[Federal Register Volume 62, Number 35 (Friday, February 21, 1997)]
[Notices]
[Pages 8130-8137]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-4317]



[[Page 8129]]

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Part III





Department of Education





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National Institute on Disability and Rehabilitation Research; Final 
Funding Priorities for Fiscal Year 1997-1998; and Applications for New 
Awards Under Certain Programs for Fiscal Year 1997; Notices

Federal Register / Vol. 62, No. 35 / Friday, February 21, 1997 / 
Notices

[[Page 8130]]



DEPARTMENT OF EDUCATION


National Institute on Disability and Rehabilitation Research

AGENCY: Department of Education.

ACTION: Notice of Final Funding Priorities for Fiscal Years 1997-1998 
for a Research and Demonstration Project and Rehabilitation Research 
and Training Centers.

-----------------------------------------------------------------------

SUMMARY: The Secretary announces final funding priorities for the 
Research and Demonstration Project (R&D) Program and the Rehabilitation 
Research and Training Center (RRTC) Program under the National 
Institute on Disability and Rehabilitation Research (NIDRR) for fiscal 
years 1997-1998. The Secretary takes this action to focus research 
attention on areas of national need consistent with NIDRR's long-range 
planning process, to improve rehabilitation services and outcomes for 
individuals with disabilities, and to assist in the solutions to 
problems encountered by individuals with disabilities in their daily 
activities.

EFFECTIVE DATE: These priorities take effect on March 24, 1997.

FOR FURTHER INFORMATION CONTACT: David Esquith. Telephone: (202) 205-
8801. Individuals who use a telecommunications device for the deaf 
(TDD) may call the TDD number at (202) 205-8133. Internet:
David__E<a href="/cdn-cgi/l/email-protection#80f3f1f5e9f4e8c0e5e4aee7eff6"><span class="__cf_email__" data-cfemail="ed9e9c98849985ad8889c38a829b">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION: This notice contains final priorities to 
establish one R&D project for research on improving employment 
practices covered by Title I of the Americans with Disabilities Act 
(ADA), and two RRTCs for research related to personal assistance 
services (PAS) and employment for persons with long-term mental illness 
(LTMI).
    NIDRR is in the process of developing a revised long-range plan. 
The final priorities in this notice are consistent with the long-range 
planning process. These final priorities support the National Education 
Goal that calls for all Americans to possess the knowledge and skills 
necessary to compete in a global economy and exercise the rights and 
responsibilities of citizenship.

    Note: This notice of final priorities does not solicit 
applications. A notice inviting applications under these 
competitions is published in a separate notice in this issue of the 
Federal Register.

Analysis of Comments and Changes

    On October 31, 1996, the Secretary published a notice of proposed 
priorities in the Federal Register (61 FR 56374-56379). The Department 
of Education received 9 letters commenting on the notice of proposed 
priorities by the deadline date. Two additional comments were received 
after the deadline date and were not considered in this response. 
Technical and other minor changes--and suggested changes the Secretary 
is not legally authorized to make under statutory authority--are not 
addressed.

Research and Demonstration Projects Program

Priority: Improving Employment Practices Covered by Title I of the 
Americans With Disabilities Act

    Comment: One commenter recommended that the grantee should research 
the practices and procedures businesses have used to create a diverse 
work force and the attitudinal factors that affect hiring and 
employment decisions regarding persons with disabilities.
    Discussion: The Secretary believes that research on the practices 
and procedures business have used to create a diverse work is an 
important, but overly broad, topic that addresses issues unrelated to 
those involving persons with disabilities. As indicated in the 
background to the priority, the Secretary believes that a sufficent 
body of attitudinal research exists, including attitudinal research on 
the factors that affect hiring and employment decisions regarding 
persons with disabilities. The Secretary does not believe that any 
further attitudinal research is necessary at this time.
    Changes: None.
    Comment: One commenter recommended that the research team include 
people with an established credibility with the corporate community.
    Discussion: The Secretary believes that the grantee's ability to 
gain the confidence and cooperation of private sector entities with 
responsibilities under Title I of the ADA is essential to the success 
of the project. The composition of the research team and the 
qualifications of key personnel are evaluated in the peer review 
process using the applicable selection criteria. The Secretary does not 
believe any further personnel requirements are necessary.
    Changes: None.
    Comment: One commenter recommended that NIDRR suggest 
collaborations that would enhance the effectiveness of the 
interventions that the project will develop to address challenging 
employment practices.
    Discussion: The Secretary believes that applicants should have 
complete discretion to select the participants in any collaborative 
effort that is proposed. The Secretary does not believe that NIDRR 
should influence this decision by making suggestions.
    Changes: None.

Rehabilitation Research and Training Centers (RRTCs)

Priority 1: Personal Assistance Services

    Comment: One commenter applauded the reference to studying PAS in 
the community (outside the home), but noted that the definition of PAS 
used in the priority referred to home-based services.
    Discussion: NIDRR used the definition of PAS that is included in 
the Rehabilitation Act. The definition specifically refers to services 
provided on the job. The commenter focused on the initial descriptive 
phrase ``forms of home-based assistance,'' which was intended to imply 
only that the services are provided outside of an institution. The 
definition of PAS in the priority encompasses community-based services, 
and this descriptive phrase in the background statement does not affect 
the required scope of work.
    Changes: None.
    Comment: Two commenters noted that the priority appeared to either 
be stating a preference for the ``independent living'' model of PAS, or 
to be suggesting a comparative evaluation of that model and the 
``medical model.'' The commenters believed that there was too much 
emphasis on the differences between the two models.
    Discussion: The discussion of the two models of PAS was intended 
only to illustrate some of the ways in which PAS is organized and 
delivered in the community. The Secretary realizes that these are two 
points on a continuum, and that in fact most programs contain elements 
of each of the ``pure'' models. The important issue is to determine 
what components of a PAS delivery system are most appropriate for 
individuals with disabilities of varying ages, types of disabilities, 
cultural backgrounds, lifestyles, and life goals. The Secretary points 
out that all of the references to models of PAS are included in the 
background section and do not have direct relevance to the activities 
to be performed by the Center.
    Changes: None.
    Comment: One commenter recommended that the compilation of a 
database on extant PAS programs should be considered a service, rather 
than a research activity, and should not compete for the limited 
resources available for this Center.

