[Federal Register: April 28, 2008 (Volume 73, Number 82)]
[Notices]
[Page 22932-22938]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr28ap08-42]
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DEPARTMENT OF EDUCATION
National Institute on Disability and Rehabilitation Research--
Disability and Rehabilitation Research Projects and Centers Program--
Rehabilitation Research and Training Centers (RRTCs)
AGENCY: Office of Special Education and Rehabilitative Services,
Department of Education.
ACTION: Notice of proposed priorities for RRTCs.
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SUMMARY: The Assistant Secretary for Special Education and
Rehabilitative Services proposes certain funding priorities for the
Disability and Rehabilitation Research Projects and Centers Program
administered by the National Institute on Disability and Rehabilitation
Research (NIDRR). Specifically, this notice proposes four priorities
for RRTCs. The Assistant Secretary may use these priorities for
competitions in fiscal year (FY) 2008 and later years. We take this
action to focus research attention on areas of national need. We intend
these priorities to improve rehabilitation services and outcomes for
individuals with disabilities.
DATES: We must receive your comments on or before May 28, 2008.
ADDRESSES: Address all comments about these proposed priorities to
Donna Nangle, U.S. Department of Education, 400 Maryland Avenue, SW.,
Room 6029, Potomac Center Plaza (PCP), Washington, DC 20204-2700. If
you prefer to send your comments through the Internet, use the
following address: donna.nangle@ed.gov.
You must include the priority title in the subject line of your
electronic message.
FOR FURTHER INFORMATION CONTACT: Donna Nangle. Telephone: (202) 245-
7462 or by e-mail: donna.nangle@ed.gov.
If you use a telecommunications device for the deaf (TDD), you may
call the Federal Relay Service (FRS) at 1-800-877-8339.
Individuals with disabilities may obtain this document in an
alternative format (e.g., Braille, large print, audiotape, or computer
diskette) on request to the contact person listed under FOR FURTHER
INFORMATION CONTACT.
SUPPLEMENTARY INFORMATION: This notice of proposed priorities is in
concert with President George W. Bush's New Freedom Initiative (NFI)
and NIDRR's Final Long-Range Plan for FY 2005-2009 (Plan). Background
information on the NFI can be accessed on the Internet at the following
site: http://www.whitehouse.gov/infocus/newfreedom.
The Plan, which was published in the Federal Register on February
15, 2006 (71 FR 8165), can be accessed on the Internet at the following
site: http://www.ed.gov/about/offices/list/osers/nidrr/policy.html.
Through the implementation of the NFI and the Plan, NIDRR seeks to:
(1) Improve the quality and utility of disability and rehabilitation
research; (2) foster an exchange of expertise, information, and
training to facilitate the advancement of knowledge and understanding
of the unique needs of traditionally underserved populations; (3)
determine best strategies and programs to improve rehabilitation
outcomes for underserved populations; (4) identify research gaps; (5)
identify mechanisms of integrating research and practice; and (6)
disseminate findings.
Invitation To Comment
We invite you to submit comments regarding these proposed
priorities. To ensure that your comments have maximum effect in
developing the notice of final priorities, we urge you to identify
clearly the specific proposed priority or topic that each comment
addresses.
We invite you to assist us in complying with the specific
requirements of Executive Order 12866 and its overall requirement of
reducing regulatory burden that might result from these proposed
priorities. Please let us know of any further opportunities we should
take to reduce potential costs or increase potential benefits while
preserving the effective and efficient administration of the program.
During and after the comment period, you may inspect all public
comments about these proposed priorities in room 6029, 550 12th Street,
SW., PCP, Washington, DC, between the hours of 8:30 a.m. and 4 p.m.,
Eastern time, Monday through Friday of each week except Federal
holidays.
Assistance to Individuals With Disabilities in Reviewing the Rulemaking
Record
On request, we will supply an appropriate aid, such as a reader or
print magnifier, to an individual with a disability who needs
assistance to review the comments or other documents in the public
rulemaking record for these proposed priorities. If you want to
schedule an appointment for this type of aid, please contact the person
listed under FOR FURTHER INFORMATION CONTACT.
We will announce the final priorities in one or more notices in the
Federal Register. We will determine the final priorities after
considering responses to this notice and other information available to
the Department. This notice does not preclude us from proposing or
using additional priorities, subject to meeting applicable rulemaking
requirements.
Note: This notice does not solicit applications. In any year in
which we choose to use these proposed priorities, we invite
applications through a notice in the Federal Register. When inviting
applications we designate the priorities as absolute, competitive
preference, or invitational. The effect of each type of priority
follows:
Absolute priority: Under an absolute priority, we consider only
applications that meet the priority (34 CFR 75.105(c)(3)).
Competitive preference priority: Under a competitive preference
priority, we give competitive preference to an application by either
(1) awarding additional points, depending on how well or the extent to
which the application meets the competitive preference priority (34 CFR
75.105(c)(2)(i)); or (2) selecting an application that meets the
competitive preference priority over an application of comparable merit
that does not meet the priority (34 CFR 75.105(c)(2)(ii)).
