E9-25667. 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 [phone].

Project: Parent-Child Assistance Program (P-CAP) in the Fetal Alcohol Spectrum Disorder (FASD) Center of Excellence—New

Since 2001, SAMHSA's Center for Substance Abuse Prevention has been operating a Fetal Alcohol Spectrum Disorder (FASD) Center of Excellence which addresses FASD mainly by providing trainings and technical assistance; and developing and supporting systems of care that respond to FASD using effective evidence based practices and interventions.

Currently the integration of evidence-based practices into service delivery organizations is being accomplished through subcontracts. One such intervention which integrates prevention strategies into service delivery organizations is the Parent-Child Assistance Program (P-CAP) targeting pregnant or postpartum women. The P-CAP program uses the following 11 data collection tools.

Description of Instruments/Activity for Parent-Child Assistance Program (P-CAP)

Instrument/Activity	Description
At Baseline/Enrollment:
CRSQ	The Community Referral Screening Questionnaire (CRSQ) is a screening form administered to individuals referred to P-CAP. The purpose of the form is to determine eligibility for enrollment in P-CAP.
ASI—Part A	The Addiction Severity Index (ASI) Part A is an intake interview administered at client enrollment. The ASI Part A includes questions about past 30-day alcohol use, lifetime use, age at first use, month and year of last use, range of use (T-ACE), and use during pregnancy, thereby providing a thorough assessment of alcohol consumption.
ASI—Part B & Twin	The Addiction Severity Index (ASI) Part B is an intake interview administered as soon as possible after the target child birth. The ASI Part B includes questions about the target child at birth and alcohol use during the pregnancy. If the target birth is of twins then the Twins Addendum form is administered.
Demographic Data	The Demographic Questionnaire is administered after client enrollment. The questionnaire includes race, educational attainment, marital status, and an alcohol assessment.
Process Monitoring:
Weekly Advocate Time Summary	The P-CAP Weekly Advocate Time Summary Sheet is administered on a weekly basis. The form tracks time spent on the phone, in person, or providing transportation to each client.
Monthly Updates	The Monthly Update form is administered on a monthly basis. The form records any changes in drug and alcohol use, pregnancy, child custody, and sources of income.
Biannual Documentation of Progress (every 6 months)	The Biannual Documentation of Progress is administered every six months. The form documents changes in alcohol/drug treatment, abstinence from alcohol/drugs, birth control and pregnancy, connection to other services, and family stability and client activity.
At Exit:
Exit ASI	The Exit ASI Follow-Up is administered at the end of the program, at 36 months. The Exit ASI uses a format that is identical to the Addiction Severity Index administered at intake, providing pre- and post-test data for the intervention.
Client Exit Close Out Form	The Client Exit Close-Out Form documents the total number of months the client spent in P-CAP, number of different advocates who worked with the client, and whether the client ever moved out of the area while enrolled in P-CAP.
Ad hoc:
Advocate Accounting of Tracing Activity on Missing Post-Exit Client	The Advocate Accounting of Tracing Activity on Missing Post-Exit Client is used to track activity to locate a missing client. When a client is missing, the form is to be completed each month, instead of the Monthly Update form, until the missing post-exit client is brought in for an Exit Interview.
Lost Post-Exit Client Form	The Lost Post-Exit Client Form is used when the client is at least six months past her three-year exit date in the program and has not completed the ASI exit interview. The form documents the reason the client has not completed the ASI exit interview.

Two P-CAP subcontracts were awarded in February 2008. P-CAP uses an intensive paraprofessional home visitation model to reduce risk behaviors in pregnant women with substance abuse problems. The primary goal of P-CAP is to prevent future births of alcohol and drug exposed children to women who are at risk. The program uses a holistic case management approach, which is a complement to traditional substance abuse treatment. In addition to addressing alcohol and drug use, the program also aims at reducing other risk behaviors and addressing the health and social well being of mothers and their children.

At the initial client visit, the women receive a comprehensive assessment which includes an assessment for alcohol consumption, contraception use, and use of community services. At-risk women receive case management and every 4 months women are re-evaluated to determine their clinical goals. Counselors complete “Documentation of Client Progress” form every 6 months and a final “Documentation of Client Progress” at 36 months. In addition, the counselors complete a weekly advocate time sheet, summarizing their activities within the program. All forms are completed online using the web-portal. All participating subcontractors will maintain identifiable information on clients for service delivery purposes but no identifiable information will be transmitted to SAMHSA.

The data collection is designed to evaluate the implementation of P-CAP by measuring whether abstinence from alcohol is achieved and risk for alcohol-exposed births is eliminated.

Estimated Annualized Burden Hours

Instrument/Activity	Number of respondents	Number of responses per respondent	Total number of responses	Average burden per response	Total burden hours collection
At Baseline/Enrollment:
CRSQ	190	1	190	0.08	15
ASI—Part A	190	1	190	2.75	523
ASI—Part B & Twin	190	1	190	0.25	48
Demographic Data	190	1	190	0.08	15
Process Monitoring:
Weekly Advocate Time Summary	190	52	9,880	0.50	4,940
Intermediate Outcomes:
Monthly Updates	190	12	2,280	0.50	1,140
Biannual Documentation of Progress (every 6 months)	161	2	322	0.33	106
At Exit:
Exit ASI	190	1	190	2.25	428
Client Exit Close Out Form	161	1	161	0.25	40
Ad hoc:
Advocate Accounting of Tracing Activity on Missing Post-Exit Client	29	1	29	0.25	7
Lost Post-Exit Client Form	29	1	29	0.25	7
Total	190		13,651		7,269

Written comments and recommendations concerning the proposed information collection should be sent by November 25, 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: 202-395-5806.

Dated: October 19, 2009.

Elaine Parry,

Director, Office of Program Services.