Child Abuse Prevention Outcome Measurement

1. Agency Name:
2. Report type:
3. Fiscal Year:
1) A copy of the instrument(s) used to determine outcomes shuold be provided with the first monthly report of the new fiscal year. Accompanying the copy of the instrument, provide a brief statement describing how the service is determined to be satisfactory/successful.

2) Provide the required information below for each service that is being measured.

3) For individuals completing the test, count only one for completion of post-test. Do not count numbers of pre-tests.
4. A: Service Provided
5. Number of instruments administered:
6. Number of instruments completed:
7. Number of satisfactory/successful:
8. Number of unsatisfactory/unsuccessful:
9. Percent satisfactory/successful:
10. B: Service Provided:
11. Number of instruments administered:
12. Number of instruments completed:
13. Number of satisfactory/successful:
14. Number of unsatisfactory/unsuccessful:
15. Number of unsatisfactory/unsuccessful:
16. Percent satisfactory/successful:
17. C: Service Provided:
18. Number of instruments administered:
19. Number of instruments completed:
20. Number of satisfactory/successful:
21. Number of unsatisfactory/unsuccessful:
22. Percent satisfactory/successful:
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