The Sweet Spot for Recovery
AN INTERVIEW WITH RIK LEMONCELLO
For the crew at one Multnomah Village bakery, the road to recovery is paved with cake. Sarah Bellum’s Bakery & Workshop is home to an innovative rehabilitation program, where adults with brain injury can practice functional baking and retail tasks in a safe space outside of the traditional therapy setting. The program does more than help participants develop greater independence and efficacy, however. Since its creation in 2017, one of the key aims of the organization has been to alleviate post-injury isolation through connection and collaboration within its team of survivors and through social inclusion in the greater community. It was an idea devised and implemented by speech language pathologist, Rik Lemoncello--who is our first interview of the new year. As someone originally from the Portland area myself, it is a great privilege to be talking to an Oregonian who is doing such amazing work locally.
First things first: tell me a little about yourself, Rik.
I’m the founder and volunteer Program Director at Sarah Bellum’s Bakery & Workshop and a full-time professor of Speech-Language Pathology at Pacific University. As an avid cake baker and speech-language pathologist, I combined my passions for cake baking with brain injury rehabilitation to create this unique program. I’ve lived in the Portland, OR area since 2008 and consider Portland home! I live in SW Portland with my partner, and we love playing board games and entertaining friends together.
Now, could you tell me about Sarah Bellum’s Bakery & Workshop?
Sarah Bellum’s Bakery & Workshop is a non-profit organization whose mission is to provide return-to-work opportunities for adults with acquired brain injury through baking and selling delicious baked goods made with organic ingredients. We specialize in cupcakes, but have also branched out to create other goodies like brownies, lemon bars, cookies, and some paleo products. We started in the summer of 2016 with a small team, baking one day a week and selling at a local farmer’s market one day each week. Since that time, we have slowly grown to become a full-time operation. We moved into our brick-and-mortar shop in SW Portland, Oregon in 2018 and just celebrated our 2-year anniversary of being in this fabulous location. We also distribute our mini cupcakes and paleo products to a local grocery chain (New Seasons Market).
At the bakery program, our volunteers help to support adults with acquired brain injury to clean, organize, prepare, mix, bake, frost, garnish, set-up, and sell our delicious baked goods. We have different team members in the “back of house” doing the baking and the “front of house” doing the sales and customer interactions. Some of our crew volunteer in just the back, just the front, or sometimes do both. We are a strength-based program and we work to match each individual’s skills and strengths to the job tasks that best match those strengths. Our support-staff learns how to best adapt each task to the individual and provide just enough support to help each baker succeed.
Sarah Bellum’s Bakery & Workshop is also a community. We are creating a safe space where survivors of acquired brain injury can gather, volunteer, and support each other through meaningful activity. We are not a support group in the traditional sense, but peer supports happen naturally through the work. We are a supportive space that allows folks to try something new, reflect on successes and challenges, and build new skills for success. Through the focus on success, people feel good about their efforts and pride in their work. This positive vibe spreads throughout the bakery to build our community of strength, support, and purpose. The bakery is embedded in the local community of Multnomah Village in SW Portland, and our customers get to meet many different survivors of brain injury, learn about their stories, and learn about the complexities of brain injury.
How did you dream up the idea for this program and why did you decide to focus on the brain injury community in particular?
As the founder of this program, I have been thinking of a way to combine my two personal passions: cognitive rehabilitation for brain injury and cake baking. I started baking cakes when I was in graduate school to become a speech-language pathologist, so I have been baking cakes as long as I have been practicing speech-language pathology (SLP).
In my clinical career as an SLP, I became most fascinated by memory and learning challenges that occur after brain injury. I continued to study about and learn more about memory and cognitive systems while working in different rehabilitation hospitals. I spent time working with survivors of acquired brain injury and their families in the hospitals, but never really knew what happened once they left the rehabilitation hospital. Later in my career, I got involved with several support groups in the Portland, Oregon area. I got to know several survivors who were living with the effects of brain injury for 2, 5, 10, 20, even 40 years later. This experience of meeting long-term survivors and their families, and seeing the chronic impact of brain injury shaped me even further. I was committed to creating a program that would provide long-term, community-based supports.
Acquired brain injury (ABI) includes causes of brain injury like traumatic brain injury (TBI), stroke, brain tumor, lack of oxygen (anoxic injury), brain infections, and other causes. This is a very diverse population. Every brain injury is so different. Every person is so different. How each brain injury affects each individual is so different. This complexity is part of what I love about working with survivors of ABI and their families. Working with a team to figure out each individual’s story, their strengths, their challenges, their motivations, and their quirks is all part of the deal. Doing this in isolation is hard. Doing this in a functional space with real, meaningful activity provides a whole new context. This work at the bakery program has continued to shape me as a clinician and as a teacher.
What differentiates the program at Sarah Bellum’s from more conventional speech and occupational therapies?
