Federal Register / Vol. 62, No. 193 / Monday, October 6, 1997 / Notices 52139

document and received comments may

be seen in the office above between 9

a.m. and 4 p.m., Monday through

Friday.

An electronic version of this guidance

is also available on the Internet at http:/

/www.fda.gov/cder/guidance/

index.htm.

Dated: September 29, 1997.

William K. Hubbard,

Associate Commissioner for Policy

Coordination.

[FR Doc. 97–26412 Filed 10–3–97; 8:45 am]

BILLING CODE 4160–01–F

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Substance Abuse and Mental Health

Services Administration

Estimation Methodology for Children

With a Serious Emotional Disturbance

(SED)

AGENCY: Center for Mental Health

Services, Substance Abuse and Mental

Health Services Administration, HHS.

ACTION: Solicitation of comments.

SUMMARY: This notice describes the

proposed methodology for identifying

and estimating the number of children

with a serious emotional disturbance

(SED) within each State. This notice is

being served as part of the requirement

of Public Law 102–321, the ADAMHA

Reorganization Act of 1992.

COMMENT PERIOD: The Administrator is

requesting written comments which

must be received on or before December

5, 1997.

ADDRESSES: Comments should be sent to

Judith Katz-Leavy, M.Ed., Senior Policy

Analyst, Office of Policy, Planning, and

Administration, Center for Mental

Health Services, Parklawn Building

Room 15–87, 5600 Fishers Lane,

Rockville, MD 20857. (301) 443–1563

fax.

FOR FURTHER INFORMATION CONTACT: A

detailed paper outlining the estimation

methodology described here is available

from: Judith Katz-Leavy M.Ed., Senior

Policy Analyst, Office of Policy,

Planning, and Administration, Center

for Mental Health Services, Parklawn

Building Room 15–87, 5600 Fishers

Lane, Rockville, MD 20857. (301)443–

1563 fax.

Background

Public Law 102–321, the ADAMHA

Reorganization Act of 1992, amended

the Public Health Service Act and

created the Substance Abuse and Mental

Health Services Administration

(SAMHSA). The Center for Mental

Health Services (CMHS) was established

within SAMHSA to coordinate Federal

efforts in the prevention, treatment, and

promotion of mental health. Title II of

Public Law 102–321 establishes a Block

Grant for Community Mental Health

Services (Block Grant) administered by

CMHS, which permits the allocation of

funds to States for the provision of

community mental health services to

children with a serious emotional

disturbance and adults with a serious

mental illness. Public Law 102–321

stipulates that States estimate the

incidence (number of new cases) and

prevalence (total number of cases in a

year) in their applications for Block

Grant funds, see 42 U.S.C. 300 (2). The

statute also requires the Secretary to

establish definitions for adults with a

serious mental illness and children with

a serious emotional disturbance. In

addition, the Secretary is required to

develop standardized methods for the

states to use in providing the estimates

required as part of their block grant

applications. See 42 U.S.C. 300 (2). As

part of the process of implementing this

new block grant, definitions of the terms

‘‘children with a serious emotional

disturbance’’ and ‘‘adults with a serious

mental illness’’ were announced on May

20, 1993, in Federal Register Volume

58, No 96, p. 29422. Subsequently, a

group of technical experts was

convened by CMHS to develop an

estimation methodology to

‘‘operationalize the key concepts’’ in the

definition of children with a serious

emotional disturbance. A similar group

has prepared an estimation

methodology for adults with a serious

mental illness.

Serious Emotional Disturbance (SED)

The CMHS definition is that

‘‘children with serious emotional

disturbance’’ are persons:

—From birth up to age 18;

—Who currently or at any time during

the past year;

—Have had a diagnosable mental,

behavioral, or emotional disorder of

sufficient duration to meet diagnostic

criteria specified within DSM–III–R

—That resulted in functional

impairment which substantially

interferes with or limits the child’s

role or functioning in family, school,

or community activities (p.29425).

The definition goes on to indicate

that, ‘‘these disorders include any

mental disorder (including those of

biological etiology) listed in DSM–III–R

or their ICD–9–CM equivalent (and

subsequent revisions) with the

exception of DSM–III–R ‘V’ codes,

substance use, and developmental

disorders, which are excluded, unless

they co-occur with another diagnosable

serious emotional disturbance’’ (p.

