I am the Emergency Services Director with Crossroads CSB in Farmville.  I have worked in the ES world for 18 years.  The more I have become informed about the Clubhouse International model, the more infeasible it seems on an economic basis for CSBs, particularly rural CSBs.  In our CSB catchment area (7 rural counties) many of our clients maintain their stability through our PSR program.  If that service or something equivalent is unavailable, I believe that the folks we serve in PSR will be less stable and will end up utilizing ES services more frequently, and being hospitalized more frequently.  This will set up a cycle of clients being hospitalized, returning home, having insufficient means to maintain stability, then being hospitalized again.  So, if CSBs end up dropping PSR because they believe they cannot financially prop up a Clubhouse International program, clients will have decreased quality of life and more frequent hospitalizations, further compounding the bed crisis in Virginia hospitals and ultimately costing the state more in hospital fees.