31324 Federal Register / Vol. 63, No. 109 / Monday, June 8, 1998 / Notices

DEPARTMENT OF EDUCATION

National Institute on Disability and

Rehabilitation Research; Notice of

Proposed Funding Priorities for Fiscal

Years 1998–1999 for Rehabilitation

Research and Training Centers

SUMMARY: The Secretary proposes

funding priorities for three

Rehabilitation Research and Training

Centers (RRTCs) under the National

Institute on Disability and

Rehabilitation Research (NIDRR) for

fiscal years 1998–1999. The Secretary

takes this action to focus research

attention on areas of national need.

These priorities are intended to improve

rehabilitation services and outcomes for

individuals with disabilities.

DATES: Comments must be received on

or before July 8, 1998.

ADDRESSES: All comments concerning

these proposed priorities should be

addressed to Donna Nangle, U.S.

Department of Education, 600 Maryland

Avenue, S.W., room 3418, Switzer

Building, Washington, D.C. 20202–2645.

Comments may also be sent through the

Internet: comment@ed.gov

You must include the term

‘‘Employment Opportunities-RRTC’s’’ in

the subject line of your electronic

message.

FOR FURTHER INFORMATION CONTACT:

Donna Nangle. Telephone: (202) 205–

5880. Individuals who use a

telecommunications device for the deaf

(TDD) may call the TDD number at (202)

205–2742.

Internet: DonnalNangle@ed.gov

Individuals with disabilities may

obtain this document in an alternate

format (e.g., Braille, large print,

audiotape, or computer diskette) on

request to the contact person listed in

the preceding paragraph.

SUPPLEMENTARY INFORMATION: This

notice contains proposed priorities

under the Disability and Rehabilitation

Research Projects and Centers Program

for three RRTCs related to: employment

opportunities for American Indians,

community integration for persons with

mental retardation, and policies

affecting families of children with

disabilities.

These proposed priorities support the

National Education Goal that calls for

every adult American to possess the

skills necessary to compete in a global

economy.

The authority for the Secretary to

establish research priorities by reserving

funds to support particular research

activities is contained in sections 202(g)

and 204 of the Rehabilitation Act of

1973, as amended (29 U.S.C. 761a(g)

and 762).

The Secretary will announce the final

priorities in a notice in the Federal

Register. The final priorities will be

determined by responses to this notice,

available funds, and other

considerations of the Department.

Funding of a particular project depends

on the final priority, the availability of

funds, and the quality of the

applications received. The publication

of these proposed priorities does not

preclude the Secretary from proposing

additional priorities, nor does it limit

the Secretary to funding only these

priorities, subject to meeting applicable

rulemaking requirements.

Note: This notice of proposed priorities

does not solicit applications. A notice

inviting applications under this competition

will be published in the Federal Register

concurrent with or following the publication

of the notice of final priorities.

Rehabilitation Research and Training

Centers

The authority for RRTCs 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

that 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.

Description of Rehabilitation Research

and Training Centers

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,

integrated, and advanced programs of

research in rehabilitation targeted

toward the production of new

knowledge to improve rehabilitation

methodology and service delivery

systems, to alleviate or stabilize

disabling conditions, and to 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 inservice training, for rehabilitation

research 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.

RRTCs disseminate materials in

alternate formats to ensure that they are

accessible to individuals with a range of

disabling conditions.

NIDRR encourages all Centers to

involve individuals with disabilities

and individuals from minority

backgrounds as recipients of research

training, as well as clinical training.

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.

Proposed General Requirements: The

Secretary proposes that the following

requirements apply to these RRTCs

pursuant to these absolute priorities

unless noted otherwise. An applicant’s

proposal to fulfill these proposed

requirements will be assessed using

applicable selection criteria in the peer

review process:

The RRTC must provide: (1) applied

research experience; (2) training on

research methodology; and (3) training

to persons with disabilities and their

families, service providers, and other

appropriate parties in accessible formats
Federal Register / Vol. 63, No. 109 / Monday, June 8, 1998 / Notices 31325

on knowledge gained from the Center’s

research activities.

