Tennessee Department of Children's Services
Child Abuse Prevention Outcome Measurement
Agency Name:
Report type:
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.
A:  Service Provided:
1.
Number of instruments administered:
2.
Number of instruments completed:
3.
Number of satisfactory/successful:
4.
Number of unsatisfactory/unsuccessful:
5.
Percent satisfactory/successful:
B:  Service Provided:
6.
Number of instruments administered:
7.
Number of instruments completed:
8.
Number of satisfactory/successful:
9.
Number of unsatisfactory/unsuccessful:
10.
Percent satisfactory/successful:
C:  Service Provided:
11.
Number of instruments administered:
12.
Number of instruments completed:
13.
Number of satisfactory/successful:
14.
Number of unsatisfactory/unsuccessful:
15.
Percent satisfactory/successful: