[Federal Register: April 21, 1997 (Volume 62, Number 76)]
[Page 19431-19439]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[[Page 19431]]


Part IV

Department of Education

National Institute on Disability and Rehabilitation Research; Notice

[[Page 19432]]


National Institute on Disability and Rehabilitation Research

AGENCY: Department of Education.

ACTION: Notice of Proposed Priorities for Fiscal Years 1997-1998 for 
Rehabilitation Research and a Knowledge Dissemination and Utilization 


SUMMARY: The Secretary proposes priorities for the Rehabilitation 
Research and Training Center (RRTC) Program and the Knowledge 
Dissemination and Utilization (D&U) Program under the National 
Institute on Disability and Rehabilitation Research (NIDRR) for fiscal 
years 1997-1998. The Secretary takes this action to focus research 
attention on areas of national need to improve rehabilitation services 
and outcomes for individuals with disabilities, and to assist in the 
solutions to problems encountered by individuals with disabilities in 
their daily activities.

DATES: Comments must be received on or before May 21,1997.

ADDRESSES: All comments concerning these proposed priorities should be 
addressed to David Esquith, U.S. Department of Education, 600 
Independence Avenue, SW., Switzer Building, Room 3424, Washington, DC 
20202-2601. Internet: NPP__D&U@ed.gov

FOR FURTHER INFORMATION CONTACT: David Esquith. Telephone: (202) 205-
8801. Individuals who use a telecommunications device for the deaf 
(TDD) may call the TDD number at (202) 205-2742. Internet: 

SUPPLEMENTARY INFORMATION: This notice contains proposed priorities to 
establish RRTCs for research related to persons who are late-deafened 
or hard-of-hearing, substance abuse, rural rehabilitation, and medical 
rehabilitation services and outcomes. In addition there is a D&U 
project on parenting.
    These proposed priorities support the National Education Goal that 
calls for all Americans to possess the knowledge and skills necessary 
to compete in a global economy and exercise the rights and 
responsibilities of citizenship.
    The Secretary will announce the final funding priorities in a 
notice in the Federal Register. The final priorities will be determined 
by responses to this notice, available funds, and other considerations 
of the Department. Funding of particular projects depends on the final 
priorities, the availability of funds, and the quality of the 
applications received. The publication of these proposed priorities 
does not preclude the Secretary from proposing additional priorities, 
nor does it limit the Secretary to funding only these priorities, 
subject to meeting applicable rulemaking requirements.

    Note: This notice of proposed priorities does not solicit 
applications. A notice inviting applications under these 
competitions will be published in the Federal Register concurrent 
with or following publication of the notice of the final priorities.

Rehabilitation Research and Training Centers (RRTCs)

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

Description of the Rehabilitation Research and Training Center 

    RRTCs are operated in collaboration with institutions of higher 
education or providers of rehabilitation services or other appropriate 
services. RRTCs serve as centers of national excellence and national or 
regional resources for providers and individuals with disabilities and 
the parents, family members, guardians, advocates or authorized 
representatives of the individuals.
    RRTCs conduct coordinated and advanced programs of research in 
rehabilitation targeted toward the production of new knowledge to 
improve rehabilitation methodology and service delivery systems, 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 in-service training, for rehabilitation research 
personnel and other rehabilitation personnel.
    RRTCs serve as informational and technical assistance resources to 
providers, individuals with disabilities, and the parents, family 
members, guardians, advocates, or authorized representatives of these 
individuals through conferences, workshops, public education programs, 
in-service training programs and similar activities.
    NIDRR encourages all Centers to involve individuals with 
disabilities and minorities as recipients in research training, as well 
as clinical training.
    Applicants have considerable latitude in proposing the specific 
research and related projects they will undertake to achieve the 
designated outcomes; however, the regulatory selection criteria for the 
program (34 CFR 352.31) state that the Secretary reviews the extent to 
which applicants justify their choice of research projects in terms of 
the relevance to the priority and to the needs of individuals with 
disabilities. The Secretary also reviews the extent to which applicants 
present a scientific methodology that includes reasonable hypotheses, 
methods of data collection and analysis, and a means to evaluate the 
extent to which project objectives have been achieved.
    The Department is particularly interested in ensuring that the 
expenditure of public funds is justified by the execution of intended 
activities and the advancement of knowledge and, thus, has built this 
accountability into the selection criteria. Not later than three years 
after the establishment of any RRTC, NIDRR will conduct one or more 
reviews of the activities and achievements of the Center. In accordance 
with the provisions of 34 CFR 75.253(a), continued funding depends at 
all times on satisfactory performance and accomplishment.


