Cultural Safety in Emergency Support Services
ABSTRACT
Wildfire and flood events of recent years, including this year, have stretched and tested British Columbia’s Emergency Support Services (ESS) system, a provincial program designed by Emergency Management BC (EMBC) to support evacuees. After action reviews from the 2017 and 2018 wildfire and flood seasons, demonstrate ESS approaches fell short of providing fully adequate support to Indigenous communities. Building upon a Master’s thesis which was designed using Indigenous research methodologies and action research engagement principles, I asked the question: “How might emergency management practitioners braid cultural safety and a respect, honouring and celebration of Indigenous traditional knowledge, and community-based practices into ESS training and practices?” This article offers a summary of findings and recommendations for practical application for communities and emergency management organizations across the country. The findings include:
Finding 1 was a theme related to the context and the current state of emergency services evacuations in 2020. This included the social and historical contexts, jurisdiction, and roles and responsibilities.
Finding 2 focused on the participants’ perspectives of a definition of ‘Cultural Safety,’ which included the identification of specific competencies, a focus on trust-based relationships, and a connection to land.
Finding 3 focused on the evacuation and registration process, including keeping families together, the use of community ‘navigators,’ (key individuals with knowledge of community protocol trusted by the community), and suggestions for reception centres in the process of registering evacuees.
Finding 4 was about providing appropriate supports and services to evacuate communities, including providing traditional food, appropriate accommodation, transportation, language, culture and cultural protocols, and including pets.
Finding 5 encompassed knowledge and training required for ESS professionals engaged in evacuation of communities. This included content for culturally relevant ESS training, which need to be codesigned and led by indigenous cultural navigators, as well as incorporating evaluation and public education.
Finding 6 is on the theme of Planning and Preparedness, and includes subtopics of relationships, professional capacity, emergency and evacuation plans, personal preparedness and responder self-care and wellness.
Keywords: Emergency Management, Cultural Safety, Indigenous, Evacuee Care, Evacuation, Emergency Services, Wildfire, Disaster Resilience
AUTHORS
Kayla Pepper, Royal Roads University
INTRODUCTION
Emergency Support Services (ESS) is a provincial government program in British Columbia managed by Emergency Management British Columbia (EMBC) and delivered in communities by First Nations and local governments in response to small- or large-scale emergency events such as house fires, wildfires, floods or landslides. The program was designed to provide short-term assistance to evacuees by providing access to food, clothing, shelter, and incidentals (i.e. personal hygiene items). Indigenous communities in British Columbia have been disproportionately impacted by emergency events yet have had little influence in designing and delivering the services they receive as evacuees or are encouraged to administer as First Nations governments (Mihychuk, 2018). This lack of representation resulted in Indigenous evacuees experiencing discrimination, feelings of exclusion, and cultural unsafety because Indigenous values and ways of knowing were absent from the evacuation process (Mihychuk, 2018; Sharp & Krebs, 2018).
This research through Royal Roads University was built upon the Indigenous Relations Behavioural Competencies (BC Public Service, 2020), the social determinants of health, and cultural safety research within the fields of health and child/youth care (Ball, 2009; Brascoupé & Waters, 2009; Martin, 2012; Owens, 2019). It also explored the intersection of Indigenous knowledge and experiences in emergency management both through peer-reviewed literature (Becker et al., 2008; Dicken, 2007; Poole, 2019) and the after-action reviews of wildfire and floods events in British Columba from the last five years (Abbott & Chapman, 2018; Sharp & Krebs, 2018; Shields, 2018; Verhaeghe et al., 2019). The overarching methodology, study design, data collection methods, data analysis methods, measures of validity, and ethical considerations were grounded in Indigenous research and decolonizing methodologies (Kovach, 2009; Strega & Brown, 2015), the concepts of “two- eyed seeing” (Colbourne et al., 2019; Marshall & Bartlett, 2018) and “relational accountability” where “systems of knowledge are built on the relationships that we have not just with people or objects, but relationships that we have with the cosmos, with ideas, concepts, and everything around us” (Wilson, 2001, p. 177). Strong relationships are central to creating change. The research explores the question, “How might emergency management practitioners braid cultural safety and respect, honouring and celebration of Indigenous traditional knowledge, and community-based practices into ESS training and practices?”
