Kawa

• Title/Author(s):
  Kawa Model
  Developed by Dr. Michael K. Iwama and colleagues.
  Referenced in: Iwama, M. K., Thomson, N. A., & Macdonald, R. M.
  
  

• Edition and Year:
  Introduced in 1998 as a conceptual model of occupational therapy practice in Japan.
  Popularized internationally through Iwama’s publications and research in the early 2000s.
  
  

Assessment Details

• Identify TWO Types:
  
  

  • Self-report
    
    

  • Semi-structured interview (guiding prompts used, but can also be made unstructured depending on the client)
    
    

• Cost & Accessibility:
  
  

  • Cost:
    
    

    • Free for clinical, educational, and non-commercial use.
      
      

  • Access:
    
    

    • Official site and resources: Kawa Model Website
      
      

    • Example scholarly resource: Kawa Model in practice example - PMC article
      
      

• Population & Setting:
  
  

  • Population:
    
    

    • Individuals aged 5 years and older, with clinical judgment used to determine developmental appropriateness.
      
      

  • Appropriate for conditions including:
    
    

    • Mental health challenges (e.g., anxiety, depression, trauma)
      
      

    • Adjustment to life transitions (e.g., immigration, career changes)
      
      

    • Physical dysfunctions (e.g., arthritis, post-COVID-19 recovery, stroke recovery)
      
      

    • Care partners of individuals with chronic conditions (e.g., caregiving burden in multiple sclerosis)
      
      

  • Settings:
    
    

    • Outpatient rehabilitation centers
      
      

    • Inpatient rehabilitation and acute care hospitals
      
      

    • Community mental health centers
      
      

    • Schools
      
      

    • Group homes
      
      

    • Telehealth and virtual occupational therapy sessions
      
      

• Purpose & Areas Assessed:
  
  

  • Purpose:
    
    

    • To explore a client's life flow, supports, challenges, and occupational identity through metaphoric storytelling (represented by a river drawing).
      
      

    • Assists therapists and clients in collaboratively identifying barriers and planning meaningful interventions.
      
      

  • Key areas assessed (metaphorically):
    
    

    • River walls and bottom: Environmental and social context
      
      

    • Water: Life flow and personal well-being
      
      

    • Rocks: Life obstacles and challenges
      
      

    • Driftwood: Personal strengths, values, liabilities
      
      

    • Spaces between elements: Opportunities for occupational growth or intervention
      
      

Administration & Scoring

• Administration:
  
  

  • Time Required: Approximately 15–30 minutes (varies based on client reflection depth).
    
    

  • Format:
    
    

    • Clients are invited to draw a river representing their life using imagery of water, rocks, driftwood, and riverbanks.
      
      

    • Therapists facilitate discussion using semi-structured guiding questions to explore meaning and significance.
      
      

• User Qualifications:
  
  

  • Should be conducted by a licensed occupational therapist familiar with the Kawa Model principles and skilled in therapeutic interviewing.
    
    

• Materials Required:
  
  

  • Paper and pen/pencil
    
    

  • Optional: Drawing templates, guiding question prompts for reflection
    
    

• Scoring:
  
  

  • No formal numeric scoring system.
    
    

  • The focus is qualitative: interpreting the client's narrative and symbolic representations to guide collaborative goal-setting and therapeutic intervention.
    
    

Psychometrics/Standardization

• Reliability:
  
  

  • No formal psychometric properties (e.g., no published interrater reliability).
    
    

• Validity:
  
  

  • High face validity and clinical utility reported anecdotally and in small qualitative studies.
    
    

  • Emphasized as a narrative, culturally responsive, client-centered process, rather than a metric-based evaluation.
    
    

• Norms:
  
  

  • No established normative scores.
    
    

  • Highly individualized interpretation based on each client’s cultural and life context.
    
    

Critical Thinking Sections

Strengths

• Highly client-centered — Tailors the therapeutic conversation to the client’s life experience and cultural worldview.
  
  

• Flexible and creative — Can be adapted for different populations, ages (5+), and clinical diagnoses.
  
  

• Culturally sensitive — Developed to overcome limitations of Western-centric OT models.
  
  

• Therapeutic engagement — The drawing process itself often deepens client insight and therapeutic rapport.
  
  

• Low-cost and accessible — Minimal materials needed; easily implemented via telehealth or community-based OT.
  
  

Weaknesses

• No formal scoring system — Difficult to track quantitative progress or outcomes across sessions.
  
  

• Requires therapist skill — Interpretation and facilitation depend heavily on the clinician’s experience and cultural competence.
  
  

• Subjectivity — Interpretation may vary between therapists unless discussed collaboratively with the client.
  
  

• Limited empirical research — Compared to standardized assessments, fewer large-scale studies validate its use.
  
  

• Not suitable for everyone — May be challenging for clients with severe cognitive impairment, profound communication barriers, or those uncomfortable with abstract/metaphorical thinking.

References 

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. https://doi.org/10.1080/09638280902773711

Schell, M. A., & Kang, H. (2023). Using the Kawa Model in occupational therapy: Exploring lived experiences. Open Journal of Occupational Therapy, 11(1), Article 7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9851780/

Kawa Model. (n.d.). Kawa Model Resources. Retrieved March 20, 2025, from https://www.kawamodel.com