A demonstration of a token economy for the real world

Token economies are rarely used in real-world psychiatric settings because of barriers to their implementation, such an institutional constraints and insufficient collegial support. The line-level treatment team at Elgin Mental Health Center was able to overcome these contraints and develop a user-friendly token economy. This article describes Elgin's simple yet effective token economy and the process used to develop it.     

A token economy program for chronic schizophrenic patients

Abstract.— A token economy program was applied on a ward for 12 chronic schizophrenic patients. An ABABC-design, i.e. a group reversal design with a noncontingent reinforcement phase at the end, was used to evaluate the treatment. The patients' activity-level increased from baseline to the treatment phase. During the reversal period the activity-level decreased but it increased again when the token economy was reintroduced. The non-contingent reinforcement resulted in the predicted decrease for two of the six behaviors recorded. Five of the twelve patients were discharged from the ward during the 8-month program period and none of them had been readmitted at the end of the one year follow-up. Individual treatment programs for two of the patients concerning aggressive acts, deficient eye-contact and lip-biting are described.     

A demonstration of a token economy for the real world

Token economies are rarely used in real-world psychiatric settings because of barriers to their implementation, such an institutional constraints and insufficient collegial support. The line-level treatment team at Elgin Mental Health Center was able to overcome these contraints and develop a user-friendly token economy. This article describes Elgin's simple yet effective token economy and the process used to develop it.     

Intrinsic reinforcers in a classroom token economy

An inexpensive, easily managed token economy was used in a normal classroom for one academic year, and data were collected for the entire academic performance in spelling, language, handwriting, and math for that year. During a baseline period, assignment completion was variable. The introduction of a token economy with a point exchange every five days increased assignment completion and decreased variability of performance. An application of a token economy that had a point exchange averaging four days was accompanied by an assignment completion rate that approximated 100%. A reinforcement contingency for which quiet behavior rather than for assignment completion was eased quiet behavior was accompanied by a marked diminution of assignment completion. A reintroduction of the token reinforcement for assignment completion system increased assignment completion again.     

A controlled evaluation of token economy procedures with chronic schizophrenic patients

Eighteen chronic schizophrenic patients were allocated to 3 matched groups, one group acting as an own-ward no-treatment control group. The two other groups moved to a token-economy ward, where the token group received contingent tokens, social reinforcement, and informational feedback as a consequence of appropriate behaviour, and where the control group received contingent social reinforcement and feedback with a matched amount of non-contingent tokens. After a 3 month baseline phase, this procedure was followed for a total of 15 months. A continuous assessment system was used with some weekly and monthly assessments, incorporating nursing checklists and ratings, psychiatric ratings, psychological tests, and time-sampling procedures, as well as continuous monitoring of the ward programme. The introduction of contingent tokens had an immediate positive effect in 3 areas of behaviour, but this advantage disappeared over the 15 months owing to the slower but sustained improvement in the control group. Significant improvement was limited to the areas of Social Withdrawal. Appearance and Routine. The patients who improved the most on any measure were those who were initially the most deteriorated. There were paradoxical changes in non-target behaviour, and in symptomatic behaviour. Suggestions and instructions to nurses may play a major part in influencing patient behaviour within and between experimental phases.     

The token economy: an evaluative review

Token economies have been applied in a wide range of settings. While there are several advantages to the use of this procedure, there are obstacles that may impede its implementation and therapeutic efficacy. These include: staff training, client resistance, circumvention of the contingencies, and non-responsiveness of subjects. Studies employing token programs with psychiatric patients, retardates, children in classroom settings, delinquents, and autistic children are reviewed. Although token economies are successful while in operation, the issue of generalization of behavior gains or resistance to extinction has not been given careful consideration. Inasmuch as generalization is perhaps the most crucial issue, several procedures are presented that are designed to facilitate maintenance of performance when reinforcement is withdrawn. Methodological suggestions for investigations on token reinforcement in applied settings are presented.     

Maintaining patients' improvements in a token economy.

Eighteen long stay male patients (diagnosis chronic schizophrenia) were involved in a six month token economy prior to random assignment to one of three experimental groups to investigate the importance of social reinforcement and other token-related variables in maintaining improvements brought about by the token system. Assessment included standardised psychiatric rating scales, nurse rating scales, and behavioural measures. Analysis of variance suggests the full token economy system produced significant improvements, but that the social factors involved in token exchanges were not demonstrably important sources of reinforcement. and that none of the variables studies at the experimental phase were critical factors. Once patients returned to a complete token system, results indicate that this may have more value in the promotion of work activities rather than social responding. It is argued that the token system provides a necessary clear structure within which nurses can encourage continuous improvements with long stay patients.     

Item preference in a token economy ward store

Token spending by 20 schizophrenic patients was monitored over a six-month period. It was found that: (1) token expenditures for cigarettes and "edibles" far surpassed other store item categories; and (2) percentage increases in token expenditures were greatest for categories of items relating to appearance and grooming, strongly suggesting that store purchasing patterns over time may provide an index of program effectiveness.     

The rise and decline of the American asylum movement in the 19th century

This paper traces the history of the American public asylum from the 1840s through the late 19th century. The focus is on social factors that contributed to the establishment of public institutions at the urging of reformers, the attempts to model them on the architecture and "moral treatment" offered by the best private institutions, the crowding of the asylums, the growing criticism aimed at the asylums and their superintendents, and the effects of calls for other approaches and for scientific management. Knowledge of the asylum's history may be useful today, as we stand at the crossroads in the treatment of the mentally ill.     

An analysis of a token economy in stuttering therapy

A stuttering therapy program in which adult stutterers were hospitalized and treated in small groups (n = 4) under token economy conditions is described. The Token System reinforced reductions and penalized increases in stuttering during conversation. The therapy program was divided into three stages. Initially, subjects were treated by the token system, which was then integrated with a delayed auditory feedback schedule designed to instate and shape a prolonged speech pattern into normal fluent speech. Finally, subjects passed through a speech situation hierarchy while under token control conditions. Experiments conducted in the first two stages of treatment are described. The first-stage experiments examined the design of the token system; the second-stage experiment assessed the effect of a contingent punishment schedule integrated with the delayed auditory feedback procedure in order to shape rate of speaking as well as fluency.     

Conflicting worlds of meaning: Juvenile delinquency in 19th century Manchester

Until recently historians and sociologists tended to view juvenile delinquency within the context of subcultural theory. This was often supported by evidence taken from contemporary sources. A closer and more skillful reading of the evidence suggests that juveniles fluctuated between normative values and those of the sub‐culture of delinquency (as stated by Matza). Also they were seen by adults within a conflicting paradigm as objects of contempt on one hand and young innocents in need of care and protection on the other.