[[Page 8131]]

    Discussion: NIDRR has identified the need for such a database for 
research purposes, not as a referral service. The types of data to be 
collected could be regularly updated to track trends in availability, 
funding sources, eligibility requirements, demand and usage, and costs 
and resources. Such a database is seen as a key to determining who has 
access to PAS, and whether the PAS that can be accessed varies 
according to characteristics of the individual consumer.
    Changes: None.
    Comment: One commenter stated that there should be more emphasis on 
training and services or technical assistance in the priority.
    Discussion: The Secretary believes that there are many research 
issues that must be addressed in the area of PAS and that there is a 
tendency to respond to the demands for training and technical 
assistance before the research base is secure. For that reason, the 
priority focuses on research. Applicants are free to propose training 
and technical assistance that they believe complements the research 
scope, but the Secretary will not impose additional requirements.
    Changes: None.
    Comment: The priority currently calls for one conference for 
consumers and one conference for policymakers to share findings and 
obtain input on outstanding issues in the final year of the project. 
One commenter stated that the priority should include a requirement for 
three conferences to assist in the design of the Center, evaluate 
progress at the mid-point, and extend the availability of effective 
PAS.
    Discussion: The Secretary requires conferences targeted to these 
two audiences as a dissemination mechanism. The commenter's suggestions 
would amount to dictating the process that the grantee would use in 
designing and evaluating its activities, and the Secretary declines to 
limit grantees in proposing their own approaches to planning and 
managing the project.
    Changes: None.
    Comment: Two commenters noted that there were many required 
activities in the priority and suggested that various of these specific 
activities could be deleted, while one suggested adding a requirement 
to examine the ways in which technology can be used to replace or 
supplement personal assistance, particularly in the workplace.
    Discussion: The Secretary points out that the Center focuses on 
four objectives: analyzing the availability of PAS; analyzing State 
policies and practices; evaluating the impact of various types of PAS; 
and developing strategies to increase the supply of qualified PAS. In 
addressing these objectives, the Center is required to conduct six 
activities. The Secretary believes that all the required activities are 
important in addressing the objectives of the Center, and declines to 
eliminate any of the basic requirements in the priority. The 
requirement to investigate the use of PAS at the workplace reflects the 
importance of identifying effective approaches that have the potential 
to expand employment opportunities and enhance employment outcomes for 
individuals with significant disabilities. In fulfilling this 
requirement, the applicant may address the use of technology to promote 
independent functioning at the workplace. The Secretary emphasizes that 
applicants are free to determine their approach to each of the 
objectives of the RRTC within the constraints of available resources.
    Changes: None.

Priority 2: Vocational Rehabilitation Services for Persons With Long-
Term Mental Illness

    Comment: Two commenters recommended studying the impact of 
behavioral managed care on the delivery of vocational rehabilitation 
services for persons with LTMI.
    Discussion: Based on the first purpose of the priority, the 
Secretary believes that an application could propose to study the 
impact of behavioral managed care on the delivery of vocational 
rehabilitation services for persons with LTMI. However, the Secretary 
prefers to provide applicants with the discretion to propose specific 
topics for investigation.
    Changes: None.
    Comment: One commenter recommended studying the cost-effectiveness 
of vocational rehabilitation for persons with LTMI, and a second 
commenter recommended studying the costs and benefits of providing 
vocational rehabilitation to persons with LTMI.
    Discussion: The Secretary believes that an applicant could propose 
to conduct either study if the study furthered the purpose of the RRTC 
to conduct research on the achievement of high quality employment 
outcomes for persons with LTMI. However, the Secretary prefers to 
provide applicants with the discretion to propose specific topics for 
investigation.
    Changes: None.
    Comment: One commenter recommended including individuals with head 
injury in the definition of individuals with LTMI.
    Discussion: The Secretary believes that individuals who have 
experienced a head injury and exhibit behaviors of individuals with a 
long-term mental illness could be included within the target population 
of this RRTC. The Secretary points out that for Fiscal Year 1996, NIDRR 
is funding ten projects related to brain injury, including two RRTCs. 
The Secretary does not believe that NIDRR should support any additional 
research on head injury at this time.
    Changes: None.
    Comment: One commenter recommended addressing the needs of persons 
with dual diagnosis, youth, women, and persons from minority 
backgrounds.
    Discussion: The Secretary points out that all applicants must meet 
the statutory requirement to demonstrate how the application will 
address the needs of individuals with disabilities from minority 
backgrounds. In regard to persons with dual diagnosis, youth, and 
women, the Secretary believes that an applicant could propose to 
address the needs of these individuals. However, the Secretary prefers 
to provide applicants with the discretion to propose specific target 
populations for investigation.
    Changes: None.
    Comment: The same commenter recommended requiring training and 
dissemination activities to provide consumers and families members with 
useful information to assist them in personal and systems advocacy. In 
addition, the commenter recommended assuring that any research and 
training activities be undertaken within an evaluative context.
    Discussion: The Secretary agrees that the RRTC should provide 
consumers and family members with useful information, and expects the 
RRTC's evaluation plan to address all research and training activities. 
Dissemination activities and the evaluation plan are evaluated in the 
peer review process using the applicable selection criteria. The 
Secretary does not believe any further personnel requirements are 
necessary.
    Changes: None.
    Comment: One commenter suggested identifying high demand 
occupational opportunities that may match the work skills and workplace 
requirements of persons with LTMI. The commenter also suggested 
identifying individualized strategies that lead to economic self-
sufficiency.
    Discussion: The Secretary believes that within the activity to 
analyze the relationships between employment experiences and the 
characteristics of

