THE TOKEN ECONOMY THE PLENUM BEHAVIOR THERAPY SERIES Series Editor: Nathan H. Azrin

THE TOKEN ECONOMY: A Review and Evaluation By Alan E. Kazdin

COGNITIVE-BEHAVIOR MODIFICATION: An Integrative Approach By Donald H. Meichenbaum THE TOKEN ECONOMY A Review and Evaluation

ALAN E. KAZDIN The Pennsylvania State University University Park, Pennsylvania

PLENUM PRESS· NEW YORK AND LONDON Library of Congress Cataloging in Publication Data

Kazdin, Alan E The token economy. (The Plenum behavior therapy series) Bibliography: p. Includes indexes. 1. Operant conditioning. 2. Reinforcement (psychology) I. Title. [DNLM: 1. Behavior therapy. 2. Reward. WM420 K235tj BF319.5.06K39 153.8'5 7644285 ISBN -13:978-1-4613-4123-9 e-ISBN -13:978-1-4613-4121-5 DOl: 10.1007/978-1-4613-4121-5

© 1977 Plenum Press, New York Softcover reprint of the hardcover 1st edition 1977

A Division of Plenum Publishing Corporation 227 West 17th Street, New York, N.Y. 10011 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from lhe Publisher To my sister, Fran PREFACE

Applications of operant techniques in treatment and education have proliferated in recent years. Among the various techniques, the token economy has been particu• larly popular. The token economy has been extended to many populations included in psychiatry, clinical psychology, education, and the mental health fields in general. Of course, merely because a technique is applied widely does not neces• sarily argue for its efficacy. Yet, the token economy has been extensively re• searched. The main purpose of this book is to review, elaborate, and evaluate critically research bearing on the token economy. The book examines several features of the token economy including the variables that contribute to its efficacy, the accomplishments, limitations, and potential weaknesses, and recent advances. Because the token economy literature is vast, the book encompasses programs in diverse treatment, rehabilitation, and educational settings across a wide range of populations and behaviors. Within the last few years, a small number of books on token economies have appeared. Each of these books describes a particular token economy in one treatment ,etting, details practical problems encountered, and provides suggestions for ad• ministering the program. This focus is important but neglects the extensive scholarly research on token economies. The present book reviews research across diverse settings and clients. Actually, this focus is quite relevant for implementing token economies because the research reveals those aspects and treatment variations that contribute to or enhance client performance. The data base now available extends the treatment recommendations that can be made beyond the necessarily limited experience that stems from only one program with a Single-client popula• tion. Aside from the general focus and orientation, other features have been in• cluded to distinguish this text from others in the area. First, specific influences on client performance that are often omitted or underplayed in other texts are elaborated. These include the influence of self-administration and peer adminis• tration of the contingencies, the relationship of economic variables in the token economy and client behavior change, the role of punishment as an adjunctive procedure, the influence of modeling and vicarious processes, the effects of dif• ferent types of contingencies, and other influences. Second, token reinforcement programs have been extended beyond the usual treatment settings. Currently, many programs focus on socially and environmentally relevant behaviors such as pol• lution, energy conservation, job procurement, and others. These applications repre- vii viii PREFACE

