The cost of Indigenous cultural safety training: examining facilitator burnout and the impacts on health and wellness

This research represents an in-depth exploration of the lived experience, demands and risks of facilitating Indigenous cultural safety and the impact it has on the health and wellness of Indigenous cultural safety facilitators. Using Indigenous and qualitative methodologies, this study gathered data from 11 Indigenous cultural safety facilitators in the Vancouver Island and Vancouver regions through in-depth interviews. Issues around training, preparation, boundaries and capacity within Indigenous cultural safety spaces were examined, as well as the resistance, harm, violence, emotional taxation, hardships and burnout often experienced by Indigenous cultural safety facilitators. With a focus on how facilitating Indigenous cultural safety affects physical, emotional, mental and spiritual wellness, as well as emphasizing the high risk of burnout, this research demonstrates that Indigenous cultural safety environments can be unsafe for Indigenous cultural safety facilitators and exposes a need to explore further how social and structural supports can better protect the health and wellness of Indigenous cultural safety facilitators.


Introduction
While the uptake of Indigenous cultural safety (ICS) initiatives is increasing in professional environments such as post-secondary and health care, the ICS literature lacks reference to the lived experience, demands and risks of facilitating ICS training. The literature primarily focuses on impacts for those who participate in such trainings, with little regard for how ICS facilitators (ICSFs) are affected. Using an Indigenous methodology and qualitative methods, this research represents an in-depth exploration of the lived experience, demands and risks of facilitating ICS and the impact it has on the health and wellness of ICSFs. With a focus on how facilitating ICS affects physical, emotional, mental and spiritual wellness, as well as emphasizing the high risk of burnout, this research demonstrates that ICS environments can be unsafe for ICSFs and exposes a need to explore further how social and structural supports can better protect the health and wellness of ICSFs.

Literature review
The concept of ICS emerged within the doctoral dissertation of Irihapeti Ramsden, a Māori (the Indigenous people of New Zealand) nurse, when she developed Kawa Whakaruruhau, translated as a safe place made from principles (Hutt Valley District Health Board, 2023), to explicitly address inequitable power relations, racism and other forms of discrimination, as well as the ongoing impacts of historical injustices (Browne et al., 2015;Ramsden, 2002). Since then, the concept of ICS has become a key component of Canada's commitment to reconciliation, as supported by the 2015 Truth and Reconciliation Calls to Action (TRC) and the 2007 United Nations Declaration on the Rights of Indigenous People (UNDRIP) (First Nations Health Authority [FNHA], 2019;Truth and Reconciliation Commission of Canada, 2015;United Nations, 2007). For example, the TRC Call to Action #23 recommends cultural competency training for all health care professionals (Truth and Reconciliation Commission of Canada, 2012).
Other approaches to improve relationships between Indigenous and non-Indigenous peoples, such as cultural sensitivity and culturally competency training, are no longer sufficient to address racism and other forms of discrimination (Duthie, 2019), and as a result, ICS today is distinct from those approaches (Churchill et al., 2020).
There is an immense need for ICS initiatives (Auger et al., 2019). Since ICS training initiatives are a response to Canada's raising national consciousness of health barriers and inequities, there is a general increased willingness among professionals to participate in ICS training initiatives, which has created an impetus for more ICS training (Wylie et al., 2021). This ongoing and increased demand for ICS training presses us to consider the health and wellness of ICSFs who manage those spaces. However, an exhaustive review of ICS literature reveals just a few studies that measured or explored how facilitating ICS training affects health and wellness. In fact, regardless of profession or environment, little research posits these spaces as sites of risk for ICSFs. Indigenous scholar Cheryl Ward's (2018) dissertation, entitled Teaching about race and racism in the classroom: Managing the Indigenous elephant in the room, is arguably the leading work in this field, providing strong evidence that ICS facilitation is risky, particularly for Indigenous educators.
Ward asserts that there are specific challenges to facilitating anti-racism training, many of which will, in some way, threaten ICSFs sense of wellbeing. When colonial attitudes and beliefs surface in ICS and anti-racism training spaces, ICSFs can experience confusion, discomfort, fear, anxiety, stress, sadness, irritation, regret and anger (Ring, 2000;Ward, 2018). Ward (2018) describes how racist comments, "stunned me . . . [left me] feeling paralyzed and deeply unsettled . . . I also felt a deep sense of foreboding, of threat, and even fear" (p. 7). This work can be both triggering and exhausting for ICSFs precisely because they have to constantly manage the harms caused by expressions of racism-for example, insults, silencing, hijacking, baiting and being pulled into conflict-while at the same time, provide learning opportunities to deconstruct the racism and conflict that often surfaces. Ward explains, Indigenous, racialized and white educators acknowledged the relentless nature of challenges before them including the emotional load of racial micro aggressions, the anxiety and fear of consequences for addressing bias and anti-Indigenous racism, and the emotional labour and exhaustion involved in this work (Ward, 2018, p. 91) . . . teaching anti-racism involves risk to the educator (p. 99) . . . "[I] learned early in my career that I would need to address the 'tender' or sensitive places within me, so that I would no longer be hurt, wounded by, or over react to the experiences of racism." (p. 128) Given the demands and challenges of facilitating ICS and anti-Indigenous racism, this article argues that ICSFs are at high risk for burnout, defined as a chronic and debilitating condition with multi-dimensional and compounding symptoms (C. W. , that affects their physical, mental, emotional and spiritual health. Without adequate social and structural supports, it is common for those experiencing high levels of burnout to develop serious health and wellness issues as well as the need to take a break from their work temporarily or permanently (C. W. Cook et al., 2021;Johnstone et al., 2016).

