Occupational Therapists practising in Australia have a professional responsibility to work respectfully and safely with Aboriginal and Torres Strait Islander Peoples.

For AAOT practitioners, this responsibility extends to assistance-animal practice.

An Aboriginal or Torres Strait Islander person considering or using an assistance animal does not arrive at an assessment simply as:

a person with a disability who may benefit from an animal.

They bring their own identity, family and community relationships, experiences, knowledge, values, connection to Country and culture, and individual circumstances.

Historical and contemporary experiences of colonisation, dispossession, racism, discrimination and interactions with government and healthcare systems may also influence people’s experiences of services.

Culturally responsive practice therefore requires substantially more than knowing a list of cultural customs.

It requires practitioners to consider relationships, power, history, communication, assumptions, systems and their own professional practice.

This is why WAFA asks AAOT participants to undertake foundational First Nations cultural-awareness learning before applying these concepts to assistance-animal practice.

Cultural Awareness Is a Starting Point, Not the Endpoint

You will encounter terms such as:

• cultural awareness;
• cultural sensitivity;
• cultural competence;
• cultural capability;
• cultural responsiveness; and
• cultural safety.

They are related, but they should not automatically be treated as interchangeable.

A short cultural-awareness course can introduce important knowledge.

It cannot make somebody an expert in Aboriginal and Torres Strait Islander cultures.

Nor should completing a course allow a practitioner to declare:

“I am culturally safe.”

Cultural safety is particularly important here because it shifts attention away from the practitioner’s intention alone.

Under the National Scheme definition used by Ahpra, cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities. Culturally safe practice requires ongoing critical reflection on practitioner knowledge, attitudes, behaviours, biases and power differentials, alongside recognition of colonisation and systemic racism.

In other words:

We do not get to decide for somebody else that our practice felt culturally safe.

Why This Is Particularly Relevant to Occupational Therapy

Cultural responsiveness is already part of contemporary Australian Occupational Therapy expectations.

Australian OT professional standards require practitioners to recognise historical, political, cultural, societal, environmental and economic factors affecting Aboriginal and Torres Strait Islander Peoples’ health, wellbeing and occupations, as well as considering the influence of their own values and culture upon practice.

Recent peer-reviewed Australian research also supports the importance of this approach.

A 2024 systematic scoping review of culturally responsive OT practice with First Nations Peoples identified the importance of relationships, practitioner self-reflection, recognising cultural biases, privileging First Nations voices and critically examining the Western foundations of Occupational Therapy practice.

These concepts have considerable relevance to AAOT.

There Is No Single “Aboriginal Culture”

One of the first things an AAOT should understand is the enormous diversity among Aboriginal and Torres Strait Islander Peoples.

Do not approach practice with a checklist that assumes:

Aboriginal client = these beliefs, these family structures, these communication preferences and these attitudes toward animals.

Australia contains diverse Aboriginal and Torres Strait Islander:

• Nations;
• communities;
• languages;
• histories;
• cultural practices;
• kinship structures;
• experiences;
• urban, regional and remote contexts; and
• relationships with Country.

People also differ individually.

A person may have a very strong connection with particular cultural practices.

Another person may not.

A person may live on Country.

Another may live hundreds or thousands of kilometres from their Country.

Someone may want family or community extensively involved in decisions.

Someone else may prefer an individual consultation.

The culturally responsive response is not to guess.

Ask, listen and avoid assumptions.

History Matters to Contemporary Practice

An AAOT does not need to become a historian before working with Aboriginal and Torres Strait Islander clients.

However, culturally responsive practice requires some understanding that contemporary relationships with healthcare, disability and government systems do not exist in a historical vacuum.

Participants should have foundational awareness of matters including:

• colonisation;
• dispossession;
• removal from Country;
• discriminatory laws and policies;
• the Stolen Generations;
• institutionalisation;
• restrictions upon autonomy;
• racism;
• health inequities; and
• continuing structural disadvantage.

These histories can affect contemporary relationships with institutions and professionals.

