September 15, 2025 • 37 mins
What if the secret to successful return-to-work for brain and spinal injury claimants lies not only in physical recovery, but in how we understand—and change—behavior? At Craig Hospital, Board Certified Behavior Analyst Arielle Reindeau reveals a pioneering model where behavioral science drives better therapy participation, faster progress, and ultimately, greater independence.
Learn why insurers and agents increasingly see the value in specialized rehabilitation centers that treat behaviors as modifiable variables—not fixed obstacles. Through remarkable case studies, you’ll hear how Craig Hospital blends intensive medical care, neuropsychology, family guidance, and data-driven behavioral interventions to overcome aggressive outbursts, refusal of care, and so-called “difficult” patient labels.
In this episode, discover actionable insights that can help you advocate for smarter claims strategies—potentially lowering costs and improving claimant outcomes. Explore the financial and human impact of integrating behavior analysis into every step of recovery, and start thinking differently about the path to independence for your insureds.
Ready to understand the future of workers’ comp? This is the episode your bottom line—and your client's families—can’t afford to miss.
Season 10 is brought to you by Berkley Industrial Comp. This episode is hosted by Greg Hamlin and guest co-host Matthew Yehling. If you want to reach out to anyone at Berkley Industrial Comp, call 1-800-448-5621.
Visit the Berkley Industrial Comp blog for more!
Got questions? Send them to marketing@berkleyindustrial.com
For music inquiries, contact Cameron Runyan at camrunyan9@gmail.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Greg Hamlin (00:11):
Hello everybody and welcome to Adjusted.
I'm your host, greg Hamlin,coming at you from sweet home
Alabama, where it is the dogdays of August, now September,
where we are just hot.
Matt, do you want to introduceyourself?
Matthew Yehling (00:29):
Hello everyone.
This is Matthew Yaling.
I'm with Midwest EmployersCasualty.
I'm joining Greg and Ari fromSt Louis, Missouri, along the
banks of the mighty Mississippi.
It's a beautiful late summer,almost fall-like weather here,
so we're enjoying the beautifulweather here.
Greg Hamlin (00:49):
And also with us.
We have our guest today, arielRolando.
Did I say that right, rolando?
Close Rolando, good BoardCertified Behavioral Analyst at
Craig Hospital, so we're excitedto have you here with us.
How's Colorado?
Arielle Reindeau (01:07):
Colorado is beautiful and sunny 300 days of
the year, highly recommend usfor our weather.
Greg Hamlin (01:14):
That's fun.
That's fun.
Yeah, this is probably theroughest time of year is like
August to September here inAlabama, where it just gets hot.
We moved here in Septemberabout seven years ago and my
wife, when we first got out ofthe car to look at houses, said
it feels like we just steppedinto a furnace.
So that's my midwestern blood,but now I think I've gotten used
(01:38):
to the heat and I'm cold allthe time so I've gotten weak.
So one of the things we wantedto start with, arielle is I
wanted to ask you a little bitabout how you got into the
position of a behavioral analystand I'm sure on career day that
was like the job you pickedright in kindergarten.
Arielle Reindeau (01:59):
It was pretty close to the job I picked when I
was younger.
I was really interested in kindof animal behavior and so
really early on I knew I wantedto work with, maybe, dogs.
I always loved my teachers so Iwas really interested in like a
school setting.
But I actually came to behavioranalysis through a volunteer
opportunity I took in highschool.
(02:20):
I attended an all-girlsCatholic school and we had to do
service hours in order to go toprom.
So you know it was a really bigthing back then and we had to
get 300 service hours to make itto junior prom.
And one of my best friends saidhey, I do a sleepaway camp with
my family every year.
You'll get all your hours inone week.
Do you want to come with me?
(02:41):
So we did the sleepaway camp.
It was almost two full weeks ofsleepaway and it was with
individuals with intellectualdisabilities and this camp is
really geared towards meetingthe needs of individuals who
probably, through insurance,would not be able to gain
support.
So people who have really severebehavioral disturbances,
(03:02):
families in a low socioeconomicstatus or just their
presentation is really medicallyunstable, so it's hard to have
them at like a day camp.
So we took the hardest of thebest, and the camp was where I
first met behavior analysts.
There was a staff namedresource and an individual
(03:22):
engaged in an event where theyneeded to be maintained
physically for their own safety,and so I saw all these people
in red shirts come and do thisphysical maintenance of this
individual and then I walkedaway and about an hour later I
went past and the same group ofred shirts was now holding a
drum circle with the sameindividual and right away I kind
(03:42):
of looked and I said who arethose people and what do they do
?
And every single person at thetime on the staff was a board
certified behavior analyst.
Greg Hamlin (03:52):
And here you are today.
Matthew Yehling (03:54):
Yeah, that's awesome.
How does one become a behavioranalyst?
Arielle Reindeau (03:59):
That is a great question.
So we are a board certification.
You are going to finish amaster's level education in
order to sit for the exam.
But on top of doing yourmaster's, you have to be
supervised for 2,500 hours.
After that supervision period,you are able to sit for the exam
(04:20):
.
Once you sit and pass weunfortunately don't have the
highest pass rate in our field,so it is something that people
are still working on.
You are able to be boardcertified and work independently
, so I am able to work on my ownthrough insurance, but I find
that working on a team is reallywhere I am the happiest.
Matthew Yehling (04:41):
What are most people?
What's the background medically?
What are most people?
What's the?
Arielle Reindeau (04:44):
background medically.
So it is actually not a medicalbackground Because we are
looking at behavior analysis.
Many people have theirbachelor's in psychology or
education or a related field andthen the master's is actually
in behavior analysis itself.
So we're not looking atanything necessarily medically.
Matthew Yehling (05:05):
We're looking at all things.
Behavior, all right, thanks forclarifying, of course.
Greg Hamlin (05:08):
So the takeaway I get there is that I need to go
to my high school and make themgive 300 hours of service.
If my kids want to go to promand be like, hey, I agree.
Arielle Reindeau (05:20):
So that's awesome.
Go find your job in life now,yeah.
Greg Hamlin (05:23):
So my father-in-law grew up in the North area of
Indiana, which is predominantlyAmish, and he was not Amish, and
so his high school was mostlyMennonite and Amish.
So for their prom they did nothave a dance, they just had a
guest speaker.
So that's why I always threatenmy kids.
I'm like if you guys act up,I'm going to go send you to live
on grandpa's farm in NorthernIndiana where there's nothing to
(05:46):
do.
Arielle Reindeau (05:49):
It'll be a fun prom, who knows?
Greg Hamlin (05:50):
That's right.
Well, so tell us a little bitabout Craig Hospital.
I know some of our listenersprobably know I know Matt's very
familiar.
We've used you guys multipletimes with some of our really
severe patients.
Talk to us a little bit aboutwhat sets Craig Hospital apart
from some of the otherfacilities that are out there.
Arielle Reindeau (06:10):
Craig Hospital is a neurorehabilitation and
research hospital.
We are looking at two separatediagnoses.
We're looking at acquired braininjury and spinal cord injuries
and within those twopopulations we are able to
provide intensive inpatienttreatment, outpatient treatment
or community-based treatment.
When we are in the inpatientsetting, we have 93 beds.
(06:34):
There are half for the spinalcord injury patients and half
for our brain injury patients.
Typical length of stay in thebrain injury program is anywhere
from 8 to 12 weeks.
The typical length of stay inthe brain injury program is
anywhere from 8 to 12 weeks.
Spinal cord is a little bitshorter than that.
But I will say one of the thingsthat I think makes us stand out
is we meet you where you needto be met.
I have had patients who livewith us for 11 months and I have
(06:57):
had patients who are out weektwo and I think Craig has a
really beautiful way of lookingat the person and meeting the
need there.
So I think that is something Ilike to tout.
The other thing that I thinkmakes Craig really special is
the interdisciplinary approachthat we're giving to each
patient.
So when you come on theinpatient side, regardless of
(07:17):
what your presentation is, youare given a physician, you have
a neuropsychologist working withyou, you have a social worker
supporting your family.
You are receiving one hour ofphysical therapy, occupational
therapy and speech therapyminimum per day, and then we
have over a dozen ancillarytherapists, including myself,
(07:37):
who can support you throughother needs.
The other thing that I thinkmakes us very unique is our
supervision.
We are one of the only TBImodel systems hospitals that
allows one-to-one supervision atthe degree that we can provide
it.
So one-to-one supervision isvery costly.
We all know how the almightydollar can really come down and
(07:59):
make it hard to provide thatlevel of support, provide that
level of support.
