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.