sent a significant extension of reinforcement techniques and are reviewed in detail. Finally, legal issues have become prominent in behavior modification in the last few years. Many court decisions have direct bearing on implementing token economies, particularly in institutional settings. Salient decisions and their implications for implementing token economies are reviewed. The book begins with a chapter that details the principles of operant condition• ing. This chapter serves only as background material for the remainder of the text and may be disregarded by the reader already quite familiar with operant principles. The main text begins by tracing the development of applied operant research in general and the token economy in particular (Chapter 2). This historical focus includes examples of large scale "token economies" that antedated the develop• ment of behavior modification. The advantages of token economies over other reinforcement practices also are detailed. The token economy is not a unitary technique. Token economies vary widely across a range of dimensions including who administers the tokens, how tokens are administered, whether back-up events are used, and if so, what events, the type of contingencies, and so on. The range of options that can be incorporated into the token economy and the effects of these options on client behavior are reviewed (Chapter 3). The token economy has been used with an amazingly large number of populations across several behaviors. Applications and accomplishments with psy• chiatric patients, the mentally retarded, individuals in classroom settings, delin• quents, adult offenders, drug addicts, alcoholics, children and adults in outpatient treatment and in the "natural environment," and several others are reviewed (Chapters 4 and 5); Several issues bear directly on the effectiveness of a token economy. Major issues are discussed including training individuals to implement a token economy, ensuring that clients respond to the contingencies, and the manipulation of eco• nomic variables (Chapter 6). Certainly, one of the most outstanding issues in the field is maintaining behavior changes effected in token economies and ensuring their transfer to non treatment settings. The technology of maintaining behavioral gains has made important advances in the last few years. With an empirical base, specific procedures can be advanced to increase the likelihood that behaviors will be maintained and transfer to new settings after the token economy has been termi• nated (Chapter 7). Although the early chapters in the book stress the accomplishments of the token economy, the criticisms that might be levied against this approach also are detailed. The token economy is critically evaluated across a number of dimensions including the treatment focus, variables contributing to its efficacy, the possible deleterious effects of extrinsic reinforcement, a comparison of the token economy with other treatment procedures, and whether token economies have achieved clinically important changes in behavior (Chapter 8). A relatively new focus in the field is the extension of reinforcement techniques to SOCially and environmentally relevant behaviors. Applications of reinforcement, particularly those based upon token reinforcement, are detailed along with broader extensions that have at• tempted to apply operant principles to community and social living situations PREFACE ix

(Chapter 9). Involvement of the courts in treatment and rehabilitation, especially in recent years, has generated legal rulings that bear directly upon the token economy as a treatment technique. Ethical and legal issues, major court decisions, and procedures designed to protect client rights are described (Chapter 10). The final chapter of the text briefly summarizes the major accomplishments and salient issues of the token economy (Chapter 11). Over the last few years, I have had the opportunity to discuss developments in applied behavior analysis with several individuals whose contributions have served as the foundation of the field. These individuals have influenced much of the content of the present text and no doubt its overall orientation. The list of individuals would be too long to acknowledge here and in any case might be omitted to avoid inadvertently implying their endorsement of the present text. As an exception to this, I wish to make a special note of my gratitude to Nathan H. Azrin whose evaluative comments on the manuscript were not only important in achieving the final version of this book but also in stimulating many of my own thoughts about the field in general. Finally, I wish to acknowledge the support of the Center for Advanced Study in the Behavior Sciences. Final preparation of the book was completed while I was on leave at the Center. Alan E. Kazdin The Pennsylvania State University CONTENTS

Chapter 1 PRINCIPLES OF OPERANT CONDITIONING 1

Reinforcement...... 2 Positive Reinforcement ...... 2 Negative Reinforcement...... 5 Punishment ...... 6 Extinction ...... 8 Maximizing the Effect of Positive Reinforcement ...... 8 Delay of Reinforcement...... 8 Magnitude or Amount of Reinforcement ...... 9 Quality or Type of the Reinforcer ...... 9 Schedules of Reinforcement ...... 10 Shaping ...... 12 Chaining ...... , 13 Prompting and Fading ...... 14 Discrimination and Stimulus Control ...... 15 Generalization ...... 16 Conclusion ...... 17

Chapter 2 INTRODUCTION AND HISTORICAL OVERVIEW...... 19

Investigation of the Influence of Response Consequences ...... 20 Extensions of Operant Methods to Human Behavior: An Overview ...... 22 Conceptual and Experimental Extensions ...... 22 Clinical Applications ...... 26 Token Economies Antedating Contemporary Behavior Modification...... 30 Joseph Lancaster and the "Monitorial System" ...... 30 The Excelsior School System ...... 33 Alexander Maconochie and the "Mark System" ...... 34 Contemporary Foundations of Token Economies ...... 35 Reinforcement Programs in Applied Settings ...... 39 Food and Other Consumable Items...... 39 Social Reinforcers ...... 41 xi xii CONTENTS

