[Federal Register: June 26, 2001 (Volume 66, Number 123)]
[Notices]
[Page 34025-34034]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr26jn01-109]
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Part IV
Department of Education
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National Institute on Disability and Rehabilitation Research
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Final Funding Priorities for Fiscal Years 2001-2003 for Four Disability
and Rehabilitation Research Projects; Invitation for Applications for
Fiscal Year 2001 New Awards and Announcement of Pre-Application
Meetings; Notices
[[Page 34026]]
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DEPARTMENT OF EDUCATION
National Institute on Disability and Rehabilitation Research;
Notice of Final Funding Priorities for Fiscal Years 2001-2003 for Four
Disability and Rehabilitation Research Projects
AGENCY: Office of Special Education and Rehabilitative Services,
Department of Education.
ACTION: Notice of final funding priorities for fiscal years 2001-2003
for four disability and rehabilitation research projects.
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SUMMARY: We are announcing four final funding priorities under the
Disability and Rehabilitation Research Projects and Centers Program
(DRRP) of the National Institute on Disability and Rehabilitation
Research (NIDRR) for FY 2001-2003: Assistive Technology Outcomes,
Impacts and Assistive Technology Research Projects for Individuals with
Cognitive Disabilities, Resource Center for Community-based Research on
Technology for Independence, and Community-based Research Projects on
Technology for Independence. We take this action to focus research
attention on areas of national need. We intend these priorities to
improve the rehabilitation services and outcomes for individuals with
disabilities.
DATES: These priorities take effect on July 26, 2001.
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) 205-4475. Internet:
Donna.Nangle@ed.gov
Individuals with disabilities may obtain this document in an
alternative 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
(DRRP) for Assistive Technology Outcomes, Impacts and Assistive
Technology Research Projects for Individuals with Cognitive
Disabilities, Resource Center for Community-based Research on
Technology for Independence, and Community-based Research Projects on
Technology for Independence.
The final priorities refer to NIDRR's Long-Range Plan (the Plan).
The Plan can be accessed on the World Wide Web at: http://www.ed.gov/
offices/OSERS/NIDRR/#LRP.
National Education Goals
The eight National Education Goals focus the Nation's education
reform efforts and provide a framework for improving teaching and
learning.
This notice addresses the National Education Goal that every adult
American will be literate and will possess the knowledge and skills
necessary to compete in a global economy and exercise the rights and
responsibilities of citizenship.
The authority for the program 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. 762(g) and 764(b)). Regulations governing this
program are found in 34 CFR part 350.
Note: This notice does not solicit applications. A notice
inviting applications is published in this issue of the Federal
Register.
Analysis of Comments and Changes
On April 6, 2001, we published a notice of proposed priorities on
the Assistive Technology Outcomes and Impacts and the Assistive
Technology Research Projects for Individuals with Cognitive
Disabilities in the Federal Register (66 FR 18366). The Department of
Education received 12 letters commenting on the notice of proposed
priorities by the deadline date. Technical and other minor changes--and
suggested changes we are not legally authorized to make under statutory
authority--are not addressed.
Priority 1: Assistive Technology Outcomes and Impacts
Comment: The primary stakeholder regarding AT outcomes is the
person who uses (or is expected to use) a particular AT device. Family
members and caregivers are secondary consumers, however, they may be
considered primary stakeholders in the sense that two thirds of all AT
is procured through first party and family funding. Therefore, it is
crucial that this priority require applicants to focus on the
individual with a disability rather than other primary and secondary
stakeholders.
Discussion: NIDRR feels the priority is sufficiently flexible to
allow the applicant to propose methodological approaches that focus on
the needs of primary stakeholders such as individuals with
disabilities. The peer review process will evaluate the merits of the
proposal.
Changes: None.
Comment: One commenter is concerned about using the word
``intervention'' in the general purpose statement suggesting that it is
a poor choice of words and may be misinterpreted. The commenter
recommends dropping the word altogether so that the last sentence of
the general purpose statement reads ``* * * determine the efficacy and
utility of AT and the implications.''
Discussion: NIDRR agrees that the term ``interventions'' may be
misconstrued because of varying definitions and interpretations.
Changes: The word ``interventions'' has been dropped from the
general purpose statement.
Comment: The second bulleted activity lists a number of relevant
organizations that applicants must collaborate with. Given that AT
users are the primary targets of this priority, this bulleted activity
should be expanded to include AT users.
Discussion: The second bulleted activity enumerates relevant NIDRR
projects and not specific stakeholders. The purpose of this priority is
to investigate AT outcomes and 2 impacts and cannot be carried out
without the full participation and support of AT users.
Changes: None.
Comment: The assessment and evaluation of AT should include
questions related to both positive and negative impacts of AT use and
the acquisition of AT through various financial means.
Discussion: Economic and cost factors, as well as positive and
negative outcomes, of AT use are discussed in the background statement.
An applicant can propose methodological approaches to measure outcomes
and impacts that take into account both positive and negative impacts
of AT use and the acquisition of AT through various financial means and
the peer review process will evaluate the merits of the proposal.
Changes: None.
Comment: One commenter feels that the application of AT to specific
populations (such as frail elderly persons, infants and toddlers, and
their care providers) should be examined in terms of financial benefits
to individuals and care systems as well as functional outcomes for
individuals.
Discussion: NIDRR agrees with the commenter that an examination of
the application of AT to specific populations and its impact on care
systems as well as individuals is critical to the development of useful
measurement systems and this was mentioned in the background statement.
An applicant may propose to examine the financial benefits to
individuals and
[[Page 34027]]
care systems as well as functional outcomes for individuals with
disabilities and the peer review process will evaluate the merits of
the proposal.
Changes: None.
Comment: One commenter suggested that long-term outcomes need to be
addressed specifically. Preliminary research indicates that the use of
AT will delay institutionalization and, along with personal attendant
services, will maintain a person in a relatively independent state for
a given period of time. For people with significant disabilities,
including those with Alzheimer's and other dementia diseases who use
assistive devices, it may be useful and instructive to discover the
long-term effects of reliance on AT for independent living.