Sample
The lead author (TE) recruited participants from Vancouver Island and Vancouver through publicly available email addresses, by word of mouth and by snowball sampling (Ritchie et al., 2013). Recruitment closed at 11 participants with length of experience ranging from 2 years to a few decades. When identity was disclosed, participants self identified as Indigenous, non-Indigenous, white settler and mixed ancestry; cis-male and cis-female; facilitating as part of their employment with a particular institution and as an independent contractor who had their own business; and facilitating either in a post-secondary institution, health care points of care or in a professional environment in the private sector. No participants identified as racialized non-Indigenous. Although there are important racial and gender differences between ICSFs that affects the lived experience of their work, this study removed such identifying features to protect the ICSFs that shared experiences of structural violence from leadership and institutional policies. All participants were honored for their time by gift card and small gift.

Method
Before the restrictions of COVID-19, each participant engaged in a face-to-face, open-ended 60-to 90-minute interview in the beginning of 2020. The interviews were intentionally flexible, relational and conversational. Kovach (2010) claims that the conversational method aligns well with "a specific way of knowing based upon oral tradition of sharing knowledge" (p. 40), making this method congruent with Indigenous worldviews.

Data analysis
With consent, all interviews were digitally recorded and transcribed verbatim. After transcription, TE coded and thematically analyzed the transcripts by systematically working through all text and "discovering, interpreting and reporting patterns and clusters of meaning within the data" (Ritchie et al., 2013, p. 271). Following Kovach (2021), TE presented the data through thematic grouping or bundling of themes. The processes of coding and thematic clustering were completed using qualitative NVivo 12 software (QSR International Pty Ltd., 2021).

Member checking
TE invited research participants to engage in a process sometimes referred to as member checking, an approach used to ensure confidence in the interpretation of the data (Birt et al., 2016;Lavallee, 2009;Lincoln & Guba, 1985). Similar to peer review in the academy, the process of participant review is "generally intended to ensure quality of the work, its relevance, and the appropriateness of interpretation" (Schnarch, 2004, p. 93). This is culturally appropriate because "much of the work accomplished by Indigenous people is communal and cooperative in nature. We could not, culturally-speaking, analyze our data without the input of the participants" (Brayboy & Deyhle, 2000, p. 168). Beyond the interview, further participation was voluntary and the extent to which each person participated varied. Half of the participants made minor changes to their transcript and to the manuscript. These changes included clarification of what they were trying to describe and the deletion of text they did not want analyzed, such as identifying or sensitive information.

