As outlined by their policy statement on cultural humility and safety, the FNHA (2016) envisions a future where First Nations people have meaningful relationships with their health care professionals. This future includes one that:

• Is based on mutual respect, lateral kindness2, common understanding and reciprocal accountability3;

• Provides understanding of what health and wellness means to First Nations people with recognition of the diversity of these understandings;

• Achieves a balance of power between health care professionals and the people they serve, people who deserve respect and have a right to access the best service we are able to deliver;

• Provides for a health system that has mechanisms that proactively and effectively addresses appropriate actions and behaviours within the operations of the various health institutions.

• Recognizes First Nations as self-determining individuals, families and communities.

• Leads to increased access to the health system by First Nations resulting in improved health outcomes.

• We will know that we have achieved cultural safety when the voice of the people receiving our services tells us we have. FNHA is committed to being a leader and partner to realize this vision.

The Past

"First Nations have a rich history of wellness that extends back in time for many thousands of years. First Nations practiced a mix of hunting, fishing and gathering foods and enjoyed good health and wellness due to a lifestyle that was active, based on healthy traditional diets and enriched by ceremonial, spiritual, emotional and healing practices. However, the arrival of Europeans marked a change of course in the First Nations wellness journey. First Nations health and wellness was disrupted through a process of colonization including aggressive tactics and policy initiatives such as the Indian Residential School System, the Indian Act, and Indian Hospitals. These institutions were part of an oppressive colonial agenda designed to eliminate First Nations jurisdiction and control and resulted in the significant degradation of First Nations health and wellness, practices, beliefs, and values, creating a legacy of trauma and health and social inequities. First Nations self-determination was undermined, and decisions about health and wellness were made for us, not with us."(FNHA, 2016)

Today

"First Nations continue to be impacted by colonization and oppression, both at the individual and system level. First Nations experience stigma, racism, and discrimination in their health care interactions. Systemic racism, also known as structural or institutional racism, is enacted through societal systems, structures and institutions in the form of “requirements, conditions, practices, policies or processes that maintain and reproduce avoidable and unfair inequalities across ethnic/racial groups” (Paradies, 2006). As a result of colonization, many First Nations experience post-traumatic stress disorders, are challenged with substance use, suicide, loss of selfesteem and cultural identity. Despite continuing to be impacted by colonization and oppression, First Nations have demonstrated remarkable resilience. The past several decades have signified a multitude of efforts by First Nations in BC to make decisions for ourselves and to reclaim our wellness through unity and by developing strategic partnerships to increase First Nations involvement in decision-making. Working together in partnership with the federal and provincial governments, First Nations in BC developed a series of political, legal and operational agreements outlining tripartite commitments to improve First Nations health, which includes an examination of policies that are not conducive to First Nations wellness and improving access to and quality of health services (First Nations Health Authority, 2015)" (FNHA, 2016)

"The concept of cultural safety was first introduced in 1990 by Irihapeti Ramsden, a Maori nurse in Aotearoa (New Zealand) (Koptie, 2009). Cultural safety includes and goes beyond cultural awareness, which refers to awareness of differences between cultures. It also goes beyond cultural sensitivity, which is about realizing the legitimacy of difference and the power of one’s own life experience can have on others (Koptie, 2009). Cultural safety is an outcome based on respectful engagement that recognizes and strives to address power imbalances inherent in the healthcare system. It results in an environment free of racism and discrimination, where people feel safe when receiving health care. " (FNHA, 2016)

Key elements of Cultural Safety inlcude:

• Recognizing the role of history and society and past traumatic experiences, and their impacts in shaping health, wellness and health care experiences;

• Understanding that culture is related to history and society and is understood as something that is complex and dynamic, rather than a static set of beliefs or practices. It requires having an understanding of how colonization has impacted and continues to impact First Nations peoples’ health, rather than just having an understanding of specific cultural practices (Browne & Varcoe, 2006);

• An understanding of what health and wellness means to First Nation individuals with recognition of the diversity of these understandings.

• Health care professionals’ self-reflection on their own assumptions and positions of power within the health care system (Health Council of Canada, 2012);

• Emphasizing peoples’ experiences of safety within the health care system and during interactions with health care professionals (Aboriginal Nurses Association of Canada, 2009).

