[Federal Register Volume 88, Number 178 (Friday, September 15, 2023)]
[Notices]
[Pages 63593-63596]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-20009]


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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) 276-0361.
    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 respondents, 
including through the use of automated collection techniques or other 
forms of information technology.

Project: GLS State/Tribal Evaluation of the Garrett Lee Smith (GLS) 
State/Tribal Youth Suicide Prevention and Early Intervention Program--
Reinstatement

    The Substance Abuse and Mental Health Services Administration 
(SAMHSA) Center for Mental Health Services (CMHS) is requesting 
clearance for the reinstatement of data collection associated with the 
previously approved evaluation of the Garrett Lee Smith (GLS) Youth 
Suicide Prevention and Early Intervention Program (GLS Suicide 
Prevention Program). The GLS State/Tribal Evaluation is a proposed 
redesign of the currently approved evaluation (OMB No. 0930-0286; 
Expiration, March 31, 2019) that builds on prior published GLS 
evaluation proximal and distal outcomes and aggregate findings from 
program activities (e.g., Condron, Godoy-Garraza, Walrath, McKeon, & 
Heilbron, 2014; Walrath, Godoy-Garraza, Reid, Goldston, & McKeon, 2015; 
Godoy-Garraza, Walrath, Kuiper, Goldston, & McKeon, 2018; Condron, 
Godoy-Garraza, Kuiper, Sukumar, Walrath, & McKeon, 2018; Godoy-Garraza, 
Kuiper, Goldston, McKeon, & Walrath, 2019; Godoy-Garraza, Kuiper, 
Cross, Hicks, & Walrath, 2020; Goldston & Walrath, 2023). As a result 
of the vast body of information collected and analyzed through the 
previous cross-site evaluation SAMHSA has identified areas for 
additional investigation and the types of inquiry needed to move the 
evaluation into its next phase.
    The purpose of the GLS Suicide Prevention Program is to facilitate 
a comprehensive public health approach to prevent suicide. Passed by 
Congress in 2004, the Garrett Lee Smith Memorial Act (GLSMA) was the 
first legislation to provide funding for States, Tribes, and 
institutions of higher education to develop, improve, and evaluate 
early intervention and suicide prevention programs. GLSMA mandates that 
the effectiveness of the GLS Suicide Prevention Program be evaluated 
through both cross-site and local evaluation and reported to Congress.
    The GLS State/Tribal Evaluation is designed to gather detailed 
outcome and impact data to provide SAMHSA with the data and information 
needed to understand what works, why it works, and under what 
conditions, relative to program activities.
    The purpose of the GLS State/Tribal Evaluation is to build the 
program's knowledge base by expanding on information gathered through 
the prior evaluation related to the process, products, context, and 
impacts of the GLS State/Tribal Program.
    The GLS State/Tribal Evaluation incorporates three areas of 
evaluation to provide a robust understanding of the implementation, 
outcomes, and impacts of the GLS State/Tribal Program. A behavioral 
health equity and cultural equity lens will be applied to each area of 
evaluation to ensure a culturally specific understanding of 
intervention implementation, outcomes, and impacts.
    The Implementation Evaluation inventories the array of strategies 
and services implemented by grantees and answers questions about the 
extent to which grantees are implementing required and allowed 
prevention strategies and services, including related settings, 
populations, and degree of fidelity to their work plan.
    The Outcome Evaluation includes three studies related to trainings, 
youths' experience of services, and the continuity of care for at-risk 
youths--i.e., the Training Outcomes Study; Youth Experience, Outcomes, 
and Resiliency Study (Youth Study); and Continuity of Care Study. These 
studies will provide a deeper examination of the effectiveness of these 
strategies as they relate to the long-term gains in trainee skills to 
identify and manage youths at risk for suicide; youths' perspectives, 
including an assessment of how youths experience services, supports and 
facets that encourage building resilience, stress tolerance, and self-
management skills; and the effectiveness of a continuum of care that 
connects youths to treatment services and supports, and post-discharge 
follow-up.

[[Page 63594]]

    Finally, the Impact Evaluation will combine data from the 
Implementation and Outcome Evaluations to assess the effectiveness of 
the GLS State/Tribal Program on decreasing suicide morbidity and 
mortality. Through implementation of this evaluation design, it will be 
possible to isolate prevention strategy impacts and explain cross-
program impacts on short-term (e.g., change in self-efficacy to 
identify change in the number of youths identified as at risk) and 
long-term program outcomes such as suicide attempts and deaths by 
suicide.
    Nine data collection activities compose the GLS State/Tribal 
Evaluation--4 revised data collection instruments and 5 new data 
collection instruments.

