Midwest Continuing Education Post-test

Fetal Alcohol Spectrum Disorders Regional Training Centers

F5_Midwest FASD Regional Training Center Continuing Education Event, Practice Behaviors Self-Efficacy, Post-Test

Midwest Continuing Education Post-test

OMB: 0920-0954

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Attachment F5 Form Approved
OMB No. XXXX-XXXX
Exp. Date xx/xx/xxxx



Midwest Regional FASD Training Center – Continuing Education Event

Practice Behaviors/Self-efficacy Post-test


Email Address: __________________________________________________

*(Used only for receiving updates. Your information will not be shared)

1. On a scale from 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

Screen women for risky or hazardous drinking

0

1

2

3

4

5

6

7

8

9

10

Educate pregnant women about the effects of alcohol on their babies

0

1

2

3

4

5

6

7

8

9

10

Conduct brief interventions for reducing alcohol consumption

0

1

2

3

4

5

6

7

8

9

10

Utilize resources to refer patients who need formal treatment for alcohol abuse

0

1

2

3

4

5

6

7

8

9

10


2. On a scale from 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

Identify persons with possible FAS or other prenatal alcohol-related disorders

0

1

2

3

4

5

6

7

8

9

10

Diagnose persons with possible FAS or other prenatal alcohol-related disorders

0

1

2

3

4

5

6

7

8

9

10

Utilize resources to refer patients for diagnosis and/or treatment services

0

1

2

3

4

5

6

7

8

9

10

Manage/coordinate the treatment of persons with FASDs

0

1

2

3

4

5

6

7

8

9

10

3. How will you use the information you received today?




4. What additional information do you need to make changes in your practice related to the prevention, identification, and treatment of FASDs?


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File Typeapplication/msword
File TitleMidwest Regional Fetal Alcohol Syndrome Training Center
AuthorSaint Louis University
Last Modified ByGrant, Dorthina G. (CDC/ONDIEH/NCBDDD)
File Modified2012-08-27
File Created2012-08-27

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