[[Page 8132]]

impairment, an applicant could propose to identify occupational 
opportunities that may match the work skills and workplace requirements 
of workers with LTMI, and identify individualized strategies that lead 
to economic self-sufficiency. However, the Secretary prefers to provide 
applicants with the discretion to propose specific topics for 
investigation.
    Changes: None.
    Comment: The same commenter suggested applying short-term outcome 
measures, such as occupational growth, improved workplace behavioral 
and coping strategies, and effective use of helping behavior in the 
workplace, to determine whether high quality employment outcomes are 
being achieved. The commenter also recommended considering economic 
self-sufficiency as a long-term outcome.
    Discussion: The Secretary believes applicants should have the 
discretion to propose the types of employment outcomes and outcome 
measures that will be used in the RRTC's research activities. The 
proposed outcomes and outcome measures will be evaluated in the peer 
review process using the applicable selection criteria. The Secretary 
does not believe any further requirements are necessary.
    Changes: None.
    Comment: The same commenter recommended identifying necessary 
supports and successful methods to secure and sustain family and 
therapeutic supports for the attainment of employment outcomes.
    Discussion: The Secretary believes that within the activity to 
identify models of long-term vocational and community support for 
persons who have achieved an employment outcome after the receipt of VR 
services, an applicant could propose to identify necessary supports and 
successful methods to secure and sustain family and therapeutic 
supports. However, the Secretary prefers to provide applicants with the 
discretion to propose specific topics for investigation.
    Changes: None.
    General
    Comment: One commenter recommended that the Centers publish their 
research findings in refereed journals.
    Discussion: The quality of an applicant's proposed dissemination 
activities are evaluated in the peer review process using applicable 
selection criteria. The Secretary does not believe any further 
dissemination requirements are necessary.
    Changes: None.
    Comment: One commenter recommended that the Secretary establish an 
RRTC focusing on individuals with a combination of significant physical 
and speech disabilities with an emphasis on those who use alternative 
and augmentative communication devices.
    Discussion: The Secretary believes that individuals with a 
combination of physical and speech disabilities face significant 
barriers. The Secretary points out that NIDRR is currently supporting a 
Rehabilitation Engineering Research Center in Augmentative 
Communication. In response to the commenter's suggestion, NIDRR will 
consider conducting a planning meeting to explore research needs in 
this area and issuing an invitational priority in the FY 1998 Field-
Initiated Research competition to address the needs of individuals with 
a combination of significant physical and speech disabilities.
    Changes: None.

Research and Demonstration Projects

    Authority for the R&D program of NIDRR is contained in section 
204(a) of the Rehabilitation Act of 1973, as amended (29 U.S.C. 760-
762). Under this program the Secretary makes awards to public agencies 
and private agencies and organizations, including institutions of 
higher education, Indian tribes, and tribal organizations. This program 
is designed to assist in the development of solutions to the problems 
encountered by individuals with disabilities in their daily activities, 
especially problems related to employment (see 34 CFR 351.1). Under the 
regulations for this program (see 34 CFR 351.32), the Secretary may 
establish research priorities by reserving funds to support the 
research activities listed in 34 CFR 351.10.

Priority

    Under 34 CFR 75.105(c)(3), the Secretary gives an absolute 
preference to applications that meet the following priority. The 
Secretary will fund under this program only applications that meet this 
absolute priority:

Priority: Improving Employment Practices Covered by Title I of the 
Americans With Disabilities Act

Background
    The intent of Title I of the Americans with Disabilities Act (ADA) 
is to include and empower people with disabilities in the work force 
(P. Blanck, The Americans with Disabilities Act: Putting the Employment 
Provisions to Work, Annenberg Washington Program, page 9, 1993). Title 
I provides that employers, employment agencies, labor organizations, or 
joint labor-management committees may not discriminate against a 
qualified individual with a disability in regard to job application 
procedures, the hiring, advancement, or discharge of employees, 
employee compensation, job training and other terms, conditions, and 
privileges of employment. Discrimination under Title I includes not 
making reasonable accommodations to the known physical or mental 
limitations of an otherwise qualified individual with a disability who 
is an applicant or employee, unless such covered entity can demonstrate 
that the accommodation would impose an undue hardship on the operation 
of the business.
    The employment status of persons with disabilities is a matter of 
critical importance, both in terms of public expenditures and in the 
right of persons with disabilities to participate fully in the labor 
market (J. McNeil, Americans with Disabilities: 1991-1992, Household 
Economic Studies, pp. 70-33, December, 1993). One of the assumptions 
underlying the ADA is that discriminatory employment practices are 
contributing significantly to the depressed employment status of 
persons with disabilities. For 1994, of the 29.41 million persons 21 to 
64 years old who had a disability, 14.03 million or 47.7 percent were 
unemployed. For the same year, the mean monthly earnings of workers 
with disabilities was $1,713 compared to $2,160 for workers without 
disabilities (J. McNeil, U.S. Bureau of the Census, Survey of Income 
and Program Participation, 1994).
    The Equal Employment Opportunity Commission (EEOC), which has 
enforcement responsibility for Title I of the ADA, estimates that Title 
I covers approximately 666,000 businesses employing approximately 86 
million workers (EEOC Press Release, July 19, 1994). Title I became 
effective for employers with 25 or more employees on July 26, 1992, and 
on July 26, 1994 for employers with 15 or more employees. Partially as 
a result of the recency of these effective dates, little is known about 
the actual impact of Title I on the employment practices of covered 
entities. The research that has been conducted on the impact of Title I 
on employment practices relies primarily on attitudinal surveys of 
employers toward the ADA, and the anticipated impact that Title I might 
have on their employment practices (see Baseline Study to Determine 
Business' Attitudes, Awareness, and Reaction to the Americans with 
Disabilities Act, Gallup Survey Report, 1992).

