[Federal Register Volume 89, Number 196 (Wednesday, October 9, 2024)]
[Notices]
[Pages 81920-81922]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-23293]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Agency Information Collection Activities: Submission to OMB for 
Review and Approval; Public Comment Request; Evaluation of the Maternal 
and Child Health Bureau Pediatric Mental Health Care Access Program and 
the Screening and Treatment for Maternal Mental Health and Substance 
Use Disorders Program

AGENCY: Health Resources and Services Administration (HRSA), Department 
of Health and Human Services.

ACTION: Notice.

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SUMMARY: In compliance with the Paperwork Reduction Act of 1995, HRSA 
submitted an Information Collection Request (ICR) to the Office of 
Management and Budget (OMB) for review and approval. Comments submitted 
during the first public review of this ICR will be provided to OMB. OMB 
will accept further comments from the public during the review and 
approval period. OMB may act on HRSA's ICR only after the 30-day 
comment period for this notice has closed.

DATES: Comments on this ICR should be received no later than November 
8, 2024.

ADDRESSES: Written comments and recommendations for the proposed 
information collection should be sent within 30 days of publication of 
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular 
information collection by selecting ``Currently under Review--Open for 
Public Comments'' or by using the search function.

FOR FURTHER INFORMATION CONTACT: To request a copy of the clearance 
requests submitted to OMB for review, email Joella Roland, the HRSA 
Information Collection Clearance Officer, at <a href="/cdn-cgi/l/email-protection#a8d8c9d8cddadfc7dac3e8c0dadbc986cfc7de"><span class="__cf_email__" data-cfemail="a1d1c0d1c4d3d6ced3cae1c9d3d2c08fc6ced7">[email protected]</span></a> or call 
(301) 443-3983.

SUPPLEMENTARY INFORMATION: Information Collection Request Title: 
Evaluation of the Maternal and Child Health Bureau Pediatric Mental 
Health Care Access Program and the Screening and Treatment for Maternal 
Mental Health and Substance Use Disorders Program, OMB No. 0906-xxxx--
New.
    Abstract: This notice describes information collection requests for 
two of HRSA's Maternal and Child Health Bureau programs: the Pediatric 
Mental Health Care Access (PMHCA) program and the Screening and 
Treatment for Maternal Mental Health and Substance Use Disorders 
(MMHSUD) program. The PMHCA program aims to promote behavioral health 
integration into pediatric primary care by developing and supporting 
state, regional, and tribal pediatric mental health care 
teleconsultation access programs. The MMHSUD program aims to support 
maternity care providers and clinical practices by supporting the 
development, improvement, and/or maintenance of statewide or regional 
behavioral health networks. Both programs support health professionals 
(HPs) \1\ in their delivery of high-quality and timely screening, 
assessment, treatment, and referrals for their targeted populations 
(e.g., children, adolescents, and young adults for PMHCA programs; 
pregnant and postpartum people for MMHSUD programs) through the 
provision of clinical behavioral health teleconsultation, care 
coordination support/navigation (i.e., resource identification and 
referrals), and training and education. Additionally, the PMHCA and 
MMHSUD programs focus on reducing racial, ethnic, and geographic 
disparities in access to care, especially in rural and other 
underserved areas.
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    \1\ HPs may include, but are not limited to, pediatricians, 
family physicians, adult primary care clinicians, obstetrician-
gynecologists, physician assistants, advanced practice nurses/nurse 
practitioners, licensed practical nurses, registered nurses, nurse 
midwives, counselors, behavioral health clinicians, social workers, 
care coordinators, medical assistants, and patient care navigators.
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    The information will be collected from PMHCA and MMHSUD award 
recipient programs funded in 2021, 2022, or 2023 and from participants 
in and stakeholders of those programs:
    <bullet> The 2021 and 2022 PMHCA programs are authorized by 42 
U.S.C. 254c-19 (sec. 330M of the Public Health Service Act), using 
funding provided by Section 2712 of the American Rescue Plan Act of 
2021 (Pub. L. 117-2).
    <bullet> The 2023 PMHCA programs are authorized by 42 U.S.C. 254c-
19 (sec. 330M of the Public Health Service Act), as amended by Section 
11005 of the Bipartisan Safer Communities Act (Pub. L. 117-159).
    <bullet> The 2023 MMHSUD programs are authorized by 42 U.S.C. 247b-
13a (sec. 317L-1 of the Public Health Service Act).
    To evaluate progress made toward the programs' goals, this data 
collection will use the following eight instruments: (1) HP Survey, (2) 
Practice-Level Survey, (3) Program Implementation Survey, (4) 
Behavioral Health Consultation Provider Semi-Structured Interview 
(SSI), (5) Care Coordinator SSI, (6) Champion SSI, (7) Community-Based 
and Other Resources SSI, and (8) Program Implementation SSI.
    A 60-day notice was published in the Federal Register on May 28, 
2024, 89 FR 46143-44. HRSA received two public comments, which included 
13 recommendations. All recommendations were considered, as detailed 
below, and no changes were made to the current information collection 
described in this notice as a result of the recommendations.
    Two recommendations focused on defining terms. One recommended use 
of the term ``mental and behavioral health'' in place of ``behavioral 
health'' and ``infant, child, and adolescent'' in place of ``child and 
adolescent'' in any survey language. HRSA selected ``behavioral 
health'' as the most concise and accepted term after consideration of 
definitions from national associations, federal agencies, and experts 
in the field. HRSA noted that the ``child and adolescent'' terminology 
is not used in the surveys for the HRSA evaluation of the PMHCA and 
MMHSUD programs. Another recommended that HRSA define PMHCA program 
training activities. In the Notices of Funding Opportunity that 
awardees responded to, HRSA describes various modalities/formats for 
training (e.g., Project Extension for Community Health Care Outcomes, 
Resource for Advancing Children's Health, learning collaboratives, in 
person, synchronous, asynchronous) as well as potential topics for 
training (e.g., psychiatric disorders and medications, screening and 
treatment protocols, practice transformation processes, trauma-informed 
care). Reflective of training-related program requirements, HRSA will 
collect data on the number of trainings attended by HPs, modality for 
training received, the number of providers trained, the number of 
trainings by topic, training methods, and materials used. Training is 
defined in the surveys using the survey question response options 
(e.g., in-person training event, webinar, self-study with program 
resources, video conferencing, learning collaborative [Project 
Extension for Community Health Care Outcomes,

