[Federal Register Volume 74, Number 221 (Wednesday, November 18, 2009)]
[Notices]
[Pages 59549-59553]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-27641]


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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
                                 -------------------------------------------------------------------------------
    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)....................
                                 -------------------------------------------------------------------------------
    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
                                 -------------------------------------------------------------------------------
    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
                                 -------------------------------------------------------------------------------
    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
                                 -------------------------------------------------------------------------------
    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
                                 -------------------------------------------------------------------------------
    Subtotal....................               1  ..............              37  ..............           30.25
                                 -------------------------------------------------------------------------------
        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
                                                                 -----------------------------------------------
    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