The business of staying in business: North Carolina Clubhouse programs

Christopher F. Akiba, Sue E. Estroff

Research output: Contribution to journalArticlepeer-review


Clubhouse Model Programs in North Carolina are threatened by significant local and state reimbursement mechanisms. The goal of this study was to examine the impact of diminished state resources and administrative changes on the ground, from the perspective of Clubhouse members and staff at two Clubhouses in North Carolina. The lead author conducted participant observation for five weeks at each site engaging in various daily activities with members and staff, conducting conversational interviews, and reviewing program administrative data to corroborate findings. Income lost to decreased Psychosocial Rehabilitation (PSR) rates, decreased billable hours, and an increased delivery of non-reimbursed services represented a significant net cost to the Clubhouses’ operations and finances. The impact of these costs varied between the two organizations largely due to differing policies enacted by their Local Management Entities (LMEs). The costs of forced budgetary changes at the state level created varying degrees of hardship between clubhouses and their service missions.

Original languageEnglish (US)
Pages (from-to)97-102
Number of pages6
JournalAmerican Journal of Psychiatric Rehabilitation
Issue number2
StatePublished - Apr 2 2016
Externally publishedYes


  • Clubhouse model programs
  • Medicaid managed care
  • state mental health policy

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Rehabilitation


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