Potential Indicators of Patient-Client Service Needs and Vulnerabilities
Second Generation Analyses [May 4, 2000]

In the CHAID analysis reported here, in addition to gender and sexual orientation, the following indicators of service needs and vulnerabilities were tested as potential predictors (or splitters) of the dependent variable.

The potential predictors were

  • age [coded as < 21, 21-55, > 55]
  • race-ethnicity [coded as African American/Black, Hispanic/Latino, Caucasian, Combined Small Groups]
  • primary language [coded as English, Not English, Missing]
  • childcare needs [coded as No Childcare Needs, 1 Child Needs Care, >1 Child Needs Care, Missing]
  • highest grade completed [coded as No HS (<10), Some HS (10-11), HS Grad (12+), Missing]
  • employment status [coded as Employed, Unemployed, Disabled, Missing]
  • insurance coverage  [coded as Public Insurance, Private Insurance, No Insurance, Missing]
  • alcohol problem [coded as Current, Prior, No, Missing]
  • heroin use [coded as Current, Prior, No, Missing]
  • crack use [coded as Current, Prior, No, Missing]
  • other illicit drug use [coded as Current, Prior, No, Missing]
  • criminal justice system involvement [coded as Current, Prior, No, Missing]
  • sex work [coded as Current, Prior, No, Missing]
  • sex with injection drug user  [coded as Current, Prior, No, Missing]
  • housing status [coded as Own Home, Friend's Home, Unstable Housing, Missing]

In some instances, we included two alternate predictors

  • dependent upon public supported medical services [coded as Not Public Medical, Public Medical, Missing]
  • drug abuse [coded as Current, Prior, No, Missing]

The following table provides definitions for the time frames listed above.

Time Period Definition
Current Risk Risk in the last 30 days
Prior Risk Risk prior to the last 30 days
No Risk Risk coded as never present

Note on the scaling of predictor variables: Unless otherwise noted, the indicators coded as "current-prior-no" were typically treated as nominal variables in the exploratory CHAID analyses conducted here. That is, rather than saying that a variable [such as coding use of heroin] has three categories and the relationships to the dependent variables should be no use > prior use > current use [or conversely no use < prior use < current use] we allowed the three categories to be ordered in the data as empirically determined to be appropriate. In many cases we have done alternate analyses considering these categorical variables [blue above] to be ordinal and the results are essentially the same. The choice of the nominal scaling was favored in that it was not always clear that individuals with prior risks would be treated by programs in a way intermediate to those with no risk and current risk. At any rate, in most cases there are no substantive differences attributable to the variable measurement issue. Note also that in all of our CHAID analyses on these variables, missing values on the service need and vulnerability indicators were considered to be a potentially valid data elements in that if the indicators were not known by the service providers, then service histories might be different.

Note on CHAID models: CHAID is a useful method of summarizing data, and can show major natural divisions of the sample by various defining variables. It must be recognized, however, that CHAID is analogous to a "forward" stepwise regression analysis and has all of the possible inferential difficulties of such stepwise regression methods. The statistical significance tests are sequential ones dependent on prior splits of the sample. In many cases, the models presented should be considered as suggestive, but not absolutely definitive as there may be alternate models that also fit these data in a statistically or theoretically acceptable manner. This model may have been manually altered very slightly from the automated CHAID modeling trees; specifically, categories for "missing values" may have been separated (or re-split) from categories for actual values with which they were statistically merged if the authors judged this would give a more clear interpretation of the data; the separation may result in a "missing category" with only a few cases that could be statistically merged with one of the other categories. [In those cases where the "missing value" category is combined with actual values, it was judged that the automated split was a better representation of these data.] The use of Bonferroni confidence intervals to correct for the potentially large number of statistical tests in this model building method and the use of more stringent alpha levels results in relatively conservative data representations. All patient-client model analyses were conducted by the senior author [GH] so that consistent data fitting techniques and judgments would be employed in the different areas studied. In many cases, alternate models are presented so that the viewer can judge the appropriateness of one or more ways of looking at the same data.

