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

CT SBI with Adolescents – Post

OMB No. 0990-0379
Exp. Date 09/30/2020
Thank you for taking SBI with Adolescents. This short survey has been designed to assist us in
assessing the simulation you just completed. 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. Thank you for your
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 support services

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CT SBI with Adolescents – Post

4. Overall, how would you rate this course?
Very Poor

Poor

Good

Very Good

Excellent

5. Would you recommend this course to your colleagues?
Yes
No

6. In your estimation, to what extent is SBI with Adolescents:
Not at all or
to very little
extent

To a little
extent

To some
extent

To a great
To a very
extent
great extent

A useful tool
Well constructed?
Easy to use?
Likely to help you help adolescents with substance use?
Based on scenarios that are relevant to you and your patients?

7. What did you like best about the course?

8. What would you change to make the course more effective?

9. Any other suggestions or comments?

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* 10. What credentials are you receiving for participating in this course?
CEU
CNE
CME
NASW - Continuing Education for Social Workers
Other
None

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CT SBI with Adolescents – Post
For Nurses Applying for Continuing Nursing Education Credit

This portion of the survey is designed specifically for nurses applying for Continuing Nursing Education Credits.

* 11. Was this presentation free from commercial bias?
Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

* 12. The overall purpose/goal for this activity was met.
Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

* 13. I found this activity worthwhile for my professional practice.
Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

14. If you selected "Disagree" or "Strongly Disagree," please provide a comment below.

* 15. This activity will enhance my knowledge/skill as a health care provider.
Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

16. If you selected "Disagree" or "Strongly Disagree," please provide a comment below.

* 17. As a result of this activity, please share at least one action you will take to change your professional
practice/performance.

* 18. What other heath care/professional topics would you like to see presented?

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CT SBI with Adolescents – Post
This question is for physicians applying for CME units only

* 19. Please rate the degree to which this activity met the Accreditation Council for Continuing Medical
Education requirement that CME activities must be free of commercial bias for or against a specific product
Strongly Disagree

Disagree

Agree

Strongly Agree

* 20. Relative to where you were prior to participating in this activity, please rate how well this activity has
affected your ability to:
Made It Much
Worse

No Change

Made It Much Better

Conduct screenings with
appropriate frequency.
Use screening tools as
recommended by
supporting research.
Determine levels of risk
based on established
use.
Use structured brief
interventions (a
conversation that can
range from a few
minutes to multiple onehour sessions).
Refer adolescents for
ongoing care for
substance use
disorders.

* 21. Please provide a brief answer to the following question:As a result of what I learned from my
participation in this activity, I intend to make the following practice/performance changes that I believe will
result in more positive patient outcomes.

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* 22. Did you feel this activity contained biased information regarding any pharmaceutical company's or
medical device manufacturer's therapeutic agents, devices, or services?
Yes
No

23. If yes, please describe:

24. Please share any other comments or recommendations, including improvements for the current activity
or topics for future educational events:

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CT SBI with Adolescents – Post

25. How many years of experience do you have as a health professional?

26. Prior to taking this course, had you received training in substance use screening and brief intervention?
Yes
No

27. Gender
Male
Female
Other

28. What is your race? (Select one or more)
White/Caucasian
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander

29. Are you Hispanic or Latino?
Yes
No

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