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Mutschler C, McShane K, Liebman R. Psychosocial Outcomes of Canadian Clubhouse Members: A Multi-Site Longitudinal Evaluation. Community Ment Health J 2024:10.1007/s10597-024-01280-9. [PMID: 38653870 DOI: 10.1007/s10597-024-01280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
The Clubhouse model of psychosocial rehabilitation supports individuals with mental health challenges using a person centered and recovery-oriented approach. Clubhouses around the world have been found to be effective in supporting their member's recovery. However, there is a lack of multi-site and longitudinal studies on the Clubhouse model. Therefore, the purpose of the present study was to longitudinally assess the psychosocial outcomes of Clubhouse members across six accredited Clubhouses in Canada. Due to the COVID-19 pandemic occurring midway through the study, a secondary aim was to assess the impact of the pandemic on the psychosocial outcomes of Clubhouse members. A total of 462 Clubhouse members consented to participate in the study. Members completed a questionnaire battery every 6 months over a 2-year period (five data points total). The last three data points were collected during the COVID-19 pandemic. Psychosocial outcomes included mental health symptoms, substance use, community integration, and satisfaction with life, and were analyzed using multilevel growth models. The results indicated that satisfaction with life and psychological integration increased over the study period, while mental health symptoms, substance use, and physical integration decreased. Examining Clubhouse participation, length of Clubhouse membership and frequency of Clubhouse use predicted higher life satisfaction, lower substance use, and fewer mental health symptoms over the study period. The results of the present study provide invaluable insight into the psychosocial impact of Clubhouses on Canadian Clubhouse members, particularly during COVID-19.
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Affiliation(s)
| | - Kelly McShane
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, ON, Canada
| | - Rachel Liebman
- Department of Psychiatry, Centre of Mental Health, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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Hinchey LME, Pernice FM, Christian JN, Michon A, Rice K. A Contemporary Review of the Clubhouse Model of Psychosocial Rehabilitation: Past, Present, and Emerging Directions. Psychiatr Q 2023; 94:569-604. [PMID: 37796378 DOI: 10.1007/s11126-023-10051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/06/2023]
Abstract
Since the 1940s, the Clubhouse model of psychosocial rehabilitation has evolved towards a comprehensive practice of social theory and intervention. Despite the model's cost effectiveness and observational evidence of its efficacy, empirical research remains lacking. The current narrative review examines studies from recent years (2015-2021), not to assess study rigor, but to identify trends in research aims, findings, and methodology, as well as specify future research directions. A narrative review was conducted using PRISMA guidelines. Using the search term "Clubhouse," 194 articles were identified in online databases. 38 met criteria for inclusion. Most studies were qualitative (60.5%) and few utilized experimental or quasi-experimental designs (7.9%). Narrative synthesis revealed research aims and outcome variables falling into six key areas: social integration and connectedness, quality of life (QOL), recovery outcomes, relational dynamics, policy, and virtual adaptations of the model. Findings indicate that recent Clubhouse-related research trends have primarily involved studies of social connectedness, QOL, recovery, relationships, and policy, as well as studies examining the value of the virtual Clubhouse in maintaining well-being. However, heterogeneity of methodologies and measures present a critical limitation to assessing results across studies. Options for increasing experimental methodologies in this area are reviewed. Recommended future directions involve moving towards a biopsychosocial approach to clarifying the mechanisms through which the model promotes recovery-aims that may yield implications beyond the realm of serious mental illness.
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Affiliation(s)
- Liza M E Hinchey
- Department of Theoretical and Behavioral Foundations, College of Education, Wayne State University, 5425 Gullen Mall, Education Building, Room 351, Detroit, MI, 48202, USA.
| | - Francesca M Pernice
- Department of Theoretical and Behavioral Foundations, College of Education, Wayne State University, 5425 Gullen Mall, Education Building, Room 351, Detroit, MI, 48202, USA
| | - Janay N Christian
- Department of Theoretical and Behavioral Foundations, College of Education, Wayne State University, 5425 Gullen Mall, Education Building, Room 351, Detroit, MI, 48202, USA
| | - Amber Michon
- Department of Theoretical and Behavioral Foundations, College of Education, Wayne State University, 5425 Gullen Mall, Education Building, Room 351, Detroit, MI, 48202, USA
| | - Kevin Rice
- Fountain House New York, 425 West 47Th Street, New York, NY, 10036, USA
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Harvey C, Zirnsak TM, Brasier C, Ennals P, Fletcher J, Hamilton B, Killaspy H, McKenzie P, Kennedy H, Brophy L. Community-based models of care facilitating the recovery of people living with persistent and complex mental health needs: a systematic review and narrative synthesis. Front Psychiatry 2023; 14:1259944. [PMID: 37779607 PMCID: PMC10539575 DOI: 10.3389/fpsyt.2023.1259944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Objective This study aims to assess the effectiveness of community-based models of care (MoCs) supporting the recovery of individuals who experience persistent and complex mental health needs. Method We conducted a systematic review and narrative synthesis of MoC studies reporting clinical, functional, or personal recovery from October 2016 to October 2021. Sources were Medline, EMBASE, PsycInfo, CINAHL, and Cochrane databases. Studies were grouped according to MoC features. The narrative synthesis was led by our researchers with lived experience. Results Beneficial MoCs ranged from well-established to novel and updated models and those explicitly addressing recovery goals and incorporating peer support: goal-focused; integrated community treatment; intensive case management; partners in recovery care coordination; rehabilitation and recovery-focused; social and community connection-focused; supported accommodation; and vocational support. None of our diverse group of MoCs supporting recovery warranted a rating of best practice. Established MoCs, such as intensive case management, are promising practices regarding clinical and functional recovery, with potential for enhancements to support personal recovery. Emerging practice models that support personal and functional recovery are those where consumer goals and priorities are central. Conclusion Evidence for established models of care shows that there is a need for inevitable evolution and adaptation. Considering the high importance of effective MoCs for people experiencing persistent and complex mental health needs, further attention to service innovation and research is required. Greater emphasis on the inclusion of lived and living experience in the design, delivery, implementation, and research of MoCs is needed, to enhance MOCs' relevance for achieving individual consumer recovery outcomes.
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Affiliation(s)
- Carol Harvey
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
- North West Area Mental Health, Division of Mental Health, Northern Health, Melbourne, VIC, Australia
| | - Tessa-May Zirnsak
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
| | - Catherine Brasier
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
| | | | - Justine Fletcher
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Bridget Hamilton
- Centre for Mental Health Nursing, Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Helen Killaspy
- Department of Epidemiology and Applied Clinical Research, Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Peter McKenzie
- The Bouverie Centre, School of Psychology and Public Health, La Trobe University, Brunswick, VIC, Australia
| | - Hamilton Kennedy
- Centre for Mental Health Nursing, Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Lisa Brophy
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
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The Impact of COVID-19 on Clubhouse Employment Programs. Community Ment Health J 2023; 59:523-530. [PMID: 36319915 PMCID: PMC9628341 DOI: 10.1007/s10597-022-01036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
The Clubhouse model of psychosocial rehabilitation provides several employment opportunities to individuals who experience mental health concerns, including transitional, supported, and independent employment. The COVID-19 pandemic resulted in Clubhouses having to adapt existing programs to online formats. Employment programs were further impacted, as many workplaces in the community closed or reduced capacity. The present study aimed to examine the rates of involvement in transitional, supported, and independent employment across six Clubhouses in Canada throughout the pandemic. 462 members completed surveys at five time points pertaining to participation in Clubhouse employment programs. The data was analyzed using Cochran's Q tests to determine differences in employment rates across time points. The results demonstrated an overall decrease in transitional and supported employment rates throughout the pandemic. Conversely, rates of independent employment were unchanged. It is evident that Clubhouse employment programs assist members in obtaining employment. The results suggest Clubhouses may benefit from exploring novel employment opportunities to support their members, such as remote work.
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Siddiqui S, Morris A, Ikeda DJ, Balsari S, Blanke L, Pearsall M, Rodriguez R, Saxena S, Miller BF, Patel V, Naslund JA. Scaling up community-delivered mental health support and care: A landscape analysis. Front Public Health 2022; 10:992222. [PMID: 36568763 PMCID: PMC9773996 DOI: 10.3389/fpubh.2022.992222] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/27/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction The mental health crisis has caused widespread suffering and has been further exacerbated by the COVID-19 pandemic. Marginalized groups are especially affected, with many concerns rooted in social determinants of mental health. To stem this tide of suffering, consideration of approaches outside the traditional biomedical model will be necessary. Drawing from task-sharing models of mental health care that have been pioneered in low-resource settings, community-initiated care (CIC) represents a potentially promising collection of approaches. This landscape analysis seeks to identify examples of CIC that have been implemented outside of the research context, with the aim of identifying barriers and facilitators of scale up. Methods A narrative review approach was used for this landscape analysis in which the PubMed database was searched and further supplemented with Google Scholar. Promising programs were then discussed over multiple rounds of meetings with the research team, consisting of collaborators with varied experiences in mental health. Using the selection criteria and feedback derived from group meetings, a final list of programs was identified and summarized according to common characteristics and features. Results The initial PubMed search yielded 16 results, supplemented by review of the first 100 entries in Google Scholar. Through 5 follow-up meetings among team members, consensus was reached on a final list of 9 programs, which were grouped into three categories based on similar themes and topics: (1) approaches for the delivery of psychosocial interventions; (2) public health and integrative approaches to mental health; and (3) approaches for addressing youth mental health. Key facilitators to scale up included the importance of sustainable financing and human resources, addressing social determinants and stigma, engaging diverse stakeholders, leveraging existing health infrastructure, using sustainable training models, ensuring cultural relevance and appropriateness, and leveraging digital technologies. Discussion This landscape analysis, though not an exhaustive summary of the literature, describes promising examples of efforts to scale up CIC outside of the research context. Going forward, it will be necessary to mobilize stakeholders at the community, health system, and government levels to effectively promote CIC.
