1. How We Can Develop Wellness Programming & Evaluate Health & Well-Being in Clubhouse Model Programs Willa 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

2. ICCD Clubhouse Model  Clubhouses serve adults diagnosed with severe & persistent mental disorders  Clubhouse International: www.iccd.orgwww.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

3. Dr. William Glasser & Choice Theory www.wglasserinternational.org  Choice Theory tells us that  We can only control our own behavior  We cannot control other peoples’ behavior  We have five Basic Needs  Survival  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

4. 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

5. 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 components  Acting  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

6. 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

7. 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)

8. 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?

9. 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?

10. 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?

11. 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?

12. 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., walks 7.Creative Activities during Socials: a.Candle-making b.Crocheting c.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

13. 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

14. 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

15. 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

16. 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!

17. 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 18 th Annual STEP Symposium, Chapel Hill, North Carolina.  Wubbolding, R E (2000). Reality therapy for the 21 st century. NY: Routledge.