literature review of video modeling

Video Modeling Interventions to Improve Play Skills of Children with Autism Spectrum Disorders: A Systematic Literature Review

• Review Paper
• Published: 21 May 2014
• Volume 1 , pages 165–178, ( 2014 )

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• Christina L. Fragale 1  

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Children with autism spectrum disorders (ASD) often experience substantial delays in developing appropriate play skills. Video modeling interventions have been successfully used to teach new skills with this population (Shukla-Mehta et al. in Focus on Autism and Other Developmental Disabilities, 25 , 23–36 2010 ). This paper reviews video modeling studies that included children with an ASD and measured a form of engagement in play as one of the dependent variables. Twenty-two studies ( n  = 57 children) were identified and divided into two categories: solitary and social play. The results indicated that video modeling is an effective intervention to teach various play-related skills. Similarities across intervention methodology are discussed in order to provide general guidelines for the design and use of video modeling interventions. Maintenance and generalization results are also highlighted. Finally, several areas for future research are considered.

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Although there is not a precise definition of play, experts agree that it is a complex, often intrinsically motivated activity characterized as spontaneous, flexible, and creative in nature (Mastrangelo 2009 ). Play is an important activity for young children to engage in because it is linked to social, cognitive, physical, and emotional development. It also provides the context in which children explore and learn how to interact with the surrounding environment (Ginsburg et al. 2007 ). For example, children may be introduced to skills such as perspective taking or emotional regulation that are foundational to developing relationships with peers (Frost et al. 2005 ; Ginsburg et al. 2007 ). However, children with autism spectrum disorders (ASDs) often do not develop appropriate play behaviors on their own. They may instead engage in rote, repetitive, or stereotypic nonfunctional play such as lining up toys (American Psychiatric Association 2013 ; Baron-Cohen 1987 ; Wulff 1985 ). Additionally, global difficulties in imitation, expressive and receptive communication skills often complicate the development of appropriate play. These challenges are often pervasive without intervention.

There are a number of behavioral interventions used to target play skills with children with ASDs. These include pivotal response training, reciprocal imitation training, differential reinforcement, in vivo modeling, play scripts, video modeling and milieu training (Stahmer et al. 2003 ; Terpstra et al. 2002 ; Lang et al. 2009 ). Video modeling, in particular, is a popular intervention used with individuals with ASDs to teach a variety of new skills. During video modeling, the individual watches a video of a person (or persons) modeling the desirable behaviors and then is asked to imitate the video (Banda et al. 2007 ; McCoy and Hermansen 2007 ). There are a number of literature reviews published on the use of video modeling interventions with individuals with autism or other developmental disabilities (Rayner et al. 2009 ; McCoy and Hermansen 2007 ; Shukla-Mehta et al. 2010 ). For example, McCoy and Hermansen ( 2007 ) reviewed the impact of the type of model used in the video (e.g., peer, adult or a mix of the two) on the effectiveness of acquisition of behaviors targeted through video modeling. Shukla-Mehta et al. ( 2010 ) reviewed the effects of various video types such as video modeling, video self modeling and point of view video modeling on social and communication skills training. Collectively, these reviews indicate that video modeling is an effective, versatile intervention for individuals with ASDs. However, a literature review on video modeling as an intervention to improve play skills for this population has not, to our knowledge, yet been published.

The primary purpose of this review is to identify, analyze, and summarize research on video modeling interventions used to improve play-related behaviors for children with ASDs. Reporting this information serves to extend the literature base by providing a more comprehensive view of video modeling as an intervention, identify the common characteristics of the studies and general effectiveness specifically for play outcomes.

An electronic database search was conducted using three databases: PsycINFO, Psychology and Behavioral Sciences Collection, and Education Resource Information Center (ERIC). The terms video model*(or video based or video instruction) were entered in the first search field, play (or leisure or toys or pretend or recreation) entered in the second field and autism (or autistic) entered in the third search field. The search was limited to entries up to and including the year 2013, published in the English language and in peer-reviewed journals and gave an initial 104 results. After duplicates were removed, there were 96 total entries. Criteria were applied in order to determine which articles would be included or excluded in the review.

Inclusion-Exclusion Criteria

To be included, the study must have met several inclusion criteria. First, the study must have involved at least one participant with an ASD up to and including 12 years of age. Second, the intervention included a video modeling component. Video modeling was defined as a process in which the participant observed a video of a model (e.g., self or another person) engaging in a target behavior and then was expected to imitate the behavior. Third, the study needed to include objective empirical data in which the effects of video modeling on play were measured. Fourth, studies must have reported play behavior as a dependent variable. Use of play as a context to teach skills without including a measure of play was excluded. For example, some researchers measured social initiations during play (e.g., Buggey et al. 2011 ; Kroeger et al. 2007 ) or used toys as props for conversational speech but did include any data or measurement of play behaviors (Charlop and Milstein 1989 ; Charlop et al. 2010 ; Gena et al. 2005 ). Twenty-two studies met the inclusion criteria. Table  1 provides a summary of each included study.

Coding and Summary of Studies

Studies that met the inclusion criteria were coded using a computerized data sheet specifically designed for this review. Each article was read and pertinent information extracted and recorded on the data sheet. Each study was classified into one of two possible categories based on the type of play, solitary play or social play. Studies were categorized as solitary play if the video showed one person playing or focused on increasing play behaviors of the participant playing alone. Studies were categorized as social play if the video model targeted improving play behaviors of the participant with one or more people. Once categorized, each study was summarized according to the following features (see Table  1 ): (a) participant characteristics (e.g., sex, diagnosis, age); (b) targeted skills (dependent variables); (c) intervention components; (d) outcomes; (e) maintenance and generalization. For each play-related dependent variable, results were reported as positive, negative or mixed in studies utilizing single-case experimental designs (Lancioni et al. 1996 ; Lang et al. 2012 ) and positive or negative in studies utilizing group design. For studies utilizing single-case experimental designs, results were classified as positive if visual analysis of the graphed data indicated improvement for all participants, negative if no improvements were apparent or minimal improvements were made (as described by authors) for all participants, and mixed if improvements for the dependent variable occurred for some, but not all participants in the study. For studies utilizing group design, results for each dependent variable were classified as positive if statistically significant improvements were reported and negative if statistically significant improvements were not reported. For maintenance and generalization results, positive results meant that the gains in play behavior remained above baseline levels for all participants whereas negative results indicate no improvements. Mixed results indicate improvement for some but not all participants. Positive, negative and mixed results were represented in Table  1 with “+”, “−”, and “+/−” respectively.

From this search, 22 studies ( n  = 57 children) were identified and included. The majority of the participants were boys ( n  = 49 or 86 %). The average age of the participants was 6 years old (range 2.5 to 15 years of age). Most of the studies (95 %) utilized a single subject design to determine effectiveness of the video model intervention. Sixteen studies (73 %) percent of studies reported maintenance results. Fifteen studies (68 %) reported generalization results.

Solitary Play

Twelve studies ( n  = 31 children) targeted play skills involving only the participant (Boudreau and D’Entremont 2010 ; D’Ateno et al. 2003 ; Dauphin et al. 2004 ; Dupere et al. 2013 ; Hine and Wolery 2006 ; Lydon et al. 2011 ; MacDonald et al. 2005 ; Palechka and MacDonald 2010 ; Paterson and Arco 2007 ; Sancho et al. 2010 ; Tereshko et al. 2010 ; Scheflen et al. 2012 ). The average age of the participants was 4 years, 2 months (range 2.5 to 7 years). Three studies (Hine and Wolery 2006 ; Scheflen et al. 2012 ; Tereshko et al. 2010 ) targeted functional play (e.g., using play items in the way they were intended to be used such as using a spoon to scoop play food into a bowl). One study targeted both functional and pretend play skills (Scheflen et al. 2012 ). The remaining studies targeted sociodramatic play, a type of pretend play in which the children take on characters or roles and act out real-life experiences, fantasy, and drama scripts. In almost all of the studies in this category, the model was an adult. Boys who were of similar age to the participants were the models in the remaining two studies (Dauphin et al. 2004 ; Paterson and Arco 2007 ). Six studies reported the length of the video model, which ranged from 71 to 160 s (Boudreau and D’Entremont 2010 ; Hine and Wolery 2006 ; Lydon et al. 2011 ; Paterson and Arco 2007 ; Sancho et al. 2010 ; Scheflen et al. 2012 ). Three studies reported number of actions or verbalizations depicted in the video rather than duration of the video, and ranged from 10–16 scripted play behaviors (D’Ateno et al. 2003 ; Dupere et al. 2013 ; MacDonald et al. 2005 ).

MacDonald et al. ( 2005 ) used video modeling to teach two boys with autism, 4 and 7 years old, play scripts using figurines and objects of town-, ship-, and house-themed toy sets. Four dependent variables were measured: scripted play actions, unscripted play actions, scripted verbalizations, and unscripted verbalizations. Scripted play actions consisted of motor responses that matched the actions of the video model and resulted in the same change in the environment. These actions included moving the toy figurines as if they were engaged in specific actions (e.g., making the figurine open the door of the play house). Scripted verbalizations were single words or short phrases that matched (or were similar enough) to the statements in the video model. Unscripted actions and verbalizations were motor and verbal responses that did not match the video model. Researchers videotaped an adult acting out each play sequence consisting of approximately 14 pretend play actions and 16 verbalizations. After viewing the video, participants were given a 4-min opportunity to play with the toys shown in the video. Both children demonstrated increases in scripted actions and verbalizations and learned to appropriately manipulate the characters and talk for them. Prior to video modeling, some unscripted play occurred but were anecdotally characterized as repetitive and unrelated to any storyline or thematic play (e.g., having a character going up and down the stairs repeatedly). After video modeling was implemented, unscripted actions and verbalizations did not occur.

Palechka and MacDonald ( 2010 ) compared the use of instructor created videos (ICV) and commercially available videos (CAV) with three children with autism, ages 3–5 years old. The CAV format consisted of a stop motion clay animation of the script in which the characters appeared to be moving by themselves while the ICV showed an adult modeling the script using the figurines and play set. The ICV was made to be as similar as possible to the CAV (e.g., video angle, length of time and number of actions/verbalizations, background props). Since two scripted storylines were used and an ICV and CAV format available for both, there were a total of four videos in the study. The dependent variables measured included attending to the video and toys, scripted vocalizations, and scripted actions. In order to compare the acquisition of scripted play using ICV or CAV, a multi-element experimental design was used and the format of the videos counterbalanced across participants. After viewing the video (ICV or CAV) twice, the children were allowed to play with the same materials from the video for 5-min. The ICV was more effective in teaching the play chains (actions and verbalizations) than the CAV for two of the participants. The third participant learned the play behaviors equally from both types of videos. Average percentage durations of attending to the videos were similar across both formats for all three participants.

Social Play

Ten studies ( n  = 26 children) included play with two or more persons (Charlop et al. 2008 ; Kleeberger and Mirenda 2010 ; MacDonald et al. 2009 ; Maione and Mirenda 2006 ; Nikopoulos and Keenan 2003 , 2004 ; Ozen et al. 2012 ; Reagon et al. 2006 ; Taylor et al. 1999 ). The average age of participants was 7 years, 5 months (range 4 years, 4 months to 15 years). In addition to functional and pretend play skills, play within a social context (e.g., parallel play, reciprocal play, cooperative play) as well as social skills within play activities (e.g., initiations and responding to others’ play bids) were measured. Adults were used exclusively as models in six studies (Charlop et al. 2008 ; Kleeberger and Mirenda 2010 ; MacDonald et al. 2009 ; Maione and Mirenda 2006 ; Nikopoulos and Keenan 2007 ; Ozen et al. 2012 ), adult and child (mixed models) in three studies (Nikopoulos and Keenan 2003 , 2004 ; Taylor et al. 1999 ) and only children models in one study (Reagon et al. 2006 ). Four studies reported video length duration, ranging from 30 s to 4 min (Maione and Mirenda 2006 ; Nikopoulos and Keenan 2003 , 2007 ; Reagon et al. 2006 ). Four studies reported number of scripted play behaviors modeled in the video, which ranged from 6 to 21 scripted actions or comments (MacDonald et al. 2009 ; Ozen et al. 2012 ; Reagon et al. 2006 ; Taylor et al. 1999 ).

Maione and Mirenda ( 2006 ) used multiple video models to teach language skills associated with toy play to a 5-year-old boy with autism, Ryan. Three toy sets (e.g., Play Doh™, toy cars, and tree house) were utilized in a multiple baseline across activities design. A total of nine videos were developed, three for each of the toy sets. The videos were approximately 1.5-min long and consisted of two adults playing with the toys and talking to each other using a variety of comments, questions, acknowledgments, initiations, and responses in three- to six-word phrases. During intervention with the first toy set, Ryan watched the three videos associated with the toy. Then a peer without disabilities joined him for a 15-min play session. The children were told, “time to play [activity]” and directed to one of the three sets of play materials. Every 5 min, the children were transitioned to a set of toys. Researchers measured scripted and unscripted verbalizations, initiations towards peers, and responses to peers. Initiations were comments or questions that were not contingent on a peer’s utterance and included requests, compliments, and comments about an object or the ongoing activity. Responses to peers were defined as verbalizations that were contingent on a peer’s immediate utterance including acknowledgements, agreements, comments about the ongoing activity, and questions related to a peer’s comments. Five phases were conducted: baseline, video modeling, video modeling plus feedback (play doh and cars only), video modeling plus feedback and prompting (cars only), and follow up. Feedback consisted of showing the Ryan a video of himself and a peer engaging in the play activities. The researcher then occasionally paused the tape and asked Ryan to evaluate his behavior in the video for “good talking” or “not good talking”. During prompting, verbal and visual prompts were used initially and then faded over time. When only video modeling was used, researchers saw improvement for unscripted and scripted verbalizations and initiations for the tree house toy set only. When video feedback was added, levels of initiations, unscripted, and scripted verbalizations improved; however, the data were still variable for one activity (cars). For this set of toys only, prompting was added leading to increased initiations, unscripted, and scripted vocalizations. Responses to peers verbalizations, however, did not increase for any of the toy sets across any of the phases. Follow-up several weeks later indicated that improvements across skills and toy sets were maintained.