"Offering health care in a way that respects First Nations people as the decision-maker in their own care requires cultural humility. Cultural humility is a process of self-reflection to understand personal and systemic conditioned biases, and to develop and maintain respectful processes and relationships based on mutual trust. Cultural humility involves humbly acknowledging oneself as a life-long learner when it comes to understanding another’s experience. Cultural humility enables cultural safety." (FNHA, 2016)

• Key elements of cultural humility for First Nations include:

• Humbly acknowledging oneself as a life-long learner when it comes to understanding another person’s experience (Hunt, 2001; Wilson et al., 2013);

• Learning may entail becoming an active participant in community events and ceremonies;

• Understanding that we cannot assume we know about another person’s cultural experience, including that culture is an important part of a person’s identity or important to discuss in relation to health care (Tervalon & Murray-Garcia, 1998);

• Health care professionals are constantly aware of how their own cultural experience shapes their own perspective and they recognize that every person is the expert on their own unique experience. Health care professionals do not try to show they are an expert or authority when it comes to another person’s culture; instead they show that they are open to learning (Coulborn & Ortega, 2011; Hook, Davis, Owen, Worthington, & Utsey, 2013).

When health care professionals engage with First Nations peoples from a place of cultural humility, they are helping to create a safer health care environment where individuals and families experience respect. First Nations peoples are therefore more likely to access care when they need it and access care that is appropriate to their wellness beliefs, goals and needs. Increased access to care results in improved health outcomes. Thus, cultural humility is an integral part of creating a health care system that is culturally safe for all.

There are many concepts and terms related to cultural safety, including the term ‘cultural competency’. First Nations leaders in BC have raised concerns that this term implies that cultural competency could be achieved through a single training or course. FNHA has moved away from using this term and believes that a person can never fully achieve cultural competency in another person’s culture. With cultural humility, a person can strive to learn about another person’s culture through a life-long learning process.

The key elements of cultural safety and humility form protocol for building relationships with First Nations whether through an individual health care interaction or through institutional policy and programming.

"Cultural safety and humility includes health literacy. There are many definitions of health literacy, however, they generally revolve around a person’s ability to gather and interpret information in ways that promote health. There is a common assumption that in health care encounters, individuals and their families need to become more health literate in order to accurately interpret information given by their health care professional (Crengle et al., 2014; Murray et al., 2008; Potvin-boucher & Malone, 2014). However, health literacy is increasingly being viewed also as an attribute of health care professionals, and not only an attribute of the people they serve. From a First Nations perspective, health literacy is a two-way conversation between people and their health care professional (Gillis, Gray & Murphy, 2013). While increasing the level of health literacy among First Nations people is important, health care professionals must also work to increase their level of health literacy in working with First Nations people, which includes understanding what health and wellness means from First Nations perspectives and how intergenerational trauma, abuse, violence, neglect, poverty, education, and housing, among other determinates of health and wellness, influence a person’s health." (FNHA, 2016)

"FNHA does not utilize the term patient-centered care as the word patient can imply a more passive role for the person in their health care interactions. Instead, FNHA utilizes the term relationship-based care which means an intentional caring relationship between health care professionals and the people they serve. This relationship is seen as core to a healing environment. People and relationships matter most, along with the dignity of human beings, mutual respect and a shared commitment to healing (Koloroutis, 2004). Relationship-based care requires attention to key elements of cultural safety and humility and the ways in which these concepts can be integrated into professional practice in BC. It also honours the value First Nations and FNHA place on relationships."(FNHA, 2016)

"Increasing the level of cultural safety in the health care system through approaches such as cultural safety, cultural humility, health literacy and relationship-based care, will assist in improving the quality of health services for First Nations people. Unfortunately, racism and discrimination towards First Nations people continues to be a major problem in many contemporary health care settings, resulting in lack of appropriate treatment and barriers to accessing health care (Allan, B. & Smylie, J. 2015). Access to respectful health care is an important determinant of health and wellness for First Nations; when First Nations people do not access the care they need, they are more likely to experience poorer health, and suffering continues. Cultural safety can play a key role in improving the quality of health care services for First Nations, which can in turn improve access to care." (FNHA, 2016)

"Increase opportunities to educate health care professionals, those training to become health professionals, and others working in the health system on the history of First Nations health, as well as the concepts of cultural safety, and cultural humility and the relevance to First Nations health." (FNHA, 2016)

Training should include:

• Recognizing the role of history and society, their impacts, and their relationship to culture in shaping health and health experiences of First Nations. This includes recognizing the role of trauma and offering trauma-informed care;

