The contribution of evidence‐based practice and the practice‐based evidence approaches to contemporary Australian psychology: implications for culturally safe practice

Psychological practice emphasises the importance of using the best available evidence to ensure accountability and promote positive outcomes for individuals and communities.1 These expectations are critical for community trust; however, without adequate consideration of broader processes of knowledge production, this focus can marginalise populations and perpetuate health inequities, such as those experienced by Aboriginal and Torres Strait Islander communities. Considering new professional practice expectations in psychology,1, 2 this article examines the foundations of these standards and how they might be effectively implemented. We present a conceptual exploration of empirical and constructionist perspectives on evidence and introduce guidelines for practice-based evidence (PBE), including theoretical and practical implications to yield the best available evidence1 that guides culturally safe practice when working with Aboriginal and Torres Strait Islander peoples.3 Although the authorship team is situated within the discipline of psychology, the arguments can be extrapolated to other health disciplines. Medicine, for example, is situated within both the pure science and social science realms. Its foundation exists within the laboratory and empirical clinical trials, but it operates in the context and complexity of human patients and the cultural, historical and political milieu they inhabit. Medicine has been a pioneer in requiring students and graduates to acknowledge the diverse experiences of Aboriginal and Torres Strait Islander peoples and was among the first disciplines to include this in its curriculum. The arguments within this article enhance the foundation work provided by Indigenous leaders such as Professor Gregory Phillips.4 Associate Professor Paul Gray is a Wiradjuri researcher and child protection advocate, focused on promoting the safety, welfare and wellbeing of Aboriginal children, families and communities through self-determination and reasserting Aboriginal systems and practices. Dr Dawn Darlaston-Jones is a non-Indigenous woman (she/her) of British descent, who lives and works on Whadjuk Noongar Boodja as a researcher and educator. She has over 20 years’ experience in developing psychology curricula within a decolonial framework. Professor Pat Dudgeon AM, from the Bardi people, is a psychologist, researcher and leader in Aboriginal and Torres Strait Islander mental health and wellbeing. Her area of research includes social and emotional wellbeing, Indigenous psychology, and suicide prevention. Dr Kate Derry is cisgender (she/her), born and raised on unceded Wadjuk Noongar Boodja. She is of Burmese immigrant and Irish/English settler heritage. Her research focus on social and emotional wellbeing has challenged her to decolonise her worldview and research approach. Dr Joanna Alexi has Cypriot heritage, was born in Larrakia Country, and is now living on Whadjuk Noongar Boodja. Dr Alexi's research has focused on decolonising psychology education and mental health systems. William Smith (he/him) is a Wiradjuri and Wemba Wemba researcher born on Bunurong Country. His work with and for Aboriginal people focuses on embedding Aboriginal ways of knowing into psychological frameworks to support decolonisation of the discipline. Tanja Hirvonen is a Jaru and Bunuba woman living and working on Kalkadoon country. She is a clinical psychologist in an executive position. Her interests include organisational wellbeing, social and emotional wellbeing, and decolonising psychology. Emeritus Professor David Badcock is a seventh generation Tasmanian of English heritage. He has contributed to the design and support for education and training pathways in psychology. His research focuses on the operation of the human visual system. Dr Shraddha Kashyap (she/her) has Indian heritage; she was born and grew up in Kenya and moved to Whadjuk Noongar Boodja 20 years ago. She is a researcher and clinical psychologist focusing on cultural safety in mental health services. Belle Selkirk is a cisgender Noongar woman living on Wadandi Boodja. She is a clinical psychologist and researcher focusing on Indigenous psychology, decolonising psychology education and practice, and cultural safety in psychological practice. The CONSIDER reporting criteria checklist for health research involving Indigenous peoples was completed for this article and can be found in the Supporting Information.5 Scientific decision making should be informed by the best available evidence.1 The Psychology Board of Australia (PsyBA) defines evidence as “any concept, strategy, intervention or practice derived from or informed by evidence from research, including Indigenous research methodologies, that supports the quality and the relevance of a particular action or decision in a particular context for a particular use”.2 The forthcoming PsyBA Code of Conduct1 emphasises grounding practice in evidence that accounts for the social, cultural and historical contexts in which it was generated. For these changes to effectively improve outcomes, particularly for Aboriginal and Torres Strait Islander communities, psychologists require further guidance on their responsibilities in understanding how evidence is developed as well as recognising the social and political factors that shape this process, perpetuating unequal outcomes. With the PsyBA set to implement the revised Professional Competencies for Psychologists and the new Code of Conduct on 1 December 2025,1, 2 aligned with the definition and principles of cultural safety,3 this conversation is timely and essential. Ensuring that psychology meets the needs of Aboriginal and Torres Strait Islander peoples is critical to achieving an equitable health care system free from racism.3 The construction of evidence does not occur in a vacuum, and the evidence employed needs to be purpose-specific and serve the values of those affected by these decisions.6-8 The examination process of evidence should recognise that the opportunity to develop and publish evidence