But here at Craig we've reallytaken a new approach to
one-to-one supervision and we'reutilizing that position and
that approach to reallystructure and maintain the
therapeutic goals throughout theday.
Matthew Yehling (08:16):
As a behavioral analyst and you said you're a
member of the team and the rehabteam there maybe tie tie that
in.
What does that look like?
You know and we're talkingspecifically, obviously, greg
and I are emphasis on workerscompensation, so I know, not all
your patients are workers comppatients, but what's that look
like for an injured employeethat ends up, you know, going to
(08:38):
one of the what we would call acenter of excellence?
Arielle Reindeau (08:42):
I think one of the best ways I can do it, matt
, is to probably highlight justa patient so de-identifying all
information older gentlemanworking at the time of his
injury, spanish and Englishspeaking, spanish being his
primary language.
When he arrived to CraigHospital he had a G-tube.
His trach was recently removedbut he did still have dressing
(09:04):
and needed to have like aMepilex over that area and
medication administration wasreally hard.
It was hard to get to hisG-tube, it was hard to bring him
to the bathroom.
This man was engaging in reallyhigh rates of aggression and a
lot of that I just like to bringback.
It's a human condition.
I never think any of theindividuals I am working with
(09:27):
are malicious or ill intent.
You know, matt, if I was toapproach you at five o'clock in
the morning and start rippingyour clothes off, you might
fight me too.
Right, it's having this layerof confusion on top of someone
trying to do personal cares foryou.
So because we had these twothings kind of coinciding the
confusion of the brain injuryand the language barrier it was
(09:50):
very dangerous at times forstaff to approach and to do the
that were needed.
So what we first did is we gotto know him and got to know him
really well to the point wherehe would say miha, which means
my child, right?
So he's literally looking at us,like his children, to come over
to him to help him with things.
And once we were able toestablish that rapport which is
(10:11):
what my team came in to do firstwe set up games, we learned his
favorite music, we figured outall the things he loved.
Then we were able to set up aschedule and that schedule was
able to really help him predictwhat was going to happen
throughout his day and decreasethat confusion and kind of those
outbursts that were happeningin correlation.
(10:31):
So when you're looking atbehavior analysis in the team, I
think really what you're seeingis an approach with which any
barriers are kind of broughtdown so that we're able to do
the rehab that we want to do,are kind of brought down so that
we're able to do the rehab thatwe want to do.
We're also able to look at theperson from different angles to
(10:53):
figure out what environment arethey going to work the best in
and learn the best in.
Unfortunately, they only get asmall time with us, so I want to
make sure they get as much asthey can out of that time.
Greg Hamlin (11:01):
That's huge.
I know we've had severalpatients spinal injury,
paraplegics that we've sent yourway and in both instances the
outcomes they received wereincredible.
And the one individual I knowhe lives completely independent
on his own now.
He was hurt in Alaska and so heneeded to have his care
(11:29):
transferred and he was from adifferent part of the country
than Colorado, so there was alot of anxiety around coming to
Craig because it would be hoursand hours away from family and
we wanted him there because weknew the interdisciplinary
approach that you guys takethere.
(11:50):
What are some of the things youdo for families of a patient?
Because I know once we startedgoing through some of those
things, I think it alleviatedsome of the concerns.
Arielle Reindeau (11:58):
So when families come to Craig they're
immediately going to be met withone of our clinical case
managers who is a social workerby trade.
That person is really going tofacilitate the understanding of
their insurance benefits andwhat they can have access to
while they're within our walls,as well as what happens after
Craig.
So that's one of the firstpieces of contact a family has.
(12:19):
I actually teach a class I'llteach it today at 2 pm for
families every Wednesday wherewe go over kind of the basics of
the brain injury milieu.
You know they're coming intocontact with other people.
They're coming into contactwith new clinicians.
There's a lot of medicalterminology to learn.
So in our basics for familieswe really just try to teach them
(12:41):
.
Here's where to get theinformation you might need
throughout the day.
So they're meeting their socialworker.
They're getting a class withother families Every Wednesday.
We also offer a support groupfor them to come and meet with
other families who are goingthrough similar experiences.
And then I feel really strongly,as we create tools to help
(13:01):
manage behavior, that that's abuy-in process, because if mom
and dad or sister, brother,husband are not willing to
continue what we do at Craig,that strategy is not the right
strategy.
So a lot of the times familiesare coming in in the very
beginning of our behaviorplanning process to say don't
say that about him on this plan.
(13:21):
I don't want people to thinkthat he's a mean man.
I want them to know he's aloving husband.
So families actually help uscraft the first section of our
behavior plan and it's calledAbout Me, and we allow families
to tell the story of their lovedone, because who we are working
with is really the crux of whatwe do.
Matthew Yehling (13:41):
That's great, right.
So why is this different thanwhat can be offered at, you know
, a trauma one center or ahospital and I'll pick on St
Louis or you know, or anywherein the country?
I mean there's, there's ahandful of places in the country
that do this really well.
Obviously, you know we reallylike Craig is one of those is
(14:08):
one of those.
What's the difference thatCraig brings to these injured
employees and these familiesthat other facilities aren't
capable of bringing?
Arielle Reindeau (14:13):
We are the first facility to embed behavior
analysis into everything we aredoing.
So, on top of having a team ofdedicated board certified
behavior analysts and registeredbehavior technicians, we
actually teach behavior analysisand behavior management
strategies to every clinicalstaff member who comes through
our doors.
We offer over 12 hours ofdedicated training on behavior
(14:37):
analysis within their clinicalorientation Once they come to
the floor.
We give them so many tools tosupport the continued use of the
science.
But I think in working withother individuals at other
hospitals, truly there is nobehavior champion.
If you want to learn how towalk, you've got PT.
You want to learn how to talk,you've got speech.
(14:58):
When they're hitting andkicking and screaming, there's
really no one on the team yetthat fills that need in other
centers.
So ideally you end up with anurse maybe, or an OT who's
passionate and starts to learnthings about behavior.
Craig has really taken thisextra step to bring expertise
into that need and that deficit,because, although we haven't
(15:23):
talked, I know, greg, you saidyou have some kids so we can
talk maybe about that.
Oh yeah, what I do is notunique to brain injury and
spinal cord injury.
It is the science of humanbehavior.
So to embed that kind of ascientific understanding into
everything we do.
It really has changed the waythat we're looking at problems,
solving them and then reallylooking for that independence,
(15:45):
because the truth is the peoplethat we used to walk in the room
and say he doesn't want to doit or he won't do it, that
language doesn't exist hereanymore.
It is now what is happening inthe environment.
Well, he's got his TV on, he'sgot a warm blanket, he's cozy.
What's happening when we say goto class?
He keeps watching TV, he keepshis warm blanket right.
(16:08):
So, starting to look rather atthe problem and the person being
a problem, looking at thebehavior and looking for that
environmental solution thatsolves it.
Greg Hamlin (16:18):
That's awesome.
Now, my understanding, myclaims director was out there to
actually do a tour and a visitand met you while she was there
and she had mentioned that youhad done some work with autistic
children and that that reallyhas influenced how you look at
traumatic brain injuries.
Can you talk to us a little bitabout that?
Arielle Reindeau (16:37):
Let's go a little bit back.
In 1950, behavior analysis wasreally formulated as a science
to approach the principles ofbehavior.
We didn't really become applieduntil the 70s and the 80s where
we tried to use the sciencethat was working on pigeons and
rats on people.
One of the first breakthroughsactually happened with a
(16:59):
researcher named Fuller in 1964,where he was able to show
someone who was then called avegetative state able to move a
digit based on the reinforcementof orange juice to his mouth.
So a lot of our field actuallybegan with intellectual
disabilities and, if you guysare aware, for a long time,
(17:25):
individuals who had morebehavioral excesses alongside a
diagnosis like autism.
They were institutionalized.
They were brought to placesthat would tie them to radiators
and straitjackets.
They were not given school.
They were not given really thekind of environment to flourish.
They were institutionalized tobe kept safe.
Aba was one of the first everapproaches that validated these
(17:47):
people could be taught that theycould change and that we could
create safe environments whereeveryone else is, where we could
all be together.
So the ability to includeindividuals with these
disabilities into generaleducation really came about with
our field.
So I started early on as apreschool teacher and I started
in inclusion where I hadneurotypically developing kids
(18:10):
and neurodivergent kids, andwhat I really enjoyed about that
is it taught me a lot of thethings that we have expected of
ourselves.
You know, sit still, lookpretty, say yes, smile, are just
artificial expectations andthat when the child doesn't sit
still or doesn't look pretty ordoesn't smile, it doesn't
(18:31):
necessarily mean that they areother than so.