[[Page 81921]]

Resource for Advancing Children's Health], and others).
    Three recommendations discussed data: the need for data to be 
comparable across PMHCA programs while still considering differences 
across these programs; ensuring data collection is conducted in a 
manner that is clear and relevant for the full range of anticipated 
data collection participants (e.g., HPs, program champions, community 
resource representatives); and the value of data to inform 
understanding of differences in rural, urban, and suburban access to 
behavioral health care. No changes will be made to the information 
collection forms in response to these recommendations because the data 
collection instruments are already responsive to these points. First, 
HRSA will record and analyze program differences such as program 
structure, funding, history, and size to help inform data findings 
across program types. Second, HRSA will collect data about settings in 
which patients live, and about practice setting, with response options 
including urban, suburban, rural, and frontier. Surveys also collect 
the ZIP Code of the primary clinical practice. While specific data on 
travel for mental and behavioral health care will not be collected, the 
Care Coordinator SSIs will provide qualitative insights on barriers to 
referrals, geographic areas of referrals, and strategies to mitigate 
barriers, which may include addressing travel time.
    One recommendation expressed concerns about HRSA's plan to assess 
changes over time in health practitioners' capacity to address 
patients' mental and behavioral health and access to mental and 
behavioral health care through screening indicating that PMHCA programs 
are typically most valuable after the need for mental or behavioral 
health interventions has been identified rather than in conducting 
initial screenings. For this data collection, HRSA has operationalized 
capacity broadly as behavioral health knowledge, skills, practice, and 
attitudes. Evaluation questions focus on change in knowledge and 
skills; screening, assessment, treatment, and referral; attitudes about 
providing behavioral health care; and how change over time differed 
based on frequency and modality of program access, treatment location, 
demographics, and treatment settings. These questions allow HRSA to 
measure changes in these different aspects of provider capacity and 
describe how these changes differ across the contexts listed above 
(e.g., treatment location, treatment settings).
    Four recommendations supported collecting patient-level data and 
the use of accessible automated collection techniques and minimally 
invasive software and strategies. HRSA disclosed that patient level 
data will not be collected under this information collection. All 
technology used for the survey administration will meet federal 
requirements for Section 508 accessibility. Survey data collection for 
the evaluation will be primarily through web-linked survey administered 
via email and via survey platform. Qualitative data collection and SSIs 
will be conducted virtually (e.g., Microsoft Teams, Zoom).
    One recommendation supported the proposed mixed evaluation plan and 
approach. HRSA will implement outcome and process evaluations, using a 
mixed-methods design, with primary and secondary quantitative and 
qualitative data collection activities across all awardees.
    One recommendation expressed support of the estimated burden and 
asked how grantees will proceed if they do not employ a likely 
respondent. HRSA will not require participation in that data collection 
activity if an awardee does not employ a likely respondent.
    One recommendation suggested that HRSA brand HRSA-MMHSUD 
programming in marketing leading up to the evaluation so that providers 
can more easily respond to questions. HRSA has developed a promotion 
packet of materials with branding guidance and customizable messages 
for awardees to use to (1) increase HP and practice engagement with 
their programs and (2) encourage participation in evaluation surveys. 
Additionally, the surveys will be customized for each program with the 
program name and logo, as applicable.
    Need and Proposed Use of the Information: HRSA needs this 
information to evaluate the PMHCA and MMHSUD programs to guide future 
decisions regarding increasing HPs' capacity to address patients' 
behavioral health and access to behavioral health services. 
Specifically, data collected for the evaluation will be used to study 
the efforts of the PMHCA and MMHSUD programs to achieve key outcomes 
(e.g., increase in access to behavioral health services; HPs trained; 
identification of community-based resources, including counselors or 