29425).

Further, the definition indicates that,

‘‘Functional impairment is defined as

difficulties that substantially interfere

with or limit a child or adolescent from

achieving or maintaining one or more

developmentally-appropriate social,

behavioral, cognitive, communicative,

or adaptive skills. Functional

impairments of episodic, recurrent, and

continuous duration are included unless

they are temporary and expected

responses to stressful events in their

environment. Children who would have

met functional impairment criteria

during the referenced year without the

benefit of treatment or other support

services are included in this definition’’

(p. 29425).

The first decision that was made was

to focus on community epidemiological

studies done in the United States that

used either the DSM–III–R, or its

predecessor, the DSM–III, and that

provided information on the prevalence

of mental disorders using a structured

interview procedure. The group decided

that given the relatively small number of

community epidemiological studies that

had been conducted in the United

States, it would be a mistake to exclude

those few studies that had used the

DSM–III, given its considerable

similarity to the DSM–III–R.

The most frequently used structured

interview procedure was the Diagnostic

Interview Schedule for Children (DISC),

originally developed by A. Costello and

his colleagues (A. Costello, Edelbrock,

Dulcan, Kalas, & Klaric, l984), which

includes both child and parent versions.

Other interview procedures include the

Diagnostic Interview for Children and

Adolescents (DICA, Herjanic & Reich,

l982), the Child and Adolescent

Psychiatric Assessment (CAPA, Angold

& E. Costello, l995), and the Composite

International Diagnostic Interview (CIDI,

Kessler et al, 1994).

The group elected to consider that a

child met the criteria of a diagnosable

disorder either if a diagnosis was

obtained from his/her own report on the

structured interview, or from the

parent’s report on the structured

interview, or from the combination of

the youth’s report and the parent’s

report, even if neither one met the

criteria separately. While there are other

approaches to combining data from two

or more sources that were considered

and have been used (Cohen, Velez, &

Kohn, l987; Reich & Earls, 1987), the

group chose to use this ‘‘either/or’’

approach because it was believed that
52140 Federal Register / Vol. 62, No. 193 / Monday, October 6, 1997 / Notices

discrepant responses can be a source of

valuable information.

The greater challenge for the group

was operationalizing the concept of

‘‘functional impairment which

substantially interferes with or limits

the child’s role or functioning in family,

school, or community activities’’

(Federal Register, l993, p. 29425). Part

of the difficulty was in identifying

appropriate measures, and

understanding the inter-relationship

between the different measures, but the

greatest difficulty was in determining

the appropriate threshold or cut-off

point on a scale for concluding that

there was functional impairment that

was ‘‘substantially’’ interfering with

functioning.

After much discussion, it was decided

that in the absence of any ‘‘gold

standard’’ that could be used as a basis

for establishing such a cut-off point, and

in the absence of any social validation

process that has established a consensus

on what the threshold should be, data

would be presented for cut-off points at

two levels of functional impairment.

This has the benefit of providing

additional information to planners and

policy-makers to use, and to stimulate

further discussion and research to try to

better establish an appropriate

threshold. The higher prevalence rate to

be reported, which uses the more

inclusive or less conservative cut-off

point, still meets the definition of

‘‘seriously emotionally disturbed.’’ The

less inclusive and more conservative

estimate can be used for more targeted

efforts to plan on behalf of a more

limited number of children whose level

of functional impairment is especially

severe.

A variety of measures of impairment

were used in the community studies,

and their psychometric properties were

reviewed for the group by Hodges

(l994). The most frequently used

measure is a global measure, the

Children’s Global Assessment Scale

(Bird, Canino, Rubio-Stipec, & Ribera,

1987; Shaffer, Gould, Brasic, Ambrosini,

Fisher, Bird, & Ahwalia, 1983), on

which a youngster receives a rating

ranging from 0 to 100 with lower scores

indicating greater impairment. Scores

are given in ten point intervals, and for

each score there is a narrative

description of the meaning of the score.

