Behavioral Interventions

Behav. Intervent. 27: 109128 (2012)

Published online 14 May 2012 in Wiley Online Library
(wileyonlinelibrary.com) DOI: 10.1002/bin.1342

IMPROVING BEHAVIOR IN A RESIDENTIAL SERVICE

FOR YOUTH IN DRUG AND ALCOHOL
REHABILITATION
Sarah Ann Taylor1,2* and Oliver C. Mudford1
1

The University of Auckland, Auckland, New Zealand

2
Odyssey House, Auckland, New Zealand

A token reinforcement program, named Thumbs Up, was introduced in a residential therapeutic
community for drug and alcohol rehabilitation. Sixteen young people aged 1417 years participated for
varying durations. Participants were able to negotiate target behaviors and choose backup reinforcers.
We evaluated the program within a multiple baseline design across participants, settings, and behaviors.
Improvements occurred in positive verbal statements across settings, timely room cleaning, and
leadership responsibilities. Inappropriate statements were also measured and did not change. One staff
member was trained in the use of Thumbs Up with positive results. Difculties with implementing
behavioral interventions in a non-behaviorally oriented treatment service were identied. Despite needing
renements, it was concluded that a token reinforcement program can be an effective and acceptable
means of improving behavior within a therapeutic community framework. Copyright 2012 John Wiley
& Sons, Ltd.

In addition to interventions targeted on abusive consumption, youth with a history

of substance abuse may require behavioral interventions for various antisocial
problem behaviors; excessive swearing, vandalistic grafti production, and violent
behavior are examples. Additionally, they may lack acceptable levels of positive
social behavior, including manners, positive statements, and promptness (Kaminer
& Tarter, 2004).
Token economies have been successful in addressing many of these behavioral
excesses and decits in a variety of community and residential settings for a range
of populations. A token economy is a behavioral procedure in which a token is
provided contingent on a desired target behavior. Tokens can later be exchanged

*Correspondence to: Sarah Ann Taylor, Applied Behavior Analysis Programme, Psychology Department, The
University of Auckland (Tamaki Campus), PB 92019, Auckland, New Zealand. E-mail: sarahleadley1@gmail.com.
A thesis describing the study fullled the requirements for an MSc degree in Psychology at The University of
Auckland.
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S. A. Taylor and O. C. Mudford

for backup reinforcers, such as highly preferred items or activities. Tokens, thereby,
become conditioned reinforcers. Populations beneting from token economies
have included adolescents in residential settings (Liberman, Ferris, Salgado, &
Salgado, 1975; Phillips, 1968; Phillips, Phillips, Fixsen, & Wolf, 1971) and adults
in drug and alcohol rehabilitation programs (Higgins et al., 1991; Miller, Hersen,
& Eisler, 1974; Preston et al., 1997; Silverman, Chutuape, Bigelow & Stitzer,
1996; Silverman, Higgins et al., 1996; Silverman, Wong et al., 1996). Behaviors
targeted in token economies have included making aggressive statements (Phillips,
1968), room cleaning (Phillips et al., 1971), positive interactions (Bowers, Woods,
Carlyon, & Friman, 2000), and reducing alcohol consumption (Miller et al., 1974).
Despite this extensive research on token economies, there does not appear to be
any research on their implementation for adolescents in residential alcohol and drug
rehabilitation facilities.
One residential treatment model for youth with substance abuse problems is
known as the therapeutic community (TC). TC residents move through treatment
levels, including an assessment phase, treatment phases, and a re-entry phase (based
on De Leon, 2004). A move up the levels occurs after a resident has met criteria for a
signicant period at their current level.
Token reinforcement should t well within a TC and cohere with many of the TC
principles. Adolescents in residential treatment favor motivational incentives (point
or token giving) and positive feedback (Wilner et al., 1977). In the TC, the only
immediate positive reinforcer available is praise. Other reinforcers available in a
TC are delayed, with the most signicant reinforcer being the opportunity to move
up the treatment levels (offering more responsibility and privileges). Additional
privileges in a token reinforcement include the opportunity to negotiate individualized
backup reinforcers.
The TCs focus on right living encourages appropriate social behaviors (De
Leon, 2004), and a token reinforcement may help to improve behavior required for
a move up the treatment levels. Adolescents with a substance abuse problem entering
a TC are claimed to have an inability to delay gratication (De Leon, 2004). Tokens
are used to bridge the delay between the appropriate behavior and the backup
reinforcer. Gratication may be further delayed by allowing participants to save
tokens for larger rewards.
This study implemented token reinforcement within a residential TC for adolescents
with substance abuse problems. It was of interest to see if tokens would serve to
improve prosocial target behaviors, especially positive statements. Also, would
inappropriate statements (including swearing and complaining) decrease as a result of
rewarding positive statements? In addition, we wanted to assess if any changes in target
and non-target behavior would be maintained once the token reinforcement was
implemented by other staff at the program.
Copyright 2012 John Wiley & Sons, Ltd.

