ADJUSTED
ADJUSTED
Unlocking Recovery: Behavioral Science as the Game Changer in Workers’ Comp Neurorehabilitation
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
Hello everybody and welcome to Adjusted. I'm your host, greg Hamlin, coming at you from sweet home Alabama, where it is the dog days of August, now September, where we are just hot. Matt, do you want to introduce yourself?
Matthew Yehling:Hello everyone. This is Matthew Yaling. I'm with Midwest Employers Casualty. I'm joining Greg and Ari from St 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 beautiful weather here.
Greg Hamlin:And also with us. We have our guest today, ariel Rolando. Did I say that right, rolando? Close Rolando, good Board Certified Behavioral Analyst at Craig Hospital, so we're excited to have you here with us. How's Colorado?
Arielle Reindeau:Colorado is beautiful and sunny 300 days of the year, highly recommend us for our weather.
Greg Hamlin:That's fun. That's fun. Yeah, this is probably the roughest time of year is like August to September here in Alabama, where it just gets hot. We moved here in September about seven years ago and my wife, when we first got out of the car to look at houses, said it feels like we just stepped into a furnace. So that's my midwestern blood, but now I think I've gotten used to the heat and I'm cold all the time so I've gotten weak. So one of the things we wanted to start with, arielle is I wanted to ask you a little bit about how you got into the position of a behavioral analyst and I'm sure on career day that was like the job you picked right in kindergarten.
Arielle Reindeau:It was pretty close to the job I picked when I was younger. I was really interested in kind of animal behavior and so really early on I knew I wanted to work with, maybe, dogs. I always loved my teachers so I was really interested in like a school setting. But I actually came to behavior analysis through a volunteer opportunity I took in high school. I attended an all-girls Catholic school and we had to do service hours in order to go to prom. So you know it was a really big thing back then and we had to get 300 service hours to make it to junior prom.
Arielle Reindeau:And one of my best friends said hey, I do a sleepaway camp with my family every year. You'll get all your hours in one week. Do you want to come with me? So we did the sleepaway camp. It was almost two full weeks of sleepaway and it was with individuals with intellectual disabilities and this camp is really geared towards meeting the needs of individuals who probably, through insurance, would not be able to gain support.
Arielle Reindeau:So people who have really severe behavioral disturbances, families in a low socioeconomic status or just their presentation is really medically unstable, so it's hard to have them at like a day camp. So we took the hardest of the best, and the camp was where I first met behavior analysts. There was a staff named resource and an individual engaged in an event where they needed to be maintained physically for their own safety, and so I saw all these people in red shirts come and do this physical maintenance of this individual and then I walked away and about an hour later I went past and the same group of red shirts was now holding a drum circle with the same individual and right away I kind of looked and I said who are those people and what do they do? And every single person at the time on the staff was a board certified behavior analyst.
Greg Hamlin:And here you are today.
Matthew Yehling:Yeah, that's awesome. How does one become a behavior analyst?
Arielle Reindeau:That is a great question. So we are a board certification. You are going to finish a master's level education in order to sit for the exam. But on top of doing your master's, you have to be supervised for 2,500 hours. After that supervision period, you are able to sit for the exam. Once you sit and pass we unfortunately 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 board certified and work independently, so I am able to work on my own through insurance, but I find that working on a team is really where I am the happiest.
Matthew Yehling:What are most people? What's the background medically? What are most people? What's the?
Arielle Reindeau:background medically. So it is actually not a medical background Because we are looking at behavior analysis. Many people have their bachelor's in psychology or education or a related field and then the master's is actually in behavior analysis itself. So we're not looking at anything necessarily medically.
Matthew Yehling:We're looking at all things. Behavior, all right, thanks for clarifying, of course.
Greg Hamlin:So the takeaway I get there is that I need to go to my high school and make them give 300 hours of service. If my kids want to go to prom and be like, hey, I agree.
Arielle Reindeau:So that's awesome. Go find your job in life now, yeah.
Greg Hamlin:So my father-in-law grew up in the North area of Indiana, which is predominantly Amish, and he was not Amish, and so his high school was mostly Mennonite and Amish. So for their prom they did not have a dance, they just had a guest speaker. So that's why I always threaten my kids. I'm like if you guys act up, I'm going to go send you to live on grandpa's farm in Northern Indiana where there's nothing to do.
