Module 4: Services Needed/Received and Barriers/Facilitators Forms

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

  • Code services needed in the last six months and last month.
  • Code services received in the last six months and last month.
  • Code reason for not seeking-receiving needed services.

Content Domain - Types of services including drug detoxification, residential drug treatment, outpatient or day treatment substance abuse treatment, shelter, food or other basic needs, dentistry, scheduled outpatient and inpatient medical, emergency room services, HIV-related services, mental health, self-help, family counseling, pharmacy, vocational training, case management, HIV testing, and prenatal/pregnancy care. Barriers including cost, accessibility, transportation, lack of child care, perceived staff disdain, language, coercion, disclosure concerns. Facilitators including caring staff, child care, convenient location, and transportation.

Operational Data Items - Form A: Services Needed and Received ID Letters/ID Numbers, Site, Sub-Provider, Service Date, Staff Code, Drug detoxification or maintenance, Residential drug treatment, Outpatient or day treatment for substance abuse, Housing or shelter, Food or other basic needs, Dental services, Scheduled out-patient medical services, Emergency room services, Inpatient medical services, HIV-related medical services, HIV-related self-care services, HIV-related home care services, HIV-related hospice, Mental health services (in-patient or out-patient), Self-help group, Family counseling, Pharmacy, Vocational training, Case management, HIV testing for partner or friend, Prenatal/pregnancy care. Form B: Barriers and Facilitators Form ID Letters/ID Numbers, Site, Sub-Provider, Service Date, Staff Code, List of Barriers, List of Facilitators.

Citations

  • Huba, G. J., Melchior, L. A., Staff of The Measurement Group, and HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1997). Module 4A: Services Needed and Received Form. Available: www.TheMeasurementGroup.com. Culver City, California: The Measurement Group.
  • Huba, G. J., Melchior, L. A., Staff of The Measurement Group, and HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1997). Module 4B: Barriers and Facilitators 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

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