Characteristics of users of consumer-run drop-in centers versus clubhouses

A Contemporary Review of the Clubhouse Model 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.

Occupational evaluation of community-based psychiatric rehabilitation outcomes in individuals with severe mental illnesses: A ten-year retrospective study

BACKGROUND

There is a lack of research on the effect of community-based psychiatric rehabilitation programs (CBPRs) in individuals with severe mental illness. This research used data from a retrospective study to examine the effect of a CBPR in a community rehabilitation center.

MATERIALS AND METHODS

Clinical outcomes measures from a retrospective study were collected. Outcome measures were the Allen Cognitive Level Screen assessment, Purdue Pegboard Test, Chu's Attention Test, and Activities of Daily Living Rating Scale-III (ADLRS-III) before and immediately after 12 months of intervention.

RESULTS

The 141 participants with mental illness were an average age of 35.29 years (SD = 8.75). The retrospective review of medical records showed 46 people dropped out within 12 months, and 95 people continued to participate in the rehabilitation program for 1 year. After 1 year of community rehabilitation, there was a trend for the participants who completed the intervention to improve on the ADLRS-III, Purdue Pegboard Test, and Chu's Attention Test. Participants who performed better on the occupational assessment were more likely to transit to the employment status.

CONCLUSION

This study found the benefits of CBPR in work-related intervention for people with mental illness. Occupational assessments are relevant for studying changes in functional outcomes in people with mental illness receiving community-based rehabilitation.

Organizational characteristics of Brain Injury Clubhouse Model programs

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.

Psychosocial Change in Members of Clubhouse Paris (France) Over an 18-Month Period: A Longitudinal Mixed Methods Study

The community-based mental health organizations known as "Clubhouses" have existed since the 1940s in the United States, and the model has since spread to many countries. The present study investigates the psychological and social trajectories of 33 members of Clubhouse Paris, the first Clubhouse in France. The study used a pre-post, mixed methods design, with three assessments over an 18-month period. A participatory action research approach was taken to ensure compatibility with Clubhouse principles. The results showed improvements in Clubhouse members' labor market integration, quality of life, sense of self-efficacy, psychosocial skills, symptoms, and hospitalization. The other variables studied (life satisfaction, social support, self-esteem) did not change over the study period. In addition to the statistical results, analysis of interviews highlights the diversity of individual patterns of change and the complexity of the interactions between the variables. These results confirm previous findings from the international literature, and the robustness of the Clubhouse model across different cultures.

Power and Sample Size Determination for Multilevel Mediation in Three-Level Cluster-Randomized Trials

Mediation analyses supply a principal lens to probe the pathways through which a treatment acts upon an outcome because they can dismantle and test the core components of treatments and test how these components function as a coordinated system or theory of action. Experimental evaluation of mediation effects in addition to total effects has become increasingly common but literature has developed only limited guidance on how to plan mediation studies with multi-tiered hierarchical or clustered structures. In this study, we provide methods for computing the power to detect mediation effects in three-level cluster-randomized designs that examine individual- (level one), intermediate- (level two) or cluster-level (level three) mediators. We assess the methods using a simulation and provide examples of a three-level clinic-randomized study (individuals nested within therapists nested within clinics) probing an individual-, intermediate- or cluster-level mediator using the R package PowerUpR and its Shiny application.

Clubhouse Model of Psychiatric Rehabilitation in China to Promote Recovery of People With Schizophrenia: A Systematic Review and Meta-Analysis

Background: Whether the clubhouse model of psychiatric rehabilitation is well-implemented in China and whether patients with schizophrenia successfully achieve symptom remission and functional recovery through engaging in the clubhouse remain unclear. Methods: Seven electronic databases were searched for relevant articles from inception to April 21, 2021. Quality assessment, data synthesis, and subgroup analysis were performed on the included studies. Results: Seven randomized controlled studies with 682 participants were included in the present meta-analysis. The clubhouse model of psychiatric rehabilitation has a significant effect on promoting the remission of psychiatric symptoms, especially negative symptoms. However, it does not show a definite effect on promoting recovery of positive symptoms. The clubhouse model of psychiatric rehabilitation has a significant effect on promoting social functioning recovery, reducing the family burden, improving the quality of life, and promoting the remission of depressive and anxiety symptoms of patients with schizophrenia in China. Conclusions: Our findings suggest that the clubhouse model of psychiatric rehabilitation can promote the remission of symptoms and functional recovery of Chinese with schizophrenia. It may be suitable to address the urgent need for better mental health services in China.