Arielle Reindeau:It'll be a fun prom, who knows?
Greg Hamlin:That's right. Well, so tell us a little bit about Craig Hospital. I know some of our listeners probably know I know Matt's very familiar. We've used you guys multiple times with some of our really severe patients. Talk to us a little bit about what sets Craig Hospital apart from some of the other facilities that are out there.
Arielle Reindeau:Craig Hospital is a neurorehabilitation and research hospital. We are looking at two separate diagnoses. We're looking at acquired brain injury and spinal cord injuries and within those two populations we are able to provide intensive inpatient treatment, outpatient treatment or community-based treatment. When we are in the inpatient setting, we have 93 beds. There are half for the spinal cord injury patients and half for our brain injury patients. Typical length of stay in the brain injury program is anywhere from 8 to 12 weeks. The typical length of stay in the brain injury program is anywhere from 8 to 12 weeks. Spinal cord is a little bit shorter than that.
Arielle Reindeau:But I will say one of the things that I think makes us stand out is we meet you where you need to be met. I have had patients who live with us for 11 months and I have had patients who are out week two and I think Craig has a really beautiful way of looking at the person and meeting the need there. So I think that is something I like to tout. The other thing that I think makes Craig really special is the interdisciplinary approach that we're giving to each patient. So when you come on the inpatient side, regardless of what your presentation is, you are given a physician, you have a neuropsychologist working with you, you have a social worker supporting your family. You are receiving one hour of physical therapy, occupational therapy and speech therapy minimum per day, and then we have over a dozen ancillary therapists, including myself, who can support you through other needs.
Arielle Reindeau:The other thing that I think makes us very unique is our supervision. We are one of the only TBI model systems hospitals that allows one-to-one supervision at the degree that we can provide it. So one-to-one supervision is very costly. We all know how the almighty dollar can really come down and make it hard to provide that level of support, provide that level of support. But here at Craig we've really taken a new approach to one-to-one supervision and we're utilizing that position and that approach to really structure and maintain the therapeutic goals throughout the day.
Matthew Yehling:As a behavioral analyst and you said you're a member of the team and the rehab team there maybe tie tie that in. What does that look like? You know and we're talking specifically, obviously, greg and I are emphasis on workers compensation, so I know, not all your patients are workers comp patients, but what's that look like for an injured employee that ends up, you know, going to one of the what we would call a center of excellence?
Arielle Reindeau:I think one of the best ways I can do it, matt, is to probably highlight just a patient so de-identifying all information older gentleman working at the time of his injury, spanish and English speaking, spanish being his primary language. When he arrived to Craig Hospital he had a G-tube. His trach was recently removed but he did still have dressing and needed to have like a Mepilex over that area and medication administration was really hard. It was hard to get to his G-tube, it was hard to bring him to the bathroom. This man was engaging in really high rates of aggression and a lot of that I just like to bring back.
Arielle Reindeau:It's a human condition. I never think any of the individuals I am working with are malicious or ill intent. You know, matt, if I was to approach you at five o'clock in the morning and start ripping your clothes off, you might fight me too. Right, it's having this layer of confusion on top of someone trying to do personal cares for you. So because we had these two things kind of coinciding the confusion of the brain injury and the language barrier it was very dangerous at times for staff to approach and to do the that were needed.
Arielle Reindeau:So what we first did is we got to know him and got to know him really well to the point where he would say miha, which means my child, right?
Arielle Reindeau:So he's literally looking at us, like his children, to come over to him to help him with things.
Arielle Reindeau:And once we were able to establish that rapport which is what my team came in to do first we set up games, we learned his favorite music, we figured out all the things he loved. Then we were able to set up a schedule and that schedule was able to really help him predict what was going to happen throughout his day and decrease that confusion and kind of those outbursts that were happening in correlation. So when you're looking at behavior analysis in the team, I think really what you're seeing is an approach with which any barriers are kind of brought down 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 that we want to do. We're also able to look at the person from different angles to figure out what environment are they going to work the best in and learn the best in. Unfortunately, they only get a small time with us, so I want to make sure they get as much as they can out of that time.