METHODOLOGY
The research question was explored through three virtual small group sessions with 23 Indigenous community emergency management or ESS support organization professionals, as well as five individual semi-structured interviews. The five cultural safety principles ofpartnerships, personal knowledge, protocols, process, and positive purpose were employed (Ball, 2009). The group methods were designed based on the Circle Way (Baldwin & Linnea, 2010) and focused on how practitioners defined cultural safety in ESS, what actions could be taken, and how cultural safety might be measured. Indigenous research methodologies (Kovach, 2009), decolonizing methodologies, and action research engagement principles were at the core of this project. Rather than force participants’ narratives to fit the study’s chosen methodologies, the researcher remained flexible to the generative data collection processes using a “bricolage” approach as described by Steinburg (2006, p. 119), “taking research strategies from a variety of scholarly disciplines and traditions as they are needed in the unfolding context of the research situation” (Lowan-Trudeau, 2012, p. 116).
Other methodological influences included intersectionality, feminist participatory action research (PAR) (Gatenby & Humphries, 2000; Gopaldas, 2013; Smooth, 2013) and appreciative inquiry (Agger-Gupta & Perodeau, 2016; Bushe, 2005, 2012). The researcher was drawn to participatory action research (PAR) and feminist research because they have been “developed by researchers aiming for involvement, activism and social critique for the purpose of liberatory change” (Gatenby & Humphries, 2000, p. 89). Appreciative inquiry complements these methodologies because “as a research method it is not interested in discovering what is but in allowing a collective to uncover what could be” (Bushe, 2012 p. 14). After emergency events, after-action-reviews often point to what went wrong, but the researcher chose to focus participants on conversations about how to shape a safer, more inclusive future in ESS. “The critical element in an Appreciative Inquiry (AI) process is therefore about exploring possibilities for appreciation and what could be done rather than a deficit-focused repair of something gone wrong” (Agger-Gupta & Perodeau, 2016, p. 2). This blend of methodologies aligned with culturally safe research because of the focus on supportive, strengths-based, and solution-oriented conversations.
Once the data was collected, an in vivo coding method was used to analyze the data based on the verbatim words spoken by participants (Saldana & Omasta, 2017). Information was organized into thematic codes, which then became the foundation of the findings, conclusions, and recommendations.
Results and Discussion
The following six findings stand out from analyzing the data.
Finding 1 was a theme related to the context and the current state of emergency services and evacuations in 2020. This included the social and historical contexts, jurisdiction, and roles and responsibilities. Finding 2 focused on the participants’ perspectives of a definition of ‘Cultural Safety,’ which included the identification of specific competencies, a focus on trust-based relationships, and a connection to land. Finding 3 focused on the evacuation and registration process, including keeping families together, the use of community ‘navigators’ (key individuals with knowledge of community protocol trusted by the community), and suggestions for reception centres in the process of registering evacuees. Finding 4 was about providing appropriate supports and services to evacuate communities, including providing traditional food, appropriate accommodation, transportation, language, culture and cultural protocols, and including pets. Finding 5 encompassed knowledge and training required for ESS professionals engaged in the evacuation of communities. This included content for culturally relevant ESS training, which needs to be codesigned and led by Indigenous cultural navigators, as well as incorporating evaluation and public education. The last finding, Finding 6, is on the theme of planning and preparedness and includes subtopics of relationships, professional capacity, emergency and evacuation plans, personal preparedness and responder self-care and wellness.
What was apparent was that ESS does not exist in a vacuum; it is intricately entwined with the broader emergency management and health systems and organizations in BC and Canada. Activities in emergency management also occur within the unique historical and cultural contexts of responders and evacuees. Participant 17 noted how important it is to understand “that culture affects our worldview, how we experience disasters, a history of intergenerational trauma, past traumas, the residential schools, the past pandemics, even power dynamics.” This context is foundational to understanding the findings, recommendations, and conclusions.
