Prepared For: Michigan Department Of Health And Human Services
Prepared for:Michigan Department ofHealth and Human ServicesPrepared by:Esther Onaga, Ph.D.Amy Kemp, B.S.Sudha Sankar, M.S.Department of HumanDevelopment and FamilyStudiesMichigan State UniversityEast Lansing, MichiganMICHIGAN CLUBHOUSESURVEY2014 Report
2014 Michigan Clubhouse SurveyPrepared by:Esther Onaga, Ph.D.Amy Kemp, B.S.Sudha Sankar, M.S.Department of Human Development and Family StudiesMichigan State UniversityEast Lansing, MichiganPrepared for:Michigan Department of Health and Human ServicesOctober 2015Supported by funds from Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, throughthe Michigan Department of Health and Human Services. 2015 Michigan State University.
Michigan Clubhouse Report 2014Michigan’s Clubhouse Survey has been conducted every year since2010, yielding findings in 2014 that certified Clubhouses performedbetter in employment outcomes than non certified Clubhouses. Thesedata have not only provided information to guide how Clubhouses growin Michigan, but enable understanding about organizational aspects ofClubhouses, which vary across the state. The longitudinal data onMichigan Clubhouses have allowed for confidence in statements aboutthe programmatic characteristics and conditions under whichClubhouses serve Michigan residents. This report describes theconditions and programmatic characteristics of Clubhouse programs inMichigan. Employment data are examined as well, and implications ofthe findings from these data are shared.stability of Clubhouse budgets are the figures for cost per member,which ranged from 8,033 in 2013 to 9,591 in 2011. The average costper member in 2014 was 8,762. In 2014 directors were asked, “Is yourbudget funded on the basis of ‘fee for service’ or ‘capitated?’” Fiftythree percent of the directors reported that they were on a capitatedsystem, and 43 percent reported being on a fee for service agreement.There were four accredited Clubhouses that were on capitated budgetsand four that were on a fee for service.Resource allocation. The question was, “What is the estimated yearlybudget allocation for staff, land/building, transportation, and other?”The following averages were calculated for each of the categories. Thehighest allocation went to staffing at 61.85%, followed by other at17.48%, building at 11.64%, and transportation at 6.98%.MethodStaffing (see Appendices B and C). The average number of full timestaff was very consistent across the years, ranging from 4.6 in 2014 to4.8 in 2011, 2012 and 2013. Part time staff numbers were equallyconsistent over the years. They ranged from .8 in 2013 to 1 in 2010,2011, and 2012. In 2014 the average was .9. Unionization of staff wasalso examined. Of the 39 directors who responded, 24 indicated thatstaff were not unionized and 17 indicated they were unionized. Whenthe status of unionization was examined with accreditation as avariable, seven were not unionized and one was unionized. Stafftraining is discussed in the section on accreditation.The data were collected from Clubhouse directors using Survey Monkey.In some instances, directors completed paper copies of the survey. Forthe most part the questions remained identical to those asked in years2010 2013. A few additional items were added to the 2014 surveyaround budget, staffing, and organizational affiliation of the program.ResultsThe conditions and organizational aspects of Michigan Clubhousesinclude: (1) budget, (2) staffing, (3) resource allocation, (4) membership,(5) outreach services, (6) transportation services, and (7) health andwellness services. The data revealed, in the main, consistency with thedata over time from 2010 to 2014.Membership (see Appendix D). Active membership was defined byhaving attended the Clubhouse at least once a month. It shows fairlystable numbers across the years from 2010 to 2014. From 2011 to 2014the average daily attendance was measured by counting the number ofmembers who attended the work ordered day for September 2014divided by the number of days the Clubhouse was open for the month.Budget (see Appendix A). Clubhouse budgets, highly dependent onnumber of members served, ranged from 457,010 in 2010 to 500,664in 2012. The average for 2014 was 474,186. More reflective of the1
The numbers for average daily attendance reveal that there was not asignificant increase or decrease in numbers across the five years.like for Clubhouse members. Examining employment, inclusive ofindividual and group transitional employment, supported employment,and independent employment, the largest number of members holdindependent employment and very few Clubhouses use the modality ofgroup transitional employment. As Appendix I 12 shows, a smallpercentage of Clubhouse members are affiliated with MichiganRehabilitation Services or Michigan Commission for the Blind. Sincetransitional employment is a unique feature of Clubhouses, this reportcovers a number of variables related to transitional employment. Thehighest gain in number of people employed from 