# 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) 276-1243.
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.
**Proposed Project: National Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program: Phase V (OMB No. 0930-0280)—Revision**
The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS), is responsible for the National Evaluation of the comprehensive Community Mental Health Services for Children and Their Families Program, which collects data on child mental health outcomes, family life, and service system development and performance. Data will be collected on 30 service systems and roughly 8,810 children and families.
The data collection for this evaluation will be conducted for a three-year period. The core of service system data will be collected twice (every 18 to 24 months) during the three-year evaluation period. A sustainability survey will be 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; services received by youth and their families, and the costs of those services; and consumer 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 interviews at six-month intervals. Client service experience information is collected at these follow-up interviews. Measures included in an outcome interview are determined by the type of assessment (intake or follow-up), child's age, and whether the respondent is the caregiver or a youth.
The outcome measures include the following: Child symptomatology and functioning, family functioning, material resources, and caregiver strain. The caregiver interview package includes the Caregiver Information Questionnaire, Child Behavior Checklist, Behavioral and Emotional Rating Scale (BERS), Education Questionnaire, Columbia Impairment Questionnaire, Living Situations Questionnaire, Family Life Questionnaire, and Caregiver Strain Questionnaire at intake, and also includes the Multi-service Sector Contacts Form, Culturally Competence and Service Provision Questionnaire and the Youth Services Survey (a national outcome measurement tool) at follow-up assessments. Caregivers of children under age 6 complete the Vineland Screener to assess development, and do not complete the BERS. The Youth Interview package includes the Youth Information Questionnaire, Revised Children's Manifest Anxiety Scale, Reynolds Depression Scale, BERS (youth version), Delinquency Survey, Substance Use Survey, GAIN-Quick: Substance Dependence Scale, and Youth Services Survey (youth version).
The evaluation also includes three special studies: (1) An evidence-based practices study that examines the effects of various factors on the implementation and use of evidence-based treatments and approaches in system of care communities; (2) A cultural and linguistic competence study that examines the extent to which the cultural and linguistic characteristics of communities influence program implementation and provider adaptation of evidence-based treatments, and provider service delivery decisions based on provider culture and language; and (3) An evaluation of the communities' use of reports produced by the national evaluation for continuous quality improvement. The national evaluation measures address the national outcome measures for mental health programs as currently established by SAMHSA.
Table 1 summarizes which national evaluation components are unchanged from the original 2006 submission and which are new or changed.
| | New or changed for 2009 | No change | Nature of change |
| --- | --- | --- | --- |
| System of Care Assessment | | | |
| Site Visit Tables | | X | |
| Interview Protocols | | X | |
| Inter-Agency Collaboration Scale (IACS) | | X | |
| Longitudinal Child and Family Outcome Study | | | |