The RRTC must develop and

disseminate informational materials

based on knowledge gained from the

Center’s research activities, and

disseminate the materials to persons

with disabilities, their representatives,

service providers, and other interested

parties.

The RRTC must involve individuals

with disabilities and, if appropriate,

their representatives, in planning and

implementing its research, training, and

dissemination activities, and in

evaluating the Center.

The RRTC must conduct a state-ofthe-science conference and publish a

comprehensive report on the final

outcomes of the conference. The report

must be published in the fourth year of

the grant.

Priorities

Under 34 CFR 75.105(c)(3), the

Secretary proposes to give an absolute

preference to applications that meet the

following priorities. The Secretary

proposes to fund under this competition

only applications that meet one of these

absolute priorities.

Proposed Priority 1: Employment

Opportunities for American Indians

Background

On August 1, 1997, the U.S.

population of American Indians,

including Alaskan Native and Aleut,

was 2.3 million. This population has the

highest rate of disability of any racial or

ethnic group. One in three American

Indians aged 15 and over reports having

a disability; about one in seven reports

having a ‘‘severe’’ disability. One in two

American Indians aged 65 or over has a

severe disability (U.S. Department of

Commerce, Bureau of the Census,

Census Facts For Native American

Month, October, 1997). American

Indians have the highest unemployment

rates, the lowest family incomes, and

highest percentage of people living

below the poverty level (U.S.

Department of Commerce, Bureau of the

Census, Current Population Reports,

Special Studies Series, P 23–189, pg. 51,

July, 1995). The Nation’s several

hundred reservations have a 50 percent

average unemployment rate (Kalt, J.

‘‘Development Strategies for American

Indians,’’ Social Policy Research

Bulletin, pg. 21, fall, 1996).

In addition, American Indians have

the most severe health problems of all

U.S. groups, including the shortest life

expectancy and highest infant mortality

rate. American Indians experience

alcohol and substance abuse, sensory

impairment, diabetes mellitus, learning

disabilities, fetal alcohol syndrome, and

accidents and injuries at alarming rates

when compared to the general

population (U.S. General Accounting

Office, Indian Health Service, Basic

Services Mostly Available; Substance

Abuse Problems Need Attention, GAO/

HRD–93–48, April, 1993). American

Indians have the Nation’s highest school

dropout rates and the lowest

postsecondary attainment rates. Only 66

percent of American Indians have high

school diplomas, compared to a 78

percent rate for whites and AsianAmericans (U.S. Department of

Education, Office of Educational

Research and Improvement, National

Assessment of Vocational Education,

Final Report to Congress, Volume IV

Access to Programs and Services for

Special Populations, pg. 70, July, 1994).

Although some data on employment

and on disability are available, there is

little specific information on

employment of American Indians with

disabilities. In addition, although

general disability rates are available for

this population, there is little

information on the distribution of

disability within the population. Many

factors may have an impact on the

employment status of, and the delivery

of, employment services to American

Indians with disabilities. These factors

include, but are not limited to health

status, poverty, educational level, and

availability of culturally relevant

vocational rehabilitation services.

State vocational rehabilitation (VR)

agencies provide employment services

to American Indians with disabilities

who meet the eligibility criteria for the

Vocational Rehabilitation Services

Program authorized by the

Rehabilitation Act of 1973 (the Act). In

1996, VR agencies assisted

approximately 1600 American Indians

with disabilities to achieve an

employment outcome. However, data

from the Rehabilitation Services

Administration (RSA) indicate that

American Indians served under the

program achieve employment outcomes

at a lower rate compared to other

populations receiving vocational

rehabilitation services (RSA Case

Service Reports, RSA–911, 1991–1996).

Geographic, cultural, language, and

political factors affect the ability of State

agencies to deliver services to this

population, particularly those

individuals residing on reservations.

Approximately, one-third of American

Indians live on reservations or trust

lands. Most reservations have

populations of less than one thousand

and are located in rural areas. Many of

these Indian communities are in

isolated areas where poor roads and

populations spread out over many

miles. In addition, tribes are often

sovereign political entities with specific

powers of self-governance, thus

affecting access to populations on

reservations.