is not equally distributed across society. The dominant research paradigm reflects the product of scientific endeavour over many generations. It reflects and entrenches social systems of power, with various groups privileged or excluded from access to resources and institutions through which knowledge and evidence may be generated.9 These realities must be acknowledged to ground psychology and related health disciplines on a stronger foundation of evidence. Key to this is the definition of what constitutes evidence, with empiricism and its theoretical framework of positivism being privileged to the detriment of social constructionist approaches. The former relies largely on laboratory-based experimentation that view variables such as “culture” and “values” as something to be controlled. In contrast, interpretivist research centres these aspects of human functioning as critical to understanding lived experience. As such, this article advocates for epistemic pluralism of evidence-based practice (EBP) that is grounded in positivism and the constructionist focus of PBE, valuing the contribution of both in the development of a more inclusive discipline to provide the “best available evidence to achieve the best possible client outcomes”.1 Given persistent inequities, especially affecting Aboriginal and Torres Strait Islander peoples, we recommend drawing on insights from Indigenous psychology, including both theory and practice frameworks, as a necessary step in enhancing social and emotional wellbeing. Although we acknowledge the considerable work in Australia and internationally of Indigenous psychologists to develop theoretical frameworks and practice evidence, specific examples are beyond the scope of this article. Rather, this article contributes to the conversation about the construction, development and application of evidence across health disciplines to improve individual and collective wellbeing within evolving professional practice expectations.3 Even though our focus is psychology, the issues discussed resonate across medicine, public health and other health professions. Therefore, a collective commitment across these disciplines, through education, research and practice, is essential to advancing equity and culturally safe care. Responsible practice is grounded in principles of non-maleficence and beneficence.10 Psychologists thus face ethical imperatives when engaged in psychological work. First, they must identify and implement the most appropriate evidence-informed practice for individuals and communities guided by current research.11, 12 Second, psychologists must be accountable and transparent in their practice,13, 14 and third, they must engage in genuine collaborative, informed consent processes10 with those they serve. These ethical imperatives enjoy broad support. However, their practical implications warrant further consideration, particularly in the context of a history of psychological practices, justified on principles of benevolence, that have demonstrably contributed to long-lasting and even intergenerational harms, including ongoing processes of colonisation.15 These lived experiences emphasise the importance of evolving professional practice standards, particularly in the context of narrow social, cultural and political constructions of theory and practice. The structural reform being implemented by PsyBA reflects these evolving standards,1, 2 extending professional practice in ways that reflect emerging discourses in critical psychological theory and practice, including commitments to Aboriginal and Torres Strait Islander health and cultural safety (eg, Code of Conduct, Principle 2; Professional Competency 8), and respectful practice with diverse peoples (eg, Code of Conduct, Principle 3; Professional Competency 7). These seek to promote safe, effective and collaborative practice that is “informed by the best available evidence to achieve the best possible client outcomes”,1 specifically, culturally safe practice with Aboriginal and Torres Strait Islander people and communities.1-3 However, if these reforms are to have a practical effect and achieve their intent of improving outcomes for clients, particularly Aboriginal and Torres Strait Islander clients, further guidance for psychologists about their responsibilities are needed. This includes building awareness of the processes by which evidence is constructed, maintained and implemented, and how the social and political components of those processes contribute to disparate outcomes. EBP and PBE approaches emphasise different philosophical and theoretical roots, with EBP reflecting a positivist-based philosophy of objectivism, whereas PBE developed from a constructionist-based philosophy of science. In psychology, it has been argued that the dominant discourse has evolved to emphasise an association with the physical sciences (ie, empiricism). This can devalue constructionist approaches and minimise consideration of social and political factors in individual and community experience, construction of meaning, and the development of knowledge.16-18 For example, the existing empirical evidence base in psychological research has predominantly involved Western, educated, industrialised, rich and democratic19-22 populations, resulting in psychological theories and practice guidance reflecting Western cultural constructs. Consequently, certain psychological constructs or interventions may be unsuitable for diverse cohorts and contexts, contributing to inequities of outcomes experienced across populations. A broader array of evidence is needed to address these gaps and apply psychological knowledge effectively and equitably. In our view, the most productive path forward is to consider the broad array of evidence that might arise from both traditions, with consideration of the social and cultural contexts in which they apply. We emphasise the need for an inclusive approach to defining and selecting evidence, recognising knowledge beyond the laboratory, such as cultural traditions and community-based data. The constructionist philosophy of science acknowledges that prior knowledge and expectations affect current behaviour.23-25 Prior knowledge stems from