40156 Federal Register / Vol. 63, No. 143 / Monday, July 27, 1998 / Notices

DEPARTMENT OF EDUCATION

National Institute on Disability and

Rehabilitation Research; Notice of

Final Funding Priorities for Fiscal

Years 1998–1999 for Certain Centers

and Projects

SUMMARY: The Secretary announces final

funding priorities for two Disability and

Rehabilitation Research Projects

(DRRPs) and 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.

EFFECTIVE DATE: This priority takes effect

on August 26, 1998.

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 final priorities under the

Disability and Rehabilitation Research

Projects and Centers Program for two

DRRPs related to a burn data

coordinating project and collaborative

research for traumatic brain injury (TBI)

model systems. This notice also

contains final priorities 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 final 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).

Note: This notice of final priorities does

not solicit applications. A notice inviting

applications was published in the Federal

Register on July 2, 1998 (63 FR 36298).

Analysis of Comments and Changes

On June 8, 1998 the Secretary

published in separate parts two notices

of proposed priorities in the Federal

Register. One notice included two

proposed priorities related to a burn

data coordinating project and

collaborative research for traumatic

brain injury (TBI) model systems (63 FR

31320–31321). The second notice

included three proposed priorities

related to employment opportunities for

American Indians, community

integration for persons with mental

retardation, and policies affecting

families of children with disabilities (63

FR 31324–313290). The Department of

Education received 17 letters

commenting on the notices of proposed

priorities by the deadline date.

Technical and other minor changes—

and suggested changes the Secretary is

not legally authorized to make under

statutory authority—are not addressed.

Disability and Rehabilitation Research

Projects

Priority 1: Burn Data Coordinating

Project

Comment: Three commenters

identified qualifications that applicants

for the Burn Data Coordination Project

should possess. The commenters

suggested that applicants for the burn

data coordinating project should

demonstrate: an understanding of burn

care, an understanding of the burn

model systems database, and the ability

and motivation to collaborate with the

database currently being generated by

the American Burn Association. In

addition, the commenters suggested that

applicants should have experience in

the development, coordination, and

management of multi-center databases

and possess the technology to respond

to idiosyncratic hardware and software

needs and issues that each burn model

system brings to the common database.

Discussion: An applicant’s

qualifications are addressed in the peer

review process and evaluated on the

basis of the competition’s selection

criteria. The qualifications identified by

the commenter will be evaluated in the

peer review process. It is unnecessary to

include these qualifications in the

priority.

Changes: None.

Comment: The Burn Data

Coordinating Project should be affiliated

with an institution that is currently

operating a Burn Model Systems Project.

Discussion: NIDRR recognizes the

advantages of having the Burn Data

Coordination Project administered by an

entity that is affiliated with an

institution that is currently operating a

Burn Model Systems Project. However,

NIDRR does not believe that this

affiliation is a prerequisite qualification

and is unwilling to limit eligible

applicants to current Burn Model

Systems projects.

Changes: None.

Comment: One commenter suggested

that the Burn Data Coordination

Project’s autonomy and authority

should be clearly defined, strict time

frames should be required for

transmission of data and other summary

reports to the model systems from the

data center, and the procedures that are

currently being developed to use

scannable forms and score certain

instruments should be continued.

Discussion: These suggestions relate

to the administration of the Burn Data

Coordination Project grant and the

project’s relationship with the Burn

Model Systems Projects. Following the

awarding of the grant, NIDRR will work

cooperatively with the Burn Data

Coordination Project and the Burn

Model Systems Projects to address and

resolve these issues. It is not necessary

to revise the priority in order to address

these administrative matters.

Changes: None.

Comment: Clarification is needed on

the requirement for the Burn Data

Coordinating Project to collaborate with

the Spinal Cord and TBI Model Systems

data collection activities.

Discussion: NIDRR believes that

communication between the Burn,

Spinal Cord, and TBI Model Systems

data collection projects may result in

improved performance of their common

data collection activities and could lead

to mutually beneficial collaborative

activities. In order to provide the project

with as much discretion as possible, the

priority indicates that this collaboration

should be carried out ‘‘as appropriate.’’