Discussion: NIDRR agrees that maintaining an independent life style
for as long as possible is critical for all people and that the use of
AT plays an important role in independent living. The background
statement and the priority support the commenter's contention. An
applicant may propose ways to measure the impact of AT on maintaining
independence in its application and the peer review process will
evaluate the merits of the proposal.
Changes: None.
Comment: The cost-benefit of AT on healthcare is an essential
impact question. Efforts to evaluate the appropriate use of AT and its
financial benefits to insurance providers (both public and private) are
essential. Related to this issue is the impact of managed care systems
on the appropriate provision of AT to persons with disabilities. The
positive or negative effects of this type of delivery system should be
investigated in terms of long-term health outcome, including the
reduction of time spent in healthcare institutions, for individuals
with disabilities.
Discussion: NIDRR agrees that there are a myriad of issues related
to the cost, economics, and financial benefits of AT. An applicant may
propose to investigate issues related to the cost, economics, and
financial benefits of AT and the peer review process will evaluate the
merits of the proposal.
Changes: None.
Comment: The same commenter believes that the impact of expanding
approved lists of durable medical equipment through DMERCs on
individual outcomes should also be assessed.
Discussion: Developing lists of approved durable medical equipment
through DMERCs and assessing their impact on individual outcomes is
beyond the scope of this priority.
Changes: None.
Comment: One commenter cites the need to develop methods and
standards of practice to help organizations monitor the quality of
services and outcomes.
Discussion: Developing methods and standards of practice for
organizational monitoring of quality assurance is beyond the scope of
this priority.
Changes: None.
Comment: The same commenter feels that three levels of information
must be measured; the impact of AT on the individual, the impact on the
community and how and in what context the service was delivered.
Discussion: NIDRR agrees that these are important dimensions of AT
use and addressed these factors in the background statement. An
applicant may propose ways to measure the different levels of impact of
the provision of AT on the consumer, on the community, and the context
in which the AT was provided. The peer review process will evaluate the
merits of the proposal.
Changes: None.
Priority 2: Assistive Technology Research Projects for Individuals With
Cognitive Disabilities
Comment: Four commenters suggest that an activity should be added
to the priority requiring applicants to investigate ways of making the
Internet accessible to people with cognitive disabilities.
Discussion: NIDRR agrees that access to the Internet, and
therefore, information is extremely important for persons with
cognitive disabilities. An applicant could propose to investigate ways
to make the Internet more accessible for persons with cognitive
disabilities and the peer review process will evaluate the merits of
the proposal.
Changes: None.
Priority 3: Resource Center for Community-Based Research for
Independence; Priority 4: Community-Based Research Projects on
Technology for Independence
On April 6, 2001, we published a notice of proposed priorities in
the Federal Register (66 FR 18360). The Department of Education
received 14 letters commenting on the notice of proposed priorities by
the deadline date. Many of the comments concerned both priorities,
raised multiple issues and suggestions, and overlapped with other
comments. NIDRR is responding to the comments on priority one and
priority two jointly. As a group, the comments indicated a need to
clarify the purposes and expectations for these priorities and to
explain some of the legislative and regulatory constraints under which
they were proposed. Technical and other minor changes--and suggested
changes we are not legally authorized to make under statutory
authority--are not addressed.
General Comments
Comment: Several commenters suggested that each project be required
to address a variety of different topics, such as rural areas, effects
of technology on health outcomes, 5 specific disability populations,
such as deaf individuals, caregivers, or families.
Discussion: A major purpose of this program is to address issues,
within the general area of access to appropriate technology, that are
identified as important by individuals with disabilities. This priority
is concerned generally with research on understanding potential roles
for community-based disability organizations in research on increasing
access to Assistive Technology (AT) and systems technology, and with
developing partnerships and research strategies for use by community-
based disability organizations. NIDRR elects not to further constrict
the selection of problems for study. Applicants may elect to study
issues of single disability populations or cross-disability concerns,
and may target any populations relevant to improving access to
technology, including families, caregivers, professional service
providers, product distributors, or others. It is up to the applicants
to convince the peer reviewers of the importance of the problem they
elect to address.
Changes: None.
Comment: Several commenters discussed the definition of community-
based disability organization and of consumer control. The gist of
these comments related to either: declaring certain types of
organizations (e.g., University Affiliated Programs, now named
University Centers of Excellence, or facility-based employment
programs) to be community-based organizations; restricting the
competition to consumer-directed organizations; or declaring various
types of organizations to be either eligible or ineligible for the
competition. One commenter argued that the intent to ``involve
community disability organizations'' is objectionable, and that grants
should be made only to grassroots organizations, and not universities.
Discussion: NIDRR does not have the authority to restrict
eligibility for the DRRP competition beyond that specified in the
statute. The regulations specify that any public or private
organization,
[[Page 34028]]
whether nonprofit or for-profit, institution of higher education, or
Indian tribe or tribal organization, is eligible to apply for a grant
in this program. Since the purpose of this priority is to build
research capacity in community-based disability organizations to study
problems of access to technology, NIDRR requires in the priority that
any application to be funded must include a community-based disability
organization, either as sole applicant or as a partner in the endeavor.
According to the priority, ``A community-based disability organization
is a consumer-directed disability organization * * * consumer control
is the key.'' While NIDRR regulations do not define these terms,
regulations for the Independent Living Programs, also funded under the
Rehabilitation Act, as amended, define ``consumer control'' to mean
that ``a center or eligible agency vests power and authority in
individuals with disabilities * * *'' [34 CFR 364.4 (b)]. Further,
dictionary definitions and the sense of this priority indicate that
community-based organizations are not institution-based, and that
disability organizations are those of, by, and for persons with
disabilities. It will be up to the peer reviewers in applying the
selection criteria to judge how well an application responds to the
purposes of the priority of building research capacity in community-
based disability organizations and works through community-based
disability organizations to ``* * * broaden the inclusion of persons
with disabilities in developing practical and affordable solutions to
AT and environmental access problems and needs''.
Changes: None.
Comment: Several commenters discussed standards and requirements
for AT to be developed under these grants. At the same time, other
commenters pointed out that there were many barriers to access beyond
the development of new technology.
Discussion: The priority does not address development of
technology, but rather research on improved access to technology.
Applicants could propose to develop new technology or devices if the
project met the basic purposes of building research capacity in
community-based disability organizations by addressing issues of
increasing access to technology, both individual AT and systems
(environmental access). However, NIDRR does not anticipate that
development of new technology will be the focus of all, or even any, of
these projects. Issues of improving access also include distribution,
diagnosis and prescription, funding, maintenance, training, and other
problems. Potential applicants are referred to both the NIDRR Long-
Range Plan (1999) and the Blueprint for the Millennium: An Analysis of
Regional Hearings on Assistive Technology for People with Disabilities
(1998) for discussions of the complex issues in technology access for
individuals with disabilities. It is up to the applicants to convince
the peer reviewers of the importance of the problem they elect to
address.
Changes: None.
Comment: Several commenters asked that additional NIDRR centers or
entities funded from other sources be specified as resources for
cooperation in the priority.
Discussion: The priority states, ``Coordinate with appropriate
federally-funded projects.'' The priority then provides examples of
what may be included. It is not feasible or necessary to list all
potential cooperators, and astute applicants will survey the field to
identify the most appropriate organizations for coordination to advance
the success of their proposed projects.
Changes: None.
Comment: One commenter requested a clarification of the meaning of
``environmental access'' and whether it applies only to AT, or could
include other environmental issues.
Discussion: The priority refers to AT and environmental access. The
Plan refers to technology to improve function and technology to improve
access to the built environment. Modifications to the physical and
telecommunications environments, including applications of universal
design, may include architectural modifications, signage for persons
with sensory or cognitive limitations, and public transit modifications
that enable persons with disabilities to access the broader
environment.
Changes: None.
Comment: One commenter stated that there should be a requirement
that every applicant must indicate how they are developing research
capacity among individuals with disabilities.
Discussion: NIDRR agrees that this is an important aspect of the
projects and has added language in the priority to this effect.
Changes: The language ``applicants must describe how they will
develop research capacity among individuals with disabilities at the
community level'' has been inserted as paragraph (c) in the final
section of both priorities.
Comment: One commenter noted that although dissemination of project
findings through electronic media is often effective, it would be
inappropriate to limit the dissemination of findings to electronic
media and that accessible electronic media in combination with other
accessible media should be used.
Discussion: Selection criteria for dissemination activities address
appropriateness of dissemination approaches and that such methods are
accessible to individuals with various disabilities.
Changes: None.
Disability and Rehabilitation Research Projects and Centers Program
The authority for Disability and Rehabilitation Research Projects
(DRRP) is contained in section 204 of the Rehabilitation Act of 1973,
as amended (29 U.S.C. 762(g) and 764(b)). The purpose of the DRRP
program is to plan and conduct research, demonstration projects,
training, and related activities to--
(a) Develop methods, procedures, and rehabilitation technology that
maximizes the full inclusion and integration into society, employment,
independent living, family support, and economic and social self-
sufficiency of individuals with disabilities; and
(b) Improve the effectiveness of services authorized under the Act.
Priority 1: Assistive Technology Outcomes and Impacts
Background
One of the greatest challenges facing health care systems, social
services providers and policymakers is to ensure that scarce resources
are used efficiently. To a large extent, this challenge explains the
growing interest in outcomes research and evidence-based medicine.
Particular interest in outcomes of assistive technology (AT) is
related to the amount of dollars spent on developing and manufacturing
AT, AT service delivery and to the need to improve the functional
independence and well-being of persons with disabilities of all ages.
Yet, assessment of the impact of technology on function and other
productivity and quality of life outcomes lags behind outcomes
measurement in other areas of rehabilitation.
There are several factors that promote concern about the paucity of
outcomes research in AT including the: (a) Ability to demonstrate
efficacy of new devices; (b) need to examine effectiveness of devices
over time; and (c) need to chart future research and development to
improve devices (Fuhrer, M. J., ``Assistive technology outcomes
[[Page 34029]]
research: challenges met and yet unmet,'' American Journal of Physical
Medicine and Rehabilitation, 2001, In press). Outcomes research and
analysis is also needed to guide decisionmaking across multiple levels
of policy and program development, including: (a) Decisions on a
societal level regarding types of public programs and services to fund;
(b) decisions on a programmatic level regarding what services to
continue, enhance, modify or eliminate; (c) decisions on an individual
level regarding AT recommendations and interventions; and (d) decisions
on a research level regarding the comparative effectiveness of
individual devices and the impact on future designs (Smith, R.,
``Measuring the outcomes of assistive technology: challenge and
innovation'', Assistive Technology, Vol. 8, No. 2, pgs. 71-81, 1996).
In the face of a growing interest in outcomes, the inconsistent use
of terminology contributes to the confusion that exists in the
application of a generally accepted outcomes approach. In the field of
rehabilitation, outcomes measurement has focused on creating outcomes
management systems and measuring and communicating outcomes.
Rehabilitation has led the health care field in its emphasis on changes
in function as an outcomes measure. Still, even in rehabilitation,
outcomes measurement systems have typically focused on process
variables, i.e., the outputs of products and services, and not on gains
to the individual or society in either the short or long term.
Wilkerson posits that this emphasis on process will change because of
three factors: (a) The pressure to cut costs; (b) growth of consumerism
leading to increased input from users and increased focus on the needs
of the end user; and (c) concerns about quality in relation to costs
(Wilkerson, D., ``Outcomes and accreditation--The paradigm is shifting
toward outcome,'' Rehab Management, August/September, pgs. 112-115,
1997).