Ethics
This research received approval from the University of Victoria's Research Ethics Board. With possible risks including fatigue, stress or emotional discomfort, TE kept the interviews at a comfortable pace and offered all participants the opportunity to bring a support person, such as colleague, friend, family member or Elder to the interview, although no one did so.

Training
The participants of this study reported providing ICS training modules ranging from 2 to 3 hr, 1 or 2 days, and up to 18 months. Some ICSFs felt that 2 hr was sufficient time to cover foundational knowledge, while others, who wanted to offer transformational learning, felt that more time is required. The duration of the training can be a source of stress for ICSFs, depending on learning objectives and expected outcomes: We do two hours and I think that's about the right amount of time. We used to try and do them in 80 minutes and that's not enough time. Three hours is too much time. So, we think that two hours for face-to-face; and it would be great if people did [additional learning] like 40 minutes before and 40 minutes after.(F01) I will do like three-hour workshops . . . but it's exhausting. It's more exhausting for me to do it in three hours . . . To have a robust conversation in three hours with all that you have to cover and feel that you're leaving the group tangible learningnot just surface stuff. (F04) All the ICSFs in this study had experience with providing face-to-face training, with a few facilitating online components as well, which were often a prerequisite that provided some basic historical information. Learning in this setting is progressive and often builds on necessary background knowledge about the history of colonialization and Canadian policy, such as the Indian Act or residential schools, as well as information about key national, international and local drivers, such as UNDRIP, TRC and Jordan's Principle.
The level of pre-learning participants receive can create safety concerns among ICSFs as participants with less foundational knowledge pose a greater cultural risk in ICS spaces: In a room where people just came in without having to do, say an online training for example, the room was much less safe . . . that kind of prep [is important], so there's a little bit more humility coming into the space. (F11)

Preparation
It takes a great deal of time and energy to prepare and facilitate ICS spaces. "If people aren't prepared-before they do a workshop-the amount of preparation for a workshop can be really more work than a workshop, depending on a lot of things" (F04). The time spent in preparation is not only important in terms of content-what to include, and learning outcomes such as personal and social change-it is also necessary for the physical, emotional, mental and spiritual wellness of ICSFs. For example, "how we're doing emotionally and spiritually and all of those things and if we're ready for that workshop . . . we also hold ourselves as part of the preparation for those workshops too" (F02). Or, It takes me time to prepare for this right . . . This isn't something that you can just slot in, in that two-hour break between other meetings, right. For me to do it well and for me to be well doing it, I need to be prepared and I also need to respect that there will be times that I'm also going to need a period of time to decompress after the session whether it goes well or not right. Because one of the things I notice is that there are many pieces of the presentation we do that affect me emotionally. I can never predict from day to day which one is going to be the one that has the biggest impact on me and so I also have done this enough and have learned the hard way about the kind of preparation that I need to do [so] that I'm able to do what I need to do to prepare; but there are still going to be times, especially if there are other things going on or I didn't sleep well the night before that well, "this is affecting me more than it usually does." So, I need to find a way to take care of myself and be gentle with myself . . . I have not felt harmed but I have felt attacked and this is part of the preparation. (F01)

Boundaries
The social demands associated with this type of work require healthy boundaries. One participant revealed, "I've had to [set boundaries] and I'm not good at it" (F07). However, given the relational nature of the work, the majority of ICSFs in this study often feel overburdened by the demands and find it difficult to maintain boundaries: There is no such thing as sitting back and relaxing in this work. If I'm in my office, I am like, absolutely inundated with everybody that wants to talk to me and there's a lot of emotional components that are associated with this . . . And I also think that there should be a limit in the number of times that you do this over the course of a month or over the course of a year. I also think that there should be space and time to think. We don't have space and time to think. We're literally like, way over capacity-running from meeting to meeting, training to training, and so you need time to be able to think. You need time to be able to be mindful. (F02)

