VISN 5 MIRECC Points Incentive Program (PIP)

Clinical Programs >> Points Incentive Program

Points Incentive Program (PIP)

Unit 364A at the Perry Point campus of the VA Maryland Health Care System provides specialized treatment and care for Seriously Chronically Mentally Ill veterans. Primary diagnoses are schizophrenia and other schizophrenia-spectrum disorders. The Points Incentive Program (PIP) is unique within VISN 5, and is in collaboration with the MIRECC (Mental Illness Research, Education, and Clinical Center). Patients admitted to the program have a history of poor response to pharmacological and/or psychosocial interventions, have required extensive hospitalizations, and have had difficulty being maintained in the community with available resources. The length of stay ranges from 14-180 days, and even longer in some cases.

Unit 364A utilizes a well-structured behavior management/incentive therapy program, known as the Points Incentive Program, or PIP. This program was implemented in 2000, and is our version of a token economy. The ultimate goal of this program is to promote the learning of behaviors that will improve functioning while a veteran is on the unit, as well as when the veteran is transferred to other, less restrictive settings. All patients who are admitted to the unit participate in the PIP as part of their treatment.

The program incorporates eleven specific target behaviors for which each patient has the opportunity to earn "points" during the course of each day. Target behaviors were selected based on their importance for community survival and their role in enhancing engagement in treatment. The target behaviors generally fall into the categories of activities of daily living (e.g., personal hygiene, cleanliness of personal living space), medication compliance, and active engagement in treatment (e.g., group attendance, involvement in activities on the unit). Objective rating criteria are specified for each behavior so that patients have a clear understanding of the expectations and staff members have the ability to make consistent and objective ratings. Points earned are tracked on a point sheet that patients keep with them throughout the day. Patients have the opportunity to spend their points on reinforcers such as privileges, personal items, and special activities. Social reinforcement, in conjunction with the awarding of points, is emphasized in the program.

Point earnings and expenditures for each patient are entered into a computer database nightly by the staff. Each day's point sheet contains updated information on the patient's total number of accumulated points and the privilege level within the program as determined by point earnings across consecutive days. The computerized data entry system improves accuracy of data, makes objective behavioral data immediately available for treatment planning, and allows rating patterns to be tracked among staff members. The computerized system also enables staff to easily weight specific behaviors differently for each patient based on the patient's presenting problems. In addition, the program includes an individualized target behavior on each patient's daily point sheet based on the clinical needs of that patient. Thus, we are able to tailor the program to patients' individual treatment needs. Patients are included in this treatment planning process.

Since the PIP's inception in 2000, we have seen a decrease in the need for patients to be secluded or restrained and some patients who were believed to need lifetime institutionalization have been successfully discharged to the community.