The Clubhouse: Addressing Work-Related Behavioral Challenges Through a Supportive
Social Community
Harvey E. Jacobs, PhD
Go to previous page
Go to next page
Page 2
The Clubhouse Model
Throughout this article the words Clubhouse and Clubhouses are used interchangeably
to represent a specific service delivery model.
Membership
A Clubhouse is a consumer-directed, community-based day program that is operated
by and for its members who experience disability following brain injury. There are
no patients or clients in a Clubhouse, only members of all ages (range 17 - 70)
who take responsibility for the program's overall goals and daily direction. In
this manner people begin to re-assume positive identities and responsibility for
their goals and destiny.
"Person first" philosophy is a matter of daily Clubhouse operation. Although most
people may enter the program by virtue of neurologic impairment, each person is
recognized according to their own interests, goals and abilities. Thus, there are
no "brain injured people" in a Clubhouse, but there are people with numerous abilities,
goals and interests who also happen to have experienced brain injury. Limited staff
assist members as needed, but they are also part of the milieu and must adhere to
the same program rules as all other members.
Each member is regarded expert in expressing their needs and long-term goals. On
a regular basis each member meets with a staff member of their choice to review
past progress, establish new goals, identify Clubhouse and community resources to
meet goals, and the means to evaluate progress. Goals are rarely disputed. Instead,
members are encouraged to break down large or magnanimous goals into smaller steps
that can have immediate benefit. Thus, the member who wants to become a truck driver
will be supported in this long term goal and encouraged to first learn how to use
local transportation without getting lost. This is not only important for truck
driving, but also necessary to be able to get to appointments and other community
commitments on time. In this manner the dignity of the larger goal is maintained
while working on a smaller component that has relevance to a variety of larger options.
The emphasis on member direction purposely affects staff behavior. Because there
are insufficient staff to operate an entire Clubhouse, staff have no choice but
to work with and rely on members. By established standards 21 no program operations
can occur without member involvement. As a result, staff roles are facilitative
rather than directive and follow members' leads. Staff are also deployed opportunistically
according to member preferences, goals, and activities. Thus, the coach on a new
job is likely to be the staff who works most closely with the member at the Clubhouse.
The two already have a good working relationship and are familiar with each other's
abilities. Similarly, staff and members work together according to need rather than
a schedule. A member with few needs may use little staff time and get most of their
support from other members and the program's social milieu, while another member
in crisis may receive intensive assistance. "As needed" usage allows “zone vs. person-to-person”
deployment of staff, which provides greater flexibility and more efficient use of
available resources.
Finally, Clubhouse membership is forever. Members may transition in and out of daily
participation for many different reasons. These may include employment, school,
personal interests, other competing activities, changes in family and extended support
network structure, and so on. Members who are absent on days they customarily attend
are contacted by other members to assure they are okay (not why they failed to come
in). Identified problems are referred to the proper resources for assistance. Similarly,
members who leave a Clubhouse day program are contacted at least monthly to learn
of their status. A member may re-appear at the Clubhouse at any time and re-enter
its activities on that same day. Re-entry is rarely difficult since people know
one another and daily program routines. Returning members never crowd out currently
active members as there is always more work than can be accomplished within the
program.
Daily Organization
Between 15 and 60 members may participate in a Clubhouse on a daily basis, according
to its size and location. As with any organization tremendous work is required to
keep the program operating. Clubhouse tasks are organized into work units to aid
the efficiency and accountability of operations. Thus, the Clerical / Communications
Unit manages Clubhouse telephones, correspondence, public relations, fund raising,
newsletter publishing, tours and training of visitors, orientation of prospective
new members and other associated tasks. The Kitchen Unit plans menus, shops for
supplies, and prepares meals, beverages and snacks that are available at a nominal
cost. The Maintenance Unit keeps the Clubhouse clean, repaired and performs minor
construction. A Research Unit maintains data on attendance and other data required
for reports, reimbursement, grants and formal publications. Other Clubhouse activities
are similarly organized to facilitate overall operations.
