[Federal Register Volume 73, Number 226 (Friday, November 21, 2008)]
[Notices]
[Pages 70663-70665]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-27696]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration


Agency Information Collection Activities: Proposed Collection; 
Comment Request

    In compliance with Section 3506(c)(2)(A) of the Paperwork Reduction 
Act of 1995 concerning opportunity for public comment on proposed 
collections of information, the Substance Abuse and Mental Health 
Services Administration (SAMHSA) will publish periodic summaries of 
proposed projects. To request more information on the proposed projects 
or to obtain a copy of the information collection plans, call the 
SAMHSA Reports Clearance Officer on (240) 276-1243.
    Comments are invited on: (a) Whether the proposed collections of 
information are necessary for the proper performance of the functions 
of the agency, including whether the information shall have practical 
utility; (b) the accuracy of the agency's estimate of the burden of the 
proposed collection of information; (c) ways to enhance the quality, 
utility, and clarity of the information to be collected; and (d) ways 
to minimize the burden of the collection of information on

[[Page 70664]]

respondents, including through the use of automated collection 
techniques or other forms of information technology.

Proposed Project: Evaluation of Networking Suicide Prevention 
Hotlines--Revision (OMB No. 0930-0274)

    This proposed project revision includes the continuation of two 
previously approved data collection activities [Evaluation of 
Networking Suicide Prevention Hotlines Follow-Up Assessment (OMB No. 
0930-0274) and Call Monitoring of National Suicide Prevention Lifeline 
Form (OMB No. 0930-0275)], and a revision to expand the scope of the 
ongoing evaluation in an effort to advance the understanding of crisis 
hotline utilization and its impact. The Substance Abuse and Mental 
Health Services Administration's (SAMHSA), Center for Mental Health 
Services (CMHS) funds a National Suicide Prevention Lifeline Network 
(NSPL), consisting of two toll-free telephone numbers that routes calls 
from anywhere in the United States to a network of local crisis 
centers. In turn, the local centers link callers to local emergency, 
mental health, and social service resources.
    The overarching purpose of the proposed Evaluation of the 
Networking Suicide Prevention Hotlines--Revision is to (1) continue to 
monitor and ensure quality of calls and gather follow-up information 
from the callers themselves, (2) expand the number of centers 
participating in order to assess whether the two national suicide 
prevention hotline numbers (i.e., 1-800-273-TALK and 1-800-SUICIDE) 
reach similar or complimentary populations of at risk callers, and, (3) 
to evaluate additional but related activities (e.g., motivational 
interviewing and safety planning) recently funded through a new 
cooperative agreement between SAMHSA and crisis hotline centers in the 
NSPL. In total this effort proposed evaluation includes six data 
collection activities.
    Clearance is being requested to continue the following two 
previously approved data collection activities to continue call quality 
monitoring and caller follow-up assessment activities. The number of 
centers proposed to participate in these continuing activities is 
sufficient to address the additional question related to use of the two 
existing hotline numbers.
    (1) To ensure quality, the vast majority of crisis centers conduct 
on-site monitoring of selected calls by supervisors or trainers using 
unobtrusive listening devices. To monitor the quality of calls and to 
inform the development of training for networked crisis centers, the 
national Suicide Prevention Lifeline proposes to remotely monitor calls 
routed to sixteen crisis centers during the shifts of consenting staff. 
The procedures are anonymous in that neither staff nor callers will be 
identified on the Call Monitoring Form. The monitor, a trained crisis 
worker, will code the type of problem presented by the caller, the 
elements of a suicide risk assessment that are completed by the crisis 
worker as well as what action plan is developed with and/or what 
referral(s) are provided to the caller. No centers will be identified 
in the reports.
    During the shifts of consenting crisis staff, a recording will 
inform callers that some calls may be monitored for quality assurance 
purposes. Previous comparisons of matched centers that did and did not 
play the recordings found no difference in hang-up rates before the 
calls were answered or within the first 15 seconds of the calls.
    The 18 centers to be monitored are selected based on the geographic 
region(s) they serve and center call volume. A total of 1,320 calls 
will be monitored during year 1 of the proposed 3-year clearance 
period.
    (2) With input from multiple experts in the field of suicide 
prevention, a telephone interview survey was created to collect data on 
follow-up assessments from consenting individuals calling the Lifeline 
network.
    During year 1 of the proposed 3-year clearance period, a total of 
1,095 callers will be recruited from 18 of the approximately 100 crisis 
hotline centers that participate in the Lifeline network. Trained 
crisis workers will conduct the follow-up assessment (``Crisis Hotline 
Telephone Follow-Up Assessment'') within one month of the initial call. 
Assessments will be conducted only one time for each client. Strict 
measures to ensure confidentiality will be followed.
    The resulting data will measure (a) suicide risk status at the time 
and since the call, (b) depressive symptoms at follow-up, (c) service 
utilization since the call, (d) barriers to service access, and (e) the 
client's perception of the efficacy of the hotline intervention.
    Clearance is also being requested for four new activities that are 
being proposed to evaluate the process and impact of motivational 
training and safety planning (MI/SP) with callers who have expressed 
suicidal desire. Five centers will train counselors to implement an 
intervention with callers during the initial call to a center, which 
incorporates aspects of motivational interviewing and safety planning 
(MI/SP) and utilizes an evidence-based practice model to provide 
follow-up to callers who have expressed a suicidal desire. An 
assessment of MI/SP fidelity and process measures will be incorporated 
into the design through the observation of calls via silent monitoring 
and the administration of two self-administered questionnaires to 
crisis center counselors. The impact assessment of MI/SP counselor 
training will include silent monitoring of calls and follow-up 
telephone interviews with callers to assess their emotions and 
behaviors following their interaction with the MI/SP trained counselor.
    (1) The ``MI/SP Counselor Attitude Questionnaire'' attitude 
questionnaire will be administered to counselors at the conclusion of 
their MI/SP training and be used as a possible predictor of fidelity of 
the MI//SP intervention. Information to be gathered includes (a) 
counselors' views of the applicability of the MI/SP for preparing them 
to conduct safety planning and follow up with callers; (b) possible 
anticipated challenges (i.e., impeding factors) to applying the MI/SP 
training in their centers; (c) the relationship of the MI/SP model to 
their centers; (d) the extent to which individuals have time, energy, 
and mental space in their work lives to make changes required to 
transfer learning on the job; (e) the degree to which training has been 
designed and delivered to give trainees the ability to transfer 
learning to the job; (f) how well training instructions match job 
requirements; (g) the extent to which trainees are provided with or 
obtain adequate resources to enable them to use training on the job; 
(h) impeding and facilitating factors; and (i) attitudes about 
counselors' self-efficacy to use MI/SP and views on its utility. It is 
expected that a total of 225 counselors will be trained over the course 
of 3 years in an effort to maintain 175 counselors at any given time. 
Thus, a total of 225 counselors are expected to complete this 
questionnaire during the 3-year data collection period.
    (2) Research monitors, trained crisis counselors not affiliated 
with the centers in the project, will access a remote ``real-time'' 
monitoring system through the Internet to conduct silent monitoring. 
Monitors will complete the ``MI/SP Silent Monitoring Form,'' to gather: 
(a) Call specifics for each call such as date, time, and length; (b) 
suicide risk status of the caller; (c) information on elements of 
safety planning, such as making the environment safe and identifying 
triggers that led to the caller's suicidality; (d) types of referrals 
the counselor gave and to what services; (e) ratings of counselor 
behaviors and caller

