The token economy program in the psychiatric hospital: a review and analysis

Reports of token economy programs with hospitalized psychiatric patients are reviewed with emphasis on three general aspects of function :(1) effectiveness. (2) factors influencing effectiveness, and (3) experimental methodology. Token economies are effective in modifying a wide variety and range of patient behavior, but it is still unclear which variable or combination of variables operating in the program are primarily responsible for the changes effected. The methodological aspects of program evaluation were found to be less than adequate in most cases because of failure to control probable operational variables. A systems analysis of the token economy program was offered in which influential aspects of the program including feedback effects were recognized and accounted for in conceptualizing function and evaluation.     

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.     

An appeals system for fines received by adolescents in a token economy

A system is described wherein adolescents participating in a token economy at a state hospital were allowed to appeal fines received from staff. Appeals were heard by a board composed of three residents and a psychology intern. The board met weekly and had full power to rescind or uphold fines. Before initiation of the appeal system, residents complained vigorously about fines received and about the "unfairness" of the staff and the token system, frequently denying responsibility for the infractions involved. Although almost half the fines were upheld, there were practically no more complaints of unfairness, and denials of responsibility declined drastically. The number of residents appealing fines fell from an average of four per week to less than one per week after the system had been in effect for one and one-half months. When asked why the system was not being used more often, residents grudgingly volunteered that most of the fines received were fair. It was not possible to determine whether this was due to changes in residents' attitudes or to actual changes in fining behavior by staff. Results are discussed in terms of effects on residents, acceptance by staff, and implications for further research.     

Achievement Place: modification of the behaviors of pre-delinquent boys within a token economy

The "pre-delinquent" behaviors of six boys at Achievement Place, a community based family style behavior modification center for delinquents, were modified using token (points) reinforcement procedures. In Exp. I, point losses contingent on each minute late were effective in producing promptness at the evening meal. During the reversal phase, threats (which were not backed up with point losses) to reinstate the point consequences initially improved promptness but the last two of five threats were ineffective. In Exp. II, point consequences effectively maintained the boys' room-cleaning behavior and, during a fading condition where the percentage of days when the contingency occurred was decreased, the point consequences remained effective for over six months, even when they were delivered on only 8% of the days. Experiment III showed that the boys saved considerable amounts of money when point consequences were available for deposits but saved little money when no points were available. Also, when points were given only for deposits that occurred on specific days the boys deposited their money almost exclusively on those days. In Exp. IV, point consequences contingent on the number of correct answers on a news quiz produced the greatest increase in the percentage of boys who watched the news and, to a lesser extent, increased the percentage of correct answers for the boys who watched the news. The results indicate that "pre-delinquent" behaviors are amenable to modification procedures and that a token reinforcement system provides a practical means of modifying these behaviors.     

Using token reinforcement to increase walking for adults with intellectual disabilities

The purpose of this study was to evaluate the effectiveness of token reinforcement, using an ABAB reversal design, for increasing distance walked for adults with mild to moderate intellectual disabilities at an adult day‐training center. Five participants earned tokens for walking 50‐m laps and exchanged tokens for back‐up reinforcers that had been identified through preference assessments. Token reinforcement resulted in a substantial increase from baseline in laps walked for 4 participants.     

Increasing volunteering at a residential facility: An experimental evaluation of a volunteer assistance program

A helpful component for comprehensive residential services for developmentally disabled persons is volunteer assistance. This investigation involved the evaluation of a program developed to increase the amount of volunteer assistance provided to a public residential facility. The program consisted of three types of related procedures: systematic volunteer recruitment steps, specific volunteer activities at the facility, and consequence/recognition for the volunteer assistance. The program was successively implemented to involve students as volunteers from two local universities, and resulted in an increase in new students volunteering from both universities. Additionally, the frequency with which the students volunteered at the residential facility increased substantially from both universities relative to control periods during which the volunteer program was not in effect. Results are discussed in terms of the benefits of volunteers and continued research to increase involvement of other prospective groups of volunteers.     

