Kawa River Model

Kawa River Model

Nicole Murlo, Allison Overhiser, Michelle Powis and Caroline Schmidt

"This material reproduced/replicated for fair use for educational purposes in OCTH 611.001, Spring 2015, Towson University and should not be copied without permission of copyright holder."

Figure 5. Clearing Your River (The Kawa Model, 2015)

Figure 4. Blocked River (The Kawa Model, 2015)

schematic

Figure 3. Filling the River (The Kawa Model, 2015)

Concepts and Constructs

• Water (mizu) ~ life, energy, or flow
• Rock (iwa) ~ a situation or circumstance that can negatively affect someone's life
• Driftwood (ryuboku)~ internal characteristics and physical resources
• River wall (Kawa no soku heki) and

river sides (Kawa no zoko) ~ social and physical environment

• Spaces between obstructions (sukima)~ the progress of your life despite the obstacles

(Iwama, 2005)

Figure 2. River Schematic (The Kawa Model, 2015)

Principles of this model

• If there is a balance between the individual and the context, they will have a good life flow.
• The relationships you maintain will determine the course of your river and life flow.
• The person is inseparable from the environment.

(Iwama, 2005)

Philosophical assumptions

Strengthening the Kawa model: Japanese perspectives on person, occupation, and environment

Author: Wada, M.

No method; critique article

He recognizes the importance of a cultural model.

Summarizes the model (similar to information given in text book).

Criticism:

• Person is already part of a larger group.
• No representation of personal desire/ individuality (needs, interests) that may differ from the group which could consequently affect flow.
• Does not express the effect/ expense of client's health by conforming to societal norms (individualistic perspective).
• Rocks may be able to represent the individual/ personal needs and desires that are not met.
• Typical protocol used for this model (e.g. drawing your river) may not actually represent the client's life flow.
• Lack of operational definition of harmony.
• Occupation is not explicitly identified & water represents too many constructs.
• Not occupation based.

Improve the cultural relevance by redefining the environment/context to include the specific, meaningful groups to which people belong "seken".

Author, Time frame and some History

(Wada, M., 2011)

The guiding nature of the kawa (river) model in Ireland: creating both opportunities and challenges for occupational therapists

• "Life is a complex, profound journey that flows through time and space like a river" (p. 218).
• Individuals have the right to a steady and even 'life flow'.
• Throughout life, people are provided with the positive qualities and traits to help alleviate stressful situations and maintain a steady life flow.
• During their lives, individuals are responsible for maintaining their flow and not restricting the flow of others.

(Iwama, 2005)

References

Carmody, S., Nolan, R., 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.

Giazzoni-Fialko, T.M. (2011). Positive Experiences and

Meaningful Interventions of Parents of Children with

Autism Spectrum Disorder: Joys and Obstacles in the Life

Flow (Masters dissertation). Retrieved from Temple

University Libraries. (UMI Number: 1488781)

Iwama, M. (2005). The Kawa (river) model: Nature, life flow, and the power

of culturally relevant occupational therapy. In F. Kronenberg, S. Simo Algado, & N. Pollard (Eds.), Occupational therapy without borders: Learing from the spirt of survivors (pp. 213-227). Churchill Livingstone: Elsevier. [Seminal work]

Medical University of South Carolina. (2013). Internationally Renowned l

ecturer, Dr. Michael Iwama. [Image file]. Retrieved from http://academicdepartments.musc.edu/chp/alumni/enewsletters/2013summer/ot/Mitcham%20Lecture.htm

Occupational Therapy Show. (November 26, 2014). Dr. Michael Iwama

Biography. Retrieved from http://www.theotshow.com/page.cfm/

Action=Visitor/VisitorID=5

Paxson, D., Winston, K., Tobey, T., Johnston, S., & Iwama, M.

(2012). The Kawa model: Therapists' experiences in mental

health practice. Occupational Therapy in Mental Health,

28(4), 340-355. doi:10.1080/0164212X.2012.708586

The Kawa Model. (February 2015). The Kawa Model. Retrieved from http://

kawamodel.com/

Wada, M. (2011). Strengthening the Kawa model: Japanese

perspectives on person, occupation, and environment.

Canadian Journal of Occupational Therapy, 78, 230-236.

doi:10.2182/cjot.2011.78.4.4

Authors: S. Carmody, R. Nolan, N. Chonchuir, M. Curry, C. Halligan and K. Robinson

Method:

• By focusing on 2 individuals with Multiple Sclerosis in Ireland, this study hoped to find the effectiveness of the Kawa River Model.
• Semi-structured interviews were conducted and the participants and researchers kept journals throughout the intervention.

