Introduction to the Kawa Model (Beki Dellow)

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Splendidly thorough introduction to the Kawa Model by Beki Dellow (York St. John University, UK)

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  • Hi Pip, I would be happy for you to use slide 6, however I would recommend asking permisson from Prof Michael Iwama as he allowed me to use some of the slides from his presentation (e.g. slide 6). You can find him on facebook. If you have difficulty finding him, let me know

    Thanks Kimberley for your kind feedback!
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  • Beki I think this is a very good presentation, I especially like the diagram on slide 6 linking the river to the first model the colleagues in Japan developed. I would like to publish something similar but in German in an article I am writing for the German OT Journal. May I please have your permission. It is a translation and the river may look a little different too but I want to use your idea of linking the two.
    Many thanks, Pip Higman (pip(at)higman.de)
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  • Beki - this is one of the BEST presentations I have read (on any topic). Well done! KK (OT)
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  • Khomarun, occupational therapy in Indonesia
    Great. I will show it for OT students in Indonesia. Would you give more information about this model
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  • oi makro
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Introduction to the Kawa Model (Beki Dellow)

  1. 1. The Kawa „River‟ Model By Beki Dellow Presentation includes some slides produced by Michael Iwama (2010), used with his kind permission
  2. 2. Learning Outcomes  Gain an overview of the Kawa ‘River’ Model  Case Study  Look at some relevant literature relating to the Kawa Model’s use in occupational therapy practice  Feedback and questions throughout presentation
  3. 3. Life is like a River… Birth TIME End of Life
  4. 4. Who founded the Kawa Model?  Michael Iwama, PhD, OTC, associate professor at the University of Toronto, with occupational therapy practitioners in Japan  Developed in 2000  Book published 2006  12 + articles in peer-reviewed journals  10 Chapters in OT & Rehabilitation textbooks  Translated into 5 languages  Taught in over 500 occupational therapy programs internationally  Used in practice across 6 continents
  5. 5. How was the Kawa Model developed? 4 Basic Concepts of the River Model Environmental factors Life (‘Ba’, Physical & Circumstances & Social) Problems Personal Factors & Life Flow & Resources Health They are all inter-related
  6. 6. Environmental factors Life Circumstances (‘Ba’, Physical & & Problems Social) Personal Life Factors & Flow & Resources Health KAWA
  7. 7. Why was the Kawa Model developed? Conventional Models in Occupational Therapy are cultural-bound in the (Western) model-maker‟s experience which: • Privileges a minority (Western) world-view of occupation • Constructs the self & environment as distinctly separate • Are based on mechanical metaphors Each person‟s experience of daily life is unique and should be the context to which occupational therapy should be adapted. Conventional models and approaches are often applied in a „one-size- fits-all‟ manner in which the client‟s experience of daily life is forced to comply to the theory-maker‟s standard view
  8. 8. If models are culture-bound, then isn‟t this model created in Japan only appropriate for use in Japan with Japanese people? The Kawa Model privileges the Client‟s worldview & perception of their day-to-day realities; told in their own words & ways. The client actually names the concepts & explains the principles, making the narrative bound to the client‟s culture…
  9. 9. Occupational Therapy’s Magnificent Promise To Enable people from all streams of life, to engage and participate in activities and Processes that have Value…(Iwama 2010)
  10. 10. When life happens…  Rocks = life circumstances  Driftwood = assets and liabilities  Riverbed/walls and bottom = environment  “An optimal state of well-being in one‟s life or river can be metaphorically portrayed by an image of a strong, deep, unimpeded flow” (Iwama 2006, p143)
  11. 11. Channels through which water flows = Opportunities for occupational therapists to maximize life flow OT OT OT OT OT ASSET / LIABILITY OT PROBLEM ENVIRONMENT
  12. 12. Life is enabled to flow more strongly and deeply despite residual obstacles and challenges…
  13. 13. Occupational Therapy‟s Aim Enabling and Maximizing “Life Flow”
  14. 14. Case Study – Meet Ben  29 years old  Lived independently in the past, but due to a recent deterioration in his mental health, currently resides with his parents  Diagnosed with chronic depression  Currently in full-time employment, although reports being dissatisfied with his work  Troubled by frequent feelings of pointlessness and is paranoid that he will lose his job
  15. 15. Ben‟s River – his life story
  16. 16. Past Life, Identity, Relationships, Ben‟s River diagram Self… allows the therapist to understand his life story, from his perspective Catastrophe, sudden changes Your Patient/Client
  17. 17. Cross-section of Ben‟s River – how life is now
