[Federal Register: April 23, 2010 (Volume 75, Number 78)]
[Notices]
[Page 21282-21285]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr23ap10-57]
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DEPARTMENT OF EDUCATION
National Institute on Disability and Rehabilitation Research
(NIDRR)--Disability and Rehabilitation Research Projects and Centers
Program--Rehabilitation Research and Training Centers (RRTCs)--Improved
Outcomes for Individuals With Serious Mental Illness and Co-Occurring
Conditions
Catalog of Federal Domestic Assistance (CFDA) Number: 84.133B-5.
AGENCY: Office of Special Education and Rehabilitative Services,
Department of Education.
ACTION: Notice of proposed priority.
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SUMMARY: The Assistant Secretary for Special Education and
Rehabilitative Services proposes a funding priority for the Disability
and Rehabilitation Research Projects and Centers Program administered
by NIDRR. Specifically, this notice proposes a priority for an RRTC on
Improved Outcomes for Individuals with Serious Mental Illness and Co-
Occurring Conditions. The Assistant Secretary may use this priority for
competitions in fiscal year (FY) 2010 and later years. We take this
action to focus research attention on areas of national need. We intend
this priority to improve rehabilitation services and outcomes for
individuals with disabilities.
DATES: We must receive your comments on or before May 24, 2010.
ADDRESSES: Address all comments about this notice to Donna Nangle, U.S.
Department of Education, 400 Maryland Avenue, SW., room 5142, Potomac
Center Plaza (PCP), Washington, DC 20202-2700.
If you prefer to send your comments by e-mail, use the following
address: donna.nangle@ed.gov. You must include the term ``Proposed
Priority for an RRTC on Improved Outcomes for Individuals with Serious
Mental Illness and Co-Occurring Conditions'' 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), call the
Federal Relay Service (FRS), toll free, at 1-800-877-8339.
SUPPLEMENTARY INFORMATION:
This notice of proposed priority is in concert with NIDRR's Final
Long-Range Plan for FY 2005-2009 (Plan). 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 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.
This notice proposes a priority that NIDRR intends to use for RRTC
competitions in FY 2010 and possibly later years. However, nothing
precludes NIDRR from publishing additional priorities, if needed.
Furthermore, NIDRR is under no obligation to make an award for this
priority. The decision to make an award will be based on the quality of
applications received and available funding.
Invitation to Comment: We invite you to submit comments regarding
this notice. To ensure that your comments have maximum effect in
developing the notice of final priority, we urge you to identify
clearly the specific topic that each comment addresses.
[[Page 21283]]
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 this proposed
priority. Please let us know of any further ways we could 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 this notice in room 5142, 550 12th Street, SW., PCP,
Washington, DC, between the hours of 8:30 a.m. and 4:00 p.m.,
Washington, DC time, Monday through Friday of each week except Federal
holidays.
Assistance to Individuals with Disabilities in Reviewing the
Rulemaking Record: On request we will provide an appropriate
accommodation or auxiliary aid to an individual with a disability who
needs assistance to review the comments or other documents in the
public rulemaking record for this notice. If you want to schedule an
appointment for this type of accommodation or auxiliary aid, please
contact the person listed under FOR FURTHER INFORMATION CONTACT.
Purpose of Program: The purpose of the Disability and
Rehabilitation Research Projects and Centers Program is to plan and
conduct research, demonstration projects, training, and related
activities, including international activities, to develop methods,
procedures, and rehabilitation technology, that maximize the full
inclusion and integration into society, employment, independent living,
family support, and economic and social self-sufficiency of individuals
with disabilities, especially individuals with the most severe
disabilities, and to improve the effectiveness of services authorized
under the Rehabilitation Act of 1973, as amended.
RRTC Program
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 that it published in a notice of
final priorities in the Federal Register on February 1, 2008 (73 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;
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.
Applicants for RRTC grants must also demonstrate in their
applications how they will address, in whole or in part, the needs of
individuals with disabilities from minority backgrounds.
Program Authority: 29 U.S.C. 762(g) and 764(b)(2).
