The findings suggest that ICCD certification is a valid indicator of program quality. The ICCD has therefore proposed that the average performance of certified U.S. clubhouses in specific domains be adopted as benchmarks for organizational performance. When tailored for programs in particular regions and with specific levels of funding, the ICCD benchmarks for clubhouse performance set fair and reasonable expectations for clubhouse programs and for the design of performance contracts between departments of mental health and ICCD clubhouses.

Participants from both the PACT and clubhouse models achieved high employment levels, with no significant differences in weekly employment or 30-month job placement rates over the course of the study. During this time, clubhouse participants earned significantly higher wages and remained competitively employed for significantly more weeks per job than PACT participants.

Participants with more Work-Ordered Day program participation prior to employment had significantly longer average competitive employment duration even when controlling for prior work history. Participation in the Work-Ordered Day program is likely to improve work readiness. Further research is warranted to study which elements of the program may foment employment success. This could lead to increased implementation of the Work-Ordered Day program and its elements as precursors to employment for adults with severe mental illness.

The Clubhouse Research and Evaluation Screening Survey (CRESS) is a brief instrument designed to predict clubhouse readiness for certification assessment and, hence, performance in regard to expected model outcomes. The development of CRESS provides a practical example of the methodological challenges involved in creating a brief and valid screening instrument. Developed over a period of 5 years, CRESS is grounded in a series of workgroups, surveys, and pilot studies conducted by Fountain House and the International Center for Clubhouse Development (ICCD) in New York City. CRESS is shown to have criterion-oriented validity for the measurement of ICCD clubhouse model-related performance, as well as demonstrated ease in administration to a national sample of mental health programs.