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THE TOKEN ECONOMY
Lisa Orsi, BA, BST, RP Behaviour Therapist, Complex Care & Recovery Program, CAMH FDDSS Conference on Risk & Recovery: September 18, 2019 (^1)
LEARNING OBJECTIVES
- Understand what token economies are and how they work
- Think critically about your own token economies to ensure optimal effectiveness for
your clients.
- Recognize common misconceptions and be able to explain why they are
misconceptions
FDDSS Conference on Risk & Recovery: September 18, 2019 2
WHAT IS A TOKEN ECONOMY?
- A form of contingency management that pairs an arbitrary or
neutral stimulus (tokens, points, stamps, checks, stickersā¦) with
established reinforcers.
- Tokens are provided immediately following targeted behaviour
(typically prosocial and adaptive behaviour) with the opportunity
to exchange for individually selected āback-upā or āsecondaryā
reinforcers later.
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FDDSS Conference on Risk & Recovery: September 18, 2019^4 āMOTIVATION STOREā ON LGUD FDDSS Conference on Risk & Recovery: September 18, 2019 5 6
FDDSS Conference on Risk & Recovery: September 18, 2019 10 FDDSS Conference on Risk & Recovery: September 18, 2019 11
Fact: Adults use token systems daily (money, loyalty cards, frequent flyer miles).
They are commonly used in business, healthcare, exercise programs, advertising,
gaming, and social media.
We exchange reinforcers in our interpersonal interactions every day!
FDDSS Conference on Risk & Recovery: September 18, 2019 12
ā¦DONāT DO THIS
FDDSS Conference on Risk & Recovery: September 18, 2019 13
MISCONCEPTIONS
Myth : The benefits of token
economies do not generalize.
FDDSS Conference on Risk & Recovery: September 18, 2019 14 FDDSS Conference on Risk & Recovery: September 18, 2019 15
FDDSS Conference on Risk & Recovery: September 18, 2019
Fact: Five decades of research across clinical populations, target behaviours, and
geographic regions have demonstrated their effectiveness.
Tokens are always paired with social praise when increasing behaviourā¦ always.
Eventually praise from staff can become a conditioned reinforcer.
19
APPLICATIONS
- Increasing engagement in physical exercise for
individuals with schizophrenia (Kokaridas et al,
- Decreasing inappropriate social behavior in
developmental disabilities (Leblanc, Hagopian, & Maglieri, 2000)
- Classroom disruption and on-task behaviour (Doll,
Mclaughlin, & Baretto, 2013)
- Developing self-care and life skills (Wi & Lang,
- Treatment of aggression and self (Smith, 2017) -injury in autism
- Reducing aggression and self inpatient units (Lepage, 1999),-injury on psychiatric
- Improve activities of daily living (Hickey et al., 2018)
- Increasing adherence with medical treatment
adherence (Lepage, 2003)
- The long safety performance in openāterm effects of a token economy onāpit mining (Fox,
Hopkins, & Anger, 1987)
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UNITS WITH TOKEN ECONOMIES
3 - 5 Assessment and Triage Unit
Medium Secure Units
3 - 2 LSUA
3 - 3 LSUB
3 - 1 SOTU/ WMSU
Minimum Units
1 - 2 LGUA
1 - 3 LGUB
1 - 4 IRU
1 - 5 LGUD
FDDSS Conference on Risk & Recovery: September 18, 2019^21
āPOINT PROGRAMā ON LATU
PRE POST
N 53 =5% difference in group attendance
90% difference in showering daily 64% difference in clean rooms
22 FDDSS Conference on Risk & Recovery: September 18, 2019 0
1
2
Indirectly Supervised Pass Unprompted Group Attendance Baseline Token Economy +^ Cell Phone Reminder
Independent Using a Reminder and Token Economy use of Passes and Group Attendance
Number Daily Occurrences Date 23
GROUP ATTENDANCE
FDDSS Conference on Risk & Recovery: September 18, 2019 24
MISCONCEPTIONS
Myth : Token economies do not promote person-centered treatment. FDDSS Conference on Risk & Recovery: September 18, 2019 28 FDDSS Conference on Risk & Recovery: September 18, 2019 29
Fact: Token system targets can be āglobalā or highly individualized.
