The Aboriginal and Torres Strait Islander Health Curriculum Framework

Title: Aboriginal and Torres Strait Islander Health Curriculum Framework

ISBN: 978-1-76007-250-6

Online ISBN: 978-1-76007-251-3

Publications Number: 11201

Logo and Logo Description

The logo was developed by Balarinji, an Australian Indigenous strategy and design company.

It depicts a scroll, symbolising the unfurling of action. The blue, brown and red ochre lines are interconnected to represent the Aboriginal and Torres Strait Islander community, government and health professionals. The dynamic of a scroll, which creates its own movement, reinforces the sustainable energy of the Aboriginal and Torres Strait Islander Health Curriculum Framework. The dots and quality of line refer to the universal Aboriginal and Torres Strait Islander style.

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Section 1 Background

Acronyms

Overview

Background to The Aboriginal and Torres Strait Islander Health Curriculum Framework

Context of Aboriginal and Torres Strait Islander people’s health

Context of Aboriginal and Torres Strait Islander health in higher education

Developing the Aboriginal and Torres Strait Islander Health Curriculum Framework

Users of The Framework

Higher Education Providers

Accreditation Authorities

Aboriginal and Torres Strait Islander Stakeholders

Health Service Employers

Clinical Placement Providers

Attachment A Summary of Data Collection Findings

Attachment B References

Section 2 The Elements

Overview

The Elements

PRINCIPLES

Graduate Capabilities For Culturally Safe Aboriginal And Torres Strait Islander Health Care

Graduate Cultural Capability Model

1.Respect

2.Communication

3.Safety and Quality

4.Reflection

5.Advocacy

Primary Learning Outcomes To Develop Graduate Cultural Capabilities

Curriculum Content, Learning Outcomes And Assessment

Primary and Secondary Learning Outcomes

A Note on Terminology

Attachment A References

Section 3 Implementation guidelines

Acronyms

Overview

Implementation Guidelines

Organisational Commitment and Leadership

Commitment and Leadership across the Health Professional Program

Resources

Reconciliation Action Plan and Advisory Group

Role modelling Aboriginal and Torres Strait Islander protocols

Health Professional Program Staff Cultural Capabilities

Overcoming challenges to implementing The Framework

Partnerships

Aboriginal and Torres Strait Islander stakeholders

Organisational Commitment and Health Professional Program Readiness Assessment Compass

Ongoing Quality Improvement

Implementing Aboriginal And Torres Strait Islander Curriculum Across The Health Professional Program

Curriculum Project Coordinator

Foundational and Integrated Curriculum Model

Quality enhancement and cyclical reviews

Educators And Aboriginal And Torres Strait Islander Health Curriculum

Who should teach Aboriginal and Torres Strait Islander content?

What capabilities are required in educators?

Approaches To Facilitating Learning In The Classroom

Privileging Aboriginal and Torres Strait Islander voices

Cultural interface and critical thinking

Yunkaporta’s 8 ways of learning

Yarning

White Privilege, Critical Whiteness Theory and Critical Race Theory

Discomfort as a transformative teaching and learning strategy

Strengths-Based Learning

Teaching and Learning for Social Change

Creating Safe, Relationship Orientated Learning Spaces

Learning Through Experience – Simulation, Clinical Placements, And Community Immersion And Engagement

Simulation

Keys to setting up a successful simulation program

Clinical Placement Programs

Community Immersion and Engagement

Considerations for Online Learning

Assessing Learning Outcomes

Attachment A Organisational Commitment And Health Professional Program Readiness Assessment Compass

Attachment B Support Resources

Attachment CTeaching and Learning Resource: Using story to assist understanding in the learning of cultural capabilities

Attachment DReferences

Acronyms

Overview

Best Practice Accreditation Guidelines

Accreditation Standard Requirements

Evaluation Of Accreditation Standards Requirements

Accreditation Assessors

Section 1 Background

Acronyms

Aboriginal and Torres Strait Islander Health Curriculum Framework The Framework

Aboriginal Community Controlled Health ServicesACCHSs

Australian Indigenous Doctors’ AssociationAIDA

Australian Nursing and Midwifery Accreditation CouncilANMAC

Committee of Deans of Australian Medical SchoolsCDAMS[1]

Congress of Aboriginal and Torres Strait Islander Nurses and MidwivesCATSINaM

Health Professional ProgramsHPPs

Health Workforce Australia HWA

Higher Education ProvidersHEPs

National Aboriginal and Torres Strait Islander Health CouncilNATSIHC

National Aboriginal and Torres Strait Islander Health Plan 2013-2023NATSIHP

Overview

The Aboriginal and Torres Strait Islander Health Curriculum Framework (The Framework) supports higher education providers (HEPs) to implement Aboriginal and Torres Strait Islander health curricula across their health professional training programs. Developed with extensive input and guidance from a wide range of stakeholders around Australia, The Framework aims to prepare graduates across health professions to provide culturally safe health services to Aboriginal and Torres Strait Islander peoples through the development of cultural capabilities during their undergraduate training.

