Cultural Safety and Wellbeing: Critical elements

The Cultural Safety and Wellbeing evidence review conducted in 2021 identified six critical elements of culturally safe service delivery for the early support sector. These elements will help to ensure the delivery of culturally safe services for Aboriginal children, young people, families and communities, and may be implemented in different ways to account for the diversity of service providers, service offerings and clients. The critical elements are:

• Recognising the importance of culture
• Self-determination
• Workforce development
• Whole of organisation approach
• Leadership and partnership
• Research, monitoring and evaluation

Some of the elements identified above are used so frequently in a broad range of policy statements that their meaning has become ambiguous. The section below provides a definition for each of the terms in relation to early support service delivery. The researchers also identified suggested implementation activities for how each critical element can be implemented. The activities were identified following an analysis of cultural safety frameworks, practice guides and the research literature. They represent good practice activities and ideas that service providers could implement as part of the ongoing process towards delivering culturally safe programs and services. 

These activities may be flexibly adapted to suit the diversity of First Nations people throughout Australia, as well as the diversity of programs.

Given that cultural safety, particularly as it is applied to child protection, is a newly emerging area of research, and policy focus, it is therefore not possible to draw definitive conclusions about the effectiveness of culturally safe service delivery in providing benefits for Aboriginal children, families and communities. The current evidence base does, however, provide guidance on how to deliver culturally safe services.

These six critical elements were validated and further built upon by key stakeholders during a Feedback Forum. During the Forum, the initial findings from the literature were shared with key stakeholders and service providers, after which participants were invited to give their feedback. Aboriginal and non-Aboriginal stakeholders affirmed the findings and contributed further evidence with regard to ‘what works’ in providing culturally safe services.

Who does it work for?

Health workers and practitioners, organisational leaders and changemakers, service providers, policy makers, program co-designers, managers and team leaders, communities and clients, funders.

Critical elements

What should I consider when working to embed cultural safety?

• These critical elements should be considered holistically as they underpin culturally safe practice for all early support services and programs, at all levels of service provision. Some cultural safety elements, however, may be more relevant or applicable depending on the context or service being provided.
• In studies that included the voices of Aboriginal service users, increased, sustained and meaningful engagement with local communities is identified as a key strategy for increasing the cultural safety of services. Aboriginal clients wanted flexible services that meet the needs of the local community, are co-designed in consultation with the community, and are informed by an understanding of Aboriginal culture and cultural protocols (Murrup-Stewart et al, 2018). This finding suggests that what works to ensure the cultural safety of Aboriginal clients in one community, may not work for another.
• ​​Cultural safety is more than the absence of racism, it is the “positive recognition and celebration of cultures… that empowers people and enables them to contribute and feel safe to be themselves” (Commonwealth of Australia, Department of Prime Minister and Cabinet, 2021, p. 7).
• In addition to these critical elements, which articulate ‘what works’ in service delivery, it is equally important to consider what Aboriginal clients or workers might experience as being culturally ‘unsafe’, when seeking to embed cultural safety within your organisation and service provision.
• Cultural safety is embedded through an ongoing process of self-reflection and improvement; it is not culturally safe to adopt a ‘tick-a-box’ approach to embedding cultural safety. This is especially important with regard to cultural competency training for non-Aboriginal staff. 
• Organisations can and should do more to utilise the cultural expertise of existing Aboriginal staff. In a study of child protection workers, Bessarab and Crawford (2010) noted that a number of Aboriginal workers commented that they were often excluded from decision making regarding Aboriginal families.
• It was repeatedly suggested that enabling self-determined, co-designed, Aboriginal-led systems was a necessary step to amend these issues and concerns.

What else should I consider?

While the evidence base demonstrated clearly ‘what works’ in terms of culturally safe service provision, the academic literature related to cultural safety in health and human service delivery is challenging to assess. Very few Australian studies have examined cultural safety as the focus of research. Rather, cultural safety is most frequently mentioned as a peripheral topic in studies that focus on the processes of service delivery and/or client outcomes. The research team could find no Australian evaluations or research studies that examine cultural safety at the systems level; nor studies that link an improvement in cultural safety to enhanced client outcomes. The current evidence base does, however, provide guidance on how to deliver culturally safe services.

Further resources

Cultural Safety and Wellbeing Evidence to Action Note (PDF , 407.9 KB)

Cultural Safety and Wellbeing Evidence Review Search Strategy (PDF , 317.6 KB)