A 6-Month Randomized Controlled Pilot Study on the Effects of the Clubhouse Model of Psychosocial Rehabilitation with Chinese Individuals with Schizophrenia

To investigate the effectiveness of the Clubhouse Model of Psychosocial Rehabilitation on psychosocial functions and recovery of native Chinese individuals with schizophrenia in a community sample. A randomized controlled design was used. A total of 56 participants were recruited from a community sample for a study lasting 6 months, but five participants dropped out. Twenty-eight participants attended the Clubhouse program, and twenty-three participants served as controls. Standardized assessments were performed on three areas at the baseline and the 6-month follow-up: 1. symptom reduction; 2. social function, self-determination, and quality of life; and 3. rehospitalization rate. Compared to the controls, the Clubhouse participants showed reductions in psychiatric symptoms and better social function, self-determination, and quality of life (p < .05), but with no difference in the rehospitalization rate between Clubhouse members and the controls. The Clubhouse Model demonstrates its effectiveness and shows its viability as a service delivery model in psychosocial rehabilitation for individuals with schizophrenia in mainland China.

Quality of life among people with psychiatric disabilities attending community-based day centres or Clubhouses

BACKGROUND

People with psychiatric disability have been found to have a poorer quality of life (QOL) compared to the general population, and QOL is an important outcome from psychosocial rehabilitation.

AIMS

This study aimed at comparing users of two approaches to psychosocial rehabilitation in Sweden, community-based mental health day centres (DCs) and clubhouses, regarding QOL. A further aim was to investigate predictors of QOL.

METHODS

People regularly attending DCs (n = 128) or clubhouses (n = 57) completed questionnaires at baseline and a 9-month follow-up about socio-demographics, QOL, self-esteem, social network, satisfaction with daily occupations, satisfaction with services and the unit's organisation.

RESULTS

Quality of life remained stable over time in both groups. QOL at follow-up was associated with baseline self-esteem, social network, satisfaction with daily occupations and QOL at baseline. The strongest indicator of a higher QOL at follow-up was attending a clubhouse programme followed by having scored high on QOL at baseline.

CONCLUSION

Both approaches were suited for supporting their users in maintaining QOL. Visiting clubhouses seems, however, advantageous for QOL in a longer-term perspective. Although this study contributed some new knowledge, research should further address which circumstances are associated with maintaining stability in QOL.

A Systematic Review of Evidence for the Clubhouse Model of Psychosocial Rehabilitation

The Clubhouse Model has been in existence for over sixty-five years; however, a review that synthesizes the literature on the model is needed. The current study makes use of the existing research to conduct a systematic review of articles providing a comprehensive understanding of what is known about the Clubhouse Model, to identify the best evidence available, as well as areas that would benefit from further study. Findings are summarized and evidence is classified by outcome domains. Fifty-two articles met the selection criteria of Randomized Clinical Trials (RCT's), quasi-experimental studies, or observational studies for domains of employment (N = 29); quality of life/satisfaction (N = 10); reductions in psychiatric hospitalization(s) (N = 10); social relationships (N = 10); education (N = 3); and health promotion activities (N = 2). RCT results support the efficacy of the Clubhouse Model in promoting employment, reducing hospitalization(s), and improving quality of life. Quasi-experimental and observational studies offer support in education and social domains. The findings from this review indicate that Clubhouses are a promising practice but additional studies using rigorous methods that report the strength of the outcomes are needed to evaluate Clubhouse programs with fidelity to the Clubhouse Model.

Programme characteristics and everyday occupations in day centres and clubhouses in Sweden

BACKGROUND

Meaningful everyday occupations are important for mental health and recovery and are provided by both community-based day centres (DCs) and clubhouses. It is unknown, however, if any of the two has more recovery-promoting features.

OBJECTIVE

This nine-month longitudinal study compared DC and clubhouses, concerning the users' perceptions of unit and programme characteristics, and aspects of everyday occupations in terms of engagement and satisfaction. Stability over time in these respects, as well as motivation for participation and relationships with occupational engagement and satisfaction, were explored.

METHODS

Participants from 10 DCs (n = 128) and 5 clubhouses (n = 57) completed self-report instruments.

RESULTS

DC attendees rated lower levels on two organizational factors; choice and ability to influence decisions, and the unit's social network. Motivation showed to be an important factor for perceived occupational engagement, which did not differ between the two groups. DC attendees were more satisfied with their everyday occupations at baseline, but that factor increased more in the clubhouse group and there was no group difference at follow-up. The unit and programme characteristics and occupational engagement showed stability over time.

DISCUSSION

Clubhouses seemed more advantageous and DC services may consider developing users' opportunities for choice and decision-making, and peer support.

[The Clubhouse model for people with severe mental illnesses: Literature review and French experiment]

AIM

The aim of this article is 1) to present the Clubhouse (CH) Model and the first French CH, and 2) study the empirical background on the efficiency of the CH concerning employment, quality of life and hospitalization for people with mental illness.

