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.     

IS IT ALL IN THE NUMBERS? A Case Study of Tokenism

The purpose of the present study is to explore whether the negative consequences of tokenism are the result of imbalanced proportions alone, or whether society-wide sex role stereotypes which affect male and female tokens differently are also a factor. Men working at concession stands at an amusement attraction were assigned by the experimenters to one of two work groups in which the numbers of women and men were either skewed or balanced. Unlike a token woman at the attraction, these token male workers did not experience the negative consequences of tokenism (visibility, contrast, and assimilation). In fact, token men identified with supervisors and advanced more quickly than their non-token counterparts of both sexes. The results are interpreted as indicating that underrepresentation alone cannot explain the negative effects of tokenism for women.     

Decreasing driver speeding with feedback and a token economy

On-road research suggests that driver feedback combined with a token economy (a system of delayed reinforcement whereby tokens or points are distributed following a desired behaviour and are later exchanged for desired items) can reduce speeding, and that an incentive system without feedback may be sufficient to achieve this reduction. In two studies, we investigated the necessary and sufficient conditions required for this intervention to reduce speeding, and the efficacy of conducting such research using a driving simulator. Study 1 served to validate the simulator procedure. Participants completed a simulated drive while receiving feedback on their speed and a speed-based token economy. The intervention decreased their speeding compared with that of a control group. Study 2 investigated the amount of speed reduction that could be achieved with just one intervention component (i.e., feedback alone or a token economy alone) compared with feedback and a token economy combined or a control condition. Participants completed a 30-min simulated drive. Overall, drivers who received feedback combined with a token economy spent the least amount of time driving above the speed limit, had the slowest mean speed, and had the smallest standard deviation of speed. Drivers exposed to a token economy alone showed similar speed reductions. However, drivers exposed to feedback alone drove at speeds similar to control participants. Replicating these results under more realistic operating conditions could inform policy-makers and car manufacturers. Furthermore, the simulator proved a cost-effective and efficient means for examining the intervention.     

Reducing assaults on an acute psychiatric unit using a token economy: a 2‐year follow‐up

Token economies are an effective way of changing various behaviors including acquiring new skills, reducing undesired behaviors, reducing aggression, increasing treatment compliance, and improving psychiatric unit management. This study examines the long‐term effect of a token economy on an acute care, inpatient psychiatric unit. The two years following the implementation of a unit based token economy are compared with the 12 months prior to implementation. The results show a significant reduction in total assaults as well as fewer staff injuries resulting in loss of time from work. Copyright © 2003 John Wiley & Sons, Ltd.     

The treatment of "anxiety-depression" via positive reinforcement and response cost

A target behavior program, structured within a token economy project, was implemented to modify the behavior of an institutionalized patient who exhibited excessive rates of crying and no smiling responses. To affect both responses concurrently, token costs were made contingent upon crying and token payments and/or social reinforcements were provided for smiling. The results indicated both the feasibility of eliminating "anxiety-depression" within an institutional environment and the efficacy of the treatment procedures 14 months after discharge.     

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.     

TEACHER POPULARITY AND CONTRAST EFFECTS IN A CLASSROOM TOKEN ECONOMY

There is a common fear that the use of a token economy in one classroom might harm pupil performance in situations where the contingencies are not in effect. This study investigated potential contrast effects on measures of children's productivity and attitudes toward teachers. Six children with reading deficits participated. A multiple baseline design was used to assess the effects of a token economy which was systematically introduced across three teachers. Dependent measures included two rating forms of teacher popularity and work rate on a programmed reading series. The results indicated that the token system was effective in increasing the children's productivity and that no consistent behavioral contrast effects occurred. Furthermore, children's attitudes toward teachers did not appear to be influenced by the token economy until only one teacher was not delivering tokens. At this point, her popularity declined until she also delivered tokens. The token economy manipulation appeared to have a specific, desirable effect on the targeted behavior (i.e., work rate) and had minimal negative or positive “side effects” on teacher popularity.     

