OTS 126: Applying the Kawa Model to School-based OT
- Jayson Davies
- Jun 12, 2023
- 2 min read
Updated: Jul 26, 2024
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Welcome to the show notes for Episode 126 of the OT Schoolhouse Podcast.
Have you heard of the Kawa model?
On this episode of the OT Schoolhouse Podcast, We'll discuss the advantages of understanding this model for occupational therapy practitioners. Dr. Iwama talks about the interrelatedness of the different factors contributing to a person's well-being and performance through the metaphor of a river.
We'll learn about how cultural differences impact the concept of occupation, and how the Kawa model emerged. Additionally, we discuss how occupational therapy practitioners can identify where the clients' water flows and work with their strengths to overcome obstacles.
Tune in to learn more!
Listen now to learn the following objectives:
Learners will identify how cultural differences impact the concept of occupation
Learners will identify what the water, driftwood, rocks, and river walls
Learners will identify the advantages of using the Kawa Model as a school-based OT
Guest(s) Bio
Michael Iwama, Ph.D., MSc, BScOT is widely recognized for having developed the “Kawa Model” (‘Kawa’ is Japanese for ‘River’), the first substantial model of practice in the field of Occupational Therapy developed outside the English-speaking world. The Kawa Model is now taught in over 600 health professions education programs internationally and used in practice across six continents. He has emerged as an important and progressive thinker in the fields of occupational therapy and rehabilitation sciences worldwide. Dr. Iwama is a Professor & Chief Program Strategist in the School of Medicine at Duke University.
Quotes
"When I have spent substantial amounts of time in different cultural settings, it really, really broadens one's perspective, gets the wheels turning in your mind."
— Michael Iwama PhD, MSc, BScOT, BSHP, OT(c)
"Water is the most important component of a river, and at different points along the river, depending on its contents and the river banks and what they look like at the time, determine what the quality of that flow is like."
- Michael Iwama PhD, MSc, BScOT, BSHP, OT(c)
"Sometimes there are certain rocks that just don't go away... but the water always finds a way to flow."
- Michael Iwama PhD, MSc, BScOT, BSHP, OT(c)
"It's really about looking at the person wholly, holistically, in the context of their circumstances and the world in which they abide."
— Michael Iwama PhD, MSc, BScOT, BSHP, OT(c)
“Understanding your own rocks, your own driftwood, and all the things going on around you. It really is just a model for better understanding your own life."
— Jayson Davies, MA, OTR/L
Resources
Episode Transcript
Expand to view the full episode transcript.
Jayson Davies
Hello and welcome to the OTs schoolhouse podcast. In this episode, we're excited to explore the kawa model with our very special guest, Dr. Michael aroma. The kawa model is a unique approach to occupational therapy that originated in Japan, and is based on the metaphor of a river. Kawa literally translates to the word River in English. And this model helps us visualize our lives as a river with various elements such as rocks, driftwood and flow. As occupational therapy practitioners are working in the schools, we can use the Kawa model to better understand our students experiences and challenges and support them in achieving their goals. Today, we're diving into how the kawa model can be applied to school based occupational therapy, and we're going to share some practical tips for using it effectively. So sit back, relax, and let's get started. Hello, and welcome to the OT schoolhouse podcast, your source for school based occupational therapy, tips, interviews and professional development. Now to get the conversation started. Here's your host, Jayson Davies, class is officially in session. Dr. Iwama, welcome to the OT schoolhouse podcast. How are you doing this afternoon?
Dr. Michael Iwama
I'm doing really great. How about you?
Doing very well, I cannot complain. And I'm even more excited today because I have such a great guest on to talk about such a wonderful model. And I'm excited for that. I hope you're excited to be here today.
Dr. Michael Iwama
I'm very, very excited to be here. And I'm just honored that that you had approached me to be one of your guests.
Jayson Davies
Definitely. So we are going to talk all about the column model. But before we dive into that, I want to give you an opportunity just to kind of share where you are in your career and a little bit about how you got here.
Dr. Michael Iwama
Great. Well, I don't know whether your session has enough time or not, because I could probably go on and on. But let me just start off by saying that I was born and raised in Japan. And when I was a teenager, my family then moved to Vancouver, Canada on the west coast of North America. And that's where I did most of my tertiary education, high school, bachelor degrees. And part of my graduate studies as well. So, you know, I studied occupational therapy at the University of British Columbia, that's also in Vancouver. And I started off with a specialty in return to work, OT and ergonomics. And I had a couple of opportunities then to go back to my native Japan as an adult, and most recently to go and teach occupational therapy at one of the first bachelors programs and OT at the time, it was in mid 1990s. And so since then, I've had the opportunity, the honor really to have worked at seven different universities in four different countries. But the most important thing I think I should point out for all of the listeners is that when I have spent substantial amounts of time, in different cultural settings, it really really broadens one's perspective gets the wheels turning in your mind. And so when you're, for example, teaching occupational therapy, and you've learned it in the western or North American context, in the English language, and then you go to a place, you cross cultural boundaries, and you go to another place, and then find that the same concepts don't resonate, or are not understood. And even personally on a social basis, you realize that here you find yourself in a collectivist culture, and you're so acculturated into individual centric life, you know, independence, autonomy, self determinism, and so on, and then find that you're running into all kinds of social problems. So it's that kind of experience that has fueled my academic work. In that, I suppose if I were to just, you know, kind of say, what my specialty area is, I think I'd say that I like to study the Nexus or the the meeting point between culture and theory construction. And it's through one of those times of tension that I realized that there was a need for more models in occupational therapy, and ones that are based on alternate views of truth and reality. And so the Kawa model was born out of that kind of tension. So then. So, in terms of my academic career, I'll just briefly say that some of the places where I've, I've lived in taught occupational therapy. I mentioned Japan, I mentioned Vancouver, British Columbia. I've also worked eight years at the University of Toronto and the faculty of medicine there. Dalhousie University in Halifax, Nova Scotia. And then I came to the United States and was chair of OT at what used to be called a Medical College of Georgia. And today, it's Augusta University. And then from there, I went to Boston to be the Dean of the School of Health and Rehabilitation Sciences at Massachusetts General Hospital of Health Professions. And from there, now, I've decided to leave senior academic leadership. And I've gotten back to my first love, which is teaching and mentoring. And I'm doing that now at Duke University School of Medicine in the brand new occupational therapy doctorate program. Fantastic. I hope that too much time.
