporated into care, CFH specialists are recommended to engage in continuous learning aside from following all relevant policies.
Australian Bureau of Statistics. (2019). Estimates and projections, Aboriginal and Torres Strait Islander Australians. Web.
Australian Health Ministers’ Advisory Council. (2016). Cultural respect framework 2016-2026 for Aboriginal and Torres Strait Islander health: A national approach to building a culturally respectful health system. Author.
Australian Institute of Health and Welfare. (n.d.). Aboriginal and Torres Strait Islander child safety: Factsheet. Author.
Berger, G., Conroy, S., Peerson, A., & Brazil, V. (2014). Clinical supervisors and cultural competence. The Clinical Teacher, 11(5), 370-374. Web.
Department of the Prime Minister and Cabinet. (2016). Communicating with Aboriginal and Torres Strait Islander audiences. Web.
Li, J. L. (2017). Cultural barriers lead to inequitable healthcare access for aboriginal Australians and Torres Strait Islanders. Chinese Nursing Research, 4(4), 207-210. Web.
Lowitja Institute. (2021). Close the Gap. Leadership and legacy through crises: Keeping our mob safe. The Close the Gap Campaign Steering Committee.
NSW Government, Centre for Aboriginal Health. (2019). Aboriginal cultural activities policy: Policy directive. Web.
NSW Ministry of Health. (2011). Respecting the difference: An Aboriginal cultural training framework for NSW Health. Web.
NSW Ministry of Health. (2019). Communicating positively: A guide to appropriate Aboriginal terminology. Web.