Agency Information Collection Activities: Submission for OMB Review; Comment Request, 29551-29552 [2010-12643]
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Federal Register / Vol. 75, No. 101 / Wednesday, May 26, 2010 / Notices
Dated: May 20, 2010.
Maryam I. Daneshvar,
Reports Clearance Officer, Centers for Disease
Control and Prevention.
[FR Doc. 2010–12665 Filed 5–25–10; 8:45 am]
BILLING CODE 4163–18–P
(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
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Substance Abuse and Mental Health
Services Administration
Agency Information Collection
Activities: Submission for OMB
Review; Comment Request
Periodically, the Substance Abuse and
Mental Health Services Administration
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
29551
supporting systems of care that respond
to FASD using effective evidence-based
practices and interventions.
Currently the integration of evidencebased 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/Activity
Description
Screening and Diagnosis Tool .....................................................
The 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.
The Positive Monitor Tracking form is to monitor the outcome of placing a child
(ages 0–3 years) on a positive monitor.
The 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.
The Services Planned and Provided based on Diagnostic Evaluation form is to
record services planned and received based on the diagnostic evaluation.
The Services Delivery Tracking form is for the services provided during every
visit.
The 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.
The 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.
The End of Intervention/Program Customer Satisfaction with Service form is to
determine customer satisfaction (parents) with the SAMHSA FASD Center
Diagnosis and Intervention project.
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.
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.
The Lost to follow-up form is used if the child is no longer accessible for follow-up.
Positive Monitor Tracking ............................................................
Services Child is Receiving at the time of the FASD Diagnosis
Services Planned and Provided based on Diagnostic Evaluation
Services Delivery Tracking Form .................................................
End of Intervention/Program Improvement Measure—Case
Manager.
End of Intervention/Program Improvement Measure—Parent/
Guardian.
End of Intervention/Program Customer Satisfaction with Service
Outcome Measures (Children 0–7 years) ...................................
Outcome Measures (Children 8–18 years) .................................
wwoods2 on DSK1DXX6B1PROD with NOTICES_PART 1
Lost to 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
VerDate Mar<15>2010
15:16 May 25, 2010
Jkt 220001
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
PO 00000
Frm 00045
Fmt 4703
Sfmt 4703
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 Hours
E:\FR\FM\26MYN1.SGM
26MYN1
29552
Federal Register / Vol. 75, No. 101 / Wednesday, May 26, 2010 / Notices
Number of
respondents
Instrument/Activity
Client Surveys: Children 0–7:
Screening and Diagnosis Tool .....................................
Positive Monitor Tracking .............................................
Services Child is Receiving at the time of the FASD
Diagnosis ...................................................................
Services Planned and Provided based on Diagnostic
Evaluation ..................................................................
Services Delivery Tracking Form .................................
End of Intervention/Program Improvement Measure—
Case Manager ...........................................................
End of Intervention/Program Improvement Measure—
Parent/Guardian ........................................................
End of Intervention/Program Customer Satisfaction
with Service ...............................................................
Outcome Measures (Children 0–7 years) ....................
Lost to follow-up ...........................................................
Client Surveys: Children 8–18:
Screening and Diagnosis Tool .....................................
Services Child is Receiving at the time of the FASD
Diagnosis ...................................................................
Services Planned and Provided based on Diagnostic
Evaluation ..................................................................
Services Delivery Tracking Form .................................
End of Intervention/Program Improvement Measure—
Case Manager ...........................................................
End of Intervention/Program Improvement Measure—
Parent/Guardian ........................................................
End of Intervention/Program Customer Satisfaction
with Service ...............................................................
Outcome Measures (Children 8–18 years) ..................
Lost to follow-up ...........................................................
Dated: May 17, 2010.
Elaine Parry,
Director, Office of Program Services.
[FR Doc. 2010–12643 Filed 5–25–10; 8:45 am]
wwoods2 on DSK1DXX6B1PROD with NOTICES_PART 1
BILLING CODE 4162–20–P
VerDate Mar<15>2010
15:16 May 25, 2010
Jkt 220001
1400
450
0.17
0.03
238
14
750
1
750
0.17
128
750
750
1
12
750
9000
0.33
0.08
248
720
750
1
750
0.02
15
750
1
750
0.02
15
750
750
135
1
5
1
750
3750
135
0.03
0.08
0.03
23
300
4
100
1
100
0.17
17
50
1
50
0.17
9
50
50
1
12
50
600
0.33
0.08
17
48
50
1
50
0.02
1
50
1
50
0.02
1
50
50
15
1
5
1
50
250
15
0.03
0.08
0.03
2
20
1
7,700
49
19,700
........................
