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A token economy with “Automated” data collection
BEHAVIORTHERAPY 6, 111--118 (1975)
INSTRUMENTS AND TECHNOLOGY
A Token Economy with "Automated" Data Collection BARRY A. TANNER, JOHN J. PARRINO, AND AUBREY C. DANIELS Georgia Regional Hospital at Atlanta
A description is provided of a hospital-wide token economyusing tokens punched through cards and computer assisted data collection. Aitchison (1972) has described a token delivery and recording system that offered several advantages over the more usual coin-like tokens, in that patients carried cards through which staff punched holes for tokens. Such tokens can be given quickly, cannot be stolen or easily forged, and provide a permanent record of patient and staff behavior. The system which is described below overcomes three disadvantages of Aitchison's system: it allows for quick monitoring of patients' earnings through a weekly computer printout; it allows the identification of each staff member's rate of reinforcement through the use of different-shaped punches; and it rules out the unintentional punching of more than one card at a time through the use of a single earning card. The system also differs from other reported economies in that it is nearly hospital wide, rather than confined to a single ward, and uses a relatively small number of tokens per transaction. An earlier report on this economy suggests that even a small number of tokens can produce desired changes in behavior (Parrino, George, & Daniels, 1971). Each unit with ambulatory patients in the 485-bed hospital has its own variation of the basic token plan. Staff punch the general earning card square(s) corresponding to the behavior emitted and day on which it occurred, making a permanent record while reinforcing the patient (Fig. 1). The unusual shape of the punches makes the tokens difficult to counterfeit, while theft of staff punches has decreased since staff Reprints may be obtained from Barry A. Tanner, Northeast Guidance Center, 17000 E. Warren, Detroit, MI 48224. Presently at Behavioral Systems Consultants, 3300 N. E. Expressway, Atlanta, Georgia 30341. 111 Copyright © 1975 by Academic Press, Inc. All rights of reproduction in any form reserved.
].12
INSTI/U3,IENTS AND T E C H N O L O G Y
IAHE:JohnDoe S#: 200/45/8888
DATE: 10/17/72
FIG. 1. An example of the general earning card. members have signed a form making them financially responsible for the punches. 1 Each hoIe punched is worth one token. The spending card (Fig. 2) is also carried by the patient. Tokens may be spent for unit privileges such as staying up after 1l P.M. or for obtaining items at the token store housed in the canteen. Tokens may also be lost for behavior which the staff wishes to discourage (Kazdin, 1972). Staff take tokens by circling the holes punched in the earning card. Once a hole is circled, it can no longer be spent. Staff also record the transaction on the spending card by circling the time of day at which the behavior 1Extra heavy-duty paper punches with a 1,~'~-inchreach and a variety of dies are available from McGill Metal Products Company, Marengo, Illinois.
INSTRUIVIENTS A N D T E C H N O L O G Y
113
occurred, or by writing the number of tokens charged in the square next to the description of the behavior. Thus, ff on Wednesday a patient wished to purchase an item worth 10 tokens, the store clerk would first check to see if he had 10 unspent tokens on his front card. If the patient had the required tokens, the clerk would draw a circle around each of any 10 tokens to indicate that they were now spent. Next she would turn to his spending card and write "10" next to "Token Store" under Wednesday, as in Fig. 2. When a patient is charged for undesirable behavior, the staff member charging him also describes the incident on the back of the card, For example, ff on Tuesday a patient verbally threatened to strike a staff
Staying Up
Ii-I 1-5
2/hr. 4/hr.
Medicine Requests
(2) Missing Activity, Un: During Activity (5/activity)
Asleep on Unit, in room with door clo= ed or bed during day (2/hr. )
Token Store (# of tk; Recreation
(# of tks)
Inappropriate Behav. A. Verbal (1-5) B. Non-Verbal (I-i0
Walk Out Pass (i0) Day Pass (i0) Weekend Pass (20) Appointment w/staff (2 tokens)
Fro. 2. An example of the general spending card.
