# 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.
**Proposed Project: National Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program: Phase IV—(OMB No. 0930-0257)—Revision**
The Substance Abuse and Mental Health Services Administration (SAMHSA), Center of Mental Health is responsible for the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program that will collect data on child mental health outcomes, family life, and service system development and performance.
The national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program will collect data on child mental health outcomes, family life, and service system development and performance. Data will be collected on 27 service systems, and roughly 5922 children and families. Data collection for this evaluation is conducted over a five-year period. The core of service system data will be collected every 18 months throughout the 5-year evaluation period, with a sustainability survey conducted in selected years. Service delivery and system variables of interest include the following: Maturity of system of care development, adherence to the system of care program model, and client service experience. The length of time that individual families will participate in the study ranges from 18 to 36 months depending on when they enter the evaluation. Child and family outcomes of interest will be collected at intake and during subsequent follow-up sessions at six-month intervals. The outcome measures include the following: child symptomatology and functioning, family functioning, material resources, and caregiver strain. Time-limited studies addressing the cultural competence of services and the role of primary care providers in systems of care will be conducted at selected points during the evaluation period. Internet-based technology will be used for collecting data via Web-based surveys and for data entry and management. The average annual respondent burden is estimated below for the final three years of data collection. The estimate reflects the average number of respondents in each respondent category, the average number of responses per respondent per year, the average length of time it will take for each response, and the total average annual burden for each category of respondent, and for all categories of respondents combined.
This revision to the currently approved information collection activities includes: (1) The addition of a Primary Care Study and (2) the addition of a Treatment Effectiveness Study. The Primary Care Study seeks to investigate the role of primary health care practitioners (PCPs) in systems of care and to further understand the impact of services provided within primary care on child and family outcomes. One goal of this study is to identify strategies that help primary care and mental health care providers to work together effectively. Another is to identify ways to integrate PCPs into systems of care. The treatment effectiveness study will examine the relative impact of community-based treatments focused within system of care sites. This study will focus on a community-based practice that has not accumulated research evidence, but rather through community-based implementation has accumulated practice-based evidence.
| Instrument | Respondent | Number of respondents | Total average number of responses per respondent | Hours per response | Total burden hours |
| --- | --- | --- | --- | --- | --- |
| | | | | | |
| Interview Guides and Data Collection Forms | Key site informants | 648 | 2 | 1.000 | 1296 |
| Interagency Collaboration Scale (IACS) | Key site informants | 648 | 2 | 0.133 | 173 |
| Caregiver Information Questionnaire (CIQ-IC) | Caregiver | 5,922 | 1 | 0.283 | 1676 |
| Caregiver Information Questionnaire Followup (CIQ-FC) | Caregiver | 5,922 | 3 | 0.200 | 3553 |
| Caregiver Strain Questionnaire (CGSQ) | Caregiver | 5,922 | 4 | 0.167 | 3956 |
| Child Behavior Checklist (CBCL)/ Child Behavior Checklist 1
-5 (CBCL 1
-5) | Caregiver | 5,922 | 4 | 0.333 | 7888 |