Instrument Removals

    The current GLS State/Tribal Evaluation does not include data 
collection with campus grantees, so all campus-specific instruments are 
being removed. Additionally, due to SAMHSA's current research 
priorities and the fulfillment of previous data collection 
requirements, 7 previously approved instruments are being revised or 
removed from the evaluation. These include: Behavioral Health Provider 
Survey (BHPS), Prevention Strategies Inventory (PSI) Campus, Student 
Behavioral Health Form (SBHF), Treatment as Prevention (TASP) Campus, 
Early Identification, Referral, Follow-up, and Treatment Individual 
Form, Early Identification, Referral, Follow-up, and Treatment 
Screening Form, Sustainability One-Year Follow-up (SFUP), SFUP Consent-
to-Contact, and Training Utilization and Preservation--Survey (TUP-S) 
Campus.

Instrument Revisions

    [ssquf] PSI: the PSI is a web-based survey that captures all State/
Tribal program prevention strategies and products. Data include 
strategy types and products distributed, intended audiences or 
populations of focus, and expenditures across major categories (e.g., 
outreach and awareness, gatekeeper training, screening programs). Each 
major strategy includes sub-strategies, enabling grantees to specify 
and provide details about the sub-strategy, including implementation 
setting/location, timeframe, and intended audiences or populations of 
focus. The PSI is completed by grantee staff each quarter. PSI data 
will inform the Training Outcomes Study and Continuity of Care Study. 
Compared to the prior version of the PSI, the revised PSI includes all 
previous strategies and integrates new or revised questions related to 
the following areas of interest: (1) grantees use of emerging 
technologies (2) implementation of evidence based practices (EBPs), (3) 
cultural adaptations and health equity practices, and (4) program 
sustainability. In addition, we have revised the PSI to optimize the 
assessment of implementation timeframe and location and the alignment 
of audiences more precisely with grantee strategies implemented.
    [ssquf] TASP: the TASP is a web-based survey collecting aggregate-
level training data from all State/Tribal grantees. Data include 
information about the type of training delivered, the number and roles 
of training participants, and the setting of the training, including 
ZIP code where the training is held (for use in analysis of GLS program 
impact). The TASP also assesses intended outcomes, as well as the 
number of online trainings completed, train-the-trainer events held, 
and booster trainings that follow the initial training. The TASP also 
gathers information about the inclusion of behavioral rehearsal or 
role-play and resources provided at the training as these elements have 
been found to improve retention of knowledge and skills post-training. 
Additionally, the TASP collects information about resources or 
materials provided to trainees (e.g., mobile or online tools or 
applications for suicide prevention, fact or resource sheets, and 
wallet card information) to improve understanding of how skills can be 
maintained over time with materials provided at trainings (Cross et 
al., 2011). A TASP is completed by grantee program staff within 2 weeks 
of each in-person training activity and quarterly for virtual training 
activities. The revised TASP includes more refined assessment of 
training format including (1) in person; (2) virtual (facilitated on a 
specific date) and (3) virtual (self-directed; trainee completes 
training at own pace) and revisions to align with updated Government 
Performance and Results Act (GPRA) indicators.
    [ssquf] EIRFT-I: the web-based EIRFT-I gathers existing data for 
each at-risk youth identified as a result of the GLS Suicide Prevention 
Program (via a GLS-trained gatekeeper, a GLS-sponsored screening 
identification, or via a discharge from an emergency room or inpatient 
psychiatric treatment). Initial follow-up information (whether a 
service was received after referral or not) is obtained along with 
details on all services received in the 6 months following 
identification. Ensuring adequate resources and services for referral 
to care is a best practice for both screenings and gatekeeper 
trainings. In addition, a response system that ensures timely referrals 
is part of GLS grant requirements. Data can be extracted from case 
records or other existing data sources, including any organizational 
staff, community members, or family members who make a mental health 
identification and referral. Respondents include grant program staff 
and service providers representing all grantees in all funding years. 
Data collection is ongoing for each youth identified at risk, screened 
positive, or discharged from an emergency room or hospital for a 
suicide attempt and/or suicidal ideation. No personal identifiers are 
requested on the EIRFT-I. Grantee program staff enter EIRF-I data on an 
ongoing basis. EIRFT-I data will inform the Training Outcomes and 
Continuity of Care Studies. This instrument builds upon the previous 
EIRF-I, with the addition of data collection on follow-up post-
discharge from emergency departments or psychiatric hospitalization and 
additional information on treatment.
    [ssquf] EIRFT-S: the web-based EIRFT-S gathers aggregate 
information about all screening activities conducted as part of the GLS 
program. Data include aggregate information on the number of youths 
screened for suicide risk through the GLS program, and the number 
screening positive. On an ongoing basis, the grantee will submit EIRFT-
S forms. EIRFT-S forms are completed once per implementation of a 
screening tool in a group setting, once per month for clinical 
screenings, and once per month for one-on-one screenings. For each 
screening event in which multiple youths are screened at a given time, 
one EIRFT-S should be completed for the event. For one-on-one 
screenings in a clinical or other setting, one aggregated EIRFT-S is 
completed per month to reflect screening outcomes of all youths 
screened during the month. Grantees develop systems locally to gather 
identification and referral data, including extracting data from 
existing electronic health records or forms. No personal identifiers 
are requested on the EIRFT-S. EIRFT-S data will inform the Continuity 
of Care Study. This instrument continues the previous EIRF-S.