• Recognizing that colonial practices and policies continue in our health system, and the importance of identifying them and transforming the impact of oppression. Transformation includes moving from discrimination and dehumanization to respectful relationships and lateral kindness;

• Involving self-reflection on one’s own assumptions and position of power within the health system and changes to behaviour according to these reflections;

• Involving self-reflection on one’s own culture, beliefs and values;

• Focusing on peoples’ experiences, including safety, respected and able to voice personal perspective;

• Building trust by communicating respect for individual beliefs, behaviours and values;

• Recognizing the First Nations Perspective on Health and Wellness and the role of culture, traditional medicine and healing;

• Recognizing cultural safety and humility as an attribute of quality of care for First Nations;

• Recognizing the links between relationship-based care and cultural safety;

• Dealing directly and openly with difficult concepts such as racism, discrimination and prejudice;

• Involving First Nations individuals as the main decision-maker in their health;

• Promoting health literacy for both health care professionals/staff and First Nations (a two-way conversation where all parties are both learning and educating);

• Expanding opportunities for cultural humility training to improve cultural safety by enlisting active participation and building partnerships between health care professionals and First Nations;

• Recognizing and addressing training challenges involves senior leadership and investments in mediation and team building.

SAN’YAS ANTI-RACISM INDIGENOUS CULTURAL SAFETY TRAINING PROGRAM

Physicians Guide to Culturally Competent Care

How to Provide Antiracist Mental Health Care

Understanding Stigma (CAMH)

Aboriginal Health: Indigenous Cultural Safety Reading List

Indigenous Engagement & Cultural Safety Guidebook

Being Culturally Connected

Aboriginal Nurses Association of Canada. (2009). Cultural competence and cultural safety in nursing education: A framework for First Nations, Inuit and Métis nursing. Ottawa.

Allan, B. & Smylie, J. (2015). First Peoples, second class treatment: The role of racism in the health and well-being of Indigenous peoples in Canada. Toronto, ON: the Wellesley Institute.

British Columbia et al (2015). Declaration of Comitment; Cultural Safety and Humility in Health Service Delivery for First Nations and Aboriginal People in British Columbia. Retrieved from http://www. slideshare.net/bcpsqc/leading-a-framework-for-cultural-safety-and-humility-for-first-nations-in-bc

Browne, A. J., & Varcoe, C. (2006). Critical cultural perspectives and health care involving Aboriginal people. Contemporary Nurse, 22, 155–167.

Crengle S, Smylie J, Kelaher M, et al. Cardiovascular disease medication health literacy among Indigenous peoples: design and protocol of an intervention trial in Indigenous primary care services. BMC Public Health. 2014;14:714. doi:10.1186/1471-2458-14-714.

Coulborn K, Ortega RM. from an Intersectional Cultural Humility Perspective : workers challenges cultural competence. Child Welfare. 2011;90(5):27–50.

First Nations Health Authority. Our History, Our Health. 2015. Available at: http://www.fnha.ca/wellness/ our-history-our-health . Accessed January 22, 2015.

First Nations Health Authority. Guidebook: Building Blocks of Transformation. 2013. Available at http:// www.fnha.ca/Documents/2013_Guidebook.pdf

Hunt, L. M. (2001). Beyond cultural competence: Applying humility to clinical settings. The Park Ridge Centre Bulletin, 24, 133–136. Health Canada. (2011). Quality of Care. Retrieved from http://www.hc-sc.gc.ca/hcs-sss/qual/index-eng. php Health Council of Canada. (2012). Empathy, dignity, and respect: Creating cultural safety for Aboriginal people in urban health care.

Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., & Utsey, S. O. (2013). Cultural humility: measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60(3), 353–66. doi:10.1037/ a0032595

Koloroutis, M., Ed. (2004). Relationship-based care: A model for transforming practice. Creative Health Care Management, Minneapolis, MN.

Murray TS, Hagey J, Willms D, Shillington R, Desjardins R. Health literacy in Canada: A healthy understanding. Ottawa; 2008.

Paradies, Y. (2006). A systematic review of empirical research on self-reported racism and health. International Journal of Epidemiology, 35 (4), p888-901.

Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes. J Health Care Poor Underserved. 1998;9(2):117–125.

