[Federal Register: November 18, 2009 (Volume 74, Number 221)]
[Notices]
[Page 59549-59553]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr18no09-54]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
Periodically, the Substance Abuse and Mental Health Services
Administration (SAMHSA) will publish a summary of information
collection requests under OMB review, in compliance with the Paperwork
Reduction Act (44 U.S.C. Chapter 35). To request a copy of these
documents, call the SAMHSA Reports Clearance Officer on (240) 276-1243.
Project: Recovery Services for Adolescents and Families--New
The Substance Abuse and Mental Health Services Administration's
(SAMHSA) Center for Substance Abuse Treatment will conduct a data
collection on the helpfulness of recovery support services for young
people and their families after leaving substance abuse treatment.
Specifically, the Recovery Services for Adolescents and Families (RSAF)
project is evaluating a pilot test of the following recovery support
services for young people and their families find the following
recovery support services helpful: (1) Telephone/text message support;
(2) a recovery-oriented social networking site; and (3) a family
program. Approximately 200 adolescent respondents will be asked to
complete 4 data collection forms (some repeated) during 5 interviews
(baseline and 4 follow-ups) over a 12 month period after enrollment or
discharge from treatment. Approximately 200 collateral respondents
(i.e., a parent/guardian/concerned other) will be asked to complete 7
data collection forms (some repeated) during 5 interviews (baseline and
4 follow-ups) over a 12 month period after their adolescent's
enrollment or discharge from treatment. Approximately 15 to 20 project
staff respondents, including Project Coordinators, Telephone Support
Volunteers, a Social Network Site Moderator, Family Program Clinicians,
[[Page 59550]]
and a Support Services Supervisor, will be asked to complete between 2
and 5 data collection forms at varying intervals during the delivery of
recovery support services. Across all respondents, a total of 28 data
collection forms will be used. Depending on the time interval and task,
information collections will take anywhere from about 5 minutes to 2
hours to complete. A description of each data collection form follows:
Adolescent Participant
Global Appraisal of Individual Needs--Initial (GAIN-I
5.6.0 Full). The GAIN is an evidence-based assessment used with both
adolescents and adults and in outpatient, intensive outpatient, partial
hospitalization, methadone, short-term residential, long-term
residential, therapeutic community, and correctional programs. There
are over 1,000 questions in this initial version that are in multiple
formats, including multiple choice, yes/no, and open-ended. Eight
content areas are covered: Background, Substance Use, Physical Health,
Risk Behaviors and Disease Prevention, Mental and Emotional Health,
Environment and Living Situation, Legal, and Vocational. Each section
contains questions on the recency of problems, breadth of symptoms, and
recent prevalence as well as lifetime service utilization, recency of
utilization, and frequency of recent utilization. GPRA data are
gathered as part of this instrument in support of performance
measurement for SAMHSA programs. It is administered at intake into
treatment by clinical staff and used as baseline data for the project.
Global Appraisal of Individual Needs--Monitoring 90 Days
(GAIN-M90 5.6.0 Full). The GAIN is an evidence-based assessment used
with both adolescents and adults and in outpatient, intensive
outpatient, partial hospitalization, methadone, short-term residential,
long-term residential, therapeutic community, and correctional
programs. There are over 500 questions in this follow-up version that
are in multiple formats, including multiple choice, yes/no, and open-
ended. Eight content areas are covered: Background, Substance Use,
Physical Health, Risk Behaviors and Disease Prevention, Mental and
Emotional Health, Environment and Living Situation, Legal, and
Vocational. Each section contains questions on the recency of problems,
breadth of symptoms, and recent prevalence as well as lifetime service
utilization, recency of utilization, and frequency of recent
utilization. GPRA data are gathered as part of this instrument in
support of performance measurement for SAMHSA programs. It is
administered by project staff at each of the follow-up timepoints.
Supplemental Assessment Form (SAF 0309). The SAF contains
72 questions that are a combination of multiple choice, yes/no, and
open-ended formats. Content areas include: race, happiness with parent
or caregiver in several life areas, participation in prosocial
activities, receipt of and satisfaction with telephone support
services, and usage of and satisfaction with the project's social
networking site. It is administered by project staff at each of the
follow-up timepoints.
