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[Federal Register Volume 89, Number 231 (Monday, December 2, 2024)]
[Notices]
[Pages 95226-95228]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-28136]

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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

    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) 276-0361.
    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: 988 Suicide & Crisis Lifeline and Crisis Services 
Program Evaluation--New Package

    The Substance Abuse and Mental Health Services Administration 
(SAMHSA) 988 & Behavioral Health Crisis Coordinating Office (BHCCO)) is 
requesting clearance for the new data collection associated with the 
evaluation of the SAMHSA 988 Suicide and Crisis Lifeline and Crisis 
Services Program Evaluation (988 Suicide and Crisis Lifeline 
Evaluation). The collection of this information is critical to 
successfully oversee operational response and quality of service 
through the 988 Suicide and Crisis Lifeline to ensure connections to 
care for individuals in suicidal crisis or emotional distress 
contacting in for 988 phone, chat, and text support for connecting 
local, state/territory, and national outcomes and monitoring 
contractual obligations for current and future 988 Suicide and Crisis 
Lifeline grant programs. Much of the information is already embedded in 
the current 988 Suicide and Crisis Lifeline

[[Page 95227]]

network administrator grants, the 988 state and territory grant 
program, or the 988 Tribal Response grant program.
    In 2020, Congress designated the three-digit number, 9-8-8 for the 
Suicide and Crisis Lifeline, and the Suicide and Crisis Lifeline 
transitioned to the 3-digit number in July 2022. As a part of the 
federal government's commitment to addressing the mental health and 
opioid crises in America, unprecedented Federal resources have been 
invested to expand crisis centers in support of 988. Since its launch 
in July 2022, the 988 Suicide & Crisis Lifeline has answered over 9.6 
million contacts (SAMHSA, 2024). Progress recognized in 2023 continues 
in all areas including crisis line features, crisis center supports, 
and funding. In FY2024, the Biden-Harris administration appropriated 
nearly $500 million in new funding opportunities for the 988 Lifeline 
Administrator and other grantees on State territorial, Tribal and 
center levels, as part of the commitment to strengthen crisis care 
nationally. In section 1103(a)(2)(B) of the Consolidated Appropriations 
Act, 2023 (Pub. L. 117-328), Congress called for enhanced program 
evaluation, including performance measures to assess program response 
and improve readiness and performance of the service, including review 
of each contact to ensure timely connection of service and quality 
provision in line with evidence-based care. To meet the standards and 
requirements set forth in the statute, ongoing communication of key 
outcomes within this OMB request must be received and reviewed to 
ensure connection and quality of care through the 988 Suicide and 
Crisis Lifeline.
    The information collected will be used by SAMHSA to conduct an 
evaluation of the 988 Suicide & Crisis Lifeline and Crisis Services, to 
ensure individuals in suicidal, mental health and/or substance use 
crisis can contact 988 Suicide and Crisis Lifeline and are connected to 
crisis centers providing evidence-based care and are able to receive 
critical resource referral and linkage, including opportunities for 
mobile crisis support, crisis receiving and stabilizing facilities, 
peer respite centers and withdrawal management services. The purpose of 
the 988 Lifeline and Crisis Services Program Evaluation is to assess 
the implementation and expansion of the 988 Lifeline in the U.S. The 
evaluation will provide SAMHSA, grantees, and other interested parties 
with the information needed to strengthen the Behavioral Health Crisis 
Services Continuum (BHCSC) for all people in crisis. The evaluation 
utilizes multiple studies to conduct the evaluation of the 988 Lifeline 
and Crisis Services across a 5-year period. The 988 Lifeline and Crisis 
Services Program Evaluation includes three levels: system-level, 
client-level, and impact. Embedded within each of the three evaluation 
levels are inquiries into behavioral health equity to investigate 
disparities in utilization of 988 Lifeline and BHCSC services and 
outcomes.
    The System-level Evaluation examines the characteristics, 
collaborations, and structures of the crisis services infrastructure 
within states, territories, and Tribal jurisdictions that support 
improved client outcomes. The Systems-level Evaluation includes two 
studies: the System Composition and Collaboration Study and the System-
Level Service Utilization Study. The System Composition and 
Collaboration Study examines the structure of the 988 Lifeline and the 
BHCSC at the national, state, territory, and Tribal levels, and the 
extent to which crisis service agencies work together. The System-level 
Service Utilization Study investigates whether the 988 Lifeline and 
BHCSC are successful in creating a behavioral-health-system-first 
response to crisis events and the resulting reduction in use of non-
behavioral health crisis services (e.g., 911, law enforcement, 
emergency medical services).
    The Client-level Evaluation provides critical information about the 
ways in which the 988 Lifeline and crisis services fulfill their 
mission to connect those in crisis with the services and supports 
needed to reduce crisis risk and improve overall behavioral health 
outcomes. The Client-level Evaluation consists of two studies: The 
Client-level Service Utilization and Outcome Study and the Client-level 
Risk Reduction Study. The Client-Level Service Utilization and Outcome 
Study explores the effectiveness of 988 Lifeline and BHCSCs in linking 
individuals to referral services following their contact with the 
crisis system and assesses the relationship between engagement with 
crisis services and behavioral health outcomes. The Client-Level Risk 
Reduction Study assesses the efficacy of 988 Lifeline and BHSCS 
contacts on immediate reductions in risks of suicide, violence toward 
others, and overdose.
    The Impact Evaluation informs SAMHSA's efforts to continue to build 
the evidence base for suicide prevention and crisis programming. 
Specifically, this evaluation will examine the impact of 988 Lifeline 
and BHCSC on suicide and overdose morbidity and mortality. A quasi-
experimental interrupted time series (ITS) design using extant, 
secondary data sources (e.g., CDC mortality data, Medicaid claims data, 
data from Healthcare Cost and Utilization Project (HCUP), data from the 
NSDUH, and SAMHSA's Performance and Accountability Reporting System 
[SPARS] data) gathered across multiple years to establish longitudinal 
state-level trends before and after major milestones in the 
implementation of the 988 Lifeline and BHCSC.
    The 988 Lifeline and Crisis Services Program Evaluation engages 
with the following SAMHSA grant-funded programs that make up the core 
of the crisis care continuum: 988 State/Territory; 988 Tribal nations; 
Community Crisis Response Program (CCRP); Crisis Center Follow-Up 
(CCFU); 988 Administrator; and Certified Community Behavioral Health 
Clinics (CCBHCs). Additional grant programs which are relevant to the 
BHCSC, such as the Mental Health Services Block Grant (MHBG), State 
Opioid Response (SOR), Tribal Opioid Response (TOR), Substance Use 
Prevention, Treatment and Recovery Services Block Grant (SUPTRS BG), 
will be included in portions of the evaluation as relevant. In 
addition, crisis-providing organizations that are not SAMHSA grantees, 
especially mobile crisis programs, crisis stabilization units, and 
CCBHCs will also be engaged to participate in the evaluation.
    Ultimately, the purpose of the SAMHSA 988 Suicide & Crisis Lifeline 
and Crisis Services Program is to build the program's knowledge base of 
effectiveness by thoroughly describing the implementation, outcomes, 
and impact of a program meant to reduce deaths by suicide.
    The total annualized burden is an estimated 16,724 respondents for 
the 988 Lifeline and Crisis Services Program Evaluation instruments, 
with a combined hourly estimate to be 8,006.10 hours. Burden estimates 
are based on the data collection requirements and the number of 
respondents. The estimated response burden to collect this information 
associated with the 988 Lifeline and Crisis Services Program Evaluation 
is as follows annualized over the requested 3-year clearance period is 
presented below:

