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The Kawa Model

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Melissa Paniccia

on 30 November 2013

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Transcript of The Kawa Model

The Kawa Model:
A Sociocultural Perspective of Rehabilitation

Today's Agenda
History of the Kawa Model
Filling the gap
Development of the model
Importance of culture

The Kawa Model
Nature/River as a metaphor
Positioning the Rehabilitation professional

Use of the Kawa Model in Rehabilitation Practice
Definition of 'Rehabilitation' and 'Function'

Strengths and Limitations

Take Home Points


History of the Kawa Model
History of the Kawa Model
Culture can be identified at the core of most Western contemporary models
However, Eastern ideas are influenced by the shared meanings established within the culture (views come from tradition)
Eastern cultures emphasize
collectivist views
of the world, where
ideas explanation of phenomena dominate.
History of the Kawa Model
Re-defined occupation from East Asian cultural perspectives
re-aligning the purposes of OT to matters of essential importance to the Japanese person’s life and world (situating self within culture)
The Kawa Model

Eastern perspective of
self and context
explained through a metaphor of nature

Optimal state of
= strong, deep, unimpeded flow

Certain structures can affect that flow, but
structures are inseparable
, determine its boundaries, shape, flow rate and overall quality

Spaces between Obstruction (Sukima):
Opportunity for Rehabilitation

Spaces are the channels through which the client’s life evidently flows
E.g. Space between a functional impairment, Arthritis (rock) and a social group/person (river walls) may represent a social role, mothering

Spaces are
foci for rehab
subsume the environment
, potential channels for client’s flow holistic framework

Spaces are opportunities for
problem solving

Western Versus Eastern Culture
Kawa Model: Rehab Science and Research
Water (Mizu)
River Side-walls and River Bottom (Kawa Zoko)
Rocks (Iwa)

Discrete circumstances that
impede life flow,
life circumstances perceived to be
, difficult to remove

Each rock has different size, shape and density thus uniquely influence flow
Since birth, e.g. congenital disease
Others, instantly, e.g. sudden illness or injury

Once rocks are known, rehab professional can help
identify areas for intervention
to enable better life flow

Enables an
intimate dialogue
between client and therapist

The river through the client's eyes

Rehabilitation and function
Focus on harmony not the individual

Life-energy/life-flow -->

Role of OT/Rehab : "help the client and community enhance and
this flow" (Iwama et al. 2009, p1133)

Represent social and physical contexts
Social context:
share a direct relationship with the client
Family members, workmates, friends, recreational club
Physical context:
home, work, and nature itself

Harmonious relationships can complement/enable life flow

Driftwood (Iwa)

Personal attributes and resources
honesty, thrift
reserved, outgoing
optimism, stubbornness
Special skill:
carpentry, public speaking
friends, siblings
Knowledge and experience:
military service
Material assets:
wealth, special equipment

Can positively or negatively impact life flow

Temporal aspect:
can appear inconsequential in some instances and significantly obstructive in others

Driftwood can nudge other obstructions out of the way and erode constraining river walls and rocks

Research :Validation
Two participants with Multiple Sclerosis in Ireland (Carmody et al., 2007) --> opportunities & challenges

Two participants in mental health setting (Paxson et al., 2012) --> very positive assessment, bias?
Research: Application
Basis of qualitative study of individuals overcoming intimate partner violence (Humbert et al., 2013)

Semi-structured interviews based on the Kawa model

Predominant themes: relationships, starting over, spirituality, expansion of self and within each forward movement.

Take Home Message
Strengths and Limitations
Carmody, S., Nolan, R., Ni 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, 221-236.

Humbert, T.K., Bess, J.L., & Mowery, A.M. (2013). Exploring women's perspectives of overcoming intimate partner violence: A phenomenological study. Occupational Therapy in Mental Health, 29, 246-265.

Iwama, M.K., Thomson, N.A., & MacDonald, R.M. (2009). The Kawa model: The power of culturally responsive occupational therapy. Disability and Rehabilitation, 31, 1125-1135.

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, 340-355.

Wada, M. (2011). Strengthening the Kawa model: Japanese perspectives on person, occupation, and environment. Canadian Journal of Occupational Therapy, 78, 230-236.
Group 5:
Gillian de Boer
Samantha D'Souza
Melissa Paniccia

(Iwama, Thomson, & MacDonald, 2009)
(Carmody et al., 2007; Iwama et al., 2009)
(Iwama et al., 2009)
(Carmody et al., 2007; Iwama et al., 2009)
(Iwama et al., 2009)
(Iwama et al., 2009)
(Iwama et al., 2009)
• Build comprehensive occupational profiles
• Does not force client into rigid norm-based classification
• Opportunity to describe their life in context, both social and physical
• Good information-gathering tool - identify performance needs or problems
• Flexible and adaptable; broad definition of problems and circumstances
Person-directed versus rehab professional directed
• Goal-setting or identification of the spaces for rehabilitation
• May be more useful for long-term, chronic diseases versus acute injury

Four Basic Concepts
All of the concepts are interconnected
Demonstrates that the self and the environment are not distinct but
inseparably integrated
'Life is like a River'
Created a metaphor of nature = a river ("Kawa" in Japanese)
it provides a
readily understandable
way for both practitioners and clients

Mosaic View
Shows that the individual human self is not situated solely at the centre 'of it all'
Filling in the Gap
Importance of Culture
Development of the Model
OT models based on Western
social norms
of health and well-being
Challenges of Western models
One size fits all concept puts OTs at risk of practicing in

unsafe manner
'the self' is rationally
to the environment and nature
Outcome Measure
Not intended as a measurement tool

Post intervention less obstructed river
increased flow

= some success
Life Flow & Health

Personal Factors & Resources

Environmental factors
(Physical & Social)

Life Circumstances & Problems

Flexible and adaptable
Good information-gathering tool
Suited to chronic diseases and mental health

Too flexible (structure, range of topics)
Preconceptions / uncertainty
Individual & cultural worldview
"Belonging" and "inner self"
one size does not fit all
"Occupational therapy and rehabilitation, in an ideal sense, should be as
unique, flexible and diverse
in approaches as its clientele changing its forms and approaches according to the client's diverse circumstances and
of well-being" (Iwama et al., 2009, p.1135)

How Does the Kawa Model Define:




life energy or life flow
- fluid, cleansing, renewing

Value of self embedded in relationships belonging and interdependence

People’s lives are
shaped by their surroundings

life energy/flow weakens

End of life:
life flow no longer present

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