Motivating adolescents to reduce their fines in a token economy

Adolescents on a 16-bed token economy ward of a state hospital were subjected to four interventions in a seven-phase experiment to reduce the number of fines they received each day. Phase I was a four-week baseline period. Phases II and III were four- and five-week periods, respectively, in which residents were awarded tickets for a weekly $10 lottery each day they were at or below a changing criterion of daily fines. In Phase IV, residents received coupons, exchangeable for money, for days with zero fines. Phase V was a return to baseline. Phase VI was a one-week period in which daily lotteries for $1 were held, with the criterion for receiving a ticket being zero fines on the previous day. Phase VII was a one-week return to baseline. No significant differences in average fines per day, number of residents meeting criteria, or mean number of zero-fine days per week were found across phases. Results are discussed in terms of amount and immediacy of reinforcement, other opportunities to gain money, possible rebelliousness of the residents against the increased aversiveness of fines, and implications for further research.     

Therapeutic Contract Program: preliminary report on a behavioral alternative to the token economy

The token economy has been the primary model for the behavioral management of inpatient populations. However, this basically operant approach seldom emphasizes the development of cognitive-coping skills to help patients more effectively manage stressors that result in hospitalization. The Therapeutic Contract Program (TCP) is described as an inpatient-treatment strategy that is designed to help foster such cognitive-coping and self-control skills. While external structure is provided by components of this program, subprograms of the TCP have as their goal the development of internally-attributed coping skills and self-perceptions of competence. This preliminary report describes the structure of the TCP, as well as planned and in-progress measures of program participation and treatment outcome.     

A system for recording individualized behavioral data in a token program

A data matrix system used to record and summarize individual behavioral data is described. The major characteristics of the system are: (1) it provides a place to record and summarize all patient token exchanges, whether for standard contingencies or for idiosyncratic behavior; (2) it serves as a record and summary for time samples observed during a 24-hr period and as a record of reliability data on time sample measures; (3) it provides a place where the new token balance for each patient can be calculated and recorded for use the next day; (4) it provides for calculation of an individual patient's token balance at any given moment; and (5) it is a permanent record of each patient's daily participation in the program and documents progress in terms of his economic status as well as in changes in critical target behaviors.     

Arranging a residential environment for the developmentally disabled to generate and maintain verbal behavior

A specialized residential unit was assembled at a state residential facility for mentally retarded residents in order to provide services for individuals who lacked functional speech but who were capable of learning manual signs. Program development focused on four areas. First, a routine was designed to engage residents in functional training activities throughout the day. Second, opportunities to teach signed verbal behavior within all components of the routine were identified. Third, structured training sessions were developed to augment training within normal daily living activities. Fourth, multiple staff training strategies were initiated. Initial outcome data indicate that signing skills of both staff and residents improved.     

A token reinforcement program in a public school: a replication and systematic analysis

A base rate of disruptive behavior was obtained for seven children in a second-grade class of 21 children. Rules, Educational Structure, and Praising Appropriate Behavior while Ignoring Disruptive Behavior were introduced successively; none of these procedures consistently reduced disruptive behavior. However, a combination of Rules, Educational Structure, and Praise and Ignoring nearly eliminated disruptive behavior of one child. When the Token Reinforcement Program was introduced, the frequency of disruptive behavior declined in five of the six remaining children. Withdrawal of the Token Reinforcement Program increased disruptive behavior in these five children, and reinstatement of the Token Reinforcement Program reduced disruptive behavior in four of these five. Follow-up data indicated that the teacher was able to transfer control from the token and back-up reinforcers to the reinforcers existing within the educational setting, such as stars and occasional pieces of candy. Improvements in academic achievement during the year may have been related to the Token Program, and attendance records appeared to be enhanced during the Token phases. The Token Program was utilized only in the afternoon, and the data did not indicate any generalization of appropriate behavior from the afternoon to the morning.