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GENERAL METHOD
Setting
The study was conducted at a residential community for adolescents of both sexes
aged between 13 and 17 years with a drug or alcohol problem. The residential
community followed the TC philosophy. There was a maximum of 11 residents at
any time. Admission was voluntary. The opportunity for adolescents to formally exit
the program with parental or social worker agreement was always available, as was
the opportunity to abscond. Recently graduated residents had taken between six
and nine months to complete the treatment program. The residential community
had a layout typical of a large modern home. The residents attended a school, which
was at a separate site within the TC.

Participants
All participants admitted to the residential TC met criteria that included an extensive substance abuse history, no community vocational or educational placement, and
failure in community-based programs. Additionally, many had a diagnosed mental
health disorder, poor or low socialization skills, persistent criminal offending, and
no stable home environment. The youth were admitted only after initial medically
directed withdrawal programs had been successful.
Of the 28 residents that participated at some point in the study, 60% were New
Zealand European, 36% were New Zealand Maori, and 4% were Pacic Islander.
Their ages ranged from 14 to 17 years. Only the most complete data sets (16 residents)
are presented in this paper.
The rst author (researcher) was employed as a youth therapist at the TC. She had
six months experience before the study commenced. Concurrently with the study, she
was receiving post-masters degree in supervised experience in applied behavior
analysis toward professional credentials.

Materials
Tokens
The tokens were printed pieces of paper measuring 2  4 cm. A thumbs up
symbol was printed on colored paper not available in the residential community.
Tokens were colored according to the setting to which they applied. Thumbs up
became the name of the token reinforcement at the TC as it signied the positive
orientation of the intervention.
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Backup Rewards
Initial backup rewards were inexpensive, required few tokens, and were easily
consumable (e.g., candy), so that employing frequent exchange periods would not
disrupt the overall program schedule. Once an effect had been demonstrated across
two settings with small rewards and a resident had been in Thumbs Up for two
weeks, they were able to choose their own rewards. Residents were advised that
the rewards had to be (i) affordable (costing $NZ20 per month maximum), (ii)
relatively easy to provide, and (iii) permitted in the residential program. Residents
could choose material awards or activity-based rewards, such as computer time,
tutoring, or help to gain his or her driving license. A notice board on a lounge wall
was dedicated to Thumbs Up and displayed information regarding the contingencies
and prices of backup items.

Interobserver Agreement
Interobserver agreement was calculated on sessions where a second observer,
either a staff member or a postgraduate student who had training, observed.
Observations were either direct in vivo or via audio recording of the behaviors
of interest.

Procedural Fidelity
When the token reinforcement was handed over to another staff member, the
researcher measured the integrity with which staff gave praise and tokens. Correct
responses involved giving praise for target behaviors, giving the correct number of
tokens, and giving corrective feedback if required (e.g., You need to tidy your
drawers to get two tokens), and incorrect responses involved not giving praise,
giving tokens for non-target behavior, failing to give tokens for target behavior, or
giving the wrong number of tokens. Percentage of correct responses was then
calculated by dividing the number of correct responses by the sum of correct
responses and incorrect responses and multiplying by 100.