| Caregiver Information Questionnaire (CIQ-I) | X | | Question 39a skip pattern revised |
| Caregiver Information Questionnaire (CIQ-F) | X | | Question 39a skip pattern revised |
| Caregiver Strain Questionnaire (CGSQ) | | X | |
| Child Behavior Checklist (CBCL)/Child Behavior Checklist 1
-5 (CBCL 1
-5) | | X | |
| Education Questionnaire—Revised (EQ-R) | X | | Slight wording change to interviewer note and the term “day care” changed to “childcare”. |
| Living Situations Questionnaire (LSQ) | | X | |
| Family Life Questionnaire (FLQ) | | X | |
| Behavioral and Emotional Rating Scale—Second Edition—Parent Rating Scale (BERS-2C) | | X | |
| Columbia Impairment Scale (CIS) | | X | |
| Vineland Screener (VS) | | X | |
| Delinquency Survey—Revised (DS-R) | | X | |
| Behavioral and Emotional Rating Scale—Second Edition, Youth Rating Scale (BERS-2Y) | | X | |
| Gain-Quick Substance Related Issues (Gain Quick-R) | | X | |
| Substance Use Survey—Revised (SUS-R) | | X | |
| Revised Children's Manifest Anxiety Scales (RCMAS) | | X | |
| Reynolds Adolescent Depression Scale—Second Edition (RADS-2) | | X | |
| Youth Information Questionnaire (YIQ-I) | | X | |
| Youth Information Questionnaire (YIQ-F) | | X | |
| Service Experience Study | | | |
| Multi-Sector Service Contacts Questionnaire—Revised (MSSC-R) | X | | Slight modification to Card 4 and Cards 6 and 7 are new. |
| Evidence-Based Practices Experience Measure (EBPEM) | | X | |
| Cultural Competence and Service Provision Questionnaire (CCSP) | | X | |
| Youth Services Survey for Families (YSS-F) | | X | |
| Youth Services Survey (YSS) | | X | |
| Services and Costs Study | | | |
| Flex Funds Data Dictionary | X | | New. |
| Services and Costs Data Dictionary | X | | New. |
| Sustainability Study | | | |
| Sustainability Survey | | X | |
| Continuous Quality Improvement (CQI) Initiative Evaluation | | | |
| CQI Initiative Survey | X | | New. |
| CQI Initiative Interview Guide | X | | New. |
| Evidence-Based Practices Study | | | |
| System-level Implementation Factors Discussion Guide | X | | New. |
| Service-level Implementation Factors Discussion Guide | X | | New. |
| Consumer-level Implementation Factors Discussion Guide | X | | New. |
| Cultural and Linguistic Competence Study | | | |
| CCIOSAS—Beneficiaries of Self-Assessment Findings Focus Group Guide—Staff and Partners | X | | New. |
| CCIOSAS—Beneficiaries of Self-Assessment Findings Focus Group Guide—Caregivers | X | | New. |
| CCIOSAS—Beneficiaries of Self-Assessment Findings Focus Group Guide—Youth | X | | New. |
| CCIOSAS—Participants in Self-Assessments Focus Group Guide—Staff and Partners | X | | New. |
| CCIOSAS—Participants in Self-Assessments Focus Group Guide—Caregivers | X | | New. |
| CCIOSAS—Participants in Self-Assessments Focus Group Guide—Youth | X | | New. |
| CCIOSAS—Users of Self-Assessment Findings Focus Group Guide—Staff and Partners | X | | New. |
| CCIOSAS—Users of Self-Assessment Findings Focus Group Guide—Caregivers | X | | New. |
| CCIOSAS—Users of Self-Assessment Findings Focus Group Guide—Youth | X | | New. |
| CCIOSAS—Telephone Interview—Staff and Partners | X | | New. |
| CCEBPS—Managers of EBP Process Focus Group Guide | X | | New. |
| CCEBPS—Providers of EBP Focus Group Guide | X | | New. |
| CCEBPS—Family Focus Group Guide | X | | New. |
| CCEBPS—Youth Focus Group Guide | X | | New. |
| CCEBPS—Telephone Interview | X | | New. |
Internet-based technology will be used for data entry and management, and for collecting data using Web-based surveys. The average annual respondent burden, with detail provided about burden contributed by specific measures, is estimated below. 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.
**Note:**
Total burden is annualized over a 3-year period.
