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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: National Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program: Phase VI (OMB No. 0930-0307)—REVISION

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center of 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. Data will be collected on 47 service systems, and approximately 6,561 children and families.

Principal changes from the previous Phase VI OMB approval include:

  • Addition of nine (9) communities awarded cooperative agreements in FY2010 for data collection.
  • Replacement of intake and follow-up questionnaires for the Child Welfare Sector and Comparison Study with an administrative record review form to lessen burden.
  • Addition of a brief 8-item Education Sector Caregiver Questionnaire to the Education Sector and Comparison Study to capture family involvement in the development and use of Individualized Education Plans (IEPs).
  • Removal of data collection activities for the Alumni Networking Study, the CQI Initiative Evaluation, and the Sustainability Study.

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 is up to 24 months. 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. 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.

In addition, the evaluation will include one special study: The Sector and 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.

Internet-based technology such as data entry and management tools will be used in this evaluation. The measures of the national evaluation address annual Congressional reporting requirements of the program's authorizing legislation, and 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.

InstrumentRespondentNumber of respondentsTotal average number of responses per respondentHours per responseTotal burden hours5-Year average annual burden hours
System of Care Assessment
Interview Guides A-SKey site informants108131.003,243649
Child and Family Outcome Study
Caregiver Information Questionnaire, Revised: Caregiver—Intake (CIQ-RC-I)Caregiver6,56110.372,406481
Caregiver Information Questionnaire, Revised: Staff as Caregiver—Intake (CIQ-RS-I)Staff as Caregiver
Caregiver Information Questionnaire, Revised: Caregiver—Follow-Up (CIQ-RC-F)Caregiver6,56140.287,4361,487
Caregiver Information Questionnaire, Revised: Staff as Caregiver—Follow-Up (CIQ-RS-F)Staff as Caregiver
Caregiver Strain Questionnaire (CGSQ)Caregiver6,56150.175,4781,096
Child Behavior Checklist 11/2-5 (CBCL 11/2-5)Caregiver6,56150.3310,9242,185
Child Behavior Checklist 6-18 (CBCL 6-18)
Education Questionnaire, Revision 2 (EQ-R2)Caregiver6,56150.3310,9242,185
Living Situations Questionnaire (LSQ)Caregiver6,56150.082,723545
Behavioral and Emotional Rating Scale—Second Edition, Parent Rating Scale (BERS-2C)Caregiver5,38950.174,500900
Columbia Impairment Scale (CIS)Caregiver6,28150.082,607521
Parenting Stress Index (PSI)Caregiver2,15150.08896179
Devereux Early Childhood Assessment for Infants (DECA 1-18M)Caregiver1,57650.08657131
Devereux Early Childhood Assessment for Toddlers (DECA 18-36M)
Devereux Early Childhood Assessment (DECA 2-5Y)
Preschool Behavioral and Emotional Rating (PreBERS)Caregiver1,57650.10788158
Delinquency Survey, Revised (DS-R)Youth3,98650.132,657531
Behavioral and Emotional Rating Scale—Second Edition, Youth Rating Scale (BERS-2Y)Youth3,98650.173,328666
Gain Quick-R: Substance Problem Scale (GAIN)Youth3,98650.081,654331
Substance Use Survey, Revised (SUS-R)Youth3,98650.101,993399
Revised Children's Manifest Anxiety Scale, Second Edition (RCMAS-2)Youth3,98650.071,329266
Reynolds Adolescent Depression Scale, Second Edition (RADS-2)Youth3,98650.05997199
Youth Information Questionnaire, Revised—Intake (YIQ-R-I)Youth3,98610.25997199
Youth Information Questionnaire, Revised—Follow-Up (YIQ-R-F)Youth3,98640.253,986797
Service Experience Study
Multi-Sector Service Contacts, Revised: Caregiver—Intake (MSSC-RC-I)Caregiver6,56110.251,640328
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)Caregiver6,56140.256,5611,312
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)Caregiver6,56140.133,499700
Youth Services Survey for Families (YSS-F)Caregiver6,56140.123,071614
Youth Services Survey (YSS)Youth3,98640.081,323265
Comparison and Sector Study: Juvenile Justice
Court Representative Questionnaire (CRQ)Court representatives20250.50505101
Electronic Data Transfer of Juvenile Justice RecordsKey site personnel20250.03347
Comparison and Sector Study: Education
Teacher Questionnaire (TQ)Teacher20250.50505101
School Administrator Questionnaire (SAQ)School administrators20250.50505101
Electronic Data Transfer of Education RecordsKey site personnel20250.03347
Education Sector Caregiver Questionnaire (ESCQ)Caregiver20250.088116
Comparison and Sector Study: Child Welfare
Electronic Data Transfer of Child Welfare RecordsKey site personnel20250.03347
Services and Costs Study
Flex Funds Data Dictionary/ToolLocal programming staff compiling/entering administrative data on children/youth1,56530.0315531
Services and Costs Data Dictionary/Data Entry ApplicationLocal evaluator, staff at partner agencies, and programming staff compiling/entering service and cost records on children/youth6,5611000.0532,8056,561

RespondentNumber of respondentsNumber of responses/ respondentAverage burden/ responseTotal average annual burden

Written comments and recommendations concerning the proposed information collection should be sent by July 12, 2012 to the SAMHSA Desk Officer at the Office of Information and Regulatory Affairs, Office of Management and Budget (OMB). To ensure timely receipt of comments, and to avoid potential delays in OMB's receipt and processing of mail sent through the U.S. Postal Service, commenters are encouraged to submit their comments to OMB via email to: Although commenters are encouraged to send their comments via email, commenters may also fax their comments to: 202-395-7285. Commenters may also mail them to: Office of Management and Budget, Office of Information and Regulatory Affairs, New Executive Office Building, Room 10102, Washington, DC 20503.

Summer King,


[FR Doc. 2012-14200 Filed 6-11-12; 8:45 am]