Beechwood NeuroRehab has adapted the Clubhouse Model, first demonstrated as successful for people with mental health challenges at Fountain House in New York City, and applied it for people with an acquired brain injury. Beechwood NeuroRehab's Clubhouse, one of only 18 in the country, utilizes the Work-Ordered Day to give people the opportunity to accomplish daily successes in the work of running the Clubhouse. This model allows “Members” to develop their individual productivity and move towards developing work skills, which can be developed using a Supported Employment model to find competitive employment. Each Member belongs to a Work Unit:
• Community Resource
The BeechTree Work Unit is actually an Affirmative Enterpise that develops and manufactures personal care products for sale through on-line and in-person sales events. Net proceeds are funneled back into the Clubhouse bank account for use as decided by the Membership. Clubhouse Members benefit by developing individual work skills, applying strategies learned from NeuroRehab therapies, and being a part of a community. This greatly enhances their self-esteem, sense of self worth, and ability to participate in everyday life activities, and the possibility to obtain competitive employment in the community.
Many behavioral health "treatment" initiatives revolve around various forms of therapy, including both individual and group. To benefit from such therapy, a person needs to understand what is going on in therapy, relate what is being discussed to their own life, remember the concepts being presented, and later apply those concepts in their everyday life. All of this depends on cognitive abilities that are frequently impaired by brain injury, including memory for new information, abstraction, reasoning, problem solving, evaluating and monitoring. The Clubhouse and Supported Employment models capitalize on a more precedural type of learning, where people learn by doing with repeated trials and coaching to help them apply strategies and refine skills within everyday life and work activities. These innovative models capitalize more on the strengths of each individual, rather than relying on older approaches that depend on impaired abilities that are not likely to improve.
Dissemination of this unique combination of Clubhouse and Supported Employment is taking many forms. At the Clubhouse dedication in 2014, Keynote Speaker Patrick Kennedy said that “ . . . we have to get to building out the community based model of care.” Staff are involved in the American Congress of Rehabilitation Medicine (ACRM) Brain Injury Interdisciplinary Special Interest Group, both the Cognitive Rehabilitation Task Force and the Pediatric Adolescent Task Force, where presentations and trainings are given. Staff are also involved with the National Collaborative on Children with Brain Injury (NCCBI), the International Pediatric Rehabilitation Collaborative (IPRC) and the Brain Injury Association of America's Academy for Certification on Brain Injury (ACBIS) all of which offer trainings. In order to further disseminate the model, the International Brain Injury Clubhouse Alliance (IBICA) is seeking to educate and promote the use of the Clubhouse Model in other organizations around the world.
The Clubhouse Model and Supported Employment are programs that, once conceived and implemented, can be sustained in an on-going fashion through various funding sources. People with brain injury can receive funding for "Structured Day" programs, for which the Clubhouse qualifies, through the PA Department of Human Services, PA Office of Long Term Living, and Medicaid (MA) Waiver Programs. There are two MA Waiver programs that support this type of work, the OBRA Waiver, for those injured before the age of 22, and the CommCare Waiver, for those injured as an adult with a TBI. In addition, the PA Office of Vocational Rehabilitation will fund Supported Employment, including Job Development, Job Placement, and Job Coaching, once an individual is demonstrated through Clubhouse, to be ready for competitive employment.
The Clubhouse Model, leading to Supported Employment, has been well demonstrated in people with mental health challenges. The application to people with brain injury has potential to serve many other populations where brain injury is a factor, but not the primary presenting problem. For example, in the prison population, it is well documented that 60% of incarcerated adults have a history of brain injury, with cognitive impairments that negatively impacts their chances for succeeding in the community once they are released. In the Juvenile Justice system it is now being documented that 50% of juvenile offenders have a history of a previous brain injury. Brain injury is also under-represented in those psychiatrically hospitalized, in victims of domestic violence, and in athletes who have received multiple mild brain injuries over their careers - so there are many different populations for which this unique combination of approaches could be applied.
Outcomes for people with life-long disabilities need to describe the individual's ability to participate in life, to the extent of their desires and abilities. The Clubhouse Model is one that empowers people to explore what they can do in life, and develops their skills to be able to do those activities. To measure that, we utilize the PROMIS Ability to Participate in Social Roles and Activities measure, a tool developed by the National Institutes of Health, Patient-Reported Outcomes Measurement Information System. An additional PROMIS measure utilized is the Satisfaction with Social Roles and Activities measure. This tool assesses an individual's satisfaction with performing their social roles and activities. By utilizing these measures that have national norms, we can compare the measures of participation and satisfaction with the participation of people served using the Clubhouse Model and Supported Employment.