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Evaluation of a level system with a built in token economy to decrease inappropriate behaviors of individuals with mental retardation
h [electronic resource] /
by Ashley Tomaka.
[Tampa, Fla] :
b University of South Florida,
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Document formatted into pages; contains 38 pages.
Thesis (M.A.)--University of South Florida, 2009.
Includes bibliographical references.
Text (Electronic thesis) in PDF format.
ABSTRACT: The level system is a behavioral procedure that alters the status of a participant contingent on his or her behaviors; within each level the amount of reinforcement is different. In most cases, level systems are paired with another form of treatment such as a token economy. In the current study, the effectiveness of a level system with a built in token economy was evaluated within three intensive residential group homes with 3 male participants. Each participant was diagnosed with mental retardation and behavioral issues. The level system was comprised of 5 different levels, each having different privileges and reinforcers. Each participant received token dollars for displaying replacement behaviors and the tokens were used to purchase items from a token store. A preference assessment was conducted to determine the items and their values. The results of the current study suggest that a level system with a built in token economy is an effective form of treatment in managing severe, inappropriate behaviors in individuals with mental retardation residing in a group home setting.
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Advisor: Raymond G. Miltenberger, Ph.D., BCBA
Inappropriate sexual behaviors
x Child and Family Studies
t USF Electronic Theses and Dissertations.
Evaluation of a Level System with a Built in Token Economy to Decrease Inappropriate Behaviors of Individuals with mental Retardation by Ashley Tomaka A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts Department of Child and Family Studies College of Behavioral and Community Sciences University of South Florida Major Professor: Raymond G. Miltenberger, Ph.D. Kimberly Church, PsyD Timothy Weil, Ph.D. Date of Approval: June 4, 2009 Keywords: Behavior Interventions, Developm entally Disabled, Inappropriate Sexual Behaviors, Individualized Treat ment, Behavior Management Copyright 2009, Ashley Tomaka
Dedication I would like to dedicate this study to my Mom, Dad, Danny, Jimi and the rest of my family. Thank you for your constant s upport and encouragement everyday; without all of you I would not have got to where I am today. Finally, to everyone who dedicates their time to improving the lives of individuals with disabilities.
Acknowledgements First and foremost, I would like to acknowledge and thank my advisor, Dr. Raymond Miltenberger for his amazing teaching capab ilities. I am very grateful to have experienced his never ending fountain of knowledge and guidance. Secondly, I would like to acknowledge Stephani Fauerbach, Dr. Kim Church, Valeria Parejo, Tamika Rickerson and the rest of the Behavior Team at the Human Development Center. I am grateful to have such amazing mentors to gui de me through the application of behavior Analysis. There is no greater group of people to work with than our team.
i Table of Contents List of Tables ii List of Figures iii Abstract iv Introduction 1 Token Economy 1 Level System 6 Level System with Built in Token Economy 7 Method 6 Participant and Setting 6 Target Behaviors 8 Data Collection 11 Interobserver Agreement 11 Treatment Integrity 12 Procedure and Design 13 Preference Assessment 13 Baseline 14 Treatment 14 Training Staff and Participants 15 Token Economy 15 Level System 16 Results 19 Discussion 26 References 31 Appendices 33 Appendix A: Target Behavior Sheet 34 Appendix B: Replacement Behavior Sheet 35 Appendix C: Token Prices 36 Appendix D: Staff Monitoring Form 37 Appendix E: Level System Test 38
ii List of Tables Table 1 Target Behaviors 8 Table 2 Replacement Behaviors 10 Table 3 Level System 17
iii List of Figures Figure 1. Daniels Level System graph whic h includes all target behaviors that were engaged in. Closed Squares = Level, Diamonds= Reducible Behaviors. 18 Figure 2. Dougs Level System graph which includes all target behaviors that were engaged in. Closed Squares = Level, Diamonds= Reducible Behaviors. 20 Figure 3. James Level System graph which includes all target be haviors that were engaged in. Closed Squares = Level, Diamonds= Reducible Behaviors. 21 Figure 4. Daniels Level System graph which includes all replacement behaviors that were engaged in. Closed Squares = Level, Diamonds= Replacement Behaviors. 22 Figure 5. Dougs Level System graph wh ich includes all replacement behaviors that were engaged in. Closed Squares = Level, Diamonds= Replacement Behaviors. 23 Figure 6. James Level System graph wh ich includes all replacement behaviors that were engaged in. Closed Squares = Level, Diamonds= Replacement Behaviors. 23
iv Evaluation of a Level System with a Built in Token Economy to Decrease Inappropriate Behaviors of Individuals with Mental Retardation Ashley Tomaka ABSTRACT The level system is a behavioral procedur e that alters the status of a participant contingent on his or her beha viors; within each level th e amount of reinforcement is different. In most cases, level systems are pair ed with another form of treatment such as a token economy. In the current study, the eff ectiveness of a level system with a built in token economy was evaluated w ithin three intensive resident ial group homes with 3 male participants. Each participant was diagnosed with mental retardation and behavioral issues. The level system was comprised of 5 different levels, each having different privileges and reinforcers. Each partic ipant received token dollars for displaying replacement behaviors and the tokens were used to purchase items from a token store. A preference assessment was conducte d to determine the items and their values. The results of the current study suggest that a level sy stem with a built in token economy is an effective form of treatment in managing seve re, inappropriate beha viors in individuals with mental retardation resi ding in a group home setting.