[[Page 8133]]

    While little is known about the actual impact of Title I on 
employment practices, data collected by the EEOC provide information 
about alleged Title I ADA violations involving employment practices. 
Since July 26, 1992 the EEOC has maintained a database regarding the 
number of ADA violations that have been cited in charges and the 
impairments cited in those charges. For the cumulative reporting period 
between July 26, 1992 and June 30, 1996, the EEOC reports that a total 
of 68,203 ADA charges were filed. Of the 68,203 charges, 52,448 or 76.9 
percent have been resolved. The majority of resolutions are either 
``Administrative Closures'' (40.2 percent) or ``No Reasonable Cause'' 
(45.2 percent). While it is impossible to determine what percentage of 
the ``Administrative Closures'' involve charges that are meritorious, 
the remaining 14.6 percent of the charges resulted in ``Merit 
Resolutions'' (settlements--4.9 percent, withdrawals with benefits--7.2 
percent, reasonable cause 2.5 percent) (EEOC Office of Program 
Operations from EEOC's Charge Data National Data Base).
    The complaints filed with the EEOC that result in ``Merit 
Resolutions'' may be indications of not only discriminatory employment 
practices, but also the difficulties that employers are having 
understanding or implementing Title I's requirements. In a 1992 survey 
of 618 employers in Georgia, 84 percent of the companies indicated that 
they would like to receive more information concerning ADA 
requirements, 65 percent wanted more information about financial 
incentives, and 62 percent wanted disability awareness training for 
employees and having access to trained, motivated employees with 
disabilities (J. Newman and R. Dinwoodie, Impact of the Americans with 
Disabilities Act on Private Sector Employers, Journal of Rehabilitation 
Administration, Vol. 20, No. 1, February, 1996).
    Persons with disabilities may be exposed to substantial emotional 
and financial hardship as a result of discrimination or an employer's 
lack of understanding of the employment practice requirements of the 
ADA. Attempting to resolve Title I disputes through the complaint 
process or litigation, can be costly and time-consuming for persons 
with disabilities, employers, and the EEOC. Preventing employment 
discrimination and disputes through the provision of information and 
technical assistance enables employers and persons with disabilities to 
share in the benefits of productive and financially rewarding 
employment.

Priority

    The Secretary will establish a research and demonstration project 
on improving employment practices covered by Title I of the ADA that 
will:
    (1) Investigate the impact of the ADA on the employment practices 
of private sector small, medium, and large businesses;
    (2) Identify the ADA employment practice requirements (with a 
special emphasis on hiring) that have been most challenging for 
employers to implement successfully;
    (3) Identify interventions that can be used by private sector 
employers and persons with disabilities to address the challenging 
employment practice requirements identified in (2) above;
    (4) Demonstrate the effectiveness of the interventions involving 
small, medium-sized, and large businesses; and
    (5) Widely disseminate information on effective interventions to 
employers and persons with disabilities.
    In carrying out the purposes of the priority, the R&D project 
shall:
    <bullet> Consult with the EEOC in order to determine how EEOC 
public-use data demonstrate the findings of compliance problems in 
covered areas, especially in hiring, and how those and future data may 
be available for the purposes of the project;
    <bullet> Complement the General Accounting Office qualitative 
evaluation of the employment provisions of the ADA; and
    <bullet> Use a variety of information dissemination strategies to 
reach as wide an audience as possible, including using the ten regional 
Disability and Business Technical Assistance Centers.

Rehabilitation Research and Training Centers (RRTCs)

    Authority for the RRTC program of NIDRR is contained in section 
204(b)(2) of the Rehabilitation Act of 1973, as amended (29 U.S.C. 760-
762). Under this program the Secretary makes awards to public and 
private organizations, including institutions of higher education and 
Indian tribes or tribal organizations for coordinated research and 
training activities. These entities must be of sufficient size, scope, 
and quality to effectively carry out the activities of the Center in an 
efficient manner consistent with appropriate State and Federal laws. 
They must demonstrate the ability to carry out the training activities 
either directly or through another entity that can provide such 
training.
    The Secretary may make awards for up to 60 months through grants or 
cooperative agreements. The purpose of the awards is for planning and 
conducting research, training, demonstrations, and related activities 
leading to the development of methods, procedures, and devices that 
will benefit individuals with disabilities, especially those with the 
most severe disabilities.
    Under the regulations for this program (see 34 CFR 352.32) the 
Secretary may establish research priorities by reserving funds to 
support particular research activities.