    The Secretary proposes that the following requirements will apply 
to these RRTCs pursuant to the priorities unless noted otherwise:

[[Page 19433]]

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


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

Proposed Priority 1: Maintaining the Employment Status and Addressing 
the Personal Adjustment Needs of Individuals Who Are Late-Deafened or 

    Individuals whose hearing is impaired, but who can understand 
conversational speech with, or without, amplification are hard-of-
hearing (HOH). Adults who are late-deafened (L-D) become deaf after 
having experienced hearing as well as speech and language development. 
Adults who are late-onset HOH and those who are L-D have common and 
different employment-related and personal adjustment needs. A third 
group of persons who are considered hearing-impaired are those persons 
who are prelingually deaf. Because the prelingually deaf have been and 
continue to be the focus of other NIDRR-funded research, this proposed 
priority is for research that addresses the needs of adults who are L-D 
or late-onset HOH.
    According to data from the Bureau of the Census, the number of 
individuals who have a functional limitation in hearing normal 
conversation is approximately 10.9 million (McNeil, J., ``Americans 
with Disabilities: 1991-1992,'' Household Economic Studies, P70-33, 
December 1993). The National Center for Health Statistics (NCHS) 
estimates the number of persons who are HOH ranges from 20 million to 
22 million (``National Health Survey,'' Series 10, No. 188, 1994). The 
NCHS studies use the ``Gallaudet Hearing Scale'' which is self-
reporting and quantifies the amount of interference with hearing in 
ordinary day-to-day situations. According to the Association of Late-
Deafened Adults, the number of persons who are L-D is estimated to be 
between 800,000 and 1.5 million. For 1991 and 1992, of all persons 21 
to 64 years old who had some functional limitation hearing normal 
conversation, 3,335,000 individuals or 63.6 percent were employed, 
while 189,000 individuals, or 58.2 percent of those who were totally 
unable to hear normal conversation, were employed (McNeil, J., 1993).
    Over the years, NIDRR has supported a number of research efforts to 
address the problems caused by various hearing impairments. At various 
times these efforts have included: developing hearing aids and 
telecommunication devices; enhancing the use and teaching of sign 
language interpreters; developing interventions for ``low-functioning'' 
deaf persons with multiple disabilities; developing more effective 
interventions and service models for hearing impaired vocational 
rehabilitation clients; and studying mental health issues of persons 
who are deaf, HOH, or L-D.
    As the population ages, as people recover from serious illness with 
hearing impairments, and as environmental factors contribute to the 
incidence of hearing loss, it has become clear that there is a growing 
population of persons who experience disabling hearing loss as adults. 
The time of onset is likely to be in older adulthood, but this 
population is distinguished by the fact that the hearing loss occurs 
after the person has developed spoken language, has completed 
substantial formal education, and may have worked, married, had 
children, or developed social relationships--as a hearing person with 
``normal'' speech.
    These individuals face major adjustment problems in all phases of 
their lives, and may undergo depression and disruption in family or 
community life, as well as in their ability to perform their work and 
maintain their career. Such individuals need to learn ways to maintain 
communication skills--both receptive and expressive--and frequently 
need interventions to enable them to maintain speech quality (i.e., 
volume, modulation, articulation). Because they socialize and work with 
colleagues, family, and friends in a hearing and speaking environment, 
and because of their age, they are not likely to make a transition to 
deaf culture even if they do learn some sign language. Most will depend 
on lip-reading, amplification, or written communication. Multiple 
personal adjustment and work performance issues confront these 
individuals ranging from safety (e.g., driving and traffic noise, fire 
alarms, public announcement warning systems) to following instructions 
at work, to communicating with doctors, dentists, and therapists about 
their health and medications.
    The impact of partial or complete hearing loss may have compound 
effects on the work status of individuals who are L-D or HOH. In 
addition to the functional impact of the hearing loss on an employee's 
performance, the employee may be unfamiliar with his or her civil 
rights and concerned about disclosing his or her condition for fear of 
dismissal, demotion, or loss of potential career advancement. This fear 
of disclosure not only produces additional anxiety, but also may delay 
or prevent the employee from obtaining needed assistance. Even if the 
employee discloses his or her condition, human resource personnel, 
family counselors, and other employment and social service providers 
may not be familiar with the sundry impacts that hearing loss and 
impairment can have on work performance and personal life. The 
inability of human resource personnel, family counselors, and others to 
provide effective services can increase the individual's sense of 
isolation and anxiety.
    Factors such as early identification, family support, and the 
provision of reasonable accommodations can play an important role in 
enabling the individual to adjust to the hearing impairment and 
maintain employment, family, and community status. Providing such 
individuals with appropriate assistive technology (e.g., assistive 
listening devices, realtime computer assisted captioning) in a timely 
manner can make a significant difference in job performance and morale.
    The onset of a hearing impairment or the increased loss of hearing 
ability also can have a significant impact on the personal life of an 
individual who is L-D or HOH. It is not uncommon for those individuals 
to experience feelings of disorientation and alienation and to withdraw 
from family and friends. That

