Intervention Summary
ICCD Clubhouse Model
The ICCD (International Center for Clubhouse Development) Clubhouse Model is a day treatment program for rehabilitating adults diagnosed with a mental health problem. The goal of the program is to contribute to the recovery of individuals through use of a therapeutic environment that includes responsibilities within the Clubhouse (e.g., clerical duties, reception, food service, transportation, financial services), as well as through outside employment, education, meaningful relationships, housing, and an overall improved quality of life. Individuals who participate in the Clubhouse are called "members." Fundamental elements of their participation include openness and choice in type of work activities, choice in staff, and a lifetime right of reentry and access to all Clubhouse services. Each individual is welcomed, wanted, needed, and expected each day and is considered a critical part of a community engaged in important work. A core component of the program is the "work-ordered day," the structure around which daily activity is organized. The day-to-day operation of the Clubhouse is the responsibility of members and staff, who work side by side in a rehabilitative environment. Other core components include transitional, supported, and independent employment through which members can secure jobs at prevailing wages in the wider community; access to community support, such as housing and medical services; assistance in accessing educational resources; "reach-out" to maintain contact with all active members; participation in program decisionmaking and governance; and evening, weekend, and holiday social programs. Clubhouses are certified and coordinated internationally through the ICCD. Clubhouse staff, who function as generalists, maintain a caseload, including managing employment placements, housing issues, and access to community supports. They also are responsible for the ongoing work of the Clubhouse and help organize and participate in social activities. Staff have diverse life experiences and backgrounds in a variety of disciplines, including psychology, counseling, social work, and education. Clubhouse members do not pay dues or membership fees. Their attendance is voluntary, and they can participate as little or as much as they choose.
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
The following populations were identified in the studies reviewed for Quality of
Research.
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
Measures used to assess employment were standardized across study sites. Employment data collected from participants were corroborated across data collection forms and were further corroborated with data collected from interviews and telephone calls with family members. The analyses used for the employment outcome were appropriate. For the quality of life and perceived recovery outcomes, the researchers did not provide a rationale for using single-item measures or any documentation supporting the psychometrics of the measures. Neither study required a standard amount of services to be provided, creating concerns about implementation fidelity and potential confounds; researchers did not provide documentation on the variation in services provided or the results from efforts to monitor intervention fidelity. The first study used only a subset of an already small sample, raising concerns about selection bias, and additional exclusion criteria were imposed by study sites. Also in this study, the attrition rate was high for the sample used in the analyses of transitional, supported, and independent employment. In the second study, there were relevant differences between groups, including differences in mental health treatment (e.g., Clubhouse participants were receiving more intensive services and were living in more supervised settings than individuals in the comparison group). The second study, which collected only posttest data for the intervention and comparison groups, serves to compare the characteristics of the groups' participants but does not provide evidence to support the effectiveness of the Clubhouse on improving program outcomes.
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials. One in Four [DVD] Program forms and templates: Sample Clubhouse Community Newsletter These Are the Stories [DVD] Together Everyone Achieves Clubhouse (TEACH) manual Other training materials:
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria: For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Materials are comprehensive, clearly written, and well organized. The resources that are available to guide new Clubhouse development are extensive and include detailed and practical tips and tools. The Web site offers numerous resources and overview information, and the DVDs provide real-life examples to assist with training and education about Clubhouses. Extensive, thorough, and well-organized training opportunities are offered, including a 3-week training for new implementers. Further, through a certification process, ongoing training, coaching, and consultation are available. The ICCD standards are clearly defined for new sites, with performance measures identified. All standards are reviewed and updated every 2 years. The certification process is comprehensive and promotes continuous quality improvement and fidelity to the model. No weaknesses were identified by reviewers.
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements. Descriptive Information
Areas of Interest
Mental health treatment
Co-occurring disorders
Outcomes
1: Employment
2: Quality of life
3: Perceived recovery from a mental health problem
Outcome Categories
Employment
Quality of life
Treatment/recovery
Ages
18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
Genders
Male
Female
Races/Ethnicities
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings
Other community settings
Geographic Locations
Urban
Suburban
Rural and/or frontier
Implementation History
The first Clubhouse, Fountain House in New York City, began when former patients of a New York psychiatric hospital began to meet informally. The "club" they organized was intended to be a support system for people diagnosed with mental illness rather than a treatment program. The ICCD Clubhouse Model has been implemented in urban, suburban, and rural areas with a wide variety of ethnic, cultural, and socioeconomic groups. Serving approximately 55,000 individuals annually, more than 300 Clubhouses operate in the United States and throughout the world, in countries such as Australia, Austria, Canada, China, Denmark, England, Estonia, Finland, Germany, Iceland, Ireland, Israel, Italy, Japan, Korea, Kosovo, the Netherlands, New Zealand, Norway, Poland, Russia, Scotland, South Africa, Sweden, and Uganda.
Clubhouses are supported and coordinated internationally through the ICCD. The ICCD coordinates training and ongoing technical support on the model through 10 international training bases and maintains both an international certification process and international standards for Clubhouse programs.