Activities, Privileges, and Other High Probability Behaviors...... 41 Informative Feedback ...... 43 Token Reinforcement ...... 44 Conclusion ...... 45

Chapter 3 THE TOKEN ECONOMY: PROGRAM OPTIONS AND VARIATIONS 47

The Basic Token Program and Its Requirements ...... 47 The Token ...... 47 Back-up Reinforcers...... 49 Specification of the Contingencies ...... 51 Examples of Token Economies in Three Settings...... 52 Psychiatric Ward ...... 52 Home-Style Facility for Pre-Delinquents ...... 55 Elementary School Classroom ...... 58 Program Variations, Options, and Their Effects...... 59 Types of Contingencies ...... 60 Administration of Consequences ...... 64 Range and Extent of Back-up Reinforcers ...... 66 Token Withdrawal or Response Cost ...... 69 Response Cost Programs ...... 70 Token Economies Including Response Cost ...... 72 Use of Response Cost...... 73 Leveled Programs ...... 73 Peer Administration of the Contingencies ...... 76 Self-Administration of Consequences ...... 79 Conclusion ...... 82 Chapter 4 REVIEW OF TOKEN ECONOMIES I ...... 85

Psychiatric Patients ...... 85 General Ward-Wide Programs...... 85 Complex and Therapeutically Relevant Behaviors and "Symptoms" . . .. 88 Social Behaviors ...... 90 Other Behaviors ...... 92 The Mentally Retarded ...... 93 Ward and Self-Care Behaviors...... 93 Verbal Behavior and Language Acquisition ...... 95 Social Behaviors ...... 98 Work-Related Behaviors...... 99 Other Behaviors " ...... 100 Individuals in Classroom Settings ...... 101 Disruptive Behavior and Inattentiveness...... 102 CONTENTS xiii

Academic Behaviors ...... 105 Other Behaviors ...... 109 Conclusion ...... 110

Chapter 5 REVIEW OF TOKEN ECONOMIES II 113

Pre-Delinquents and Delinquents ...... 113 Antisocial Behavior ...... 117 Classroom and Academic Behaviors ...... 117 Social Skills ...... 119 Adult Offenders ...... 119 Drug Addicts and Problem Drinkers ("Alcoholics") ...... 126 Applications with Drug Addicts ...... 126 Applications with Alcoholics ...... 128 Outpatient Applications...... 129 Outpatient Therapy ...... 130 Interventions in the Natural Environment with Children and Adolescents l32 Interventions in the Natural Environment with Adults ...... 135 Other Populations and Applications...... l36 Geriatric Residents ...... '...... 136 Stutterers ...... 138 Aphasics...... 138 Social Extensions ...... l38 Conclusion ...... 139

Chapter 6 MAJOR ISSUES AND OBSTACLES IN ENSURING EFFECTIVE PROGRAMS ...... 141

Training Staff and Other Behavior-Change Agents ...... 141 Staff Training Techniques ...... 142 Instructional Methods ...... 142 Feedback ...... 143 Self-Monitoring ...... 144 Modeling and Role-Playing ...... 145 Social Reinforcement ...... 146 Token Reinforcement ...... 147 Combined Techniques ...... 148 Training Techniques: General Comments...... 150 The Effects of Token Economies on Staff Behavior...... 151 Unresponsive Clients ...... 153 Explanations of Unresponsiveness ...... 154 Techniques to Enhance Responsiveness ...... 155 xiv CONTENTS