Being able to bring thatappreciation for we all have a
different presentation.
We all have a different waythat we're interacting with the
world came from my experiencewith the autism community.
In moving to brain injury, onething remained true In autism we
(18:51):
say when you've met one personwith autism, you've met one
person with autism.
The same is true of brain injury.
Every individual is so unique,every instance is so unique that
what I appreciate is autismgave me the framework that just
because we said it has to bedoesn't mean it's the best way.
Brain injury has reallysolidified that there are so
(19:13):
many ways for people to be apart of our everyday lives and
that those all can all lookdifferent.
That's wonderful.
Greg Hamlin (19:18):
My wife got her degree in early childhood
education, so similar start andsimilar passion on that for sure
.
Arielle Reindeau (19:34):
So can you talk to us a little bit about
what the programs you'vedeveloped at Craig and what
you've learned from those?
Can I ask questions back?
Of course, go ahead.
So in just kind of hearing whatI just described about clinical
staff knowing behavior, youguys do send people to a lot of
institutions and places.
What happens to the worst ofthe worst behaviorally Like,
what do you see other placesable to do?
Where is their capacity?
Greg Hamlin (19:56):
So, at least for me , and I'll let Matt share some
of his experiences.
We've had some families thataren't always as cooperative or
they don't understand the whybehind what we're doing.
Their assumption sometimesstarts with well, you're the
evil insurance company andyou're wanting me to go to this
(20:16):
place because you want to savemoney, when in reality that's
not what it's about.
It's outcomes Like if we'retalking about somebody in
workers' comp that we could bepaying for their lifetime
medical and that could be 30years, then we want to invest as
much as we can up front to geta really amazing outcome on the
back end.
Unfortunately, there's a lot ofmedia out there that would
(20:39):
paint insurance in a certainlight.
That can sometimes make thatlook challenging.
So if they don't know who Craigis, or Shepard or Shirley Ryan
or some of these real leaders inthe industry, then to them it
feels like well, why are youtaking my family member away
from me?
And so we've had a fewchallenges on our end on that.
(21:02):
We've had some.
We've been able to work throughwith Dr Bronco, who works with
Matt's team, who will actuallyget on the phone and kind of
talk through it with the familyand help them understand the why
behind what we're doing and whywe want to do that.
Not in every state can wedirect care, so a lot of times
they have a say in that and theymay not understand.
(21:24):
So I think that's one challenge.
And then what I've seen on theflip side, when it's not gone
well, I can think of oneindividual we have had who's a
paraplegic, who wasn't at acenter of excellence and he was
very overweight before he becamea paraplegic, so he couldn't
(21:45):
transfer, self-transfer.
And then, because he couldn'tself-transfer and he's with all
these elderly people by himselfand he's like 30s, 40s, he
doesn't have any socialinteraction.
So he was video gaming all daylong and then Uber eating
because there's nothing else todo.
So while he's doing that, hewas gaining even more weight,
(22:09):
which is causing even moreproblems instead of the outcome
of living independently, andthat's what he wants.
But what he wants in thesupport system to get him where
he wants didn't line up, and sosometimes I think that's what I
see is the biggest challenge onour end, at least from a carrier
perspective.
Matt, how about you?
Matthew Yehling (22:30):
Yeah, I mean, I love what you said earlier
about if you've met one childwith autism, you've met one
child with autism.
Or you've met one brain injurypatient, you've met one brain
injured patient, right.
So I think the big thing thatthat I've noticed between a
center of excellence like Craigversus another center that might
(22:51):
have some of theinterdisciplinary approach but
they're not as sophisticated ormaybe they don't have the
behavioral model like you'vebeen talking about, is that, to
the point Greg made, we areinterested in saving money,
right, but we're investing inthese more expensive centers to
get that better outcome down theroad.
(23:13):
So the independence that Gregjust mentioned is a great
example of somebody that can beindependent and be left alone
and doesn't require a higherlevel of skill, versus somebody
that now you know they didn'tadvance to their full capability
and now I have to have an LPNor somebody sitting with them 24
(23:37):
hours a day because you knowthey can't self-care or they
can't administer their ownmedication.
So it's just, you know, thosetwo items like a loan.
If we can get an injuredemployee to do self-care and be
able to be responsible for theirown medication level, the cost
savings in the long-term for aninsurance carrier.
(23:57):
I don't think it's a bad thingto say we're interested in
saving money.
We're interested in savingmoney and getting the injured
employee the better outcome.
We want them to be moreindependent.
We want them to be more capable, more self-managed.
My family doesn't want to haveto care for me all the time.
You don't want to have to carefor your loved ones all the time
.
We want to make them asindependent as possible.
(24:19):
I say this to my kids all thetime I will not do something for
you that you can do foryourself.
And I think, like some placesenable the injured employee and
you know they're like, oh well,they had this terrible thing
happen to them and it's like,yeah, they did, they definitely
did, and that's why we need to,you know, educate them on hey,
(24:39):
here's how we get over thisadversity and here's how we
overcome this thing.
So that's kind of the approachwe take is like, hey, you know,
it's not a secret that we'retrying to save money.
We're trying to save moneybecause we want a better outcome
for your loved one.
We want them to be independent.
We don't want the spouse to getexhausted by caring for them
for the next 25, 30, 40 years.
(25:01):
So you know, we don't want themto be that burden on both
society.
It's a societal thing too, ifyou think about it.
No-transcript.
Yes, do we want to save money?
I would say, yes, we do, but wewant to do it at the advantage
(25:21):
for the injured employee, youknow, get them a better outcome.
So I would take a different,slightly different approach and
just say like, yeah, we want thebest outcome for them, and the
best outcome for them is thebest outcome for you and the
best outcome for their employerand the best outcome for society
.
And so maybe I'm a little, youknow, optimistic on some of that
, but I think that's the whatthe centers of excellence had,
(25:45):
that more behavioral model, andsome of those approaches do a
little better job at, and Ishouldn't even say a little
better, they do a lot better job.
The other thing that I see isbrain injured patients do better
with other brain injuredpatients and people that treat
brain injured patients.
Even in a metropolitan area, abig hospital might only have
(26:05):
five or six of those patientscoming through their system.
You know, at any time, at anyone given time.
So the fact that you said youcan accommodate, you know 93 or
half of that.
So 45, 48, you know patients atone time.
That's that speaks volumebecause like, yeah, each one is
(26:26):
unique.
There is commonalitiesobviously between those
uniquenesses.
But you know the, if you'regoing over five a year versus 50
, or you know, and that's at oneone time, right, so you're
probably going through.
You know 500 a.
That's at one time, right, soyou've probably gone through.
You know 500 a year or whatever.
So the volume and theexperience, like you get better
reps and the more you see this,the more you become.
(26:48):
It's kind of that rule of10,000, right, you become an
expert after you see somethingand do something for 10,000
hours.
So I mean you guys are theexperts in this and like I want
to send people, like any injuredemployee, I want to send them
to the expert.
I don't want to send thisinjured employee any injury, if
it's a broken bone or a spinalcord injury or a brain injury.
(27:09):
I want to get them the bestcare for the best outcome so
they have the best recovery.
So that's the approach I thinkGreg and I are pretty aligned on
.
Like our approaches are verysimilar.
How we get them there might bea little different and how we
convince the family, each personyou know has to be, you know,
individualized and spoken to,and you know what's.
What are you trying to achievein this?
(27:30):
So that's my thoughts, butthanks for asking.
Arielle Reindeau (27:35):
What I like that you both said is you
indicated when there arechallenges.
Those challenges are humanbehavior, and I think that is
something that I am so gratefulfor.
My field, you asked the lastquestion was what are you
grateful for?
And I laughed because I waslike, oh boy, they're going to
have me on my soapbox.
I was a very bad kid.
(27:55):
My poor mother and my poorfather were divorced parents in
the 90s trying to figure out howdo we deal with very different
children, and the truth is is Ineeded a lot of attention and I
wasn't getting it for doing goodthings.
So I recognized the worse I was, the more I got.
And what ends up happening inthese cycles is the human
(28:17):
behavior is reinforced in thewrong paradigms, right?
So you don't want your kids toyell, you don't want them to
cuss, but when they're gettingmore attention from you and
they're getting more energy fromyou, when those behaviors are
exhibited, they're more likelyto do those in the future.
So really, I think what ends uphappening for us is, a lot of
the times, we're able to takethat step back and we're able to
(28:40):
not look at this person is lazyor this person doesn't care,
and we're able to look at theenvironment and then the
consequences, because truly mostpeople do care, most people are
motivated to improve uponthemselves, but in the wrong
environment that is very hard todo.
