Join the Club: Faculty Member Joy Agner Mobilizing Knowledge about the Clubhouse Model to Support People with Mental Health Conditions
By partnering with a community organization, one USC Chan faculty member demonstrates how to engage a user base, develop a collaborative research agenda and put knowledge to work for the people who can most use it.
By Katharine Gammon
Before she found Sheldon House, life seemed to be a constant challenge for Leasa Holton. Managing a major mental illness led her to repeated hospitalizations over two decades. But when she discovered the so-called “Clubhouse” in her area, a place where she could go every day to work and socialize, it was a game changer.
“I came into Clubhouse because it was a safe space for me,” Holton says. “I can do work here, be involved here, and I’m always welcome from the minute I come in right until the time I leave.”
Clubhouse International is a nonprofit organization that helps communities create programs for people experiencing mental illnesses via a network of more than 350 Clubhouses around the world. These non-residential spaces offer a safe, welcoming environment in which people with serious mental illness can work, socialize and actively participate in their own recovery.
That’s what Holton found. And as a Clubhouse member, she’s now helping the organization gather stories — qualitative data, if you will — behind the everyday work that Clubhouses are doing.
Clubhouse members at Stepping Stone, a Clubhouse International-affiliated organization in Brisbane, Australia, which describes itself as dedicated to suicide prevention and to ending social and economic isolation for people living with mental illness (photo courtesy of Clubhouse International)
Data is also at the heart of what Joy Agner, an assistant professor at USC Chan, does every day. Agner specializes in community-based participatory research, which means she works hand-in-hand with the people whose lives she’s researching. In this case, it means Clubhouse members and staff are empowered to formulate the questions that matter most to them, and help conduct the research that will generate answers. Agner knew that Clubhouses rely on external funding, but she didn’t always have the data to objectively tell the entire story about members’ successes. Some research is out there, she says, but it was often frustratingly hard to access, locked behind paywalls or filled with academic jargon.
So in addition to doing her own research, Agner put together a comprehensive review of the existing research literature about Clubhouses in a user-friendly, graphics-forward format. Transforming Lives: Clubhouse Impact Report integrates findings from 15 peer-reviewed studies conducted between 1999 and 2021 that together demonstrate what she calls an “integrated theory of change” that explains how and why the model works.
Some findings show the direct impact that Clubhouses have on their members. For example, research shows Clubhouse members are much more likely to be employed after six months of attendance, as compared to groups who didn’t have access to a Clubhouse. Members’ quality of life is also much higher, with people experiencing fewer psychiatric symptoms and less hospitalizations over time — which means lower total costs of their care.
Many people experiencing mental illness have nowhere to go during the day. Without occupations to engage in, they often report a sense of isolation, separation from their community and feelings of stigma, all of which can cascade into a variety of other health problems. For people with existing health conditions, it becomes increasingly difficult to successfully manage their symptoms and care.
Clubhouse Impact Theory of Change (Joy Agner, Yongshi Wang, & Elizabeth Bau, 2023)
Clubhouses change that. At the center of it all, Agner says, is a community-based approach.
“Our findings show that Clubhouses improve social connection and functioning,” she says. “They treat mental illness through community, and that community is developed through occupation.”
The model is relevant both for national efforts to reduce isolation and to treat mental illness, and it does so with a focus on occupation — what people actually do to occupy time during the course of a day.
Agner and her collaborators created a modifiable slide deck that can also include personal stories of members, stories that Holton has been helping gather for her Clubhouse. The report is a tool, Agner says, “for engaging the base and developing a collaborative research agenda, and putting this knowledge to work and making some actual impact with it.”
Often, research produced at universities can remain stuck there. But mobilizing the evidence — putting it into action for those whose lives might actually benefit from it — is a goal of Agner’s.
“Knowledge mobilization means getting research into the hands of people who can use it, including those making decisions about where tax dollars should go for different types of health services,” she says. “We also need to think creatively about how we can support this kind of work on a systems level, at USC and other places.”
Moving the needle
Sometimes shortened to “KMb,” knowledge mobilization is a term used to describe the non-linear, flexible process of knowledge generation, uptake and impact. The term is a rebuke to more traditional concepts portraying a linear, uni-directional “dissemination” of research flowing out of the ivory towers of academia.
To help conceptualize KMb relationships and interactions, a team of USC Chan faculty have developed a new visual model specific to occupational science and occupational therapy. The model shows a four-phase process of generating, spreading, grasping and using knowledge, all of which is centered around stakeholders’ shared priority(ies). These four phases interact in dynamic, fluid and unexpected ways, and yield impacts that can ripple within the contexts of people’s everyday lives.
Agner hopes that putting rigorous research into the community work that Clubhouses are doing actually moves the needle on funding. California’s Medicaid program, Medi-Cal, is considering funding the work of Clubhouses. At the federal level, there is a move underway to further analyze the organization as a model of effective mental health treatment. Taken together, reducing social isolation, raising mental health visibility and moving towards community drivers of health signal a shift in consciousness on a broader level, Agner says.
“People are looking to alternative models, knowing that a purely biomedical model is not working.”
Product development partners
Leasa Holton (photo courtesy of Clubhouse International)
The approach that Agner and her USC Chan occupational therapy students took in partnership with Clubhouse was fundamental to their success, says Lee Kellogg, a program officer with the nonprofit. By working with Clubhouse International’s research committee to solicit feedback and generate ideas, the relevant needs of all partners were woven into the process and final product.
“It’s really giving those Clubhouses tools to speak more confidently and more articulately in a way that stakeholders want to hear,” Kellogg says. “The stories resonate to convince stakeholders that we need Clubhouse funding, and they want to see the evidence and research. So that’s of huge value.
Tying peer-reviewed data to members’ own stories can make them even more powerful, says Patricia O’Brien, with Clubhouse Coalition California.
“Joy [Agner] has an amazing level of insight and vision — she understood how people were going to need to use this material and distilled it down to a level where really everyone can use it,” O’Brien says.
In the future, Agner is looking to gather more research ideas from the community and from her own work. Future questions might focus on the rehabilitation processes that happen within a Clubhouse; how housing impacts Clubhouse members; and the effects upon caregivers and family members when someone with serious mental illness has a safe place available to go.
For Holton, the resources offered by her Clubhouse are vast: educational support, employment support, a culinary unit, phone answering and assistance with banking and money management. All of it, she adds, is designed to meet real needs within the community. For example, if a member is stuffing envelopes with papers, it’s not just to stay busy, it’s to send newsletters to friends and colleagues about the great things happening at that Clubhouse. In the end, she says, the occupation-centric aspect is what makes the Clubhouse model unique. And it’s making a difference — Holton has not been hospitalized since she started coming to the Clubhouse.
“It’s meaningful work. It’s important; it’s not busy work,” she says. “And while doing that, I’m increasing my connections. I’m increasing opportunities to build meaningful relationships. I’m building skills. I’m having a sense of purpose, a reason to get out of bed.”
To access Transforming Lives: Clubhouse Impact Report, visit clubhouse-intl.org/impact-report.
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