[[Page 95228]]

                                                         Total Annualized Burden Hours and Costs
                                                          [Across the 3-year clearance period]
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                                                            Number of                       Total      Burden per     Annual       Hourly       Total
       Type of respondent              Instrument          respondents    Responses per   number of     response      burden     wage  rate   annualized
                                                            per year       respondent     responses     (hours)      (hours)        ($)       cost  ($)
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                                                       System Composition and Collaboration Study
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Organizational Staff/Crisis      SIS...................              73               1           73         0.75        54.75       $78.06    $4,273.79
 System Administrator \1\.
Organizational Staff/Crisis      CCPS..................            1034               1         1034         1.00     1,034.00        58.80    60,799.20
 Agency Manager \2\.
Organizational Staff/Crisis      KII-CS................              35               1           35         1.00        35.00        27.46       961.10
 Agency Staff \3\.
Organizational Staff/Crisis      KII-CS-CSS............              13               1           13         0.50         6.50        27.46       178.49
 Agency Staff \3\.
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                                                   Client-Level Service Utilization and Outcome Study
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Organizational Staff/Crisis      CCDF..................           6,000               1        6,000         0.15       900.00        27.46    24,714.00
 Agency Staff \3\.
Parents/Caregivers \4\.........  CCDF Parent Supplement       \5\ 1,560               1        1,560         0.10       156.00         7.25     1,131.00
Client \4\.....................  CES--Baseline.........           6,000               1        6,000         0.75     4,500.00         7.25    32,625.00
Client \4\.....................  CES--3 months.........           1,500               1        1,500         0.65       975.00         7.25     7,068.75
Client \4\.....................  CES--6 months.........             375               1          375         0.65       243.75         7.25     1,767.19
Client \4\.....................  CES--12 months........              94               1           94         0.65        61.10         7.25       442.98
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                                                            Client-Level Risk Reduction Study
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Client \4\.....................  C-KII-DC..............              30               1           30         1.00        30.00         7.25       217.50
Client \4\.....................  C-KII-TPC.............              10               1           10         1.00        10.00         7.25        72.50
                                                        ------------------------------------------------------------------------------------------------
    Total......................  ......................          16,724  ..............  ...........  ...........     8,006.10  ...........   134,251.49
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\1\ BLS OES May 2022 National Industry-Specific Occupation Employment and Wage Estimates mean hourly salary for General and Operations Managers (code 11-
  1021), https://www.bls.gov/oes/current/oes111021.htm.
\2\ BLS OES May 2022 National Industry-Specific Occupation Employment and Wage Estimates mean hourly salary for Social and Community Service Managers
  (code 11-9151), https://www.bls.gov/oes/current/oes119151.htm.
\3\ BLS OES May 2022 National Industry-Specific Occupation Employment and Wage Estimates mean hourly salary for Counselors, Social Workers, and Other
  Community and Social Service Specialists (code 21-1000), https://www.bls.gov/oes/current/naics5_541720.htm#29-0000.
\4\ https://www.usa.gov/minimum-wage.
\5\ This number represents an estimate based on the average distribution of monthly contacts by modality, cited in Lifeline Performance Metrics (SAMHSA,
  April 2024), and assumes that 40% of all individuals who contact 988 through chat or text (as cited in Gould et al., 2021 and Pisani et al., 2022) and
  20% of those who contact 988 through phone call are below the age of 18.

    Send comments to SAMHSA Reports Clearance Officer, 5600 Fisher 
Lane, Room 15E45, Rockville, MD 20852 OR email a copy at 
[email protected]. Written comments should be received by 
January 31, 2025.

Alicia Broadus,
Public Health Advisor.
[FR Doc. 2024-28136 Filed 11-29-24; 8:45 am]
BILLING CODE 4162-20-P
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