2013 to 2014 occurredin individual transitional employment. Although 75% of Clubhousessupported transitional employment in 2014, 11 Clubhouses had noindividual transition employment positions. There was a significantincrease, not only with the numbers employed but equally with theirearnings (see Appendix I 2).Education (see Appendix E). The data across the five years show amodest percentage of members engaging in formal education (between4 and 6%). No significant difference was detected between accreditedand non accredited Clubhouses.Housing status (see Appendix F). The data averages across the fiveyears remain fairly consistent. However, there are differences acrossClubhouses for variables, percent of homeless, members living in grouphomes, and members being hospitalized. For example, the averagepercent of homeless people assisted in 2014 was four percent. Butthere were Clubhouses reporting 24%, 19%, 15%, and 13%. Thedifferences across Clubhouses on the percentages of members living ingroup homes are notable. The averages across the five years range from30 35%. However, there are Clubhouse differences, with the highpercentages including 78%, 68%, 59%, 58%, and 48%, and lowpercentages including 5%, 7%, 8% and 9%. Rehospitalization meanpercentages decreased from 10% to 8%. However, between Clubhousedifferences in 2014 are notable, from 0% to 23%.Another notable fact is the variety of jobs held by individual members.No Clubhouse had only one type of job. The most prevalent types ofjobs were in maintenance/janitorial followed by clerical, food service,and retail, as Figure 1 (next page) shows.Buy in to the concept of transitional employment varied. Buy instakeholders included: director, staff, members, advisory board, auspiceadministrators, and auspice board of directors (auspice meaningorganization that backs or supports the Clubhouse). All accreditedClubhouses reported they had buy in from all of the stakeholders. Theimmediate stakeholders within a Clubhouse include the director, staff,and members. Table 1 (next page) shows the distribution of buy in forthe three groups. The buy in seems to be consistent over the years andseems to be specific to the Clubhouse. If there is director buy in, thenthere is more likely to be staff and member buy in (See Appendix I 9).Housing transition (see Appendix G). The average figures for each yearfrom 2012 to 2014 suggest that Clubhouses have increased the numberof members helped around housing needs.Work ordered day (see Appendix H). The accredited Clubhousesreported higher numbers of weekly work ordered day hours over thenon accredited Clubhouses. The accredited Clubhouse hours rangedfrom 35 hours to 40 hours, in contrast to non accredited Clubhousehours, which ranged from 25 to 40 hours.Employment (see Appendix I). Employment continues to be a majoroutcome monitored for Michigan Clubhouses. This report describesvariables that provide a descriptive picture of what employment looks2
Member support services (see Appendix L). There was a slight drop inthe number of members who received outreach services from theClubhouse. Also a drop is noted in the number who received face toface outreach. In 2014 three Clubhouses show no one receivingoutreach services.Figure 1. Type of Job30252015105020122013Health and wellness (see Appendix M). The notable outcome forClubhouses is that the health initiatives indicated in years past appearto be maintained in 2014. Social activity plans are done with health andwellness in mind in almost all of the Clubhouses. Walks at lunch timeare a routine activity in almost all Clubhouses. Resources related tosmoking cessation appear to be available in most Clubhouses. The focuson health and wellness is most apparent in activities involving food inthe Clubhouse: wellness minded menu planning, food preparation andserving size, snack shop offerings, and increasing resources for healthyfoods (example: planting garden).2014Table 1. Clubhouse Stakeholder Buy InDIRECTORSSTAFFMEMBERSYearYesNoYes NoYesNo2014 77.50% 22.5% 75% 25%70%30%201370%30% 70% 30% 72.5% 27.5%2012 77.50% 22.5% 75% 25% 67.5% 32.5%Social connectedness and community involvement (see Appendix N).Volunteering independent of Clubhouse opportunities and thoseopportunities sponsored by the Clubhouse are a part of mostClubhouses. The numbers are lower for independent volunteering thanClubhouse sponsored events. In 2014 there were three Clubhouses withno independent volunteers and four Clubhouses not offering Clubhousevolunteer opportunities. The number of members participating insocial/recreational activities sponsored by the Clubhouse indicates adrop from 2013 to 2014. In 2014 there were four Clubhouses that had 0members participating in these activities.Transportation (see Appendix J). The average numbers across the fiveyears appear to be fairly stable, but looking across Clubhouses thenumbers widely vary. They range from no one receiving transportationservices to 120 members receiving services.Access to Clubhouse (see Appendix K). Access was defined as numberof days the Clubhouse was open in the evenings, weekends, andholidays. The average number of days across the years remained fairlystable, between 73 and 80 days. The numbers across Clubhouses werevariable from one day to 233 days.Accreditation (see Appendix O). In 2014 we measured staffinvolvement with training provided by Clubhouse International, theaccreditation body for Clubhouses. Interest in accreditation washeightened given the SAMHSA award of Clubhouse being evidencebased for accredited Clubhouses. Given the goal of Michigan supportingevidence based practices, the accreditation factor for Clubhouses has3
