# 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.
**Project: National Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program: Phase VI-NEW**
The Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services is responsible for the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program (Children's Mental Health Initiative—CMHI) that will collect data on child mental health outcomes, family life, and service system development and performance. Data will be collected on 26 service systems, and approximately 5,541 children and families.
Data collection for this evaluation will be conducted over a five-year period. Child and family outcomes of interest will be collected at intake and during subsequent follow-up sessions at six-month intervals. The length of time that individual families will participate in the study ranges from 12 to 24 months depending upon when they enter the evaluation. The outcome measures include the following: Child symptomatology and functioning, family functioning, satisfaction, and caregiver strain. The core of service system data will be collected every 18-24 months throughout the 5-year evaluation period, with a sustainability survey conducted in years 3 and 5. Service utilization and cost data will be tracked and submitted to the national evaluation every six months using two tools, the Flex Fund Tool and the Services and Costs Data Tool, to estimate average cost of treatment per child, distribution of costs, and allocation of costs across service categories. Service delivery and system variables of interest include the following: Maturity of system of care development in funded system of care communities, adherence to the system of care program model, and client service experience. We will also conduct a comprehensive evaluation of the CMHI's data driven technical assistance; this component of the evaluation will employ a mixed-methods approach, combining qualitative and quantitative data to provide a comprehensive assessment of the continuous quality improvement (CQI) process in funded system of care communities. Specifically, data will be gathered through three complementary activities: A baseline survey of key constituents in all funded communities; a subsequent monitoring survey administered every two years to the same constituents; and biennial case studies of four selected communities.
In addition, the evaluation will include three special studies: (1) The sector specific assessment and quasi-experimental comparison study will examine in more detail the outcomes and service experience of children from multiple child-serving sectors and, through child-level matching, compare these outcomes with those not receiving system of care services; (2) The Alumni Network Study will examine the effectiveness of the system of care Alumni Network Web site by evaluating end-user satisfaction and usability of the Web site and will also assess the collaboration between communities via a Web-based Networking and Collaboration Survey that will measure the nature and extent of the interaction between communities; (3) The Study of State Strategies for Sustainability will examine the state's role in sustaining communities after federal funding ceases and describe effective strategies for sustaining funded systems of care. A short version of the sustainability survey developed for this evaluation will be used to gather this information.
Internet-based technology such as Web-based surveys and data entry and management tools will be used in this evaluation. The measures of the national evaluation address the national outcome measures for mental health programs as currently established by SAMHSA.