Response Priming...... 156 Reinforcer Sampling ...... 157 Selecting Increasingly Potent Reinforcers ...... 158 Modeling Influences...... 159 Individualized Contingencies ...... 161 Group Administration of Consequences...... 162 Unresponsiveness: Summary ...... 163 Economic Variables in Token Economies ...... 163 Income and Savings ...... 164 Expenditures and Back-up Events ...... 165 Economic Variables: General Comments ...... 168 Conclusion ...... 169

Chapter 7 GENERAliZATION OF BEHAVIOR CHANGE...... 173

Maintenance of Behavior after Withdrawal of Tokens ...... 175 Transfer of Training across Situations ...... 177 Techniques to Program Maintenance and Transfer ...... 177 Selecting Behaviors That Are Likely to Be Maintained...... 178 Substituting One Program for Another ...... 180 Fading the Contingencies ...... 183 Expanding Stimulus Control ...... 184 Scheduling Intermittent Reinforcement...... 188 Delaying Reinforcer Delivery ...... 190 Self-Reinforcement ...... 191 Self-Instruction Training ...... 193 Programming Maintenance and Transfer: General Comments ...... 194 Conclusion ...... 196

Chapter 8 CRITICAL EVALUATION OF THE TOKEN ECONOMY 197

Focus of Token Programs ...... 197 Target Behaviors ...... 197 Settings ...... '199 Populations ...... 201 Focus of Token Programs: Summary ...... " 202 Analysis of the Token Economy and Its Effects ...... 203 Variables Contributing to the Token Economy ...... 203 Instructions...... 203 Social Reinforcement and Interpersonal Interaction ...... 205 Feedback ...... 207 Modeling Influences ...... 207 CONTENTS xv

Subject and Demographic Variables ...... 208 Variables Contributing to the Token Economy: Summary ...... 210 Possible Deleterious Effects of Extrinsic Reinforcement ...... 210 Comparison of the Token Economy with Other Treatment Techniques .... 214 The Token Economy versus Standard or Routine Treatment ...... 214 The Token Economy versus Other Specific Treatments ...... 216 The Token Economy versus Pharmacotherapy ...... 218 Evaluation of the Effects of Treatment ...... 221 Important Considerations in Validating the Effects of Treatment ...... 223 Conclusion ...... 225

Chapter 9 EXTENSIONS OF REINFORCEMENT TECHNIQUES TO SOCIETY ..... 229

Pollution Control and Energy Conservation ...... 229 Littering...... 229 Recycling Wastes ...... 231 Energy Conservation ...... 233 Mass Transportation...... 234 Excessive Noise ...... 236 Job Performance and Unemployment ...... 236 On-the-Job Performance ...... 236 Obtaining Employment ...... 239 Community Self-Government ...... 240 Racial Integration ...... 242 Military Training ...... 243 Broader Social Extensions: The Design of Communities and Society ...... 244 Walden Two ...... 244 Twin Oaks Community ...... 246 Experimental Living Project...... 148 Evaluation of Social Extensions of Reinforcement Techniques ...... 251 Conclusion ...... 252

Chapter 10 ETHICAL AND LEGAL ISSUES ...... 255

Ethical Issues ...... 256 Behavior Control ...... 256 Control for What Purposes and by Whom? ...... 257 Individual Freedom ...... 258 Legal Issues ...... 260 Contingent Consequences and Environmental Restraint ...... 261 Selection of Target Behaviors...... 264 Right to Treatment ...... 265 xvi CONTENTS

Refusal of Treatment ...... 266 Informed Consent ...... 268 Protection of Client Rights ...... 270 Conclusion ...... 275

Chapter 11 SUMMING UP ...... 279

The Accomplishments of the Token Economy ...... 279 Outstanding Issues ...... 281 When and How to Use the Token Economy...... 283 The Ethical and Legal Challenge ...... '285

REFERENCES ...... 287

AUTHOR INDEX ...... 329

SUBJECT INDEX ...... •.... 339