These symbols and objects are comparably worthless outside of the patient–clinician or teacher–student relationship, but their value lies in the fact that they can be exchanged for other things.
[citation needed] Shaping implies clients aren't expected to do everything perfectly at once; behavior can be acquired in steps.
[7] Sometimes clients can earn larger rewards like the permission to spend a weekend at home, going to a movie, or having a class excursion.
When such rewards would be given at once for one instance of a target behavior, the scarce resources would soon be depleted and consequently the incentives would be lost.
This implies they shouldn't immediately spend all earned tokens on attractive smaller rewards, and instead learn to plan ahead.
In the early 19th century, long before there was any knowledge about operant learning, there were some precursors of token economies in schools and prisons.
Teodoro Ayllon, Nathan Azrin and Leonard Krasner were important pioneers in these early years.
[10] This study showed the superiority of a token economy compared to standard treatment and specialized milieu therapy.
[citation needed] Token economies have proven their effectiveness and utility for chronic psychiatric patients, despite requiring months or even years to achieve optimal results.
This causes problems when insurance and government policies increasingly require the shortest possible hospital stays.
Because emphasis has shifted to community-based treatment, outpatient and home-based care is often the preferred choice over institutionalization.
The right to have their personal properties, basic comfort and freedom of choice of treatment constrains the possibilities for token economies.
[citation needed] In adult settings token economies are mostly applied in mental health care.
When offered a choice, the vast majority of clients in past studies voluntarily chose to stay in the program.
Even now token economies are applied to clients with schizophrenia, who are often resistant to common behavioral treatment approaches.
A token economy, in combination with other interventions, succeeded in the community reintegration of 78% of the clients within an average period of 110 days, after more than seven years of uninterrupted hospital stay.
The token economy approach may have effects on symptoms such as apathy and poverty of thought, but it is unclear if these results are reproducible, clinically meaningful and are maintained beyond the treatment programme.
This was especially the case in substance abuse treatment settings (although some systems for smoking cessation continue to use the term token economy).
[19] For some time, systems derived from token economies were used under the name contingency management; initially this was more broadly defined and referred to any direct coupling of consequences (reinforcements or punishments) with behavior (for example staying clean [20][21]); later it referred specifically to one kind of token economy.
[citation needed] A token economy has proven effective in increasing attentiveness and motivation in completion of tasks for children with developmental disabilities.
[25] In educational settings token economy seems to raise the intrinsic motivation to complete assigned tasks.