Module Three: Clubhouse Model Programs and Services

Overview: 

The programs and services offered by a Clubhouse are designed to support a person attempting to put their life on track again following a period of mental illness. To facilitate this effort, the Clubhouse provides a range of social, vocational, and educational services and resources to assist the person to accomplish their recovery goals. Clubhouse programs are different than other mental health programs in that a Clubhouse model is a holistic approach that promotes choice and relies upon the social support and acceptance of a Clubhouse community made up of other people living with mental illness and professional staff to build self-confidence, encourage positive change and offer real opportunities to do so. Two of the more distinguishing features of a Clubhouse are the active involvement members have in the daily operation of the Clubhouse and the roles they play in that operation, and, secondly, the degree to which the Clubhouse exploits the many opportunities within the community for education, employment and socialization.

Despite the many challenges facing people with serious mental illness, returning to work is the number one dream of many people with whom we work. Clubhouses have been successful in helping thousands of people return to work by using service approaches that offer different levels of employment and social support as the person requires them. Program services that form the basic Clubhouse model include both core and specialized service offerings described below. 

Core Clubhouse Programs:

The programs and services described below are considered "core" programs of the Clubhouse Model and form the essential program components as defined by the International Standards Clubhouse for Clubhouse Programs™. Every accredited Clubhouse program would be expected to offer the following program services: 

 Work-ordered Day:

The Clubhouse is a place where members are truly needed, wanted, expected, and welcomed into the work of running the Clubhouse. The Clubhouse is more accurately a community of people who believe in these fundamental, humanistic values. It is neither a staff-run nor a peer-run organization; staff and members, working together, make up the fabric of the Clubhouse community, contributing their skills, talents, and abilities to the operation and enhancement of the Clubhouse. The daily routine of the Clubhouse is organized around a work-ordered day, i.e. the day-to-day work needed to operate the Clubhouse. Members are engaged side-by-side with program staff to complete the work of the Clubhouse, e.g. make lunch, create a daily newsletter, operate switchboards, give tours, etc. 

Working together side-by-side as a community restores a sense of self-worth and draws out our strengths and talents. Working side-by-side promotes egalitarian, work-mediated, and deeply human relationships that become the central tool of recovery in a Clubhouse community. Members are not "clients" and staff are not the “expert provider”. Members contribute to the life of the community and their participation helps them pursue their recovery while helping others in the process. While members join with personal goals, such as employment, housing, education, etc., the Clubhouse offers opportunities for members to work towards those goals in the context of a community that is dependent on the support of staff and members alike. 

   Employment Services:

Participating in meaningful work that is needed and appreciated by others is a core value of the Clubhouse Model. When asked about their goals for recovery,  many people who participate as members of the Clubhouse state that their primary goal is to obtain paid, competitive employment in the community. The financial gain from paid employment is an important way to address the poverty that many people with mental illness experience as a result of their unemployment. Work is also important because many people define themselves through their employment and working is one important way to strengthen a person's resiliency and capacities to cope. Because it is such an important activity in people's lives, the Clubhouse is organized around the work-ordered day to afford members opportunities to engage in meaningful work opportunities and offers a range of employment services that can assist Clubhouse members to access and sustain paid employment with different levels of support.  These programs are described below: 

Transitional Employment:

The Transitional Employment Program is a highly structured vocational rehabilitation program for members returning to work (or working for the first time) in local businesses and industries. Transitional Employment placements are developed and managed by the Clubhouse and placements are at the employer’s place of business, are part-time with vocationally significant hours (generally 12-20 hours per week), and include regular on-the-job and off-site support from Clubhouse staff and other members. These placements generally last from six to nine months so that multiple members have the opportunity to utilize the vocational rehabilitation opportunity. Members can work multiple placements, or move on to permanent employment opportunities. Transitional Employment is specifically designed as a vocational rehabilitation program where a member is employed in a “real world” position and are supported to intentionally utilize the placement to gain or regain the skills and confidence necessary to sustain permanent employment. The only requirement for the member to participate in Transitional Employment is the expressed desire to work, and Transitional Employment placements are designed to place members with the most significant vocational challenges. The effectiveness of Transitional Employment, as compared to other supportive employment services, has been well documented.

Supported Employment:

The Supported Employment Program is recognized as an evidenced-based practice by the U.S. Substance Abuse and Mental Health Services Administration of the U.S. Dept. of Health and Human Services Administration (SAMSHA). The principles and practices of the supported employment model were pioneered by Clubhouses and are one of the standard program elements of the Clubhouse model. The program helps members access paid employment with community businesses and provides assistance to help ensure the placement is successful. Supported Employment positions are not time-limited and members can retain their employment as long as they choose. They can be entry-level jobs or career-oriented opportunities with the potential for advancement and salary increases. Clubhouse staff and other members provide on-site and off-site support for the member and the employer as needed and requested. There is usually a competitive interview process for the position and the job is not reserved for the Clubhouse or a Clubhouse member. Employment can be either full- or part-time and paid at the prevailing wage for the position. The type and duration of the support provided to the member and the employer may differ from member to member, and from job to job, and may eventually no longer be needed.

