Analysis of outcome variables of a token economy system in a state psychiatric hospital: a program evaluation

This study describes the outcome of a token economy treatment applied to 2 distinct patient populations on the same unit of a stare psychiatric hospit al: individuals with a dual diagnosis of mental retardation and a DSM-IV Ax is I diagnosis of either (a) a severe behavior disorder (BD) or ib) a serio us and persistent psychiatric disorder (PD), Results showed that patients i n the PD group were more likely to complete the treatment (17/20) than thos e in the ED group (17/31) who were more likely to be terminated from the pr ogram (14/31). Individuals who did not complete the program were distinguis hed early, within the first 3 weeks of treatment. These noncompleters recei ved significantly more fines and earned significantly fewer tokens than tho se who completed the program. At an average of 2.7 years post-discharge, th ere was no difference in the proportion of PD (12/16) and ED completers (9/ 11) and ED noncompleters (3/7) remaining in the community. These data show that diverse populations of patients can be treated within the same token e conomy program, thereby improving cost effectiveness. Future research shoul d be directed toward characterizing those patients (e.g., ED) less likely t o succeed when they enter treatment, and determining if modifications in th e program can improve that outcome. (C) 2001 Elsevier Science Ltd. All righ ts reserved.