Outcomes research is defined in different ways across
rehabilitation and health services research as well as in the social
services field. The Foundation for Health Services Research (Foundation
for Health Services Research, Health Outcomes Research: A Primer,
Washington, DC, 1994) characterized outcomes research as research
focused on the ``end results of medical care--the effect of the health
care process on the health and well-being of patients and
populations.'' The Institute of Medicine (IOM) (Feasley, J.C., ed.,
Health Outcomes for Older People: Questions for the Coming Decade,
Washington, DC: National Academy Press, 1996) expanded this definition
to include ``the clinical signs and symptoms, well-being or mental and
emotional functioning; physical, cognitive, and social functioning;
satisfaction with care; health-related quality of life, and costs and
appropriate use of resources.'' Outcomes research has also been defined
as research designed to discover the sustained impact of rehabilitative
strategies and treatments in the everyday lives of persons with
disabilities. ``Outcomes research attempts to build a bridge between
interventions and long-term improvements in the lives of persons served
as they reenter the community'' (Johnston, M., et al., ``Outcomes
research in medical rehabilitation--foundations from the past and
directions for the future,'' Assessing Medical Rehabilitation
Practices: The Promise of Outcomes Research, Marcus J. Fuhrer, ed.,
pgs. 1-42, 1997). Regardless of how it is defined, outcomes research is
part of the larger framework of program evaluation (Fuhrer, op. cit.,
1997), and includes both outcomes analysis and outcomes measurement
also known as performance measurement (Jennings, B.M. and Staggers, N.,
The language of outcomes, Journal of Rehabilitation Outcomes
Measurement, Vol. 3, No. 1, pgs. 59-64, 1999).
Rehabilitation outcomes are changes produced by rehabilitation
services in the lives of service recipients and their environments.
Outcome indicators are measures of the amount and frequency of those
occurrences, and include service quality. Within this perspective, some
analysts use the word ``impacts'' to distinguish between long-term
outcomes or end results that occur on a societal versus an individual
level. Still others use the term ``impact'' more strictly to refer to
estimates of the extent to which the program actually ``caused''
particular outcomes (Hatry, H., et al., Customer Surveys for agency
managers: What Managers Need to Know, Washington, DC: Urban Institute,
1998). Deconstructing these various definitions and types of outcomes
and impacts requires recognition of complexity on many levels.
Although AT has grown as a discipline and as an industry over the
past two decades, there has not been a corresponding maturity in
developing or assessing the outcomes or impacts of AT upon individuals
with disabilities. AT devices and services outcomes also may be
difficult to define because of the ways AT is used. For example, AT is
used to increase participation in the environment, enhance normative
social roles, promote and sustain employment, and facilitate activities
of daily living. Some devices, such as computers, increase access to
information and support life long learning. AT devices vary
significantly from highly complex and sophisticated computer-operated
systems to low tech approaches that can be easily purchased or built.
Complicating the issue even further are the individual characteristics
of the AT user and the varied environments in which users live, work,
and learn.
Approximately one-third of AT devices will be abandoned by the user
(Phillips, B. and Zhao, H. ``Predictors of assistive technology
abandonment'', Assistive Technology, Vol. 5, pgs. 36-45, 1995). There
are many reasons why individuals with disabilities choose to accept or
reject AT devices. Since public funds provide a major source for
purchasing AT devices and services, useful and accurate measures of
outcomes and impacts is critical for accountability and to avoid
wasteful outcomes. Is abandonment a negative or could it be a positive
outcome? Abandonment has been viewed as the end result of fragmented
service provision, poor assessment techniques, lack of consumer choice
in device selection, inattention to device use across environments,
inadequate training, costly repairs, need to upgrade and obsolete or
inappropriate technology. However, abandonment may be a natural
phenomenon related to improved physical or cognitive function, the
result of a technology upgrade or because different technology is a
better fit between the end-user and the environment.
There are other reasons to account for the lack of momentum in
measurement development and outcomes and impact research on AT. Most of
the endorsements of a particular device or service are based on
anecdotal information (Fuhrer, 1999) rather than data generated from
research. Frank DeRuyter (``Evaluating outcomes in assistive
technology: do we understand the commitment,'' Assistive Technology,
Vol. 7, No. 1, pgs. 3-16, 1995), observed that historically, AT was
considered a remedy to impairment or dysfunction, and the urgency of
consumer need was of greater importance than relying upon data to
document the efficacy of a particular device. In addition, quality was
perceived as too abstract and difficult to measure and define. Vendors
and practitioners may feel threatened by potential findings and
accountability demands, which may also have contributed to the lack of
outcomes studies (DeRuyter, op. cit., 1995).
While the AT arena is complex and broad, several outcomes studies
have
[[Page 34030]]
focused on a discrete segment of the entire system. Smith says that
there are essentially two domains of outcome measurement: the
performance of an individual using assistive technology and the cost of
achieving the level of performance (Smith, R. O., ``Accountability in
assistive technology interventions: measuring outcomes,'' Volume I--
RESNA Resource Guide of Assistive Technology Outcomes: Measurement
Tools, pgs. 15-43, 1998). Minkel proposed that the primary measure to
determine the value of the assistive technology is the basic formula of
outcomes divided by cost (Minkel, J., ``Assistive technology and
outcomes measurement: Where do we begin?'' Technology and Disability,
July, pgs. 285-288, 1996). There are others within the AT community who
operate under the assumption that improvements and innovation in
technology will ``naturally'' lead to successful use and
implementation, and therefore do not need to be evaluated. From this
perspective, technological solutions have been viewed as a panacea
without the benefit of data to support prevailing assumptions
(DeRuyter, F., ``Concepts and rationale for accountability in assistive
technology,'' Volume I--RESNA Resource Guide of Assistive Technology
Outcomes: Measurement Tools, pgs. 2-15, 1998).
