Models in Practice, Occupational Therapy in Practice, OTalk

#OTalk- The Kawa Model 01/05/12 by @GillyGorry

#OTalk – Kawa Model

Date:  01/05/2012   Host: @GillyGorry

Blog Post  –  Transcript

The Kawa Model, 1st May 2012.

Hosted and blog written by Gillian Gorry

This chat generated lots of enthusiastic discussion about the Kawa Model. There were many examples of its use in Occupational Therapy practice and beyond OT. There were many descriptions of the metaphor and how people understood it in practice and how the metaphor could be reinterpreted to be more meaningful to the client.  There was discussion about whether it is a model or a tool? And whether it really needs to be defined as either? Tweeters shared some examples of difficulty in using in certain settings and whether it was always appropriate to use? There was also talk about whether having somewhere official to share anecdotal evidence would help to encourage further research or use in practice.

Thanks to all those who contributed to the discussion. @Helen_otuk, @Bradpnixon, @Kirstyes, @Jfaias, @claireOT, @adiemusfree, @allisulli, @emilyhack, @OT_for_Kids, @rebelraising, @gillypatrick, @OTSalfordUni, @LeonoraOT, @AuntyHel, @mommagilly, @Living_as_if

Knowledge of the Kawa Model

There was some discussion about theoretical knowledge, cultural and practical application of the Kawa Model.

@Helen_otuk @gilliancrossley yes had a look… but I must admit my knowledge is mostly theoretical, not actually ‘used’ 1/2 #OTalk
(Tue, 01 May 2012 19:12:24 +0000)
@Helen_otuk But as usual open to learning and really like the theoretical aspects i am aware of. Would love to hear about how people ‘use’ it #OTalk
(Tue, 01 May 2012 19:14:51 +0000)
@bradpnixon @gilliancrossley #otalk the km challenges us to depart from traditional thinking – it is a way of constructing a narrative 1/2
(Tue, 01 May 2012 19:15:40 +0000)
@Helen_otuk am i right in thinking that the banks are seen and supports? #OTalk
(Tue, 01 May 2012 19:17:31 +0000)
@kirstyes @Helen_otuk I think they can be supports or can build up to block flow, e.g social stigma etc. #OTalk
(Tue, 01 May 2012 19:20:54 +0000)
@jfaias ” @OTalk_Occhat : @jfaias welcome to #OTalk , lovely to have you with us” Thanks. Not able to stay, unfortunely. Very curious about Kawa Model.
(Tue, 01 May 2012 19:21:55 +0000)
@jfaias @kirstyes @gilliancrossley #OTalk I’ve read the book and some texts about Kawa Model. It deserves some cultural adaptation
(Tue, 01 May 2012 19:24:13 +0000)
@claireOT Celebrating our cultural competence could be premature if we don’t have culturally appropriate concepts to hand during treatment #OTalk
(Tue, 01 May 2012 19:56:54 +0000)
@claireOT Not just linguistic barriers, but also we Westerners have a very individualistic focus, quite alien to many cultures #OTalk (Tue, 01 May 2012 19:57:39 +0000)
@kirstyes @adiemusfree @emilyhack centred that way obviously. You would determine impact and size of boulders etc but don’t we do that #OTalk (Tue, 01 May 2012 19:57:44 +0000)
@adiemusfree @kirstyes @emilyhack not sure of this – don’t always need language of Kawa to be client-centred #OTalk (Tue, 01 May 2012 19:58:39 +0000).
@adiemusfree @claireOT is Kawa treatment or assessment or both? is it always culturally appropriate? #OTalk
(Tue, 01 May 2012 19:59:31 +0000)
@OTalk_Occhat @adiemusfree I think all OT assessments are the start of the therapeutic relationship, ergo are part of therapy 😉 #OTalk
(Tue, 01 May 2012 20:00:41 +0000)

Discussion about whether the Kawa Model is a model or tool? And how it has been used in practice.

Some key points were that The Kawa Model, didn’t seek to be defined as either a model or a tool and that it was a way to illicit discussion of the clients own narrative.  Discussion included thoughts that it was both a model and a tool, dependant on its application and context. For example maybe a tool to when intended to illicit a narrative and a model when used by an occupational therapist to identify occupational needs. Can also be used to view multiple river options and help the client decide which way to flow.

