Academic journal article New Zealand Journal of Occupational Therapy

The Kawa Model: Informing the Development of a Culturally Sensitive, Occupational Therapy Assessment Tool in Aotearoa/New Zealand

Academic journal article New Zealand Journal of Occupational Therapy

The Kawa Model: Informing the Development of a Culturally Sensitive, Occupational Therapy Assessment Tool in Aotearoa/New Zealand

Article excerpt


The Kawa Model has been heralded as an innovative and exciting occupational therapy model. It is a model that is designed to help occupational therapists work in a more culturally relevant, person-centred, and holistic way. This paper reports the implementation of the Kawa Model into practice in a forensic mental health unit.

Key words

Culture, forensic, mental health, client-centred.


Leadley, S. (2015). The Kawa Model: Informing the development of a culturally sensitive, occupational therapy assessment tool in Aotearoa/New Zealand. New Zealand Journal of Occupational Therapy, 62(2), 48-54.

The Kawa Model offers a unique, occupation-focused, person-centred, holistic, recovery-based, and culturally responsive way of working with service users. It challenges some of the assumptions and concepts that are inherent in other occupational therapy models. This article will discuss the significance of the Kawa Model to occupational therapy, despite the paucity of published literature on its use in practice, before describing the Kawa Model in brief. The development, implementation, and outcome of a Kawa Model assessment reporting tool for an inpatient, forensic mental health setting will also be discussed. The practice setting and the role of the occupational therapist in a forensic mental health setting are described.

The Kawa Model

Culture is a significant factor in occupational therapy models. The subject is widely discussed in occupational therapy literature (Munoz, 2007; Gray & McPherson, 2005; Iwama, 2006a). Both the Canadian Model of Occupational Performance and Engagement (CMOP-E) and the Model of Human Occupation (MOHO) are considered to be culturally responsive (Abelenda, Kielhofner, Suarez-Balcazar & Kielhofner, 2005; Egan & Townsend, 2005; Polatajko et al., 2007). Nonetheless, Iwama, Thomson, and MacDonald (2009) have pointed out that these traditional occupational therapy models continue to take a Westernised approach that assumes "a theory/model... should fit and benefit everyone" (p.1127).

The Kawa Model differs from these traditional occupational therapy models as culture is its primary focus. Furthermore the model espouses a broader understanding of culture. According to Iwama, Thomson, and MacDonald (2009), culture should be redefined in occupational therapy models from being about race and ethnicity to become "shared experiences and common spheres of meaning, and the (collective) social processes by which distinctions, meanings, categorisations of objects and phenomena are created and maintained" (p.1126). Unlike traditional occupational therapy models and other contemporary models of rehabilitation, which are imbued with Western rationale such as reductionism and individualistic notions, the Kawa Model draws from Eastern cosmological notions that emphasise a collective view of society (Iwama, 2005). In this holistic, non-reductionist, and collectivist worldview individual persons are not separate from his/her environment or world and neither are they in the centre of it. Instead they are a part of the greater whole, they are not seen in a purely individualistic manner (Iwama, 2006a). According to Carmody et al. (2007) the Kawa Model is an approach that can help the profession of occupational therapy maintain its cultura relevance. Equally, the Kawa Model can help facilitate cultura competency for occupational therapists in practice (Paxson, Winston, Tobey, Johnston, & Iwama, 2012).

Michael Iwama and colleagues developed the Kawa Model from an underlying ontology and philosophy that originates from a Japanese social and cultural milieu (Iwama, 2006a). The mode uses the metaphor of a river and its surrounding environment to conceptualise the client's life and story. However, as Iwama, Thomson and MacDonald (2009) pointed out, the metaphor is open and flexible allowing the person/client to use whatever images feel comfortable. …

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