Recent Research

If you have any questions regarding Clubhouse research, please contact

Colleen McKay, Assistant Professor & Director
Program for Clubhouse Research
Systems and Psychosocial Advances Research Center
University of Massachusetts Medical School
222 Maple Avenue
Shrewsbury, MA 01545
(508) 856-8471
colleen.mckay@umassmed.edu

Clubhouses and Recent Clubhouse Research

The Clubhouse Model was accepted for inclusion on the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence Based Practices and Programs (NREPP) in 2011. The review indicates that the ICCD Clubhouse Model surpassed the minimum levels of research required for inclusion. There is evidence that supports clubhouse outcomes from studies with experimental or quasi-experimental designs. The review highlights the need for more research on ICCD Clubhouses. SAMHSA announced the intent to re-review currently posted NREPP programs to comport with new review criteria and ratings in July 2015. The Clubhouse Model was submitted for re-review in December 2016. Additional updates regarding the re-review will be posted here as we receive them.

The existing NREPP ICCD Clubhouse Model intervention summary is available online at: http://legacy.nreppadmin.net/ViewIntervention.aspx?id=189

Clubhouse information and outcomes are also available in two SAMHSA publications:

The United States Substance Abuse and Mental Health Services Administration (SAMHSA)’s Behavioral Health United States 2012. Clubhouse content is available on pages 148, 236, 324, 362, & 369:

  • Page 148, Table 67. Demographic and diagnostic characteristics for members of clubhouses, by certification status: number and percentage, United States
  • Page 236, Table 114. Clubhouses providing specific services and activities: percentage, United States
  • Page 324, Table 161. Funding sources and management structure for clubhouses, by certification status: percentage, United States
  • To download a PDF visit SAMHSA’s website: http://media.samhsa.gov/data/2012BehavioralHealthUS/2012-BHUS.pdf
  • Recommended Citation:
    Substance Abuse and Mental Health Services Administration. (2013). Behavioral Health, United States, 2012. HHS Publication No. (SMA) 13-4797. Rockville, MD: Substance Abuse and Mental Health Services Administration.

The United States Substance Abuse and Mental Health Services Administration (SAMHSA)’s Mental Health United States 2010. This publication is part of a series and this issue reports on the nation’s mental health system across three themes: people; treatment facility characteristics; and payers and payment mechanisms. It includes all sort of useful information including state-level data and services in non-traditional settings such as clubhouse programs. Data from an earlier version of the Clubhouse Profile Questionnaire (CPQ) was published in SAMHSA’s Mental Health, United States, 2010. Clubhouse content is available on page 22, 154 -157, 168, & 239:

  • Page 154, Table 42. Number of members served in clubhouses, United States
  • Page 155, Table 43. Demographic and diagnostic information for members of clubhouses
  • Page 156, Table 44. Percentage of clubhouses, by funding source and management structure
  • Page 168, Table 54. Percentage of clubhouses providing specific services
  • Page 239, Table 97. Clubhouse costs, United States
  • To download a PDF visit SAMHSA’s web site:
              http://www.samhsa.gov/data/2k12/MHUS2010/MHUS-2010.pdf
  • Recommended Citation:
    Substance Abuse and Mental Health Services Administration. (2012). Mental Health, United States, 2010. HHS Publication No. (SMA) 12-4681. Rockville, MD: Substance Abuse and Mental Health Services Administration. The United States Substance Abuse and Mental Health Services Administration (SAMHSA)’s Mental Health United States 2010. This publication is part of a series and this issue reports on the nation’s mental health system across three themes: people; treatment facility characteristics; and payers and payment mechanisms. It includes all sort of useful information including state-level data and services in non-traditional settings such as clubhouse programs. Data from an earlier version of the Clubhouse Profile Questionnaire (CPQ) was published in SAMHSA’s Mental Health, United States, 2010.
  • Page 154, Table 42. Number of members served in clubhouses, United States
  • Page 155, Table 43. Demographic and diagnostic information for members of clubhouses
  • Page 156, Table 44. Percentage of clubhouses, by funding source and management structure
  • Page 168, Table 54. Percentage of clubhouses providing specific services
  • Page 239, Table 97. Clubhouse costs, United States
  • To download a PDF visit SAMHSA’s web site: http://www.samhsa.gov/data/2k12/MHUS2010/MHUS-2010.pdf
  • Recommended Citation:

    Substance Abuse and Mental Health Services Administration. (2012). Mental Health, United States, 2010. HHS Publication No. (SMA) 12-4681. Rockville, MD: Substance Abuse and Mental Health Services Administration.


Additional information regarding clubhouse research is available in the following articles. Click on the Author Name(s) to view the Abstract for each article:

