Clubhouse Model Research Articles

The growth and diversity of the evidence base for the clubhouse model.

The Clubhouse Model is a long-standing form of psychosocial rehabilitation that has been in existence for over 75 years. Today, over 350 Clubhouse programs in 33 countries affiliate with Clubhouse International and operate as nonclinical community-based recovery centers for adults and young adults living with mental illness. Clubhouses provide a strengths-based approach to recovery and offer participants, referred to as members, a variety of supports and services including assistance with obtaining and maintaining community-based employment, education, housing, social integration, outreach and advocacy, wellness and health promotion activities, and linkages to medical and psychiatric services. There is evidence and support for the Clubhouse Model in improving quality of life and social functioning, reducing hospitalization(s) and/or psychiatric symptoms, and promoting employment. This special issue has nine articles that highlight ongoing research collaborations from across the globe that examine the impact of the Clubhouse Model on a variety of novel outcomes. While more research is needed, the articles in this special issue reflect the growth and diversity of the evidence base for the Clubhouse Model. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Expanding community-based participatory action research practices to clubhouses through sustainable research activities.

There is growing utilization and acknowledgement of the benefits of community-based participatory action research (CBPAR) in advancing health practices and equity. However, the sustainability and full impact of CBPAR in health care settings faces many obstacles and limitations. The present article examines the synergies between CBPAR and Clubhouse programs, presents the demonstration and ongoing implementation of sustainable CBPAR practices at Fountain House in New York City, and offers lessons learned for other Clubhouses and similar programs seeking to integrate CBPAR. Alignment in practice and principles between CBPAR and Clubhouse programs are presented. The innovation and ongoing sustainable CBPAR practices in the Fountain House Clubhouse program are examined with a contribution of practice guidance for other Clubhouse and similar programs in further adopting and learning CBPAR into participatory health practices. Clubhouse psychosocial rehabilitation programs present structurally conducive settings for the success and sustainability of CBPAR activities and projects. The Fountain House examination and demonstration of integrating CBPAR sustainably into core Clubhouse programming presents opportunities for further integration, research, and practice guidance in uniquely leveraging features of the Clubhouse model to advance health equity and rehabilitative outcomes through CBPAR. The opportunity for incorporating structural CBPAR activities within Clubhouse programs can be informed by the experience, processes, and lessons applied in the Fountain House example. Further research into the rehabilitation, program, and equity benefits of Clubhouse and CBPAR integration could uniquely contribute to the advancement of sustainable participatory research practices across the mental health field generally. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychosocial Outcomes of Canadian Clubhouse Members: A Multi-Site Longitudinal Evaluation.

The Clubhouse model of psychosocial rehabilitation supports individuals with mental health challenges using a person centered and recovery-oriented approach. Clubhouses around the world have been found to be effective in supporting their member's recovery. However, there is a lack of multi-site and longitudinal studies on the Clubhouse model. Therefore, the purpose of the present study was to longitudinally assess the psychosocial outcomes of Clubhouse members across six accredited Clubhouses in Canada. Due to the COVID-19 pandemic occurring midway through the study, a secondary aim was to assess the impact of the pandemic on the psychosocial outcomes of Clubhouse members. A total of 462 Clubhouse members consented to participate in the study. Members completed a questionnaire battery every 6months over a 2-year period (five data points total). The last three data points were collected during the COVID-19 pandemic.Psychosocial outcomes included mental health symptoms, substance use, community integration, and satisfaction with life, and were analyzed using multilevel growth models. The results indicated that satisfaction with life and psychological integration increased over the study period, while mental health symptoms, substance use, and physical integration decreased. Examining Clubhouse participation, length of Clubhouse membership and frequency of Clubhouse use predicted higher life satisfaction, lower substance use, and fewer mental health symptoms over the study period. The results of the present study provide invaluable insight into the psychosocial impact of Clubhouses on Canadian Clubhouse members, particularly during COVID-19.

Community as therapy: The theory of social practice.