A practitioner who does not understand this context might interpret caution toward a service as:

“non-compliance”

or:

“lack of engagement”.

A culturally responsive practitioner asks a different question:

What might be influencing this person’s experience of our service, and what can we do differently?

Cultural Safety Is About Power

This connects directly with concepts you have already explored in the Human Rights Model of Disability and Supported Decision-Making.

Professionals hold power.

An Occupational Therapist may influence:

• access to services;
• funding recommendations;
• NDIS evidence;
• assistance-animal recommendations;
• workplace or educational adjustments;
• reports relied upon by other professionals; and
• how a person’s circumstances are represented in official records.

The participant may know that a few sentences in an OT report could significantly affect what happens next.

That creates a power imbalance.

Culturally responsive practice requires the practitioner to recognise rather than pretend that imbalance does not exist.

Relationships May Come Before Assessment

Western health systems can prioritise efficiency:

appointment → assessment → form → recommendation → discharge

But good practice with a particular person may require greater emphasis upon establishing trust and relationships.

This does not mean making assumptions about what every First Nations client wants.

Rather, an AAOT should consider whether their usual assessment process unnecessarily prioritises administrative efficiency over relationship-building.

The 2024 Australian OT scoping review specifically identified establishing relationships with First Nations Peoples as an important feature of culturally responsive OT practice. (Wiley Online Library)

Sometimes the most important thing you achieve in an initial appointment is not completing your assessment template.

It may be establishing enough trust for a meaningful assessment to occur later.

Ask Who Should Be Involved

Individualistic healthcare models can assume that decisions occur primarily between:

client + practitioner

This may not always reflect how the person wants decisions to be made.

Depending upon the individual, they may wish to involve:

• family;
• carers;
• Elders;
• community members;
• Aboriginal health professionals;
• Aboriginal liaison staff;
• advocates; or
• other trusted people.

Do not assume they want these people involved simply because they are Aboriginal or Torres Strait Islander.

Ask.

Similarly, do not exclude people who are important to the person merely because your normal assessment process expects an individual appointment.

Country, Community and Environment Matter to Assistance-Animal Assessment

Assistance-animal assessment is inherently environmental.

The animal does not work inside an OT report.

It works in the person’s actual life.

For an Aboriginal or Torres Strait Islander participant, this may require understanding environments and occupations that your standard assessment template does not adequately capture.

Consider:

• Where does the person live?
• Where do they travel?
• What occupations are important?
• What community environments do they participate in?
• What is their connection with Country?
• Are there cultural activities relevant to planning?
• What environmental conditions will the animal encounter?
• What other animals are present?
• What transport is available?
• How accessible is veterinary care?
• What happens during travel?
• Are services available locally?
• Would the proposed assistance-animal model actually work in this person’s circumstances?

The answers may substantially influence whether an assistance animal is appropriate and, if so, what the partnership needs to look like.

Remote and Regional Practice May Require Different Thinking

Some established assistance-animal systems are implicitly designed around metropolitan assumptions.

For example:

regular access to specialist trainers

• nearby veterinary services
• reliable public transport
• frequent face-to-face professional appointments
• access to equipment and supplies.

Those assumptions may not apply everywhere.

A person living in a rural or remote community may encounter:

• long travel distances;
• limited veterinary availability;
• limited specialist animal-training services;
• higher transport costs;
• different environmental conditions;
• limited access to replacement equipment;
• fewer disability services; and
• difficulties obtaining ongoing professional support.

These factors should not automatically exclude someone from an assistance-animal pathway.

They require better planning.

A metropolitan service model should not be treated as the universal definition of good assistance-animal practice.

Animals May Have Different Cultural Meanings

Animals do not necessarily have identical cultural meanings for every person or community.

Do not assume that because you see a dog as:

companion + disability aid + working animal

the person, their family or community necessarily conceptualises the animal in exactly the same way.

Likewise, do not assume that an Aboriginal or Torres Strait Islander person holds a particular cultural belief about dogs or other animals.

Ask appropriate questions.