HISTORICAL, THEORETICAL AND INSTITUTIONAL BACKGROUND

The first Clubhouse was created sixty years ago in the U.S. The Clubhouse model of psychosocial rehabilitation is a program that offers to people with mental illness support and opportunities to find a job and return to a normal social life. The Clubhouse model has been built over the years thanks to the experiences of members and staff. It is based on "36 standards" (rules which each Clubhouse follows in order to attain its goals). Supported by associations and families of people with mental illness, health professionals, and the international federation of Clubhouses (Clubhouse International), the first Clubhouse in France has opened in November 2011. This non-medicalized association and its co-management by both members and staff are innovative in France. The aims of the Clubhouse are founded on the concept of empowerment and "peer-help", and on the fight against isolation and stigmatization. Clubhouses offer day-programs which allow people with mental illness to have a sense of community and a useful purpose within the association. Indeed, the salaried management team is voluntarily understaffed so that the participation of members is necessary and so that they can benefit from the opportunities for useful activity within the Clubhouse, developing a real opportunity of empowerment.

METHOD

In order to study the efficiency of CH, we conducted a systematic review of publications on CH, first in the database of Club House International (500 publications) and second, in the scientific data base (Psycinfo, Psycarticles, Academic Search Premier, Medline et Science Direct) (205 publications included in the 500). We identified 64 scientific studies. We have selected 28 of them that focused on the variable: employment, quality of life and hospitalisation.

RESULTS

Clubhouses have shown their effectiveness regarding employment, quality of life and hospitalization. Indeed, several studies compare Clubhouses with other programs of psychosocial rehabilitation. The results have demonstrated that Clubhouses' members: find more salaried work, find jobs of higher quality, have a better quality of life and face fewer hospitalizations, than people in other psychosocial rehabilitation programs.

DISCUSSION

We discuss the interest of the CH in France using the experiment of the CH in Paris. This experiment in providing an innovative place of support, mutual aid, and autonomy is currently successful in France. Over 18 months, a team of 65 members and 3 staff members has come together. This enthusiasm is probably due to the fact that the Clubhouse in Paris is a place which helps people with mental illness establish a daily rhythm, social usefulness and affective links, all essential for recovery, in a context different from the usual medically supervised care in other settings: people are treated as individuals rather than as "sick persons" or "patients". This article discusses the benefits of this new model of psychosocial rehabilitation in France, by presenting the originality and complimentarity of this concept, in comparison with other health structures.

Peer support within Clubhouse: a grounded theory study

Peer support facilitates recovery. However, little is known about the role of peer support within the Clubhouse model. This article reports on Clubhouse members' experiences of peer support and the outcomes they identify from engaging in this phenomenon. Grounded theory guided the study design involving 17 semi-structured interviews conducted with 10 Clubhouse members. Constant comparison and open coding were undertaken to identify underlying concepts within transcripts. A conceptual model of peer support was derived from Clubhouse members' experience. Four levels of peer support emerged: Social inclusion and belonging; shared achievement through doing; interdependency; and at the deepest level, intimacy. Peer support within Clubhouse is a multi-layered construct in terms of depth and nature of relationships. Clubhouse appears to contribute a unique tier within the layered construct of peer support. This tier is based on the sharing of achievement through working together on shared tasks within the work-ordered day Clubhouse structure.

Determinants, self-management strategies and interventions for hope in people with mental disorders: systematic search and narrative review

Developing a recovery focus in mental health services is a policy goal internationally, and hope is a central component of recovery. Yet determinants of hope of people with mental disorders are not well known, nor are strategies and interventions that increase hope. This study aims to systematically summarise the available evidence to fill four relevant knowledge gaps: (1) hope scales used in psychiatric research, (2) determinants of hope, (2) hope-fostering self-management strategies, and (3) interventions to increase hope for people with mental disorders. We conducted a systematic literature search in April 2011 and a narrative synthesis of publications including qualitative and quantitative studies. Results for the first time provide a comprehensive overview of existing evidence and identify important scientific knowledge gaps: (1) Hope scales used do slightly vary in focus but are overall comparable. (2) Most published research used cross-sectional designs resulting in a high number of potential determinants of hope. No studies prospectively investigated the influence of these determinants. (3) Hope fostering self-management strategies of people with mental disorders were described in qualitative studies only with experimental studies completely missing. (4) While some recovery oriented interventions were shown to increase hope as a secondary outcome, there are no successful interventions specifically aimed at increasing hope. This review provides the basis for both practical and research recommendations: The five most promising candidate interventions to improve hope in people with mental disorders are (i) collaborative strategies for illness management, (ii) fostering relationships, (iii) peer support, (iv) helping clients to assume control and to formulate and pursue realistic goals, and (v) specific interventions to support multiple positive factors such as self-esteem, self-efficacy, spirituality and well-being. These may serve to directly improve care and to develop theory-based models and testable interventions to improve hope in mental health as well as in allied fields.