Description of the Rehabilitation Research and Training Center 
Program

    RRTCs are operated in collaboration with institutions of higher 
education or providers of rehabilitation services or other appropriate 
services. RRTCs serve as centers of national excellence and national or 
regional resources for providers and individuals with disabilities and 
the parents, family members, guardians, advocates or authorized 
representatives of the individuals.
    RRTCs conduct coordinated and advanced programs of research in 
rehabilitation targeted toward the production of new knowledge to 
improve rehabilitation methodology and service delivery systems, 
alleviate or stabilize disabling conditions, and promote maximum social 
and economic independence of individuals with disabilities.
    RRTCs provide training, including graduate, pre-service, and in-
service training, to assist individuals to more effectively provide 
rehabilitation services. They also provide training including graduate, 
pre-service, and in-service training, for rehabilitation research 
personnel and other rehabilitation personnel.
    RRTCs serve as informational and technical assistance resources to 
providers, individuals with disabilities, and the parents, family 
members, guardians, advocates, or authorized representatives of these 
individuals through conferences, workshops, public education programs, 
in-service training programs and similar activities.
    NIDRR encourages all Centers to involve individuals with 
disabilities and minorities as recipients in research training, as well 
as clinical training.
    Applicants have considerable latitude in proposing the specific 
research and related projects they will undertake to achieve the 
designated outcomes; however, the regulatory selection criteria for the 
program (34 CFR 352.31) state that the Secretary reviews the

[[Page 8134]]

extent to which applicants justify their choice of research projects in 
terms of the relevance to the priority and to the needs of individuals 
with disabilities. The Secretary also reviews the extent to which 
applicants present a scientific methodology that includes reasonable 
hypotheses, methods of data collection and analysis, and a means to 
evaluate the extent to which project objectives have been achieved.
    The Department is particularly interested in ensuring that the 
expenditure of public funds is justified by the execution of intended 
activities and the advancement of knowledge and, thus, has built this 
accountability into the selection criteria. Not later than three years 
after the establishment of any RRTC, NIDRR will conduct one or more 
reviews of the activities and achievements of the Center. In accordance 
with the provisions of 34 CFR 75.253(a), continued funding depends at 
all times on satisfactory performance and accomplishment.

General

    The following requirements apply to these RRTCs pursuant to the 
priorities unless noted otherwise:
    Each RRTC must conduct an integrated program of research to develop 
solutions to problems confronted by individuals with disabilities.
    Each RRTC must conduct a coordinated and advanced program of 
training in rehabilitation research, including training in research 
methodology and applied research experience, that will contribute to 
the number of qualified researchers working in the area of 
rehabilitation research.
    Each Center must disseminate and encourage the use of new 
rehabilitation knowledge. They must publish all materials for 
dissemination or training in alternate formats to make them accessible 
to individuals with a range of disabling conditions.
    Each RRTC must involve individuals with disabilities and, if 
appropriate, their family members, as well as rehabilitation service 
providers in planning and implementing the research and training 
programs, in interpreting and disseminating the research findings, and 
in evaluating the Center.

Priorities

    Under 34 CFR 75.105(c)(3), the Secretary gives an absolute 
preference to applications that meet one of the following priorities. 
The Secretary will fund under these competitions only applications that 
meet one of these absolute priorities:

Priority 1: Personal Assistance Services

Background
    Over the past 20 years, various forms of home-based assistance have 
emerged as alternatives to institutional or congregate care for 
individuals who are unable to perform activities of daily living (ADLs, 
such as eating, speaking, toileting), or instrumental activities of 
daily living (IADLs, such as housekeeping, shopping, or food 
preparation). This assistance often comes in the form of chore services 
or home health aides provided for older persons through community 
agencies or corporations and financed through public or private health 
insurance. However, individuals with disabilities, particularly through 
the independent living movement, have developed and promoted an 
alternative model of personal assistance featuring consumer direction. 
In this priority, personal assistance services (PAS) is used to refer 
to the full range of service delivery models for providing home-based 
support services, including chore services, home health care, and 
consumer-directed personal assistants (PAs).
    Programs to fund and provide personal assistance services for 
individuals with severe disabilities have developed in response to the 
increased numbers of persons with disabilities living independently in 
their homes (Kennedy, J., Policy and Program Issues in Providing 
Personal Assistance Services, Journal of Rehabilitation, July/August/
September, 1993). The term ``personal assistance services'' was added 
to the Rehabilitation Act of 1973, with the 1992 amendments, and 
defined as ``a range of services, provided by one or more persons, 
designed to assist an individual with a disability to perform daily 
living activities on or off the job that the individual would typically 
perform if the individual did not have a disability'' (section 7(11)). 
The provision of on-the-job or related PAS is specifically authorized 
under the Vocational Rehabilitation Services Program while an 
individual is receiving services under the program (section 
103(a)(15)). In addition, PAS is considered to be an element in the 
definition of ``independent living services'' in section 7(30)(B)(vi) 
of the Act.
    PAS is also supported by health care agencies, public welfare 
agencies, educational institutions, private insurance providers, 
nonprofit organizations, client self-funding, and a host of less common 
sources. Indeed, researchers have identified more than 300 State level 
PAS programs, and suggest that they may be categorized by: (1) target 
population, such as persons who are aged, persons with developmental 
disabilities, persons with mental illness; (2) type of service, such as 
chore services and medical services; and (3) method of funding, such as 
public Medicaid assistance or private individual or insurer purchase of 
care from home health care providers (Medlantic Research Foundation, 
The Feasibility of Establishing a Regional Personal Assistance Program 
in the Metropolitan Washington D.C. Area, 1991).
    Information from the 1990 Survey of Income and Program 
Participation (SIPP) and the 1990 Decennial Census indicates that about 
4.1 million nonelderly adults, and 5.8 million elderly persons living 
in community settings have acute or chronic health conditions that may 
make them candidates for individual personal assistance in their homes 
(Adler, Population Estimates of Disability and Long-Term Care, ASPE 
Research Notes, l995). The population potentially in need of PAS is 
very diverse in terms of geographic location, disability or medical 
condition, personal health care needs, and psychosocial 
characteristics.
    Two major contrasting models of personal assistance may be 
identified as the independent living (IL) model, and the medical model. 
The range of personal services programs may be arrayed on a continuum 
between the two pure archetypes, with many variations falling at 
various points on the continuum. The original, or medical model, is 
characterized by professionalism; agency control and supervision of 
service providers; and strictly specified tasks that generally must be 
provided in the home. An agency hires, trains (usually under a medical, 
nursing, or health services approach), pays, assigns, supervises, and 
terminates the workers, commonly referred to as health aides, and the 
user has a limited role in planning, directing, and assessing this 
delimited range of services. In the IL model, individuals with 
disabilities have a substantial role in determining the terms and 
conditions of PAS, and they hire, train, and supervise their PAs (A 
Comparison of Some of the Characteristics of Two Models of Personal 
Assistance Services, World Institute on Disability, 1995). Although 
research has shown that PAS are effective, cost efficient, and popular 
with those assisted under the IL model, the medical model predominates 
throughout the United States (Kennedy, 1991; Kennedy and Litvak, S. 
Case Studies of Six State Personal Assistance Service Programs funded 
by the

