Great Lakes Comprehensive Follow-up - Word

E11_Great Lakes FASD RegionalTraining Center FASD Comprehensive_1.docx

Fetal Alcohol Spectrum Disorders Regional Training Centers

Great Lakes Comprehensive Follow-up - Word

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Exp. Date xx/xx/xxxx


First 2 letters of your mother’s maiden name ___ ___

Month of your birthday ___ ___

Last 2 digits of your social security number ___ ___


E11. Great Lakes FASD Regional Training Center

FASD Comprehensive Post-Training Evaluation


Please circle the BEST answer for each of the following:

Staff

Use Only

The best public health message related to alcohol consumption by women of childbearing age is:

  1. Women who know they are pregnant should not consume alcohol.

  2. Women who are pregnant or could become pregnant should not consume alcohol.

  3. All sexually active women should not consume alcohol.

  4. Women of childbearing age should not consume alcohol.

  5. Alcohol use, in moderation, is safe for all women.

1

(I-C)

An episode of binge or risky drinking for women of childbearing age (18-44) is defined as more than ___ standard drinks in about a two hour period.

a. 2

b. 3

c. 4

d. 5

e. 6

2

(II-C)

Which one of these is NOT considered a standard drink?

  1. 12 ounces of beer

  2. 12 ounces of wine cooler

  3. 5 ounces of wine

  4. 3 ounces of vodka

  5. All of the above are standard drinks

3

(II-C)

Positive responses given to items on the TWEAK or the T-ACE screening instruments indicate:

  1. A diagnosis of alcoholism

  2. The likelihood that the woman will seek treatment for alcohol abuse

  3. The need for the health care provider to discuss the risks associated with drinking alcohol, especially when the woman is pregnant

  4. The difference between binge drinking and problem drinking

  5. The need for immediate admission to a treatment facility for further evaluation

4

(II-C)

Which of these is NOT part of the addictive disease process?

a. Craving and compulsion

b. Violent behavior

c. Loss of control

d. Continued use despite adverse consequences

e. All of the above are part of the addictive disease process

5

(III-C)

Shape2 Shape1

1

(over)

The public reporting burden of this collection of information is estimated to average 20 minutes 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 Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333 ATTN: PRA (XXXX-XXXX)



Please circle the BEST answer for each of the following:

Staff

Use Only

Scientific studies of the effects of alcohol on the fetus have shown that:

a. Alcohol has no effect on the development of the fetus in the third trimester.

b. Alcohol can only affect fetal development in the first trimester.

c. A small to moderate amount of alcohol is safest during the second trimester.

d. Of all the different types of alcohol, wine is the safest for a pregnant woman to consume.

e. None of the above is correct.

6

(IV-C)

(I)

Although specific deficits experienced by individuals with an FASD vary widely, behavioral deficits are likely to include which of the following:

  1. Memory problems, underactivity, and self-injurious behavior

  2. Inattention, memory problems, and hyperactivity

  3. Particular mannerisms, hoarding, and memory problems

  4. Emotion regulation, weight loss, fatigue, irritability

  5. Auditory hallucinations, disorganized speech, and flat affect

7

(V-C)

Which of the following include all three facial abnormalities associated with fetal alcohol syndrome?

  1. Low set ears, large palpebral fissures, large forehead

  2. Small palpebral fissures, smooth philtrum, thin upper lip

  3. Large palpebral fissures, smooth philtrum, thin upper lip

  4. Large forehead, flattened cheeks, small palpebral fissures

  5. Thin upper lip, distinct philtrum, ectropion

8

(V-C)

Which of the following is NOT required to confirm a diagnosis of fetal alcohol syndrome (FAS)?

  1. Facial dysmorphia

  2. Growth retardation

  3. Central nervous system (CNS) abnormalities

  4. Documentation of prenatal alcohol exposure

  5. All of the above are required for a diagnosis of FAS

9

(V-C)

(I)

A variety of strategies have been found to be effective when working with individuals with an FASD. Which one of the following may not be as effective?

  1. Concise, explicit instructions

  2. Stable routines

  3. Social cues

  4. Visual aids

  5. Repetition

10

(VI-C)

Which one of the following statements is NOT correct?

  1. Some women expose their fetus to alcohol because of alcohol dependence or addiction.

  2. Health providers seek the best outcomes for women and fetuses by efforts to increase foreseeable benefits and minimize foreseeable harms.