Does it need to be defined as either? If we leave them with occupation.. @kirstyes

@gilliancrossley Do people consider the Kawa a model or a tool? can it be compare with moho cmop #OTalk
(Tue, 01 May 2012 19:14:09 +0000)
@kirstyes @gilliancrossley A model and a tool all in one. #OTalk Yes there are some similarities but possibly Kawa all guided by client to define
(Tue, 01 May 2012 19:16:07 +0000)
@bradpnixon @bradpnixon @gilliancrossley #otalk but does not seek to define it. It is not a model or a meta narrative.
(Tue, 01 May 2012 19:16:33 +0000)
@allisulli @kirstyes @helen_otuk results r very positive, re context for therapeutic group process and for constructing occupational narrative #OTalk
(Tue, 01 May 2012 19:22:52 +0000)
@claireOT I like to have Kawa in my toolkit- many cultures don’t share language we use e.g.””recovery”” so it’s good to have another model #OTalk
(Tue, 01 May 2012 19:25:43 +0000)
@bradpnixon @OTalk_Occhat @allisulli @kirstyes @helen_otuk #otalk “”narrative”” is the key. a river tells the story of a journey – it is perfect tool
(Tue, 01 May 2012 19:26:08 +0000)
@gilliancrossley @jfaias @kirstyes #otalk , its great for understanding cultural boundaries, and not fitting into boxes
(Tue, 01 May 2012 19:27:31 +0000)
@Helen_otuk Yes it is the ‘narrative’ aspect that i like… have always preferred to work with a clients ‘narrative’ than other methods. #OTalk
(Tue, 01 May 2012 19:27:54 +0000)
@bradpnixon @gilliancrossley @jfaias @kirstyes #otalk this is also causing problems – is it a model? is it a tool? Why won’t it conform?
(Tue, 01 May 2012 19:28:51 +0000)
@kirstyes @gilliancrossley Possibly. This is where the model aspect comes in though. I thought it was designed to help identify where OT needed #OTalk
(Tue, 01 May 2012 19:28:53 +0000)
@jfaias @bradpnixon @gilliancrossley @kirstyes or a framework? We need Hagedorn here to help us. I see it more as model. But i don’t use it #OTalk
(Tue, 01 May 2012 19:34:45 +0000)
@allisulli Imperative, really. #clientcentered #occupation based. #Kawa affords an occupational narrative for tx needs of those with #trauma hx #OTalk
(Tue, 01 May 2012 19:34:55 +0000)
@adiemusfree Depends on ontology/epistemology but tool is an enabler for therapy like whiteboard, pen, model allows testing/theoretical expansion #OTalk
(Tue, 01 May 2012 19:35:44 +0000)
@kirstyes @gilliancrossley @adiemusfree A tool when uses to simply harness narrative. But a model when used by a qualified OT to guide OT int? #OTalk
(Tue, 01 May 2012 19:38:12 +0000)
@adiemusfree As tool w/in OT provides opp. for effective communication about occupation: is model for each individual, allows hypothesis testing #OTalk
(Tue, 01 May 2012 19:40:31 +0000)
@kirstyes @adiemusfree And do you not see Kawa as allowing testing/theoretical expansion? #OTalk
(Tue, 01 May 2012 19:41:00 +0000)
@adiemusfree Can test out potential solutions systematically using Kawa metaphor #OTalk
(Tue, 01 May 2012 19:41:40 +0000)
@kirstyes @gilliancrossley @otsalforduni I don’t think so if introduced to clients as a tool. Aft all we leave them with occupation too! #OTalk
(Tue, 01 May 2012 19:41:53 +0000)
@allisulli RT @kirstyes : @adiemusfree @gilliancrossley True. What def would you use? I think Kawa could be used similarly to CMOP-E/MOHO/PEO #OTalk
(Tue, 01 May 2012 19:53:23 +0000)
@adiemusfree @kirstyes @gilliancrossley Agree Kawa similar to CMOP etc – all of which are metaphoric rather than verifiable in empiric way #OTalk
(Tue, 01 May 2012 19:55:19 +0000)

Description of the Kawa metaphor and some difficulty using in certain settings.

Understanding the metaphor and how this could be interpreted in practice. Rocks could represent, loss or trauma, flow could be affected by sediment in the river bed; such as unhappy experience or unhelpful habits. Some people gave examples of it being difficult to use, within particular settings due to the client not being able to relate.  Discussion about considering which clients would be appropriate when using the Kawa and about always choosing client appropriate tools, within the individuals’ context.

