Analysis of outcome variables of a token economy system in a state psychiatric hospital: a program evaluation.
Token fines in week three flag adults who will drop out of a psychiatric token economy.
01Research in Context
What this study did
Staff ran a token economy on an adult psychiatric ward. They gave plastic tokens for self-care and job tasks. They took tokens away for rule breaking.
They tracked who finished the program and who got community placement. They compared people with mild behavior problems to people with severe behavior problems.
What they found
More people with mild problems finished the program. People with severe problems lost more tokens and dropped out sooner.
In the end, both groups got community placements at the same rate. Early token data showed who would quit.
How this fits with other research
Pliskoff et al. (1972) watched the same ward thirty years earlier. They saw residents start buying combs and soap as the program worked. Meuret et al. (2001) later used finish rates instead of store sales, but both papers show the same ward getting better over time.
Whitehouse et al. (2014) and Silva et al. (2020) both found that taking tokens away works faster than giving them. Meuret et al. (2001) also saw more drop-outs when fines piled up. The pattern holds from first grade to adult wards.
Macdonald et al. (1973) let kids elect their own peer manager on a token ward. They finished more chores. Meuret et al. (2001) kept adult staff in charge and still saw gains, showing token systems work with or without peer control.
Why it matters
You can spot quitters early. Count tokens lost in week three. If the number is high, add more teaching or lower the price of daily tasks. The ward kept the same final outcome for both groups, so early help is the only place you can move the needle.
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02At a glance
03Original abstract
This study describes the outcome of a token economy treatment applied to 2 distinct patient populations on the same unit of a state psychiatric hospital: individuals with a dual diagnosis of mental retardation and a DSM-IV Axis I diagnosis of either (a) a severe behavior disorder (BD) or (b) a serious and persistent psychiatric disorder (PD). Results showed that patients in the PD group were more likely to complete the treatment (17/20) than those in the BD group (17/31) who were more likely to be terminated from the program (14/31). Individuals who did not complete the program were distinguished early, within the first 3 weeks of treatment. These noncompleters received significantly more fines and earned significantly fewer tokens than those who completed the program. At an average of 2.7 years post-discharge, there was no difference in the proportion of PD (12/16) and BD completers (9/11) and BD noncompleters (3/7) remaining in the community. These data show that diverse populations of patients can be treated within the same token economy program, thereby improving cost effectiveness. Future research should be directed toward characterizing those patients (e.g., BD) less likely to succeed when they enter treatment, and determining if modifications in the program can improve that outcome.
Research in developmental disabilities, 2001 · doi:10.1016/s0891-4222(01)00070-1