[Federal Register Volume 72, Number 58 (Tuesday, March 27, 2007)]
[Notices]
[Pages 14283-14286]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-5582]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration


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: Independent Evaluation of the Substance Abuse 
Prevention and Treatment Block Grant Program--NEW

    The Substance Abuse and Mental Health Services Administration 
(SAMHSA), Center for Substance Abuse Treatment (CSAT), Division of 
State and Community Assistance administers the Substance Abuse 
Prevention and Treatment Block Grant (SAPT BG) in collaboration with 
the Center for Substance Abuse Prevention (CSAP), Division of State 
Programs. The Substance Abuse Prevention and Treatment Block Grant is 
funded by Congress to provide monies to States, Territories, and one 
Native American Tribe for the purpose of planning, carrying out, and 
evaluating activities to prevent and treat substance abuse and other 
allowable activities. The SAPT BG constitutes approximately 40 percent 
of all States budgets for substance abuse prevention and treatment 
services and activities, and is the primary Federal source of funding. 
States have flexibility in determining how funds should be allocated, 
but there are specific set-aside and maintenance of effort requirements 
that must be met in order to receive funding. These requirements, 
introduced by both the ADAMHA Reorganization Act of 1992 and the 
Children's Health Act of 2000, are listed below:

                Table 1.--SAPT BG Set-Aside Provisions a
------------------------------------------------------------------------
               Category                       Set-aside provision
------------------------------------------------------------------------
Prevention and treatment activities    Not less than 35 percent of SAPT
 regarding alcohol.                     BG funding.*
Prevention and treatment activities    Not less than 35 percent of SAPT
 regarding other drugs.                 BG funding.*
Primary prevention programs..........  Not less than 20 percent of SAPT
                                        BG funding.
Pregnant women and women with          Not less than amount equal to
 dependent children.                    expenditure in FY1994.
Tuberculosis services................  No set amount but services must
                                        be provided to receive SAPT BG
                                        funds.
HIV services b.......................  No more than 5 percent increase
                                        over State allotment for HIV
                                        services in FY 1991.
Prohibition of sale of tobacco to      State must enforce law against
 individuals under age of 18 (Synar     sale of tobacco to underage
 amendment).                            individuals to receive SAPT BG
                                        funds--noncompliance leads to a
                                        10 percent reduction in funds
                                        the first applicable fiscal
                                        year; 20 percent, the second
                                        year; 30 percent, the third
                                        year; and 40 percent, the fourth
                                        year.
Maintenance of effort (MOE) for State  State will maintain funding at no
 expenditures.                          less than the average level of
                                        expenditures for the 2 years
                                        preceding the fiscal year for
                                        which the State is applying.
Administrative expenses..............  Limited to 5 percent of SAPT BG
                                        funding.
------------------------------------------------------------------------
a These set-asides shown in this table were included in the 1992 SAPT BG
  authorizing legislation 42 U.S.C. 300x-21 to 42 U.S.C. 300x-62). In
  the Children's Health Act of 2000 (Pub. L. 106-310) Sec. 3303(a)(1)),
  however, the set-asides marked with asterisks were removed.
b For designated States whose rate of AIDS cases is 10 or more per
  100,000 individuals as confirmed by the Centers for Disease Control
  and Prevention.

    In addition to the set-asides, the SAPT BG Program has identified 
17 goals which must be met by States in order to receive this Federal 
funding:

Table 2.--Federal Goals for the Substance Abuse Prevention and Treatment
                               Block Grant
------------------------------------------------------------------------
 
------------------------------------------------------------------------
GOAL <greek-i>1: Continuum of          The State shall expend block
 substance abuse treatment services.    grant funds to maintain a
                                        continuum of substance abuse
                                        treatment services that meet
                                        these needs for the services
                                        identified by the state (see 42
                                        U.S.C. 300x-21(b) and 45 CFR
                                        96.122(f)(g)).
GOAL <greek-i>2: Spending on primary   The State agrees to spend not
 prevention programs.                   less than 20 percent on primary
                                        prevention programs for
                                        individuals who do not require
                                        treatment for substance abuse,
                                        specifying the activities
                                        proposed for each of the six
                                        strategies (see 42 U.S.C. 300x-
                                        22(b)(1) and 45 CFR
                                        96.124(b)(1)).