Though the efficacy of the Clubhouse model's interventions and practices in supporting recovery from serious mental illness (SMI) have been demonstrated by prior research, the causal mechanisms and theory driving these outcomes have yet to be comprehensively defined. This theory article aims to synthesize existing knowledge of these methods to define a unified theory of social practice, outline its role in SMI recovery, and discuss future implications. Historical, theoretical, and practical foundations of social practice were synthesized to define a current theory of social practice and expand the term to apply to the methods and interventions that define the Clubhouse model. Based on prior theory and findings, we define social practice as "the informed application of a specialized form of environmental therapy that utilizes an intentional community to assist people in their recovery." Key facets of social practice in the Clubhouse model of SMI recovery are discussed, including the efficacy of the practice in addressing SMI outcomes such as isolation and low self-efficacy, as well as its impact on both internal and external motivational forces. The theory of social practice describes a process of engaging people to become collaborators and contributors to a social environment. This article describes the philosophy and practices of Clubhouses and introduces the theory of social practice as an empirical means of unifying and communicating the methods, practices, and outcomes of both the Clubhouse model and the broader implications of intentional community as therapy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Confirmatory Factor Analysis of the 12-Item World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) Within the Clubhouse Model of Psychosocial Rehabilitation for Serious Mental Illness

Supplemental Material for Confirmatory Factor Analysis of the 12-Item World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) Within the Clubhouse Model of Psychosocial Rehabilitation for Serious Mental Illness

Confirmatory factor analysis of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) within the clubhouse model of psychosocial rehabilitation for serious mental illness.

The Clubhouse model (CM) for serious mental illness is a recovery-oriented and member-driven program that aims to facilitate functional recovery. Efficacy evaluation of the CM is limited by lack of uniform functional disability assessment. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) is a widely accepted measure of functional disability, but its psychometric properties have yet to be examined within the CM. This research sought to confirm the generic six-factor structure of the 12-item WHODAS-2.0 using retrospective administrative data from 339 adults with serious mental illness from an accredited Clubhouse. A second-order confirmatory factor analysis was conducted, followed by secondary known-groups analyses to examine whether the WHODAS-2.0 differentiates between subgroups with varying degrees of disability. The WHODAS-2.0 demonstrated good overall reliability. The generic six-factor structure produced nonsignificant loadings due to lack of independence between the "participation" and "getting along" factors. The items of these two factors were combined into a five-factor model, which displayed excellent fit, with all significant paths and adequate-to-strong loadings, and no correlation among errors. The WHODAS-2.0 significantly differentiated members by receipt of public assistance, employment status, and number of medical comorbidities, supporting construct validity. These results provide initial support for the use of the 12-item WHODAS-2.0 as a CM-related outcome measure and encourage future research of the full 36-item version. The intentional community approach of the CM is unique and may require adjustments to the factor structure of the WHODAS-2.0 by merging the "participation" and "getting along" domains. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

AContemporary Review oftheClubhouseModel of Psychosocial Rehabilitation:Past, Present, and Emerging Directions.

Since the 1940s, the Clubhouse model of psychosocial rehabilitation has evolved towards a comprehensive practice of social theory and intervention. Despite the model's cost effectiveness and observational evidence of its efficacy, empirical research remains lacking. The current narrative review examines studies from recent years (2015-2021), not to assess study rigor, but to identify trends in research aims, findings, and methodology, as well as specify future research directions. A narrative review was conducted using PRISMA guidelines. Using the search term "Clubhouse," 194 articles were identified in online databases. 38 met criteria for inclusion. Most studies were qualitative (60.5%) and few utilized experimental or quasi-experimental designs (7.9%). Narrative synthesis revealed research aims and outcome variables falling into six key areas: social integration and connectedness, quality of life (QOL), recovery outcomes, relational dynamics, policy, and virtual adaptations of the model. Findings indicate that recent Clubhouse-related research trends have primarily involved studies of social connectedness, QOL, recovery, relationships, and policy, as well as studies examining the value of the virtual Clubhouse in maintaining well-being. However, heterogeneity of methodologies and measures present a critical limitation to assessing results across studies. Options for increasing experimental methodologies in this area are reviewed. Recommended future directions involve moving towards a biopsychosocial approach to clarifying the mechanisms through which the model promotes recovery-aims that may yield implications beyond the realm of serious mental illness.

