This document summarizes research from the RISE Project examining cultural safety training. It provides context on the research partnership with Six Nations of the Grand River and discusses preliminary findings from qualitative interviews with community members about a cultural safety module. Key themes included: the module was seen as having overall value but being Western-centric; a need for greater inclusion of Indigenous contexts; recognition that Indigenous service providers are also impacted by trauma; and a preference for case examples that do not reinforce stereotypes.

1. Creating Safety in
Indigenous Context:
The RISE Project
vegaproject.mcmaster.ca
International Society for the Prevention
of Child Abuse & Neglect (ISPCAN)
2022 Conference
March, Quebec City, Canada Presenter:
Dr. Christine Wekerle, McMaster
University, wekerc@mcmaster.ca
@DrWekerle (IG, Twitter)
@RISE_McMaster
https://riseproject.mcmaster.ca

2. This research uses data that was generated with support for the Researching the
Impact of Service provider Education (RISE) Project, a research program led by
Melissa Kimber (McMaster University), Meredith Vanstone (McMaster University)
and Donna E. Stewart (University of Toronto and University Health Network), and
included co-investigators and collaborators located in Ontario, Quebec and Alberta.
The RISE Project is funded by the Public Health Agency of Canada (Agreement
Number: 1920-HQ-000088; Agence de la santé publique du Canada). The views
expressed in this paper do not necessarily represent the views of the Public Health
Agency of Canada.”
Disclaimer

3. This research was conducted at McMaster University,
Hamilton, Ontario, Canada and on-line with Six Nations of the
Grand River Research Advisory Committee
● McMaster University is located in Hamilton, Ontario, which is within
the traditional territory of the Anishinaabe, Mississaugas of the
Credit, and Haudenosaunee Nations as part of the Upper Canada
Treaty, and within the lands protected by the Dish With One Spoon
Wampum Belt Covenant.
● I am a non-Indigenous person and identify as an ally committed to
following the 94 calls to action in the Truth and Reconciliation
Commission (TRC).I have worked in research relationship with Six
Nations of the Grand River community for the past 3 years. I
express gratitude for the being in a position to learn and live on this
land.

4. Six Nations of the Grand River
community guidance
Six Nations Youth Mental Wellness Advisory Committee
Members include (in alphabetical order by last name): Tristan
Bomberry*, Lori Davis Hill*, Daogyehneh (Amy) General*,
Tehota’kerá:tonh (Jeremy) Green*, Chase Harris*, Beverly Jacobs*,
Norma Jacobs*, Katherine Kim, Makasa Looking Horse*, Dawn
Martin-Hill*, Kahontiyoha (Cynthia Denise) McQueen*, Tehanhateh
(Frank) Miller*, Noella Noronha, Savanah Smith, Kristen Thomasen,
Christine Wekerle
* Six Nations of the Grand River members

5. Cultural Safety
● Originated in Aotearoa New Zealand by Maori nurse and
scholar, Irihapiti Ramsden (2002):
“CULTURAL SAFETY is an outcome of nursing and
midwifery education that enables safe service to be
defined by those that receive the service.”
● Indigenous organizations, professional and government
bodies have called for increased training in cultural safety in
preparedness for service provision
● Cultural safety module in VEGAProject training
Violence-Evidence-Action-Guidance (VEGA) Project from
McMaster University https://vegaproject.mcmaster.ca/
Ramsden 2002, p117; NCCIH 2022; FNHA 2016; RCPSC 2009; AMA 2021; Government of Australia 2020; Medical Council of NZ, 2019; Tiatia 2008; Government of Victoria; FNHA 2016 )

6. ● VEGAtraining available in English & French languages
MacMillan, H. L., Kimber, M., & Stewart, D. E. (2020) Intimate partner violence: Recognizing and responding
safely. JAMA, 324(12), 1201-1202. DOI: 10.1001/jama.2020.11322
Stewart, D. E., MacMillan, H. L., & Kimber, M. (2020). Recognizing and responding to intimate partner violence
– An update. The Canadian Journal of Psychiatry. DOI: 10.1177/0706743720939676

7. Cultural Awareness is a step towards Cultural Safety
ARRIVAL OF SETTLERS: Europeans arrived and the colonial encounter ensued. The
result there, he said, was the destruction of our traditional customs and ways of life. .
And that that really did undermine a lot of our customs and practices. Papal Bulls -
Doctrine of Discovery
FORCED SETTLEMENTS/RESERVES: Loss of ancestoral lands - loss of identity,
purpose, land-based location, banning of cultural practices, GENOCIDAL POLICIES
1970+ American Indian Movement - AIM - regain right to heritage, UNDRIP RIGHTS
BACKLASH targeting women and girls (sexual) and boys and men (incarceration) and
children (child removal)
CURRENT EARTH STEWARDSHIP & ADVOCACY - Indigenous growth in service and
health professions, Indigenous leadership outside communities

