Nutritional Disorders Telehealth Network Project

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Behavioral Contracting

A behavioral contract is a written agreement between a caregiver and a child to help them to achieve a specified goal. In a medical context this tool is generally used to help with adherence to a medical plan. Typically, the goal is stated in clear terms that the caregiver and the child understand, the behavior is defined, and a reward is agreed upon which is available upon completing the conditions of the contract.
Background Education for Providers
Using behavioral contracts to treat nutrition problems is a common practice. Previous studies support the use of this technique, especially when a clearly defined behavior is identified which can be easily modified and monitored.
Typically a behavioral contract includes (1) who the caregivers and child are, (2) the targeted problem to change, (3) the goal or objective, (4) method of monitoring, and (5) consequences, which may include both positive and negative consequences dependent upon the child’s progress.    
When developing a contract make sure that each participant is aware of their role. Typically, the caregiver is responsible for monitoring progress and giving rewards/consequences as appropriate. The child must follow the behavioral objective guidelines (engaging in a specified behavior or refraining from a specified behavior) to earn the reward. The most effective contracts have only 1 or 2 target behaviors which are clearly defined and which are easily monitored. Monitoring should be done daily and rewards and/or consequences should be given at the appropriate interval. Rewards and/or consequences should match the difficulty of the task. In other words, do not over reward believing this will improve the likelihood a child will comply. Past studies show that children who are over compensated actually decrease the frequency of the target behavior! Likewise, rewards and consequences should be in close proximity to the behavior otherwise the reward/consequence loses its effectiveness to change behavior.
Instructions for Provider
A behavioral contract is a written agreement that allows a child to earn a small reward or privilege by demonstrating a desirable behavior. Effective contracts are negotiated between adult caregivers and a child. In negotiation, the caregivers and child decide on a clearly defined target or goal, choose measureable short term objectives, establish methods for tracking progress, arrange for frequent positive consequences for meeting the terms of the contract, and specify dates and times for evaluation and renegotiation of the contract.
Goals should be likened to specific behavioral changes as opposed to clinical outcomes. For example, eating 3 servings of vegetables a day is a better goal than reaching a weight goal. Once the desired behavior has changed for a sustained period the contract should be renegotiated to promote continued progress on nutrition goals.
Supplemental Materials
© 2015 Medical College of Wisconsin
Page Updated 04/15/2014