Invitational priority: Under an invitational priority, we are
particularly interested in applications that meet the invitational
priority. However, we do not give an application that meets the
invitational priority a competitive or
[[Page 22933]]
absolute preference over other applications (34 CFR 75.105(c)(1)).
Priorities
In this notice, we are proposing four priorities for RRTCs.
Priority 1--Enhancing the Functional and Employment
Outcomes of Individuals Who Experience a Stroke.
Priority 2--Enhancing the Functional and Employment
Outcomes of Individuals With Multiple Sclerosis.
Priority 3--Aging With Physical Disability: Reducing
Secondary Conditions and Enhancing Health and Participation, Including
Employment.
Priority 4--Participation and Community Living for
Individuals With Psychiatric Disabilities.
Rehabilitation Research and Training Centers (RRTCs)
The purpose of the RRTC program is to improve the effectiveness of
services authorized under the Rehabilitation Act of 1973, as amended,
through advanced research, training, technical assistance, and
dissemination activities in general problem areas, as specified by
NIDRR. Such activities are designed to benefit rehabilitation service
providers, individuals with disabilities, and the family members or
other authorized representatives of individuals with disabilities. In
addition, NIDRR intends to require all RRTC applicants to meet the
requirements of the General Rehabilitation Research and Training
Centers (RRTC) Requirements priority, which was published in a notice
of final priorities in the Federal Register on February 1, 2008 (72 FR
6132). Additional information on the RRTC program can be found at:
http://www.ed.gov/rschstat/research/pubs/res-program.html#RRTC.
Statutory and Regulatory Requirements of RRTCs
RRTCs must--
Carry out coordinated advanced programs of rehabilitation
research;
Provide training, including graduate, pre-service, and in-
service training, to help rehabilitation personnel more effectively
provide rehabilitation services to individuals with disabilities;
Provide technical assistance to individuals with
disabilities, their representatives, providers, and other interested
parties;
Demonstrate in their applications how they will address,
in whole or in part, the needs of individuals with disabilities from
minority backgrounds;
Disseminate informational materials to individuals with
disabilities, their representatives, providers, and other interested
parties; and
Serve as centers of national excellence in rehabilitation
research for individuals with disabilities, their representatives,
providers, and other interested parties.
Priority 1--Enhancing the Functional and Employment Outcomes of
Individuals Who Experience a Stroke
Background
According to the American Heart Association's most recent
estimates, each year approximately 780,000 individuals in the United
States (U.S.) experience a stroke and nearly 5.7 million individuals in
the U.S. today have survived a stroke. Stroke patients continue to be
the largest diagnostic group in medical rehabilitation, and stroke is a
leading cause of serious, long-term physical and cognitive disabilities
(American Heart Association, 2008).
Significant progress has been made in the development of
rehabilitation interventions and in the assessment of outcomes for
those who experience a stroke. An example of recent advances in
rehabilitation interventions includes constraint-induced movement
therapy. This repetitive training of the arms on task-oriented
activities has been shown to improve the functional abilities of stroke
survivors (Wolf et al., 2006). Another novel and promising technology
that is in development is the BION, a family of implantable
neuromuscular microstimulation devices that are designed to treat
complications of paralysis and disuse atrophy, including shoulder
subluxation, hand contractures, drop foot and osteoarthritis (Loeb et
al., 2006).
Given the large and growing incidence of stroke in the U.S. and the
high levels of physical and cognitive disabilities often associated
with strokes, there is a need for further research on promising new
interventions, such as CI therapy, bodyweight supported treadmill
training (BWS-TT), electrical stimulation, and robotic technology
(Bassett, 2006). In addition, research is needed to develop more
sensitive measures of neuro-recovery and post-stroke secondary health
conditions, as well as interventions to prevent a variety of post-
stroke secondary health conditions, such as fatigue (Gladstone et al.,
2002; Roth, 2005; Campbell, Sheets, & Strong, 1999).
Individuals who experience a stroke are at increased risk for
depression, and depression among stroke survivors is associated with
poor functional outcomes (Goodwin & Devanand, 2008).
Typical clinical assessments of depression ask patients questions
to detect the presence of negative affect and the absence of positive
affect. However, the connection between emotional well-being and stroke
outcomes is not yet very well understood. Additional research is needed
to investigate whether interventions aimed at improving an individual's
level of positive affect can improve recovery from stroke.
Post-stroke rehabilitation interventions that focus on health and
function and emotional well-being may improve employment outcomes of
this population. Emotional well-being in the general population is
related to many positive outcomes, including employment (Seligman,
1991, 2002). However, this connection has not been validated nor
explored for the population of individuals with disabilities, including
individuals who experience a stroke. The employment statistics for the
post-stroke population are poor. Estimates of rates of return to work
following stroke vary widely (Wozniak & Kittner, 2002). According to
the U.S. Department of Education's Rehabilitation Services
Administration's Case Service Report, also called the RSA-911 database,
in 2006, of the more than 5,300 individuals with disabilities caused by
a stroke who exited the State Vocational Rehabilitation Services
program after receiving services, only about 25 percent were employed
when they left the program.
