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Results for “Token Economy”

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At least 19 recordsLinked to original sources

PubMed1976

The cellblock token economy: token reinforcement procedures in a maximum security correctional institution for adult male felons.

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.

Activities of Daily Living↗

PubMed1978

Results of a token economy.

A token economy for chronic psychiatric patients (average hospital stay of ten years) is reported. One hundred seventy-four patients were treated. Follow-up data were obtained on 173 patients who had been discharged from the hospital for an average of three years at the time of follow-up. One hundred twenty-five patients completed the program, which featured a graduated method for shaping behavior (functional levels). Ninety-one of the 125 patients who completed the program and were living in the community were employed. The program was most effective with patients who had been in the hospital for less than ten years and had an IQ above 80.

Adult↗

PubMed2000

Token economy for schizophrenia.

BACKGROUND: A token economy is a behavioural therapy technique in which the desired change is achieved by means of tokens administered for the performance of predefined behaviours according to a program. Though token economy programmes were widespread in the 1970s they became largely restricted to wards where long-stay patients from institutions are prepared for transfer into the community and were particularly aimed at changing negative symptoms of schizophrenia - poor motivation, poor attention and social withdrawal. OBJECTIVES: To review the effects of token economies for people with schizophrenia, or other serious or chronic mental illnesses, compared with standard care. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1985-1999), CINAHL (1982-1998), The Cochrane Library (Issue 1, 1999), The Cochrane Schizophrenia Group's Register of Trials (February 1999), EMBASE (1980-1999) and PsycLIT (1987-1998) were supplemented with reference searches, personal contact with trial authors and hand searches. SELECTION CRITERIA: Randomised studies comparing a token economy regime (one in which change is achieved by means of use of non-monetary, non-consumable tokens) to standard care for those with schizophrenia or any other similar chronic or serious mental illness. DATA COLLECTION AND ANALYSIS: Studies were reliably selected, quality rated and data extracted. For dichotomous data relative risk (RR) with 95% confidence intervals (CI) was estimated. Where possible, the number needed to treat statistic (NNT) was also calculated. Analysis was by intention-to-treat. Normal continuous data were summated using the weighted mean difference (WMD). Scale data were presented only for those tools that had attained pre-specified levels of quality. MAIN RESULTS: Only three randomised controlled trials could be included in the analyses (total n=110). There were no usable data on target or non-target behaviour. One small study favoured the token economy approach for the outcome 'change in mental state' on the SANS-CV with improvement in negative symptoms at three months (n=40, WMD -12. 7, CI -21.44 to -3.96). REVIEWER'S CONCLUSIONS: The token economy approach may have effects on negative symptoms but it is unclear if these results are reproducible, clinically meaningful and are maintained beyond the treatment programme. Token economy remains worthy of careful evaluation in well designed, conducted and reported randomised trials.

Humans↗

PubMed1972

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.

Journal Article↗

PubMed1972

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.

Journal Article↗

PubMed1982

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.

Adolescent↗

PubMed1995

Use of a token economy with seriously mentally ill patients: criticisms and misconceptions.

Although use of a token economy has been shown to have significant impact on adults and children with serious mental illness who participate in inpatient and community treatment programs, the intervention has not been widely adopted. The paper presents common criticisms of token economies, which may explain the infrequent use of this treatment strategy. They include perceptions that token economies are ineffective, that their benefits do not readily generalize to other settings, that token economies do not foster individualized treatment plans, that participating in a token economy is humiliating, that token economies are abusive, that concerns about milieu management are unimportant and irrelevant to treatment delivery in the 1990s, and that effective token economies are impractical. In an effort to rekindle interest in this potent treatment technique, the author shows that many of these criticisms rest on misconceptions and provides rebuttals based on empirical research. He describes three steps in establishing a token economy.

Adult↗

PubMed1979

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.

Adolescent↗

PubMed1988

Token economy in a hospital rehabilitation system.

