Jessica Breland, MS, PhD is a licensed clinical psychologist and a postdoctoral fellow in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine, and at the Center for Innovation to Implementation in the VA Palo Alto Health Care System. Dr. Breland received her PhD in psychology from Rutgers and completed her clinical internship at the Baylor College of Medicine in Houston, TX.
Her work focuses on using quantitative and qualitative methods to: 1) assess outcomes related to the implementation of evidenced-based treatments, especially through controlled trials in novel settings (e.g., primary care) or with novel methods (e.g., apps); 2) identify and reduce racial and ethnic disparities in health; and 3) enhance care for patients with chronic conditions, such as obesity or diabetes.
Honors & Awards
Excellence Fellowship, Rutgers, The State University of New Jersey, Department of Psychology (2008; 2010)
Fellow, Annual Summer Institute on Randomized Behavioral Clinical Trials, National Institutes of Health, Office of Behavioral and Social Science Research (2015)
Doctor of Philosophy, Rutgers University (2013)
Predoctoral Clinical Internship, Baylor College of Medicine (2013)
MS, Rutgers University (2010)
Bachelor of Arts, University of Pennsylvania (2005)
Craig Rosen, Postdoctoral Faculty Sponsor
Key ingredients for implementing intensive outpatient programs within patient-centered medical homes: A literature review and qualitative analysis.
Healthcare (Amsterdam, Netherlands)
2016; 4 (1): 22-29
Intensive outpatient programs aim to transform care while conserving resources for high-need, high-cost patients, but little is known about factors that influence their implementation within patient-centered medical homes (PCMHs).In this mixed-methods study, we reviewed the literature to identify factors affecting intensive outpatient program implementation, then used semi-structured interviews to determine how these factors influenced the implementation of an intensive outpatient program within the Veterans Affairs' (VA) PCMH. Interviewees included facility leadership and clinical staff who were involved in a pilot Intensive Management Patient Aligned Care Team (ImPACT) intervention for high-need, high-cost VA PCMH patents. We classified implementation factors in the literature review and qualitative analysis using the Consolidated Framework for Implementation Research (CFIR).The literature review (n=9 studies) and analyses of interviews (n=15) revealed key implementation factors in three CFIR domains. First, the Inner Setting (i.e., the organizational and PCMH environment), mostly enabled implementation through a culture of innovation, good networks and communication, and positive tension for change. Second, Characteristics of Individuals, including creativity, flexibility, and interpersonal skills, allowed program staff to augment existing PCMH services. Finally, certain Intervention Characteristics (e.g., adaptability) enabled implementation, while others (e.g., complexity) generated implementation barriers.Resources and structural features common to PCMHs can facilitate implementation of intensive outpatient programs, but program success is also dependent on staff creativity and flexibility, and intervention adaptations to meet patient and organizational needs.Established PCMHs likely provide resources and environments that permit accelerated implementation of intensive outpatient programs.V.
View details for DOI 10.1016/j.hjdsi.2015.12.005
View details for PubMedID 27001095
- Longitudinal changes in somatic symptoms and family disagreements among depression and community groups: a 23-year study BMC PSYCHIATRY 2015; 15
Identification of Anxiety Symptom Clusters in Patients with COPD: Implications for Assessment and Treatment
INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE
2015; 22 (5): 590-596
Treatment of chronic obstructive pulmonary disease (COPD) is palliative, and quality of life is important. Increased understanding of correlates of quality of life and its domains could help clinicians and researchers better tailor COPD treatments and better support patients engaging in those treatments or other important self-management behaviors.Anxiety is common in those with COPD; however, overlap of physical and emotional symptoms complicates its assessment. The current study aimed to identify anxiety symptom clusters and to assess the association of these symptom clusters with COPD-related quality of life.Participants (N = 162) with COPD completed the Beck Anxiety Inventory (BAI), Chronic Respiratory Disease Questionnaire, Patient Health Questionnaire-9, and Medical Research Council dyspnea scale. Anxiety clusters were identified, using principal component analysis (PCA) on the BAI's 21 items. Anxiety clusters, along with factors previously associated with quality of life, were entered into a multiple regression designed to predict COPD-related quality of life.PCA identified four symptom clusters related to (1) general somatic distress, (2) fear, (3) nervousness, and (4) respiration-related distress. Multiple regression analyses indicated that greater fear was associated with less perceived mastery over COPD (β = -0.19, t(149) = -2.69, p < 0.01).Anxiety symptoms associated with fear appear to be an important indicator of anxiety in patients with COPD. In particular, fear was associated with perceptions of mastery, an important psychological construct linked to disease self-management. Assessing the BAI symptom cluster associated with fear (five items) may be a valuable rapid assessment tool to improve COPD treatment and physical health outcomes.