The Framework contains four sections:

Section 1Background

Context of Aboriginal and Torres Strait Islander health and curricula, and history to the development of The Framework;

Section 2The Elements

A composite of resources that outline, map and align the implementation of Aboriginal and Torres Strait Islander health curricula with learning outcomes and the development of clearly articulated graduate cultural capabilities;

Section 3Implementation Guidelines

Resources, suggestions, tools and guidelines to assist higher education providers in the process of implementing Aboriginal and Torres Strait Islander health curricula; and

Section 4Accreditation Guidelines

Suggestions for accreditation bodies in defining criteria that could be expected in undergraduate health professional programs to demonstrate curricula is being delivered in line with professional standards.

In the following pages, the background to the development of The Framework is presented. This content, together with the other three sections of The Framework, addresses core aspects of successful implementation of Aboriginal and Torres Strait Islander health curricula, as well as learning outcomes that may reflect requirements within the health sector.

Background to The Aboriginal and Torres Strait Islander Health Curriculum Framework

The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (NATSIHP) draws attention to ‘the centrality of culture in the health of Aboriginal and Torres Strait Islander peoples and the rights of individuals to a safe, healthy and empowered life’ (Australian Government 2013, p.4). Good health care outcomes for Aboriginal and Torres Strait Islander peoples require health professionals to be both clinically and culturally capable. Ensuring all health care professionals develop cultural capabilities before graduating from higher education is one way of enhancing health service delivery to Aboriginal and Torres Strait Islander peoples.

In 2011 Health Workforce Australia (HWA) released Growing Our Future: Final Report of the Aboriginal and Torres Strait Islander Health Worker project. The purpose of the report was to inform policies and strategies that could strengthen the Aboriginal and Torres Strait Islander Health Worker workforce.

The report recognised the critical importance of non-Indigenous health professionals understanding the role of Aboriginal and Torres Strait Islander Health Workers and what it means to work in partnership with them to deliver cultural safe health care to Aboriginal and Torres Strait Islander communities. Recommendation 23 of the report articulated the need to:

Embed mandatory cultural competency curricula, including an understanding of the role of the Aboriginal and Torres Strait Islander Health Worker, in vocational and tertiary education for health professionals (HWA, 2011, p.56)

Development of The Framework was initiated in direct response to this Report. The Framework also responds to and builds on, extensive evidence and recommendations from other related reports, studies and consultations to actively develop greater cultural safety in health service delivery. The Framework contextualises the issue of Aboriginal and Torres Strait Islander health, responds to the need to improve tertiary education in this area, offers suggestions that encourage consistent learning outcomes related to Aboriginal and Torres Strait Islander health and wellbeing, and provides a benchmark for graduate cultural capability standards. It offers opportunities and guidelines to support stakeholders to work together to achieve systemic change in this area.

Context of Aboriginal and Torres Strait Islander people’s health

Disparities in health between Aboriginal and Torres Strait Islander and other Australians have been well documented, with the reasons for such inequalities many and varied (Pink & Allbon 2008; Australian Institute of Health and Welfare 2014). Aboriginal and Torres Strait Islander Australians fare worse in conditions such as chronic disease, mental health, oral health, and cancer (Australian Institute of Health and Welfare 2014). While risk factors include smoking, diet, exercise and misuse of alcohol and drugs (Di Giacomo et al. 2011; Australian Institute of Health and Welfare 2014; Australian Institute of Health and Welfare 2013; Australian Bureau of Statistics 2013a), other social determinants play a significant role in undermining Aboriginal and Torres Strait Islander health. These include inadequate housing, poverty, poor education, unemployment and limited access to services in some areas (Australian Institute of Health and Welfare 2014).

Discrimination based on race or racism is also a social determinant of Aboriginal and Torres Strait Islander health (Paradies, Harris & Anderson 2008; Larson et al. 2007; Henry, Houston & Mooney 2004).[2] Racism harms the physical and mental health of Aboriginal and Torres Strait Islander Australians (Kelaher, Ferdinand & Paradies 2014; Larson et al. 2007). Evidence suggests that racism occurs in health services (JohnstoneKanitsaki 2009; Durey, Thompson & Wood 2011), compromising care and leading to reluctance by Aboriginal and Torres Strait Islander people to attend services for treatment (Shahid, Finn & Thompson 2009). Evidence also suggests that racism occurs at a systemic level where Aboriginal and Torres Strait Islander people are offered fewer procedures for treating illness and promoting health than other Australians (Boffa 2008; National Heart Foundation of Australia & Australian Healthcare and Hospitals Association 2009).

