[Federal Register Volume 74, Number 74 (Monday, April 20, 2009)]
[Notices]
[Pages 17964-17966]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-8974]
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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: Evaluation of Networking Suicide Prevention Hotlines (OMB No.
0930-0274)--Revision
This 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 route 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
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SAMHSA and crisis hotline centers in the NSPL. In total this effort's
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 three 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 three 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 privacy will be followed.
Telephone scripts provide potential participants with standardized
information to inform their consent decision. Using the Crisis Hotline
Telephone Initial Script, trained crisis counselors will ask for
permission to have the evaluation staff re-contact the caller. The
Crisis Hotline Telephone Consent Script, used at the time of re-
contact, incorporates the required elements of a written consent form,
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 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) 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 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 1110 calls will be monitored
across the 3-year data collection period. Prior to monitoring and
collecting of the data, crisis counselors must have read and signed a
MI/SP Counselor Consent. This form explains the purpose of the
research, privacy, risks and benefits, what the study entails, and
participant rights.
(2) 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 trainees are provided with or
obtain adequate resources to enable them to use MI/SP on the job; (h)
impeding and facilitating factors; and (9) 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.
(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
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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 MI/SP Caller
Initial Script protects the privacy of callers by asking the caller how
and when they want to be contacted, and what type of message (if any)
can be left on an answering machine or with the person picking up the
telephone. The caller also has the option of not providing contact
information to the crisis center if he/she prefers to call the
evaluation team back directly. The telephone script used when the
evaluation team contacts the participant for their follow-up interview
(MI/SP Caller Follow-up Consent Script, see Attachment H) includes (1)
the fact that the information collection is sponsored by an agency of
the Federal Government, (2) the purpose of the information collection
and the uses which will be made of the results, (3) the voluntary
nature of participation, and (4) the extent to which responses will be
held confidential.
The estimated response burden to collect this information is as
follows annualized over the requested three year clearance period is
presented below:
Total and Annualized Averages: Respondents, Responses and Hours
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Number of
Instrument Number of responses per Hours/ Response
respondents respondent* response burden*
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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 Caller 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
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Total....................................... 2,471 .............. .............. 1,181
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* Rounded to the nearest whole number.
Written comments and recommendations concerning the proposed
information collection should be sent by May 20, 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: 202-395-6974.
Dated: April 13, 2009.
Elaine Parry,
Director, Office of Program Services.
[FR Doc. E9-8974 Filed 4-17-09; 8:45 am]
BILLING CODE 4162-20-P