View details for DOI 10.1007/s12529-014-9450-2
View details for Web of Science ID 000361736300004
View details for PubMedID 25622813
Models for treating depression in specialty medical settings: a narrative review
GENERAL HOSPITAL PSYCHIATRY
2015; 37 (4): 315-322
This review answered two questions: (a) what types of specialty medical settings are implementing models for treating depression, and (b) do models for treating depression in specialty medical settings effectively treat depression symptoms?We searched Medline/Pubmed to identify articles, published between January 1990 and May 2013, reporting on models for treating depression in specialty medical settings. Included studies had to have adult participants with comorbid medical conditions recruited from outpatient, nonstandard primary care settings. Studies also had to report specific, validated depression measures.Search methods identified nine studies (six randomized controlled trials, one nonrandomized controlled trial and two uncontrolled trials), all representing integrated care for depression, in three specialty settings (oncology, infectious disease, neurology). Most studies (N=7) reported greater reductions in depression among patients receiving integrated care compared to usual care, particularly in oncology clinics.Integrated care for depression in specialty medical settings can improve depression outcomes. Additional research is needed to understand the effectiveness of incorporating behavioral and/or psychological treatments into existing methods. When developing or selecting a model for treating depression in specialty medical settings, clinicians and researchers will benefit from choosing specific components and measures most relevant to their target populations.
View details for DOI 10.1016/j.genhosppsych.2015.04.010
View details for Web of Science ID 000355555800009
View details for PubMedID 25956666
Racial Differences in Chronic Conditions and Sociodemographic Characteristics Among High-Utilizing Veterans.
Journal of racial and ethnic health disparities
2015; 2 (2): 167-175
African-Americans are disproportionally represented among high-risk, high-utilizing patients. To inform program development for this vulnerable population, the current study describes racial variation in chronic conditions and sociodemographic characteristics among high-utilizing patients in the Veterans Affairs Healthcare System (VA).We identified the 5 % most costly Veterans who used inpatient or outpatient care at the VA during fiscal year 2010 (N = 237,691) based on costs of inpatient and outpatient care, pharmacy services, and VA-sponsored contract care. Patient costs and characteristics were abstracted from VA outpatient and inpatient data files. Racial differences in sociodemographic characteristics (age, sex, marital support, homelessness, and health insurance status) were assessed with chi-square tests. Racial differences in 32 chronic condition diagnoses were calculated as relative risk ratios.African-Americans represented 21 % of high-utilizing Veterans. African-Americans had higher rates of homelessness (26 vs. 10 %, p < 0.001) and lower rates of supplemental health insurance (44 vs. 58 %, p < 0.001). The mean number of chronic conditions was similar across race. However, there were racial differences in the prevalence of specific chronic conditions, including a higher prevalence of HIV/AIDS (95 % confidence interval (CI) 4.86, 5.50) and schizophrenia (95 % CI 1.94, 2.07) and a lower prevalence of ischemic heart disease (95 % CI 0.57, 0.59) and bipolar disorder (95 % CI 0.78, 0.85) among African-American high-utilizing Veterans.Racial disparities among high-utilizing Veterans may differ from those found in the general population. Interventions should devote attention to social, environmental, and mental health issues in order to reduce racial disparities in this vulnerable population.
