A review of rural, remote, and northern competency in Canada: Cultural safety considerations for telepsychology and traditional psychological practice.

Abstract

Provision of telepsychological services rose dramatically during the COVID-19 pandemic and continues to be a highly sought service (Calkins, 2022; Madigan et al., 2021). With this rise came increased awareness of ethics of telepsychology, new resources, and a push for training to provide competent virtual services. In rural, remote, and northern (RRN) Canadian communities, increased use of telepsychological services translated into greater access in areas that have historically had exceptional barriers to receiving psychological services. However, there has been less conversation regarding cultural competency issues that can arise when psychology services are offered to individuals in RRN communities. Rather, there may be an assumption that these are just smaller versions of urban centers, with no modifications needed. RRN communities present with diverse geographies, economic conditions, and cultures, often differing from each other and urban Canadian centers. This diversity necessitates the mental health clinician practice cultural humility to provide a culturally safe therapeutic setting; however, it can be difficult to be aware of aspects of culturally safe care within the context of telepsychology, particularly if the provider is not familiar with the client’s rural or remote community. This article outlines considerations for providing RRN culturally competent telepsychological services, beginning with defining RRN, and exploring RRN competent practices. We then discuss the regulatory issues of providing culturally informed and responsive telepsychological services to these communities. Finally, we highlight practical considerations for psychologists and trainees working within RRN communities.

A Canadian psychologist’s primer to telehealth practice.

“…More specifically, the notion of cultural safety is about acknowledging the barriers to clinical effectiveness that come from inherent power imbalances between the psychologist and the patient (Curtis et al, 2019). Towards this end, the psychologist must consider the influence of cultural safety for both themselves and the patients through self-reflection (i.e., develop cultural humility), ideally before beginning work with individuals of differing cultures across Canada (Goodwin et al, 2023). This self-reflection is multifaceted.…”

“…Creating further challenge, these biases are often unconscious and result in the devaluation of rural knowledge and conventions without a psychologist’s awareness (Fors, 2018). As such, the psychologist should take the time to learn about the cultural identity of the patient (e.g., different races, ethnicities, family structures, ways of life), as well as the predominant cultural identification and beliefs of the region in which they are serving, especially if they are less familiar with different parts of Canada (Curtis et al, 2019; Goodwin et al, 2023). Through the integration of a psychologist’s self-reflection, the psychologist should directly consider cultural safety from the patient’s perspective.…”

Serving psychology: An advocate’s journey looking forward for psychology in Canada.

“…There are of course barriers-particularly for underserved or underresourced populations who may not have the technological resources to reliably or securely access virtual care. There is also the important issue of cultural competence when health providers deliver care (virtually or otherwise) to communities of which they are not part (Goodwin et al, 2023).…”