| Instrument | Respondent | Number of respondents | Total average number of responses per respondent | Hours per response | Total | 3-year |
| --- | --- | --- | --- | --- | --- | --- |
| System of Care Assessment | | | | | | |
| Interview Guides and Data Collection Forms | Key site informants | 630 | 1 | 1.00 | 630 | 210 |
| Interagency Collaboration Scale (IACS) | Key site informants | 630 | 1 | 0.13 | 82 | 27 |
| Longitudinal Child and Family Outcome Study | | | | | | |
| Caregiver Information Questionnaire (CIQ-IC) | Caregiver | 8,810 | 1 | 0.283 | 2,493 | 831 |
| Caregiver Information Questionnaire Followup (CIQ-FC) | Caregiver | 8,810 | 2 | 0.200 | 3,524 | 1,175 |
| Caregiver Strain Questionnaire (CGSQ) | Caregiver | 8,810 | 3 | 0.167 | 4,414 | 1,471 |
| Child Behavior Checklist (CBCL)/Child Behavior Checklist 1
-5 (CBCL 1
-5) | Caregiver | 8,810 | 3 | 0.333 | 8,801 | 2,934 |
| Education Questionnaire—Revised (EQ-R) | Caregiver | 8,810 | 3 | 0.333 | 8,801 | 2,934 |
| Living Situations Questionnaire (LSQ) | Caregiver | 8,810 | 3 | 0.083 | 2,194 | 731 |
| The Family Life Questionnaire (FLQ) | Caregiver | 8,810 | 3 | 0.050 | 1,322 | 441 |
| Behavioral and Emotional Rating Scale—Second Edition, Parent Rating Scale (BERS-2C) | Caregiver | 7,488 | 3 | 0.167 | 4,193 | 1,398 |
| Columbia Impairment Scale (CIS) | Caregiver | 8,369 | 3 | 0.083 | 2,084 | 695 |
| The Vineland Screener (VS) | Caregiver | 1,321 | 3 | 0.250 | 330 | 110 |
| Delinquency Survey—Revised (DS-R) | Youth | 5,286 | 3 | 0.167 | 2,648 | 883 |
| Behavioral and Emotional Rating Scale—Second Edition, Youth Rating Scale (BERS-2Y) | Youth | 5,286 | 3 | 0.167 | 2,648 | 883 |
| Gain-Quick Substance Related Issues (Gain Quick-R) | Youth | 5,286 | 3 | 0.083 | 1,316 | 439 |
| Substance Use Survey—Revised (SUS-R) | Youth | 5,286 | 3 | 0.100 | 1,586 | 529 |
| Revised Children's Manifest Anxiety Scales (RCMAS) | Youth | 5,286 | 3 | 0.050 | 793 | 264 |
| Reynolds Adolescent Depression Scale—Second Edition (RADS-2) | Youth | 5,286 | 3 | 0.050 | 793 | 264 |
| Youth information Questionnaire—Baseline (YIQ-I) | Youth | 5,286 | 1 | 0.167 | 883 | 294 |
| Youth information Questionnaire—Follow-up (YIQ-F) | Youth | 5,286 | 2 | 0.167 | 1,766 | 589 |
| Service Experience Study | | | | | | |
| Multi-Sector Service Contacts—Revised (MSSC-R) | Caregiver | 8,810 | 2 | 0.250 | 4,405 | 1,468 |
| Evidence-Based Practice Measure (EBPEM) | Caregiver | 8,810 | 2 | 0.167 | 2,943 | 981 |
| Cultural Competence and Service Provision Questionnaire (CCSP) | Caregiver | 8,810 | 2 | 0.167 | 2,943 | 981 |
| Youth Services Survey—Family (YSS-F) | Caregiver | 8,810 | 2 | 0.117 | 2,062 | 687 |
| Youth Services Survey (YSS) | Youth | 5,286 | 2 | 0.083 | 877 | 292 |
| Services and Costs Study | | | | | | |
| Flex Funds Data Dictionary | Local staff compiling/entering data | 2,670 | 3 | .033 | 218 | 73 |
| Services and Costs Data Dictionary | Local staff compiling/entering data | 10,680 | 100 | .033 | 29,073 | 9,691 |
| Sustainability Study | | | | | | |
| Sustainability Survey | Caregiver | 52 | 2 | 0.75 | 78 | 26 |
| Sustainability Survey | Provider/Administrator | 156 | 2 | 0.75 | 234 | 78 |
| Continuous Quality Improvement (CQI) Initiative Evaluation | | | | | | |