Appendix: More Detailed Description of How Selected Variables are Coded

Indicator Time Frame Coding How Coded from Module 1 (Enrollment form) Valid Cases Missing Cases
Age At Enrollment If age at enrollment is less than 21 years, code as "Age <21". If age at enrollment is between 21 and 55 years (inclusive), code as "Age 21-55". If age at enrollment is greater than 55 years, code as "Age >55". 4804 0
Race-Ethnicity At Enrollment Major categories are "African American/Black," "Hispanic/Latino," and "Caucasian". Small groups of Asian/Pacific Islanders, Native Americans, and persons with other/unknown ethnic-racial backgrounds are combined into "Combined Small Groups". 4804 0
Primary Language At Enrollment If primary language at enrollment is other than English, code as "Not English". If primary language at enrollment is English, code as "English". If primary language at enrollment is not indicated, code as missing. 4523 281
Childcare Needs At Enrollment At enrollment, if the client-patient has no children needing care, code as "No Childcare Needs". If the client-patient needs care for one child, code as "1 Child Needs Care". If the client-patient needs care for more than one child, code as ">1 Child Needs Care". Cases with missing data as to childcare needs are coded as missing. 3310 1494
Highest Grade Completed At Enrollment If highest grade completed at enrollment is greater than 0 and less than 10, code as "No HS (<10)". If highest grade completed is 10 or 11, code as "Some HS (10-11)". If highest grade completed is at least 12 or the individual has a GED at the time of enrollment, code as "HS Grad (12+)". Cases with missing data as to education are coded as missing. 3097 1707
Employment Status At Enrollment If the individual is unemployed (seeking or not seeking employment) at the time of enrollment, code as "Unemployed". If the individual is employed (part-time or full-time), code as "Employed". If the individual is disabled, code as "Disabled". Cases with missing data as to employment status are coded as missing. 3552 1252
Insurance Coverage At Enrollment "Public Insurance" is coded if the patient-client has Medicaid managed care, Medicaid fee-for-services, other public insurance, or other insurance (institutional) at enrollment. If the person has private insurance or is covered by an HMO, code as "Private Insurance". If the person has no insurance, code as "No Insurance". Cases with missing data as to insurance source are coded as missing. 4132 672
Alcohol Problem At any time recorded during service episode If abuse in the past 30 days is ever noted, code as "Current Alcohol Problem". If no abuse in the past 30 days is coded and abuse prior to the past 30 days is ever noted, code as "Prior Alcohol Problem". If no abuse is ever noted, code as "No Alcohol Problem". Code most severe level of risk identified. Cases with missing data as to problem alcohol use are coded as missing. 2128 2676
Heroin Use At any time recorded during service episode If use in the past 30 days is ever noted, code as "Current Heroin". If no use in the past 30 days is coded and use prior to the past 30 days is ever noted, code as "Prior Heroin". If no use is ever noted, code as "No Heroin". Code most severe level of risk identified. Cases with missing data as to heroin use are coded as missing. 2115 2689
Crack Use At any time recorded during service episode If use in the past 30 days is ever noted, code as "Current Crack". If no use in the past 30 days is coded and use prior to the past 30 days is ever noted, code as "Prior Crack". If no use is ever noted, code as "No Crack". Code most severe level of risk identified. Cases with missing data as to crack use are coded as missing. 2113 2691
Other Illicit Drug Use At any time recorded during service episode If use in the past 30 days is ever noted, code as "Current Other Drug". If no use in the past 30 days is coded and use prior to the past 30 days is ever noted, code as "Prior Other Drug". If no use is ever noted, code as "No Other Drug". Code most severe level of risk identified. Cases with missing data as to other illicit drug use are coded as missing. 2197 2607
Criminal Justice System Involvement At any time recorded during service episode If CJS involvement in the past 30 days is ever noted, code as "Current CJS". If no CJS involvement in the past 30 days is coded and involvement prior to the past 30 days is ever noted, code as "Prior CJS". If no CJS involvement is ever noted, code as "No CJS". Code most severe level of risk identified. Cases with missing data as to CJS involvement are coded as missing. 2019 2785
Sex Work At any time recorded during service episode If sex work in the past 30 days is ever noted, code as "Current Sex Work". If no sex work in the past 30 days is coded and sex work prior to the past 30 days is ever noted, code as "Prior Sex Work". If no sex work is ever noted, code as "No Sex Work". Code most severe level of risk identified. Cases with missing data as to sex work are coded as missing. 2125 2679
Sex with Injection Drug User At any time recorded during service episode If sex with IDU in the past 30 days is ever noted, code as "Current Sex with IDU". If no sex with IDU in the past 30 days is coded and sex with IDU prior to the past 30 days is ever noted, code as "Prior Sex with IDU". If no sex with IDU is ever noted, code as "No Sex with IDU". Code most severe level of risk identified. Cases with missing data as to sex with IDU are coded as missing. 1497 3307
Housing Status At enrollment "Unstable Housing" is coded if the patient-client lives anywhere other than his/her own house or apartment at enrollment (including transitional housing, on the street, or short- and long-term institutions). "Own Home" is coded if the person lives in his/her own house or apartment at the time of enrollment. "Friend's Home" is coded if the person lives in someone else's house or apartment at enrollment. Cases with missing data as to housing status are coded as missing. 3898 906
Dependent Upon Public Supported Medical Services At Enrollment "Public Medical" is coded if the patient-client has Medicaid managed care, Medicaid fee-for-services, other public insurance, other insurance (institutional) or no insurance at enrollment. "Public Medical" is also coded if the person uses a publicly-funded community health center or another public clinic or department as his/her primary healthcare source. If the person does not have Medicaid and does not have other public insurance, and does not receive services from a publicly-funded clinic, code as "Not Public Medical". 4298 506
Drug Abuse At any time recorded during service episode This indicator is a composite of crack use, heroin use, other illicit drug use, injection drug use, and needle sharing. If any of these drug abuse behaviors are coded in the past 30 days, code as "Current Drug Abuse". If no drug abuse in the past 30 days is coded and any of these drug abuse behaviors are noted prior to the past 30 days, code as "Prior Drug Abuse". If no drug abuse is ever noted on all of the drug abuse behaviors, code as "No Drug Abuse". Code most severe level of risk identified. Cases with missing data as to drug abuse are coded as missing. 2399 2405