Models /metaphors provide a framework for clinical reasoning, not a straight Jacket @adiesmufree

@gilliancrossley Brief recap of the Kawa, Rocks are challenges, driftwood resources/ attributes.. how does your river flow..#OTalk
(Tue, 01 May 2012 19:16:40 +0000)
@OT_for_Kids RT @kirstyes : I have the Kawa book and have had a little look. As a writer I like the metaphor idea. And the storytelling aspects #OTalk
(Tue, 01 May 2012 19:19:26 +0000)
@bradpnixon @Helen_otuk @kirstyes #otalk it is important to see the components of the river and in constant flux. Change is constant in the river
(Tue, 01 May 2012 19:24:53 +0000)
@kirstyes @Helen_otuk I think though we give the metaphor over to the client and listen to their narrative. #OTalkthey define if bank or stone barrier
(Tue, 01 May 2012 19:25:42 +0000)
@Helen_otuk I especially like the visual aspect as I think this can translate to all levels of education or intellect? #OTalk
(Tue, 01 May 2012 19:29:50 +0000)
@emilyhack I like the model in theory, but in practice I felt I spent more time explaining the model than listening to the client’s story #OTalk
(Tue, 01 May 2012 19:32:49 +0000)
@claireOT @DownsSideUp our flow can be affected by sediment at the riverbed, that can be unhelpful habits or unhappy experiences #OTalk
(Tue, 01 May 2012 19:38:57 +0000)
@claireOT @DownsSideUp or blocked by boulders such as loss, or trauma. We work around any blockages, or remove them #OTalk
(Tue, 01 May 2012 19:39:38 +0000)
@emilyhack @kirstyes Liaison psychiatry. I think the client couldn’t relate to it, and was questioning why we were talking about rocks etc… #OTalk
(Tue, 01 May 2012 19:39:39 +0000)
@claireOT @DownsSideUp to re-create the river’s flow. There are also life stage analogies of the river flowing into the ocean at death #OTalk
(Tue, 01 May 2012 19:40:30 +0000)
@Helen_otuk @emilyhack if client can not relate… then possibly not the right approach with that individual? #OTalk
(Tue, 01 May 2012 19:40:39 +0000)
@adiemusfree @emilyhack same prob with concrete thinkers in pain mgmt – have to select patient carefully #OTalk
(Tue, 01 May 2012 19:42:34 +0000)
@emilyhack @Helen_otuk I agree, but kind of client or client need would suit the model? #OTalk
(Tue, 01 May 2012 19:42:34 +0000)
@gilliancrossley @adiemusfree #otalk I like the idea of viewing multiple river options, let the client choose which direction to flow
(Tue, 01 May 2012 19:43:53 +0000)
@bradpnixon @gilliancrossley #otalk Do not forget the poetics of the river, this is where your understanding of the model will come from.
(Tue, 01 May 2012 19:49:01 +0000)
@adiemusfree @emilyhack @kirstyes River metaphor used in chronic pain group setting to help participants consider life direction #OTalk
(Tue, 01 May 2012 19:49:27 +0000)
@bradpnixon @gilliancrossley #otalk Kawa breaks from traditional western OT thinking, if you feel that you resist its approach, this might be a rock.
(Tue, 01 May 2012 19:49:31 +0000)
@gilliancrossley @emilyhack @kirstyes #otalk I don’t know.. I have only used in mental health and No diagnosis, also used in groups as review of team working
(Tue, 01 May 2012 19:53:57 +0000)
@emilyhack @kirstyes At a Michael Iwama lecture in 2010 OT’s discussed using it post stroke to support reconstructing a new life story #OTalk
(Tue, 01 May 2012 19:55:31 +0000)
@gilliancrossley @kirstyes @emilyhack I think we need to choose the appropriate model for the person in context of setting.. #otalk
(Tue, 01 May 2012 19:55:31 +0000)
@adiemusfree @gilliancrossley @kirstyes @emilyhack Well said – models/metaphors provide framework for clinical reasoning, not straitjacket! #OTalk
(Tue, 01 May 2012 19:57:07 +0000)

 Beyond OT

Discussion about the model being taken beyond the realms of Occupational Therapy.

Some discussion about why it should be taken beyond OT, when it is still fairly new to Occupational Therapy. Some examples of how it has been used well in non-traditional OT settings and discussion that the metaphor of a river is not exclusive to Occupational Therapy.