The group considered several

potential cut-off points on the CGAS,

and decided to use a score of 60 or

lower as the cut-off point for the less

conservative definition of serious

emotional disturbance. The narrative

description for 60 is:

‘‘Variable functioning with sporadic

difficulties or symptoms in several but

not all social areas. Disturbance would

be apparent to those who encounter the

child in a dysfunctional setting or time

but not to those who see the child in

settings where functioning is

appropriate.’’

This decision was made partly on the

basis of the work by Bird and his

colleagues that indicates that,

‘‘Empirical work has demonstrated that

the optimal cut-off score on the CGAS

that demonstrates definite impairment

is a score lower than 6l’’ (Bird, Shaffer,

Fisher, Gould, Staghezza, Chen, &

Hoven, l993, p. 103).

The score of 50 will be used as the

more stringent cut-off point to denote

the more severe impairment. The

narrative description for 50 is:

‘‘Moderate degree of interference in

functioning in most social areas or

severe impairment of functioning in one

area, such as might result from, for

example, suicidal preoccupations and

ruminations, school refusal and other

forms of anxiety, obsessive rituals,

major conversion symptoms, frequent

anxiety attacks, frequent episodes of

aggressive or other anti-social behavior

with some preservation of meaningful

social relationships’’.

Data Sources

There are no national epidemiological

studies of mental disorders for children

and/or adolescents that have been

conducted in the United States. This

deficit makes it difficult to derive

prevalence rates that are generalizable to

the entire United States. In the absence

of national studies, the group chose to

examine the results from eight smaller,

and more localized studies including,

Kashani, et.al (1987), Costello, et. al

(1988) (1994), Bird, et. al (1988),

Kessler, et. al (1994), Jensen, et. al

(1995), MECA (Lahey, et. al, 1996,

Shaffer, et. al, 1996), and Costello, et. al

(1995). (see Table 1 for a summary of

these studies).

The group of technical experts

determined that it is not possible to

develop estimates of incidence using

currently available data. However, it is

important to note that incidence is

always a subset of prevalence. In the

future, incidence and prevalence data

will be collected.

TABLE ONE.—SUMMARY OF STUDIES

Study Measure and DSM system SystemSample size and age Measure of impairment

Kashani et al 1987 .................. DICA/DSMIII ........................... N=150, 14–16 yr. olds ..................................... Rating of 3 or 4 by Clinicians

on 4 Point Scale of Need

for Tx and Impairment.

Costello et al 1988 .................. DISC 1.3 DSMIII ..................... Screened=789, Interviewed=278, 7–11 yr.

olds.

CGAS 60 or less.

1994 (follow-up) ...................... DISC 2.3 DSMIIIR .................. Screened=789, Interviewed=263, 12–18 yr.

olds.

CGAS 60 or less.

Bird et al 1988 ......................... DISC 1.3*/DSMIII .................... n=777 first stage n=386 second stage 4–16

yr. olds

CGAS 60 or less.

Kessler et al 1994 ................... CIDI/DSMIII–R (adult diagnoses).n=600 (about) 15–17 yr. olds (Part of study of

15–54 yr. olds).

Aggregation of 5 Measure.

Jensen et al 1995 ................... DISC2.1/DSMIIIR .................... n=295 6–17 yr. old .......................................... •In tx or in need of tx.

•Internal Impairment (1 or

more).

•Internal Impairment (2 Domains or more).

MECA (Lahey et al, 1996

Shaffer et al, 1996).

DISC2.1/DSMIII–R .................. n=1265 9–17 yr. olds ...................................... •CGAS 60 or Less.

•CGAS 50 or less.

•Internal Impairment,

(3 or more),

(5 or more).
Federal Register / Vol. 62, No. 193 / Monday, October 6, 1997 / Notices 52141

TABLE ONE.—SUMMARY OF STUDIES—Continued

Study Measure and DSM system SystemSample size and age Measure of impairment

Costello et al 1995 .................. CAPA/DSMIII–R ..................... 2 stages n=4500 9, 11, and 13 yr. olds .......... •Internal Impairment,

(1 or more),

(2 or more),

(3 or more).

