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Name of prevention program, model, practice or intervention usedType of prevention program (Mental health, substance use, in-home or community-based parenting skill building program, other)Level of evidence
(Well supported, supported, promising, no evidence, unsure)		Intended outcomesPrimary population served (Parents, children, families)
Age of children served (if children are primary population)Number served in _____ year
(Number in primary population)		Average duration of service (in weeks)If applicable, number on waitlist (as of __________date)Geographic area served Funding sources Mode/setting for program (Inpatient, outpatient, day treatment, in-home, other)Child-welfare related populations served (If applicable, list all that apply: Children in foster care, teen parents in foster care, biological families with children in foster care, relative foster families, adoptive families, families with children at risk of entering foster care)Notes (Makes notes related to this program. For example, provide more information on "other" responses or provide more details related to level of evidence.)
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