Instrument Additions

    Five instruments will augment the evaluation.
    [ssquf] TSA-P: the Training Skills Assessment-Post Training (TSA-P) 
is a web-based survey to assess trainee confidence in identifying and 
managing youth at risk for suicide after participation in a training 
event. At the conclusion of all training events,

[[Page 63595]]

trainees will be asked to complete the TSA-P. The instrument is 
designed to assess baseline confidence following the training, 
knowledge of suicide prevention, confidence in identifying and managing 
suicidal youth, and pretraining behaviors related to identifying and 
managing youths at risk of suicide. As part of the TSA-P, trainees will 
be asked to complete a consent-to-contact web form indicating their 
willingness to be contacted by the GLS State/Tribal Evaluation team to 
participate in the TSA-F and TSA-PS. If a trainer is unable to 
administer the survey or consent-to-contact form electronically, or a 
trainee does not have access to a mobile device or computer, they may 
also complete the survey and consent-to-contact form on paper. The 
grantee will submit this information to ICF, through direct data entry 
into the Suicide Prevention Data Center (SPDC), within 2 weeks of the 
training event. Once consent to contact has been received, ICF will 
create a random sample of participants for the phone simulation and the 
6- and 12-month follow-up surveys. TSA-P data will inform the Training 
Outcomes Study.
    [ssquf] TSA-F: The Training Skills Assessment-Follow up (TSA-F) is 
a follow-up web-based survey to assess trainees' sustained confidence 
and skills in identifying and managing youth at risk for suicide, as 
well as experience with managing at-risk youth since training 
(interventions with youths, additional training, etc.). The survey will 
be administered to a sample of training participants at 6- and 12-
months after the initial TSA-P is completed. TSA-F data will inform the 
Training Outcomes Study.
    [ssquf] TSA-PS: The Training Skills Assessment-Phone Simulation 
(TSA-PS) is a follow-up phone simulation using standardized interaction 
to assess trainee skills in identification and management of a youth in 
suicidal crisis. A random subsample of training participants will be 
contacted by the evaluation team to participate in a simulated 
conversation with a youth in suicidal crisis portrayed by a trained 
actor. These simulations will occur between 3 and 6 months following 
their initial training. The simulated conversation between the training 
participant and actor will last approximately 10 to 30 minutes 
(community gatekeeper sessions will likely be shorter than the 
clinician interactions). In total, the session will be scheduled for 45 
minutes to allow for consent, instructions, and a debrief. These phone 
sessions will be administered via tele video and recorded for 
additional post-simulation scoring and analysis. All sessions will be 
attended by the training participant, an actor, and an evaluation team 
member (observer), who will be responsible for facilitating the 
interaction, administering the consent, scoring the interaction (both 
in real time and based on the recording), and providing a short debrief 
to the training participant. TSA-PS data will inform the Training 
Outcomes Study.
    [ssquf] YORS: the Youth Outcomes and Resiliency Survey (YORS) is a 
web-based survey assessing the experience and outcomes of those youth 
who are served by the GLS Program. The instrument is designed to assess 
suicidality, positive youth development, satisfaction with services 
received, youth engagement experience, and family and school dynamics. 
Youth between the ages of 14-24 years who receive a positive screening 
result (as part of the GLS program activities) and receive a referral 
to a mental health service, or youths who attend skills-based training 
will be considered eligible for the study. A sample of eligible youth 
will be enrolled in the Youth Study. The age of the youth respondent 
will dictate how consent is obtained for the YORS. All youths under the 
age of 18 at selected grantee sites will be asked to have their parent 
complete consent-to-contact forms and participate in the YORS and Youth 
Experience Reflective (YER) Journal when they consent to receiving 
screening from the grantee. Youths over the age of 18 will be asked to 
complete consent-to-contact forms at the time of initial referral and 
screening (after gatekeeper identification). The YORS will be 
administered at 3-, 6-, and 12-months post enrollment, with enrollment 
occurring no later than 1 month following referral to a behavioral 
health service.
    [ssquf] YER Journal: the YER Journal is a web-based survey 
consisting of a weekly journal prompt that youth can respond to with a 
photo and corresponding narrative interpretation of the photo. For 
example, youths may be asked to reflect on a recent experience 
receiving services. The youth would be asked to submit a photo that 
represents that experience, followed by a prompt that asks: ``What 
words come to mind? How did it make you feel?'' The narrative 
description of what the photo represents will be analyzed using 
qualitative methodologies. Up to 25 youths will be recruited to 
participate in the YER Journal each year. Youths participating in the 
YORS will be invited to join the YER Journal via contact through the 
YORS data collection activities. For example, a youth may complete 
their third quarterly YORS follow-up, and be invited to join the YER 
Journal study simultaneously. Our team will leverage innovative data 
collection technology to engage youth. Weekly prompts will be sent to 
youths for 6 weeks post enrollment to discover, for example, which 
components of what youths are receiving are meaningful and helpful, and 
how youths may be utilizing skills or services following the initial 
screening, both in the short and long terms.
    The estimated response burden to collect this information 
associated with the redesigned GLS State/Tribal Evaluation is as 
follows annualized over the requested 3-year clearance period is 
presented below:

