Outcome Information and Forms for Block Grant-Funded Agencies

In the spirit of using block grant funds towards practicing in an "evidence-based" manner, a core set of outcomes will be collected on all individuals served through block grant funded programs. 

Access to the web-based outcomes reporting system

The forms which follow on this page contain the same information that is in the web-based outcomes reporting system.  If users prefer, they can download these forms as word documents, and have clinicians enter the information that way initiailly.  HOWEVER, all data must be entered into the web-based system at each individual site!

Outcomes Materials for Adults with Serious Mental Illness (SMI)

Client Intake Form for Adults with SMI

This form must be completed for all adult clients in block-grant funded programs.  It assigns a 10 digit unique client identifier (birthdate + social security number) which must be used on all subsequent outcomes material for this client.  Additionally, gender, race and diagnostic information is coded here.

Quarterly Outcomes Form for Adults with SMI

This document is the form to be used for adults with serious mental illness who are receiving services through block grant-funded programs. 

Explanatory Infomation on Adult Outcome Form

This document provides definitions and other explanatory information for each of the variables to be collected on the adult outcomes form above.

Web-based Training Information on Adult Intake and Outcomes Form (August 2006)

Outcomes Materials for Children with Serious Emotional Distrubances (SED)

Client Intake Form for Children with SED

This form must be completed for all children with SED being served in block-grant funded programs.  It assigns a 10 digit unique client identifier (birthdate + social security number) which must be used on all subsequent outcomes material for this client.  Additionally, gender, race and diagnostic information is coded here.

Quarterly Outcomes Form for Children SED

This document is the form to be used for children with SED who are receiving services through block grant-funded programs. 

Explanatory infomation on Child Outcome Form

This document provides definitions and other explanatory information for each of the variables to be collected on the child outcomes form above.

Web-based Training Information on Child Intake and Outcomes Form (August 2006)

Training Resources

Training on Global Assessment of Functioning (adult and children's versions)

This website from Washington University provides free on-line training for both the GAF and C-GAS via vignettes that have been pre-scored.  A good resource for new and experienced users alike.  (The GAF is required on the adult outcomes form and the C-GAS is required on the children's form).