References
American Heart Association (AHA) (2008). Heart Disease and Stroke
Statistics--2008 Update At-A-Glance: Our Guide to Current Statistics
and the Supplement to our Heart and Stroke Facts. See: http://
www.americanheart.org/downloadable/heart/1200078608862HS_
Stats%202008.final.pdf.
Bassett, J. (2006). A Lifelong Journey. Advance for Directors in
Rehabilitation, 15(10), 42-48.
Campbell, M.L., Sheets, D., & Strong, P.S. (1999). Secondary health
conditions among middle-aged individuals with chronic physical
disabilities: implications for unmet needs for services. Assistive
Technology. 11(2): 105-122.
Gladstone, D.J., Danells, C.J., & Black, S.E. (2002). The fugl-meyer
assessment of motor recovery after stroke: a critical review of its
measurement properties. Neurorehabilitation and Neural Repairs,
16(3): 232-40. See: http://www.medscape.com/medline/abstract/
12234086.
Goodwin, R.D. & Devanand, D.P. (2008). Stroke, depression, and
functional health outcomes among adults in the community. Journal of
Geriatric Psychiatry and Neurology. 21(1): 41-46.
[[Page 22934]]
Loeb, G.E., Richmond, F.J.R., & Baker, L.L. (2006). The BION
Devices: Injectable interfaces with peripheral nerves and muscles.
Neurosurgery Focus, 20(5) E2. See: http://www.medscape.com/
viewarticle/542356.
Roth, E. (2005). Aging Issues: Neurological Disorders: crosscutting
breakout session. Neurorehabilitation and Neural Repair, 10(1), S70.
Seligman, M.E.P. (1991). Learned Optimism. New York: Pocket Books.
Seligman, M.E.P. (2002). Authentic Happiness. Simon & Schuster.
U.S. Department of Education: Case Service Report (RSA-911), FY
2006. (2006). Washington, DC. Aggregated 911 data by state is
available. See: http://rsamis.ed.gov.
Wolf, S.L., Weinstein, C.J., Miller, J.P., Taub, E., Uswatte, G.,
Morris, D., Giuliani, C., Light, K.E., & Nichols-Larsen, D. (2006).
Effect of constraint-induced movement therapy on upper extremity
function 3 to 9 months after stroke. Journal of the American Medical
Association, 296(17), 2095-2104.
Wozniak, M. & Kittner, S. (2002). Return to Work After Ischemic
Stroke: A Methodological Review. Neuroepidemiology, 21, 159-166.
Proposed Priority
The Assistant Secretary for Special Education and Rehabilitative
Services proposes a priority for a Rehabilitation Research and Training
Center (RRTC) on Enhancing the Functional and Employment Outcomes of
Individuals Who Experience a Stroke. This RRTC must conduct rigorous
research, training, technical assistance, and dissemination activities
to enhance the functional and employment outcomes of individuals who
experience a stroke.
In doing so, the RRTC must focus on no more than two of the
following dimensions: Improved mobility; secondary conditions (e.g.,
pain, fatigue); and emotional well-being. Under this priority, the RRTC
must be designed to contribute to the following outcomes:
(a) Improved outcome measures for use with individuals who
experience a stroke. The RRTC must contribute to this outcome by
identifying or developing and testing methods and measures to assess
outcomes in the dimensions that the RRTC chooses to focus on (e.g.,
mobility, secondary conditions, emotional well-being).
(b) Improved medical rehabilitation or community-based
rehabilitation interventions for individuals who experience a stroke.
The RRTC must contribute to this outcome by identifying or developing
and testing new rehabilitation interventions that are designed to
improve mobility, reduce the onset of secondary conditions, or improve
emotional well-being among individuals who have experienced a stroke.
Where possible, the Center must use scientifically based research (as
this term is defined in section 9101(34) of the Elementary and
Secondary Education Act of 1965, as amended) methods to test these
interventions.
(c) Improved employment outcomes among individuals who experience a
stroke. The RRTC must contribute to this outcome by conducting research
on the experiences and outcomes of individuals who experience stroke
and who seek to return to work. The RRTC's research must include
research on individuals who are served by the State Vocational
Rehabilitation Services program or who receive stroke/neuro-
rehabilitation services from other sources, and must identify neuro-
rehabilitation services that are associated with positive outcomes in
the treatment of specific stroke-related impairments and functional
limitations thereby allowing individuals to return to work.
Priority 2--Enhancing the Functional and Employment Outcomes of
Individuals With Multiple Sclerosis
Background
While prevalence estimates vary, according to the National Multiple
Sclerosis Society, approximately 400,000 Americans have multiple
sclerosis (MS) (National Multiple Sclerosis Society, 2005). For most
individuals, the age of onset for the disease is in early adulthood.