Applicable Program Regulations: 34 CFR part 350.
Proposed Priority
This notice contains one proposed priority.
Improved Outcomes for Individuals With Serious Mental Illness and Co-
Occurring Conditions
Background
As many as 6.5 percent of adults ages 18-64 experience serious
mental illness (SMI) during any 12-month period (Kessler et al., 2008).
Individuals with SMI are at high risk for chronic diseases such as
cardiovascular disease, diabetes, asthma, and cancer (Colton &
Manderscheid, 2006; Sederer, et al., 2006). The comorbidity of SMI and
chronic disease is associated with limitations on activities such as
self-care and employment (McKnight-Eily et al., 2007). Individuals with
SMI experience disproportionately low rates of employment compared to
the general United States population and to other individuals with
disabilities, and those with SMI and co-occurring conditions work even
fewer hours, have lower total earnings, and are less likely to engage
in competitive employment than those with SMI alone (Cook et al., 2005;
Goldberg et al., 2007).
Health promotion, illness self-management, and using a holistic
approach to rehabilitation are practices that have been rigorously
studied and effectively used to prevent, control, or treat a variety of
medical conditions such as diabetes, breast and cervical cancer, heart
disease, and stroke. Peer-delivered health and wellness education
curriculums also have been widely implemented to reduce tobacco or
alcohol usage, improve nutrition, and modify risk behaviors among the
general population or subpopulations, including women, workers, and
members of racial or ethnic minorities (CDC, 2009; Collins, Marks, and
Koplan, 2009). While some of this research and practice addresses
health promotion for individuals with SMI, the science for individuals
with SMI is still emerging, and has not sufficiently advanced to
address the needs and experiences of individuals with SMI and co-
occurring conditions (CMHS, 2005; Richardson et al., 2005; Sederer et
al., 2006).
Past research funded by NIDRR and others provides a potential base
for testing models that link management and self-management of SMI and
co-occurring physical conditions to mental health recovery (Vandiver,
2007). For example, consumer-to-consumer education and consumer-
directed programs \1\ for individuals with SMI can be effective in
promoting recovery from mental illness and merit further study as
mechanisms for health promotion (CMHS, 2005). At the systems level,
lack of integration and coordination of mental health and primary care
services contribute to poor health outcomes for those with SMI (CMHS,
2005). Further study on integration and coordination of mental health
and primary care services at the systems level, therefore, would be
highly beneficial for individuals with SMI and co-occurring physical
conditions.
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\1\ Consumer-directed models of service delivery are defined by
the belief that individuals with disabilities should determine the
types, amounts, and sources of the services they receive. In the
mental health services context, consumer-directed care approaches
include self-help and mutual-aid support groups, mental illness
self-management, and advance crisis planning by individuals with SMI
(Cook, 2005).
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Improved management of SMI and co-occurring conditions could
contribute to improved health and employment outcomes for these
individuals (Merikangas et al., 2007). Research is
[[Page 21284]]
needed to develop interventions that address the interactions between
SMI and health that are potential barriers to competitive employment,
economic well-being, and maximum participation in society.
References
Center for Mental Health Services (CMHS), Substance Abuse and
Mental Health Services Administration. (2005). HHS Pub. No. 4040.
Rockville, MD: Building Bridges: Mental Health Consumers and Primary
Care Representatives in Dialogue. U.S. Department of Health and Human
Services. See http://download.ncadi.samhsa.gov/ken/pdf/SMA06-4040/
Policy_Makers_Booklet.pdf.
Centers for Disease Control and Prevention (CDC). (2009). The Guide
to Community Preventive Services. U.S. Department of Health and Human
Services. See http://www.thecommunityguide.org/index.html.
Collins, J., Marks, J., & Koplan, J. (2009). Chronic disease
prevention and control: Coming of age at the Centers for Disease
Control and Prevention. Preventing Chronic Disease [serial online]. See
http://www.cdc.gov/pcd/issues/2009/jul/08_0171.htm.