In recognition of this problem,

Congress amended the Act in 1978 to

authorize grants for American Indian

Vocational Rehabilitation Service

Projects (Section 130 Projects) to

support tribal vocational rehabilitation

programs. These discretionary grant

projects, also administered by RSA, are

awarded to the governing bodies of

Indian tribes located on Federal and

State reservations to provide VR

services for American Indians who are

individuals with disabilities residing on

reservations. There are currently 39

such projects.

Nearly two-thirds of American

Indians live in urban areas. Much of the

urban Indian population is assimilated

and dispersed throughout urban census

tracts, making it difficult for Vocational

Rehabilitation agencies to identify and

serve this population (The National

Urban Indian Policy Coalition, Report to

the White House Domestic Policy

Council, April, 1995). The lack of

culturally sensitive definitions of

disability in national data collection

efforts, such as the National Health

Interview Survey or the Survey of

Income and Program Participation,

further complicates this problem.

Cultural and language barriers

significantly impede delivery of

employment services, including

vocational rehabilitation programs.

There are 557 federally recognized

tribes, speaking about 200 languages

and dialects. Cultural barriers affect

knowledge, understanding, and

acceptance of disability and

contemporary medical and health

practices. In addition, concepts such as

self-sufficiency, self-determination and

self-advocacy may have very different

meanings across Indian cultures.

Proposed Priority 1

The Secretary proposes to establish a

RRTC to improve the employment status

of American Indians with disabilities.

The RRTC shall:

(1) Investigate and analyze existing

data, demographic and other, relevant to

disability and employment outcomes

and recommend methodological

improvements to enhance the

usefulness and comprehensiveness of

such data for the purpose of planning

and evaluating employment services,

including vocational rehabilitation

services (as described in 34 CFR

361.48), for Indians with disabilities;
31326 Federal Register / Vol. 63, No. 109 / Monday, June 8, 1998 / Notices

(2) Analyze existing employment and

vocational rehabilitation service

strategies for American Indians with

disabilities and identify those that have

produced successful employment

outcomes, taking into consideration the

actual employment opportunities that

exist on and off the reservation, and

examine how these strategies might be

applied to the Section 130 Projects;

(3) Develop and evaluate model

employment services, including

vocational rehabilitation services, for

American Indians with disabilities,

incorporating best practices from the

review of existing services, taking into

account cultural issues and reflecting

needs of American Indians on and off

the reservations as well as the Section

130 Projects; and

(4) Disseminate both the

recommendations for data collection

improvements and the results of the

evaluation of model employment

services to a range of relevant

audiences, using appropriate accessible

formats.

In carrying out the purposes of the

priority, the RRTC must:

• As appropriate, carry out separate

analyses for Indians with disabilities

who live on the reservation and for

those who live off the reservation; and

• Collaborate with the Section 130

Projects, and coordinate with the

Rehabilitation Services Administration,

the Bureau of Indian Affairs and the

Indian Health Service, the RRTC on

Disability Statistics, and other entities

carrying out related research or training

activities.

Proposed Priority 2: Community

Integration for Persons with Mental

Retardation

Background

Since 1965, NIDRR has supported

research and demonstrations in the area

of developmental disabilities,

particularly in the area of mental

retardation. During these years,

researchers have addressed issues

involving deinstitutionalization, special

education, transition from school to

work, supported employment and the

overall supports persons with mental

retardation need to live in the

community.

Based on the 1994–1995 National

Health Interview Survey-Disability

Supplement on adults living in the

general household population and

surveys of people in formal residential

support programs, about .78 percent or

1,250,000 of the population of the U.S.

can be identified as being limited in a

major life activity and having a primary

or secondary condition of mental

retardation. Until the Disability

Supplement survey was conducted,

information was not available about

individuals with mental retardation

who are not participants in specialized

programs, but live in the community

with their families or on their own.

Many persons with mental retardation

and their families receive long-term

services and supports through State

developmental disability authorities

(SDDAs) that are funded primarily by

the State or Federal Medicaid program.

According to the results of a recent

membership survey conducted by the

National Association of State Directors

of Developmental Disabilities Services

(NASDDS), many SDDAs are currently

designing or launching large scale

system change initiatives. This is due,

in part, to Medicaid reforms, managed

care initiatives and budget constraints.