  18. 18. Ben‟s River LOST Self destructive Lack of qualifications No transport Capability Fear of failure Poor concentration Self-understanding Finances Lack of opportunities and Creative interests Lack of confidence Poor motivation Unable to find enjoyment in anything Work Mental health Family (helpful but can be too How society is constructed Emptiness much) Lack of purpose Why? and direction Confusion
  19. 19. Assessment • The Kawa metaphor allows the therapist to gain further insight into Ben‟s life flow and health (river water), personal assets and liabilities (driftwood), life circumstances/problems (rocks) and environment (river sides/bed) • These combine to form a unique picture of Ben‟s life at this point in time • Using the Kawa Model, the purpose of occupational therapy is to gain an understanding of Ben‟s metaphorical representations and his occupational circumstances, clarifying their meaning and aiming to facilitate Ben‟s life flow
  20. 20. Goal Planning and Intervention • The therapist works collaboratively with Ben, using his Kawa diagrams to identify personal assets (strengths) and liabilities, problems and challenges, temporary issues and environmental factors (physical, social, political and institutional) which effect his „life flow‟ • Upon further analysis of Ben‟s Kawa diagrams, it becomes clear that potential spaces to increase „life flow‟ (areas for occupational therapy intervention) are limited. Ben‟s river is impacted with rocks (problems), virtually blocking the flow. A fuller and unobstructed river represents a better state of well being (Iwama, 2006) • Goal planning with Ben, referral to psychiatrist to review medication and assess level of suicide risk
  21. 21. Occupational Subjective Objective Assessment Components Assessment Assessment Outcomes Outcomes Tool Choice 1) Life Flow & Health / Overall Occupations OT 2) Circumstances & Problems INTERVENTION 3) Environment OPTIONS / PLAN (Social & Physical) Interventions 4) Personal Assets & Liabilities OUTCOME EVALUATION
  22. 22. Analysing Ben‟s Kawa metaphors and planning appropriate interventions
  23. 23. Evaluation If time had allowed, the Kawa Model could be effectively used to evaluate and complete the occupational therapy process. Ben could be asked to draw another metaphorical diagram of his „river‟ post intervention to identify any changes to his „life flow‟
  24. 24. Person-centered Practice Client Health Professional COMMON Expressing my daily Cultivating my reality from my own METAPHOR understanding of the „normal‟ client‟s daily „normal‟ Sphere of shared experience Sphere of shared experience
  25. 25. Evidence-base: Kawa Model  It is evident that there is limited published research on the effectiveness of the Kawa Model in practice in a Western context, and on occupational therapists‟ experience of using the Model
  26. 26. Physical Health and Well-being A qualitative pilot study conducted by occupational therapists in Ireland, aimed to explore the effectiveness of the Kawa Model when used to guide intervention with two individuals with multiple sclerosis (Carmody et al, 2007)  Assessment The guiding nature of the Kawa Model enabled the occupational therapy process, helping to build a therapeutic relationship and gain detailed occupational profiles of the participants using the river metaphor „a good information gathering tool‟  Planning The model aided facilitation of occupation-based goal setting and identification of the spaces for occupational therapy intervention
  27. 27. Physical Health and Well-being  Intervention Facilitated the participants‟ engagement in occupation-based therapy by allowing an understanding of what was important and meaningful to them  Evaluation Enabled review, evaluation and completion of the occupational therapy process  Limitations Challenges identified: therapist preconceptions of the Model and participant uncertainty in how to draw the river diagrams  Conclusion The Kawa Model may be identified as a mediator of person-centered practice as it led the participants to identify problems or impediments of the flow of water in their rivers and facilitated their engagement in the process of therapy
  28. 28. Mental Health and Well-being Practice Report: Fieldhouse (2008) charts his personal journey of discovery regarding his use of the Kawa as a community mental health practitioner and senior lecturer/educator  The Kawa metaphor supports currently „high profile‟ features of community mental health practice (recovery, social inclusion, person- centeredness, strength-based assessment, and positive risk management) – these can be „fed into‟ the model and, therefore, worked with  The Kawa Model‟s language and imagery are easily graspable by both students and practitioners  Highlights the great suitability of the Kawa as a tool in community mental health practice
  29. 29. Education Fieldhouse (2008 p104)  The Kawa Model was „accessible enough for students to embrace early on, yet also sophisticated enough to draw them forward in their clinical reasoning. It seemed to enable them to bridge the gulf between theory and practice‟  Students working in groups to develop intervention plans based on a fictional-based mental health client, realised the Model‟s „simplicity‟ and had enabled some highly sophisticated clinical reasoning to take place  Asking students to „stop trying to learn the model and to just try to think with some of its ideas‟ was a helpful strategy