Individuals with MS may have symptoms such as fatigue, motor weakness,
spasticity, poor balance, heat sensitivity, pain, cognitive
impairments, and mood disorders (Wynn, 2006; Mikol, 2006). The variety
of symptoms that an individual with MS may experience and the uncertain
prognosis of MS can impair an individual's routine activities;
vocational, social, and interpersonal functioning; and quality of life
(Kalb, 2004).
While some research has been conducted regarding the functional
outcomes of individuals with MS, there is a significant need for
further research in the areas of outcomes measurement and
rehabilitation interventions to maximize the health, well-being, and
community and workplace participation of individuals with MS.
Experienced MS care providers participating in a recent survey
identified a number of areas in which clinical consultation and
continuing medical education (CME) would improve their ability to treat
individuals with MS, and the wide range of symptoms associated with MS
(Turner et al., 2006). Fatigue, depression, cognitive impairment, and
pain were among the most frequently cited areas for consultation and
CME (Mikol, 2006). Research that addresses the frequent co-occurrence
of these four symptoms, and the effect of central-nervous-system-active
medications that are typically used to treat them, is also needed (Oken
et al., 2006). For individuals with MS, there is a ``continued need for
effective therapeutic approaches to symptom management'' (Joy &
Johnston, 2001).
The relatively early age of onset, the variety of symptoms and
secondary conditions associated with MS, and the intermittent and
uncertain course of the disease present a variety of challenges to
continuous participation by individuals with MS in the labor force.
Estimates are that as many as 50 percent of individuals with MS report
they cannot work due to their disabilities (Buchanan et al., 2006).
Interventions to improve the health and function of individuals with MS
may improve their employment outcomes. Recent data from the U.S.
Department of Education's Rehabilitation Services Administration's Case
Service Report, also called the RSA-911 database, suggest that
vocational rehabilitation services can be improved for this population.
According to the RSA-911 database, in 2006, of the more than 3,000
individuals with MS who exited the State Vocational Rehabilitation
Services program, after being determined eligible and receiving a
service, only one-third were employed when they exited the program.
References
Buchanan, R.J., Schiffer, R., Stuifbergen, A., Zhu, L., Wang, S.,
Chakravorty, B.J., & Kim, M. (2006). Demographic and Disease
Characteristics of People with Multiple Sclerosis Living in Urban
and Rural Areas. International Journal of MS Care, 8(11), 89-97.
Joy, J.E. & Johnston, R.B. (Eds.). (2001). Multiple Sclerosis:
Current Status and Strategies for the Future. Washington, D.C.:
National Academy Press.
Kalb, R.C. (2004). Multiple Sclerosis: The Questions You Have--The
Answers You Need, 3rd Edition. New York: Demos Medical Publishing.
National Multiple Sclerosis Society (2005). Multiple Sclerosis
Information Sourcebook. New York: National Multiple Sclerosis
Society. See: http://www.nationalmssociety.org/Sourcebook-Topic.asp.
Oken, B.S., Flegal, K., Zajdel, D., Kishiyama, S.S., Lovera, J.,
Bagert, B., & Bourdette, D.N. (2006). Cognition and Fatigue in
Multiple Sclerosis: Potential Effects of Medications With Central
Nervous System Activity. Journal of Rehabilitation Research &
Development, 43(1), 83-90.
Turner, A.P., Martin, C., Williams, R.M.,
[[Page 22935]]
Goudreau, K., Bowen, J.D., Hatzakis, M., Whitham, R.H., Bourdette,
D.N., Walker, L., & Haselkorn, J.K. (2006). Exploring Educational
Needs of Multiple Sclerosis Care Providers: Results of a Care-
Provider Survey. Journal of Rehabilitation Research & Development,
43(1), 25-34.
U.S. Department of Education: Case Service Report (RSA-911), FY
2006. (2006). Washington, DC: Author.
Wynn, D.R. (2006). Management of Physical Symptoms. International
Journal of MS Care, 8, Supplement 1, 13-20.
Proposed Priority
The Assistant Secretary for Special Education and Rehabilitative
Services proposes a priority for a Rehabilitation Research and Training
Center (RRTC) on Enhancing the Functional and Employment Outcomes of
Individuals With Multiple Sclerosis. This RRTC must conduct rigorous
research, training, technical assistance, and dissemination activities
to enhance the functional and employment outcomes of individuals with
multiple sclerosis (MS).
In doing so, the RRTC must focus on how one or both of the
following dimensions affect the employment outcomes of individuals with
MS: The prevention or reduction of secondary conditions (e.g., pain,
fatigue, depression, cognitive impairment) and improved mobility. Under
this priority, the RRTC must be designed to contribute to the following
outcomes:
(a) Improved outcome measures for use with individuals with MS. The
RRTC must contribute to this outcome by identifying or developing and
testing methods and measures to assess outcomes in the dimensions on
which the RRTC chooses to focus.
(b) Improved medical rehabilitation or community-based
rehabilitation interventions. The RRTC must contribute to this outcome
by improving the ability of individuals with MS to remain in the
workforce and to live in community-based settings through identifying
or developing and testing new rehabilitation interventions. Where
possible, the Center must use scientifically based research (as this
term is defined in section 9101(34) of the Elementary and Secondary
Education Act of 1965, as amended) methods to test these interventions.