Changes: None.

Priority 2: Collaborative Research for

Traumatic Brain Injury Model Systems

Comment: The priority should be

revised to address the needs of

individuals in correctional facilities.

Discussion: An applicant could

propose to address the needs of

individuals with TBI in correctional

facilities. The peer review process will

evaluate the merits of the proposal.

However, NIDRR declines to specify any

particular subpopulations of research

subjects.

Changes: None.

Comment: The priority should be

revised to require projects to use the TBI

Model Systems database.

Discussion: NIDRR recognizes the

advantages of using the TBI model

systems database and expects that a
Federal Register / Vol. 63, No. 143 / Monday, July 27, 1998 / Notices 40157

number of applicants will propose

collaborative research projects that use

the database. Because there may be

highly meritorious collaborative

research projects that do not use the

database, NIDRR declines to limit the

scope of research to only those that use

the database.

Changes: None.

Comment: The priority should be

revised to require collaboration with

more than one Model System.

Discussion: NIDRR recognizes the

advantages of collaboration with more

than one Model System. However, there

may be highly meritorious research

projects that involve only one Model

System. NIDRR declines to require that

applicants collaborate with more than

one Model System in order to provide

applicants with as much discretion as

possible.

Changes: None.

Comment: The meaning of

collaboration should be clarified.

Discussion: The selection criteria on

collaboration (see 34 CFR 350.54(k))

provide all applicants with guidance on

the meaning of collaboration for the

purpose of the priority. No further

guidance is necessary.

Changes: None.

Comment: Any non-Model System

applicant should demonstrate

equivalent levels of data quality control

as achieved by the Model System.

Discussion: The peer review process

will evaluate the merits of the research

that applicants propose, including the

level of data quality control. It is not

necessary to revise the priority in order

to address the quality of the data that

applicants’ propose to collect.

Changes: None.

Comment: The priority should be

revised to include collaborative projects

on costs of rehabilitative interventions

and their relationship to the effects of

those interventions.

Discussion: An applicant could

propose to address the costs of

rehabilitative interventions and their

relationship to the effects of those

interventions. The peer review process

will evaluate the merits of the proposal.

However, NIDRR has no basis for

requiring all applicants to carry out this

research.

Changes: None.

Comment: In the Background

statement to the priority, one of the

examples of the collaborative research

that could be carried out under the

priority is assessment and treatment of

persons with mild TBI. Individuals with

mild TBI are not currently captured by

the Model System database.

Collaborative research on this topic,

though very important, would involve a

brand new effort, and one for which

existing Model Systems offer no special

advantages.

Discussion: The fact that assessment

and treatment of persons with mild TBI

was one of a number of examples

included in the Background statement

does not bind or encourage applicants to

propose this research.

Changes: None.

Comment: The priority should be

revised to acknowledge need for an

assessment tool to measure community

integration of persons with TBI.

Discussion: An applicant could

propose to carry out research

contributing to the development of these

tools. The peer review process will

evaluate the merits of the research.

However, NIDRR has no basis for

requiring all applicants to carry out this

research.

Changes: None.

Rehabilitation Research and Training

Centers

Priority 1: Employment Opportunities

for American Indians

Comment: The fourth activity should

be revised to require the RRTC to

provide a technical assistance training

program to counseling staff from

community based service programs,

American Indian Vocational

Rehabilitation Projects supported under

Section 130 of the Rehabilitation Act,

and State VR agencies that serve

American Indians.

Discussion: In part, the general RRTC

training requirement specifies that the

RRTC must provide training to persons

with disabilities and their families,

service providers, and other appropriate

parties in accessible formats on

knowledge gained from the Center’s

research activities. No further

requirements are necessary for the RRTC

to carry out the training suggested by

the commenter.

Changes: None.

Comment: The priority should be

expanded to include two new activities:

(1) analyzing existing data to determine

the specific risk factors for severe

disabilities among American Indian

people, and developing primary and

secondary prevention strategies that

address these risk factors in order to

achieve long-term reduction in lifestyle

risk factors that contribute to disability;

and (2) developing and evaluating a

model Independent Living Service

program.

