The Kawa Model Meghan Smith July 26, 2011 OCTH 611 Department of Occupational Therapy and Occupational Science Towson University
Agenda• History of Kawa model• Understand components• Application to an individual and a population• Review current research• Strengths• Limitations• Future development• Activity incorporating knowledge drawing a river for a peer
Michael Iwama• BScOT, MSc, PhD, OT(c)• Has studied kinesiology, occupational therapy, and sociology• Currently an Associate Professor, Department of Occupational Science and Occupational Therapy at the University of Toronto• A third generation Japanese Canadian who was born in Japan and raised in Canada• Strived to create a “culturally safe” model (Iwama, 2005b, p. 216). (Iwama, 1999, 2006a)
Cultural Comparisons• Cosmological Myth• Self and environment• View of occupation• Individualism• Belonging, being, and doing• Social positioning (Iwama, 2006a)
Creation of the model• Team composed of 15 occupational therapists, 3 educators, and 2 students• Explored definitions of health and well-being that would apply to the East• Qualitative method (codes, categories, and themes)• Aimed to guide the practice of occupational therapy with cultures not following Western philosophy (Iwama, 2006a)
Philosophical Assumptions• Largely based on Eastern philosophy, and views context as physical and social• Self assumes a decentralized position• Does not view the individual as what he or she does• “Belonging rather than doing becomes the social ethos” (p. 137) (Iwama, 2005a, 2005b)
Principles• Respect the client• “Client’s narrative becomes the model…” (p. 160)• Equality, all are part of a greater whole• Culture is defined as “shared spheres of meanings” (p. 160)• Harmony and balance (Iwama, 2006a)
Concepts• River as a metaphor for life• Water• River floor and walls• Rocks• Driftwood• Space between obstructions (Iwama, 2006)
River MetaphorNote. From “Concepts and structure”, by Michael Iwama, n.d., figure1. Retrieved July 15, 2011, from http://www.kawamodel.com. Thismaterial reproduced/replicated for fair educational purposes inOCTH611, Summer 2011, Towson University and should not becopied without permission of copyright holder.
Water Mizu• Depicts life flow• “…water in its liquid state adopts its form from its container, people in many collective-oriented societies often interpret the social as a shaper of individual selves and groups.” (Iwama, 2006a, p. 145)
Walls and Floor Torimaki: Kawa no Soku-Heki to Kawa Zoko•Client’s contexts (socialand physical); includes arange personal Microrelationships with theliving and nonliving(Iwama, n.d.)•Have a great impact onflow in a collectivist Macrosocial context(Iwama, 2006b) Note. From “Concepts and structure”, by Michael Iwama, n.d., figure 6. Retrieved July 15, 2011, from http://www.kawamodel.com. This material reproduced/replicated for fair educational purposes in OCTH611, Summer 2011, Towson University and should not be copied without permission of copyright holder.
Rocks Iwa•Negative circumstances blocking or slowingflow; can be permanent or temporary(Iwama, n.d.)•“Every rock, like every life circumstance, has aunique size, density, shape, colour, and texture”(Iwama, 2006b, p. 156)
Driftwood Ryuboku•Various attributes and resources of theindividual (Iwama, n.d.) o Monetary resources o Personality o Skills•Can be negative or positive, depending onwhat surrounds them or what they collide into(Iwama, 2005b)
Spaces between obstructions Sukima•Therapy occurs within the spaces betweenobstructions and is based on what thoseelements are/entail (Iwama, n.d.)•“Occupation… is regarded in wholes, toinclude the meaning of the activity to self andcommunity to which the individual inseparablybelongs, and not just in terms of biomechanicalcomponents…” (Iwama, 2006a, p. 153)
ApplicationNote. From “Application to practice,” by Michael Iwama, n.d. Retrieved July15, 2011, from http://www.kawamodel.com. This material reproduced/replicatedfor fair educational purposes in OCTH611, Summer 2011, Towson Universityand should not be copied without permission of copyright holder.
Application to an individual Justin, a 26 year old firefighter and paramedic currently recovering from surgical repair of a rotator cuff tear.Justin’s health insurance only covers three weeks of therapy. In order to return to the field, Justin must be able to lift 150 pounds without assistance. Otherwise, he must transfer to administrative work.
Individual, continued• Rocks o Pain after surgery o Anxiety about meeting lift requirement o Physical abilities• River Floor and Walls o Micro: Lives in an apartment o Macro: Employment with fire department, Health Insurance Coverage
Individual, continued• Driftwood o Supportive girlfriend o Generally positive attitude o Good paramedic skills• Water o Provide encouragement• Spaces between obstructions o Inquire about taking on a teaching role
Application to a population Individuals with a history of substance abuse being released from prison on parole to live in supportive housing who are expected to attendweekly substance abuse meetings, and gain, then maintain employment
Population, continued• Rocks o Needing a job o Lack of professional skills o Dedicating time to weekly meetings• River Floor and Walls o Micro: Surrounded by others with a history of substance abuse o Macro: Stigma from having been in prison
Population, continued• Driftwood o Determined not to relapse o Stubborn at times• Water o Provide encouragement• Spaces between obstructions o Social Skill classes
Research 1Iwama, M. K., Thomson, N. A., & Macdonald, R. M. (2009). The Kawa model: The power of culturally responsive occupational therapy. Disability and Rehabilitation, 31(14), 1125-1135.Examines the need for a non-Western based model and explainsthe relevance of the Kawa model.
Research 2Carmody, S., Nolan, R., Ni Chonchuir, N., Curry, M., Halligan, C., & Robinson, K. (2007). The guiding nature of the Kawa (river) model in Ireland: creating both opportunities and challenges for occupational therapists. Occupational Therapy International, 14(4), 221-236.Two case studies using the Kawa model to guide occupationaltherapy intervention examine the model’s effectiveness.
Research 3Suyi, Y., Mei Poh, S., Tsunaka, M., & Hua Beng, L. (2006). Cultural influences on occupational therapy practice in Singapore: a pilot study. Occupational Therapy International, 13(3), 176-192.Explores the relevance of occupational therapy frameworks inSingapore.
Research 4Nelson, A. (2007). Seeing white: a critical exploration of occupational therapy with Indigenous Australian people. Occupational Therapy International, 14(4), 237-255.Using critical race theory to help therapists learn more about theculture they are working with.
Research 5Iwama invites discussion forum readers to participate indeveloping research.Iwama offers encouragement and support along with possibleresearch questions about the model and how it ties into currentpractice. (Iwama, n.d.)
Strengths• Encourages adaptation of the model as needed• Culturally safe• Non-biased• Not similar to other models• Modern, has Face Book page and web site• Facilitates occupation based interventions (Iwama et al., 2007)• Author discusses case studies from Eastern and Western parts of the world.
Limitations• May be difficult to apply in the West due to the difference of the importance of self• Abstract• Clinicians feel unsure of their understanding based on the client’s interpretation(s) (Iwama et al., 2007)• Clients may not understand• Small amount of research on diagnostic populations• Easy to get caught up in detail when drawing river(s)
Future Development• Increase guidance in placing elements in the river• More specific research• Your thoughts?