 

Time Period Definition
Current Risk Risk in the last 30 days
Prior Risk Risk prior to the last 30 days
No Risk Risk coded as never present

Notes illustrating specific issues.

Note 1. Coding Racial-Ethnic Group from original codes.




First Generation Analyses [June 15, 1999]: In most cases these analyses were or will be replaced with second generation predictors.

In the first generation CHAID analyses reported here, in addition to gender, indicators of service needs and vulnerabilities were tested as potential predictors of the dependent variable.

The potential predictors were

  • under age 21 [coded as yes, no]
  • person of color [coded as yes, no]
  • primary language other than English [coded as yes, no]
  • children requiring care [coded as yes, no]
  • education of less than 12 years [coded as yes, no]
  • not working [coded as yes, no]
  • dependent on public support for medical services [coded as yes, no]
  • current or prior alcohol problem [coded as current, prior, no]
  • used or had used heroin [coded as current, prior, no]
  • used or had used crack [coded as current, prior, no]
  • used or had used another illicit drug [coded as current, prior, no]
  • were or had been involved with the criminal justice system [coded as current, prior, no]
  • engaged in current or prior sex work [coded as current, prior, no]
  • without stable housing [coded as yes, no]

As the analyses for this Knowledge Base were conducted over an 18-month period, two major variations of the labeling of the service needs and vulnerabilities indicators were used (with certain other minor variations occasionally used). The variables and data are the same in all analyses; the labels were changed to make some of the analyses (especially those done near the end of the analysis cycle) more self explanatory in the case of complex CHAID diagrams and other analyses. In some cases, the CHAID diagrams in a Knowledge Item will label the variables using Variation 2 while a series of pie diagrams may label them using Variation 1. [Note: the variable labeling-coding does not affect any of the statistical results, just the variable labeling within tables or diagrams.]

Indicator Labeling Variation 1 Labeling Variation 2 How Coded from Module 1 (Enrollment form)
Under age 21 coded as yes, no "Age < 21" / "Age 21+" Youngest while in program
Person of color coded as yes, no "Person of Color" / "Not person of Color" On first enrollment form
Primary language other than English coded as yes, no "Not English" / "English" On first enrollment form
Children requiring care coded as yes, no "Needs Childcare" / "No Childcare" On first enrollment form
Education of less than 12 years coded as yes, no "Not HS Grad" / "HS Grad" On first enrollment form
Not working coded as yes, no "Unemployed" / "Employed" On first enrollment form
Dependent on public support for medical services coded as yes, no "Public Medical" / "Not Public Medical" On first enrollment form
Current or prior alcohol problem coded as current, prior, no "Current Alcohol" / "Prior Alcohol" / "No Known Alcohol" Most severe level ever coded
Used or had used heroin coded as current, prior, no "Current Heroin" / "Prior Heroin" / "No Known Heroin" Most severe level ever coded
Used or had used crack coded as current, prior, no "Current Crack" / "Prior Crack" / "No Known Crack" Most severe level ever coded
Used or had used another illicit drug coded as current, prior, no "Current Other Drug" / "Prior Other Drug" / "No Known Other Drug" Most severe level ever coded
Were or had been involved with the criminal justice system coded as current, prior, no "Current CJS" / "Prior CJS" / "No Known CJS" Most severe level ever coded
Engaged in current or prior sex work coded as current, prior, no "Current Sex Work" / "Prior Sex Work" / "No Known Sex Work" Most severe level ever coded
Without stable housing coded as yes, no "Unstable Housing" / "Stable Housing" On first enrollment form