•CGAS (60 or less) CAFAS

(20 or higher).

Estimation Procedures

Based on the CMHS definition of

serious emotional disturbance, and the

existing data bases which provide

prevalence rates that can be applied to

this definition, it is estimated that the

prevalence rate of serious emotional

disturbance in children 9–17 years of

age is in the range of 9–13 percent.

Presently, the data are inadequate to

estimate prevalence rates for children

under the age of nine. It is also

concluded that if a more stringent

definition of impairment is desired than

was used for the estimated range of 9–

13 percent, then the range is from 5–9

percent. The difference between the two

estimates is that the measured level of

functional impairment is greater in the

second estimate and has been

characterized in Figure 1 as ‘‘extreme

functional impairment.’’ Children at

both levels of impairment are

considered to have a ‘‘serious emotional

disturbance’’ however; the group of

children falling into the range of 5–9

pecent constitutes a subset of the 9–13

percent.

It should be noted that the estimated

prevalence range for 9–17 year olds is

higher than the range recommended by

Kessler et al. (1995) for serious mental

illness in adults (5.7 percent). The

higher estimate for 9–17 years olds is

consistent with the fact that using the

National Comorbidity Study (NCS) data

base, which served as the main data

base for the estimation of prevalence in

adults, Kessler found that the 12 month

prevalence for 15–17 year olds was 8.7

percent. The twelve month prevalance

for 18–54 year olds was 6.5 percent. To

further understand this difference,

however, it is important to recognize

that within the 18–54 year range there

are differences associated with age. For

example, in Kessler’s first article, it was

reported that ‘‘disorders are consistently

most prevalent in the youngest cohort

(age range 15–24 years) and generally

decline monotonically with age’’

(Kessler et al., 1994, p. 13). This was

also the case with serious mental

illness, as reported by Kessler et al.

(1995). This finding of highest

prevalence rates in youngest adults with

rates decreasing with increasing age was

not only obtained in the NCS but also

in the Epidemiological Catchment Area

study, completed in the early 1980s

(Regier et al., 1988). Also, the

longitudinal research by Cohen et al.

(1993), and the findings by Reinherz et

al. (1993) on 17–19 year olds point to

especially high prevalence rates for

older adolescents.

Within the 9–17 year age range, the

data are adequate to permit

determination of gender and socioeconomic differences but are not

adequate to permit determination of

race differences. The comparative

analyses by Costello & Messer (l995) are

particularly useful for looking at gender

and socio-economic differences. Both

for global and specific measures of

impairment, they find the prevalence

rates of serious emotional disturbance in

the samples already mentioned to be

about twice as high in low socioeconomic groups as in high socioeconomic groups. This finding is

consistent for every one of the seven

data bases included in the analysis by

Costello & Messer (l995). Jensen et al.

(l995) fail to find different prevalence

rates by socio-economic status in their

study. However, as they point out the

socio-economic range in their sample

was limited by the fact that all of the

youngsters were military dependents.

The following steps were taken to

adjust for the difference in state socioeconomic circumstances. The 1995

estimates of children and adolescents

with serious emotional disturbance by

state are provided in Table 3.

Step 1

States were sorted by poverty rates

(1995), in ascending order. Using this

sort order, States were initially

classified into three groups of equal

proportions, i.e., the first 17 states were

put into Group A; the next 17 States into

Group B; the remaining 17 States, into

Group C. However, in reviewing the

results, we noted that observations 17

and 18 differed by .01 percent.

Observation number 18 was included in

group A. For this reason, Group A has

18 cases, Group B has 16 cases, and

Group C has 17 cases. Group A is the

group that has a relatively low

percentage of children in poverty.

Group B is the mid point, and Group C

is the group with the highest percentage

of children in poverty.

Step 2

At a level of functioning of 50

(LOF=50), the number of children and

adolescents with SED is calculated to be

between 5–7 percent of the number of

youth 9–17 years for Group A. For

Group B, the estimate is between 6–8

percent of the number of youth 9–17

years. The estimated SED population for

Group C is calculated to be between 7–

9 percent of the number of youth 9–17

years.

