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[Federal Register Volume 75, Number 78 (Friday, April 23, 2010)]
[Notices]
[Pages 21282-21285]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-9511]

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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]
BILLING CODE 4000-01-P
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