 

Time Period Definition
Current Risk Risk in the last 30 days
Prior Risk Risk prior to the last 30 days
No Known Risk Risk not known to service provider

Note on the scaling of predictor variables: Unless otherwise noted, the three category variables were typically treated as nominal variables in the exploratory CHAID analyses conducted here. That is, rather than saying that a variable [such as using heroin coded] has three categories and the relationships to the dependent variables should be no use > prior use > current use [or conversely no use < prior use < current use] we allowed the three categories to be ordered in the data as empirically determined to be appropriate. In many cases we have done alternate analyses considering the three category variables [blue above] to be ordinal and the results are essentially the same. The choice of the nominal scaling was favored in that it was not always clear that prior users of drugs would be treated by programs in a way intermediate to nonusers and active users. At any rate, in most cases there are no substantive differences attributable to the variable measurement issue. Note also that in all of our CHAID analyses on these variables, missing values on the service need and vulnerability indicators were considered to be a potentially valid data elements in that if the indicators were not known by the service providers, then service histories might be different.

Note on CHAID models: CHAID is a useful method of summarizing data, and can show major natural divisions of the sample by various defining variables. It must be recognized, however, that CHAID is analogous to a "forward" stepwise regression analysis and has all of the possible inferential difficulties of such stepwise regression methods. The statistical significance tests are sequential ones dependent on prior splits of the sample. In many cases, the models presented should be considered as suggestive, but not absolutely definitive as there may be alternate models that also fit these data in a statistically or theoretically acceptable manner. This model may have been manually altered very slightly from the automated CHAID modeling trees; specifically, categories for "missing values" may have been separated (or re-split) from categories for actual values with which they were statistically merged if the authors judged this would give a more clear interpretation of the data; the separation may result in a "missing category" with only a few cases that could be statistically merged with one of the other categories. [In those cases where the "missing value" category is combined with actual values, it was judged that the automated split was a better representation of these data.] The use of Bonferroni confidence intervals to correct for the potentially large number of statistical tests in this model building method and the use of more stringent alpha levels results in relatively conservative data representations. All patient-client model analyses were conducted by the senior author [GH] so that consistent data fitting techniques and judgments would be employed in the different areas studied. In many cases, alternate models are presented so that the viewer can judge the appropriateness of one or more ways of looking at the same data.