[[Page 8135]]

Medicaid Personal Care Option, 1991). The reasons for the prevalence of 
the medical model are not entirely clear, but there are several 
possible explanations. The medical model emerged earlier, in response 
to the needs of elderly persons, who were then being cared for in a 
medical or quasi-medical environment. It was a logical extension to 
duplicate the medical model in home-based services, including elements 
of medical prescriptiveness, health services training and 
qualifications, and focus on such things as security and 
accountability. It is also possible that older clients are less 
comfortable with learning new roles in determining their own needs and 
supervising their care, and that some may lack the physical or 
cognitive capacities to assume these roles. On the other hand, it may 
be that younger disabled individuals place much higher value on 
autonomy, social integration, self-determination and independence than 
do many of the frail elderly.
    Although researchers have described these two models of PAS, there 
is insufficient information on the characteristics of the PAS that is 
available to various subgroups of individuals with disabilities, 
including not only information on the service delivery models, but also 
factors such as eligibility criteria, quantity and nature of services 
provided, sources of financing, and costs (per client, per unit of 
services, and total). Researchers, service providers, policymakers, and 
advocates would benefit from greater knowledge about the kinds of PAS 
services available to disabled individuals with various 
characteristics, including age, type of disability, geographic 
location, work history, and residential and family status. A 
comprehensive database of available PAS, on a State-by-State basis, is 
fundamental to conducting the analyses that will accomplish the 
purposes of this priority.
    Beyond improving understanding of what exists, it is important to 
both assess the contributions of these services to individuals with 
disabilities and to society, and to anticipate new developments in 
service provision and planning. The objectives of the IL model of PAS 
are somewhat different from those of the medical model. To some extent, 
these are the individual goals and objectives of the disabled persons 
who use PAS. However, there are some overall objectives or expectations 
that society has in their establishment and funding of these programs. 
It is important to define both sets of objectives and develop standards 
and measures that will permit an assessment of the effectiveness of PAS 
in achieving societal objectives as well as in satisfying the 
expectations of the users of PAS. The objectives of these two groups 
are expected to be similar, although not necessarily identical and not 
prioritized in the same order. Societal objectives may include the 
avoidance of costly future interventions through health maintenance, 
prevention of further disablement, safety, and return to work, and 
these may be reasonably objective and quantifiable outcomes. Consumer 
objectives may focus on more subjective measures such as autonomy, 
social integration, and quality of life. Consumers and policymakers 
will be best served by a comprehensive assessment of PAS outcomes. This 
priority focuses on the access to, use and outcomes of, and 
satisfaction with, various configurations of PAS by individuals of 
working age.
    Increasingly, individuals using PAS, and often the PAs as well, are 
entering the worksite as a result of innovations in telecommuting, 
flexiplace, home businesses, and individual accommodations for workers 
in traditional work sites. There is need for studies that will examine 
alternative approaches to providing PAS to individuals with 
disabilities in employment settings, including on-site versus off-site 
assistance, configurations of services necessary to support employment, 
and that examine relations between PAs and job coaches, rehabilitation 
counselors, interpreters, and other service personnel. The relationship 
between the types of services available through PAS and the likelihood 
of maintaining employment is an area for investigation.
    The introduction of managed care approaches to health care delivery 
and financing and the influence of Federal court decisions are likely 
to result in extensive changes to State-administered Medicaid programs 
providing PAS. In addition, the Robert Wood Johnson Foundation is 
providing $3 million in grants to stimulate States, nonprofit 
organizations, and communities to demonstrate the effectiveness of the 
choice concept in PAS. There is also an anticipated decentralization of 
responsibility for service delivery and devolution of regulatory 
control over funds and services to the States or local government 
levels. It is unclear what effect these new patterns will have on 
availability, eligibility, and service configurations. There is a need 
to analyze the impact of these anticipated new public program and 
policy directions on the administration of PAS, and to improve public 
information, increase interagency collaboration on effective program 
features, and develop strategies to address shortages of trained 
personnel for providing PAS.
    Priority 1: The Secretary will establish an RRTC that will 
contribute to the understanding of personal assistance services that 
informs policymaking and practice throughout the nation by:
    (1) Analyzing the patterns of access to PAS in terms of the 
characteristics of the consumers with disabilities, the components of 
the PAS programs, and the administrative requirements;
    (2) Assessing the impact of devolution/decentralization on PAS 
through the analysis of trends in the availability of PAS and the 
correlation of these trends with new developments in State policies;
    (3) Evaluating the impact of various types and amounts of PAS on 
desired consumer outcomes, including health maintenance and secondary 
prevention, appropriate versus inappropriate health care utilization, 
productivity and employment, community participation, emotional well-
being, and life satisfaction; and
    (4) Developing strategies to increase the availability of effective 
PAS and qualified PAs.
    In addition to activities proposed by the applicant to carry out 
these objectives, the RRTC must conduct the following activities:
    <bullet> Develop and maintain a comprehensive database on types of 
PAS available on a State-by-State basis, including relevant descriptors 
of the PAS and the clients served;
    <bullet> Investigate existing practices of integrating PAS into the 
workplace, and disseminate models of effective practices;
    <bullet> Assess the availability of qualified PAs and develop 
strategies to increase the pool, skill levels, work performance, job 
satisfaction, and sustained involvement of qualified PAs in the field;
    <bullet> Identify new models at the State level, including service 
configurations, financing methods, or delivery practices that have the 
potential to make more effective PAS available to individuals with 
disabilities who need PAS;
    <bullet> Conduct at least one conference for consumers and one 
conference for policy makers in the final year of operations to share 
findings with these target audiences and to obtain feedback on 
outstanding issues; and
    <bullet> Coordinate with ongoing research activities in the Robert 
Wood Johnson Independence initiative and the Department of Health and 
Human Services Cash and Counseling demonstration, as well as with other