MacDonald et al. ( 2009 ) taught two boys, 5 and 7 years to engage in sequences of reciprocal play with typically developing peers. Play was centered around three play sets (e.g., airport, zoo, and barbeque grill set) consisting of a base structure and several characters and objects. Three videos were made, one for each play set. In the video, two adults, matched for gender of the participant and peer, acted out scripts containing 14 to 17 play actions and accompanying verbalizations. Scripts consisted of manipulating the characters and “speaking” for them such that the characters were interacting or conversing. Four-minute play sessions were conducted in baseline, training and probes. Six variables were measured: scripted play (actions and verbalizations), unscripted play (actions and verbalizations), cooperative play, and reciprocal verbal interaction chains. Scripted and unscripted play was measured throughout the study while cooperative play and reciprocal chain interactions were measured only in baseline and mastery. During baseline, the participant and peer were allowed to play with the toy set for 4 min. During video modeling, the pairs watched the video twice and then were immediately provided with the toy from the videos. No prompts or reinforcement were provided. After the participant met mastery criteria, mastery probes were conducted without the video model. Follow-up probes were conducted 1 month following mastery. Similar results were reported for both participants. Therefore, only one participant’s result will be discussed. Both scripted actions and verbalizations increased with the introduction of video modeling, indicating acquisition of the script. Cooperative play, defined as being within close proximity with another peer and engaging in the same activity, increased from 17, 0.06, and 15 % of intervals during baseline for the airport, zoo and grill to 87, 85 and 90 % respectively. Reciprocal verbal interaction chains, defined as a sequence of two or more verbalizations between the participant and peer, increased from zero sequences in baseline to means of five sequences for the airport toy, six for both the zoo and grill toys during mastery probes. These sequences were not only increased in frequency, but the mean lengths of interaction were 7.5, 10, and 7 s, for the airport, zoo and grill toys. These outcomes were maintained at follow-up probes. Results for unscripted behaviors, however, were mixed as one participant demonstrated increased unscripted play for two of the toy sets while the second participant did not show any improvements.

This review identified 22 studies that reported the effects of video modeling on play behaviors for children with ASDs. The results suggest that video modeling is an effective intervention, corresponding with the positive findings reported in other reviews on video modeling (McCoy and Hermansen 2007 ; Shukla-Mehta et al. 2010 ). Of the 22 reviewed studies, use of video modeling was effective for 82 % of participants in increasing scripted play actions and vocalizations. In addition to using video modeling to intervene on play skills, a number of studies also targeted social skills. These studies were categorized as social play and included teaching initiating or responding to bids to play with others, imitation skills and reciprocal play (Charlop et al. 2008 ; Kleeberger and Mirenda 2010 ; MacDonald et al. 2009 ; Maione and Mirenda 2006 ; Nikopoulos and Keenan 2003 , 2004 ). In two studies, targeting social skills within a play context led to collateral increases in cooperative play (Charlop et al. 2008 ) and reciprocal play (Nikopoulos and Keenan 2007 ). A majority of studies targeted either functional or pretend play skills. Functional play included using toys as their intended function (e.g., throwing or bouncing a ball) or in a conventional association of two objects (e.g., putting plastic food on a spoon). Pretend play (also called symbolic play), included using an object as if it were another object (e.g., using a ball as if it were a cannonball), attributing properties to an object which it does not have (e.g., using the spoon as an extension of a robot) or referring to absent objects as if they were present (e.g., make believe food on the spoon; Baron-Cohen 1987 ). Nearly half of the studies involved sociodramatic play, a more advanced form of pretend play in which the children take on characters or roles and act out real-life experiences, fantasy, and drama scripts. Sociodramatic play was taught in both solitary and social play situations (Boudreau and D’Entremont 2010 ; D’Ateno et al. 2003 ; MacDonald et al. 2005 , 2009 ; Maione and Mirenda 2006 ; Palechka and MacDonald 2010 ; Ozen et al. 2012 ; Reagon et al. 2006 ; Taylor et al. 1999 ). Given the lack of appropriate play and social skills as diagnostic criteria for ASDs, it is not unusual that they are often targeted in intervention programs for young children with autism. Additionally, play activities were utilized as the medium for teaching social skills, a practice often utilized in programs for early learners.

Similar to previous reviews on video model interventions, the models in the intervention videos were adults rather than children. Adults are often selected out of convenience because they are easy to recruit and direct. Although few studies made efforts to individualize the models in the videos to characteristics of the participants (e.g., gender), most studies resulted in positive outcomes for acquisition of play behaviors. These results support previous research that successful video model interventions have been achieved regardless of whether the model in the video is an adult, peer, or of matched gender to the participants (McCoy and Hermansen 2007 ). However, little is known about the effects of the model type (e.g., adult, peer, sibling) on generalization of learned skills. A child’s ability to play next to or with other children is an important outcome since play is often the context used to target social skills with other children (e.g., inclusion, free play, recess). Recruitment of siblings and/or peers to serve as the model in a video modeling intervention may be a viable strategy to naturally program for generalization. Of the six studies in which a child played with one of the models in the video intervention, two studies measured generalization with other peers and reported positive results (Nikopoulos and Keenan 2003 , 2007 ). An additional study reported anecdotal positive evidence of generalization with a sibling who was not part of the study (Reagon et al. 2006 ). Of two studies that used adults as models and reported generalization with other people, the results were mixed for play skills. Charlop et al. ( 2008 ) showed two boys with autism video models of two people having conversations with and about toys and measured play as an ancillary variable during free play sessions. Both participants increased parallel and interactive play with another child with autism and a peer, but only one showed positive results with an adult. Kleeberger and Mirenda ( 2010 ) reported a low level increase in generalization probes of play with another adult. Given these limited results, further research should explore the effects of the type of model on generalization probes. There are, potentially, other positive effects for involving peers and siblings as the model and play partner. Engaging siblings as part of interventions with children with autism may result in positive changes in familial relationships (Ferraioli et al. 2012 ). Reagon et al. ( 2006 ), for example, reported that after the participant’s brother was involved as the model and play partner, the sibling felt that “playing with his brother was fun and he learned how to play with him”. Understanding the positive and negative aspects of including similarly aged peers or siblings as models and play partners requires more systematic inquiry.

Additional strategies were employed in combination with video modeling for half of the studies. The most common addition was the use of noncontingent or contingent reinforcement, usually in the form of verbal praise and/or small edible foods (reported in nine studies). Noncontingent reinforcement was mainly used to maintain interest and general participation. Contingent reinforcement was provided to increase imitation of the target behaviors in the video, however it is not known the extent that either reinforcement procedure is required to garner positive outcomes. The second most common additional component included prompting during play (reported in six studies). Verbal or visual prompts were delivered either prior to the occurrence of behavior to encourage correct responding or as part of an error correction procedure (i.e., after the child has made an error, the prompt indicates what the response should be). Prompted behaviors were usually followed by reinforcement. The addition of reinforcement or prompts to the video modeling intervention increased the effectiveness of the overall intervention. For example, Sancho et al. ( 2010 ) compared the effectiveness of traditional video modeling and simultaneous prompting during video modeling to teach scripted play actions and verbalizations to two children with autism. During traditional video modeling, a 2-min video of the experimenter manipulating the toys was shown without any other prompts or further instruction. During simultaneous video modeling, researchers physically prompted and reinforced imitated play actions throughout the showing of the video. Prompts were faded and an error correction procedure was also implemented. Although both formats increased scripted actions, the simultaneous video model format increased scripted verbalizations within fewer sessions. In a few cases, more intensive strategies or modifications such as direct feedback (Maione and Mirenda 2006 ) or modifying the video into shorter, separate segments (Taylor et al. 1999 ; Tereshko et al. 2010 ) were required to produce behavior change. Although the traditional video modeling format may not be fit for all children, but it is encouraging that relatively simple modifications may improve participant outcomes.

There is a scarcity of research on the identification of prerequisite skills participants need to be successful with video model interventions. In previous video modeling literature, researchers have suggested memory, attending, and imitation skills, however support for these as prerequisites for video modeling is mainly through conjecture rather than an empirical analysis (McCoy and Hermansen 2007 ; Rayner et al. 2009 ). Five of the studies in the current review reported formal or informal assessments for skills thought to facilitate the success of a VM play intervention (e.g., imitation, attending, communication, play skills) prior to intervention (Hine and Wolery 2006 ; Lydon et al. 2011 ; Palechka and MacDonald 2010 ; Paterson and Arco 2007 ; Tereshko et al. 2010 ; however, only one study used the assessments as inclusion criteria for participant selection (Paterson and Arco 2007 ). This distinction is important because two participants were excluded from continuing the study due to their inability to attend to the video without being distracted. It is unknown whether these individuals would have benefited from a video model intervention or from a different format of instruction. One study linked pretreatment assessment results to the need to adapt the video model intervention to gain successful outcomes (Tereshko et al. 2010 ). Tereshko et al. ( 2010 ) taught four participants to build toy figurines using blocks that stack and connect. When all eight steps of the video model were shown in one sitting, three out of four participants performed poorly. The authors observed that these three students also performed poorly on delayed match-to-sample assessments. After the video was reduced to smaller video segments (one to two steps) and then chained together upon mastery of each of the smaller segments, these three participants were successful in learning how to put together the toys. The authors noted that the fourth participant, who was successful with the full video model intervention, also reached mastery for delayed match-to-sample skills. These descriptive data highlight the need for research to provide a comprehensive picture of the prerequisite skills needed for individuals to benefit from video model interventions.

One of the indicators of true acquisition of new skills includes maintenance and generalization results (Stokes and Baer 1977 ). A total of 16 studies reported maintenance data. Improvements from video model interventions appeared to be maintained, at least for the short term. Fourteen studies reported positive results for short-term maintenance data (withdrawal of intervention immediately after mastery up to 3 weeks post intervention). Five studies reported mixed results for long-term maintenance data (1 to 4 months post intervention). It may be necessary to provide booster sessions to help maintain newly learned play skills over a longer period of time. A total of fifteen studies reported generalization data. Five of the six studies that measured generalization of newly acquired play skills across settings and people reported positive results. Generalization across novel toys and materials in eight studies were mixed, however. Studies with positive results indicate there are some strategies that may aid in generalization with new materials. Dupere et al. ( 2013 ) examined the use of substitutable video model loops on play behaviors with toy characters that were not shown in the video model training. Substitutable video model loops are sections of the video model script that can be applied to various characters, representing slight variations of the same video model intervention storyline or a version of multiple-exemplar training (Stokes and Baer 1977 ). Two of three children applied the play behaviors from the video model with the toy characters not shown in the substitutable video model loops. Paterson and Arco ( 2007 ) studied how the level of similarities between the toys used in training and novel toys used in generalization probes could affect results with two boys with autism. When novel toys were thematically related to the toys used in the training phase (e.g., all construction themed such as construction bulldozer, dump truck, control booth with boom gate and figurines in hard hats), one child participant demonstrated generalization of verbal and motor play behaviors with the novel toys. Alternatively, when the novel toys were not thematically related (e.g., construction bulldozer, jet ski, helicopter, and male figurines), the second participant did not demonstrate generalization of play behaviors. The authors concluded that when assessing generalization of play with toys, the types of toys should be carefully selected. Caution is warranted, as the support for these strategies has not yet been replicated.

Several studies highlighted the substantial lack of unscripted play as a concern with video modeling interventions used to teach play skills. Eight studies measured unscripted play behaviors. One study reported positive results (Maione and Mirenda 2006 ), two reported mixed results (one participant showed improvement while others did not) (MacDonald et al. 2009 ; Taylor et al. 1999 ), and five reported little or no improvements for any participants (Boudreau and D’Entremont 2010 ; D’Ateno et al. 2003 ; MacDonald et al. 2005 ; Reagon et al. 2006 ; Sancho et al. 2010 ). However, even the improvements for unscripted play behaviors were not without limitations. Sancho et al. ( 2010 ) reported unscripted verbalizations but noted they were repetitive or stereotypic in nature. Although Maione and Mirenda ( 2006 ) described improvements in unscripted verbalizations, they reported baseline data as total numbers of verbalizations rather than differentiating between scripted and unscripted verbalizations. Therefore, it is unclear whether unscripted verbalizations improved or stayed the same after the introduction of the video model intervention. Given that one of the core characteristics of autism spectrum disorders is a lack of spontaneous play and a penchant for repetitive or routine behaviors, current video model research has not sufficiently addressed this aspect of improving play behavior.

Although current research supports the use of video modeling to teach new play skills to children with ASDs, the application of this technology is still limited. For example, although most of the intervention sessions took place in applied settings (e.g., home and school settings), participants often received the intervention on an individual basis. Given the relative simplicity of video model interventions, future research may explore “scaling up” the administration of video model interventions with small groups of children or as part of the curriculum lesson for pullout type of services common in special education of public schools. Ozen et al. ( 2012 ) utilized video model interventions successfully within a small group format, but did not provide additional details of the groups (e.g., number of children, involvement of typically developing peers).

Most of the reviewed studies utilized single subject research designs. However, none of the studies utilized the media equipment during baseline sessions to rule out the effects of introducing technology on play skills. While Palechka and MacDonald ( 2010 ) reported that the play skills of three children did not improve by watching a commercially developed cartoon version of the same storyline in the video model, it is essential to reduce threats to internal validity when possible. Future research should therefore use the technology during baseline as well as intervention.

In order to increase the effectiveness of video modeling interventions on play behaviors of children with autism, future research should develop a consistent assessment protocol that includes the identification of prerequisite skills. Few of the reviewed studies included a clear assessment procedure to determine children who were most likely to succeed with a video modeling intervention. Tereshko et al. ( 2010 ) assessed a battery of potential prerequisite skills (e.g., motor imitation, attending to the video, actions with objects) yet the only prerequisite skill required to be included in the study was to be able to manipulate the toy blocks without additional help. It is not clear what types of assessments or participant characteristics are necessary for a video model intervention to be suitable for improving play.