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Affiliation(s)
| | - Angelika Morris
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | - Satchit Balsari
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | | | | | - Shekhar Saxena
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Benjamin F. Miller
- Well Being Trust, Oakland, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
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Tanaka K, Stein E, Craig TJ, Kinn LG, Williams J. Conceptualizing participation in the community mental health context: Beginning with the Clubhouse model. Int J Qual Stud Health Well-being 2021; 16:1950890. [PMID: 34252011 PMCID: PMC8276650 DOI: 10.1080/17482631.2021.1950890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Although participation is key to community mental health, the concept remains elusive. The study explored a conceptualization of participation in the community-based mental health agencies context from a first-person perspective, using the Clubhouse model as an example. Methods Qualitative data, collected from 21 Clubhouse service users through three focus groups (1 UK and 2 US) for primary analysis and secondary data from 104 individual interviews, were analysed using a grounded theory approach. Results Focus group narratives revealed three main domains of what may be named everyday participation process, Making Decisions, Doing Work, and Locating Oneself in Community, blended with each other rather than forming clear-cut stages. Sixty-six extracted primary codes, with two underlying interrelated core categories identified, named Autonomy and Egalitarian Connection, were organized by domain and by category. Conclusions The findings suggest a 3 × 2 axial model of participation that participation signifies a behaviour, comprised of three blended activity domains, entailing actions and interactions that concern Autonomy and Egalitarian Connection, which, dynamically interacting with each other, appear to condition meaningful participation the next day. Egalitarian relationship skills development appears critical for training practitioners to help promote service users’ quality everyday participation and getting-a-life-back experiences towards well-being, or meaningful life.
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Affiliation(s)
- Kimiko Tanaka
- Department of Social Welfare, Tokyo Fukushi University, Tokyo Japan
| | - Eric Stein
- Center for Social Work Education, Widener University, Chester, PA, U.S.A
| | - Thomas J Craig
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Liv Grethe Kinn
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Julie Williams
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Michon A, Hinchey L, Pernice F, Drews J, Price M, Christian J, Rice K, Kellogg L. Responding to the Global Pandemic: A Pulse of the Well-Being of Clubhouse Communities Moving Virtual. ACTA ACUST UNITED AC 2021; 8:171-183. [PMID: 33903848 PMCID: PMC8059420 DOI: 10.1007/s40737-021-00217-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/08/2021] [Indexed: 12/01/2022]
Abstract
Clubhouse communities rapidly responded to the COVID-19 pandemic to keep members connected as psychosocial rehabilitation programs were globally disrupted. This investigation aims to elucidate how Clubhouse directors responded to the pandemic and their members’ needs, while also directly assessing the needs and well-being of members. This study utilized secondary data from Director and Member surveys designed to capture Clubhouse status, member engagement, and measures of well-being. Descriptive statistics and correlation coefficients were computed across data from directors (n = 140) and members (n = 1136). Directors across 19 countries indicated that the majority of Clubhouses closed and were engaging with members using a variety of technologies, primarily Zoom videoconferencing. For members, greater levels of virtual Clubhouse engagement were positively correlated with physical and mental well-being and negatively correlated with hospitalization rates. This study provides support for an association between virtual Clubhouse engagement and well-being. Repeated measures studies are needed to further investigate this association.
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Affiliation(s)
- Amber Michon
- 351 College of Education, Wayne State University, Detroit, MI 48202 USA
| | - Liza Hinchey
- 351 College of Education, Wayne State University, Detroit, MI 48202 USA
| | - Francesca Pernice
- 351 College of Education, Wayne State University, Detroit, MI 48202 USA.,Fountain House, 425 W 47th St, New York, NY 10036 USA
| | - Jessica Drews
- 351 College of Education, Wayne State University, Detroit, MI 48202 USA
| | - Megan Price
- 351 College of Education, Wayne State University, Detroit, MI 48202 USA
| | - Janay Christian
- 351 College of Education, Wayne State University, Detroit, MI 48202 USA
| | - Kevin Rice
- Fountain House, 425 W 47th St, New York, NY 10036 USA
| | - Lee Kellogg
- Clubhouse International, 845 Third Avenue, 6th Floor, New York, NY 10022 USA
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