Well, that’s a big question. The fields of speech-language pathology (SLP) and occupational therapy (OT) are both vast professions. Three key team members who focus on cognitive rehabilitation after brain injury are the SLP, the OT, and the Neuropsychologist. The SLP and OT should be working together to help support an individual plan to help a survivor return to life, work, and play throughout the lifelong recovery following brain injury.
In the medical rehabilitation model, the SLP and OT work in hospital or clinical settings. A main challenge in these settings can be to work on skills that are “functional” (meaningful) for each individual survivor. The clinical context is often not very functional. So, working to support an individual client’s rehabilitation can be challenging. The context of a real-world, actual bakery program that provides supports and training gives us a unique place to work. We are not a medical rehabilitation center, and our focus is not on “rehabilitation” in the traditional sense.
Instead, we help each individual baker or salesperson to develop the skills to be successful in those work tasks. These might include elements of SLP or OT practice, such as errorless instruction, repeated practice, task analysis, environmental set-up, or reflection exercises. Our focus is on the work task(s), and we collaborate with each survivor to figure out what will help them succeed.
I know that when you receive speech and/or occupational therapy, you’re encouraged to have goals. Could you give me some examples of goals that crew members might work towards at Sarah Bellum’s Bakery & Workshop?
Since we are not a traditional model of medical rehabilitation, our goals look a little different. It’s important to acknowledge that each individual’s goals are unique to that person. Each baker or salesperson has their own skills they might want to improve on. Examples of meaningful, individual goals for our team have included:
Arriving to work on time and prepared
Reading a customer’s body language to figure out if they want to hear more information about our program or if they are in a hurry
Having a social experience out of the house once a week
Improving loudness of your voice so customers can understand you
Learning to frost cupcakes efficiently and consistently
Figuring out ways to adapt the baking process for yourself
Increasing awareness for pacing (e.g., knowing when it’s time to take a break)
Learning to use the cash register and remember the different buttons
Learning to make change
Initiating conversation with peers during breaks
and many more…
What adjustments have you had to make at the bakery to better suit the needs of the crew that works there?
There are many adaptations we have made along the way, and continue to make, so that each individual baker or salesperson can feel successful. Some examples of work-place adaptations include:
Procedures. We try to keep things organized and consistent to help establish new procedures and skills. One example of this is our “check-in” procedures when a team member arrives at the bakery.
Recipe Adaptation. Our cupcake recipes have been created with many steps broken down and explained so that each new baker can learn our baking procedures. Each recipe starts with gathering all the necessary equipment, includes explicit instructions for handling the mixers, and includes details like how long to mix each batter. Some recipes are easier and some are more difficult, so we also match the recipe to each individual’s strengths.
Organization. We keep our kitchen and bakery space very clean and organized. There are labels on every container, rack, and cabinet for where each item belongs. That makes it consistent so that we always know where to locate an item when we need it.
Pacing. Being on your feet and using high cognitive effort for a 2- to 6-hour shift can be taxing. We also help to pace the day to ensure there are natural breaks built-in, we adjust the level of stimulation (e.g., music on or off), and we match each person’s level of endurance to the best tasks and schedule. For example, some folks start out with a one-hour shift during the quiet set-up in the morning and gradually work up to more stimulation.
Awareness & Motivation. Most of our volunteers have not yet attempted to return-to-work after their brain injury. Part of this return-to-work program is to provide the safe space for each individual to try a new task, reflect on strengths and challenges, and continue to learn about themselves. Finding what motivates each individual and working to build their self-esteem is an important part of this program. Success produces more success.
And there are many more examples. It’s all about an individualized, customized experience for each unique volunteer in our program to adapt to what they need.
Another focus of the bakery is alleviating social isolation. Why do you find survivors often experience isolation after their injury, and in what ways can it work as a barrier to recovery?
Social isolation is one of the top reported long-term symptoms after brain injury. Acquired brain injury can affect so many different aspects of a person’s life. A person may become more depressed and withdrawn after a brain injury because of this major life change. A person may have difficulty interacting with others in social situations as a result of their brain injury. A person may have difficulty with moving around and getting around, making it harder to engage in social activities in the community. A person may have difficulty with noise or light sensitivity, making it difficult to be out in social situations. As a result, a person may lose their job, their driver’s license, and their self of self.
How does working at Sarah Bellum’s help relieve this?
The isolation that can happen long-term is a major reason why I created this program – to provide a safe space with meaningful and purposeful activity to regain a feeling of self-esteem in the “real world.” Having purpose and meaning, and feeling like you contribute to a program, are important aspects of developing a sense of identity at work. Feeling pride in your work, a sense of accomplishment, and continuing to develop new skills can all continue to motivate lifelong improvement. Learning from each other and peers with brain injury can also foster community. We can all continue to learn new ways to engage!
So how has COVID-19 affected Sarah Bellum’s Bakery & Workshop and its crew? Have you taken any steps to address the increased isolation they must be facing during the pandemic?