Given the lack of improvement in unscripted play behaviors, future research should identify strategies or adaptations to video modeling that encourages unscripted play. Some researchers have hypothesized a potential interaction between repeated viewings of video model or the use of dense reinforcement schedules and decreased unscripted or novel play (Boudreau and D’Entremont 2010 ). Future research should identify the instructional conditions or modifications that foster the efficacy of video model interventions and novel play. Taylor et al. ( 1999 ) observed more unscripted verbalizations using a mastery criterion that allowed for unscripted commenting and forward chaining. For example, to meet mastery criterion, the child was required to give the same number of verbalizations as was shown in the video model, but they could be either scripted or unscripted verbalizations. The forward chain consisted of systematically adding more scripted actions. For example, if the video model consisted of four scripted play verbalizations, upon demonstrating any four appropriate play verbalizations, the child then watched the video model with the same four actions and one to two additional actions. These less stringent criteria may have encouraged increased play behavior for unscripted play while still providing a model for appropriate play. Other behavioral strategies associated with increasing spontaneous responding could be combined with video modeling. For example, script fading is effective in the production of unscripted social interaction skills (Krantz and McClannahan 1998 ; Wichnick et al. 2010 ). It seems plausible that a similar use of video modeling in which the video model is faded or cut shorter over time might be explored. Given that reinforcement was commonly used in addition to video modeling, the type of reinforcement schedule should be explored in future research. Although fixed or variable ratio schedules of reinforcement are often used to teach new skills, some research suggests that differentially reinforcing variable or novel responding may lead to behaviors that are not explicitly taught. For example, lag schedules could potentially be used to enhance video model interventions. Lag schedules are a type of differential reinforcement schedule with a multitude of evidence in the basic arena for increasing variability and novel responding of nonhuman subjects. However, the research involving lag schedules is severely lacking in current applied research. Future studies should replicate and address other strategies to foster unscripted play behavior.

*indicates articles selected for review

*D’Ateno, P., Mangiapanello, K., & Taylor, B. (2003). Using video modeling to teach complex play sequences to a preschooler with autism. Journal of Positive Behavior Interventions, 5 , 5–11.

*Boudreau, E., & D’Entremont, B. (2010). Improving the pretend play skills of preschoolers with autism spectrum disorders: the effects of video modeling. Journal of Developmental and Physical Disabilities, 22 , 415–431. doi: 10.1007/s10882-010-9201-5 .

*Charlop, M. P., Gilmore, L., & Chang, G.T. (2008). Using video modeling to increase variation in the conversation of children with autism. Journal of Special Education Technology, 23 , 47–66.

*Dauphin, M., Kinney, E.M., & Stromer, R. (2004). Using video-enhanced activity schedules and matrix training to teach sociodramatic play to a child with autism. 2008 or 2009 Journal of Positive Behavior Interventions, 4 , 238–250.

*Dupere, S., MacDonald, R. P. F., & Ahearn, W. H. (2013). Using video modeling with substitutable loops to teach varied play to children with autism. Journal of Applied Behavior Analysis, 46 , 662–668.

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Fragale, C.L. Video Modeling Interventions to Improve Play Skills of Children with Autism Spectrum Disorders: A Systematic Literature Review. Rev J Autism Dev Disord 1 , 165–178 (2014). https://doi.org/10.1007/s40489-014-0019-4

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• Published: 30 April 2024

Ecological money and finance—upscaling local complementary currencies

• Thomas Lagoarde-Ségot   ORCID: orcid.org/0000-0002-0960-9096 1 &
• Alban Mathieu 2  

Humanities and Social Sciences Communications volume  11 , Article number:  545 ( 2024 ) Cite this article

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This paper puts forth a new pathway to sustainable policy to upscale the transformative power of local complementary currencies. It first reviews the mechanisms by which complementary currencies re-embed monetary circulation within sustainability and biomimetic resilience criteria. It then puts forth a prototype policy pathway whereby private banks swap SDG impact certificates of their complementary currency loans against new reserve assets held at the Central Bank. It finally provides analytical insight on this prototype policy with a a new PK-SFC model comprising 106 accounting and behavioral equations. Simulations show that the prototype policy generates short-lived economic expansion, increases banking stability, and induces structural change through increased systemic capacity for evolution, resilience, and fitness for evolution. We finally discuss the practical implications of our results for sustainability policies.

Introduction

Multilateral development banks have recently committed to “ developing, testing, and expanding the use of innovative instruments to support nature positive investment ” (Multilateral Development Banks 2021 ). The UN Secretary General has also called for “ innovative approaches, bold policy decisions, and new sources of funding ” (UN 2023 ) to “ aggressively scale up sustainable development goals (SDG) financing” (UN 2023 ). This paper contributes to these objectives by putting forth a policy prototype to upscale the transformative power of local complementary currencies (LCCs).

LCCs consist in monetary token, backed up by a guarantee fund in the legal tender, and used to exchange goods and services within a specific community. Several studies have highlighted LCC’s contribution to sustainability (Lietaer et al. 2010 ; Escobar et al. 2020 ; Aglietta 2018 ; Ansart and Monvoisin 2017 ; Blanc 2018 ; Blanc and Lakócai 2020 ). Yet, the consensus is that LCCs should be integrated into public policies to induce structural change (Blanc 2020, 2022 ; Cauvet and Perrissin Fabert 2018 ; Aglietta and Espagne 2016 ).

We thus put forth a simple mechanism to endogenize the creation and destruction of LCCs deposits in the economy. New LCC deposits would be created though new bank loans and destroyed with the payment of taxes or the reimbursement of loans. This would disconnect the supply of LCCs from the ‘deposit guarantee fund’ and maintain their value through a full integration into the monetary system. Banks would then swap LCC loan impact ratings against new reserve assets at the Central Bank, which would apply a discretionary haircut rate. To mitigate moral hazard, the proposed setting also envisages a clear separation of mandates and responsibilities across stakeholders. This prototype policy would contribute to the SDGs by supplying rapid finance for sustainable public goods, and by harnessing the circulation properties of LCCs. It could thus open a new sustainable policy pathway.

Following Lucarelli and Gobbi ( 2016 ), we provide analytical insight using a simple new stock-flow consistent (SFC) model of 106 equations. This model also contributes to the ecological SFC modeling literature by including new metrics for total capacity for development, resilience and fitness for evolution (Ulanowicz et al. 2009 ).

In our simulations, the prototype policy increases the circulation of LCC and exerts an expansionary effect on the economy. Incremental GDP growth is fueled by new LCC loans that bridge the finance gap for social businesses. This in turn generates LCC investment and consumption spending, and LCC profits. The policy also appears to induce structural change, as shown by increased capacity for development, resilience, and fitness for evolution. Finally, simulations report increased financial stability, banking sector profits, and household savings diversification.

The remainder of this paper is structured as follows. Section 2 briefly reviews the literature on LCC schemes and sustainability. Section 3 outlines and discusses our prototype monetary policy mechanism. Section 4 presents the model’s transaction matrix and its behavioral equations. Section 5 analyzes our simulations. Section 6 outlines our conclusions and discusses their practical implications.

Local complementary currencies

Delineating local complementary currencies (lccs).

Alternative currencies are monetary devices created by non-banking actors in order to trigger a socio-economic transformation. These monetary innovations are diverse in terms of their organization, relationship with the monetary system, and purpose. As opposed to banking deposits, they are not issued by governments (though deficit spending), nor by banks (through credit), but by a business or by an association. A wide range of alternative currencies have developed in recent years, such as cryptocurrencies (e.g. Bitcoin), business to business to mutual credit (e.g. Sardex), inconvertible local currencies (e.g. Ithaca Hour), convertible local currency (e.g. Palmas), general mutual credit (e.g. LETS), mutual credit between individuals based on times-based services (e.g. Time banks), or green practices reward schemes (e.g. NU spaarpas). Within this classification, local complementary currencies (LCCs) share a set of specific attributes (Table 1 ).

LCCs are complementary, rather than alternative, given that they do not challenge the modern monetary order, but extend it, by giving money new purpose-driven objectives such as solidarity, sharing, reciprocity, and environmental protection (Blanc 2011 , 2017 ; Didier 2022 ).

LCCs are initiatives of citizens seeking to re-embed money within the logic of the commons. LCCs are issued by associations of citizens wishing to use money for a given purpose , which can be economic (e.g. supporting local businesses), social (e.g. promoting social and ecological values in the economy), or territorial (e.g. building to sustainable communities) (Fare and Ould Ahmed 2017 ). LCC communities usually favor a sociocratic governance, i.e. “a mode of governance and decision-making that allows an organization to behave like a living organism, that is, to self-organize ” (Buck and Endenburg 2004 ).

LCC participants cannot be qualified as pure utility-maximizing money users , but instead as local monetary community members (Blanc 2018 ). LCC transactions indeed involve strong ties of reciprocity, transparency, fairness and solidarity (Blanc 2017 , 2022 ). The socioeconomic literature thus characterizes LCCs as social innovations that seek to re-embed—in the Polanyian sense—economic exchange within shared ecological and social criteria (Richez-Battesti et al. 2012 ; Polanyi 2009 ).

LCCs are fully convertible into legal tender. Convertibility is typically guaranteed by a one-to-one matching between each unit of LCC and previous legal tender banking deposits (held by LCC users, most often in a social economy bank or a mutual bank) Footnote 1 . From a financial perspective, holding LCCs is thus akin to holding cash or sight deposits in legal tender (with or without demurrage) . .

Finally, LCCs self-identify their own socio-economic and spatial limits in order to fulfil their ecological and social agenda (Blanc 2022 , pp. 14–19).

More than 4000 LCCs have been developed in more than 50 countries since 1990 (Carrillo 2018 ). However, LCCs are diverse and evolve over time. According to Blanc ( 2011 8), “ each generation [of CCs] included a series of experiences often related to each other, while each generation entertains links with experiences from previous ones and provides models, positive or negative, for futures ones ”. Four generations of LCCs have been identified in the literature. First and second generations LCC schemes, take the form of mutual credit systems (e.g. LETS) and time exchange schemes, respectively, and emerged in the early 1980s. Third generation schemes, beginning with Ithaca in 1999, gave rise to LCCs as they are known today. Fourth generation schemes, which have been implemented since 2002–2003, include local governments as stakeholders, often in the context of sustainability policies.

All LCC schemes contribute to sustainability by developing an ecological awareness, by reorienting household consumption accordingly, and by promoting solidarity and social ties (Garcia-Corral et al. 2020 ; Magnen and Fourel 2015 ; Lung 2022 ; Lafuente-Sampietro 2023 ; Fois Duclerc and Lafuente-Sampietro 2023 ).

LCCs and sustainability in a biomimicry perspective

According to Lietaer et al. ( 2012 ), the monetary system is merely one subsystem of the economy, which is itself a subset of society and the environment; and no subsystem can function effectively unless it is in harmony with that wider entity. According to cybernetics, natural, economic and monetary and systems rely on transfers between actors and their fitness for evolution depends on a trade-off between throughput efficiency and resilience (Ulanowicz et al. 2009 ; Lietaer et al. 2010 ) Footnote 2 .

In an economy, the catalysing medium (money) should thus circulate amongst all corners, flow through all forms of organization (charity, limited liability company—LLC, public limited company—PLC, cooperative, mixed association, small and medium-sized enterprises (SMEs), etc.) and allow for various forms of exchange to take place (including gift, reciprocity, non-market exchange, and market exchange) (Lagoarde-Segot and Paranque 2018 ).

The fitness for evolution curve (F) observed in natural ecosystems is shown in Fig. 1 and highlights a trade-off between diversity and efficiency/optimization. Excessive diversity (e.g. too many species) leads the system to stagnate, and excessive throughput efficiency (e.g. each predator matches a single abundant prey) increases the risk of systemic collapse (e.g. if the single prey disappears). The ‘natural window of resilience’, where F  > 0.95, requires more diversity than efficiency Footnote 3 .

Note: this graph represents the ability of the system to evolve \({\rm{F}}=-{\rm{kalog}}({\rm{a}})\) for different values of 0 < a < 1. The dotted line indicates values above 0.954 and the resilience window. See Ulanowicz et al. ( 2009 ), for more details.

Note that fitness for evolution can take on significantly different values for the same level of throughput. For a given GDP, a lack of interconnectivity may create a stranglehold undermining resilience and fitness for evolution. Excessive money concentration, and insufficient connectiveness weakens the system’s ability to absorb unexpected shocks. The purpose of LCC schemes being to increase monetary circulation where it is the most needed, one may expect their development to be conductive to improved resilience, fitness for evolution, and sustainability.

Linking LCCs and public policies

Literature review.

Policy interest in LCCs can be traced back to Gesell ( 1929 ) and the infamous 1930’s Wörgl experiment. It experienced a revival in the early 21st century, in the wake of success stories (such as the Swiss WIR or the Italian Sardex) (see Lucarelli and Gobbi 2016 ). Many policy proposals have emerged in recent years to upscale the sustainability potential of complementary currencies.

One of the most notorious was perhaps Greek Finance Minister Yanis Varoufakis’ plan for Greek complementary fiscal currencies in case of a Grexit during the 2012 Eurozone sovereign (Varoufakis 2017 ). Drawing on Cuban experiences with monetary dualism (Théret and Marques-Pereira 2007 ) and Argentinean provincial currency (Zanabria and Théret 2007 ), Varoufakis envisioned the creation of complementary fiscal currencies taking the form of Treasury-bills issued by the government in payment for civil servants’ salaries, pensions, and benefits. These Treasury Bills were to be convertible at par with the euro throughout their maturity, and not exchangeable outside of Greece (nor within the banking system). The Greek government, however, would accept it in payment of taxes. The macroeconomic objectives targeted through this policy were to include economic growth and reduced twin deficits (Théret 2012 , 2015 ; Coutrot and Théret 2019a , b ).

