Table A1

Code book

SubthemeCodeDescription
Helps with daily functioningPresence on unitTE helps patient to attend group moments on the unit (breakfast, coffee break, lunch, dinner)
Eating healthierTE helps patient to develop healthy eating habits
Sleep wake rhythmTE helps patients to maintain clear day-night rhythm
Physical activityTE helps patient to increase physical activity level
Social contactTE helps patient to increase social contact (with staff, or other patients)
Personal hygieneTE helps patient with hygiene tasks like showering, brushing teeth, cleaning of clothes
No cues needed for choresStaff does not need to tell patients that they need to do daily choses (like cleaning up after a meal, cleaning their room, etc.)
Attention to positivesAchievements are valuedTE gives the indication that positive behaviours and achievements are valued
complimentsTE results in compliments being given
Not only about flawsThe focus is not solely on what is done wrong or what the flaws are
Makes me feel good about myselfPatient indicates they feel good/better about themself because of TE
More clarity of behavioural goalsReminds me of goalsBecause of TE, patient/staff are reminded of what the behavioural goals are
Goals made explicitGoals are specifically described and made explicit to both patient and staff
Frequent evaluation of goalsTE results in a frequent evaluation, and if necessary, update of the behavioural goals
Goals topic of conversationBecause of TE, behavioural goals have become a topic of conversation
More patient staff interactionInvites for conversation on daily tasksTE leads to conversation about daily tasks and general topics related to the patients well-being
Eases contact with patientsTE eases contact, results in less conflicts
Forces interaction with patientsTE forces staff to make time for interactions with patients, priority on social interaction
I talk more with staffPatient indicates that they interact/talk more with staff members
Social contact is one of my goalsPatient indicates that one of their goals is to increase social contact, and that this goal is easier to achieve because of TE
Extra moneyI have little spending moneyPatient indicates that because they have little money to spent they appreciated the financial stimulation provided by TE
Liking extra moneyPatient indicates that the like/appreciate the extra money they get from participation in TE
Motivation: for the moneyMotivation depends on financial needIf patient has sufficient financial means motivation is limited/the financial situation determines the effect of the TE
Sole motivation is moneyPatient is solely motivated by the money
General statement about motivationStaff mentions what they believe motivates the patient to participate
Questionable enduring effectUncertain about long termWhether TE results in an enduring change in behaviour is still uncertain
Participation dependent of receiving tokensWhen tokens are not given any longer, the goals are no longer achieved
No learning occursIt is not clear, or questioned, whether the patients learn what the benefit of the goal behaviour is during the TE
Unsure on habit developmentIt is uncertain that habits are formed due to TE
Old goals are forgottenWhen a new goal is introduced, the old goals are forgotten, and these behavioural goals are no longer achieved
Does not work for allOnly works for someOnly a selection of the patients benefit from TE
Not for more intelligent patientsIt works better with patient with a lower IQ, patients with a higher IQ are often resistance to TE
Not for patients with financial meansWhen patients have sufficient financial means, the financial reward provided by TE is insufficient and TE does not work
Some patients resistant to TESome patients are resistant to participate in TE. Patients do not want to participate in TE because they do not believe it will help them
Better for patient with negative symptomsWorks well for patients with more severe negative symptoms, not so much for other patients
Considered childishSome patients consider TE childish and therefore do not wish to participate
Competition patientComparison between patientsTE leads to comparison between patients, which can be undesirable as it distracts from personal goals
Competition unwantedTE results in competition among patients, which is unwanted
Group process negativeThe TE has a (negative) effect on the group dynamic
Motivation decreases over timeNovelty wears offInitially TE brings excitement, but over time, the novelty of it wears off and motivation decreases
Get bored with token goalsPatient indicates that after a while they become bored with their behavioural goals
Motivation does not lastThe motivation to participate decreases over time and the effects of TE diminish over time
Focus shift to daily hasslesAfter a while the focus shifts from TE to the daily hassles and TE gets forgotten
Goals need to change more frequentlyBehavioural goals need to change more frequently to maintain the motivation to engage
Not enough moneyMore money would increase motivationPatients indicate they would feel more motivated if the monetary reward would have been higher
I cannot buy what need/wantPatient indicates that their motivation is limited because with the current reward, they are not able to buy the item they desire (e.g. cigarettes or razor)
I want to savePatient indicates that they would be more motivated if they could save the tokens and get paid out less frequently but a larger amount
Other codesNo added pressure workloadStaff indicates that TE has not changed their workload significantly
Demographic infoDemographic information of either patient or staff member
Interesting for other populationsTE is deemed interesting for other forensic populations or other departments within or outside the same institute
Training staff necessaryStatements about the necessity of training in TE for the staff
Initial resistance staffStatements about the initial resistance to TE from the staff

Note(s):

*The codes and description displayed were translated from Dutch and re-organised by (later) identified themes

Source(s): Authors’ own creation

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