(c) Improved employment outcomes among individuals with MS. The
RRTC must contribute to this outcome by conducting research on the
experiences and outcomes of individuals with MS who are served by the
State Vocational Rehabilitation Services program or who receive MS-
rehabilitation services from other sources, and by identifying
rehabilitation services that are associated with the reduction of
specific MS-related symptoms and functional limitations. Research must
include investigation of job modifications and accommodations
associated with successful employment.
Priority 3--Aging With Physical Disability: Reducing Secondary
Conditions and Enhancing Health and Participation, Including Employment
Background
With recent medical and technological advancements, many
individuals with early onset of physical disabilities acquired at birth
or in childhood or young adulthood are surviving long enough to
experience the rewards and challenges of aging (Campbell, Sheets, &
Strong, 1999). Determining the size of this emerging segment of the
disabled population has been difficult due to the lack of sufficient
population data on age of onset and duration of disability (Kemp,
2005). The only national estimate available to date comes from a
secondary analysis of the 1990 U.S. Census data, which suggests that
there may be as many as 25,000,000 Americans who are aging with various
long-term physical disabilities (McNeil, 1994).
As many researchers have documented, a primary challenge associated
with increased longevity among this population is an increased risk of
secondary conditions (Kemp & Mosqueda, 2004). Although there is
widespread agreement that secondary conditions can be debilitating,
costly in terms of financial and social consequences, and potentially
fatal in some circumstances, how to define secondary conditions remains
an active debate within the disability community (Wilber et al., 2002;
Rimmer, 2005).
While a precise definition of secondary conditions is still
evolving, the emerging consensus is that secondary conditions often
increase the severity of an individual's physical disability (Brandt &
Pope, 1997). As individuals with long-term physical disabilities age
into middle and later adulthood, there is an enormous physical and
psychological burden associated with having to manage various secondary
health conditions, in addition to managing the chronic health effects
related to the aging process generally (Rimmer, 2005). There is,
however, widespread agreement that certain secondary conditions are
preventable, and that learning how to prevent the onset or reduce the
severity and impact of these new or increased impairments, functional
limitations, and age-related health problems is vital to enhancing the
health and participation of individuals aging with long-term physical
disabilities (Simeonsson et al., 1999; Lollar, 2002; Wilber et al.,
2002).
To date there are no national estimates of the number of
individuals with long-term physical disabilities who are experiencing
one or more types of secondary conditions. Most of what is known about
the prevalence and consequences of secondary conditions for health and
participation comes from clinical studies of patients, a handful of
community-based studies and secondary analyses of population surveys,
and the evolving theoretical understanding of the general aging process
(Cristian, 2005; Kemp, 2005; Seekins et al., 1994; Campbell, Sheets, &
Strong, 1999; Wilber et al., 2002; Verbrugge & Yang, 2002; Kinne et
al., 2004).
Results of these studies underscore the importance of improving
treatment options to prevent or reduce the consequences of secondary
conditions. Exercise, lifestyle and behavioral changes, and
psychosocial and environmental factors are known to influence the
development of secondary health conditions (Seekins et al., 1994;
Wilber et al., 2002; Kemp, 2005; Rimmer, 2005). However, research on
these factors has been limited by the lack of measurement tools to
characterize the types and severity of secondary conditions experienced
by individuals aging with physical disabilities, and the lack of
experimental and quasi-experimental studies to test the effectiveness
of various intervention strategies (Wilber et al., 2002; Rimmer, 2005).
The variety of secondary conditions that individuals aging with
physical disability are at risk of developing, and the relatively early
age of onset of those conditions, pose challenges to maintaining their
participation in the labor force. In some cases, secondary conditions
can lead to premature retirement and the loss of economic self-
sufficiency. The employment consequences of aging with a physical
disability have yet to be examined in large-scale national surveys.
However, results of a recent quasi-experimental study indicate that
those aging with polio, cerebral palsy, rheumatoid arthritis, and
stroke reported a 50 percent reduction in employment compared to a 35
percent reduction for the non-disabled comparison group (Mitchell,
Adkins, & Kemp, 2006). Given the economic consequences of premature
disruptions in labor force participation, vocational rehabilitation
[[Page 22936]]
strategies need to be identified and tested for their effectiveness in
improving the employment outcomes of the growing segment of the
population experiencing the challenges of aging with long-term physical
disabilities.
References
Brandt, E.N. & Pope, A.M. (1997). Enabling America: Assessing the
Role of Rehabilitation Science and Engineering. Committee on
Disability Research, Institute of Medicine, National Academy of
Sciences. Washington, DC: National Academies Press.
Campbell, M.L., Sheets, D.S., & Strong, P.S. (1999). Secondary
health conditions among middle-aged individuals with chronic
physical disabilities: Implications for ``unmet needs'' for
services. Assistive Technology, 11(2), 3-18.