Another frequently discussed policy proposal consists in the issuing of LCCs to remedy auction failures (Fantacci 2005 , 2008 ; Amato and Fantacci 2016 ). During bankruptcies, insolvent firms must indeed liquidate their assets through an auction process to pay off their creditors. During this auction, potential buyers have a considerable bargaining power over firms in financial distress. This, in turn, depresses prices and increases systemic risk (creditors being exposed to a drop in asset value). To remedy this problem, Amato and Fantacci ( 2016 ) called for introducing a complementary currency (the com.mons ), which creditor firms would book as an asset and debtor firms as a liability. Com.mons issues would cover the value of the defaulted credits, following an independent evaluation of the debtor’s assets, and would be traded through a clearinghouse Footnote 4 . This would allow creditor firms to recover liquidity more easily during bankruptcies Footnote 5 , increase the negotiation power insolvent firms’ during auction, and enhance financial stability.

Other authors suggest formally tying LCC communities with monetary authorities in the framework of territorial level SDG strategies (Blanc and Perrissin Fabert 2016 ; Blanc 2020, 2022 ). These authors frequently note that the legal requirement to back up LCC issues with a reserve fund, although necessary to lock-up their value, tends to hinder the development of LCC communities (Blanc and Fare 2016 ; Rosa and Stoddder 2015 ).

To remedy for this, Blanc and Perrissin Fabert ( 2016 ) suggested that LCC communities issue new LCCs for firms that undertake ecological projects. The value of these LCC issues would be backed by CO2 reduction certificates issued by a reliable third party. Local governments would then accept LCCs in payment of taxes. The new LCC deposits hence created should generate ripple effects of income and spending. This paper contributes to this literature by proposing a new policy prototype along similar lines.

A prototype policy mechanism

The basic idea.

In the modern economy, money creation typically involves four balance sheet entries: a new deposit is recorded as an asset for the borrower and as a liability for the bank. It is matched by a debt instrument which the bank accumulates as an asset, and which the borrower records as a liability. These deposits are destroyed when agents reimburse their bank loans or pay taxes to the government. For the payment system to function properly, these deposits are convertible into reserve assets at the Central Bank, which accommodates the banking system’s demand for excess reserves in its role of lender in last resort. This endogenous cycle of monetary influx, circulation and reflux, driven by banks’ and entrepreneurs’ bets, constitutes the economy’s lifeblood (Graziani 2003 ; Ehnts 2017 ).

By contrast, LCCs are akin to ‘loanable funds’ backed up by existing legal tender deposits. The proposed policy thus seeks to integrate LCCs into the monetary system. Just like euro deposits, new LCC deposits would be created (and destroyed) through the issuance (and reimbursement) of bank loans. To ensure a proper integration of LCCs they should also be convertible into Central Bank’ reserve assets.

To rapidly scale up SDG financing and ensure accountability at all levels, we propose a new monetary policy mechanism inspired by rediscounting (a tool often used by Central Banks to align the provision of credit with specific policy objectives (US Federal Reserve 1942 ; Leclercq 1982 )). The Central Bank would rediscount LCC loans, based on their ex-post contribution to the SDG agenda, using monetized impact ratings carried out by an independent agency. The Central Bank maintains control over the supply of reserve issued through this process by applying a discretionary haircut rate.

These transactions would lead the Central Bank to accumulate ex-post impact certificates on its balance sheets. These non-tradeable assets would quantify the Central Bank’s contribution to the SDGs, in line with its mandate Footnote 6 . Finally, all debts and settlement instruments used in these transactions would be labeled in the legal tender, to ensure that LCCs do not spread to the interbank and financial markets.

A more precise description

The prototype policy mechanism would thus involve three main steps:

1. Private banks issue LCC loans in response to credit demand emanating from social businesses. Borrowing firms must be LCC community-members, and the funded investment project must contribute to the LCC objectives.

2. Banks accept cash, deposits in legal tender, and LCCs in payment for all loans that are due to them. The Treasury also accepts LCCs in payment for taxes. Banks operate a conversion desk, through which households can switch their euros deposits into LCCs accounts, and vice-versa Footnote 7 .

3. Impact rating agencies compute the social return on investment (SROI) of the stock of LCC deposits issued through banking loans at the previous period ( \({L}_{s,{lc}-1}\) ), and issues corresponding impact certificates, which banks book as asset in their balance sheets. These certificates cannot be traded in secondary markets. Their nominal value \((\varphi )\) is given by Eq. ( 1 ):

3. Banks turn to the Central Bank and swap these impact certificates for new reserve assets. The Central Bank rediscounts a fraction ( \(\tau )\) ) of these impact certificates, which it accumulates in its balance sheet. Letting \(\triangle A\) be the flow of reserve deposits credited to the banking sector, and \(\tau\) be the haircut used by the Central Bank, the amount of reserve assets created through this process is given by Eq. ( 2 ). By adjusting \(\tau\) , the Central Bank keeps control over the supply of reserves, in line with its monetary policy objectives.

Figure 2 illustrates the above mechanism with a simple flow diagram. LCC member firms obtain a flow of loans from the banking sector to undertake SDG contributing investments. Impact rating agencies monitoring the ex-post SROI of these loans issue new impact certificates. Finally, banks swap these impact certificates against new reserve deposits at the Central Bank.

A flow chart representation.

Just like legal tender deposits, LCC deposits are hence created through bank credit, and destroyed when loans are repaid. This mechanism thus endogenizes LCCs. The demand for LCCs depends on social businesses’ demand for loans, and the supply of LCCs depends on banks’ expectations regarding SDG impact - with independent impact ratings, in conjunction with the Central Bank’s discretionary haircut policy, influencing decisions and expectations in the background.

This policy would modify the channels by which Central Banks supply reserves to the banking sector. Indeed, the current collateral system is forward-looking , and cash-flow based . As the Central Bank wants to operate risk-free, it adjusts the collateral haircut rate by assessing the solvability of the underlying borrower (for instance, the applied haircut is usually lower for sovereign bonds than for corporate bonds).

By contrast, the prototype policy introduces a backward-looking and impact-based procedure, whereby the Central Bank rewards the independently assessed, ex-post impact of LCC loans by crediting banks with new reserve. Banks are thus strongly incentivized to thoroughly screen loan applications for SDG impact to secure access to liquid reserve assets.

Governance issues

The policy mechanism generates several governance concerns. The first concern has to do with the fear that developing SDG monetized impact ratings would imply excessive commodification and financialization of nature, in opposition to the values held by LCC communities. Note however that SDG impact ratings would use the language of money to coordinate human activities, without implying the actual creation of markets. They would be akin to the shadow prices used by international organizations and social security systems to determine social opportunity costs in cases where markets do not exist or give wrong signals (Drèze and Stern, 1988 ) Footnote 8 , Footnote 9 .

A second concern has to do with difficulties in estimating the ‘true’ monetary value of SDG-related externalities. This legitimate concern, however, applies to all financial markets, as asset prices result from mere conventions of judgement amongst market participants. Investing based on a hypothetical ‘fundamental’ asset value often leads to market losses (Bourghelle 2023 ; Chambost et al. 2019 ). By contrast, monetized impact ratings, which are built on a participative method and with the active engagement of all stakeholders, might provide a better picture of fundamental value that most financial market transactions (which only involve the bid and ask sides of the deal) (UK Cabinet Office 2012 ).

A third concern relates to risks of ratings manipulation and greenwashing Footnote 10 . We should first note that public impact ratings would improve the transparency of monetary policy and the accountability of Central Banks (in comparison to the present situation in which Central Banks adopt in-house, undisclosed, rating system when assessing the risk of various collaterals supplied by banks borrowing reserves). However, we agree that a strong governance structure must be put in place around these new policies to mitigate moral hazard. To prevent abuse, we suggest establishing a system of checks and balances through a clear separation of mandates, as follows:

The mandate to define impact shall be attributed to parliaments, governments, and LCC communities through a democratic institutional process;

The mandate to measure impact shall be attributed to new multilateral impact ratings institutions, for instance by relying on the United Nations;

The mandate to value impact (that is to turn impact into reserves) shall be attributed to national Central Bank, setting the rediscounting rate in line with their sustainability mandates and other monetary policy objectives.

A fourth concern relates to fears that the prototype policy would entail too radical a change in banking systems. We should first note that this policy would not put an end to Central Bank independence. It is a tool that may help independent Central Banks’ hit their mandates to sustainability objectives. It might also be worth outlining that all economic systems, and free markets in particular, are inscribed a set of transient social, cultural, relational, and political rules, which evolve over time with policies, interpersonal relations, and cultural representations (Le Velly 2002 ; Granovetter 1973 ; Polanyi 2009 ). This observation holds for monetary system too, as shown by the outstanding diversity of monetary policy frameworks across time and space (Fig. 3 ).

Source: Cobham ( 2023 ).

Insight from a simple PK-SFC model

This section yields analytical insight into the above strategy with a new Post-Keynesian Stock-Flow Consistent (PK-SFC) model in the spirit of Godley and Lavoie ( 2012 ) Footnote 11 . The model is comprised of 106 accounting and behavioral equations interlocked in a sectoral transaction matrix, as well as one ‘hidden’ equation implied by all the other. The model contributes to the SFC modeling literature by including local complementary currencies and new resilience metrics.

The transaction flows matrix

The model’s transaction matrix is shown in Table 2 . This transaction matrix ensures that all flows and stock readjustment are interlocked in a watertight accounting structure, while integrating the real and financial sides of the economy. The matrix describes a simplified economy with five institutional sectors: households, production firms (divided into the LCC and the euro sector), a banking sector and a Central Bank. There is no government nor public sector in the model. This assumption means that money is emitted through bank loans (in the form of new deposits).

Each economic transaction is double-sided: one sector’s income is another sector’s spending, and one sector’s asset is another sector’s liability. Annual change to the stock of assets and liabilities held by each sector (columns) result from the budget constraint of each individual sector, defined by annual flows of income and spending (rows). This approach ensures a full integration of the real and financial sides of the economy. Following SFC modelling convention, a (+) sign indicates a source of funds while a (–) sign indicates a use of funds.

Column 1 shows the budget constraint of households. Households receive income as wages ( W ), profits redistributed by firms ( F ) and banks ( FB ), and interests on their euro ( \({r}_{d,m\left(-1\right)}{M}_{h,m,s\left(-1\right)}\) ) and local complementary currency deposits ( \({r}_{d,{lcc}\left(-1\right)}{M}_{h,{lcc},s\left(-1\right)}\) ). Households spend their income on consumption expenditures in euros ( C m ) and in complementary currency ( \({C}_{{lcc}}\) ). At the end of each period, excess of income over spending accumulates in stocks of banking deposits, which households hold both in euros ( \(\triangle {M}_{m}\) ) and in local complementary currency units ( \(\triangle {M}_{{lcc}}\) ).

Columns 2 and 3 divide the production firm sector’s transactions into a current and capital account. It amalgamates the LCC eligible sector (where both euros and LCCs can circulate) and the non-eligible sector (where only the euro can circulate). Column 2 shows the receipts and outlays of production firms. Firms receive payment flows on their sales of final goods in euros ( \({C}_{m}\) ) and in local complementary currencies ( \({C}_{{lcc}}\) ), as well as their sales of capital goods (in euros ( \(I\) ) and in local complementary currencies ( \({I}_{{lcc}}\) )). Firms pay wages to households ( W ) (in euros and LCCs) and interest on their loans in euros ( \({r}_{l,m\left(-1\right)}{L}_{m,-1}\) ) and in local complementary currencies ( \({r}_{l,{lcc}\left(-1\right)}{L}_{{lcc},-1}\) ) and set aside funds for depreciation allowances ( DA ) – also decomposed into euros and LCC allowances.

Column 3 shows firms’ capital expenditures, which are financed by depreciation allowances ( DA ), new loans in euros ( \(\triangle {L}_{d,m}\) ) and in local complementary currencies ( \(\triangle {L}_{d,{lcc}}\) ). In our simple framework, profits ( F ) are fully redistributed to households (in euros and LCCs).

Columns 4 and 5 show the current account and the capital account of banks. As shown in column 4, banks receive interest payments on loans in euros ( \({r}_{l,m\left(-1\right)}{L}_{m,-1}\) ) and local complementary currencies ( \({r}_{l,{lcc}\left(-1\right)}{L}_{{lcc},-1}\) ) and pay interests on deposits in euros ( \({r}_{d,m\left(-1\right)}{M}_{h,m,s\left(-1\right)}\) ) and in local complementary currencies ( \({r}_{d,{lcc}\left(-1\right)}{M}_{h,{lcc},s\left(-1\right)}\) ). Column 5 shows that new deposits in euros ( \(\triangle {M}_{m})\) and in complementary local currencies ( \(\triangle {M}_{{lcc}}\) ) are recorded on the liability side of banks’ balance sheets. Bank assets include loans in euros \((\triangle {L}_{d,m}\) ), in local complementary currencies \((\triangle {L}_{d,{lcc}})\) , and high-powered money ( \(\triangle A\) ). The latter is emitted through the ex-post rediscounting of LCC loan impact certificates ( φ ). The difference between bank’s interest income from loans and interest payments and deposits, plus annual additions in reserve assets obtained through loan rediscounting, constitutes their profit, which is entirely redistributed to the household sector (in euros and LCCs) ( FB ). Column 6 shows the capital account of the Central Bank. In this simplified setting, the Central Bank’s only liability is the high-powered money (reserve currency) that it issues ( \(A\) ), in exchange for impact certificates ( φ ). These impact certificates measure a net contribution to SDGs, and therefore do not appear as a liability for any sector.

Behavioral equations

We begin with the definition of total gross production (GDP). GDP ( Y ) is the sum of all expenditures on goods and services, including consumption \((C)\) and investment goods \({(I}_{f,s})\) (Eq. 1.1 ). GDP is decomposed into euro \({(Y}_{m})\) and LCC \({(Y}_{{lcc}})\) spending (Eqs. 1.2 and 1.3 )

GDP also corresponds to the sum of factor payments, which includes the wage bill (WB), production firms’ profits (F), banking profits (FB), and the depreciation and amortization funds (DA) that firms set aside to replace used-up capital. The model’s accounting closure shall ensure that Eqs. ( 1.4 ) and ( 1.1 ) are equal in all states of the model.