Discussion: NIDRR acknowledges the

importance of the suggested activities,

however, the purpose of this RRTC is to

improve the employment status of

American Indians with disabilities. The

suggested activities are not sufficiently

related to the purpose of the RRTC to be

added to the priority. Also, adding them

to the priority is not feasible in light of

the resources available to the RRTC.

Changes: None.

Comment: It would be interesting to

assess whether American Indians with

disabilities seek seasonal subsistence

employment such as ricing, fishing,

hunting, sheepherding, and

berrypicking. The priority should

include culturally-specific strategies for

employment such as subsistence

employment.

Discussion: An applicant could

propose to carry out research on

subsistence employment. The peer

review process will evaluate the merits

of the research. However, NIDRR has no

basis for requiring all applicants to carry

out this research.

Changes: None.

Discussion: The RRTC is expected to

be national in scope and address the

needs of American Indians with

disabilities in all parts of the country.

Changes: None.

Priority 2: Community Integration for

Persons With Mental Retardation

Comment: Recreation and leisure

should be included in the RRTC’s efforts

in studying effective and cost-beneficial

approaches for community integration.

Discussion: An applicant could

propose to integrate recreation and

leisure into the research activities of the

RRTC. The peer review process will

evaluate the merits of the research.

However, NIDRR has no basis for

requiring all applicants to integrate

recreation and leisure into the research

activities of the RRTC.

Changes: None.

Disability and Rehabilitation Research

Projects

Authority for Disability and

Rehabilitation Research Projects

(DRRPs) is contained in section 202 of

the Rehabilitation Act of 1973, as

amended (29 U.S.C. 761a). DRRPs carry

out one or more of the following types

of activities, as specified in 34 CFR

350.13–350.19: research, development,

demonstration, training, dissemination,

utilization, and technical assistance.

Disability and Rehabilitation Research

Projects 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. In addition, DRRPs improve

the effectiveness of services authorized
40158 Federal Register / Vol. 63, No. 143 / Monday, July 27, 1998 / Notices

under the Rehabilitation Act of 1973, as

amended.

Priorities: Under 34 CFR 75.105(c)(3),

the Secretary gives an absolute

preference to applications that meet the

following priorities. The Secretary will

fund under this competition only

applications that meet one of these

absolute priorities.

Priority 1: Burn Data Coordinating

Project

Background. In 1994 NIDRR

established the Burn Injury

Rehabilitation Model Systems of Care

(Burn Model Systems) by awarding

three 36-month projects. In 1997 NIDRR

reestablished the Burn Model Systems

with the award of four 60-month

projects. These projects develop and

demonstrate a comprehensive,

multidisciplinary model system of

rehabilitative services for individuals

with severe burns, and evaluate the

efficacy of that system through the

collection and analysis of uniform data

on system benefits, costs, and outcomes.

The projects study the course of

recovery and outcomes following the

delivery of a coordinated system of care

including emergency care, acute care

management, comprehensive inpatient

rehabilitation, and long-term

interdisciplinary follow-up services.

The Burn Model Systems projects

serve a substantial number of patients,

allowing the projects to conduct clinical

research and program evaluation. In

addition, the Burn Model Systems

projects utilize a complex data

collection and retrieval program with

the capability to analyze the different

system components and provide

information on project effectiveness and

benefits. The projects are intended to

establish appropriate, uniform

descriptors of rehabilitation care.

Information is collected throughout the

rehabilitation process. Systematic burn

injury care permits long-term follow-up

on the course of injury and the

identification of continuing needs and

results in areas such as functional

outcome, health and rehabilitation

services, procedures for costreimbursement and billing and

community integration. The Burn Model

Systems projects serve as regional and

national models for program

development and as information centers

for consumers, families, and

professionals.

In order to take full advantage of the

data collected by individual Burn Model

System projects, there is a need for a

project to assist the projects in their

research efforts and establish and

maintain a combined database for shortand long-term outcome evaluations

(functional, health, psycho-social and

vocational status measures) and

financial assessments (rehabilitation,

professional and hospital charges) for

various burn care and injury

rehabilitation strategies.