The average annual respondent burden 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 to complete each response, and the total average annual burden for each category of respondent, and for all categories of respondents combined.
| Instrument | Respondent | Number of | Total average number of | Hours per | Total burden hours | 5-year average annual burden hours |
| --- | --- | --- | --- | --- | --- | --- |
| | | | | | | |
| Interview Guide A. Core Agency Representative | Key site informants | 598 | 3 | 1.00 | 1,794 | 359 |
| Interview Guide B. Project Director | | | | | | |
| Interview Guide C. Family Representative/Representative of Family/Advocacy Organizations | | | | | | |
| Interview Guide D. Program Evaluator | | | | | | |
| Interview Guide E. Intake Worker | | | | | | |
| Interview Guide F. Care Coordinator | | | | | | |
| Interview Guide G. Direct Service Delivery Staff | | | | | | |
| Interview Guide H. Care Review Participant | | | | | | |
| Interview Guide I. Caregiver of Child or Youth Served by the Program | | | | | | |
| Interview Guide L. Direct Service Staff from Other Public Child-Serving Agencies | | | | | | |
| Interview Guide M. Care Record/Chart Review | | | | | | |
| Interview Guide N. Other Staff | | | | | | |
| Interview Guide O. Debriefing Document | | | | | | |
| Interview Guide P. Youth Respondent | | | | | | |
| Interview Guide Q. Youth Coordinator | | | | | | |
| Interview Guide R. Cultural and Linguistic Competence Coordinator | | | | | | |
| Interview Guide S. Social Marketing Communications Manager | | | | | | |
| | | | | | | |
| Caregiver Information Questionnaire, Revised: Caregiver—Intake (CIQ-RC-I) | Caregiver | 5,541 | 1 | 0.37 | 2,032 | 406 |
| Caregiver Information Questionnaire, Revised: Staff as Caregiver—Intake (CIQ-RS-I) | Staff as Caregiver | | | | | |
| Caregiver Information Questionnaire, Revised: Caregiver—Follow-Up (CIQ-RC-F) | Caregiver | 5,541 | 4 | 0.28 | 6,280 | 1,256 |
| Caregiver Information Questionnaire, Revised: Staff as Caregiver—Follow-Up (CIQ-RS-F) | Staff as Caregiver | | | | | |
| Caregiver Strain Questionnaire (CGSQ) | Caregiver | 5,541 | 5 | 0.17 | 4,627 | 925 |
| Child Behavior Checklist 1
-5 (CBCL 1
-5) | Caregiver | 5,541 | 5 | 0.33 | 9,226 | 1,845 |
| Child Behavior Checklist 6-18 (CBCL 6-18) | | | | | | |
| Education Questionnaire, Revision 2 (EQ-R2) | Caregiver | 5,541 | 5 | 0.33 | 9,226 | 1,845 |
| Living Situations Questionnaire (LSQ) | Caregiver | 5,541 | 5 | 0.08 | 2,300 | 460 |
| Behavioral and Emotional Rating Scale—Second Edition, Parent Rating Scale (BERS-2C) | Caregiver | 4,909 | 5 | 0.17 | 4,099 | 820 |
| Columbia Impairment Scale (CIS) | Caregiver | 5,348 | 5 | 0.08 | 2,219 | 444 |
| Parenting Stress Index (PSI) | Caregiver | 2,030 | 5 | 0.08 | 846 | 169 |
| Devereux Early Childhood Assessment for Infants (DECA 1-18M) | Caregiver | 1,528 | 5 | 0.08 | 637 | 127 |
| Devereux Early Childhood Assessment for Toddlers (DECA 18-36M) | | | | | | |
| Devereux Early Childhood Assessment (DECA 2-5Y) | | | | | | |
| Preschool Behavioral and Emotional Rating (PreBERS) | Caregiver | 1,528 | 5 | 0.10 | 764 | 153 |
| Delinquency Survey, Revised (DS-R) | Youth | 3,624 | 5 | 0.13 | 2,416 | 483 |
| Behavioral and Emotional Rating Scale—Second Edition, Youth Rating Scale (BERS-2Y) | Youth | 3,624 | 5 | 0.17 | 3,026 | 605 |
| Gain Quick-R: Substance Problem Scale (GAIN) | Youth | 3,624 | 5 | 0.08 | 1,504 | 301 |
| Substance Use Survey, Revised (SUS-R) | Youth | 3,624 | 5 | 0.10 | 1,812 | 362 |
| Revised Children's Manifest Anxiety Scales (RCMAS) | Youth | 3,624 | 5 | 0.05 | 906 | 181 |