Social Acceptability
A six-item survey was completed by clients about their experience with the
Thumbs Up program. Items concerned whether they liked and understood the
intervention and whether they recommended its continuation beyond the research
study. The participants marked their responses on a 10-cm visual analog scale. A
Copyright 2012 John Wiley & Sons, Ltd.

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neutral response was 50. Responses toward the negative end of the scale were values
049, and responses toward the positive end of the scale were values 51100.

EXPERIMENT I: POSITIVE STATEMENTS

Following a meeting with the management, initial target behaviors were selected in
areas that were considered to be important to the residents while in treatment and
after discharge. The rst of these target behaviors was positive statements.

Method
Settings
Settings in which data were collected were termed Mealtimes, Morning Meeting,
and Start Group.

Dependent Variables and Measurement

Positive statements were verbal statements that (i). indicated approval, either in
regular English (e.g., She always looks pretty) or slang (e.g., Sweet as, That
was a mean lunch); or (ii) described a desirable state or mood (e.g., Im so happy);
or (iii) showed concern for another resident, gave thanks, or provided an apology to
another resident. Statements containing swear words or immediately followed by a
negative (e.g., Youre so cool. . . Not!) were not scored as positive. These statements
were measured as frequency within 5-min intervals.
Inappropriate statements were verbal statements that (i) contained swear words; (ii)
included venting, that is, strong disapproval of a person, the program, or an activity;
or (iii) Neg-raving, that is, romanticizing positively about alcohol and drug use or
criminal behaviors. These statements were measured as frequency within 5-min intervals.
Measurement of frequency within 5-min intervals was facilitated by using an
Invisible Clock (Time Now Corporation, 2004), which was programmed to signal
5-min intervals with a tone or vibration. The device measured 5.5  4 cm and
resembled a pager. When a session was <5 min, the number of positive statements
was extrapolated.
Interobserver agreement. A second observer was present for at least 20% of the
sessions for each setting. Interobserver agreement was calculated using the block-byblock agreement method (Page & Iwata, 1986). For each interval, the smaller number
of occurrences was divided by the larger number of occurrences, multiplied by 100,
and averaged across intervals. Interobserver agreement for positive statements was
84% (50100%) and for inappropriate statements, 86% (67100%).
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Procedure
Baseline. Positive statements were recorded in Mealtime, Morning Meeting, and
Start Group. Positive statements were followed by praise from the researcher in
all settings. During Morning Meeting, the residents were often prompted to say
something positive in the Positive Acknowledgements section.
Thumbs Up: Start Group. The researcher verbally gave the participants the
denition of positive statements and role-modeled examples. The participants were
advised that they could earn one token per 5-min interval. Contingent upon a positive
statement, a participant generally received a token immediately. Labeled verbal
praise was also delivered with the token. If the researcher was not able to immediately give the token (e.g., when across the room), she stated thumbs up or
gestured a thumbs up sign to the participant. New residents who joined the Start
Group during the intervention remained in baseline for the rst two sessions.
Exchange times were set immediately after each Start Group. Once participants had
demonstrated an increase in positive statements over three sessions, they had the
opportunity to save their tokens until the end of the second session to gain a larger
reward. Residents who had chosen individual rewards were able to save until they
chose to exchange their tokens.
Thumbs Up: Mealtimes. The procedure for earning and receiving tokens at
mealtimes was the same as those in Start Group. Exchange times for the initial
rewards were set at about an hour after mealtime when the participants had nished
their post-meal cleaning jobs.
Thumbs Up: Morning Meeting. Tokens were earned in the same manner as
previous settings. However, the researcher could not provide tokens immediately as
that would disrupt the ow of the meeting. Contingent on a positive statement, the
researcher made a thumbs up gesture or statement and provided labeled praise.
Tokens were given out at the end of the meeting, and exchange times occurred
immediately after.
Generalization: extending Thumbs Up to other staff. Following training, a staff
member (Heidi) implemented Thumbs Up in Morning Meeting. Training involved
teaching the staff member to accurately identify positive statements from a 5-min
criterion record that was created from audio recordings of Morning Meeting and
Mealtime settings. In addition, the staff member was taught (using modeling, rehearsal,
and feedback) how to accurately record the data and conduct the exchange of tokens.