Step 3

At a level of functioning of 60

(LOF=60), the number of children and

adolescents with SED is calculated to be

between 9–11 percent of the number of

youth 9–17 years for Group A. For

Group B, the estimate is between 10–12

percent of the number of youth 9–17

years. The estimated SED population for

Group C is calculated to be between 11–

13 percent of the number of youth 9–17

years.
52142 Federal Register / Vol. 62, No. 193 / Monday, October 6, 1997 / Notices

TABLE 2.—1995 ESTIMATES OF CHILDREN AND ADOLESCENTS WITH SERIOUS EMOTIONAL DISTURBANCE; STATE

ESTIMATES ALGORITHMS

States

Estimated population

LOF*=50 LOF*=60

Lower limit

(percent)

Upper limit

(percent)

Lower limit

(percent)

Upper limit

(percent)

Group A, Lowest percent in poverty ................................................................................ 5 7 9 11

Group B, Medium percent in poverty ............................................................................... 6 8 10 12

Group C, Highest percent in poverty ............................................................................... 7 9 11 13

*LOF=Level of functioning from the Children’s Global Assessment Scale.

TABLE 3.—1995 ESTIMATES OF CHILDREN AND ADOLESCENTS WITH SERIOUS EMOTIONAL DISTURBANCE BY STATE

State Number of

youth 9–17

Percent in

poverty

LOF*=50 LOF*=60

Lower limit Upper limit Lower limit Upper limit

Total ....................................................................... 33,706,204 .................... 2,118,269 2,792,391 3,466,516 4,140,636

1 New Hampshire ..................................................... 147,695 4.07 7,385 10,339 13,293 16,246

2 Alaska .................................................................... 90,955 8.96 4,548 6,367 8,186 10,005

3 New Jersey ............................................................ 932,671 9.60 46,634 65,287 83,940 10,259

4 Utah ....................................................................... 349,086 9.76 17,454 24,436 31,418 3,839

5 Minnesota .............................................................. 643,892 11.30 32,195 45,072 57,950 70,828

6 Colorado ................................................................ 491,930 11.34 24,597 34,435 44,274 54,112

7 Nebraska ............................................................... 231,037 11.62 11,552 16,173 20,793 25,414

8 Missouri ................................................................. 709,439 11.74 35,472 49,661 63,850 78,038

9 Kansas ................................................................... 354,722 12.55 17,736 24,831 31,925 39,019

10 Wisconsin .............................................................. 706,004 12.56 35,300 49,420 63,540 77,660

11 Hawaii .................................................................... 143,901 13.97 7,195 10,073 12,951 15,829

12 North Dakota ......................................................... 91,443 14.13 4,572 6,401 8,230 10,059

13 Virginia ................................................................... 790,359 14.38 39,518 55,325 71,132 86,939

14 Nevada .................................................................. 186,695 14.41 9,335 13,069 16,803 20,536

15 Indiana ................................................................... 758,633 15.24 37,932 53,104 68,277 83,450

16 Rhode Island ......................................................... 115,176 15.36 5,759 8,062 10,366 12,669

17 Delaware ............................................................... 85,396 15.56 4,270 5,978 7,686 9,394

18 Maine ..................................................................... 160,434 15.57 8,022 11,230 14,439 17,648

19 Vermont ................................................................. 76,500 15.79 4,590 6,120 7,650 9,180

20 Maryland ................................................................ 608,209 15.80 36,493 48,657 60,821 72,985

21 Wyoming ................................................................ 75,106 16.21 4,506 6,008 7,511 9,013

22 Georgia .................................................................. 942,161 16.30 56,530 75,373 94,216 113,059

23 Massachusetts ....................................................... 680,101 17.12 40,806 54,408 68,010 81,612

24 Iowa ....................................................................... 385,583 17.39 23,135 30,847 38,558 46,270

25 Washington ............................................................ 714,567 17.81 42,874 57,165 71,457 85,748

26 Connecticut ............................................................ 378,473 18.03 22,708 30,278 37,847 45,417

27 Pennsylvania ......................................................... 1,462,731 18.07 87,764 117,018 146,273 175,528

28 Oregon ................................................................... 411,543 18.22 24,693 32,923 41,154 49,385

29 Michigan ................................................................ 1,275,452 18.36 76,527 102,036 127,545 153,054