Total personal disposable income (YD) is equal to GDP net of depreciation and amortization funds (Eq. 2.1 ). It is also equal to the sum of euro disposable income ( \({{YD}}_{m})\) and LCC disposable income \({({YD}}_{{lcc}})\) (Eqs. 2.2 and 2.3 ).

The wage bill ( WB ) is a fixed proportion \((w)\) of GDP. It is decomposed into euro wages \({({WB}}_{m})\) and LCC wages \({({WB}}_{m})\) (Eqs. 3.1 to 3.3 ).

Total household consumption is the sum of euro and LCC consumption. Households determine the level of euro consumption by drawing on their disposable income and on the stock of banking deposits which they inherit from the previous period. Macroeconomic consumption (in euros) depends on an autonomous incompressible component ( \({\alpha }_{0}\) ), on disposable income \(({{YD}}_{m})\) (according to a factor \({\alpha }_{1}\) ) and euro banking deposits \({(M}_{h,m,s-1})\) (according to a factor \({\alpha }_{2}\, < \,{\alpha }_{1}\) ). Given that households hold LCC mostly for consumption purposes, the propension to draw from LCC income and deposits depends on a single factor \({\alpha }_{3}\) (Eqs. ( 4.1 ) to ( 4.3 )). In the baseline simulation, \({shock}=0\) , which means that there is no LCC consumption expenditure in the economy (Eq. ( 4.3 )).

We now describe the budget constraint and the portfolio behavior of households. We follow Godley and Lavoie ( 2012 , ch.4) and model households’ demand for liquid assets (which includes sight deposits and LCCs) as a buffer, which varies according to unexpected variations in household income. At the end of each year, whatever total disposable income \(({YD})\) not spent on consumption \((C)\) is added to households’ total financial wealth \({M}_{h}\) (5.1). Households’ euro-denominated holdings are determined using similar principles (Eq. 5.2 ). Households’ LCC holdings is determined using an accounting criterion (Eq. ( 5.3 )).

The model contains three financial assets: savings account deposits, sight deposits (both in euros) and LCC holdings. Households’ demand for savings account deposits \(({\triangle M}_{h,m,d})\) depends on their expected total financial wealth \(({M}^{e})\) and expected euro disposable income ( \({{YD}}^{e})\) .

Households wish to hold a given proportion \(({\lambda }_{0})\) of their expected wealth in the form of savings account deposits, and this proportion increases with their expected disposable income, according to a parameter \({\lambda }_{1}\, > \,0\) (Eq. ( 6.1 )). Households’ targeted holdings of sight deposits \(({\triangle M}_{h,h,d}\) ) can then be determined with an accounting closure criterion, as shown in Eq. ( 6.2 ). Finally, whatever amount of LCCs is not spent at the end of the year is simply added to the stock of LCC holdings (6.3). In the baseline scenario, \({shock}=0\) so that households do not allocate any share of their wealth in LCCs. The supply of financial assets is equal to demand (Eqs. ( 6.4 ) to ( 6.6 )).

Expected wealth \({(M}^{e})\) is the mirror of realized wealth (equation (5)) in the realm of expectations. It is defined in Eq. ( 7 ):

Expected euro disposable income ( \({{{YD}}_{m}^{e}}^{}\) ) is modeled as a weighted average of its past and expected value (Godley and Lavoie 2012 , p.291) (Eq. ( 8 )).

Let us now look at the production sector. In both the euro and LCC-denominated sectors, the demand for investment \({(I}_{f,m,d}\) and \({I}_{f,{lcc},d}\) , respectively) is based on the partial accelerator model and has two components: the first is forward-looking and adjusts partially \(\left(\gamma\, < \,1\right)\) to the discrepancy between the targeted capital stock \({(K}^{T})\) and the stock of productive assets \({(K}_{-1}\) ) inherited from the previous period. The second component consists in expenditure required to replace the used-up machines ( DA ) (equation (11)):

In both sectors, depreciation and amortization funds ( DA ) are defined as a fixed proportion \((0\,< \,\delta \,<\, 1)\) of the stock of capital \(({K}_{-1})\) that firms hold at the beginning of the fiscal year (equation (12)).

Entrepreneurs have adaptive expectations and index the targeted capital stock \({(K}^{T})\) to total macroeconomic income achieved in the previous period (Eq. ( 13.1 )). However, LCC sector entrepreneurs adjust their capital stock target in reference to LCC-denominated income (i.e. to the size of the LCC community) (Eq. ( 13.2 )).

The stock of productive capital \((K)\) is equal to the stock inherited from the previous period \({(K}_{-1})\) net of depreciation allowances \((\delta {K}_{-1})\) , plus newly acquired capital \({(I}_{f,s})\) (equation (14)). It is decomposed into euro and LCC denominated capital (equation (14)).

The above framework ensures that the introduction of LCCs affects both firms’ investment behavior and the stock of productive capital. Sectoral balance sheets track the euro and LCC components of physical capital assets, amortization funds, capital stock targets, financial wealth and income flows.

The profits of both banks and productive firms are fully distributed as dividends to the household sector. Thus, firms finance net investment through new bank loans. Money creation results from the interplay between firms’ productive bets and banks’ lending decisions. The demand for new loans \((\triangle {L}_{d})\) equals the net demand for investment, i.e. the difference between gross demand for investment \({(I}_{f,d})\) and set-aside amortization funds ( \({DA}\) ) in euros and LCCs (Eqs. ( 16.1 ) to ( 16.3 )). In the baseline simulations, \({shock}\) is set to zero and there is no demand for credit in LCCs (Eq. ( 16.2 )).

The afflux of money is described in Eqs. ( 17.1 ) to ( 17.6 ). Banks screen euro loans applications based on the expected creditworthiness of borrowers \((\rho )\) (Eq. ( 17.1 )). The supply of LCC loans equals demand from LCC firms, plus a fraction (which we set to one) of the rejected applications for euro-loans.

We assume that banks reject SDG-contributing, yet non-creditworthy demand for investment. Yet, these investments carry a positive SDG impact, which banks can rediscount at the Central Bank. In the baseline simulations \({shock}\) is set to zero so that euro-investment is constrained and no LCC credit takes place (Eq. ( 17.2 )). Equations ( 17.3 ) to ( 17.6 ) are accounting equations defining the stock of loans and annual total, euro and LCC investment, respectively.

At each period, productive firms’ profits are equal to the difference between GDP and other factor payments (using the income definition for GDP) (Eq. ( 18.1 )). Profits are broken down into euro and LCC profits (Eqs. ( 18.2 ) and ( 18.3 )) here

Banks charge different interest on loans issued in euros \(\left({r}_{l,M}\left({L}_{s,m,-1}\right)\right)\) and LCC \(\left({r}_{l,{lcc}}\left({L}_{s,{lcc},-1}\right)\right)\) . Their profit is the interest spread, plus any new reserve assets \({\triangle A}_{s}\) obtained from the Central Bank through impact rediscounting. Rediscounting implies that LCC loans are less risky from the banks’ perspective. We thus set \({r}_{l,{lcc}}\)  <  \({r}_{l,M}\) (see Table A2 in the appendix) (Eq. ( 19 )).

We now turn to the Central Bank’s rediscounting policy. As discussed, impact rating agencies compute the annual SROI of the circulation of the LCC deposits emitted through bank loans at the previous period. Banks obtain an annual flow of impact certificates \(({\varphi }_{s}\) ) (Eqs. ( 20.1 ) and ( 20.2 )).

Banks swap these impact certificates for new reserve assets at the Central Bank.

The Central Bank applies a haircut \((\tau )\) in this transaction (Eq. ( 21.2 ). The haircut rate is a discretionary yet, as shown in Eq. ( 22 ), we model it as an endogenous variable. The haircut rate depends on two components: its past value, and the product of normally distributed random shocks \((\varepsilon\) ) (reflecting the evolution of the monetary policy framework) and first-differenced impact ratings. This means that an increase in the SDG performance of LCC loans shall lead Central Banks to decrease of the haircut rate, subject to any other random shock \((\varepsilon\) ). We set the starting value of the haircut rate at 4.5%, which corresponds to the valuation markdown which the ECB applied to asset-backed securities at the time of writing (European Central Bank 2022a , b ).

Interest rates are set as exogenous parameters. SROI impact ratings of LCC deposits are modeled as a stochastic process, with annual random innovations \(\xi\) following a Laplace distribution around a mean of 15% (Walter 2020 ) (Eqs. ( 23.1 ) to ( 23.5 )).

The supply of money \({(M}_{h})\) (in euros and local complementary currency) held by households is modeled in Eq. ( 5.1 ). New loans (in euros and local complementary currency) recorded in banks’ balance sheets are given by Eq. ( 17.3 ). Although the supply and demand of bank deposits depend on different process, they shall be equal in all states of the model by virtue of its accounting consistency (i.e. without any equilibrium condition being imposed). Equation ( 24 ) is therefore the model’s hidden equation. This feature of the model qualifies it as a post-Keynesian SFC model insofar as money creation is entirely driven by the behavior of banks and productive firms. The model assumes no multiplier mechanism that would run from the reserves to new deposit creation by private banks (Bank of England 2014 ; Wray 2012 ; Ehnts 2017 ).

Finally, the model features a resilience block based on Ulanowicz et al. ( 2009 ). This requires us to introduce the following definitions. Let \({T}_{i.}\) represent the expenditure of each sector i to any other sector; \({T}_{.j}\) is the net income of sector j from any other sector; and \({T}_{{ij}}\) the expenditure of any sector i to any sector j. The sum of all net transfers of money between sectors i and j is \({{T}_{..}=\sum _{{ij}}T}_{{ij}}\) . We focus on private sector transactions only, and consider households (h), banks (b) and productive firms (f).

Equation (24.1) shows that the expenditure of household to other units \({(T}_{h.})\) equates consumption spending to the firm sector, in the legal tender and in LCCs \({(C}_{m}+{C}_{{lcc}})\) . Equation (24.2) shows that the income of households from other sectors \({(T}_{.h})\) is the sum of wages and distributed profits paid by productive firms in the legal tender and in LCCs \({({WB}}_{m}+{{WB}}_{{lcc}}+{F}_{m}+{F}_{{lcc}})\) , interest payments and distributed profits from banks \(\left({r}_{l,M}\left({L}_{s,m,-1}\right)+{r}_{l,{lcc}}\left({L}_{s,{lcc},-1}\right)+{FB}\right)\) .

Equation (24.3) shows that the expenditure of productive firms to other units \({(T}_{f.})\) is the sum of net investment spending \({(\triangle L}_{s,m}+{\triangle L}_{s,{lcc}})\) , wages and profits paid to the household sector \({({WB}}_{m}+{{WB}}_{{lcc}}+{F}_{m}+{F}_{{lcc}})\) , and interest paid to the banking sector \(\left({r}_{l,M}\left({L}_{s,m,-1}\right)+{r}_{l,{lcc}}\left({L}_{s,{lcc},-1}\right)\right)\) .

Equation (24.4) shows that the net income of productive firms from other units \({(T}_{.f})\) is the sum of the new loans issued by the banking sector \({(\triangle L}_{s,m}+{\triangle L}_{s,{lcc}})\) and household consumption \({(C}_{m}+{C}_{{lcc}})\) .

Equation (24.5) defines the banking sector’s expenditure \({(T}_{b.})\) to other units as the sum of new loans issued to productive firms \({(L}_{s,m}+{L}_{s,{lcc}})\) , interest payments, and profits distributed to households \(\left({r}_{d,M}\left({M}_{s,m,-1}\right)+{r}_{d,{lcc}}\left({M}_{{lcc},-1}\right)+{FB}\right)\) . Equation (24.6) measures the income of the banking sector \({(T}_{.b})\) as the sum of the interest payments received from productive firms \(\left({r}_{l,M}\left({L}_{s,m,-1}\right)+{r}_{l,{lcc}}\left({L}_{s,{lcc},-1}\right)\right)\) .

Defining the sum of all net transfers of money between units i and j as \({{T}_{..}=\sum _{{ij}}T}_{{ij}}\) , the occurrence probability of each transaction is equal to its observation frequency:

Following Ulanowicz et al. ( 2009 ), we can now define the evolutionary capacity of the economic system as \(C=A+\Phi\) . Each term is defined in Eqs. ( 26.1 ) to ( 26.3 ):

Letting \(a=\frac{{\rm{A}}}{C}\) , and applying a Boltzmann transformation yields the system’s fitness for evolution metric F (Eq. ( 27 )):

Where k is a positive scalar set to 2.71. As discussed in Section 2.2., when \(a=\) 1, \(F\) tends to zero due to a lack of resilience. When \(a\,=\,0\) , \(F\) also tends to zero due to a lack of ascendency. \(F\) increases for intermediate values of \(a\) and peaks when \(a=\frac{1}{e}\)  = 0.36 (see Fig. 1 ).

Simulation results

Numerical properties.

Our model respects the four validity criteria put forth in Godley and Lavoie ( 2012 ) and used in the stock-flow consistent modeling literature:

One implicit accounting equality holds in all periods and all states of the model. As discussed in Eq. ( 24 ) and shown in Fig. 3 , additions to household deposits are equal to new bank loans to productive firms. Yet, the model contains no equilibrium condition which makes the two equal to one another;

Using the Broyden algorithm, the model reaches a stationary state (with a GDP of 1,579,375) after 10 replications. This stationary state holds for 1000 periods;

The model allows for a coherent stock-flow integration of income and financial accounting in line with the National Income and Product Account (NIPA). As shown in Fig. 3 , the expenditure and income definitions of GDP (Eqs. ( 1.1 ) and ( 1.4 )) are equal in all states of the model—even though the former relies on flows, and the latter on both stocks and flows.

Stocks of assets, liabilities, and flows of income and spending take meaningful values in all states of the model. This allows to interpret causal relationships between income, stocks, and rates of return over several assets, and model to financial operations.