Listen.

Where cultural knowledge is outside your expertise, recognise that limitation.

This is another example of why cultural humility is preferable to attempting to memorise “facts about Aboriginal culture” and then applying them indiscriminately.

Assistance-Animal Practice Can Create New Cultural Questions

Assistance animals may introduce situations requiring careful discussion.

For example:

• Is the animal appropriate within the person’s household?
• How do family members feel about it?
• What role does the animal have within the household?
• Where will it sleep?
• Who will care for it?
• Are there other community animals?
• How will training occur?
• What environments will it enter?
• Are there cultural or community considerations that the practitioner does not understand?
• Who could appropriately advise?

The answer is not for an AAOT to become an authority on somebody else’s culture.

The professional skill is recognising:

I may not know enough about this. Who should I ask?

Avoid Deficit-Based Thinking

First Nations healthcare has historically been characterised by substantial deficit-focused language.

Professionals may concentrate upon:

• disadvantage;
• disease;
• dysfunction;
• risk;
• poor outcomes; and
• what communities supposedly “lack”.

These issues cannot simply be ignored.

However, culturally responsive practice should also recognise:

• strengths;
• resilience;
• knowledge;
• relationships;
• family and community resources;
• cultural identity;
• connection to Country;
• existing strategies; and
• self-determination.

The 2024 OT literature emphasises both First Nations strength and resilience and the need for practitioners to privilege First Nations voices rather than reinforcing oppressive systems through established professional practice.

This aligns closely with the strengths-based approach introduced earlier in AAOT.

Be Careful With Standardised Assessment

Occupational Therapists use many standardised tools.

These can be valuable.

But an AAOT should consider whether a tool:

• has been validated with the population in question;
• relies upon culturally specific assumptions;
• assumes a particular family structure;
• assumes particular occupations are important;
• uses inappropriate language;
• interprets communication through a Western framework; or
• adequately captures the person’s actual environment.

A standardised score should not automatically override what the person is telling you about their own life.

Where a tool has limitations, acknowledge them.

Cultural Safety Includes Examining Yourself

Cultural responsiveness is not simply knowledge about another culture.

It also requires examining your own.

Every practitioner brings assumptions about:

• independence;
• family;
• disability;
• animals;
• professionalism;
• communication;
• time;
• health;
• acceptable risk;
• evidence;
• decision-making; and
• what a “good life” looks like.

Some of these assumptions may come from Occupational Therapy.

Some may come from broader Australian culture.

Some are personal.

The practitioner needs to ask:

Which of my assumptions am I treating as universal?

This reflective component is central to cultural safety. Ahpra’s framework explicitly requires practitioners to examine their own biases, assumptions, stereotypes and prejudices and recognise power differentials in healthcare.

Cultural Safety Is Ongoing

Completing the required foundation training does not mean:

“I have completed cultural safety.”

There is no such endpoint.

Knowledge changes.

Communities differ.

People differ.

Language develops.

Your own understanding develops.

Culturally responsive practice requires continued:

• learning;
• listening;
• reflection;
• consultation;
• relationship-building; and
• willingness to recognise mistakes.

Sometimes the appropriate professional response is simply:

I don’t know. I need to seek appropriate guidance.

That is preferable to confidently applying an assumption.

First Nations Leadership and Consultation

Where practice questions specifically concern Aboriginal and Torres Strait Islander Peoples, AAOT practitioners should seek appropriate First Nations expertise and leadership rather than assuming that mainstream professional organisations can speak on behalf of First Nations communities.

Depending upon the context, this may involve engagement with:

• Aboriginal Community Controlled Health Organisations;
• Aboriginal health workers and practitioners;
• Indigenous allied health professionals;
• local community organisations;
• appropriate Elders or community representatives; and
• First Nations professional bodies.

The appropriate person or organisation will depend upon the issue and the community concerned.

Consultation should also be meaningful.

It should not amount to:

“We already decided what we are doing; can you approve it?”

Cultural Safety Is a Professional Responsibility

This learning is not an optional extra because an OT happens to be particularly interested in First Nations health.

