Australian Indigenous Studies Reflection
Deficit discourse entails the disempowering practice, language, and thought patterns that represent Indigenous people in terms of failures and deficiencies. It mainly entails the discourse that vests responsibility for challenges with the concerned communities or individuals, ignoring the broader socioeconomic variables and structures in which they are anchored (Fogarty, Bulloch, McDonnell, & Davis, 2018). Ethnocentric perception of Aboriginal and Torres Strait Islander deficit has characterised associations with non-Indigenous individuals since colonialism. For instance, in the past, Indigenous people were portrayed as backwards and primitive (Fogarty, Bulloch, McDonnell, & Davis, 2018). The present-day deficit discourse is shaped and in some aspects reinforced by these negative race-based stereotypes. When people republish deficit discourse, they often have positive intentions. They may not have the knowledge that they are basing their arguments on discredited social constructs.
Deficit discourse is mostly prevalent in deficit statistics. A good example is the Closing the Gap report, which systematically compares Indigenous Australians to their non-Indigenous counterparts (Bainbridge, McCalman, Clifford, & Tsey, 2015). In most of these deficit statistics, the Aboriginal status appears to be below the national norms. Besides, deficit statistics may help in politicizing health inequality issues by drawing the attention of the citizens to the failure by the government to provide efficient and culturally accepted services to people. An emphasis on a narrow range of metrics and targets may sometimes depict the reasons for the statistical differences (Paradies, 2016). This may entail the inability to access adequate health services, racism, structural difference, and differences in life choices and values made by Indigenous people that sometimes rank bellow the mainstream norms.
Notably, the standpoints, individual or collective, held by Indigenous and non-Indigenous Australians have contributed to the deficit model. In some discursive areas in Australia, the term Indigenous has been linked with specific negative tropes like being undereducated, socially dysfunctional, violent, unhealthy, and unemployed (Paradies, 2016). Some sub-tropes have also been tied to these tropes. For instance, ‘unhealthy’ is associated with substance abuse, overcrowding, and neglect. Such tropes homogenise Aboriginals and tell them nothing concerning their complex socioeconomic situations and personal lives (Fogarty, Bulloch, McDonnell, & Davis, 2018). It has sometimes been more comfortable for people to assume blatantly or latently that these challenges are derived from the cultural and moral failings of the Aboriginal Australians themselves.
Media and policy have played a critical role in reproducing deficit discourse. Political and media discourses often work closely to establish negative concepts of Indigenous identity with negative results for health policies (Taylor & Guerin, 2019).The reproduction, distribution, reception, and circulation of discourses of Indigenous health and wellbeing through various media channels occupy specific ideological and political spaces. The government and citizens can alter this trend by adopting a strength-based strategy that emphasises human rights, culture, holism, wellbeing, and partnership as a foundation for delivering health care services.
The Occupational Therapy Board of Australia [OTBA] has introduced the new occupational standards for Australian occupational therapists (Occupational Therapy Board of Australia, 2018). The standards became effective on January 1, 2019. Occupational therapists need to know what these standards mean for them and their professional practice. They are developed for all occupational therapists working in various settings such as research, management, education, and other roles that do not involve direct contacts with patients or clients. They are four standards: the occupational therapy process and practice, communication, knowledge and learning, and professionalism.
An occupational therapist is required to act in a safe, lawful, accountable, and ethical manner to support clients in improving their health and wellbeing through occupation and considering the individuals in their environments. They should comply with the standards and code of conduct proposed by OTBA (Occupational Therapy Board of Australia, 2018). Besides, occupational therapists are required to incorporate and respond to historical, cultural, political, environmental, economic, and societal factors that influence health occupations, wellbeing, and safety of Indigenous people and communities. They should exhibit cultural awareness and respect the diverse cultures of the Aboriginal communities. Furthermore, the standard requires them to collaborate and consult ethically for effective interprofessional and patient-centred practice. They must practice within the limits of their levels of expertise and competence.
Knowledge and Learning
The behaviours, knowledge, and skills of occupational therapists in practice should be informed by contemporary theory, evidence, and practice theory. They should be developed and maintained through continuous learning and professional development. Occupational therapists should apply informed knowledge and current evidence in decision-making and professional practice (Di Tommaso, Isbel, Scarvell, & Wicks, 2016). They are required to understand and respond to the health philosophies, research, practices, and leadership models of Indigenous people. Furthermore, they should maintain updated knowledge of the cultural responsiveness of different groups in Australia in their practice setting (Occupational Therapy Board of Australia, 2018). They should implement targeted learning and develop actionable plans when moving to new areas of practice or when returning to practice. Finally, they should maintain digital literacy and knowledge and relevant technologies and resources for their practice.