Collateral Participant (Parent/Guardian)
Global Appraisal of Individual Needs--Collateral
Monitoring--Initial (GCI). The GCI contains over 200 items in this
initial version that are in multiple formats, including multiple
choice, yes/no, and open-ended. The following content areas are
covered: relationship to the adolescent respondent, background, and the
adolescent's background and substance use, environment and living
situation, and vocational information. There are questions on the
recency of problems, breadth of symptoms, and recent prevalence as well
as lifetime service utilization, recency of utilization, and frequency
of recent utilization. It is administered at baseline by project staff.
Global Appraisal of Individual Needs--Collateral
Monitoring--Monitoring (GCM 5.3.3). The GCM contains over 200 items in
this follow-up version that are in multiple formats, including multiple
choice, yes/no, and open-ended. The following content areas are
covered: relationship to the adolescent respondent, background, and the
adolescent's background and substance use, environment and living
situation, and vocational information. There are questions on the
recency of problems, breadth of symptoms, and recent prevalence as well
as lifetime service utilization, recency of utilization, and frequency
of recent utilization. It is administered at each of the follow-up
timepoints by project staff.
Supplemental Assessment Form--Collateral (SAF--
Collateral). The SAF contains 72 questions that are a combination of
multiple choice, yes/no, and open-ended formats. Content areas include:
knowledge about the adolescent's participation in prosocial activities,
receipt of and satisfaction with telephone support services, and usage
of and satisfaction with the project's social networking site. It is
administered at each of the follow-up timepoints by project staff.
Self-Evaluation Questionnaire (SEQ). The SEQ contains 40
multiple choice items that ask the collateral about feelings and
symptoms of anxiety. It is administered at each of the follow-up
timepoints by project staff.
Family Environment Scale (FES). The FES contains 18 yes/no
items that measure family cohesion and conflict. It is administered at
each of the follow-up timepoints by project staff.
Relationship Happiness Scale (Caregiver Version). The
Relationship Happiness Scale contains 8 items that ask the collateral
about happiness with his/her relationship with the adolescent
respondent in various life areas. It is administered at each of the
follow-up timepoints by project staff.
Project Coordinator
Eligibility Checklist. The Eligibility Checklist contains
12 yes/no items that are used to determine whether or not an adolescent
meets inclusion/exclusion criteria for the project and is eligible to
be approached for informed consent. It is completed prior to informed
consent by project staff.
Telephone Support Volunteer Notification Form. This form
contains a participant's name and contact information. It is completed
by project staff and given to volunteers to notify them when someone is
assigned to receive telephone support.
Family Program Notification Form. This form contains a
participant's name. It is completed by project staff and given to
clinicians to notify them when someone is assigned to the family
support group.
Follow-Up Locator Form--Participant (FLF-P). The FLF-P
contains over 50 items that are a combination of yes/no, multiple
choice, and open-ended formats. At the time of informed consent, data
are gathered by project staff about an adolescent's contact
information, personal contacts, criminal justice contacts, school/job
contacts, hang-out information, Internet contacts, and identifying
information in order to locate and interview that adolescent over
multiple follow-up intervals.
Follow-Up Locator Form--Collateral (FLF-C). The FLF-C
contains over 50 items that are a combination of yes/no, multiple
choice, and open-ended formats. Data are gathered about a collateral's
contact information, personal contacts, and job contacts in order to
locate and interview that collateral over multiple follow-up
[[Page 59551]]
intervals. It is administered at the time of informed consent by
project staff.
Follow-Up Contact Log. The Follow-Up Contact Log is open-
ended and provides space for all data collected during attempted and
completed follow-up contacts, over the phone and in-person, to be
recorded. It is completed throughout the follow-up time period.
Volunteer/Staff Survey. The Volunteer/Staff Survey
contains 10 items in fill-in-the-blank, yes/no, and multiple choice
formats. Items ask about background, demographic information, and role
in the project. It is completed once by all volunteers and staff at the
start of the project.
Telephone Support Volunteer
Telephone Support Case Review Form. The Telephone Support
Case Review Form contains multiple rows that allow a volunteer to
record 5 pieces of data about adolescents that they make phone calls
to: initials, treatment discharge status/date, weeks since treatment
discharge, date of last telephone session, and number of completed
telephone sessions since discharge. This allows the volunteer and
supervisor to monitor the progress of active cases. The form is
completed by the volunteers every week.
