Rewarding psychiatric aides for the behavioral improvement of assigned patients.

Pomerleau et al. (1973) paid psychiatric aides cash when their own patients showed more appropriate behavior. The aides also got daily graphs that showed how their patients were doing.

Other aides got the same cash, but it was not tied to patient gains. A third group only had to attend weekly meetings. The study ran on an adult psychiatric ward.

Patient behavior improved only when the aides' money depended on that improvement. The daily graphs plus cash created the change.

Cash handed out for ‘good effort’ and required meetings did nothing. The link between patient data and aide pay made the difference.

Boren et al. (1970) used tokens with patients on a similar ward three years earlier. They showed the ward economy itself can work; F et al. added the twist of paying staff, not patients.

Tracey et al. (1974) copied the cash-plus-feedback idea with child-care staff one year later. Public posting plus one-dollar tokens kept staff tasks on track, showing the method travels across settings.

Yuwiler et al. (1992) moved the feedback part to brain-injury nurses. Weekly goals plus written notes quintupled nurse feedback and raised glove use. They kept the feedback, dropped the cash, and still saw gains.

If you supervise aides, RBTs, or teachers, tie their bonus to a clear client metric and give them daily visuals. The cash does not need to be large; the contingency needs to be certain. Start with one measurable behavior, post the data where staff can see it, and release the bonus only when the line goes up. This old study still beats vague ‘employee of the month’ programs.