So what I really love is theability to look at the behavior,
(29:02):
to look at the refusal or thedenied access or the I don't
care, I don't want to do ittoday type of vocalization and
treat that as something that ischangeable, because I think a
lot of people are met with thesekinds of patients and I, like
Matt that you spoke about, youknow units that only see about
five of these patients a year.
(29:23):
When that patient startspushing back and saying I need
to get out of here, I don't needto be here anymore, I have
things to do, I got to go home.
Those staff are not prepared torecognize that behavior is
maintained by the way they areresponding to it.
Right, it's because they keeptelling him oh, hold on, the
doctor will come talk to you.
Right, the way they'reresponding is leading to it
(29:45):
increasing.
Here we're able to take thatstep back and say, if we keep
managing the same thing over andover again, we got to do
something different.
And I think what I would loveto see you know I appreciate the
approach of like we want tomaximize time Behavior is, and
treating behavior as its ownentity, I think, is what is
(30:07):
going to maximize our rehabbenefits the most.
Because I cannot tell you theamount of people that I met them
day 16 of rehab because in thebeginning they didn't really
scream, they weren't hitting out, so there was no obvious need
for my attention.
But now we're on day 16 ofrehab and they haven't gone to
(30:27):
class and they haven't beeneating and they haven't been
showering, and now I have 16days that have been reinforced,
that I have to work around totry to get them onto the better
routine.
So what I would really love tosee in every system really is a
better understanding of humanbehavior, so that when we do get
refusals, when we do have thesebarriers, the next question
(30:50):
isn't so how do we get them out?
The next question is so how dowe change this behavior?
Because I really do think thatis what rehab is about.
Greg Hamlin (30:59):
That's so awesome.
One of the things, as you weretalking, that I feel like we've
run into sometimes it's achallenge and I imagine you do
too is sometimes the behavior isnot just the injured worker,
it's the support system aroundthe injured worker, and that can
be so challenging becauseyou've got people who do care a
lot.
They love this person, but thenthey bring with them all of
(31:22):
their life and all theexperiences they've had.
I think some of the morechallenging claims I've had have
been family members sometimeswhose behaviors are actually
either sabotaging the roadforward for the injured patient
or there are just some otherdynamics going on there.
Do you see that at Craig withsome of the patients that you
(31:45):
have, and how do you workthrough that?
Arielle Reindeau (31:47):
The best part about my job behavior is
behavior is behavior.
So mom's behavior isn't thatmuch different than patient's
behavior.
They work under the samecontingencies.
They follow the same principles.
So if I can look at mom in anobjective way and say, okay,
what is mom getting out of this?
Every time they cry, mom comesover and hugs them.
Okay, she's also getting a hug.
(32:07):
So how can I reset this up sothat mom still gets what she
wants that hug and that time.
But it's not coming as we'recrying and saying we don't want
to do PT the other reallybeautiful part of my field,
which I will say it's moreintensive than other fields in
this degree.
We believe very strongly in datacollection to demonstrate
(32:29):
change.
So I actually had a youngerwoman who was injured and she
was aggressive in physicaltherapy and I wanted to figure
out the conditions under whichthis individual was most likely
to be aggressive.
Do you want to know the numberone variable that was present
when she was aggressive?
What was it Mom Interesting?
(32:50):
And this was a loving mother,she was very sweet.
I liked her a ton and say so.
My data shows that you are thenumber one thing correlated with
aggression was a really hardthing to come to this parent to
say you know, I know you havegreat intention, I know you love
her, I don't think it'sanything you're doing, but the
(33:12):
facts are the facts.
And so we were able to sit downand say are you willing to take
a step back to see if itchanges this behavior?
And it does become apartnership?
It becomes.
Here's what we're seeing.
Are you willing to do a littleso that I can see a little?
And sometimes the answer isnope, I'm not willing to step
out.
I need to see her walking, Ineed to see this.
(33:33):
And then I have to change myapproach because at the end of
the day, the care partners andthe care family is who I'm going
to hand off to, so I alwayshave to be in alignment with
them.
But this mom, thankfully, waswilling.
She stepped out.
Aggression went to zero rightaway, which was kind of
challenging too, because then Iwas like so can mom just never
(33:56):
come back to PT?
And mom was like, nope, I needto come back.
So then we started thinking,okay, let's introduce her in the
last five minutes of session,only once we've sat back in the
chair and as a reinforcer, tojust talk about how great she
did, and we started to slowlyfade mom back in until she could
be at the whole session withoutaggression occurring, and we
(34:18):
have the data to support that.
We made the change right.
So it's a partnership withevery family that you come into
contact with, but your datashould support their goals and
the things that they're lookingto see change.
That's awesome.
Greg Hamlin (34:33):
So, as you think about where things go next in
the field that you're in, whatare some of the biggest things
you'd like to see change, orsome of the biggest things you'd
like to see change, or some ofthe biggest areas, you think
that there's room forimprovement in the world of
traumatic brain injuries.
Arielle Reindeau (34:48):
When I started at Craig seven years ago I was
working with Dr Alan Weintraubwho started the brain injury
program here at the hospital,and Dr Weintraub was really
married to this idea of rehabnursing and having a nursing
staff that could reallyunderstand not only the rehab
part of the brain injury and thespinal cord injury but also the
(35:10):
nursing part.
I would love to build from whereDr Weintraub saw and actually
see behavioral rehab nursing.
I want to see a rehab nurse whocan go in the room and who can
say, hey, every time Gregscreams, we're going.
Hey, greg, stop screaming.
We need to stop doing thatbecause he's screaming more than
(35:33):
he was yesterday.
And I want to see the abilityfor the nursing clinicians to
see kind of those contingenciesthat are happening and to see if
we made this change to behaviorwe could see this kind of an
improvement.
I think that is the next step.
I love OT and PT and all of myother disciplines too, but
(35:54):
nursing makes the world go round.
It is the 24-hour team that ishere seven days a week and if we
could really embed behavioralunderstanding into the staff, I
think that is the next forefrontwith which we'll see the best
healthcare delivered.
Greg Hamlin (36:10):
That's huge.
I think you hit on a really,really important concept, and
for those who aren't in thehealthcare system, they probably
don't realize how much nursesare involved in everything that
goes on, so it's definitelytheir role has been even more so
now than maybe 20 years ago, sothey're playing more and more
(36:31):
role in everything, and I knowboth Matt and I have nurses on
our teams, on our side, helpingus to make sure we're making the
right clinical decisions whenit comes to our patients.
So I love where you went therewith that.
Well, I've certainly enjoyedchatting with you today.
One thing that we've done everyseason of Adjusted is I really
(36:53):
like to focus on the positiveand put good vibes out in the
universe.
I always feel like it will comeback, and I think we live in a
well, we do live in a societythat is very self-focused, with
selfies and everything's kind ofabout me and what makes me
happy and I think, at least forme, one of the things that I've
(37:14):
learned is happiness also canreally be improved by being
grateful, and so one of thethings I like to ask every
single person that we've had onthe show is something they're
grateful for, and it could beanything.
It could be work-related, notwork-related, doesn't matter.
Arielle Reindeau (37:30):
I think what I am most grateful for is the
degree to which I have become ahuman again as well as a
behavior analyst.
At times our field has thecriticisms that we're cold, that
we're too objective, that we'renot looking at the whole person
to really deliver the treatmentthat we need.
I, to a degree, agree with thatstatement.
(37:53):
You know, it was harder sevenyears ago for me to look at the
mental health need alongside thebehavioral disorder that was
occurring.
Working on an interdisciplinaryteam has allowed me to look at
the person first and the humanfirst and to make sure that
that's always the center of mycare and to really align myself
(38:15):
with what this human needsversus what's best for this
behavior.
And they seem like similarquestions.
They are, but the answers canbe really different.
So that is what I am mostgrateful for is Craig Hospital
has been the kind of place thathas made me more human.
Greg Hamlin (38:31):
That's great, that's beautiful, and I think
hopefully our audience justtakes a minute to think about
what they're grateful for.
For me today, I'm supergrateful because I have a
19-year-old son that washospitalized over the weekend
because he accidentally ate acookie with nuts in it and it
escalated to the point he was inthe ICU.
(38:53):
And he's hundreds and hundredsof miles away from me and my
wife.
So it's always a super scarything when it happens.
But to know that there werepeople there to take care of him
, that he was able to get thetreatment he needed and that
he's back out there doing whathe's doing what an amazing world
we live in.
That that same thing could haveresulted in him not being with
(39:15):
us in a different time.