Yeah, yeah, I love the finish with just a little plug for Duke. So if you're looking for an OTD program, check out Duke. And you can catch up with Dr. Iwama.
Dr. Michael Iwama
That's right, yeah
Jayson Davies
I wanted to tie something in that if I recall correctly from hearing you in the past, you've talked a little bit just about the word, or the term occupational therapy, and even how with in the Japanese language, that there is no real translation for that. And so I wanted to give you just a moment to talk about that. Just little tiny conundrum that is probably much larger than just a small, little tiny conundrum.
Dr. Michael Iwama
Well, yeah, you know, we, you know, sometimes don't realize or recognize the fact that that concepts are like language, they are cultural artifacts, or cultural products. And so when Western occupational therapists were thinking about the concept of occupation, as occupational therapists like to define it, you know, because if you go out into the public today out on the streets, and you ask somebody, what does occupation mean? They'll tell you, is it my job or my career? Yeah, you know, what you mean, right. But OTs, in their very own culture, have developed this specialized definition of occupation. So that is really driven by individual centric route, in that, when you put yourself in the center of the universe, then all of a sudden, what you want to do, and what you do becomes really, really important. So, in fact, we go on to say, in our literature, we talked about doing being becoming belonging, and, you know, everybody is an occupational being and through occupation, we can affect the state of our health, and, and so on. So imagine taking that concept, and going to Japan, which has been described by social scientists as being collectivist group oriented. Where that group isn't, is is rigidly structured in a hierarchy. And so the average Japanese person really can't make sense of democracy, even because they have learned the world to be vertically structured in a hierarchy, and limited to groups, divided by groups. So you take the individual centric view of occupation, and all of the meanings that we've given to it. And then now you say, you know, you go and try to teach them to Japanese OT students, and they can't quite figure it out. And, and so, you know, here's an important point. And it may be a point of interest to the listeners, but, but I think that so when we look at our basic views of the world, I just mentioned that here in the West, we like to put the self in the center of the universe. And we like to think about the environment as being a separate entity to the self, the self is a self, the environment is the environment. Then when you go to places like Japan, or Africa or South America, the indigenous peoples of the world, the old world, Asia, South Asia, and so on and so forth. You find out that that they haven't learned that view of the world. What they've learned is more akin to what's described in the Bible, are the books of the law as the Garden of Eden where all things are together in separately in harmony. And the self is not even recognized until They eat the fruit. And notice that they're naked, and they notice themselves. But in that kind of view of the world, I would ask my Japanese OT students, so this is what occupation is, the environment and the self are separate. And through occupation, we connect with the environment, we do things in the environment, we do things to the environment, and we get this feedback. And then we make decisions about whether we want to continue that activity, or not, the Japanese student listening to that, raise their hand and says, I'm really confused. Because if the environment is in me, as I am in the environment, then if we're all one, then what's the instrumental value of this thing that you call occupation. So the Japanese don't have a word in their lexicon in their language that really captures or translates occupation, as we in the world of Western occupational therapy, have come to know it, and discourse it and honor it and venerate it. So you know, so that's a long winded answer. The actual word that the Japanese do use for occupation is sakio. And that literally means tedious, laborious, repetitive work. And it's just very different than, you know how the meanings that we have ascribed to to it, right? So in Japan, they have really struggled for more than 50 years to try to come up with a word in their language, to represent occupation in occupational therapy. And so that's the conundrum. And if that's what happens with occupation, what about all of the other concepts? 100%? And is this just Japan? Or is it other cultural spaces? Wherever we, you know, we just were so individual centric, that we just think, well, if we think it's correct, and right, and if we've done the research to, you know, verify it within our populations, then it must be good for everybody else. And, and that's not the case. And as OT becomes more and more of an inter international concern, then I think that these kinds of issues are going to pop up. And people will then begin to appreciate where the caller model is coming from, and why it had to be created in the first place.
Jayson Davies
That is just so informative. I, so do they actually use that term? I'm not going to try and say because I don't want to butcher it. But is that the term that they use for occupational therapy in Japan?
Yeah, so occupation, as I've just mentioned, is pronounced Sagio again. So if it's an occupational therapist, it's therapy, it's sung to real whole. And then if it's occupational therapist, it's the same Sangyo lio ho shi. And, yeah, that's, that's what it literally means. And that's why many people in the Japanese public. And even OTs don't really know what occupation is the way that we refer to it in the West. And so they've just decided to just live with it. And, but to the Japanese, who are very, you know, industrious, hard working people, tedious, laborious, repetitive work is not necessarily such a bad thing. Understand that. And in conclusion, I'll just say that wherever you go in Asia, and Southeast Asia, be it you know, Hong Kong, Singapore, China, you know, Malaysia, and so on Indonesia, all of those OT associations have a different concept, in their language, for occupation, in occupational therapy.
Interesting. And, you know, when you kind of think back to occupation, the word for us here and the Western civilization, right, we think of it as meaningful activities, but obviously, meaningful activities, culture has an impact on that. 100%. Right. And like you said, for us, when we hear tedious, habitual, whatever those types of terms, yeah, we don't think of that necessarily, as we have. We are beyond that, per se, right? We're not just helping people with the tedious stuff, we're helping them with the things they enjoy. But as you mentioned, in Japan, that is an important part of their culture. And so it's not as such a bad language or bad term to use there as it might be. Here. If we just explained that to a client. We're here to help you do the tedious stuff. But in Japan, it sounds like that might kind of resonate with clients.