At a minimum, the process of evaluating AT outcomes must measure
and establish a baseline of what works, identify how well and for whom
it works, and at what level of economy and efficiency. This process
will necessitate taking information from several performance monitoring
dimensions (De Ruyter, op. cit., 1998). In approaching the challenges
of AT outcomes measurement, it is important to identify if the outcomes
relate to the AT product or service, the user, or to the environment in
which the technology is being used. While not standardized or widely
endorsed, a variety of measurement techniques and instruments are
currently utilized. These measurement tools tend to be specific to a
given practice area or limited to a functional domain, (Volume I:
RESNA--Resource Guide for Assistive Technology Outcomes: Measurement
Tools, 1998).
To proceed with assessing AT outcomes and impacts, the following
questions need to be addressed. First, what are the key gaps and
weaknesses in our knowledge of AT use and its impacts? Are the key
research questions related to a particular intervention at a particular
point in time? How do device modifications and upgrades change the
intervention? How do characteristics of the population including
severity of impairment, duration of disability, presence of co-
morbidities, aging and other sociodemographic factors influence
technology utilization and bias outcomes study? What is the role of
environmental, economic, awareness and training barriers in AT use and
outcomes? These different levels of outcomes can look at impacts and
effects of technology at one point in time, more typically a clinical
or functional outcome, or can be examined in terms of long-term impacts
on individual quality of life, productivity and social participation.
As one researcher expressed it, in addition to longitudinal studies,
``the research agenda must consider lifelong use of assistive
technology, documenting effectiveness of that technology as an
intervention, identifying stages for reconsideration of its use, and
defining environmental and social considerations'' (Turk, M. A.,
``Early development-related condition,'' Assessing Medical
Rehabilitation Practices--The Promise of Outcomes Research, Marcus J.
Fuhrer, ed., pgs. 367-392, 1997).
Innovations in AT will continue to evolve and many AT users, as
they have in the recent past, will experience increases in
independence, function, and general well being. Concurrently, the gap
between the promise of technology and the ability of individuals and
funding sources to afford them will continue to widen. This will result
in a greater need for knowledge about the cost-effectiveness and
efficiency of particular devices and services (Fuhrer, M.J.,
``Assistive technology outcomes research: challenges met and yet
unmet,'' American Journal of Physical Medicine and Rehabilitation,
2001, In press).
Priority 1
We will establish multiple research projects on AT outcomes and
impacts to determine the efficacy and utility of AT and the
implications for abandonment of AT devices. In carrying out these
purposes, the projects must:
(a) Assess the current status of AT outcomes and impacts
measurement systems and approaches, identifying measurement
methodologies, characteristics of key instruments including utility to
AT field, and critical gaps in measurement;
(b) Based upon the findings of paragraph (a), evaluate efficacy of
existing measurement instruments or develop and evaluate new outcomes
and impacts measurement methodologies to meet the needs of AT
stakeholders; and
(c) Investigate and analyze the complexity of factors contributing
to the abandonment of AT, including age-related changes, and identify
how these factors are incorporated into outcomes and impacts
measurement instruments.
In addition to activities proposed by the applicants to carry out
these purposes, each project must:
Develop and disseminate to AT stakeholders and other
interested and relevant audiences, as determined by NIDRR, materials on
AT outcomes studies and impacts analyses and, periodic updates on the
project's milestones, products and results; and
Collaborate with relevant NIDRR-sponsored projects, such
as the AT/IT Consumer Survey (University of Michigan), the RESNA
Technical Assistance projects, and the RRTC on Medical Rehabilitation
Outcomes, as identified through consultation with the NIDRR Project
Officer.
Priority 2: Assistive Technology Research Projects for Individuals
With Cognitive Disabilities
Background
Technology and assistive devices have commonly been used to assist
persons with mobility, communication and sensory difficulties. Because
of the positive impact that technology has played in the lives of these
individuals, there is now a strong push toward the development of such
devices for people with cognitive disabilities. The Assistive
Technology Act of 1998 defines an AT device to be any item, piece of
equipment or product system whether acquired commercially off the
shelf, modified or customized that is used to increase, maintain or
improve functional capabilities of individuals with disabilities. Rapid
advances in technology provide great potential for development of new
devices or adaptation of available devices to assist individuals with
cognitive disabilities to develop and maintain skills.
Technology professionals, such as computer scientists and
rehabilitation engineers, have limited experience applying AT solutions
to users with cognitive disabilities. Nor do they yet understand the
mapping between specific needs and equally specific design solutions.
Most people with cognitive disabilities have a range of learning and
processing capabilities. Wide variations in cognitive functioning make
it difficult to develop generic solutions appropriate for all
individuals. Functional capabilities associated with these disabilities
may include wide ranges of ability in memory, reasoning, and language
comprehension. Cognitive
[[Page 34031]]
functioning also includes perception, problem-solving, conceptualizing,
reading, thinking and sequencing (Electronic and Information Technology
Access Advisory Committee, ``EITAAC Report, May 13, 1999,'' A Report to
the Architectural and Transportation Barriers Compliance Board). Common
strategies to improve functioning in activities of daily living across
various cognitive disabilities need to be identified, as do, issues
regarding information processing that may be unique to each of these
groups.
Persons with cognitive disabilities often have difficulty in
carrying out Instrumental Activities of Daily Living (IADLs) because of
problems with time management and information retrieval. Researchers
are experimenting with the use of electronic personal computers to
compensate for memory problems. Other researchers are examining methods
of matching individual cognitive problems with compensatory strategies
provided by a variety of commercially available portable electronic
devices. In traumatic brain injury treatment, researchers are
investigating the use of virtual reality technology to test visual
acuity and reaction times to stimulus. Research is also being conducted
on the use of text-based messages to enhance communication.
Technology is often viewed as facilitating employment of persons
with disabilities. However, inaccessible technology can be a barrier to
all persons with disabilities. This is particularly true for persons
with cognitive impairments who may have difficulty using telephones,
computers, and other equipment that are staples of most work
environments. Developers and manufacturers of AT often do not consider
issues of cognitive access and flexibility when designing their
products.