So, while that's not a hugething, I've been thinking about
it a lot, just how quicklythings can change and how much
we take for granted thehealthcare system around us,
that if things do get bad, thereare people who are so
well-trained who can provide theresources that we need to make
(39:38):
it from today to tomorrow.
So certainly thankful foreverything you do, and I hope
our listeners will check outCraig Hospital if they have not,
and consider them if they havethat traumatic brain injury or
that spinal injury, because theycertainly are excellent at what
they do and remind ourlisteners.
(40:00):
We release episodes every twoweeks on Monday.
We'd really appreciate it ifyou would like and follow us and
if you could leave comments,that would be even better,
because that helps other peoplefind their way to our podcast.
So again, thank you, ariel foryour time and thanks Matt for
(40:20):
joining us, and with that we'llsay leave with our motto do
right, think differently anddon't forget to care.
Thanks everybody, thank you.
Hello everybody and welcome to Adjusted.
I'm your host, greg Hamlin,coming at you from sweet home
Alabama, where it is the dogdays of August, now September,
where we are just hot.
Matt, do you want to introduceyourself?
Matthew Yehling (00:29):
Hello everyone.
This is Matthew Yaling.
I'm with Midwest EmployersCasualty.
I'm joining Greg and Ari fromSt Louis, Missouri, along the
banks of the mighty Mississippi.
It's a beautiful late summer,almost fall-like weather here,
so we're enjoying the beautifulweather here.
Greg Hamlin (00:49):
And also with us.
We have our guest today, arielRolando.
Did I say that right, rolando?
Close Rolando, good BoardCertified Behavioral Analyst at
Craig Hospital, so we're excitedto have you here with us.
How's Colorado?
Arielle Reindeau (01:07):
Colorado is beautiful and sunny 300 days of
the year, highly recommend usfor our weather.
Greg Hamlin (01:14):
That's fun.
That's fun.
Yeah, this is probably theroughest time of year is like
August to September here inAlabama, where it just gets hot.
We moved here in Septemberabout seven years ago and my
wife, when we first got out ofthe car to look at houses, said
it feels like we just steppedinto a furnace.
So that's my midwestern blood,but now I think I've gotten used
(01:38):
to the heat and I'm cold allthe time so I've gotten weak.
So one of the things we wantedto start with, arielle is I
wanted to ask you a little bitabout how you got into the
position of a behavioral analystand I'm sure on career day that
was like the job you pickedright in kindergarten.
Arielle Reindeau (01:59):
It was pretty close to the job I picked when I
was younger.
I was really interested in kindof animal behavior and so
really early on I knew I wantedto work with, maybe, dogs.
I always loved my teachers so Iwas really interested in like a
school setting.
But I actually came to behavioranalysis through a volunteer
opportunity I took in highschool.
(02:20):
I attended an all-girlsCatholic school and we had to do
service hours in order to go toprom.
So you know it was a really bigthing back then and we had to
get 300 service hours to make itto junior prom.
And one of my best friends saidhey, I do a sleepaway camp with
my family every year.
You'll get all your hours inone week.
Do you want to come with me?
(02:41):
So we did the sleepaway camp.
It was almost two full weeks ofsleepaway and it was with
individuals with intellectualdisabilities and this camp is
really geared towards meetingthe needs of individuals who
probably, through insurance,would not be able to gain
support.
So people who have really severebehavioral disturbances,
(03:02):
families in a low socioeconomicstatus or just their
presentation is really medicallyunstable, so it's hard to have
them at like a day camp.
So we took the hardest of thebest, and the camp was where I
first met behavior analysts.
There was a staff namedresource and an individual
(03:22):
engaged in an event where theyneeded to be maintained
physically for their own safety,and so I saw all these people
in red shirts come and do thisphysical maintenance of this
individual and then I walkedaway and about an hour later I
went past and the same group ofred shirts was now holding a
drum circle with the sameindividual and right away I kind
(03:42):
of looked and I said who arethose people and what do they do
?
And every single person at thetime on the staff was a board
certified behavior analyst.
Greg Hamlin (03:52):
And here you are today.
Matthew Yehling (03:54):
Yeah, that's awesome.
How does one become a behavioranalyst?
Arielle Reindeau (03:59):
That is a great question.
So we are a board certification.
You are going to finish amaster's level education in
order to sit for the exam.
But on top of doing yourmaster's, you have to be
supervised for 2,500 hours.
After that supervision period,you are able to sit for the exam
(04:20):
.
Once you sit and pass weunfortunately don't have the
highest pass rate in our field,so it is something that people
are still working on.
You are able to be boardcertified and work independently
, so I am able to work on my ownthrough insurance, but I find
that working on a team is reallywhere I am the happiest.
Matthew Yehling (04:41):
What are most people?
What's the background medically?
What are most people?
What's the?
Arielle Reindeau (04:44):
background medically.
So it is actually not a medicalbackground Because we are
looking at behavior analysis.
Many people have theirbachelor's in psychology or
education or a related field andthen the master's is actually
in behavior analysis itself.
So we're not looking atanything necessarily medically.
Matthew Yehling (05:05):
We're looking at all things.
Behavior, all right, thanks forclarifying, of course.
Greg Hamlin (05:08):
So the takeaway I get there is that I need to go
to my high school and make themgive 300 hours of service.
If my kids want to go to promand be like, hey, I agree.
Arielle Reindeau (05:20):
So that's awesome.
Go find your job in life now,yeah.
Greg Hamlin (05:23):
So my father-in-law grew up in the North area of
Indiana, which is predominantlyAmish, and he was not Amish, and
so his high school was mostlyMennonite and Amish.
So for their prom they did nothave a dance, they just had a
guest speaker.
So that's why I always threatenmy kids.
I'm like if you guys act up,I'm going to go send you to live
on grandpa's farm in NorthernIndiana where there's nothing to
(05:46):
do.
Arielle Reindeau (05:49):
It'll be a fun prom, who knows?
Greg Hamlin (05:50):
That's right.
Well, so tell us a little bitabout Craig Hospital.
I know some of our listenersprobably know I know Matt's very
familiar.
We've used you guys multipletimes with some of our really
severe patients.
Talk to us a little bit aboutwhat sets Craig Hospital apart
from some of the otherfacilities that are out there.
Arielle Reindeau (06:10):
Craig Hospital is a neurorehabilitation and
research hospital.
We are looking at two separatediagnoses.
We're looking at acquired braininjury and spinal cord injuries
and within those twopopulations we are able to
provide intensive inpatienttreatment, outpatient treatment
or community-based treatment.
When we are in the inpatientsetting, we have 93 beds.
(06:34):
There are half for the spinalcord injury patients and half
for our brain injury patients.
Typical length of stay in thebrain injury program is anywhere
from 8 to 12 weeks.
The typical length of stay inthe brain injury program is
anywhere from 8 to 12 weeks.
Spinal cord is a little bitshorter than that.
But I will say one of the thingsthat I think makes us stand out
is we meet you where you needto be met.
I have had patients who livewith us for 11 months and I have
(06:57):
had patients who are out weektwo and I think Craig has a
really beautiful way of lookingat the person and meeting the
need there.
So I think that is something Ilike to tout.
The other thing that I thinkmakes Craig really special is
the interdisciplinary approachthat we're giving to each
patient.
So when you come on theinpatient side, regardless of
(07:17):
what your presentation is, youare given a physician, you have
a neuropsychologist working withyou, you have a social worker
supporting your family.
You are receiving one hour ofphysical therapy, occupational
therapy and speech therapyminimum per day, and then we
have over a dozen ancillarytherapists, including myself,
(07:37):
who can support you throughother needs.
The other thing that I thinkmakes us very unique is our
supervision.
We are one of the only TBImodel systems hospitals that
allows one-to-one supervision atthe degree that we can provide
it.
So one-to-one supervision isvery costly.
We all know how the almightydollar can really come down and
(07:59):
make it hard to provide thatlevel of support, provide that
level of support.
But here at Craig we've reallytaken a new approach to
one-to-one supervision and we'reutilizing that position and
that approach to reallystructure and maintain the
therapeutic goals throughout theday.
Matthew Yehling (08:16):
As a behavioral analyst and you said you're a
member of the team and the rehabteam there maybe tie tie that
in.
What does that look like?
You know and we're talkingspecifically, obviously, greg
and I are emphasis on workerscompensation, so I know, not all
your patients are workers comppatients, but what's that look
like for an injured employeethat ends up, you know, going to
(08:38):
one of the what we would call acenter of excellence?
Arielle Reindeau (08:42):
I think one of the best ways I can do it, matt
, is to probably highlight justa patient so de-identifying all
information older gentlemanworking at the time of his
injury, spanish and Englishspeaking, spanish being his
primary language.
