SBIRT Learning Series Session 6: SBIRT Referral to Treatment Evaluation

Post Training Evaluation

Thank you for attending this learning activity. Please take a few moments to evaluation this training.
IMPORTANT!!
Once you complete the post-training evaluation and click FINISHED and you will be redirected to a webpage to print or save your continuing education certificate.
If you have difficulties completing this survey, contact Amy Wales at amy.wales@miccsi.org.

Demographics

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* 1. Personal Information

First Name

Last Name

Credential

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* 2. Please choose your organization from the choices below:

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* 3. Please choose your role:

Provider (MD, DO, PA-C, NP, etc.)

Nurse or Nurse Care Manager

Social Worker Care Manager/Behavioral Health Specialist

Pharmacist

Other Clinical (LPC, CMA, RMA, etc.)

Non-Clinical (Practice Manager, Support Staff, CHW, etc.)

Leadership

Other (please specify)

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* 4. After attending this session, please indicate your confidence in managing patients with AUD & SUD.

Less Confident-1

Same Confidence-2

Increased Confidence-3

Less Confident-1

Same Confidence-2

Increased Confidence-3

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* 5. On a scale of 1-5, how would you rate this training overall? (Scale: 1=very dissatifed & 5=very satisfied)

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* 6. What did you like most about this activity?

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* 7. What did you like least about this activity?

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* 8. Do you have specific suggestions as to how this learning activity might be improved?

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* 9. Did you feel the content was:

Just right

Too advanced

Too basic

Just right

Too advanced

Too basic

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* 10. Did the presentations and materials meet the following objectives?
Objective 1: Identify referral to treatment steps.
Objective 2: Using a self-evaluation tool, evaluate your performance through the interactive video responses.

Yes

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* 11. Please provide your impressions about Richard Brown's presentation by rating each category on a scale of 1-5 where:

1=VERY POOR
2=POOR
3=AVERAGE
4=GOOD
5=EXCELLENT

	1	2	3	4	5
Knowledge of presenter	Knowledge of presenter 1	Knowledge of presenter 2	Knowledge of presenter 3	Knowledge of presenter 4	Knowledge of presenter 5
Overall rating of topic/presentation	Overall rating of topic/presentation 1	Overall rating of topic/presentation 2	Overall rating of topic/presentation 3	Overall rating of topic/presentation 4	Overall rating of topic/presentation 5
This topic was relevant to my role	This topic was relevant to my role 1	This topic was relevant to my role 2	This topic was relevant to my role 3	This topic was relevant to my role 4	This topic was relevant to my role 5

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* 12. After attending this session, do you intend to change your practice behavior?

Yes

I need more information before I will change my practice

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* 13. After attending this session, I have the ability to apply the skills learned in my role.

Yes

N/A

SBIRT Learning Series Session 6: SBIRT Referral to Treatment Evaluation

Post Training Evaluation

Question Title

* 1. Personal Information

Question Title

* 2. Please choose your organization from the choices below:

Question Title

* 3. Please choose your role:

Question Title

* 4. After attending this session, please indicate your confidence in managing patients with AUD & SUD.

Question Title

* 5. On a scale of 1-5, how would you rate this training overall? (Scale: 1=very dissatifed & 5=very satisfied)

Question Title

* 6. What did you like most about this activity?

Question Title

* 7. What did you like least about this activity?

Question Title

* 8. Do you have specific suggestions as to how this learning activity might be improved?

Question Title

* 9. Did you feel the content was:

Question Title

* 10. Did the presentations and materials meet the following objectives?
Objective 1: Identify referral to treatment steps.
Objective 2: Using a self-evaluation tool, evaluate your performance through the interactive video responses.

Question Title

* 11. Please provide your impressions about Richard Brown's presentation by rating each category on a scale of 1-5 where:

1=VERY POOR
2=POOR
3=AVERAGE
4=GOOD
5=EXCELLENT

Question Title

* 12. After attending this session, do you intend to change your practice behavior?

Question Title

* 13. After attending this session, I have the ability to apply the skills learned in my role.

Question Title

* 14. What new abilities/strategies have you gained from this training?

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* 15. Was the information/material presented in this learning activity free from commercial bias?

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* 16. If you answered no to the above question, please explain.

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* 17. Additional Comments:

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* 1. Personal Information

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* 2. Please choose your organization from the choices below:

Question Title

* 3. Please choose your role:

Question Title

* 4. After attending this session, please indicate your confidence in managing patients with AUD & SUD.

Question Title

* 5. On a scale of 1-5, how would you rate this training overall? (Scale: 1=very dissatifed & 5=very satisfied)

Question Title

* 6. What did you like most about this activity?

Question Title

* 7. What did you like least about this activity?

Question Title

* 8. Do you have specific suggestions as to how this learning activity might be improved?

Question Title

* 9. Did you feel the content was:

Question Title

* 10. Did the presentations and materials meet the following objectives?Objective 1: Identify referral to treatment steps.Objective 2: Using a self-evaluation tool, evaluate your performance through the interactive video responses.

Question Title

* 11. Please provide your impressions about Richard Brown's presentation by rating each category on a scale of 1-5 where:1=VERY POOR2=POOR3=AVERAGE4=GOOD5=EXCELLENT

Question Title

* 12. After attending this session, do you intend to change your practice behavior?

Question Title

* 13. After attending this session, I have the ability to apply the skills learned in my role.

Question Title

* 14. What new abilities/strategies have you gained from this training?

Question Title

* 15. Was the information/material presented in this learning activity free from commercial bias?

Question Title

* 16. If you answered no to the above question, please explain.

Question Title

* 17. Additional Comments:

* 10. Did the presentations and materials meet the following objectives?
Objective 1: Identify referral to treatment steps.
Objective 2: Using a self-evaluation tool, evaluate your performance through the interactive video responses.

* 11. Please provide your impressions about Richard Brown's presentation by rating each category on a scale of 1-5 where:

1=VERY POOR
2=POOR
3=AVERAGE
4=GOOD
5=EXCELLENT