Capacity
Six ICSFs commented on operating with not enough ICSFs or how this type of work is not-and should not be-for everyone: Finding people to do . . . actually do this work is really hard . . . You kind of have to be ready to do it . . . like I said, this work is not for everybody and you can only put so many safety mechanisms in place to protect facilitators; but especially when like, we're doing an intervention right; like we're intervening in like, racism and so if you're not in a place where you can respond to that, you can really put yourself in severe harm. (F03) Although capacity is growing with increased resource allocation and policy implementation, there continues to be a lack of ICSFs able to take on this type of work. This shortage translates into waitlists and programs running over capacity, which further overburdens ICSFs. One facilitator talked about how being so overworked leaves them feeling unsupported: The interest to participate in the training was growing . . . It was really, really, challenging to keep up. We could not keep up with the work. We were above capacity. We were having to overload facilitators all the time . . . And so, we try to have conversations with leadership around that and say, you know, we need to figure out a better process here because we're overworking our facilitators . . . We're all working really late hours and we were basically told "suck it up. If we can do it, you can do it." (F06) Sufficient resources and institutional readiness are components of capacity that also have impact on ICSFs safety: If you're forcing people to come into these learning opportunities and it's surfacing all this unsettledness that exists in this conversation-you know, the shame, the guilt, the blame, the . . . you know, that really reactive white fragility . . . and outright hostility; it would send that organization into a bit of a tailspin unless the workspace is ready, unless the leadership was ready, unless our performance management system was handling that and our managers were ready for that. The consequences are quite significant and we could create more backlash than we need. (F02)

Resistance, harm and violence
The experiences of and reactions to ICS training can be intense and participants often enter these spaces on edge and with high levels of anxiety: There's group dynamics, group cycles, there's interpersonal cliques maybe, there's resistance, just endless things. But in this particular topic, it's really heightened. And people are already activated. I really believe that. I believe that when people know they're coming to a cultural safety workshop or Indigenous specific anti-racist workshop . . . they're alreadyon some level, they're getting activated in their thoughts and their hearts and their bodies. And there's a little bit of that feeling of being on edge when they get in the room. (F04) Seven of the participating ICSFs talked about fighting resistance to ICS training, particularly when discussions of anti-racism are Indigenous specific, and all but one spoke of experiences of harm or attacks from participants. For example, "Resistance-it's always a challenge. I understand it now. I understand resistance as a way of managing discomfort for the learner and it can be exhausting to work in it day in and day out" (F07). Or, There was a lot of resistance to like, "why are we learning about this? There's huge diversity in Canada, why aren't we learning about all the other different people-in the multicultural nation? . . . " So . . . I feel like I'm teaching something-I'm not only teaching the content but I'm . . . needing to convince them that this is important and relevant information. (F10) When they have to look at a realistic scenario of something that could happen in their workplace, and that they are responsible for addressing, that's when people kind of-their resistance can come out or just simply their naivety or their lack of information. (F04) Hostility and harm can result from resistance, especially as the content moves past historical information to the everyday reality of ongoing racism that directly implicates participants. Thus, ICSFs can be exposed to overt criticism and attack. For example, "I was quite devastated. . . . There was some real deep-seated racism starting to come up in the small groups and I was really quite devastated" (F09). Dealing with the resistance is exhausting and the potential for aggression and harm is high: There were times where I felt like my . . . like I was at risk. . . . Like verbal, like verbal violence right, and I felt like my back was against the wall . . . [It] can go awry so quickly if one person makes a racist comment and then somebody agrees and then it just compounds after that . . . I just remember shutting down and I was in tears and I just called my co-facilitator . . . I said I can't do this anymore; I cannot expose myself to this anymore. I am on edge. (F06) In ICS settings, when those who are in positions of power within an organization lack understanding or fail to support ICSFs, including the failure to adequately resource them, it can put them at greater risk: So, I have some sadness about that and yeah, I can be quite emotional about that because we haven't had the support that we've needed [participant began crying]. Surprised that I'm emotional about that. It's been painful to deal with trying to increase your leadership's understanding and knowledge of what it is that we're dealing with and what it is that we need in terms of support . . . I've had a person in leadership, in the middle of a workshop, walk across the room and stand face-toface with me and say, "This is not happening. This is not okay. This is stopping. You're going to stop doing this right now". . . . So there's all this violence and vulnerability that's happening in this room and I have to negotiate that all by myself, cause I used to facilitate by myself and I have to negotiate that all by myself. And then the repercussions that come from that, cause that person has power, and that person then went after me saying that I was incompetent, and that I wasn't qualified, and blah, blah, blah, which impacts my own insecurities-not true. And then also the program; attacks the program as well . . . And we're not resourced. That actually feels painful. That's the structural violence; that I feel the structural violence. The lack of leadership is particularly painful. (F02) Both Indigenous and non-Indigenous ICSFs acknowledged that the potential for harm and violence is greater for Indigenous ICSFs because of who they are-many feel the aggression and harm targets on personal, familial and community levels. Countering and responding to harm directed at you personally in a way that is respectful, educational, diplomatic and informative is a challenge. Furthermore, experiencing and addressing harm, aggression and resistance, because you are an Indigenous person, takes a significant toll on ICSFs, especially because that exposure to harm is not just part of their job, it is also part of everyday life: [The] importance of reminding people that asking Indigenous people, asking people who are racialized into non-majority categories, to do this work is to ask them to share their trauma with people. And so, to think about that idea that this is not an intellectual exercise for the facilitators doing it. That it's based on lived experience . . . . That it's not abstract. . . . Whereas, other people who are racialized differently or have different family experiences are able to . . . a lot of them will see this as simply an intellectual exercise and be surprised about the preparation required and the impact that it has right. . . . And so, that's one of things that I think that people, both participants and policy makers, need to be made aware of-is that this work is intensely personal. (F01)