Dr. Michael Iwama
Yes. And I'll just you know, you just mentioned the word you know, A meaningful that the things that we do that are meaningful to us? Well, in Japan, they might ask the question like meaningful to who meaningful to the self, are meaningful to this collective or this group to which I belong to. And that the social is such a strong driver of activity and the meaning of activity in the Japanese context. And my guess is, is not much different amongst indigenous peoples of the world.
Jayson Davies
Wow, wow, that's great for us to realize just because we never know who our next client is going to be, or who, who past clients have been in the cultures that they have. So we're going to circle back around to culture and just a little bit, but I think this is the perfect time to kind of talk about the column model itself. And we're going to dive into the constructs of it. But first, I just want to let you kind of just a quick background and kind of how it came to be.
Dr. Michael Iwama
Well, I mentioned earlier that, you know, occupational therapy, and its ideas and everything about it had a very difficult entry into Japan. You know, when you can't even make sense of the core concept, or construct of occupation. It causes all kinds of, of issues. And so when I went back to Japan to teach occupational therapy, they all wanted to know theory. Why, because American occupational therapists have theory, they're developing it. And it's very prominent in their discourse. So the Japanese were, they couldn't understand OT theory. And so they thought that I was kind of like the Savior that was coming, that could explain it to them all. And, you know, Japanese language and, and do it slowly, so that everybody could understand. And so I ran a national workshop, that people from all over OTs, from all over Japan came. But it was just really mild, catastrophic, in that, you know, a two and a half day conference, just after the first day, I realized that people were confused, and they were frustrated, they were angry, that they still could not understand and make sense of OT theory. And at about the same time, I was having all kinds of social problems and faux pas, you know, in daily life, like with my neighbors, and with fellow faculty members at the at the university, they would say, Why are you always speaking your mind? How can you speak out of turn, you know, you're, you're always so loud. And it's almost like, You're so selfish, that you and God are just talking about your own thoughts, you know, and things like that. And it's like being a bull in a china shop. And then so it just dawned on me, I just thought, Oh, my goodness, maybe occupational therapy is wrong. And so then I thought, you know, what, you know, Western OTs had the luxury of going back historically, and really, enshrining and canonizing. These concepts of life, to form the core of their theory. And I said, I thought Japan, you know, also needs to do the same. In fact, a lot of people around the world need to do that. So I assembled everybody to get all of the frustrated, disillusion discouraged, OTs that came to the conference, I brought them all together. And we started a qualitative research process, in which I said, we're going to develop a new model of occupational therapy. And we want to make it in a way in which our clients can readily understand it. And if that's the case, then the OTs could understand it. And so you know, so that had a bearing on what what came out at the end of the day, but it's through that qualitative research process, that the caller model then emerged. And it was not so easy, because I was still thinking with the western part of my brain, you know, telling the group we're going to build theory, but it's going to look like a plus b plus c equals D. It's going to be linear, and directional, and, you know, made up of boxes and arrows that kind of go in one direction. And, and the qualitative and so the the actual basic color model, the first rendition of the column model that emerged, actually was a circle with four boxes inside of the circle with arrows connecting all of the boxes. In every direction, and those boxes later would become water, river walls, driftwood and rocks. And and let me just quickly mention that even qualitative research methods are culturally bound. Can you imagine running a focus group and using something like method called grounded theory? You know, you're running a focus group and everybody's brainstorming, and everybody is responding to a particular question or a concept or something. So, you take that process over to Japan into what I earlier described as a collective or group oriented, and each of those groups are, are, are impacted and led by the hierarchy that is embedded in there. So when you're running a focus group, you ask a question, and everybody's quiet. Everybody is quietly waiting for the most senior person in the room to give the first answer. And then that then triggers the next in line and the next in line and the next in line. And so, you know, it was really quite an interesting, exciting, and I don't know, intriguing process. Yeah. And at the end of the day, you know, further it would evolve. And then that's how we got the so called Kawa, or river model. Kala is the Japanese word for river. And so it's often referred to as the river model, or the Kawah model or the Colorado River model, as they like to call it in the United Kingdom. Yeah, so I think that's probably much longer than what you were banking on. But there it is, for everyone, everyone to see.
Jayson Davies
No, that's exactly yeah, thank you. That's exactly what I was looking for. To be honest, I will share my personal view on the matters of podcast for those who schoolhouse podcasts I love in depth answers because our listeners, the people right now that are listening, they have the opportunity to press pause, they have the opportunity to rewind, they have the opportunity to fast forward, they have the opportunity to come back another day and finish. And so I really actually appreciate the answers that you provide. I really do. So yeah.
Dr. Michael Iwama
And these are things that that are never ever presented in a 20 minute conference presentation. So I'm glad to Thanks for giving me the opportunity that to honor the you know, the Japanese OTs that I worked with, you know, and being able to get these stories out.
Jayson Davies
Yeah, yeah, definitely. So I do want to dive into those four constructs that you mentioned. But really, maybe this one can be brief. But where did those terms actually come from? Because I'm assuming those terms probably didn't necessarily come from that focus group. But But maybe, but where did those terms? Why did you ultimately decide on this river framework?
