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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Acknowledgments
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.
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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)
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