Microreconciliation as transformational practice Dr Caroline L Tait

Micro-reconciliation as transformational practice Dr. Caroline L. Tait Department of Psychiatry, University of Saskatchewan February 13, 2020 �ait, C. L. , Mussell, W. & Robert, H. (2019). Micro-Reconciliation as a Pathway for Transformative Change. International T Journal of Indigenous Health, 14(2), 19 - 38. DOI 10. 32799/ijih. v 14 i 2. 31928. Retrieve from https: //jps. library. utoronto. ca/index. php/ijih/article/view/31928/25135

“Collective efforts from all peoples are necessary to revitalize the relationship between Aboriginal peoples and Canadian society – reconciliation is the goal. It is a goal that will take the commitment of multiple generations but when it is achieved, when we have reconciliation – it will make for a better, stronger Canada. ” 1 Honourable Justice Murray Sinclair, Chair, Truth and Reconciliation Commission of Canada 1 Truth and Reconciliation Commission of Canada. (n. d. ). Truth and Reconciliation Commission of Canada main page. Retrieved from www. trc. ca/reconciliation. html

• TRC raised expectations similar to those raised by RCAP, that Canada’s leadership and society is committed to transformational change. 2 • First Nations, Métis, Inuit people have once again responded to the promises made, this time in the form of Calls to Action and are working towards the goal of reconciliation and the transformational change promised by the 94 Calls to Action. 3 • Sovereignty is a central focus for First Nations, Métis and Inuit. 4 • Rights include, UN Declaration on the Rights of Indigenous Peoples, 5 Treaty Rights, including Treaty Right to Health, 6 Constitutional Rights, 7 Human Rights 8, Rights of the Child 9

2 Truth and Reconciliation Commission of Canada. (2015). Honouring the Truth, Reconciling for the Future: Summary of the Final Report of the Truth and Reconciliation Commission of Canada. Ottawa, ON. Retrieved from http: //www. trc. ca/websites/trcinstitution/File/2015/Exec_Summary_2015_06_25_web_o. pdf � 3 Truth and Reconciliation Commission of Canada. (2015). Truth and Reconciliation Canada: Calls to Action. Winnipeg, MB. Retrieved from http: //trc. ca/assets/pdf/Calls_to_Action_English 2. pdf 4 National Collaborating Centre for Aboriginal Health. (2014). Landscapes of First Nations, Inuit, and Métis Health: An Environmental Scan of Organizations, Literature and Research, 3 rd Edition. Prince George, BC. Retrieved from https: //www. ccnsa-nccah. ca/docs/context/RPT-Landscapesof. Health 2014 -EN. pdf � 5 United Nations Declaration. (2008). United Nations Declaration on the Rights of Indigenous Peoples. United Nations General Assembly, (Resolution 61/295), 10. https: //doi. org/10. 1093/iclqaj/24. 3. 577 6 Government of Canada. (n. d. ). Treaties and Agreements. Retrieved from https: //www. rcaanccirnac. gc. ca/eng/1100100028574/1529354437231#chp 6 7 Canadian Charter of Rights and Freedoms, s 7, Part I of the Constitution Act, 1982, being Schedule B to the Canada Act 1982 (UK), 1982, c 11 8 United Nations General Assembly. (1948). Universal Declaration of Human Rights. Retrieved from http: //www. un. org/en/universal-declaration-human-rights/ � 9 UNCRC. (1989). Convention on the Rights of the Child. Office of the High Commissioner. https: //www. ohchr. org/en/professionalinterest/pages/crc. aspx

Colton Boushie August 9, 2016, Colten Boushie, a 22 -year-old Cree man, was fatally shot by Gerald Stanley on Stanley’s farm near Biggar, Saskatchewan. 10 Stanley was acquitted on February 9, 201810 The Boushie family and Indigenous people across the country felt the trial was unfair. The jury was made up of all “white” people. 10 Prime Minister Trudeau and Minister of Justice Wilson. Raybould denounced the verdict. 10 10 Quenneville, G. , & Warick, J. (2018, February 9). Shouts of ‘murderer’ in courtroom after Gerald Stanley acquitted in Colten Boushie shooting. CBC News. Retrieved from https: //www. cbc. ca/news/canada/saskatoon/gerald-stanley-coltenboushie-verdict-1. 4526313

