Clubhouse Research

Module Four: The Effectiveness of The Clubhouse Model

Overview:

Clubhouses are a community-based, evidence-based approach that has been proven to help people recover their lives following episodes of mental illness. A Clubhouse focuses on the person's strengths and abilities rather than deficits and illness. Through friendship, shared work, education, and employment, Clubhouses help people regain hopeful and fulfilling lives. In physical as well as virtual connections, Clubhouses make a real and lasting difference in people’s lives by helping them achieve their social, educational, and employment goals.

Through its various educational, employment, and social programs, Clubhouse participation can help people avoid psychiatric hospitalization, improve their quality of life, and increase their level of social integration with their community. In 2018, a systematic review of the literature by the Program for Clubhouse Research in the Department of Psychiatry at the University of Massachusetts Medical School supported the conclusion that the clubhouse model was “a promising practice” and encouraged further research. As program service models, the Supported Employment and Supported Education programs offered at Clubhouses are both considered evidence-based practices. In program outcome evaluation studies, researchers found that nearly 42% of members at Accredited Clubhouses were likely to be employed and that Clubhouse members were significantly less likely to be hospitalized or incarcerated as well as have better overall physical and mental health.

The Empirical Evidence in Support of the Clubhouse Model:

In 2018, a systematic review of past research on the Clubhouse model was conducted by the Program for Clubhouse Research at the UMass Chan School of Medicine and their findings published in the Journal of Administration and Policy in Mental Health (McKay, et. al. 2018). The review provided overwhelming evidence to demonstrate the effectiveness of the Clubhouse model and the long-term benefits accrued by clubhouse members. We now have over a half-century of research on the Clubhouse model. Multiple studies over the past 50 yrs. have demonstrated that Clubhouse services help increase the likelihood of employment, reduce or delay rehospitalization, and improve health outcomes at a lower cost. The Clubhouse model has helped define the recovery movement worldwide and has become one of the foundations for mental healthcare. 

Various empirical research studies investigating the effectiveness of the Clubhouse Model have found the following: 

• • • Higher rates of employment, with 42% of members at Accredited Clubhouses employed – more than double the average rate for people in the public mental health system, plus longer on-the-job tenure for members engaging in Clubhouse Transitional Employment.

    • A significant decrease in hospitalizations resulted from membership in a Clubhouse program.

    • Reduced incarcerations, with criminal justice system involvement substantially diminished during and after Clubhouse psycho-social program membership.

    • Better physical and mental health: a study suggests that service systems like Clubhouses that offer ongoing social support enhance mental and physical health by reducing disconnectedness.

    • Cost Effective: The annual cost of Clubhouses is about one-third to one-half the cost of comparable models of service interventions, e.g. case management.

Learning Objectives:

1. Appreciate how the clubhouse assesses and reports its program performance.

2. Understand the various criteria used to establish the effectiveness of the Clubhouse Model.

3. Review the evidence in support of specific program forms typically offered through Clubhouse, e.g. supported education, transitional employment, supported housing. 

4. Cite evidence in support of the Clubhouse Model as a "Best Practice" in psychiatric Rehabilitation.

5. Explore the growth of Clubhouse programs internationally.

Suggested Study Questions: 

1. Why is it important for a Clubhouse to assess its performance?

2. What methods are used by Clubhouses to assess the effectiveness of their programs? 

3. What information is collected to assess performance?

4. How does the Clubhouse report the findings of their performance assessments?

5. What role do the International Clubhouse Standards play in the assessment process? 

6. What evidence exists to establish the effectiveness of the Clubhouse Model?

Essential Readings: 

The journal articles listed below report on research and studies conducted on the effectiveness of the Clubhouse Model and the factors that contribute to the model's success. The articles can be viewed on the site or downloaded directly to your device. To view an article, click on the document below and open it with the expand icon found on the upper left side of the document box. Once the document is opened, you can then use the download icon on the screen to either view online or save the article in PDF format.

• C. McKay, et. al. (2018). "A Systematic Review of Evidence for the Clubhouse Model of Psychiatric Rehabilitation".  Journal of Administration and Policy in Mental Health.

• Battin, C., et al. (2016). A systematic review of the effectiveness of the clubhouse model. Psychiatric Rehabilitation Journal, 39 (4).

• Chung, C. et. al. (2016). Family perspectives of how their relatives with mental illness benefit from clubhouse participation: A qualitative inquiry. Journal of Mental Health.

• Ritter, V.C., R. Fekete, O.R., Nordli, H. & Bonsaksen, T. (2019) Measuring perceived outcomes from participating at a clubhouse for persons with mental illness: Psychometric properties and associated factors, Scandinavian Journal of Occupational Therapy.

• Dougherty, S. (1996). "Supported Education: A Qualitative Study of The Student Experience". Psychosocial Rehabilitation Journal.  

Optional Discussion: 

To join the Module Four Discussion, <<<<<<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

Supplemental Readings: 

Cost Efficiencies of the Clubhouse Model: 

Hwang, S. et. al. (2016). Analysis of the Association of Clubhouse Membership with Overall Costs of Care for Mental Health Treatment. Journal of Community Mental Health

Effectiveness of Employment Services: 

Gold, P., Macias, C. & Rodican, C. (2014). Does Competitive Work Improve Quality of LIfe for Adults with Severe Mentall Illness? Evidence from a Randomized Trial of Supported Employment. Journal of Behavioral Health Services and Research.