[[Page 14284]]

 
GOAL <greek-i>3: Spending on services  The State agrees to expend not
 for pregnant women and children.       less than an amount equal to the
                                        amount expended by the State for
                                        FY 1994 to establish new
                                        programs or expand the capacity
                                        of existing programs to make
                                        available treatment services
                                        designed for pregnant women and
                                        children with dependent
                                        children; and, directly or
                                        through arrangements with other
                                        public or nonprofit entities, to
                                        make available prenatal care to
                                        women receiving such treatment
                                        services, and, while the women
                                        are receiving services, child
                                        care (see 42 U.S.C. 300x-
                                        22(c)(1) and 45 CFR
                                        96.124(c)(e)).
GOAL <greek-i>4: Treatment for         The State agrees to provide
 intravenous drug abusers.              treatment to intravenous drug
                                        abusers that fulfills the 90
                                        percent capacity reporting, 14-
                                        120 day performance requirement,
                                        interim services, outreach
                                        activities and monitoring
                                        requirements (see 42 U.S.C. 300x-
                                        23 and 45 CFR 96.126).
GOAL <greek-i>5: Tuberculosis          The State agrees, directly or
 services for people in substance       through arrangements with other
 abuse treatment.                       public or nonprofit private
                                        entities, to routinely make
                                        available tuberculosis services
                                        to each individual receiving
                                        treatment for substance abuse
                                        and to monitor such service
                                        delivery (see 42 U.S.C. 300x-24
                                        and 45 CFR 96.127).
GOAL <greek-i>6: Early intervention    Designated States agree to
 services for HIV for people in         provide treatment for persons
 substance abuse treatment.             with substance abuse problems
                                        with an emphasis on making
                                        available within existing
                                        programs early intervention
                                        services for HIV in areas of the
                                        state that have the greatest
                                        need for such services and to
                                        monitor such service delivery
                                        (see 42 U.S.C. 300x-24(b) and 45
                                        CFR 96.128).
GOAL <greek-i>7: Group homes for       Designated States agree to
 recovering substance abusers.          provide for and encourage the
                                        development of group homes for
                                        recovering substance abusers
                                        through the operation of a
                                        revolving loan fund (see 42
                                        U.S.C. 300x-25 and 45 CFR
                                        96.129).
GOAL <greek-i>8: State efforts to      The State agrees to continue to
 reduce the availability of tobacco     have in effect a State law that
 products.                              makes it unlawful for any
                                        manufacturer, retailer, or
                                        distributor of tobacco products
                                        to sell or distribute any such
                                        product to any individual under
                                        the age of 18; and, to enforce
                                        such laws in a manner than can
                                        reasonably be expected to reduce
                                        the extent to which tobacco
                                        products are available to
                                        individuals under age 18 (see 42
                                        U.S.C. 300x-26 and 45 CFR
                                        96.130).
GOAL <greek-i>9: Preferential          The State agrees to ensure that
 admission of pregnant women to         each pregnant woman be given
 substance abuse treatment.             preference in admission to
                                        treatment facilities; and, when
                                        the facility has insufficient
                                        capacity, to ensure that the
                                        pregnant woman be referred to
                                        the State, which will refer the
                                        woman to a facility that does
                                        have the capacity to admit the
                                        woman, or if no such facility
                                        has the capacity to admit the
                                        woman, will make available
                                        interim services within 48 hours
                                        (see 42 U.S.C. 300x-27 and 45
                                        CFR 96.131).
GOAL <greek-i>10: Improved process     The State agrees to improve the
 for referring individuals to           process in the State for
 substance abuse treatment.             referring individuals to the
                                        treatment modality that is most
                                        appropriate for the individual
                                        (see 42 U.S.C. 300x-28 and 45
                                        CFR 96.132(a)).
GOAL <greek-i>11: Continuing           The State agrees to provide
 education for employees at substance   continuing education for the
 abuse prevention and/or treatment      employees of facilities which
 facilities.                            provide prevention activities or
                                        treatment services (or both)
                                        (see 42 U.S.C. 300x-28(b) and 45
                                        CFR 96.132(b)).
GOAL <greek-i>12: Coordination of      The State agrees to coordinate
 services.                              prevention activities and
                                        treatment services with the
                                        provision of other appropriate
                                        services (see 42 U.S.C. 300x-
                                        28(c) and 45 CFR 96.132(c)).
GOAL <greek-i>13: Needs assessment by  The State agrees to submit an
 State and locality.                    assessment of the need for both
                                        treatment and prevention in the
                                        State for authorized activities,
                                        both by locality and by the
                                        State in general (see 42 U.S.C.
                                        300x-29 and 45 CFR 96.133).
GOAL <greek-i>14: Ensuring that        The State agrees to ensure that
 needles and syringes are not           no program funded through the
 provided for illegal drug use.         block grant will use funds to
                                        provide individuals with
                                        hypodermic needles or syringes
                                        so that such individuals may use
                                        illegal drugs (see 42 U.S.C.
                                        300x-31(a)(1)(F) and 45 CFR
                                        96.135(a)(6)).
GOAL <greek-i>15: Improving the        The State agrees to assess and
 quality and appropriateness of         improve, through independent
 treatment services.                    peer review, the quality and
                                        appropriateness of treatment
                                        services delivered by provider
                                        that receive funds from the
                                        block grant (see 42 U.S.C. 300x-
                                        53(a) and 45 CFR 96.136).
GOAL <greek-i>16: Protecting patient   The State agrees to ensure that
 records from inappropriate             the State has in effect a system
 disclosure.                            to protect patient records from
                                        inappropriate disclosure (see 42
                                        U.S.C. 300x-53(b), 45 CFR
                                        6.132(e), and 42 CFR part 2).
GOAL <greek-i>17: Compliance with 42   The State agrees to ensure that
 CFR part 54 Charitable Choice          the State has in effect a system
 Provisions and Regulations.            to comply with 42 CFR part 54
                                        (see 42 CFR 54.8(c)(4) and
                                        54.8(b)) Charitable Choice
                                        Provisions and Regulations).
------------------------------------------------------------------------
SOURCE: Performance Partnership Grant Branch, Division of State and
  Community Assistance, Center for Substance Abuse Treatment, Substance
  Abuse and Mental Health Services Administration, ``Uniform
  Application, FY 2007, Substance Abuse Prevention and Treatment Block
  Grant (42 U.S.C. 300x-21 through 300x-64),'' Rockville, MD, 2004.

