[Federal Register Volume 89, Number 52 (Friday, March 15, 2024)]
[Notices]
[Pages 18952-18954]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-05585]


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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 at 
[email protected].

Proposed Project: 2023-2026 Advancing Wellness and Resilience in 
Education and Trauma Informed Services in Schools Cross-Site 
Evaluation--New Collection

    The Substance Abuse and Mental Health Services Administration 
(SAMHSA) Center for Mental Health Services (CMHS) is requesting 
clearance for data collection that is part of a national cross-site 
evaluation of process, outcomes, and impact for the Advancing Wellness 
and Resilience in Education (hereinafter referred to as Project AWARE) 
and Trauma-Informed Services in Schools (TISS) programs.
    The purpose of the Project AWARE-TISS Cross-Site Evaluation is to 
better understand how each program is implemented, the extent to which 
they facilitate collaboration between education agencies and mental 
health systems, and how each program contributes to access and referral 
to mental health services and improved outcomes for youth.
    The AWARE-TISS Cross-Site Evaluation incorporates four evaluation 
components to provide a robust understanding of the implementation 
(process), outcomes, and associated impacts of the AWARE and TISS 
Programs and includes program-specific components to ensure 
programmatic differences and commonalities are understood. With this 
integrated evaluation design, SAMHSA maintains the ability to evaluate 
and report on each program separately, while additionally benefiting 
from the ability to understand the overarching impact of both programs 
collectively.
    Approval is being requested for data collection associated with a 
Process Evaluation and an Outcome Evaluation. Several program specific 
sub-studies and cross-program impact analyses will also be conducted to 
assess implementation and outcomes overall as well as those outcomes 
specific to high-need subpopulations and under-resourced communities. 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 Process Evaluation will contain two studies (Implementation and 
Sustainability Study and Systems Change Study) that examine strategies 
common to both programs related to program implementation facilitators 
and barriers, workforce development, and grantees' plans to sustain 
critical program components beyond their grant period. This assessment 
of common elements will provide a means to compare the implementation 
strategies that are successful across both AWARE and TISS grantees and 
identify successes and challenges in changing systems, policies, 
service provision, and school climate; increasing behavioral health 
equity in access and service delivery; and increasing social and 
emotional development and well-being in school-aged children and youth. 
The Process Evaluation will also address implementation of program-
specific components.
    For AWARE, the evaluation will document how the grantees implement 
the three-tiered public health model in schools, inclusive of (Tier 1) 
universal prevention and mental health promotion; (Tier 2) secondary 
prevention and brief intervention services; and (Tier 3) tertiary 
intervention and behavioral health treatment along with the referral 
pathways to increase access to mental health promotion, prevention, and 
intervention. The evaluation will assess the grantee collaborative 
efforts and grantee activities intended to increase workforce capacity 
to identify the signs and symptoms of mental illness and ability to 
refer to appropriate services promptly.
    For TISS, the Process Evaluation will focus on examining what 
innovative strategies the grantees use to increase access to trauma 
informed services for school-aged youth and how the collaborative 
efforts of grantees and their partners develop/improve a school-based 
system for identification, referral, early intervention, treatment, and 
supportive services. Additionally, the Process Evaluation will assess 
the implementation of training to improve school capacity to address 
trauma support needs and engagement of families and communities to 
increase awareness of the effects of trauma on children and youth.
    The Outcome Evaluation will include two studies that examine 
important facets of the AWARE and TISS programs: (1) identification and 
referral infrastructure (Identification and Referral Study); and (2) 
youth resiliency and outcomes (Youth Resiliency and Outcomes Study). 
Both studies will provide critical information about the effectiveness 
of the AWARE and TISS programs in establishing and enhancing school-
based mental health supports for students.
    Program specific sub-studies, inclusive of two TISS case studies 
and an AWARE Suicide Awareness and Prevention Sub-Study, will be 
conducted to provide more extensive contextual and implementation 
information related to the AWARE and TISS programs.
    Finally, in addition to assessing the process and outcomes of each 
of the AWARE and TISS programs, we will conduct two cross-program 
analyses that examine the associated impacts of the both programs on 
the establishment and enhancement of school-based mental health 
supports for students (Cross-Program Impact Analysis) and the 
relationships of program and contextual factors with outcomes 
(Behavioral Health Equity Cross-Study Analysis).
    The proposed multimethod approach considers allowable and required 
activities, variation in the partnerships and provider networks/
infrastructure, program settings, populations being served, the range 
of program implementation plans and goals, existing data systems, and 
grant infrastructures that support implementation and evaluation 
participation. In addition, the design considers the stage of 
implementation of currently funded grantees to seamlessly integrate 
cohorts appropriately into the evaluation studies.
    Fourteen primary data collection activities compose the AWARE-TISS 
Cross-Site Evaluation.