Seventy-one percent of the respondents

said that cost containment is a major

factor prompting system change. The

initiatives differ in their specifics but

share several common themes:

decentralizing authority to local

managing entities; shifting to less

categorical budgeting; promoting greater

flexibility in the purchase and provision

of community services and supports;

and embracing self determination to

define a new relationship between the

system and individuals and their

families (NASDDS, Community Services

Reporter, pg. 3, Jan, 1998).

Since 1981, the Medicaid Home and

Community Based Services (HCBS)

waiver has facilitated flexibility and

service innovation. HCBS waivers afford

States the flexibility to develop and

implement creative alternatives to

placing Medicaid eligible individuals in

facilities such as nursing homes. The

HCBS waiver program recognizes that

many individuals at risk of being placed

in a long-term care facility can be

supported in their own homes and

communities, preserving their

independence and ties to family and

friends at a cost no higher than that of

institutional care. Services that may be

provided in HCBS waiver programs are

case management, homemaker services,

home health aide services, personal care

services, adult day health services,

habilitation, and respite care. Other

services States request may include

transportation and meal services. States

have the flexibility to design each

waiver program and select the mix of

waiver services that best meet the needs

of the population they wish to serve.

HCBS waiver services may be provided

statewide or may be limited to specific

geographic subdivisions.

However, in the last several years,

States have attempted to contain

Medicaid spending through the

application of managed care

approaches. Long-term care services,

including Medicaid-funded

intermediate care facilities for persons

with mental retardation and HCBS

waiver services for persons with mental

retardation, account for 35 percent of all

Medicaid spending. Programs serving

persons with mental retardation are not

likely to be exempt from these cost

containment measures (Center on

Human Policy, Information Package on

Managed Care and Long-term Supports

for People with Developmental

Disabilities, pg. 3, June, 1997).

There is little information available

on the use and outcomes of managed

care practices in providing long-term

supports to persons with mental

retardation. Currently, States are

implementing various models to

consolidate health and long-term care

services under one managed care

organization. This approach is intended

to be cost-effective and improve service

coordination. Under some of these

models, support networks for persons

with mental retardation that now stand

alone, could become subspecialty

branches of larger care delivery systems

(Ashbaugh, J. and Smith, G., ‘‘MCARE

Policy Brief, ‘‘Integration of Health and

Long-term Care Services: A Cure in

Search of and Illness,’’ No. 1, pg. 12,

1997). Some observers have voiced

concern that the use of consolidated

models may lead to reduced funding for

services. Organizations representing

persons with mental retardation have

proposed integrated models that

combine under a single umbrella

organization, health and long-term

supports in a configuration uniquely

suitable for this population.

Emerging practice suggests that

people with mental retardation should

play leading roles in determining the

substance of their lives and that services

should be developed as needed to

support their preferences. For example,

some current service delivery models

may provide new options for

individuals and their families to self

manage their chosen services through

vouchers, individual budgets or cash.

The field is moving past traditional

service delivery approaches to become

more responsive to the demands of

service recipients and to promote self

determined lifestyles. Services

developed around the specific needs

and choices of an individual may

produce better outcomes and cost

savings.

There are a number of emerging

models for system redesign. Participant

driven managed supports refer to a

variety of strategies for administering
Federal Register / Vol. 63, No. 109 / Monday, June 8, 1998 / Notices 31327

systems to increase their effectiveness

and efficiency, while maintaining a

commitment to community integration

and self determination (Agosta, J., et al.,

‘‘MCARE Policy Brief,’’ Developmental

Disability Services at the Century’s End:

Facing the Challenges Ahead, No. 2, pg.

4, 1997). The consumer managed care

approach assumes that consumers with

limited budgets will spend more

prudently in order to get the most value

for their money and increase their use

of natural supports in lieu of public

supports. Accordingly, consumer choice

will spawn a competitive market

economy where those providers

representing the most value to all

consumers will survive (Smith, G. and

Ashhbaugh, J., Managed Care and

People with Developmental Disabilities:

A Guidebook, pg. 8, 1996).