Burnout, emotional taxation and hardships
The high demands of this work, and its toll on physical, mental, emotional and spiritual wellness, can result in burnout and emotional taxation. Half the participants spoke of significant burnout and emotional taxation at some point in their career. ICSFs describe it as "very hard work. Very emotionally exhausting" (F11) and "I carry this work and I can't carry this work all the time. It's really painful, it's really hard, it's really tiring" (F09). Or, It really takes a toll . . . I mean, I was driving down the road and I was having panic attacks. I was having nightmares about my platform, not being caught up, and about the comments that were coming up . . . I was just . . . I couldn't escape it. I was overworked and I just like, I remember at one point, I'd had a dream and I woke up in a panic because I had so much work to do . . . I woke up in a panic and I was like oh my God, I can't even sleep without thinking about work. But when I was driving daily, I was having chest pains . . . It was taking a toll on me physically with my own health and I saw my own colleague being treated badly. And so, I just left. But it should never get to that point . . . . and I don't share that story really with anybody. But what I do try and say is that, I've been in situations where my work has really taken a toll on me physically with my health, intellectually, emotionally, and in order to prevent that from happening anymore, I had to set really clear boundaries. . . . It does take a huge toll on you. It's the hardest work I've ever done my whole life. (F06) The burnout experienced by ICSFs can increase the risks of even more harm because it can compromise their ability to be mindful, watchful and fully engaged. When they experience burnout, they are not able to respond as needed: I have been in workshops where I've been so tired, burnt out, and been in workshops and I'm thinking to myself, there's so much risk right now because I got to make sure I'm listening to every single word and watching every single thing that's going on in this space, which takes an incredible amount of energy. And if you're burnt out or over-tired, it's a recipe for a problem-for harm. (F04) There is greater harm to facilitator health and wellness without regular and frequent time off from the work: If you're doing this year after year, you're just going to normalize and be in that-it will show up different for different people; you can't feel yourself breathing or you're in a constant state of heart palpitations, like these things are real and you normalize them. If I think of the impact on sleep and physical health-it's there but it's normalized. I've heard myself tell people, I'm fine when I'm in it. But when I'm in it, I feel like I'm fine because I've normalized it. When I'm outside of it, I'm like whoa, I haven't thought about oppression this whole entire week, like whoa. . . . Whenever I go away and I'm away from it, I get how much it impacts me until I'm back in it. (F10) It's exhausting facilitating any group, any time, any way . . . I would actually say to prevent burnout altogether-not to get there. I don't mean when you are just tired one day, and you and your co-facilitator can support each other, I mean actual burnout from being too immersed in the work, without proper breaks and care. That kind of tiredness is different, and requires recovery time. That's how I would say it now. And this is after going through burnout. . . . There is a certain degree of violence or harm in every workshop room, even if you are highly skilled, you can't be immersed in this too often all at once . . . like the physical, emotional, spiritual, intellectual energy that goes into one day with a group of people is intense. Even if it's successful, even if it's successful . . . the amount of output of energy is intense. (F04) As people who are passionate about and committed to helping create a better future, ICSFs can put high demands and pressure on themselves: Sometimes I feel guilty that I'm not doing enough. . . . It's almost like everything I do makes more work. . . . And you think you're not doing enough. You're actually not doing enough or maybe you know the other part is like, what else can I do to do it different or to do it better right, and if we're taking all these peoples' time, including our own and our emotional, spiritual efforts, we want to make sure we're doing a good job and we don't know right. I think we are, and I think you know, all of those sorts of things, but those are the things that plague me. (F02)