Dr. Michael Iwama
Well, it's another thing that just kind of emerged in that, as I said, I told everybody, we're going to if you're going to build a model, then it's got to be boxes connected by plus signs, and, you know, an arrows and things like that. And so they, you know, they saw me as being at the top of this, this pyramid, this hierarchy in that room. And so they bent over backwards to just try to, you know, put something together that would satisfy what I demanded of them. And the best that they could come up with was this circle with four boxes. Now, the boxes, were not necessarily named water, rocks, driftwood, and so on, you're correct. And that that's something that emerged a little bit later. But in the beginning, it had to do with the words, for example, problems, you know, abilities, difficulties and challenges, and internal or personal factors. And so those were what were in the boxes. And I asked, Well, why is each box connected to all of the other boxes, you know, and then basically is as well, you know, everything is all interconnected. And they're kind of like in this state of impermanence, as people like to say in the Buddhist traditions, that everything is in flux. It's kind of like an amoeba where everything is always moving, but it never comes apart. So then, you know, as we were talking about it, they said, you know, a much easier way to explain this to clients that know nothing about occupational therapy, or you know, medicine is to use the metaphor of a river. And at the time, it made sense because It dawned on me that most western models of occupational therapy are based on a metaphor of a machine, you know, general systems theory, that conjures up this idea that you got these components that are in relation to one another, and they all work together in some kind of way. Whereas this is much more kind of fluid in that, you know, the parts are always there, but they're configured differently. If you change one of those components, it changes the whole thing. So you change one part of the river, the whole river actually changes, maybe even ever so slightly, but it does change. And so that is really how those concepts came to be. Yeah, yeah. You know, and maybe a treat for your listeners is I don't think people have ever heard this before is that one of the even before we talked about, you know, the, these four concepts being the core concepts of the column model, we were drawing images on a on a whiteboard of a river, with a piece of heavy machinery, you know, like a digger, I think that's what it's called,
Jayson Davies
Okay.
Dr. Michael Iwama
got a scoop thing that, you know, comes forward and moves dirt, like we're digging a ditch, right. And so, you know, at one time, there was one of these objects on the side of the riverbanks. And that was what we had symbolized for surgery and medical intervention, that some of these structures could be physically just removed. Right?
Jayson Davies
Yeah.
Dr. Michael Iwama
But then, you know, and, and so for good reason. You know, the model was defined over time, and it was then reduced down to its most simplest form. And that's what we have.
Jayson Davies
You know, that's funny, though. Because as you were explaining that digger, I was trying to, you know, figure out where you were going. And my instinct was that you were going to call that digger, the OT, but you went in with a much more western side of things. And it's surgery or, you know, more of the traditional medicine. But I guess that just kind of speaks again to the culture.
Yeah. And I think that the Japanese OTs, because they can't understand Western theory, or constructs like occupation, have really defined occupational therapy, to the techniques, and the assessments and procedures that OTs use. So you know, they'll say that, well, everybody uses sensory integration, but they'll say sensory integration is OT, or, you know, splinting is OT or, you know, Bobath training is OT or the use of the clpm is OT, they never go back to a philosophical explanation of, you know, what drives their therapy, what, what is the rationale and the impetus for them to do these particular techniques? And they'll have much more difficulty answering those questions, because they can't go back and say, Well, you know, at the root of all of this is the concept of occupation. And we believe as OTs that occupation is necessary for this, this, this this right. A lot of people around the world can't do that. And you know, what, one more bomb that I'll drop, Jason, is that our clients often don't understand our concepts. Yeah. Is there a way that we can stay true to, you know, our philosophy and our values, and even our concepts, but be able to discourse or talk about it In much simpler ways, with our clients and, and that definitely fits into the spirit of the Kawa Model
Jayson Davies
Yeah, yeah, definitely. Well, thank you. Thank you. Thank you so much for that. And I'm excited because I think all of this that we've shared now brings even more meaning to what we're going to talk about right now. And that is those four constructs. And so what do you want to start with? You want to start with the water, the river bank? What works for you?
Dr. Michael Iwama
Let's start with water.
Jayson Davies
All right, let's do it.
Dr. Michael Iwama
Yeah, and you know, water is the most important element. If you don't have water, you don't have a river. Very true. Right. And so early on, that was the, the component that we named for life force. And so as long as there's water, it means the person is alive. And sometimes you don't have to be alive for the river to continue to flow on them. But regardless of that, it is really it encompasses all of the good things, the strengths, you know, adaptation, any any kind of positive attributes within your culture that you want to give to the definition of life or life force. That's what it is. And you'll, you'll notice in the column model, for example, that there is no concept for occupation. And so people ask, well, how can this be occupational, an OT model? Well, many Western OTs have reconceptualize over the water to meet occupation. Okay, yeah. And so the, the other structures in the river will either impede or enable flow, right. In other words, impede or enable occupation. And so that's a clue into how to segue into some of the other concepts that we can talk about. But that's essentially what what it is, water is the most important component of a river. And at different points along the river, depending on its contents. And the riverbanks and what they look like at the time, determine what the quality of that flow is, like, either rapid or slow and deep or calm, or, you know, whatever it is, it becomes the total of all of the other parts of the whole other components.
Jayson Davies
Yeah. And so before we move on to the riverbank, or one of the others, just briefly talking about the water flow, and tying that to school based OT what I would imagine that would be, I mean, at an individual level, that is a student, going to school, getting through their day, making it through getting the education that they need to get, and then maybe at a larger level, right, it could be a school wide, classroom wide, district wide, as you know, collectively, the kids getting through graduation rates going up, or whatever it might be teachers being happy and successful in their job, all of that, does that make sense?
Dr. Michael Iwama
It makes sense. And it's whatever the individual, and sometimes if you're too young, and you don't have the words, or the ability to be able to, you know, explain things effectively, to adults, is that, you know, the people who care for and love that child can also pipe into be able to imagine, in this case is water. So it's those things that are going well. It's it's those things that are proceeding along, that are adaptive. And hopefully, and most importantly, they're important to the person to in this case, the student. And you know, the student may name some other things. And it may, it may be due to things that are outside of the classroom that actually support their, their abilities, and their performance in the classroom. And that has to do with family values, faith, religion, you know, there are many, many different kinds of things that people give to the attribute of water, not the attributes of water.