114
INSTRUMENTS
AND
TECHNOLOGY
member, he would be charged five tokens. The staff member would circle any five holes punched through the patient's earning card, and would then write a "5" next to "Inappropriate Behavior" under Tuesday on the spending card. He would also describe the incident in detail on the back of the patient's spending card. The individual plan card is used whenever a patient's particular needs require that tokens be given or taken for behaviors not covered under the general system. This card is typed out individually for each person, and may include things such as work, school, particular topics of conversation, or talking with specific persons. The token data are coded weekly for each unit and each resident on the unit, key punched and fed into the hospital computer. The unit psychologist then receives a printout for each patient, as well as summary printouts for the unit. z A typical unit summary (Fig. 8) provides the following information along the top: the week in which the data were collected, the hospital unit on which the data were collected, the number of residents for whom data were reported, the mean length of stay in the hospital, the mean length of stay on the particular unit, and the number of new residents DATE
17/10/72
RESIDENTS REPORTED=3E
L~IT IV
AV. IN HOSP.=6,77
ON UNIT=6.03
THERE ARE 7 NEW RESIDENTS ON THE UNIT
EARNINGS ~MOUNT 304 267
316 482 33 80 301 225 79
SPENDING CATEGORY
AMOUNT
BED P.M. BED A.M. BOOM CHEEK GROOMING RELAXATION AFPR, TALK PHYS. FITNS. SPEC. SKILLS
NEG. CATEGORY
SPENDING
AMOUNT
914 50 15 54
STORE WALK OUT RECRF~ATION STAFF APPT,
260
PASSES
CATEGORY
20 4 132 5 72
STAYING UP MEDICINES UNIT ACT. BED DAY INA VERBAL INA NONVBL
303
TOTAL, AND 19%/8
70
BONES
2087 215 .....
TOTAL, AND INDIVIDUAL
2302
GB~-~'D TOTAL
52%/PO88
1293
TOTAL, AND
81%/S
TOTAL SPENDING 1596, 69%/E
CUt~R'LATIVE TOTALS
TOTAL INDIVIDUAL = 215 FROM 17 PLANS 9% OF TOTAL EARNINGS
EAKNED
9809
SPENT
7008
N/SPG
1525
DIFFERENCE
2801
RECENT HISTORY WEEKS AGO % EAKNED/NEG S
2
3
47/326
54/524
FIG.
4 49/372
5
6
50/399
58/480
7 66/478
3. An example of a unit summary printout.
2The program was written by June Woodward.
8
57/473
INSTRUMENTS
AND TECHNOLOGY
115
on the unit. The printout in Fig. 3 summarizes data collected during the week ending October 17, 1973, on Unit IV. Data were reported for 31 residents, with a mean stay in the hospital of 6.77 wk, and a mean stay on the unit of 6.03 wk (some patients were transferred from other units). Seven of the residents were new to the unit that week. The next major division of the printout provides summaries for earnings, as well as for desirable and undesirable spending. Total number of tokens earned in nine categories are listed under the "Earnings" heading. Then the sum of these nine categories is given under "total" (2,087), followed by the total number of tokens earned on individual plans (215). These are added together to produce the grand total for earnings on the unit that week (2,302). The 2,087 tokens earned under the general economy are 52~ of the tokens which could have been earned during the week, while the 215 tokens earned on individual plans were earned by 17 residents, and represents 9~ of the grand total of tokens earned. The next column on the printout is for desirable spending. Residents spent the greatest number of tokens at the store (914), followed by passes (260). The total of 1,293 tokens spent for desirable items and events represents 81~ of the total number of tokens spent during the week (1,596), and 69~ of the tokens earned that week. The third column summarizes undesirable or negative spending on the unit. The largest number of tokens was spent for being in bed during the day, suggesting that this is a unit-wide problem. The 303 tokens spent for undesirable behavior represent 19~ of the tokens spent that week. Dropping down to the cumulative totals, one finds that patients earned 9,809 tokens and spent 7,008 tokens for desirable activities during their stay on the unit. They were charged an additional 1,525 tokens for undesirable behavior, thereby leaving 1,276 tokens unaccounted for. An unspecified number of these tokens are likely to be in patient's savings accounts, while some might have been lost when cards were misplaced. The bottom rows of the printout show the unit's token history for 7 wk in the form of a ratio of the percentage of possible tokens earned to the absolute number of tokens charged for undesirable behavior. Two weeks earlier, the residents had earned an average of 47~ of all possible tokens available under the general plan, while being charged 326 tokens for undesirable behavior. In general, negative spending increased as earnings increased, reflecting the patient's ability to pay for privileges such as staying in bed during the day. A second unit summary sheet (Fig. 4) provides critical information for each patient. The first two columns indicate the number of tokens earned by each patient under the basic system and individual plans, while the next two columns list each patient's desirable and undesirable spend-
116 UNIT
/NSTHUMENTS AND TECHNOLOGY IV
E,LRNED BASE IND
.!ohn Smich
37
John Jones
60
J o h n Doe
94
10
16
SPENT POS NEC,
5
26
45
24
39
14
ON TH~ UNIT NEW 10420+
X
BObqJS
g
907~E
IIISTOR¥ NO NEC
1
83% ]2
X
1
S/E RATIO
49% 3
50~
Etc.