Discussion
The findings of this research clearly demonstrate the impact ICS training has on the wellness of ICSFs. These findings also support those of Ward (2018), which reveal that dealing with resistance and a refusal to know is an essential and persistent aspect of teaching and facilitating learning about race and racism. Dealing with intentional or unintentional acts of resistance takes a toll on ICSFs, no matter their level of preparedness or experience. In comparison to non-Indigenous ICSFs, dealing with resistance has a greater impact on the health and wellness of ICSFs who identify as Indigenous because they are highly scrutinized, exposed as a direct target of resistance, and have personal lived experience with the violence of colonialism and racism. Dr Chelsea Bond's symposium presentation entitled Teaching while black: Navigating race and racism within higher education, acknowledged that "the extra labour placed upon Indigenous academics to give of themselves within teaching contexts, while critical in the teaching and learning space, does takes its toll" (Duthie, 2019, p. 114). This is similar to racial battle fatigue experienced by activists of color who experience ongoing racism, yet, endlessly have to justify their perspective and experiences to white people who refuse to acknowledge racism (Gorski, 2019).
This research demonstrates that the work demands and environment of ICSFs puts them at high risk for burnout that takes a toll on their physical, mental, emotional and spiritual health. While there is virtually no literature focused on experiences of burnout among ICSFs, we can begin to understand their experiences by examining other professions with high rates of burnout, such as nurses, counselors, and social justice and human rights activists. Chen and Gorski (2015) define burnout not as a temporary struggle with stress, but as a chronic and debilitating condition in which the symptoms are multidimensional as well as compounding and intersectional. Some of the key causes of burnout found in the literature include emotional stressors and demands, interpersonal nature of the job (Cook et al., 2021), challenging and heavy work environments or workloads (S.-C. Chen & Chen, 2018), inadequate professional resources (Nantsupawat et al., 2016) and a culture of selflessness (Danquah et al., 2021;. In this research, all of the ICSFs spoke about contributors to burnout found in the literature. In fact, for ICSFs, emotional stressors and demands are high, as they described their work as sometimes devastating, painful and intensely personal. Furthermore, they discussed that, due to a lack of resources, the environment often challenges them because they are overworked and running programs over capacity. The symptoms of burnout are wide ranging and include physical, emotional, mental and spiritual manifestations. Common symptoms in the literature include exhaustion, cynicism, insomnia, stress, anxiety and hopelessness. In this study, we have reported on several examples of burnout, such as anxiety, panic attacks, nightmares, chest pains, difficulty breathing or heart palpitations. Several studies have suggested that it is common for those experiencing high levels of burnout to take a break from their work temporarily or permanently (C. W. Cook et al., 2021;Johnstone et al., 2016). This study revealed similar findings in terms of ICSFs needing respite from chronic and debilitating symptoms that threaten both their wellbeing and the ability to sustain the work.
The existing literature on burnout purposes various prevention and treatment modalities. The most obvious is to increase professional resources in the form of training as well as social and structural supports. Chen and Chen (2018) conclude that buffering burnout requires leadership support and mentorship from those more experienced in how to recognize and cope with burnout. More importantly, Johnstone et al. (2016) placed an emphasis on burnout prevention, explaining that, if you are experiencing symptoms of burnout, then it may be too late to intervene. They also concluded that specific interventions are required to address the distinct stressors of diverse professions. In the case of ICSFs, we need more research about their unique roles and responsibilities. A better understanding of their experiences with burnout could lead to effective, profession-specific prevention strategies and treatments. For example, the Counselor Burnout Inventory is a publicly available quantitative tool to help self-monitor levels of burnout, which distinguishes between low and high burnout (Cook et al., 2021;Warlick et al., 2021). Creating a tool like the Counselor Burnout Inventory for ICSFs would be a preventable measure that could limit the experience of burnout for ICSFs.
ICSFs hold themselves accountable to Indigenous communities, collectives and organizations to create change and help others mentally, emotionally, physically and spiritually understand the ways in which they participate in the harms of colonialism. They do this work to help create a better future; yet, if they are unsuccessful, for whatever reason, it is Indigenous peoples who continue to bear the consequences in the form of ongoing racism and colonization. This is a tremendous responsibility to carry. Yet, ICSFs put their body, mind, heart and spirit in harms-way to walk others along a journey toward new relationships and social change. Evidence suggests that ICSFs have similar work demands and environments as other professions that experience high rates of burnout. It is documented that burnout can have severe negative effects on a person, community, organization and the health care system (Warlick et al., 2021). As part of Canada's commitment to reconciliation, it is our collective responsibility to better understand the cost of facilitating ICS learning, how we can continue to support this work, and how we can ensure the wellbeing of ICSFs.