Telephone Support Call Log. The Telephone Support Call Log
is open-ended and provides space for all data collected during
attempted and completed support contacts to be recorded. The form is
completed by the volunteer throughout the period of telephone support.
Adolescent Telephone Support Documentation Form. The
Adolescent Telephone Support Documentation Form contains 22 items that
are asked of an adolescent during a telephone support contact by a
volunteer. The form is used to record yes/no and open-ended responses
to questions asking about substance use and recovery-related
activities. The volunteers complete the form every time there is a
telephone support session with an adolescent.
Telephone Support Discharge Form. The Telephone Support
Discharge Form contains 10 fields to record the following information
at the end of an adolescent's participation in telephone support:
adolescent name, today's date, volunteer name, notification date,
telephone support intake date, telephone support discharge date, reason
for discharge, number of completed sessions, referral for more
intervention, and successful contact for more intervention. This form
is completed by volunteers when telephone support ends for each
adolescent.
Volunteer/Staff Survey (Telephone Support Volunteer)--See
Volunteer/Staff Survey (Project Coordinator) above.
Social Network Site Moderator
Social Networking Moderator Log. The Social Networking
Moderator Log contains 11 fields for the moderator to record usage data
for the project's social networking site. The moderator tracks number
of visits to the site, number of unique visitors, messages posted, chat
room attendance, and problems with users. This form is completed weekly
by project staff.
Volunteer/Staff Survey--See Volunteer/Staff Survey
(Project Coordinator) above.
Family Program Clinician
Family Program Progress Notes. The Family Program Progress
Notes form is open-ended and provides space for all data collected
during attempted and completed family program contacts to be recorded.
This form is completed by the clinician throughout the time family
members are active in the family support program.
Family Program Attendance Log. The Family Program
Attendance Log is used to record 6 pieces of information about each
attempted session: Session number, scheduled date, was the session
rescheduled (yes/no), was the family member a no-show (yes/no), did the
family member attend the session (yes/no), and comments. This form is
completed by the clinician throughout the time family members are
active in the family support program.
Family Program Case Review Report. The Family Program Case
Review Report contains multiple rows that allow a clinician to record
information that allows the clinician and supervisor to monitor the
progress of active cases. Areas asked about include: family program
procedures delivered, date of last session, and weeks in family
program. This form is completed by the clinician weekly throughout the
time family members are active in the family support program.
Family Program Discharge Form. The Family Program
Discharge Form contains 9 fields to record the following information at
the end of participation in the family program: caregiver name, today's
date, adolescent name, notification date, clinician name, family
program intake date, family program discharge date, reason for
discharge, and number of completed sessions. This form is completed by
the clinician each time family members of a given participant end
involvement in the family support program.
Volunteer/Staff Survey--See Volunteer/Staff Survey
(Project Coordinator) above.
Support Services Supervisor
Adolescent Telephone Support Quality Assurance Checklist.
This checklist contains 43 items that ask the supervisor to rate how
well a telephone support volunteer delivered required service
components to adolescents. Volunteers are rated on a scale of 1 through
5 in the following areas: substance use since last call (no use),
substance use since last call (use), substance use since last call
(still using), substance use since last call (stopped using),
attendance at 12-step meetings, recovery-related activities, activities
related to global health, follow-up since last call, closing the call,
overall, general clinical skills, and overall difficulty of session.
This form is completed for each reviewed recording of a telephone
session by a supervisor.
Social Networking Quality Assurance Checklist. This
checklist contains 17 items that ask the supervisor to rate how well a
social networking site moderator delivered required service components
to adolescents. The moderator is rated on a scale of 1 through 5 in the
following areas: group discussions, administrative tasks, overall, and
general skills. This form is completed for each review of the social
networking site by a supervisor.
Family Program QA Checklist. This checklist contains 72
items that ask the supervisor to rate how well a family program
clinician delivered required service components to family members. The
clinician is rated on a scale of 1 through 5 in the following areas:
initial meeting motivational strategies, domestic violence precautions,
functional analysis of substance use, positive communication skills,
use of positive reinforcement, time out from positive reinforcement,
allowing the identified patient to experience the natural consequences
of substance use, helping concerned significant others' enrich their
own lives, maintaining the identified patient in recovery-oriented
systems of care, and general. This form is completed for each reviewed
recording of a family session by a supervisor.
Volunteer/Staff Survey--See Volunteer/Staff Survey
(Project Coordinator) above.