The bottom right quadrant of Fig. 4 shows the values of annual SROI impact metrics. These are modeled through a Laplace distribution centered around a mean of 15%. This figure also reports the value of the Central Bank’s haircut rate \(\tau\) (Eq. 22 ).

Source: author’s simulations. The replication code is available upon request.

Simulation strategy

We set \({shock}=0\) in Eqs. ( 4.3 ), ( 6.3 ), ( 16.2 ) and ( 17.2 ), and bring the model to stationary steady-state Footnote 12 . In this baseline scenario, banks do not issue LCC loans and do not operate a conversion desk for households. Therefore, there is no impact rediscounting by the Central Bank either.

We then set \({shock}=1\) . This allows LCC circulation, LCC lending and the impact rediscounting mechanism to kick in. Holding all other parameters constant, we inspect the response of the entire system, as it transits towards a new stationary steady-state.

Figures 5 – 7 display the response of the models’ key variables Footnote 13 . Due to a higher resilience, capacity for evolution and fitness for evolution metrics both increase significantly. We also observe a short-run, SDG-driven economic expansion. Both GDP and SROI impact certificates (‘ Philia ’) increase in the short-run and stabilize in the long-run. GDP growth peaks at 3% and vanishes after seven periods. The share of LCC investment in total private investment and the share of LCC wages in total wages are both permanently higher. Therefore, these figures indicate that economy has undergone sustainable structural change.

As shown in Fig. 5 , the policy shock induces a short-turn increase in macroeconomic spending, which increases private sector profits. The circulation of LCCs also triggers an expansion of the social business sector, contributing to sustainable structural change.

Macroeconomic private investment increases due to additional LCC loans to the social business sector. Entrepreneurs in other sectors of the economy respond to increased economic growth by adjusting their capital target upwards, which increases euro investment as well (equation (13).

The impact of this dynamic on sustainability is ambiguous. LCC-induced economic growth might indeed spill-over to the ‘brown’ sector. On the other hand, additional investment in euros is likely to affect sectors or territories in which an LCC-driven expansion has taken place, thereby accelerating the SDG transformation. More empirical analysis as well as field work is needed to determine the conditions leading one of these two mechanisms to dominate the other.

Figure 7 displays the monetary and financial side of the model. The Central Bank credits the banking sector with new reserves in exchange for new impact certificates. This policy appears to enhance financial stability as the banking sector posts a higher reserve to loan ratio. Banking sector profits increase due to the higher volume, and to annual net flows of reserve assets. Total household financial wealth increases and appears to diversify, with households holding LCC assets along with sight and savings deposits in euros. This new asset structure locks up a portion of household wealth for sustainable consumption purposes, contributing to sustainable structural change.

Scaling up SDG financing requires innovative approaches and bold policy decisions (UN 2023 ). This paper thus contributed to the SDG finance literature by putting forth a prototype policy seeking to endogenize the creation of LCC deposits in the economy. We laid out a framework in which banks would issue LCC loans linking up LCC deposit creation to future productive bets. LCC convertibility in the legal tender is implied by Central Bank rediscounting of the ex-post SDG impact of LCC loans.

We then attempted to raise analytical insight on this new idea by developing a new PK-SFC model comprised 106 accounting and behavioral equations and biomimetic indicators. Our simulations suggested that this prototype policy may generate a short-lived economic expansion embedded in the SDGs, while also increasing banking stability. We also observed an increase the economy’s total capacity for development, resilience, and fitness for evolution, in line with Lietaer et al. ( 2012 ).

This policy prototype is promising but calls for additional research. A more elaborate SFC model should consider endogenous structural change, which is an important component when discussing the transition to an ecologically sensitive economic structure (Caiani et al. 2014 ). The policy mechanism should be refined by drawing lessons from the history of policy innovations, with a focus on governance, accountability, and incentives. Finally, we need to develop new databases to be able to measure the SDG impact of LCCs, as well as the value of multipliers.

We call for multilateral institutions to support this new approach to SDG financing by undertaking small-scale, pilot experiments. As the success of such experiments would require strong actor engagement, developing a strong trust relationship between multilateral institutions, domestic banks, Central Banks and LCC communities appears of utmost importance. We thus call for the organization of regular multilateral workshops around this project to create a feedback loop between economists, policy makers, multilateral institutions, and local stakeholders. Such workshops would provide a community of practice for small-scale policy experiments, allowing countries with varying development paths to share and draw lessons from each other’s experiences. If successful, such small-scale experiments could eventually be upscaled and contribute to a new sustainable economic model in line with the SDGs.

Data availability

The Eviews code is available from the contact author upon request.

The supply of major LCCs such as the Bristol Pound in the UK, the Eusko in the Southwestern France, or the Chiemgauer in Bavaria is indeed backed up by deposits in the legal tender.

“ Nature does not select for maximum efficiency, but for a balance between the two opposing poles of efficiency and resilience. Because both are indispensable for long-term sustainability and health, the healthiest flow systems are those that are closest to an optimal balance between these two opposing pulls. Conversely, an excess of either attribute leads to systemic instability. Too much efficiency leads to brittleness and too much resilience leads to stagnation: the former is caused by too little diversity and connectivity and the latter by too much diversity and connectivity” (Lietaer et.al, 2010, p.6).

Appendix 2 discusses the fitness for evolution function.

In a clearinghouse, the assets of some are the liabilities of others. Such a tool allows to untie the bilateral side of the debt and to create a multilateral compensation between the different participants increasing liquidity.

Unspent com.mons after three years are exchanged either into currency (assets sold on the market) or into unsold assets.

For instance, the European Central Bank (ECB) abide to the 1992 Maastricht Treaty outlining the promotion of sustainable development as a cornerstone of the European Union. Many Central Banks around the world—especially in emerging and developing countries—are increasingly taking ecological and social objectives into account (Dikau and Volz 2021 ). At the European level, a recent step was also taken in this direction, with the ECB committing to decarbonizing its corporate bond purchasing and collateral framework (European Central Bank 2022).

In Europe, several branches of local government accept LCCs in payment of taxes, and make outgoing payments in LCCs (such as Bristol Pound in the UK, or the Eusko in Bayonne (France)).

In recent years, participative methods such as the social return on investment (SROI) method have gained traction to measure monetized ecological and social impact at the project-scale level ((Raiden and King 2021 ; World Health Organization 2017 ). These methods permit to construct worthiness and value creation for activities, even in cases where no actual cash flows are generated (Yates and Marra 2017 ; Cooney 2017 ).

The evaluation of shadow prices is not an easy task, and their use does not guarantee the success of the policy per se. As pointed out by an anonymous referee, shadow prices should ideally incorporate all the interrelationships between objectives and constraints that characterize a given economy. Given that our knowledge about them is too limited, shadow prices can often appear artificial. Policy makers wishing to test the proposed mechanism should thus carefully analyze experience with shadow prices at an international level.

Private credit ratings agencies suffer from “ birth defects, notably conflict of interests, biased decision-making, oligopoly, wrong business model and lack of transparency ” (Li 2020 , p. 1). According to the UNCTAD ( 2020 , p. 131) “ ratings agencies, like banks, act in a pro-cyclical manner that (…) accentuates broader financial sector vulnerabilities (…). It is not appropriate that credit rating agencies should continue to hold this de facto role of arbiters of responsible financial behavior – especially when they are also players in the same market they regulate ”.

Theoretical foundations and methodological guidelines for PK-SFC modeling can be found in Godley and Lavoie’s ( 2012 ) seminal book.

In a stationary steady-state, stock and flow variables are in a constant relationship to each other and stable in levels. Such a state is unlikely to be reached in the real world where parameters and structural relationship move all the time. It is a numerical construct which permits to monitor the stream of causal sequences impulse by a specific shock to the economic system, as it transits towards a new steady state.

The Eviews code is available upon request from the contact author.

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Lagoarde-Ségot, T., Mathieu, A. Ecological money and finance—upscaling local complementary currencies. Humanit Soc Sci Commun 11 , 545 (2024). https://doi.org/10.1057/s41599-024-02993-8

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• Best practices for the dissemination and implementation of neuromuscular training injury prevention warm-ups in youth team sport: a systematic review
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• http://orcid.org/0009-0005-0529-0398 Destiny Lutz 1 ,
• http://orcid.org/0000-0001-6429-4333 Carla van den Berg 1 ,
• http://orcid.org/0000-0003-3056-8169 Anu M Räisänen 1 , 2 ,
• Isla J Shill 1 , 3 ,
• Jemma Kim 4 , 5 ,
• Kenzie Vaandering 1 ,
• Alix Hayden 6 ,
• http://orcid.org/0000-0002-0427-2877 Kati Pasanen 1 , 7 , 8 , 9 ,
• http://orcid.org/0000-0002-5951-5899 Kathryn J Schneider 1 , 3 , 8 , 9 , 10 ,
• http://orcid.org/0000-0002-9499-6691 Carolyn A Emery 1 , 3 , 8 , 9 , 11 , 12 , 13 ,
• http://orcid.org/0000-0002-5984-9821 Oluwatoyosi B A Owoeye 1 , 4
• 1 Sport Injury Prevention Research Centre, Faculty of Kinesiology , University of Calgary , Calgary , Alberta , Canada
• 2 Department of Physical Therapy Education - Oregon , Western University of Health Sciences College of Health Sciences - Northwest , Lebanon , Oregon , USA
• 3 Hotchkiss Brain Institute , University of Calgary , Calgary , Alberta , Canada
• 4 Department of Physical Therapy & Athletic Training , Doisy College of Health Sciences, Saint Louis University , Saint Louis , Missouri , USA
• 5 Interdisciplinary Program in Biomechanics and Movement Science , University of Delaware College of Health Sciences , Newark , Delaware , USA
• 6 Libraries and Cultural Resources , University of Calgary , Calgary , Alberta , Canada
• 7 Tampere Research Center for Sports Medicine , Ukk Instituutti , Tampere , Finland
• 8 McCaig Institute for Bone and Joint Health , University of Calgary , Calgary , Alberta , Canada
• 9 Alberta Chilrden's Hopsital Research Institute , University of Calgary , Calgary , Alberta , Canada
• 10 Sport Medicine Centre , University of Calgary , Calgary , Alberta , Canada
• 11 O'Brien Institute for Public Health , University of Calgary , Calgary , Alberta , Canada
• 12 Department of Community Health Sciences , Cumming School of Medicine, University of Calgary , Calgary , Alberta , Canada
• 13 Department of Paediatrics , Cumming School of Medicine, University of Calgary , Calgary , Alberta , Canada
• Correspondence to Ms Destiny Lutz, Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; destiny.lutz{at}ucalgary.ca

Objective To evaluate best practices for neuromuscular training (NMT) injury prevention warm-up programme dissemination and implementation (D&I) in youth team sports, including characteristics, contextual predictors and D&I strategy effectiveness.

Design Systematic review.

Data sources Seven databases were searched.

Eligibility The literature search followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria: participation in a team sport, ≥70% youth participants (<19 years), D&I outcomes with/without NMT-related D&I strategies. The risk of bias was assessed using the Downs & Black checklist.

Results Of 8334 identified papers, 68 were included. Sport participants included boys, girls and coaches. Top sports were soccer, basketball and rugby. Study designs included randomised controlled trials (RCTs) (29.4%), cross-sectional (23.5%) and quasi-experimental studies (13.2%). The median Downs & Black score was 14/33. Injury prevention effectiveness (vs efficacy) was rarely (8.3%) prioritised across the RCTs evaluating NMT programmes. Two RCTs (2.9%) used Type 2/3 hybrid approaches to investigate D&I strategies. 19 studies (31.6%) used D&I frameworks/models. Top barriers were time restrictions, lack of buy-in/support and limited benefit awareness. Top facilitators were comprehensive workshops and resource accessibility. Common D&I strategies included Workshops with supplementary Resources (WR; n=24) and Workshops with Resources plus in-season Personnel support (WRP; n=14). WR (70%) and WRP (64%) were similar in potential D&I effect. WR and WRP had similar injury reduction (36–72%) with higher adherence showing greater effectiveness.

Conclusions Workshops including supplementary resources supported the success of NMT programme implementation, however, few studies examined effectiveness. High-quality D&I studies are needed to optimise the translation of NMT programmes into routine practice in youth sport.

Data availability statement

Data are available in a public, open access repository. Not Applicable.

https://doi.org/10.1136/bjsports-2023-106906

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WHAT IS ALREADY KNOWN ON THE TOPIC

Neuromuscular training (NMT) injury prevention warm-up programmes are effective at preventing injury rates in youth sports. However, for proper dissemination and implementation (D&I) by multiple stakeholders, barriers such as low adoption, adherence and lack of time must be addressed.

WHAT THIS STUDY ADDS

There are limited high-quality research studies to facilitate the widespread adoption of, and improved adherence to, NMT programmes. Few studies used D&I theories, frameworks or models. Programme flexibility is a common barrier to implementation; adaptation of NMT programmes to fit local contexts is imperative. Comprehensive workshops and supplementary resources currently support the success of NMT programme implementation.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

Promotion of NMT programmes as the standard of practice is essential to increase practical D&I of these programmes, and thus reduce the burden of youth sport injuries. This work provides some directions for stakeholders, including researchers, implementation support practitioners and youth sport policymakers, on current best practices for the delivery of NMT programmes in local youth sport settings. This work also provides the evidence base for more translational research efforts in youth sport injury prevention, a much-needed next step to optimise NMT programmes into youth sport practice.

Introduction

Youth (<19 years) sport participation provides numerous benefits, positively impacting physical and mental health. 1 Youth sport participation rates are high, with up to 90% of youth participating in sport globally. 2–5 However, with increased sport participation comes increased injury risk. One-in-three youth sustain a sport-related injury each year, leading to a significant public health burden with high healthcare costs. 3 6–8 Sport-related injuries may also result in long-term health consequences (eg, poor mental health, reduced physical activity, post-traumatic osteoarthritis). 7–9 Implementing injury prevention strategies is critical to mitigate the injury risk associated with youth sport participation.

