A “ticket” system for reducing ward rules violations on a token economy program

The present study explored the effectiveness of a “violation ticket” feedback procedure as a means of reducing minor ward rules violations on a token economy ward. Nursing assistants identified 16 frequently-occurring maladaptive behaviors shown by patients on the ward and attached a small token fine to each behavior. Whenever an infraction occured, the patient was given a ticket detailing the offense, the fine, and the date and time of the offense. The fines were subtracted from the 15-token reward that every patient routinely received daily, and patients who had more than 15 tokens' worth of infractions had to pay additional tokens to make up the difference. The average weekly fine per patient dropped from 20·8 to 5·5 tokens in 8 weeks and significant differences (P < 0·01) between patients' pre- and post-experimental adherence to ward rules were found. The results are discussed in terms of the utility of providing consistent feedback to patients in a behavior modification program.