The Clubhouse as an Empowering Setting
Carol T. Mowbray, Lisa Lewandowski, Mark Holter, and Deborah Bybee Attention to psychosocial rehabilitation (PSR) practice has expanded in recent years. However, social work research studies on PSR are not numerous. This study focuses on operational characteristics of clubhouses, a major PSR program model, and the organizational attributes (including resource levels) that predict the extent to which the clubhouse constitutes an empowering setting. The authors present data from a statewide sample of 30 clubhouses, annually serving nearly 4,000 consumers (adults with serious mental illnesses), based on interviews of clubhouse directors, on-site observations, and government information sources. Results indicate that users were predominantly male, white, and middle age; about one-third had a major functional disabihty. There were wide variations in member characteristics as well as in resource levels. In terms of empowerment, this sample of clubs averaged rather low levels of member involvement in governance and operations but seemed to provide members with opportunities and assistance in making their own decisions. The empowerment variables had different predictors, including client characteristics, urban-related characteristics, staffing, and resource levels. Imphcations for social work practice in PSR settings are discussed. KEY WORDS: clubhouse; empowerment; mental health consumers; mental health services;psychiatric disorders
U.S. Surgeon Generals 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 comnumities. 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 gencralist 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 opera tions. 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 disabiUty 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 rehabihtation to adults with psychiatric disabihties (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), includingjapan, 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)
CCC Code: 0350-7283/06 t3.00 ©2006 National AHOdation ot Social Workers
voiced concern over variations in descriptions of the clubhouse model in published literature, even in...
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