Instrument Descriptions

    [ssquf] Implementation Survey (IS): The IS is a web-based survey 
that includes questions on protocols, policies, and structures present 
as part of schools'

[[Page 18953]]

AWARE and TISS implementation processes; school/community integration; 
barriers and facilitators to implementation, and sustainability 
capacity. The survey also includes questions to gather program-specific 
information--for example, implementation of the pyramid model and 
suicide prevention policies in the case of AWARE grantees and details 
on trauma-informed services in the case of TISS grantees. The IS will 
be completed by project coordinator and program staff representatives 
annually. IS data will inform the Implementation and Sustainability 
Study, AWARE Suicide Awareness and Prevention Sub-Study and Behavioral 
Health Equity Cross-Study Analysis.
    [ssquf] Implementation Key Informant Interview (IKII): 
Supplementing IS findings, IKIIs will be conducted to obtain in-depth 
information about AWARE and TISS program implementation and 
sustainability based on the perspectives of grantee program staff and 
local mental health system partner staff. In each year of the 3-year 
data collection period, individual semi-structured interviews will be 
conducted with key representatives of each grantee's collaborative 
partnership group. Questions will focus on partnership development, 
coordination, and shared decision-making; perspectives on 
implementation including challenges, strategies, and successes; 
contextual, systems, or other factors that affect implementation; and 
approaches to planning for program sustainability. Interviews will be 
conducted in person during training and technical assistance (TTA) site 
visits or virtually when needed. IKII data will inform the 
Implementation and Sustainability Study, TISS Case Studies and 
Behavioral Health Equity Cross-Study Analysis.
    [ssquf] Youth and Family Focus Group--Youth (YFFG-Y) and Youth and 
Family Focus Group--Family (YFFG-F): The YFFG-Y and YFFG-F will be 
conducted with youth (aged 14-18 or older if appropriate) who attend 
schools implementing the AWARE or TISS programs and/or their parents/
family representatives. The moderator guides will be semi-structured 
and include open-ended questions to understand experiences and 
perspectives related to school climate, positive supports, youth or 
parent engagement, student resiliency and coping skills, awareness of 
school-based programs or resources to promote mental health literacy 
and meet mental health needs, mental health resource availability, and 
satisfaction with the program. Youth and family focus groups will be 
conducted annually and will include youth or parents representing a 
sample of AWARE and TISS grantees per year, such that all grantees will 
participate in the focus groups at least once during the evaluation. 
The YFFG-Y and YFFG-F will inform the Implementation and Sustainability 
Study and Behavioral Health Equity Cross-Study Analysis. Data collected 
through the YFFG-Y will also inform the Youth and Resiliency Outcomes 
Study.
    [ssquf] Collaboration and Partnership Survey (CPS): CPS is a web-
based survey that assesses communication, working relationships, 
leadership, role-expectations, resources, and partner engagement/
commitment. Respondents will also be asked whether their organization 
currently has a formal, signed memorandum of agreement with the grantee 
and what changes to policy and infrastructure have been made in the 
past year. State and local entities, including project coordinators, 
school administrators, and mental health providers, identified as 
partners by AWARE and TISS Grantees will be considered for 
participation. The CPS will be administered annually and will inform 
the Systems Change Study.
    [ssquf] Training Summary Form (TSF): TSF is a web-based form that 
will be used annually by AWARE and TISS grantees to document training 
and educational seminars. It will include training dates, length of 
time of training (in hours), topic of the training, training 
objectives, format of training delivery (in-person, webinar, online 
asynchronous, etc.), intended audience, and number of training 
participants. It is estimated that grantees will conduct up to 10 
trainings annually for different groups (e.g., teachers, mental health 
professionals, instructional support personnel). The TSF will inform 
the Systems Change Study and AWARE Suicide Awareness and Prevention 
Sub-Study.
    [ssquf] Participant Feedback Form (PFF): The PFF is a web-based 
form that assesses perceptions of immediate and longer-term benefits in 
training areas that research has linked to effective implementation and 
practice change. The PFF will be completed annually by grantee training 
participants after training events to gather perception of the training 
experience and perceived feasibility of using the information. The PFF 
will inform the Systems Change Study.
    [ssquf] AWARE Pre-Post Training Survey (APPTS) and TISS Pre-Post 
Training Survey (TPPTS): The APPTS and TPPTS are web-based surveys 
intended to be taken before and after AWARE or TISS grantee trainings 
across the 3-year data collection period. The APPTS will be completed 
by a sample of training participants per AWARE grantee annually and 
assesses knowledge, attitudes, and beliefs related to identifying 
students in need of mental health services and referring them for 
mental health services, mental health literacy, attitudes, beliefs 
(including stigma), and self-efficacy to provide support and referrals 
to youth experiencing mental health symptoms. The TPPTS will be 
completed by sample of training participants per TISS grantee annually 
and assesses trainee's knowledge of and self-efficacy to use trauma-
informed strategies in their work. The APPTS and TPPTS will inform the 
Systems Change Study.
    [ssquf] Workforce Follow-up Survey (WFS): The WFS is a web-based 
survey that assesses barriers and facilitators to training use and the 
extent to which participants identified students in need of mental 
health services and referred them to services. The WFS will be 
administered to approximately 50% of AWARE and TISS training 
participants that also completed the APPTS or TPPTS. The WFS will be 
completed 3- and 12-months after training events and will be used to 
measure behavioral changes and longer-term impact on systems and 
communities. The WFS will inform the Systems Change Study.
    [ssquf] Student Climate and Safety Survey (STCSS), School Staff 
Climate and Safety Survey (SSCSS), and Parent Climate and Safety Survey 
(PCSS): The STCSS, SSCSS, and PCSS are web-based surveys assessing 
school climate and safety among students attending grantee LEAs, 
parents of students, school personnel, and LEA staff. Surveys will be 
administered in year one and in year three of the evaluation and assess 
availability and utilization of referral for services (for students, 
parents, and school staff), trauma-informed practices (for school 
staff), respect for diversity (for school staff), racial climate (for 
students). The STCSS, SSCSS, and PCC will inform the Systems Change 
Study.
    [ssquf] Student Identification and Referral Form (SIRF): The SIRF 
is a web-based form that gathers existing data detailing each how youth 
in need of mental health, substance use, or trauma-specific support 
services were identified because of an AWARE or TISS program, whether 
and to which services youth were referred, and resulting services 
received. Establishing identification and referral systems, including 
coordination with support service providers equipped to meet the needs 
of youth, is a core component of AWARE and TISS grant requirements. The 
SIRF will be completed by grantee program staff for up to 100 youth 
annually per grantee as