@bradpnixon @gilliancrossley #otalk my feeling is that the KM needs to find a route for development which might extend beyond the profession of OT.
(Tue, 01 May 2012 19:18:14 +0000)
@kirstyes @bradpnixon @gilliancrossley Interesting. What makes you say that when we have barely begun to explore within OT? #OTalk
(Tue, 01 May 2012 19:22:11 +0000)
@gilliancrossley @kirstyes @allisulli @helen_otuk Interesting use, I can see how Kawa works well in non-trad OT #OTALK
(Tue, 01 May 2012 19:22:42 +0000)
@kirstyes @gilliancrossley @bradpnixon What happens after the narrative when used by non-OTs. How is it taken forward? #OTalk
(Tue, 01 May 2012 19:27:43 +0000)
@OTalk_Occhat ” @kirstyes : @gilliancrossley @bradpnixon What happens after the narrative when used by non-OTs.#OTalk ” <interesting question!
(Tue, 01 May 2012 19:30:26 +0000)
@adiemusfree @kirstyes @emilyhack I think river metaphor is used by others, & for years, not exclusive to OT tho not used exactly the same way #OTalk
(Tue, 01 May 2012 20:01:38 +0000)

Evidence based

There was discussion about the evidence base and appropriateness for some settings. Would having an official place to share anecdotal evidence of use in practice be a benefit and possibly encourage more research/ use? Some discussion about whether people would be willing to share their experience of using the Kawa Model.

@Rebelraising has been working on an outcome measurement tool for the Kawa as part of her University work.

@gilliancrossley Do you feel it is evidence based enough to use in all settings? if not what can be done about this? #OTALK
(Tue, 01 May 2012 19:18:51 +0000)
@kirstyes @gilliancrossley Not yet but then are the more established models even? I do wonder how it would ‘go down’ in some settings. #OTalk
(Tue, 01 May 2012 19:23:45 +0000)
@gilliancrossley @kirstyes #OTalk if OTs were willing to share their exper of KAWA do you think this would help the evidence base encourage research #otalk
(Tue, 01 May 2012 19:26:02 +0000)
@claireOT I love metaphor and narrative, so I would be happy to use Kawa with someone. But do services pre-define a model to be used? #OTalk
(Tue, 01 May 2012 19:32:28 +0000)
@kirstyes @claireOT Some services definitely Pre-define model though I think it should be on a client by client basis. Related to cost #OTalk 1/2
(Tue, 01 May 2012 19:35:20 +0000)
@kirstyes @adiemusfree @emilyhack You have given me food for thought. Would you see Kawa as being a tool to be freely used by non OTs then? #OTalk
(Tue, 01 May 2012 19:58:57 +0000)
@rebelraising I came up with a Kawa-based outcome measure using area of water flow for a viva last year – never had chance to use in practice! #otalk
(Tue, 01 May 2012 20:00:17 +0000)
@gilliancrossley Would people be willing share their experiences, in formal way? build the anecdotal evidence base?#OTalk
(Tue, 01 May 2012 20:00:55 +0000)
@allisulli RT @kirstyes : @rebelraising Ooh. You should take that forward. @adiemusfree Would this be considered empiric? #OTalk
(Tue, 01 May 2012 20:03:24 +0000)
@Helen_otuk Outcome ‘measure’ feels like GAS/COPM/ etc to me! Will have the same issues. Not that is always bad of course. #OTalk
(Tue, 01 May 2012 20:05:49 +0000)

Self directed and alternative uses/ interpretations of the model

As occupational therapists, can we teach clients to use the Kawa Model in a self directed way?  Some concerns about whether the clients could misunderstand the Kawa Model; however as it is the clients own river to interpret, is this a problem? Some examples of use were; As a reflective tool for both clients and occupational therapists, a tool for CPD, as a way to review within groups and identify immediate challenges.

Also examples of how the metaphor could be adapted to be more meaningful to the client; Astrology, Motorway etc..