View details for DOI 10.1007/s40615-014-0060-0
View details for PubMedID 26863335
Correlates of Pain Intensity in Community-Dwelling Individuals With Mild to Moderate Dementia
AMERICAN JOURNAL OF ALZHEIMERS DISEASE AND OTHER DEMENTIAS
2015; 30 (3): 320-325
To identify correlates of participant-reported pain in community-dwelling individuals with mild to moderate dementia.Associations among participant-reported pain intensity and depressive symptoms, mental health diagnoses, pain diagnoses, pain medications, level of functional ability, and cognitive impairment were assessed in 136 community-dwelling veterans with mild to moderate dementia and pain. Univariate and multiple regressions were used to assess relationships among the independent variables and participant-reported pain.Pain diagnoses (β = .23, t 132 = 2.65, P < .01) and pain medications (β = .21, t 132 = 2.48, P < .05) were correlated with participant-reported pain intensity in univariate regression models. Only pain diagnoses (β = .20, t 132 = 2.17, P < .05) remained a significant predictor in adjusted models.Participant-reported pain in individuals with dementia appears to be a unique construct for which other psychosocial indicators cannot be substituted. Therefore, directly asking community-dwelling individuals with mild to moderate dementia about their pain is a critical component of assessment.
View details for DOI 10.1177/1533317514545827
View details for Web of Science ID 000354411000012
View details for PubMedID 25107934
The Effect of Medical Comorbidities on Male and Female Veterans' Use of Psychotherapy for PTSD.
2015; 53 (4): S120-7
Posttraumatic stress disorder (PTSD) is associated with an increased risk for medical comorbidities that may prevent participation in psychotherapy. The present study investigated whether medical comorbidities were associated with lower initiation rates and fewer psychotherapy visits for PTSD. Because women are more likely to initiate psychotherapy after traumatic events, we also assessed whether relationships were weaker among women.Veterans (N=482, 47% women) recently diagnosed with PTSD completed a survey assessing demographics, mood, functional status, and interest in treatment. Data on medical comorbidities, psychotherapy visits, antidepressant prescriptions, and service connection were assessed longitudinally through administrative files. Logistic and negative binomial regressions assessed associations between number of medical comorbidities in the 2 years before the survey and the initiation and number of psychotherapy visits for PTSD in the year after the survey. All analyses were stratified by sex and controlled for survey and administrative variables.The relationship between medical comorbidities and number of psychotherapy visits was stronger among women than among men. A greater number of medical comorbidities was associated with significantly fewer psychotherapy visits in the total sample [incidence rate ratio: 0.91; 95% confidence interval (CI): 0.83, 1.00] and among women (incidence rate ratio: 0.87; 95% CI: 0.77, 0.99), but not among men (95% CI: 0.75, 1.01). Medical comorbidities were not associated with the initiation of psychotherapy among men or women.Addressing medical comorbidities may help individuals remain in psychotherapy for PTSD. Medical comorbidities may play a larger role in the number of psychotherapy visits among women than men.
View details for DOI 10.1097/MLR.0000000000000284
View details for PubMedID 25767965
Partnered research in healthcare delivery redesign for high-need, high-cost patients: development and feasibility of an Intensive Management Patient-Aligned Care Team (ImPACT).
Journal of general internal medicine
2014; 29: 861-869
We employed a partnered research healthcare delivery redesign process to improve care for high-need, high-cost (HNHC) patients within the Veterans Affairs (VA) healthcare system.Health services researchers partnered with VA national and Palo Alto facility leadership and clinicians to: 1) analyze characteristics and utilization patterns of HNHC patients, 2) synthesize evidence about intensive management programs for HNHC patients, 3) conduct needs-assessment interviews with HNHC patients (n = 17) across medical, access, social, and mental health domains, 4) survey providers (n = 8) about care challenges for HNHC patients, and 5) design, implement, and evaluate a pilot Intensive Management Patient-Aligned Care Team (ImPACT) for a random sample of 150 patients.HNHC patients accounted for over half (52 %) of VA facility patient costs. Most (94 %) had three or more chronic conditions, and 60 % had a mental health diagnosis. Formative data analyses and qualitative assessments revealed a need for intensive case management, care coordination, transitions navigation, and social support and services. The ImPACT multidisciplinary team developed care processes to meet these needs, including direct access to team members (including after-hours), chronic disease management protocols, case management, and rapid interventions in response to health changes or acute service use. Two-thirds of invited patients (n = 101) enrolled in ImPACT, 87 % of whom remained actively engaged at 9 months. ImPACT is now serving as a model for a national VA intensive management demonstration project.Partnered research that incorporated population data analysis, evidence synthesis, and stakeholder needs assessments led to the successful redesign and implementation of services for HNHC patients. The rigorous design process and evaluation facilitated dissemination of the intervention within the VA healthcare system.Employing partnered research to redesign care for high-need, high-cost patients may expedite development and dissemination of high-value, cost-saving interventions.