| Education Questionnaire—Revised (EQ-R) | Caregiver | 5,922 | 4 | 0.100 | 2369 |
| Living Situations Questionnaire (LSQ) | Caregiver | 5,922 | 4 | 0.083 | 1966 |
| The Family Life Questionnaire (FLQ) | Caregiver | 5,922 | 4 | 0.050 | 1184 |
| Behavioral and Emotional Rating Scale—Second Edition, Parent Rating Scale (BERS-2C) | Caregiver | 5,626 | 4 | 0.167 | 3758 |
| Columbia Impairment Scale (CIS) | Caregiver | 5,922 | 4 | 0.083 | 1966 |
| The Vineland Screener (VS) | Caregiver | 2,369 | 4 | 0.250 | 2369 |
| Delinquency Survey—Revised (DS) | Youth | 3,553 | 4 | 0.167 | 2374 |
| Behavioral and Emotional Rating Scale—Second Edition, Youth Rating Scale (BERS-2) | Youth | 3,553 | 4 | 0.167 | 2374 |
| GAIN Quick—R: Substance Problem Scale (GAIN) | Youth | 3,553 | 4 | 0.083 | 1180 |
| Substance Use Survey—Revised (SUS) | Youth | 3,553 | 4 | 0.100 | 1421 |
| Revised Children's Manifest Anxiety Scales (RCMAS) | Youth | 3,553 | 4 | 0.050 | 711 |
| Reynolds Adolescent Depression Scale—Second Edition (RADS-2) | Youth | 3,553 | 4 | 0.050 | 711 |
| Youth information Questionnaire—Baseline (YIQ-I) | Youth | 3,553 | 1 | 0.167 | 593 |
| Youth information Questionnaire—Follow-up (YIQ-F) | Youth | 3,553 | 3 | 0.167 | 1780 |
| | | | | | |
| Multi-Sector Service Contacts—Revised (MSSC-RC) | Caregiver | 5,992 | 3 | 0.250 | 4442 |
| Cultural Competence and Service Provision Questionnaire (CCSP) | Caregiver | 5,992 | 3 | 0.167 | 2967 |
| Youth Services Survey (YSS—F) | Caregiver | 5,922 | 3 | 0.117 | 2079 |
| Cultural Competence Practices Study (Focus Groups—F) | Caregiver | 36 | 1 | 1.500 | 54 |
| Youth Services Survey (YSS—Y) | Youth | 3,553 | 4 | 0.083 | 1180 |
| Cultural Competence Practices Study (Focus Groups—Y) | Youth | 36 | 1 | 1.500 | 54 |
| Cultural Competence Practices Study (Focus Groups—P) | Provider | 60 | 1 | 1.500 | 90 |
| | | | | | |
| Diagnostic Interview Schedule for Children (DISC—Predictive Scales) | Caregiver | 262 | 1 | 1.000 | 262 |
| Conflict Behavior Questionnaire (CBQ) | Caregiver | 240 | 4 | .167 | 160 |
| Family Assessment Measure (FAM) | Caregiver | 240 | 4 | .250 | 240 |
| Therapeutic Alliance Scale—caregiver (TAS) | Caregiver | 240 | 3 | .167 | 120 |
| Ohio Scales (caregiver) | Caregiver | 240 | 4 | .250 | 240 |
| Therapy Adherence Form—Revised | Caregiver | 240 | 1 | .167 | 40 |
| Therapeutic Alliance Scales—youth (TAS-Y) | Youth | 192 | 4 | .167 | 128 |
| Ohio Scales—youth | Youth | 192 | 4 | .250 | 192 |
| Evidence-Based Practices Provider Attitudes Scale | Provider | 50 | 1 | .083 | 4 |
| | | | | | |
| Beck Depression Inventory (BDI) | Caregiver | 300 | 3 | .117 | 105 |
| Parenting Sense of Competence Scale (PSOC) | Caregiver | 300 | 3 | .167 | 150 |
| Alabama Parenting Questionnaire (APQ) | Caregiver | 300 | 3 | .117 | 105 |
| Duke Social Support Scale | Caregiver | 300 | 3 | .067 | 60 |
| Vanderbilt Mental Health Services Self-Efficacy Questionnaire | Caregiver | 300 | 3 | .050 | 45 |
| FES—Focus groups | Caregiver | 54 | 1 | 1.500 | 81 |
| FES—Focus groups | Provider | 54 | 1 | 1.500 | 81 |
| FES—Interview | Provider/Administrator | 12 | 1 | 1.000 | 12 |
| | | | | | |
| Primary Care Provider Survey | Provider | 540 | 1 | .500 | 270 |
| | | | | | |
| Sustainability Survey—Caregiver | Caregiver | 27 | 2 | 0.500 | 27 |
| Sustainability Survey—Provider | Provider/Administrator | 81 | 2 | 0.500 | 81 |
| | Number of distinct respondents | Number of responses per respondent | Average 3-year burden per response | Total burden |
| --- | --- | --- | --- | --- |
| | | | | |
| Caregivers | 5,922 | 1.13 | 2.08 | 13,954 |
| Youth | 3,553 | 1.19 | 1.00 | 4,220 |
| Provider/Administrators | 648 | .542 | 1.90 | 669 |
| Total Summary | 10,123 | | | 18,844 |
| Total Annual Average Summary | 3,374 | | | 6,281 |
Written comments and recommendations concerning the proposed information collection should be sent May 7, 2007 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 3, 2007
Elaine Parry,
Acting Director, Office of Program Services.