1 Introduction Historically, token economies have b een the most widely used behavior management procedure in residential, in-pa tient, school, and correctional settings (Jones, Downing, Latkowski, Ferre, & McMahon, 1992). Originally developed to manage inappropriate or maladaptive behaviors with in the institutionalized population, the token economy has morphed its function to increa sing pro-social beha viors and correcting academic deficits as well (Allyon & Azri n, 1968; Birnbrauer, Wolf, Kidder, &Tague, 1965; Clark, Lachowicz, & Wolf, 1968; J ones et al., 1992; Kazdin & Bootzin, 1972; Liberman, 2000; Wolf, Giles, & Hall, 1968). The token economy has been paired with many other behavior management procedures; more recently the Level System (Cavalier, Ferretti, & Hodges, 1997; Kerr & Nelson, 1989). The Level System is a behavioral procedure that alters the stat us of participants contingent on their behavior; each status level differs in the amount of reinforcement (Hagopian et al., 2002). The token economy is a behavioral procedur e that administers an exchange unit or token (for example, a coupon, poker chip, a penny, a hole punch in a card or small cardboard cutout) to an indi vidual contingent on speci fically defined behaviors (Dickerson, Tenhula, & Green-Paden, 2004). Th e tokens become conditioned reinforcers because they are then turned in at desi gnated times for back-up reinforcers (Comaty, Stasio, & Advokat, 2001). The components of a token economy are very simple. First, the target behaviors to be increased or minimized must be identi fied (Kazdin, 1982). This is the foundation of
2 the token economy. Contingent on target behaviors to be increased or the absence of target behaviors to be decreased th e participant will receive tokens. Second, you must identify what you w ill use as tokens. The purpose of the token economy is to increase the occurrence of good behaviors and decrease the occurrence of bad behaviors. Each good behavior immediat ely receives a token and is exchanged later for a back-up reinforcer; because the tokens are paired with other reinforcers they become conditioned reinforcers which in crease the likelihood of good behaviors occurring (Miltenberger, 2008). When choosing the back-up reinforcer to pair with the token it is important to choos e items that are preferred by the participants; this will increase the likelihood of the pa rticipants engaging in the ap propriate behaviors so that they will earn the items of their choice (Miltenberger, 2008). Lastly, you must identify how the toke ns will be earned and sp ent to access the backup reinforcers. It has to be decided for what behaviors and under what conditions the tokens will be dispensed. These conditions mu st be consistent in order for the treatment to be effective. The same goes for spending the tokens. If the t okens are used to buy tangible items it is best to se t-up a specific time in which th e tokens can be spent and only allow spending at that time. This makes the reinforcing value of the tokens higher (Kazdin, 1982). In order for the token economy to r un smoothly, the observation, quantification, recording, and analyzing of the participants data are crucial (Milby, Herman, Willcutt, & Hawk, 1973). The behaviors must be obser ved and the individual must immediately receive the token. Data collection is crucia l in the implementation and analysis of the effectiveness of the token economy.
3 Since its development the token economy ha s been used across a range of settings and populations. Token economies have been implemented in schools, group homes, and correctional facilities. Studi es have indicated that teac hers, therapists, and ward personnel can produce changes in behavior by manipulating the consequences through a token economy (Phillips, Phillips, Fixsen & Wolf, 1971). Phillips (1968) conducted a study at Achievement Place, a community ba sed, family style be havior modification program for pre-delinquents, and found the use of a token economy resulted in decreases in the instances of poor grammar and aggressi ve statements and in creases in tidiness, punctuality, and the amount of work comple ted at home. At Achievement Place the participants earned tokens for specified a ppropriate behaviors and lost tokens for specified inappropriate behaviors. As the to kens were earned or lo st throughout the day they were recorded on a 3 X 5 index card. At the end of the day the participants subtracted the total lost from the total earned and the remaining value was what was used to buy privileges for the followi ng day (Phillips et al., 1971). The use of a token economy has also b een proven to be effective in treating problem behaviors of school children, mental health pa tients, and delinquent youths (Milan & McKee, 1976). Mila n and McKee (1976) develope d a token economy for the appropriate behavior of adult male felons in the prison syst em and the behaviors needed outside the facilities walls in order to prepare the felons for their release. The study focused on how various arrangements of beha viors and token reinforcement procedures affected the performance of ac tivities centered on hygiene and orderly operations in large institutions. The results of the study suggested that a token economy could be effective even in a large institutional setting in mainta ining appropriate behavi ors. In correctional
4 facilities a token econo my may be paired with an a dditional behavioral intervention procedure such as the Level Sy stem (Milan & McKee, 1976). To date there are very few studies pu blished on the Level System; however, for years educators have implemented level syst ems to motivate and encourage students with emotional and behavioral disorders to exce l in the classroom (Morgan & Jensen, 1988; Scheuermann, Webber, Partin, & Knies, 1994) In the Level Syst em the participant advances through the levels by displaying more appropriate behavior s and fewer problem behaviors. As the participant advances access to more privileges and items of reinforcement that are found to be more desirable increase (Hagopian et al., 2002). However, if the participant engages in ina ppropriate and problem behaviors his or her status in the Level System drops. In the lowe r levels there are fewer privileges and more restrictions to preferred item s (Hagopian et al., 2002). Generally, Level Systems are used within groups of people to promote socially desirable behaviors and compliance with the rules of an institution (Hagopian et al., 2002). This behavioral procedure is used in schools, psychiatric hospitals, correctional facilities, and residential programs (Hagopian et al., 2002). Most Level Systems are designed so that the participants advance or drop levels based on id entical contingencies (Hagopian et al., 2002). For example, in orde r to advance from Level 3 to Level 4 each participant must have indepe ndently made their lunch by 4 pm or, in order to advance from level to level, each participant must go the designated time w ithout engaging in any inappropriate verbal behavior such as swear ing or speaking in a loud voice while inside the house. The privileges accessed, generally, ar e also the same across participants; these privileges could include outings to specific places or access to television or radio. In the same respect, when participants engage in in appropriate behaviors, the response cost is
5 generally the same across participants, dependi ng on severity of the behavior (Hagopian et al., 2002). Many Level Systems are designed so that the participant starts in the most restrictive level and by displa ying the appropriate behaviors for a given period of time is then able to advance to higher levels. However, within the p ublished research there have been limitations to the implementation of a Level System. Many beli eve the Level System is not individualized enough for the participant, it ca nnot adequately treat all pr oblem behaviors, and it is questionable in the eyes of the law (Scheuer mann et al., 1994). Level Systems in the past have been applied only to group settings and not used as an individualized treatment (Hagopian et al, 2002). Therefore, this pos es a problem because the treatment design is not based on functional assessment or pref erence assessment; two essential components of behavior analysis interv entions (Hagopian et al., 2002). An additional limitation to most of the literature is that research is descri ptive in nature and suggests outcomes that the Level System is an effective treatment option; however there has been a lack of empirical data and experimental control to support these claims (Bauer, Shea & Keppler, 1986; Klotz, 1987; Mastropieri, Jenne, & Scruggs, 1988; Smith & Farrell, 1993). Although some literature exists on the use of level systems, this literature is limited by the fact that procedures are not described well, the programs are not individualized, and they are not evaluated through sound rese arch designs. Therefore the purpose of this study is to utilize a within-s ubject experimental design to evaluate the effectiveness of a Level System with a built in token economy that is individualized to each participant yet conduc ted on a group level.
