Ernest Quimby

Social networks and clinical outcomes of dually diagnosed homeless persons

Longitudinal associations between social network characteristics and clinical outcomes were examined in a group of 130 homeless persons diagnosed with substance abuse and severe mental illness. Patients whose alcohol-use disorder remitted over 18 months had more frequent contact with Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) members at baseline, and those whose other substance use disorder remitted had fewer substance users in their baseline social networks. Smaller social networks predicted heavier alcohol use over time which, in turn, predicted attrition of abstinence supporters and decreased multiplexity of relationships. More frequent social contact predicted improved Expanded Brief Psychiatric Rating Scale (BPRS) symptoms. Improved BPRS symptoms and greater multiplexity of social relationships predicted each other over time. More severe BPRS symptoms and attrition of abstinence supporters predicted each other, but the mechanisms of this relationship and possible associations with alcohol or drug use remain to be tested. More severe BPRS symptoms also predicted later, proportional loss of professional contacts. Addiction Severity Index (ASI) drug use showed no longitudinal associations with social network characteristics.

Dynamics of Black Mobilization against AIDS in New York City

Blacks have been disproportionately likely to get AIDS through male/male sex, intravenous drug use, and heterosexual transmission. In spite of the long history of black mobilization, there has been little mobilization around AIDS, even though collective effort could reduce the extent of HIV spread, provide care and services for sick people who now die in isolated loneliness, and create a voice in budgetary and policy decisions that have so far failed to deal adequately with AIDS among minorities. Attempts at black AIDS mobilization in New York City are described and assessed on the basis of field research conducted in 1987-88. Reasons for the failure of these attempts to produce sizable mobilization include socially structured divisions among blacks; ideological paralysis of key actors such as churches and politicians confronted by an epidemic spread by risk behaviors they oppose; poverty; the inherent contradictions of attempted mobilization by elites whose interests differ from those of the threatened population; and the weakening of organizational ties and experience from the 1960s.

Reducing disparities in mental health care: Suggestions from the Dartmouth-Howard collaboration

This article presents recent collaborative efforts between the Dartmouth Psychiatric Research Center and Howard University to understand (and ultimately reduce) disparities in mental health care among African Americans. Researchers from Dartmouth and Howard recently formalized a longstanding collaboration through the support of a grant aimed at understanding recovery and rehabilitation for African Americans with severe mental illness. Grant-sponsored efforts have included two seminars between multi-disciplinary mental health researchers and clinicians to inform the implementation of a collaborative research and training program. This article outlines the prominent themes arising from these seminars on the issue of health disparities agreed upon by our multi-disciplinary research team. These are (1) situating disparity research in the context of social justice; (2) understanding trends in disparities; (3) promoting a sophisticated understanding of ‘culture’ and its role in disparities; (4) critically assessing strategies that attempt to mitigate disparities; (5) developing a reflexive research agenda.

Obstacles to Reducing AIDS among African Americans

The major obstacles to sustaining mobilization efforts are objective conditions, attitudes toward sexuality, perceptions of substance abuse and HIV/AIDS, and conflicting policy views. Organizational responses to the epidemic occur within circumstances ofperceived oppression, neglect, competing and conflicting agendas, and religious conservatism. Suspicion, often dismissed by public health officials and community-based outreach workers, neutralizes programmatic activities. Popular reactionsfocus on debates about conspiracy theories, fear of racist stigmatization, anda pervasive sense that only marginal groups are affected. Ambivalence hampers prevention and treatment. Public health education is still not sufficiently penetrating African American neighborhoods. Efforts have not been systematic or continous. Many are top-down actions organized by professional elites aimed at their constituencies rather than neighborhoods. Addicts and their sex partners have not been sufficiently empowered or persuaded in large numbers to change their vulnerable actions. Unfortunately the crisis has not waned.

Process Evaluation in the Washington, D.C., Dual Diagnosis Project

In health service demonstration research, process evaluation refers to measuring the program itself rather than its effects. A model-guided process evaluation includes specifying the treatment model, assessing its implementation, monitoring the fidelity of the model throughout the project, assessing model exposure and absorption, and helping to understand the programs intermediate effectsxa0(i.e., proximal outcomes) as well as final effects (i.e., distal outcomes). To illustrate the mechanisms and uses of a process evaluation, this article describes the Washington, D.C., Dual Diagnosis Project, a research demonstration project for homeless persons with co-occurring severe mental disorders and substance use disorders.