Experimental Design
The intervention was introduced rst for Jay and Lisa targeting positive statements
in Start Group once baseline data appeared stable. When an improvement in their
Copyright 2012 John Wiley & Sons, Ltd.

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behavior was shown, the intervention was introduced to Robyn. Following this initial
demonstration of apparent treatment effect, baseline lengths were then minimized in
Start Group and Mealtime for ethical and practical reasons. The sequence of intervention for positive statements met the criteria for multiple baseline across participants
experimental design.
A return to baseline (time out from tokens) was implemented for participants
when they returned to the program after being discharged for disciplinary reasons
or had returned from absconding. Thus, there were ABA and ABAB withdrawal
elements included.
The intervention was introduced in Start Group once stable baseline data had been
gained. Once an increase in positive statements was shown across residents, the
intervention was introduced in Mealtime. Subsequently, the intervention was
introduced in Morning Meeting. This sequence met the criteria for multiple baseline
across settings.

Results
Figure 1 shows data for positive statements presented as a non-concurrent multiple
baseline across participants and settings (Mealtimes, Morning Meeting, and Start
Group) for positive statements and inappropriate statements. Data paths for most
participants were variable.
In baseline, most participants showed low, stable responding, or a decreasing trend
(e.g., MealtimeBree). Some residents, however, showed increasing frequencies
during baseline (e.g., MealtimeTim).
The left panel of Figure 1 shows increases in the frequency of positive statements
from baseline to intervention for all participants except Tim (Mealtime), who left the
program, returned briey, and then left again. Bree (Mealtime) also left the program
and returned to baseline in her last session.
The center panel of Figure 1 shows increases in the frequency of positive
statements from baseline to intervention for all participants except for Tim (Morning
Meeting), for whom there were limited data. Some of these residents left the program
(Nevil, Lisa, and Mandy) and returned (Nevil). Although there were not sufcient
data for Jay (Start Group), there was an increasing trend in his positive statements
during the intervention.
The right panel of Figure 1 shows an increase in positive statements from baseline
to intervention for most residents. Limited data were gained for Hannah (Mealtime)
and Bree (Morning Meeting) but showed that the frequency of positive statements
was decreasing during intervention. For Jon (Mealtime) in session 31, the interval
was only 30-s long and Jon said three positive statements, causing an inated
extrapolated value. Jon left the program and upon return, positive statements
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Figure 1. Multiple baseline across participants and settings for positive (lled points) and inappropriate
(unlled points) statements. The arrows pointing at data points are explained in the text.

decreased to zero in a return to baseline in Mealtime and Morning Meeting and then
increased again.
Before the tokens could be introduced for subsequent behaviors, data were
analyzed to assess if Thumbs Up had served to increase positive statements. The data
for positive statements were inspected across the 16 graphs in Figure 1 that have
arrows displayed. The arrows indicate the session up to which data had been gained
when the graphs were analyzed.
Graphs were visually inspected using Millers (1997) method for visual inspection
of behavioral data or the split-middle line of progress method (White, 1974). With the
use of these methods, it was determined that 11 graphs showed an increase when
comparing baseline and intervention phases, four showed no change, and one showed
a decrease. A sign test (Siegel & Castellan, 1988) was performed with these results.
With an alpha level of .05, the benecial effect of tokens on positive statements was
statistically signicant (z = 2.89, p = .006).
Data for inappropriate statements showed low frequencies for all participants in
baseline, with the exception of Jay in Start Group. The frequency of inappropriate
statements remained at near-zero levels across all participants during the token phase
apart from Jay (Start Group).
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Thumbs Up

Figure 2 displays the frequency of positive statements across three participants in

Morning Meeting when both the author (lled points) and Heidi (unlled points)
were implementing Thumbs Up. There was no visually signicant change in the
frequency of positive statements when Heidi was implementing Thumbs Up when
compared with the researcher.
Heidis average percentage of correct responses for positive statements was 85%.
She was also 100% correct on three occasions where she and the researcher roleplayed token exchange.