    The FY 2003 Office of Management and Budget (OMB) Program 
Assessment Rating Tool (PART) assessment of the SAPT BG Program rated 
the program as ``Ineffective.'' The SAPT BG received high scores on 
three of four PART areas rated, including Program Purpose and Design, 
Strategic Planning, and Program Management. However, the scores could 
have been even higher in these areas if data were available to document 
that the resources were reaching the intended beneficiaries or the 
program had ambitious targets and long-term measures. In the fourth 
area, Program Results/Accountability, where a low rating was achieved, 
it was found that ``no independent evaluation of the program has been 
completed'' to establish that the SAPT BG Program is effective and 
fulfilling its legislative mandates.
    In direct response to this OMB finding, a contract was developed 
and awarded in FY 2003 to conduct an Evaluability Assessment (EA) to 
determine the feasibility of conducting an independent evaluation of 
the SAPT BG Program, and subsequently, to fund such an evaluation 
effort. EA is a recognized program evaluation methodology which 
involves collaboration with multiple stakeholders and development of a 
program logic model used to plan formal evaluations of large and/or

[[Page 14285]]

complex programs, such as the SAPT BG program. The findings of the EA 
were used as a foundation in the development and awarding of a multi-
year contract in FY 2004 to conduct an independent, comprehensive 
evaluation of the SAPT BG Program.
    As noted in the OMB PART Assessment, the legislative intent of the 
SAPT BG is to provide funding to states by formula to plan, carry out, 
and evaluate activities to prevent and treat substance abuse. 
Therefore, the evaluation is designed to examine the system-level 
activities, outputs, and outcomes associated with the program in 
relation to its goals.
    In this evaluation, a multi-method evaluation approach is being 
used to examine Federal and State performance with regard to the SAPT 
BG and its identified goals. This approach emphasizes a qualitative and 
quantitative examination of both the SAPT BG process (e.g., activities 
and outputs in the logic model) and system-level outcomes whereby 
Federal and State stakeholder perspectives on the SAPT BG, as captured 
through semi-structured interviews and surveys, are corroborated and 
compared to the considerable amount of already-collected source 
documents and data provided by States, CSAT, and CSAP (e.g., BGAS 
applications, Treatment Episode Data Set (TEDS), National Survey on 
Drug Use and Health (NSDUH), the Minimum Data Set (MDS), Technical 
Review Reports, State Prevention and Synar System Reports).
    The purpose of the evaluation is to determine the extent to which 
States and the Federal Government are implementing the SAPT BG 
according to the authorizing legislation. The evaluation will cover the 
following domains: the State SAPT BG planning process, Federal review 
of SAPT BG applications and implementation reports, Federal technical 
assistance, State SAPT BG implementation, Federal oversight and 
management, State SAPT BG reporting, and State-level outcomes. The 
results of this evaluation will not only document the effectiveness of 
the Program in supporting the Substance Abuse Prevention and Treatment 
system, they will also help guide CSAT and CSAP and the States to 
improve the methods by which they implement the SAPT BG, including the 
capacity to collect, analyze, and interpret the National Outcome 
Measures (NOMS). As a separate, parallel SAMHSA initiative, the NOMS 
project began after the SAPT BG Evaluation contract inception and was 
not used in the SAPT BG EA or the development of the evaluation 
framework and logic model. However, selected NOMS items that relate to 
the evaluation framework and logic model will be examined in the 
independent evaluation. These selected NOMS items include:
    <bullet> Increase in number of persons reporting a reduction in 30-