No member is assigned to any unit or required to do any work. Members select any
unit they wish to participate in according to personal interests and can change
units at any time. Some members select a unit based on a vocational goal and the
skills that they can learn. Others select a unit based on personal interest or to
survey different jobs in order to find their work aptitude and interests. Still
other members may select a unit because of people they know, or according to other
personally relevant criteria. Members rarely move capriciously across units and
most changes are made following careful deliberation.
All work in a Clubhouse is functionally related to member goals and program operations.
Aggregate member goals set the focus and direction of the overall program and daily
program activities concomitantly help members achieve their goals. There is simply
no "make work" designed to keep members busy.
Members place a greater value and responsibility to their work since it has direct
programmatic implications. Aggregately, the success or failure of a Clubhouse may
depend on how well people work together. However, this long-term outcome is beyond
most people's awareness. Instead, the daily events direct the focus and molding
of individual member skills. Thus, members purchasing meals from the kitchen clearly
make their pleasure or concern known to the cooks. The telephone receptionist may
receive a thank you for a message he or she took for another member that resulted
in a new apartment. A member who fails to show up for a meeting with another member
will probably hear about it from the other member and how it prevented their job
from getting done. Somebody who passes off shoddy work will probably get it returned
by the recipient. Alternatively, someone who helps another member with a difficult
task will frequently receive their sincere appreciation.
This type of feedback is very concrete, generally well articulated and immediate.
Most people are willing to listen because of the supportive Clubhouse environment.
The context of the feedback is also clear since it is provided in the setting where
the work or behavior occurred. These are all critical features for any effective
behavior change program.
Program Costs
By virtue of its community basis, member direction and organizational structure,
Clubhouses can provide their full-day services for a direct cost between $30.00
and $60.00 per member per day, depending on location and organizational affiliation.
This makes long term programmatic support financially viable for many potential
members.
Skill Development
Within a Clubhouse people focus on practical goals that relate to daily life. Few
members "learn the computer," but many people learn how to keep daily logs, manage
expenses, write letters, etc., using a computer. This helps provide a direct and
immediate benefit to skill mastery.
Second, large - global skills are broken down into daily steps consistent within
program activities.
Third, the rich context of events in a Clubhouse provides broad support and numerous
cues to support learning.
Fourth, members learn experientially, through daily activities with numerous opportunities
for feedback and repetition. Training is also adapted to the manner in which each
member actually learns, rather than how they are "supposed" to learn.
Fifth, members look to one another as well as staff for training and assistance.
There is usually someone close by when help is needed.
Sixth, the long term focus of a Clubhouse supports gradual assimilation of skills,
allowing people to learn at their own pace.
Seventh, people learn skills and the situations in which the skills are customarily
used. For example, it is one thing to learn how to operate office equipment in a
classroom and another to learn how to use the equipment in an operating work environment
where other people are also using the machines, equipment failures occur, and deadlines
loom.
Finally, a Clubhouse environment is not capable of helping all members develop requisite
skills. However, through Clubhouse experience it is possible to more precisely identify
a person's training needs and refer them to more appropriate services through schools,
therapies, apprenticeships and other venues.
The daily Clubhouse milieu may also support practical and continuous assessment
of each member's strengths and challenges. Different indices can be combined to
assess different activity patterns. Thus, daily attendance, productivity with in
work units, initiation, time on task and social interaction can help determine if
a member may be capable of attempting employment. Information on a member's interpersonal
relationships, task demands, and activity levels within a Clubhouse may help to
determine when he or she is able to work with others and when behavioral decompensation
is likely to occur.
Go to previous page
Go to next page
Click here to view or download the entire document in PDF format
You will need Adobe® Acrobat® Reader to view PDF documents.
Click
here to download a free copy from the Adobe Web site
Back to the top