The document provides an overview of the Kawa model, an occupational therapy framework created by Michael Iwama. It discusses the model's history and key concepts including the river metaphor. The river represents a person's life flow and incorporates elements like rocks, driftwood, river walls and spaces between obstructions. The document reviews the model's application to individuals and populations. It also summarizes current research on the Kawa model and discusses its strengths, limitations and opportunities for future development.

1. The Kawa Model
Meghan Smith
July 26, 2011
OCTH 611
Department of Occupational Therapy
and Occupational Science
Towson University

2. Agenda
• History of Kawa model
• Understand components
• Application to an individual and a population
• Review current research
• Strengths
• Limitations
• Future development
• Activity incorporating knowledge drawing a
river for a peer

3. Michael Iwama
• BScOT, MSc, PhD, OT(c)
• Has studied kinesiology, occupational
therapy, and sociology
• Currently an Associate Professor, Department
of Occupational Science and Occupational
Therapy at the University of Toronto
• A third generation Japanese Canadian who was
born in Japan and raised in Canada
• Strived to create a “culturally safe” model
(Iwama, 2005b, p. 216).
(Iwama, 1999, 2006a)

4. Cultural Comparisons
• Cosmological Myth
• Self and environment
• View of occupation
• Individualism
• Belonging, being, and doing
• Social positioning
(Iwama, 2006a)

5. Creation of the model
• Team composed of 15 occupational
therapists, 3 educators, and 2 students
• Explored definitions of health and well-being
that would apply to the East
• Qualitative method (codes, categories, and
themes)
• Aimed to guide the practice of occupational
therapy with cultures not following Western
philosophy
(Iwama, 2006a)

6. Philosophical Assumptions
• Largely based on Eastern philosophy, and
views context as physical and social
• Self assumes a decentralized position
• Does not view the individual as what he or she
does
• “Belonging rather than doing becomes the
social ethos” (p. 137)
(Iwama, 2005a, 2005b)

7. Principles
• Respect the client
• “Client’s narrative becomes the model…” (p.
160)
• Equality, all are part of a greater whole
• Culture is defined as “shared spheres of
meanings” (p. 160)
• Harmony and balance
(Iwama, 2006a)

8. Concepts
• River as a metaphor for life
• Water
• River floor and walls
• Rocks
• Driftwood
• Space between obstructions
(Iwama, 2006)

9. River Metaphor
Note. From “Concepts and structure”, by Michael Iwama, n.d., figure
1. Retrieved July 15, 2011, from http://www.kawamodel.com. This
material reproduced/replicated for fair educational purposes in
OCTH611, Summer 2011, Towson University and should not be
copied without permission of copyright holder.

10. Water
Mizu
• Depicts life flow
• “…water in its liquid state adopts its form from
its container, people in many collective-oriented
societies often interpret the social as a shaper of
individual selves and groups.”
(Iwama, 2006a, p. 145)

11. Walls and Floor
Torimaki: Kawa no Soku-Heki to Kawa Zoko
•Client’s contexts (social
and physical); includes a
range personal
Micro
relationships with the
living and nonliving
(Iwama, n.d.)
•Have a great impact on
flow in a collectivist Macro
social context
(Iwama, 2006b)
Note. From “Concepts and structure”, by Michael Iwama, n.d., figure 6.
Retrieved July 15, 2011, from http://www.kawamodel.com. This material
reproduced/replicated for fair educational purposes in OCTH611, Summer 2011,
Towson University and should not be copied without permission of copyright
holder.

