WASHING HANDS BEFORE MEALS OF A LONG-STAYING HOSPITALIZED SCHIZOPHRENIC PATIENT AND ITS TREATMENT THROUGH APPLIED BEHAVIOUR ANALYSIS: A CASE STUDY

Abstract

Objective: The purpose of conducting the present study was to determine whether Applied Behavior Analysis implemented through token economy and social reinforcements could successfully address poor hygiene behavior (washing hands before meals) in a psychiatric hospital setting. It was hypothesized that there would be significant increase in washing hands before meals of a long-staying hospitalized schizophrenic patient after the application of Token Economy and Social Reinforcements.

Place of Study:  Karachi, Pakistan

Research Design: Case Study

Sample and Method: The present study was conducted on a 44 year old female patient with chronic schizophrenia for the past 23 years. A functional analysis was conducted together with baseline observations.  The entire study was divided into three main phases; pre-intervention, intervention and post intervention. These were pursued by follow-ups. An implementation design was developed together with hospital staff and the patient’s guardian. The implementation phase was conducted by hospital staff with regular meetings with the researcher. Reinforcement during the intervention phase was initially through the provision of a star, selected from a sticker sheet of various coloured stars by the subject herself, with each star exchangeable for a candy during the first week (continuous reinforcement) in addition to social reinforcement from staff and family where possible (variable interval). During the second week, phasing out of the reinforcement was initiated with one candy for every 2 stars (fixed ratio) for the first three days, and then 1 candy for every 3 stars on average but given randomly during the last three days. Social reinforcement continued on a variable interval schedule throughout. Thus first phase consisted of continuous

reinforcement with fading to a fixed ratio and then variable ratio in the second week, followed by post-observation and follow ups.

Results: Results indicated increase in washing hands before meals behavior in the intervention phase compared to the pre-intervention phase.

Conclusion: The results revealed that the techniques used were successful in increasing the target behavior that is washing hands before meals of the patient. The desired behavior was modified and the outcome supports the underlying construct of Applied Behavior Analysis.