  3. Most medical societies advocate coercive methods as a first intervention for women who expose a fetus to alcohol.

  4. Health providers have an ethical duty to respect their patients.

  5. Under certain circumstances health providers cannot guarantee confidentiality.

11

(VII-C)








Shape3

2

(continued)



2. In your current position, do you provide services to women of childbearing age?


YES NO



3. On a scale of 0 to 10 where 0 means, “Not confident in my skills” and 10 means “Totally confident in my skills,” how confident are you in your skills to do the following? (circle one number per row)



NOT

Confident in my skills










TOTALLY

Confident in my skills

a. Screen women for risky or hazardous

drinking

0

1

2

3

4

5

6

7

8

9

10

b. Educate pregnant women about the

effects of alcohol on their babies

0

1

2

3

4

5

6

7

8

9

10

c. Conduct brief interventions for reducing

alcohol consumption

0

1

2

3

4

5

6

7

8

9

10

d. Utilize resources to refer patients who

need formal treatment for alcohol abuse

0

1

2

3

4

5

6

7

8

9

10



NOT

Confident in my skills











TOTALLY

Confident in my skills

a. Identify persons with possible FAS or

other prenatal alcohol-related disorders


0


1


2


3


4


5


6


7


8


9


10

b. Diagnose persons with possible FAS or

other prenatal alcohol-related disorders


0


1


2


3


4


5


6


7


8


9


10

c. Utilize resources to refer patients for

diagnosis and/or treatment services


0


1


2


3


4


5


6


7


8


9


10

d. Manage/coordinate the treatment of

persons with FASDs


0


1


2


3


4


5


6


7


8


9


10



4. In your current position, do you provide services to individuals who may be at risk of an FASD?


YES NO



5. On a scale of 0 to 10 where 0 means, “Not confident in my skills” and 10 means “Totally confident in my skills,” how confident are you in your skills to do the following? (circle one number per row)



Shape5 Shape4

3

(over)

3

(over)



6. How will you use the information you received during the training today?






7. What additional information do you need to make changes in your practice?






8. What additional comments do you have about this training?






9. We would like to know your thoughts about this training/presentation. Please circle the number that most clearly represents the extent to which you agree with each of the following statements.

To what extent to you agree with the following statements?

Strongly disagree

Disagree

Neither Agree nor Disagree

Agree

Strongly agree

  1. The training content will be useful to me professionally.

1

2

3

4

5

  1. The training content increased my awareness & knowledge of the harmful effects of alcohol on the developing fetus.

1

2

3

4

5

  1. This training had a positive impact on my level of comfort in discussing issues related to FASDs with my patients/clients.

1

2

3

4

5

  1. The presentation content was culturally relevant.

1

2

3

4

5

  1. The speaker(s) provided the information in a culturally competent/sensitive manner.

1

2

3

4

5

  1. I am satisfied with my experience in this training.

1

2

3

4

5

The instructor seemed knowledgeable about the topics.

TRAINER 1 (NAME)

1

2

3

4

5

TRAINER 2 (NAME)

1

2

3

4

5

TRAINER 3 (NAME)

1

2

3

4

5

TRAINER 4 (NAME)

1

2

3

4

5


Shape6

4

(continued)




Please take a moment to tell us about yourself:

Are you (Circle one):

1=Male

2=Female

3=Transgender


In which State do you provide services?

1=Wisconsin

2=Michigan

3=Indiana

4=Ohio

5=North Carolina

6=Minnesota

7=Hawaii

8=Other

Specify ______________________ (8a)


Are you Hispanic or Latino(a)?

1=Yes

2=No


How would you describe your race?

(Select all that apply)

1=American Indian/Alaska Native

2=Asian

3=Black or African American

4=Native Hawaiian or other Pacific

Islander

5=White


Are you a parent/caregiver of a child with FAS/FASD?

1=Yes

2-No

If you are a PROFESSIONAL, please circle the one that best represents your current position:


PHYSICIAN

1=OB/GYN

2=Geneticist

3=Pediatrician

4=Psychiatrist

5=Family Physician

6=Internist

7=Preventive Medicine

8=Occupational Medicine

9=Addiction Medicine

10=Physician, other

Specify ____________(10a)


OTHER MEDICAL

11=Dentist

12=Physician Assistant

13=Nurse (NP, RN, LPN)

14=Other Medical

Specify _____________(14a)



ALLIED HEALTH

15=Psychologist (unspecified)

16=Rehabilitation Psychologist

17=Clinical Psychologist

18=Community Psychologist

19=Counselor (including AODA

Counselor)

20=Social worker

21=OT/PT/SLP

22=Medical Technologist

23=Other allied health professional:

Specify _____________ (23a)


OTHER

24=Public Health

25=Special Educator

26=Other Educator

27=Administrator

28=Corrections

29=Lawyer/Judge

30=Scientist

31=Prevention

32=Other:

Specify ______________ (32a)


If you are a STUDENT OR RESIDENT, please circle all that apply:


MEDICAL AND NURSING STUDENTS

1a=Med 1

1b=Med 2

1c=Med 3

1d=Med 4

1e=Clerkship

1f=Preceptorship

2=Nursing

3=Dental


ALLIED HEALTH

4=Allied Health (inc. OT/PT

SLP/Social Work,

Counseling, etc.)


RESIDENT

5=OB/GYN

6=Genetics

7=Pediatric

8=Psychiatry

9=Family Medicine

10=Internal Medicine

11=Preventive Medicine

12=Occupational Medicine

13=Addiction Medicine

14=Dental

15=Other resident:

Specify ________ (15a)


OTHER STUDENT

16=Pre-doctoral student

17=Graduate Student

18=Undergraduate Student

19=Other

Specify _______ (19a)




THANK YOU!

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