family service providers) and to measure whether and to what extent 
awardee programs are associated with changes in these outcomes. The 
evaluation will examine changes over time across PMHCA and MMHSUD 
programs, regarding the PMHCA- and MMHSUD-enrolled/participating HPs' 
and practices' (1) capacity to address patients' behavioral health and 
access to behavioral health care, through screening, assessment, 
treatment, and referral for behavioral health conditions; and (2) use 
of program services (e.g., consultation, care coordination, training).
    Likely Respondents:
    <bullet> HP Survey: Pediatricians, family physicians, obstetrician-
gynecologists, physician assistants, advanced practice nurses/nurse 
practitioners, licensed practical nurses, registered nurses, 
counselors, social workers, medical assistants, and patient care 
navigators
    <bullet> Practice-Level Survey: Practice managers (e.g., office 
managers, office leadership, nurse champions)
    <bullet> Program Implementation Survey: Cooperative agreement-
funded project directors/principal investigators
    <bullet> Behavioral Health Consultation Provider SSI: PMHCA and 
MMHSUD program-level behavioral health consultation providers
    <bullet> Care Coordinator SSI: PMHCA and MMHSUD program-level care 
coordinators
    <bullet> Champion SSI: PMHCA and MMHSUD program champions (e.g., 
HPs, community, and social service specialists)
    <bullet> Community-Based and Other Resources SSI: PMHCA and MMHSUD 
program-level community resource partner representatives (e.g., 
counselors, social workers, other community and social service 
specialists, other HPs/support workers, practice/organization managers)
    <bullet> Program Implementation SSI: Cooperative agreement-funded 
project directors/principal investigators
    Burden Statement: Burden in this context means the time expended by 
persons to generate, maintain, retain, disclose, or provide the 
information requested. This includes the time needed to review 
instructions; to develop, acquire, install, and utilize technology and 
systems for the purpose of collecting, validating, and verifying 
information, processing and maintaining information, and disclosing and 
providing information; to train personnel and to be able to respond to 
a collection of information; to search data sources; to complete and 
review the collection of information; and to transmit or otherwise 
disclose the information. The total annual burden hours estimated for 
this ICR are summarized in the table below.
    The burden estimates below have changed from the estimates of 
burden provided in the previous notice (60-day notice published on May 
28, 2024, 89

[[Page 81922]]

FR 46143-44). The estimated burden total is slightly higher in this 
revised notice because it incorporates estimates for an MMHSUD program 
that was funded following submission of the previous notice.

                                     Total Estimated Annualized Burden Hours
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                                                     Number of                    Average burden
            Form name                Number of     responses per       Total       per response    Total burden
                                    respondents     respondent       responses      (in hours)         hours
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HP Survey.......................          23,256               1          23,256            0.33        7,674.48
Practice-Level Survey...........           6,172               1           6,172            0.33        2,036.76
Program Implementation Survey...              67               1              67            0.33           22.11
Behavioral Health Consultation                67               1              67            0.75           50.25
 Provider SSI...................
Care Coordinator SSI............              67               1              67            0.75           50.25
Champion SSI....................              67               1              67            0.50           33.50
Community-Based and Other                     50               1              50            0.50           25.00
 Resources SSI..................
Program Implementation SSI......             134               1             134            1.00          134.00
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    Total.......................          29,880  ..............          29,880  ..............       10,026.35
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Amy P. McNulty,
Deputy Director, Executive Secretariat.
[FR Doc. 2024-23293 Filed 10-8-24; 8:45 am]
BILLING CODE 4165-15-P


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