6 Method Participants and Setting Three adult males, all diagnosed with mental retardation and severe problem behaviors were chosen to participate in the current study; each of th e participants has had some form of involvement in the criminal sy stem. All three indivi duals currently reside in an intensive residential habilitation ag ency that specializes in aggressive and inappropriate sexual behaviors. The reside nces, located in the Tampa area, are three different group-homes located on one campus. Each group-home has 6 residents and is staffed at a 1:3 staff to participant ra tio. The Adult Day Training (ADT) program attended by the individuals, wh ich teaches horticulture and lawn care, is also located on the same campus. Daniel is a Caucasian male in his late tw entys. He has been diagnosed with Fetal Dilantin Syndrome and Mental Retardation. Prio r to his current placement, Daniel, served time at the state facility for individuals dia gnosed with Mental Reta rdation who engage in criminal activity. On two separate occas ions Daniel has had involvement with the Juvenile Court System. Both offenses i nvolved him engaging in inappropriate sexual behaviors with a minor; the second offense result ed in a charge of a Lewd, Lascivious or Indecent Act with a Minor. Since his releas e to his current placement Daniel has engaged in serious problem behaviors such as inappr opriate sexual behavi or with and without contact, stripping, physical aggression, el opement, abusing the emergency response system (pulling the fire alarm), and propert y destruction, which includes damages up to
7 $1000. Daniel has the ability to communi cate in complete sentences, ambulate independently, follow simple instructions and complete simple daily living skills with minimal prompting. Doug is an African American male in hi s late twenties diagnosed with Moderate Mental Retardation and has a lengthy history of behavior problems. Information on his history is scanty but it was reported that Doug experienced developmental delays as a child. It was reported that he was placed in the care of an elderly neighbor at a young age, who was unable to manage his behaviors. As a result she placed Doug in a cage with dogs where he spent majority of his time. Doug was found by DCF when the death of the elderly neighbor was reported, na ked in the dog cage with many forms of mutilation to his body from the dogs. From th at point on Doug was placed in different families in the foster care system and other group homes until his placement at his current group home. At his previous placements Doug was found to be a high risk to others after engaging in inappropriate sexua l behavior with two vulnerabl e peers. Previous to his current placement, Doug had served time with in the judicial system after attacking a teenage girl in a mall bathroom. At his current placement Doug has engaged in inappropriate sexual behavior with and w ithout contact, property destruction, and elopement. Despite his disabilities Doug can communicate in complete sentences, ambulate independently, follow simple instru ctions and complete simple daily living skills with minimal prompting. James is a Caucasian male in his early twenties diagnosed with Mental Retardation. It is reported that James was pl aced in the custody of th e State of Florida at a young age due to poor family conditions. While in the foster care system James was charged with several incidents of sexual misconduct resulting in him spending time at
8 juvenile detention facilities. After turni ng 18, James was placed at his current location for treatment where he has engaged in inappr opriate sexual behavior with and without contact, physical aggression, property destruc tion and elopement. James has the ability to communicate in complete sentences, ambulate independently, follow simple instructions and independently comp lete simple daily living skills. In addition to their severe problem behavior s, these three participants were chosen for this study because they would not be leav ing their current residential setting due to court orders or having no othe r available placements that would meet their behavioral needs at this time. In add ition, each of the participants ha s had prior experience with a level system at the state f acility for those diagnosed with Mental Retardation that engaged in criminal activity. It should be noted that none of the participants was incarcerated during the study; how ever, all had the potential of being incarcerated if they were to engage in a serious enough problem behavior, such as inappropriate sexual behavior that included cont act towards a minor. To pr event the possibilities of incarceration each particip ant received 24 hour supervision from their direct care staff. Target Behaviors The target behaviors to be decreased in this study were inappropriate sexual behavior with and without contact, physical aggression, property destruction, stripping, abusing the emergency response system (pulling the fire alarm) and elopement. Each participant had an individualized definition fo r these behaviors that had been determined during a functional assessment; the assessment s uggested that the participants engaged in these behaviors to access attention, tangibl es, escape, and automatic reinforcement.
9 Table 1 Target Behaviors Daniel Physical Aggression : Hitting with an open or closed hand, ki cking, flicking (snapping his fingers in a whip-like fashion) or attempti ng to punch or flick other individuals with enough intensity to cause reddening or bruising, using items such as his boots or lunch box to throw at others. (Access to tangibles and Escape) Inappropriate Sexual Behavior with contact : Defined as touching others inappropriately, engaging in forced, coerced or non-consensual sexual behavior and/or any other violations of the 5-Rules i dentified in HDCs Sexual Behav ior Policy (appropriate place, appropriate time, partner over 18 years old and able to consent, consent of partner (no means no), and use of safe sex practices). (Automatic Reinforcement) Inappropriate Sexual Behavior without contact : Defined as making sexual comments or propositions to others, staring, leering or any attempt to groom others to engage in sexual behavior without contact, or a violati on of another persons personal space (within arms reach of the other person when the si tuation does not warrant close contact). (Automatic Reinforcement) Elopement: Leaving sight of staff by walking away from the worksite or the fenced area at Seffner campus. (Access to tangibles and escape) Property Destruction (High Intensity ): Breaking items with his body, hands, legs, feet or any combination thereof, throwing objects in an attempt to break items, such as his bedroom window or van windshields. (Acce ss to tangibles, Escape, and Attention) Property Destruction (Low Intensity ): Spilling items such as shampoo, powder, or mouthwash, using anything readily available to cause minor (less than $5) damage to property, and throwing items on the roof (with the exception of his clothing, which is included in his stripping definition). (Access to tangibles, Escape, and Attention) Stripping: Daniel will remove any article of clot hing or shoes in an any area outside his room or bathroom. At times Daniel may rip his clothes off with hi s hands. After taking off clothes or shoes Daniel may throw these articles of clothing on the roof. Abusing the Emergency Response System: Pulling fire alarm or calling 911/abuse when warranted. Doug Physical Aggression is defined as the act or attempted act of physical harm by hitting, kicking, or throwing objects at others with the intent to injure. (Access to tangibles, Escape, and Attention) Inappropriate Sexual Behavior with Contact: is defined as 1) any non-consensual sexual contact including the touching of others private areas wit hout permission, coercing others to participate by providing gifts or money in exchange for sexual favors, attempting to engage in horseplay with others, or grooming in preparation for sex with anyone, 2), rubbing his own chest while staring at other s, grabbing genital area with or without clothing, or any attempt to approach a child, 3) any violations of the rules identified in HDCs Sexual Behavior policy which include (1. Adult person18 years or older, 2. Must use a condom, 3. Keep it private, 4.Duri ng non-obligated time, 5. Must be agreed each time, 6. No means no). (Automatic Reinforcement) Inappropriate Sexual Behavior Without Contact: is defined as staring and/or leering at children or animals either through a media s ource or while out in the community. Having possession of items that contain children or animals. An exposing himself to others. (Automatic) Property Destruction : is defined as the act of hitting or kicking objects with the intention of breaking them. (Access to tangibles, Escape, and Attention) Elopement: Leaving sight of staff by walking away from the worksite or the fenced area at Seffner campus. (Access to tangibles and escape)
