Exploring Staff Practice in a Clubhouse for People with Severe Mental Illness
The clubhouse model is an evidence-based program that provides a working community, rather than treatment or intervention, for people with a psychiatric history to support their continuous growth despite the impact of severe mental illness. People with mental illness are members to a clubhouse and the clubhouse’s programmatic elements strive to enhance recovery, empowerment, and competency through members and staff working side-by-side as equals. While the clubhouse model is well researched and documented, its practice has not been well examined. This research proposed to explore staff’s role and functions in developing the working relationship and identify specific practice approaches and strategies, while taking into account the influential factors at individual, program, and organizational levels.
Methods:
This grounded theory study focused on Fountain House in New York City, the original clubhouse. Embedded in sociology, grounded theory has a tradition of combining interviewing and field observation. The combined research approaches are particularly suitable in capturing intricacies of practice. 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 in the House over a five-month period. Participant observation influenced the formulation of interview questions while interviewing clarified observation and generated directions for observation. All interviews were verbatim transcribed and analyzed by using dimensional analysis procedures. Memos were taken from participant observation focusing on unit characteristics, activity flow, specific practice episodes, and reflective memos for theoretical and methodological considerations and the researcher’s reflexivity. The multiple modes of data collection (interviewing and observation) from multiple perspectives (staff, members, and supervisors) provided the basis for comparative analysis and triangulation.
Results:
Results confirmed the signature member-staff collaboration practice style in Fountain House. Members’ choice was fully embraced, including their decisions on attendance, tasks to partake, and staff to collaborate. To keep up operation of the House while respecting members’ autonomy, staff identified relationship as fundamental to working side-by-side as equals in the clubhouse. Staff characterized the relationship as genuine, and differentiated it from professional relationship in traditional clinical settings. Developing this relationship required a prolonged engagement process, during which staff paced themselves according to progression of mutual understandings between staff and members. To enhance mutual understandings, staff stressed the importance of observation, conversations, sharing of personal interests, and attentive listening in their interactions with members. These approaches were facilitated by the flexibility and openness of the organizational structure and the intentionality of the program design.
Implications:
Overt participant observation allowed the researcher to experience as a new comer to this working community, undergo aspects of staff roles and functions, and observe staff-member dynamics and interactions. These first-hand experiences were invaluable in verifying data from in-depth interviews, discovering contradictory scenarios for further analysis and exploration, and gaining insights into nuances in materializing the idea of “working side-by-side.” This approach also demanded the researcher’s constant ethical decision-making, particularly regarding boundary setting and level of involvement during her engagement with this community.