Jayson Davies
Awesome. Thank you. And so then I think that kind of leads us potentially into the river bank, when I think of river banks, I think of the depth of the water, the the width of the river, sometimes river being split off and come back, there's bends forks, so I'd love for you to explain the riverbank a little bit.
Dr. Michael Iwama
Well, the riverbanks and sometimes it's referred to as the river walls and floor, but they're all the same entity. So the river walls in the column model symbolizes the environment, and more concretely, the physical environment and the social environment. And they're not necessarily divided into two different entities that So, for example, let's take the physical environment, it may be the home, the actual house that the person lives in, it might be the truck that they drive for a living, it could be the workplace, you know, school or whatever the person defines it to be. And so, if that is a good environment, for the person, then it will be depicted as the river walls being thinner or they sort of expand outward, that to allow a greater volume of water than to flow. Okay. Now, the social environment have to do with relationships with people Family, friends, partners, Workers. Yeah. And so if things are going really well there, if you have the supportive set of parents, and family members, if you are facing any kind of difficulties, often these entities if they're helpful, and they are depicted by again, the river walls expanding outwards, to allow more water to flow. Now, conversely, if you have any difficulties or problems in any of these areas, you know, let's just say for example, a person has a mental health diagnosis. And the parents come from a culture and tradition that that's something that's very, very bad and negative. And they're in denial of it, and are mad at you. That can be depicted as the walls actually constricting, becoming thicker, encroaching in on the volume of water that flows in that particular river. Yeah. Also, given an example, with the physical environment, if there are difficulties, let's say that you got difficulty walking as a result of an injury or something, well, you know, all of a sudden, the house with its five steps up to the front door, and then the 20 steps up to the bedroom, and bathroom becomes like a river wall that has thickened in a particular area. So think about the river walls as just sort of being all of these factors, physical and social, spiritual, if the person names it, and these can either become thick, or they can be expanded backwards, to create more flow. And that should give your listeners the idea of, Oh, I see, I can see the interventions that I can think about with the children and students that I work with in the schools. And that I can also be vigilant or be cognizant of the environmental factors that also contribute to the performance and well being of the that student. Yeah, right. And it's, and lastly, I just want to say that the newest variation to the cow model, is that there's one more deeper layer of the river walls and floor. And that deeper layer, it's more distal away from the water. So it affects the water indirectly through the through the immediate river walls and floor, we refer to this as the ambient environment. And the ambient environment is those things that are happening out there in the world, like a pandemic, or political strife, war, you know, diaspora, natural disasters, like earthquakes and tsunamis, you know, things that sort of happen around us, but ultimately, determine the how our rivers flow by pushing up the river walls. Yeah, having them constrict and become smaller.
Jayson Davies
That's yeah, yeah, definitely, wow, you just got so much in my mind thinking, like, I keep going back to the digger and how, like, you know, a physical injury, or a mental health concern could be like the digger putting instead of taking, you know, land out, putting land back into the river to, you know, build up that that wall, and then what you just mentioned, you know, with the outside factors, I'm thinking I just went to Hawaii. So I'm thinking about volcanoes and how volcanoes make land change very quickly. And you know, how something that doesn't seem like it would impact you. In a split second, an earthquake, a tsunami of volcano can just change your entire geographical landscapes. So yeah,
Dr. Michael Iwama
the lava could flow over the the main road that comes into your your town, affecting the shipment of groceries and other kinds of goods. Yeah. And you know, then will that impact, ultimately, your occupation of eating and of taking, you know what I mean? I mean, these are the things indirectly can come into the picture, and affect how we live.
Jayson Davies
Yeah. You know, one thing that we haven't discussed, and maybe we should before we dive into the driftwood and the rocks, is that whenever we're talking about the Cava model, and we're talking about this river at any moment, we're talking about one specific cross section of the river Correct.
Dr. Michael Iwama
That is correct. It changes from instance, to instance, to instance. And, and so again, I think that this was really influenced by Buddhist philosophy of impermanence, you know that nothing stays the same. Everything is in flux. Everything is changing. And moving, like a river.
Jayson Davies
Yeah, yeah. So three years ago, during COVID, you know, our walls were constricting in our river for a lot of us. For other people, like people who were selling face masks, it was open. But, you know, they move they change from day to day, moment to moment, as you mentioned, so thanks.
Dr. Michael Iwama
Yeah, unemployment, losing your job, you know, students that can't go on field work placements, because they've just disappeared. Absolutely,
Jayson Davies
absolutely. That's why we need more people to open up and take more students. So there's ever more students coming into OT and we need to support them any way we can. So a little little shameless plug back. All right, room. So now we've got this idea of the river, the river bank, the cross section of that river, I'm not even going to ask you to kind of split them up, because I know that goes so hand in hand, but share the driftwood and the rocks.
Dr. Michael Iwama
Hey I want to start, I'll elect to start off with the rocks first. And that makes explanation of the driftwood much easier. So the third main concept of the Calvo model are the rocks. And just like in a river, if you take a look at a river, you'll see rocks of different sizes and shapes. And these are symbolic of challenges, difficulties, even problems. But again, it's the client or the person that basically dictates what those problems are, from their experience from their view of reality. And so some of these rocks are big, and really affect the flow of the river. And then there are also a lesser rocks, and if, if our listeners were actually thinking about their own lives, like a river, they'll recognize that there are always some rocks that are there. But on the whole, there's more water. So the rocks are tolerable. And, you know, we can handle the fact that they are there. So problems difficulties and challenges. And what these rocks do is that they impede, they form an obstacle to the flow of water. So these difficulties, these challenges and problems actually form an impediment to life force to your occupations that you know, all other aspects of your well being. Okay, so that's that now I'll just say that I mentioned earlier that the river walls can also become thicker, and also serve to impede or limit the flow of water. But when rocks when big rocks, you know, jam up against the riverbank, which is also thick, in combination, their effect on slowing the water or blocking, it just becomes that much greater. So many of the problems that we and difficulties we face in our life are not floating in the air separately, they're actually problems and difficulties that impact or involve the social, the, you know, our people in our social environment, be it family or parents or lovers or whoever. And also, that particular problem of maybe, you know, back pain and sciatica I should be using some sub school based on but, but you know, may then you know, you know, if a person has issues with cerebral palsy, for example, there may be aspects of the physical environment, in combination with those symptoms are features of that particular condition combined together to form even a larger impediment or blockage to flow. So, so again, you know, there is this what's forming, hopefully in everybody's mind is that you've got water, the river walls, and you've got these rocks, and they're all connected together. You know, they all they they are now forming the river. Yeah. Okay. So are there any questions about that? Because then I can then go on to what driftwood are?