Greg Hamlin:That's huge. I know we've had several patients spinal injury, paraplegics that we've sent your way and in both instances the outcomes they received were incredible. And the one individual I know he lives completely independent on his own now. He was hurt in Alaska and so he needed to have his care transferred and he was from a different part of the country than Colorado, so there was a lot of anxiety around coming to Craig because it would be hours and hours away from family and we wanted him there because we knew the interdisciplinary approach that you guys take there. What are some of the things you do for families of a patient? Because I know once we started going through some of those things, I think it alleviated some of the concerns.
Arielle Reindeau:So when families come to Craig they're immediately going to be met with one of our clinical case managers who is a social worker by trade. That person is really going to facilitate the understanding of their insurance benefits and what they can have access to while they're within our walls, as well as what happens after Craig. So that's one of the first pieces of contact a family has. I actually teach a class I'll teach it today at 2 pm for families every Wednesday where we go over kind of the basics of the brain injury milieu. You know they're coming into contact with other people. They're coming into contact with new clinicians. There's a lot of medical terminology to learn. So in our basics for families we really just try to teach them. Here's where to get the information you might need throughout the day. So they're meeting their social worker. They're getting a class with other families Every Wednesday. We also offer a support group for them to come and meet with other families who are going through similar experiences.
Arielle Reindeau:And then I feel really strongly, as we create tools to help manage behavior, that that's a buy-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 families are coming in in the very beginning of our behavior planning process to say don't say that about him on this plan. I don't want people to think that he's a mean man. I want them to know he's a loving husband. So families actually help us craft the first section of our behavior plan and it's called About Me, and we allow families to tell the story of their loved one, because who we are working with is really the crux of what we do.
Matthew Yehling:That's great, right. So why is this different than what can be offered at, you know, a trauma one center or a hospital and I'll pick on St Louis or you know, or anywhere in the country? I mean there's, there's a handful of places in the country that do this really well. Obviously, you know we really like Craig is one of those is one of those. What's the difference that Craig brings to these injured employees and these families that other facilities aren't capable of bringing?
Arielle Reindeau:We are the first facility to embed behavior analysis into everything we are doing. So, on top of having a team of dedicated board certified behavior analysts and registered behavior technicians, we actually teach behavior analysis and behavior management strategies to every clinical staff member who comes through our doors. We offer over 12 hours of dedicated training on behavior analysis within their clinical orientation Once they come to the floor. We give them so many tools to support the continued use of the science. But I think in working with other individuals at other hospitals, truly there is no behavior champion. If you want to learn how to walk, you've got PT. You want to learn how to talk, you've got speech. When they're hitting and kicking and screaming, there's really no one on the team yet that fills that need in other centers. So ideally you end up with a nurse maybe, or an OT who's passionate and starts to learn things about behavior.
Arielle Reindeau:Craig has really taken this extra step to bring expertise into that need and that deficit, because, although we haven't talked, I know, greg, you said you have some kids so we can talk maybe about that. Oh yeah, what I do is not unique to brain injury and spinal cord injury. It is the science of human behavior. So to embed that kind of a scientific understanding into everything we do. It really has changed the way that we're looking at problems, solving them and then really looking for that independence, because the truth is the people that we used to walk in the room and say he doesn't want to do it or he won't do it, that language doesn't exist here anymore. It is now what is happening in the environment. Well, he's got his TV on, he's got a warm blanket, he's cozy. What's happening when we say go to class? He keeps watching TV, he keeps his warm blanket right. So, starting to look rather at the problem and the person being a problem, looking at the behavior and looking for that environmental solution that solves it.
Greg Hamlin:That's awesome. Now, my understanding, my claims director was out there to actually do a tour and a visit and met you while she was there and she had mentioned that you had done some work with autistic children and that that really has influenced how you look at traumatic brain injuries. Can you talk to us a little bit about that?