Together, Resilient: Serious Mental Illness, Social Capital, and the Role of Meaningful Engagement Within the Clubhouse Model

Together, Resilient: Serious Mental Illness, Social Capital, and the Role of Meaningful Engagement Within the Clubhouse Model

The Impact of COVID-19 on Clubhouse Employment Programs.

The Clubhouse model of psychosocial rehabilitation provides several employment opportunities to individuals who experience mental health concerns, including transitional, supported, and independent employment. The COVID-19 pandemic resulted in Clubhouses having to adapt existing programs to online formats. Employment programs were further impacted, as many workplaces in the community closed or reduced capacity. The present study aimed to examine the rates of involvement in transitional, supported, and independent employment across six Clubhouses in Canada throughout the pandemic. 462 members completed surveys at five time points pertaining to participation in Clubhouse employment programs. The data was analyzed using Cochran's Q tests to determine differences in employment rates across time points. The results demonstrated an overall decrease in transitional and supported employment rates throughout the pandemic. Conversely, rates of independent employment were unchanged. It is evident that Clubhouse employment programs assist members in obtaining employment.The results suggest Clubhouses may benefit from exploring novel employment opportunities to support their members, such as remote work.

A Health Equity-Oriented Research Agenda Requires Comprehensive Community Engagement.

Health policy and research communities have taken new approaches to addressing health equity, going beyond traditional methods that often excluded the contributions of health care consumers and persons with lived experience. This reevaluation has the potential to drive critical improvements in how we conduct research and innovate policy toward reducing health and health care disparities in the United States. Such considerations have led Fountain House, the founder of the Clubhouse model for peer-based psychosocial rehabilitation for persons with histories of serious mental illness, to incorporate community-based participatory action research (CBPAR) protocols within their research and service programs. The combination of CBPAR research methods within novel participatory care settings like Clubhouse programs presents unique and informative opportunities for the advancement of innovative health equity approaches to consumer empowerment in health care. In this piece, the authors (two staff researchers and one member researcher) propose how CBPAR research methods conducted in Clubhouses can uniquely advance equity-focused research methods, and how the benefit and enhancements from equity-focused research are continuously applied, practiced, and accountable to the communities within which the research is conducted. Embedding CBPAR practices within participatory care settings like Clubhouses, creates novel opportunities for research work to not only become more equitable but also become a part of the rehabilitative process, empowering the main beneficiaries of the research with the means to sustain and achieve further improvements for themselves. Such experiences are particularly important within rehabilitation settings, where there is a process of reclaiming empowerment and self-efficacy over a disability or illness and the social circumstances surrounding those conditions. Different stakeholders can all play important roles in advancing health equity–oriented research agendas by leveraging CBPAR principles. Academics and others in the research community can more comprehensively embed CBPAR methods into the design of their research studies. A critical link exists among how researchers conduct their studies, how providers organize care delivery and support, and how health plans pay for and evaluate care. CBPAR-generated research needs to fully engage clinical teams to ensure that ongoing community-involved care settings have direct applications to real-world care delivery. It is equally important that providers fully engage with their communities as they adjust their approaches to supporting the populations they serve.