| Reynolds Adolescent Depression Scale—Second Edition (RADS-2) | Youth | 3,624 | 5 | 0.05 | 906 | 181 |
| Youth Information Questionnaire, Revised—Intake (YIQ-R-I) | Youth | 3,624 | 1 | 0.25 | 906 | 181 |
| Youth Information Questionnaire, Revised—Follow-Up (YIQ-R-F) | Youth | 3,624 | 4 | 0.25 | 3,624 | 725 |
| | | | | | | |
| Multi-Sector Service Contacts, Revised: Caregiver—Intake (MSSC-RC-I) | Caregiver | 5,541 | 1 | 0.25 | 1,385 | 277 |
| Multi-Sector Service Contacts, Revised: Staff as Caregiver—Intake (MSSC-RS-I) | Staff as Caregiver | | | | | |
| Multi-Sector Service Contacts, Revised: Caregiver—Follow-Up (MSSC-RC-F) | Caregiver | 5,541 | 4 | 0.25 | 5,541 | 1,108 |
| Multi-Sector Service Contacts, Revised: Staff as Caregiver—Follow-Up (MSSC-RS-F) | Staff as Caregiver | | | | | |
| Cultural Competence and Service Provision Questionnaire, Revised (CCSP-R) | Caregiver | 5,541 | 4 | 0.13 | 2,955 | 591 |
| Youth Services Survey for Families (YSS-F) | Caregiver | 5,541 | 4 | 0.12 | 2,593 | 519 |
| Youth Services Survey (YSS) | Youth | 3,624 | 4 | 0.08 | 1,203 | 241 |
| | | | | | | |
| Court Representative Questionnaire (CRQ) | Court representatives | 212 | 5 | 0.50 | 530 | 106 |
| Electronic Data Transfer of Juvenile Justice Records | Key site personnel | 212 | 5 | 0.03 | 35 | 7 |
| | | | | | | |
| Teacher Questionnaire (TQ) | Teacher | 212 | 5 | 0.50 | 530 | 106 |
| School Administrator Questionnaire (SAQ) | School administrators | 212 | 5 | 0.50 | 530 | 106 |
| Electronic Data Transfer of Education Records | Key site personnel | 212 | 5 | 0.03 | 35 | 7 |
| | | | | | | |
| Child Welfare Sector Study Questionnaire—Intake (CWSQ-I) | Care coordinators | 212 | 1 | 0.50 | 106 | 21 |
| Child Welfare Sector Study Questionnaire—Follow-Up (CWSQ-F) | Care coordinators | 212 | 4 | 0.50 | 424 | 85 |
| Electronic Data Transfer of Child Welfare Records | Key site personnel | 212 | 5 | 0.03 | 35 | 7 |
| | | | | | | |
| Sustainability Survey: Brief Form | Project Director | 79 | 2 | 0.17 | 26 | 5 |
| Sustainability Survey | Providers | 126 | 2 | 0.75 | 189 | 38 |
| | Caregiver | 42 | 2 | 0.75 | 63 | 13 |
| | | | | | | |
| CQI Baseline Survey, Web-Based | Key site personnel | 208 | 1 | 0.50 | 104 | 21 |
| CQI Monitoring Survey, Web-Based | Key site personnel | 208 | 2 | 0.50 | 208 | 42 |
| CQI Local Focus Group Guide | Key site personnel | 30 | 2 | 1.00 | 60 | 12 |
| CQI National Focus Group Guide | National TA providers | 20 | 2 | 1.00 | 40 | 8 |
| | | | | | | |
| Networking and Collaboration Survey | Key site personnel | 248 | 2 | 0.50 | 248 | 50 |
| Alumni Network Web Site Satisfaction Survey | Key site personnel, National TA providers, Branch staff | 458 | 2 | 0.25 | 229 | 46 |
| | | | | | | |
| Flex Funds Data Dictionary/Tool | Local programming staff compiling/entering administrative data on children/youth | 1,306 | 3 | 0.03 | 129 | 26 |
| Services and Costs Data Dictionary/Data Entry Application | Local evaluator, staff at partner agencies, and programming staff compiling/entering service and cost records on children/youth | 5,541 | 100 | 0.05 | 27,705 | 5,541 |
| | | | | | | |
| | Number of distinct respondents | Number of responses per respondent | Average 5-year burden per response (hours) | Total annual burden (hours) | | |
| Caregivers | 5,541 | 0.9 | 2.2 | 10,959 | | |
| Youth | 3,624 | 0.9 | 1.0 | 3,261 | | |
| Providers/Administrators | 598 | 10.8 | 1.0 | 6,593 | | |
| Total Summary | 9,763 | 13 | | 20,812 | | |
Written comments and recommendations concerning the proposed information collection should be sent by August 28, 2009 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: July 27, 2009.
Elaine Parry,
Director, Office of Program Services.