Coupled with States’ efforts toward

containment of long-term care costs,

most States have long waiting lists for

services. Waiting lists are expected to

grow in the future due to increased

longevity and higher expectations of

families. After examining State-by-State

data regarding the status of requests for

residential, day care, vocational and

other community support services, a

1997 Arc study found that 218,000

requests for community-based support

services remained unanswered. In

addition to individuals living in

institutions and nursing homes, these

waiting lists include students exiting

from special education programs and

individuals living at home with

caregivers. There is a need to

understand the methods and procedures

that States are using to provide

community-based services, as well as to

identify ways in which service systems

can be redesigned to better respond to

the needs of persons with mental

retardation and their families.

Residential direct care providers (e.g.,

group home staff members, foster family

members, roommates in supported

living arrangements) are the primary

providers of support, training,

supervision and personal assistance to

persons with mental retardation in

home and community settings (Larson,

S. A., et al., ‘‘Residential Services

Personnel,’’ Challenges for a Service

System in Transition, pg. 313, 1994). In

community residential settings, there

have been few attempts to study the

effects of staff orientation and in-service

training programs on important

outcomes for persons with mental

retardation as well as on direct service

personnel (Larson, S. A., ibid., pg. 326).

As the service delivery system changes,

training for these providers will be

essential. In addition, it will be

important to determine what training

efforts contribute to the desired

outcomes of fuller community

participation and autonomy for persons

with mental retardation.

Proposed Priority 2

The Secretary proposes to establish an

RRTC to improve community

integration outcomes for individuals

with mental retardation. The RRTC

shall:

(1) Investigate effective and costbeneficial approaches to assist families

to support members with mental

retardation at home, or in homes of their

own;

(2) Describe and analyze efforts to

redesign policy and services in selected

State systems serving persons with

mental retardation and their families;

(3) Identify and analyze State policies

and practices in the management of

Medicaid resources that foster or

impede access to supports and services;

(4) Identify and analyze policies that

foster or impede (e.g., result in

individuals being placed on waiting

lists for community-based services) the

full participation and integration of

persons with mental retardation into

their communities;

(5) Analyze the outcomes of the

implementation of consumer-controlled

services, personal assistance, and

individual control-of-service purchasing

in areas of quality of life and cost

effectiveness; and

(6) Identify outcomes of training for

residential direct care providers and the

long-term costs and benefits of specific

training strategies.

In carrying out the purposes of the

priority, the RRTC must: coordinate

with research and demonstration

activities sponsored by the Health Care

Financing Administration, the

Administration on Developmental

Disabilities, the Office of Disability,

Aging, and Long-term Care Policy in the

Department of Health and Human

Services, and other entities carrying out

related research or training activities.

Proposed Priority 3: Policies Affecting

Families of Children with Disabilities

Background

The 1992 National Health Interview

Survey (NHIS) estimates that 4 million

children and adolescents, or 6.1 percent

of the U.S. population under 18 years of

age, have disabilities. The NHIS broadly

defines disability to include any

limitation in activity due to a chronic

health condition or impairment. Among

children under age five, 2 percent are

limited in play activities and among

children 5–17, 5.5 percent have school

related disabilities. In addition, the

NHIS estimates that 3.8 million families,

or 5.5 percent of all families, contain

one or more children with disabilities.

Families of children with disabilities

must interact with at least three large

service systems: health care, human and

social services, and educational

systems. It is often difficult to assess the

impact of policies, service systems, and

service delivery practices because the

organizational structures and the

services provided under the auspices of

public and private institutions vary. The

integration and coordination of these

systems can be inferred from the

patterns of interagency relationships

involving client referrals, information

flows and resource exchanges

(Morrissey, J.P., et al., ‘‘Methods for

System-Level Evaluations of Child

Mental Health Service Networks’’

Outcomes for Children and Youth with

Behavioral and Emotional Disorders

and Their Families: Programs and

Evaluation Best Practices, pg. 299,

1998). For the purposes this priority, the

policies affecting families of children

with disabilities include, but are not

limited to, those in the areas of health

care (including mental health), human

and social services (including legal

systems such as juvenile services), and

public and private education.