1,821
Centers for Disease Control and
Prevention
[60Day–10–09CL]
Proposed Data Collections Submitted
for Public Comment and
Recommendations
In compliance with the requirement
of Section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995 for
opportunity for public comment on
proposed data collection projects, the
Centers for Disease Control and
Prevention (CDC) will publish periodic
summaries of proposed projects. To
request more information on the
proposed project or to obtain a copy of
data collection plans and instruments,
call the CDC Reports Clearance Officer
on 404–639–5960 or send comments to
CDC Assistant Reports Clearance
Officer, 1600 Clifton Road, MS D–74,
Atlanta, GA 30333 or send an e-mail to
omb@cdc.gov.
Comments are invited on: (a) Whether
the proposed collection of information
is necessary for the proper performance
of the functions of the agency, including
whether the information shall have
Frm 00046
Total burden
hours per
collection
1
1
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
PO 00000
Average
burden per
response
Total number
of responses
1400
450
TOTAL ...................................................................
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.
Number of
responses per
respondent
Fmt 4703
Sfmt 4703
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 the use of
automated collection techniques or
other forms of information technology.
Written comments should be received
within 60 days of this notice.
Proposed Project
Calibration of the Short Strengths and
Difficulties Questionnaire (SDQ) in the
National Health Interview Survey
(NHIS)—New—National Center for
Health Statistics (NCHS), Centers for
Disease Control and Prevention (CDC).
Background and Brief Description
Section 306 of the Public Health
Service (PHS) Act (42 U.S.C. 242k), as
amended, authorizes that the Secretary
of Health and Human Services (DHHS),
acting through NCHS, shall collect
statistics on the extent and nature of
illness and disability of the population
of the United States. Section 520 [42
U.S.C. 290bb–31] of the Public Health
Service Act, establishes the Center for
Mental Health Services (CMHS),
E:\FR\FM\26MYN1.SGM
26MYN1
]]>Agencies
[Federal Register Volume 75, Number 101 (Wednesday, May 26, 2010)]
[Notices]
[Pages 29551-29552]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-12643]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
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: 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/Activity Description
------------------------------------------------------------------------
Screening and Diagnosis Tool........... The 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 Tracking.............. The 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 The Services Child is Receiving
of the FASD Diagnosis. 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 The Services Planned and
Diagnostic Evaluation. Provided based on Diagnostic
Evaluation form is to record
services planned and received
based on the diagnostic
evaluation.
Services Delivery Tracking Form........ The Services Delivery Tracking
form is for the services
provided during every visit.
End of Intervention/Program Improvement The End of Intervention/Program
Measure--Case Manager. 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 The End of Intervention/Program
Measure--Parent/Guardian. 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 The End of Intervention/Program
Satisfaction with Service. 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-up...................... The 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 Hours
[[Page 29552]]
----------------------------------------------------------------------------------------------------------------
Number of Average Total burden
Instrument/Activity Number of responses per Total number burden per hours per
respondents respondent of responses response collection
----------------------------------------------------------------------------------------------------------------
Client Surveys: Children 0-7:
Screening and Diagnosis Tool 1400 1 1400 0.17 238
Positive Monitor Tracking... 450 1 450 0.03 14
Services Child is Receiving 750 1 750 0.17 128
at the time of the FASD
Diagnosis..................
Services Planned and 750 1 750 0.33 248
Provided based on
Diagnostic Evaluation......
Services Delivery Tracking 750 12 9000 0.08 720
Form.......................
End of Intervention/Program 750 1 750 0.02 15
Improvement Measure--Case
Manager....................
End of Intervention/Program 750 1 750 0.02 15
Improvement Measure--Parent/
Guardian...................
End of Intervention/Program 750 1 750 0.03 23
Customer Satisfaction with
Service....................
Outcome Measures (Children 0- 750 5 3750 0.08 300
7 years)...................
Lost to follow-up........... 135 1 135 0.03 4
Client Surveys: Children 8-18:
Screening and Diagnosis Tool 100 1 100 0.17 17
Services Child is Receiving 50 1 50 0.17 9
at the time of the FASD
Diagnosis..................
Services Planned and 50 1 50 0.33 17
Provided based on
Diagnostic Evaluation......
Services Delivery Tracking 50 12 600 0.08 48
Form.......................
End of Intervention/Program 50 1 50 0.02 1
Improvement Measure--Case
Manager....................
End of Intervention/Program 50 1 50 0.02 1
Improvement Measure--Parent/
Guardian...................
End of Intervention/Program 50 1 50 0.03 2
Customer Satisfaction with
Service....................
Outcome Measures (Children 8- 50 5 250 0.08 20
18 years)..................
Lost to follow-up........... 15 1 15 0.03 1
-------------------------------------------------------------------------------
TOTAL................... 7,700 49 19,700 .............. 1,821
----------------------------------------------------------------------------------------------------------------
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.
Dated: May 17, 2010.
Elaine Parry,
Director, Office of Program Services.
[FR Doc. 2010-12643 Filed 5-25-10; 8:45 am]
BILLING CODE 4162-20-P
