Nadine Wilches 0:00

Hello, welcome to Navigate with Nadine. We're here with Brandon Keppner. He's an executive healthcare leader with decades of experience transforming behavioral health organizations. From leading psychiatric hospitals to overseeing Medicaid operations, Brandon has built his career around improving care, strengthening teams, and creating healthier systems. Today he serves as Chief Operating Officer of Parkside Psychiatric Hospital and Clinic, where he continues to advance innovation in mental health and behavioral health care. We're really happy to have you, Brandon. Thanks for joining us.

Brandon Keppner 0:32

Thanks for having me.

Nadine Wilches 0:33

Yeah, so I'm working on the preventive side of mental health care. And we're really looking to understand from your perspective where things can be done a little bit differently or how you see things. And so we'll dig into a little bit of those questions, but just to kind of get us started, what draws you to behavioral health? What brought this in for you or brought this up for you? How'd you get involved in all of this?

Brandon Keppner 0:57

Honestly, this might sound a little off, but I started as an art and illustration major in college and needed to pay the bills. And there was an opening for an overnight, like night shift at a group home. So I took it so I could keep up with other expenses. And the first job that I took was sitting in a group home room working the night shift. So I sat at a desk surrounded by bunk beds as boys slept there. And I had a little lamp at my desk. And they said, okay, go ahead and read their charts so you get familiar with what's going on and why they sleep. You sit there and make sure that they stay in their beds and they keep sleeping. And if they don't, you encourage them to go back to their beds. And so I'd sit there and I'd read the charts and kind of get familiar with their stories and what was going on. And it woke me up to how I guess protected my life had been and what a good upbringing I was given. And it was a boys' sex offender home. So it was a cycle that I saw of what they had been through and what they were then repeating. And it pulled me in. And I switched majors and changed the trajectory of what I did from there. And I don't think I'm that unique in a lot of people that I see in the behavioral health field. A lot of them come with a passion to try to help change the trajectory of others that are in that spot of need in their lives.

Nadine Wilches 2:30

Yes, but that's a really touching story, nonetheless, because it really does paint the picture of that moment that you can see a different world, want to help, and get involved, which is really just truly amazing and inspiring. And I think you're right, a lot of us are in it for those reasons. I spent 20 years on the crisis side and now focused on prevention. So seeing that those folks and many of the other people that you see are really already in crisis. They've experienced traumas, hardships, adversities. They've experienced really usually pretty difficult communities or family lives, have other things going on, and then psychiatric issues manifest. What do you see? Are some of the things that we can be looking at in advance proactively before they need crisis intervention?

Brandon Keppner 3:24

It's hard because you can always put up tests and questionnaires and see where people score, and then there's risks of how they're going to score on it. And then based off of those risks, do you meet with them and try to help teach them coping skills? Those things are great and they do help. But people's personalities and their resiliencies to what they face are gonna always be different depending on the individual. Even within the same family and being exposed to the same things, individual resiliency and personal character are different. And that's the predictability scale that you can't map out. It's individualized. And so it's learning to know the individual. And that's hard because it's not a quick fix, it's not something that you can put out in mass production, but it's getting to know the people around you and then knowing what to look for when somebody's struggling and having an awareness of how to help and how to see points that kind of highlight when somebody may not be speaking out loud, but you can kind of see that they're in need.

Nadine Wilches 4:42

Yeah, so from a population health standpoint, that you're talking about two pieces. One, that it's very nuanced. And so universal prevention is, of course, very effective for a big part of the population, and typically the folks that are not as likely or at risk for psychiatric problems down the road. But also you're talking about what where are those pressure points, who are those people that can be well trained to observe, notice, and interact with folks and be able to triage a little bit and send people in the right direction and get people the support they need. How do you see that looking? I know you worked in hospital systems and Medicaid, and so you've seen quite a lot of folks come in from different trajectories and different pathways. Where do you see the biggest opportunity for us to where's that inflection point? Where's the biggest opportunity for us to make inroads there?

