How We Can Develop Wellness Programming & Evaluate Health & Well-Being in Clubhouse Model ProgramsWilla J. Casstevens, PhD, MSW, LCSW

Acknowledgements & thanks go to:

• North Carolina Clubhouse members & staff from Threshold, Club Horizon, & Club Nova

• North Carolina State University Extension, Engagement, & Economic Development Seed Grant funding, with special thanks to J. M. Spellmeyer & K. Swann for their work on the project

• The Glasser Scholar Program of the William Glasser Institute for training & Choice Theory/Reality Therapy Certification

ICCD Clubhouse Model

Clubhouses serve adults diagnosed with severe & persistent mental disorders

Clubhouse International: www.iccd.org

Clubhouses emphasize

Relationships

Support

A work-ordered day

Clubhouses are

relatively small not-for-profit agencies

designed to provide community membership

psychosocial rehabilitation

Dr. William Glasser & Choice Theorywww.wglasserinternational.org

Choice Theory tells us that

We can only control our own behavior

We cannot control other peoples’ behavior

We have five Basic NeedsSurvival

Love & belonging

Power or recognition

Freedom

Fun & learning

Our most important Basic Need is LOVE & BELONGING which refers to closeness & connectedness with the people we care about

Choice Theory: The Quality World

Our Quality World can be seen as a "personal picture album" of all the people, things, ideas, and ideals that we have discovered increase the quality of our lives

Everyone’s Quality World is unique, because the things we value are different for each of us

Our Quality Worlds change over time

Choice Theory: Total Behavior

One of the Ten Axioms of Choice Theory is “All we do is behave” (wglasser.com)

All behavior is Total Behavior & made-up of 4 componentsActing

Thinking

Feeling

Physiology

Almost all behavior is chosen We can choose to directly control our Acting & Thinking

We can only control our Feeling & Physiology indirectly, by how we choose to act &/or think

Choice Theory & Reality Therapy

Reality Therapy

Based on Choice Theory

Developed by Dr. William Glasser

Dr. Robert Wubbolding subsequently developed the WDEP Model of Reality Therapy

WDEP Model of Reality Therapy

W = wants & needs

D = doing & direction

E = evaluation

P = planning

How We Can Use Choice Theory to Develop Wellness Programming

Build from the ground up! (not the top down)

Clubhouse members are central to the process

Focus group series

The series consists of 4 open groups

Voluntary participation – include members & staff

Groups are held weekly at the Clubhouse

Groups can support &/or generate interest in topic (which is health & wellness)

Group I: Wants/Needs

Explores health & wellness related pictures in participants’ Quality Worlds

Asks about participants’ their wants & needs related to health & wellness

Questions

(1) how do you view your health?

(2) would you like to improve it?

(3) what would this mean to you?

Group II: Doing/Direction & Evaluation

Examines health & wellness related aspects of participants’ Total Behavior

Considers what participants are doing & the directions this is taking them relative health & wellness

Helps participants evaluate how their choices are working out

Questions

(1) what do you do now that helps you feel better?

(2) what have you done in the past that helped you feel better?

(3) how have these things worked out?

Group III: Planning Encourages participants to let go of External Control

Psychology & to start planning for health & wellness related goals

Helps participants with planning health & wellness related choices

Questions

(1) what do you think it would take for you to feel better?

(2) what can you do that might help this happen?

(3) what could the Clubhouse do that might help you make this happen?

Group IV: Planning

Specifically considers the planning process & encourages suggestions for change at the Clubhouse

Questions

(1) what could happen at the Clubhouse that would help you feel better?

(2) what could staff do at the Clubhouse that would help you feel better?

(3) what could you do at the Clubhouse (and/or at home) that would help you feel better on an ongoing basis?

Threshold Club Horizon Club Nova

•In Durham, NC

•24 years old

•85 active members

•Average daily attendance = 60

•In Carrboro, NC

•22 years old

•90 active members

•Average daily attendance = 43

•In Knightdale, NC

•7 years old

•72 active members

•Average daily attendance = 47

1. Fresh Produce from Durham Farmers’ Market & Interfaith Food Shuttle

2. Healthy changes in Snack Bar & Lunch menus

3. Nutrition Education – Durham County Public Health & Interfaith Food Shuttle

4. Health Education – Durham County Public Health

5. Sexual Health Education – Durham County Public Health

6. Walking Group ongoing

1. Fresh Produce from Local Coop & Farmers’ Markets

2. Desserts removed from Lunch menu

3. Psychotropic Medication Education – nurse volunteer

4. Nutrition Education – UNC student volunteers

5. Safety Education – Fire Marshall & Clubhouse staff

6. Weekly exercise, e.g., walks7. Creative Activities during

Socials:a. Candle-makingb. Crochetingc. Art & Music

1. Fresh Produce from State Farmers’ Market in Raleigh & Interfaith Food Shuttle

2. Healthy menu planning & additions to Snack Bar

3. Health Education – Wake County Public Health

4. Knightdale Parks & Recreation outings

5. Walking Support Group ongoing

6. Wii Fit Activity donated/available

7. Exercise equipment purchased using tobacco settlement funds

Three North Carolina Clubhouses’ Initial 2009 Health & Wellness Programming

Similarities / Differences

All 3 Clubhouses included:

Healthy changes to menus

Obtaining fresh fruits & vegetables

Walking groups

Unique aspects included:

Advertising health programming

Including creative projects & activities

Pitfalls in Developing / Maintaining Wellness Programming Can Include

Preconceptions in note-taking during groups

Staff turnover

Low support from staff

Lack of direct support from administration

Objections from Board members or officers

Evaluation!

Can take place within the work-ordered day

Recording options

Paper forms & file folders

Excel pages & saved data files

Equipment can include

Scale

Blood pressure cuffs in the appropriate sizes

Tape measure

Standardized instruments can be used at longer intervals

Instrument options:

Quality of Life Inventory (QOLI) available through Pearson

36-Item Short Form Survey Instrument available online

Track weekly measurements, for example

Weight

Waist

Blood pressure

Track healthy foods eaten, for example

Fresh fruits & veggie portions

Other vegetables, unless fried

Set individualized goals and update your progress!

References Casstevens, W J (2011). A pilot study of health and wellness program

development in an ICCD clubhouse. Psychiatric Rehabilitation Journal, 35(1), 161-240.

Casstevens, W J (2013). Health and Wellness at a Clubhouse Model Program in North Carolina: A Choice Theory Based Approach to Program Development and Implementation. International Journal of Choice Theory and Reality Therapy, 32(2), 48-53.

Casstevens, W J, & Cohen, M B (2011). A groupwork approach to focus group research in a psychiatric clubhouse program. Groupwork, 21(1), 46-58.

Glasser, W (1998). Choice theory: A new psychology of personal freedom. NY: HarperCollins.

Glasser, W (2000). Counseling with choice theory: The new reality therapy. NY: HarperCollins.

Threshold Clubhouse (2011). Implementing a health and wellness program within a clubhouse model program. Presentation at the 18th Annual STEP Symposium, Chapel Hill, North Carolina.

Wubbolding, R E (2000). Reality therapy for the 21st century. NY: Routledge.