[[Page 18954]]

part of a record review for each youth identified and referred to 
support services. Information about the initial identification, 
including the location and pathway to identification (e.g., individual, 
screening tool, staff role), is obtained, along with information about 
referrals and support services received following identification. The 
form also includes deidentified demographic information about the youth 
receiving the identification, referral, and follow-up care. SIRF data 
can be extracted from case records of school-based care coordinators or 
mental health providers, or other existing data sources, including any 
school staff, support service provider, and family members who make a 
mental health, substance use, or trauma-related identification and 
referral. No personal identifiers are requested on the SIRF. SIRF data 
will inform the Identification and Referral Study and Behavioral Health 
Equity Cross-Study Analysis.
    The estimated response burden to collect this information 
associated with the AWARE-TISS Cross-Site Evaluation is as follows 
annualized over the requested 3-year clearance period is presented 
below. Annual Burden (hours) and Total Cost ($) are rounded to the 
nearest whole number.
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    \1\ BLS OES May 2022 National Industry-Specific Occupation 
Employment and Wage Estimates average annual salary for Community 
and Social Service Specialists, All Other (code 21-1099); https://www.bls.gov/oes/current/oes_nat.htm#21-0000.
    \2\ BLS OES May 2022 National Industry-Specific Occupation 
Employment and Wage Estimates average annual salary for Community 
and Social Service Assistants (code 21-1093); https://www.bls.gov/oes/current/oes_nat.htm#21-0000.