  1. McKay, C., Nugent, K.L., Johnsen, M., Eaton, W.W., & Lidz, C.W. (2016). A systematic review of evidence for the clubhouse model of psychosocial rehabilitation. Administration and Policy in Mental Health and Mental Health Services Research, 1-20. https://doi.org/10.1007/s10488-016-0760-3  PMID: 27580614
  2. Hwang, S., Woody, J., & Eaton, W.W. (2016). Analysis of the association of clubhouse membership with overall costs of care for mental health treatment. Community Mental Health Journal, 53 (1), 102-106. https://doi.org/10.1007/s10597-016-0041-3  PMID:27380210
  3. Gorman, J.A., McKay, C.E., Yates, B.T., & Fisher, W.H. (2016). Keeping clubhouses open: Toward a roadmap for sustainability. Administration and Policy in Mental Health and Mental Health Services Research, 1-10. https://doi.org/10.1007/s10488-016-0766-x PMID: 27631611
  4. Gold, P.B., Macias, C., & Rodican, C.F. (2016). Does competitive work improve quality of life for adults with severe mental illness? Evidence from a randomized trial of supported employment. The Journal of Behavioral Health Services & Research, 43(2), 155-171. https://doi.org/10.1007/s11414-014-9392-0  PMID:24504832
  5. Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2016). The use of social environment in a psychosocial clubhouse to facilitate recovery-oriented practice. British Journal of Psychiatry Open, 2(2), 173–178. https://doi.org/10.1192/bjpo.bp.115.002642  PMID:27703771
  6. Bonsaksen, T., Fouad, M., Skarpaas, L., Nordli, H., Fekete, O., Stimo, T., et al. (2016). Characteristics of Norwegian clubhouse members and factors associated with their participation in work and education. British Journal of Occupational Therapy, 79(11), 669-676. https://doi.org/10.1177/0308022616639977
  7. Hultqvist, J., Markström, U., Tjörnstrand, C., & Eklund, M. (2016). Programme characteristics and everyday occupations in day centres and clubhouses in Sweden. Scandinavian Journal of Occupational Therapy, 24(3), 197-207. DOI: https://doi.org10.1080/11038128.2016.1200669  PMID:27347874
  8. Chung, C-L., Pernice-Duca, F., Biegel, D.E., Norden, M. & Chang, C-W. (2016). Family perspectives of how their relatives with mental illness benefit from clubhouse participation: A qualitative inquiry. Journal of Mental Health, 25(4), 372-378. https://doi.org/10.3109/09638237.2016.1149805  PMID:26942501
  9. Mandiberg, J.M. & Edwards, M. (2016). Business incubation for people with severe mental illness histories: The experience of one model. Journal of Policy Practice, 15(1-2), 82-101. https://doi.org/10.1080/15588742.2016.1109964
  10. Prince, J.D., Ansbrow, J., Bennedict, A., DiCostanzo, J., Mora, O., & Schonebaum, A.D. (2016). Making connections: Severe mental illness and closeness with other people. Social Work in Mental Health, 15(1), 1-13. https://doi.org/10.1080/15332985.2016.1148095
  11. Virkki, T. (2016). Working experiences of members of the Sörnäinen Clubhouse and their visions for improving the employment of mental health rehabilitators. Bachelor’s Thesis. Laurea University of Applied Sciences. Retrieved from: http://publications.theseus.fi/bitstream/handle/10024/114040/Virkki_Taina.pdf?sequence=1
  12. Raeburn, T., et al. (2016). Autonomy support and recovery practice at a psychosocial clubhouse. Perspectives in Psychiatric Care. https://doi.org/10.1111/ppc.12149  PMID:26813736
  13. Fitzgerald, S., et al. (2016). Psychometric properties of the Vocational Rehabilitation Engagement Scale when used with people with mental illness in clubhouse settings. Rehabilitation Research, Policy, and Education, 30(3), 276-285. https://doi.org/10.1891/2168-6653.30.3.276
  14. Akiba, C.F. & Estroff. S.E. (2016). The business of staying in business: North Carolina Clubhouse programs. American Journal of Psychiatric Rehabilitation, 19(2), 97-102. https://doi.org/10.1080/15487768.2016.1162756
  15. Battin, C., et al. (2016). A systematic review of the effectiveness of the clubhouse model. Psychiatric Rehabilitation Journal, 39(4), 305-312. https://doi.org/10.1037/prj0000227  PMID:27786524
  16. Raab, P.A., Claypoole, K.H., Rhoads Merriam, K., Subica, A.M., Larsen, J.D., Chow, M,, & Golis, K. (2015). Indicators of success: academic research partnerships to implement performance indicator systems in clubhouses. Psychiatric Rehabilitation Journal, 37(7), 55-57. DOI: https://doi.org/10.1037/prj0000023  PMID: 24274063
  17. Farmer, S. (2015). Spotlight on the safety net: Traumatic brain injury clubhouses in North Carolina. North Carolina Medical Journal, 76(2), 123-124. https://doi.org/10.18043/ncm.76.2.123 PMID:25856361
  18. Grinspan, Z. (2015). Brief research report: Fountain House and use of healthcare resources.
  19. Gorman, J. (2015). Keeping the clubhouse open: Toward a road map for clubhouse sustainability (Doctoral dissertation), American University. Ph.D.
  20. Hancock, N., et al. (2015). Sources of meaning derived from occupational engagement for people recovering from mental illness. British Journal of Occupational Therapy, 78(8), 508-515. https://doi.org/10.1177/0308022614562789
  21. Karnieli-Miller, O., et al. (2015). It's in the cards: The contribution of illustrated metaphor cards to exploring values within narratives. Qualitative Health Research, 27(1), 138-151. https://doi.org/10.1177/1049732315609897  PMID:26489712
  22. Pernice-Duca, F., et al. (2015). Family members' perceptions of how they benefit when relatives living with serious mental illness participate in clubhouse community programs. Family Relations, 64(3), 446-459. https://doi.org/10.1111/fare.12127
  23. Okon, S., et al. (2015). Health and wellness outcomes for members in a psychosocial rehabilitation clubhouse participating in a healthy lifestyle design program. Occupational Therapy in Mental Health 31(1), 62-81. https://doi.org/10.1080/0164212X.2014.1001012
  24. Raeburn, T., et al. (2015). The contribution of case study design to supporting research on clubhouse psychosocial rehabilitation. BMC Research Notes, 8(1), 521. https://doi.org/10.1186/s13104-015-1521-1  PMID:26427943
  25. Tanaka, K., et al. (2015). Clubhouse community support for life: Staff–member relationships and recovery. Journal of Psychosocial Rehabilitation and Mental Health, 2(2), 131-141. https://doi.org/10.1007/s40737-015-0038-1
  26. Tanaka, K. & Davidson, L. (2015). Reciprocity in the clubhouse context. International Journal of Psychosocial Rehabilitation, 19(2), 21-33.
  27. Raeburn, T., et al. (2015). Self-determination theory: A framework for clubhouse psychosocial rehabilitation research. Issues in Mental Health Nursing, 36(2), 145-151. https://doi.org/10.3109/01612840.2014.927544  PMID:25325308
  28. Bouvet, C., et al. (2015). The Clubhouse model for people with severe mental illnesses: Literature review and French experiment. L'Encéphale, 41(6), 477-486. https://doi.org/10.1016/j.encep.2014.09.001  PMID:25438970
  29. Swensen, A. (2014). Serious and Persistent Mental Illness (SPMI): The Impact of Clubhouse Participation on the Utilization of Mental Health Service Westminster College. https://www.westminstercollege.edu/docs/default-source/departments-and-offices-documents/mcnair-scholars-program/mcnair-research-journal/2008-and-2009/angela-swensen-paper.pdf?sfvrsn=2
  30. Chang, C.W., Chung, C.L., Biegel, D.E., Pernice-Duca, F., Min, M.O., & D'Angelo, L. (2014). Predictors of loneliness of clubhouse members. Psychiatric Rehabilitation Journal, 37, 51-54. https://doi.org/10.1037/prj0000052  PMID:24660951
  31. Gorman, J. (2014). Cost-benefit and cost-effectiveness analysis of employment services offered by the clubhouse model. Master's Thesis. American University. Retrieved from: http://hdl.handle.net/1961/14036
  32. Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2014). Self-determination Theory: A Framework for Clubhouse Psychosocial Rehabilitation Research. Issues in Mental Health Nursing, 36(2), 145-151. https://doi.org/10.3109/01612840.2014.927544 PMID: 25325308
  33. Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2014). Clubhouse model of psychiatric rehabilitation: How is recovery reflected in documentation? International Journal of Mental Health Nursing, 23(5), 389-97. https://doi.org/10.1111/inm.12068  PMID: 24698159
  34. Tanaka, K. & Davidson, L. (2014). Meanings associated with the core component of clubhouse life: The Work-Ordered Day. Psychiatric Quarterly, 86(2), 269-83. https://doi.org/10.1007/s11126-014-9330-6  PMID:25417121
  35. Tsoi, E., Lo, I., Chan, C., Siu, K., & Tse, S. (2014). How recovery oriented are mental health services in Hong Kong? Snapshots of service users' perspectives. Asia Pacific Journal of Social Work and Development, 24, 82-93. https://doi.org/10.1080/02185385.2014.885211
  36. Biegel, D.E., Pernice-Duca, F., Chang, C-W., Chung, C-L., Min, M.O., & D'Angelo, L. (2013). Family social networks and recovery from severe mental illness of clubhouse members. Journal of Family Social Work, 16, 274-296. https://doi.org/10.1080/10522158.2013.794379
  37. Chapleau, A. & Powers Dirette, D. (2013). An evaluation of the potential effectiveness of a tai chi program for health promotion among people with severe mentall illness. The Open Journal of Occupational Therapy, 1(2), 1-13. http://dx.doi.org/10.15453/2168-6408.1036
  38. Conrad-Garrisi, D.L. & Pernice-Duca, F. (2013). The relationship between sense of mattering, stigma, and recovery: An empirical study of clubhouse participants in the U.S. Midwest. International Journal of Self Help and Self Care, 7, 41-57. https://doi.org/10.2190/SH.7.1.d
  39. Doyle, A., Lanoil, J., & Dudek, K.J. (2013). Fountain House: Creating community in mental health practice. New York, New York: Columbia University Press.
  40. Fitzgerald, S.D. (2013). Validating the self-determination theory as a work motivation model for Clubhouse members with severe and persistent mental illness. Dissertation #3591017 The University of Wisconsin - Madison.
  41. Hancock, N., Bundy, A., Honey, A., Helich, S., & Tamsett, S. (2013). Measuring the later stages of the recovery journey: Insights gained from clubhouse members. Community Mental Health Journal, 49, 323-330. https://doi.org/10.1007/s10597-012-9533-y  PMID:22825568
  42. Jones, N. & Jansson Selim, A. (2013). Education - the rainbow at the end of the tunnel. A study of a supported education program in a consumer-operated organization, with a focus on experiences of stigma. Bachelor's thesis Ersta Skondal University College, Stockholm, Sweden. https://www.diva-portal.org/smash/get/diva2:665197/FULLTEXT01.pdf
  43. Karlsson, M. (2013). Introduction to mental health clubhouses: How the Fountain House clubhouse became an international model. International Journal of Self Help and Self Care, 7, 7-18. https://doi.org/10.2190/SH.7.1.b
  44. Mandiberg, J.M. & Edwards, M. (2013). Collective identity formation in the mental health clubhouse community. International Journal of Self Help and Self Care, 7, 19-39. https://doi.org/10.2190/SH.7.1.c
  45. Pernice-Duca, F., Markman, B., & Chateauvert, H. (2013). Recovery in the clubhouse environment: Applying ecological and social cognitive theories. International Journal of Self Help and Self Care, 7, 181-165. https://doi.org/10.2190/sh.7.2.d
  46. Raeburn, T., Halcomb, E., Walter, G., & Cleary, P.D. (2013). An overview of the clubhouse model of psychiatric rehabilitation. Australasian Psychiatry, 21, 376-378. https://doi.org/10.1177/1039856213492235  PMID:23817899
  47. Tanaka, K. (2013). Clubhouse peer support among individuals with psychiatric illness. International Journal of Self Help and Self Care, 7, 191-149. https://doi.org/10.2190/sh.7.2.c
  48. Biegel, D.E., Pernice-Duca, F., Chang, C.W., & D'Angelo, L. (2012). Correlates of peer support in a clubhouse setting. Community Mental Health Journal, 48, 153-160. https://doi.org/10.1007/s10597-010-9358-5  PMID:20972830
  49. Jung, S.H. & Kim, H.J. (2012). Perceived stigma and quality of life of individuals diagnosed with schizophrenia and receiving psychiatric rehabilitation services: A comparison between the clubhouse model and a rehabilitation skills training model in South Korea. Psychiatric Rehabilitation Journal, 35, 460-465. https://doi.org/10.1037/h0094580  PMID:23276240
  50. Kidong, Y., Mihyoung, L., Ji Young, L., & So Hee, K. (2012). Costs of Korean clubhouses for community mental health service. Journal of Korean Academic Social Home Care Nursing, 19(2), 119-126.
  51. Glickman, M. (2012). Personal Accounts: My recovery: A long, winding yellow brick road. Psychiatric Services, 63, 1169-1170. https://doi.org/10.1176/appi.ps.631201  PMID:23203356
  52. Kidong, Y., Kunsook, B., Mihyoung, L. (2012). Recovery of people living with mental illness: A concept analysis. Journal of Korean Academic Social Home Care Nursing, 19(1), 46-54.
  53. Schonebaum, A. & Boyd, J. (2012). Work-ordered day as a catalyst of competitive employment success. Psychiatric Rehabilitation Journal, 35, 391-395. https://doi.org/10.1037/h0094499  PMID:23116381
  54. McKay, C.E., Osterman, R., Shaffer, J., Sawyer, E., Gerrard, E., & Olivera, N. (2012). Adapting services to engage young adults in ICCD clubhouses. Psychiatric Rehabilitation Journal, 35, (3), 181-188. https://doi.org/10.2975/35.3.2012.181.188  PMID:22246116
  55. Coniglio, F., Hancock, N., & Ellis, L. (2012). Peer support within clubhouse: A grounded theory study. Community Mental Health Journal. 48(2), 153-160. https://doi.org/10.1007/s10597-010-9358-5  PMID:20972830
  56. Hancock, N., Bundy, A., Honey, A., Helich, S., & Tamsett, S. (2012). Measuring the later stages of the recovery journey: Insights gained from clubhouse members. Community Mental Health Journal, 49(3), 323-30. https://doi.org/10.1007/s10597-012-9533-y
  57. Clements, K. (2012). Participatory action research and photovoice in a psychiatric nursing/clubhouse collaboration exploring recovery narrative. Journal of Psychiatric and Mental Health Nursing, 19(9), 785-91. https://doi.org/10.1111/j.1365-2850.2011.01853.x  PMID: 22212193

1. McKay, C., Nugent, K.L., Johnsen, M., Eaton, W.W., & Lidz, C.W. (2016). A systematic review of evidence for the clubhouse model of psychosocial rehabilitation. Administration and Policy in Mental Health and Mental Health Services Research, 1-20. https://doi.org/10.1007/s10597-016-0041-3 PMid:27380210

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.

