Midwest Continuing Education Pre-test

Fetal Alcohol Spectrum Disorders Regional Training Centers

F4_Midwest FASD Regional Training Center Continuing Education Event, Practice Behaviors Self-Efficacy, Pre-Test

Midwest Continuing Education Pre-test

OMB: 0920-0954

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OMB No. XXXX-XXXX
Exp. Date xx/xx/xxxx



Midwest Regional FASD Training Center – Continuing Education Event

Practice Behaviors/Self-efficacy, Pre-test


Email Address: __________________________________________________

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


1. In your current position, do you provide services to women of childbearing age? Yes No

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

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


3. In your current position, do you provide services to individuals who may be at risk of an FASD? Yes No

4. 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


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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 Created2012-04-20

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