Participants defined ‘cultural safety’ within the ESS context and provided recommendations for a reimagined system of evacuee care that is culturally safe, relevant, and supports the holistic well-being of all people and those who care for them (including mental, emotional, spiritual well-being, as well as physical safety). The group co-created the following definition of “cultural safety in Emergency Support Services”:
“Cultural safety is defined as creating safe spaces, free from discrimination, where Indigenous people, families and communities can continue practicing their culture even when displaced. ESS practitioners accompany evacuees with humility, open listening, kindness, compassion, respect, and consideration for themselves and others’ mental, emotional, physical, spiritual, and cultural well-being.”
The findings of the research were presented in a recommendation report which was shared with participants for their input and validation before using that data in a thesis. A meeting with EMBC partners in Fall 2020 was held to prioritize actions and design the path forward. To support a transformative, long-term systems change process, the recommendations were organized using Margo Greenwood’s framework, which depicts three interconnected layers of structural change, system change and service delivery to support the integration of cultural safety in BC’s health care system (Greenwood, 2019).
Research Outcomes
Based on the findings in this research project, the literature, and the organizational realities at EMBC, this section outlines the six outcomes.
Outcome 1: ESS needs a cultural safety framework
This research project revealed the program might benefit from working with Indigenous partners to co-develop, co-implement and co-evaluate an overarching cultural safety in ESS framework. A foundational framework would knit together cultural safety concepts and commitments within the ESS program and its program guide. Systems thinking principles also ensure that everyone is involved who needs to be involved, and positive change occurs across the multiple layers of the system (Senge, 2006; Stroh, 2015).
Systems analysis is key to transforming ESS teams into learning organizations prepared to provide “place-based” or “whole systems approach” results by “moving away from the siloed structures and programmatic measures of success” and rather listening deeply and strengthening partnerships on behalf of shared strategies and goals (Stroh, 2015, p. 63). This approach aligns with the international emergency management Sendai Framework for Disaster Risk Reduction, which promotes an ‘all-of-society’ approach to increase community disaster resilience through interagency and cross-community collaboration amongst all who play a role in supporting those impacted by emergency events (United Nations Office for Disaster Risk Reduction, 2015).
Outcome 2: Cultural safety needs to be an outcome of ESS practices
While definitions of “cultural safety” varied, some common behavioural competencies and practices might benefit all people who deliver or receive Emergency Support Services.
Participants defined cultural safety as creating safe spaces, free from discrimination, where Indigenous people, families and communities can continue practicing their culture even when displaced. This is achieved when ESS practitioners accompany evacuees with humility, open listening, kindness, compassion and respect, and consideration for self and others’ mental, emotional, physical, spiritual and cultural well-being. Working in cross-cultural ways requires a “two eyed seeing approach” that honours and upholds both Indigenous and Western ways of knowing. This definition of cultural safety in ESS aligned with existing definitions of cultural safety found across the literature, including where ‘unsafe practices’ were defined as “any actions that diminish, demean or disempower the cultural identity and well-being of an individual” (Cooney, 1994 as cited by Brascoupe & Waters, 2009, p. 6).
When participants described what cultural safety looked like in action, it was described by phrases like “meet people where they are at” and “accompanying what’s best for evacuees based on the different cultural needs.” This approach overlapped with how Jessica Ball defined cultural safety as “respectful engagement that supports many paths to well-being” (2017).
Cultural safety also involves the transfer of decision-making power to Indigenous communities. However, as noted by a participant in BC, while that transfer is welcomed, First Nations communities also need the financial and personnel resources to plan, respond and recover from emergency events (Participant 10). This conclusion confirms that cultural safety needs to become an outcome in ESS.