FtG. 4. An example of a unit individual s u m m a r y printout.
ing. Columns 5-7 are used to identify each person's length of stay on the unit. During a patient's first week on the unit an "X" appears in the "New" column. If no "X" appears in a patient's row, then he has been on the unit from 2 to 10 wk. An "X" appears in the remaining columns if a patient has been on the unit between 11 and 20 wk or more than 20 wk. An "X" appears in the "Bonus" column if a patient earned all of his bonus tokens during the week. A bonus token is given each evening if a patient has earned at least a specified number of tokens that day. The bonus token, therefore, is an indication that a patient has performed at a minimally successful level during the day. The bonus tokens are especially valuable to patients because the price of a pass always includes several bonus tokens, e.g., 20 tokens, four of which must be bonus tokens. The next two columns are also used as measures of patients" overall performance. The ninth column specifies the prior weeks in which the patient has earned at least 90% of all possible tokens in the general economy, while the 10th column indicates the weeks in which he has lost no tokens for undesirable behavior. A 'T' in the "90~E" column means that the patient earned at least 90~ of all possible tokens during the previous week, while a "2" and "3" in the "History No Neg" column means that he was not charged for undesirable behavior 2 or 3 wk prior to the report. The final column specifies the percentage of his earnings which a patient spent during the week. A consistently low percentage suggests that few backup reinforcers are being provided for the patient, while expenditures consistently in excess of i00~ suggest that the patient is obtaining illegal tokens. A patient can occasionally spend more than he has earned in a given week, by withdrawing tokens from his savings account. A separate printout (Fig. 5) gives a detailed report for each patient. Looking at the top of Fig. 5, one learns that this is a record of the token activity of John Doe, social security number 200-45-8888, during the week ending October 17, 1972. Mr. Doe has been in the hospital and on Unit IV for 9 wk. The remainder of the printout is organized much like the unit summary
INSTRU'A~ENTS AND
117
TECHNOLOGY
in Fig. 3. The left-hand column lists the patient's earnings for specific behaviors, as well as his total earnings under the general economy and his individual plan. Mr. Doe earned 81~ of all possible tokens in the general economy, and earned 10 more tokens with his individual plan. His individual plan requires that he emit specified problem-solving behaviors. The middle column lists Mr. Doe's desirable spending. Most of his tokens were spent at the store, with the remainder going for passes. He spent 84~ of his earnings in these two categories. The third column lists spending for undesirable behavior. Mr. Doe was charged 10 tokens for staying in bed during the day, but was charged for no other undesirable behavior. He was left with a balance of eight tokens. During his 9 wk on the unit, Mr. Doe has earned 731 tokens, spent 525 tokens for desirable events, and another 128 for undesirable activities. During this period he has spent an average of 72?o of his earnings. From Mr. Doe's recent history it appears that he has consistently earned around 50.?o of all possible tokens, and has generally been charged few tokens. Exceptions to this occurred 5 and 6 wk previously when Mr. Doe was charged 38 and 53 tokens, respectively. 17/10/72
DATE
IN HOSPITAL
UNIT IV SSNO
John Doe
I0 i0 iO 15 13 24 15
5
SPENDING
NEE.
AMOUNT CATEGORY
CATEGORY BED P.M. BED A.M. ROOM CHECK GROOMING RELAXATION APPR. TALK PHYS. FITNS.