View details for DOI 10.1007/s11606-014-3022-7
View details for PubMedID 25355084
Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial
BMC HEALTH SERVICES RESEARCH
Depression and diabetes cause significant burden for patients and the healthcare system and, when co-occurring, result in poorer self-care behaviors and worse glycemic control than for either condition alone. However, the clinical management of these comorbid conditions is complicated by a host of patient, provider, and system-level barriers that are especially problematic for patients in rural locations. Patient-centered medical homes provide an opportunity to integrate mental and physical health care to address the multifaceted needs of complex comorbid conditions. Presently, there is a need to not only develop robust clinical interventions for complex medically ill patients but also to find feasible ways to embed these interventions into the frontlines of existing primary care practices.This randomized controlled trial uses a hybrid effectiveness-implementation design to evaluate the Healthy Outcomes through Patient Empowerment (HOPE) intervention, which seeks to simultaneously address diabetes and depression for rural veterans in Southeast Texas. A total of 242 Veterans with uncontrolled diabetes and comorbid symptoms of depression will be recruited and randomized to either the HOPE intervention or to a usual-care arm. Participants will be evaluated on a host of diabetes and depression-related measures at baseline and 6- and 12-month follow-up. The trial has two primary goals: 1) to examine the effectiveness of the intervention on both physical (diabetes) and emotional health (depression) outcomes and 2) to simultaneously pilot test a multifaceted implementation strategy designed to increase fidelity and utilization of the intervention by coaches interfacing within the primary care setting.This ongoing blended effectiveness-implementation design holds the potential to advance the science and practice of caring for complex medically ill patients within the constraints of a busy patient-centered medical home.Behavioral Activation Therapy for Rural Veterans with Diabetes and Depression: NCT01572389.
View details for DOI 10.1186/1472-6963-14-191
View details for Web of Science ID 000336764700001
View details for PubMedID 24774351
Correlates of Pain Intensity in Community-Dwelling Individuals with Mild-to-Moderate Dementia
American Journal of Alzheimer’s Disease and Other Dementias
View details for DOI 10.1177/1533317514545827
Challenges to healthy eating for people with diabetes in a low-income, minority neighborhood.
2013; 36 (10): 2895-2901
This study used qualitative interviews with black and Latino participants with diabetes to further understanding about types of foods eaten, food preparation, sources of foods and meals, communication with providers, and effects of race and ethnicity on eating in this population.Researchers recruited black and Latino adults from East Harlem, New York, to participate in four English and Spanish focus groups. Discussions were transcribed, coded, and analyzed to uncover prevalent themes, which were interpreted with the Common Sense Model of Self-Regulation.Thirty-seven adults with diabetes participated in four focus groups. The following four major themes emerged from the analyses: 1) The food environment limited participants' access to healthy foods; 2) understanding of diabetes and communication with clinicians about healthy eating was limited and abstract; 3) the short-term, negative consequences of healthy eating outweighed the benefits; and 4) stress, in large part from poverty and discrimination, was seen as a causal factor for both poor eating and diabetes.Participants' responses indicated that using healthy eating to control diabetes does not provide immediate, tangible results. Thus, these participants followed their own common sense to guide their diabetes management and improve their health. Clinicians may be better able to help patients eat healthfully if they consider these factors during medical visits.
View details for DOI 10.2337/dc12-1632
View details for PubMedID 23877980
Adherence to evidence-based guidelines among diabetes self-management apps.