Occupational Therapy Process and Practice
Occupational therapists must acknowledge the association between human occupation, wellbeing, and health. Their practice must be client-centred for populations, communities, groups, and individuals (Di Tommaso, Isbel, Scarvell, & Wicks, 2016). An occupational therapist must address the participation and occupational performance of clients and identify the barriers and enablers of engagement, perform appropriate data gathering and analysis when identifying a customer’s strengths, status, functioning, goals, and occupational performance, collaborate with the client and other relevant stakeholders to identify their occupational therapy goals and priorities and develop plans with the clients and other relevant people to meet designated occupational therapy objectives. They are required to select and implement safe and culturally responsive practice strategies to meet the occupational therapy needs of the clients and seek to identify, understand, and appreciate Indigenous people’s experiences, cultural connections, wellbeing, and health in their practice (Occupational Therapy Board of Australia, 2018). Occupational therapists should also reflect on their practice to communicate and make informed professional decisions and identify and use relevant protocols and practice guidelines suitable for their practice settings or work environments.
Occupational therapists are expected to work in a safe, ethical and lawful manner to support the health and wellbeing of the clients. They should appreciate the culture and environments of the clients when offering their services (Paradies, 2016). Thus, the key to this standard is the need to enhance cultural responsiveness concerning Aboriginal cultures. Aboriginal communities have a higher likelihood to access health care services when providers understand their underlying cultural, social, and economic issues (Di Tommaso, Isbel, Scarvell, & Wicks, 2016). By ensuring professionalism, occupational therapists will develop respectful working partnerships with Indigenous Australians because they will be able to offer culturally accepted services. Bainbridge et al. (2015) view cultural competency as a critical strategy in minimising healthcare access inequalities and bolstering healthcare quality and effectiveness for Indigenous Australians. Implementing and anchoring cultural competence on health care services demands sustained emphasis on awareness, behaviour, knowledge, attitudes, and skills at different service levels.
Knowledge and Learning
The knowledge, behaviours, and skills in practice are maintained and improved by ongoing learning and professional development. Key to this standard is the need to be up-to-date with new evidence relevant to the practice and to modify, reflect and use modern assistive technology (Occupational Therapy Board of Australia, 2018). It is only through learning that occupational therapists can get to understand and respond to the leadership, practices, and cultural philosophies of Indigenous Australians. They will also be able to develop successful partnerships with these communities by understanding and learning to appreciate their values and norms. Furthermore, through learning, occupational therapists will understand the different social health determinants associated with Aboriginal communities and provide culturally accepted remedies to their clients. According to Taylor and Guerin (2019), social determinants have a strong link with desirable health outcomes.
OT Process and Practice
On Occupational therapist must acknowledge the relationship that exists between a person, occupation, health and the environment. Their practice should be client-centered (Occupational Therapy Board of Australia, 2018). The standard address occupational performance, goals, and collaboration. The standard allows occupational therapists to establish successful partnerships and positive relationships with Aboriginal Australians by ensuring they implement safe and culturally responsive health care strategies that suit the Aboriginal environments and occupation therapy goals. Occupational therapy mainly aims to prevent and overcome emotional, social, or physical disabilities among clients of different ages. Many factors contribute to low social status and health of Indigenous people in Australia (Di Tommaso, Isbel, Scarvell, & Wicks, 2016). Among these factors is the lack of a treaty with the Indigenous community. Occupational therapists must understand these factors when designing their treatment strategies.
Bainbridge, R., McCalman, J., Clifford, A., & Tsey, K. (2015). Cultural competency in the delivery of health services for Indigenous people. Issues paper no. 13 Produced for the Closing the Gap Clearinghouse.
Di Tommaso, A., Isbel, S., Scarvell, J., & Wicks, A. (2016). Occupational therapists’ perceptions of occupation in practice: An exploratory study. Australian Occupational Therapy Journal, 63(3), 206-313.
Fogarty, W., Bulloch, H., McDonnell, S., & Davis, M. (2018). Deficit Discourse and Indigenous Health: How Narrative Framings of Aboriginal and Torres Islander People are Reproduced in Policy. Melbourne: The Lowitja Institute.
Occupational Therapy Board of Australia. (2018). Australian occupational therapy competency standards 2018. Retrieved from https://www.occupationaltherapyboard.gov.au/Codes-Guidelines/Competencies.aspx
Paradies, Y. (2016). Colonisation, racism and indigenous health. Journal of Population Research, 33, 83-96.
Taylor, K., & Guerin, T. P. (2019). Health Care and Indigenous Australians : Cultural Safety in Practice (3rd ed.). London, UK: Macmillan Education.