Evaluation - Module 3: Introduction to Motivational Interviewing

PLEASE NOTE: ALL CERTIFICATES WILL BE SENT ELECTRONICALLY. IF YOU WOULD LIKE TO RECEIVE A HARD-COPY OF YOUR CERTIFICATE, BE SURE TO PROVIDE YOUR COMPLETE MAILING ADDRESS IN THE APPROPRIATE QUESTIONS BELOW. ------------------------------------------------------------------------------------------ Learning Objectives: 1. Participants will explore the "righting reflex" and determine one situation in which the righting reflex was not effective. 2. Participants will discuss when and how to apply Motivational Interviewing when working with patients in a health center setting. 3. Participants will be able to synthesize the spirit of Motivational Interviewing

Please utilize the 4 - 1 rating scale below: 4 - The learning objectives were fully met. 3 - The learning objectives were mostly met. 2 - The learning objectives were somewhat met. 1 - The learning objectives were not met.

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Please utilize the 4 - 1 rating scale below: 4 - Excellent 3 - Good 2 - Fair 1 - Poor

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Please utilize the 4 - 1 rating scale below: 4 - Completely satisfied 3 - Mostly satisfied 2 - Somewhat satisfied 1 - Dissatisfied

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Please utilize the 4 - 1 rating scale below: 4 - Completely agree 3 - Mostly agree 2 - Somewhat agree 1 - Disagree

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Please utilize the 4 - 1 rating scale below: 4 - Completely agree 3 - Mostly agree 2 - Somewhat agree 1 - Disagree

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Please utilize the 4 -1 rating scale below: 4 - Completely helpful 3 - Mostly helpful 2 - Somewhat helpful 1 - Not helpful N/A - Not applicable

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Please utilize the key below to answer questions 8 and 9: 1 - Yes 2 - No

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NOTE: TEXAS CHW CERTIFICATES ARE NOT AVAILABLE FOR THIS TRAINING. Key: 1 - Continuing Medical Education (CME) 2 - Continuing Nursing Education (CNE) 3 - Texas CHW Certificate 4 - Certificate of Attendance

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Key: 1 - Yes please 2 - No thanks

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Key: 1 - PCA 2 - Health Center 3 - HCCN 4 - Self reported other 5 - None of the above / I'm not sure

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Please provide your phone number in the following format: (xxx) xxx - xxxx

Key: 1 - Cell phone / Mobile phone 2 - Home phone 3 - Work/business phone

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