Appendix: More Detailed Description of How Selected Variables are Coded

Indicator Time Frame Coding How Coded from Module 1 (Enrollment form) Valid Cases Missing Cases
Under age 21 At Enrollment If age at enrollment is less than 21 years, code as "< Age 21". If age at enrollment is 21 years or older, code as "Age 21+" 4804 0
Person of color At Enrollment If ethnicity is coded as African American; Hispanic-Latino; Asian-Pacific Islander; Native American, Aleutian, or Native Alaskan (or any group within these major categories), code as "Person of Color". If ethnicity is coded as Caucasian, code as "Not Person of Color". For clients who are inconsistently coded at more than one time, coded as "Not Person of Color". 4785 19
Primary language other than English At Enrollment If primary language at enrollment is other than English, code as "Not English". If primary language at enrollment is English, code as "English". 4523 281
Children requiring care At Enrollment At enrollment, if client-patient needs childcare for at least one child, code as "Needs Childcare". If the client-patient has no children needing care, code as "No Childcare Needs". Also, if the client-patient is under the age of 18 and has missing data as to childcare responsibilities, code as "No Childcare Needs". 3313 1491
Education of less than 12 years At Enrollment If highest grade completed at enrollment is greater than 0 and less than 12, code as "Not HS Grad". If highest grade completed is at least 12 or the individual has a GED at the time of enrollment, code as "HS Grad". 3098 1706
Not working At Enrollment If the individual is unemployed (seeking or not seeking employment) or disabled at the time of enrollment, code as "Unemployed". If the individual is employed (part-time or full-time), code as "Employed". Also, if the client-patient is under age 16 or over age 65, missing data are coded as "Unemployed". 3581 1223
Dependent on public support for medical services At Enrollment "Public Medical" is coded if the patient-client has medicaid managed care, medicaid fee-for-services, other public insurance, other insurance (institutional) or no insurance at enrollment. "Public Medical" is also coded if the person uses a publicly-funded community health center or another public clinic or department as his/her primary healthcare source. If the person does not have medicaid and does not have other public insurance, and does not receive services from a publicly-funded clinic, code as "Not Public Medical". 4298 506
Current or prior alcohol problem At any time recorded during service episode If use in the past 30 days was ever noted, code as "Current Alcohol". If no use in the past 30 days was coded and use prior to the past 30 days was ever noted, code as "Prior Alcohol". If no use ever noted, code as "No Known Alcohol". Code most severe level of risk identified. 2782 2022
Used or had used heroin At any time recorded during service episode If use in the past 30 days was ever noted, code as "Current Heroin". If no use in the past 30 days was coded and use prior to the past 30 days was ever noted, code as "Prior Heroin". If no use ever noted, code as "No Known Heroin". Code most severe level of risk identified. 2782 2022
Used or had used crack At any time recorded during service episode If use in the past 30 days was ever noted, code as "Current Crack". If no use in the past 30 days was coded and use prior to the past 30 days was ever noted, code as "Prior Crack". If no use ever noted, code as "No Known Crack". Code most severe level of risk identified. 2782 2022
Used or had used another illicit drug At any time recorded during service episode If use in the past 30 days was ever noted, code as "Current Other Drug". If no use in the past 30 days was coded and use prior to the past 30 days was ever noted, code as "Prior Other Drug". If no use ever noted, code as "No Known Other Drug". Code most severe level of risk identified. 2782 2022
Were or had been involved with the criminal justice system At any time recorded during service episode If CJS involvement in the past 30 days was ever noted, code as "Current CJS". If no CJS involvement in the past 30 days was coded and involvement prior to the past 30 days was ever noted, code as "Prior CJS". If no CJS involvement ever noted, code as "No Known CJS". Code most severe level of risk identified. 2644 2160
Engaged in current or prior sex work At any time recorded during service episode If sex work in the past 30 days was ever noted, code as "Current Sex Work". If no sex work in the past 30 days was coded and sex work prior to the past 30 days was ever noted, code as "Prior Sex Work". If no sex work ever noted, code as "No Known Sex Work". Code most severe level of risk identified. 2782 2022
Without stable housing At enrollment "Unstable Housing" is coded if the patient-client lives anywhere other than his/her own house or apartment at enrollment (including someone else's house/apartment, transitional housing, on the street, or short- and long-term institutions). "Stable Housing" is coded if the person lives in his/her own house or apartment at the time of enrollment. 3898 906

 

Time Period Definition
Current Risk Risk in the last 30 days
Prior Risk Risk prior to the last 30 days
No Known Risk Risk not known to service provide



Last Updated: January 02, 2008; data through June 15, 1999; analyses conducted November 1999 - May 2000 .


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Findings from 27 Cooperative Agreement Projects funded by the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) as Special Projects of National Significance (SPNS) from 1994-1999. Cross-cutting (multisite) evaluation and Knowledge Base by The Measurement Group. The Evaluation and Dissemination Center was funded from 1994-2001.

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Knowledge Base Citation: The Knowledge Base was designed and authored by G. J. Huba, Ph.D.; in collaboration with Lisa A. Melchior, Ph.D.; A. T. Panter, Ph.D.; and the staff of The Measurement Group. Cite this work as "Huba, G. J., Melchior, L. A., and Panter, A. T. (1998 - 2001). The Measurement Group Knowledge Base on HIV/AIDS Care. On the World Wide Web: http://www.TheMeasurementGroup.com." This Knowledge Base has been authored and published by The Measurement Group using results generated in its cross-cutting evaluation studies of the 27 HRSA SPNS Cooperative Agreements. 

Questions or Comments: Contact The Measurement Group.

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Collaborators from Participating Projects: Cooperative Agreement Steering Committee 1999.

Participating Projects: This Knowledge Base is based on the service delivery experiences of 27 Cooperative Agreement Projects on Innovative Models of HIV/AIDS Care. These projects and the Evaluation and Dissemination Center were funded by the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) as Special Projects of National Significance (SPNS) between 1994 and 1999. Click the Model Programs button in any individual Knowledge Item for descriptions of the projects that contributed to the specific Knowledge Item, a list of key staff at the projects, and  grant numbers.

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Work on the Knowledge Base and the cross-cutting evaluation was supported in part by Grant Number 5 U90 HA 00030-05 from the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau's (HAB) Special Projects of National Significance (SPNS). The contents of this Knowledge Base are solely the responsibility of The Measurement Group and do not necessarily represent the official views of HRSA or HRSA/HAB's Special Projects of National Significance nor may they represent the positions of the individual grantees whose projects are included in the cross-cutting evaluation.


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