NIH Funding/CER Studies
Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations
Materials are available in eight languages other than English: Chinese, Finnish, German, Hebrew, Korean, Polish, Russian, and Spanish. In addition, the ICCD Clubhouse Model has been adapted for individuals diagnosed with traumatic brain injury.
Adverse Effects
No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories
IOM prevention categories are not applicable.
Documents Reviewed
Outcomes
Outcome 1: Employment
Description of Measures
Employment was assessed by self-report during face-to-face or phone interviews conducted by independent interviewers. Interviews were conducted at baseline and every 6 months thereafter using employment tracking forms. All jobs that were held for at least 5 days and met the U.S. Department of Labor's definition of competitive employment (mainstream, integrated work paying at least minimum wage) were included in the assessment of job duration (total number of hours, days, or weeks of employment per job), hourly wage earned per job, and total wages earned per job.
Key Findings
A randomized trial compared participants in one certified Clubhouse with individuals receiving vocationally integrated Assertive Community Treatment (ACT), another multiservice program designed to provide employment assistance. Analysis of supported employment data showed that over 24 months:
Analysis of transitional, supported, and independent employment data showed that over 30 months:
Studies Measuring Outcome
Study 1
Study Designs
Experimental
Quality of Research Rating
2.5
(0.0-4.0 scale)
Outcome 2: Quality of life
Description of Measures
Quality of life was assessed by self-report using a single question from the Global Quality of Life scale: "Which of the following best describes how you feel about your life as a whole?" Response options ranged from 1 (terrible) to 7 (delighted).
Key Findings
One study examined the participants of 31 geographically matched pairs of certified Clubhouses and consumer-run drop-in centers (CRDIs). At posttest, Clubhouse members reported a higher quality of life than CRDI consumers (mean score of 4.88 vs. 4.55; p < .04).
Studies Measuring Outcome
Study 2
Study Designs
Preexperimental
Quality of Research Rating
1.6
(0.0-4.0 scale)
Outcome 3: Perceived recovery from a mental health problem
Description of Measures
Perceived recovery from a mental health problem was measured by self-report using a single item from the Recovery Attitudes Questionnaire: "Do you consider yourself to be in recovery from a mental health problem?" Response options were 1 (yes) and 0 (no/do not know).
Key Findings
One study examined the participants of 31 geographically matched pairs of certified Clubhouses and consumer-run drop-in centers (CRDIs). At posttest, a higher percentage of Clubhouse members than CRDI consumers believed they were in recovery (71.2% vs. 52.3%; p < .04), a finding associated with a small effect size (odds ratio = 1.54).
Studies Measuring Outcome
Study 2
Study Designs
Preexperimental
Quality of Research Rating
1.6
(0.0-4.0 scale)
Study Populations
Study
Age
Gender
Race/Ethnicity
Study 1
18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
55% Male
45% Female
84% White
8% Black or African American
6% Hispanic or Latino
1% American Indian or Alaska Native
1% Asian
Study 2
18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
60% Male
40% Female
82% Race/ethnicity unspecified
18% Black or African American
Quality of Research Ratings by Criteria (0.0-4.0 scale)
Outcome
Reliability
of Measures
Validity
of Measures
Fidelity
Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Employment
2.5
3.0
2.5
2.3
2.0
2.8
2.5
2: Quality of life
1.5
2.0
2.0
1.3
1.5
1.5
1.6
3: Perceived recovery from a mental health problem
1.5
2.0
2.0
1.3
1.5
1.5
1.6
Study Strengths
Study Weaknesses
Materials Reviewed
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
4.0
4.0
4.0
4.0
Dissemination Strengths
Dissemination Weaknesses
Item Description
Cost
Required by Developer
All implementation and training materials
Free
Yes
5-day international seminar
About $1,000 per participant
No
2.5-day regional conference
About $500 per participant
No
3-day, off-site orientation visit for one mental health consumer and one staff person/interested party
$1,000 per site for two participants (includes lodging), plus $500 for each additional participant
No
2-day new Clubhouse development training held near an established Clubhouse (includes 1 year of ongoing mentoring and support)
$1,000 per site for three to six participants (includes lodging)
No
3-week, off-site initial training (for new Clubhouses) for director, one staff person, one member, and one administrator
$6,500 per site for four participants (includes lodging)
No
2- to 3-week, off-site ongoing training (for established Clubhouses) for one staff person, one member, and one administrator
$4,500 per site for three participants (includes lodging)
No
1-week, off-site specialized training (for certified Clubhouses) for one staff person and one member (topics include housing, work-ordered day, transitional employment, leadership, young adult supports, and supported education)
$2,000 per site for two participants (includes lodging), plus $900 for each additional participant
No
Training site visit 6-9 months after training
Varies depending on site needs and location
No
ICCD certification and associated materials (includes self-study; Clubhouse Profile Questionnaire; 4-day, on-site visit; preliminary findings meeting; written report on outcome status; and ongoing consultation)
$2,550 per site
No
Annual membership dues
0.25% of the Clubhouse's annual budget
Yes, for sites in operation for more than 2 years