individual experiences and interaction with the world.9, 16 Inclusive approaches have been applied in various psychological fields, necessitating the development of diverse research methodologies to capture the complex interplay of social, cultural, economic and political factors. These methodologies ensure that psychological practices remain relevant and effective in addressing the needs of diverse peoples, and this is increasingly reflected in global practice,26-28 including efforts for antiracist and decolonial practice that shift from individualist to structural perspectives.29 PBE recognises environmental, community, social and cultural factors influencing the perception and evaluation of information more than EBP.8 In alignment with National Health and Medical Research Council (NHMRC) principles, PBE allows individuals and groups to be involved in decisions that affect them, advocating for the inclusion of people with lived experience in research design.8 This is a critical component of ethical research with Aboriginal and Torres Strait Islander communities.30 Both EBP and PBE can provide meaningful insights for diverse groups through research protocols that are culturally safe and relevant. They may both provide dual paths to helpful understandings with Aboriginal and Torres Strait Islander peoples and diverse populations. We particularly emphasise a focus on Indigenous Standpoint Theory (IST) and Indigenous Knowledge Systems (IKS).19 Indigenous Research Methodologies (IRMs) are positioned within Indigenous standpoints and draw from IKS in the development of insights and evidence.19 IST examines how Aboriginal and Torres Strait Islander peoples exercise sovereignty in their ways of being, knowing and doing, and the role of power in knowledge formation.19 It values Aboriginal and Torres Strait Islander lived experiences, knowledge systems, politics and history, challenging Western epistemology and promoting respect for IKS.19 IKS enable Aboriginal and Torres Strait Islander peoples to create an evidence hierarchy for quality research, evidence, and effective intervention for social and emotional wellbeing.8 For example, Indigenous psychology is rooted in IST and IKS, and challenges colonial narratives and structural inequities affecting mental health.31 It integrates diverse approaches, blending empirical and practice-based evidence for a broader understanding of wellbeing. Consequently, Indigenous psychology acknowledges that the unique social and political status of Indigenous peoples. The increased consideration of social and cultural factors, including engagement with specific populations and lived experience, can assist in developing a more inclusive evidence base that reflects the diversity of the Australian community. Within the context of PBE, practice is informed by shared scientific evidence, and the contribution of experience and expertise that psychologists and health practitioners bring in their engagement with and application of the evidence base.32 In some areas of investigation, what constitutes the best available quality research processes and methods differ for Aboriginal and Torres Strait Islander and non-Indigenous communities,33 with implications for how existing evidence is applied, including the need to avoid potential harms to Aboriginal and Torres Strait Islander peoples.8, 15 Thus, the challenge for the health disciplines, including psychology, is to provide avenues for diverse research, and practitioner education and training to ensure their knowledge encompasses relevant evidence. Ultimately, psychologists and health practitioners must recognise the necessity of gathering the best available evidence for their work, balancing the value and limitations of both EBP and PBE in the process. Cultural safety is by Aboriginal and Torres Strait Islander and communities. safe is the ongoing critical of health practitioner and power in safe, and free of racism.3 safe practice is the ongoing critical of health practitioner and power in safe, and free of and It but is not the history, and to and other cultural and social of health and wellbeing in Aboriginal and Torres Strait Islander on a of action in psychological or health care practice, research evidence a as to its to the unique and of those of the are factors that need to be For example, in clinical contexts, client include individual of the history of for and In an to the (eg, the of can be implemented to enhance and without the of the that Research has the importance of shared decision making in the health care process and the value of client in selecting a approach. in decision making an effective and is with outcomes and of This may the of communities, into the design of available approaches and the application of evidence. In research, education and contexts, the social and cultural of health are as they on the of intervention that may be are many factors for psychologists and health practitioners to consider when the of an For if the of mental health among groups of people being provided with the for groups in the may not yield information for Consequently, using Western of mental health and research methodologies to the of an intervention for Aboriginal and Torres Strait Islander peoples might be by with Aboriginal and Torres Strait Islander perspectives that consider physical and mental health and individual and collective This of health is as social and emotional the and of an intervention improving the social and emotional wellbeing for Aboriginal and Torres Strait Islander peoples, for example, culturally appropriate methodologies and are It should be that practical of social and emotional wellbeing can apply to other groups beyond Aboriginal and Torres Strait Islander peoples. For collective including the social of health such as and access to the wellbeing of families and communities of in the areas of environmental, and are Indigenous psychological should consider the outcomes that can be by Indigenous and its to other cultural however, a of adequate evidence that Western of practice are or effective with Aboriginal and Torres Strait Islander or with other culturally diverse Western approaches are effective and can be for Aboriginal