When he arrived to CraigHospital he had a G-tube.
His trach was recently removedbut he did still have dressing
(09:04):
and needed to have like aMepilex over that area and
medication administration wasreally hard.
It was hard to get to hisG-tube, it was hard to bring him
to the bathroom.
This man was engaging in reallyhigh rates of aggression and a
lot of that I just like to bringback.
It's a human condition.
I never think any of theindividuals I am working with
(09:27):
are malicious or ill intent.
You know, matt, if I was toapproach you at five o'clock in
the morning and start rippingyour clothes off, you might
fight me too.
Right, it's having this layerof confusion on top of someone
trying to do personal cares foryou.
So because we had these twothings kind of coinciding the
confusion of the brain injuryand the language barrier it was
(09:50):
very dangerous at times forstaff to approach and to do the
that were needed.
So what we first did is we gotto know him and got to know him
really well to the point wherehe would say miha, which means
my child, right?
So he's literally looking at us,like his children, to come over
to him to help him with things.
And once we were able toestablish that rapport which is
(10:11):
what my team came in to do firstwe set up games, we learned his
favorite music, we figured outall the things he loved.
Then we were able to set up aschedule and that schedule was
able to really help him predictwhat was going to happen
throughout his day and decreasethat confusion and kind of those
outbursts that were happeningin correlation.
(10:31):
So when you're looking atbehavior analysis in the team, I
think really what you're seeingis an approach with which any
barriers are kind of broughtdown so that we're able to do
the rehab that we want to do,are kind of brought down so that
we're able to do the rehab thatwe want to do.
We're also able to look at theperson from different angles to
(10:53):
figure out what environment arethey going to work the best in
and learn the best in.
Unfortunately, they only get asmall time with us, so I want to
make sure they get as much asthey can out of that time.
Greg Hamlin (11:01):
That's huge.
I know we've had severalpatients spinal injury,
paraplegics that we've sent yourway and in both instances the
outcomes they received wereincredible.
And the one individual I knowhe lives completely independent
on his own now.
He was hurt in Alaska and so heneeded to have his care
(11:29):
transferred and he was from adifferent part of the country
than Colorado, so there was alot of anxiety around coming to
Craig because it would be hoursand hours away from family and
we wanted him there because weknew the interdisciplinary
approach that you guys takethere.
(11:50):
What are some of the things youdo for families of a patient?
Because I know once we startedgoing through some of those
things, I think it alleviatedsome of the concerns.
Arielle Reindeau (11:58):
So when families come to Craig they're
immediately going to be met withone of our clinical case
managers who is a social workerby trade.
That person is really going tofacilitate the understanding of
their insurance benefits andwhat they can have access to
while they're within our walls,as well as what happens after
Craig.
So that's one of the firstpieces of contact a family has.
(12:19):
I actually teach a class I'llteach it today at 2 pm for
families every Wednesday wherewe go over kind of the basics of
the brain injury milieu.
You know they're coming intocontact with other people.
They're coming into contactwith new clinicians.
There's a lot of medicalterminology to learn.
So in our basics for familieswe really just try to teach them
(12:41):
.
Here's where to get theinformation you might need
throughout the day.
So they're meeting their socialworker.
They're getting a class withother families Every Wednesday.
We also offer a support groupfor them to come and meet with
other families who are goingthrough similar experiences.
And then I feel really strongly,as we create tools to help
(13:01):
manage behavior, that that's abuy-in process, because if mom
and dad or sister, brother,husband are not willing to
continue what we do at Craig,that strategy is not the right
strategy.
So a lot of the times familiesare coming in in the very
beginning of our behaviorplanning process to say don't
say that about him on this plan.
(13:21):
I don't want people to thinkthat he's a mean man.
I want them to know he's aloving husband.
So families actually help uscraft the first section of our
behavior plan and it's calledAbout Me, and we allow families
to tell the story of their lovedone, because who we are working
with is really the crux of whatwe do.
Matthew Yehling (13:41):
That's great, right.
So why is this different thanwhat can be offered at, you know
, a trauma one center or ahospital and I'll pick on St
Louis or you know, or anywherein the country?
I mean there's, there's ahandful of places in the country
that do this really well.
Obviously, you know we reallylike Craig is one of those is
(14:08):
one of those.
What's the difference thatCraig brings to these injured
employees and these familiesthat other facilities aren't
capable of bringing?
Arielle Reindeau (14:13):
We are the first facility to embed behavior
analysis into everything we aredoing.
So, on top of having a team ofdedicated board certified
behavior analysts and registeredbehavior technicians, we
actually teach behavior analysisand behavior management
strategies to every clinicalstaff member who comes through
our doors.
We offer over 12 hours ofdedicated training on behavior
(14:37):
analysis within their clinicalorientation Once they come to
the floor.
We give them so many tools tosupport the continued use of the
science.
But I think in working withother individuals at other
hospitals, truly there is nobehavior champion.
If you want to learn how towalk, you've got PT.
You want to learn how to talk,you've got speech.
(14:58):
When they're hitting andkicking and screaming, there's
really no one on the team yetthat fills that need in other
centers.
So ideally you end up with anurse maybe, or an OT who's
passionate and starts to learnthings about behavior.
Craig has really taken thisextra step to bring expertise
into that need and that deficit,because, although we haven't
(15:23):
talked, I know, greg, you saidyou have some kids so we can
talk maybe about that.
Oh yeah, what I do is notunique to brain injury and
spinal cord injury.
It is the science of humanbehavior.
So to embed that kind of ascientific understanding into
everything we do.
It really has changed the waythat we're looking at problems,
solving them and then reallylooking for that independence,
(15:45):
because the truth is the peoplethat we used to walk in the room
and say he doesn't want to doit or he won't do it, that
language doesn't exist hereanymore.
It is now what is happening inthe environment.
Well, he's got his TV on, he'sgot a warm blanket, he's cozy.
What's happening when we say goto class?
He keeps watching TV, he keepshis warm blanket right.
(16:08):
So, starting to look rather atthe problem and the person being
a problem, looking at thebehavior and looking for that
environmental solution thatsolves it.
Greg Hamlin (16:18):
That's awesome.
Now, my understanding, myclaims director was out there to
actually do a tour and a visitand met you while she was there
and she had mentioned that youhad done some work with autistic
children and that that reallyhas influenced how you look at
traumatic brain injuries.
Can you talk to us a little bitabout that?
Arielle Reindeau (16:37):
Let's go a little bit back.
In 1950, behavior analysis wasreally formulated as a science
to approach the principles ofbehavior.
We didn't really become applieduntil the 70s and the 80s where
we tried to use the sciencethat was working on pigeons and
rats on people.
One of the first breakthroughsactually happened with a
(16:59):
researcher named Fuller in 1964,where he was able to show
someone who was then called avegetative state able to move a
digit based on the reinforcementof orange juice to his mouth.
So a lot of our field actuallybegan with intellectual
disabilities and, if you guysare aware, for a long time,
(17:25):
individuals who had morebehavioral excesses alongside a
diagnosis like autism.
They were institutionalized.
They were brought to placesthat would tie them to radiators
and straitjackets.
They were not given school.
They were not given really thekind of environment to flourish.
They were institutionalized tobe kept safe.
Aba was one of the first everapproaches that validated these
(17:47):
people could be taught that theycould change and that we could
create safe environments whereeveryone else is, where we could
all be together.
So the ability to includeindividuals with these
disabilities into generaleducation really came about with
our field.
So I started early on as apreschool teacher and I started
in inclusion where I hadneurotypically developing kids
(18:10):
and neurodivergent kids, andwhat I really enjoyed about that
is it taught me a lot of thethings that we have expected of
ourselves.
You know, sit still, lookpretty, say yes, smile, are just
artificial expectations andthat when the child doesn't sit
still or doesn't look pretty ordoesn't smile, it doesn't
(18:31):
necessarily mean that they areother than so.
Being able to bring thatappreciation for we all have a
different presentation.
We all have a different waythat we're interacting with the
world came from my experiencewith the autism community.
In moving to brain injury, onething remained true In autism we
(18:51):
say when you've met one personwith autism, you've met one
person with autism.
The same is true of brain injury.
Every individual is so unique,every instance is so unique that
what I appreciate is autismgave me the framework that just
because we said it has to bedoesn't mean it's the best way.
Brain injury has reallysolidified that there are so
(19:13):
many ways for people to be apart of our everyday lives and
that those all can all lookdifferent.
That's wonderful.
Greg Hamlin (19:18):
My wife got her degree in early childhood
education, so similar start andsimilar passion on that for sure
.