30 Ohio ....................................................................... 1,451,220 19.33 87,073 116,098 145,122 174,146

31 Idaho ...................................................................... 183,829 20.57 11,030 14,706 18,383 22,059

32 South Dakota ......................................................... 108,855 20.74 6,531 8,708 10,886 13,063

33 North Carolina ....................................................... 879,091 21.06 52,745 70,327 87,909 105,491

34 Kentucky ................................................................ 504,373 21.25 30,262 40,350 50,437 60,525

35 Illinois ..................................................................... 1,517,182 22.14 106,203 136,546 166,890 197,234

36 Tennessee ............................................................. 658,573 22.23 46,100 59,272 72,443 85,614

37 Montana ................................................................. 126,834 22.39 8,878 11,415 13,952 16,488

38 Arkansas ................................................................ 337,718 22.44 23,640 30,395 37,149 43,903

39 Texas ..................................................................... 2,623,654 24.53 183,656 236,129 288,602 341,075

40 California ............................................................... 3,968,950 24.97 277,827 357,206 436,585 515,964

41 Oklahoma .............................................................. 457,496 24.98 32,025 41,175 50,325 59,474

42 Arizona .................................................................. 542,019 25.31 37,941 48,782 59,622 70,462

43 Florida .................................................................... 1,623,697 25.50 113,659 146,133 178,607 211,081

44 New York ............................................................... 2,141,435 25.51 149,900 192,729 235,558 278,387

45 West Virginia ......................................................... 231,390 26.93 16,197 20,825 25,453 30,081

46 Alabama ................................................................ 547,671 27.50 38,337 49,290 60,244 71,197

47 Louisiana ............................................................... 639,158 29.69 44,741 57,524 70,307 83,091

48 South Carolina ....................................................... 470,875 32.11 32,961 42,379 51,796 61,214

49 Washington, DC .................................................... 48,365 35.33 3,386 4,353 5,320 6,287

50 New Mexico ........................................................... 251,231 36.59 17,586 22,611 27,635 32,660

51 Mississippi ............................................................. 392,694 37.03 27,489 35,342 43,196 51,050
Federal Register / Vol. 62, No. 193 / Monday, October 6, 1997 / Notices 52143

Analyses show very similar

prevalence rates for girls and boys in the

seven sites. The absence of gender

differences is also apparent in the

findings of Jensen et al. (1995). Kessler

(1995), however, reports a higher

prevalence rate in females than males

using the adult diagnostic categories,

and an older adolescent sample (15–17

year olds). There is no indication that

overall prevalence rate of serious

emotional disturbance differs by gender

within the 9–17 year age range although

there clearly are gender differences in

prevalence of particular diagnoses, such

as conduct disorder and depression, and

there are suggestions that the rates may

diverge in later years of adolescence.

Overall, there is support for the use of

socio-economic status as a correction

factor in developing a methodology for

the estimation of the prevalence of

serious emotional disturbance. There is

no empercial basis at this point for

using other correction factors.

Conclusions

Of the 33 million children and

adolescents between the ages of 9–17 in

the United States, 9–13 percent or 3.5-

4 million of these youngsters have a

serious emotional disturbance at a score

of 60 or lower on the Children’s Global

Assessment Scale. A more stringent

definition of impairment, representing a

score of 50 or lower on the Children’s

Global Assessment Scale shows a range

of 5–9 percent or 2.1–2.8 million

youngsters with a serious emotional

disturbance (see Figure 1). Currently

there are not sufficient studies to

determine the prevalence rate in very

young children ages birth—8. Therefore

the estimated number of children with

serious emotional disturbance presented

here is a low estmate since it only

included data for 9–17 year olds.

Limitations

There are several limitations for these

estimates. First, it must be recognized

that these estimated ranges are based on

the findings from many modest-sized

studies which varied not only in

population but often in instruments that

were used (particularly for measurement

of impairment), methods that were used

to collect the data, and even the

diagnostic system that was used.