10 James Physical Aggression is defined as the act or attempted act of physical harm by hitting, kicking, or throwing objects at others with the intent to injure. (Access to tangibles, Escape, and Attention) Inappropriate Sexual Behavior with Contact: is defined as 1) any non-consensual sexual contact including the touching of others private areas wit hout permission, coercing others to participate by providing gifts or money in exchange for sexual favors, attempting to engage in horseplay with others, or grooming in preparation for sex with anyone, 2), rubbing his own chest while staring at other s, grabbing genital area with or without clothing, or any attempt to approach a child, 3) any violations of the rules identified in HDCs Sexual Behavior policy which include (1. Adult person18 years or older, 2. Must use a condom, 3. Keep it private, 4.Duri ng non-obligated time, 5. Must be agreed each time, 6. No means no). (Automatic Reinforcement) Inappropriate Sexual Behavior Without Contact: is defined as staring and/or leering at children or animals either through a media s ource or while out in the community. Having possession of items that contain children or animals. An exposing himself to others. (Automatic) Property Destruction : is defined as the act of hitting or kicking objects with the intention of breaking them. (Access to tangibles, Escape, and Attention) Elopement: Leaving sight of staff by walking away from the worksite or the fenced area at Seffner campus. (Access to tangibles and escape) The target behaviors to be increas ed included the following replacement behaviors: appropriate sexual behavior (6 ru les), manding for atten tion, avoidance skills, manding for tangibles, manding for escape from aversive situations, and manding for escape from tasks. Each definition for these behaviors had been determined based on the results of a direct observa tion functional assessment. Table 2 Replacement Behaviors Daniel, Doug, and James Appropriate Sensory 6 Rules : Appropriate masturbation and sexual behavior that follows the 6 rules for appropriate sexual behavior (which includes: 1. Adult person18 years or ol der, 2. Must use a condom, 3. Keep it private, 4.During non-obligated time, 5. Must be agreed each time, 6. No means no). Manding for Attention : Participant will appropriately access attention by calling others by their name or saying excuse me. Manding for Tangibles: Participant will appropriately ask for the item he is requesting by saying Excuse me, may I have that? or I would like that, please. Manding for Escape from Task: Participant will ask May I take a break? or Can I work on this in a few minut es? and walk away from the task. Manding for Escape from Aversive Situations: Participant will ask Can we
11 leave? or Can I go and do something else? and walk away from the situation. Appropriate Sexual BehaviorAvoidance Skills: When a child or when media that possess a child (such as television/movies or magazine pictures) are present, Participant will tu rn his head, look away, or leave the area. Data Collection Staff documented the frequency of probl em behaviors and replacement behaviors on a data sheet throughout the day. Each time a problem behavior occurred the staff placed a checkmark next to the following categories on the ABC (Antecedent-BehaviorConsequences) data sheet: the setting in which the problem behavior occurred, the antecedent to the problem behavior, the problem behavior topography, the time it occurred, and the consequence to the behavior. The ABC data sheet was specific to each participants problem beha viors (See Appendix 1). Each time a replacement behavior occurred the staff placed a checkmark next to the following categories on a replacement beha viors data sheet: the setting in which the behavior occurred, the beha vior topography, whether the behavior occurred independently, and the type of reinforcer earned for the behavior. The replacement behavior data sheet was specific to each participants behavi ors (See Appendix 2). At the end of each day, staff documented on graph paper the current level each participant was on. The graph di splayed the participants leve l for each day in the month. The primary investigator, at the end of the day, reviewed all data sheets and graphed the behaviors using Excel. Interobserver agreement On at least 33% of the days a second observer scored the responses simultaneously but independently on an id entical antecedent-behavior-consequences
12 (ABC) data sheet. Interobs erver agreement was calculate d by dividing the number of agreements by the number of agreements plus disagreements and multiplying the total by 100. An agreement is defined as the recordi ng of the same behavior by both observers within a one minute time difference. M ean interobserver agreement for problem behaviors was 93% for Daniel, 90% for Doug, and 78% for James. Mean interobserver agreement for replacement behaviors was 98% for Daniel, 91% for Doug, and 93% for James. Treatment Integrity Both staff implementing the Level System and participants participating in the Level System were monitored by a Behavior Analyst or a Be havior Specialist throughout the day (See Appendix D). If at any point during implementation the staff were observed implementing the Level System incorrectly th ey were immediately retrained and tested before being allowed to continue implementa tion of treatment. In addition, staff were tested weekly on the Level System and required a score of at least 90% to continue with implementation (See Appendix E). Observations conducted by the primary rese archer and the trained behavior team reported the Level system being correctly impl emented 94% of the time. Each incident of incorrect implementation was stopped and th e staff immediately re trained on the spot. The average score for the weekly Level System test by staff was 85%. When tested, staff generally missed 1 or 2 questions, on the bed ti me or television/radio privileges, giving them a score of 85%. This resulted in the immediate retraining of the Level System. After completion of re-training, the staff answ ered questions by the trainer, or primary investigator, to demonstrate they understood th e Level System. This generally involved them repeating the question and answer back to the primary researcher If the staff had
13 additional questions or it was decided further training was needed, the primary investigator continued with the trai ning session until the staff had a thorough understanding of the Level System. Procedure and Design An ABAB design was used to evaluate the effects of a token economy with a Level System, with A being baseline and B being the treatment phase, for two of the participants (Daniel and Doug) An AB Within-Subject design was used for the third participant (James). Prior to baseline a pr eference assessment was conducted. Following the completion of each baseline phase, staff training was conducted prior to implementation of the intervention (Level System). Preference assessment A preference assessment was conducted for each participant. First, the sta ff who frequently work one to one with the participants was interviewed to identify several stimuli that ar e preferred by the part icipant. Second the participants were interviewed to identify seve ral stimuli that are preferred by them. Each participant was then shown 10 pictures of stimuli identified during the interview and asked to rank them in hierarchy of most preferred (wanted most) to least preferred (wanted least). For all part icipants, food items were th e most preferred items. The preference assessment was conducte d in this fashion to minimize the occurrence of problem behaviors. Based on knowledge of these participants, it was hypothesized that the presence of the actual stimu li in a preference assessment would result in the participants attempts to steal the item or engage in problem behaviors when immediate access to the item was denied. Al so, each participant had the intellectual ability to rank the items in hierarchical order.