Colton, C. & Manderscheid, R. (2006). Congruencies in increased
mortality rates, years of potential life lost, and causes of death
among public mental health clients in eight States. Preventing Chronic
Disease [serial online]. See http://www.cdc.gov/pcd/issues/2006/apr/
05_0180.htm.
Cook, J. (2005). ``Patient-Centered'' and ``Consumer-Directed''
Mental Health Services. Prepared for the Institute of Medicine,
Committee on Crossing the Quality Chasm--Adaptation to Mental Health &
Addictive Disorders. See http://www.cmhsrp.uic.edu/download/
IOMreport.pdf.
Cook, J., Burke-Miller, J., Blyler, C., Leff, H., Mueser, K., Gold,
P., Goldberg, R., Mueser, K., Toprac, M., McFarlane, W., Shafer, M.,
Blankertz, L., Dudek, K., Razzano, L., Grey, D., & Burke-Miller, J.
(2005). Results of a Multisite Randomized Trial of Supported Employment
Interventions for Individuals With Severe Mental Illness. Archives of
General Psychiatry, (62), 505-512. See http://archpsyc.ama-assn.org/
cgi/content/full/62/5/505.
Goldberg, R., Shafer, M., Onken, S., McFarlane, W., Donegan, K.,
Carey, M., Kaufmann, C. & Grey, D. (2007). Effects of co-occurring
disorders on employment outcomes in a multisite randomized study of
supported employment for people with severe mental illness. Journal of
Rehabilitation Research and Development, 44(6), 837-850.
Kessler, R., Heeringa, S., Lakoma, M., Petukhova, M., Rupp, A.,
Schoenbaum, M., Wang, P., & Zaslavsky, A. (2008). The Individual-Level
and Societal-Level Effects of Mental Disorders on Earnings in the
United States: Results From the National Comorbidity Survey
Replication. American Journal of Psychiatry, 165, 703-711.
McKnight-Eily, L., Elam-Evans, L., Strine, T., Zack, M., Perry, G.,
Presley-Cantrell, L., Edwards, V., & Croft, J.B. (2007). Activity
limitation, chronic disease, and comorbid serious psychological
distress in U.S. adults--BRFSS 2007. International Journal of Public
Health, 54, S111-S119.
Merikangas, K., Ames, M., Cui, L., Stang, P., Ustun, T., Von Korff,
M., & Kessler, R. (2007). The Impact of Comorbidity of Mental and
Physical Conditions on Role Disability in the US Adult Household
Population. Archives of General Psychiatry, 64(10), 1180-1188. See
http://archpsyc.ama-assn.org/cgi/content/full/64/10/1180.
Richardson, C., Faulkner, G., McDevitt, J., Skrinar, G.,
Hutchinson, D., & Piette, J. (2005). Integrating Physical Activity Into
Mental Health Services for Persons With Serious Mental Illness.
Psychiatric Services, 56(3), 324-331. See http://
ps.psychiatryonline.org.
Sederer, L., Silver, L., McVeigh, K., & Levy, J. (2006).
Integrating care for medical and mental illnesses. Preventing Chronic
Disease [serial online]. See http://www.cdc.gov/pcd/issues/2006/apr/
05_0214.htm.
Vandiver, V. (2007). Health Promotion as Brief Treatment:
Strategies for Women with Co-morbid Health and Mental Health
Conditions. Brief Treatment and Crisis Intervention, 7(3), 161-175. See
http://btci.edina.clockss.org/cgi/content/abstract/7/3/161.
Proposed Priority
The Assistant Secretary for Special Education and Rehabilitative
Services proposes a priority for a Rehabilitation Research and Training
Center (RRTC) on Improved Outcomes for Individuals with Serious Mental
Illness and Co-Occurring Conditions. The RRTC must conduct research to
adapt, modify, and enhance health and mental health models to improve
health and employment outcomes for individuals with serious mental
illness (SMI) and co-occurring conditions. The RRTC must conduct
research, knowledge translation, training, dissemination, and technical
assistance within a framework of self-management and consumer-directed
services. Under this priority, the RRTC must contribute to the
following outcomes:
(a) Increased knowledge that can be used to enhance the health and
well-being of individuals with SMI and co-occurring conditions. The
RRTC must contribute to this outcome by:
(1) Conducting research to develop a better understanding of the
health, and health care needs of individuals with SMI and co-occurring
conditions.
