1. Development of Kawa Model workshop for patients of an adult community mental health team
Beki Dellow . Community Occupational Therapist . Dorset HealthCare University NHS Foundation Trust . &
Hannah Skeels. Occupational Therapy Student. Bournemouth University.
1. Introduction
A Kawa Model (Iwama 2006) workshop was developed to help promote occupational engagement and recovery for service users of the adult community mental health team who were referred to the occupational therapist for treatment. The Kawa (‘river’ in Japanese) Model uses the metaphor of a river to describe a person’s life journey. It enables them to describe their personal life story and current difficulties that are significant using a familiar metaphor that others can easily understand and relate to.
Occupational therapy aims to maximise life flow
Life flow and well-being = river water
Environmental factors (e.g. physical, social, cultural) = river sides and riverbed
Life circumstances and problems/challenges = rocks/obstacles
Personal factors and resources (e.g. strengths and barriers) = driftwood
2. Methods
The Kawa Model uses the metaphor of a river to describe a person’s life story and current circumstances (Kawa cross-section) and help them to share elements with others that they feel are significant (Iwama 2006; Iwama 2013).
Participants were introduced to the Kawa Model with a short presentation and then supported to create their personal cross-section. The eight-week workshop focused on developing participants’ understanding of and use of the Kawa Model.
A final Kawa cross-section was created by each person at week eight to measure change over the period of the workshop and use as an outcome measure.
Week 1 & 2
Introduction to the
Kawa Model
Orientation and introductions and develop/agree group rules.
Share presentation on the Kawa Model.
Issue workbook and interest checklist (Matsutsuyu 1967).
Create initial Kawa cross-sections using art materials provided.
Week 3 & 4
Life flow and well-being (river water)
Discuss personal river water and current occupational engagement.
Review completed interest checklists and encourage development of personal short-term goals from interests identified.
Explain and discuss occupational balance and complete a weekly planner of current occupations and how time is currently spent.
Week 5
My Environment
(river sides and bed)
Revisit Kawa cross-sections, break down elements and set short-term goals.
Go out as a group into the local environment by the river and discuss how it impacts on well-being.
Week 6 & 7
Rocks (problems)
&
Driftwood
(personal resources)
Break down these elements and understand the impact they have on life flow/well-being.
Discuss how driftwood can help the flow or block it further.
Complete the role checklist and discuss the impact of roles on well-being.
Week 8
Reflections on life flow and the future
Create second cross-section and measure changes in comparison to week one and set goals for the future.
Create a cross-section of how participants would like their life to look/be in the future.
Reflect on progress so far and consider how the skills learnt and ideas/strategies discussed may help in moving forward and recovery.
3. Results
4. Impact and implications for occupational therapy
Understanding of the concept of driftwood was a challenge to some participants and it was suggested that different metaphors could be used to help service users to communicate their needs, problems and life story to others. These could be linked to an individual’s meaningful occupation such as a forest path which could be impeded by tall grasses (small problems), shrubs (problems that are more difficult to get out of the way) and trees which are difficult to pass and may take up the entire path (deeply rooted issues).
Attendance was optimised at four weeks. Facilitators found that they lacked opportunities and time to focus on participants’ cross-sections and help them to focus on their personal issues. Follow up sessions were identified as needed.
There were minimal significant changes to participants’ Kawa cross-sections (life challenges/problems, environmental influences and personal factors) created during week one and week eight of the workshop. We realised that it is unrealistic to expect much change over such a short period and time would be better used asking participants to build/create one Kawa cross section over the course of the workshop.
Using the Kawa Model…….
Encouraged communication between participants during the workshop sessions.
Helped participants and facilitators to identify common experiences/themes such as loneliness, depression, poor motivation and poor self-esteem.
Participants felt they were more able to share personal stories without judgement.
Being open about the cultural stigma of mental illness helped to increase confidence, self-understanding and self-management.
Further developments:
A social group named ‘Bridge over Troubled Waters’ was created to help to reduce social isolation, encourage connections with others, friendships and a an on-going peer support network.
A Facebook group is being developed to enhance communication between group members and facilitators and encourage engagement in shared occupations of interest.
A ‘What’s on in your local community booklet was developed in collaboration with a group member based on the interest checklist.
The workbook was developed further to help with the flow of the weekly sessions.
References: Iwama, M.,K, The Kawa Model: Culturally Relevant Occupational Therapy. Philadelphia: Churchill Livingstone Elsevier & Iwama, M.,K, Occupational Therapy News. Future-proofing OT for a multicultural world. 21 (3), 35; Matsutsuyu, J., The Interest Checklist. The American Journal of Occupational Therapy. 11, p179 – 181.