Families of children with disabilities

often need assistance with accessing

and financing services, information

about caring for their child, support

from other families, community-based

respite care, and case management

services. Case management services are

intended to ensure that services are

delivered in an effective and efficient

manner. Numerous models of case

management currently exist. However,

there is little extant research on the

effectiveness, either at the family or

system level, of case management

services for families of children with

disabilities.

Numerous methodological problems

limit the study of the complex service

systems surrounding children with

disabilities and their families. Current

methods of measuring service

coordination and examining roles in

service delivery systems are not

structured to assess the needs of

children and their families (Koren, P. E.,

et al., ‘‘Service Coordination in

Children’s Mental Health: An Empirical

Study from the Caregivers Perspective,’’

Journal of Emotional and Behavioral

Disorders, 5(3), pg. 164, 1997).

Measurement issues become even more

complex when the focus of a study

moves from the individual and family

level to the State and local service

system level or when policy analysis is

required. There is currently a shortage
31328 Federal Register / Vol. 63, No. 109 / Monday, June 8, 1998 / Notices

of methods for assessing the

interrelationship between Federal, State,

and local policy, service systems, and

outcomes for families of children with

disabilities. The limited availability of

data and methodological tools needed

for scientific measurement of the impact

of systemic and policy reforms on

families of children with disabilities

serves as a barrier to increasing our

understanding of the relationship

between policy and outcomes. Recent

major changes in Federal policies for

social services, child care, family

preservation and support services, and

related educational and health care

services may be having profound

impacts upon these families.

Changes at the Federal level may be

having an impact at the State and local

level. However, little is known or

documented about the effects of Federal

policy changes on State and local

service systems and families of children

with disabilities.

Under new Federal and State

legislation, States have more flexibility

to administer human service programs.

Policymakers and legislators have new

opportunities to shape integrated and

flexible programs to better serve the

needs of families and their children

with and without disabilities. Some

States are experimenting with a

decategorization of State and Federal

funding streams so that local

communities can reshape their service

systems through the use of vouchers.

Some State and local agencies are

conducting demonstrations of family

support programs that decentralize

public services for families of children

with disabilities.

The impact of devolution from a

system with authority at the Federal

level and management of public services

at the State level, to a system of both

authority and management at the local

level has not been documented.

Information is needed on these practices

and other interventions, the family

benefits associated with these policies

and practices, and the consequences of

practice and policy change in order to

facilitate implementation of policies and

programs that are sensitive to the needs

of families of children with disabilities

and to promote effective models of care

for families of children with disabilities.

In addition to policy changes in the

social services arena, health care

systems are changing rapidly the way

they provide services to consumers.

Families of children with disabilities,

and the health care providers that serve

them, are facing many challenges that

differ from the coverage and access

issues that are present for the general

population. Even families of children

with disabilities that use few medical

services often require special knowledge

or accommodations when they do

access the health care system. Many

States have little or no experience in

assuring that their health care providers

meet the specialized needs of families of

children who have disabilities. These

challenges are further complicated by

the high cost of services for children

with disabilities.

Among children enrolled in

Medicaid, the average per-person health

care costs in 1992 were seven times

higher for disabled than nondisabled

children. Compared with nondisabled

children in the general population,

some disabled children use twice as

many physician visits and five times as

many ancillary services, such as

physical therapy. Under current policies

and practices, the potential exists to use

medical necessity standards to prevent

disabled children from receiving

therapy or equipment when they need it

to maintain existing levels of

functioning (U.S. General Accounting

Office, Medicaid Managed Care: Serving

the Disabled Challenges States

Programs, (GAO/HEHS Publication No.

96–136) pg. 16, 1996). Research is

needed on health care policies and

service delivery practices in order to

develop longterm strategies to remove

service delivery barriers that exist in the

health care system and to facilitate

establishment of policies that support

access to services for families of

children with disabilities.

Frequently, children with disabilities

who are participating in special

education programs and their families

have needs that are addressed by health

care or social service agencies. As

public schools’ regular and special

education programs restructure,

opportunities may arise to expand

successful service delivery strategies

and develop new ones to fill in existing

gaps in the service delivery systems.

