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.     

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.     

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.     

OVERJUSTIFICATION EFFECTS IN TOKEN ECONOMIES

This study tested the relevance to clinical token economies of the overjustification hypothesis that tangible reward interferes with intrinsic interest in target behaviors and causes such behaviors to be less probable following a period of reinforcement than preceding such a period. The study was carried out in an ongoing token economy for chronic psychiatric patients. Alternated over an 8-week period were weeks of token and no-token reward for one of the program's target behaviors, toothbrushing. Two different amounts of token reward were employed in order to examine whether reward magnitude might influence the presence or extent of overjustification effects. Little evidence was found for the presence of overjustification effects in token economies. However, maintenance of toothbrushing was greater in no-token weeks following weeks of low amounts of token reward than in no-token weeks following weeks of higher amounts of reward. The importance of such complex functional relationships is discussed.     

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.     

MULTIPLE-BASELINE ANALYSIS OF A TOKEN ECONOMY FOR PSYCHIATRIC INPATIENTS

Twelve behaviors selected for reinforcement among 16 chronic psychiatric inpatients were divided into four classes: (a) personal hygiene, (b) personal management, (c) ward work, and (d) social skills. A token economy program was introduced for each class in a sequential, cumulative, multiple-baseline format. Corrections were included for methodological deficiencies frequently encountered in past studies. Treatment variables were systematically monitored, and target behavior rates, levels of global individual functioning, general ward behavior, and off-ward behavior were assessed during baseline, implementation, and probe periods. Results indicated abrupt and substantial increases in performance of most target behaviors, significant improvements in global individual functioning (p < .025), positive changes in general ward behavior, and increases in social interaction during off-ward activities. The findings provide strong evidence for the efficacy of a token economy and indicate that the multiple-baseline design can be a useful method for evaluating token economy programs.     

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.     

Effects of a token reinforcement system on journal reshelving

A token reinforcement program involving two levels of token value and backup reinforcers to increase journal reshelving behavior in a large university library was experimentally evaluated. Results showed that instructions (in which signs asked users to reshelve journals) had no impact. By contrast, token reinforcement contingent on reshelving behavior led to a marked increase in journals reshelved. A return to instructions-only conditions, when data were corrected for library usage, showed an increase in unreshelved journals over the token reinforcement period, though the increase was not to baseline levels. For the next 11 months, library staff maintained a modified token program. Follow-up data collected after that interval showed that number of unreshelved journals remained markedly lower than levels at baseline and the first instructions-only period, though they were slightly higher than at the token reinforcement period. Token reinforcement of the variety employed in this study constitutes an efficient, economical means of changing the behavior of library users who fail to reshelve books and journals.     

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.     

Second-order schedules of token reinforcement with pigeons: implications for unit price

Four pigeons were exposed to second-order schedules of token reinforcement, with stimulus lights serving as token reinforcers. Tokens were earned according to a fixed-ratio (token-production) schedule, with the opportunity to exchange tokens for food (exchange period) occurring after a fixed number had been produced (exchange-production ratio). The token-production and exchange-production ratios were manipulated systematically across conditions. Response rates varied inversely with the token-production ratio at each exchange-production ratio. Response rates also varied inversely with the exchange-production ratio at each token-production ratio, particularly at the higher token-production ratios. At higher token-production and exchange-production ratios, response rates increased in token-production segments closer to exchange periods and food. Some conditions were conducted in a closed economy, in which the pigeons earned all their daily ration of food within the session. Relative to comparable open-economy conditions, response rates in the closed economy were less affected by changes in token-production ratio, resulting in higher levels of food intake and body weight. Some of the results are consistent with the economic concept of unit price, a cost-benefit ratio comprised of responses per unit of food delivery, but most are well accounted for by a consideration of the number of responses required to produce exchange periods, without regard to the amount of reinforcement available during those exchange periods.     