Discussion
Positive statements improved across settings for most participants in the current
study, supporting the results of previous studies that have also selected positive
statements or interactions as a target behavior (Bowers et al., 2000; Ervin, Miller, &
Friman, 1996; Sanson-Fisher, Seymour, Montgomery, & Stokes, 1978). However,
the increases in positive statements in the current study were not dramatic. This may
have been because the frequency of positive statements was limited by the contingencies. The aim was to increase the frequency of positive statements to one per 5-min
interval. Having this ceiling may have prevented further improvements of positive
statements. It may have been benecial to give tokens for more than one positive
statement per 5-min or to shorten the intervals to see a more dramatic behavior change.
However, this should be balanced against the possibility of teaching residents to be
too positive, that is, more so than their typical age peers.
Baseline

Tokens

FREQUENCY PER 5-MINUTE INTERVAL

Annabelle

4
3
2
1
0
5
4
3
2
1
0

Rachel

Baseline Tokens

30

Jon

5
0
5

10

15

20

25

30

35

40

45

50

55

60

SESSIONS

Figure 2. Positive statements data obtained from Morning Meeting comparing the sessions in which
Heidi (unlled points) and the researcher (lled points) were implementing Thumbs Up.
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The levels of inappropriate statements were socially acceptable for most participants and did not change when Thumbs Up was introduced. Previous literature
showed antisocial comments to decrease as a result of increasing prosocial comments
(Sanson-Fisher et al., 1978). In the current study, inappropriate statements may have
been low because of being under aversive control (the presence of staff in all of the
settings). Petry et al. (1998) found similar results in an outpatient substance abuse
treatment center.

EXPERIMENT II: PROMPTNESS FOR DORM TIGHT

After token reinforcement demonstrated a signicant effect with positive statements,
it was of interest whether similar effects could be demonstrated with room cleanliness.

Method
Setting
Bedroom areas were checked for tidiness to a set of criteria 30 min after all
residents were up and dressed in the mornings. Breakfast was not announced until
all rooms met all criteria.

Response Denition and Measurement

Promptness for dorm tight was dened as the residents room clean and tidy to 11
Dorm Tight criteria on time. Criteria included oors being cleared, clothes folded in
drawers, and beds made neatly with sheets tucked in. Residents were given a 2-min
warning before checks occurred. This is measured as yes/no.
A second observer was present for at least 20% of sessions, and interobserver
agreement was calculated by the number of agreements divided by the sum of agreements
plus disagreements and multiplied by 100. Average agreement values for Dorm Tight
were 82% (range 58100%).

Procedure
Baseline. The researcher checked a residents room and assessed whether it
met all of the Dorm Tight criteria (standards). If it did not meet all the standards,
the researcher pointed out and explained what needed to be xed. A resident was
praised if his or her room was up to standard.
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Thumbs Up. A resident received two tokens and verbal praise if his or her room
met all the standards at Dorm Check time. If one standard was not met, a resident was
given one token with praise for the standards that had been met. The researcher
informed them what needed to be performed next time to earn two tokens. If more
than one standard were not met, corrective feedback was delivered and sometimes
a TC consequence resulted (e.g., loss of a privilege).
Generalization: extending Thumbs Up to other staff. Following further training,
Heidi also implemented Thumbs Up in Dorm Tight. Further training involved
teaching the staff member to accurately check dorm rooms.

Experimental Design
A multiple baseline across participants was used to assess the effects of token
reinforcement on Dorm Tight.

Results
Figure 3 shows the days in which the participants were able to achieve the criterion
during baseline and token phases. An improvement for most participants occurred
when tokens were introduced. However, for some participants, baseline levels
appeared to be increasing before the intervention (Ken, Edward, and Annabelle).
The proportion of days that participants could meet the standards in token phases
was higher for all participants when compared with baseline. Averaged across the
participants, the percentage of days that standards were met in baseline was 37%
(range 066%) and more than doubled to 80% (range 56100%) in intervention.
However, data for the participants were variable and limited data were gained for
some participants (Nevil and Mandy).
A return to baseline was implemented for Nevil and Jon upon their return to the
program and showed that both did not meet Dorm Tight standards. When returned
to the token phase, Nevil was able to meet the standards for two days then left the
program. Jon returned to the token phase and was able to meet the standards on most
days.
Figure 4 displays data obtained from Dorm Tight across three participants
including sessions where Heidi was implementing Thumbs Up. For Annabelle and
Rachel, there was no visually signicant change in data when Heidi was implementing Thumbs Up when compared with the researcher. For Jon, there was a reduction
in the number of days where Dorm Tight standards were met when Heidi was
implementing Thumbs Up. Heidis average percentage of correct responses for Dorm
Tight was 94%.
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Baseline
1