Tina Fontaine On August 17, 2014, Tina Fontaine’s 72 -pound body was found in Winnipeg’s Red River, wrapped in a duvet cover and weighed down with rocks. She was 15 and in the care of provincial child welfare. 11 On February 22, 2018, a jury found Raymond Cormier not guilty in the death of Tina Fontaine, even though there was strong evidence indicating Cormier was responsible for her death. Cormier was not charged with any other offenses including child sexual abuse. 11 “We've all failed her. We as a nation need to do better. ” 11 Sheila North, Former Manitoba Keewatinowi Okimakanak Grand Chief 11 Mac. Lean, C. (2018). Jury finds Raymond Cormier not guilty in death of Tina Fonataine. CBC News. Retrieved from https: //www. cbc. ca/news/canada/manitoba/raymond-cormier-trial-verdict-tina-fontaine-1. 4542319

Pragmatic Solidarity Based in human and Indigenous rights frameworks (UN Declaration on Human Rights 8, UN Declaration on the Rights of Indigenous Peoples 5), pragmatic solidarity 12 requires taking a moral stance in solidarity with First Nations, Métis and Inuit peoples and in doing so, to come up with pragmatic solutions that not only improve health and social outcomes but seek to address structural violence through the reinforcement of the social and economic rights of Indigenous peoples. 5 United Nations Declaration. (2008). United Nations Declaration on the Rights of Indigenous Peoples. United Nations General Assembly, (Resolution 61/295), 10. https: //doi. org/10. 1093/iclqaj/24. 3. 577 8 United Nations General Assembly. (1948). Universal Declaration of Human Rights. Retrieved from http: //www. un. org/en/universal-declaration-human-rights/ � 12 � Farmer, P. (2004). Pathologies of power: Health, human rights, and the new war on the poor (Vol. 4). Oakland, California: University of California Press.

Cultural Safety emerged apart from the evolution of the concept of cultural competence, originating from the work of Maori nursing scholars and educators in the 1990 s. 17 applies to improvements to cross-cultural relationships between Indigenous patients, families, and communities and non. Indigenous service providers and systems. 17 focuses on the nature of these relationships by concentrating on how historical and contemporary power imbalances, racial discrimination, cultural genocide, oppression, and marginalization, manifest in the individual and collective experiences of Indigenous peoples as they engage with the human service sector, including health care. 17 17 � Papps, E. , & Ramsden, I. (1996). Cultural safety in nursing: the New Zealand experience. Journal of the International Society for Quality in Health Care, 8(5), 491– 497. https: //doi. org/10. 1093/intqhc/8. 5. 491

Cultural Safety the concept is considered to be a “more radical, politicized understanding of cultural consideration, effectively rejecting the more limited cultural competent approach for one based not on knowledge but rather on power”. 18 While theoretically upsetting entrenched power relations, the practical application of cultural safety remains a challenge. 19 18 � Brascoupé, S. , & Waters, C. (2009). Cultural safety: Exploring the applicability of the concept of cultural safety to Aboriginal health and community wellness. International Journal of Indigenous Health, 5(2), 6. Retrieved from https: //jps. library. utoronto. ca/index. php/ijih/article/view/28981/23928 19 Browne, A. J. , Varcoe, C. , Smye, V. , Reimer-Kirkham, S. , Lynam, M. J. , & Wong, S. (2009). Cultural safety and � the challenges of translating critically oriented knowledge in practice. Nursing Philosophy, 10(3), 167– 179. https: //doi. org/10. 1111/j. 1466 -769 X. 2009. 00406. x