9
SPEC ACT STORE WALK OUT RECREATION STAFF APPT
84
SPENDING
AMOUNT
CATEGORY STAYING UP MEDICINES UNIT ACT BED DAY INA VERBAL INA NONVBL
I0
BONUS
102 10
TOTAL, AND INDIVIDUAL
112
GRAND TOTAL
81%/POSS
I0
PASSES
94
TOTAL, AND
84%/E
104
INDIVIDUAL PLANS I0
ONUNIT
200/45/8888
EARNINGS AMOUNT
9
10
TOTAL, AND I0%/S
ALL SPENDING, 93~/E
BALANCE IS
8
CUMMULATIVE TOTALS
PB SOLVING
EARNED
TOTAL =
10
731
SPENT
525
DIFFERENCE
206
N/SPG
128
SP/E RATIO
72%
9X OF TOTAL E m ~ E ~
RECENT HISTORY WEEKS AGO % EARNED/NEG B
2
54/008
3
69/002
4
B6/Oll
5
69/038
6
56/053
7
52/004
FIG. 5. An example of an individual patient's printout.
8 4710OO
11.8
INSTRUMENTS AND TECHNOLOGY
The economy has frequently been revised to meet the needs of the patients and in order for the printout to provide more meaningful information. We hope to soon substitute percentage of unit mean for percentage of possible tokens earned as one measure of a patient's performance. Earning 90g of all tokens was originally intended as a signal to the staff that the patient was doing almost everything which was required of him, and that he should either be discharged or placed on an individual plan. However, the 90~; appears to be unrealistically high given the small number of people who attain it. The major disadvantage of this system is that it requires weekly coding of the token transactions, a job which is often regarded as trivial by the staff doing it. REFERENCES AITCmSON, R. A. A low cost, rapid delivery point system with "automatic" recording. Journal of Applied Behavior Analysis, 1972, 5, 572-628. KnZDn~, A. E. Response cost: The removal of reinforcers for therapeutic change. Behavior Therapy, 1972, 3, 533-546. PARR/NO, J. J., GEORGE, L., & DAN1ELS, A. C. Token control of pill-taking behavior in a psychiatric ward. Journal of Behavior Therapy and Experimental Psychiatry, 1971, 2, 181-185.
INSTRUMENTS AND TECHNOLOGY
A Token Economy with "Automated" Data Collection BARRY A. TANNER, JOHN J. PARRINO, AND AUBREY C. DANIELS Georgia Regional Hospital at Atlanta
A description is provided of a hospital-wide token economyusing tokens punched through cards and computer assisted data collection. Aitchison (1972) has described a token delivery and recording system that offered several advantages over the more usual coin-like tokens, in that patients carried cards through which staff punched holes for tokens. Such tokens can be given quickly, cannot be stolen or easily forged, and provide a permanent record of patient and staff behavior. The system which is described below overcomes three disadvantages of Aitchison's system: it allows for quick monitoring of patients' earnings through a weekly computer printout; it allows the identification of each staff member's rate of reinforcement through the use of different-shaped punches; and it rules out the unintentional punching of more than one card at a time through the use of a single earning card. The system also differs from other reported economies in that it is nearly hospital wide, rather than confined to a single ward, and uses a relatively small number of tokens per transaction. An earlier report on this economy suggests that even a small number of tokens can produce desired changes in behavior (Parrino, George, & Daniels, 1971). Each unit with ambulatory patients in the 485-bed hospital has its own variation of the basic token plan. Staff punch the general earning card square(s) corresponding to the behavior emitted and day on which it occurred, making a permanent record while reinforcing the patient (Fig. 1). The unusual shape of the punches makes the tokens difficult to counterfeit, while theft of staff punches has decreased since staff Reprints may be obtained from Barry A. Tanner, Northeast Guidance Center, 17000 E. Warren, Detroit, MI 48224. Presently at Behavioral Systems Consultants, 3300 N. E. Expressway, Atlanta, Georgia 30341. 111 Copyright © 1975 by Academic Press, Inc. All rights of reproduction in any form reserved.