Jayson Davies
No, I don't think any question. I mean, what's coming to my mind you know, is there could be small little pebbles and some of those pebbles might be that red light It's on your way to work that it's just gonna make you a minute late. But then there are larger rocks, right, the more larger boulders that maybe you had a death in the family, or, you know, there's a number a number of things. Like you mentioned, having cerebral palsy is something that it gets in the way, but water can still get around it. And over time, now, I think this is going to lead us into the driftwood that rock could potentially move. So I'll lead you in with that.
Dr. Michael Iwama
Yeah, and I think that that, you just mentioned something really insightful and important about the Kaabah model. And that is that, that even though the rocks and those hard structures and obstacles are there, water has a way to slip around those and continue to flow. And so the solution often is not to just explode or obliterate the rock that's in the way. Because sometimes there are certain rocks that just don't go away, they don't go away that quickly. And they've been there for a long, long time, maybe since birth, but the water always finds a way to flow. And, again, think about what the water represents occupations, aspects of your well being, the good things, the strengths that and so on. So now, the last component, the fourth component in the river, is the driftwood. And the driftwood are really quite kind of interesting, because they can have an adaptive, enabling kind of characteristic to them. But they can also have the opposite, they can have a negative effect on flow, especially when they get caught between the rocks and between the river walls and, and so on and so forth. When that happens, that's a that's a negative value that we place upon that particular driftwood. Because it's just compounding the blockage to the water flow. Okay. So there's a little bit of a hint, when we talk about the color model, we talk about driftwood, there's always a plus and minus sign to it, because these are things that are there, they are personal factors, I'll go on explain this in a moment, but, but they can act positively to a person's life flow, they can also impede it, and cause difficulties and, and block the flow. So I should have mentioned at the very beginning that the driftwood are symbolic of what I like to call personal factors. And these are things that the person has within themselves. They're not just physical ability, but they have to do with everything that that person has within them. And so that would be things like, well, personality, maybe the person is really headstrong and has a great sense of determinism. And that's been proven over time, blockages to the flow become frustrating and become you know, seem to make the driftwood even bigger, or they may have a quite a laissez faire kind of attitude about things, nothing, you know, fazes them, nothing troubles them, everything is okay. tomorrow's a new day, everything is going to be okay. So just like relax, okay? Big driftwood can also be things that the person has, you know, maybe been given through their DNA, like, an uncanny ability, with music, or their artistic and they're really good at drawing pictures and painting and so on, are good at photography, or maybe they have an affinity for computers are really good with that kind of technology. A person may you know, like whatever it is, these are features or factors within the person that are also there as resources. It may be something social, like connections with powerful politicians, or, or with or with people that can help you in some kind of way. Maybe it's wealth that the person has, that has a lot of material resources. Another part of driftwood could be again, internal, which is like maybe it's something that they've learned, or maybe it's their experiences of life, to that point in time. That these experiences are things that the person can look back onto. And you know, take something positive or adaptive from those to help through a difficult passage between someone marks, or it could be maybe they went to school and got a diploma in this or that or, you know, earned a badge at at at scouts. Yeah, yeah, you know, certain abilities and competencies and things like that, whatever those things are, all of those things are driftwood. And they are things that just appear in the river, they're out there, they're, sometimes they just go floating right on by without any kind of consequence. They are just a part of the flow. Other times, as I mentioned earlier, they can get caught between the heart structures to then compound or increase the blockage to flow. But they can do one more thing. And this has to do with a positive value of driftwood. And that is that they can actually go and collide with a rock, maybe even breaking a piece off the rock, fracturing it, or to erode to rub up against the side of these rocks, and erode them back a little bit of make them a bit smaller, or just smacking right into them, and actually moving the rock out of the way, does that creating a new channel of flow, they can also rub up against the river walls and also erode those services back to again, allow greater volume of flow. So you can see these, these, these driftwood as coming along. And, you know, I can't think of a of an appropriate example. But the one that I often use is that the person, you know, is a very stubborn and determined person and you know, wants to have their way all the time. And they're hardworking, and they feel that they deserve everything that they work hard for, but they're gonna get their way. So when a particular rock appears in the river, that is in the way of their flow, or the river walls, also, they've become thicker, and combined with that rock to create this impediment. That piece of driftwood that is now caught between the rocks, and the walls can be frustration, a sense of being dejected, of not having confidence, or whatever the effect is, yeah, that's that driftwood that's there in tangled up in all of these other impediments to flow, right. And so, the OT then coming into that situation, might think, and by the way, the OE T is like, vigilant, and looking for every, every place, even if it's tiny, every place where the water is still flowing. Why? Because there's potential for greater flow. It's about it's about strengths, it's about, you know, you know, those are good points. So, maybe, to work with a student and to be able to, to structure certain adaptive activities that are maybe I haven't worked in school, so.
Jayson Davies
Well, if I can, you know, I was kind of thinking about a student who learns a new adaptation, a new skill, and maybe that is, you know, they have handwriting difficulties, and now they've learned typing. And so that typing, does that typing become part of the, the water the flow? Or does it become a driftwood that can now potentially knock that that rock loose that they had, because of difficulty with typing, but at the same time, potentially, you know, in another instance, become a blockade?
