OSH uses positive reinforcement to 'REACH' patients
For patients at Oregon State Hospital, changing the way they respond to certain situations is often a key component to their recovery. Most come to the hospital with deeply ingrained negative behavior patterns and, while many want to make changes in their lives, most need help finding the motivation.
In an effort to help patients find that motivation and work toward positive behavioral goals, OSH introduced the REACH program earlier this year. Recovery Environments Actively Creating Hope, or REACH, is a token economy program, which uses positive reinforcement to help patients learn to replace negative behaviors with more constructive ones.
Although the concept of a token economy is new to OSH, these types of programs have been used in psychiatric hospitals throughout the country to make behavior modifications since the 1960s. While the specifics of such programs vary from hospital to hospital, the basic premise is the same reward patients for positive behavior.
OSH first began considering a token economy late in the summer of 2010 due to the large numbers of consultation requests for Behavioral Psychology Program (BPS) services.
"We realized one of the reasons we kept getting these requests was because we had no consistent behavioral foundation in place hospital-wide," explained, REACH Program Coordinator Cynthia Kountz, "Token economies do a good job of fostering patient accountability and providing clear guidelines for behavioral expectations."
As they started researching the effectiveness of token economies at various psychiatric hospitals, the BPS team was surprised by what they found. Central State Hospital in Petersburg, Virginia, for example, saw a 75 percent reduction in patient seclusion and restraints after implementing its program. In turn, this created a safer environment for patients and staff, resulting in less worker's compensation claims and lowering insurance and operating costs.
BPS staff tailored the REACH program to meet the needs of OSH, and as each wing of the newly remodeled hospital has opened, REACH has been introduced to it. So far the program has been well received.
"I think that REACH is great," said patient Greg Nohrenberg. "It gives you an incentive to show up and participate in what you're here for, which is treatment."
For patients like Nohrenberg, that incentive is the points they earn from attending the daily treatment mall and participating in activities or groups. Their points accumulate throughout the week and add up into a series of steps. Patients who maintain a step two or three, meaning that along with participating in treatment, they have had no major behavioral issues, are able to visit the REACH store once a week and "shop" with their points. Those who do not maintain a step two or three lose their store visit for that week.
Over time, as the patients become more invested in the program, staff work with them to change their external motivation receiving their points into an internal motivation that values their treatment more than the points.
The program, which is now available to the majority of the hospital's patients, is voluntary, but since it was introduced in February 2011, the average participation rate has been nearly 94 percent. And of those patients who participate, 85 percent, on average, have been able to visit the store on a weekly basis.
Nohrenberg said that while he is now very active in his treatment, he has had days in the past when earning his REACH points was the sole reason he got out of bed.
"It lifts people's spirits to be down here shopping," he said. "Plus, they've got some great stuff at the store."
Patients can exchange their points for a wide range of items including clothing, small food items, movies, books, games, stationary, hygiene products and portable radios.
"It seems to be something the patients are really engaged in," Kountz said. "We've seen a lot of patients who have had really bad behavior problems in the past actually say they are learning to control their impulses so they can attend store that week. So they're realizing there are consequences for their actions, and that's definitely a positive effect."
Kountz said there are plans to expand the program beyond the treatment mall and onto all of the hospital's units. According to Nohrenberg, this idea could benefit both staff and patients.
"I think that would be fantastic," he said. "I think you might see an improvement in behavior and quite possibly overall lifted moral when people see benefits for good behavior throughout the whole hospital."