Adolescent SBIRT (A-SBIRT) Online Training (Kognito) Feedback Surveys

CT SBI with Adolescents – Follow up

OMB No. 0990-0379
Exp. Date 09/30/2020
Several months ago you completed SBI with Adolescents, an online training simulation for
health professionals for the assessment and management of adolescent substance use. This short
survey has been designed to assist us in assessing the course. Your participation in this survey is
voluntary. There will be no negative consequences to you if you decide not to participate. All of
your identifying information is confidential and your answers will be anonymous. Your results will
be combined with responses from other survey participants and may be presented at scientific or
medical meetings or published in scientific journals. By submitting your answers to this survey,
you are agreeing that you have read and understand the nature and consequences of participation.
"Substance use" refers to the use of tobacco, alcohol and all other drugs, including inappropriate
use of prescription drugs.

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1. Please indicate how professionally competent you feel in performing these alcohol- and drug-related
aspects when working with an adolescent:
Not at
Only
all competent a little competent Moderately competent Very competent
Asking adolescents about their alcohol and drug use.
Asking adolescents about quantity and frequency
of alcohol and drug use.
Screening adolescents for alcohol and drug
problems using a formal standardized screening
instrument
Discussing/ advising adolescents to reduce or halt their
drinking and drug use behavior.
Providing personalized feedback to adolescents
about their risk associated with drinking and drug use.
Tailoring brief interventions to adolescents' motivational
level.
Helping adolescents identify benefits of cutting back
or stopping use of alcohol and drugs.
Helping adolescents identify challenges/barriers in
cutting back or stopping use of alcohol and drugs.
Helping adolescents develop a personal plan for cutting
back or stopping alcohol and drug use.
Referring adolescents with alcohol and drug problems
to appropriate treatment sources based on the their need.
Engaging parents in the discussion about treatment.
Arranging follow-up to help adolescents cut down or
stop using alcohol and drugs.

* 2. How likely are you to conduct substance use screening, brief interventions, and referrals to adolescents?
Very Unlikely

Unlikely

Likely

Very Likely

* 3. Please rate how much you agree/disagree with the following statements:
Strongly
Disagree

Disagree

Agree

Strongly Agree

I feel confident in my ability to screen adolescents for substance
use
I feel confident in my ability to provide brief motivational counseling
for substance use
I feel confident in my ability to refer adolescents to additional
substance use treatment services

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* 4. For practitioners and interns only: In the past two months, approximately how many adolescents have
you:
Screened for substance use

Engaged in brief motivational counseling for substance use

Referred to additional substance use treatment services

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays
a valid OMB control number. The valid OMB control number for this information collection is 0990-0379. The time required to complete
this information collection is estimated to average 7 minutes per response, including the time to review instructions, search existing
data resources, gather the data needed, to review and complete the information collection. If you have comments concerning the
accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services,
OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

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