Dr. Michael Iwama
Well, for one thing, you know, what comes to mind is that, that the acquisition of the typing ability, may actually take certain rocks that are that are there and make them smaller, the kinds of things that were that were impeded, because the person who could not express themselves in written form. And then it also means that if the rocks become smaller, and the driftwood becomes dislodged, it just becomes a part of the flow. And it may be the handwriting isn't as important to be able to attain, you know, the ability to do. But you know, but that's not to say, like, I know how important handwriting is. Oh, yeah. Yeah. But, but that's just one scenario as to how that can kind of be explained through this narrative.
Jayson Davies
Yeah. And if I may, really quickly, I mean, it's very likely that you know, the student who has learned who has learned to type I At a fourth in the fourth grade, and you know, they've got 15, maybe 20 letters per words per minute, that's fine and dandy at this point in the river. But now when they're in college, that 15 to 20 words per minute, that's not as great as it was back in fourth grade. And so now, maybe it is getting that driftwood potentially has grown. And maybe it's gonna get more caught up in those rocks of homework and school assignments, as opposed to in the fourth grade, it was knocking those knocking those rocks away, So.
Dr. Michael Iwama
yeah, and, you know, I think that the resourceful OT that's working in the school, now has all of these points of, if I could call it intervention, in which they're not just looking at a particular skill, but they're looking at it in the context of all of these other things that are in that student's world. And so sometimes, you know, you'll be working on handwriting, but then your attention will also go to some aspect of the environment that can be pushed back a little bit, aspects of the rocks that can be addressed in a certain way, thus making them symbolically smaller and less of an impediment to flow. But I think that this is probably a good place to be able to tell your to inform your listeners that, that you will have noticed that, you know, I've just explained the column model, like that's it. And but you'll notice that hey, well, what about the concept of, of self of the individual? Like, where is the student? Where is my student in this particular river? And if you recall, back to what we were talking about, at the very beginning of this, that? Should I say that, you know, we're looking at the totality of the river as being all interrelated and connected. Yeah. Right. So the whole river is actually the student. We're not drawing these rational boundaries between the self, and all of the things that the person is connected to, whether it's their thoughts, their attributes, their personal factors, their environment, their circumstances. So it's really about looking at the person poorly, holistically, in the context of their circumstances, and the world in which they applied. Right. So it's kinda like, you got to do some mental gymnastics a little bit, because we're conditioned, to just want to just take things apart, and put things into categories, and then treat things in components, rather than doing that, but also recognizing and appreciating the fact that all of these things are connected. And you change one aspect, it changes the whole river, it changes the whole person and their situation.
Jayson Davies
Yeah, yeah. You know, and I love that that is the case, because I can imagine an occupational therapist, you know, going to IEP meetings, which are individualized meetings for a student in the schools, and almost explaining this river model a little bit and explaining how the goals that we're putting in place for a student are in a way to kind of create some some new skills or new driftwood to help that student get past those rocks that are currently in the way to, you know, meet their long term goals and create more flow. And I think that this is definitely you know, it's a model, it's a theory, it's a it's a larger picture thing, versus, you know, the tiny or the not tiny issue in se, but the actual therapy intervention that you're going to do, right, you can still use sensory integration within the column model, you can use executive functioning, you know, training within the column model, right?
Dr. Michael Iwama
Yes. And it'll also identify, or give you some good ideas about what kinds of assessments and instruments you need to employ in order to understand the rock this rock better, you know, to really figure out like, you know, what the river walls are, like, I think about when people do home at home assessment, that's an assessment of the physical environment. Yeah. But again, a person's river will point you to those places where the water is flowing, that has a greater potential to flow. And if you look at the structures that are around that channel of flow, it will then tell you, Oh, here's a rock. And I want to understand this rock better so that we can address it and we can make smaller, let's take this driftwood and let's use this in a different, you know, adaptive way. Whatever it is, I have found that. And I've heard also and seen OTs and various areas of practice, be able to use the Carlmont. This way. That's why the color model doesn't come with standardized assessments for this and that. And the reason why is that this is not a one size fits all kind of model, where if it's good for me, it's good for everybody else. We deal with that cultural problem by turning it upside down and empowering the this this, in this case, the student or the client, as being in the center of the universe. And yeah, so I think I think I just got off on a tangent here.
Jayson Davies
No, but I think that if I can, I want to use where you kind of just left off. And that is, with kind of having the client understand their own river is kind of what I was hearing you go to, and now I'm getting, you know, I'm just going to the next step, right. But in practice, whether it be school Bayes, geriatric, wherever I can imagine you kind of pulling out this image of a river, and having some magnetic rocks that can go on to that image, or just paper rocks that can be thrown onto the river. And somehow the the walls can come in and go out and have some pieces of driftwood that they can, you know, throw on to the river and explaining to them what those pieces mean, and letting them self identify what those are in their life. Have you done that? Or is that what it looks like?
Dr. Michael Iwama
I mean, as far as children and students are concerned, I've heard that there are OTs, that are working with students and with children, in which they actually, they, they have an activity where the child just draws, you know, a river, and then the person is then guided, they don't have to be, you know, they don't have to sit back and kind of, you know, draw their own rocks and things. But maybe the person that is leading them might say, what kinds of things do you like doing every day? You know? Or what do you enjoy? What's your favorite food? What's your favorite color, I mean, whatever it is, sometimes these are those things that come to the surface that that can help the OT get a good sense of what this child's river is like. And, you know, Jason, I just want to just add one more thing, because I don't want to forget to say this is that every child or person's life, or their river, is unique, and beautiful. And that the river, everybody's river comes from a unique place. And so how our rivers flow today, are very much influenced by what happened in our rivers upstream, you know, earlier in life, and that's how some of those things can still affect us today, and have the potential to affect us in the future. Yeah, and so goes our river flowing into the future as well. And that, that can also change and it carries hope, hope for easier, better flow.