A ward-based token economy programme which formed one part of a larger rehabilitative service for long-stay psychiatric patients is described. The clinical effectiveness of the programme is examined by the use of various nursing, psychological and psychiatric assessments before and after the patients' treatment on the ward, and the progress of former patients is followed-up as they move to different parts of the rehabilitation service. Significant clinical gains in patients' psychiatric symptomatology and problem behaviour on the ward are reported, although there were indications that improvement was not fully maintained as the patients moved on to other parts of the service. Comparison of the present clinical programme with the earlier research programmes on the ward indicated that the present regime was superior. The advantages and problems of token economy as a rehabilitative facility are discussed, outlining the various different roles for token economy with psychiatric rehabilitation. Finally, the future of token economy for long-stay patients is considered, questioning whether it might more appropriately be replaced by other structured ward programmes.

Adult↗

PubMed1999

The impact of a token economy on injuries and negative events on an acute psychiatric unit.

OBJECTIVE: Although the use of token economies has been shown to facilitate patient change and improve program functioning in numerous settings, token economies have received little attention in acute psychiatric settings. A token economy was introduced on an acute care unit in a rural hospital, and rates of negative events were compared before and after implementation. METHODS: Negative events were defined as patient and employee injuries that were not accidents. Unauthorized absences and use of emergency medications were also counted as negative events. Rates of negative events were calculated over two four-month periods, before and after the token economy was introduced on a 24-bed acute care unit that housed the hospital's neo-adult program for patients between the ages of 18 and 20. The unit also served as an admitting unit for patients over age 20. RESULTS: When the analysis controlled for unit census and the number of neo-adults, an analysis of covariance indicated that the number of negative events fell significantly after the token economy was introduced, from 129 in the four months before implementation to 73 after implementation, a 43 percent reduction. Both staff and patient injuries were significantly reduced. A small increase in use of emergency medications was noted, but it was not statistically significant. CONCLUSIONS: Findings support the use of the token economy in acute settings to improve the unit milieu by reducing negative events.

Adult↗

PubMed1976

Some antitherapeutic effects of the token economy: a case in point.

This paper deals with some of the complaints of patients and difficulties in treatment which arose on a psychiatric ward which was administered as a token economy. Most evaluations of token economies have been made by advocates of the technique and have selected specific behaviors as "targets" for reinforcement. I do not wish to engage in polemics regarding the relative worth of behavioral and psychodynamic theories of treatment, but this paper reflects my own misgivings about certain aspects of the token economy and is concerned more with the quality of the ward atmosphere it creates than with specific behavior changes. I will describe the difficulties encountered on a single ward because I suspect that such difficulties, while perhaps ubiquitous to psychiatric wards and mental hospitals, are amplified within the token economy to the detriment of patient care. My purposes in this paper, then, are twofold: to present and briefly analyze several recurrent problems on a token economy within a wider context of events than is typical for such discussions; and to provoke advocates of the token economy system to consider the possibility that their favorite treatment modality may actually limit the potential for therapy. In fulfilling these purposes, I shall also be making reference to some psychiatric literature, now fifteen to twenty years old, which has struggled with similar problems with partial success, and of which psychologists and younger psychiatrists are too often unaware.

Humans↗

PubMed1987

The long-term effects of a token economy on safety performance in open-pit mining.

A token economy that used trading stamps as tokens was instituted at two dangerous open-pit mines. Employees earned stamps for working without lost-time injuries, for being in work groups in which all other workers had no lost-time injuries, for not being involved in equipment-damaging accidents, for making adopted safety suggestions, and for unusual behavior which prevented an injury or accident. They lost stamp awards if they or other workers in their group were injured, caused equipment damage, or failed to report accidents or injuries. The stamps could be exchanged for a selection of thousands of items at redemption stores. Implementation of the token economy was followed by large reductions in the number of days lost from work because of injuries, the number of lost-time injuries, and the costs of accidents and injuries. The reductions in costs far exceeded the costs of operating the token economy. All improvements were maintained over several years.