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2. Hwang, S., Woody, J., & Eaton, W.W. (2016). Analysis of the association of clubhouse membership with overall costs of care for mental health treatment. Community Mental Health Journal, 53 (1), 102-106. https://doi.org/10.1007/s10597-016-0041-3 PMid:27380210

We examined whether frequency of attendance at the B’More Clubhouse was associated with lower mental health care costs in the Medicaid database, and whether members in the B’More Clubhouse (n = 30) would have lower mental health care costs compared with a set of matched controls from the same claims database (n = 150). Participants who attended the Clubhouse 3 days or more per week had mean 1-year mental health care costs of US $5697, compared to $14,765 for those who attended less often. B’More Clubhouse members had significantly lower annual total mental health care costs than the matched comparison group ($10,391 vs. $15,511; p < 0.0001). Membership in the B’More Clubhouse is associated with a substantial beneficial influence on health care costs.

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3. Gorman, J.A., McKay, C.E., Yates, B.T., & Fisher, W.H. (2016). Keeping clubhouses open: Toward a roadmap for sustainability. Administration and Policy in Mental Health and Mental Health Services Research, 1-10. https://doi.org/10.1007/s10488-016-0766-x

Clubhouses are recovery centers that help persons with serious mental illness obtain and maintain community-based employment, education, housing, social integration, and other services. Key informants from U.S. clubhouses were interviewed to create a conceptual framework for clubhouse sustainability. Survival analyses tested this model for 261 clubhouses. Clubhouses stayed open significantly longer if they had received full accreditation, had more administrative autonomy, and received funding from multiple rather than sole sources. Cox regression analyses showed that freestanding clubhouses which were accredited endured the longest. Budget size, clubhouse size, and access to managed care did not contribute significantly to sustainability. https://link.springer.com/article/10.1007/s10488-016-0766-x

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4. Gold, P.B., Macias, C., & Rodican, C.F. (2016). Does competitive work improve quality of life for adults with severe mental illness? Evidence from a randomized trial of supported employment. The Journal of Behavioral Health Services & Research 43(2), 155-171. https://doi.org/10.1007/s11414-014-9392-0 PMid:24504832

A randomized trial comparing a facility-based Clubhouse (N = 83) to a mobile Program of Assertive Community Treatment (PACT; N = 84) tested the widely held belief that competitive employment improves global quality of life for adults with severe mental illness. Random regression analyses showed that, over 24 months of study participation, competitively employed Clubhouse participants reported greater global quality of life improvement, particularly with the social and financial aspects of their lives, as well as greater self-esteem and service satisfaction, compared to competitively employed PACT participants. However, there was no overall association between global quality of life and competitive work, or work duration. Future research will determine whether these findings generalize to other certified Clubhouses or to other types of supported employment. Multi-site studies are needed to identify key mechanisms for quality of life improvement in certified Clubhouses, including the possibly essential role of Clubhouse employer consortiums for providing high-wage, socially integrated jobs.

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5. Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2016). The use of social environment in a psychosocial clubhouse to facilitate recovery-oriented practice. British Journal of Psychiatry Open 2(2), 173-178. http://doi.org/10.1192/bjpo.bp.115.002642 PMid:27703771

Background: Recovery-oriented language has been widely adopted in mental health policy; however, little is known about how recovery practices are implemented within individual services, such as psychosocial clubhouses. Aims: To explore how recovery practices are implemented in a psychosocial clubhouse. Method: Qualitative case study design informed by self-determination theory was utilized. This included 120 h of participant observation, interviews with 12 clubhouse members and 6 staff members. Field notes and interview transcripts were subject to theoretical thematic analysis. Results: Two overarching themes were identified, each comprising three sub-themes. In this paper, the overarching theme of 'social environment' is discussed. It was characterized by the sub-themes, 'community and consistency', 'participation and opportunity' and 'respect and autonomy'. Conclusions: Social environment was used to facilitate recovery-oriented practice within the clubhouse. Whether recovery is experienced by clubhouse members in wider society, may well depend on supports and opportunities outside the clubhouse.

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6. Bonsaksen, T., Fouad, M., Skarpaas, L., Nordli, H., Fekete, O., Stimo, T., et al. (2016). Characteristics of Norwegian clubhouse members and factors associated with their participation in work and education. British Journal of Occupational Therapy, 79(11), 669-676. https://doi.org/10.1177/0308022616639977

Abstract: Introduction: People with mental illness, in particular those with psychosis, have more problems related to getting and keeping a job than people in the general population. Clubhouses for people with mental illness are becoming increasingly common, but little is known about clubhouse members and their participation in work and education. The aim of this study was to explore these issues. Method: A member survey was conducted at one clubhouse in Oslo during February 2015. The data were analyzed with descriptive statistics and logistic regression analysis. Results: Eighty-nine clubhouse members completed the survey (response rate 55.6%). More than half of the sample had a desire to work, but only 14% participated in ordinary work. Sixty-seven percent of the participants were more than 50 years old, and they were frequent users and long-time members of the clubhouse. Higher age among the participants decreased their chances for participating in work and/or education. Conclusion: The study indicates that the clubhouse is of importance to its members, and that older members who have a desire to participate in work and/or education may be particularly challenged in their work towards such goals.

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7. Hultqvist, J., Markström, U., Tjörnstrand, C., & Eklund, M. (2016). Programme characteristics and everyday occupations in day centres and clubhouses in Sweden. Scandinavian Journal of Occupational Therapy, 24(3), 197-207. https://doi.org/10.1177/0308022616639977

Abstract: 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.

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8. Chung, C-L., Pernice-Duca, F., Biegel, D.E., Norden, M. & Chang, C-W. (2016). Family perspectives of how their relatives with mental illness benefit from clubhouse participation: A qualitative inquiry. Journal of Mental Health, 25(4), 372-378. https://doi.org/10.3109/09638237.2016.1149805 PMid:26942501

Background: Although researchers have demonstrated the benefits of psychosocial Clubhouse participation on a number of clinical and psychosocial outcomes, few studies have investigated the consumer's participation from the perspectives of others. Aim: This study aimed to investigate family members' perspectives of how Clubhouse programming has affected consumers' recovery. Method: Twenty-four relatives of Clubhouse members were interviewed using a semi-structured protocol. Relatives were nominated by their Clubhouse members as their family member who provided them with the most social support. All interviews were transcribed and underwent content analysis yielding multilevel coding. Results: Four main dimensions emerged from family interviews about how Clubhouses affected their relatives. These dimensions aligned with areas of clinical recovery and personal growth. Family members observed and noted changes in: (1) positive affective changes, (2) improved goal directed and challenging behaviors, (3) positive attitude changes and (4) greater social interactions. Conclusion: As one of the first studies to document the perspectives of the relatives of Clubhouse members, this exploratory study indicates that family members recognize positive changes in their Clubhouse family members and these changes align with areas of functional recovery. Implications for practice and future studies are discussed.

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9. Mandiberg, J. M., & Edwards, M. (2016). Business incubation for people with severe mental illness histories: The experience of one model. Journal of Policy Practice 15(1-2): 82-101. http://dx.doi.org/10.1080/15588742.2016.1109964

ABSTRACT: The Enterprise People was a business incubator for people with serious mental health conditions that operated in Madison, Wisconsin, from 1998–2005. It supported entrepreneurs with learning basic business skills, start-up processes and expenses, back office supports, ongoing problem solving, and for some, with space to conduct their businesses. The original impetus was to discover whether people with SMI histories could successfully start and operate small businesses. Although this was confirmed, the experience also uncovered factors that will allow other projects of this sort to succeed, and some core infrastructural supports that need to be created. The experience demonstrates that self-employment supported by formal business incubation is a viable option in the range of mental health vocational rehabilitation models.

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10. Prince, J. D., et al. (2016). Making connections: Severe mental illness and closeness with other people. Social Work in Mental Health, 15(1), 1-13. https://doi.org/10.1080/15332985.2016.1148095

Much has been written about social lives of people with severe mental illness (SMI). Before social lives can flourish, however, people with SMI must first get close to other people. We studied this closeness by holding three hour-long focus groups at Fountain House, a community mental health agency in New York City. We found that closeness between two people with SMI is challenging because someone with depression, for example, may have trouble understanding someone with a different disorder (e.g., schizophrenia). Romantically, closeness is also challenging—SMI is hard to explain to partners. In the workplace, closeness is difficult because SMI can alienate coworkers. It could push them away. In mental health programs, we found that closeness has more chance to develop: (1) in evening and weekend activities; (2) when activities are planned often enough to prevent isolation; and (3) when staff reach out to people before extended absence causes distance.