14 Baseline. During baseline the participants had no intervention for problem behaviors in place other than the standard proc edures used in the agency. The standard procedures were StopRedi rect-Reinforce; which consis ted of stopping a dangerous behavior by least-to-most intrus ive methods, redirecting the pa rticipant to another activity and then reinforcing the participants appr opriate behavior thr ough verbal praise, a tangible item, or special priv ilege. For example, if a pa rticipant engaged in physical aggression a staff member pr ovided the verbal prompt stop first then proceeded to physical techniques to prevent further harm to the participant or another if necessary. The participant was then redirected to an a ppropriate activity in a nother room and after 15 minutes of engagement in the appropriate activity gi ven verbal praise for the appropriate behavior. Ignor e-Redirect-Reinforce consis ted of ignoring the problem behaviors, redirecting the pa rticipant to another activity and then reinforcing the participants appropriate beha vior. Planned ignoring consiste d of providing no attention to the individual engaging in the problem be havior and then providing reinforcement for appropriate behavior once the problem be havior had stopped. Finally, community restrictions were employed to ensure the safe ty of others if a pa rticipant engaged in inappropriate sexual behavior s with or without contact. Treatment. The treatment phase consisted of staff training followed by the implementation of the token economy and Le vel System. Each participant started treatment on Level 2 (described below). The rational for starting on Level 2 is to allow the participants to experience the reinforcing value in engaging in appropriate behaviors and the reinforcers that come al ong with the higher levels. As the participants engaged in the appropriate behaviors and followed the ru les of the Level System they advanced through the treatment. A requirement to advan ce within the Level Sy stem of the current
15 study was to receive signatur es for each awake shift fr om staff. The signatures represented the participants appropriate beha vior and completion of required tasks for the day. Each Level required a particular number of signatures in order to advance. Initially, the participants could lose their signatures if they enga ged in inappropriate behaviors such as inappropriate social beha viors or antagonizing their peers. These behaviors were not considered serious enough to result in a Level Reduction but serious enough to not earn additional privileges or the signature for the day. Training Staff and Participants Each staff member and participant was trained on the Level System by the Master Trainer. The Master Trainer for the purpose of this study was the author. The training was based on th e Level System manual. Both staff and participants needed to demonstrate 80% accura cy when taking the written/verbal exam on the Level System prior to implementation. Bo th staff and participants were retested weekly on the Level System; staff were re quired to demonstrate 90% accuracy to continue implementation. Token Economy. A token economy was implemented in each participants residence during the treatment phase. Once the participant was placed on the Level system, he was informed he would now be able to earn token dollars that could be used to shop in the token store. Each participant received tokens in the form of paper play money for completing his hygiene, chores, ma king his lunch for ADT the next day, and engaging in replacement behaviors. Sp ecific amounts were predetermined for each chore. Additionally, th e participants had the opportunity to earn additional token dollars for appropriate behaviors and completing extra activities outside their daily routine; such as an additional chore, skill acquisition, or learning activity like math skills (See Appendix C). The token dollars were then spent at the token store, when on the
16 appropriate levels (Level 2-4), at 8 pm each evening and at an additional time on Saturdays and Sundays at noon. The token st ore was filled with the items determined from the preferences assessments. The prici ng of the items was determined by the order of most preferred to least pr eferred item for the participant. Most preferred item had the higher token price. The Le vel System was implemented in the context of the ongoing token economy; in order to advance through th e Level system each Level had a token fee that was required to be paid by the participant. For example, to advance from Level 1 to Level 2 a fee of 200 token dollars was required. Level System. Each participant participated in the same Level System which was taught based on a Level System Manual. The Level System Manual is a training manual designed from existing Level Systems that are being implemented by Sunland of Marianna, the Mentally Retarded Defenda nt Program, and the Human Development Center, Inc. The Level System used consisted of five different levels (Level O, level 1, Level 2, Level 3, and Level 4). The level st atus was contingent on the participants problem behaviors. Within each level the number of privileges and reinforcing contingencies increased. The Level System di d not specifically addr ess the functions of the behaviors. However, within the Le vel System each participant engaged in individualized skill acquisition se ts, which are a set of questions and role plays specific to the problem behaviors an d their maintaining functions. Each participant practiced with staff the skill acquisitions twice a day. To a ddress behaviors that f unction for attention, verbal praise was given conti ngent on all occurrences of a ppropriate behavi or throughout the study. Problem behaviors that were categorized as dangerous behaviors resulted in a level drop to O. The behaviors that were categorized as dangerous were any behaviors
17 for which the participant could be arrested a ccording to the law, in cluding inappropriate sexual behaviors with and w ithout contact, physical aggres sion, stripping abusing the emergency response system (pulling the fire alarm), property destruction and elopement. Due to the seriousness of the target behavi ors levels did not drop in sequence, for example from Level 3 to Level 2. If the pa rticipant engaged in da ngerous behaviors he was reduced to Level O immediately. Table 3 Level System Level: Level O Level 1 Level 2 Level 3 Level 4 # of Days: 2 5 14 21 N/A # of Signatures to Advance 4 6 10 14 N/A $ Token Dollar Amount to Advance 100 200 500 1000 N/A Off-Campus/OnCampus Activities Only Medical/Legal Appointments No Access to Club House Only Medical/Legal/ Training Activities No Access to Club House All Scheduled Activities and Medical/Legal/ Training No Access to Club House All Scheduled Activities and Medical/Legal/ Training and Day HomeVisits Allowed in Club House 1 night a week All Scheduled Activities and Medical/Legal/ Training and Over-Night Home-Visits Free Access to Club House Pay Check Limitations 100% Deposited in Bank 75% Deposited in Bank 50% Deposited in Bank 25% Deposited in Bank 100% Choice Television/Radio/ Computer/Video Game Access None Can purchase: 1 hour per day for 100 token dollars Can purchase: 2 hour per day for 200 token dollars Unlimited Access Unlimited Access Ability to Shop in 8 pm week nights 8 pm week nights 8 pm week nights
18 Token Store None None 12pm, 8 pm Sat. & Sun 12pm, 8 pm Sat. & Sun 12pm, 8 pm Sat. & Sun
19 Results Figure 1 shows the results for Daniels be havior and level in each phase of the study. During the first baseline, Daniel enga ged in a serious problem behavior on two thirds of the days. Initially, when the firs t phase of treatment was implemented Daniel engaged in problem behaviors every 3 days; however, as treatment continued the number of days that elapsed between problem behaviors went from 3 days to 6 days to 11 days, allowing him to reach Level 2 before treatm ent was removed and baseline was initiated again. The second baseline phase was longer than the first; w ith 9 days elapsing before a serious problem behavior occurred. Once th ree problem behaviors occurred, which was within two days, Daniel was placed back on th e Level System. Once Daniel was placed on the Level System for the second time his frequency of problem behaviors dropped to zero and remained there for th e rest of study allowing him to achieve and maintain Level 4. Daniel refrained from engaging in serious problem behaviors for 46 days before data collection ended on the 89th day, he was hospitalized for health issues.