Tokens

Annabelle

0
Baseline Tokens

DORM TIGHT STANDARDS MET (1 = YES/ 0 = NO)

Nevil

0
1

Edward

0
1

Ken

0
1

Rachel

0
1

Mandy

0
Baseline Tokens

Jon

0
5

10

15

20

25

30

35

40

45

50

DAYS

Figure 3. Multiple baseline across participants for Dorm Tight. This shows the days in which participants
met criterion during baseline and token phases.

Discussion
In Dorm Tight, there was an improvement shown for all participants in the
percentage of days that they were able to meet all the Dorm Tight standards. These
results follow those of previous studies that have also improved tidiness (Phillips,
1968; Phillips et al., 1971). Improving promptness to Dorm Tight also helped with
the running of the morning schedule.
Despite improvements, the participants did not consistently meet Dorm Tight
standards when receiving tokens. Data were recorded as yes/no for Dorm Tight.
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Thumbs Up

DORM TIGHT STANDARDS MET (1 = YES/ 0 = NO)

Baseline Tokens
1

Annabelle

0
Rachel

0
Baseline Tokens

Jon

0
5

10

15

20

25

30

35

40

45

50

55

DAYS

Figure 4. Dorm Tight data obtained comparing the days in which Heidi (unlled points) and the
researcher (lled points) were implementing Thumbs Up.

The participants often failed on more than one standard during baseline and improved
to only failing on one standard occasionally in the token phase. Failing on only one of
11 standards was still recorded as no. Having an all or nothing measure made it
impossible to see improvements on different areas in the room. It would have been
benecial to record the percentage of Dorm Tight standards that were met. Phillips
et al. (1971) had divided room cleaning into 10 areas that were scored according to
whether they met specic criteria.

EXPERIMENT III: ANNOUNCING JOB FUNCTION

Method
Setting
Job function occurred immediately after breakfast. Residents were required to
complete rostered domestic activities (e.g., mopping) for approximately 20 min.

Response Denition and Measurement

Job function was dened as announcing to other residents that it was time to start
their domestic chores within 1 min of breakfast ending. The resident announcing Job
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Function must be moving to start his or her own rostered chore within 1 min of
making the announcement. This is measured as yes/no. A second observer was
present for at least 20% of sessions, and interobserver agreement was calculated by
the number of agreements divided by the sum of agreements plus disagreements
and multiplied by 100. Interobserver agreement was 100%.

Procedure
Baseline. If the resident did not announce Job Function by the required time, the
researcher prompted them (e.g., Jon, you need to be getting the others into Job
Function now). If the resident announced Job Function unprompted, the researcher
gave praise.
Thumbs Up. Contingent upon announcing Job Function, a resident received one
token. If they announced Job Function late or announced it but continued to eat or
talk to residents, they were not awarded a token. They were also reminded of the
contingencies, Annabelle, you need to announce Job Function on time if you
want to earn a token. Initial exchange times occurred after residents had completed
their jobs.

Experimental Design
An AB design across two participants was used to assess the effects of token
reinforcement on announcing job function. Token reinforcement was introduced for
job function following intervention with positive statements and Dorm Tight. Thus,
the overall study design also met the criteria for multiple baseline across behaviors.

Results
Figure 5 shows the number of days that Jon and Annabelle announced Job Function
during baseline and token phases. Tokens succeeded in increasing the number of days
Jon announced Job Function. Annabelle also showed an improvement in announcing
Job Function. However, neither participant was 100% reliable.