                                             Total and Annualized Averages--Respondents, Responses and Hours
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                                                                             Responses      Total      Burden per     Annual
         Type of respondent                  Instrument         Number of       per       number of     response      burden    Hourly wage   Total cost
                                                               respondents   respondent   responses     (hours)      (hours)      rate ($)       ($)
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Project Evaluator...................  PSI....................           31            4          124         1.25          155    \1\ 37.11       $5,752
Project Evaluator...................  TASP...................           31           10          310         0.25           78        37.11        2,876
Project Evaluator...................  EIRFT-Individual Form..           31            4          124            2          248        37.11        9,203
Project Evaluator...................  EIRFT-Screening Form...           31            4          124         0.75           93        37.11        3,451
Provider Trainee....................  TSA Consent to Contact.       10,000            1       10,000         0.08          800        27.46       21,968
Provider Trainee....................  TSA-P..................       10,000            1       10,000          0.3         3000        27.46       82,380
Provider Trainee....................  TSA 6-month............          187            1          187          0.3           56        27.46        1,541
Provider Trainee....................  TSA 12-month...........          140            1          140          0.3           42        27.46        1,153
Provider Trainee....................  TSA-PS.................          101            1          101         0.75           76        27.46        2,080
Youth...............................  YORS baseline..........          300            1          300          0.5          150         7.25        1,088
Youth...............................  YORS 3-month...........          240            1          240          0.5          120         7.25          870
Youth...............................  YORS 6-month...........          192            1          192          0.5           96         7.25          696
Youth...............................  YORS 12-month..........          115            1          115          0.5           58         7.25          417

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Youth...............................  YER Journal............           25            6          150         0.25           38         7.25          272
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    Total...........................  .......................       21,424  ...........       22,107  ...........        5,008  ...........      133,747
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* Rounded to the nearest whole number.

    Send comments to Carlos Graham, SAMHSA Reports Clearance Officer, 
[email protected]. Written comments should be received by 
November 14, 2023.
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    \1\ BLS OES May 2022 National Industry-Specific Occupation 
Employment and Wage Estimates average annual salary for Survey 
Researchers (code 19-3022); https://www.bls.gov/oes/current/naics5_541720.htm.

Alicia Broadus,
Public Health Advisor.
[FR Doc. 2023-20009 Filed 9-14-23; 8:45 am]
BILLING CODE 4162-20-P