Arielle Reindeau (19:34):
So can you talk to us a little bit about
what the programs you'vedeveloped at Craig and what
you've learned from those?
Can I ask questions back?
Of course, go ahead.
So in just kind of hearing whatI just described about clinical
staff knowing behavior, youguys do send people to a lot of
institutions and places.
What happens to the worst ofthe worst behaviorally Like,
what do you see other placesable to do?
Where is their capacity?
Greg Hamlin (19:56):
So, at least for me , and I'll let Matt share some
of his experiences.
We've had some families thataren't always as cooperative or
they don't understand the whybehind what we're doing.
Their assumption sometimesstarts with well, you're the
evil insurance company andyou're wanting me to go to this
(20:16):
place because you want to savemoney, when in reality that's
not what it's about.
It's outcomes Like if we'retalking about somebody in
workers' comp that we could bepaying for their lifetime
medical and that could be 30years, then we want to invest as
much as we can up front to geta really amazing outcome on the
back end.
Unfortunately, there's a lot ofmedia out there that would
(20:39):
paint insurance in a certainlight.
That can sometimes make thatlook challenging.
So if they don't know who Craigis, or Shepard or Shirley Ryan
or some of these real leaders inthe industry, then to them it
feels like well, why are youtaking my family member away
from me?
And so we've had a fewchallenges on our end on that.
(21:02):
We've had some.
We've been able to work throughwith Dr Bronco, who works with
Matt's team, who will actuallyget on the phone and kind of
talk through it with the familyand help them understand the why
behind what we're doing and whywe want to do that.
Not in every state can wedirect care, so a lot of times
they have a say in that and theymay not understand.
(21:24):
So I think that's one challenge.
And then what I've seen on theflip side, when it's not gone
well, I can think of oneindividual we have had who's a
paraplegic, who wasn't at acenter of excellence and he was
very overweight before he becamea paraplegic, so he couldn't
(21:45):
transfer, self-transfer.
And then, because he couldn'tself-transfer and he's with all
these elderly people by himselfand he's like 30s, 40s, he
doesn't have any socialinteraction.
So he was video gaming all daylong and then Uber eating
because there's nothing else todo.
So while he's doing that, hewas gaining even more weight,
(22:09):
which is causing even moreproblems instead of the outcome
of living independently, andthat's what he wants.
But what he wants in thesupport system to get him where
he wants didn't line up, and sosometimes I think that's what I
see is the biggest challenge onour end, at least from a carrier
perspective.
Matt, how about you?
Matthew Yehling (22:30):
Yeah, I mean, I love what you said earlier
about if you've met one childwith autism, you've met one
child with autism.
Or you've met one brain injurypatient, you've met one brain
injured patient, right.
So I think the big thing thatthat I've noticed between a
center of excellence like Craigversus another center that might
(22:51):
have some of theinterdisciplinary approach but
they're not as sophisticated ormaybe they don't have the
behavioral model like you'vebeen talking about, is that, to
the point Greg made, we areinterested in saving money,
right, but we're investing inthese more expensive centers to
get that better outcome down theroad.
(23:13):
So the independence that Gregjust mentioned is a great
example of somebody that can beindependent and be left alone
and doesn't require a higherlevel of skill, versus somebody
that now you know they didn'tadvance to their full capability
and now I have to have an LPNor somebody sitting with them 24
(23:37):
hours a day because you knowthey can't self-care or they
can't administer their ownmedication.
So it's just, you know, thosetwo items like a loan.
If we can get an injuredemployee to do self-care and be
able to be responsible for theirown medication level, the cost
savings in the long-term for aninsurance carrier.
(23:57):
I don't think it's a bad thingto say we're interested in
saving money.
We're interested in savingmoney and getting the injured
employee the better outcome.
We want them to be moreindependent.
We want them to be more capable, more self-managed.
My family doesn't want to haveto care for me all the time.
You don't want to have to carefor your loved ones all the time
.
We want to make them asindependent as possible.
(24:19):
I say this to my kids all thetime I will not do something for
you that you can do foryourself.
And I think, like some placesenable the injured employee and
you know they're like, oh well,they had this terrible thing
happen to them and it's like,yeah, they did, they definitely
did, and that's why we need to,you know, educate them on hey,
(24:39):
here's how we get over thisadversity and here's how we
overcome this thing.
So that's kind of the approachwe take is like, hey, you know,
it's not a secret that we'retrying to save money.
We're trying to save moneybecause we want a better outcome
for your loved one.
We want them to be independent.
We don't want the spouse to getexhausted by caring for them
for the next 25, 30, 40 years.
(25:01):
So you know, we don't want themto be that burden on both
society.
It's a societal thing too, ifyou think about it.
No-transcript.
Yes, do we want to save money?
I would say, yes, we do, but wewant to do it at the advantage
(25:21):
for the injured employee, youknow, get them a better outcome.
So I would take a different,slightly different approach and
just say like, yeah, we want thebest outcome for them, and the
best outcome for them is thebest outcome for you and the
best outcome for their employerand the best outcome for society
.
And so maybe I'm a little, youknow, optimistic on some of that
, but I think that's the whatthe centers of excellence had,
(25:45):
that more behavioral model, andsome of those approaches do a
little better job at, and Ishouldn't even say a little
better, they do a lot better job.
The other thing that I see isbrain injured patients do better
with other brain injuredpatients and people that treat
brain injured patients.
Even in a metropolitan area, abig hospital might only have
(26:05):
five or six of those patientscoming through their system.
You know, at any time, at anyone given time.
So the fact that you said youcan accommodate, you know 93 or
half of that.
So 45, 48, you know patients atone time.
That's that speaks volumebecause like, yeah, each one is
(26:26):
unique.
There is commonalitiesobviously between those
uniquenesses.
But you know the, if you'regoing over five a year versus 50
, or you know, and that's at oneone time, right, so you're
probably going through.
You know 500 a.
That's at one time, right, soyou've probably gone through.
You know 500 a year or whatever.
So the volume and theexperience, like you get better
reps and the more you see this,the more you become.
(26:48):
It's kind of that rule of10,000, right, you become an
expert after you see somethingand do something for 10,000
hours.
So I mean you guys are theexperts in this and like I want
to send people, like any injuredemployee, I want to send them
to the expert.
I don't want to send thisinjured employee any injury, if
it's a broken bone or a spinalcord injury or a brain injury.
(27:09):
I want to get them the bestcare for the best outcome so
they have the best recovery.
So that's the approach I thinkGreg and I are pretty aligned on
.
Like our approaches are verysimilar.
How we get them there might bea little different and how we
convince the family, each personyou know has to be, you know,
individualized and spoken to,and you know what's.
What are you trying to achievein this?
(27:30):
So that's my thoughts, butthanks for asking.
Arielle Reindeau (27:35):
What I like that you both said is you
indicated when there arechallenges.
Those challenges are humanbehavior, and I think that is
something that I am so gratefulfor.
My field, you asked the lastquestion was what are you
grateful for?
And I laughed because I waslike, oh boy, they're going to
have me on my soapbox.
I was a very bad kid.
(27:55):
My poor mother and my poorfather were divorced parents in
the 90s trying to figure out howdo we deal with very different
children, and the truth is is Ineeded a lot of attention and I
wasn't getting it for doing goodthings.
So I recognized the worse I was, the more I got.
And what ends up happening inthese cycles is the human
(28:17):
behavior is reinforced in thewrong paradigms, right?
So you don't want your kids toyell, you don't want them to
cuss, but when they're gettingmore attention from you and
they're getting more energy fromyou, when those behaviors are
exhibited, they're more likelyto do those in the future.
So really, I think what ends uphappening for us is, a lot of
the times, we're able to takethat step back and we're able to
(28:40):
not look at this person is lazyor this person doesn't care,
and we're able to look at theenvironment and then the
consequences, because truly mostpeople do care, most people are
motivated to improve uponthemselves, but in the wrong
environment that is very hard todo.
So what I really love is theability to look at the behavior,
(29:02):
to look at the refusal or thedenied access or the I don't
care, I don't want to do ittoday type of vocalization and
treat that as something that ischangeable, because I think a
lot of people are met with thesekinds of patients and I, like
Matt that you spoke about, youknow units that only see about
five of these patients a year.
(29:23):
When that patient startspushing back and saying I need
to get out of here, I don't needto be here anymore, I have
things to do, I got to go home.
Those staff are not prepared torecognize that behavior is
maintained by the way they areresponding to it.
Right, it's because they keeptelling him oh, hold on, the
doctor will come talk to you.
Right, the way they'reresponding is leading to it
(29:45):
increasing.
Here we're able to take thatstep back and say, if we keep
managing the same thing over andover again, we got to do
something different.
