Skip to content
ACEs Aware Assessment for Physicians
Pediatric Mental Health Day Conference Pre-Assessment
To better gage your experience with ACEs and trauma informed care, we have created this survey to provide you with tools to improve your expertise in your practice.
*
1.
What is your discipline/area of practice?
(Required.)
Licensed Clinical Social Worker (LCSW)
Marriage and Family Therapist (MFT)
Nurse Practitioner (NP)
Physician Assistant (PA)
Pediatrician
Family Practice
Resident
Other practitioner/license (please specify)
*
2.
Years of clinical experience:
(Required.)
0-5
6-15
16-25
25+
*
3.
Please give us an idea of the ACEs screening you have given for children and teens in your area:
I feel that my patients have appropriate access to ACEs screening services.
(Required.)
Most of the time
Some of the time
Seldom
Never
*
4.
Please describe your confidence in your ability to:
Identify common symptoms of toxic stress in children and teenagers you provide for.
(Required.)
Very confident
Moderately confident
Somewhat confident
Limited confidence
Not confident
Very confident
Moderately confident
Somewhat confident
Limited confidence
Not confident
*
5.
Please describe your confidence in your ability to:
Assess for and appropriately address emotional trauma in my patients.
(Required.)
Very confident
Moderately confident
Somewhat confident
Limited confidence
Not confident
Very confident
Moderately confident
Somewhat confident
Limited confidence
Not confident
*
6.
Please describe your confidence in your ability to:
Initiate a work-up for co-existing or precipitating medical conditions that as present as mental health concerns.
(Required.)
Very confident
Moderately confident
Somewhat confident
Limited confidence
Not confident
Very confident
Moderately confident
Somewhat confident
Limited confidence
Not confident
*
7.
Full Name
(Required.)
First Name
Last Name
*
8.
Email address
(Required.)