Clubhouse Membership: 

Bonsaksen, T. et. al. (2016). Characteristics of Norwegian clubhouse members and factors associated with their participation in work and education. British Journal of Occupational Therapy, 

Stakeholder Perspective of the Clubhouse Model: 

Chung, C. et. al. (2016). Family perspectives of how their relatives with mental illness benefit from clubhouse participation: A qualitative inquiry. Journal of Mental Health.

Consumers Employed in Mental Health Services

Mandiberg, J. et. al. (2017). A Community Practice For Peer Mental Health Workers. Journal of Psychiatric Rehabilitation. 

Work Ordered Day:

Hultquist, J. et.al. (2017) Program Characteristics and Everyday Occupations in Day Centers and Clubhouses in Sweden. Journal of Occupational Therapy.

Member Engagement in The Work Ordered Day: 

Fitzgerald, S. et. al. (2016). Psychometric properties of the Vocational Rehabilitation Engagement Scale when used with people with mental illness in clubhouse settings. Rehabilitation Research, Policy, and Education.

Clubhouse Funding:

Akiba, C. et.al. (2016). The business of staying in business: North Carolina Clubhouse programs. American Journal of Psychiatric Rehabilitation. 

Performance Indicators Used in Clubhouse Evaluations: 

Raab, P.A., et. al. (2015). Indicators of success: academic research partnerships to implement performance indicator systems in clubhouses. Psychiatric Rehabilitation Journal.

Versions of The Clubhouse Model:

Farmer, S. (2015). Spotlight on the safety net: Traumatic brain injury clubhouses in North Carolina. North Carolina Medical Journal.

Hancock, N., et al. (2015). Sources of meaning derived from occupational engagement for people recovering from mental illness. British Journal of Occupational Therapy, 78(8).

Family Members’ Perceptions of the Clubhouse Model: 

Pernice-Duca, F., et al. (2015). Family members’ perceptions of how they benefit when relatives living with serious mental illness participate in clubhouse community programs. Family Relations, 64(3).

How the Clubhouse Fosters Health and Wellness:  

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(1). 

Case Study Research Designs and The Clubhouse Model: 

Raeburn, T., et al. (2015). The contribution of case study design to supporting research on clubhouse psychosocial rehabilitation. BMC Research Notes, 8(1).

Clubhouse Relationships and Recovery:

Tanaka, K., et al. (2015). Clubhouse community support for life: Staff–member relationships and recovery. Journal of Psychosocial Rehabilitation and Mental Health, 2(2).

Clubhouse Relationships and Recovery:

Tanaka, K. & Davidson, L. (2015). Reciprocity in the clubhouse context. International Journal of Psychosocial Rehabilitation, 19(2),

Cognitive Improvements Associated With Clubhouse Participation: 

Rice, K. (2020). Metacognition and the Clubhouse Model in Treating Severe Mental Illness. Psychiatric Rehabilitation Journal. Vol. 43, No. 4, 284 –289

Clubhouse Members: 

 Chang, C.W., et.al. (2014). Predictors of loneliness of clubhouse members. Psychiatric Rehabilitation Journal. 37, 51-54.

Documenting Recovery In the Clubhouse Model: 

Raeburn, T., et.al. (2014). Clubhouse model of psychiatric rehabilitation: How is recovery reflected in documentation? International Journal of Mental Health Nursing, 23(5), 389-397

The Work Ordered Day: 

Tanaka, K. & Davidson, L. (2014). Meanings associated with the core component of clubhouse life: The Work-Ordered Day. Psychiatric Quarterly, 86(2), 269-83

Gumber, S., & Stein, C. H. (2018). Beyond these walls: Can psychosocial clubhouses promote the social integration of adults with serious mental illness in the community? Psychiatric Rehabilitation Journal, 41(1), 29–38.

Recovery and The Clubhouse Model: 

Tsoi, E., Lo, I., Chan, C., Siu, K., & Tse, S. (2014). How recovery oriented are mental health services in Hong Kong? Snapshots of service users’ perspectives. Asia Pacific Journal of Social Work and Development, 24, 82-93

Clubhouse Relationships: 

Chen, F.P., Oh, H. (2019). Staff views on member participation in a mental health Clubhouse. Health & Social Care In The Community, 27, 788-796

Clubhouse Supported Education: 

• Dougherty, S. et.al.(1996). "Supported Education: A Qualitative Study of The Student Experience". Psychosocial Rehabilitation Journal.  

• Dougherty, S. et.al.(1993). "Supported Education: A Clubhouse Experience". Psychosocial Rehabilitation Journal.  

The Role of Employment in Stigma Management: 

Valkeapää, T., Tanaka, K., Lindholm, C., Weiste, E., & Stevanovic, M. (2019). Interaction, Ideology, and Practice in Mental Health Rehabilitation. Journal of Psychosocial Rehabilitation and Mental Health,

Clubhouse Programs and Social Integration: 

Gumber, S. & Stein, C.H. (2018). Beyond these walls: Can psychosocial clubhouses promote the social integration of adults with serious mental illness in the community? Psychiatric Rehabilitation Journal, 41(1)

Clubhouse Programs and Young Adult Populations: 

Pardi, J., Willis, M. (2018) How Young Adults in London Experience the Clubhouse Model of Mental Health Recovery: A Thematic Analysis. Journal of Psychiatric Rehabilitation and Mental Health, 5(2)

Staff Member Relationships in Clubhouse Programs: 

Chen, F., Oh. H. (2017). Building a working community: Staff practices in a clubhouse for people with severe mental illness. Administration and Policy in Mental Health and Mental Health Research, 44,

Psychosocial Development and Clubhouse Model Programs: 

Psychosocial Change in Members of Clubhouse Paris (France) Over

an 18‐Month Period: A Longitudinal Mixed Methods Study