Priority 1: The Secretary will establish

a Burn Data Coordinating Project for the

purpose of maintaining a common

database of burn care and injury

rehabilitation information compiled by

the Burn Model Systems projects

supported by NIDRR. The project shall:

(1) Establish and maintain a common

database through the data collection,

entry, transfer, editing, quality control,

issues resolution, and integration efforts

of NIDRR’s Burn Injury Rehabilitation

Model Systems’ projects;

(2) Provide technical assistance to the

Burn Model Systems projects in the

compilation of common data values

from each Burn Injury Model System

into a single quality information

database for both joint and site specific

management reporting, center

evaluations and research analyses;

(3) Develop management reports on

each Burn Injury Model System

project’s database-related activities and

on trends that can be combined with

and compared to other national data

systems for evaluation of burn injury

outcomes;

(4) Provide technical assistance to the

Burn Model System projects in the

preparation of scientific articles by

providing statistical and analytical

support;

(5) Provide technical assistance to the

Burn Model Systems projects in the

design, implementation, and analysis of

specialized clinical studies that assess

new burn injury rehabilitation

methodologies; and

(6) Provide technical assistance to the

Burn Model Systems projects in the

clinical and systems analysis studies by

collecting and analyzing data on patient

characteristics, diagnoses, causes of

injury, interventions, outcomes, and

costs within a uniform standardized

database.

In carrying out these purposes, the

project must:

• As appropriate, collaborate with

other model systems (such as spinal

cord and traumatic brain injury model

systems) data collection activities; and

• Link Burn Injury Model Systems,

NIDRR Staff, and the project as required

to facilitate database interactions and

information dissemination

opportunities.

Priority 2: Collaborative Research for

Traumatic Brain Injury Model Systems

Background. In 1987 NIDRR funded

four research and demonstration

projects to establish the Traumatic Brain

Injury Model Systems of Care (TBI

Model Systems) for individuals in need

of comprehensive, multidisciplinary

rehabilitative services. At present

NIDRR supports five TBI Model Systems

projects to study the course of recovery

and outcomes following the delivery of

a coordinated system of care including

emergency care, acute neuro-trauma

management, comprehensive inpatient

rehabilitation, and long-term

interdisciplinary follow-up services.

The TBI Model Systems projects collect

and analyze uniform data from projects

on system benefits, costs, and outcomes.

The TBI Model Systems projects serve

a substantial number of individuals,

allowing the projects to conduct clinical

research and program evaluation, and

maximize the potential for project

replication. In addition, the systems

have a complex data collection and

retrieval program with the capability to

analyze different system components

and provide information on cost

effectiveness and benefits. Information

is collected throughout the

rehabilitation process, permitting longterm follow-up on the course of injury,

outcomes, and changes in employment

status, community integration,

substance abuse and family needs. The

TBI Model Systems projects serve as

regional and national models for

program development and as

information centers for consumers,

families, and professionals.

On January 21, 1998, NIDRR

published a notice in the Federal

Register inviting applications to

establish 10 additional TBI Model

Systems projects (63 FR 3240). In

conjunction with the establishment of

these new TBI Model Systems projects,

NIDRR is establishing collaborative

research projects to broaden knowledge

and encourage multi-institutional

studies of outcomes, rehabilitation

interventions and service delivery

system innovation for individuals with

traumatic brain injury. The following

are examples of collaborative research

topics that the proposed project could

carry out: evaluation of emerging

pharmacologic interventions;

examination of the effects of specific

type and intensity of rehabilitative

treatments; aging with TBI; secondary

conditions of TBI; assessment and

treatment in mild traumatic brain

injury; impact of environmental factors

on long term outcomes; impact of

substance abuse on memory; and

implications of managed care on

availability and type of care for persons

with TBI.