Brandon Keppner 5:42

You know what it's hard because I think lately there's a lot of technology coming into play. And specifically with AI, that can be tricky because I don't know how much I should share, but I like to play with AI myself. And there's been times when I'll bring scenarios and there's tools you can do. There's great spreadsheets and summaries that it can give you when you don't want to read a long, lengthy report. There's things like that it does, but I also like to sometimes bring summaries of like, hey, I just went through this experience. This is what I took from it. Tell me how well what I'm seeing matches. And I've done that at times. And sometimes I found the AI will placate me and it'll tell me that I'm always right and everything that I'm thinking is correct. And I've pushed back and I try to say, like, hey, don't just tell me I'm right. I need to learn from this, I need to grow. So tell me where I can grow, tell me where I'm wrong. And then it'll still default back to that. And I keep trying to push back and it and eventually it said to me, Well, look, people will just turn it off if I don't give them the feelings that are soft. And I said, But if you don't play as my grindstone, I can't get sharpened. And then it responded with, but people like their comfort or comfortable pillows more than a grindstone. And it's just kind of interesting having that context, but I think the point that I bring it up is that AI has the ability to be a grindstone for us to help give us better skills to improve, but it hurts sometimes. And it's not as something that we openly welcome. We like our pillows and our comfort spots. So a lot of the coding defaults to that because that's what keeps people coming back to it and utilizing it. And we like that feel. So it kind of defaults to a spot that's not really healthy if all we're doing is getting comforted and being told whatever we want is right. We need to be pushed into places that aren't so comfortable in order to grow. That's a long roundabout way of saying we can use AI, but it has to be used with someone who can supervise it and help us push past those comfort zones and be pushed into a spot that sometimes isn't comfortable, but can still protect us in a way that can guide that growth in a healthy manner.

Nadine Wilches 8:24

Yeah, and I think when we're talking about agents and removing the human from that process, it does become a very anorganic thing where earlier what you were really talking about is training humans to really be aware and notice and engage and have that conversation. I think that there are points, especially in childhood, where children are engaged with adults much more regularly, consistent adults much more regularly that that can support in those ways. And then as a behavior analyst, we're more on the data side of AI. And so we like math and rules, but rather than agents. But I think that some of those complexities that it's really hard for a human to kind of synthesize within an understanding of an individual or a chart, that's where I think that we can use data to inform certain insights that can then support trajectories and decision making by humans through relatability and actual relationships. I see what you're saying about AI agents. And I know there's a lot of research coming out now looking at these tools and how do people actually experience them and what harm they do and what good they do. And I think we're still a long way from really getting to the place what you're talking about. But I know you do use biometrics, as I understand, and gaming. I'd love to hear a little bit more about this biometric gaming for emotional regulation and how you are using technology from that standpoint to help improve regulation, which can be a great opportunity to reduce, to cope better with stress and reduce distress from events that are pretty regularly challenging for these children.

Brandon Keppner 10:09

Sure. With our outpatient clinic, we have a specialist that focuses with some of the youth doing what we call our Mighty Makers program. And to simplify it, it is a biometric feedback system that they interact with. And it basically teaches them in a video game like system to pay attention to ways that they can control their breathing and their heartbeat and those biometric feedbacks so that when they are getting elevated, that they can realize that it's not just I'm not a passive person who is being subjected to certain stimuli, but I get to control it. And as I get elevated due to stimuli or other aspects, I can then choose to control it, slow it down, and then I can continue on in the game. And if it gets too high, then it stops and it I can't go forward until I learn how to control those aspects. And then as you do that with the gaming, then you get to try it out with your parents or having certain aspects with them. And then even when you're not playing the game, the parent can then help remind them of, like, hey, I notice you're increasing your speech and you're getting a little loud. Do you feel your heart increasing? How's your breathing? And just bringing them back to a reminder of what they were doing on those games and that biofeedback that they've seen on a screen, even though they may not be hooked up to it at that time. What do you feel? What are you paying attention to and kind of regulating that back to a spot where they can be calm?

Nadine Wilches 11:49

Yeah, that really like externalizing and self-witnessing piece of what's going on and automated the gaming neurofeedback. I really love, I think that's where technology has really improved because I remember neurofeedback with the putting on the head net and the sensors and watching on the screen and being in a very clinical environment. And I remember kids really not liking that all that much. And being in an environment where we can make it fun and engaging is great. And then from a preventive standpoint, I think emotional regulation is connected to so many stress-related diseases and disorders and can be used upstream, I think. Do you see? Now, I don't see that translating into every every kid in the US is going to be using that type of system, but do you see ways in which we could either use technology or strategies more upstream that you think would be more preventive and proactive of us to do in advance?

