A cultural safety-centric approach 

By Valentín Quiroz Sierra (Yo’eme), PhD, MSW & Victoria O’Keefe, PhD, MS (Cherokee Nation/Seminole Nation), Johns Hopkins Bloomberg School of Public Health 

Lios em chaniavu/Siyo/Hello! We’re proud members of our Tribes, working to promote mental health and wellness across Indian Country through community-engaged research. With training in social work and clinical psychology, we’ve been honored to serve Indigenous children, adolescents, and adults in diverse healthcare settings. This work teaches us that relationships centering trust and culture are cornerstones of exceptional care. 

While community organizing years ago, I (Victoria) sat beside Elder, artist, and professor, Hulleah Tsinhnahjinnie (Seminole/Muscogee/Diné), who shaped how I understand culture. During a conversation, someone asked how to become “culturally competent.” Hulleah paused, then gently laughed. She explained that competency is next to currency—non-Indigenous people think it’s something they can earn, like money, and once they’ve got it, they’re done. Her teaching reminds us that culture isn’t a checklist, but rather a relationship. And in relationships, trust is always in motion, always earned in context, and never yours to claim alone. 

Although Tribes are incredibly diverse, there are shared worldviews where holistic health is embedded within relationships—to ancestors, family, community, lands, and relationships across physical-mental-emotional-spiritual health domains. Healing isn’t a service delivered, it’s a process deeply rooted within Tribal values and traditions. These practices long predate the U.S. healthcare system, and continue today despite centuries of attempted genocide, historical trauma, and ongoing systemic racism. 

That’s why we believe it’s time to move beyond the concept of cultural competence. While often well-intentioned, it suggests culture is a finite body of knowledge to acquire, like memorizing a symptom set or billing codes. But as Elder Hulleah reminds us that competency equates to currency. In practice, this can lead to one-size-fits-all assumptions and missed connections. This doesn’t mean healthcare professionals should stop learning about culture, but that care requires more than knowledge. It requires curiosity, collaboration, and relationships.

Cultural safety 

We advocate for a shift towards cultural safety, a model emphasizing patients’ experiences over clinicians’ knowledge. Cultural safety transforms questions like “What do I know about this culture?” into “Does this patient feel safe, heard, and respected?” When patients feel safe, they are more likely to share and stay engaged in their healing. This shift requires clinicians to reckon with power dynamics and systemic inequalities beyond individual biases. When paired with a relational mindset, cultural safety becomes a path toward meaningful, trust-based care.  

Three things you can do: 

1. Learn from Native-led resources.  

Start with tools like SAMHSA’s American Indian and Alaska Native Culture Card for enhancing cultural awareness when working with Indigenous patients. But don’t stop there! Find materials created by, with, and for Indigenous peoples including information about your patient’s Tribe, identity, and connection to culture/spirituality.   

2. Understand that healing exists beyond clinic walls.  

Traditional Medicine or Healing practices may be central to a patient’s well-being. Ask about these supports and respect them as valid forms of care.  

3. Build cultural safety.  

Commit to ongoing learning. The Indian Health Service, Association of American Indian Physicians, Society of Indian Psychologists, and others provide ongoing education to grow in this work.  

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.