Priority 2: The Secretary will establish

collaborative research projects for the
Federal Register / Vol. 63, No. 143 / Monday, July 27, 1998 / Notices 40159

purpose of improving the knowledge

about rehabilitation outcomes in order

to improve the lives of persons with

TBI, their families, and caregivers. A

collaborative research project shall:

(1) Investigate rehabilitation

interventions or service delivery issues;

and

(2) Disseminate information based on

that investigation to TBI Model Systems

projects and other appropriate

rehabilitation settings.

In carrying out the purposes of the

priority, the project must:

• Collaborate with one or more of the

17 NIDRR TBI Model Systems projects

that are directed by the following

individuals: (1) Dr. Thomas Novack,

University of Alabama—Birmingham,

AL, (205) 934–3454; (2) Dr. Karyl Hall,

Santa Clara Valley Medical Center—San

Jose, CA, (408) 295–9896; (3) Dr. Gale

Whiteneck, Craig Hospital—Englewood,

CO, (303) 789–8204; (4) Dr. Anthony

Stringer, Emory University—Atlanta,

GA, (404) 712–5667; (5) Dr. Mel B.

Glenn, The Spaulding Rehabilitation

Hospital—Boston, MA, (617) 720–6821;

(6) Dr. Mitchell Rosenthal, Wayne State

University/Rehabilitation Institute of

Michigan—Detroit, MI, (313) 745–9769;

(7) Dr. James F. Malec, Mayo

Foundation—Rochester, MN, (507) 255–

5199; (8) Dr. Mark Scherer, Mississippi

Methodist Rehabilitation Center—

Jackson, MS, (601) 364–3490; (9) Dr.

Brick Johnstone, University of

Missouri—Columbia, MO, (573) 882–

6290; (10) Dr. Mark V. Johnston, Kessler

Medical Rehabilitation Research and

Education Corporation—West Orange,

NJ, (973) 414–4734; (11) Dr. Flora

Hammond, Charlotte-Mecklenburg

Hospital Authority—Charlotte, NC,

(704) 355–4300; (12) Dr. John Corrigan,

Ohio State University—Columbus, OH,

(614) 293–3830; (13) Dr. Randall M.

Chestnut, Oregon Health Services

University—Portland, OR, (503) 494–

4314; (14) Dr. John Whyte, Moss

Rehabilitation Research Institute—

Philadelphia, PA, (215) 456–9597; (15)

Dr. Walter High, Jr., The Institute for

Rehabilitation and Research—Houston,

TX, (713) 666–9550; (16) Dr. Jeffrey S.

Kreutzer, Medical College of Virginia—

Richmond, VA, (804) 828–9055; and

(17) Dr. Sureyya S. Dikmen, University

of Washington—Seattle, WA, (206) 685–

7529; and

• Once a year, participate in the TBI

Model Systems project directors’

meeting.

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.

General Requirements: The following

requirements apply to these RRTCs

pursuant to these absolute priorities

unless noted otherwise. An applicant’s

proposal to fulfill these 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

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 gives an absolute

preference to applications that meet the

following priorities. The Secretary will

fund under this competition only

applications that meet one of these

absolute priorities.
40160 Federal Register / Vol. 63, No. 143 / Monday, July 27, 1998 / Notices

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.

Priority 1: The Secretary will establish

an 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 set forth in 34 CFR 361.48),

for Indians with disabilities;

(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
Federal Register / Vol. 63, No. 143 / Monday, July 27, 1998 / Notices 40161

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.

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 may request 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

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
40162 Federal Register / Vol. 63, No. 143 / Monday, July 27, 1998 / Notices

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.

Priority 2: The Secretary will 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.

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 who have 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 who have 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

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
Federal Register / Vol. 63, No. 143 / Monday, July 27, 1998 / Notices 40163

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 long-term 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.

Priority 3: The Secretary will 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.

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.

Program Authority: 29 U.S.C. 760–762.

(Catalog of Federal Domestic Assistance

Numbers 84.133B, Rehabilitation Research

and Training Centers)

Dated: July 22, 1998.

Judith E. Heumann,

Assistant Secretary for Special Education and

Rehabilitative Services.

[FR Doc. 98–20009 Filed 7–24–98; 8:45 am]

BILLING CODE 4000–01–P