[[Page 70665]]

behavioral changes that occurred; and (f) re-contact permission status. 
At the end of the call and once the counselor deems the intervention to 
be complete, counselors will ask all appropriate callers, using the MI/
SP Caller Initial Script, for permission to be re-contacted by research 
staff for a follow-up interview. Only a caller whose call has been 
silently monitored is eligible to be followed by the research team; 
thus, counselors will state that the caller may be contacted by the 
research team if randomly selected for a follow-up call. A total of 
1,110 calls will be monitored across the 3-year data collection period.
    (3) Counselors will be asked to complete the ``MI/SP Counselor 
Follow-up Questionnaire'' for each call that is monitored. The 
questionnaire will incorporate an assessment of the outreach, 
telephonic follow-up and/or other strategies that the center has 
proposed to implement, and whether the counselor was able to implement 
the center's site plan as originally conceived. The questionnaire will 
also include items on the demographic characteristics of the caller, 
whether contact was successfully made with the caller, whether the 
caller followed through with the safety plan and/or referral given by 
the counselor, whether MI/SP was re-implemented during the follow-up 
contact, whether another follow-up is scheduled, the educational and 
crisis experience of the person attempting re-contact with the caller, 
and that person's prior experience with follow-up. Barriers to 
implementing the follow-up, as well as types of deviation from the 
site's follow-up plan will also be assessed. Open-ended questions about 
what led to deviations from the site's follow-up plan will also be 
included. In total, it is expected that counselors will complete the 
questionnaire for each of the calls that were monitored.
    (4) Researchers will begin conducting follow-up interviews with 
callers approximately 6 weeks after the initial call to the center. 
This follow-up telephone interview (``MI/SP Caller Follow-up 
Interview'') will be conducted to collect information on demographic 
characteristics, gather caller feedback on the initial call made to the 
center, suicide risk status at the time of and since the call, current 
depressive symptomatology, follow through with the safety plan and 
referrals made by the crisis counselor, and barriers to service. Taking 
into account attrition and the number of callers who do not give 
consent, it is expected that the total number of follow-up interviews 
conducted by the research team will not exceed 885.
    The estimated response burden to collect this information, 
annualized over the requested three year clearance period, is presented 
below:

                         Total and Annualized Averages: Respondents, Responses and Hours
----------------------------------------------------------------------------------------------------------------
                                                                      No. of
                   Instrument                         No. of       responses per      Hours/         Response
                                                    respondents    respondent *      response        burden *
----------------------------------------------------------------------------------------------------------------
National Suicide Prevention Lifeline--Call                    10              44             .58             249
 Monitoring Form................................
Crisis Hotline Telephone Initial Script.........             365               1             .08              29
Crisis Hotline Telephone Consent Script.........             365               1             .17              62
Crisis Hotline Telephone Follow-up Assessment...             365               1             .67             245
MI/SP Silent Monitoring Form....................              10              37             .58             214
MI/SP Caller Initial Script.....................             368               1             .08              29
MI/SP Call Follow-up Consent Script.............             368               1             .17              63
MI/SP Caller Follow-up Interview................             295               1             .67             198
MI/SP Counselor Consent.........................              75               1             .08               6
MI/SP Counselor Attitudes Questionnaire.........              75               1             .25              19
MI/SP Counselor Follow-up Questionnaire.........             175               2             .17              89
                                                 ---------------------------------------------------------------
    Total.......................................           2,471  ..............  ..............           1,203
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* Rounded to the nearest whole number.

    Send comments to Summer King, SAMHSA Reports Clearance Officer, 
Room 7-1044, One Choke Cherry Road, Rockville, MD 20857 AND e-mail her 
a copy at [email protected]. Written comments should be 
received within 60 days of this notice.

    Dated: October 16, 2008.
Elaine Parry,
Acting Director, Office of Program Services.
 [FR Doc. E8-27696 Filed 11-20-08; 8:45 am]
BILLING CODE 4162-20-P