 Independent Employment:

The Independent Employment Program assists Clubhouse members to seek and obtain permanent jobs of their own, members are not independent of Clubhouse support, rather they choose to not disclose their relationship with the Clubhouse to their employer. The Clubhouse can assist and encourage members seeking employment to find and sustain permanent, competitive employment opportunities for members as long as they choose to have that additional assistance. Unlike Supported Employment, there is no on-site support provided by the Clubhouse at the place of business and support takes place at the Clubhouse or in the community.

Housing Support: 

Accessing and sustaining stable housing is an essential part of the recovery process and Clubhouse members often use the support of the Clubhouse to overcome the typical barriers associated with independent living. This form of support may include the following: finding housing opportunities, assistance with subsidies and recertification, physically moving into new places, mediating with landlords, maintaining apartments, and any other support needed to live independently in the community. The Clubhouse will typically assist members to find stable housing in their community, however, some Clubhouse's provide permanent supported housing for members who qualify which includes an apartment and all the other supports. 

 Supported Education:  

As with employment, education is a real and immediate path back into the community. The Supported Education Program is an evidence-based practice originally developed to assist people with histories of mental illness to pursue their individual educational goals. Supported education services provide social and material support to assist members at all levels, from attending adult basic education through graduate school. Supported Education services are offered in a variety of mental health and community settings, including the educational setting and Clubhouses where it is a standard feature of the Clubhouse model. The Clubhouse assists members in accessing educational opportunities in the community and provides the support needed to pursue and succeed with their educational goals. In addition, the Clubhouse can organize in-house support that significantly utilizes the teaching and tutoring skills of members. Many studies have demonstrated the effectiveness of the Supported Education program model. 

Wellness:

The World Health Organization (WHO) reports that people with severe mental disorders tend to die on average 10-25 years earlier than the general population. Emotional and physical health are not mutually exclusive and the Clubhouse offers a community where members have the opportunity to address multiple aspects of their lives as they choose. Clubhouses work with members to not only add wellness activities into their lives but also to develop and maintain healthy lifestyles to live longer and healthier lives. Wellness opportunities are integrated into the Clubhouse environment so that members and staff can make informed decisions regarding their health and well-being.

Evening and Weekend Social Program:

In addition to work opportunities, Clubhouses provide evening, weekend, and holiday social and recreational programming. Members and staff together organize structured and non-structured social activities. These activities are scheduled outside of the work-ordered day. Holidays are celebrated on the day on which they fall. Activities are scheduled both at the Clubhouse and in the community.

Reach Out: 

Social isolation is a hallmark experience for many people living with mental illness that has an impact on overall well-being and recovery. Reaching out to absent members is a critically important function in the Clubhouse community to reduce isolation and support members with their identified needs. While returning to the Clubhouse after a period of isolation is the goal, members don’t have to be at the Clubhouse to feel cared about and receive the support of the Clubhouse. Reach-out efforts assist members with their immediate needs in the community, such as accessing reliable transportation to go to appointments, the grocery store, etc. Sometimes, it is quite simply a visit to remind members that they are wanted, needed, welcome, and expected by their Clubhouse community. In a Clubhouse community of friends and colleagues, reach-out is most effective when it is relationship-based and utilizes the method of reach-out that is preferred by members, such as phone calls, text or facebook messages, video calls, or community visits. 

For more information about Clubhouse reach-out services, Click here to learn more from members discussing the significance of reach-out in their recovery from three different Clubhouses: Alliance House in Utah, USA, Fontenehuset Honefoss in Norway, and Liberty Centre in Nebraska, USA.  

Specialized Programs:

For a variety of reasons, some Clubhouse programs will provide additional services and resources for Clubhouse membership. These services are focused on the specialized needs of certain population sub-groups of clubhouse members, such as young adults and seniors. Although they are consistent with Clubhouse standards and integrate well with other Clubhouse Programs, they are not considered "core programs" under Clubhouse standards and are not required for clubhouse accreditation. 

• Young Adult Program:

There are many new and innovative programs for young adults (18-25 yrs.) with mental illness and the Clubhouse is one especially effective way to deliver rehabilitation and recovery services for the young adult population. Young adults can fall through the cracks in the mental health system, particularly because of the issues involved in the transition from adolescent services to adult services. The intergenerational Clubhouse experience and working community - where the foundations for employment, education, and structured work-ordered day are in place - are especially suitable for supporting young adults living with a mental illness to reach their goals. Young adults are in a distinct period of life where they are developing an identity and cognitively maturing to make adult decisions - the Clubhouse Young Adult Program offers a safe space where young adults can transition into adult responsibilities while working side-by-side with members and staff who model and bring more life experience.