].12
INSTI/U3,IENTS AND T E C H N O L O G Y
IAHE:JohnDoe S#: 200/45/8888
DATE: 10/17/72
FIG. 1. An example of the general earning card. members have signed a form making them financially responsible for the punches. 1 Each hoIe punched is worth one token. The spending card (Fig. 2) is also carried by the patient. Tokens may be spent for unit privileges such as staying up after 1l P.M. or for obtaining items at the token store housed in the canteen. Tokens may also be lost for behavior which the staff wishes to discourage (Kazdin, 1972). Staff take tokens by circling the holes punched in the earning card. Once a hole is circled, it can no longer be spent. Staff also record the transaction on the spending card by circling the time of day at which the behavior 1Extra heavy-duty paper punches with a 1,~'~-inchreach and a variety of dies are available from McGill Metal Products Company, Marengo, Illinois.
INSTRUIVIENTS A N D T E C H N O L O G Y
113
occurred, or by writing the number of tokens charged in the square next to the description of the behavior. Thus, ff on Wednesday a patient wished to purchase an item worth 10 tokens, the store clerk would first check to see if he had 10 unspent tokens on his front card. If the patient had the required tokens, the clerk would draw a circle around each of any 10 tokens to indicate that they were now spent. Next she would turn to his spending card and write "10" next to "Token Store" under Wednesday, as in Fig. 2. When a patient is charged for undesirable behavior, the staff member charging him also describes the incident on the back of the card, For example, ff on Tuesday a patient verbally threatened to strike a staff
Staying Up
Ii-I 1-5
2/hr. 4/hr.
Medicine Requests
(2) Missing Activity, Un: During Activity (5/activity)
Asleep on Unit, in room with door clo= ed or bed during day (2/hr. )
Token Store (# of tk; Recreation
(# of tks)
Inappropriate Behav. A. Verbal (1-5) B. Non-Verbal (I-i0
Walk Out Pass (i0) Day Pass (i0) Weekend Pass (20) Appointment w/staff (2 tokens)
Fro. 2. An example of the general spending card.
114
INSTRUMENTS
AND
TECHNOLOGY
member, he would be charged five tokens. The staff member would circle any five holes punched through the patient's earning card, and would then write a "5" next to "Inappropriate Behavior" under Tuesday on the spending card. He would also describe the incident in detail on the back of the patient's spending card. The individual plan card is used whenever a patient's particular needs require that tokens be given or taken for behaviors not covered under the general system. This card is typed out individually for each person, and may include things such as work, school, particular topics of conversation, or talking with specific persons. The token data are coded weekly for each unit and each resident on the unit, key punched and fed into the hospital computer. The unit psychologist then receives a printout for each patient, as well as summary printouts for the unit. z A typical unit summary (Fig. 8) provides the following information along the top: the week in which the data were collected, the hospital unit on which the data were collected, the number of residents for whom data were reported, the mean length of stay in the hospital, the mean length of stay on the particular unit, and the number of new residents DATE
17/10/72
RESIDENTS REPORTED=3E
L~IT IV
AV. IN HOSP.=6,77
ON UNIT=6.03
THERE ARE 7 NEW RESIDENTS ON THE UNIT
EARNINGS ~MOUNT 304 267
316 482 33 80 301 225 79
SPENDING CATEGORY
AMOUNT
BED P.M. BED A.M. BOOM CHEEK GROOMING RELAXATION AFPR, TALK PHYS. FITNS. SPEC. SKILLS
NEG. CATEGORY
SPENDING
AMOUNT
914 50 15 54
STORE WALK OUT RECRF~ATION STAFF APPT,
260
PASSES
CATEGORY
20 4 132 5 72
STAYING UP MEDICINES UNIT ACT. BED DAY INA VERBAL INA NONVBL
303
TOTAL, AND 19%/8
70
BONES
2087 215 .....
TOTAL, AND INDIVIDUAL
2302
GB~-~'D TOTAL
52%/PO88
1293
TOTAL, AND
81%/S
TOTAL SPENDING 1596, 69%/E
CUt~R'LATIVE TOTALS
TOTAL INDIVIDUAL = 215 FROM 17 PLANS 9% OF TOTAL EARNINGS
EAKNED
9809
SPENT
7008
N/SPG
1525
DIFFERENCE
2801
RECENT HISTORY WEEKS AGO % EAKNED/NEG S
2
3
47/326
54/524
FIG.
4 49/372
5
6
50/399
58/480
7 66/478
3. An example of a unit summary printout.
2The program was written by June Woodward.