Second, there are only two studies

that include youngsters under the age of

nine, and these studies are not adequate

to provide a base for any estimate of the

prevalence of serious emotional

disturbance for children under the age

of nine. The estimate presented here is

intended for children between nine and

17 years of age.

Third, the data are also inadequate to

determine prevalence estimates for

children of different racial and ethnic

backgrounds. Several of the studies

included youngsters of color in their

sample and two studies were done

exclusively on Hispanic youngsters in

Puerto Rico (Bird et al., 1988, & one of

the MECA sites). However, the sample

sizes are too small and not sufficiently

representative of African-American,

Hispanic, Asian American, or native

American populations to permit

estimates to be made.

Fourth, with the absence of any large

national studies, it is not possible to

determine whether rates differ in urban

versus rural areas, or different regions of

the country.

Scope of Application

Inclusion in or exclusion from the

definition is not intended to confer or

deny eligibility for any service or benefit

at the Federal, State, or local levels.

Only a portion of children with a

serious emotional disturbance seek

treatment in any given year. Due to the

episodic nature of serious emotional

disturbance, some children and

adolescents may not require mental

health service at any particular time.

Additionally, the definition is not

intended to restrict the flexibility or

responsibility of the State or local

government to tailor publicly funded

service systems to meet local needs and

priorities. However, all individuals

whose services are funded through

Federal Community Mental Health

Services Block Grant funds must fall

within the criteria set forth in these

definitions. Any ancillary use of these

definitions for purposes other than

those identified in the legislation is

outside the purview and control of

CMHS.

It is anticipated that additional work

will be done in future years to refine

and update the estimation methodology.

CMHS will keep States apprised as this

work develops.

References

Achenbach, T.M., & Edelbrock, C. (1983).

Manual for the Child Behavior Checklist

and Revised Child Behavior Profile.

Burlington, VT: Queen City Printers.

Angold, A., & Costello, E.J. (1995). A testretest reliability study of child-reported

psychiatric symptoms and diagnoses

using the Child and Adolescent

Psychiatric Assessment (CAPA–C).

Psychological Medicine, 25, 755–762.

Bird, H.R., Canino, G., Rubio-Stipec, M.,

Gould, M.S., Riobera, J., Sesman, M.,

Woodbury, M., Huertas-Goldman, S.,

Pagan, A., Sanchez-Lacay, A., &

Moscoso, M. (1988). Estimates of the

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BILLING CODE 4160–20–U
Federal Register / Vol. 62, No. 193 / Monday, October 6, 1997 / Notices 52145

BILLING CODE 4160–20–C

Dated: September 22, 1997.

Richard Kopanda,

Executive Officer SAMHSA.

[FR Doc. 97–26372 Filed 10–3–97; 8:45 am]

BILLING CODE 4160–20–U

DEPARTMENT OF THE INTERIOR

Privacy Act of 1974—Notice of

Establishment of System of Records

Pursuant to the provisions of the

Privacy Act of 1974, as amended (5

U.S.C. 552a), notice is hereby given that

the Department of the Interior proposes

to establish a new system of records to

be maintained by the Interior Service

Center. The system, entitled

‘‘Computerized ID Security System—

Interior, OS–01,’’ will include

information pertaining to Departmental

employees and other individuals who

have had access to the Main and South

Interior Buildings. The information

contained in this system will be used for

the purpose of operating and

maintaining a computerized security

access-card system. The system will

enhance the security of the Main and

South Interior Buildings, while enabling

the Department to assure the safety of

building occupants in the event of an

emergency. Individuals entering or

leaving the Main or South Interior

Buildings will be required to scan a

computerized identification (ID) card,

equipped with a magnetic device,

through a card reading device. The

device will identify the card holder

based on personal information encoded

on the card, and will either authorize

entry or deny access to the building in

question.

The potential impact on the privacy of

individuals covered by the system will

be minimal. Data pertaining to the date

and time of entry and exit of an Interior

employee will not be disclosed to

supervisors, managers, or any other

persons (other than the individual to

whom the information applies) to verify

time and attendance records for

personnel-related purposes because 5

U.S.C. 6106 prohibits Federal Executive

agencies (other than the Bureau of