| Main Purpose |
The purpose of this module is to have a standardized way of tracking
service referrals that are made to collateral and cooperating agencies. |
| Description |
- Checklist of types of referrals.
- The draft shows each referral agency as generic; for example, "Agency 1,"
"Agency 2," etc. If projects wish they may type in the names of these agencies
for their project. Obviously, this portion of the form will not be standardized across
projects, but the EDC can track this for individual projects. The portion labeled
"Referrals Made For" will be kept standard across all projects.
- Completion time is 1-2 minutes.
|
| Target Projects for Form |
- Any project documenting service linkages and referrals.
|
| Major Evaluation Function |
- Characterize referral history of project clients.
- Referrals and follow-through (documented by local evaluators) may be an important
outcome for individual projects.
|
| Comments |
- As noted above, individual projects may type in the name of local service agencies on
the generic form. This would allow specific referrals to be tracked.
|
| Implementation |
- Module 51 Current Version (dated 1/5/96) Activation Number: 47613.
- Module 51 (Well Being Institute Form) Current Version (dated 2/14/96) Activation Number:
6674.
- Module 51 (Outreach, Inc. Form) Current Version (dated 1/21/97) Activation Number: 4802.
- Module 51 (Center for Community Health Education & Research) Current Version (dated
8/22/96) Activation Number: 51097.
|
| Citation(s) |
- Huba, G. J., Melchior, L. A., Staff of The Measurement Group, and
HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1996). Module 51: Referral Form. Available:
www.TheMeasurementGroup.com. Culver City, California: The
Measurement Group.
|