Arielle Reindeau:Let's go a little bit back. In 1950, behavior analysis was really formulated as a science to approach the principles of behavior. We didn't really become applied until the 70s and the 80s where we tried to use the science that was working on pigeons and rats on people. One of the first breakthroughs actually happened with a researcher named Fuller in 1964, where he was able to show someone who was then called a vegetative state able to move a digit based on the reinforcement of orange juice to his mouth. So a lot of our field actually began with intellectual disabilities and, if you guys are aware, for a long time, individuals who had more behavioral excesses alongside a diagnosis like autism. They were institutionalized. They were brought to places that would tie them to radiators and straitjackets. They were not given school. They were not given really the kind of environment to flourish. They were institutionalized to be kept safe. Aba was one of the first ever approaches that validated these people could be taught that they could change and that we could create safe environments where everyone else is, where we could all be together. So the ability to include individuals with these disabilities into general education really came about with our field.
Arielle Reindeau:So I started early on as a preschool teacher and I started in inclusion where I had neurotypically developing kids and neurodivergent kids, and what I really enjoyed about that is it taught me a lot of the things that we have expected of ourselves. You know, sit still, look pretty, say yes, smile, are just artificial expectations and that when the child doesn't sit still or doesn't look pretty or doesn't smile, it doesn't necessarily mean that they are other than so. Being able to bring that appreciation for we all have a different presentation. We all have a different way that we're interacting with the world came from my experience with the autism community. In moving to brain injury, one thing remained true In autism we say when you've met one person with autism, you've met one person with autism.
Arielle Reindeau:The same is true of brain injury. Every individual is so unique, every instance is so unique that what I appreciate is autism gave me the framework that just because we said it has to be doesn't mean it's the best way. Brain injury has really solidified that there are so many ways for people to be a part of our everyday lives and that those all can all look different. That's wonderful.
Greg Hamlin:My wife got her degree in early childhood education, so similar start and similar passion on that for sure.
Arielle Reindeau:So can you talk to us a little bit about what the programs you've developed at Craig and what you've learned from those? Can I ask questions back? Of course, go ahead. So in just kind of hearing what I just described about clinical staff knowing behavior, you guys do send people to a lot of institutions and places. What happens to the worst of the worst behaviorally Like, what do you see other places able to do? Where is their capacity?
Greg Hamlin:So, at least for me, and I'll let Matt share some of his experiences. We've had some families that aren't always as cooperative or they don't understand the why behind what we're doing. Their assumption sometimes starts with well, you're the evil insurance company and you're wanting me to go to this place because you want to save money, when in reality that's not what it's about. It's outcomes Like if we're talking about somebody in workers' comp that we could be paying for their lifetime medical and that could be 30 years, then we want to invest as much as we can up front to get a really amazing outcome on the back end. Unfortunately, there's a lot of media out there that would paint insurance in a certain light. That can sometimes make that look challenging. So if they don't know who Craig is, or Shepard or Shirley Ryan or some of these real leaders in the industry, then to them it feels like well, why are you taking my family member away from me? And so we've had a few challenges on our end on that. We've had some. We've been able to work through with Dr Bronco, who works with Matt's team, who will actually get on the phone and kind of talk through it with the family and help them understand the why behind what we're doing and why we want to do that. Not in every state can we direct care, so a lot of times they have a say in that and they may not understand. So I think that's one challenge.
Greg Hamlin:And then what I've seen on the flip side, when it's not gone well, I can think of one individual we have had who's a paraplegic, who wasn't at a center of excellence and he was very overweight before he became a paraplegic, so he couldn't transfer, self-transfer. And then, because he couldn't self-transfer and he's with all these elderly people by himself and he's like 30s, 40s, he doesn't have any social interaction. So he was video gaming all day long and then Uber eating because there's nothing else to do. So while he's doing that, he was gaining even more weight, which is causing even more problems instead of the outcome of living independently, and that's what he wants. But what he wants in the support system to get him where he wants didn't line up, and so sometimes I think that's what I see is the biggest challenge on our end, at least from a carrier perspective. Matt, how about you?
Matthew Yehling:Yeah, I mean, I love what you said earlier about if you've met one child with autism, you've met one child with autism. Or you've met one brain injury patient, you've met one brain injured patient, right. So I think the big thing that that I've noticed between a center of excellence like Craig versus another center that might have some of the interdisciplinary approach but they're not as sophisticated or maybe they don't have the behavioral model like you've been talking about, is that, to the point Greg made, we are interested in saving money, right, but we're investing in these more expensive centers to get that better outcome down the road. So the independence that Greg just mentioned is a great example of somebody that can be independent and be left alone and doesn't require a higher level of skill, versus somebody that now you know they didn't advance to their full capability and now I have to have an LPN or somebody sitting with them 24 hours a day because you know they can't self-care or they can't administer their own medication. So it's just, you know, those two items like a loan. If we can get an injured employee to do self-care and be able to be responsible for their own medication level, the cost savings in the long-term for an insurance carrier.
Matthew Yehling:I don't think it's a bad thing to say we're interested in saving money. We're interested in saving money and getting the injured employee the better outcome. We want them to be more independent. We want them to be more capable, more self-managed. My family doesn't want to have to care for me all the time. You don't want to have to care for your loved ones all the time. We want to make them as independent as possible. I say this to my kids all the time I will not do something for you that you can do for yourself. And I think, like some places enable 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, here's how we get over this adversity and here's how we overcome this thing. So that's kind of the approach we take is like, hey, you know, it's not a secret that we're trying to save money. We're trying to save money because we want a better outcome for your loved one. We want them to be independent. We don't want the spouse to get exhausted by caring for them for the next 25, 30, 40 years. So you know, we don't want them to be that burden on both society. It's a societal thing too, if you think about it. No-transcript. Yes, do we want to save money? I would say, yes, we do, but we want to do it at the advantage for the injured employee, you know, get them a better outcome. So I would take a different, slightly different approach and just say like, yeah, we want the best outcome for them, and the best outcome for them is the best outcome for you and the best outcome for their employer and the best outcome for society. And so maybe I'm a little, you know, optimistic on some of that, but I think that's the what the centers of excellence had, that more behavioral model, and some of those approaches do a little better job at, and I shouldn't even say a little better, they do a lot better job.
Matthew Yehling:The other thing that I see is brain injured patients do better with other brain injured patients and people that treat brain injured patients. Even in a metropolitan area, a big hospital might only have five or six of those patients coming through their system. You know, at any time, at any one given time. So the fact that you said you can accommodate, you know 93 or half of that. So 45, 48, you know patients at one time. That's that speaks volume because like, yeah, each one is unique. There is commonalities obviously between those uniquenesses.
Matthew Yehling:But you know the, if you're going over five a year versus 50, or you know, and that's at one one time, right, so you're probably going through. You know 500 a. That's at one time, right, so you've probably gone through. You know 500 a year or whatever. So the volume and the experience, like you get better reps and the more you see this, the more you become. It's kind of that rule of 10,000, right, you become an expert after you see something and do something for 10,000 hours.
Matthew Yehling:So I mean you guys are the experts in this and like I want to send people, like any injured employee, I want to send them to the expert. I don't want to send this injured employee any injury, if it's a broken bone or a spinal cord injury or a brain injury. I want to get them the best care for the best outcome so they have the best recovery. So that's the approach I think Greg and I are pretty aligned on. Like our approaches are very similar. How we get them there might be a little different and how we convince the family, each person you know has to be, you know, individualized and spoken to, and you know what's. What are you trying to achieve in this? So that's my thoughts, but thanks for asking.
Arielle Reindeau:What I like that you both said is you indicated when there are challenges. Those challenges are human behavior, and I think that is something that I am so grateful for. My field, you asked the last question was what are you grateful for? And I laughed because I was like, oh boy, they're going to have me on my soapbox. I was a very bad kid. My poor mother and my poor father were divorced parents in the 90s trying to figure out how do we deal with very different children, and the truth is is I needed a lot of attention and I wasn't getting it for doing good things. So I recognized the worse I was, the more I got.
