CBIT Online Program Evaluation

Comprehensive Behavioral Intervention for Tics - Online Program
Form Approved, OMB No. 0920-XXXX Exp. Date XX/XX/20XX
This survey is in reference to the online educational video you viewed on the Tourette Syndrome Association website:
CBIT: Comprehensive Behavioral Intervention for Tics. This resource was developed through a partnership with the US
Centers for Disease Control and Prevention. We would like to assess the impact of the program on your patient care and
survey results will enable us to better focus our outreach efforts.
Public reporting burden of this collection of information is estimated to average  minute per response, including the time for reviewing

instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D- 74, Atlanta,
Georgia 30333; ATTN: PRA (0920-XXXX).

1. Please indicate your profession.
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Physician

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n

Nurse Practitioner

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n

Social Worker

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n

Physician Assistant

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n

Ph.D.

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n

Counselor

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Nurse

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Psychologist

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Occupational Therapist

Other (please specify)

2. Do you have experience in managing patients with TS or tic disorders?
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No

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Yes, 1-5 patient/s

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Yes, 6-10 patients

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Yes, > 10 patients

3. Please rate your knowledge related to the following areas before and after viewing
this program.
Knowledge Before

Knowledge After

TS symptoms

6

6

Co-occurring conditions

6

6

Impact of environmental events on tics

6

6

Evidence for non-pharmacological interventions

6

6

CBIT protocol methods

6

6

Comprehensive Behavioral Intervention for Tics - Online Program
4. Do you think that your skills in managing patients with TS have improved, as a result
of the watching the program?
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Yes

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No

Other (please specify)

5. How have you integrated the information you learned into patient care?
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g

I now implement CBIT with my patients

c
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e
f
g

I now educate my patients about CBIT

c
d
e
f
g

I now refer patients to CBIT practitioners

c
d
e
f
g

I have not integrated the information into my care

Other (please specify)

6. Whether or not you have made a change, please rate the usefulness of the program to
your current practice.
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Very useful

c
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f
g

Useful

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f
g

Somewhat useful

c
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e
f
g

Not at all useful

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