I/DD Primary Care Provider Survey Question Title * 1. How confident are you in your ability to communicate with a person who is intellectually and/or developmentally disabled? Very Confident Not Confident Very Confident Not Confident Question Title * 2. How confident are you in your ability to communicate with a person who is intellectually and/or developmentally disabled and non-verbal? Very Confident Not Confident Very Confident Not Confident Question Title * 3. How confident are you in your ability to care for a person who is intellectually and/or developmentally disabled? Very Confident Not Confident Very Confident Not Confident Question Title * 4. How confident are you in your ability to care for a person who is intellectually and/or developmentally disabled and non-verbal? Very Confident Not Confident Very Confident Not Confident Question Title * 5. Patients with disabilities should be offered the same primary care screening and interventions as people without disabilities. Agree Disagree Agree Disagree Question Title * 6. How knowledgeable are you about the various community programs and supports available to people with disabilities? Very knowledgeable Not knowledgeable Very knowledgeable Not knowledgeable Question Title * 7. How confident are you in your ability to provide behavioral crisis prevention, intervention and/or stabilization services for a person with intellectual and/or developmental disabilities? Very Confident Not Confident Very Confident Not Confident Question Title * 8. Of the following, what kind of training would you and/or your staff need in order to begin providing these services? (please select all that apply) Communicating effectively with a person with intellectual and/or developmental disabilities Communicating effectively with a person with intellectual and/or developmental disabilities Understanding informed consent Understanding informed consent Initial Management of Behavioral Crisis in Primary Care Initial Management of Behavioral Crisis in Primary Care Using the Risk Assessment Tool for Adults wtih I/DD in Behavioral Crisis Using the Risk Assessment Tool for Adults wtih I/DD in Behavioral Crisis Recognizing behavioral problems and emotional concerns Recognizing behavioral problems and emotional concerns Psychiatric symptoms and behavioral checklist Psychiatric symptoms and behavioral checklist Use of ABC (Antecedent-Behavioral-Consequence) Chart Use of ABC (Antecedent-Behavioral-Consequence) Chart Crisis Prevention and Management Planning Crisis Prevention and Management Planning Psychotropic Medication issues Psychotropic Medication issues None of the above None of the above Question Title * 9. Address Name Company Address City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Phone Number Please complete the Address section above to assist Amerigroup in obtaining needed informatoin to determine I/DD training needs throughout the regions of the State. Done