8
57/473
INSTRUMENTS
AND TECHNOLOGY
115
on the unit. The printout in Fig. 3 summarizes data collected during the week ending October 17, 1973, on Unit IV. Data were reported for 31 residents, with a mean stay in the hospital of 6.77 wk, and a mean stay on the unit of 6.03 wk (some patients were transferred from other units). Seven of the residents were new to the unit that week. The next major division of the printout provides summaries for earnings, as well as for desirable and undesirable spending. Total number of tokens earned in nine categories are listed under the "Earnings" heading. Then the sum of these nine categories is given under "total" (2,087), followed by the total number of tokens earned on individual plans (215). These are added together to produce the grand total for earnings on the unit that week (2,302). The 2,087 tokens earned under the general economy are 52~ of the tokens which could have been earned during the week, while the 215 tokens earned on individual plans were earned by 17 residents, and represents 9~ of the grand total of tokens earned. The next column on the printout is for desirable spending. Residents spent the greatest number of tokens at the store (914), followed by passes (260). The total of 1,293 tokens spent for desirable items and events represents 81~ of the total number of tokens spent during the week (1,596), and 69~ of the tokens earned that week. The third column summarizes undesirable or negative spending on the unit. The largest number of tokens was spent for being in bed during the day, suggesting that this is a unit-wide problem. The 303 tokens spent for undesirable behavior represent 19~ of the tokens spent that week. Dropping down to the cumulative totals, one finds that patients earned 9,809 tokens and spent 7,008 tokens for desirable activities during their stay on the unit. They were charged an additional 1,525 tokens for undesirable behavior, thereby leaving 1,276 tokens unaccounted for. An unspecified number of these tokens are likely to be in patient's savings accounts, while some might have been lost when cards were misplaced. The bottom rows of the printout show the unit's token history for 7 wk in the form of a ratio of the percentage of possible tokens earned to the absolute number of tokens charged for undesirable behavior. Two weeks earlier, the residents had earned an average of 47~ of all possible tokens available under the general plan, while being charged 326 tokens for undesirable behavior. In general, negative spending increased as earnings increased, reflecting the patient's ability to pay for privileges such as staying in bed during the day. A second unit summary sheet (Fig. 4) provides critical information for each patient. The first two columns indicate the number of tokens earned by each patient under the basic system and individual plans, while the next two columns list each patient's desirable and undesirable spend-
116 UNIT
/NSTHUMENTS AND TECHNOLOGY IV
E,LRNED BASE IND
.!ohn Smich
37
John Jones
60
J o h n Doe
94
10
16
SPENT POS NEC,
5
26
45
24
39
14
ON TH~ UNIT NEW 10420+
X
BObqJS
g
907~E
IIISTOR¥ NO NEC
1
83% ]2
X
1
S/E RATIO
49% 3
50~
Etc.
FtG. 4. An example of a unit individual s u m m a r y printout.
ing. Columns 5-7 are used to identify each person's length of stay on the unit. During a patient's first week on the unit an "X" appears in the "New" column. If no "X" appears in a patient's row, then he has been on the unit from 2 to 10 wk. An "X" appears in the remaining columns if a patient has been on the unit between 11 and 20 wk or more than 20 wk. An "X" appears in the "Bonus" column if a patient earned all of his bonus tokens during the week. A bonus token is given each evening if a patient has earned at least a specified number of tokens that day. The bonus token, therefore, is an indication that a patient has performed at a minimally successful level during the day. The bonus tokens are especially valuable to patients because the price of a pass always includes several bonus tokens, e.g., 20 tokens, four of which must be bonus tokens. The next two columns are also used as measures of patients" overall performance. The ninth column specifies the prior weeks in which the patient has earned at least 90% of all possible tokens in the general economy, while the 10th column indicates the weeks in which he has lost no tokens for