Kawa model

Along with a team of Japanese OTs, Dr. Michael Iwama first developed the Kawa model in 1999. The Kawa model is the first in occupational therapy "developed from clinical practice outside of the Western English-speaking world through qualitative research." Because "Eastern culture emphasizes the harmony between the person and environmental factors, which is believed to enhance health and well-being[,] ... the model focuses heavily on the client's environmental contexts and how that impacts the flow of harmony in life, rather than mainly focusing on the individual client." In 2006, Iwama published The Kawa Model: Culturally Relevant Occupational Therapy, a textbook that provides an overview of the model. The model is now actively taught in over 500 OT programs and utilized on six continents. == Core concepts ==

Water The concept of "water" represents an individual's life flow and priorities, including their cognition, emotion, physical impairments, occupations, roles, and life experiences. In nature, water often flows from a mountain, which would symbolize a person's birth, and runs into an ocean or other large body of water, which would represent the person's death. it reflects the dynamic nature of occupation and the constant interaction between individuals and their environment. Iwama and other proponents of the model suggest that without water flowing and moving, life is stagnant. the individual should experience optimal well-being. Driftwood can include personal traits (e.g., being optimistic or determined); personal skill sets and experiences (e.g., being trained in carpentry); specific beliefs, values and principles; and/or material/social capital (e.g., financial wealth or strong social networks). Driftwood can have either a positive or negative impact on the river's flow. It generally flows with the current but may become stuck on a rock and become an impediment; however, it may also unearth rocks to make them less challenging. Spaces The concept of "spaces" represents "opportunities for expanding flow and well-being in accordance with the client's perspective and priorities." Using the metaphor, the overarching goal of occupational therapy is to increase spaces for water to flow through the river. OTs can work with their clients to decrease the size of rocks, widen the river banks, and/or better utilize driftwood. For the former, clients may find ways to eliminate burdens in their life and/or develop strategies to overcome those barriers. To widen the metaphorical river banks, OTs may work with clients to implement universal design methods into their daily lives and/or find other ways to alter the physical environment to make it less of a barrier. Lastly, OTs can work with clients to better utilize existing skill sets and attributes and/or develop new ones to help address barriers. Through these practices, the client's well-being should be positively impacted. == Use ==

When utilizing the Kawa model, OTs often begin by requesting their clients create a visual representation of their life using the river metaphor. During and after the client's creation, the OT will ask "open-ended, clarifying questions", which allow the OT and client "to explore life's problems, to discuss support systems, and to brainstorm effective methods of problem resolution." This conversation helps ensure the client's drawing accurately portrays how they perceive their life. Importantly, the Kawa model is meant to be used as a flexible guide that can be utilized in multiple ways. In an interview, Iwama discussed how the model may be used for individuals who may not be able to communicate their life flow for themselves, such as individuals with severe cognitive impairments, young children, or people with dementia. In these cases, Iwama suggested communicating with a group of people close to the individual to collectively discuss the individual's values, barriers, and priorities and thus, as a group, develop their personal Kawa model and collectively problem-solve how to help the individual's river flow. Some researchers have also suggested using the model for interprofessional discussions regarding clients as a tool to promote team-building collaboration. Importantly, "teambuilding has been positively correlated with job satisfaction, and quality of client care," whereas "a lack of teamwork can lead to decrease morale/job satisfaction, decreased productivity and lost revenue, and decreased client satisfaction and quality of care." In one study, Lape et al. used the Kawa model within a collaborative care team to facilitate communication about a patient's care needs. Using the model, the care team developed created a Kawa depiction for a client that included perspectives from multiple care providers. Participants in the study found that using the model provided new opportunities for collaboration across the care team; they determined the tool could be effectively used within their profession. == Strengths ==

Studies utilizing and analyzing the Kawa model have recognized multiple strengths across various domains. The greatest finding across all use cases "was that the Kawa model provides a unique platform for open communication and deeper perspective." In part, this is because an individual's values, beliefs, ways of thinking and behaving depend upon their cultural backgrounds. Many OTs consider the Kawa model to be culturally responsive. This is, in part, because the model was developed outside the Western world and does not rely upon "Western cultural norms". For example, occupational therapy models often focus on the future, despite some cultures being more focused on the past and present. Additionally, because the model was developed by Japanese OTs, it has a more collectivistic focus than many Western models. In part, this is because the model encourages OTs to discuss with clients what they perceive as barriers, strengths, and opportunities. Because the model is client-centered, it requires discussion between the OT and the client, as well as collaboration between them throughout the process, including discussions regarding the client's values and priorities, goal-setting, and more. == Limitations and criticisms ==

Both OTs and clients can find the conceptual framework difficult to understand. Multiple studies have found that OTs who are new to the Kawa model, as well as those new to occupational therapy, may struggle to use the model with clients. This can be seen in some studies in which a participant described the river as "one big wave hitting me over and over again." Some researchers have also noted that the model doesn't focus on the individual's inner self, that is, the unique and independent part of them that is separate from their surroundings. They also posit that it doesn't pay enough attention to the idea of belonging, which involves being actively involved in a social group and having specific roles and routines. This ambiguity may also result in the OT imposing their own views and biases. Further, the Kawa model relies upon in-depth discussions with clients. As such, OTs who do not have practice conversing with clients in-depth may struggle to understand their clients' perspectives and needs. However, OTs with proficient interviewing skills may be "more confident in facilitating and guiding the participants to complete their drawings without fear of errors." == References ==