Cristian, A. (Ed.) (2005). Aging with a Disability: Physical
Medicine and Rehabilitation Clinics of North America 16. Oxford, UK:
Elsevier.
Kemp, B.J. (2005). What the rehabilitation professional and the
consumer need to know. In Adrian Cristian (ED), Aging with a
Disability: Physical Medicine and Rehabilitation Clinics of North
America, 16 (pp. 1-18). Oxford, UK: Elsevier.
Kemp, B.J. & Mosqueda, L. (Eds.) (2004). Aging with a Disability.
Baltimore: The Johns Hopkins University Press.
Kinne, S., Patrick, D.L., & Lochner, D.D. (2004). Prevalence of
secondary conditions among people with disabilities. American
Journal of Public Health, 94(3), 443-445.
Lollar, D. (2002). Public health and disability: emerging trends.
Public Health Report, 117, 131-136.
McNeil, J. (1994). Americans with Disabilities, Bureau of the
Census, Statistical Brief, SB/94-1.
Mitchell, J.M., Adkins, R.H., & Kemp, B.J. (2006). The effects of
aging on employment of people with and without disabilities.
Rehabilitation Counseling Bulletin, 49(3), 157-165.
Rimmer, J.L. (2005). Exercise and physical activity in persons aging
with a physical disability. In A. Cristian (Ed), Aging with a
Disability: Physical Medicine and Rehabilitation Clinics of North
America, 16, (pp. 41-56). Oxford, UK: Elsevier.
Seekins, T., Clay, J., & Ravesloot, C.H. (1994). A descriptive study
of secondary conditions reported by a population of adults with
physical disabilities served by 3 independent living centers in a
rural state. Journal of Rehabilitation, 60, 47-51.
Simeonsson, R.J., Bailey, D.B., Scandlin, D., Huntington, G.S., &
Roth, M. (1999). Disability, health, secondary conditions and
quality of life: Emerging issues in public health. In R.J.
Simeonsson & L.N. McDevitt (Eds.), Issues in Disability and Health:
The Role of Secondary Conditions and Quality of Life (pp. 51-72).
Chapel Hill: University of North Carolina Press.
Wilber, N., Mitra, M., Walker, D.K., Allen, D., Meyers, A.R., &
Tupper, P. (2002). Disability as a public health issue: Findings and
reflections from the Massachusetts Survey of Secondary Conditions.
Milbank Quarterly, 80, 393-421.
Verbrugge, L.M., & Yang, L. (2002). Aging with Disability and
Disability with Aging. Journal of Disability Policy Studies, 12(4),
253-267.
Proposed Priority
The Assistant Secretary for Special Education and Rehabilitative
Services proposes a priority for a Rehabilitation Research and Training
Center (RRTC) on Aging With Physical Disability: Reducing Secondary
Conditions and Enhancing Health and Participation, Including
Employment. This RRTC must conduct rigorous research, training,
technical assistance, and dissemination activities to improve
rehabilitation outcome measures and rehabilitation interventions that
can be applied in clinical or community-based settings and used by
other researchers. The intended outcome of the RRTC is to enhance
community participation, including employment, of individuals aging
with long-term physical disabilities by advancing knowledge about the
identification, assessment, treatment, and improved management of the
secondary conditions likely experienced by individuals aging with a
physical disability.
In addressing this priority, the RRTC must propose a limited number
of high-quality, cross-disability research projects to address the
secondary conditions that are most relevant to the lives of individuals
with physical disabilities. To ensure the feasibility of the RRTC's
proposed activities and increase the likelihood of achieving planned
outcomes, the RRTC must focus on two to four discrete impairment groups
(e.g., spinal cord injury, cerebral palsy, multiple sclerosis,
rheumatoid arthritis, stroke, post-polio), and must limit intervention
strategies to no more than two of the following modalities: Exercise,
health promotion, psychological adaptation, life planning or self-
management skills, and environmental or technological supports. Under
this priority, the RRTC must be designed to contribute to the following
outcomes:
(a) Enhanced understanding of the natural course of aging with a
physical disability. The RRTC must contribute to this outcome by
documenting the life trajectories and average age of onset of the major
types of secondary conditions experienced by individuals living with
long-term physical disabilities in the selected impairment groups, and
examining the interrelationships among different types of secondary
conditions and the consequences of variations in timing of onset for
health and community participation.
(b) Improved tools and measures for use with individuals aging with
long-term physical disabilities. The RRTC must contribute to this
outcome by identifying, developing or modifying, and testing
measurement tools that improve the identification and assessment of the
major types of secondary conditions affecting individuals in the
selected impairment groups, as well as the outcomes of interventions
designed to prevent or reduce these conditions.
(c) Improved rehabilitation or community-based interventions that
enhance the health and participation in work and the community of
individuals aging with physical disabilities. The RRTC must contribute
to this outcome by identifying, developing or modifying, and testing
interventions that show promise in preventing the onset of or improving
the management and reducing the impact of secondary conditions on
individuals in the selected impairment groups. Where possible, the
Center must use scientifically based research (as this term is defined
in section 9101(34) of the Elementary and Secondary Education Act of
1965, as amended) methods to test these interventions.