Cultural Safety culture and safety have the potential to be narrowly interpreted, and the use of cultural safety in practice (or in research and teaching), can unintentionally foster the further objectification of people who are already vulnerable. 19 “the power relationship is inherently unbalanced, where the qualified healthcare professional retains the power of their professional knowledge and practical capabilities of their position in relation to the relatively less powerful position of the patient. 18 � 1 Brascoupé, S. , & Waters, C. (2009). Cultural safety: Exploring the applicability of the concept of cultural safety to Aboriginal health and community wellness. International Journal of Indigenous Health, 5(2), 6. p. 13. Retrieved from https: //jps. library. utoronto. ca/index. php/ijih/article/view/28981/23928 19 Browne, A. J. , Varcoe, C. , Smye, V. , Reimer-Kirkham, S. , Lynam, M. J. , & Wong, S. (2009). Cultural safety and the challenges of translating critically oriented knowledge in practice. Nursing Philosophy, 10(3), 167– 179. https: //doi. org/10. 1111/j. 1466 -769 X. 2009. 00406. x

Cultural Humility ”Cultural humility incorporates a lifelong commitment to selfevaluation and critique, to redressing the power imbalances in the physician-patient dynamic, and to developing mutually beneficial and non-paternalistic partnerships with communities on behalf of individuals and defined populations. ” 20 “Cultural humility is possible when one is open, self-aware, humble, reflective, and supportive with others” 21 20 Tervalon, M. , & Murray-Garcia, 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(2), 117 -125. Retrieved from https: //doi. org/10. 1353/hpu. 2010. 0233 https: //muse. jhu. edu/article/268076/summary 21 Foronda, C. , Baptiste, D. , Reinholdt, M. , Ousman, K. (2016). Cultural Humility: A Concept of Analysis. Journal of Transcultural Nursing. 27(3), 210 -217. Retrieved from � http: //journals. sagepub. com/doi/10. 1177/1043659615592677

How do we apply cultural safety and humility? If a cultural safety approach is unachievable in our current health care context because of inherent power imbalances between providers and Indigenous patients and families that are not easily changed, how do we move forward with the concept and our goals of cultural safety and reconciliation?

Truth and Reconciliation Calls to Action 23 calls for governments to “[p]rovide cultural competency training for all health care professionals” 3 Action 24 directs “medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration of the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism” 3 3 Truth and Reconciliation Commission of Canada. (2015). Truth and Reconciliation Canada: Calls to Action. Winnipeg, MB. Retrieved from http: //trc. ca/assets/pdf/Calls_to_Action_English 2. pdf

Truth and Reconciliation “We also have to talk about reconciliation at the personal, and family and community level. That is where true change will occur, for it is in our daily lives where we seek and, hopefully, find peace. …Our leaders need to show the way, but no matter how many deals and agreements they make, it is in our daily conversations and interactions that our success as a nation in forging a better place, will ultimately be measured. ” 22 Chief Justice Murray Sinclair, Truth and Reconciliation Commission of Canada 22 � Sinclair, M. (2014, April 18). Reconciliation not opportunity to “get over it”: Justice Murray Sinclair. [Opinion]. CBC News. Retrieved from https: //www. cbc. ca/news/indigenous/reconciliation-not- opportunity-to-get-over-it-justicemurray-sinclair-1. 2614352

Micro-Reconciliation To provide the base essentials to support anti- racist training and re-education of those who have First Nations, Métis, and Inuit peoples as clients. The framework is to be applied along with cultural safety training across all levels of service provision, management, and administration.

Micro-Reconciliation Despite the momentous effort by the TRC, this has done little to motivate non-Indigenous Canadians to deeply reflect on how they and their families have benefited from colonization, been socialized to view the historical and contemporary plight of First Nations, Métis, and Inuit peoples, and to understand how they can actively participate in reconciliation. 23 Less than half (about 40%) of non-Indigenous Canadians reported ever having heard or read anything about the TRC, and the large majority (95%) could not name a single Call to Action (Environics, 2016)23 23 The Environics Institute for Survey Research. (2016). Canadian Public Opinion on Aboriginal Peoples: Final Report June 2016. Environics Institute. Retrieved from https: //www. environicsinstitute. org/projects/project-details/publicopinion-about-aboriginal-issues-in-canada-2016

Micro-Reconciliation Research shows that non-Indigenous Canadians commonly blame First Nations, Métis, and Inuit peoples for the health disparities and social ills that characterize Indigenous communities, 23, 24, 25 while failing to acknowledge the impact of systemic violence directed towards Indigenous peoples and the intergenerational transmission of racist attitudes that persist across the country 26, 27

