Partnerships for Success (PFS) Community-Level Instrument—Revised (CLI-R) Question 33 Worksheet 33f. Institute of 33e. CSAP strategy Medicine (IOM) 33g. Intervention 33a. Intervention name 33b. Service Type 33c. Service Type name 33d. Date started type category targets Select the name of each Select the service type for each Write in the name of the specific Date you began funding Select the CSAP Select the IOM Select the option prevention intervention you major set of services or activities you set of services or activities that this intervention service strategy type that best category for this that best describes are implementing, or select are implementing for this you implemented as part of your type through your PFS describes this intervention service the targets of this and write in the intervention, or select and intervention. In many cases, this initiative intervention service type type intervention service “other” “other” name write in the name. Many strategies will be the same as the type (MM/YYYY) may consist of only one service type. intervention name.
Partnerships for Success (PFS) Community-Level Instrument—Revised (CLI-R) Question 33 Worksheet 33a. Intervention name 33b. Service Type 33c. Service Type name 33d. Date started 33e. CSAP strategy type 33f. Institute of Medicine (IOM) category 33g. Intervention targets Select the name of each prevention intervention you are implementing, or select “other” and write in the name Select the service type for each major set of services or activities you are implementing for this intervention, or select “other” and write in the name. Many strategies may consist of only one service type. Write in the name of the specific set of services or activities that you implemented as part of your intervention. In many cases, this will be the same as the intervention name. Date you began funding this intervention service type through your PFS initiative (MM/YYYY) Select the CSAP strategy type that best describes this intervention service type Select the IOM category for this intervention service type Select the option that best describes the targets of this intervention service type
CLI-R%20Q33%20Worksheet_2015_0508%20(3).docx