Evaluation - Module 4: Developing Motivational Interviewing Skills

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 illustrate how to use OARS through the use of role-playing exercises. 2. Participants will explore ways to use OARS to work with particularly challenging patient situations. 3. Participants will compare patient engagement strategies using OARS versus previously used strategies.

1. Did the training meet all of the learning objectives listed above?

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.

2. The scholarship and expertise of Sarah Solis, LCSW?

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

3. Your overall satisfaction with the webinar training?

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

4. The webinar presented new areas of knowledge and/or new ideas/methods to implement?

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

5. The webinar contained information at a level commensurate with my training and experience?

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

6. How helpful was the information you learned today in enhancing the performance and operations of your health center?

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

7. If applicable, how do you plan to use the information you learned in your daily work?

8. Was the content balanced and free of commercial bias?

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

9. Did the speaker(s) fully disclose any conflict of interest and discussion of off-label usage of medications and/or medial devices?

10. Do you have any training, technical assistance, or resource needs? If so, please specify below.

11. What is the biggest challenge for your clinic in providing quality care to patients?

12. Name (as it should appear on your certificate)

13. Credentials

14. Please identify the type of certificate you would like to receive for this training.

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

15. Would you like to receive a hard-copy of your certificate?

Key: 1 - Yes please 2 - No thanks

16. Name of the organization you represent.

17. What type of organization is this?

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

18. What is your occupational title?

19. Street or Mailing Address

20. City

21. State

22. Zip Code

23. E-Mail Address

24. Phone Number

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

25. Type of phone number provided?

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

Send me a copy of my responses

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