Academic journal article Health and Social Work

The Clubhouse as an Empowering Setting

Academic journal article Health and Social Work

The Clubhouse as an Empowering Setting

Article excerpt

A U.S. Surgeon General's report (U.S. Department of Health and Human Services, 1999) concluded that psychosocial rehabilitation (PSR) practice should now be a significant component of mental health service systems, as it promotes the rehabilitation and integration of adults with serious mental illnesses into their communities. Among the best-known and most widely implemented models of PSR for adults with psychiatric disabilities is the clubhouse. The clubhouse is an intentional community composed of generalist staff who work there and consumers who are its members. Staff and members work side by side to perform jobs essential to the operation of the clubhouse, such as food preparation, maintenance, member orientation and reception services, clerical work, and record keeping. Members take part in all aspects of clubhouse governance and operations. The clubhouse achieves rehabilitation goals by providing a protective community, the security of lifelong membership and continuous availability of clubhouse support services, prevocational but meaningful work running the club, opportunities to develop and practice vocational skills, and the availability of paid work outside the clubhouse. Clubhouses operate on the belief that members who have a psychiatric disability can achieve their goals and contribute to their communities, with appropriate supports.

The first clubhouse, Fountain House in New York City, was founded in 1948 by a group of former patients from a nearby state hospital to provide refuge, support, and rehabilitation to adults with psychiatric disabilities (Macias, Jackson, Schroeder, & Wang, 1999). As of 2000, there were at least 350 clubhouses worldwide, in 44 U.S. states and 21 other countries (Wang, Macias, &Jackson, 1999), including Japan, Korea, Pakistan, South Africa, Germany, Sweden, and Australia, serving an estimated 25,000 psychiatric consumers ("Gold Award: The Wellspring of the Clubhouse Model," 1999; Lucca, 2000; Mastboom, 1992). Despite this proliferation and the large numbers of individuals served, surprisingly little research has been conducted on the operation of the clubhouse model. For example, Stein and colleagues (1999) noted that characteristics of consumers using these programs have not been systematically assessed. Macias and colleagues (1999) voiced concern over variations in descriptions of the clubhouse model in published literature, even in regard to services provided. Macias and colleagues (2001) raised the question of whether external constraints (for example, lack of Medicaid funding) or organizational resources might affect fidelity of a clubhouse to the intended model's principles and operations.

The lack of quantitative data on clubhouse operations has been remedied, to some extent, by a series of recent publications reporting findings from data collected through the clubhouse certification process. However, the clubhouse standards, which undergird certification, focus primarily on the model's structural characteristics (that is, administration, staffing, position descriptions, eligibility criteria, rules, space, services, and activities) rather than on its process aspects (for example, relationships between staff and members, how members are treated, hierarchies, opportunities, personal development).


Characteristics of Clubhouse Users

The literature reviewed ranges from studies of members in a single clubhouse (Accordino & Herbert, 2000; Kosciulek & Merz, 2001; Stein et al., 1999; Warner, Huxley, & Berg, 1999) to surveys of directors from numerous clubhouses (that is, 40 in Mastboom, 1992; 128 in Macias et al., 2001; and 173 in Macias et al., 1999) (Table 1). The number of members covered by the studies ranges from 26 to more than 20,000. Despite the diversity of the samples, some commonalities emerge. Female members are consistently in the minority--usually around 40 percent to 45 percent. …

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