Working hours, job stress, work satisfaction, and accident rates among medical practitioners and allied personnel

Predictors of accident behavior among German medical staff revealed that work-related injuries/accidents experienced during a recent 12-month period were significantly related to working hours per week, distance from home to practice, number of dependent children, gender, and job-related stress. The average yearly number of car accidents was predicted by age and number of working hours. Furthermore, driving accidents going to or coming from work during the last year was determined by working climate, hours of work, length of lunchtime break, distance traveled to and from work, number of dependent children, and gender. Physicians working in excess of 48 hours per week displayed significantly more driving accidents but not work-related accidents, and they reported significantly higher levels of job-related stress than those colleagues working fewer than 48 hours per week. The implications of these results are discussed in the framework on risk management in the health services.     

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.     

Token economy systems: breakdown and control

Attention is drawn to the relatively high rate of breakdown of token economy programmes, and the reasons for this are considered. Reference is made to the results of a questionnaire circulated to British token economy programmes. Reasons for breakdown are considered in five categories, these being: nonexistent or poor patient selection; inadequate selection and training of nursing and ward staff; lack of definition of the functions of the supervising psychologist; poor co-operation from, and communication with, administrative staff; and active interference by the community. Solutions to these problems are suggested. The value of alternative or additional theoretical frameworks in promoting positive control of token systems is discussed.     

A Review of: “Kennedy-Moore,E., & Lowenthal,M. S. (2011). Smart Parenting for Smart Kids: Nurturing Your Child's True Potential.”

Behavioral procedures aimed at decreasing disruptiveness through increasing self-evaluative skills and programming generalization in a class of disruptive retarded children were examined. Phases of the study included: (a) baseline; (b) systematic feedback; (c) a token economy; (d) matching of teacher's ratings by students; (e) four fading phases during which progressively fewer students were required to match the teacher; (f) self-evaluation during which each student received the amount of points self-allotted regardless of teacher's ratings; (g) doubling of point costs of back-up reinforcers ("Inflation"); (h) complete removal of back-up reinforcers ("Points Only"); and (i) return to baseline conditions. The class was observed 5 days per week dueing a morning experimental period and several times per week in the afternoon as a measure of generalization. Additional measures of generalization included days when the token program was not in effect ("Off Days") and when the class was taught by a substitute teacher. Behavior was recorded according to an interval sampling observational code. The results showed that systematic feedback was effective in significantly reducing disruptiveness with even greater reductions resulting from the token program and the subsequent matching and fading phases. Decreased levels of disruptiveness were maintained throughout self-evaluation and the phases which followed. Decreased levels of disruption also generalized to afternoon sessions, to days when the experimental procedures were not in effect, and to self-evaluate, the class initially matched the teacher's ratings with about 50% accuracy. This gradually increased to consistently above 90% during the latter phases. The study demonstrated that retarded children can learn to accurately observe and veridically evaluate their own behavior, and that this has beneficial effects in terms of decreased disruptiveness.     

Substitution effects in a generalized token economy with pigeons

Pigeons made repeated choices between earning and exchanging reinforcer‐specific tokens (green tokens exchangeable for food, red tokens exchangeable for water) and reinforcer‐general tokens (white tokens exchangeable for food or water) in a closed token economy. Food and green food tokens could be earned on one panel; water and red water tokens could be earned on a second panel; white generalized tokens could be earned on either panel. Responses on one key produced tokens according to a fixed‐ratio schedule, whereas responses on a second key produced exchange periods, during which all previously earned tokens could be exchanged for the appropriate commodity. Most conditions were conducted in a closed economy, and pigeons distributed their token allocation in ways that permitted food and water consumption. When the price of all tokens was equal and low, most pigeons preferred the generalized tokens. When token‐production prices were manipulated, pigeons reduced production of the tokens that increased in price while increasing production of the generalized tokens that remained at a fixed price. The latter is consistent with a substitution effect: Generalized tokens increased and were exchanged for the more expensive reinforcer. When food and water were made freely available outside the session, token production and exchange was sharply reduced but was not eliminated, even in conditions when it no longer produced tokens. The results join with other recent data in showing sustained generalized functions of token reinforcers, and demonstrate the utility of token‐economic methods for assessing demand for and substitution among multiple commodities in a laboratory context.     