12. Rocks
Iwa
•Negative circumstances blocking or slowing
flow; can be permanent or temporary
(Iwama, n.d.)
•“Every rock, like every life circumstance, has a
unique size, density, shape, colour, and texture”
(Iwama, 2006b, p. 156)

13. Driftwood
Ryuboku
•Various attributes and resources of the
individual (Iwama, n.d.)
o Monetary resources
o Personality
o Skills
•Can be negative or positive, depending on
what surrounds them or what they collide into
(Iwama, 2005b)

14. Spaces between obstructions
Sukima
•Therapy occurs within the spaces between
obstructions and is based on what those
elements are/entail (Iwama, n.d.)
•“Occupation… is regarded in wholes, to
include the meaning of the activity to self and
community to which the individual inseparably
belongs, and not just in terms of biomechanical
components…” (Iwama, 2006a, p. 153)

15. Application
Note. From “Application to practice,” by Michael Iwama, n.d. Retrieved July
15, 2011, from http://www.kawamodel.com. This material reproduced/replicated
for fair educational purposes in OCTH611, Summer 2011, Towson University
and should not be copied without permission of copyright holder.

16. Application to an individual
Justin, a 26 year old firefighter and paramedic
currently recovering from surgical repair of a
rotator cuff tear.
Justin’s health insurance only covers three weeks
of therapy. In order to return to the field, Justin
must be able to lift 150 pounds without
assistance. Otherwise, he must transfer to
administrative work.

17. Individual, continued
• Rocks
o Pain after surgery
o Anxiety about meeting lift requirement
o Physical abilities
• River Floor and Walls
o Micro: Lives in an apartment
o Macro: Employment with fire
department, Health Insurance Coverage

18. Individual, continued
• Driftwood
o Supportive girlfriend
o Generally positive attitude
o Good paramedic skills
• Water
o Provide encouragement
• Spaces between obstructions
o Inquire about taking on a teaching role

19. Application to a population
Individuals with a history of substance abuse
being released from prison on parole to live in
supportive housing who are expected to attend
weekly substance abuse meetings, and gain, then
maintain employment

20. Population, continued
• Rocks
o Needing a job
o Lack of professional skills
o Dedicating time to weekly meetings
• River Floor and Walls
o Micro: Surrounded by others with a
history of substance abuse
o Macro: Stigma from having been in prison

21. Population, continued
• Driftwood
o Determined not to relapse
o Stubborn at times
• Water
o Provide encouragement
• Spaces between obstructions
o Social Skill classes

22. Research 1
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.
Examines the need for a non-Western based model and explains
the relevance of the Kawa model.

23. Research 2
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(4), 221-236.
Two case studies using the Kawa model to guide occupational
therapy intervention examine the model’s effectiveness.

24. Research 3
Suyi, Y., Mei Poh, S., Tsunaka, M., & Hua Beng, L. (2006).
Cultural influences on occupational therapy practice in
Singapore: a pilot study. Occupational Therapy
International, 13(3), 176-192.
Explores the relevance of occupational therapy frameworks in
Singapore.

25. Research 4
Nelson, A. (2007). Seeing white: a critical exploration of
occupational therapy with Indigenous Australian people.
Occupational Therapy International, 14(4), 237-255.
Using critical race theory to help therapists learn more about the
culture they are working with.

26. Research 5
Iwama invites discussion forum readers to participate in
developing research.
Iwama offers encouragement and support along with possible
research questions about the model and how it ties into current
practice.
(Iwama, n.d.)

27. Strengths
• Encourages adaptation of the model as needed
• Culturally safe
• Non-biased
• Not similar to other models
• Modern, has Face Book page and web site
• Facilitates occupation based interventions
(Iwama et al., 2007)
• Author discusses case studies from Eastern
and Western parts of the world.

28. Limitations
• May be difficult to apply in the West due to the
difference of the importance of self
• Abstract
• Clinicians feel unsure of their understanding
based on the client’s interpretation(s) (Iwama et
al., 2007)
• Clients may not understand
• Small amount of research on diagnostic
populations
• Easy to get caught up in detail when drawing
river(s)

29. Future Development
• Increase guidance in placing elements in the
river
• More specific research
• Your thoughts?

30. Activity
Refer to handout

31. References
See reference list handout