                                            Total and Annualized Averages: Respondents, Responses, and Hours
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                                                                                            Total      Burden per     Annual
            Instrument              Type of respondent      Number of     Responses per   number of     response      burden    Hourly wage   Total cost
                                                           respondents     respondent     responses     (hours)      (hours)      rate ($)       ($)
--------------------------------------------------------------------------------------------------------------------------------------------------------
IS...............................  Project Coordinator.             143               1          143          0.5           72   \1\ $35.52       $2,557
IS...............................  Program Staff.......              15               1           15          0.5            8    \2\ 21.71          174
IKII.............................  Project Coordinator.              94               1           94            1           94        35.52        3,339
IKII.............................  Mental Health                    141               1          141            1          141    \3\ 69.39        9,784
                                    Provider.
IKII.............................  School Administrator              47               1           47            1           47    \4\ 54.21        2,548
YFFG-Y...........................  Youth...............              79               1           79          1.5          119     \5\ 7.25          863
YFGG-F...........................  Parent of Youth.....              79               1           79          1.5          119         7.25          863
CPS..............................  Project Coordinator.             143               1          143         0.25           36        35.52        1,279
CPS..............................  Program Staff.......              47               1           47         0.25           12        21.71          261
CPS..............................  School Administrator              47               1           47         0.25           12        54.21          651
TSF..............................  Program Staff.......              47              10          470         0.15           71        21.71        1,541
PFF..............................  Program Trainee.....           2,775               1        2,775         0.15          416    \6\ 26.81       11,153
APPTS............................  Program Trainee.....           4,000               2        8,000         0.25        2,000        26.81       53,620
TPPTS............................  Program Trainee.....             750               2        1,500         0.25          375        26.81       10,054
WFS..............................  Program Trainee.....           2,391               2        4,782         0.25        1,196        26.81       32,065
PCSS.............................  Parent of Youth.....             282               1          282          0.4          113         7.25          819
STCSS............................  Youth...............             282               1          282          0.4          113         7.25          819
SSCSS............................  School Staff........             282               1          282          0.5          141    \7\ 30.20        4,258
SSCSS............................  School Administrator             188               1          188          0.5           94        54.21        5,096
SIRF.............................  Program Staff.......              47             100        4,700          0.5        2,350        21.71       51,019
                                                        ------------------------------------------------------------------------------------------------
    Total........................  ....................          11,879  ..............       24,096  ...........        7,529  ...........      192,763
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    Written comments and recommendations for the proposed information 
collection should be sent within 30 days of publication of this notice 
to www.reginfo.gov/public/do/PRAMain. Find this particular information 
collection by selecting ``Currently under 30-day Review--Open for 
Public Comments'' or by using the search function.
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    \3\ BLS OES May 2022 National Industry-Specific Occupation 
Employment and Wage Estimates average annual salary for Healthcare 
Diagnosing or Treating Practitioners (code 29-1000); https://www.bls.gov/oes/current/naics5_541720.htm#29-0000.
    \4\ BLS OES May 2022 National Industry-Specific Occupation 
Employment and Wage Estimates average annual salary for Educational 
Administrators, All Other (code 11-9039); https://www.bls.gov/oes/current/naics5_541720.htm#11-0000.
    \5\ https://www.usa.gov/minimum-wage.
    \6\ BLS OES May 2022 National Industry-Specific Occupation 
Employment and Wage Estimates average annual salary for Community 
and Social Service Occupations (code 21-0000); https://www.bls.gov/oes/current/oes_nat.htm#21-0000.
    \7\ BLS OES May 2022 National Industry-Specific Occupation 
Employment and Wage Estimates average annual salary for Educational, 
Guidance, and Career Counselors and Advisors (code 21-2012); https://www.bls.gov/oes/current/naics5_541720.htm#21-0000.

Alicia Broadus,
Public Health Advisor.
[FR Doc. 2024-05585 Filed 3-14-24; 8:45 am]
BILLING CODE 4162-20-P