Characterizing Social Determinants of Health in Research Regarding the Clubhouse Model for Individuals with Mental Health Conditions

Characterizing Social Determinants of Health in Research Regarding the Clubhouse Model for Individuals with Mental Health Conditions

Conflicts and tensions in dual roles

Those living with mental illness have benefitted from non-clinical recovery organisations, such as the Clubhouse Model of Psychosocial Rehabilitation. Research conducted for a Clubhouse brings many benefits to it. However, the model is governed by cultural practices. These practices create beliefs that influence the conduct of the research despite the benefits it can bring. This autoethnographic account is about my involvement as a member and researcher within a Clubhouse. How cultural practices and beliefs influenced the research is detailed from observation notes and memory work. The conflicts and tensions I experienced were shaped by such cultural factors. This account concludes with reflections on how I felt about the events. It advises other ethnographers to research the mental illness field before attempting a project in it.

The Impact of the COVID-19 Pandemic on the Clubhouse Model

The COVID-19 pandemic posed challenges to the traditional Clubhouse Model of Psychosocial Rehabilitation (Clubhouse). The COVID-19 pandemic forced many Clubhouses around the world to rapidly pivot from face-to-face services and support programs at the Clubhouse to hybrid or virtual services. The Clubhouse community quickly mobilized to establish new structures to maintain connections with Clubhouse members and provide them with essential supports. This brief describes adaptations that Clubhouses made during the COVID-19 pandemic. We also describe supports offered by Clubhouse International to inform their international network about innovative approaches and best practices for Clubhouses during the COVID-19 pandemic.

Engaging U.S. Adults with Serious Mental Illness in Participatory Design Research Exercises

Clubhouses are non-clinical, community-based centers for adult members with serious mental illness. The evidence-based model assists adults with identifying employment, housing, education, and social opportunities; wellness and health-promoting activities; reducing hospitalizations and criminal justice system involvement; and improving social relationships, satisfaction, and quality of life. The model enables member participation in all Clubhouse operations, yet offers little guidance concerning facility design and member engagement in the design process. This case study explored the use of participatory design research exercises to (1) document member needs, preferences, and priorities to inform the design of a new midwestern U.S. Clubhouse facility and (2) meaningfully engage members (n = 16) in the design process. Four participatory design research exercises were developed, administered, and analyzed. Results revealed aesthetics and ambience; safety and security; ease of use and maintenance; adaptability, flexibility, and accessibility; and transportation as future priorities. Space and furnishing needs and priorities were also identified. Informal observations and participant feedback suggested that the participatory exercises meaningfully engaged members in a manner aligned with Clubhouse Model principles by centering member dignity, strengths, and work-oriented expectations. Future directions for research on Clubhouse design and member engagement in the design process are also discussed.

Organizational characteristics of Brain Injury Clubhouse Model programs

ABSTRACT Objective We provide an overview of the Clubhouse Model and the history and development of Brain Injury Clubhouses. We describe organizational-level characteristics associated with eight Brain Injury Clubhouses to address gaps in the literature and inform future studies or program development. Methods A electronic survey, the Clubhouse Profile Questionnaire (CPQ) was tailored for Brain Injury Clubhouses. The CPQ gathers program-level data that can be used to identify active ingredients of Clubhouses, understand best practices, examine, and evaluate program characteristics. The brain injury version of the CPQ was administered to a sample of eight Clubhouses affiliated with the International Brain Injury Clubhouse Association as part of a project designed to gather data on Clubhouse program characteristics and describe sociodemographic characteristics of people served by Brain Injury Clubhouses. Results CPQ data from eight Brain Injury Clubhouses was analyzed. Brain Injury Clubhouse programs in this sample served approximately 17 members per day. There was wide variability in the size, funding and funding mechanisms, and length of operation of Brain Injury Clubhouses in this study. Conclusions Findings suggest that Brain Injury Clubhouses offer a wide range of services and supports. Additional research on the impact of Brain Injury Clubhouses is needed.