(d) Improved employment outcomes among working-age individuals
aging with long-term physical disabilities. The RRTC must contribute to
this outcome by conducting research on the experiences, including
employment outcomes, of individuals aging with long-term physical
disabilities in the selected impairment groups who are served by the
State Vocational Rehabilitation Services program or who receive
rehabilitation services from other sources, and by identifying specific
secondary conditions that require improved and unique vocational
rehabilitation services and approaches.
Priority 4--Participation and Community Living for Individuals With
Psychiatric Disabilities
Background
Individuals with psychiatric disabilities have one of the lowest
rates of employment of any disability group--only one in three
individuals with psychiatric disabilities in the United States is
employed (Kaye, 2002). They also comprise the largest diagnostic
category of working-age adults receiving Supplemental Security Income
or Social Security Disability Insurance (McAlpine and Warner, 2001).
[[Page 22937]]
In addition, individuals with psychiatric disabilities constitute a
large proportion of the homeless population. Of 2 million adults
experiencing an episode of homelessness, for example, 46 percent have a
psychiatric disability (Burt, 2001).
In April 2002, the President signed Executive Order 13263
establishing a New Freedom Commission on Mental Health, and charged the
Commission with completing a comprehensive study of the mental health
service delivery system in the United States. The Commission's report,
Achieving the Promise: Transforming Mental Health Care in America, set
the course for public and private efforts across the country to improve
the state of mental health care (New Freedom Commission on Mental
Health, 2003). The Commission calls for a transformation of the mental
health service delivery system, focusing on recovery and resilience for
individuals with psychiatric disabilities. As stated in the
Commission's report, recovery is, in part, ``the process in which
people are able to live, work, learn, and participate fully in their
communities,'' while resilience indicates ``the personal and community
qualities that enable us to rebound from adversity, trauma, tragedy,
threats, or other stresses--and to go on with life with a sense of
mastery, competence, and hope'' (New Freedom Commission on Mental
Health, 2003).
Federal legislation has long aimed to facilitate the full inclusion
of individuals with psychiatric disabilities into the mainstream of
society. For example, the centers for independent living, established
by title VII of the Rehabilitation Act of 1973, as amended, provide
information and referral, advocacy, peer support, and independent
living skill building to individuals with disabilities, including
individuals with psychiatric disabilities. Grantee-reported data from
the U.S. Department of Education's Centers for Independent Living
program indicate that nearly 31,000 individuals with psychiatric
disabilities were served by centers for independent living in 2006.
However, there is a general lack of evidence on what independent living
services are most effective in addressing the needs of individuals with
psychiatric disabilities. Increased knowledge in this area could lead
to more effective independent living services for individuals with
psychiatric disabilities, and result in enhanced community living and
participation for this population.
In addition, there is a strong need for research on understudied
aspects of community participation and community living for individuals
with psychiatric disabilities. Two examples, among many, are emergency
preparedness and mental health disparities for traditionally
underserved populations (e.g., individuals from diverse racial, ethnic,
and linguistic backgrounds, and individuals with multiple disabilities)
with psychiatric disabilities (National Council on Disability, 2006;
New Freedom Commission on Mental Health, 2003; U.S. Public Health
Service, Office of the Surgeon General, 2001).
According to the Institute on Medicine report, Crossing the Quality
Chasm: A New Health System for the 21st Century, the time lag between
the discovery of effective medical treatments and the incorporation of
those treatments into practice is 15 to 20 years. The President's New
Freedom Commission on Mental Health called for a reduction in this
delay as part of an overall transformation of mental health care in
America (Substance Abuse and Mental Health Services Administration,
2005; New Freedom Commission on Mental Health, 2003; Institute of
Medicine, 2001).
References
Burt, M.R. (2001). What will it take to end homelessness? Urban
Institute Brief. Washington, DC: Urban Institute.
Institute of Medicine. (2001). Crossing the Quality Chasm: A New
Health System for the 21st Century. Washington, DC: National Academy
Press.
Kaye, H.S. (2002). Employment and Social Participation Among People
with Mental Health Disabilities. San Francisco, CA: National
Disability Statistics & Policy Forum.
McAlpine, D.D. & Warner, L. (2001). Barriers to Employment Among
Persons with Mental Illness: A Review of the Literature. New
Brunswick, NJ: Institute for Health.
National Council on Disability (July 7, 2006). The Needs of People
with Psychiatric Disabilities During and After Hurricanes Katrina
and Rita: Position Paper and Recommendations. Washington, DC:
Author. http://www.ncd.gov/newsroom/publications/2006/
peopleneeds.htm.
Department of Health and Human Services. (2003). New Freedom
Commission on Mental Health (2003). Achieving the Promise:
Transforming Mental Health Care in America. (DHHS Pub. No. SMA-03-
3832). Rockville, MD: Author.
U.S. Department of Health and Human Services. (2005). Transforming
Mental Health Care in America. Federal Action Agenda: First Steps.
(DHHS Pub. No. SMA-05-4060). Rockville, MD: Author.