• Art and Creative Expression:

People living with mental illness often identify different forms of creative expression as integral to their recovery. While the Clubhouse is structured in a work-focused day that relies on the contributions of members and staff to accomplish the important day-to-day work of operating the Clubhouse, there are some ways in which the Clubhouse supports and celebrates a member's creative expression. The Clubhouse community can display member art throughout the Clubhouse and utilize member art in Clubhouse materials. The Clubhouse can also build partnerships to bridge access to community opportunities, such as art classes, or organize art shows to sell and celebrate member art.

• Older Adults:

Many of the original Clubhouses are beginning to enter their third and fourth decades. Since deinstitutionalization, particularly in the United States, and modern psychotropic medications, people living with serious mental illness are living full lives outside of state hospitals. This has created a need for Clubhouses to focus on the specialized needs of aging adults in the Clubhouse. Older adults in the Clubhouse have identified needs such as transitioning from disability benefits to retirement benefits, understanding the efficacy of medication as people age, funeral and estate planning, and navigating loss and grief, including the loss of a job, mobility, health, etc. For many older adults, isolation, and lack of access can be a significant barrier to staying connected with the Clubhouse in many of the ways that they once were, and it is important that the Clubhouse support aging members to truly experience membership without time limits.   

Learning Objectives: 

• Examine what is meant by the "work-ordered day".

• Understand the critical role that the work-ordered day has for the day-to-day operations of the Clubhouse.

•  Understand the impact that the work-ordered day has on the individual member.

• Gain knowledge of the various programs and services that support the Clubhouse community.

Study Questions: 

1. Why is it important for all staff to share in evening/weekend/ unit/ employment/ and housing responsibilities?

2. How does the concept of ‘empowerment’ and "recovery" fit in the Clubhouse?

3. Are members and staff interchangeable in the Clubhouse? What is meant by the "generalist role"?

4. What are work-mediated relationships?

5. How does the term ‘member’ (rather than client, patient, consumer) affect relationships in the Clubhouse?

6. What are the best Clubhouse practices to assist members find and maintain employment?

7. How does Clubhouse develop relationships with employers and educational programs in their community? 

Essential Reading: 

• Beard, J., Malamud, T. & Propst, R. (1989). The Fountain House Model of Psychiatric Rehabilitation. Psychiatric Rehabilitation Journal.

• Hultquist, j. et.al. (2017) Programme characteristics and everyday occupations in day centers and clubhouses in Sweden. SCANDINAVIAN JOURNAL OF OCCUPATIONAL THERAPY, 2017 VOL. 24, NO. 3, 197–207

• Shinakee Gumber, S. & Stein, C. ( 2018) Beyond These Walls: Can Psychosocial Clubhouses Promote the Social Integration of Adults With Serious Mental Illness in the Community? Psychiatric Rehabilitation Journal: Vol. 41, No. 1, 29 –38

• Okon, s. et.al. (2015) Health and Wellness Outcomes for Members in a Psychosocial Rehabilitation Clubhouse Participating in a Healthy Lifestyle Design Program. Occupational Therapy in Mental Health, 31:62–81.

• Dougherty, S. (1992). Supported Education: A Clubhouse Experience. Psychiatric Rehabilitation Journal.

• Davidson, L. & Tanaka, K. (2015). Meanings Associated with the Core Component

• of Clubhouse Life: The Work-Ordered Day. Psychiatric Quarterly. 86:269–283

Suggested Readings / Videos: 

Video: 

• Interview With John Beard On The Origins of Transitional Employment (1978)

• WANA Webinar Series: Organizing Tools for The Work Ordered Day.

• Rethinking Housing and The Role of The Clubhouse.

• Supported Education: Students Describe Returning to School

• Who We Are - Clubhouse International

Articles: 

• Dougherty, S. et.al. ( 1995) Supported Education: A Qualitative Study of The Student Experience. Psychiatric Rehabilitation Journal. 

• McKay, C. (2018). A Systematic Review of Evidence For The Clubhouse Model of Psychiatric Rehabilitation. Journal of Administration Policy in Mental Health.  

Optional Discussion Forum: 

To join the Module Three Discussion Forum, <<<<<<CLICK HERE>>>>>>

Optional Zoom Seminar:

To access the Module Three Zoom Seminar, contact the Site Administrator for available dates, times, and Zoom Link using the contact information below:  

Steve Dougherty

Clubhouse Learning and Education Resource Site Administrator

doughertystephenj@gmail.com