The following table is a list of the hour burden of the information
collection by form and by respondent:
[[Page 59552]]
Detailed Information on Forms Grouped by Respondent
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Total
Instrument/form Number of Responses per Total Hours per annualized
respondents respondent responses response hour burden *
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Adolescent Participant
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GAIN-I 5.6.0 Full............... 200 1 200 2 400
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GAIN-M90 5.6.0 Full............. 200 4 800 1 800
SAF............................. 200 5 1,000 .25 250
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Subtotal.................... 200 .............. 2,000 .............. 1,450
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Collateral (Parent/Guardian/Concerned Other) Participant
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Collateral-I.................... 200 1 200 .25 50
Collateral-M.................... 200 4 800 .25 200
Collateral SAF.................. 200 5 1,000 .25 250
Self-Evaluation Questionnaire... 200 5 1,000 .16 250
Family Environment Scale 200 5 1,000 .08 80
(Cohesion and Conflict Scales).
Relationship Happiness Scale 200 5 1,000 .08 80
(Caregiver)....................
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Subtotal.................... 200 .............. 5,000 .............. 910
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Project Coordinator
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Eligibility Checklist........... 4 50 200 .25 50
Locator--Participant............ 4 50 200 .32 64
Locator--Collateral............. 4 50 200 .25 50
Follow-Up Contact Log........... 4 50 200 .16 32
Telephone Support Volunteer 4 50 200 .16 32
Notification Form..............
Family Program Notification Form 4 50 200 .16 32
Volunteer/Staff Survey.......... 4 1 4 .25 1
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Subtotal.................... 4 .............. 1,204 .............. 261
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Telephone Support Volunteer
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Telephone Support Case Review 8 450 3,600 .25 900
Form...........................
Telephone Support Call Log...... 8 25 200 .16 32
Telephone Support Documentation 8 450 3,600 .5 1,800
Form...........................
Telephone Support Discharge Form 8 25 200 .16 32
Volunteer/Staff Survey.......... 8 1 8 .25 2
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Subtotal.................... 8 .............. 7,608 .............. 2,766
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Social Network Site Moderator
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Social Networking Moderator Log. 1 52 52 .5 26
Volunteer/Staff Survey.......... 1 1 1 .25 .25
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Subtotal.................... 1 .............. 53 .............. 26.25
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Family Program Clinician
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Family Program Progress Notes... 4 650 2,600 .16 416
Family Program Attendance Log... 4 50 200 .08 16
Family Program Case Review Form. 4 650 2,600 .25 650
Family Program Discharge Form... 4 50 200 .16 32
Volunteer/Staff Survey.......... 4 1 4 .25 1
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Subtotal.................... 4 .............. 5,604 .............. 1,115
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Support Services Supervisor
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Telephone Support QA Checklist.. 1 12 12 1 12
Social Networking QA Checklist.. 1 12 12 .5 6
Family Program QA Checklist..... 1 12 12 1 12
Volunteer/Staff Survey.......... 1 1 1 .25 .25
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Subtotal.................... 1 .............. 37 .............. 30.25
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Total................... 418 .............. 21,506 .............. 6,558.50
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[[Page 59553]]
Annualized Summary Table
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Total
Respondents Number of Total annualized
respondents responses hour burden *
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Adolescent...................................................... 200 2,000 1,450
Collateral...................................................... 200 5,000 910
Project Coordinator............................................. 4 1,204 261
Telephone Support Volunteer..................................... 8 7,608 2,766
Social Network Site Moderator................................... 1 53 26.25
Family Program Clinician........................................ 4 5,604 1,115
Support Services Supervisor..................................... 1 37 30.25
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Total....................................................... 418 21,506 6,558.50
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Written comments and recommendations concerning the proposed
information collection should be sent by December 18, 2009 to: SAMHSA
Desk Officer, Human Resources and Housing Branch, Office of Management
and Budget, New Executive Office Building, Room 10235, Washington, DC
20503; due to potential delays in OMB's receipt and processing of mail
sent through the U.S. Postal Service, respondents are encouraged to
submit comments by fax to: 202-395-5806.
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* Total Annualized Hour Burden = Total Responses x Hours per
Response.
Dated: November 12, 2009.
Elaine Parry,
Director, Office of Program Services.
[FR Doc. E9-27641 Filed 11-17-09; 8:45 am]
BILLING CODE 4162-20-P