Accident Prevention↗

PubMed2005

The token economy for schizophrenia: review of the literature and recommendations for future research.

The token economy is a treatment intervention based on principles of operant conditioning and social learning. Developed in the 1950s and 1960s for long-stay hospital patients, the token economy has fallen out of favor since that time. The current review was undertaken as part of the 2003 update of the schizophrenia treatment recommendations of the Patient Outcomes Research Team (PORT). A total of 13 controlled studies of the token economy were reviewed. As a group, the studies provide evidence of the token economy's effectiveness in increasing the adaptive behaviors of patients with schizophrenia. Most of the studies are limited, however, by methodological shortcomings and by the historical context in which they were performed. More research is needed to determine the specific benefits of the token economy when administered in combination with contemporary psychosocial and psychopharmacological treatments.

Behavior Therapy↗

PubMed1982

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.

Attitude↗

PubMed1975

A review of token economy treatment programs for psychiatric inpatients.

The author has reviewed outcome studies of token economy programs for psychiatric inpatients. Only studies that employed some control procedures in their evaluation were included. Token economies were most effective in modifying inhospital work, personal care, and some psychotic behaviors. Studies that assessed token programs to prepare patients for community living and reduce recidivism generally affirmed the effectiveness of token procedures, but the studies were poorly designed, and they lacked systematic follow-up data. Almost all studies failed to examine possible interactions between chemotherapy and the token economies. The author suggests the need for studies using token economies with psychiatric patients other than chronic schizophrenics, who have been studied almost exclusively to date.

Adolescent↗

PubMed1979

The evolution of a token economy programme for female chronic schizophrenic patients.

Token economy programmes are becoming an increasingly familiar sight in British psychiatric hospitals, yet many remain inflexible and prone to breakdown after a period in operation. This paper describes the evolution of a token economy for female chronic schizophrenic patients, where the nursing staff with minimal 'psychological' support and in dealing with a programme free of research constraints, aimed to increase the therapeutic potential of the system. The major developments arose from the need: (i) to extinguish the emergence of undesirable behaviour; (2) to develop a more individualized approach to treating patients' problems; (3) to keep consistent adequate records; (4) to re-establish contact with the community and (5) to cater for patients' varied responses to treatment.

Aftercare↗

PubMed1980

Peer managed token economies: evaluation and description.

Evaluated peer Managed Token Economy Programs (TEP) to determine their effectiveness in influencing patients' behaviors on the treatment unit and psychosocial adjustment as rated by treatment staff. Two experiments were conducted with adult patients (N = 56) in a residential treatment program. The first study indicated that patients' ward behaviors were maintained at a satisfactory level by either a special peer managed or staff managed TEP. An identical program that operated with non-contingent reinforcement, however, was shown to result in dramatic decrements in patients' ward behavior. The second experiment compared two peer managed token economy programs, one that operated with a group incentive and one with an individual incentive orientation. Results indicated that both of these programs effectively maintained patients' daily ward performance, reduced psychological problems, increased social adequacy, and enhanced community adjustment potential. The relative advantages and potential uses of peer managed programs were discussed.

Adult↗

PubMed1976

Token economies in institutional settings. Historical, political, deprivation, ethical, and generalization issues.

The use of the token economy in institutional settings is examined in light of historical, political, deprivation, ethical, and generalization issues. The major points may be summarized as follows. a) The token economy may be viewed as a palliative measure to prevent the incredibly regressive effects of institutionalization. b) To achieve control in token programs in many "total institutions," an artificial state of deprivation must be achieved. c) Generalization of behaviors into the natural environment following the patient's stay in a token economy program should not be taken for granted. d) What the patient learns in a token economic system may not be what the token economy's program director probably intends.

Behavior Therapy↗