become increasingly important. The directors provided informationabout where their Clubhouse was in the pursuit of accreditation. Thechart below (Figure 2) shows the Michigan Clubhouses’ distribution ontheir effort to become accredited. Four of the directors reported nointerest in going after accreditation and 10 other directors checked“other” with explanations that might also indicate no interest at thistime. However, 11 Clubhouses had made good progress in either gettingtraining from the Clubhouse International training sites or arranging fora site visit (see Figure 2).Figure 3. Who Has Received TrainingNeitherdirector norstaff trained15%Both directorand staff/memberstrained67%Figure 2. Progress toward AccreditationAccredited23%20%10%27%Directortrained butnot staff5%In Process towards accreditation(enrolled for or completedtraining)Working towards accreditation(planning)Staff trainedbut notdirector13%Figure 4. Date of TrainingNot interested in accreditation20%20Other1510Another measure was who of the unaccredited Clubhouses hadcurrently received training (see Figure 3). CI offers training of directors,staff, and members. Directors of six Clubhouses reported that no one inthe Clubhouse had been trained at a CI training site and 26 Clubhouseshad both directors and staff/members trained.502010 20142005 2009DirectorHow recent was the training was next examined in increments of about5 years (see Figure 4). Eighteen directors and 24 staff/members hadreceived training in the last 10 years. Training is critical, as Clubhouseadministrators and staff need to be knowledgeable about what is aquality program.2000 2004 2000StaffA few questions focused on the director’s training: “Has the director ofthe Clubhouse been to 2 or 3 week trainings at ClubhouseInternational?” “When was the last time the Director has been to4
training?” Have members or staff been to 2 or 3 week training?” and“When was the last time staff or members went to training?”example, the highly varied percentages of members residing in grouphomes across Michigan Clubhouses suggest that there are communitieswith a larger prevalence of group homes than others. The same mayapply to the number of homeless served.Summary, Limitations and ImplicationsIn the main, the data across five years provide stable information aboutMichigan Clubhouses. The data describe access to the program, fundingand staffing structures, services delivered, social and communityconnections, and outcomes for members. Three areas of focus from thedata for 2014 include: employment, health and wellness, andaccreditation.Michigan Clubhouses continue to strive for excellence. The 2015 datashow that Michigan has eight accredited Clubhouses out of the 40, andthat there are 11 Clubhouses that have either arranged for a site visit orattended training with hopes of receiving accreditation. A conversationwith Clubhouse directors having no interest in accreditation may beuseful. Perhaps they can provide a rationale for their disinterest.Barriers and incentives encountered in the work related to accreditationmight be helpful to examine.The somewhat low percentage of members interested in employmentshould be explored further. Why are more members not interested injobs? With this information a strategy of how employment can beoffered to members may emerge. The 2014 employment data continueto suggest that accredited Clubhouses have better transitionalemployment outcomes than non accredited Clubhouses. Overall, morepeople were accessing transitional employment in 2014 than in yearsprior. Most of the transitional employment programs had staffcoverage. Income from transitional employment increased in 2014 incontrast to prior years. Looking at transitional employment—not onlynumbers employed but the factors associated with their employment—would reveal how much members may be gaining from this type ofemployment. The data collected on fidelity of implementing individualtransitional employment are a place to begin. The structures supportingintegration of the employment function as part of the work ordered daystaffing, covering for absences, having diversity of types of jobs, havingjobs outside of auspice agencies, and providing long term supports areefforts that might yield more people accessing jobs and moving intomore independent jobs.Health and wellness initiatives are especially of interest with the largercommunity wanting integrative health care. The current data