The document describes the application of the Kawa Model in occupational therapy to illustrate compassionate care for a client named Julie. The Kawa Model uses a river metaphor to represent a person's life. The summary includes: 1) Julie struggles with a wrist injury, divorce, loneliness, and Asperger's Syndrome which impact her ability to pursue her primary occupation of painting. 2) Occupational therapy aims to help Julie adapt her painting to accommodate her injury, improve her social skills to build connections, and find ways to feel inspired again. 3) The case example demonstrates the first four steps of the Kawa Model: understanding the client's context, clarifying contextual issues, prioritizing concerns,

1. Kawa Model Application: Illustration of Compassionate CareKawa Model Application: Illustration of Compassionate Care
http://www.youtube.com/watch?v=VaWt3tHZL7ohttp://www.youtube.com/watch?v=VaWt3tHZL7o
Kari Tracy, OTSKari Tracy, OTS
Contributing Author: Sandra F. Countee, OTR/L, Ph.D.Contributing Author: Sandra F. Countee, OTR/L, Ph.D.
OverviewOverview Alternate ModelAlternate Model
Occupational ProfileOccupational Profile
RocksRocks
SpacesSpaces
Implementation StepsImplementation Steps
The Kawa Model describes a culturally relevant
model of practice, using the metaphor of a river to
describe the many issues inherent in people’s lives1
.
This presentation on the Kawa Model explains its
foundational concepts. The model has six steps, four
of which are outlined. An alternative metaphor is also
illustrated for use in practice.
WaterWater
ReferencesReferences
Kawa
Concept
Client
Centered
Issues
Occupational Therapy
Intervention
Rocks
Life
circumstance&
Problems
-Pain and
decreased
mobility from
wrist injury
-Divorce:
Can’t fulfill
family duty
as wife
-Feels alone
and
uninspired
-Attend activity group on
exercise and education of body
mechanics. Learn joint
preservation approaches and
techniques
-Coordinate with other team
members, such as nursing,
psychology and counselors to
set up a series of family
meetings to discuss family
duties and roles in order to
explore more avenues to deal
with disability experience
Kawa
Concept
Client
Centered
Issues
Occupational Therapy
Intervention
Driftwood
Liabilities
-Aloofness
-Lack of
communication
and social skills
-Perseveration
-Asperger’s
Syndrome
-Encourage interaction
with environment and
people, teach ways to
engage others
-Establish communication
techniques and teach social
roles within community
-Prevent perseveration from
impacting life by redirecting
Julie to engage in new
activities
-Attend a social skills
training support group.
Encourage social situations
Kawa
Concept
Client Centered
Issues
Occupational
Therapy
Intervention
Water
Purity,
spirit,
cleansing,
renewal
-Water continues to flow
around Julie’s wrist injury,
divorce and lack of social
environment but…
-Water is slowed due to
Julie feeling uninspired in
the most important
occupation of her life and
her feelings of aloneness
due to her lack of
communication and social
skills
-Use the clients
assets and abilities to
work at decreasing
problems and
liabilities
--Encourage and
provide positive
feedback
-Involve other
members of support
network (with client’s
consent) as much as
possible
The first four steps of the model illustrated in this case
include:
1) Appreciating the client in context
2) Clarifying the context
3) Prioritizing issues according to client’s perspective,
and
4) Assessing focal points of occupational therapy
intervention.
Steps 5 and 6 (Intervention and Evaluation) should
follow but are not presented in this case.
Kawa
Concept
Client Centered
Issues
Occupational
Therapy
Intervention
Spaces
Life flow &
Health
-Potential OT treatment
approaches and points of
interventions are seen in
the channels between
Asperger’s Syndrome,
divorce, pain in wrist,
feeling alone and
uninspired, art studio,
inability to paint while
injured, lack of family and
friends, financial stability,
art supplies,
determination, aloofness,
lack of communication and
-Avenues to explore
are increasing social
skills as to build up a
support by
reconnecting with
family and making new
friends. Finding ways
to adapt art to allow
for participation in
this occupation which
will open client up to
feeling inspired again
Julie is a young adult who views her primary role as
that of an artist and identifies painting as her most
significant occupation. Julie has Asperger’s Syndrome
and hyper-flexion of the wrist but even though she is
divorced, her ex-husband has provided her with
financial resources to continue her painting. A lack of
family support has created a barrier in her life. In
addition, Julie’s deficits in communication have acted
as a barrier to forming friendships; Julie feels alone
and uninspired.
DriftwoodDriftwood
River Walls and BottomRiver Walls and Bottom
1. Iwama, M. (2006). The Kawa Model: Culturally relevant
occupational therapy. Philadelphia: Churchill Livingston Elsevier.
2. Kawa Model Website. (2010). Retrieved June 11, 2012. From
http://www.kawamodel.com
3. American Psychiatric Association. (2000). Diagnostic and
statistical manual of mental disorders (4th ed. text rev).
Washington, DC: Author
-Metaphors are best understood when they are
presently tangible
-The river is an excellent metaphor but in urban
settings, they are difficult to come by
-A window is easily accessible in most environments
Kawa- (River), life flow
Goal- strong, deep,
unimpeded flow
Mado- (Window), enlightened
life
Goal- bright, wide, long,
unimpeded shineRiver- Fluid, beginning to
end (birth to death)
Window- Opening, portal to
the soul, two-way interaction
between client and environment
Water- Cleansing, purity,
spirit, renewal
Light- Cleansing, purity,
revelation
Rocks- Problematic,
difficult to move
Trees- Solid, difficult to
remove, blocks light
Driftwood- Blocks,
enhances, or does not impact
flow
Curtains- Shutting out light
or letting it in
River walls & bottom-
Confines river, give it shape
Window frame- Confines
window, determines how much
light can shine through
Spaces- Channels for
water to seep through
between barriers
Window pane- Where light
can still shine through between
barriers
Kawa
Concept
Client
Centered
Issues
Occupational Therapy
Intervention
River walls
&
bottom
Physical &
Social
Environment
Physical:
-Art studio
-Inability to
paint with
injury
Social:
-Lack of
family
-Establish a plan in which Julie
can ensure financial stability to
maintain her art studio after
funds from her ex-husband dry
up
-Adapt a way in which Julie will
be able to engage in her art to
inspire her soul
-Teach social skills and roles in
an attempt to reconnect Julie
with estrange family and
Driftwood
Assets
-Financial
stability
-Art supplies
-Determination
-Asperger’s
-Establish a plan to budget
money to continue financial
situation as long as possible
-Learn ways to maintain
integrity of art supplies to
make them last
-Work on maintaining
determination to paint and
learn ways to shift
determination to other
aspects of life such as
making friends and
reconnecting with family
-Maintain the unique
qualities inherent from this
syndrome that have given