An autobiographical case study by the author to describe use of the Kawa Model in dealing with personal grief and its effects on occupational flow.

1. OCCUPATIONS FOR
LIFE
Mrs Samantha Jefferies
Freelance Occupational Therapist

2. WELCOME
Please help yourself to
refreshments provided for your
enjoyment and it’s my birthday!

3.  Demonstrate how an Occupational Therapist would
think and do in relation to using occupations for life to
maintain function during difficult life situations.
 Using the KAWA Model to gain a holistic picture of
the case study, aka me, sailing through grief!
AIMS OF THE PRESENTATION

4. CASE STUDY MRS JEFFERIES
INITIAL ASSESSMENT
 Characteristics: 41, Female, Lives alone, White, British, Home owner,
 Diagnosis/referral reason: Recently widowed, Reactive Anxiety/Depression
 Medical History: Dyslexia, Anxiety, including acute anxiety episode, Hypertension, Asthma, Allergies
 ADL’s: Late husband took responsibility for all bills, cars, help needed with household management
 Person Centred Goals : Long term –maintain pre-grief abilities, Short term –be proud of self and
own abilities, need to channel emotions functionally. Do lots of positive character building occupations to
build confidence, shape identity and provide meaning and purpose.
*Ethics & Code of Professional Conduct: 2.1 Duty of Care, 2.2 Welfare, 2.4. Section 3 Service Provision
3.3.2 (p.16). Section 6; 6.1 (p.33)

5. FUNCTIONAL ASSESSMENT
 Executive Function affected by emotional processes- short term memory affected,
planning, organising compromised
 Physical mobility – emotions affecting muscles in relation to anxiety and depression
 Home Environment compromised due to husband dying in main bedroom and
memories and prompts needed to manage bills and maintenance.
 Risk –loneliness and possible isolation, depression, lowered motivation

6. HOME ENVIRONMENT VISIT
 Home is a 2 bedroom dwelling with a large attic space and a garden within a private estate
 Husband died in home of a subarachnoid haematoma (massive brain bleed)
 Mrs Jefferies lives in a small rural community where everyone knows her and late husband and
situation, mostly supportive but raises self consciousness/awareness, friendships locally
 Mother, Farther & Brother live 250 miles away, Clive’s parents live around the corner
 Resources in local community: village shop, hair-dressers, community centre with activities,
literary and garden society near by, local pub and restaurants within the local town, nature reserve
and beach within 10 minutes walk from home, nearest town 2 miles away, train station in town with
parking, church nearby for flower arranging,& enabling social contact

7. MY INDIVIDUALISED GRIEF
PROCESS Myself and professional medic implemented the following process:
 Shock, Notice & Be Present; Clearance; Re-adjustment
 Bowlby ‘s Stages of Grief is what I mostly identified with: shock and numbness; yearning and searching;
despair and disorganisation; re-organisation and recovery.
 From the start I recognised this would be normal and my reactions would be unique to myself. I also
researched previous writings on grief and then recognised how important it was for me to view myself with an
occupational lens. This resulted in a fast processing of emotions and remaining in control, which benefitted me
enormously. Some of my friends even doubting I was dealing with my situation, which struck me was a reflection
of themselves. Actually I impressed myself and was proud of my resilience . I would also add I didn’t feel a need
to recover I kept going by being kind to myself, being present with my emotions and physical state

8. SAILING THROUGH GRIEF
 Learning a new skill –Sailing.
 Learning to use the tide and wind to enable me to go places rather than fighting
against them, turning potential hazards to my advantage, increasing confidence &
self efficacy. Using the elements and being in contact with nature as therapy.
 Sailing allowed me to use existing skills and develop new ones and go in all
different directions of my own choosing, an uncanny parallel with life.
 Benefits of new skills gave opportunities for matching skills and challenges,
sailing and boat maintenance, doing a boat delivery to Holland, sailing with a
disabled charity, winning first in class in Round the Island Race, completing AMPS
assessments on boats.

9.  Flower arranging with Clive’s Mother, we have
the slot to remember his Grandfather in the Church
Flower Rotas
 Funeral Flowers
 Allowing for time to be structured, taking me out
of myself, doing things for others, increase in
confidence, practicing skills, creating aesthetically
colourful, control, connecting myself to others,
pleasure, relaxing, connecting with nature, local
community and wider world, exercise, photography
MEANING, PURPOSE,
CREATIVITY, RELAXATION
 Engaging with activities
and occupations enables
further engagement with
other activity ad
occupations

10. KAWA MODEL CONCEPTS
 Drift Wood –Ryuboku Various attributes & resources of the individual
 Water – Mizu Depicts Life Flow
 Rocks – Iwa Negative circumstances blocking or slowing flow: can be permanent or
temporary; rocks and circumstances can be unique
 River Walls & Floor -Torimaki: Kawano soku–heki & Kawano zoko Context social
and physical; includes a range of personal relationships with the living and non-living.
Have a great impact on flow in a collectivist social context.
 Spaces between obstructions – holistic occupational therapy occurs here including
meaning of the activity to self and community