8. Truth and Reconciliation Report - Categorization as “Cultural Genocide” rather than Genocide of Indigenous
Peoples - https://nctr.ca/records/reports/
● Mandatory Residential School Attendance - coerced and forced separation from parents, experience of emotional,
physical, sexual abuse and neglect by school (Mosby & Galloway, 2017; DOI: https://doi.org/10.1503/cmaj.170448
●
● “Sixties Scoop” - placement of Indigenous children in non-Indigenous foster care (Sinclair, 2007; Retrieved from
https://fpcfr.com/index.php/FPCFR/article/view/25
● Treaty Violations - Reduction in land ownership and decision-making in use of environmental resources
● Murdered & Missing Indigenous Women and Girls - Lack of police action on Indigenous missing persons and
homicides (Moeke-Pickering et al., 2017; https://doi.org/10.1177/1329878X18803730)
● Forced Sterilization of Indigenous Women - coerced tubal ligation (Collier, 2017;
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566614/
● Failures to comply with Jordan’s Principle - resources for Special Needs children (Kamram, 2022; doi:
10.1093/pch/pxaa109) The Canadian Human Rights Tribunal found the definition and implementation of Jordan’s Principle to be
racist and discriminatory in 2016, ordering the Canadian government to make immediate changes. Failing to make changes to
Jordan’s Principle, the Canadian government was found to be noncompliant with the Canadian Human Rights Tribunal orders in
2018.

9. Background: The Six Nations of the Grand River Ontario
● The Haudenosaunee or Six Nations (SN) is a matrilineal
society, across Turtle Island (the US and Canada), sustained
through reciprocal relationships with nature and all creation.
● Six Nations is the largest reserve in Canada, 6 nations living
together under Great Law of Peace
(https://www.sixnations.ca/)
(1) Seneca: People of the Great Hill
(2) Cayuga: People of the Great Swamp
(3) Onondaga: People of the Hills
(4) Oneida: People of the Upright Stone
(5) Mohawk: People of the Flint
(6) Tuscarora: Shirt-wearing People

10. Current Qualitative Study - Preliminary Findings
Purposive sampling, semi-structured 1:1 online interviews moving through
each section of VEGA’s Cultural Safety module

11. Qualitative Analysis
Theme 1: Overall positive value of cultural safety module
● Cultural Safety module provides information on general good practice
principles, rather than match to specific cultural groups
● P11: “I think this is really important. …trying to ..work on some positives. So,
stuff like this really, really excites me because it's happening, you know?
We’re working towards something.”
● P20: …this is an overarching training, right? It's more sort of generalized to
any service provider.
● Trauma-and-violence informed care seen as particularly relevant, where the
violence reflecting structural and systemic violence, is more in-line with
Indigenous community (versus individualistic) approaches

12. Theme 2: Cultural Safety is Western-centric
P21: [the training is] very Western throughout…what we
think is going on is not necessarily what actually goes on
[in family violence]. Multigenerational families living in
households…individuals, you know, not necessarily
being able to, if they’re in danger, to leave. And you
know we have this assumption, just get up and go. Well,
it doesn’t work that way for a lot of these people because
they can’t leave their aunties, uncles, siblings, you know.
So understanding all of those pieces too, and how to
work around that, to make sure that they’re having the
adequate supports they need…

13. Cultural Safety → Cultural Humility
• Cultural Humility - Need to be developed by
Indigenous providers - Need is with
non-Indigenous providers to create safety for
Indigenous clients
(1) Commitment to self-evaluation and self-critique.
(2) Recognition of power dynamics and imbalances
(3) Develop partnerships with people and cultural
groups
(3) Institutional accountability
Tervalon, M., Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician
training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9, 117-125.

14. Theme 3: Greater inclusion of Indigenous context
● P04: “...if you don't know a fulsome
history of the residential school
system or the reservation system in
Canada, and the history of the
place…”
• No pan-Indigenous approach to research
• In US, there are 574 tribes recognized, across 35 United States,
with 9.7 million identifying as AI/AN (Foxworth et al., 2021)
• In Canada, over 1.6 million individuals (First Nations, Innuit,
Métis) identified as Indigenous in the 2016 census (Government
of Canada, 2019)
• Different cultural teachings, histories, geographies, language

15. Theme 4: Indigenous service providers are themselves
directly and indirectly impacted by trauma
● P20: “I think just noting that …it's also that the provider is
also dealing with their own trauma and their own, you know,
trying to access supports and services, right? …But the
reality is, you have people supporting people, but the people
that are providing support are also being supported by the
people, you know what I mean?”
● Cultural Safety Module discusses vicarious trauma and supportive
practices and agency checklist in trauma-and-violence-informed
care

16. Theme 5: Relatability of case examples
● No case example specified a cultural context in Cultural Safety
module
● 18/21 participants described appreciation for case examples that did
not reinforce negative stereotypes about Indigenous individuals and
families by explicitly identifying culture
● Challenges described were viewed as seen frequently in reserve
services
● A small number of participants also offering amendments to the
case scenarios to improve the validity of how and when patient
information is typically available.
● Concept of relationship raised, e.g., if a brief clinical encounter for
physical health purpose, there is no context for engaging in
emotional health discussion without established therapeutic
relationship

17. Summary of Findings
● Overall, positive view of VEGA Project Cultural Safety module, seen as relevant to
providing service to the Indigenous client, as well as training to Indigenous service
providers
● Value added in the VEGAProject open access provision – allows for community
group-based learning and follow-up workshops
● Main adaptation is in terms of further information provided in regards to Indigenous
issues, with linkages for further education opportunities
● Cultural humility may be an important concept to present, along with cultural safety
○ THANK YOU for your time and attention :)
○ Dr. Melissa Kimber (kimberms@mcmaster.ca)
○ Dr. Christine Wekerle (wekerc@mcmaster.ca)
○ Upcoming Special Issue in Child Abuse & Neglect on Indigenous risk, trauma and resilience – look for
call for papers