Australian health-practitioner standards explicitly recognise cultural safety for Aboriginal and Torres Strait Islander Peoples. Ahpra’s current Shared Code states that practitioners should consider the specific needs of Aboriginal and Torres Strait Islander Peoples and foster open, honest and culturally safe professional relationships.

For Occupational Therapists specifically, culturally responsive practice is also reflected in professional competency expectations.

Therefore, the purpose of including this topic within AAOT is not to turn participants into specialists in First Nations health.

It is to reinforce that culturally safe practice is part of competent professional practice.

What This Means for an AAOT

When working with an Aboriginal or Torres Strait Islander participant, consider questions such as:

What do I actually know about this person, and what have I merely assumed?

Have I taken sufficient time to establish a relationship?

Who does the person want involved?

Is my communication appropriate and accessible?

Am I privileging professional knowledge over the person’s lived experience?

What historical or systemic factors may be relevant?

What strengths, relationships and community resources exist?

Am I imposing metropolitan or Western assumptions upon the assistance-animal pathway?

Does my assessment process actually fit this person’s circumstances?

What cultural or community considerations might affect the animal?

Is the proposed intervention sustainable where the person actually lives?

Have I examined my own biases and assumptions?

Is there knowledge here that sits outside my professional or cultural expertise?

Who would be appropriate to consult?

Most importantly:

Am I listening to the person rather than trying to demonstrate how much I know about their culture?

Connecting This Topic to the Rest of AAOT

This topic connects strongly with the material you have already completed.

Human rights remind us that Aboriginal and Torres Strait Islander Peoples are rights-holders.

The Human Rights Model of Disability reminds us to examine structural and environmental barriers rather than locating every problem within the individual.

Supported Decision-Making reminds us to protect the person’s voice and avoid unnecessary professional paternalism.

NDIS participant rights remind us of autonomy, dignity, safeguarding and choice and control.

Culturally responsive practice asks us to bring these ideas together while also recognising:

history + culture + Country + relationships + power + self-determination + individual experience.

These principles are particularly important because cultural safety is ultimately determined by First Nations people themselves, not by the practitioner’s belief that they have behaved appropriately.

Continue This Topic in Your Reflective Workbook

You have now completed the foundation material for:

Topic 6 — First Nations Cultural Awareness and Culturally Safe Practice

Please complete the recommended First Nations cultural-awareness learning identified in your AAOT Foundation Learning requirements and then refer to the corresponding section of your AAOT Foundation Learning Reflective Workbook.

The workbook will ask you to consider issues such as:

• cultural awareness compared with cultural safety;
• the diversity of Aboriginal and Torres Strait Islander Peoples;
• historical and contemporary influences upon healthcare relationships;
• trust and relationship-building;
• practitioner power;
• self-determination;
• family and community involvement;
• Country and environment;
• rural and remote assistance-animal practice;
• assumptions about animals;
• culturally responsive assessment;
• strengths-based rather than deficit-based practice;
• consultation and professional scope; and
• your own cultural assumptions and biases.

The purpose is not to test whether you can memorise facts about Aboriginal and Torres Strait Islander cultures.

We want you to demonstrate that you can reflect upon your own practice, recognise where your knowledge is limited, listen to the individual, identify when consultation is required and consider how assistance-animal practice can be made culturally responsive and safe.

You may return to these questions throughout AAOT as your understanding develops. The issues you identify may also contribute to your Capstone Portfolio and Capstone projects, particularly where you explore accessibility, culturally responsive service delivery, rural and remote assistance-animal practice, health inequities, professional education or sector reform.

A useful peer-reviewed starting point for further reading is Meechan et al. (2024), Culturally responsive occupational therapy practice with First Nations Peoples—A scoping review, which specifically examines Australian OT practice and the Indigenous Allied Health Australia Cultural Responsiveness in Action Framework.

Once you have completed or commenced the corresponding workbook activities, continue to Topic 7 — Neurodivergent-Affirming Practice.