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11. Virkki, T. (2016). Working experiences of members of the Sörnäinen Clubhouse and their visions for improving the employment of mental health rehabilitators. Laurea University of Applied Sciences. Bachelor’s Thesis.

http://www.theseus.fi/bitstream/handle/10024/114040/Virkki_Taina.pdf?sequence=1&isAllowed=y

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12. Raeburn, T., et al. (2016). Autonomy support and recovery practice at a psychosocial clubhouse. Perspectives in Psychiatric Care. https://doi.org/10.1111/ppc.12149 PMid:26813736

Purpose: To explore how recovery practices are embodied in the behavior of staff and implemented by staff and members at a psychosocial clubhouse. Design and Methods: Case study design guided 120 hr of participation observation and 18 interviews at a psychosocial clubhouse. Data were subjected to thematic analysis guided by self-determination theory. Findings: "Autonomy support" emerged as an overarching theme, with three subthemes: "voice cultivating”, "talent scouting”, and "confidence coaching.” Practice Implications: Autonomy support is an important means of supporting the self-determination of clubhouse members. The findings of this study inform the ongoing development of the clubhouse involved and also provide insights for health services generally in relation to how to implement recovery-oriented practice.

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13. Fitzgerald, S., et al. (2016). Psychometric properties of the Vocational Rehabilitation Engagement Scale when used with people with mental illness in clubhouse settings. Rehabilitation Research, Policy, and Education, 30(3), 276-285. https://doi.org/10.1891/2168-6653.30.3.276

Abstract: Purpose: The purpose of this study was to validate the Vocational Rehabilitation Engagement Scale (VRES) for use in the Clubhouse Model of Psychosocial Rehabilitation. Method: There were 124 individuals with serious mental illness recruited from 8 Clubhouse programs in Hawaii. Measurement structure of the VRES was evaluated using exploratory factor analysis. Results: Exploratory factor analysis of the Clubhouse version of the VRES yielded 2 reliable factors (cognitive-affective engagement and behavioral engagement). Both the cognitive-affective engagement and behavioral engagement factors were found to correlate with other self-determination theory constructs including autonomy support, relatedness, and outcome expectancy. Conclusions: The Clubhouse version of the VRES is a brief, reliable, and valid instrument for assessing vocational rehabilitation (VR) engagement and contributes to the use of self-determination as a paradigm for improving recovery outcomes in psychiatric rehabilitation.

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14. Akiba, C.F. & Estroff. S.E. (2016). The business of staying in business: North Carolina Clubhouse programs. American Journal of Psychiatric Rehabilitation, 19(2), 97-102. https://doi.org/10.1080/15487768.2016.1162756

Clubhouse Model Programs in North Carolina are threatened by significant local and state reimbursement mechanisms. The goal of this study was to examine the impact of diminished state resources and administrative changes on the ground, from the perspective of Clubhouse members and staff at two Clubhouses in North Carolina. The lead author conducted participant observation for five weeks at each site engaging in various daily activities with members and staff, conducting conversational interviews, and reviewing program administrative data to corroborate findings. Income lost to decreased Psychosocial Rehabilitation (PSR) rates, decreased billable hours, and an increased delivery of non-reimbursed services represented a significant net cost to the Clubhouses’ operations and finances. The impact of these costs varied between the two organizations largely due to differing policies enacted by their Local Management Entities (LMEs). The costs of forced budgetary changes at the state level created varying degrees of hardship between clubhouses and their service missions.

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15. Battin, C., et al. (2016). A systematic review of the effectiveness of the clubhouse model. Psychiatric Rehabilitation Journal, 39 (4), 305-312. https://doi.org/10.1037/prj0000227 PMid:27786524

Objective: The aim of the article is to synthesize studies that investigate the effectiveness of clubhouses, to summarize the strength of the evidence for this model, and to discuss methodological issues in the research. Methods: We collected 216 studies referencing clubhouses in the principal international scientific databases (PsycINFO, Psycarticles, Academic Search Premier, Medline, PubMed, and Science Direct). We then selected 77 studies that used experimental (randomized controlled trial) or quasi-experimental designs (with control group, without randomization and/or pre–post studies). As part of the 77 selected studies, we focused on 15 studies that specifically addressed the effectiveness of clubhouses. Results: There are few studies on the effectiveness of clubhouses, and the existing studies, because of their methodological design, allow us to affirm only moderate (quality of life, employment, rate of hospitalization) or low (symptomatology, social functioning) levels of evidence for the effectiveness of clubhouses. Most studies are limited by a lack of randomization, absence of a comparison group, or absence of a longitudinal design. Furthermore, the diversity of methodologies used makes a comparison of the results difficult. Conclusions and Implications for Practice: We offer several recommendations for future research to build the evidence base regarding this model and enhance comparability of studies.

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16. Raab, P.A., Claypoole, K.H., Rhoads Merriam, K., Subica, A.M., Larsen, J.D., Chow, M,, & Golis, K. (2015). Indicators of success: academic research partnerships to implement performance indicator systems in clubhouses. Psychiatric Rehabilitation Journal, 37(7), 55-57. DOI:10.1037/prj0000023 PMID: 24274063

This article describes collaboration between academic researchers and Clubhouses to develop and implement a statewide Clubhouse performance indicator system. PURPOSE: Given the challenging funding climate, it is important that Clubhouses are able to gather service provision and performance data. However, establishing the necessary data structures can be a daunting task, and partnerships with academic researchers can aid in this process. We detail one such collaboration, utilizing a participatory research public-academic liaison framework, between researchers and Hawai'i's Clubhouses. SOURCES USED: Sources used include published literature, personal communication, and personal observation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Lessons learned during the collaboration include the importance of face-to-face contact, technology training, duplicated and unduplicated variables, and tailoring data structures to the culture and work-ordered day of each Clubhouse. Experiences in this collaboration confirm that with support Clubhouse members are capable of fulfilling the rigorous responsibilities of contributing to a performance indicator system.

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17. Farmer, S. (2015). Spotlight on the safety net: Traumatic brain injury clubhouses in North Carolina. North Carolina Medical Journal, 76, 123-124. https://doi.org/10.18043/ncm.76.2.123 PMid:25856361

Abstract: Traumatic brain injury (TBI) is a major and growing public health problem in North Carolina. Individuals who have experienced a moderate to severe TBI require a continuum of care involving acute hospitalization and post-acute rehabilitation; the latter should include community reintegration that, ideally, allows them to return home and to function as a productive member of the community. Specialized clubhouse/day programs are one model of community reintegration that has demonstrated some success.

A brain injury clubhouse is a community center for people living with the effects of TBI. The clubhouse is based on a model that has been recognized for more than 70 years. In 1948, Fountain House was founded on the premise that clubhouse members could work productively and have socially satisfying lives in spite of mental illness [1]. Over the years, the clubhouse model has been adapted to accommodate other disability groups, including people with brain injuries. A clubhouse offers a safe environment where people are treated with dignity and respect. Table 1 provides online resources related to TBI clubhouses.

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18. Grinspan, Z. (2015). Brief research report: Fountain House and use of healthcare resources. Weill Cornell Medical College. Healthcare Policy & Research, 1-5.

Fountain House is a service organization dedicated to improving the lives of people with mental illness. In New York City, Fountain House provides residential rehabilitation for selected individuals. It is unclear how often these individuals use other health services, such as inpatient admissions emergency department (ED) visits, or outpatient care visits. It is also unclear how their use of these services compares to similar individuals who use residential rehabilitation services elsewhere in New York City. http://www.fountainhouse.org/sites/default/files/WCMC%20HPR%20Report%20-%20Fountain%20House%20-%201%20June%202015.pdf

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19. Gorman, J. (2015). Keeping the clubhouse open: Toward a road map for clubhouse sustainability (Doctoral dissertation), American University. Doctoral Disseration. UMI Dissertation # 3720527. http://search.proquest.com/docview/1719260709

Clubhouses are nonprofit human services organizations that provide a variety of programming including educational opportunities, housing, employment, and other supports to persons diagnosed with Serious Mental Illness (Glickman, 1992). Researchers conducted and analyzed interviews of key informants from U.S. clubhouses (N = 7) to create a basic conceptual framework for clubhouse sustainability. Retrospective multisite (N = 261) survey data were used to find the best predictors of sustainability using survival analyses. Key informants suggested immediate and long-term factors that influence clubhouse sustainability differed by circumstance. The Kaplan-Meier estimator showed that clubhouses with longer program sustainability had higher clubhouse accreditation levels (p < .001), clubhouse autonomy (p < .001), and multiple funding sources (p = .01). Cox regression analyses suggested clubhouses that were freestanding entities (p < .001) and were fully accredited (p = .025) were most likely to sustain programming over time. Future research could focus on aspects of model adherence and autonomy that increase the likelihood of program sustainability.

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20. Hancock, N., et al. (2015). Sources of meaning derived from occupational engagement for people recovering from mental illness. British Journal of Occupational Therapy, 78(8), 508-515. https://doi.org/10.1177/0308022614562789

Introduction: Engagement in meaningful occupations is of central importance in mental health recovery. The purpose of this study was to gain a richer understanding of the relationships between occupations, sources of meaning and recovery for people living with mental illness. Method: People living with mental illness (n=78) attending an Australian Clubhouse completed the recovery assessment scale and socially valued role classification scale. Qualitative and quantitative data were analysed using mixed methods. Findings: The most meaningful occupations were those most likely to provide opportunities for social connection and being valued by others. The frequency with which these socially derived sources of meaning were identified far outweighed other sources: positive sense of self; skills/personal development; time use/routine; financial gain and fun/pleasure. Neither the occupations identified as most meaningful nor the source of meaning differed depending on level of recovery. Conclusion: Irrespective of stage of recovery, socially derived aspects of meaning are most frequently prioritized by people living with mental illness. In facilitating engagement in personally meaningful occupations, occupational therapists need to understand that, for many, meaningfulness centres around inter-dependence: being with others, belonging, giving, or contributing and being valued by others.

