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
ICCD Clubhouse Model
 Clubhouses serve adults diagnosed with severe & persistent
mental disorders
 Clubhouse International:
 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 Theory
 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
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” (
 All behavior is Total Behavior & made-up of 4 components
 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
 Questions
 (1) what do you do now that helps you feel better?
 (2) what have you done in the past that helped you feel
 (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
 (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?
Three North Carolina Clubhouses’ Initial 2009
Health & Wellness Programming
Club Horizon
Club Nova
•In Durham, NC
•In Knightdale, NC
•In Carrboro, NC
•24 years old
•7 years old
•22 years old
•85 active
•72 active
•90 active
•Average daily
attendance = 60
•Average daily
attendance = 47
•Average daily
attendance = 43
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
4. Health Education – Durham
County Public Health
5. Sexual Health Education –
Durham County Public
6. Walking Group ongoing
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
6. Wii Fit Activity
7. Exercise equipment
purchased using tobacco
settlement funds
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
a. Candle-making
b. Crocheting
c. Art & Music
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
 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
Instrument options:
 Quality of Life Inventory (QOLI) available through
 36-Item Short Form Survey Instrument available
 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!
 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),
 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:

How We Can Develop Wellness Programming - NAMI-NC