Multiple-baseline analysis of a token economy for psychiatric inpatients.

Foster et al. (1979) ran a token economy inside a psychiatric hospital. They picked four skill areas: hygiene, self-care, work, and talking with others.

Staff gave tokens when patients showered, dressed, finished job tasks, or joined group talk. Tokens bought snacks, TV time, and weekend passes.

The team used a multiple-baseline design. They started the program for one skill, then added the next, and so on. This showed if the gains truly came from the tokens.

Each time tokens began for a skill, the behavior jumped up right away. Patients showered more, dressed faster, worked longer, and talked more.

The gains were large and held while other skills were still waiting for tokens. Social talk even rose before tokens started for that area, a sign of generalization.

Burgess et al. (1971) and Phillips (1968) ran token economies with pre-delinquent boys in group homes. They saw the same quick jumps in chores and punctuality. The 1979 study moves the idea to adult psychiatric wards and keeps the strong effect.

Varghese et al. (2025) later used tokens with orphanage children. Challenging behavior dropped to mild levels for all 50 kids. The pattern matches: tokens work across ages and settings.

Hangen et al. (2023) sounds like a warning. They found tokens were weaker than primary reinforcers in a lab test. But their test used brief, artificial tasks. In real wards, classrooms, and orphanages, tokens still produce big daily gains when they buy valued items and activities.

If you run a day program, group home, or classroom, a simple token board can lift hygiene, work, and social skills at the same time. Start with one target, show clear gains, then add the next skill. Let clients trade tokens for things they really want. The 50-year track record says the jump in behavior will be both fast and large.