(2) Conducting research to identify or develop and then test
interventions that aim to improve health outcomes and promote recovery
among individuals living with SMI and co-occurring conditions. These
interventions must include individual-level health promotion
strategies, such as peer supports and consumer control, as well as
system-level strategies for the delivery of physical and mental health
services. These interventions must be based on the findings of research
conducted under paragraph (a)(1) of this proposed priority. In carrying
out this activity, the grantee must investigate the applicability of
strategies that have proven successful with the general population or
other subpopulations to determine if they are effective with
individuals with SMI and co-occurring conditions.
(b) Improved employment outcomes among individuals with SMI and co-
occurring conditions. The RRTC must contribute to this outcome by
conducting research that demonstrates how improvements in health
service delivery mechanisms, self-management, peer support, and
consumer control affect employment outcomes in individuals with SMI and
co-occurring conditions. In carrying out this activity the grantee must
utilize one or more of the interventions developed under paragraph
(a)(2) of this proposed priority.
(c) Increased incorporation of research findings related to SMI,
co-occurring conditions, health management, and employment into
practice or policy. The RRTC must contribute to this outcome by
coordinating with appropriate NIDRR-funded knowledge translation
grantees to advance their work in the following areas:
(1) Developing, evaluating, or implementing strategies to increase
utilization of research findings related to SMI, co-occurring
conditions, health management, and employment.
(2) Conducting training, technical assistance, and dissemination
activities to increase utilization of research findings related to SMI,
co-occurring conditions, health management, and employment.
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Types of Priorities
When inviting applications for a competition using one or more
priorities, we designate the type of each priority as absolute,
competitive preference, or invitational through a notice the Federal
Register. 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 (1)
awarding additional points, depending on the extent to which the
application meets the priority (34 CFR 75.105(c)(2)(i)); or (2)
selecting an application that meets the 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 priority.
However, we do not give an application that meets the priority a
preference over other applications (34 CFR 75.105(c)(1)).
Final Priority: We will announce the final priority in a notice in
the Federal Register. We will determine the final priority after
considering responses to this notice and other information available to
the Department. This notice does not preclude us from proposing
additional priorities, requirements, definitions, or selection
criteria, subject to meeting applicable rulemaking requirements.
Note: This notice does not solicit applications. In any year in
which we choose to use this priority, we invite applications through
a notice in the Federal Register.
Executive Order 12866: This notice 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 proposed regulatory
action.
The potential costs associated with this proposed regulatory action
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 proposed regulatory action, we have determined
that the benefits of the proposed priority justify the costs.
Discussion of 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. This proposed
priority will generate new knowledge through research and development.
Another benefit of this proposed priority is that the establishment
of a new RRTC will improve the lives of individuals with disabilities.
The new RRTC will disseminate and promote the use of new information
that will improve the options for individuals with disabilities to
obtain, retain, and advance in employment.
Intergovernmental Review: This program is not subject to Executive
Order 12372 and the regulations in 34 CFR part 79.
Accessible Format: Individuals with disabilities can obtain this
document in an accessible format (e.g., braille, large print,
audiotape, or computer diskette) by contacting the Grants and Contracts
Services Team, U.S. Department of Education, 400 Maryland Avenue, SW.,
room 5075, PCP, Washington, DC 20202-2550. Telephone: (202) 245-7363.
If you use a TDD, call the FRS, toll free, at 1-800-877-8339.
Electronic Access to This Document: You can view this document, as
well as all other documents of this Department 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.
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.
Dated: April 20, 2010.
Alexa Posny,
Assistant Secretary for Special Education and Rehabilitative Services.
[FR Doc. 2010-9511 Filed 4-22-10; 8:45 am]
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