day drug/alcohol use
    <bullet> Increase in number of persons employed or in school
    <bullet> Reduction in number of drug or alcohol-related arrests
    <bullet> Increase in number of persons in stable housing situations 
(reduction in homelessness)
    <bullet> Increase in access to services measured by unduplicated 
counts of persons served and numbers served compared to those in need
    <bullet> Increase in number of persons receiving evidence-based 
services.
    In addition, the evaluators will attempt to collect information on 
system-wide client perception of care. Statistical tests for 
association between outcome measures and a number of independent 
variables will be conducted. Examples of independent variables include, 
but are not limited to, level of funding, level of the SSA within State 
government, degree of SSA partnership with other State agencies and 
community organizations, and amount of State-funded support available 
for research and training activities.
    In addition to information about the selected NOMS domains, the 
evaluation will also examine systemic measures related to 
infrastructure. Infrastructure refers to the resources, systems, and 
policies that support the nation's public substance abuse prevention 
and treatment system, and is a potential contributor to significant 
State behavioral health system outcomes. Examples of infrastructure 
include staff training, policy changes, and service availability.
    Because this is the first-ever comprehensive evaluation of the 
Program, the data collection activities are more extensive (and time 
intensive) than would be expected of a Program that has been regularly 
evaluated. These data will serve as a baseline for future evaluations.
    The two primary data collection strategies will include open-ended 
interviews and web-based surveys. Interviews will be conducted with 
Federal staff involved in the administration of the SAPT BG and State 
staff from all States and Territories involved in their State's 
implementation of the SAPT BG program. Two web-based surveys will be 
administered to all individuals who formally participate in monitoring 
the SAPT BG as part of the Technical Review or State Prevention and 
Synar System Review Teams.
    The interview protocol for Federal staff includes 79 questions 
(mostly open-ended), and, on average, should take 90 minutes to 
complete. The interview protocol for the State staff includes 99 
questions (again, mostly open-ended), and should take, on average, 3 
hours to complete. Both the Federal staff interviews and the State 
staff interviews will be conducted as in-person interviews. While the 
Federal staff will each be interviewed individually, a single group 
State staff interview will be conducted for all relevant State staff. 
State Substance Abuse Authority Directors will be asked to select those 
State staff who they believe are most knowledgeable about the SAPT BG 
for participation in the interviews. It is anticipated that, at a 
minimum, the State Planner, the State Data Analyst, the State 
Prevention Lead, the State Treatment Lead, one additional State staff 
member, and the State SSA Director will participate.
    The two web-based surveys will be distributed to the two current 
sets of formal reviewers for the SAPT BG: Technical Reviewers and State 
Prevention and Synar System Reviewers. The web-based surveys are 
designed so that each stakeholder group receives survey questions 
designed to capture their specific knowledge of and experience with the 
SAPT BG. The Technical Reviewer survey contains 47 questions and the 
State Prevention and Synar System Reviewer survey has 27 questions. 
Each survey should take approximately 1 hour or less to complete. 
Reviewers will submit their responses to the survey online over a 3-
week period.
    Table 3 summarizes the estimated annual total burden hours for the 
in-person and web-based surveys for the Federal and State staff 
stakeholders, Technical Reviewers, Synar Reviewers, and SPSA.

