Kawa River Model Study Guide

Kawa (River) Model

Presenter:

  • Darby Kyler, OTD, OTR/L, CBIS

  • DES MOINES UNIVERSITY

  • MEDICINE & HEALTH SCIENCES

Course Context

OTD 1614: Foundations of Occupational Therapy
Topics Covered:

  • Topic 1: History & Philosophy of OT

  • Topic 2: OT Domain & Process

  • Topic 3: OT Theory

Weekly Breakdown:

  • Week 1: Philosophy

  • Week 2: History and Contemporary Practice

  • Week 3: OT History Day Tour & The OT Calling Card, Applicaion Settings

  • Week 4: Occupations, Performance Patterns & Skills

  • Week 5: Client Factors, Contexts & Culture

  • Week 6: OT Process

  • Week 7: Explaining OT, OT Evidence

  • Week 8: New Paradigm of OT

  • Week 9: Occupational Behavior, Canadian Model of Occupational Performance (CMOP), Model of Human Occupation (MOHO), Person-Environment-Occupation (PEO)

  • Week 10: Occupational Adaptation (OA), Ecology of Human Performance (EHP), Person-Environment-Occupation-Performance (PEOP)

  • Week 11: Kawa, Biomechanical, Rehabilitative Models

  • Week 12: Developmental Impact Assessment (DIA), Cognitive Development (CD), Cognitive Orientation to daily Occupational Performance (CO-OP)

  • Week 13: Lifespan, Sensory Integration (SI), Co-occupation

  • Week 14: Motor Control, Motor Learning

  • Week 15: Behavioral, Cognitive Behavioral Approach (CB), Psychodynamic

  • Week 17 & 18: Eclectic Framework, Case Application

  • Week 18: Theory in Practice Paper

  • Weeks 9-15: Theory Case Application

Learning Objectives

  1. Demonstrate an understanding of all components of the Kawa (River) Model.

  2. Identify the key people, purpose, and origins of the Kawa Model.

  3. Recognize how the Kawa Model can be applied to occupational therapy evaluation and intervention.

  4. Understand how the Kawa Model fits into the types of theoretical knowledge.

  5. Integrate knowledge of the Kawa Model to apply to case examples.

Kawa River Model Overview

  • Definition: Kawa is the Japanese word for river.

  • Metaphor: The Kawa Model considers the past, present, and future needs of the client, similar to how a river has a source representing the beginning of life and a mouth meeting the sea representing the end of life (Teoh & Iwama, 2015, pp. 2).

Background of the Kawa Model

  • Origin: Created by a group of occupational therapists in Japan.

  • Population Focus: Individuals, families, groups, and organizations.

  • Reason for Development: Japanese occupational therapists found that Western occupation-based models were not culturally relevant to explain OT.

  • Inclusivity: Intended to be relevant across cultures, viewing occupations collectively.

  • Context Importance: Occupations are inseparable from social groups and context (Iwama et al., 2016; Iwama, Thomson, & Macdonald, 2009).

Focus of the Kawa Model

  • Metaphor: The river exemplifies the inseparable nature of individuals from their social groups, and the connection of occupations to natural and spiritual contexts.

  • Collaboration: Occupational therapists work with entire groups, recognizing that occupations are collective experiences.

  • Identity: Families and social groups share combined identities, and the successes and failures of individual members reflect on the whole group.

  • Goals: Goals often shift from occupational performance to inclusion and harmony within the group.

  • Utility: The model serves both as an assessment tool and a practice model.

Kawa Model Components

River Life Flow and Occupations

  • Description Includes:

    • Priorities

    • Roles

    • Activities

    • Life processes covering the past, present, and future

River Bank Environment

  • Description Includes:

    • Physical environment

    • Social environment

    • Social support

    • Various contexts

Driftwood: Personal Resources

  • Description Includes:

    • Personal traits and characteristics

    • Skills, abilities, and experiences

    • Beliefs, values, and principles

Rocks: Barriers

  • Description Includes:

    • Obstacles and challenges that impede life flow

    • Circumstances blocking occupational performance difficulties

    • Fears and concerns regarding capabilities

Water/River: Life Flow and Health

  • Covers the full life cycle from birth to death, emphasizing communal life within the social context.

Understanding the Components

  • Spaces: Opportunities for enhancing flow; places that allow for OT intervention.

