First Breath Mini Module: Prenatal Cannabis Use

2. Have you completed the First Breath New Provider Onboarding Training?
This is a 50-minute online training that provides an overview of First Breath and how to implement it. *This question is required.

• Yes
• No

4. Which of the following describes your agency? Ok to choose more than one. *This question is required.

• Health Department
• Clinic
• Hospital
• Federally Qualified Health Center
• Tribal Health Center
• Treatment Center
• Social Service Provider
• WIC Site
• PNCC Agency
• Home Visiting
• Other - Please specify Please enter an 'other' value for this selection. * This question is required.

5. Does your agency primarily serve any of First Breath's priority populations? Select all that apply. *This question is required.

• Native American/American Indian
• Black or African American
• Limited English Proficiency
• Low socio-economic status
• Medicaid (BadgerCare Plus) Members

6. How much do you agree with the following statements?

As a result of this mini-module... *This question is required.

Space Cell	Strongly agree	Somewhat agree	In the middle	Somewhat disagree	Strongly disagree	Does not apply
I learned new skills, tools, or approaches that I can use with my patients.	I learned new skills, tools, or approaches that I can use with my patients.: Strongly agree	I learned new skills, tools, or approaches that I can use with my patients.: Somewhat agree	I learned new skills, tools, or approaches that I can use with my patients.: In the middle	I learned new skills, tools, or approaches that I can use with my patients.: Somewhat disagree	I learned new skills, tools, or approaches that I can use with my patients.: Strongly disagree	I learned new skills, tools, or approaches that I can use with my patients.: Does not apply
I feel more knowledgeable about prenatal cannabis use.	I feel more knowledgeable about prenatal cannabis use.: Strongly agree	I feel more knowledgeable about prenatal cannabis use.: Somewhat agree	I feel more knowledgeable about prenatal cannabis use.: In the middle	I feel more knowledgeable about prenatal cannabis use.: Somewhat disagree	I feel more knowledgeable about prenatal cannabis use.: Strongly disagree	I feel more knowledgeable about prenatal cannabis use.: Does not apply
I feel more confident in my ability to address prenatal cannabis use with my patients.	I feel more confident in my ability to address prenatal cannabis use with my patients.: Strongly agree	I feel more confident in my ability to address prenatal cannabis use with my patients.: Somewhat agree	I feel more confident in my ability to address prenatal cannabis use with my patients.: In the middle	I feel more confident in my ability to address prenatal cannabis use with my patients.: Somewhat disagree	I feel more confident in my ability to address prenatal cannabis use with my patients.: Strongly disagree	I feel more confident in my ability to address prenatal cannabis use with my patients.: Does not apply
Completing this mini-module was a good use of my time.	Completing this mini-module was a good use of my time.: Strongly agree	Completing this mini-module was a good use of my time.: Somewhat agree	Completing this mini-module was a good use of my time.: In the middle	Completing this mini-module was a good use of my time.: Somewhat disagree	Completing this mini-module was a good use of my time.: Strongly disagree	Completing this mini-module was a good use of my time.: Does not apply

7. How likely are you... *This question is required.

Space Cell	Very	Somewhat	A little	Not at all	Does not apply
Use the Ask-Advise-Refer model to address cannabis with your patients?	Use the Ask-Advise-Refer model to address cannabis with your patients?: Very	Use the Ask-Advise-Refer model to address cannabis with your patients?: Somewhat	Use the Ask-Advise-Refer model to address cannabis with your patients?: A little	Use the Ask-Advise-Refer model to address cannabis with your patients?: Not at all	Use the Ask-Advise-Refer model to address cannabis with your patients?: Does not apply
Refer patients who use cannabis to First Breath?	Refer patients who use cannabis to First Breath?: Very	Refer patients who use cannabis to First Breath?: Somewhat	Refer patients who use cannabis to First Breath?: A little	Refer patients who use cannabis to First Breath?: Not at all	Refer patients who use cannabis to First Breath?: Does not apply
Share First Breath's cannabis materials (booklet and handouts) with your patients?	Share First Breath's cannabis materials (booklet and handouts) with your patients?: Very	Share First Breath's cannabis materials (booklet and handouts) with your patients?: Somewhat	Share First Breath's cannabis materials (booklet and handouts) with your patients?: A little	Share First Breath's cannabis materials (booklet and handouts) with your patients?: Not at all	Share First Breath's cannabis materials (booklet and handouts) with your patients?: Does not apply