@claireOT Just thinking that we often use the analogy of a river to talk about Tweetstreams… How could we think about it using Kawa?! #OTalk
(Tue, 01 May 2012 19:29:17 +0000)
@gilliancrossley @kirstyes @bradpnixon #otalk , can be used to plan next steps, identify challenges and what resources can help you achieve goals,
(Tue, 01 May 2012 19:29:27 +0000)
@gilliancrossley Do you think we could teach are clients to use in a self directed way? how would Kawa team feel about that? #OTALK
(Tue, 01 May 2012 19:30:58 +0000)
@adiemusfree @gilliancrossley Kawa is a tool, although model for each individual’s situation – metaphor & communication aid many times #OTalk
(Tue, 01 May 2012 19:32:10 +0000)
@adiemusfree @gilliancrossley Kawa is a tool, although model for each individual’s situation – metaphor & communication aid many times #OTalk
(Tue, 01 May 2012 19:32:10 +0000)
@Helen_otuk @gilliancrossley I think it is an excellent tool for individuals to use to evaluate personally… #OTalk
(Tue, 01 May 2012 19:32:31 +0000)
@gilliancrossley @Helen_otuk #OTalk can we use it as a way to teach clients reflective skills? help them identify their own way to move forward?
(Tue, 01 May 2012 19:34:06 +0000)
@bradpnixon @OTSalfordUni #otalk self directed could be extremely effective for empowerment, therapeutic self, transformation and managing change.
(Tue, 01 May 2012 19:34:52 +0000)
@allisulli RT @mommagilly : @gilliancrossley #otalk could that not lead to some misinterpretation than someone who is skilled in the application and interpretation ?
(Tue, 01 May 2012 19:35:37 +0000)
@kirstyes @claireOT which is benefit of Kawa as I believe everyone can use freely. #OTalk
(Tue, 01 May 2012 19:35:51 +0000)
@gilliancrossley @OTSalfordUni No, we couldn’t stop them but how does that affect the Kawa identity? would it become non OT or occupation specific #OTALK
(Tue, 01 May 2012 19:36:34 +0000)
@Helen_otuk @gilliancrossley Does it matter? If our clients can benefit from taking it forward! That is all good no?#OTalk
(Tue, 01 May 2012 19:37:31 +0000)
@adiemusfree River metaphor not exclusive to Kawa, has been around a long time, can’t prevent its use by others, but as tool w/in OT provides 1/2 #OTalk
(Tue, 01 May 2012 19:38:36 +0000)
@gilliancrossley @mommagilly #otalk possibly, but isn’t it the clients river to interpret?
(Tue, 01 May 2012 19:39:00 +0000)
@allisulli RT @kirstyes : @claireOT which is benefit of Kawa as I believe everyone can use freely. #OTalk
(Tue, 01 May 2012 19:39:08 +0000)
@allisulli @emilyhack @kirstyes #Kawa may be useful for #occupationaltherapists themselves in re: to constructing meaningful career narrative #OTalk
(Tue, 01 May 2012 19:42:36 +0000)
@kirstyes @emilyhack I saw an example in OT News where a student had reinterpreted it to astrology related metaphor to engage a client. #OTalk
(Tue, 01 May 2012 19:44:24 +0000)
@kirstyes @mommagilly @gilliancrossley I agree I still think we need to promote our role as OTs in helping at least initially with process #OTalk
(Tue, 01 May 2012 19:47:30 +0000)
@gilliancrossley @bradpnixon #otalk If the Kawa is being used with the KM in mind, then we would like to be referenced. But it is hard to apply IP to a river
(Tue, 01 May 2012 19:47:33 +0000)
@bradpnixon @gilliancrossley @adiemusfree #otalk Kawa can also be used to construct taxonomies, with ontological value.
(Tue, 01 May 2012 19:48:19 +0000)
@gillydpatrick Have used Kawa Model as a reflective tool for CPD #otalk
(Tue, 01 May 2012 19:56:20 +0000)
@gilliancrossley @gillydpatrick #OTalk so have I,also as way of reflecting on working in a multidisciplinary way. I am part of a collective, others resources
(Tue, 01 May 2012 19:58:54 +0000)
@gilliancrossley @adiemusfree @kirstyes @emilyhack yes, I have seen a moutain metaphor used often which is similar#otalk
(Tue, 01 May 2012 20:04:25 +0000)
@gillydpatrick It doesn’t have to be a river. Can be anything meaningful to client who can construct their own version. E.g a motorway #otalk
(Tue, 01 May 2012 20:05:14 +0000)
@emilyhack @kirstyes @adiemusfree I have seen a similar bus metaphor used to, with very literal depictions of life pathways and choices #OTalk
(Tue, 01 May 2012 20:07:25 +0000)
@adiemusfree @gillydpatrick Great! I’ve used motorvehicle with men #OTalk
(Tue, 01 May 2012 20:07:30 +0000)
  • Some tweeters wanted more information from @bradpnixon regards to this Tweet-  #otalk Kawa can also be used to construct taxonomies, with ontological value.

David Nixon has offered to write a blog post about this, so that he can explain in detail. We will post the link, once it has been written.

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