By Elizabeth Hume, Occupational Therapy Student and LEND Trainee
I am currently in my first year of my entry-level occupational therapy doctorate program at the University of Illinois at Chicago. As I am sure many health care practitioners can attest to, the biggest learning curve when entering professional training is learning to think like a practitioner. Understanding the paradigm, or the concepts, beliefs, and values, that defines your practice is at the crux of understanding what your practice does and why it is important. As I have come to learn very quickly us occupational therapists especially need to be ready with an “elevator pitch” to explain why and how our profession can provide unique care that can’t be given by any other profession. With that we must also strive for cultural competency. In other words, in order to truly put patients at the center of our practice we must possess the ability to recognize our cultural beliefs and practices, understand how they differ from those of cultures other than ours, and then educate ourselves on how to respectfully communicate with individuals of cultures other than our own. In order to provide equitable care, we must be able to provide therapy to our clients regardless of their background.
The current paradigm of contemporary occupational therapy evolved largely in the United States and Canada. Compared to other health care professions, occupational therapy is fairly new. Its roots sprouted in the 1700s and grew into the 1800s with health care professionals using leisure and daily activities, such as gardening, to rehabilitation individuals in the mental health setting. Then the field really emerged in the early 1900s during and after the first world war when reconstruction aides were called upon to rehabilitate soldiers. From there, interest in using meaningful activities, or what we call occupations in the OT world, sparked in both physical and behavioral health realms to develop what we know as occupational therapy today. Despite our Western origins, as culturally competent practitioners, occupational therapists know that not every client that we are treating will have the same experience because they simply don’t live the same lives.
Here’s how I have come to think of this concept:
Let’s think of a task, brushing your teeth. Did you brush your teeth this morning? Did you do it right when you got up? Where did you brush your teeth? Did you have to travel far to get there, or was it close? Did you use a toothbrush or something else? If you used a toothbrush, what does your toothbrush look like? Did you use toothpaste? How much toothpaste did you use? Did you use water? How did you get the water, did it come from a faucet or from another source? Did you feel safe when you were brushing your teeth? Why do you brush your teeth? Now think how a friend of yours might brush their teeth, and then someone in a different state as you. Now think of someone in a different country. How might their experience differ from yours? An occupational therapist considers the answers to these questions to determine how to deliver individualized care to each consumer.
Traditionally, the ideals of Western cultures are individualistic, considering what and how an individual wants to do. The individual “self” is central and exists within the environment. The individual is the creator of their destiny. In contrast, there are other cultures that emphasize community needs and values as well as being in harmony with one’s context. An East Asian perspective views the “self” as part of a collective whole, inseparable from the environment. Under this ideology, health and disability is defined by a multitude of factors both in and outside of the physical body. It is occupational therapy practitioners’ duty to recognize and understand that the origins of occupational therapy can carry Western bias, possibly denying consumers the quality of care they need. One way that occupational therapy has adopted other perspectives of the world is through the Kawa (River) Model. Developed by a Japanese-Canadian occupational therapist, the Kawa Model emphasizes the self as being infused with and affected by the components of the self, deities, and nature. The individual self is not centrally located among it all. The Kawa Model, “kawa” meaning “river” in Japanese, explains these ideas through a metaphor of a river and the components that exist within it. The river’s stream represents an individual’s state of well-being through life while the aspects of the river such as driftwood, rocks, and the walls and bottom represent changes and obstacles in life. Sometimes the stream may become disrupted, rehabilitation using the Kawa Model aims to show the individual how they can once again become in harmony with the inseparable components of their life. Unlike other Western models of occupational therapy, which analyze the relationship between the person, environment, and occupation, the Kawa Model challenges the individual to look inward, and asks for their perspective. It helps the consumer and their family understand their personal relationship with their circumstances and visualize change in their life.
The Kawa Model – InfOT (InfOT): https://www.youtube.com/watch?v=Kl9U2-zvUCg
As a new student in occupational therapy, I admittedly did not consider how models of occupational therapy have the potential to put occupational therapists at risk of providing inequitable care. If I as a practitioner fail to recognize and consider the experiences and culture of the consumers of my care, I risk providing services that are less than therapeutic. Recognizing and utilizing non-Western models of occupational therapy can validate occupational therapy practice around the world. Not only will it help us provide the most equitable care possible, it will expand the use of occupational therapy. The Kawa Model doesn’t have to be strictly used with individuals from cultures with collectivist ideals. It can help consumers who are more visual see how their life changes overtime and how their life course is connected to life events and obstacles. It may help consumers visualize goals they have for themselves understand the path they need to take to achieve them. It can also help someone look back on their life and understand obstacles they have faced and how they allowed their life course to continue on. In my opinion, there are exponentially more routes to take when considering worldly perspectives.
An Introduction to the Kawa Model (The Royal College of Occupational Therapists): https://www.youtube.com/watch?v=3HwYUIZiCZI
Occupational therapy is a unique practice that promotes lifelong well-being through engaging in meaningful activities, although there are places around the world where occupational therapists are yet to practice because the profession just does not meet the needs of the people. As a future occupational therapist my goal through being culturally competent is to be confident in the use of various approaches and be able to look at health through a multitude of lenses. I will do this by striving to make myself aware of emerging models in occupational therapy, work to understand the cultural dynamics my clients’ backgrounds, and being aware of my own inevitable biases. For the sake of equitable care and for the love of learning, I urge students and practioners, new and experienced, to do the same.
References
Fisher, G. (2023, August 22). OT 600: The Historical Development of Occupational Therapy’s Conceptual Foundations Part 1: 1800-1979 [PowerPoint Slides]. Department of Occupational Therapy, University of Illinois at Chicago. Blackboard. https://www.blackboardconnect.com
Fisher, G. (2023, August 27). OT 600: Overview of the Main Occupation-Focused Models [PowerPoint Slides]. Department of Occupational Therapy, University of Illinois at Chicago. Blackboard. https://www.blackboardconnect.com
Gillen, G., & Brown, C. (2023). Willard & Spackman’s Occupational Therapy, Centennial Anniversary Version (14th edition). Wolters Kluwer.
InfOT (2019, September 7). The Kawa Model-InfOT [Video]. YouTube. https://www.youtube.com/watch?v=Kl9U2-zvUCg
Iwama, M. K., Tomson, N. A., & MacDonald, R. M. (2009). The Kawa model: The power of culturally responsive occupational therapy. Disability and Rehabilitation, 31(14), p. 1125-1135. https://doi.org/10.1080/09638280902773711
The Royal College of Occupational Therapists (2023, May 1). An introduction to the Kawa Model [Video]. YouTube. https://www.youtube.com/watch?v=3HwYUIZiCZI