undesirable behavior. A 'T' in the "90~E" column means that the patient earned at least 90~ of all possible tokens during the previous week, while a "2" and "3" in the "History No Neg" column means that he was not charged for undesirable behavior 2 or 3 wk prior to the report. The final column specifies the percentage of his earnings which a patient spent during the week. A consistently low percentage suggests that few backup reinforcers are being provided for the patient, while expenditures consistently in excess of i00~ suggest that the patient is obtaining illegal tokens. A patient can occasionally spend more than he has earned in a given week, by withdrawing tokens from his savings account. A separate printout (Fig. 5) gives a detailed report for each patient. Looking at the top of Fig. 5, one learns that this is a record of the token activity of John Doe, social security number 200-45-8888, during the week ending October 17, 1972. Mr. Doe has been in the hospital and on Unit IV for 9 wk. The remainder of the printout is organized much like the unit summary
INSTRU'A~ENTS AND
117
TECHNOLOGY
in Fig. 3. The left-hand column lists the patient's earnings for specific behaviors, as well as his total earnings under the general economy and his individual plan. Mr. Doe earned 81~ of all possible tokens in the general economy, and earned 10 more tokens with his individual plan. His individual plan requires that he emit specified problem-solving behaviors. The middle column lists Mr. Doe's desirable spending. Most of his tokens were spent at the store, with the remainder going for passes. He spent 84~ of his earnings in these two categories. The third column lists spending for undesirable behavior. Mr. Doe was charged 10 tokens for staying in bed during the day, but was charged for no other undesirable behavior. He was left with a balance of eight tokens. During his 9 wk on the unit, Mr. Doe has earned 731 tokens, spent 525 tokens for desirable events, and another 128 for undesirable activities. During this period he has spent an average of 72?o of his earnings. From Mr. Doe's recent history it appears that he has consistently earned around 50.?o of all possible tokens, and has generally been charged few tokens. Exceptions to this occurred 5 and 6 wk previously when Mr. Doe was charged 38 and 53 tokens, respectively. 17/10/72
DATE
IN HOSPITAL
UNIT IV SSNO
John Doe
I0 i0 iO 15 13 24 15
5
SPENDING
NEE.
AMOUNT CATEGORY
CATEGORY BED P.M. BED A.M. ROOM CHECK GROOMING RELAXATION APPR. TALK PHYS. FITNS.
9
SPEC ACT STORE WALK OUT RECREATION STAFF APPT
84
SPENDING
AMOUNT
CATEGORY STAYING UP MEDICINES UNIT ACT BED DAY INA VERBAL INA NONVBL
I0
BONUS
102 10
TOTAL, AND INDIVIDUAL
112
GRAND TOTAL
81%/POSS
I0
PASSES
94
TOTAL, AND
84%/E
104
INDIVIDUAL PLANS I0
ONUNIT
200/45/8888
EARNINGS AMOUNT
9
10
TOTAL, AND I0%/S
ALL SPENDING, 93~/E
BALANCE IS
8
CUMMULATIVE TOTALS
PB SOLVING
EARNED
TOTAL =
10
731
SPENT
525
DIFFERENCE
206
N/SPG
128
SP/E RATIO
72%
9X OF TOTAL E m ~ E ~
RECENT HISTORY WEEKS AGO % EARNED/NEG B
2
54/008
3
69/002
4
B6/Oll
5
69/038
6
56/053
7
52/004
FIG. 5. An example of an individual patient's printout.
8 4710OO
11.8
INSTRUMENTS AND TECHNOLOGY
The economy has frequently been revised to meet the needs of the patients and in order for the printout to provide more meaningful information. We hope to soon substitute percentage of unit mean for percentage of possible tokens earned as one measure of a patient's performance. Earning 90g of all tokens was originally intended as a signal to the staff that the patient was doing almost everything which was required of him, and that he should either be discharged or placed on an individual plan. However, the 90~; appears to be unrealistically high given the small number of people who attain it. The major disadvantage of this system is that it requires weekly coding of the token transactions, a job which is often regarded as trivial by the staff doing it. REFERENCES AITCmSON, R. A. A low cost, rapid delivery point system with "automatic" recording. Journal of Applied Behavior Analysis, 1972, 5, 572-628. KnZDn~, A. E. Response cost: The removal of reinforcers for therapeutic change. Behavior Therapy, 1972, 3, 533-546. PARR/NO, J. J., GEORGE, L., & DAN1ELS, A. C. Token control of pill-taking behavior in a psychiatric ward. Journal of Behavior Therapy and Experimental Psychiatry, 1971, 2, 181-185.