REMEDIATION OF NEGATIVE SIDE EFFECTS OF AN ON-GOING RESPONSE-COST SYSTEM WITH CHRONIC MENTAL PATIENTS1

Response-cost procedures within a token economy with extremely regressed residents excluded many residents from access to positive reinforcement. Procedures allowing residents to “purchase eligibility” to obtain backup reinforcers through contingent payment on standing fines, combined with proportional fine payoff schedules contingent upon time without new fines, increased payment on fines, reduced incidence of new fines, and increased utilization of backup reinforcers. These modifications removed adverse side effects while retaining the benefits associated with response costs. Failures or adverse effects of elements of token systems should not occasion abandonment of token economies, but rather encourage their continual evaluation and modification.     

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.     

THE EFFECT OF THE ABSENCE OF CLOSE SUPERVISION ON THE USE OF RESPONSE COST IN A PRISON TOKEN ECONOMY1

A naturally occurring experiment, in which direct supervision of a token economy in a penal system was removed and re-instated, is reported. A retrospective analysis revealed that in the absence of close supervision the use of response cost rose dramatically, both in terms of categories of behaviors for which response costs were levied and in the frequency of their use. The return of direct supervision led to a decreased use and an end to the growth of categories of behaviors punished.     

Preference Assessment for Dimensions of Reinforcement to Inform Token Economies Targeting Problem Behavior

The purpose of the current two-experiment study was to examine the use of a preference assessment for dimensions of reinforcement to inform an effective token economy arrangement. Three participants diagnosed with developmental disabilities who engaged in negatively reinforced problem behavior participated in this study. During Experiment 1, a preference assessment for four dimensions of reinforcement (i.e., quality, immediacy, magnitude, and rate) occurred to inform a more- and less-preferred token economy arrangement. During Experiment 2, a treatment evaluation compared these two token economy arrangements. Results for all three participants showed lower rates of problem behavior under the more-preferred token economy arrangement compared to the less-preferred token economy arrangement. Rates of task completion were higher under the more-preferred token economy arrangement for one of the three participants. Results are discussed in terms of their practical implications for clinicians and educators implementing token economies to manage problem behavior.     

Public health consequences of road traffic injuries – Estimation of seriously injured persons based on risk for permanent medical impairment

Despite the fact, that Sweden has one of the safest traffic environments in the world, a large number of people are still injured in road traffic accidents in Sweden. The core concept of the Vision Zero that was adopted by the Swedish parliament in 1997 is to decrease the number of deaths and serious injuries caused by traffic. The vision has been followed-up in terms of decreased mortality, but there was not a consensus on how the concept “seriously injured” should be measured at that time. The aim of this paper is to describe how to develop a measure to estimate the number of seriously injured people in Sweden. The results show that it is possible to estimate the health impact of road traffic accidents based on the definition of medical impairment. According to the results, 8389 people were seriously injured (permanently medical impaired more then 1%) in the road transport area in Sweden in 2013. If the number of people who had slipped or fallen down without any vehicle being involved is excluded, the number of seriously injured was around 4700. The result of the study has been included in the road safety goal for Sweden with the aim to have 25% less seriously injured people in 2020 than the average for the years 2006–2008. The results also showed that 91% of the seriously injured were transported by car, bike or by foot. The relatively high proportion of pedestrian fall accidents happening within the transport system irrespective of whether a vehicle was moving or not raises the question whether these types of accidents should be included in the reporting of formal road traffic accidents.     

Driving Under the Influence (of Mass Media): A Four‐Year Examination of NASCAR and West Virginia Aggressive‐Driving Accidents and Injuries1

To assess the impact of televised, competitive, dangerous automobile racing (NASCAR) mass media on viewers' driving behaviors, all automobile accidents and injuries as a result of aggressive driving on file at the West Virginia Division of Highways for the years 2003 through 2006 were subjected to a regression analysis controlling for confounding variables, such as weather and road conditions. While the number of accidents declined on the day of the televised events, the number of accidents and injuries increased 5 days following the events. A priming theory of mass‐media influence is discussed.     

Reducing Excessive Television Viewing

Excessive television watching among children can have several negative consequences, including exposure to frequent violent and aggressive scenes and limitations in their opportunities to engage in alternative educational and prosocial activities. In the present study, a youngster evidencing high levels of television viewing behavior was placed on a modified token economy: earned tokens were used to activate the television for set periods of time. With onset of the intervention, immediate and dramatic reductions in television viewing were noted. High levels returned during a return to baseline phase, but reductions again occured when the intervention was reimplmented. Positive second-order effects were noted in the child's school work, in the amounts of time the family spent together, and in the mother's perception of a social support variable.