Module 61: Hotline Client Background and Referral Tracking Form

A Module Used in The Measurement Group's Cross-Cutting Evaluation of the HRSA HIV/AIDS Bureau's Special Projects of National Significance on Innovative Models of HIV/AIDS Care

Purpose

• Codes client calls to a hotline or agency when such calls constitute a service.

• Codes referrals made to participating social service agencies.

Content Domain - Tracking of client characteristics and nature of the call. Tracking of referrals for social services, mental health, substance abuse treatment, basic needs services, etc.

Operational Data Items - ID Letters/ID Numbers, Site, Sub-Provider, Date, Client Initials, Gender, DOB, Racial/Ethnic Identity, Staff Code, Phone Inquiry, Phoneline, Topics Discussed, Minutes, Generic List of Referral Agencies (to be customized for sites), Referrals Made, "Other."

Citation - Huba, G. J., Melchior, L. A., Staff of The Measurement Group, and HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1996). Module 61: Hotline Client Background and Referral Tracking Form. Available: www.TheMeasurementGroup.com. Culver City, California: The Measurement Group.

Usage - Permission is granted for non-commercial use so long as form is not altered, the copyright is not removed, and a proper citation is made to the instrument. Non-commercial use is use by a not-for-profit organization in which the instrument is not sold. If you have questions about appropriate and proper uses, contact The Measurement Group.

Findings from Evaluating HIV/AIDS Programs

Reliability and Validity Studies