Wilson, D., de la Ronde, S., Brascoupé, S., Apale, A. N., Barney, L., Guthrie, B., … Robinson, N. (2013). Health professionals working with First Nations, Inuit, and Métis Consensus Guideline. Journal of Obstetrics and Gynaecology Canada, 35(6, Supplement 2), S1.

As outlined by the First Nations Health Authority's "Leading a Framework for Cultural Safety," to whom we give all credit. Please see their website for more information.

• Anti-Racism, Cultural Safety & Humility Framework (document)

• Anti-Racism, Cultural Safety & Humility Action Plan​ (document)

• Creating a Climate for Change (booklet)

• FNHA former CEO Joe Gallagher on Cultural Humility (video)

• FNHA’s Policy Statement on Cultural Safety and Humility ​(poster)

• Key Drivers and Ideas for Change​ (booklet)

• Leading a Framework for Cultural Safety & Humility for First Nations in BC (PowerPoint presentation)

As compiled on the Victoria DoFP's website:

Training

• San'yas Indigenous Cultural Safety Training - 14 Funded Seats Available!
  
  San'yas Indigenous Cultural Safety Training, “Core ICS Health”, is available online and is self-paced over an eight-week window and typically takes between eight-ten hours to complete. This self-learning program has been certified by the College of Family Physicians of Canada for up to 20 Mainpro+ credits. The course is available complimentary for those that have an Island Health email address. For those not employed by Island Health, the Division is supporting the $300.00 registration fees for up to 14 physicans, as at March 2021. Click here for information on the training.
  
  Please email Alyssa Beurling at abeurling@divisionsbc.ca for details on how to support your registration.

• Island Health’s Aboriginal Health Program, “For the Next Seven Generations – for the Children” is available online to the public. The course is self-paced and takes approximately 3-4 hours to complete. Click here to learn more.
  

Resources

NEW - Power and Privilege in Canada by Dr Amy Tan

NEW - The Inconvenient Indian: A Curious Account of Native People in North America by Thomas King

NEW - The Deepest Well by Nadine Burke Harris

NEW - 21 Things You May Not Know About the Indian Act by Bob Joseph, et al.

NEW - Project of Heart: Illuminating the hidden history of Indian Residential Schools in BC by the BCTF.”

The Indigenous Learning Series (Canada School of Public Service)

BCCFP: Practicing Cultural Safety and Humility in the Response to COVID-19

BC Learning Circle: Cultural Safety in the Face of a Pandemic: Historic and Contemporary Realities through a Trauma Informed Lens

https://www.fnha.ca/Documents/FNHA-Care-of-the-Deceased-Body-Guide.pdf

Creating a Climate for Change -Cultural Safety and Humility in Health

FHNA website

Island Health Aboriginal Health

Some free cultural safety modules through UVic:

• Module 1

• Module 2

• Module 3 (specific to health)

Resources for practicing differently with Indigenous clients:

• R.E.S.P.E.C.T. Model of Cross-Cultural Communication

• CIHR Guidelines for Health Research Involving Aboriginal People (2007-2010)

Examples of how to put cultural safety into action:

• Health Council Canada - Report on Creating Cultural Safety for Aboriginal People in Urban Health Care (2012)

This map of our region can help start conversations about the specific Nations a care provider might serve and open up avenues for learning about those specific Nations rather than Indigenous Peoples generally.

The Richardson and Williams (2007) article may be a starting point for conversations as a learning group.

Addressing Racism in Team-Based Care

• Learnings from the In Plain Sight report

• The In Plain Sight reports

• In Plain Sight: Elaboration on the Review – Article by Mary Ellen Turpel-Lafond, Laurel Lemchuk-Favel and Harmony Johnson that was recently published in the BC Medical Journal.

• Cultural Safety & Humility Action Series – Previous webinar series hosted in partnership by the First Nations Health Authority and BC Patient Safety & Quality Council.

• Cultural Safety & Humility – Resources from the First Nations Health Authority.

As compiled on the BCCDC's website:

Online Courses

What: Social Determinants, Culture and Contact Tracing, Australian National University, hosted by GOARN – only available in English

• Time commitment: About 45 minutes

• How can it be used: This module provides a general introduction to the importance of recognizing social determinants and culture in the design and implementation of contact tracing activities. This module aims to build awareness and enable the participant to apply learnings to real-world contexts through working examples from a variety of infectious diseases where contact tracing is a core public health intervention to mitigate transmission. This module is relevant for both novice and experienced contact tracers. To gain access to the module, you must subscribe to GOARN using PHAC as your institution.

