Name* First Last Name as it should appear on certificate* Email* Please indicate the certificate that is most appropriate for you needs:* Psychologists (APA) Social Workers (ASWB) General Attendance How long did it take you to complete this activity?Hours*21.5021.2521.020.7520.5020.2520.019.7519.5019.2519.018.7518.5018.2518.017.7517.5017.2517.016.7516.5016.2516.015.7515.5015.2515.014.7514.5014.2514.013.7513.5013.2513.012.7512.5012.2512.011.7511.5011.2511.010.7510.5010.2510.09.759.509.259.08.758.508.258.07.757.507.257.06.756.506.256.05.755.505.255.04.754.504.254.03.753.503.253.02.752.502.252.01.751.501.251.0.75.50.25HH:MMCommitment to ChangeAs a result of my participation in this activity, I will commit to:Learning ObjectivesPlease rate your level of agreement with the course meeting the stated learning objectives:1. Explain 3 qualities describing the Secure Attachment caregiving style*Strongly disagreeDisagreeNeutralAgreeStrongly agree2. Identify 3 parenting behaviors that might contribute to Avoidant Attachment Adaptation in their child.*Strongly disagreeDisagreeNeutralAgreeStrongly agree3. Describe 2 characteristics of the Avoidant Attachment style*Strongly disagreeDisagreeNeutralAgreeStrongly agree4. Identify 3 parenting behaviors that might contribute to Anxious/Ambivalent Attachment Adaptation in their child.*Strongly disagreeDisagreeNeutralAgreeStrongly agree5. Describe 2 characteristics of the Anxious/Ambivalent Attachment style*Strongly disagreeDisagreeNeutralAgreeStrongly agree6. Identify 3 parenting behaviors that might contribute to the Disorganized Attachment Adaptation in their child.*Strongly disagreeDisagreeNeutralAgreeStrongly agree7. Describe 2 characteristics of the Disorganized Attachment style.*Strongly disagreeDisagreeNeutralAgreeStrongly agree8. Write 1 clinical Corrective Experience that might help move a person back toward Secure attachment after they’ve adapted to deficits or caregivers that cause attachment disruptions such as Avoidant, Anxious/Ambivalent and Disorganized Attachment Styles*Strongly disagreeDisagreeNeutralAgreeStrongly agree9. Describe the tones of voice (prosody) by gender that communicate comfort and safety to others compared to the use of the voice to alert others to threat.*Strongly disagreeDisagreeNeutralAgreeStrongly agree10. Explain the importance of Stephen Porges’ theory related to the Social Engagement System and the correlation to threat extinction.*Strongly disagreeDisagreeNeutralAgreeStrongly agree11. Discuss the results of the Attachment Questionnaire with clients and evaluate how the results might give clues to their predominant attachment style.*Strongly disagreeDisagreeNeutralAgreeStrongly agree12. Demonstrate 2 experiential exercises to help a client to return to a more secure attachment adaptation.*Strongly disagreeDisagreeNeutralAgreeStrongly agree13. Identify 2 areas that need to simultaneously be tracked when excavating the wound*Strongly disagreeDisagreeNeutralAgreeStrongly agree14. Describe at least 2 characteristics of how attachment styles are fluid.*Strongly disagreeDisagreeNeutralAgreeStrongly agree15. Identify several types of secure attachment for resourcing.*Strongly disagreeDisagreeNeutralAgreeStrongly agreeContentPlease rate your level of agreement with the following statements. This activity… Helped me to have a better understanding of the topic(s).*Strongly disagreeDisagreeNeutralAgreeStrongly agreeAssisted me to consider using the information in a different way to improve my practice.*Strongly disagreeDisagreeNeutralAgreeStrongly agreeProvided me with resources I can use in my daily practice or with my patients.*Strongly disagreeDisagreeNeutralAgreeStrongly agreeWill support my routine clinical practice to deliver evidence-based, best practice that improves patient health outcomes.*Strongly disagreeDisagreeNeutralAgreeStrongly agreeFacultyRate the quality of the speakers listed below, from 5 (Excellent) to 1 (Poor). Alicen Louanne Halquist, MA, LPC, SEP*54321N/AContentClinical RelevanceTeaching StrategiesLevel of ExpertiseCredibilityWill you change the way you practice based on this activity?* Yes No Do you feel the activity was balanced and objective?* Yes No Do you feel the activity was free of commercial bias?* Yes No Approximately what percent of this content was NEW to you?*25%50%75%This was all new information to me.As compared to other CME activities you have participated in the past six months, do you believe this activity:* Increased your knowledge Will improve patient outcomes in your practice What I liked about this activity…? (Select all that apply)* It increased my knowledge It will improve my communication with the healthcare team It provided information in ways that I can review again later It gave me the opportunity to apply information to realistic scenarios that I confront in my practice It facilitated applying values/ethics to interprofessional practice In the past six months, how many CME programs have you participated in?*1 – 45 – 1011 – 15Greater than 15What was the most useful information you gained from this activity?Suggested Topics for future activities:General comments/suggestions: Δ