11. MRS JEFFERIES KAWA
 BIRTH
 Phase 1 – Active, Independent
 Phase 2 – Married Life, IVF
 Phase 3 – IVF & Death of Husband, Grandma & Pet Cat
 Phase4 - Grief and Loss; Mental and Physical ill health
 Phase5 – Re-adjustment, Active, Independent
 END OF LIFE

12.  Overall Occupations in Daily Life - Routine
 06:30 Wake up, Facial wash prompted by Mother gave me a routine for the
morning and a prompt to start the morning routine. Eat breakfast drink
 Start/continue with responsibilities after someone has died with assistance
 12:00 Eat Lunch, drink
 Continue with death responsibilities
 Go to the shop, walk outside, hairdressers, flower arranging, gardening,
 22:00 Watch film, Read, Stroke cat, Sleep
WATER-LIFE FLOW

13.  Hormone Levels
ROCKS - IWA
N E G A T I V E C I R C U M S TA N C E S B L O C K I N G L I F E F L O W
A N D C A U S E DY S F U N C T I O N / D I S A B I L I T Y
 Grief, death of one Cat
 Grief, death of Husband
 Grief, death of Grandma
 Pain Levels
 Dyslexia
 Asthma
 Anxiety
 Lives away from family

14. RIVER WALLS AND FLOOR
P H Y S I C A L & S O C I A L E N V I R O N M E N T
 Family, Friends, Neighbours, War
Veterans, Work Colleagues, mine &
Husband’s
 Work, local community activities,
societies and associations
 Facebook friends
 Internet
 College of Occupational Therapists
 Sailing & Interest Clubs Nationally
 Home environments
 Boat in London and Isle of
Wight
 Cats
 Late Husband, Grandma

15. Monetary Resources, Ability to Work
Strength of Character & Personality, with
positive attitude, optimism
Occupational Therapist awareness of using
occupations and activity for health
Being a woman
DRIFT WOOD

16. MRS JEFFERIES-RIVER DIAGRAM
 Anxiety
 Dyslexia
 Grief, death of Husband
 Asthma
 Pain Levels
 Hormone Levels
 Rocks
Walls & Floor
Family, Friends, Neighbours, War Veterans, Work
Colleagues, mine & Husband’s
Work, local community activities, societies and
associations; Facebook friends; Internet;
College of Occupational Therapists; Sailing &
Interest Clubs Nationally; Home Environment,
Cat
Driftwood
Finances, Ability to Work,
Personality,
Occupational Therapy Skills
Water
Routine, Activities
of Daily Living,
Personal Care,
 Lives away from family

17.  Mrs Jefferies husband died suddenly, Grandma died within last year and Cat
 Grieving process needed to be supported; processing negative emotions
 Mrs Jefferies past experiences of anxiety led to Mother supporting how people are
going to react and setting expectations and encouraging Daughter to ask for help. Also
supported death responsibilities – Social, Emotional, Practical, Organisational
 Mrs Jefferies need for help to remain independent and maintain own home
environment. – PADL’s & ADL’s –needed prompting
 Return to work on a very gradual basis, Activities daily, Learning a new activity
SPACES BETWEEN OBSTRUCTIONS
PROBLEM IDENTIFICATION

18. TREATMENT
SHORT TERM GOALS
 Develop abilities and implement organisational tools for supporting executive & working memory
 Coping with chaotic, fire fighting situation relating to finances, organising funeral, emotional aspects,
whilst developing a new routine for lifestyle
 Implementing Mindfulness and Flow for emotional regulation and processing
 Increase skill in autonomy , independence and well-being and confidence in own abilities to cope when
faced with adversity and maintain motivation
 Maintain social environment and financial security, making good decisions
 Build on success and positive experiences to counteract negative aspects of reactive depression and
anxiety by focus on occupational performance areas of tasks

19. TREATMENT
LONG TERM GOALS
 Maintain independence in own environment and learn strategies
 Increase confidence in own abilities, function and motivation
 Return to work within a sustainable environment for Mrs Jefferies
 Build resilience and develop identity and self efficacy to cope with grief and
mental health
 Lean a new skill to enable Mrs Jefferies to sail through grief, loss, change,
increase and maintain well-being and control

20. REFERENCES
 Bowlby, J. (1961). Processes of mourning. International Journal of
Psychoanalysis, 42, 317-339.
 College of Occupational Therapists (2010) Code of Ethics and Professional
Conduct, London
 Creek Jennifer (2010) The Core Concepts of Occupational Therapy: A
Dynamic Framework for Practice, Jessica Kindsley, London
 Iwana Michael K (2006) The Kawa Model: Culturally Relevant Occupational
Therapy, Churchill Livingstone, Elsevier

21. MY CONTACT DETAILS
samanferotjefferies@gmail.com