Translational behavioral medicine
2013; 3 (3): 277-286
Smartphone apps can provide real-time, interactive self-management aid to individuals with diabetes. It is currently unclear whether existing diabetes self-management apps follow evidence-based guidelines. The purpose of this study was to evaluate the extent to which existing diabetes self-management apps address the seven self-management behaviors recommended by the American Association of Diabetes Educators (the AADE7™). The term "diabetes" identified relevant self-management apps via the Apple App Store search engine in March 2012. Ratings were based on app descriptions and downloads. Chi-square analyses assessed differences in apps based on developer type. Apps promoted a median of two AADE7™ skills. Overall reliability between description and download ratings was good (kappa = .66). Reliability of individual skills was variable (kappa = .25 to .91). Most diabetes apps do not conform to evidence-based recommendations, and future app reviews would benefit from testing app performance. Future apps may also benefit from theory-based designs.
View details for DOI 10.1007/s13142-013-0205-4
View details for PubMedID 24073179
Using the Common Sense Model of Self-regulation to review the effects of self-monitoring of blood glucose on glycemic control for non-insulin-treated adults with type 2 diabetes.
2013; 39 (4): 541-559
This systematic review examined the relationship between self-monitoring of blood glucose (SMBG) and glycemic control in patients with type 2 diabetes. The Common Sense Model of Self-Regulation (CSM) served as a theoretical framework for examining how, when (mediators), and for whom (moderators) SMBG improved glycemic control.Five databases were searched: Medline, PsychInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing & Allied Health Literature.Included studies had cross-sectional, longitudinal, or randomized controlled trial designs; were published between 2007 and 2011; and included patients with type 2 diabetes at least some of whom were not taking insulin; 1318 studies were screened, 119 were reviewed in detail, and 26 were included.Data were collected on the relationship between SMBG and glycemic control, study design, mediators, moderators, participant characteristics, the CSM, and limitations.Twenty-six studies met criteria for inclusion: 11 cross-sectional, 4 longitudinal, and 11 randomized controlled trials. The results of the cross-sectional studies were inconclusive. Results from the longitudinal studies and randomized control trials suggested that SMBG may improve glycemic control. The few studies investigating mediators or moderators reported mixed results. Few studies effectively measured the CSM.Data suggested that SMBG may help improve glycemic control. Future trials must be designed to test hypotheses and improve our understanding of when, how, and for whom SMBG can enhance glycemic control. Rigorously controlled repetitions of current 2-arm trials will yield little new knowledge of theoretical or practical value.
View details for DOI 10.1177/0145721713490079
View details for PubMedID 23749773
Applying a common-sense approach to fighting obesity.
Journal of obesity
2012; 2012: 710427-?
The obesity epidemic is a threat to the health of millions and to the economic viability of healthcare systems, governments, businesses, and nations. A range of answers come to mind if and when we ask, "What can we, health professionals (physicians, nurses, nutritionists, behavioral psychologists), do about this epidemic?" In this paper, we describe the Common-Sense Model of Self-Regulation as a framework for organizing existent tools and creating new tools to improve control of the obesity epidemic. Further, we explain how the Common-Sense Model can augment existing behavior-change models, with particular attention to the strength of the Common-Sense Model in addressing assessment and weight maintenance beyond initial weight loss.
View details for DOI 10.1155/2012/710427
View details for PubMedID 22811889
Cognitive Science Speaks to the "Common-Sense" of Chronic Illness Management
ANNALS OF BEHAVIORAL MEDICINE
2011; 41 (2): 152-163
We describe the parallels between findings from cognitive science and neuroscience and Common-Sense Models in four areas: (1) Activation of illness representations by the automatic linkage of symptoms and functional changes with concepts (an integration of declarative and perceptual and procedural knowledge); (2) Action plans for the management of symptoms and disease; (3) Cognitive and behavioral heuristics (executive functions parallel to recent findings in cognitive science) involved in monitoring and modifying automatic control processes; (4) Perceiving and communicating to "other minds" during medical visits to address the declarative and non-declarative (perceptual and procedural) knowledge that comprise a patient's representations of illness and treatment (the transparency of other minds).
View details for DOI 10.1007/s12160-010-9246-9
View details for Web of Science ID 000290802000003
View details for PubMedID 21136224