Micro-Reconciliation 23 The Environics Institute for Survey Research. (2016). Canadian Public Opinion on Aboriginal Peoples: Final Report June 2016. Environics Institute. Retrieved from https: //www. environicsinstitute. org/projects/project-details/publicopinion-about-aboriginal-issues-in-canada-2016 24 Clair, M. , & Denis, J. S. (2015). Sociology of Racism. In J. D. Wright (Ed. ), International Encyclopedia of the Social & Behavioral Sciences: 2 nd Edition, 857– 863. Elsevier Ltd. Retrieved from https: //scholar. harvard. edu/files/matthewclair/files/clair_denis_2015. pdf 25 Tang, S. Y. , & Browne, A. J. (2008). “Race” matters: racialization and egalitarian discourses involving Aboriginal people in the Canadian health care context. Ethnicity & Health, 13(2), 109– 127. Retrieved from https: //www. researchgate. net/publication/5426567_'Race'_matters_Racialization_and_egalitarian_discourses_involving _Aboriginal_people_in_the_Canadian_health_care_context 26 Sinclair, S. , Dunn, E. , & Lowery, B. S. (2005). The relationship between parental racial attitudes and children's implicit prejudice. Journal of Experimental Social Psychology, 41(3), 283– 289. Retrieved from https: //pdfs. semanticscholar. org/f 3 a 8/39 bfcbf 5214 cacfea 2 d 9 c 9 bdb 0 bcb 5141 ddd. pdf 27 Miklikowska, M. (2015). Like parent, like child? Development of prejudice and tolerance towards immigrants. British Journal of Psychology, 107(1), 95 -116. Retrieved from https: //www. researchgate. net/publication/272525071_Like_Parent_Like_Child_Development_of_Prejudice_and_Tolera nce_Towards_Immigrants

How do we apply cultural safety in a health care setting? • • Health care providers are responsible for some of the most vulnerable patients in Canada. Indigenous peoples will be overrepresented in this group of patients. Micro-reconciliation Acknowledgement Witness Moral Courage Pragmatic Solidarity Denial (shame, guilt, indifference) Bear false witness Silence Racism

Micro-reconciliation Unravelling Canada’s colonial history and reimagining a future freed from the past depends on reconciliation that occurs in four spheres: acknowledgement of the wrong doings, the experiences, and the evidences witnessing the ways in which underlying assumptions of racism and microaggression influence health care interactions and other systems and institutional practices of care moral courage, specifically the empowerment of individual practitioners (Indigenous and non-Indigenous) and their professional bodies to name and speak out about injustice engaging in, and advancing pragmatic solidarity as a professional and institutional pathway forward to reconciliation.

How do we apply reconciliation and cultural safety? Macro-Reconciliation Micro-Reconciliation in Health Training of health care providers Training of senior management Built into organizational values The ethics and practice of care: cultural safety-humility and performance outcomes Organizational supports and rewards for “champions of cultural safety” Mentoring the next generation

Moral Courage “Pragmatic solidarity” is having the moral courage to move beyond acknowledgment and witnessing of human suffering, marginalization and injustices. Begins with relationships, respect, relevance, reciprocity and at all times supports the voices of Indigenous peoples to moblize the changes that they want to see. Moral courage also means professional associations and organizations must support Indigenous health leaders at local, regional, provincial and national levels.

How to transform your organization Education yourself and your staff about the history of Indigenous peoples Cultural safety vs cultural competency and cultural awareness “Health Professionals Working With First Nations, Inuit, and Métis Consensus Guideline”. 28 � 8 Wilson, D. , Ronde, S. de la, Brascoupé, S. , Nicole Apale, A. , Barney, L. , Guthrie, B. , … Wolfe, S. (2013). Health 2 Professionals Working With First Nations, Inuit, and Métis Consensus Guideline. Journal of Obstetrics and Gynaecology Canada, 35(6), 550– 553. https: //www. jogc. com/article/S 1701 -2163(15)30915 -4/pdf

Thank you caroline. tait@usask. ca