Results:

• The Kawa River Model proved to be an effective tool that can be spread to various cultures.
• The Kawa River Model allowed participants to evaluate their lives and shape their goals.

The Kawa model: Therapists' experience in mental health

• Model was created by a group of Japanese Canadian academics with connection to Japanese practitioners.
• The initiation of this model was around the year 2000.
• Western models were not fitting occupational therapy practices in Eastern cultures.
• The Kawa Model was originally used specifically in Asian cultures, but has grown and adapted to fit various cultural views around the world.

(Iwama, 2005)

• Michael K. Iwama is most associated with the Kawa River Model.
• Internationally known and respected in the field of occupational therapy.
• Currently Professor and Chair of Occupational Therapy at Georgia Regents University.

(Occupational Therapy Show, 2014)

(S. Carmody et al., 2007)

activity

Let's see how your rivers flow!

Authors: Paxson, D., Winston, K., Tobey, T., Johnston, S., & Iwama, M.

Method:

In the study, two occupational therapists were trained on the model. They were required to use the model during therapy for six weeks with at least one patient who had the cognitive abilities to understand the river metaphor.

Researchers checked in with the therapists frequently to address questions, concerns and progress. Informal interviews with the therapists were conducted at the end of the six week period to gather data.

Results indicated six themes:

1. Develops a positive client-therapist relationship and collaboration.

2. Metaphor was "fun and exciting" and created "positive energy."

3. Nervous to use because it is a newer model.

4. Challenged to think differently and expand outlook on therapy.

5. Patients understand and find meaning.

6. Positive outcomes for both therapists and patients.

Positive Experience and meaningful interventions of parents of children with autism spectrum disorder: joys and obstacles in the flow of life

(Paxson et al., 2012)

ideas for future refinement and research

Figure 1. Michael Iwama (Medical University of South Carolina, 2013)

• Provide alternative metaphors that can be applied outside of the Japanese society.
• More definitive description of what parts of the river represent.
• More research and studies on the Kawa River Model.
• A more up to date website.
• Additional resources online.
• Make it a practice model.

Author: Tina M. Giazzoni- Fialko (Thesis submitted to Temple University Graduate Board)

Population: 5 parents of children who are on the autism spectrum were used for the sample.

Method:

• Grounded theory was the chosen as the method for this study. This was chosen because currently, there is not a lot of literature on the topic of how parents process and cope with the joys and stresses of raising children with autism. There is also a lack of information on what interventions parents felt were most important in improving the child's quality of life.

Results:

• "The flow of life" between parents and children was strong.
• The circumstance of being a parent of a child with autism.
• Helping the flow.
• Family participation in social activities strengthens the bond of the family unit.

Strengths

Application to case study

Pedro Mendez

limitations

Figure 6. Mr. Mendez's River (The Kawa River, 2015)

• There are no "definites" in this model.
• Culturally flexible.
• This model allows practitioners to use the model with individuals or groups.
• Unique that the person is physically in an environment within the model. Gives the person a great visualization.
• Client-centered in Western civilizations.

(Giazzoni-Fialko, 2011)

• 66 year old man from Central America.
• Spanish is his primary language.
• Diagnosed with osteoarthritis with pain in his back.
• Difficulty with self care and ADL tasks.
• Not currently engaging in group activities.
• He does do what is asked of him in terms of therapy.
• Defers questions of what he likes to do for leisure to his son.
• Occupational therapist decided to try the Kawa Model to get a better understanding of Mr. Mendez.
• He and his family are part of a close knit community and do not want to bring any shame upon the community.
• Son may be facing deportation and it is putting stress on Mr. Mendez.
• Having issues of self-esteem and self-worth.
• After therapy, he hopes to be able to play with his grandchildren and walk his dog.
• Therapy focuses on involving Mr. Mendez in purposeful activities, drawing on family and social support, adapting the home environment to ensure safety and mobility, providing him with counseling, and addressing the issue of immigration.
• Addressing all of these issues will create a better life flow for Mr. Mendez.

(Iwama, 2005)

• People do not know how to interpret the metaphors in the model.
• There is a lack of what 'occupation' is in the river.
• Person is already seen as part of a group, but the model does not explain how someone wants to expand into new groups and environments.
• No area for personal desires.
• Does not express the clients' health or needs by conforming to the goals.

(The Kawa Model, 2015)

(Wada, M., 2011; Carmody, S. et al., 2007)