While the congruence between the promise of AT and the needs of
many people attempting to achieve community integration is obvious,
little has been written about the manner in which technology affects
community adaptation or the service needs of individuals with cognitive
disabilities in community settings. While specific manifestations of AT
have identifiable benefits, the central question needs to be
empirically addressed--how can assistive technologies contribute to
community integration and in what manner can the linkage be
facilitated? The state of knowledge about the use of AT for persons
with cognitive disabilities, as well as the outcomes of that use or
lack of use and the cost-effectiveness in achieving community
integration is limited. There are only a few large assessments of the
technology needs of persons with cognitive disabilities and results are
ambiguous because of difficulties in identifying persons with low
incidence conditions and specific technology needs within the study
population (Lakin, C. et al., NIDRR Long-Range Plan Commissioned Paper
on Community Integration, 1996).
In order to take advantage of any potential that technological
advances may have, it is important to define what makes a device easier
or more difficult for a person with a cognitive disability to use.
Products that are simpler and require fewer cognitive skills are easier
to operate for everyone (Vanderheiden, G., 1992, ``A brief look at
technology and mental retardation in the 21st century,'' in Mental
Retardation in the Year 2000, Louis Rowitz, ed., New York: Springer-
Verlag). ``Design guidelines'' must then be communicated to the
manufacturers of consumer products and business information systems.
Instructions for training on the use and maintenance of the device also
need to be part of this design process. It is important for designers
to be aware of the real world tasks with which the user has difficulty;
hence, research needs to include persons with cognitive disabilities at
the front end of all technology development. End product affordability
is important not only in meeting consumer needs, but also in creating
the market demand that will encourage manufacturers to enter
production.
The NIDRR Long-Range Plan discusses three objectives in developing
technology to meet the needs of people with limitations in cognitive
functioning: to assure that new technologies are accessible and do not
exacerbate exclusion from mainstream activities; to assist people with
cognitive limitations in the performance of daily activities; and to
develop technologies that can enhance or restore some cognitive
functions (NIDRR, Long-Range Plan: 1999-2003, pg. 57).
The University of Colorado recently accepted a gift of $250
million. The endowment will fund advanced research and development of
innovative technologies to enhance the lives of people with cognitive
disabilities. The endowment, to be paid over five years, will be used
to establish the Coleman Institute for Cognitive Disabilities located
at the University of Colorado. Applicants for this project should
provide information on proposed coordination with the Coleman
Institute.
Priority 2
We will establish multiple research projects on technology access
for persons with cognitive disabilities leading to practical and
affordable solutions to identified community and workplace needs of
this population. The projects must:
(a) Conduct an assessment of state-of-the-art technology
applications for persons with cognitive disabilities;
(b) Based on the assessment results of paragraph (a), identify
technology gaps and needs for persons with cognitive disabilities and
make recommendations for new technology and modifications to existing
technology;
(c) Identify features that may be incorporated into existing,
commercially available technology that could benefit persons with
cognitive disabilities; and
(d) Develop and explore strategies for strengthening partnerships
with developers and manufacturers of devices in order to facilitate the
development of new technologies and applications to incorporate
cognitive access.
In addition to the activities proposed by the applicants to carry
out these purposes, the projects must:
Coordinate with the appropriate Federal agencies and
privately-funded projects, such as the University of Colorado's Coleman
Institute for Cognitive Disabilities, that are relevant to the
applicants proposed activities as identified through consultation with
the NIDRR project officer; and
Involve individuals with cognitive disabilities in all
aspects of the project.
Priorities for Community-Based Rehabilitation Projects on
Technology for Independence
Background on Issues in Involvement of Community-Based Organizations of
People With Disabilities in Promoting Technology for Independence
As stated in the Plan, ``It is the mission of NIDRR to generate,
disseminate, and promote the full use of new knowledge that will
improve substantially the options for disabled individuals to perform
regular activities in the community, and the capacity of society to
provide full opportunities and appropriate supports for its disabled
citizens.'' Assistive Technology (AT) and environmental access play key
roles in this mission. The Plan provides detailed definitions,
examples, and research objectives for AT and environmental access,
including universal design.
According to a National Center for Health Statistics report titled
``Trends
[[Page 34032]]
and Differential Use of Assistive Technology Devices: United States,
1994,'' approximately 17 million people used at least one AT device. AT
and related environmental access approaches (environmental access
approaches include the concept of universal design) help people with
disabilities function on a more equal basis in society. For more
information on the contributions of AT and access solutions, see the
examples and links to relevant web sites provided by the United States
Architectural and Transportation Barriers Compliance Board, also known
as the Access Board (http://www.access-board.gov/), and the Doorway to
Research on Technology for Access and Function at the National Center
for the Dissemination of Disability Research (NCDDR) (http://
www.ncddr.org/rpp/techaf/index.html).
The new paradigm of disability embodied in the Plan requires
analysis of the extent to which AT and environmental access helps
individuals with disabilities in attaining full participation in
society. Much of NIDRR's work reflects the components of the
Independent Living (IL) philosophy: consumer control, self-help,
advocacy, peer relationships and peer role models, and equal access to
society, programs, and activities. IL and achieving community
integration to the maximum extent possible are issues at the crux of
NIDRR's mission. Furthermore, NIDRR is committed to the creation of a
theoretical framework with measurable outcomes that is based upon the
experiences of individuals with disabilities.
To improve ``end-user'' participation in addressing AT problems,
and related environmental access solutions, NIDRR will support projects
that involve community-based organizations in researching AT related
problems and needs. Two types of projects will be supported. The first
type includes research projects that will investigate the use of, and
need for, AT devices and services at the community level. The second
type of project is a community-based research ``Resource Center'' that
will develop, evaluate, and disseminate improved research and training
methods appropriate to AT and environmental access involvement of
community-based disability organizations. The Resource Center will also
provide AT and environmental access technical assistance to community-
based organizations and will foster cooperation among the funded
projects. These community-based research projects will broaden the
inclusion of persons with disabilities in developing practical and
affordable solutions to AT and environmental access problems and needs.