U.S. General Accounting Office. (1996, April). SSA disability:
Program redesign necessary to encourage return to work. (GAO/HEHS
96-62). Washington, DC: Author.
United States Public Health Service Office of the Surgeon General.
(2001). Mental Health: Culture, Race, and Ethnicity: A Supplement to
Mental Health: A Report of the Surgeon General. Rockville, MD:
Author.
Proposed Priority
The Assistant Secretary for Special Education and Rehabilitative
Services proposes a priority for a Rehabilitation Research and Training
Center (RRTC) on Participation and Community Living for Individuals
With Psychiatric Disabilities. The RRTC must conduct rigorous research,
training, technical assistance, and dissemination activities that
contribute to improved community participation and community living
outcomes for individuals with psychiatric disabilities. Under this
priority, the RRTC must be designed to contribute to the following
outcomes:
(a) Improved individual and system capacity to maximize the
involvement of individuals with psychiatric disabilities in community
life. The RRTC must contribute to this outcome by:
(1) Generating new knowledge through research on effective
strategies to meet the needs of individuals with psychiatric
disabilities who are served by centers for independent living and
identifying independent living services and service-delivery approaches
that meet the unique needs of this population.
(2) Increasing the knowledge base and advancing the application of
theories, measures, methods, or interventions that facilitate
participation and community living of individuals with psychiatric
disabilities. In this regard, the RRTC must focus its efforts on at
least three of the following areas: Employment, housing, education,
health and mental health care, recreation, social relationships, or
other public and private sector activities related to community living.
If the Center engages in interventions testing, the Center must use
scientifically based research (as this term is defined in section
9101(34) of the Elementary and Secondary Education Act of 1965, as
amended) methods.
(3) Reducing disparities in service delivery and program
development by focusing its work on one or more of the following
understudied areas: (i) Emergency preparedness for individuals with
psychiatric disabilities; (ii) individuals with psychiatric
disabilities from diverse racial, ethnic, and linguistic backgrounds;
or (iii) individuals with psychiatric disabilities who have co-
occurring sensory or physical disabilities.
[[Page 22938]]
(b) Increased incorporation of mental health research findings into
practice or policy. The RRTC must contribute to this outcome by
coordinating with appropriate NIDRR-funded knowledge translation
grantees to advance or add to their work in the following areas:
(1) Developing and implementing procedures to evaluate the
readiness of mental health research findings for translation into
practice.
(2) Collaborating with stakeholder groups to develop, evaluate, or
implement strategies to increase utilization of mental health research
findings.
(3) Conducting training, technical assistance, and dissemination
activities to increase utilization of mental health research findings.
Information on knowledge translation projects funded by NIDRR can
be found at http://www.naric.com/research/pd/priority.cfm.
Executive Order 12866
This notice of proposed priorities has been reviewed in accordance
with Executive Order 12866. Under the terms of the order, we have
assessed the potential costs and benefits of this regulatory action.
The potential costs associated with this notice of proposed
priorities are those resulting from statutory requirements and those we
have determined as necessary for administering this program effectively
and efficiently.
In assessing the potential costs and benefits--both quantitative
and qualitative--of this notice of proposed priorities, we have
determined that the benefits of the proposed priorities justify the
costs.
Summary of Potential Costs and Benefits
The benefits of the Disability and Rehabilitation Research Projects
and Centers Programs have been well established over the years in that
similar projects have been completed successfully. These proposed
priorities will generate new knowledge and technologies through
research, development, dissemination, utilization, and technical
assistance projects.
Another benefit of these proposed priorities is that the
establishment of new RRTCs will support the President's NFI and improve
the lives of individuals with disabilities. The new RRTCs will
generate, disseminate, and promote the use of new information that will
improve employment and community living options for individuals with
disabilities.
Intergovernmental Review
This program is not subject to Executive Order 12372 and the
regulations in 34 part 79.
Applicable Program Regulations: 34 CFR part 350.
Electronic Access to This Document
You may view this document, as well as all other Department of
Education documents published in the Federal Register, in text or Adobe
Portable Document Format (PDF) on the Internet at the following site:
http://www.ed.gov/news/fedregister.
To use PDF you must have Adobe Acrobat Reader, which is available
free at this site. If you have questions about using PDF, call the U.S.
Government Printing Office (GPO), toll free, at 1-888-293-6498; or in
the Washington, DC, area at (202) 512-1530.
Note: The official version of this document is the document
published in the Federal Register. Free Internet access to the
official edition of the Federal Register and the Code of Federal
Regulations is available on GPO Access at: http://www.gpoaccess.gov/
nara/index.html.
(Catalog of Federal Domestic Assistance Numbers 84.133B
Rehabilitation Research and Training Centers Program)
Program Authority: 29 U.S.C. 762(g) and 764(b)(2).
Dated: April 23, 2008.
Tracy R. Justesen,
Assistant Secretary for Special Education and Rehabilitative Services.
[FR Doc. E8-9237 Filed 4-25-08; 8:45 am]
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