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21. Karnieli-Miller, O., et al. (2015). "It's in the cards": The contribution of illustrated metaphor cards to exploring values within narratives. Qualitative Health Research, 27(1), 138-151. https://doi.org/10.1177/1049732315609897 PMid:26489712

In this article, we present the use of illustrated metaphorical cards as a technique to enrich the qualitative narrative interview. We examine the advantages of incorporating a projective tool to assist in constructing and understanding personal narratives of people living with severe mental illness. We interviewed 25 participants-staff and members of a clubhouse in Israel (an international community model of rehabilitation in mental health)-and sought to understand their stories focused on personal and organizational values. The findings revealed that, in most cases, the cards contributed to data collection by enhancing the interviewees' ability for expression and by facilitating richer, more comprehensive stories and descriptions. This in turn enhanced the researcher's ability to understand the messages and stories presented. The research conclusions discuss the cards' potential contribution to improving data collection and analysis. The cards became an additional channel for expressing participants' experiences, emotions, and unique voice.

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22. Pernice-Duca, F., et al. (2015). Family members' perceptions of how they benefit when relatives living with serious mental illness participate in clubhouse community programs. Family Relations, 64(3), 446-459. https://doi.org/10.1111/fare.12127

Family members provide a significant source of social support to relatives living with a serious mental health disorder, such as schizophrenia. Few public mental health programs offer families a supportive environment where their relatives can develop independence, life skills, and satisfying relationships that are not dependent on the family's involvement. The Clubhouse is one such model. Although family members are not directly involved, they may experience indirect effects from their relative's participation. Family members with relatives involved in Clubhouse (n=35) completed an in-depth semi-structured interview. Transcripts were analyzed to identify underlying themes. Five primary themes emerged ranging from less burden to greater positive family interaction. Specifically, family members attributed Clubhouses as providing a supportive external community for their loved ones, but also ameliorating negative aspects of family care and improving family interactions. Practical implications for family professionals are discussed.

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23. Okon, S., et al. (2015). Health and wellness outcomes for members in a psychosocial rehabilitation clubhouse participating in a healthy lifestyle design program. Occupational Therapy in Mental Health, 31(1), 62-81. https://doi.org/10.1080/0164212X.2014.1001012

This study describes the development, execution, and outcomes of a health and wellness program at a certified clubhouse in Southwest Florida. Individuals with severe mental illnesses are at a higher risk of co-morbid health problems and lower quality of life. The Healthy Lifestyles Design Program consisted of 16 sessions and educated members about the topics of nutrition, physical activity, spirituality, and tobacco awareness through engagement in meaningful goal-directed occupations. The projected outcomes were to empower members to engage in healthy lifestyle activities and establish resources for members within the clubhouse and community for sustainable health and wellness.

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24. Raeburn, T., et al. (2015). The contribution of case study design to supporting research on clubhouse psychosocial rehabilitation. BMC Research Notes, 8(1), 521. https://doi.org/10.1186/s13104-015-1521-1 PMid:26427943

Background: Psychosocial Clubhouses provide recovery-focused psychosocial rehabilitation to people with serious mental illness at over 300 sites in more than 30 countries worldwide. To deliver the services involved, Clubhouses employ a complex mix of theory, programs and relationships, with this complexity presenting a number of challenges to those undertaking Clubhouse research. This paper provides an overview of the usefulness of case study designs for Clubhouse researchers; and suggests ways in which the evaluation of Clubhouse models can be facilitated.

Results: The paper begins by providing a brief explanation of the Clubhouse model of psychosocial rehabilitation, and the need for ongoing evaluation of the services delivered. This explanation is followed by an introduction to case study design, with consideration given to the way in which case studies have been used in past Clubhouse research. It is posited that case study design provides a methodological framework that supports the analysis of either quantitative, qualitative or a mixture of both types of data to investigate complex phenomena in their everyday contexts, and thereby support the development of theory. As such, case study approaches to research are well suited to the Clubhouse environment. The paper concludes with recommendations for future Clubhouse researchers who choose to employ a case study design.

Conclusions: While the quality of case study research that explores Clubhouses has been variable in the past, if applied in a diligent manner, case study design has a valuable contribution to make in future Clubhouse research

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25. Tanaka, K., et al. (2015). Clubhouse community support for life: Staff–member relationships and recovery. Journal of Psychosocial Rehabilitation and Mental Health, 2(2), 131-141. https://doi.org/10.1007/s40737-015-0038-1

With signs that early interventions for severe mental illness have at best only a modest impact on longer-term outcome, a need for a long-term care and support system that facilitates recovery is resurfacing. This article describes a well-established long-term support program, the clubhouse model, drawing on qualitative interview data from 105 users and 25 staff from 5 clubhouses in the U.S. and Finland, which was analyzed using a grounded theory approach. Recurrent patterns of transformative life changes emerged. Central to these processes was a sense of equality between staff and members that transcended social roles and mental health status and was experienced as embodying trust in human potential and respecting member's choice. This staff–member relationship can be framed by the Aristotelian notion of friendship for life. The clubhouse, offering a home base to which members can return in times of need, may provide a viable safety net for recovery.

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26. Tanaka, K. & Davidson, L. (2015). Reciprocity in the clubhouse context. International Journal of Psychosocial Rehabilitation, 19(2), 21-33. http://www.psychosocial.com/IJPR_19/Reciprocity_Tanaka.html

Albeit still limited, the literature has begun to document reciprocity, including service user-provider reciprocity, as key to psychiatric recovery. This article presents a thick description of reciprocity occurring in the mental health clubhouse context, drawing on qualitative interview data from 103 users and 25 staff at 5 clubhouses in the U.S. and Finland, which was analyzed using a grounded theory approach. We found that receiving and giving support appears to be a part of everyday life at the clubhouse. We also found that this seemed conducive to recovery in that it helped users, through what we identified as clubhouse ways, to experience personhood, thereby transforming their battered sense of existence into a sense of agency and, perhaps more importantly, a sense of self-worth and being part of society. The clubhouse model may represent a viable collective approach to complement current community-based mental health systems of care that emphasize individual support.

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28. Bouvet, C., Battin, C., & Le Roy-Hatala, C. (2014). The Clubhouse model for people with severe mental illnesses: Literature review and French experiment. L’Encéphale [Epub ahead of print] [Article in French]. https://doi.org/10.1016/j.encep.2014.09.001 PMid:25438970

Abstract: 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.

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29. Swensen, A. (2014). Serious and Persistent Mental Illness (SPMI): The Impact of Clubhouse Participation on the Utilization of Mental Health Service Westminster College.

Abstract: Persons with serious and persistent mental illness (SPMI are frequent users of mental health services. Such services may be delivered by mental health and/or other medical professionals in a hospital, emergency room or outpatient clinic setting. In addition, individuals with SPMI may participate in community based mental health care programs known as Clubhouses. Here they are considered members, and participate in the day-to-day business of running the Clubhouse. This business includes placement of members in supported employment opportunities, housing, educational assistance, and a variety of other activities that promote recovery and integration into the community. However, there is no direct delivery of mental health services, such as counseling or medication management. The current study seeks to measure the impact of Clubhouse participation on the use of other mental health services. Billing records for 37 individuals with SPMIs were analyzed to determine use of inpatient, outpatient, and emergency services for a three-year period before joining a local Clubhouse, as well as the three-year period following initial contact with the Clubhouse. It was hypothesized that usage of other mental health services would decrease after participation in Clubhouse. Statistical analysis indicated no significant difference in utilization of outpatient and emergency or crisis care before, as compared to after Clubhouse participation. However, there was a trend towards significance particular to the decrease in hospital readmission after Clubhouse participation.

        Available: https://www.westminstercollege.edu/pdf/mcnair/Swensen,A_Sr.Paper_Final_Really.pdf

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30. Chang, C.W., Chung, C.L., Biegel, D.E., Pernice-Duca, F., Min, M.O., & D'Angelo, L. (2014). Predictors of loneliness of clubhouse members. Psychiatric Rehabilitation Journal, 37, 51-54. https://doi.org/10.1037/prj0000052 PMid:24660951

Abstract: Objective: Loneliness can impede subjective experiences of recovery. This study examines the relationship between clubhouse participation and loneliness using standardized instruments while controlling for age, gender, living status, and social network characteristics. METHOD: A random sample of 126 members from one clubhouse was recruited for this cross-sectional investigation. A hierarchical multiple regression analysis was performed to examine the association between participation and loneliness. RESULTS: A greater number of clubhouse visits, greater perceived availability of social support and higher levels of overall satisfaction with social network relationships were significantly related to a lower level of loneliness after controlling for covariates. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Service providers may want to pay more attention to those members experiencing loneliness and help them connect with others. Future studies using longitudinal analyses are needed to further assess the causal relationship between clubhouse participation and loneliness. Multiple aspects of participation should be examined.