What: San’yas Indigenous Cultural Safety Training Program, Provincial Health Services Authority

• Time Commitment: The 8-week facilitated course consists of 5 modules and takes about 8 hours (depending on prior knowledge and learning style) to complete.

• How can it be used: This is a unique, online training program designed to increase knowledge, enhance self-awareness, and strengthen the skills of those who work both directly and indirectly with Indigenous people. The goal is to develop understanding and promote positive partnerships between service providers and Indigenous people.

• The program is based on the concept of cultural safety: an ongoing process of actively working to make services and systems safer and more equitable for Indigenous people. Topics covered include colonization in Canada; anti-Indigenous racism, stereotyping and discrimination; and social determinants of Indigenous peoples’ health. San’yas participants are guided by skilled facilitators to examine these issues in their own work or practice settings.

What: For the Next Seven Generations – for the Children, Island Health’s Cultural Safety Online Course

• Time commitment: The course is a 3-4 hour, self-paced, non-facilitated course available on LearningHub.

• How can it be used: It is intended to improve health outcomes for present and future generations of Aboriginal peoples living on Vancouver Island. The module provides an opportunity for healthcare providers to strengthen their cultural awareness and to enhance their ability to establish culturally safe, respectful engagements and environments.

What: Introduction to Health Equity Online Course, National Collaborating Centre for Determinants of Health, NCCDH

• Time commitment: The course consists of 5 modules and requires at least 2.5 hours. The option to access a PDF version for each module is available as an alternate learning version.

• How can it be used: The Introduction to Health Equity online course is a collaboration of the National Collaborating Centre for Determinants of Health (NCCDH) and Public Health Ontario (PHO). The objective of this course is to offer a free, self-directed, and introductory online course to help public health staff, managers, and leaders build the knowledge, skills, and competencies to support action on health equity.

What: Equipping for Equity Modules, Equip Health Care

• Time commitment: The resource consists of 9 modules, and any of them can be accessed at any time. Each module is designed to take 10 to 30 minutes, with a focus on action-oriented strategies, tools and templates to help integrate health equity into practice.

• How can it be used: These online modules are presented by EQUIP Health Care — organizational-level intervention studies funded by the Canadian Institutes of Health Research (CIHR), designed to enhance the capacity of primary health care clinics and emergency departments to provide equity-oriented care, particularly for marginalized populations.

Webinars

What: Indigenous Cultural Safety Learning Series, Provincial Health Services Authority (PHSA), PHSA Indigenous Health, Southwest Ontario Aboriginal Health Access Centre

• Time commitment: Webinars are generally 90 minutes.

• How can it be used: This national webinar series from the Indigenous Cultural Safety (ICS) Learning Series covers issues related to Indigenous cultural safety and anti-racism in health and social services.

What: Cultural Safety & Health Webinars, First Nations Health Authority

• Time commitment: Webinars are generally 60 minutes.

• How can it be used: These webinars were held to encourage participation, learning, self-reflection and positive change among B.C.'s health care professionals.

• The series supports the development of tools and skills for advancing cultural safety and humility and understanding and integrating this work into practice and interaction with First Nations clients.

What: Cultural Safety in the Face of a Pandemic: Historic and Contemporary Realities through a Trauma Informed Lens with Harley Eagle, UBC Learning Circle, Centre for Excellence in Indigenous Health

• Time commitment: 90 minutes.

• How can it be used: In this time of crisis, now is the time to look to cultural safety processes in working with Indigenous people which can then inform how we can better equip medical professionals to cultivate a trauma-informed practice that better supports Indigenous people through medical crises in a culturally safe way. Harley supplies a connection to the colonial history and current realties that may be the root of triggering for Indigenous Peoples and communities.

Reference Guides and Fact Sheets

What: BCCDC COVID-19 Language Guide, Provincial Health Services Authority

• How can it be used: This guide aims to assist with COVID-19 messaging and content development by using positive, acknowledging, and inclusive, rather than (potentially) stigmatizing language that may provoke fear. Tables are found that offer words, terms or phrases to replace commonly or historically used language as well as the rationale for the suggestions. Key sections include Disease Basics and Racial, Ethnic & Cultural Identities; Pronouns and Gender Inclusive Language; and Health Harming Coping Strategies.