[[Page 8136]]

relevant NIDRR research centers and projects.

Priority 2: Vocational Rehabilitation Services for Persons With Long-
term Mental Illness

Background
    The National Institute of Mental Health estimates that there are 
over 3 million adults ages 18-69 who have a serious mental illness 
(Manderscheid, R.W. & Sonnenschein, M.A. (Eds.), Mental Health, United 
States 1992 U.S. Department of Health and Human Services, Rockville, 
MD; DHHS Publication No.(SMA) 92-1942). Estimates of unemployment among 
this group remains in the 80-90 percent range (Baron, R., NIDRR Public 
Hearing on Disability Research, November 28, 1995).
    The Social Security Administration (SSA) operates the nation's two 
largest Federal programs providing cash benefits to people with 
disabilities--the Supplemental Security Income (SSI) and the Social 
Security Disability Insurance (SSDI) programs. The number of SSI/SSDI 
beneficiaries with severe mental illness, and the nation's expenditures 
for them, have continued to grow over the last ten years and SSA 
expects the number will continue to grow (SSA, Developing a World-Class 
Employment Strategy for People with Disabilities, September, 1994). A 
recent study by the U.S. General Accounting Office (GAO) found that by 
1994, mental impairments, which are associated with the longest 
entitlement periods, accounted for 57 percent of the SSI beneficiary 
population aged 18 to 64 and 31 percent of the SSDI beneficiary 
population (GAO Report, SSA DISABILITY, Program Redesign Necessary to 
Encourage Return to Work, April, 1996).
    There are significant complexities in designing effective return-
to-work strategies to assist individuals in the SSA caseload. Assisting 
those individuals who can return to work will require varying 
approaches and levels of support. Individuals who have completed the 
process of establishing themselves as disabled for SSA purposes may 
find it difficult to later view themselves as having remaining work 
potential. The transfer payments and other benefits contingent on SSI/
SSDI eligibility (especially medical insurance benefits) may increase 
the opportunity costs involved in return to work beyond the level 
acceptable to the individual. The benefit structure may provide a 
particular barrier for low-wage workers, those who are unskilled, or 
had marginal attachments to the labor market in the past. Beneficiaries 
face the loss of Medicare or Medicaid benefits if they return to work 
and marginal jobs may not offer adequate, or any, medical coverage, 
especially for pre-existing conditions. Relinquishing these benefits is 
particularly risky for individuals with LTMI, since recurring episodes 
of their illness may result in repeated job loss and the need for quick 
access to benefits.
    SSA has implemented several work incentive programs to help people 
with disabilities enter or re-enter the workforce by protecting their 
cash and medical benefits until they can support themselves (Red Book 
on Work Incentives--A Summary Guide to Social Security and Supplemental 
Security Income Work Incentives for People with Disabilities, SSA Pub. 
No. 64-030, U.S. Government Printing Office, June, 1992). For 
individuals with a LTMI, the Social Security Work Incentives (SSWI) 
have the potential to be a valuable component of the overall 
rehabilitation process. However, there has been neither a comprehensive 
assessment of the effectiveness of the SSWI programs nor an 
identification of the possible improvements to the program. There is 
some evidence, especially anecdotal evidence, that rather than using 
SSA work incentives, individuals may decide to work for earnings at a 
level that does not threaten continued eligibility for benefits 
(Rehabilitation Services Administration (RSA), Program Administrative 
Review--The Provision of Vocational Rehabilitation Services to 
Individuals Who Have Severe Mental Illness, 1995).
    The State Vocational Rehabilitation (VR) Program provides services 
to nearly 1,000,000 individuals with disabilities each year. In fiscal 
year 1992, individuals with the primary disabling condition of a mental 
illness made up about 19 percent of those who received services from 
the State VR Program, the second largest disability group. However, RSA 
has reported that the success rate for this population generally falls 
below the average success rate for the VR program. In 1993, RSA 
conducted a Program Administrative Review (PAR) in order to improve the 
provision of vocational rehabilitation services to individuals who have 
severe mental illness. Specifically the study examined the use of 
identified best practices including their use and relationship to 
successful outcomes and made recommendations for actions to be taken by 
VR State agencies to improve employment outcomes. In their review of a 
sample of case records of individuals with severe mental illness, 
documentation of the use of SSWIs was found in a relatively small 
percentage of the records of those individuals eligible for such 
incentives. RSA also found that individuals who achieved employment 
outcomes were more likely to have used work incentives.
    There are numerous other barriers facing individuals with severe 
mental illness seeking vocational rehabilitation including the often 
chronic and episodic nature of the illness, the iatrogenic effects of 
pharmacological and psychological treatment interventions, difficulties 
in assessing clients' work readiness, and stigma toward persons with 
mental illness. There is still much to be learned about the interaction 
of diagnosis, symptoms, skills and job environment. Because the 
severity of symptoms does not necessarily correspond with an 
individual's functional limitations, it is important to develop a 
better understanding of how psychiatric symptoms and diagnosis affect 
vocational outcomes (Cook, J.A. & Picket, S.A., Recent Trends in 
Vocational Rehabilitation for Persons with Psychiatric Disabilities, 
American Rehabilitation, 20(4), pages 2-12, 1995).
    There have been a variety of types or models of vocational 
rehabilitation programs and techniques that have been developed to 
increase the employment of individuals with mental illness, including 
models which have demonstrated effectiveness in returning persons with 
LTMI to competitive employment. What we do not know is which types of 
vocational rehabilitation model are most beneficial for which types of 
consumers and at which stages of their recovery process (McGurrin, 
M.C., An Overview of the Effectiveness of Traditional Vocational 
Rehabilitation Services in the Treatment of Long Term Mental Illness, 
Psychosocial Rehabilitation Journal, 17(3), pp. 37-54, 1994).
    In addition, there is a need for more information on duration and 
quality of employment, including issues of disclosure and consumer 
choice. Individuals with mental illness bring to the work place a range 
of unique needs. Because the episodic nature of the disability may 
cause intermittent instability, ongoing support is often needed for 
both the employee with mental illness and the employer in order to 
maintain employment. One study of outcomes among this population found 
that the occurrence of uninterrupted vocational support was a major 
predictor of employment status, even controlling for prior work 
history, client demographics, and level of functioning (Cook, J.A. et 
al., Cultivation and Maintenance of

