A comparison of competitive employment outcomes for the clubhouse and PACT models

Authors: Secker, J., & Membrey, H.
Year Published 2006
Publication Psychiatric services
Volume 57
Number 10
Pages 1416-1420
Publisher Psychiatric Services

The unemployment rate among individuals with severe mental illness is high, ranging from 67 to 85 percent. Many studies focus on job placement rates without considering job retention. Supported employment programs vary a lot and no single definition exists. Furthermore, the rapid placement guideline may mean that a lack of job readiness may be impacting an individual's success at work. The clubhouse model to employment may be able to help individuals gain and maintain work at higher rates than other approaches.


The goal of this study was to determine if a clubhouse model could achieve and maintain employment rates comparable to the Program of Assertive Community Treatment model of supported employment.


The study was conducted in Western Massachusetts Genesis Club.


The study sample included 177 individuals who data was collected over a four year time period. All had a diagnosis of bipolar disorder, depression or schizophrenia and were 18 years of age or older. They were not screened for work readiness and interest in work was not required.

Data Collection

After acceptance into the study the Positive and Negative Syndrome Scale was conducted. Interviews were also conducted at baseline and then every 6 months over two and half years. Questions related to symptoms, jobs, hospitalizations and more. Program staff tracked job information. Employment data was also provided by staff or through interviews with participants. Each participant was followed for the study period or until he or she exited services. Time based analyses compared weekly employment and job placement rates for participants in each group. Binary employment outcomes were analyzed with generalized estimating equations of the Genmod procedure in SAS with a logit link function. Another group of job based analyses was also conducted to examine average job duration, hours and wages to compare outcomes from participants in the two groups. Spearman rank-order correlations between job duration, hours and wages were estimated to identify potential covariates in the hours and wages test model.


The control was Supported Employment services delivered via Program of Assertive Community Treatment (PACT).


The PACT model had a 14% higher job placement rate than the clubhouse model. Participants in either approach maintained weekly employment levels at or exceeding other published reports. On average participants in more than 2 jobs during the study period and worked 20 hours a week. Clubhouse participants remained employed 2 months longer than individuals in PACT, which resulted in a 66% difference in duration.


No difference was found in job placement rates between clubhouse and PACT participants over two and half years. Clubhouse participants remained employed for more weeks and earned slightly higher wages than participants in PACT.

URL http://www.fountainhouse.org/sites/default/files/C.%20Schonebaum%20article.pdf
Disabilities Emotional disturbance
Populations Male & Female | Other
Outcomes Increase in tenure | Wages | Other
Research Design Randomized Controlled Trials (RCTs)
Peer Reviewed Yes