  • Therapeutic Focus: Occupational therapists study the dynamics of the river components to identify ways to improve life flow and work together with clients in meaningful interventions.

    • Influential areas include removing or diminishing components that hinder flow.

Philosophical Consideration of Disability

  • Within the Kawa Model, disability is seen as a collective experience.

  • Function exists when individuals harmonize with their group and their natural environment.

  • Conceptual Contrast: Function vs Dysfunction is explored in relation to social and environmental factors.

Evaluation Process

Components of the Evaluation:

  • Drawing the Kawa

  • Identifying current status within social exclusion or support

  • Exploration of Life flow conditions

Example: Client Profile

  • Health concerns: Poor concentration, difficulty coping, interested in employment opportunities, long-term mental health issues.

  • Social dynamics: Supportive friendships vs. experiences of bullying and low self-esteem.

  • Activities of interest: Football, art, volunteer work, and reading.

Guiding Questions for Client Interaction

River Flow Questions

  • Describe your river currently.

  • How do you spend your day?

  • What activities do you enjoy and why?

  • What significant life changes have you faced recently?

Rock Questions

  • What difficulties are you currently facing?

  • Is there something you want to do but feel unable?

  • What is something in your life you would like to change?

River Bank Questions

  • Who do you live or spend time with?

  • Can you describe your living or working environment?

Driftwood Questions

  • How do you see challenges?

  • What special skills or abilities do you have?

  • Are there any thoughts that hinder your progress?

Intervention Strategies

  • Goal: Create or broaden spaces for water flow in the Kawa.

  • Approach: Increase flow without necessarily altering circumstances.

  • Methods include:

    • Reducing size or quantity of rocks (barriers)

    • Adjusting or widening riverbanks (environmental conditions)

    • Utilizing existing or introducing new driftwood (personal resources).

Principles of Application

  • Client-Centric Focus: Honor the client's perspective and narrative.

  • Modify metaphors to fit client needs.

  • Understand and address cultural influences on the occupational therapy process (Teoh & Iwama, 2015).

Research Applications of Kawa Model

  1. Lape & Scaife (2017): Kawa used for team-building among rehabilitation professionals.

  2. Ober & Lape (2019): Kawa to enhance inter-professional collaboration in acute care settings.

  3. Yeh, Huang, & Wu (2018): Analysis of activity participation among individuals with schizophrenia using Kawa.

  4. Gregg et al. (2015): Development of interventions for military service members incorporating Kawa principles.

Case Application Exercise

Example Case: Vista Village

  • Location: Mixed-use housing complex in St. Louis for low-income older adults.

  • Demographics: Tenants aged 65-90 relying on social security or pension.

  • Challenges: Chronic conditions, mobility issues, limited social support, safety concerns in the community, and barriers to medical care.

  • Community Engagement: Interest in intergenerational programming but lacks established opportunities.

Activity:

  • Work in groups to use the Kawa Model to interpret life flow in Vista Village focusing on:

    • River Flow

    • River Banks

    • Rocks

    • Driftwood

References

  1. Gregg, B. T., Howell, D. M., Quick, C. D., & Iwama, M. K. (2015). The Kawa River Model: Applying theory to develop interventions for combat and operational stress control. Occupational Therapy in Mental Health, 31(4), 366-384.

  2. Iwama, 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.

  3. Iwama, M., Teoh, J. Y., Tripathi, N., Murthi, K., & Feng, W. (2016). The Kawa Model. Retrieved from http://www.kawamodel.com

  4. Lape, J. E., & Scaife, B. D. (2017). Use of the Kawa model for teambuilding with rehabilitative professionals: An exploratory study. The Internet Journal of Allied Health Science and Practice, 15(1).

  5. Ober, J. L., & Lape, J. E. (2019). Cultivating acute care rehabilitation team collaboration using the Kawa model. The Internet Journal of Allied Health Science and Practice, 17 (3).

  6. Teoh, J. Y., & Iwama, M. (2015). The Kawa Model made easy: A guide to applying the Kawa Model in occupational therapy practice (2nd edition). Retrieved from www.kawamodel.com

  7. Yeh, E., Huang, L. J., & Wu, C. (2016). Activity participation for community clients with schizophrenia through the Kawa Model perspective. American Journal of Occupational Therapy, 70.