Research
The findings of this research are ideally suited to inform a large-scale provincial or national study of the impacts of ICS on health and wellness of facilitators. In particular, ICSF demographics, such as racial identity, gender identity and sector, might reveal critical lived experiences and demands between and within groups as well as the ways in which colonialism, racism, power and privilege manifest in these spaces and how such manifestations affect the wellness of diverse groups of ICSFs. Furthermore, by examining demographics such as racial identity, we can better understand the ally-ship model of co-facilitation and how that relationship could potentially reduce the increased impact on the health and wellness of Indigenous ICSFs.
Future research could lead to the development of a tool to measure ICSF burnout, where ICSFs could self-report and interpret their scores and the severity of symptoms or different levels of burnout. This would include a validation study to examine psychometric proprieties as well as indicators specific to ICSF burnout. This research could inform early intervention and burnout prevention strategies targeted toward ICSF burnout.

ICSF preparation: education and training
ICSFs require appropriate preparation and resources, including local and place-based supports, emphasizing individual and intergenerational trauma. The findings of this study indicate that, whether Indigenous or settler, ICSFs need to be far enough along on their own ICS journey to undertake this work, with healing and identity development as ongoing processes. Formal and ongoing preparation in the form of education and training that is grounded in decolonizing and Indigenous pedagogies can offer facilitators safe opportunities to critically analyze individual standpoint, learn from other facilitators' stories, create personalized wellness and burnout prevention plans, receive mentorship from experienced ICSFs, as well as role-play challenging scenarios and build a supportive network of other ICSFs.