Discursive contestation in mental health rehabilitation: How Clubhouse support workers expose clients to new interpretative repertoires of work

AbstractIn our society, work is generally considered central to citizenship and individual well‐being. However, paid employment is often out of reach for individuals with mental illness. The Clubhouse model is a community‐based rehabilitation programme that therefore offers people with mental illness the possibility to enjoy some social advantages of work. However, the status of the day‐to‐day Clubhouse activities as “work” is a matter of discursive contestation. Drawing on 29 meetings of a Clubhouse rehabilitation group as data, and using conversation analysis and discourse analysis as methods, this study examines two competing interpretive repertoires that are systematically manifested in this context: the capitalist “paid work” repertoire used by Clubhouse clients and the more flexible “productive activity” repertoire used by support workers. The adoption of these two repertoires reflects two competing discursive agendas, which define the scope of mental health rehabilitation and the role of the client in their own rehabilitation process in distinct ways. From this perspective, the support workers' central institutional task is essentially of a discursive and ideological nature—exposing the clients to new ways of talking about their lives with reference to work.

Clubhouses as Essential Communities During the COVID-19 Pandemic.

Intentional recovery communities, such as Clubhouses, exist as physical spaces for individuals living with Serious and Persistent Mental Illness. Due to the COVID-19 pandemic, it was necessary for these facilities to rapidly convert to virtual platforms. The aim of this study was to assess the extent to which virtual Clubhouse communities impacted the well-being of their members during the initial weeks of pandemic-related closures. Two hundred and eighty nine Clubhouse members across 19 countries responded to weekly measures of Clubhouse engagement, contact with other members, and well-being. A repeated measures multivariate analysis of covariance indicated that members with high levels of Clubhouse engagement reported higher mental and physical health ratings over time than those with low levels of engagement. These findings support the virtual Clubhouse model and highlight the efficacy of Clubhouses’ rapid adaptations to the pandemic.

Clubhouse Model and Its Impact on Psychiatric Hospitalization in Canada: A Cohort Study

We investigated the relationship between membership in an accredited Clubhouse for mental health support and psychiatric hospitalization in Canada using linked administrative data. Results show that Clubhouse members were less likely to be hospitalized after enrollment and after longer-term enrollment, and younger members diagnosed with schizophrenia and/or bipolar disorders were at increased risk of hospitalization compared to older members without such diagnoses. These findings provide evidence of the possible benefits of Clubhouses in Canada and the characteristics of members who may benefit from support.

Transitional Employment Programs within Clubhouses as a Means of Promoting Recovery for Individuals Living with Mental Illness: Reviewing the Case for Québec

Transitional employment (TE) within the Clubhouse model has been adopted across Canada and the world for its effectiveness in promoting work and recovery for persons living with mental illness. However, attempts to establish a TE program in the province of Québec have been met with numerous roadblocks. Using a qualitative phenomenological approach, this study aimed to synthesize knowledge that could inform local implementation of TE. Experiences of Montréal Clubhouse members and Canadian Clubhouse directors were examined. Member narratives identified employment-program and systemic shortcomings, while directors provided key strategies for overcoming barriers to TE implementation.

Conceptualizing participation in the community mental health context: Beginning with the Clubhouse model

ABSTRACT Purpose Although participation is key to community mental health, the concept remains elusive. The study explored a conceptualization of participation in the community-based mental health agencies context from a first-person perspective, using the Clubhouse model as an example. Methods Qualitative data, collected from 21 Clubhouse service users through three focus groups (1 UK and 2 US) for primary analysis and secondary data from 104 individual interviews, were analysed using a grounded theory approach. Results Focus group narratives revealed three main domains of what may be named everyday participation process, Making Decisions, Doing Work, and Locating Oneself in Community, blended with each other rather than forming clear-cut stages. Sixty-six extracted primary codes, with two underlying interrelated core categories identified, named Autonomy and Egalitarian Connection, were organized by domain and by category. Conclusions The findings suggest a 3 × 2 axial model of participation that participation signifies a behaviour, comprised of three blended activity domains, entailing actions and interactions that concern Autonomy and Egalitarian Connection, which, dynamically interacting with each other, appear to condition meaningful participation the next day. Egalitarian relationship skills development appears critical for training practitioners to help promote service users’ quality everyday participation and getting-a-life-back experiences towards well-being, or meaningful life.