Discussion
Token reinforcement also served to increase the number of days on which two
residents announced Job Function. Improving this behavior ensured that Job Function
started on time without prompting from the researcher. However, neither resident was
completely reliable at announcing Job Function. This may have been due to disruption
caused by tokens only being available on days when the researcher was present (four
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ANNOUNCED JOB FUNCTION (1=YES/0=NO)

Thumbs Up
Baseline

Tokens

Annabelle

0
1

Jon
1

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

DAYS

Figure 5. Multiple baseline across participants for Announcing Job Function.

days per week) and the residents losing the responsibility when placed on sanction.
There were no data taken on these days. It would have been of interest to reward
announcing Job Function in the evening and other scheduled events (e.g., mealtimes
and meetings).

SOCIAL ACCEPTABILITY
Five participants completed the client satisfaction survey. Participants gave high
ratings for Thumbs Up in areas of enjoyment, (mean 87, range 72100), understanding
how to earn tokens (mean 99, range 98100), continuing Thumbs Up (mean 89, range
46100), recommending new residents to participate (mean 90, range 63100),
improvement of behaviors (mean 94, range 74100), and for making the stay at the
residential community more enjoyable (mean 65, range 38100).

GENERAL DISCUSSION
In summary, token reinforcement served to improve three target behaviors for most
participants despite poor retention in the treatment program. Another staff member
was also able to implement token reinforcement (known as Thumbs Up in the
facility) in some settings with positive results. Residents who responded to the social
validity survey found the intervention highly acceptable. The token reinforcement
was inexpensive and easy to implement for both the researcher and another
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staff member. This study extends current literature by implementing token reinforcement in a residential rehabilitation facility for adolescents with substance abuse
problems. Overall, the study design was multiple baseline across participants,
settings, and behaviors with some treatment withdrawal elements (Barlow, Hayes,
& Nelson, 1984).
Another staff member also implemented Thumbs Up with positive results in
Morning Meeting and Dorm Tight. The staff member showed correct responding
above 80% on most training sessions; however, she occasionally neglected to give
tokens out. The researcher reduced this lapse somewhat by instructing the residents
to request their tokens if they had not been given out. Training participants to request
reinforcement has been reported in previous studies (Seymour & Stokes, 1976).
It was aimed to train the staff to implement Thumbs Up in other settings, however
her role was restructured before the end of the study and she was no longer present in
these settings.
Some residents in the current study saved their tokens and only exchanged a small
number once before leaving the treatment program. Reasons for this may have been
that the tokens themselves may have been reinforcing: Residents were observed to
compete with their peers in acquiring and saving their tokens. The praise provided
with tokens may have been the reinforcer for most participants rather than the
eventual gain of the backup reward. Previous literature has also shown the token
alone to reinforce behavior (Hall et al., 1972).
A more probable reason for savings in the current study may be attributed to the
control over naturally occurring items or activities as backup rewards. In the current
study, television, board games, a weekly allowance, and basic snacks were freely
available at the residential community and did not need to be purchased with tokens.
However, previous studies have required basic activities such as these to be
purchased with tokens before any other privilege (e.g., Phillips, 1968; Phillips
et al., 1971). Including basic activities (such as television) as a backup reward may
have ensured that token spending was maintained.
Enabling participants to change their rewards or negotiate prices may have helped
to increase the motivation of participants (Barkley, 1987). Karraker (1977) reported a
higher rate of math performance for students who chose rewards from a list they had
constructed than for students who received a teacher-selected reward. Kamon,
Budney, and Stanger (2005) allowed adolescents to exchange vouchers for their
chosen appropriate reward.
Exchange times in the study were at set daily times for participants in their rst two
weeks of the program. These new residents were not permitted to save tokens until
the next day. This ensured that new participants came into contact with the backup
rewards. For individualized rewards, exchange periods generally occurred when the
resident had saved the required amount of tokens. Not having a specied exchange
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time on the schedule may have also resulted in high savings, as residents were not
being prompted frequently to purchase backup rewards.
Studies at Achievement Place implemented specied exchange periods (Wolf
et al., 1976). A new resident rst exchanged points at the end of the day for
privileges the next day. After demonstrating skills and self-control, the resident
then exchanged points at the end of the week for privileges the following week.
Similar exchange times may have improved behavior in the current study. Participants may have shown higher frequencies of target behaviors if they needed to
have a set number of tokens by a specied time. It may have also encouraged
regular spending.
Because of the difculty with retention, the researcher did not manage to fade the
token reinforcement for any participants. However, there was an attempt made to
remove Jon from the token reinforcement by electing him as a manager. This was
only attempted on a few occasions before he started a community-based educational
course and was no longer present in the settings in which the token reinforcement was
operating. Previous studies have reported the positive results of peers acting as
behavior modiers (Bailey, Timbers, Phillips, & Wolf, 1971; Phillips, Phillips, Wolf,
& Fixsen, 1973).
Data did not detect generalization across settings for positive statements or
across behaviors for three residents. Other work duties meant that the researcher
had limited observation of non-intervention settings. It would have been benecial
to train a staff member to record positive statements when the researcher could not
be present. Generalization across behaviors was not expected, as Dorm Tight
and announcing Job Function were not similar to positive statements. Shortened
baselines meant that generalization across participants could not be assessed.
Most new participants came into the program, whereas longer-term residents were
already in the intervention phase.
The rst author continued to lead the administration of Thumbs Up for one
year following the study and added further target behaviors, such as completing
academic work and participating in a job skills training program (Taylor, Mudford,
& Phillips, 2011).
There were several difculties in conducting the study. First, the number of
participants varied greatly during the study. At the beginning of the study, ve
residents consented to being in the study. Numbers changed as new residents arrived
and other residents left. Three residents opted not to participate in Thumbs Up at rst,
but two later changed their minds. One other resident who chose not to participate
stayed in the program for two weeks before the residential community discharged
her because of rule violations. One resident withdrew from Thumbs Up shortly after
the intervention started in Start Groups. Therefore, 29 out of 30 residents at the
residential community chose to participate in Thumbs Up at some stage.
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S. A. Taylor and O. C. Mudford