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31. Gorman, J. (2014). Cost-benefit and cost-effectiveness analysis of employment services offered by the clubhouse model. Master's Thesis. American University.

Abstract: Clubhouses are community-based mental health programs that offer participants (members) educational opportunities, housing, employment, and other services (Macias, Barreira, Alden, & Boyd, 2001). Currently, clubhouses dedicate many resources towards services to help members enter into community-based employment through Transitional Employment (TE), Supported Employment (SE), and Independent Employment (IE). Benefits from employment can assist in offsetting costs to mental health services. This study measured costs of member employment services in 43 US clubhouses. The present study found several relationships between how member earnings and employment may be affected by specific member and staff characteristics. Results demonstrated that for every hour a staff member dedicates to employment services members earn $38.73 and for every one dollar invested in employment services members earn $1.31. Further, clubhouses dedicated a median of 120.55 hours and $3,438 to employment services for every member employed for at least 6 months in a given year.

Available: http://hdl.handle.net/1961/14036

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32. Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2014). Self-determination Theory: A Framework for Clubhouse Psychosocial Rehabilitation Research. Issues in Mental Health Nursing, 36(2), 145-151. https://doi.org/10.3109/01612840.2014.927544 PMid:25325308

Abstract: The Clubhouse model is a widely used approach to psychosocial rehabilitation that has been a pioneer in supporting recovery-oriented programmes. Little consideration has been given however, to the theories that guide research of the recovery practices used by Clubhouses. In this paper, we provide a description of self-determination theory, including its philosophical background followed by explanation of its relevance to health care and Clubhouse contexts. We argue that self-determination theory provides a robust social constructionist theoretical framework that is well-suited to informing research related to psychosocial rehabilitation, recovery-oriented practices, and the Clubhouse Model.

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33. Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2014). Clubhouse model of psychiatric rehabilitation: How is recovery reflected in documentation? International Journal of Mental Health Nursing, 23(5), 389-397. http://dx.doi.org/10.1111/inm.12068

Abstract: Recovery-oriented models of psychiatric rehabilitation, such as the Clubhouse model, are an important addendum to the clinical treatment modalities that assist people with chronic and severe mental illness. Several studies have described the subjective experiences of personal recovery of individuals in the clubhouse context, but limited research has been undertaken on how clubhouses have operationalized recovery in practice. The research question addressed in this paper is: How are recovery-oriented practices reflected in the documentation of a clubhouse? The documents examined included representative samples of key documents produced or utilized by a clubhouse, including public health-promotion materials and policy and membership documents. Data were subjected to content analysis, supported by the Recovery Promotion Fidelity Scale. The recovery categories identified in the documents included collaboration (27.7%), acceptance and participation (25.3%), quality improvement (18.0%), consumer and staff development (14.5%), and self-determination (14.5%). These categories show how the clubhouse constructs and represents personal recovery through its documentation. The findings are important in light of the role that documentation can play in influencing communication, relationships, and behavior within organizations. The findings can also be used to inform future research related to recovery-oriented practices in clubhouse settings.

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34. Tanaka, K. & Davidson, L. (2014). Meanings associated with the core component of clubhouse life: The Work-Ordered Day. Psychiatric Quarterly, 86(2), 269-83. https://doi.org/10.1007/s11126-014-9330-6 PMid:25417121

Abstract: Despite the clubhouse model's 60-year existence internationally, the central nature of its core program, the "work-ordered day" (WOH) (Beard et al. in Psychosocial Rehabilitation Journal 5:47-53, 1982), is not well understood; hence, the primary focus of the present study was to explore members' experiences of the nature and meaning of the WOH. The study drew on qualitative interview data collected in 2009-2013 through open-ended questions and probes with 102 members and 24 staff from 5 Clubhouse International-certified clubhouses (2 US and 3 Finnish). Participant observation supplemented the interviews and all data were analyzed using a grounded theory approach (Charmaz in Rethinking methods in psychology, 1995; Glaser and Strauss in The discovery of grounded theory: strategies for qualitative research, 1967). Two major themes clustered around: (a) WOH in service of autonomy (things to do, sense of accomplishment, respite, development of occupational skills) and (b) WOH in service of relationships (receiving support; collaboration; and making contributions to the clubhouse community). Clubhouse members appeared to experience the WOH as meaningful because it helps them, as its best, reconstruct a life, develop their occupational self and skill sets, and experientially learn and live what parallels a good life in the general community. It appears that these experiences, interconnecting with the fundamental human needs for autonomy and relationship, point to wellbeing and recovery as part of personal growth. These findings can guide clubhouse daily practice in assessing members' psychosocial strengths and needs pertaining to recovery. Future research should elaborate on influences of sources of meaning, including work designs and the contributions of everyday socio-cultural interactive and reciprocal processes to these meanings

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35. Tsoi, E., Lo, I., Chan, C., Siu, K., & Tse, S. (2014). How recovery oriented are mental health services in Hong Kong? Snapshots of service users' perspectives. Asia Pacific Journal of Social Work and Development, 24, 82-93. https://doi.org/10.1080/02185385.2014.885211

Abstract: Today we are witnessing a slow paradigmatic shift in Hong Kong's mental health services to becoming more recovery oriented, the context, meaning and process of which, however, is highly individualised as well as culturally sensitive. Therefore, it is imperative to gather the voices of service users. This paper serves to capture the views of a group of service users on the changes they have seen and the ongoing challenges in mental health services in Hong Kong; and to compare the Hong Kong experience with international experience with a view to reflecting on the directions for future development. Today we are witnessing a slow paradigmatic shift in Hong Kong's mental health services to becoming more recovery oriented, the context, meaning and process of which, however, is highly individualised as well as culturally sensitive. Therefore, it is imperative to gather the voices of service users. This paper serves to capture the views of a group of service users on the changes they have seen and the ongoing challenges in mental health services in Hong Kong; and to compare the Hong Kong experience with international experience with a view to reflecting on the directions for future development.

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36. Biegel, D.E., Pernice-Duca, F., Chang, C-W., Chung, C-L., Min, M.O., & D'Angelo, L. (2013). Family social networks and recovery from severe mental illness of clubhouse members. Journal of Family Social Work, 16, 274-296. https://doi.org/10.1080/10522158.2013.794379

Abstract: This study examined the contribution of family social network variables to recovery among Clubhouse members. A random sample of 118 members from one Clubhouse was recruited for this cross-sectional study. Among all respondents, greater overall family support and better relationship quality with the most supportive network member were correlated with greater levels of recovery. Clubhouse members perceived higher quantity and quality of support and more criticalness from their most supportive network members, principally family members, compared to the rest of their family members. Longitudinal studies are needed to further investigate the relationship between family support and recovery.

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37. Chapleau, A. & Powers Dirette, D. (2013). An evaluation of the potential effectiveness of a tai chi program for health promotion among people with severe mentall illness. The Open Journal of Occupational Therapy, 1(2), 1-13. https://doi.org/10.15453/2168-6408.1036

Abstract: In response to the significant health disparities among persons with severe mental illness (SMI), this pilot study was developed to evaluate the potential effectiveness of a Tai Chi program provided to adults who are members of a psychosocial clubhouse program. A non-randomized, controlled pretest-posttest design was used, and qualitative data from a program evaluation survey is shared to provide insight into the strengths and limitations of this explorative study. A simplified, beginner-level Tai Chi program was provided twice a week for 12 weeks. Changes in cardiac and pulmonary function and perceived quality of health were measured. Results support the potential for Tai Chi to promote health among this population. Challenges to conducting this type of research are discussed, as well as implications for future, larger studies of health promotion interventions.

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38. Conrad-Garrisi, D. L. & Pernice-Duca, F. (2013). The relationship between sense of mattering, stigma, and recovery: An empirical study of clubhouse participants in the U.S. Midwest. International Journal of Self Help and Self Care, 7, 41-57. https://doi.org/10.2190/SH.7.1.d

Abstract: Individuals who experience a sense of mattering are more likely to experience higher levels of psychosocial well-being. Individuals with serious mental illness (SMI) often experience ostracism and social rejection rather than a sense of mattering, partly due to the stigma associated with SMI. Examining sense of mattering as a component of social support is a contribution of this study. Clubhouses provide support and assistance to individuals with SMI. The clubhouse program provides an intentional environment that creates a sense of community and offers an opportunity to develop sense of mattering, build skills, and develop peer relationships, which promotes recovery. A sample of 143 clubhouse members from 10 clubhouses participated in interviews about experiences of being a clubhouse member; perceptions of sense of mattering, stigma, and recovery. Results confirmed a sense of mattering is predictive of a subjective recovery. Individuals that experience a greater sense of mattering experienced less perceived stigma.

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39. Doyle, A., Lanoil, J., & Dudek, K.J. (2013). Fountain House: Creating community in mental health practice. New York, New York: Columbia University Press.

Abstract: Often people with mental illness feel alone in society, with no place to go and little hope. Their isolation can be further perpetuated through typical approaches to treatment, such as case management and psychotherapy. Since 1948, the Fountain House "working community" has worked to address the isolation and social stigmatization faced by people with mental illness. This volume describes in detail its evidence-based, cost-effective, and replicable model, which produces substantive outcomes in employment, schooling, housing, and general wellness. Through an emphasis on personal choice, professional and patient collaboration, and, most important, "the need to be needed," Fountain House demonstrates that people with serious mental illness can not only live but also contribute and thrive in society. The authors also explore the evolution of Fountain House practice, which is grounded in social work and psychiatry and informs current strength-based and recovery methodologies. Its inherent humanity, social inclusivity, message of personal empowerment, and innovation—a unique approach on behalf of people suffering from mental illness—have led to the paradigm's worldwide adoption.