While discharges against medical advice (DAMA) – particularly common among young men (Katzenellenbogen et al. 2013) – and not attending follow-up appointments are serious concerns in terms of compromising optimum care, the blame is often apportioned to Aboriginal and Torres Strait Islander people (Durey & Thompson 2012). However, the question must be asked about the extent to which the system and health services themselves are responsible for providing care that is discriminatory, however inadvertently, so people are reluctant to access services. Most non-Indigenous health care providers would be appalled to think that the care they are offering their patients is racist; as health care providers their intention is to improve health, not undermine it. However, many health care providers may be unaware that their behaviour, or the normalised practices and systems in which they work, are discriminatory, with significant impacts on Aboriginal and Torres Strait Islander people’s health and wellbeing.

Indigenous scholar Aileen Moreton Robinson (2009) suggests that the dominance of white Anglo-Australian culture, represented in a Western biomedical model of care, is often invisible, and as the norm, shapes the lives of all Australians, privileged and disadvantaged. It is also the standard against which differences from the norm are often judged and demeaned, however inadvertently. When such privilege is invisible, normalised and socially sanctioned, assumptions and practices that may demean Aboriginal and Torres Strait Islander people, such as stereotyping, are not critiqued for their negative effect on health and wellbeing but remain unacknowledged (Pease 2010). If such practices, or health care providers’ beliefs and assumptions about Aboriginal and Torres Strait Islander people, are not examined for whether they undermine, rather than promote, health and wellbeing, discrimination continues.

If care that is discriminatory compromises Aboriginal and Torres Strait Islander health and wellbeing, culturally safe care is likely to increase better health outcomes for Aboriginal and Torres Strait Islander peoples. This requires offering health services that respect Aboriginal and Torres Strait Islander people and their culture - an aspect that many services around Australia have taken extremely seriously with clear evidence of positive outcomes. In Queensland, the Inala mainstream health service changed its practices to be respectful, welcoming and honouring of Aboriginal and Torres Strait Islander people and dramatically increased patient attendance (Hayman, White & Spurling 2009). In order to achieve this outcome more widely, a multi-pronged approach is needed. This includes establishing and building partnerships between Aboriginal and Torres Strait Islander communities and health service providers. These partnerships will support ongoing reflection and assessment of current beliefs and practices about Aboriginal and Torres Strait Islander health at the level of policy and practice. This might also involve stakeholders critically reflecting on the barriers and facilitators within the health care system to delivering high quality, comprehensive, equitable health care to Aboriginal and Torres Strait Islander peoples.

Cultural respect is essential for effective health service delivery to people of all backgrounds, but is especially significant in the context of the unacceptably poor health outcomes experienced within the Aboriginal and Torres Strait Islander population. The Australian Bureau of Statistics reports that data for 2010-2012 shows life expectancy of Aboriginal and Torres Strait Islander men to be around ‘10.6 years lower than non-Indigenous men, while life expectancy of Aboriginal and Torres Strait Islander women is 9.5 years lower than non-Indigenous women’ (Australian Bureau of Statistics 2013b). While this gap has slightly lessened in recent years it continues to represent an enormous discrepancy in health outcomes. One of the contributing factors is the lack of cultural safety that many Aboriginal and Torres Strait Islander peoples experience in the health system.

Research indicates that Aboriginal and Torres Strait Islander Australians are often reluctant to access health services because of discrimination, misunderstanding, fear, poor communication and lack of trust in service providers (Durey, Thompson & Wood 2011; Shahid et al. 2009; Shahid, Finn & Thompson 2009). Aboriginal and Torres Strait Islander peoples are also six times more likely (age adjusted) to discharge themselves from hospital against medical advice, a significant indicator of discomfort in the hospital environment (Australian Institute of Health and Welfare 2011). Evidence has repeatedly shown that Aboriginal and Torres Strait Islander patients are more likely to access health services where service providers communicate respectfully, have some understanding of culture, build good relationships with Aboriginal and Torres Strait Islander patients, and where Aboriginal or Torres Strait Islander Health Workers are part of the health care team (Durey, Thompson & Wood 2011; Shahid et al. 2009; Taylor et al. 2009).

The NATSIHP Australian Government 2013, builds on the Closing the Gap policy, which aims to close the unacceptable gaps between Aboriginal and Torres Strait Islander and non-Indigenous Australians across a variety of indicators. The NATSIHP is based on four principles: Health Equality and a Human Rights Approach; Aboriginal and Torres Strait Islander Community Control and Engagement; Partnership; and Accountability. In the context of improving health outcomes, the NATSIHP specifically calls for racism and inequality to be eliminated from the Australian health system and for health services to address social inequalities and social determinants of health to be effective, appropriate, high quality and accessible for Aboriginal and Torres Strait Islander peoples.