Continuing Excellence - Course Evaluation Form
Course Name: Effective Use of Motivational Interviewing to Engage and Help People with Intimate Partner Violence

Date: March 8, 2022

Learning Objectives

As a result of this training, participants will be better able to:
1) Demonstrate skills for deeply listening to and understanding clients
2) Describe four components of the “spirit” of motivational interviewing
3) Explain the difference between motivational interviewing and person-centered and other models of care
4) Enact skills for responding to others with complex, empathic reflective statements using open questions to “move” the conversation.
5) Identify “change talk” within a person’s statements
6) Provide a crisp empathic summary statement collecting change talk with a closing inquiry/ open question
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Email *
Last Name (as you'd like printed on your certificate) *
First Name (as you'd like printed on your certificate) *
License Number, if applicable (for identity verification purposes)
Issuing state/province, if applicable
Which of the following best describes you? *
Would you like to receive a certificate of credit from Continuing Excellence? *
For more information, please refer to [url TBA]
I certify that I am the above-named person completing this form and that the information I submit here is accurate. *
Required
1. How much did you learn as a result of this CE program? *
5 = Very much, 1 = Very little
2. Rate the quality of the program content *
5 = Very High, 1 = Very Low
3. Rate how current/relevant the program content is *
5 = Very High, 1 = Very Low
4. How useful was the content of this CE program for your practice or other professional development? *
5 = Extremely Useful, 1 = Not Useful at all
5. Rate the instructor(s) knowledge and expertise of the subject *
5 = Very High, 1 = Very Low
6. Rate the instructor(s) teaching ability *
5 = Very High, 1 = Very Low
7.1. Would you agree that learning objective #1 was met? *
Learning Objective #1: "Demonstrate skills for deeply listening to and understanding clients," 5 = Strongly agree, 1 = Strongly disagree
7.2. Would you agree that learning objective #2 was met? *
Learning Objective #2: "Describe four components of the “spirit” of motivational interviewing," 5 = Strongly agree, 1 = Strongly disagree
7.3. Would you agree that learning objective #3 was met? *
Learning Objective #3: "Explain the difference between motivational interviewing and person-centered and other models of care," 5 = Strongly agree, 1 = Strongly disagree
7.4. Would you agree that learning objective #4 was met? *
Learning Objective #4: "Enact skills for responding to others with complex, empathic reflective statements using open questions to “move” the conversation," 5 = Strongly agree, 1 = Strongly disagree
7.5. Would you agree that learning objective #5 was met? *
Learning Objective #5: "Identify “change talk” within a person’s statements," 5 = Strongly agree, 1 = Strongly disagree
7.6. Would you agree that learning objective #6 was met? *
Learning Objective #6: "Provide a crisp empathic summary statement collecting change talk with a closing inquiry/ open question," 5 = Strongly agree, 1 = Strongly disagree
7.7. Would you agree that learning objective #7 was met? *
Learning Objective #7: "," 5 = Strongly agree, 1 = Strongly disagree
7.8. Would you agree that learning objective #8 was met? *
Learning Objective #8: "," 5 = Strongly agree, 1 = Strongly disagree
8. Rate how well the program met your expectations (according to the promotional materials) *
5 = Very well, 1 = Not well at all
9. Rate the quality of the provided course materials *
5 = Very High, 1 = Very Low
10. Rate the quality of the facilities (in-person) or technology (online). *
5 = Very High, 1 = Very Low
11. Rate how well disability accommodations were met, if requested. *
5 = Very High, 1 = Very Low
12. Rate the ease of the registration process *
5 = Very Easy, 1 = Very Difficult
13. Rate the instructor(s) responsiveness to questions *
5 = Very High, 1 = Very Low
14. Rate the program staff's responsiveness to questions *
5 = Very High, 1 = Very Low
15. How will the information from this program be useful to you in the future? *
16. What did the program (or presenter/s) do particularly well that helped you understand the material? *
17. What, if anything, could the program (or presenter/s) have done differently to help you understand the material better? *
18. About how long did it take you to complete this course (including completing this form)? *
19. OPTIONAL: How did you learn about this training?
20. OPTIONAL: Do you have any additional thoughts or comments you'd like to share with us?
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