The development of integrated,

community-based services for children

with disabilities and their families is an

essential component of this reform effort

(Duchnowski, A. J., et al., ‘‘Integrated

and Collaborative Community Services

in Exceptional Student Education,’’

Special Education Practice: Applying

the Knowledge, Affirming the Values

and Creating the Future, pgs. 177–188,

1997).

Many communities have begun

initiatives to create more responsive

family-centered service delivery

systems. Mechanisms for interagency

coordination at the State and local

levels are necessary to ensure optimal

service delivery conditions. Service

coordination should involve linkages

between education agencies, health care

systems, and social services systems. In

addition, due to the changing

demographics of society, little is known

about the influence of culture, ethnicity

and socioeconomics on how families

seek and receive services for their

children with disabilities.

Basic information sharing,

coordination and collaboration between

agencies that provide services to

families of children with disabilities is

limited. There is a need to evaluate

current best practices in service delivery

coordination and collaboration, develop

a methodology for analyzing

collaboration among agencies, establish

principles for coordination and

collaboration, and develop performance

indicators that foster partnerships.

Proposed Priority 3

The Secretary proposes to establish an

RRTC to assess the impact of policies on

service delivery and outcomes for

families of children with disabilities.

The RRTC shall:

(1) Develop an analytical framework,

including tools for assessing: family

characteristics and policies, structure of

service systems, service delivery

processes, interagency coordination and

collaboration, and outcomes for families

with disabled children;

(2) Using the methodology developed

above, determine the effectiveness of

specific policies, implementation

strategies, service delivery procedures,

and coordination practices in meeting

the needs of families of children with

disabilities;

(3) Identify the impact of specific

characteristics of interagency

collaboration and coordination on

families of children with disabilities;

and

(4) Assess the impact of specific

policies on access to services of families

from diverse cultural, linguistic, ethnic

and socioeconomic backgrounds.

In carrying out these purposes, the

RRTC must:

• Disseminate materials and

coordinate research and training

activities with the Maternal and Child

Health Bureau, the Administration on

Developmental Disabilities, the Office of

Policy and Planning in the Department

of Health and Human Services, the

Office of Special Education, the Federal

Interagency Coordinating Council, and

other entities carrying out related

research or training activities; and

• Establish practical statistical

methodologies and measurement tools

that specifically assess the policies

affecting families of children with

disabilities.
Federal Register / Vol. 63, No. 109 / Monday, June 8, 1998 / Notices 31329

Electronic Access to This Document

Anyone may view this document, as

well as all other Department of

Education documents published in the

Federal Register, in text or portable

document format (pdf) on the World

Wide Web at either of the following

sites:

http://ocfo.ed.gov/fedreg.htm

http://www.ed.gov/news.html

To use the pdf you must have the Adobe

Acrobat Reader Program with Search,

which is available free at either of the

preceding sites. If you have questions

about using the pdf, call the U.S.

Government Printing Office at (202)

512–1530 or, toll free at 1–888–293–

6498.

Anyone may also view these

documents in text copy only on an

electronic bulletin board of the

Department. Telephone: (202) 219–1511

or, toll free, 1–800–222–4922. The

documents are located under Option

G—Files/Announcements, Bulletins and

Press Releases.

Note: The official version of this document

is the document published in the Federal

Register.

Invitation to Comment: Interested

persons are invited to submit comments

and recommendations regarding these

proposed priorities. All comments

submitted in response to this notice will

be available for public inspection,

during and after the comment period, in

Room 3424, Switzer Building, 330 C

Street S.W., Washington, D.C., between

the hours of 9:00 a.m. and 4:30 p.m.,

Monday through Friday of each week

except Federal holidays.

Applicable Program Regulations: 34

CFR Part 350.

Program Authority: 29 U.S.C. 760–762.

(Catalog of Federal Domestic Assistance

Numbers 84.133B, Rehabilitation Research

and Training Centers)

Dated: June 3, 1998.

Curtis L. Richards,

Acting Assistant Secretary for Special

Education and Rehabilitative Services.

[FR Doc. 98–15166 Filed 6–5–98; 8:45 am]

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