KNOWLEDGE:
The best public health message related to alcohol consumption by women of childbearing age is...
Women who know they are pregnant should not consume alcohol.
Women who are pregnant or could become pregnant should not consume alcohol.
All sexually active women should not consume alcohol.
Women of childbearing age should not consume alcohol.
Alcohol use, in moderation, is safe for all women.
2. 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
3. Which one of these is NOT considered a standard drink?
a. 12 ounces of beer
b. 12 ounces of wine cooler
c. 5 ounces of wine
d. 3 ounces of vodka
e. All of the above are standard drinks
Positive responses given to items on the TWEAK or the T-ACE screening instruments indicate:
a diagnosis of alcoholism
the likelihood that the woman will seek treatment for alcohol abuse
the need for the health care provider to discuss the risks associated with drinking alcohol, especially when the woman is pregnant
the difference between binge drinking and problem drinking
the need for immediate admission to a treatment facility for further evaluation
5. 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
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)
Scientific studies of the effects of alcohol on the fetus have shown that:
Alcohol has no effect on the development of the fetus in the third trimester.
Alcohol can only affect fetal development in the first trimester.
A small to moderate amount of alcohol is safest during the second trimester.
Of all the different types of alcohol, wine is the safest for a pregnant woman to consume.
None of the above is correct.
Although specific deficits experienced by individuals with an FASD vary widely, behavioral deficits are likely to include which of the following:
memory problems, underactivity, and self-injurious behavior
inattention, memory problems and hyperactivity
particular mannerisms, hoarding, and memory problems
emotion regulation, weight loss, fatigue, irritability
auditory hallucinations, disorganized speech, and flat affect
8. Which of the following include all three facial abnormalities associated with fetal alcohol syndrome?
a. Low set ears, large palpebral fissures, large forehead
b. Small palpebral fissures, smooth philtrum, thin upper lip
c. Large palpebral fissures, smooth philtrum, thin upper lip
d. Large forehead, flattened cheeks, small palpebral fissures
e. Thin upper lip, distinct philtrum, ectropion
9. Which of the following is NOT required to confirm a diagnosis of fetal alcohol syndrome (FAS)?
a. Facial dysmorphia
b. Growth retardation
c. Central nervous system (CNS) abnormalities
d. Documentation of prenatal alcohol exposure
e. All of the above are required for a diagnosis of FAS
10. 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?
a. Concise, explicit instructions
b. Stable routines
c. Social cues
d. Visual aids
e. Repetition
11. Which one of the following statements is NOT correct?
a. Some women expose their fetus to alcohol because of alcohol dependence or addiction.
b. Health providers seek the best outcomes for women and fetuses by efforts to increase foreseeable benefits and minimize foreseeable harms.
c. Most medical societies advocate coercive methods as a first intervention for women who expose a fetus to alcohol.
d. Health providers have an ethical duty to respect their patients.
e. Confidentiality is an essential aspect of the health provider-patient relationship.
PRACTICE BEHAVIORS/COMFORT/SELF-EFFICACY:
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)
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Not confident in my skills |
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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 |
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 |
|
|
|
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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 |
How will you use the information you received today? _________________________________
______________________________________________________________________________
What additional information do you need to make changes in your practice related to the prevention, identification, and treatment of FASDs? ___________________________________
______________________________________________________________________________
Please take a moment to tell us about yourself: |
||
Are you (Circle one): Male Female Transgender
In which State do you provide services? Specify ______________________
Are you Hispanic or Latino(a)? Yes No
How would you describe your race? (Select all that apply)
American Indian/Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White
I am the parent/caregiver of a child with FAS/FASD |
If you are a PROFESSIONAL, please circle the one that best represents your current position:
PHYSICIAN OB/GYN Geneticist Pediatrician Psychiatrist Family Physician Internist Preventive Medicine Occupational Medicine Addiction Medicine Physician, other Specify ____________
OTHER MEDICAL Dentist Physician Assistant Nurse (NP, RN, LPN) Other Medical Specify _____________
ALLIED HEALTH Psychologist (unspecified) Rehabilitation Psychologist Clinical Psychologist Community Psychologist Counselor (including AODA Counselor) Social worker OT/PT/SLP Medical Technologist Other allied health professional: Specify _____________
OTHER Public Health Special Educator Other Educator Administrator Corrections Lawyer/Judge Scientist Prevention Other: Specify ______________
|
If you are a STUDENT OR RESIDENT, please circle all that apply:
MEDICAL AND NURSING STUDENTS Med 1 Med 2 Med 3 Med 4 Clerkship Preceptorship Nursing Dental
ALLIED HEALTH Allied Health (inc. OT/PT SLP/Social Work, Counseling, etc.)
RESIDENT OB/GYN Genetics Pediatric Psychiatry Family Medicine Internal Medicine Preventive Medicine Occupational Medicine Addiction Medicine Dental Other resident: Specify ________
OTHER STUDENT Pre-doctoral student Graduate Student Undergraduate Student Other Specify _______
|
We would like to know your thoughts about the FASD training/presentation. Please circle the number that most closely represents the extent to which you agree with the following statements.
To what extent do you agree with the following statements? |
Strongly disagree |
Disagree |
Neither agree nor disagree |
Agree |
Strongly agree |
Overall, the FASD training was interesting. |
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5 |
The training content will be useful to me professionally. |
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5 |
The training content increased my awareness & knowledge of the harmful effects of alcohol on the developing fetus. |
1 |
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4 |
5 |
The training exercises were relevant to the topics covered. |
1 |
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5 |
The training handouts enhanced the lecture material. |
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The instructor seemed knowledgeable about the topics. |
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The instructor seemed comfortable presenting the material. |
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5 |
This training had a positive impact on my level of comfort in discussing issues related to FASDs with my patients/clients. |
1 |
2 |
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5 |
The presentation content was culturally relevant. |
1 |
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5 |
The speaker provided the information in a culturally competent/sensitive manner. |
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5 |
I am satisfied with my experience in this training. |
1 |
2 |
3 |
4 |
5 |
Thank you! Visit us at www.FASDsoutheast.org
File Type | application/msword |
File Title | FETAL ALCOHOL SPECTRUM DISORDERS REGIONAL TRAINING CENTER CORE EVALUATION QUESTIONS |
Author | efp0 |
Last Modified By | Grant, Dorthina G. (CDC/ONDIEH/NCBDDD) |
File Modified | 2012-04-20 |
File Created | 2012-04-20 |