20 Daniel Level System Graph0 1 2 3 4 5 1611162126313641455055606570758085DaysFrequency of Problem Behaviors0 1 2 3 4Level Reducible Bxs Current LevelBL BL TreatmentTreatment Figure 1 Daniels Level System graph which incl udes all target behaviors that were engaged in. Closed Squares = Leve l, Diamonds= Reducible Behaviors. Figure 2 displays the results for Dougs be havior and level for each phase of the study. During the first baseline phase, on average Doug engaged in serious problem behaviors every two days. Init ially, when the first phase of treatment was implemented Doug engaged in problem behaviors every 3 days; however, as treatment continued the number of days that elapsed between problem behaviors went from 3 days to 7 days to 13 days, allowing him to reach Level 2 before treatment was removed and baseline was initiated again. The second baseline phase was longer than the first, with 12 days elapsing before 2 serious problem behaviors occurred and then anot her the following day before being placed back on the Level System. Once Doug was placed on the Level System for the second time he averaged an occurrence of problem behaviors every two days for almost a week. After the initial w eek of being placed b ack on the Level System Dougs frequency of problem behaviors droppe d to zero and remained there allowing him to advance to Level 4. Note: Doug was having difficulty with the pace of level advancements. In order to increase the value of the reinforcers in the higher Levels Doug
21 was advanced when he displayed at least 6 c onsecutive days of good be havior rather than 14 days that were initially re quired. Dougs problem behaviors remained at 0 with him at Level 4 for 18 days; with a total of 43 days in which he refrained from engaging in the targeted behaviors. Doug Level System Graph0 1 2 3 4 5 16111621263136414651566166717681869196101106DaysFrequency of Problem Behaviors0 1 2 3 4Level TreatmentTreatment BLBL Level Reducible Bx Early Advancement Figure 2. Dougs Level System graph which in cludes all target behaviors that were engaged in. Closed Squares = Leve l, Diamonds= Reducible Behaviors. Figure 3 displays the results for James behavior and level for each phase of the study. James had a longer baseline phase than Daniel and Doug. On average James engaged in problem behaviors every 10 days Initially, when the Level System was implemented in the first treatment phase, Ja mes engaged in serious problem behaviors 2 times in the first 10 days and then went 15 days before engaging in problem behavior more frequently again. However, James rema ined on Level 0 for an extended period of time, as a result of him not earning his si gnatures to advance due to engaging in inappropriate social behavior or antagonizing his peers. On the 69th day of the study a change was made and James no longer lost his signature for the day preventing his advancement to the next Level for these non-se rious behaviors. As the graph indicates after the modification was implemented Ja mes refrained from engaging in serious
22 problem behaviors and began advancing thr ough the level system. He refrained from engaging in the targeted behaviors fo r 35 days and made it to Level 3. James Level System Data0 1 2 3 4 5 1611162125303540455055606570758085909510DaysFrequency of Problem Behavior s 0 1 2 3 4Level Treatment Baseline Reducible Bxs Current Level Figure 3 James Level System graph which incl udes all target behaviors that were engaged in. Closed Squares = Leve l, Diamonds= Reducible Behaviors. For Doug and James, the procedure of lo sing the ability to earn shift signatures for engaging in inappropriate social beha viors was changed in the second treatment phase. From direct observati on it was hypothesized that these two participants were receiving attention for antagonizing their peer s and losing their signature for the day. This form of attention was acting as a mo re potent reinforcer than receiving their signature for the day that applied towards a dvancement in the Level System. The change issued involved staff ignoring the inappr opriate social and antagonizing behaviors completely and only withholding the signature fo r the day if the part icipant engaged in a serious or reducible behavior. In these cas es, substantial praise and attention were provided for receiving their signature, no longe r for not earning thei r signature due to antagonizing others. This change resulted in both participants advancing to the higher Levels and demonstrating more replacement behaviors.
23 Figure 4 displays the results of Daniels replacement behavior and level for each phase of the study. During the first baseline phase Daniel e ngaged in an average of 2.7 replacement behaviors per day. The average increased to 4.1 replacement behaviors per day during the first phase of implementation of the Level System. In the second baseline phase Daniel engaged in an average of 3.2 replacement beha viors per day. Once the Level System was re-implemented Daniel engaged in average of 4.6 replacement behaviors per day. The data also reveals, as Daniel advanced to the higher Levels he engaged in more replaceme nt behaviors each day. Daniel Level System Graph0 1 2 3 4 5 6 7 8 9 10 1611162126313641465156616671768186DaysFrequency of Replacemen t Behaviors0 1 2 3 4Level Replacement Bxs Current LevelBLBL Treatment Treatment Figure 4. Daniels Level System graph which includes all replacement behaviors that were engaged in. Closed Squares = Le vel, Diamonds= Replacement Behaviors. Figure 5 displays the results of Dougs replacement behavior and level for each phase of the study. During the first baselin e phase Doug engaged in an average of 2.3 replacement behaviors per day. The average increased to 3.7 replacement behaviors per day during the first phase of implementation of the Level System. In the second baseline phase Doug engaged in an average of 2.5 repl acement behaviors per day. Once the Level System was re-implemented Doug engaged in average of 5.3 replacement behaviors per
24 day. Like Daniel the data also reveals, as Doug advanced to the higher Levels he engaged in more replaceme nt behaviors each day. Doug Level System Graph0 1 2 3 4 5 6 7 8 9 10 16111621263136414651566368737883889398103DaysFrequency of Replacement Behaviors0 1 2 3 4Level Treatment Treatment BL BL Level Replacement Bx Figure 5 Dougs Level System graph which include s all replacement behaviors that were engaged in. Closed Squares = Leve l, Diamonds= Replacement Behaviors. Figure 6 displays the results of James replacement behavior and level for each phase of the study. During the baseline pha se James engaged in an average of 2.2 replacement behaviors per day. The average increased to 2.6 replacement behaviors per day after implementation of the Level Syst em. Like Daniel and Doug, the data also reveals, as James advanced to the higher Levels he engaged in more replacement behaviors each day. James Level System Data0 1 2 3 4 5 6 7 8 9 10 16111621253035404550556065707580859095100DaysFrequency of Replacement Behaviors0 1 2 3 4Level Treatment BaselineReplacement Bxs Current Level
25 Figure 6 James Level System graph which incl udes all replacement behaviors that were engaged in. Closed Squares = Le vel, Diamonds= Replacement Behaviors
