THE EFFECT OF AN IN-HOSPITAL TOKEN ECONOMY PROGRAM UPON SUBSEQUENT TIME SPENT IN THE COMMUNITY AND IN A VOCATIONAL REHABILITATION PROGRAM (TREATMENT, CHRONIC, PSYCHIATRIC PATIENTS

Despite advances in mental health care, there remains in the United States a large population of psychiatric patients who are chronically hospitalized. These patients have not responded to any form of treatment and, consequently, have received minimal treatment. This situation has been reflected at Essex County Hospital Center where there is a large chronic population. A token economy program was introduced into this setting in 1973. Its purpose was to prepare patients for more independent functioning and eventual discharge into the community or transfer to a vocational rehabilitation program. It was expected that the token economy treatment would increase the amount of time patients could spend in these settings. It was also expected that the token economy treatment would increase the percentage of patients discharged to the community and the percentage transferred to the vocational rehabilitation program. The purpose of this study was to evaluate if the token economy program at Essex County Hospital Center, indeed, improved patient functioning by comparing equated groups of regressed and chronically hospitalized patients from the token economy wards with those from non-token economy wards on five subsequent dependent variables: (a) proportion of time spent in the community; (b) proportion to time spent in a rehabilitation program; (c) proportion of time spent in the community and the rehabilitation program combined; (d) percentage of patients ever discharged; and (e) percentage of patients ever in the rehabilitation program. Statistical analyses did not show evidence of improved functioning on the dependent variables. Methodological flaws and problems inherent in the token economy program were discussed.