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40. Fitzgerald, S.D. (2013). Validating the self-determination theory as a work motivation model for Clubhouse members with severe and persistent mental illness. Dissertation # 3591017. The University of Wisconsin - Madison.

Abstract: Many vocational service providers perceive persons with severe and persistent mental illness (SPMI) to be low on work motivation, yet motivation has been considered to be the most important factor that contributes to a successful employment outcome. Moreover, there is a general lack of understanding in the field of psychiatric vocational rehabilitation about the social and psychological processes that interact to drive volitional behavior. Self-determination theory (SDT) is a useful framework from which to discern the host of social factors and the subsequent cognitive processes that influence motivation and is the central motivational framework utilized in this study from which an expanded work motivation model was developed which includes: (1) demographic covariates and disabilities related factors (e.g., age, gender, ethnicity, educational attainment, functional disability, secondary health conditions); (2) contextual factors (e.g., cultural orientation, perceived workplace stigma), and (3) the central SDT constructs (e.g., autonomy support, relatedness, vocational self-efficacy, autonomous motivation). The contributions of each of the personal, contextual, and SDT factors on the outcome variables (e.g., perceived benefits of vocational program, vocational engagement, stages of change in employment readiness), were examined through a hierarchical regression analysis. The study found that overall, the expanded work motivation model based on SDT accounted for over 51% of the variance in perceived benefits of vocational program, 57% of the variance in vocational engagement, and 43% of the variance in stages of change related to employment readiness for persons with SPMI who are participating in the Clubhouse psychosocial rehabilitation program. This study contributes new knowledge about the utility of SDT to examine work motivation factors for persons with SPMI who are traditionally considered "amotivated" to work. Implications for vocational rehabilitation counseling practice to consider autonomy supportive choices for vocational engagement, enhancing relatedness and vocational self-efficacy among the Clubhouse members participating in vocational rehabilitation and the important consideration to cultural orientation (e.g., interdependent self-construal, independent self-construal) for ethnically diverse Clubhouse populations, are indicated. However, the lack of members actually working for pay and the high number of members receiving both cash and non-cash public support benefits (e.g., SSI, SSDI), are inherent limitations of this study and should be considered for future research

Available: http://gradworks.umi.com/35/91/3591017.html

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41. Hancock, N., Bundy, A., Honey, A., Helich, S., & Tamsett, S. (2013). Measuring the later stages of the recovery journey: Insights gained from clubhouse members. Community Mental Health Journal, 49, 323-330. https://doi.org/10.1007/s10597-012-9533-y PMid:22825568

Abstract: The Recovery Assessment Scale (RAS) is a frequently used measure of recovery from mental illness but has previously been shown to poorly differentiate between more recovered consumers. This research aimed to: (1) identify components of later recovery stages; (2) ascertain the extent to which these are measured in the RAS; and (3) suggest modifications to improve the ability of the RAS to differentiate between more recovered consumers. Clubhouse members who scored high on the RAS participated in focus groups in which they discussed areas of recovery most recently or yet to be achieved. Constant comparative analysis of data indicated that later stages of recovery are characterized by: (a) accepting your illness and gaining control over symptoms (b) self love and optimism, (c) doing things for and experiencing pleasure, (d) contributing through meaningful activity, (e) having a diversity of friendships, (f) being needed and valued by others and (g) coming to terms with family relationships. Results suggest the RAS would be improved by addition of items, particularly in functional and social recovery domains.

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42. Jones, N., & Jansson Selim, A. (2013). Education - the rainbow at the end of the tunnel. A study of a supported education program in a consumer-operated organization, with a focus on experiences of stigma. Bachelor's thesis Ersta Skondal University College, Stockholm, Sweden.

Abstract: Experiences of stigma, isolation and discrimination are major barriers to accomplished higher education for people with mental illness. It has been argued that students are not receiving sufficient support to overcome these barriers. This qualitative study explores perceptions and experiences of barriers to education with focus on stigma amongst participants in a Supported Education program. The Supported Education (SEd) program in this study is located in a consumer-operated organization, Genesis Club in Worcester, Massachusetts. The empirical material was collected through a two weeks participant observation in Genesis Club's Career Development Unit and through six interviews with members of the Clubhouse. The results show that the informants' experiences of stigmatization have acted as a barrier to education. The SEd program at Genesis Club assists the participants in overcoming barriers. Peer support, role models, empowerment, not using labels, focusing on what you can contribute are all examples of factors that are present in the informants' narratives about the SEd program at Genesis Club. Earlier research has shown that these are all factors that can counteract self-stigmatization. To problematize the results, the study has been inspired by theories on labeling and stigma.

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43. Karlsson, M. (2013). Introduction to mental health clubhouses: How the Fountain House Clubhouse became an international model. International Journal of Self Help and Self Care, 7, 7-18. https://doi.org/10.2190/SH.7.1.b

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44. Mandiberg, J.M. & Edwards, M. (2013). Collective identity formation in the mental health clubhouse community. International Journal of Self Help and Self Care, 7, 19-39. https://doi.org/10.2190/SH.7.1.c

Abstract: Contemporary community-based mental health programs are predominantly individually focused. Those programs provide few opportunities to develop collective identity among service users. Yet several lines of identity research have demonstrated that strong and positive collective identity may buffer the ill effects of stigma and discrimination on individuals from stigmatized populations. This article reviews that research and through it analyzes the Fountain House model mental health clubhouse and the international clubhouse movement. The collective, mutual aid and social movement activities within and between clubhouses are considered in light of their contribution to collective identity formation. The article concludes with an appeal to go beyond the typical services research that is focused upon incremental improvements to interventions, and to include research on basic social and psychological processes, such as identity, to inform the way mental health services are designed.

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45. Pernice-Duca, F., Markman, B., & Chateauvert, H. (2013). Recovery in the clubhouse environment: Applying ecological and social cognitive theories. International Journal of Self Help and Self Care, 7, 181-165. https://doi.org/10.2190/sh.7.2.d

Abstract: A psychosocial model of psychiatric rehabilitation known as the Clubhouse has been founded on the principles of peer support and empowerment and now is recognized as part of the United States National Registry of Evidenced-based Practices and Programs (NREPP). The objectives of this article are to align recovery-oriented principles with clubhouse practices and offer ecological and psychological theoretical frameworks to further understand the clubhouse methodology. Specifically, Bronfenbrenner's ecological theory of development and Bandura's Social Cognitive Theory within the context of a humanistic environment are examined in relation to clubhouse programming.

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46. Raeburn, T., Halcomb, E., Walter, G., & Cleary, P.D. (2013). An overview of the clubhouse model of psychiatric rehabilitation. Australasian Psychiatry, 21, 376-378. https://doi.org/10.1177/1039856213492235 PMid:23817899

Abstract: OBJECTIVE: The aim of this article is to provide an overview of the clubhouse model and its capacity to assist people with severe mental illness. METHOD: The paper uses a sample vignette (with all identifying information removed) and survey of literature describing clubhouses over the last 15 years. RESULTS: Strengths of the clubhouse model include its ability to provide a safe environment, supportive relationships and supported employment activities. Criticisms include its failure to provide onsite psychiatry clinics and a risk of promoting service dependence. CONCLUSIONS: Modern clubhouses continue to provide useful models of psychiatric rehabilitation which are popular worldwide. Studying and describing the model is challenging due to its complexity. Mixed methodological approaches and recovery-orientated measurement tools may assist future research and development.

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47. Tanaka, K. (2013). Clubhouse peer support among individuals with psychiatric illness. International Journal of Self Help and Self Care, 7, 191-149. https://doi.org/10.2190/sh.7.2.c

Abstract: The purpose of the study was to delineate peer support among clubhouse members in the context of the "work-ordered day (WOD)”, the core of the clubhouse model for psychiatric recovery. The study drew on qualitative data collected in 2009-2011 via participant observation and in-depth interviews

with 45 members and 11 staff of a clubhouse in New York City. A grounded theory approach to data analysis yielded themes including "peer to peer collaboration" during WOD and "circle of personal peer relationships" expanded as secondary to WOD participation. The study also highlighted how side-by-side WOD participation mediates these personal relationships. The clubhouse peer support, while paralleling daily patterns seen in the outside world of work, also embraced ranges of positive self-help group experiences. An underlying notion seemed to be the sense of normalcy, which can be integral to recovery. Future research should compare peer support across clubhouses in different cultures and societies.

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48. Biegel, D.E., Pernice-Duca, F., Chang, C.W., & D'Angelo, L. (2012). Correlates of peer support in a clubhouse setting. Community Mental Health Journal, 48, 153-160. https://doi.org/10.1007/s10597-010-9358-5 PMid:20972830

Abstract: The purpose of this study was to examine the social support characteristics and correlates of peer networks for Clubhouse members. A random sample of 126 members from one Clubhouse was requested to nominate social network members and asked a series of questions about characteristics of supports provided by each network member. Respondents with both peers and non-peers in their network, three fifths of the sample, had more frequent contacts with peers than with non-peers and were more satisfied with peer relationships than with non-peer relationships. Those respondents also reported that peers were less critical than non-peers. Among all respondents, being Caucasian and having better quality of social life were correlated with having a peer network while higher degree of reliance on others and more Clubhouse visits were correlated with having a Clubhouse network. Longitudinal studies are needed to further investigate the relationship between quality and benefits of peer support.