26 Discussion The results show a Level System with a built in token economy was an effective form of treatment for two of the participan ts in an ABAB design. The data are simply suggestive for the third partic ipant (James) in an AB design. The Level System, which was developed to be used at a group level, was individualized in th e current study in the following ways: the token stores were made up of the items identif ied by each participant in their preference assessment, the behaviors ta rgeted were specific to each participant, and each participant was reduced (moved back to level O) based on his own behaviorno one participants behavior affected the other participants le vel. Although it took substantial time for the participants to adva nce to the higher levels once the higher level was reached they were able to maintain that status for a lengthy period of time, refrained from engaging in the targeted behaviors, a nd increased their engagement in replacement behaviors. As the results show, in the first phase of treatment, the frequency of targeted behaviors was higher than in the second treatment phase. Ea ch of the participants had been previously exposed to a Level Syst em; some were even removed from a Level System to start baseline for the current study. It is hypothesized the higher frequency of targeted behaviors in the first phase may be due in part to an extinction burst. Direct observations by the researchers throughout th e study suggest that the previous Level Systems were not followed consistently by sta ff, causing an increase in target behaviors once the current Level System was impl emented and followed. The previous
27 inconsistency may have caused an increase in the frequency of target behaviors engaged in by the participants (because the behaviors had been intermittently reinforced), resulting in them remaining at lower levels. This in consistency was rectifie d and procedural drift was reduced with constant monitoring by those implementing the Level System. For Daniel and Doug, the data demonstrat e some degree of experimental control within the ABAB reversal design and show th at both Daniel and Doug were able to make it to and maintain Level 4 status for weeks. During the course of the study, the decision was made to employ only an AB design for James. Because James had an extended baseline and then frequently engaged in pr oblem behaviors during the first half of the treatment phase, substantial time had elapsed befo re the behavior stabilized at zero in the treatment phase. Due to the extended time he had been in the study and the concerns about his behavior should the intervention be withdrawn, the decision was made not to withdraw the intervention, ev en though it resulted in the inability to demonstrate experimental control for this participant. In addition to the limitation of an AB de sign with James, another limitation is the seeming increase in the problem behavior in the first half of th e intervention phase. Direct observation suggested th at James was not receiving hi s daily signatures to advance as a result of engaging in inappropriate so cial behaviors and wa s receiving excessive amounts of attention from staff for these be haviors. Although, inappropriate social behaviors were not targeted behaviors for re duction, the participant could lose the ability to earn his shift signature by engaging in this behavior. Failure to earn the shift signature then prevented the participant from advanc ing levels which may have contributed to further problem behaviors. During the interv ention phase for James a modification was implemented; staff began ignoring these behaviors and no longer denied James his
28 signature for inappropriate social behavior a nd instead provided subs tantial verbal praise for engaging in appropriate behaviors. This change resulted in James advancing to the higher levels and exhibiting a consistent decrease in th e targeted behaviors. Although the results suggest that the level system was effective, a major limitation of the study was the relatively low le vel of the target behavior in baseline, especially for James. A baseline of three be havior problems was chosen for James due to the high intensity, low frequency of the problem behaviors. The beha viors targeted were very serious behaviors such as inappropriate sexual behavior agai nst vulnerable adults and minors, physical aggression, property dest ruction, and elopement; all of which could have serious consequences. For that reason, the researchers could not allow several of these behaviors to occur with no response or consequences to the behavior. In society, these behaviors would normally result in jail time or involvement of the judicial system. A longer baseline with more instances of the be havior may have been preferable from an experimental design perspective, but from an ethical perspective, the decision was made to proceed to the intervention. The Level System is a complicated system to implement that requires substantial staff involvement, monitoring, a nd clarity. One limitation discovered in the current study was that the descriptions of some of the topographies of th e behaviors were not precise enough. In order for there to be consistency acr oss staff the definitions needed to be clear and concise so that staff knew exactly wh en the targeted behavior occurred. For example, when James engaged in blowing in other peoples ears; it could be interpreted as an inappropriate sexual ac t but this was not described in the definition. In these instances this behavior was not recorded by the researchers but was responded to by the staff.
29 An additional limitation is the amount of time required to fully train and monitor staff implementing the level system. Cons tant monitoring was required to ensure implementation was correct and no coercion was being used. It would be very easy for staff to threaten Level Reductions or barg ain Level Advancements for work to be completed. In an industry that is known for fr equent staff turnover, the Level System is a time consuming treatment to train and implement. One suggestion for future research in the area of Level Systems would be to increase the length of data coll ection. It is hypoth esized that at least a year of data collection would be needed to show control and indicate that the Level System is a highly effective form of treatment for individuals at a group level. A further suggestion would be to increase the potency of reinforcers fo r each Level and individualize them more for each participant. This modification would not only increase the effectiveness of the treatment but it would better individualize the Level System. Another limitation of the current stud y, which may be inherent in any level system or token economy, is the fact that the intervention is not a function based intervention. Although appropriate behavior wa s reinforced with level advancements and problem behavior was punished with leve l decreases, the functi ons of the problem behaviors were not addressed in the interventi on. In fact, it is not known to what degree problem behaviors continued to be reinforced while the participants were in baseline or while the level system was being implemented. However, each part of the individualized treatment each participant received included sk ill acquisition training twice per day that centered around the functions of the behaviors. For example, Daniel engaged in property destruction to access a tangible. Twice per day the staff sat with Daniel, asked him a set
30 of questions on how to appropr iately access an item, and th en role-played by having him demonstrate this skill. Future research might further investigat e the influence of problem function on the effects of a level system. Alternatively, futu re research might integrate the use of a functional approach to assessm ent and intervention with the level system to see if the effects can be enhanced.