What: Social Determinants, Culture and Contact Tracing - The Quick Reference Guide (QRG), Australian National University, hosted by GOARN – only available in English

• How can it be used: Located in the last chapter of the online module and attached here as a PDF, this QRG summarizes the key messages provided throughout the Social Determinants, Culture and Contact Tracing module. It lists the key factors to consider when developing approaches to contact tracing, provides examples (or the 'what') of each of the factors and describes how they may be addressed in order to design and implement effective and culturally safe contact tracing activities. It can be downloaded, printed, and kept for easy reference.

What: Let’s Talk Racism and Health Equity, National Collaborating Centre for Determinants of Health (NCCDH)

• How can it be used: This document is designed to encourage public health to act on racism as a key structural determinant of health inequities. It is part of a collection of resources designed to promote discussion and understanding of how key concepts in health equity apply in public health practice.

What: Aboriginal Racism in Canada Fact Sheets, National Collaborating Centre for Aboriginal Health (NCCAH)

• How can it be used: This series of fact sheets provides an overview of racism experienced by Indigenous peoples in Canada. The three documents focus on the historical context of racism towards Canada’s Indigenous peoples, strategies to combat racism and the effect racism has had on both individuals and communities.

Provincial Resources

What: Culturally Connected Website, Provincial Health Services Authority

• How can it be used: Culturally Connected is an approach that brings together cultural humility and health literacy to help care providers and their clients develop a shared understanding of each other's values, beliefs, needs, and priorities. The resource was developed in collaboration by the Health Literacy team of BC Children’s Hospital and the Population Health Promotion team of BC Women’s Hospital. It includes definitions, case studies, cultural humility & health literacy tools and resources helpful to care providers.

What: Cultural Safety: Respect and Dignity in Relationships Video, Indigenous Health Cultural Safety Initiative, Northern Health Authority

• How it can be used: This 5-minute animated video introduces cultural safety and related concepts in an easily understandable way. It invites health care providers to participate in making the health system more culturally safe for Indigenous people and families.

What: Aboriginal Cultural Safety Resources, Interior Health Authority

• How can it be used: This website offers links to podcasts, webinars, a video series and a collaborative learning series on Indigenous cultural safety.

What: Provincial Language Services, Provincial Health Services Authority

• How can it be used: The Provincial Language Service provides interpreting and translation services to B.C. health authorities and private physician offices. It helps organizations provide services to their linguistically and culturally diverse clients including immigrants, refugees, official minority language speakers and members of the deaf, deaf-blind and hard of hearing community through high-quality interpreting and translation.

• Services include:

  • Spoken language interpreting services

  • Sign language interpreting services

  • Translation services

  • Services Francophones

What: Translated and downloadable material to help answer questions about COVID-19, Fraser Health Authority (FHA)

• How it can be used: The Shareable resources section of the FHA website includes posters and images to share in a variety of languages to help teach clients and communities about the COVID-19 public health safety measures in place in B.C.

• Develop strategies and frameworks for increasing cultural safety and humility in various health care organizations and clinical practice settings and incorporate cultural safety and humility protocols into organizational policies (e.g. human resources);

• Identify and address organizational and public policy barriers to creating culturally safe health care environments and health programming, including barriers to integrating First Nations approaches and traditional healing practices in the mainstream health system;

• Conduct patient journey mapping to support ongoing improvement and learning.

Aboriginal Policy and Practice Framework

Approach to Implementation of the Inherent Right and the Negotiation of Aboriginal Self Government

UN Declaration on the Rights of Indigenous People

Recognition and Reconciliation of Rights Policy for Treaty Negotiations in British Columbia

Commission Rights Recognition Handbook

The First Nations Summit is comcprised of a majority of First Nations and Tribal Councils in British Columbia and provides a forum for First Nations in BC to address issues related to Treaty negotiations as well as other issues of common concern

• Develop and implement mechanisms for health professionals and First Nations to provide feedback, whether positive or constructive, without fear of judgment or reprisal. Develop systems to address complaints directly with a focus on relationships in a timely manner and with options for mediation through traditional ways such as circles and inclusion of Elders;

• Development of measures to assess cultural safety and humility across an organization or program, as a part of quality improvement;

• Commit to evaluation, publically reporting, and continuously improving cultural safety within the health system for First Nations.