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49. Jung, S.H. & Kim, H.J. (2012). Perceived stigma and quality of life of individuals diagnosed with schizophrenia and receiving psychiatric rehabilitation services: A comparison between the clubhouse model and a rehabilitation skills training model in South Korea. Psychiatric Rehabilitation Journal, 35, 460-465. https://doi.org/10.1037/h0094580 PMid:23276240

Abstract (from journal): Objective: This study aimed to identify the perceived stigma toward, and quality of life of, individuals diagnosed with a mental illness in South Korea, and how these two variables related to the clubhouse model and the rehabilitation skills training model in psychiatric rehabilitation. Method: In August 2007, a self-report survey questionnaire regarding perceived stigma (Perceived Stigma Scale; PSS) and perceived quality of life (Korean Quality of Life; K-QOL) was administered to 521 individuals diagnosed with schizophrenia, who, at the time, had been participating in one of the two different models of psychiatric rehabilitation for over 3 months. Results: The participants in the clubhouse model group reported significantly lower PSS scores and significantly higher K-QOL scores than did the recipients of the rehabilitation skills training model. Participants in the clubhouse model reported significantly higher interpersonal relationship scores in K-QOL than did the recipients of the rehabilitation skills training model. Conclusions and Implications for Practice: The individuals who participated in the clubhouse model reported significantly lower scores of perceived stigma and higher scores of perceived quality of life than did those who participated in the rehabilitation skills training model. These findings suggest that active participation, self-determination, and increased roles in rehabilitation programs as experienced in these programs in South Korea will be effective in decreasing perceived stigma and promoting quality of life in individuals diagnosed with mental illness.

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50. Kidong, Y., Mihyoung, L., Ji Young, L., & So Hee, K. (2012). Costs of Korean Clubhouses for Community Mental Health Service. Journal of Korean Academic Social Home Care Nursing, 19(2), 119-126.

Abstract: The purpose of this study is to identify clubhouses general characteristics, core services, funding sources and costs in Korean Clubhouse Model, and to compare with Korean and international clubhouses. We explored the annual budget, cost per member, and cost per visit for 1 year. Methods: The data were collected from 14 Korean clubhouses and analyzed using descriptive statistics and Spearman's rank correlation with the SPSS 14.0 program. Results: The average of clubhouse operating period was 8.2 years. There were an average of 40.4 active members; among them, 84.1% were schizophrenia. In addition, there were an average of 5.8 staff and 15.3 services in each clubhouse. Cost estimates were as follows: annual budget (excluding housing) $223.633, cost per member $5,704, and cost per visit $21.35. There were significant differences among the annual budget, number of staff, number of service, and active members, but hours of Work-Ordered Day and social activities hours were not statistically significant. Conclusion: Findings provide a more understanding of operations, programs, and costs of Korean clubhouses.

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51. Glickman, M. (2012). Personal Accounts: My Recovery: A Long, Winding Yellow Brick Road. Psychiatric Services, 63, 1169-1170.

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52. Kidong, Y., Kunsook, B., Mihyoung, L. (2012). Recovery of People Living with Mental Illness: A Concept Analysis. Journal of Korean Academic Social Home Care Nursing, 19(1), 46-54.

Purpose: The purpose of this study is to analyze the concept of recovery in relation to those living with mental illness and provide a better understanding to the definition, perspectives, and paradigm of recovery in phenomenon, as a conceptual knowledge. Methods: A literature review was conducted to define the concept of recovery from a mental illness by using key words, “recovery”, “mental health and illness”, “concept analysis” and “recovery-oriented nursing”, and searching the Cumulative Index to Nursing and Allied Health Literature, PubMed, Cochrane library and RISS4U database. Concept analysis of recovery was done, by using the Walker and Avant’s framework of concept analysis. Results: Attributes of recovery for those living with mental illness included regain life reconstruction, hope, adjustment, and health. Antecedents of recovery from mental illness included instilling hope, recovery vision, belief, peer support, recovery-oriented services, empowerment, personal accountability, education, human rights and culture. The consequences, as meanings of recovery included self-esteem, hopeful life, positive adjustment, and healthy life. Conclusion: Concept of recovery is important for a nurse to understand when caring for a person living with mental illness. This concept of recovery from mental illness may apply to future studies to develop a recovery-oriented nursing intervention.

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53. Schonebaum, A. & Boyd, J. (2012). Work-Ordered Day as a Catalyst of Competitive Employment Success. Psychiatric Rehabilitation Journal, 35, 391-395. https://doi.org/10.1037/h0094499 PMid:23116381

Abstract (from journal): Objective: This purpose of this study was to determine whether participation in the Work-Ordered Day program of the Clubhouse model has a positive effect on vocational outcomes. Method: The longitudinal study followed a group of individuals with severe mental illness who were randomly assigned either to a Clubhouse program or a Program of Assertive Community Treatment team. Study participants were tracked for 135 weeks. These analyses evaluated the relationship between Work-Ordered Day participation and employment duration for the 43 study participants enrolled in the Clubhouse program who were active throughout the study and competitively employed during the study. Results: Participation in the Work-Ordered Day program had a significant positive impact on average duration of employment. On average, a 1-hr increase in participation prior to employment led to an increase of 2.3 weeks in competitive employment. Conclusions and Implications for Practice: Participants with more Work-Ordered Day program participation prior to employment had significantly longer average competitive employment duration even when controlling for prior work history. Participation in the Work-Ordered Day program is likely to improve work readiness. Further research is warranted to study which elements of the program may foment employment success. This could lead to increased implementation of the Work-Ordered Day program and its elements as precursors to employment for adults with severe mental illness. Available: http://psycnet.apa.org/doi/10.1037/h0094499

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54. McKay, C.E., Osterman, R., Shaffer, J., Sawyer, E., Gerrard, E., & Olivera, N. (2012). Adapting Services to Engage Young Adults in ICCD Clubhouses. Psychiatric Rehabilitation Journal, 35, (3), 181-188. https://doi.org/10.2975/35.3.2012.181.188 PMid:22246116

Abstract (from journal): Topic: This article describes efforts to develop and offer supports for young adults within two clubhouse programs affiliated with the International Center for Clubhouse Development (ICCD). Purpose: In response to a need to address service gaps and create supports to engage young adults transitioning to the adult mental health system, the authors describe the background, development, and adaptations of services and supports for young adults within their respective clubhouse programs. The authors highlight details and challenges associated with program adaptation and success stories of transition aged youth actively engaged in their clubhouses. Sources Used: Published literature, personal observation, and member feedback. Conclusions and Implications for Practice: These clubhouse programs share successful strategies used to engage young adults including outreach efforts led by young adults, developing supports and linkages with local educational institutions, addressing housing issues specific to young adults, and using current technologies that young adults find appealing. These strategies may prove useful to other service models that serve this population. Clubhouses affiliated with the ICCD show promise in expanding their approach and services to engage and support young adults.

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55. Coniglio, F., Hancock, N., & Ellis, L. (2012). Peer support within clubhouse: A grounded theory study. Community Mental Health Journal, 48(2), 153-160. https://doi.org/10.1007/s10597-010-9358-5 PMid:20972830

Abstract (from journal):

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.

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56. Hancock, N., Bundy, A., Honey, A., Helich, S., & Tamsett, S. (2012). Measuring the Later Stages of the Recovery Journey: Insights Gained from Clubhouse Members. Community Mental Health Journal, 49(3), 323-30. https://doi.org/10.1007/s10597-012-9533-y PMid:22825568

Abstract: The Recovery Assessment Scale (RAS) is a frequently used measure of recovery from mental illness but has previously been shown to poorly differentiate between more recovered consumers. This research aimed to: (1) identify components of later recovery stages; (2) ascertain the extent to which these are measured in the RAS; and (3) suggest modifications to improve the ability of the RAS to differentiate between more recovered consumers. Clubhouse members who scored high on the RAS participated in focus groups in which they discussed areas of recovery most recently or yet to be achieved. Constant comparative analysis of data indicated that later stages of recovery are characterized by: (a) accepting your illness and gaining control over symptoms (b) self-love and optimism, (c) doing things for and experiencing pleasure, (d) contributing through meaningful activity, (e) having a diversity of friendships, (f) being needed and valued by others and (g) coming to terms with family relationships. Results suggest the RAS would be improved by addition of items, particularly in functional and social recovery domains.

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57. Clements, K. (2012). Participatory action research and photovoice in a psychiatric nursing/clubhouse collaboration exploring recovery narrative. Journal of Psychiatric and Mental Health Nursing, 19(9), 785-91. https://doi.org/10.1111/j.1365-2850.2011.01853.x PMid:22212193

Abstract (from Journal):

The Clubhouse of Winnipeg (a community psychosocial rehabilitation centre) collaborated with a psychiatric nursing assistant professor on a participatory action research (PAR) project exploring the concept of recovery using a using a research method called photovoice. The collaborative project "Our Photos Our Voices" demonstrates how PAR and photovoice are well suited for collaborative research in mental health, which honors principles underlying consumer empowerment and recovery. The foundation of empowerment is the power to act on one's behalf; PAR and photovoice support the full participation of concerned individuals in all aspects of research with the ultimate goal of action to solve problems or to meet goals identified by those individuals. Empowerment is also the ability to lay claim to one's own truth. At the core of the recovery model is the principle that recovery is defined by the individual and based on individual determinations of meaningful goals and a meaningful life. The Our Photos Our Voices project uses PAR and photovoice to effectively access, explore, document and share personal, local knowledge about recovery grounded in the personal experience of the Clubhouse researchers.

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