Outcome 3: Engage familiar faces; create familiar spaces
Two of the greatest leverage points to influence culturally safe evacuation outcomes are engaging community representatives and setting up familiar spaces to welcome and house evacuees. In the initial stages of the evacuation and registration, Indigenous participants in British Columbia echoed much of what was shared by Poole (2019). Participants in both studies spoke to the importance of keeping families together, clarifying jurisdictional roles and responsibilities, maintaining open communication, and engaging community members to assist the Red Cross (or, in BC, Emergency Support Services). Saskatchewan participants also spoke to the need for the evacuee support organizations to “work in tandem with local people in a more effective way to improve evacuation experiences” (Poole, 2019, p. 75). Engaging someone familiar to community members might create a welcoming environment for evacuees in support of emotional and mental well-being. An Elder from Pelican Narrows also recommended using a ‘Jordan’s principle’ approach to emergency services (Poole, 2019, p. 60), which echoed comments made by a participant in BC who stated that services should be delivered to evacuees first and then the paperwork dealt with afterward (Participant 15).
Establishing reception centres that can be made to feel familiar to evacuees is a wise practice shared by emergency management and health care academics and practitioners. These facilities might be based in non-impacted, neighbouring Indigenous communities or be established in local government centres, but designed based on Indigenous values (i.e. the Māori welfare centres established after the 2010 earthquake (Yumagulova et al., 2019)).
Outcome 4: Flexible, adaptable, wrap-around service delivery
While the ESS program has a set list of eligible services (food, clothing, shelter, incidentals, emotional supports), flexibility and adaptability are key to ensure that those services are delivered in a wrap-around way that is culturally safe and inclusive. Several factors influence how someone experiences health and safety during an emergency event. Participants spoke to the tension between “dealing with an entity of bureaucracy [EMBC] that keeps making us the enforcers of policy and…yet the need for flexibility in how we assist people and how we support them” (Participant 5). Cultural resilience is a key outcome of cultural safety practices. Furthermore, evacuee support agencies (including ESS, ISC, FNHA, Red Cross) need to come together to provide wrap-around support to evacuees. Participants recommended that agencies ensure that they are: 1.) requested and invited into the community and 2.) they are working in close collaboration with community leaders and other agencies. When partners come together to collaboratively support community-driven solutions, cultural safety is more easily realized.
Outcome 5: Expand culturally safe and relevant training, and transform ESS teams into learning organizations
Participants advocated that culturally relevant and culturally safe ESS training be made available to all responders and evaluated by Indigenous emergency management practitioners. Further efforts could also be made to make ESS teams learning organizations.
Without nurturing a culture of continuous learning and expanding awareness to see “the whole,” responders might struggle to cultivate the connections and creativity required to serve evacuees’ emerging needs. This conclusion stemmed from participant feedback that training alone cannot prepare ESS personnel for every situation, so workers must remain flexible to the situation at hand. One participant stated that while training is “really important,” you have to “observe and respond, not just lead based on the experience and the training that practitioners have received” (Participant 4). This learning is supported by building relationships and practicing humility, so each evacuation is framed as an opportunity to learn about community needs rather than approach the event with a preconceived notion of what the needs might be. By practicing two-eyed seeing and humility, open listening, kindness, compassion and respect, ESS teams might gain the qualities of learning organizations. Indigenous responders are also best positioned to evaluate current and future training material for its cultural relevance and safety.
All future ESS curriculum might benefit from being co-developed with Indigenous partners. Increasing community awareness about the ESS system also dismantles the power dynamic between responders and evacuees. Further planning and preparedness considerations are outlined in the next conclusion.
Outcome 6: Plan, prepare and build relationships
Promoting personal preparedness and building interagency / inter-community relationships is essential to increase disaster and cultural resilience. Indigenous communities also need ESS resources and the capacity to build relationships and develop ESS teams and plans. The most unifying theme across the health and emergency management literature was the importance of developing relationships between response organizations and Indigenous communities in advance of an emergency event. Poole cited that many issues might have been prevented if the community had been involved with planning efforts (2019), and this was echoed in the works of other scholars and the themes that emerged in 2017/2018 after-action reviews. The transfer of responsibilities to the Indigenous-led, community-driven and Nation-based First Nations Health Authority is an example of an organization co-developing and planning services that respond to the needs of those they serve. I concluded that relationship-building is the most important area of focus in preparedness. As one participant mentioned, without pre-established relationships, no work can continue. Creating regional ESS plans might help bridge relationships and help Emergency Support Services practitioners feel prepared and confident that the work that they are doing truly reflects the distinct needs of those they serve.