In recent years, a number of NIDRR grant competitions have led to
research projects and activities that aim at improving access to AT and
reducing environmental barriers. For many years, NIDRR funded grants to
States under the Technology-Related Assistance for Individuals with
Disabilities Act of 1988 (Tech Act). In addition to research programs
under title II of the Rehabilitation Act of 1973, as amended (29 U.S.C.
796) (the Rehabilitation Act), NIDRR now has responsibility for AT
programs under the Assistive Technology Act of 1998 (AT Act), which
replaced the Tech Act. A June 5, 2000 notice (65 FR 35768-35774) for a
new Alternative Financing Program under title III of the AT Act
identified numerous issues affecting access of people with disabilities
to AT. An April 5, 1999 notice (64 FR 16531) under NIDRR's
Rehabilitation Engineering Research Center (RERC) program discussed the
importance of improving access to the environment through universal
design. For information on ongoing and completed NIDRR-supported
activities in these areas, contact the National Rehabilitation
Information Center at or telephone 1-800-346-2742.
This year, NIDRR anticipates awarding a number of projects related
to AT and environmental access. For updates on the status of
announcements please see the Education Department Forecast of Funding
Opportunities under Department of Education Discretionary Grant
Programs for FY 2001 at: http://ocfo.ed.gov/grntinfo/forecast/
forecast.htm
According to the Rehabilitation Act, the purpose of IL programs is
``to promote a philosophy of consumer control, peer support, self-help,
self-determination, equal access, and individual empowerment, equal
access, and system advocacy, in order to maximize the leadership,
empowerment, independence, and productivity of individuals with
disabilities, and the integration and full inclusion of individuals
with disabilities into the mainstream of American society.'' The
concepts in this philosophy of consumer control, peer support, and
self-help place these title VII independent living centers (CILs)
within a broader world-wide grouping known as ``community-based''
organizations.
The term ``community-based'' organization has varying meanings in
disability and rehabilitation programs and in social research. For the
purpose of these two priorities, a ``community-based disability
organization'' is a consumer-directed community organization such as a
CIL. Consumer control is the key. Some community rehabilitation service
organizations, for example psychosocial rehabilitation programs, also
value consumer direction. Other disability-related organizations are
located in community settings, but do not have significant consumer
direction. Section 7 of the Rehabilitation Act, for example, identifies
community rehabilitation programs as providers of AT devices and
services for persons with disabilities, but such organizations may or
may not be consumer directed. Organizations with consumer direction,
including CILs and other organizations such as protection and advocacy
(P&A) agencies, are in a unique position to help identify and study the
specific needs for AT and environmental access of individuals from
diverse populations and therefore are the focus of this research
effort.
A number of private foundations and international agencies have
identified the value of investing in ``grassroots'', consumer-directed
organizations, particularly in public health and economic development.
These organizations aim at reducing poverty or specific diseases such
as HIV/AIDS, or they provide assistance to special needs groups such as
people in troubled urban and rural areas (see the World Wide Web sites
or publications of the Pew Fund for Health and Human Services http://
www.pewtrusts.com/, the World Health Organization http://www.who.int/,
and the Robert Wood Johnson Foundation http://www.rwjf/org/index.jsp
for examples).
Community-based research encompasses a broad set of research
activities with differing, and sometimes competing, concepts and
methods. Sociology, anthropology, community psychology and public
health, for example, use applied community research methods. For the
purpose of these two proposed priorities, community-based research is
intensive, systematic study directed toward new or full scientific
knowledge or understanding of AT or environmental access problems. In
addition, the research must be completed in the community under the
direction of community-based disability organizations (Sclove, R.E,
Scammell, M.L. & Holland, B. (1998). Community-based Research in the
U.S. Amherst, MA: The Loka Institute (http://www.loka.org/)).
Community-based disability and rehabilitation research puts primary
emphasis on assisting persons with
[[Page 34033]]
disabilities by producing and disseminating knowledge and technology
and promoting and advancing the rehabilitation and integration process
at the community level. Community-based disability and rehabilitation
research, according to these two priorities, applies to the use of, or
need for, AT devices and services by persons with disabilities in the
community, and related issues of environmental access. Such research
should be performed by qualified researchers in cooperation with
community-based disability organizations. NIDRR supports the notion
that persons with disabilities provide unique perspectives about living
with disability and must be included in community-based research
projects to the greatest possible extent. Their experience with, and
interest in, finding practical solutions to problems encountered in
home, school, place of work, and community make them informed
participants, if not particularly qualified researchers. To ensure that
technology-related problems relevant to persons with disabilities are
studied, contributions from such persons are encouraged. In addition,
university-based research on disability needs to be complemented by
community-based research to provide the community with useful and
immediate tools, technologies, and knowledge for overcoming barriers to
access and participation in economy and society.
Community-based rehabilitation research is particularly suited for
persons with disabilities. According to the University of Washington
School of Public Health and Community Medicine's Principles of
Community-Based Research, a research partnership between a university
and community-based organizations should accomplish the following:
Community partners should be involved at the earliest
stages of the project, helping to define research objectives and having
input into how the project will be organized.
Community partners should have real influence on project
direction--that is, enough leverage to ensure that the original goals,
mission, and methods of the project are observed.
Research processes and outcomes should benefit the
community. Community members should be hired and trained whenever
possible and appropriate, and the research should help build and
enhance community assets.
Community members should be part of the analysis and
interpretation of data and should have input into how the results are
distributed. This does not imply censorship of data or of publication,
but rather the opportunity to make clear the community's views about
the interpretation prior to final publication.
Productive partnerships between researchers and community
members should be encouraged to last beyond the life of the project.
This will make it more likely that research findings will be
incorporated into ongoing community programs and therefore provide the
greatest possible benefit to the community from research.
Community members should be empowered to initiate their
own research projects that address needs they identify themselves.
