# 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.
**Cross-Site Accountability Assessment of the Residential Treatment for Pregnant and Postpartum Women and Their Minor Children Program (PPW)—New**
The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT), has funded the Cross-Site Accountability Assessment of the Residential Treatment for Pregnant and Postpartum Women and Their Minor Children Program (PPW). In addition to assessing project activities, the purpose of the PPW is to expand the availability of comprehensive, high quality residential treatment services for pregnant and postpartum women who suffer from alcohol and other drug use problems, and for their infants and children impacted by the perinatal and environmental effects of maternal substance use and abuse.
Section 508 [290bb-1] (o) of the Public Health Service Act mandates the evaluation and dissemination of findings of residential treatment programs for pregnant and postpartum women. This cross-site accountability assessment will assess project activities implemented for these services.
With input from multiple experts in the field of women and children's treatment programs, the projects selected, by consensus, a common core of data collection instruments that will be used for program and treatment planning, local evaluations, and for this cross-site accountability evaluation. For mothers, five different interview instruments will be used: (1) Child Data Collection Tool, Part 1 (personal background) and Part 2 (infant and child background); (2) Child Well-Being Scale #24 (brief observation of mother/child interaction), (3) Ferrans and Powers Quality of Life Index; (4) BASIS 32 (behavioral health assessment); and (5) Allen's Barriers to Treatment. For children of all ages, program staff will collect information from observation, interview, and records review. Children's data collection tools include: (1) Child Well-Being Scales (all children), (2) Denver Developmental Screening Inventory II (ages 1m-6y), (3) Middle Childhood Developmental Assessment Guide (ages 7-10), (4) Adolescent Development Assessment Guide (ages 11-17), and (5) the CRAFFT substance abuse screening instrument (ages 14-17). Additional records review will be conducted by program staff on all program participants at discharge.
All data will be collected using a combination of observation, records review, and computer-based personal interviews. CSAT will use this data for this accountability assessment to influence public policy, research, and programming as they relate to the provision of women's services. Data produced by this study will provide direction to the type of technical assistance that will be required by service providers of women's programming. In addition, the data will be used by individual grantees to support progress report efforts.
Tables A-1 through A-4 below show the estimated annual response burden for this collection.
| Form name | Respondent | Estimated number of | Responses per | Total | Hours per | Total hour |
| --- | --- | --- | --- | --- | --- | --- |
| Child Data Collection Tool | Mother interview | 414 | 3.23 | 1,337 | .83 | 1,110 |
| Child Well-Being Scale #24 | Mother observation | 414 | 4 | 1,656 | .03 | 50 |
| Allen's Barriers to Treatment | Mother interview | 414 | 3 | 1,242 | .33 | 410 |
| Ferrans and Powers Quality of Life Index | Mother interview | 414 | 3 | 1,242 | .50 | 621 |
| BASIS 32 | Mother interview | 414 | 3 | 1,242 | .25 | 311 |
| Total for Women: | Mother | 414 | | 6,719 | | 2,502 |
| Form name | Respondent | Estimated number of | Responses per | Total | Hours per | Total hour |
| --- | --- | --- | --- | --- | --- | --- |
| Child Well-Being Scales (ages 0 through 17) | Child observation and records | 924 | 4 | 3,696 | .33 | 1,220 |
| Denver Developmental Screening Inventory II (ages 1 month through 6 years) | Child interview and observation | 462 | 3 | 1,386 | .33 | 457 |
| Middle Childhood Developmental Assessment Guide (ages 7 through 10) | Child interview and observation | 168 | 3 | 504 | .33 | 166 |
| Adolescent Development Assessment Guide (ages 11 through 17) | Child interview and observation | 294 | 3 | 882 | .33 | 291 |
| CRAFFT (ages 14 through 17) | Child interview | 168 | 3 | 504 | .08 | 40 |
| Total for Minor children/Staff: | | 924 | | 6,972 | | 2,174 |
| Form name | Respondent | Estimated number of | Responses per | Total | Hours per | Total hour |
| --- | --- | --- | --- | --- | --- | --- |
| Women's Discharge Tool | Records review | 414 | 1 | 414 | .25 | 104 |
| Children's Discharge Tool | Records review | 924 | 1 | 924 | .25 | 231 |
| Total for Staff: | | 1,338 | | 1,338 | | 335 |
| Form name | Respondent | Estimated number of | Responses per | Total | Hours per | Total hour |
| --- | --- | --- | --- | --- | --- | --- |
| Total for Women | | 414 | | 6,719 | | 2,502 |
| Total for Minor Children/Staff | | 924 | | 6,972 | | 2,174 |
| Total for Staff | | 1,338 | | 1,338 | | 335 |
| Total | | 2,676 | | 15,029 | | 5,011 |
Written comments and recommendations concerning the proposed information collection should be sent by March 24, 2005, 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: January 24, 2005.
Anna Marsh,
Executive Officer, SAMHSA.