Building a Working Community: Staff Practice in a Clubhouse for People with Severe Mental Illness
The clubhouse model is an evidence-based program providing a restorative environment for people with a psychiatric history to support their continuous growth despite the impact of severe mental illness. Clubhouses’ programmatic elements strive to enhance empowerment, competency, and recovery through members and staff working side-by-side as equals. Much of the effort to create and maintain such an environment is made possible through staff’s understanding of, and capacity to carry out the principles of a clubhouse. Although practice in a clubhouse plays such an important role, little research was conducted to explicate the intricacies of the day-to-day operation. This research project purposes to establish an empirical understanding of practice in a clubhouse, taken into account of influences at individual, program, and organizational levels.
Methods:
This grounded theory study focused on Fountain House in New York City, the original clubhouse. In addition to in-depth interviews with 25 staff members, 8 supervisors, and 15 members, the researcher conducted 220 hours of participant observation in 36 visits to all 7 program units over a five-month period. Participant observation was essential to study the nature of working relationship, because the researcher was able to have first-hand experiences of aspects of staff roles and functions and observe their interactions with members and other staff. Participant observation influenced the formulation of interview questions while interviewing was used to clarify observation and generate directions for observation. All interviews, ranging from 30 to 60 minutes in length, were verbatim transcribed and analyzed by using dimensional analysis procedures. Notes were taken on participant observation, focusing on unit characteristics, activity flow during the observed period, specific practice episodes, and reflective memos for theoretical and methodological considerations and the researcher’s reflexivity. The multiple sources (staff, members, and supervisors) and types of data (interviews and observation) provided the basis for comparative analysis.
Results:
Staff indicated intertwined practice domains of social connections, unit work, and individual needs in the clubhouse. To function as clubhouse staff, staff focused on (a) professional use of self to develop a genuine relationship to engage members, reduce power differential, model management of relational boundaries, promote positivity, and develop individualized relationships, and (b) community building to facilitate community identity, connect with the larger community, orchestrate flow of the work day, and teamwork with members and other staff. These practice foci were facilitated by the flexibility and openness of the organizational structure and the intentionality of the program design.
Implications:
The study identified a multifaceted practice model in which staff employed approaches and strategies that were fostered by specific model designs. This result may support staff training in clubhouses and the ongoing dissemination of the clubhouse model. Moreover, the identified model of practice differed significantly from traditional clinical practices. The details delineated in the findings offered basis for deliberating alternative forms of mental health service delivery and practices to support mental health recovery. Finally, participant observation allowed the researcher to have first-hand experience, which was particularly beneficial in examining nuances of complex, multifaceted practice.