Priority 3: Resource Center for Community-Based Disability and
Rehabilitation Research Projects on Technology for Independence
There is a need for capacity-building on conceptual and
methodological approaches to research on the involvement of community-
based organizations of people with disabilities in promoting technology
for independence. There is need for training, technical assistance, and
dissemination efforts to guide ongoing efforts. Advice and strategies
are needed in specific areas including, but not limited to, research
designs and methodologies, case studies, focus group research, AT and
environmental assessment, small sample surveys, participant
observation, ethnography, and participatory action research. There is a
need to develop ``how-to-do'' materials on disability-related AT and
environmental access community-based research, reference resources,
web-based access to materials, and other means of communicating
knowledge about community-based rehabilitation research in the U.S.
Priority 3
We will establish a resource center to assist Disability and
Rehabilitation Research Projects on Technology for Independence and
other related NIDRR activities under the Plan with capacity-building
for improving the involvement of community-based organizations of
people with disabilities in promoting technology for independence.
In carrying out these purposes, the project must:
(a) Establish and conduct a significant and substantial resource
program on capacity-building in research, training, and TA on the
involvement of community-based disability organizations in promoting
technology for access and function that will contribute to the
advancement of knowledge in accordance with the Plan.
(b) Disseminate findings from the Resource Center's program on
community-based research to DRRPs on Technology for Independence and
other related NIDRR-funded activities under the Plan; and
(c) Describe how the resource center will develop research capacity
among individuals with disabilities at the community level.
In addition to the activities proposed by the applicant to carry
out these purposes, the Resource Center must:
Involve individuals with disabilities and, if appropriate,
their representatives, in planning and implementing the research,
training, and dissemination activities, and in evaluating the Center;
Coordinate with appropriate federally funded projects.
Coordination responsibilities will be identified through consultation
with the NIDRR project officer and may include outreach to specific
NIDRR DRRPs, RERCs, RRTCs, DBTACs and AT Projects; Office of Special
Education technology projects and Parent Training and Information
Centers; and Rehabilitation Services Administration training, special
demonstration, and IL projects;
Convene a formative review session within six months of
project award with the DRRPs on Technology for Independence to assist
these community-based rehabilitation researchers in the finalization of
their research plans, and to help them with the commencement of their
research projects; and
Conduct a state-of-the-science conference, including the
DRRPs on Technology for Independence, in the third year of the grant
and publish a comprehensive report on the final outcomes of the
conference in the fourth year of the grant.
Priority 4: Community-Based Disability and Rehabilitation Research
Projects on Technology for Independence
The Plan identifies disability in terms of the relationship between
the individual and the natural, built, cultural, and social
environments (63 FR 57189-57219). The Plan focuses on both individual
and systemic factors that have an impact on the ability of people to
function. The elements of the Plan include employment outcomes, health
and function, technology for access and function, and IL and community
integration. To attain the goals in these areas, the Plan also includes
capacity building for research and training, and to ensure knowledge
dissemination and utilization. Each area
[[Page 34034]]
of the Plan includes objectives at both the individual and system
levels. For example, the technology for access and function area of the
Plan includes research objectives to develop AT that supports people
with disabilities to function and live independently and obtain better
employment outcomes, and research objectives to promote improved access
to the built environment and concepts of universal design. It is clear
that the challenges and opportunities for AT and improved environmental
access reflect all of the priority areas of the Plan.
Priority 4
We will establish research projects to involve community-based
disability organizations in AT and environmental access research
leading to practical and affordable solutions to identified problems
and needs, and building research capacity at the community level and in
community-based organizations serving persons with disabilities.
In carrying out these purposes, a project must:
(a) From the examples of research objectives below, conduct a
significant and substantial research program on the involvement of
community-based disability organizations in promoting technology for
access and function that will contribute to the advancement of
knowledge in accordance with the Plan by:
Investigating and developing research questions,
methodologies, and recommendations for use by other research entities
in solving technology-related, engineering, psychosocial, economic and
other problems at the individual and systems levels, in the United
States (U.S.); and
Designing and testing models for partnership of community-
based disability organizations in research, participant observation
studies and other qualitative and quantitative research approaches to
using technology in community-based settings;
(b) Disseminate findings from community-based research to persons
with disabilities, their representatives, disability and rehabilitation
service providers, researchers, planners, and policy makers; and
(c) Describe how the applicant will develop research capacity among
individuals with disabilities at the community level.
In carrying out these purposes, the project must:
Coordinate with appropriate federally funded projects.
Coordination responsibilities will be identified through consultation
with the NIDRR project officer and may include outreach to specific
NIDRR DRRPs, RERCs, Rehabilitation Research and Training Centers
(RRTCs), Disability Business Technical Assistance Centers (DBTACs) and
AT Projects; Office of Special Education technology projects and Parent
Training and Information Centers; and Rehabilitation Services
Administration training, special demonstration, and IL projects.
Involve individuals with disabilities in key decision-
making.
Participate in a formative review session to be convened
by the Resource Center within six months of award, and cooperate with
the Resource Center's capacity-building and evaluation activities.
Participate in a state-of-the-science conference in the
third year of the grant.
Selection Criteria
The selection criteria to be used for these competitions will be
provided in the application package for each competition.
Applicable Program Regulations: 34 CFR part 350.
Electronic Access to This Document
You may view this document, as well as all other Department of
Education documents published in the Federal Register, in text or Adobe
Portable Document Format (PDF) on the Internet at the following site:
www.ed.gov/legislation/FedRegister
To use PDF you must have Adobe Acrobat Reader, which is available
free at this site. If you have questions about using PDF, call the U.S.
Government Printing Office (GPO), toll free, at 1-888-293-6498; or in
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Note: The official version of the document is published in the
Federal Register. Free Internet access to the official edition of
the Federal Register and the Code of Federal Regulations is
available on GPO Access at: http://www.access.gpo.gov/nara/
index.html
(Catalog of Federal Domestic Assistance Numbers 84.133A, Disability
Rehabilitation Research Project)
Program Authority: 29 U.S.C. 762(g) and 764(b).
Dated: June 20, 2001.
Francis V. Corrigan,
Deputy Director, National Institute on Disability and Rehabilitation
Research.
[FR Doc. 01-15959 Filed 6-25-01; 8:45 am]
BILLING CODE 4000-01-P