Neuromuscular training (NMT) injury prevention warm-up programmes in youth team sport are effective in reducing injury rates by up to 60% and decreasing costs associated with injury based on randomised controlled trials (RCT) and systematic reviews. 10–21 NMT programmes include exercises that can be categorised across aerobic, balance, strength and agility components 22 23 and typically take 10–15 min. 24 25 Originally implemented with the intention of reducing non-contact lower extremity injury risk, 26–28 the effectiveness of NMT programmes has since been evaluated across numerous sports, age groups and levels of play and are associated with lower extremity and overall injury rates compared with standard of practice warm-ups. 12 20 21 25 In youth team sports, a protective effect has been demonstrated in soccer, handball, basketball, netball, rugby and floorball. 11 16 29–31 The International Olympic Committee Consensus Statement on Youth Athletic Development recommends multifaceted NMT warm-up programmes in youth sport. 32

Despite being a primary injury prevention strategy across youth sports, NMT programme adoption remains low. 33–38 For evidence-informed interventions to be successful and have a practical impact, pragmatic approaches derived from dissemination and implementation (D&I) science are necessary across multiple socioecological levels including organisation, coach and player. 36 Dissemination is defined as ‘the active process of spreading evidence-based interventions to a target population through determined channels and using planned strategies’. Implementation is ‘the active process of using strategies across multiple levels of change to translate evidence-based interventions into practice and prompt corresponding behaviour change in a target population’. 36

The aim of this systematic review was to evaluate current best practices for the D&I of NMT programmes in a youth team sport. The specific objectives of this systematic review were to: (1) describe the characteristics of identified D&I-related studies (studies with at least one D&I outcome directly or indirectly assessed as primary, secondary or tertiary outcome); (2) evaluate factors associated with the D&I of NMT warm-up programme across socioecological levels, including barriers and facilitators; (3) examine the effect of D&I strategies in delivering NMT warm-ups across multiple socioecological levels; and (4) examine the influence of D&I strategies on injury rates. Our protocol was registered in PROSPERO (CRD42021271734), and the review is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines ( supplemental appendix S1 ).

Supplemental material

Search strategy and data sources.

A comprehensive search was developed with a librarian (KAH) in MEDLINE, incorporating four main concepts: child/youth, injury prevention, implementation/compliance/adherence and sports. The author team reviewed the final search strategy which was then piloted against the known key studies to ensure that the search was capturing relevant studies. Finally, the MEDLINE search was translated to the other databases. Searches were conducted 25 August 2021 (updated 16–18 August 2022; 5 September 2023). Search strategies are available in Supplemental Appendix S2 . Studies were identified by searching seven databases: MEDLINE(R) and EPUB Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Embase, Cochrane Central Register of Controlled Trials, Cochrane database of Systematic Reviews (all Ovid); CINAHL Plus with Full Text, SPORTDiscus with Full Text (EBSCO) and ProQuest Dissertations & Thesis Global.

Study selection and eligibility

All database search results were uploaded and duplicates were removed in Covidence (Veritas Health Innovation, Melbourne, Australia). Records were independently reviewed by authors in pairs (DL/IJS, CV/JK, KV/DL), starting with a screening of 50 randomly selected citations to assess inter-rater agreement with a threshold set at 90%. Each pair of reviewers performed title/abstract screening and full-text screening independently, providing reasons for exclusion at full-text stage ( figure 1 ). Any disagreements for exclusion, where a consensus could not be reached within pairs, were resolved by a senior author (OBAO). A secondary evaluation of included manuscripts was performed by senior authors (OBAO and CAE) to ensure appropriate inclusion. Study inclusion criteria were: (1) Participation in a team sport (male and female); (2) a minimum of 70% of participants as a youth (<19 years) or coaches of these youth teams; (3) reported dissemination and/or implementation outcomes (eg, self-efficacy, adherence, intention); (4) reported D&I strategies related to NMT warm-up programmes (ie, NMT delivery strategies, where applicable eg, in RCTs). Exclusion criteria were: (1) Studies evaluating rehabilitation programmes, non-team-based or physical education programmes; (2) non-peer-reviewed; (3) not English. The screening process was reported using the PRISMA flow diagram. 39

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Study identification Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.

Risk of bias

To assess the risk of bias, three sets of paired reviewers independently used the Downs & Black (D&B) quality assessment tool. 40 The tool consists of a 27-item checklist (total score/33). A third senior reviewer (OBAO or CAE or AMR) resolved any disagreements. The rating of evidence and strength of recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. 41–43

Frameworks/models

The proportion of studies that used D&I research theories/frameworks/models, including behaviour change frameworks/models, was examined to identify commonly used frameworks/models.

Efficacy-effectiveness orientation in RCTs

We assessed the components of 12 RCTs using the Rating Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool, as adapted by Maddox et al 44 RITES scores RCTs in systematic reviews based on a continuum of efficacy-effectiveness across four domains: Participant characteristics, trial setting, flexibility of intervention(s) and clinical relevance of experimental and comparison intervention(s) ( online supplemental table S1 ). 45 We modified the Likert grading system to classify studies depending on whether their emphasis was more on efficacy or effectiveness or balanced for both. Given that different aspects of each trial may fall in different places along the efficacy-effectiveness continuum, each RITES domain is scored independently and a composite score is not applicable. To minimise subjectivity, the RITES evaluation for included RCTs was completed by two reviewers (AMR and OBAO). Any disagreements were resolved through discussion to reach a consensus.

Study typologies and assessment of study relevance to D&I

The level of relevance of individual studies (RCTs and quasi-experiments) to D&I was determined based on the implementation-effectiveness hybrid taxonomy: Type 1 (primarily focused on clinical/intervention outcomes), Type 2 (balance focused on both clinical/intervention outcomes and D&I outcomes) and Type 3 (primarily or ‘fully’ (our adaptation) focused on D&I outcomes) studies. 36 46 For ease of interpretation of results, studies were rated considering three broad traditional research design categories (ie, hierarchy of evidence): RCTs, quasi-experimental and observational studies, including cohort, cross-sectional, pre-experimental, qualitative, mixed-methods and ecological studies. Observational studies were categorised as ‘fully focused’ observational-implementation (if only D&I outcomes were evaluated) or ‘partially focused’ observational-implementation (if a combination of clinical and D&I outcomes were evaluated’ D&I studies. 47 RCTs and quasi-experimental studies with Type 2 or Type 3 hybrid approaches were indicated as ‘highly relevant’ towards informing D&I best practices. Furthermore, observational-implementation studies that are fully focused on D&I were also indicated as ‘highly relevant’.

Data extraction

The extracted data included: study design, author, journal, year, population (eg, 13–17 years old female soccer players), participant demographics, D&I intervention strategies (eg, workshops, supplementary resources), D&I framework/model, control group strategies, D&I outcomes (eg, adoption, adherence, intention, fidelity, self-efficacy) and injury outcomes. Study design classification was completed based on data extracted and the process taken by authors, 48 which may have differed from the original classification. Furthermore, prospective, and retrospective cohort studies were consolidated into ‘cohort’ to improve ease of readability. D&I outcomes indicated as compliance were included in the appropriate adherence category as defined in Owoeye et al and described as ‘adherence-related’ outcomes, to maintain unified language across results; the full list is provided in online supplemental table S2 . 36 49–51 Based on the dose-response thresholds reported for NMT programmes within current literature, measures of adherence were used to indicate potential D&I effect ( online supplemental table S5 ). 24 36 52–54 Studies with cumulative utilisation (sessions completed/total possible) of ≥70%, utilisation frequency of ≥1.5 sessions/week or a significant association between D&I exposures and outcomes were defined as moderate-to-highly relevant and identified as having a potential D&I effect (ie, yes). Studies presenting cumulative utilisation <70%, utilisation frequency <1.5 sessions/week or no association between D&I exposures and outcomes were defined as low-to-no relevance (ie, no). Studies reporting both frequency utilisation and cumulative utilisation must both reach the established dose-response thresholds to be considered as having a potential D&I effect. D&I barriers and facilitators, factors influencing injury prevention implementation success and the identification of any frameworks used were also extracted and categorised into themes. Measures of potential effect for these results were summarised using OR, proportions and mean differences in D&I outcomes (eg, adoption, adherence). Injury-specific results were reported as incidence rate ratios, risk ratios, ORs or prevalence. D&I strategies were classified into various categories, including workshops, supplementary resources, personnel support, supervision and combinations of these strategies.

Equity, diversity and inclusion statement

Our author team is comprised of student and senior researchers across various disciplines with representation from low-to-middle-income countries. A variety of demographic, socioeconomic and cultural backgrounds were included in our study populations.

PRISMA flow, characteristics of included studies and risk of bias assessment

A total of 68 relevant studies were included from our initial and updated search yield of 9021 studies ( figure 1 ). Across included studies, 13 included only male youth participants, 13 included only female youth participants, 26 included both and 16 reported coach-focused findings. Sports represented were soccer (n=33), rugby (n=8), basketball (n=7), multisport (n=7), handball (n=5), floorball (n=3), field hockey (n=3), volleyball (n=1) and futsal (n=1).

Details of study characteristics and risk of bias are presented in online supplemental table S3 . D&B scores ranged from 4/33 to 24/33 (median=14/33) from a variety of study designs, including 20 RCTs, 16 cross-sectional, 9 quasi-experimental, 8 cohort, 6 qualitative, 3 ecological, 3 mixed-methods and 3 pre-experimental. The D&B scores for the two top D&I-related relevant studies—an RCT Type 2 study (n=1) was 21/33 and an RCT Type 3 hybrid study (n=1) was 17/33. Using the GRADE guidelines for the process of rating the quality of evidence available and interpreting the quality assessment, the strength of recommendations was ‘low’ given the multiplicity of designs. 42 43

Characteristics of current D&I-related studies

23 studies (33.8%) reported using a D&I /behaviour change framework/model. D&I frameworks included Reach, Effectiveness, Adoption, Implementation and Maintentance (RE-AIM) Framework (n=7), Consolidation Framework for Implementation Research (n=1), Precede-Proceed Model (n=1), Translating Research into Injury Prevention Practice (n=1) and Promoting Action on Research Implementation of Health Sciences (n=1) and the Adherence Optimisation Framework (n=1). Behaviour change models included the Health Action Process Approach (HAPA) (n=8), Theory of Planned Behaviour (n=1) and the Health Belief Model (n=1).

Assessment of study relevance to D&I

Two RCTs of 68 included D&I-related studies (2.9%) were identified as highly relevant to D&I best practices (ie, Type 2 or 3 hybrid approach). 55 56 18 (27.9%) RCTs reported a secondary analysis of D&I strategies 12 16 19 30 53 57–69 ; classified as Type 1 hybrids. Five (8.3%) quasi-experimental studies used Type 2 or Type 3 hybrid approach 22 70–73 ; the remaining studies (n=4; 5%) were classified as quasi-experimental Type 1 hybrids. 74–77 Many observational studies (n=17; 26.7%), 78–94 were highly relevant based on being fully-focused observational-implementation studies; 5 (6.7%) were partially-focused observational-implementation studies. 52 95–98 The remaining observational studies (n=17; 23.3%) were observational-implementation studies, 35 99–114 reporting D&I outcomes from a qualitative lens using interviews and surveys.

The RITES scores for the 14 D&I-related RCTs that examined injuries as primary outcome and D&I outcomes as secondary (Type 1 hybrid approach) are presented in table 1 . Almost all (13 of 14; 92.9%) of the RCTs focused mainly on intervention efficacy (as opposed to effectiveness) regarding the flexibility of NMT warm-up programmes. Cumulatively, effectiveness was rarely (7.1%) prioritised as a primary focus across all the 56 possible ratings of the RITES domains for all 14 studies. 50% of the domain ratings demonstrated efficacy as a priority and 42.9% of the ratings were indicated for a balance between efficacy and effectiveness.

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RITES domain scores for included trials

Contextual predictors of NMT warm-up programme implementation

50 (73.5% of total) studies identified ≥1 barrier or facilitator within their findings, with 10 (14.7% of total) specifically examining barriers/facilitators as their main objectives. Full list is provided in online supplemental table S4 . The most common barriers identified were time restrictions (n=30), 30 35 59 62 69 70 73 74 78 79 81 82 84 87–91 93 96 98 101 102 105 107 108 112 114 reduced buy-in/support (n=8) 62 75 84 87 105 110–112 and limited awareness of preventative effects of programmes (n=8). 74 84 103 104 107 109 113 Facilitators included comprehensive workshops from trained instructors (n=11), 53 71 78–80 84 90 96 99 100 112 accessibility of supplementary resources (n=10) 82 84 87 89 90 105 114 and uptake/support from multiple stakeholders (n=7). 56 67 84 101 103 105 112 Moreover, suggestions from multiple socioecological levels indicated that increasing programme education and support, increased sport-specific activities and improved awareness of preventive effects, influence NMT implementation success. 36 88 89 115 116 Figure 2 , adapted from Basow et al 117 illustrates the contextual factors reported in the literature. 117 This evidence-informed model shows the important barriers and facilitators that influence the end-user implementation of NMT warm-up programmes across the three key socioecological levels of change.

Contextual predictors of NMT implementation across multiple socioecological levels. (Adapted from Basow et al (2021)).(116). Notes. SE, self-efficacy. NMT, neuromuscular training. Bold represents top barrier(s)/facilitator(s).

51 (75%) studies used implementation strategies for NMT warm-up programmes. The most frequently used strategies were Workshops with supplementary Resources (WR; n=24), followed by Workshops with supplementary Resources, plus in-season Personnel support (WRP; n=14). Three studies employed both WR and WRP strategies. Other methods for implementation included only workshops (n=9), only supplementary resources (n=4), supplementary resources and personnel support (n=2), workshops with personnel support (n=1) and supervision (n=1). Note, some studies are duplicated throughout the table when multiple D&I strategies are compared. 22 53 56 86

The key D&I concepts that were reported within the included studies were adherence or adherence-related (eg, self-efficacy, translation and perception). Specific outcomes within these concepts were further examined from the individual study results. We did not have enough evidence to present a meta-analysis of the effect of D&I strategies on D&I outcomes. Therefore, online supplemental table S5 presents a qualitative summary of the relationships between reported D&I exposure and D&I outcomes. 40 studies reported adherence-related outcomes, of which 32 (80%) were indicated to have potential D&I effect. Studies using WRP (n=14) reported completing between 1.4 and 2.6 sessions/week and cumulative utilisation of 39–85.6%; 9 of these 14 studies have potential D&I effect. Studies using WR (n=24) presented utilisation frequency ranging from 0.8 to 3.2 sessions/week and cumulative utilisation of 55–98% of sessions; 16 of these 24 have potential D&I effect. In studies evaluating workshops only (n=9; 22%), frequency utilisation was reported between 1 and 2 sessions/week across eight of the nine studies and one study had 52% cumulative utilisation; two have potential D&I effect.