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Unit wide programs:
- Taking showers
- Keeping bedroom tidy
- Attending programming
- Attending therapy
- Doing exercise
Individual programs:
- Testing blood sugar
- Wearing clean clothes
- Using passes / being active
- Sitting for 15 mins. after meds
- Using treadmill
- Using CPAP machine
- Using coping skills
MISCONCEPTIONS
Myth : Token economies equate to bribery and coercion. FDDSS Conference on Risk & Recovery: September 18, 2019 31 FDDSS Conference on Risk & Recovery: September 18, 2019 32
Fact: freedom of movement), do not require a response cost component, and provide incentives for Token economies do not restrict access to necessary items or liberties (food, clothing, linen,
behaviour that benefits the client.
Also, bribery is usually involves someone is being coerced to do something illegal and the person
offering the bribe is the one will benefit most.
Token economies can transform cultures of coercion by increasing staff success. -client interactions related to
FDDSS Conference on Risk & Recovery: September 18, 2019 33
BENEFITS
3. Reinforcement items remain effective longer!
- Many clients will become bored with reinforcers E.g. coffee, certificates of
participation, āgood jobā.
- Some clients may be insensitive, indifferent, or even adverse to social praise or
feedback from clinicians. ā
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BENEFITS
4. Token economies encourage clients to become active participants in their
care!
- Clients may only be passively engaged in treatment, with the care team typically
taking on a large share of structuring weekly schedules and working to motivate
individuals to engage.
- As clients are responsible for collecting, counting, and spending tokens, token
economies promote self-management, planning, and positive engagement with
staff.
FDDSS Conference on Risk & Recovery: September 18, 2019 38
BENEFITS
5. Token economies can promote positive rapport and increase the value of
social praise.
- It provides opportunity for staff to more readily ānoticeā gains and improvements.
People tend to like people who make them feel good about themselves ļ
- It can give clients something positive to talk about with their care team. FDDSS Conference on Risk & Recovery: September 18, 2019 39
SCORE REPORTS
40 46 24
SOCIAL VALIDITY AND CONTEXT MATTER TOOā¦
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WHAT ARE CLIENTS SAYING?
ļ¼ āThe points system gives something fun and rewarding to look forward toā
āGood program to keep people doing the basics and to recoverā
ļ¼ āI really like this new body wash. It makes me look forward to showering because it smells so good.ā
ļ¼ āCollecting stamps is like a challenge for myself. Itās fun. I try to get more each week.ā
ļ¼ āThanks for doing this. I wouldnāt get any of this stuff if you didnāt.ā
ļ¼ āPoints system helps lift your mood to rewards. Plus something to look forward to and work towards. Programs like this are a life saver. Gets your mind off the rest of that stuff.ā
ļ¼ āI try to get stamps so that I can get good hygiene products instead of buying cheap ones that donāt
work.ā
FDDSS Conference on Risk & Recovery: September 18, 2019 42
- Lin, M. F., (4), 315 - Chiou323., J. H., Chou, M. H., & Hsu, M. C. (2006). Significant experiences of token economy from the perspective of psychotic patients. Journal of Nursing , 14
- Mcdonell management for stimulant use in community mental health patients with serious mental illness., M.G., Srebnik, D., Angelo, F., Mcpherson, S., Lowe, J.M., Sugar, A., Short, R.A., Roll, J.M., Reis, R.K. (2013). Randomized controlled trial of contingency Journal of American Psychaitry , 170 (1), 94 - 101.
- Nelson, G., & Cone, J.D. (1979). Multiple baseline of a token economy for psychiatric inpatients. Journal of Applied Behavior Analysis , 12 (2), 255 - 271.
- Austin Analysis , J.L., & Bevan, D. (2011). Using differential reinforcement of low rates , 44 (3), 451 - 461. to reduce childrenās requests for teacher attention. Journal of Applied Behavior
- Deitz S.M. (1977). An analysis of programming DRL schedules in educational settings. Behaviour Research and Therapy, 15 , 103 ā 111.
- Gaucher language and cognitive, M., Forget, J., & Clement, C. (2015 functioning on temporal regulation.). Temporal control of behaviour in children with differential reinforcement of low rates schedule: Behavioural Processes , 119 , 58 - 69. The role of age,
- Kostinas retardation and obsessive compulsive disorder., G., Scandlen, & Luiselli, J.K. (2001). Effects Behavioral interventions of DRL and DRL combined with response cost on perseverative verbal behavior of an adult with mental, 16 , 27 - 37.
- Turner head injured man., J. M., Green, G., Behavioral Braunling Residential Treatment - McMorrow, D. (1990). Differential reinforcement of low rates of responding (DRL) to reduce dysfunctional social behaviors of a , 5 (1), 15-27. 46
