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Agency Information Collection Activities: Submission for OMB Review; Comment Request

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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: FASD Diagnosis and Intervention Programs in the Fetal Alcohol Spectrum Disorder (FASD) Center of Excellence—New

Since 2001, SAMHSA's Center for Substance Abuse Prevention has been operating a Fetal Alcohol Spectrum Disorder (FASD) Center of Excellence which addresses FASD mainly by providing trainings and technical assistance and developing and supporting systems of care that respond to FASD using effective evidence-based practices and interventions.

Currently the integration of evidence-based practices into service delivery organizations is being accomplished through subcontracts. One such intervention which integrates diagnosis and intervention strategies into existing service delivery organizations is the FASD Diagnosis and Intervention programs targeting children 0-18 years of age. The Diagnosis and Intervention programs use the following 11 data collection tools.

Description of Instruments/Activity for the Diagnosis and Intervention Programs

Instrument/ActivityDescription
Screening and Diagnosis ToolThe purpose of the screening and diagnosis tool is to determine eligibility to participate in the SAMHSA FASD Center Diagnosis and Treatment Intervention. The form includes demographic, screening, and diagnostic data.
Positive Monitor TrackingThe Positive Monitor Tracking form is to monitor the outcome of placing a child (ages 0-3 years) on a positive monitor.
Services Child is Receiving at the time of the FASD DiagnosisThe Services Child is Receiving at the time of the FASD Diagnosis form is to record services the child is receiving at the time of an FASD diagnosis.
Services Planned and Provided based on Diagnostic EvaluationThe Services Planned and Provided based on Diagnostic Evaluation form is to record services planned and received based on the diagnostic evaluation.
Services Delivery Tracking FormThe Services Delivery Tracking form is for the services provided during every visit.
End of Intervention/Program Improvement Measure—Case ManagerThe End of Intervention/Program Improvement Measure—Case Manager form is for the case manager to report on the overall improvement in the child as a result of receiving services.
End of Intervention/Program Improvement Measure—Parent/GuardianThe End of Intervention/Program Improvement Measure—Parent/Guardian form is for the parent/guardian to report on the overall improvement in the child as a result of receiving services.
End of Intervention/Program Customer Satisfaction with ServiceThe End of Intervention/Program Customer Satisfaction with Service form is to determine customer satisfaction (parents) with the SAMHSA FASD Center Diagnosis and Intervention project.
Outcome Measures (Children 0-7 years)The Outcome Measures (Children 0-7 years) form is an outcomes measure checklist used to record measures every six months from start of service to end of service, at end of intervention, at 6 months follow-up, and 12 months follow-up.
Outcome Measures (Children 8-18 years)The Outcome Measures (Children 8-18 years) form is an outcomes measure checklist used to record measures every six months from start of service to end of service, at end of intervention, at 6 months follow-up, and 12 months follow-up.
Lost to follow-upThe Lost to follow-up form is used if the child is no longer accessible for follow-up.

Eight subcontracts were awarded in February 2008 to integrate the FASD Diagnosis and Intervention program within existing service delivery organization sites. Using an integrated service delivery model all sites are screening children using an FASD screening tool, obtaining a diagnostic evaluation, and providing services/interventions as indicated by the diagnostic evaluation. Specific interventions are based upon the individual child's diagnosis. Six of the sites are integrating the FASD Diagnosis and Intervention projects either in a child mental health provider setting or in a dependency court setting and serve children ages 0-7 years. Two of the sites are delinquency courts and serve children 10-18 years of age. Data collection at all sites involves administering the screening and diagnosis tool, recording process level indicators such as type and units of service provided; improvement in functionality and outcome measures such as school performance, stability in housing/placement, and adjudication measures (10-18 yrs only). Data will be collected at baseline, monthly, every six months from start of service to end of service, at end of intervention, at 6 months follow-up, and 12 months follow-up.

Estimated Annualized Burden HoursStart Printed Page 29552

Instrument/ActivityNumber of respondentsNumber of responses per respondentTotal number of responsesAverage burden per responseTotal burden hours per collection
Client Surveys: Children 0-7:
Screening and Diagnosis Tool1400114000.17238
Positive Monitor Tracking45014500.0314
Services Child is Receiving at the time of the FASD Diagnosis75017500.17128
Services Planned and Provided based on Diagnostic Evaluation75017500.33248
Services Delivery Tracking Form7501290000.08720
End of Intervention/Program Improvement Measure—Case Manager75017500.0215
End of Intervention/Program Improvement Measure—Parent/Guardian75017500.0215
End of Intervention/Program Customer Satisfaction with Service75017500.0323
Outcome Measures (Children 0-7 years)750537500.08300
Lost to follow-up13511350.034
Client Surveys: Children 8-18:
Screening and Diagnosis Tool10011000.1717
Services Child is Receiving at the time of the FASD Diagnosis501500.179
Services Planned and Provided based on Diagnostic Evaluation501500.3317
Services Delivery Tracking Form50126000.0848
End of Intervention/Program Improvement Measure—Case Manager501500.021
End of Intervention/Program Improvement Measure—Parent/Guardian501500.021
End of Intervention/Program Customer Satisfaction with Service501500.032
Outcome Measures (Children 8-18 years)5052500.0820
Lost to follow-up151150.031
TOTAL7,7004919,7001,821

Written comments and recommendations concerning the proposed information collection should be sent by June 25, 2010 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: 202-395-5806.

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Dated: May 17, 2010.

Elaine Parry,

Director, Office of Program Services.

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[FR Doc. 2010-12643 Filed 5-25-10; 8:45 am]

BILLING CODE 4162-20-P