And I think what I would loveto see you know I appreciate the
approach of like we want tomaximize time Behavior is, and
treating behavior as its ownentity, I think, is what is
(30:07):
going to maximize our rehabbenefits the most.
Because I cannot tell you theamount of people that I met them
day 16 of rehab because in thebeginning they didn't really
scream, they weren't hitting out, so there was no obvious need
for my attention.
But now we're on day 16 ofrehab and they haven't gone to
(30:27):
class and they haven't beeneating and they haven't been
showering, and now I have 16days that have been reinforced,
that I have to work around totry to get them onto the better
routine.
So what I would really love tosee in every system really is a
better understanding of humanbehavior, so that when we do get
refusals, when we do have thesebarriers, the next question
(30:50):
isn't so how do we get them out?
The next question is so how dowe change this behavior?
Because I really do think thatis what rehab is about.
Greg Hamlin (30:59):
That's so awesome.
One of the things, as you weretalking, that I feel like we've
run into sometimes it's achallenge and I imagine you do
too is sometimes the behavior isnot just the injured worker,
it's the support system aroundthe injured worker, and that can
be so challenging becauseyou've got people who do care a
lot.
They love this person, but thenthey bring with them all of
(31:22):
their life and all theexperiences they've had.
I think some of the morechallenging claims I've had have
been family members sometimeswhose behaviors are actually
either sabotaging the roadforward for the injured patient
or there are just some otherdynamics going on there.
Do you see that at Craig withsome of the patients that you
(31:45):
have, and how do you workthrough that?
Arielle Reindeau (31:47):
The best part about my job behavior is
behavior is behavior.
So mom's behavior isn't thatmuch different than patient's
behavior.
They work under the samecontingencies.
They follow the same principles.
So if I can look at mom in anobjective way and say, okay,
what is mom getting out of this?
Every time they cry, mom comesover and hugs them.
Okay, she's also getting a hug.
(32:07):
So how can I reset this up sothat mom still gets what she
wants that hug and that time.
But it's not coming as we'recrying and saying we don't want
to do PT the other reallybeautiful part of my field,
which I will say it's moreintensive than other fields in
this degree.
We believe very strongly in datacollection to demonstrate
(32:29):
change.
So I actually had a youngerwoman who was injured and she
was aggressive in physicaltherapy and I wanted to figure
out the conditions under whichthis individual was most likely
to be aggressive.
Do you want to know the numberone variable that was present
when she was aggressive?
What was it Mom Interesting?
(32:50):
And this was a loving mother,she was very sweet.
I liked her a ton and say so.
My data shows that you are thenumber one thing correlated with
aggression was a really hardthing to come to this parent to
say you know, I know you havegreat intention, I know you love
her, I don't think it'sanything you're doing, but the
(33:12):
facts are the facts.
And so we were able to sit downand say are you willing to take
a step back to see if itchanges this behavior?
And it does become apartnership?
It becomes.
Here's what we're seeing.
Are you willing to do a littleso that I can see a little?
And sometimes the answer isnope, I'm not willing to step
out.
I need to see her walking, Ineed to see this.
(33:33):
And then I have to change myapproach because at the end of
the day, the care partners andthe care family is who I'm going
to hand off to, so I alwayshave to be in alignment with
them.
But this mom, thankfully, waswilling.
She stepped out.
Aggression went to zero rightaway, which was kind of
challenging too, because then Iwas like so can mom just never
(33:56):
come back to PT?
And mom was like, nope, I needto come back.
So then we started thinking,okay, let's introduce her in the
last five minutes of session,only once we've sat back in the
chair and as a reinforcer, tojust talk about how great she
did, and we started to slowlyfade mom back in until she could
be at the whole session withoutaggression occurring, and we
(34:18):
have the data to support that.
We made the change right.
So it's a partnership withevery family that you come into
contact with, but your datashould support their goals and
the things that they're lookingto see change.
That's awesome.
Greg Hamlin (34:33):
So, as you think about where things go next in
the field that you're in, whatare some of the biggest things
you'd like to see change, orsome of the biggest things you'd
like to see change, or some ofthe biggest areas, you think
that there's room forimprovement in the world of
traumatic brain injuries.
Arielle Reindeau (34:48):
When I started at Craig seven years ago I was
working with Dr Alan Weintraubwho started the brain injury
program here at the hospital,and Dr Weintraub was really
married to this idea of rehabnursing and having a nursing
staff that could reallyunderstand not only the rehab
part of the brain injury and thespinal cord injury but also the
(35:10):
nursing part.
I would love to build from whereDr Weintraub saw and actually
see behavioral rehab nursing.
I want to see a rehab nurse whocan go in the room and who can
say, hey, every time Gregscreams, we're going.
Hey, greg, stop screaming.
We need to stop doing thatbecause he's screaming more than
(35:33):
he was yesterday.
And I want to see the abilityfor the nursing clinicians to
see kind of those contingenciesthat are happening and to see if
we made this change to behaviorwe could see this kind of an
improvement.
I think that is the next step.
I love OT and PT and all of myother disciplines too, but
(35:54):
nursing makes the world go round.
It is the 24-hour team that ishere seven days a week and if we
could really embed behavioralunderstanding into the staff, I
think that is the next forefrontwith which we'll see the best
healthcare delivered.
Greg Hamlin (36:10):
That's huge.
I think you hit on a really,really important concept, and
for those who aren't in thehealthcare system, they probably
don't realize how much nursesare involved in everything that
goes on, so it's definitelytheir role has been even more so
now than maybe 20 years ago, sothey're playing more and more
(36:31):
role in everything, and I knowboth Matt and I have nurses on
our teams, on our side, helpingus to make sure we're making the
right clinical decisions whenit comes to our patients.
So I love where you went therewith that.
Well, I've certainly enjoyedchatting with you today.
One thing that we've done everyseason of Adjusted is I really
(36:53):
like to focus on the positiveand put good vibes out in the
universe.
I always feel like it will comeback, and I think we live in a
well, we do live in a societythat is very self-focused, with
selfies and everything's kind ofabout me and what makes me
happy and I think, at least forme, one of the things that I've
(37:14):
learned is happiness also canreally be improved by being
grateful, and so one of thethings I like to ask every
single person that we've had onthe show is something they're
grateful for, and it could beanything.
It could be work-related, notwork-related, doesn't matter.
Arielle Reindeau (37:30):
I think what I am most grateful for is the
degree to which I have become ahuman again as well as a
behavior analyst.
At times our field has thecriticisms that we're cold, that
we're too objective, that we'renot looking at the whole person
to really deliver the treatmentthat we need.
I, to a degree, agree with thatstatement.
(37:53):
You know, it was harder sevenyears ago for me to look at the
mental health need alongside thebehavioral disorder that was
occurring.
Working on an interdisciplinaryteam has allowed me to look at
the person first and the humanfirst and to make sure that
that's always the center of mycare and to really align myself
(38:15):
with what this human needsversus what's best for this
behavior.
And they seem like similarquestions.
They are, but the answers canbe really different.
So that is what I am mostgrateful for is Craig Hospital
has been the kind of place thathas made me more human.
Greg Hamlin (38:31):
That's great, that's beautiful, and I think
hopefully our audience justtakes a minute to think about
what they're grateful for.
For me today, I'm supergrateful because I have a
19-year-old son that washospitalized over the weekend
because he accidentally ate acookie with nuts in it and it
escalated to the point he was inthe ICU.
(38:53):
And he's hundreds and hundredsof miles away from me and my
wife.
So it's always a super scarything when it happens.
But to know that there werepeople there to take care of him
, that he was able to get thetreatment he needed and that
he's back out there doing whathe's doing what an amazing world
we live in.
That that same thing could haveresulted in him not being with
(39:15):
us in a different time.
So, while that's not a hugething, I've been thinking about
it a lot, just how quicklythings can change and how much
we take for granted thehealthcare system around us,
that if things do get bad, thereare people who are so
well-trained who can provide theresources that we need to make
(39:38):
it from today to tomorrow.
So certainly thankful foreverything you do, and I hope
our listeners will check outCraig Hospital if they have not,
and consider them if they havethat traumatic brain injury or
that spinal injury, because theycertainly are excellent at what
they do and remind ourlisteners.
(40:00):
We release episodes every twoweeks on Monday.
We'd really appreciate it ifyou would like and follow us and
if you could leave comments,that would be even better,
because that helps other peoplefind their way to our podcast.
So again, thank you, ariel foryour time and thanks Matt for
(40:20):
joining us, and with that we'llsay leave with our motto do
right, think differently anddon't forget to care.
Thanks everybody, thank you.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.