KAWA

Overview

Author(s): Teoh, J.Y. & Iwama, M.K.

Year of Publication: 2015

Publisher: Iwama, M.K.

Type of Assessment: 

• Non-standardized (no fixed scoring/administration)

• Interview

• Client-centered

Cost: Free

How to Access: https://www.kawamodel.com/download/KawaMadeEasy2015.pdf 

Age: Adolescents, Adults, Elderly Adults

Diagnoses: Age-related concerns, mental health issues, rehabilitation needs, multiple sclerosis

Setting: mental health rehab, geriatric care, inpatient psychiatric hospitals, school-based/college, early intervention, pediatric outpatient, community-based/social services, acute care, home health, skilled nursing, assisted living

Areas Assessed:

• River Flow = life flow & priorities

• Riverbanks = environments/contexts (social & physical)

• Rocks = obstacles & challenges

• Driftwood = influencing factors

• Spaces = opportunities for enhancing flow

Administration 

Time: As time permits

Group/Individual: Individual

Subtests: Questions should fall within each category

• River Flow: "If your life was a river, what does your river look like and how would you describe the flow of your river right now?" or "What makes you happy and how/why does it make you happy?"

  • Questions take the past, present, & future into consideration

  • Can include client's work history, medical history, life roles, processes (e.g. aging), self-care & leisure activities

  • Can comprise of many little streams flowing into one

  • The areas of significant persons in the client's life should be considered and incorporated where relevant

• Rocks: "Are you having any difficulties right now? What are they and why/how are these things difficult for you?" or "Is there anything in particular that you would like to do but are unable to because of your current situation? How are these things typically done? Why do you think you are unable to do them?"

  • Typically categorized into occupational performance difficulties, fears, concerns, inconvenient circumstances outside of OTs control, and impairments/medical concerns

  • The areas of significant persons in the client's life should be considered and incorporated where relevant

• Riverbanks: "Who are you currently living with? Who do you spend most of your time with? How do you spend your time together?" or "Where do you typically spend most of your time? Can you describe to me places that are important to you like home or work?"

  • Social environments can be family, friends, colleagues, pets, deceased relatives, etc.

• Driftwood: "How do you typically cope with stress? How do you see challenges in life? How would you describe yourself and why? Do you have any special skills or abilities?" or "Are there any things or thoughts that get in the way of your life going better? Are there any activities that you are good at or enjoy doing?"

  • Can have a positive or negative effect of the river flow (e.g. wood that pushes rocks out the way is positive but wood that gets stuck between rocks is negative)

  • Includes personality traits, skills, abilities experiences, beliefs, values, principles or material/social capital

Instructions: The interview is not structured in any particular order but rather will flow as a river does where asking a riverbank question will lead to a river flow question. 

• The interview should allow the person to explain the components that make up their life process, not whether the therapist agrees on the classification as this is from the client's perspective. 

• The client should be allowed to express themselves freely and not follow a particular procedure.

• Therapist should discard all assumptions about the model and work with the client from a clean, objective slate.

• Questions asked should align with each client that is appropriate for their circumstance and situation.

  • Asking "Why" and "How" questions are ideal 

Materials: Interview questions suitable for each situation based on each section of the river (e.g. river flow vs. riverbank)

User Qualifications: N/A

Scoring Procedures

How to Score: As a non-standardized assessment, there are no quantifiable scores, only qualitative data is collected based on the client's responses to screen for challenge areas and interests

Psychometrics

Reliability: N/A

Validity: N/A

Pros & Cons

Strengths:

• Flexible administration

• Qualitative - allows the client to portray their narrative & deduce their interpretation

• Assists in intervention planning

• Can be utilized as an intervention/modality, frame of reference, and model of practice

• Developed by OTs to encourage the holistic, client-centered approach

• Incorporates past, present, and future needs of the client

• The outline of the model can be translated into more meaningful metaphors if the river-based theme does not resonate 

• Culturally sensitive by incorporating cultural factors into client's perspectives

Weaknesses:

• No strict protocol to ensure consistency across practitioners

• No quantifiable or repeatable measure

• Client hesitancy/lack of cooperation

References

• Teoh, J.Y. & Iwama, M.K. (2015). The Kawa model made easy: A guide to applying the Kawa model in occupational therapy practice (2nd edition). Retrieved from www.kawamodel.com 

• Serra, B. (2023, August 29). Kawa model. Physiopedia. https://www.physio-pedia.com/index.php?title=Kawa_Model&oldid=340640