  30. 30. Preceptorship Recent Feature Article published in the July edition of the OTnews (Buchan, 2010)  Used newly registered staff experiences of transition to influence change within a trust-based preceptorship programme  80 participaants (Allied Health Professionals, nurses and social workers) attended workshops to discuss the various aspects of preceptorship  The Kawa Model was used as a data collection tool to seek the experiences and needs of newly registered staff within their first year of practice (in both focus groups and semi-structured interviews to help guide the transition narratives. Participants were asked to review their personal transitions or „riverbeds‟ and identify their needs and areas of potential development  A significant amount of data was created from the research to influence the development of the preceptorship, support systems and the new preceptorship policy
  31. 31. The Kawa „River‟ flows Worldwide
  32. 32. Development of our Profession  ‘It is important to ensure practitioners (who, after all, are uniquely placed to see what interventions ‘work’ and what service users’ needs actually are) can contribute fully to ‘shaping’ the knowledge-base of the profession. It ensures both practice and education can be responsive to change’ (Fieldhouse, 2008 p101)
  33. 33. What is expected of us?  College of Occupational  Health Professions Council Therapists (2010) Code of (2008) Standards of Conduct, Ethics and Professional Performance and Ethics Conduct – Section Six (6.1.1):  Section 1 – „You must act in Developing and using the the best interest of service profession‟s evidence base users‟  Section 5 – „You must keep  „You should be able to access, your professional skills and understand and critically knowledge up to date‟ evaluate research and its  Section 7 – „You must outcomes incorporating it into communicate properly and your practice where effectively with service users appropriate‟ (p 33) and other practitioners‟ (p3)
  34. 34. Do you think you could add the Kawa Model to your toolkit?
  35. 35. Summary of Basic Principles  Life is like a river … All things are connected… (self & environment, past-present-future)  Understand the complexity of client experiences – from their perspective, in their own words…through a reversal of power  Occupational Therapy is informed by the client‟s day to day realities  Diverse worldviews necessitate diverse interpretations of „occupation(s)‟  Occupational Therapy = “Enabling Life Flow”
  36. 36. Your turn! How does your river flow? •Rocks = life circumstances •Driftwood = assets and liabilities •Riverbed/walls and bottom = environment
  37. 37. References  Buchan T (2010) Implementing Appropriate Support Systems OTnews 18 (7), 26 – 27  Carmody S, Nolan R, Chonchuir NI, 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  College of Occupational Therapists (201) Code of Ethics and Professional Conduct London: College of Occupational Therapists  Fieldhouse J (2008) Using the Kawa Model in Practice and in Education Mental Health Occupational Therapy 13 (3), 101 – 106  Health Professions Council (2008) Standards of Conduct, Performance and Ethics London: Health Professions Council
  38. 38. References  Iwama MK (2005) The Kawa River Model: Nature, life flow, and the power of culturally relevant occupational therapy. In: Kronengerg F, Algado SA, Pollard N (Eds) Occupational Therapy Without Borders – Learning from the Spirit of Survivors Edniburgh: Churchill Livingstone  Iwama MK (2006) The Kawa Model: Culturally Relevant Occupational Therapy Philadelphia: Churchill Livingstone Elsevier  Turpin M, Nelson A (2007) The Kawa Model: Culturally Relevant Occupational Therapy Australian Occupational Therapy Journal (54), 323 – 324  http://www.kawamodel.com/  http://kawamodel.phpbbnow.com/ (discussion forum)  http://www.therapytimes.com/content=0602J84C48769494406040441  http://occupational-therapy.advanceweb.com/Article/KAWA-Model- Project.aspx (videos)  Facebook:http://www.facebook.com/photo.php?pid=288121&fbid=147680 675266270&id=139318639435807&ref=nf#!/KawaModel
  39. 39. References Other useful references:  Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The Validity of the Hospital Anxiety and Depression Scale. An Updated Literature Review Journal of Psychosomatic Research Vol./is. 52/2 (69-77) 0022-3999  Canadian Association of Occupational Therapists (1991) Occupational Therapy Guidelines for Client-Centred Practice Toronto, ON: CAOT Publications ACE  Coelho HF, Canter PH, Ernst E (2007) Mindfulness-Based Cognitive Therapy: Evaluating Current Evidence and Informing Future Research Journal of Consulting and Clinical Psychology 75(6), 1000-1005  Davies T (2009) Risk Management in Mental Health. In: Davies T, Craig T (Eds) ABC of Mental Health (2nd Ed) Oxford: Wiley-Blackwell
  40. 40. References  Forsyth K, Lai J, Kielhofner G (1999) The Assessment of Communication and Interaction Skills (ACIS): Measurement Properties British Journal of Occupational Therapy 62(2) 69-74  Forsyth K, Salamy M, Simon S, Kielhofner G (1998) A User‟s Guide to The Assessment of Communication and Interaction Skills (ACIS) (Version 4.0) Chicago: The Model of Human Occupation Clearinghouse  Matsutsuyu JS (1969) The Interest Checklist American Journal of Occupational Therapy 23(4), 323-395  Roger S (Ed) Occupation-Centred Practice with Children: A Practical Guide for Occupational Therapists Oxford: Wiley-Blackwell  Snaith RP (2003) The Hospital Anxiety and Depression Scale Health and Quality of Life Outcomes 1(29), 1-29

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