Dr. Alison Gerlach, currently Assistant Professor and Graduate Advisor in the School of Child and Youth Care at the University of Victoria, was formerly a CIHR Banting Postdoctoral Fellow and MSFHR Research Trainee with Dr. Margo Greenwood at the NCCIH at University of Northern BC (UNBC). Her work draws on 25 years of providing occupational therapy with dis/abled children in diverse community and family contexts, and in partnership with Indigenous organizations and First Nations in B.C.

Dr. Gerlach is particularly interested in the continuities between children’s early experiences of adversity, dis/ability, and health inequities and the development of inclusive, responsive, and equity-oriented structural, organizational, and practice level approaches. She is committed to community-based participatory research that engages with communities, organizations, families, and children as research partners.

The National Collaborating Centre for Indigenous Health (NCCIH) webinar with supporting PowerPoint slides, available at https://www.nccahccnsa.ca/495/Webinar__Culturally_Safe_Children%E2%80%99s_Rehabilitation.nccah?id=252 Making Steps towards the Provision of Culturally Safe Children’s Rehabilitation Services with Indigenous Communities, Families and Children, provides

• A critical analysis of the concept of ‘children’s rehabilitation’ in the context of Indigenous families and children in Canada

• An understanding of how children’s rehabilitation programs and practices with Indigenous communities, families and children can be responsive to the historical and ongoing effects of colonization in Canada

• A review of current practices that are aligned with the principles of cultural safety

Dr. Gerlach posits that how we think about children’s health and development, and childhood dis/abilities, shapes how we think about, fund & provide children’s rehabilitation. She compares the biomedical/individualistic model, which uses western & ‘normative’ assessments/standards, diagnostic and deficit-oriented labels, and has a decontextualized, medicalized approach, to a social model, which focuses on promoting social inclusion, equal rights, and addressing underlying socio-economic and political structural inequities. She points to the research of Gilroy et al (2013) which found that “prevailing perspectives on disability and mainstream rehabilitation organizational and practice approaches have largely failed to recognize the multifaceted disabling impacts of colonization on the health and well-being of Indigenous families and children”. She cites McKenzie et al (2016) on continuities in structural violence from the residential school system, through the ‘Sixties scoop’, to the child welfare system, and outlines her own research findings on how an understanding of families’ everyday lived realities is impacted by the legacies of state intervention, the ‘relentless gaze of the state’, and the downstream effects of poverty.

Dr. Gerlach discusses Cultural Safety and Cultural Risk, looking at how to bring a Cultural Safety lens to children’s rehabilitation. She addresses the emerging circular themes of:

• Reaching rural and northern communities

• Responding to communities’ rights to self-determination

• Learning from ‘community’

• Focusing on strengths & wellbeing

• Investing in relationships

• Making space for Indigenous knowledges & languages

• Using assessments cautiously

She references comments from participants in her study, including PT (Yukon Territory) who stated, “[There] needs to be a broadening and recognition that how we interact with a person likely has a greater impact on them than anything else we are doing. Your technical knowledge is a small piece compared to your ability to develop trust and relationships with families.”

Dr. Gerlach sets three challenges to professionals in their work with children in Indigenous communities:

1. How do you come to know and respond to the unique and multifaceted context of each family’s life and child’s life – including how their health and wellbeing are influenced by broader social and structural factors? How do you take these factors into consideration in your organization’s policies and your routine practices?

2. What changes do you need to make at an organizational, professional, personal level in order to provide socially-responsive and culturally safe rehabilitation in partnership with Indigenous communities and organizations?

3. How will you know if your service is culturally safe?