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Indigenous Cultural Safety, Humility, and Anti-Racism Standard of Practice

CMTBC Standards of Practice

Purpose

Practice standards define the minimum level of expected performance for registered massage therapists, and therefore define what constitutes safe, ethical, and competent delivery of care by RMTs.

RMTs are responsible for exercising their professional judgment to apply the standards to the situations that they face in practice.

Description

The purpose of this standard is to set clear expectations for how registered massage therapists (RMTs) are to provide culturally safe and anti-racist care for Indigenous patients.

This standard is organized into six core requirements.

Definitions

Indigenous Peoples is a collective noun that describes First Nations, Inuit and Métis people. Indigenous Peoples are not a homogenous group, and their languages, culture, customs, traditions, and spirituality vary in important ways.

Indigenous-specific racism is the historic and ongoing race-based discrimination, negative stereotyping and injustice experienced by Indigenous people. It contributes to and perpetuates power imbalances, systemic discrimination, and inequitable outcomes – including health outcomes – stemming from colonial policies and practices.

Cultural humility refers to a process of ongoing self-reflection and self-critique that begins with an in-depth examination of the RMT’s assumptions, beliefs, biases, and privilege, as well as the goals of the patient-therapist relationship. It involves humbly acknowledging oneself as a learner and promotes patient/RMT relationships based on mutual respect, open and effective communication and mutual trust and decision-making.

Cultural safety occurs when the Indigenous person receiving care experiences the treatment and the treatment environment as respectful, safe and allowing for meaningful communication and service. A culturally safe environment is one that is experienced as being physically, socially, emotionally and spiritually safe, without challenge, ignorance or denial of the patient’s identity.

2SLGBTQQIA+ (two spirited, lesbian, gay, bisexual, transgender, queer, questioning, intersex and asexual) is the acronym used to refer to a community of gender-diverse people across all Indigenous Peoples, while recognizing the limitations of any acronym.

Requirements

  1. Building knowledge through education

    RMTs continually seek to improve their ability to provide culturally safe care for Indigenous patients by:
    1. Learning about colonialism, including the historical and current impacts of colonialism and trauma (personal and intergenerational) on Indigenous Peoples and how this may impact their health care experiences and lack of access to and exclusion from health care services, including massage therapy.
    2. Learning about the negative impact of Indigenous-specific racism on patients accessing the health care system, and its disproportionate impact on Indigenous women and girls and 2SLGBTQQIA+ people.
    3. Undertaking ongoing education on Indigenous health care, determinants of health, cultural safety, cultural humility, and anti-racism.
    4. Learning about the Indigenous communities located in the areas where they work, recognizing that languages, histories, heritage, cultural practices, and systems of knowledge may differ between Indigenous communities, and building relationships with and within those communities where possible.
  2. Self-reflective practice

    RMTs practice in a self-reflective manner by:
    1. Reflecting on, identifying, and not acting on any stereotypes, assumptions or misconceptions they may hold about Indigenous Peoples.
    2. Reflecting on how their own privileges, biases, values, belief structures, behaviours, and position of power as an RMT may impact the therapeutic relationship with patients.
    3. Evaluating and seeking feedback on their own behaviour towards Indigenous people.
  3. Creating culturally safe massage therapy treatment experiences

    RMTs embed cultural safety and humility within massage therapy practice by:
    1. Treating patients with compassion, respect and empathy.
    2. Acknowledging the patient’s cultural identity.
    3. Listening to and holding space for the patient’s lived experiences.
    4. Being open to learning from the patient and others.
    5. Within the RMT’s scope of practice, caring for a patient holistically, considering their physical, mental/emotional, spiritual, and cultural needs.
    6. Acknowledging and respecting Indigenous cultural rights, values, and practices, including ceremonies and protocols related to illness, birth, and death.
    7. Respecting a patient’s request to have a family or community member present during a massage therapy appointment or any portion of the appointment.
  4. Relational and patient-centred care

    RMTs provide relational and patient-centered care1 by:
    1. Respectfully listening to the patient about the reasons the patient has sought massage therapy.
    2. Engaging with patients and their identified supports to identify, understand, and address the patient’s health and wellness goals, including through home care recommendations.
    3. Actively supporting the patient’s right to decide on their treatment plan.
    4. Providing the patient with the necessary time and space to share their needs and goals.
    5. Ensuring that they have a current and clear understanding of the requirements of CMTBC’s Consent Standard of Practice and that they apply these requirements when treating Indigenous patients.
  5. Trauma-informed practice2

    RMTs practice in a trauma-informed manner by:
    1. Recognizing the potential for trauma (personal or intergenerational) in a patient’s life and adapting their approach to be thoughtful and respectful of this, including seeking informed consent during patient intake, and before engaging in assessments or treatments.
    2. Recognizing that colonialism and trauma may affect how patients view, access, and interact with the health care system and health care providers generally, including RMTs.
    3. Recognizing that Indigenous women and girls and 2SLGBTQQIA+ people are disproportionately impacted by Indigenous-specific racism in the health care system and consider the impact gender-specific trauma may have on the patient.
    4. Working with the patient to incorporate their personal strengths that will support the achievement of their health and wellness goals.
  6. Anti-racist action

    RMTs take appropriate action when others act in a racist or discriminatory manner towards Indigenous people by:
    1. Helping colleagues to identify and eliminate racist attitudes, language, or behaviour.
    2. Supporting patients, colleagues, and others who experience and/or report acts of racism.
    3. Reporting acts of racism to relevant health regulatory colleges.
1 “Patient-centred care means the RMT is dedicated to professional excellence in responsible care and serving the best interests of the patient at all times. This enables the patient to make informed choices about their treatment and/or options.” (CMTBC: Cultural Safety and Humility – Applications to Practice for RMTs)
2 Trauma-informed Practice is a framework grounded in an understanding of and responsiveness to the impact trauma has when providing patient-centred care. It emphasizes physical, psychological, emotional, and spiritual safety for all patients, preventing the patient from experiencing further trauma.

Applications to Practice

RMTs are encouraged to read the Applications to Practice page, published by CMTBC in September 2022, for comprehensive information that supports application of the Indigenous Cultural Safety, Humility, and Anti-Racism standard to practice.

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