Jayson Davies
100%. Wow. So since you mentioned it, or we're talking about drawing, I did just do a quick Google search while we're talking in just a river model coloring sheets, and I found some that, you know, you can print out and it actually uses a coloring sheet. But I also found some that people have actually, you know, they took a picture of either their own river or their client's River and they put it up on Google. And, yeah, they have, what my river looks like, and what my river now looks like. And for some of them, there's more rocks, and there's more driftwood for others. There's less rocks and less driftwood nowadays. And so as I'm seeing this, I can just, you can do so much with this, like what's coming to my mind is that you can focus just on one aspect, you could have a student draw a river and maybe only focus on social components right now because that is the main concept that you want to work on. Or you can open it up and let's just talk about your entire life. Like is it? Is it just social? Or is it also other things going on that you want to put in there as rocks and driftwood? I just think there's so much that OTs can do. And you know my mind being a school based OT it's just going in circles now you got me thinking, but yeah, I really, I really do hope the school based OTs, you know Listen to this episode. And we might see some, some some really cool things come of this. So I'm excited.
Dr. Michael Iwama
You know, I want to invite your listeners to really, what I want to say is, the column model really was built in the spirit of a gift from practitioners to practitioners. And I want to look at it as open source software. And that this is not some an empire that I'm trying to build. No, not at all. In fact, you know, I'm trying to enable people to take this metaphor or take this model, and to be able to adapt it, change it, and make it work in the context of your place of practice. And when you make those changes, and they're they're adaptive, share those with others, that are also using the model or, you know, can really benefit from your insights and your discoveries. I guess what I'm asking people to do is to be theorists, and to create models. And one way to do it is to take an existing model and to reconfigure it. But I'm giving everybody the green light to go and innovate. But the only stipulation is that we don't want you to make money, or profit from the Kawa model itself. You know, you can have a practice, and use the Kawa model as one of your instruments or whatever, that's okay. But however, you know, I have vowed from the very beginning that we wanted this to be free. And so I have not made a penny. I have not profited at all from the column model. Yeah, you know, I get sometimes they get an honorarium to speak or something, but that's fine. But however, I'm not out there saying, if you want to lecture on the Kawa model, it's going to cost you $5,000. You know, no, it there's an opening in my schedule, like, penciled me and I'm there, because I'm really excited to talk about this.
Jayson Davies
Yeah, yeah. And Dr. Iwama, we want to thank you so much for exactly that for coming on the OT squad podcast. And, you know, I know that the day that you thought about the column model, the day that that team, you know, came up with it. School Based OT probably wasn't on your radar. I mean, I don't think any of you were probably school based. OTs, maybe not even pediatric. But a good model is a good model. And it extends beyond its potential or original uses, I should say. And I just want to thank you so much for coming on. And really quickly, just where's the best place for people to go and learn more about the Kawa model?
Dr. Michael Iwama
You know, I get asked this quite a bit. And a few years ago, we took a stab at putting together a website. It was it's an it's still there. It's www dot Kawamodel.com. You know, which is pretty easy, isn't it. But it needs to be brought up to date, it was a place where everybody could go and, and upload their their conference poster presentations, papers, ideas, reports of how they're using the Kawa model, and also be a place of resources. And so I'm just now reconfiguring and reviving that now. And that's going to come to the forefront. But I would say that the best way to get information on the caller model is to just Google it, or Google my name. And then you'll find the links to Kawa model everywhere. And yeah, you know, YouTube,
right, right, YouTube, podcasts that you just listened to. So much free stuff out there.
Dr. Michael Iwama
Think the OT students at the University of Tel Aviv in Israel actually went and took an animation from The Lion King and made it all about the Kawa model. It's all in Hebrew, I think. They sing and they sound just like the very characters. Just go to the web. And and it's there. And and if there's something specific you're looking for, also get in touch with me. And I think that if you Google that you'll find that link as well. Right, we're all somewhere. Yeah. And you know what, at the OT schoolhouse, we're gonna go ahead and we'll find some of those that we find to be readily useful for school based OTs related to the Kawa model, and just the column model in general. And we'll make sure to link those in the show notes to this episode. So click on over to the show notes, and you'll be able to learn or at least find some of the resources that we found to help you out a little bit so yeah. Thank you so much. Yeah. Well, Dr. Iwama, thank you so much. It has been a pleasure having you This has been a great conversation, one that I think I told you, and we haven't talked about it today. But I think we talked about it in a previous meeting, you know, the column model is just something that, yeah, as an OT, you can use it in your practice. But it's just something that extends beyond that. And you know, you use it for yourself. It's a life model. It's not just an occupational therapy model, you know, just understanding your own rocks, your own driftwood, all the things going on around you. It really is just a model for better understanding your own life. So I really appreciate you coming on and sharing. It's been my pleasure. And thank you for giving me this honor to appear on this podcast.
Jayson Davies
Yeah, thank you. Take care. Have a great rest of your day.
Dr. Michael Iwama
Okay, good bye for now.
Jayson Davies
Alright, and that wraps us up for episode 126 of the OT schoolhouse podcast. Thank you so much for being here. And thank you one more time to Dr. Iwama, for joining us today. He cares so deeply for our profession, and he was extremely grateful and happy to be able to share this model with you. I hope you enjoyed learning all about the color model and how it can be applied within school based occupational therapy. Remember, just like a river, our lives are constantly changing and evolving, and a school based occupational therapy practitioners, we have the privilege of supporting our students on their unique journeys. If you have any questions or comments about today's episode, please feel free to reach out to me on Instagram or via email. And don't forget to subscribe to our podcast so you never miss an episode. Thanks for listening and I'll catch you next time on the OT schoolhouse podcast.
Amazing Narrator
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