Module 3: Critical Appraisal & Kawa Model Flashcards
What are a few things that are unique about the Kawa Model?
- First OT practice model to use a non-Western perspective
- Client creates the model (with OT direction/support), rather than OT creating the model
- focuses on value and belonging, rather then individualism
In the Kawa model, what is the goal of occupational therapy?
To enhance the flow of the river (one’s life flow) by enhancing the harmony of the elements of the river
What are a few key differences between Kawa and CMOP-E?
- CMOP-E is more a point in time, Kawa looks at past, present, future
- Kawa shows the person as embedded in their environment and shaped by it (and vice versa, the river flow can shape the river walls)
- Kawa includes personal attributes and resources (driftwood) which are largely missing from CMOP-E
What are some criticisms of the Kawa model?
-Not clear where occupation goes/is (is this a challenge or an asset?)
- Relationship between the self and environment could be clarified
(Wada, 2011)
Describe the Mizu (water, life flow) in the Kawa model?
- the water in the river touches all other aspects
- a strong flow is the goal - removing obstacles and increasing the space between the other elements
- a weakened flow indicates disharmony, being unwell, but also opportunity
Describe the driftwood in the Kawa model
Driftwood can be
- personal attributes (skills, values, character, knowledge, life experiences) - resources (materials and immaterial)
- Can have a positive or negative impact on life flow (e.g., driftwood could get caught on the rocks and impede flow or it could help push the rocks (challenges) out of the way).
Describe the Sukima (spaces) in the Kawa model
- The Sukima are the spaces through which the water flows (the spaces between the other elements in the model).
- The goal of OT is to enlarge these spaces to increase life flow of the river
What if the river metaphor doesn’t resonate with a client?
No worries. They can pick some other metaphor that is meaningful to them (sports, nature, etc.). It’s a tool for drawing out a life story, the metaphor doesn’t matter.
Describe the Iwa (rocks) in the Kawa model
- Life circumstances and challenges that are affecting the flow of the river
What are some questions to ask the client regarding ways to enhance the flow of their river in the Kawa model?
- Can we shrink the rocks (i.e., the challenges)?
- Can some of the driftwood be used to move the rocks?
- Are there pieces of driftwood that are impeding river flow, that could be addressed?
- How is the river wall (environment) impacting the flow of the river (and vice versa)?
- Is there something happening upstream (i.e., in their past) that might be impeded flow and needs to be addressed?
What are YOUR criticisms of the CMOP-E?
Obviously personal. Some things we discussed in class include:
- snapshot in time: where does past and future go?
- Individual situated in the middle, very western idea
- The idea of leisure is very privileged and may not resonate in other cultures/languages
Describe the difference between being reflective and reflexive?
Reflection: Describing what happened, why did I make that decision (in terms of clinical reasoning), what did I learn?
Reflexivity: Examine/question your underlying assumptions, attitudes, biases, thought patterns that led to what happened
Why it is important for us to learn critical appraisal (of our own action but also of OT theories/practices)?
- Leads to better care/outcomes for our clients
- leads to growth of the profession over time (by allowing a climate where we can question accepted dogma, and move forward with new learnings)
What is Lily Owen’s critique of the OT field in her paper “Our professional existence is political: critical reflection on ‘seeing white’ in OT’?
- OT has a problem with enthocentricism, i.e., taking Western worldviews as universal (e.g., our ideas of client ‘progress’, our ideas of independence)
- This has negative outcomes for our clients, and for non-white OTs
- OT doesn’t recognize/account for the structural barriers that our clients face