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‐based contingency management increases daily steps in adults with developmental disabilities

Adults with developmental disabilities are less likely to meet physical activity guidelines than typically developing counterparts. Contingency management (CM) interventions increase physical activity in sedentary adults. The current study systematically replicated previous research among sedentary adults diagnosed with developmental disabilities living in a residential group home, using a token economy in the context of a CM intervention. Using a changing criterion design, participants (N = 4) were given tokens contingent on meeting increasing step goals over 8 weeks, tracked via a Fitbit Flex?. CM increased the number of steps substantially for three of four participants. These findings extend previous research supporting the use of token‐based CM interventions for increasing daily steps among individuals with developmental disabilities. Because the current study was conducted in a residential group home setting, it may offer a long‐term sustainable approach to improving the health of some individuals living with developmental disabilities.     

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.     

Effects of a Perseverative Interest-Based Token Economy on Challenging and On-Task Behavior in a Child with Autism

We compared the effects of a token economy intervention that either did or did not include the perseverative interests of a 7-year-old boy with autism. An alternating treatment design revealed that the perseverative interest-based tokens were more effective at decreasing challenging behavior and increasing on-task behavior than tokens absent the perseverative interest during an early literacy activity. The beneficial effects were then replicated in the child’s classroom. The results suggest that perseverative interest-based tokens might enhance the effectiveness of interventions based on token economies.     

THE TOKEN ECONOMY: A DECADE LATER

In the last decade, the token economy has been extended widely across populations and behaviors in treatment, rehabilitation, educational, and community settings. Outcome research has expanded as well to include large-scale program evaluations and comparative and combined treatment studies of the token economy. In a previous review (Kazdin & Bootzin, 1972), several obstacles were identified for the effective application of the token economy. These included identifying procedures to enhance program efficacy, to train staff, to overcome client resistance, and to promote long-term maintenance and transfer of training. The present paper discusses recent advances in research and reviews progress on the major issues identified previously. New issues have become salient in the last decade that pertain to the extension of the token economy to institutional settings. The demands for maintaining the integrity of treatment, the ability to integrate token economies within existing institutional constraints, and the disseminability of the procedures on a large scale are major issues that may dictate the future of the token economy.     

THE CELLBLOCK TOKEN ECONOMY: TOKEN REINFORCEMENT PROCEDURES IN A MAXIMUM SECURITY CORRECTIONAL INSTITUTION FOR ADULT MALE FELONS1

Two experiments were conducted (1) to explore the application of token reinforcement procedures in a maximum security correctional institution for adult male felons and (2) to determine to what extent the reinforcement procedures disrupted the day-to-day lives of inmate participants. In Experiment 1, an expanded reversal design revealed that the combination of praise and token reinforcement was more effective than the combinations of praise and noncontingent token award or direct commands on four common institutional activities. The latter two combinations were not found to be any more effective than praise alone. Experiment 2, which also employed a reversal design, indicated that the high levels of performance observed during the token reinforcement phases of Experiment 1 could be attained without subjecting participants to undue hardship in the form of increased deprivation of either social intercourse or the opportunity to engage in recreational and entertainment activities. Client safeguards are discussed in detail.     

Effects of token reinforcement and response cost on the accuracy of spelling performance with middle-school special education students with behavior disorders

The effects of token reinforcement and response cost on the accuracy of spelling performance with three adolescent special education students were examined. A multiple-baseline design across students was used to evaluate the effects of token reinforcement and response cost intervention. A greater percent of accuracy on daily spelling exams was obtained during the token reinforcement plus response cost condition than during the baseline condition. This was replicated for each student. Follow-up data collection indicated maintenance of behavior change over time. The benefits of implementing a token economy with a response cost component with middle-school students with behavior disorders were discussed. © 1998 John Wiley & Sons, Ltd.     

Predicting treatment outcome and recidivism among patients in a maximum security token economy

The relationship between program performance and outcome for patients in maximum security token economy programs has not been previously studied. We examined variables related to success in a token economy program and to postrelease failure for 92 men in a maximum security psychiatric hospital. Point earnings later in the program were best predicted by earlier point earnings. Variables that best predicted postrelease failure, defined in various ways, were similar to those found in other studies; youthfulness, having spent more time in institutions, a diagnosis of personality disorder or retardation rather than psychosis, not having been found not guilty by reason of insanity or unfit to stand trial, and having been referred from another psychiatric hospital. That program variables were generally unrelated to later outcome suggests that treatment programs for patients in maximum security settings must emphasize skills that are relevant to postrelease success.     

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.