Recommendations and Concluding Remarks
Based on the findings and conclusions, the four high-level recommendations for Emergency Management BC included:
1) Co-create a Cultural Safety in ESS Champions Table,
2) Co-develop an ESS Cultural Safety Framework (Figure 1),
3) Co-draft a Cultural Safety in ESS Policy Statement, and
4) Co-produce and monitor a Cultural Safety in ESS Transformative Change Plan that knits together all these concepts for change across the Emergency Support Services system.
The goal was to create the conditions for shared leadership so that Emergency Management BC and Indigenous ESS champions had a road map to “lead the way with cultural safety” while respecting, honouring, and supporting Indigenous resilience and knowledge. The data collection methods and actions that flowed from this work aimed to bring together the Western/dominant perspective (the current ESS model) and Indigenous experiences and perspectives (research participant perspectives) to create a future state where two-eyed seeing is applied to evacuation and evacuee supports.
Figure 1: Graphic Depiction of ‘Wrap-Around Support’ Model for Emergency Support Services (ESS). (Source: Pepper, 2021, p. 36)
Application of Research Outcomes to the 2021 BC Wildfire Season
The relevance of the research findings has inspired systemic change at the community, regional, provincial, and federal levels in emergency management within the Province of BC. On June 30, 2021, one of the most devastating wildfires in BC history, the Lytton Creek wildfire, tore through Lytton First Nation and the Village of Lytton, resulting in extensive structure loss and the tragic death of two residents. Throughout the summer, tens of thousands of British Columbians found themselves displaced by several catastrophic wildfires, which resulted in a record number of evacuation orders and alerts. Several other First Nations communities were displaced.
As an insider within Emergency Management BC, I observed ESS demonstrating greater flexibility as compared with previous years. They also worked more closely with partner organizations including FNHA, ISC, and FNESS. While still not meeting the needs of all evacuees, I did observe incremental improvements in alignment with the findings from this research that had been implemented.
As one community example of the impact of this research, a Tŝilhqot’in National Government representative told me they based their host-community emergency lodging plan on the Cultural Safety in Emergency Support Services thesis (Pepper, 2021). This included their expanding of the ‘culture camp’ concept. At the regional level, partnerships were strengthened between EMBC and the First Nations Health Authority (FNHA) to provide culturally safe support and the First Nations Emergency Services Society (FNESS) was brought into the Provincial Regional Emergency Operations Centre (PREOC) to advise on appropriate Indigenous community supports.
The Provincial Emergency Coordination Centre (PECC), engaged Indigenous people with lived experience for their advice and created two policies to solidify the concepts of ‘Community Navigators’ and ‘Cultural Safety Sites,’ both discussed in this thesis (Pepper, 2021). Much of this work was led by thesis inquiry team member Stephanie Papik. The Province has also initiated new ESS training partnerships with the First Nations Emergency Services Society (FNESS) and, for the first time, the BC Association of Aboriginal Friendship Centres was invited to join the Indigenous Agency Working Group (recognizing their critical role in ESS). On the topic of training, EMBC also invested in their first Indigenous ESS Training Position in September 2021.
The research circle conversations last Fall sparked new relationships that supported collaborative inter-agency responses to the catastrophic wildfires this summer. In addition to substantive findings and recommendations, this project’s action research process itself created a foundation for transformative change.
The hope is that this exploration of the intersections of Indigenous experience, knowledge, and culturally safe practices in emergency management will help further inform ESS policies and also contribute to academic knowledge.
In conclusion, there is hope. ESS Champions across the system are connected and are ushering in a new era in emergency management which is centred around the holistic needs of individuals, families, and communities. This project has inspired a reimagining of the Emergency Support Services system, but this is just the beginning. Our systems and policies need to adapt. Practitioners must also continue to deepen their personal awareness and understanding and cultivate the two-eyed seeing skills to uphold and honour both Indigenous and Western ways of preparing, responding to and recovering from emergency evacuations.
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