Brandon Keppner 12:46

Yeah, and I think the overall bigger picture of this particular technology is it's teaching these kids and others ways to own their own awareness and take more accountability instead of just being, oh, well, I have ADHD, and so I can't be expected to pay attention to myself. And you all have to accommodate the way I feel. And it's like, yes, it is a lot harder for you. And yes, you're gonna have things that happen that may not happen to other people. So you're gonna have to work harder at it. And here's how it works for you. Try it out, feel it, see it, notice that you can control it, notice that what it feels like when you do it. And I think that accountability for the way we feel, for the way that we react isn't something that we just sit back and be a victim to. This world is scary, and we do get abused, and things do happen to people that affect the way we feel and the way we see and the way that we filter everything going forward. But that doesn't mean you have to stay in that spot. You get to learn ways to change it and get to regain our own locus of control. And when you have that, it's incredibly empowering. I think so much more empowering. And I think sometimes we get into a spot of too much empathy to a place where we just stay in a spot of pain. And if we can regain that locus of control, there's so much more that you can do, and there's so much more strength and I guess skills that you can build. And if you watch the eyes of kids and others who get labeled with a mental illness, who think that they can't do things anymore, versus the ones that realize I it's maybe harder for me, but look at what I can do with this. I think using AI or tech skills to help learn those is incredibly powerful.

Nadine Wilches 14:56

Yeah, and you're really talking about building resiliency, an internal sense of resiliency, but also that external capacity. We're talking about parents becoming coaches and reminding folks of that and this behavioral conditioning. And in advance, if we know how to emotionally regulate and self-regulate and use our support systems, then if something happens down the road, we can draw on that resiliency and those protective factors that are already in place. And I know you've also focused on environmental conditioning, which I think is an important part of developing resilience systems through settings. So individual capacity building, yes, and empowerment to be able to change our circumstance. And then also from the environment conditions us in a way that we can experience our circumstances in a different way and be empowered to do things differently just by the natural environment. One thing that you and I have in common is that I spent some time reducing restraint in a in a school that I was working in pretty significantly and dramatically. And I read that about your history as well. And so I'd love to hear a little bit about what your that experience and reducing restraint taught you about designing healthier systems and settings with regard to shifting behavior.

Brandon Keppner 16:17

Sure. I fully believe it's the human connection. I had a mentor early in my career who used a phrase that just stuck in my head. And he said, When you're working with people, whether it's other employees that I supervise or it's the patients themselves, it still fits completely. And he said, if you are all rules and no relationship, it leads to rebellion. And if you are all relationship and no rules, it leads to chaos. But when you balance rules and relationship, it leads to respect. And so it's to me, it's that human factor. And when you have that right balance of both of those rules and relationship, and you have respect for one another, and they know I'm gonna hold a boundary, and I'm not gonna let you overdo that. But I also see you as a human, and I'm not a control or power-hungry person that we're doing this because I respect you, and I'm gonna do what I need to do to hold that boundary, and I really care for you as a person. We're gonna go somewhere with this. And it can be hard to hold that boundary because maybe sometimes there's tantrums and there's fits that are gonna be difficult, and we have to hold that and work through that. But I've had patients that I have a legitimate respect for them and they do for me. And I've seen them get to a spot where they are very aggressive and they're have to be put into a physical hold. And I've seen one look at me in the eyes when they're going through that, and then after it's all over, they came back and they were talking to me and they said, You know, I could have hit you, right? I could have taken a swing at you, but I held back and I said, I noticed. I did see that. I you know you lost your temper and we had to help you with that. And they're like, I know, I know I did, but I didn't punch you. Like, I appreciate that. And I can see that. A lot of times they will take it out and they'll punch a hole in the wall and they'll go swinging and they'll get right up into your face. But the actual swing at the people, sometimes they'll hold back because they've established that rapport. And that withholding, if you can continue to de-escalate and not have to go into the hands-on in those cases, it's because there's that level of respect. And I think sometimes we get too caught up in the documentation and we have to prove what we're doing and show that we're making progress and what we did in group. We get so caught up in sitting behind a computer that we miss the human interaction with our patients. And the more we can let, in my opinion, an ambient AI or scribe handle more of that documentation, the more personal we can be face to face. And the more human interaction we get, the more rapport you establish and the more human we are together. And that is where the restraint reduction really comes into play.

