[Federal Register Volume 74, Number 74 (Monday, April 20, 2009)]
[Notices]
[Pages 17964-17966]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-8974]


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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: Evaluation of Networking Suicide Prevention Hotlines (OMB No. 
0930-0274)--Revision

    This project revision includes the continuation of two previously 
approved data collection activities [Evaluation of Networking Suicide 
Prevention Hotlines Follow-Up Assessment (OMB No. 0930-0274) and Call 
Monitoring of National Suicide Prevention Lifeline Form (OMB No. 0930-
0275)], and a revision to expand the scope of the ongoing evaluation in 
an effort to advance the understanding of crisis hotline utilization 
and its impact. The Substance Abuse and Mental Health Services 
Administration's (SAMHSA), Center for Mental Health Services (CMHS) 
funds a National Suicide Prevention Lifeline Network (NSPL), consisting 
of two toll-free telephone numbers, that route calls from anywhere in 
the United States to a network of local crisis centers. In turn, the 
local centers link callers to local emergency, mental health, and 
social service resources.
    The overarching purpose of the proposed Evaluation of the 
Networking Suicide Prevention Hotlines--Revision is to (1) continue to 
monitor and ensure quality of calls and gather follow-up information 
from the callers themselves, (2) expand the number of centers 
participating in order to assess whether the two national suicide 
prevention hotline numbers (i.e., 1-800-273-TALK and 1-800-SUICIDE) 
reach similar or complimentary populations of at risk callers, and, (3) 
to evaluate additional but related activities (e.g., motivational 
interviewing and safety planning) recently funded through a new 
cooperative agreement between

[[Page 17965]]

SAMHSA and crisis hotline centers in the NSPL. In total this effort's 
proposed evaluation includes six data collection activities.
    Clearance is being requested to continue the following two 
previously approved data collection activities to continue call quality 
monitoring and caller follow-up assessment activities. The number of 
centers proposed to participate in these continuing activities is 
sufficient to address the additional question related to use of the two 
existing hotline numbers.
    (1) To ensure quality, the vast majority of crisis centers conduct 
on-site monitoring of selected calls by supervisors or trainers using 
unobtrusive listening devices. To monitor the quality of calls and to 
inform the development of training for networked crisis centers, the 
national Suicide Prevention Lifeline proposes to remotely monitor calls 
routed to sixteen crisis centers during the shifts of consenting staff. 
The procedures are anonymous in that neither staff nor callers will be 
identified on the Call Monitoring Form. The monitor, a trained crisis 
worker, will code the type of problem presented by the caller, the 
elements of a suicide risk assessment that are completed by the crisis 
worker as well as what action plan is developed with and/or what 
referral(s) are provided to the caller. No centers will be identified 
in the reports.
    During the shifts of consenting crisis staff, a recording will 
inform callers that some calls may be monitored for quality assurance 
purposes. Previous comparisons of matched centers that did and did not 
play the recordings found no difference in hang-up rates before the 
calls were answered or within the first 15 seconds of the calls.
    The 18 centers to be monitored are selected based on the geographic 
region(s) they serve and center call volume. A total of 1,320 calls 
will be monitored during year 1 of the proposed three year clearance 
period.
    (2) With input from multiple experts in the field of suicide 
prevention, a telephone interview survey was created to collect data on 
follow-up assessments from consenting individuals calling the Lifeline 
network.
    During year 1 of the proposed three year clearance period, a total 
of 1,095 callers will be recruited from 18 of the approximately 100 
crisis hotline centers that participate in the Lifeline network. 
Trained crisis workers will conduct the follow-up assessment (``Crisis 
Hotline Telephone Follow-Up Assessment'') within one month of the 
initial call. Assessments will be conducted only one time for each 
client. Strict measures to ensure privacy will be followed.
    Telephone scripts provide potential participants with standardized 
information to inform their consent decision. Using the Crisis Hotline 
Telephone Initial Script, trained crisis counselors will ask for 
permission to have the evaluation staff re-contact the caller. The 
Crisis Hotline Telephone Consent Script, used at the time of re-
contact, incorporates the required elements of a written consent form,
    The resulting data will measure (a) suicide risk status at the time 
and since the call, (b) depressive symptoms at follow-up, (c) service 
utilization since the call, (d) barriers to service access, and (e) the 
client's perception of the efficacy of the hotline intervention.
    Clearance is also being requested for four new activities are being 
proposed to evaluate the process and impact of motivational training 
and safety planning (MI/SP) with callers who have expressed suicidal 
desire. Five centers will train counselors to implement an intervention 
with callers during the initial call to a center, which incorporates 
aspects of motivational interviewing and safety planning (MI/SP) and 
utilizes an evidence-based practice model to provide follow-up to 
callers who have expressed a suicidal desire. An assessment of MI/SP 
fidelity and process measures will be incorporated into the design 
through the observation of calls via silent monitoring and the 
administration of two self-administered questionnaires to crisis center 
counselors. The impact assessment of MI/SP counselor training will 
include silent monitoring of calls and follow-up telephone interviews 
with callers to assess their emotions and behaviors following their 
interaction with the MI/SP trained counselor.
    (1) Research monitors, trained crisis counselors not affiliated 
with the centers in the project, will access a remote ``real-time'' 
monitoring system through the Internet to conduct silent monitoring. 
Monitors will complete the ``MI/SP Silent Monitoring Form,'' to gather: 
(a) Call specifics for each call such as date, time, and length; (b) 
suicide risk status of the caller; (c) information on elements of 
safety planning, such as making the environment safe and identifying 
triggers that led to the caller's suicidality; (d) types of referrals 
the counselor gave and to what services; (e) ratings of counselor 
behaviors and caller behavioral changes that occurred; and (f) re-
contact permission status. At the end of the call and once the 
counselor deems the intervention to be complete, counselors will ask 
all appropriate callers, using the MI/SP Caller Initial Script, for 
permission to be re-contacted by research staff for a follow-up 
interview. Only a caller whose call has been silently monitored is 
eligible to be followed by the research team; thus, counselors will 
state that the caller may be contacted by the research team if randomly 
selected for a follow-up call. A total of 1110 calls will be monitored 
across the 3-year data collection period. Prior to monitoring and 
collecting of the data, crisis counselors must have read and signed a 
MI/SP Counselor Consent. This form explains the purpose of the 
research, privacy, risks and benefits, what the study entails, and 
participant rights.
    (2) The ``MI/SP Counselor Attitude Questionnaire'' attitude 
questionnaire will be administered to counselors at the conclusion of 
their MI/SP training and be used as a possible predictor of fidelity of 
the MI//SP intervention. Information to be gathered includes (a) 
counselors' views of the applicability of the MI/SP for preparing them 
to conduct safety planning and follow up with callers; (b) possible 
anticipated challenges (i.e., impeding factors) to applying the MI/SP 
training in their centers; (c) the relationship of the MI/SP model to 
their centers; (d) the extent to which trainees are provided with or 
obtain adequate resources to enable them to use MI/SP on the job; (h) 
impeding and facilitating factors; and (9) attitudes about counselors' 
self-efficacy to use MI/SP and views on its utility. It is expected 
that a total of 225 counselors will be trained over the course of 3 
years in an effort to maintain 175 counselors at any given time. Thus, 
a total of 225 counselors are expected to complete this questionnaire 
during the 3-year data collection period.
    (3) Counselors will be asked to complete the ``MI/SP Counselor 
Follow-up Questionnaire'' for each call that is monitored. The 
questionnaire will incorporate an assessment of the outreach, 
telephonic follow up and/or other strategies that the center has 
proposed to implement, and whether the counselor was able to implement 
the center's site plan as originally conceived. The questionnaire will 
also include items on the demographic characteristics of the caller, 
whether contact was successfully made with the caller, whether the 
caller followed through with the safety plan and/or referral given by 
the counselor, whether MI/SP was re-implemented during the follow-up 
contact, whether another follow-up is scheduled, the educational and 
crisis experience of the person attempting re-contact with the caller, 
and that person's prior experience with