The number of residents leaving and entering the program limited the collection of
data. Therapeutic gains for participants also may have been lost because of the
limited time spent in intervention. Gaining informed consent from parents or
guardians delayed the intervention in some cases, and some residents were not
exposed to tokens at all. Poor retention of residents also made individualized rewards
difcult. Three residents who initially chose individualized backup rewards left
within days of the researcher purchasing the items.
A second set of difculties concerned changes in rules at the residential community, resulting in restrictions on some popular backup rewards (e.g., a new rule
preventing residents from using the computer at the facility). Hobbs and Holt
(1976) reported similar organizational obstacles in implementing a token reinforcement. Additionally, there were days when Thumbs Up was administratively
suspended because of participants being placed on sanction. Residents who were
on sanction in the facility could earn tokens but not exchange them for backup
rewards. This meant that these residents experienced time out from exchanging
tokens, which was not part of Thumbs Up. We had not experienced these administrative hurdles with another behavioral intervention successfully conducted in the TC
(Taylor, Anderson, & Mudford, 2010). In that study, we taught residents to prepare
for activities outside the TC in a more timely manner. It is likely that the Thumbs
Up study ran into difculties as it extended over several activities, involved more
residents, and was conducted over a longer time.
Hobbs and Holt (1976) discussed the failure of token economies to observe the
change in behavior outside of the treatment facility. In the current study there
were no data obtained for adolescents who had left the treatment facility as this
was against the organizations policy. Occasionally, graduated residents return to
the treatment program to visit. It would be of interest to observe behavior in
this situation.
In summary, this study extends the current literature by implementing a token
reinforcement within a TC framework and with adolescents with a substance abuse
problem. Results were consistent with those of previous studies with delinquent
adolescents for most of the participants and target behaviors. Despite some identied
difculties, the token reinforcement was a successful means of increasing appropriate
behaviors that generally worked within TC standard procedures.

ACKNOWLEDGEMENTS
The study was partly funded by a University of Auckland Masters Scholarship awarded to
the rst author. We thank Kerrie Anderson for her contributions to the study.
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