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Like a River; An Introduction to the Kawa (River) Model

Michael Iwama, PhD, MSc, BScOT, BSc

October 1, 2017



What year was the Kawa Model developed?

Can you talk about the sampling and validation process for the model?

Do I use art supplies to introduce this concept to clients or premade icons?

Can the Kawa model be used with families and children?


The Kawa model was developed in 1999 and into the year 2000.

I am assuming that you are talking about the model being used at the endpoint in practice. With a model like the Kawa, which is not  a classic, universal framework, we look at things from a power dynamic viewpoint where the professional takes the one structure or framework and then applies it to a situation. You could then collect your data and then look at the evidence in terms of its efficacy and whether the process was effective or not. With the Kawa Model it is your clients who are going to be able to validate the model for you. They are going to tell you whether it is making a difference in their lives. At that point, you might then use other quantitative measurements and assessments or standardized assessments to assess this. For example, if the person says, my ability to function in everyday life is better. Well then you might take something like AMPS or FIMS or something that is standardized to assess this improvement. It is best to go with gold standards. Then you can use those measures to then be able to quantify and measure the changes and the differences that occurred over time.

Yes to both. In Australia, there are OT's who are working with groups like adolescent psychiatry and domestic violence survivors. The therapist will come into the room with a tray full of all kinds of different objects and items, and put it in the center of the floor and ask everybody to use the materials to depict a river, a three dimensional river. There is no right way. The magic in the Kawa Model is in the explanation of what is in the person's river. You can use three dimensional objects, you can use art supplies, you can use premade things, or you can even use the app for example that I just talked about. When a person is composing and building their rivers, sit back and encourage them to put as many things as they want into their rivers because when they begin to explain at the end what is in their rivers, they will then give you a rare and treasured view into what day to day life looks like through their eyes and through their experience. And when we can align occupational therapy to those very real needs in their everyday life, that is when the power of occupational therapy and the value of occupational therapy is demonstrated and then celebrated.

Absolutely. Some of the first criticisms of the Kawa Model, made by people who really did not understand the model and the use of the metaphor, was that you could not use the model with children or with elderly people who had varying degrees of dementia or organic brain syndromes. There was this assumption that a person would have to be able to draw a river and then have the knowledge and the insight to be able to reflect upon one's life and circumstances to express what was going on. The power of this metaphor is in how you employ it. When you are dealing with children, for example, they might not have the capacity to speak or look at a diagram or understand what a metaphor of a river is. The same goes for an elderly gentleman with dementia. What is wrong with the family coming together that have this person's best interest at heart and collectively crafting their river?

michael iwama

Michael Iwama, PhD, MSc, BScOT, BSc

Dr. Michael Iwama is Dean of Health and Rehabilitation Sciences at the MGH Institute in Boston. He was previously
Professor and Chair of the Department of Occupational Therapy at Augusta University (formerly the Medical College of Georgia). He is also an Adjunct Professor in the Faculty of Medicine at the University of Toronto and holds similar adjunct professorial appointments at six universities in Canada, the United Kingdom, Australia, and Asia.

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