[[Page 17966]]

follow-up. Barriers to implementing the follow-up, as well as types of 
deviation from the site's follow-up plan will also be assessed. Open-
ended questions about what led to deviations from the site's follow-up 
plan will also be included. In total, it is expected that counselors 
will complete the questionnaire for each of the calls that were 
monitored.
    (4) Researchers will begin conducting follow-up interviews with 
callers approximately 6 weeks after the initial call to the center. 
This follow-up telephone interview (``MI/SP Caller Follow-up 
Interview'') will be conducted to collect information on demographic 
characteristics, gather caller feedback on the initial call made to the 
center, suicide risk status at the time of and since the call, current 
depressive symptomatology, follow through with the safety plan and 
referrals made by the crisis counselor, and barriers to service. Taking 
into account attrition and the number of callers who do not give 
consent, it is expected that the total number of follow-up interviews 
conducted by the research team will not exceed 885. The MI/SP Caller 
Initial Script protects the privacy of callers by asking the caller how 
and when they want to be contacted, and what type of message (if any) 
can be left on an answering machine or with the person picking up the 
telephone. The caller also has the option of not providing contact 
information to the crisis center if he/she prefers to call the 
evaluation team back directly. The telephone script used when the 
evaluation team contacts the participant for their follow-up interview 
(MI/SP Caller Follow-up Consent Script, see Attachment H) includes (1) 
the fact that the information collection is sponsored by an agency of 
the Federal Government, (2) the purpose of the information collection 
and the uses which will be made of the results, (3) the voluntary 
nature of participation, and (4) the extent to which responses will be 
held confidential.
    The estimated response burden to collect this information is as 
follows annualized over the requested three year clearance period is 
presented below:

                         Total and Annualized Averages: Respondents, Responses and Hours
----------------------------------------------------------------------------------------------------------------
                                                                     Number of
                   Instrument                        Number of     responses per      Hours/         Response
                                                    respondents     respondent*      response         burden*
----------------------------------------------------------------------------------------------------------------
National Suicide Prevention Lifeline--Call                    10              44             .58             249
 Monitoring Form................................
Crisis Hotline Telephone Initial Script.........             365               1             .08              29
Crisis Hotline Telephone Consent Script.........             365               1             .17              62
Crisis Hotline Telephone Follow-up Assessment...             365               1             .67             245
MI/SP Silent Monitoring Form....................              10              37             .58             214
MI/SP Caller Initial Script.....................             368               1             .08              29
MI/SP Caller Follow-up Consent Script...........             368               1             .17              63
MI/SP Caller Follow-up Interview................             295               1             .67             198
MI/SP Counselor Consent.........................              75               1             .08               6
MI/SP Counselor Attitudes Questionnaire.........              75               1             .25              19
MI/SP Counselor Follow-up Questionnaire.........             175               2             .17              89
                                                 ---------------------------------------------------------------
    Total.......................................           2,471  ..............  ..............           1,181
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* Rounded to the nearest whole number.

    Written comments and recommendations concerning the proposed 
information collection should be sent by May 20, 2009 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: 202-395-6974.

    Dated: April 13, 2009.
Elaine Parry,
Director, Office of Program Services.
[FR Doc. E9-8974 Filed 4-17-09; 8:45 am]
BILLING CODE 4162-20-P