"Indigenous patients can now report health system concerns anonymously using Safespace Networks on the B.C. Association of Aboriginal Friendship Centres’ (BCAAFC) website. Safespace Networks is a community-led, nationwide initiative to create change in the health care system by holding individuals, organizations and institutions accountable to addressing racism.The app’s design follows the advice of Te′ta-in (Sound of Thunder) Shane Pointe, Knowledge Keeper within Mary Ellen Turpel Lafond’s “In Plain Sight” report to focus on change, rather than a “shame and name” approach. “As described in Mary Ellen Turpel Lafond’s ‘In Plain Sight’ report, the existing internal processes for monitoring and addressing racism within health care systems functions primarily to defend health care institutions. Racism complaints have been risk managed within the system, and this is now going to change,” said Leslie Varley, Executive Director of the BCAAFC, “Safespace Networks will help our people define their own quality of care by providing a culturally safe and accessible way for their concerns to be heard.” B.C. Friendship Centres are leading the Safespace Networks initiative in British Columbia. The app is available through the BCAAFC website under “Report Racism with Safespace”, alongside support resources for individuals who have experienced racism and discrimination in healthcare. The app will be available on every B.C. Friendship Centre website, and Friendship Centre staff will be available to support community members in making a report using the Safespace Networks web app. As the network is adopted by patients in B.C., new features will be released that support racialized patients to self-navigate the health system and for health stakeholders to become aware of issues earlier than in the current system" (BCAAFC, 2020).

The 2020 In Plain Sight Report outlines immediate, principled and comprehensive efforts to eliminate all forms of prejudice and discrimination against Indigenous Peoples evidently present in the BC healthcare system.

• Summary Report (PDF)

• Full Report (PDF)

"Make specific efforts to ensure a workforce that includes First Nations leadership and staff are visible across all levels of the organization" (FNHA, 2016). Initiatives may include:

• Support First Nations health care professionals to work in First Nations communities;

• Develop initiatives to recruit and retain First Nations health leaders, health care professionals and other employees;

• Encourage First Nations students to become health professionals (e.g. offer scholarships, outreach);

• Provide incentives for health organizations to foster cultural humility and offer culturally safe healthcare for First Nations people (e.g. adjust billing structures, include in performance reviews);

• Create First Nation navigator positions to support First Nations in their interactions with the health system.

"Create physical environments that are culturally safe for First Nations and that are connected with other services" (FNHA, 2016).

Two-eyed seeing is the practice of learning to see using two knowledge systems, drawing on both to guide discovery and problem solving. It is within this Ethical Space that all collaboration, mutual support, and multi-directional knowledge sharing occurs (Gary Pritchard, 2020).

• Remember the knowledge systems shared in the space are to complement the other. Not validate or limit the other. Most certainly not dominant or command the other.

• Should be co-facilitated by a knowledge keeper or Elder from each knowledge system.

• When and where possible, have a balanced circle

• The first gathering of minds should be focused on relationship building interactions not business. Learn and share from each other.

• Should have both forms of knowledge transfer, the Western written and Indigenous oral methodologies.

• Should be opened and closed in a good way, through the use of ceremony

The focus: “How the design and programming of the built environment of settler cities have contributed to the invisibility of Indigenous peoples and minimizing their cultural influence.”

Place making is broadly understood as employing a community’s strengths to create a presence in public spaces that reflects that community’s identity, health, and well-being. Indigenous place making is aimed at restoring Indigenous presence in Canada through art and design that is created, produced, and driven by Indigenous communities and underpinned by Indigenous knowledge (Gary Pritchard, 2020).

• Project development & programing through a place-making lens and in an Indigenous context means incorporating the spiritual, the emotional, the physical and the mental ways of being into urban development at multiple levels.

• Urban Indigenous communities have a strong emphasis on collaboration, are grounded in traditional values/principles, work with traditional Knowledge Keepers, such as Elders and healers, and can provide strong resources to help move the agenda forward on Indigenous place making.

"Cultural safety and humility protocol requires individuals changing their attitudes, skills, and/or behaviour. It is important change leadership approaches are integrated into cultural safety and humility initiatives. Leadership are key to setting an example and can demonstrate their commitment through participation in National Aboriginal Day events, video blogs, and promotional materials" (FNHA, 2016).

• Build meaningful relationships with First Nations communities for co-development of strategies and services to inform and foster cultural safety within the health system;

• Encourage community visits and exposure to traditional protocol by leadership and staff;

• Ensure First Nations representation on boards, advisories, and in senior leadership positions

Victoria Native Friendship Centre

Indigenous Culture in BC

Indigenous Experiences in BC