31 References Ayllon, T. & Azrin, N.H. (1968). Token economy : A motivational system for therapy and rehabilitation. New York: Appleton-Century-Crofts. Birnbrauer, J., Wolf, M., Kidder, J., & Tague, C. (1965). Classroom behavior of retarded pupils with token reinforcement. Journal of Experimental Child Psychology, 2, 119-135. Bauer, A.M., Shea, T.M., & Keppler, R. ( 1986). Level systems: A framework for the individualization of behavior management. Behavior Disorders, 12 28-35. Cavalier, A.R., Ferretti, R.P., & Hodges A.E. (1997). Self-management within a classroom token economy for student s with learning disabilities. Research in developmental disabilities, 18 (3), 167-178. Clark, M., Lachowicz, J., & Wolf, M. (1968). A pilot basic education program for school dropouts incorporating a t oken reinforcement system. Behavior Research and Therapy, 6, 183-188. Comaty, J.E., Stasio, M., & Advokat, C. (2001) Analysis of outcome variables of a token economy system in a state psyc hiatric hospital: a pr ogram evaluation. Research in Developmental Disabilities, 22, 233-253. Dickerson, F.B., Tenhula, W.N., Green-Pa den, L.D. (2005). The token economy for schizophrenia: Review of the literature and recommendations for future research. Schizophrenia Research, 75 (2-3), 405-416. Hagopian, L.P., Rush, K.S., Richman, D.M ., Kurtz, P.F., Contrucci, S.A., & Crossland, K. (2002). The development a nd application of individualized level systems for the treatment of severe problem behavior. Behavior Therapy, 33, 65-86. Jones, R.N., Downing, R.H., Latkowski, M. E., Ferre, R.C., & McMahon, W.M. (1992). Level systems as shaping and fading pr ocedures: Use in a child inpatient psychiatry setting. Child and Family Behavior therapy, 14, 15-37. Kazdin, A.E. (1982). The token economy: A decade later. Journal of Applied Behavior Analysis, 15(3), 431-445. Kazdin, A.E. & Bootzin, R.R. (1972). Th e token economy: An evaluative review. Journal of Applied Behavior Analysis, 5, 343-372. Kerr, M. M., & Nelson, C. M. (1989). Strategi es for managing behavior problems in the classroom (2nd ed.). Columbus, OH: Merrill. Klotz, M.E. (1987). Development of a be havior management level system: A comprehensive school-wide behavior management program for emotionally
32 disturbed adolescents. The Pointer, 31 5-11. Liberman, R. P. (2000). The token economy. The American Journal of Psychiatry, 157, 1368. Mastropieri, M.A, Jenne, T., & Scruggs, T. E. (1988). A level system for managing problem behaviors in a hi gh school resource program. Behavioral Disorders, 13, 202-208. Milan, M.A. & McKee, J.M. (1976). The cellb lock token economy: Token reinforcement procedures in a maximum security correctional institution for adult male felons. Journal of Applied Behavior Analysis, 9, 253-275. Milby, J. Willcutt, H. Hawk, J., MacDonald, M. & Whitfield (1973). A system for recording individualized behavi oral data in a token program. Journal of Applied Behavior Analysis, 6, 333-338. Miltenberger, R.G. (2008). Behavior Modi fication Principles and Procedures (4th Ed.). Thomas Higher Education, Belmont, CA. Morgan, D.P. & Jenson, W.R. (1988). Teach ing behaviorally diso rdered students: Preferred practices. Columbus, OH: Merrill. Phillips E.L., Phillips, E.A., Fixsen, D.L ., & Wolf, M.M. (1971). Achievement place: Modifications of behavior of predelinquent boys with in a token economy. Journal of Applied Behavior Analysis, 4, 45-49. Scheuermann, B., Webber, J., Partin, M., & Ki nes, W. (1994). Level systems and the law: Are they compatible? Behavioral Disorders, 19, 205 220. Smith, S. W., & Farrell, T. D. (1993). Level sy stem use in special education: Classroom intervention with prima facie appeal. Behavioral Disorders, 18(4), 251-264. Wolf, M., Giles, D., & Hall, R. (1968). E xperiments with token reinforcement in a remedial classroom. Behavioral Research and Therapy, 6, 51-64.
34 Appendix A: Target Behavior Data Sheet Target Behavior Form Instructions: Place the date, time, and check marks in the corresponding boxes when the target behavior occurs. Client Name: Date Time Location Kitchen Porch Bedroom Living Room Van Community ADT Outside Antecedent Denied request Alone Delivered instruction Staff interacting with others Provoked Other Behaviors Inappropriate Sexual w/contact Inappropriate Sexual w/o contact Property Destruction Physical Aggression Consequence Escape from Task Prompted to Same Task Attention Tangible Staff initials
35 Appendix B: Replacement Behavior Data Sheet Replacement Behavior Form Instructions: Place the date, time, and check marks in the corresponding boxes when the target behavior occurs. Client Name: Participant 1 Date Location Kitchen Porch Bedroom Living Room Van Community ADT Outside Prompts Independent Verbal Modeling Physical Replacement Bx Approp. Sexual Behavior (6 Rules) Attention Avoidance Skills Manding for Tangibles Escape from Task Escape from Aversive Situations Consequence Verbal Praise Tangible Natural Reinforcement Attention Other Staff initials
36 Appendix C: Token Prices Hygiene Completion No Verbal Prompts . 150 Token Dollars 1 Verbal Prompt . 100 Token Dollars 2 or More Verbal Prompts . .... 75 Token Dollars Chore Completion No Verbal Prompts . 150 Token Dollars 1 Verbal Prompt . 100 Token Dollars 2 or More Verbal Prompts . .... 75 Token Dollars Lunch Completion No Verbal Prompts . 150 Token Dollars 1 Verbal Prompt . 100 Token Dollars 2 or More Verbal Prompts . .... 75 Token Dollars Extra Chore ...50 Token Dollars Replacement Skills 20 Token Dollars (Manding for Tangible, Atte ntion, Escape Appropriately) Ignoring Others Problem Behaviors .50 Token Dollars Room Cleanliness .50 Token Dollars
37 Appendix D: Staff Monitoring Sheet Staff Monitoring Level System Staff Name: Date: Did staff review with the p articipant his current Level? Y N Did staff provide immediate reinforcement (tokens) for chore completion? Y N Did staff provide immediate reinforcement (tokens) for hygiene completion? Y N Did staff provide immediate reinforcement (tokens) for lunch completion? Y N Did staff provide reinforcement (verbal/token) for replacement behaviors? Y N Did staff use coercion? Y N Did staff document participants curre nt Level at the end of shift? Y N Did staff implement Level Syst em correctly throughout shift? Y N
38 Appendix E: Level System Test for Staff Human Development Center, Inc. Level System and Token Economy Competency Drill Staff Name:_______ _______________ ___________ Position:________________ Evaluator: ________ _________________________ Position:________________ Date: __________________________ Score:__________________ Cleared to Implement Level Sy stem: Y N 1. Staff is able to identify the locat ion in the residence and the function of the following: Level System Manual Y N Advancement Contracts Y N Warning Tickets Y N Token Points Y N Token Store Values Y N Grievance Procedure Y N All Client Current Level s Y N House Meeting Minutes Y N 2. Staff are able to identify the 5 levels. Y N 3. Staff are able to identify the bedtimes for each level. Y N 4. Staff are able to identify money/payc heck limitations for each level. Y N 5. Staff are able to identify off/on-campus activity privileges by level: Y N 6. Staff are able to identify the number of signatures needed to advance: Y N 7. Staff are able to give an overall d escription of the Level System with an emphasis on reinforcing the appropriate behaviors. Y N 8. Staff are able to identify wh en/how to issue token points: Y N 9. Staff are able to describe the procedure for advancement: Y N 10. Staff are able to describe a warning ticket: Y N 11. Staff are able to role-play ho w to complete a Level Reduction: Y N 12. Staff are able to identify the level of supervision required for an individual on Level O and wh y this is important: Y N 13. Staff are able to explain how reinforcement is u sed in the Level System: Y N