This descriptive study of clubhouse and socialization programs was a collaboration of staff and faculty from San Diego County, Adult and Older Adult Mental Health Services (AMHS); San Diego State University, School of Social Work; University of California, San Diego, Department of Psychiatry; and Community Research Foundation (CRF). Clients were also involved in every aspect of the study including having a client on the Investigation Team. The study, funded by AMHS and CRF, included six clubhouse and three socialization programs.
The study had three major aims: Aim 1 was to describe participating programs, Aim 2 was to supplement the program descriptions by collecting qualitative and quantitative information from a group of at least 15 randomly selected clients from each participating program, and Aim 3 was to assess program fidelity to the Fountain House Clubhouse model as specified in the 35 standards of the International Center for Clubhouse Development (ICCD).
Program directors, Governing Board Members, and clients from each program were interviewed using a semi-structured interview format. A broad array of information was collected on each program, including self-report information from each program director on compliance with each of the thirty-five ICCD Standards.
In addition, at least 15 clients who were randomly selected from each program completed interviews and standardized instruments to assess their perceptions of the program atmosphere and satisfaction with services received. Measures of level of functioning, quality of life, and empowerment were also included.
Clubhouse programs were found to be substantially different from socialization programs. In general, clubhouse programs were less structured, more client-directed and staffed, and had greater representation of clients in decision-making processes and on governing and/or advisory boards than socialization programs. Clubhouse programs tended to receive more favorable scores on client satisfaction than socialization programs. Socialization programs were more likely to have licensed staff. Neither the clubhouse or socialization programs demonstrated a systematic incorporation of ethno-cultural aspects into services provided or a structured evaluation component prior to this study.
Clubhouse programs also differed from one another. Factors that varied included: the number of members, how members were recruited, hours of operation, governance, hiring and training of staff, services provided, and program goals. In general, the level of satisfaction with services and clients' perceptions of the program "atmosphere" were somewhat similar among clubhouse programs, although certain programs consistently received more favorable scores from clients on both measures. We also found some consistency among programs receiving less favorable responses. Five of the six clubhouse programs receive funding from AMHS.
Study participants among the different clubhouse programs were similar in level of functioning, empowerment, quality of life, and diagnostic categories. However, the proportion of study participants who were competitively employed was different among clubhouses, varying from 0% to 28%, with 9% of
participants competitively employed for all programs combined. Also, the proportion of ethnic minorities (non-white) among clients varied from 27% to 93%. These differences were somewhat consistent with the ethnicity of the communities in which the programs were located.
All socialization programs are governed by the Board of Directors of the parent organization, receive referrals from similar sources, and receive funding from AMHS. Client satisfaction and clients' perceptions of the program environment among socialization programs varied from each other in somewhat consistent ways, with one program having less favorable scores than the other two. However, this finding is not surprising given that nearly all clients were homeless at that program. Specific characteristics of each program are detailed in the attached Report.
We found considerable variation in the degree of compliance to the 35 ICCD Standards among programs. Overall ICCD compliance for all programs combined was 69%, with a range from 40% to 81%.
Many of the measures used in this study would offer better utility when used over time, such as at program entry and then again after some specified time to measure change. This descriptive study provided only a "snapshot" of a given point in time at each of the participating programs. Changes have occurred in some clubhouse and socialization programs since data for this pilot study were collected.
All data collected were from self-report sources and were not corroborated. Results on fidelity to individual ICCD Standards were not weighted, although some Standards are clearly more important and/ or challenging to comply with than others.
Despite these limitations, this is the first study to provide a common set of descriptive information on clubhouse and socialization programs in San Diego County. We hope this information will be useful to clubhouse and socialization programs for quality improvement purposes and to stimulate thinking on the utility of collecting structured program evaluation information. The study may also prove useful to inform resource allocation.