Form Approved
OMB No. XXXX-XXXX
Exp. Date xx/xx/xxxx
Month of your birthday ___ ___
Last 2 digits of your social security number ___ ___
FASD Comprehensive Pre-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 (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?
|
3 (II-C) |
Positive responses given to items on the TWEAK or the T-ACE screening instruments indicate:
|
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) |
1 (over)
The public reporting burden of
this collection of information is estimated to average 15 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:
|
7 (V-C) |
Which of the following include all three facial abnormalities associated with fetal alcohol syndrome?
|
8 (V-C) |
Which of the following is NOT required to confirm a diagnosis of fetal alcohol syndrome (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?
|
10 (VI-C) |
Which one of the following statements is NOT correct?
|
11 (VII-C) |
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 |
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)
|
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 |
THANK YOU!
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | RMS397 |
File Modified | 0000-00-00 |
File Created | 2021-01-30 |