[[Page 14286]]



                                      Table 3.--Estimated Annualized Burden
----------------------------------------------------------------------------------------------------------------
                                                   Number of     Response per    Average hours   Estimated total
                  Respondents                     respondents     respondent     per interview   burden  (hours)
----------------------------------------------------------------------------------------------------------------
In-person Interviews:
    State Substance Abuse Prevention and                    60               1              3              180
     Treatment Agency Commissioner............
    State Planners............................              60               1              3              180
    State Data Analysts.......................              60               1              3              180
    State Prevention Lead.....................              60               1              3              180
    State Treatment Lead......................              60               1              3              180
    Additional State Staff....................              60               1              3              180
    Federal SAPT Block Grant Staff............              35               1              1.5             52.5
                                               -----------------------------------------------------------------
        Subtotal..............................             395  ..............  ...............           1132.5
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Web-based Interviews:
    Technical Reviewers.......................              15               1              1               15
    State Prevention and Synar System                       30               1              1               30
     Reviewers................................
                                               -----------------------------------------------------------------
        Subtotal..............................              45  ..............  ...............             45
�����������������������������������������������
            Total.............................             440  ..............  ...............           1177.5
----------------------------------------------------------------------------------------------------------------

    This Federal Register Notice is focused on the interviews and 
surveys that will be administered to the SAPT BG stakeholders as those 
methods of data collection require OMB approval. It is anticipated that 
in future independent evaluations of the SAPT BG Program focus will be 
given to the NOMS and their implications for program performance and 
goals.
    Send comments to Summer King, SAMHSA Reports Clearance Officer, 
Room 7-1044, One Choke Cherry Road, Rockville, MD 20857. Written 
comments should be received within 60 days of this notice.

    Dated: March 20, 2007.
Elaine Parry,
Acting Director, Office of Program Services.
[FR Doc. E7-5582 Filed 3-26-07; 8:45 am]
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