[[Page 8137]]

Relationships with Employers of People with Psychiatric Disabilities, 
Psychosocial Rehabilitation Journal, 17(3), pp. 103-115, 1994).
    RSA in its examination of the use of best practices in VR State 
agencies found that the use of ongoing vocational support services and 
community-based support services were not frequently planned for at the 
time individuals' service plans were being developed nor routinely 
planned for at the time individuals were leaving the VR program. 
However, individuals who achieved employment outcomes were more likely 
to have had post-employment needs assessed during the development of 
their individualized rehabilitation program
    There is a need for studies that examine long-term employment 
issues including the experiences of employers and employees with LTMI 
in long term employment relationships and that assess the vocational 
and community supports needed to maintain employment.
    Priority 2: The Secretary will establish an RRTC for the purpose of 
conducting a comprehensive program of research on the achievement of 
high quality employment outcomes for persons with LTMI. The RRTC shall:
    (1) Examine how public policies and benefit programs affect the 
employment of individuals with LTMI;
    (2) Identify the characteristics of consumers (including their 
stage in the recovery process) that benefit from various types of 
vocational rehabilitation models;
    (3) Examine factors that promote long term job retention such as 
workplace strategies that assist in the maintenance of employee--
employer relationships and the availability of long-term supports; and
    (4) Develop and deliver training and technical assistance to 
rehabilitation service providers and consumers of mental health 
services on new and effective rehabilitation techniques and 
accommodations and evaluate the efficacy of the training.
    In addition to the activities proposed by the applicant to fulfill 
these objectives, the RRTC shall:
    <bullet> Identify effective strategies to broaden the understanding 
and use of the SSA's Work Incentives Program for individuals with LTMI;
    <bullet> Conduct studies on long-term relationships between 
employers and persons with LTMI including in-depth assessment of 
disclosure issues, career patterns, accommodations and conflict 
resolution in the workplace;
    <bullet> Analyze the relationships between employment experiences 
and the characteristics of impairment (e.g., diagnosis, periodicity, 
medication, symptoms), and between employment experiences and the 
characteristics of the work environment; and
    <bullet> Identify successful models of long-term vocational and 
community support for persons who have attained employment after the 
receipt of VR services.
    In carrying out the purposes of the priority, the RRTC shall:
    <bullet> Involve individuals with psychiatric disabilities in all 
phases of the planning, implementation, evaluation and dissemination of 
project activities; and
    <bullet> Coordinate with the Social Security Administration and 
with other relevant research and demonstration activities sponsored by 
the Center for Mental Health Services, Rehabilitation Services 
Administration and the NIDRR.
    Applicable Program Regulations: 34 CFR Parts 350, 351, and 352.

    Program Authority: 29 U.S.C. 760-762.

(Catalog of Federal Domestic Assistance Numbers: 84.133A, Research 
and Demonstration Projects, 84.133B, Rehabilitation Research and 
Training Center Program)

    Dated: February 18, 1997.
Judith E. Heumann,
Assistant Secretary for Special Education and Rehabilitative Services.
[FR Doc. 97-4317 Filed 2-20-97; 8:45 am]
BILLING CODE 4000-01-P


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