Oh, this is a big one! 2020 was a tough year! As we learned more about the COVID-19 pandemic and things started shutting down in March 2020, the bakery also shut down. We closed for two weeks at the start of the pandemic to figure out how to proceed. The Board has met regularly to keep our priorities in place: 1) Keep our crew, volunteers, and team safe and healthy, 2) Sustain our program so that we can still be here post-pandemic as the only program of its kind, and 3) Continue to provide supports for adults with acquired brain injury.
We re-opened in April 2020 with limited operations by some of our core team. Roles have shifted. Most importantly, we have found new ways to connect and stay connected. Each week, we have 4 different online “groups” taking place: a meditation group, a social chat time, a game group, and a movie discussion group. It has been so great to see our team connect in a whole new way, and to take leadership with developing new skills to organize and run these different groups each week. We also created a “directory” so that our crew can connect with each other on their own time outside of these structured group chats. New friendships have formed, and that has been the best “surprise” of COVID-19!
We are all very much looking forward to the day in 2021 when it will be safe to return to our “full” operations at the bakery program. The Board is very pleased that we just wrapped up a successful online fundraiser that will allow us to continue to sustain our work and be here in 2021. It’s an ongoing effort to keep up this work, and “it takes a village!” There are so many people who are working hard to keep our program going, and that energy sustains us.
I’ve seen that you also display and sell the art of folks with brain injury at the bakery. Can you tell me a little about that?
Yes, we have a good sized “blank” wall in the café space at the bakery (pre-pandemic). We decided early on to use this wall as an “art wall” to feature art by artists with brain injury. We rotate artists every 2 or 3 months. Each artist decides what they would like to display and sets their prices. The artwork is for sale to the public. We do not charge a fee for this art display, but do ask each artist to donate at least 10% of all sales back to the bakery program.
When a new artist hangs their artwork, it is fun to have an artwork reception. That is up to each artist. We help to promote the event. We also encourage each artist to hang up a short bio about themselves so that customers can learn about them.
We have had 10 different artists featured on our “art wall” so far, and are booked out for the first few months of 2021 already. If any artists with brain injury are interested in displaying and selling their works at our bakery, please email firstname.lastname@example.org for details.
What do you find speech language pathology, occupational therapy, and rehabilitation psychology graduate students gain from participating in this program that they might not otherwise?
The student experience is an important part of what we do at the bakery program. My full-time job is working as a professor of speech-language pathology. I get to teach classes in brain injury, speech disorders, swallowing disorders, and cognitive challenges. In the classroom, students learn about the “theories” of how to work with folks with these different challenges. In their clinical rotations, students learn to actually do various assessments and to customize treatment plans for each client they see. It’s a steep learning curve for beginning graduate students. The fields of speech-language pathology (SLP) and occupational therapy (OT) are both so broad. Students need to learn to work with clients at all ages (birth thru geriatrics) for a variety of disorders/challenges. Learning about acquired brain injury is just one of many topics that graduate students learn about.
Setting up a student clinical rotation at Sarah Bellum’s Bakery & Workshop has been a part of the program and our educational outreach from the beginning. Since we are not a traditional medical rehabilitation program, students gain a very different experience at the bakery program. In my approach to supporting student learning over the years, I have adapted a new approach. Now, students focus on developing their observation skills. They start by observing how each individual baker approaches their work, analyzes the work task, and develops work-related goals to help each individual improve some aspect of their work. It can be challenging when students first start out, but over the semester, they learn more about their individual baker as a person, develop meaningful goals, collaborate with their “client,” and learn about the many different aspects of what it means to live with brain injury. This is not an experience students would get in any other clinical rotation.
And finally, how has the local community responded to Sarah Bellum’s?
The community outreach, support, and enthusiasm for our program has been great. First, it’s important that we make delicious cupcakes and baked treats. That is what helps to bring people back. It’s fun when a customer asks who “Sarah Bellum” is. That way we get to explain that Sarah Bellum is a play on words (the cerebellum is in the brain). We help to educate the public about brain injury and the many different ways that brain injury can affect someone. Most people do actually have some personal connection to acquired brain injury, whether they themselves sustained a concussion, know someone who had a TBI, or a family member or friend who had a brain tumor or stroke. I think the best indicator is that we have sustained a small non-profit program with a retail/bakery operation, during a pandemic, and are about to celebrate our 5-year anniversary in May 2021. As one of our bakers says, “This program just wants to happen.”
My sincere hope is that Rik Lemoncello’s approach will inspire us all to reevaluate how we, too, can better make long term healing “happen.” What I find particularly exciting are the ways in which this kind of comprehensive program can support the (oft-neglected) psychosocial component of recovery. You need look no further than Sarah Bellum’s to see the immense therapeutic potential. Empowering survivors’ in rebuilding their identity, purpose, and self esteem--the bakery truly is changing lives one cupcake at a time.