A hospital's mini-system for behavior modification.

Abstract

lAt a time when mental health funds are becoming scarce, many desirable programs are faced with being reduced in scope or else being eliminated. That situation arose with our transitional-care program at Elgin (ill.) State Hospital in the fall of 1972, when only $500 was allotted for a behavior modification program for the 28 residents; the money was to be spaced over a six-month period. Previously there had been a full-scale token economy in which residents were reinforced for a wide variety of tasks with tokens redeemable at the canteen. A staff committee was organized to work out a behavior modification system that might work within the restrictions set by the small amount of funds. They decided that the system should focus on a limited number of goals for each patient, involve little paperwork or monitoring by staff, and place some responsibiity on the residents to carry through their assignments and receive credit. At the same time, it should be flexible enough to deal with the residents’ individual problems. The mini-system that was finally created met all of those conditions. Each resident was to meet on Monday mornings with his counselor to select a given task, or a series of closely related tasks, that the resident was to carry out during the week. For one patient it might be to take a bath daily, for another to report for medications without being called, and for another to go out to dinner with another resident. For each task performed, the resident would receive 14 tokens, worth about 70 cents. Although that was considerably less than the 150 to 200 tokens a week a resident could earn under the full-scale program, we hoped that he would respond to having to work on only a single task at a time, and one that was not too far beyond his present functioning. To increase the residents’ responsibility and de-