on healthand wellness are encouraging, for they show that the initiatives takenseem to be continued from year to year. However, what is unknown isthe linkages being made for individuals with health issues and the foodand exercise access in the Clubhouse.The data related to accreditation show a progress toward increasingnumbers of Clubhouses working toward accreditation. The sixClubhouses with neither director nor staff who received training need tobe addressed. Having a framework for implementing an evidence basedClubhouse requires leadership and staff training. There might be a needto have a refresher course for those who attended training more than10 years ago.The biggest limitation of this study is that the data are based on theClubhouse directors’ word. Clubhouses that have a data system toroutinely collect this type of information have reported that they haveinformation readily at hand. Others have struggled to respond in atimely fashion. Since the responses are the directors’ self report, forThe data related to housing may be less reflective of Clubhouse servicesthan about the community in which the Clubhouse is situated. For5
items that are highly reliant on perception, such as the questionregarding stakeholders’ buy in, those responses have to be examinedwith knowledge that the different stakeholders did not have theopportunity to respond. Rather, the directors’ perceptions determinedthe responses on those items.become an evidence based service, it may be helpful to conducttargeted observations and data collection beyond simply having thevoice of the directors. Getting feedback from the key stakeholders inthe Clubhouse would provide other voices that might confirm what thedirectors are reporting or yield a new perspective.For areas that are of high interest, such as health and wellness,employment, and organizational capacity to support the program to6
Appendices
APPENDICESA.Annual BudgetJ.TransportationB.StaffingK.Access to ClubhouseC.Support StaffL.Member Support ServicesD.MembershipM.Health and WellnessE.EducationN.Social Connectedness and Community InvolvementF.Housing StatusO.AccreditationG.Housing TransitionH.Work Ordered DayI.EmploymentIIIIII1.2.3.4.5.6.I 7.I 8.I 9.I 10.I 11.I 12.I 13.Individual Transitional Employment PositionsIndividual Transitional EmploymentGroup Transitional EmploymentSupported EmploymentIndependent EmploymentMoving from Transitional to Supported and IndividualEmploymentTransitional Employment DetailDiversity of Transitional EmploymentStakeholder Buy InTarget Employment Development CharacteristicsSupported Employment and Individual Employment DetailEmployment SupportEmployment at a GlanceNOTE: In this Appendix, clubhouse names shown in bold and marked with an asterisk (*) are accredited clubhouses.APPENDICES 1
APPENDICES 2
A. Annual BudgetClubhouseA Place of Our Own (Detroit-Wayne MH Authority)Bayside Lodge (Mid-State Health Network)Blue Water Clubhouse (Region 10)Charter House (Mid-State Health Network)Circle of Friends (SW MI Behavioral Health)Club Cadillac* (Northern MI Regional Entity)Club Interactions (Lakeshore Regional Entity)Clubhouse Inspiration (Oakland Co CMH Authority)Crossroads Clubhouse (Macomb Co CMH Services)Crossroads Clubhouse of Monroe (CMH Partnership of SE MI)Dreams Unlimited* (Oakland Co CMH Authority)Fresh Start Clubhouse* (CMH Partnership of SE MI)Friendship Clubhouse (Macomb Co CMH Services)Genesis House* (CMH Partnership of SE MI)Harmony Hall (Region 10)Heartland House (Mid-State Health Network)HOPE Center (SW MI Behavioral Health)House of Dreams (NorthCare Network)Inner City Clubhouse (Detroit-Wayne MH Authority)J-Town Clubhouse (Mid-State Health Network)Lakeshore Clubhouse (Lakeshore Regional Entity)Light of Hope (Northern MI Regional Entity)Motor City Clubhouse (Detroit-Wayne MH Authority)New Beginnings (SW MI Behavioral Health)New Directions Clubhouse (Detroit-Wayne MH Authority)New Horizons Clubhouse (Northern MI Regional Entity)New Journey Clubhouse (Mid-State Health Network)Northern Lights Clubhouse (NorthCare Network)Opportunity Center (Mid-State Health Network)Our House Clubhouse (Oakland Co CMH Authority)Outlook (SW MI Behavioral Health)Pathways Clubhouse (SW MI Behavioral Health)Petoskey Club* (Northern MI Regional Entity)Phoenix Friendship House (Detroit-Wayne MH Authority)Rainbow Connection (Region 10)Sheldon House* (Lakeshore Regional Entity)The Gathering Place Clubhouse* (Detroit-Wayne MH Authority)The Summit Clubhouse (Mid-State Health Network)Traverse House* (Northern MI Regional Entity)Visions Clubhouse (Oakland Co CMH Authority)Average2010 546,000 370,000 515,000 812,500 296,223 292,109 422,200 467,591 800,274 397,845 440,000 300,000 316,000 380,000 527,268 351,533 437,034NA 380,388 555,443 618,02
Prepared by: Esther Onaga, Ph.D. Amy Kemp, B.S. Sudha Sankar, M.S. Department of Human Development and Family Studies Michigan State University East Lansing, Michigan Prepared for: Michigan Department of Health and Human Services October 2015
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