Academic journal article Australian Journal of Social Issues

Towards Better Preparation and Support for Health and Social Care Practitioners Conducting Specialised Assessments in Remote Indigenous Contexts

Academic journal article Australian Journal of Social Issues

Towards Better Preparation and Support for Health and Social Care Practitioners Conducting Specialised Assessments in Remote Indigenous Contexts

Article excerpt


Remote health professionals are often at the forefront of some of the most challenging health care issues. In many remote communities, the problems associated with health care are compounded by a range of factors. Issues include: a low density but dispersed population; isolation and marginalisation; and poor access to specialist services, with access often requiring long-distance travel. High staff turnover, difficulties in recruiting and retaining health and welfare professionals, harsh climatic conditions, and professional isolation are further challenges, along with other issues specific to some fields of practice (Mason 2010). Health and community services workers in rural and remote communities are often disadvantaged in access to professional development opportunities (Green & Gregory 2004; Mason 2010). This affects retention rates (Curran, Fleet & Kirby 2006), staff confidence levels, and understanding of role expectations. Poor professional development opportunities are among the greatest challenges to practising in rural and remote areas (Roots & Li 2013), with geographic isolation and poor technological and telecommunications infrastructure identified as critical barriers (Curran et al. 2006).

The majority of health care workers in Indigenous communities are non-Indigenous. They work in cross-cultural contexts, and may even experience culture shock (Muecke, Lenthall &C Lindeman 2011). It is now well-established that cultural safety with Aboriginal communities is an important issue for remote practice (Mason 2010; Muecke et al. 2011), although there has been little consensus as to the best way to achieve this. Mason (2010) uses the term 'cultural competence'. We choose to use the term 'cultural safety', while recognising that the terms are not usually used interchangeably and may reflect preferences regarding emphasis of particular factors. Consistent with Mason's use of cultural competence, cultural safety requires service providers to engage in dialogue with their clients, reflect on power relationships and systems that may continue to colonise and disempower already marginalised people, and use reflective processes to minimise the risks associated with dominance and powerlessness (Ramsden 2002; Taylor & Guerin 2010). While remote practice is undoubtedly challenging, it also offers unique opportunities for professional and personal growth (Mason 2010), with reflection critical to the process.

Despite long-standing knowledge of the need for assessment practice to accommodate cultural differences (Panos & Panos 2000) and for staff training in the area to be standard (Vrantsidis et al. 2014; Weber 2007), deficits in preparing the workforce remain. A recent study of aged care assessment practices in Victoria, for example, found that training for clinicians in working with culturally and linguistically diverse (CALD) clients, their families and interpreters was rare, particularly in rural areas (Vrantsidis et al. 2014). Conducting client assessments in remote settings with Indigenous communities is seldom specifically catered for by professional development opportunities. Rare examples include single workshops in the community aged care sector in the Northern Territory (Lindeman & Newman 2006), and fee-based workshops

in mental health assessment, usually delivered in larger urban settings nationally (see, for example, Indigenous Psychological Services).

Single, one-off workshops are typically offered as solutions to workforce and professional development needs, particularly where resource constraints limit more intensive or ongoing programs. However, such traditional in-service training models have an inconclusive correlation to changed--improved performance in the workplace (Clarke 2001), with recognition that success is often dependent on the informal learning that follows in the workplace (Eraut 2004). Effective training provision for health and social care professionals requires a combination of blended techniques, including interactive components and learning materials. …

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