Arielle Reindeau:And what ends up happening in these cycles is the human behavior is reinforced in the wrong paradigms, right? So you don't want your kids to yell, you don't want them to cuss, but when they're getting more attention from you and they're getting more energy from you, when those behaviors are exhibited, they're more likely to do those in the future. So really, I think what ends up happening for us is, a lot of the times, we're able to take that step back and we're able to not look at this person is lazy or this person doesn't care, and we're able to look at the environment and then the consequences, because truly most people do care, most people are motivated to improve upon themselves, but in the wrong environment that is very hard to do. So what I really love is the ability to look at the behavior, to look at the refusal or the denied access or the I don't care, I don't want to do it today type of vocalization and treat that as something that is changeable, because I think a lot of people are met with these kinds of patients and I, like Matt that you spoke about, you know units that only see about five of these patients a year. When that patient starts pushing back and saying I need to get out of here, I don't need to be here anymore, I have things to do, I got to go home.
Arielle Reindeau:Those staff are not prepared to recognize that behavior is maintained by the way they are responding to it. Right, it's because they keep telling him oh, hold on, the doctor will come talk to you. Right, the way they're responding is leading to it increasing. Here we're able to take that step back and say, if we keep managing the same thing over and over again, we got to do something different. And I think what I would love to see you know I appreciate the approach of like we want to maximize time Behavior is, and treating behavior as its own entity, I think, is what is going to maximize our rehab benefits the most.
Arielle Reindeau:Because I cannot tell you the amount of people that I met them day 16 of rehab because in the beginning 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 of rehab and they haven't gone to class and they haven't been eating and they haven't been showering, and now I have 16 days that have been reinforced, that I have to work around to try to get them onto the better routine. So what I would really love to see in every system really is a better understanding of human behavior, so that when we do get refusals, when we do have these barriers, the next question isn't so how do we get them out? The next question is so how do we change this behavior? Because I really do think that is what rehab is about.
Greg Hamlin:That's so awesome. One of the things, as you were talking, that I feel like we've run into sometimes it's a challenge and I imagine you do too is sometimes the behavior is not just the injured worker, it's the support system around the injured worker, and that can be so challenging because you've got people who do care a lot. They love this person, but then they bring with them all of their life and all the experiences they've had. I think some of the more challenging claims I've had have been family members sometimes whose behaviors are actually either sabotaging the road forward for the injured patient or there are just some other dynamics going on there. Do you see that at Craig with some of the patients that you have, and how do you work through that?
Arielle Reindeau:The best part about my job behavior is behavior is behavior. So mom's behavior isn't that much different than patient's behavior. They work under the same contingencies. They follow the same principles. So if I can look at mom in an objective way and say, okay, what is mom getting out of this? Every time they cry, mom comes over and hugs them. Okay, she's also getting a hug. So how can I reset this up so that mom still gets what she wants that hug and that time. But it's not coming as we're crying and saying we don't want to do PT the other really beautiful part of my field, which I will say it's more intensive than other fields in this degree.
Arielle Reindeau:We believe very strongly in data collection to demonstrate change. So I actually had a younger woman who was injured and she was aggressive in physical therapy and I wanted to figure out the conditions under which this individual was most likely to be aggressive. Do you want to know the number one variable that was present when she was aggressive? What was it Mom Interesting? And this was a loving mother, she was very sweet. I liked her a ton and say so.
Arielle Reindeau:My data shows that you are the number one thing correlated with aggression was a really hard thing to come to this parent to say you know, I know you have great intention, I know you love her, I don't think it's anything you're doing, but the facts are the facts. And so we were able to sit down and say are you willing to take a step back to see if it changes this behavior? And it does become a partnership? It becomes. Here's what we're seeing. Are you willing to do a little so that I can see a little? And sometimes the answer is nope, I'm not willing to step out. I need to see her walking, I need to see this. And then I have to change my approach because at the end of the day, the care partners and the care family is who I'm going to hand off to, so I always have to be in alignment with them.
Arielle Reindeau:But this mom, thankfully, was willing. She stepped out. Aggression went to zero right away, which was kind of challenging too, because then I was like so can mom just never come back to PT? And mom was like, nope, I need to 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, to just talk about how great she did, and we started to slowly fade mom back in until she could be at the whole session without aggression occurring, and we have the data to support that. We made the change right. So it's a partnership with every family that you come into contact with, but your data should support their goals and the things that they're looking to see change. That's awesome.