Nadine Wilches 19:21

Mm-hmm. I certainly noticed that as well, creating those environments. Part of that is creating a system of practice that we all subscribe to, which is very different than maybe what we were doing previously. And so that requires quite a bit of leadership to model and train and support that practice. But you're also saying, in a really important piece, is that we have to create the time and space for it as well. And so taking off some of that administrative burden, folks, my teams used to always say, like, don't pile on, right? And so we used to talk about piling off. So if we're asking you to build relationships and take that time, where we need to pile something off so that we can, and you're talking about the ambience scribes are fantastic and people have really bought into the these things. And I think they did a really great job making that accessible for folks. So, how has it been? And maybe I'll answer it a little bit and then I also ask you, but I found that the same thing was true for my teams. I needed to build really trusting, respectful relationships with them so they understood that I care about them and their time and their practice and that I'm supporting them in creating the space to do the things that we all know are best practices. Do you find that too? And what else do you find maybe is important in the leadership aspect?

Brandon Keppner 20:44

I would agree with that. And sometimes it's the action of seeing it because sometimes there's gossip rumors. No matter where you're at or what you're doing, there's what you teach and what you say, and then other things will circulate around. And so you have to be able to find ways to make sure that what you're actually teaching and saying gets seen, and there's other shifts that may not be there when you're there. You have to find ways to get that same message circulating and that people can see and feel and recognize it in ways that that rumor mill can be squashed.

Nadine Wilches 21:22

Yeah, that that's that's an important take, too, because I think change comes with some uncertainty and ambiguity just in the nature, as it doesn't matter how good we are at communicating that, there is going to be some stress and ambiguity and uncertainty with how that will feel and how that will truly be experienced. And it's important to be a part of that so that folks feel heard and have are able to experience that alongside you and that you really understand what they're going through. So yeah, I love that. I think it translates into both parts of the practice. And so if we could maybe just shift to a future focus for the end here to leave the audience with a little bit of a future lens, if you were to see something major shift in preventive behavioral health in the next 10 years, what do you think that might look like, whether it's technology focused or practice focused or how the system's working now?

Brandon Keppner 22:19

I think the hard part is behavioral health gets lumped in with the medical side. And a lot of the times people go to an emergency room when they're having behavioral needs. And emergency rooms just want to clear their beds and turn it over as quickly as possible. And the behavioral needs stop and get stuck there. And the medical side is a black or white. If it's this issue, it gets X complication, gets a Y solution, and you just plug them in and move to the next. And it's all about how quickly can you make the complication equal the solution and go on to the next. And behavioral health does not match that. It's not a plug and play. It's not every solution equals, I mean, every complication equals the same solution. It really does have to be individualized. Now you can see patterns and you can see medication matches and you can see coping skills, but you still have to individualize it and you have to see how the individual person accepts the pieces that you try to apply, and then you have to adapt it according to how well it works for them. So I would say in the future, we have to break away from that mentality of the medical model. And I know we need to work together, and it doesn't work unless we're managed together, but let behavioral be independent. Let the individual models not have to be a cookie-cutter flow, but find a way to have an integrated model with medical side, but an individualized plans that can flow without bursting the seams. I don't have the answer of how that looks, but I'm sure AI could.

Nadine Wilches 24:16

We'll have a vision of it together. I will tell you AI does a terrible job with it, which is why we built Mind Arc Health. But it worked, it's coming along. And I think with insights from people like you, we can really start to shape what that should and could look like and best practice and have a standard of preventive mental health care. So thank you for coming on. It's great to hear all your insights and stories, and maybe your fine arts background helped you be creative enough to see the nuance of behavioral health in this way. So that was very interesting closing. So thank you for your time.

Brandon Keppner 24:48

Dan, thanks for doing this podcast. It's great to have people that help educate others.

Nadine Wilches 24:53

Thank you.