I have a great deal of concern regarding the new roll out around clubhouse going forward.  Clubhouse International tries to follow the philosophy of Fountain House, which is admirable, but the ability to have fund raising and donors to consistently support the clubhouse are more difficult in smaller communities.

The amount of money up front that CSBs need to pay is significant and the rate for a 3 unit day is worse than the original fee for service ($72.69), which was difficult enough to sustain a program.

Also there is a significant push in Clubhouse International for Transitional Employment.  In a smaller area where businesses are not as plentiful this makes running a clubhouse according to CI standards impossible. 

The rules for the clubhouse is that once a member always a member.  CI believes that members should be able to come as often or as little as they want.  Are MCOs on board with this position?  Other than the few blurbs about CI in the regulations - there is nothing else to discuss how this is going to work with clubhouse. 

Psychosocial Rehabilitation is a program that have assisted many clients over my 25 years.  The idea of their "progress" does not look the same on paper as it does in real life.  The ability to maintain our clients and keep them out of the hospital is "progress," but all anyone seems to want to see are more and more "progress." 

We are now having quite a few of our members kicked out of clubhouse because they haven't met someone obscure "progress" matrix. 

I can appreciate the CPST  focus on clients needing less and less of our time.  That does happen from time to time; however, most of our clients have chronic mental health issues. We put out a lot of small fires before they become crisis fires. 

The CPST does not offer this type of assistance. I'm not really certain how the CPST is going to help long term.  The services offered are not enough to support a program to support clients. I am hopeful that DMAS will extend the deadlines or cutout another option for PSR.