Club House International standards focus heavily on preparing people for competitive work.  The work requirements are overly burdensome in rural areas where jobs are few, even for those without disabilities.  Additionally, the lack of transportation creates another barrier that is REAL.  We do not have bus service (with the exception of limited  bus service within the city limits of Farmville) within our 7 rural counties.  Finally, many of the members of our current psychosocial program are simply to symptomatic or cognitively involved, whether the model acknowledges this reality or not,  to make competitive employment an option.  I am also very concerned about the cost of transitioning to this program.  We will likely need to hire an employment specialist, which is not a billable service, maintaining clubhouse accredidation is costly, and the reimbursement rates are insufficient to support the program.  Fundraising in poor rural communities is not a reasonable way to sustain a program like this without sufficient reimbursement from Medicaid.  Please reconsider requiring club house international as the only model for those CSB's who are not CARF accredited.