| CQI Initiative Survey | Key community staff | 150 | 1 | 0.5 | 75 | 25 |
| CQI Initiative Interview Guide | Key community staff | 50 | 1 | 1.0 | 50 | 17 |
| Evidence-Based Practices Study | | | | | | |
| System-level Implementation Factors Discussion Guide | SOC leadership team member | 90 | 1 | 0.75 | 68 | 23 |
| Service-level Implementation Factors Discussion Guide | Provider | 60 | 1 | 0.75 | 45 | 15 |
| Consumer-level Implementation Factors Discussion Guide | Caregivers | 30 | 1 | 0.5 | 15 | 5 |
| Cultural and Linguistic Competence Study | | | | | | |
| CCIOSAS—Beneficiaries of Self-Assessment Findings Focus Group Guide | Provider | 40 | 1 | 1.0 | 40 | 13 |
| CCIOSAS—Beneficiaries of Self-Assessment Findings Focus Group Guide | Administrators/Managers | 20 | 1 | 1.5 | 30 | 10 |
| CCIOSAS—Beneficiaries of Self-Assessment Findings Focus Group Guide | Caregivers | 40 | 1 | .75 | 30 | 10 |
| CCIOSAS—Beneficiaries of Self-Assessment Findings Focus Group Guide | Youth | 40 | 1 | .75 | 30 | 10 |
| CCIOSAS—Participants in Self-Assessments Focus Group Guide | Provider | 40 | 1 | 1.0 | 40 | 13 |
| CCIOSAS—Participants in Self-Assessments Focus Group Guide | Administrators/Managers | 20 | 1 | 1.5 | 30 | 10 |
| CCIOSAS—Participants in Self-Assessments Focus Group Guide | Caregivers | 16 | 1 | .75 | 12 | 4 |
| CCIOSAS—Participants in Self-Assessments Focus Group Guide | Youth | 16 | 1 | .75 | 12 | 4 |
| CCIOSAS—Users of Self-Assessment Findings Focus Group Guide | Provider | 40 | 1 | 1.0 | 40 | 13 |
| CCIOSAS—Users of Self-Assessment Findings Focus Group Guide | Administrators/Managers | 20 | 1 | 1.5 | 30 | 10 |
| CCIOSAS—Users of Self-Assessment Findings Focus Group Guide | Caregivers | 16 | 1 | .75 | 12 | 4 |
| CCIOSAS—Users of Self-Assessment Findings Focus Group Guide | Youth | 16 | 1 | .75 | 12 | 4 |
| CCIOSAS—Telephone Interview | Providers | 2 | 1 | 1.0 | 2 | 0.67 |
| CCIOSAS—Telephone Interview | Administrators/Managers | 3 | 1 | 1.0 | 3 | 1 |
| CCEBPS—Managers of EBP/PBE Interventions Focus Group Guide | Providers | 16 | 1 | 1.0 | 16 | 5 |
| CCEBPS—Managers of EBP/PBE Interventions Focus Group Guide | Administrators/Managers | 20 | 1 | 1.5 | 30 | 10 |
| CCEBPS—Providers of EBP/PBE Interventions Focus Group Guide | Providers | 40 | 1 | 1.0 | 40 | 13 |
| CCEBPS—Family Focus Group Guide | Caregivers | 40 | 1 | .75 | 30 | 10 |
| CCEBPS—Youth Focus Group Guide | Youth | 40 | 1 | .75 | 30 | 10 |
| CCEBPS—Telephone Interview Guide | Providers | 2 | 1 | 1.0 | 2 | 0.67 |
| CCEBPS—Telephone Interview Guide | Administrators/Managers | 3 | 1 | 1.0 | 3 | 1 |
| | Number of distinct respondents | Number of responses per respondent | Average | Total annual burden |
| --- | --- | --- | --- | --- |
| Caregivers | 8,810 | 2.46 | 2.36 | 51,147 |
| Youth | 5,286 | 2.56 | 0.99 | 13,397 |
| Community staff | 870 | 72.22 | 0.86 | 54,035 |
| Total Summary | 14,996 | 6.54 | | 118,579 |
| Total Annual Average Summary | 4,989 | 2.18 | | 39,526 |
Send comments to Summer King, SAMHSA Reports Clearance Officer, Room 7-1044, One Choke Cherry Road, Rockville, MD 20857 and e-mail her a copy at *[email protected]* . Written comments should be received within 60 days of this notice.
Dated: April 1, 2009.
Elaine Parry,
Director, Office of Program Services.