Greg Hamlin:So, as you think about where things go next in the field that you're in, what are some of the biggest things you'd like to see change, or some of the biggest things you'd like to see change, or some of the biggest areas, you think that there's room for improvement in the world of traumatic brain injuries.
Arielle Reindeau:When I started at Craig seven years ago I was working with Dr Alan Weintraub who started the brain injury program here at the hospital, and Dr Weintraub was really married to this idea of rehab nursing and having a nursing staff that could really understand not only the rehab part of the brain injury and the spinal cord injury but also the nursing part.
Arielle Reindeau:I would love to build from where Dr Weintraub saw and actually see behavioral rehab nursing. I want to see a rehab nurse who can go in the room and who can say, hey, every time Greg screams, we're going. Hey, greg, stop screaming. We need to stop doing that because he's screaming more than he was yesterday. And I want to see the ability for the nursing clinicians to see kind of those contingencies that are happening and to see if we made this change to behavior we could see this kind of an improvement. I think that is the next step. I love OT and PT and all of my other disciplines too, but nursing makes the world go round. It is the 24-hour team that is here seven days a week and if we could really embed behavioral understanding into the staff, I think that is the next forefront with which we'll see the best healthcare delivered.
Greg Hamlin:That's huge. I think you hit on a really, really important concept, and for those who aren't in the healthcare system, they probably don't realize how much nurses are involved in everything that goes on, so it's definitely their role has been even more so now than maybe 20 years ago, so they're playing more and more role in everything, and I know both Matt and I have nurses on our teams, on our side, helping us to make sure we're making the right clinical decisions when it comes to our patients. So I love where you went there with that. Well, I've certainly enjoyed chatting with you today.
Greg Hamlin:One thing that we've done every season of Adjusted is I really like to focus on the positive and put good vibes out in the universe. I always feel like it will come back, and I think we live in a well, we do live in a society that is very self-focused, with selfies and everything's kind of about me and what makes me happy and I think, at least for me, one of the things that I've learned is happiness also can really be improved by being grateful, and so one of the things I like to ask every single person that we've had on the show is something they're grateful for, and it could be anything. It could be work-related, not work-related, doesn't matter.
Arielle Reindeau:I think what I am most grateful for is the degree to which I have become a human again as well as a behavior analyst. At times our field has the criticisms that we're cold, that we're too objective, that we're not looking at the whole person to really deliver the treatment that we need. I, to a degree, agree with that statement. You know, it was harder seven years ago for me to look at the mental health need alongside the behavioral disorder that was occurring. Working on an interdisciplinary team has allowed me to look at the person first and the human first and to make sure that that's always the center of my care and to really align myself with what this human needs versus what's best for this behavior. And they seem like similar questions. They are, but the answers can be really different. So that is what I am most grateful for is Craig Hospital has been the kind of place that has made me more human.
Greg Hamlin:That's great, that's beautiful, and I think hopefully our audience just takes a minute to think about what they're grateful for. For me today, I'm super grateful because I have a 19-year-old son that was hospitalized over the weekend because he accidentally ate a cookie with nuts in it and it escalated to the point he was in the ICU. And he's hundreds and hundreds of miles away from me and my wife. So it's always a super scary thing when it happens. But to know that there were people there to take care of him, that he was able to get the treatment he needed and that he's back out there doing what he's doing what an amazing world we live in. That that same thing could have resulted in him not being with us in a different time.
Greg Hamlin:So, while that's not a huge thing, I've been thinking about it a lot, just how quickly things can change and how much we take for granted the healthcare system around us, that if things do get bad, there are people who are so well-trained who can provide the resources that we need to make it from today to tomorrow. So certainly thankful for everything you do, and I hope our listeners will check out Craig Hospital if they have not, and consider them if they have that traumatic brain injury or that spinal injury, because they certainly are excellent at what they do and remind our listeners. We release episodes every two weeks on Monday. We'd really appreciate it if you would like and follow us and if you could leave comments, that would be even better, because that helps other people find their way to our podcast. So again, thank you, ariel for your time and thanks Matt for joining us, and with that we'll say leave with our motto do right, think differently and don't forget to care. Thanks everybody, thank you.