Effects of D&I strategies on injury outcomes

Three RCTs specifically examined the effects of the D&I strategies used to deliver NMT programmes on injury outcomes ( table 2 ). Two studies that compared both WR and WRP to supplementary resource only found no significant differences between strategies, 53 56 they reported reduced injury rates in the highest adherence groups by 56% and 72%, respectively. Another study comparing WR and WRP to a standard of practice warm-up found a 36% reduction of ankle and knee injuries when using WR and a 38% reduction in ankle and knee injuries without supervision. 22 There were no significant differences in injury rates between groups.

Injury Outcomes by D&I strategies and adherence

This study evaluated current literature to inform evidence-based best practices for the D&I of NMT programmes in youth team sport. To our knowledge, this is the first systematic review evaluating the D&I of NMT programmes in youth sport. To improve the practical implementation of NMT warm-ups, factors associated with implementation success and current best practices for delivering context-specific NMT programmes are required to be evaluated. 118 In this review, we found few D&I-related studies use D&I or behaviour change frameworks, theories or models to guide their research questions. We discovered the number of RCTs examining the effectiveness of D&I strategies for NMT programme delivery is limited. Common barriers to NMT implementation include programme flexibility and time restrictions; and the use of coach workshops and supplementary resources are currently the primary strategy in NMT programme D&I facilitation.

One-third of the included studies used a D&I framework or behaviour change model in their research work. The HAPA and RE-AIM models were the most frequently used. These models are a conceptual and organised combination of theories required to direct the design, evaluation and translation of evidence-based interventions (NMT programmes) and the context in which they are being implemented. 36 71 119 It is imperative for D&I studies to use these frameworks/models to fully understand specific implementation processes and contexts. Future D&I studies should consider using appropriate frameworks or models, including adaptations and combination of models to guide their specific aims.

Relevance to D&I

Across the relevant literature, a variety of designs and levels of evidence were included.

Of 68 studies, 7 (10.3%) were found to be ‘highly relevant’ toward informing D&I best practice (2 (2.9%) RCTs, 5 (7.4%) quasi-experimental). Other ‘relevant’ studies evaluated implementation as secondary objectives (Type 1 hybrid designs) and/or were of lower level of evidence. 33 observational studies were ‘highly relevant’ to D&I, assessing D&I outcomes and barriers and facilitators from a qualitative lens. While these studies are important for understanding D&I context, more high-quality and highly relevant studies such as RCTs and quasi-experimental designs using the Type 3 hybrid approach, or non-hybrid approach focused on solely evaluating the effectiveness of D&I strategies, are needed to advance the widespread adoption and continued use of NMT programmes in youth team sport.

Effectiveness versus efficacy

Effectiveness is indicative of an evidence-informed intervention’s readiness for practical implementation. 36 Findings from our RITES scores evaluation indicate that the majority of the RCTs had a primary focus on efficacy and not effectiveness. Although many RCT studies had a fair balance between efficacy and effectiveness for participant characteristics, trial settings and clinical relevance domains (≥50% of RCTs), there is a lack of flexibility in the development and evaluation of the evidence supporting current NMT warm-up programmes. These disparities regarding practical implementation have implications for D&I research and practice in this field. Current NMT programmes may need to be modified or adapted to the local context and evaluated further to improve implementation in youth sport settings.

Contextual considerations

In our Adapted Socioecological Model ( figure 2 ), we demonstrate that the utilisation of NMT programmes by individual players within youth team sport can depend on their coach adopting and implementing the warm-up, which may also be dependent on larger organisational systems. Barriers related to end-users’ success in wide-spread adoption and long-term maintenance can be moderated; however, researchers and implementers have to be intentional about tackling these recognised barriers and associated challenges 25 87 104 115 ; integrating the facilitators of successful implementation intending to reduce and address these obstacles is essential. The barriers and facilitators identified in this systematic review provide insight into the combination of D&I strategies that should be formulated and tested by D&I researchers in the sports injury prevention field.

Within the current review, lack of time, whether it be learning, instructing and/or practicing the programme, is a common barrier that plays a significant role in implementation. A recent narrative review focused solely on the barriers and facilitators associated with exercise-based warm-up programmes showed similar conclusions regarding time restrictions. 115 Collective themes within this literature for players, coaches and organisations found that reduced buy-in and support at different levels impacted the adoption of NMT warm-up programmes. The lack of awareness and knowledge of the injury prevention benefits of NMT warm-up programmes also presented major barriers to buy-in, leading to reduced implementation success. Future interventions should ensure that education about evidence-informed injury prevention outcomes associated with programme adherence is integrated within their D&I strategies.

D&I science is a growing field of study. A variety of D&I outcomes were identified such as self-efficacy, intention, reach, outcome expectancy and most commonly, adherence or adherence-related outcomes. These outcomes were evaluated using different D&I strategies for NMT warm-up programmes. The most commonly reported strategies were Workshops with supplementary Resources with/without in-season Personnel support. Evaluation of D&I outcomes showed that adherence or adherence-related outcomes were most frequently reported across studies. Various measures of adherence as defined by Owoeye et al (2020) were identified, including cumulative utilisation, utilisation frequency, utilisation fidelity, duration fidelity and exercise fidelity. 36

Adherence remains the most common D&I outcome in the sport injury prevention literature. 36 120 In this review, we defined adherence and adherence-related thresholds for a moderate-to-high dose-response to be ≥70% cumulative utilisation and/or ≥1.5 session/week to achieve the desired protective effects. This was done with consideration of pragmatism and a practical balance between programme efficacy and effectiveness given the existing literature. 24 91 32 of 40 studies (80%) from those with adherence or adherence-related outcomes had a potential D&I effect based on a moderate-to-high adherence or adherence-related outcome level. The use of WR and WRP was the most common D&I strategies for delivering NMT warm-up programmes. While there are several areas for improvement for the practical D&I of NMT warm-up programmes in youth sport settings, the use of comprehensive workshops and supplementary resources at various levels, particularly with coaches, appears to be the optimal best practice. However, only two ‘highly relevant’ D&I studies (RCTs) from the current systematic review presented conclusions based on the effectiveness of D&I strategies and outcomes specifically.

Many studies (n=26/68; 38.2%) included both male and female participants; however, no sex-differences were described. When examining D&I outcomes, only 7/26 (26.9%) had moderate-to-high adherence when looking at both male and female youth players. In total, 84.6% of the female-only (11/13) and 72.7% of the male-only studies (8/11) reported moderate-to-high adherence levels. These findings suggest greater attention and efforts for adherence and implementation of NMT programmes in the male youth team sport setting may need further consideration compared with the female youth sport context.

Of the preliminary evidence for Type 2 and 3 hybrid designs, the literature highlighted in the synthesis of this data that WR are effective strategies in injury prevention and showed more moderate-to-high adherence levels. Given that most studies are doing some form of WR, adding in-season personnel support does not increase the protective effect and may be less sustainable given that resources, time and support are significant barriers to the D&I of these programmes.

Additionally, greater implementation and programme buy-in were found in studies where uptake of these NMT programmes was supported across multiple stakeholders, particularly at the organisation level. 19 67 90 103 112 Catering to programme deliverers (coaches, organisations, parents) and evaluating their awareness, perception and self-efficacy may help further inform our understanding of D&I and how we can best work to promote programme uptake further.

D&I strategies and injury outcomes

The findings from this systematic review suggest that while various D&I intervention strategies are effective at reducing injuries in youth team sports, the ranges of injury rate ratios are similar across studies employing different strategies (32–88% lower injury rates across WR strategy studies and 41–77% lower injury rates across WRP strategy studies). 22 53 56 Although this was not the proposed evaluation of these studies, our findings demonstrate that the use of workshops may influence D&I success and the availability of supplementary resources alone may not be efficacious. Future evaluation of the influence of delivery strategies should be considered.

Future directions

Using facilitators to reduce barrier burden.

Regarding NMT strategy evaluation, our findings show that most of the current programmes focus on efficacy over effectiveness, particularly in the aspect of intervention flexibility; this suggests a need for the adaptation of NMT programmes to fit local contexts. NMT programme developers should consider more enjoyable and user-friendly exercises that include sport-specific activities (eg, ball work, partner drills, tags). Increasing variations also improves player buy-in and increases intrinsic motivation. At a coaching level, workshops on NMT programmes should include evidence-informed education on the injury prevention benefits and should incorporate content addressing coach self-efficacy to enhance implementation quality. 16 100 121 An ongoing pragmatic evaluation of NMT programme effectiveness is warranted as they undergo adaptation to local contexts.

Organisations have expressed limited knowledge and education for implementation as a significant barrier to successful NMT programme use. 90 99 101 105 112 115 122 Implementers should look to provide accessible resources and encourage further support from multiple stakeholders, including the governing bodies. This could lead to policy changes within the club and result in greater uptake of these programmes long-term. Collaborations among stakeholders (researchers, youth sport administrators, coaches and players) in programme development, evaluation, D&I are necessary to improve efforts for impactful practical translation of programmes.

Research recommendations

The support for NMT programmes within youth sport is extensive. 28 Although these programmes have been shown to be effective for injury prevention in many sports, 10 11 sport representation across D&I studies in our review was limited. Scaling up of NMT programmes and supporting continued research into other sports is vital for increased context-specific D&I of these programmes to reduce the overall burden of youth sport injuries.

Compliance and adherence were often used interchangeably, despite having distinct definitions. Although their mathematical calculations are similar, these two constructs are contextually different. Compliance refers to individuals conforming to prescribed recommendations in controlled intervention settings, 123 while adherence refers to the agreement of an individual’s behaviour to recommended evidence-based interventions in uncontrolled settings. 36 Standardised definitions should be considered more frequently by researchers to build on current knowledge and inform future D&I research.

Using D&I frameworks/models can improve NMT programme implementation success in a practical setting. 71 124 Application of D&I frameworks/models, including behaviour change models, 124 is limited in injury prevention and this is reflected in the current systematic review. Future studies should use D&I frameworks/models to help guide the implementation of these NMT programmes. In doing so, researchers can gain a better understanding of the contextual and behaviour change aspects related to youth sport injury prevention. 115

Limitations

Given the broad nature of our research question, specific results were required for inclusion. Despite being specific to our objectives, our limitations set for participant age range, team sport settings and English language studies only, may have resulted in missing other studies that evaluated D&I interventions and outcomes related to NMT programmes.

Due to the heterogeneous nature of studies, meta-analysis was not possible for any of our objectives. Inclusion of various study designs, although comprehensive, impeded this process and resulted in inconsistent injury and adherence definitions across our population of interest. Furthermore, the subjective nature of many qualitative studies included may have resulted in variability within the data extracted. With the varied definitions used for each specific outcome and design, we looked to consolidate the terminology used into more succinct and unified language and we encourage this to be employed by researchers.

Methodological flaws existed in the included studies that may warrant caution about the interpretation of our conclusions. For example, many of the included studies did not include power calculations or reported low power, increasing the chance of Type 2 error. Further, many studies did not consider confounding or effect modification in their analyses or failed to report the validity of measurement tools used for injury data collection. We also acknowledge that publication bias may have favoured the inclusion of studies demonstrating significant findings (eg, effectiveness, efficacy). By considering quality assessment as an objective, we aimed to account for these limitations.

There was limited evidence supporting the effect of D&I strategies on D&I-specific outcomes. There were only two high-level evidence (RCTs) studies in this review that directly discussed the matter of D&I strategies on D&I outcomes. 55 56 D&I-related outcomes were evaluated as secondary objectives in other high-level evidence studies, therefore, we could only examine the relationship between D&I strategy and outcome to assess if the strategy used resulted in moderate-to-high adherence levels, given our pre-established thresholds.

Conclusions

This systematic review demonstrates that: (1) Few D&I-related studies are based on D&I or behaviour change theories, frameworks or models; (2) few RCTs have examined the effectiveness of D&I strategies for delivering NMT programmes; (3) programme flexibility and time restrictions are the most common barriers to implementation and; (4) a combination of coach workshops and supplementary resources are currently the primary strategy facilitating NMT programme D&I; however their effectiveness is only evaluated in a few studies. This systematic review provides foundational evidence to facilitate evidence-informed knowledge translation practices in youth sport injury prevention. Transitioning to more high-quality D&I research RCTs and quasi-experimental designs that leverage current knowledge of barriers and facilitators, incorporates Type 2 or Type 3 hybrid approaches and uses behaviour change frameworks are important next steps to optimise the translation of NMT programmes into routine practice in youth team sport settings.

Ethics statements

Patient consent for publication.

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Ethics approval

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1
• Data supplement 2

X @carlavdb_, @amraisanen, @KatiPasanen, @Kat_Schneider7, @CarolynAEmery, @owoeye_oba

Contributors DL, CE and OBAO contributed to development of study proposal and design. DL, CvdB, AMR, IJS, KV, JK, AH, CE and OBAO conducted search, study selection and screening, data extraction and synthesis and quality assessment. DL led the writing of the manuscript and was the guarantor for the project. All authors contributed to drafting and revising the final manuscript. All authors approved the submitted version of the manuscript.

Funding This study was funded by Canadian Institutes for Health Research Foundation Grant Program (PI CAE).

Competing interests OBAO is a Deputy Editor for the British Journal of Sports Medicine. CE, KJS and KP are Associate Editors for the British Journal of Sports Medicine.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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