Integration of a token economy into a child and adolescent psychiatry training clinic

We developed a token economy pilot program in which reinforcers were provided by a university outpatient child and adolescent psychiatry clinic to address two problems common to psychiatry training programs: 1) psychiatric residents have insufficient opportunity to learn to use behavior modification techniques with outpatients, and 2) many patients and their parents seen in training clinics are poorly motivated and noncompliant with treatment, which leads to psychiatry resident discouragement and frustration. The rationale for the program is presented from the perspective of both the resident and the patient. The implementation of the program with 25 cases is described, including potential and actual difficulties. One case treated by a psychiatry resident is presented in more detail.