and Torres Strait Islander peoples if not situated within Indigenous and lived than on Western of health and wellbeing, constructions of mental and experiences, and and culturally safe research that to Indigenous of quality is A practice approach that evidence without these issues than and and must be A of PBE approaches is the opportunity to consider the diverse perspectives and experiences of individuals and This is particularly relevant to populations who have been through the development of EBP and to experience outcomes from the application of Given the need to address these persistent inequities, we the principles to implement PBE approaches, which have been informed by the ethical guidelines for research with Aboriginal and Torres Strait Islander the Cultural and the Aboriginal and Torres Strait Islander and include specific for application with Aboriginal and Torres Strait Islander peoples as an We insights into PBE approach in the a constructionist the role of and how people of their experiences, and the complex that from their experiences are to understanding the and community. The inclusion of this broader of evidence is in contexts, including when an EBP This how IST and IKS are to understanding the experiences of Aboriginal and Torres Strait Islander peoples within social, and cultural of Both IST and constructionist approaches emphasise the importance of practice and a process that is and The Supporting a of Aboriginal and Torres Strait Islander lived experience to the and of and knowledge gathering in PBE is an approach situated within IKS and which with the dominant of This approach to evidence is focused on the specific context of its Although might be some that can to other this is not a works for the or a specific is for that or that This approach the of power in and The of Western and practices effectively other experiences and ways of resulting in a of professional that that knowledge system is to other of this professional can people from and with health and mental health in the practice is but to knowledge systems is equally are that EBP and PBE from being the individual a is the of training and in and methodologies, the application of ongoing critical on the evidence hierarchy and the importance of and knowledge of culturally safe practices. the organisational but are not and an that ongoing critical and culturally safe practices. addressing these through individuals and can enhance the of evidence in their practice and contribute to the development and application of evidence-informed approaches for diverse populations, addressing persistent inequities, and improving the quality of care As a example, psychologists and health practitioners should seek information from the being that many criteria that have to it being to publish IKS practitioners need to be of the authorship of to ensure it includes Aboriginal and Torres Strait Islander meaningful with Aboriginal and Torres Strait Islander communities and or the of Aboriginal and Torres Strait are need to the broader including community-based that are more to diverse approaches. practitioners should seek cultural and from Aboriginal and Torres Strait Islander and communities. The Supporting further examples of ways to address some of the in this article. to the PsyBA standards are a positive step in psychology but must be by action to ensure that beyond the of practice and into the lived experiences of communities, including Aboriginal and Torres Strait Islander peoples, in and should with Aboriginal and Torres Strait Islander communities in developing guidance and for evidence-informed practice. This should include of practice standards and their implications for Aboriginal and Torres Strait Islander communities for and of Aboriginal and Torres Strait Islander peoples, than this in the of non-Indigenous professional and must be in Aboriginal and Torres Strait Islander theory and practice through research processes that to Indigenous research and Aboriginal and Torres Strait Islander communities the of research to address the of these perspectives in the discipline and evidence with these ethical frameworks, this research must ensure Indigenous cultural and is by Aboriginal and Torres Strait Islander peoples and is to Aboriginal and Torres Strait Islander frameworks of knowledge and not or by or non-Indigenous research institutions for Aboriginal and Torres Strait Islander people might not be effectively This article has the value of both EBP and PBE and the application of of these approaches. Both approaches have unique and has a role to in the practice and education, and training of psychologists and health Professional Competencies for Psychologists and Code of Conduct an shift recognising the importance of cultural lived experience, and IKS in what constitutes the best available evidence. These insights for health disciplines, including medicine, which scientific and The necessity to epistemic cultural safety, and critical the need for health disciplines to both scientific evidence and grounded a broader and more inclusive approach to evidence an step addressing the persistent inequities experienced by many Aboriginal and Torres Strait Islander peoples and diverse communities. Professor Pat Dudgeon a from the National Health and Medical Research Council (NHMRC) Medical Research Indigenous Health and which from the Australian Indigenous Psychology and Indigenous Health and to in the and the work. We to acknowledge from the Australian Psychological who contributed to on evidence. This article was for the on Indigenous Health on As we more than be in a the and team Pat Dudgeon Professor Associate Professor Professor Professor and Torres Strait and Associate Professor Paul have this article as the with by Aboriginal and Torres Strait Islander and and guidance by the across of the and process. access by The of Western as of the The of Western Australia the Council of Australian Pat Dudgeon is a for the and was not involved in decision making about this article. Gray and Darlaston-Jones and Dudgeon Derry Alexi Smith and Hirvonen and Badcock Kashyap Selkirk and examples The is not for the or of information by the than should be to the for the article.