[[Page 19434]]

withdrawal reinforces the individual's isolation and can, in extreme 
instances, lead to secondary complications such as alcohol and drug 

Proposed Priority 1

    The Secretary proposes to establish an RRTC for the purpose of 
conducting research on the maintenance of employment status and 
personal adjustment of persons who are L-D or HOH. The RRTC will:
    (1) Identify and analyze the factors that negatively impact the 
employment status and the personal life of persons who are L-D or HOH;
    (2) Develop and disseminate interventions that address these 
employment and personal adjustment problems, including early 
identification, reasonable accommodations, counseling, and assistive 
    (3) Develop information materials on effective interventions and 
disseminate those materials to employers, human resource organizations, 
appropriate counseling organizations, and organizations representing 
persons who are L-D or HOH;
    (4) Identify materials that address the rights of persons who are 
L-D or HOH under the ADA, and other disability rights laws, disseminate 
these materials to organizations representing those persons, and inform 
those organizations about opportunities to receive training and 
technical assistance from entities such as the Disability and Business 
Technical Assistance Centers (DBTACs); and
    (5) Develop training and technical assistance materials and provide 
training and technical assistance to employers, human resource 
organizations, appropriate counseling organizations, and organizations 
representing persons who are L-D or HOH to enable them to address 
effectively the employment and personal adjustment problems experienced 
by persons who are L-D or HOH.
    In carrying out the purposes of the priority, the RRTC shall:
    * Identify and address the employment and personal
adjustment issues that are common to both persons who are L-D and those 
who are HOH, as well as those issues that are unique to each 
population; and
    * Coordinate with NIDRR's other research projects addressing
individuals who are L-D or HOH, the DBTACs, and the Assistive 
Technology Projects.

Proposed Priority 2: Improving Vocational Rehabilitation Outcomes for 
Individuals Who Are Substance Abusers

    In 1993, NIDRR funded the establishment of a three-year RRTC on 
Substance Abuse and Disability to address the vocational rehabilitation 
needs of two major categories of eligible individuals served by the 
State Vocational Rehabilitation (VR) Services program. The two 
categories of VR eligible individuals were: (1) Those whose substance 
abuse has resulted in a work disability; and (2) those who have some 
other disability but whose substance abuse interferes with their 
ability to benefit from vocational rehabilitation services.
    In addition, the 1993 priority authorizing the RRTC limited the 
scope of substance abuse to substances other than alcohol abuse 
(although the presence of alcohol abuse in conjunction with other 
substance abuse was within the scope of the RRTC). For the purposes of 
this priority, NIDRR is proposing to expand the scope of the priority 
to include alcohol abuse with or without the presence of other 
substance abuse. NIDRR is particularly interested in receiving public 
comments on expanding the scope of substance abuse addressed by the 
    Individuals with a disability that results in a substantial 
impediment to employment and who can benefit from VR services, 
including those individuals whose disabling condition is due to 
substance abuse, are eligible for services through the State Vocational 
Rehabilitation (VR) Services Program, authorized under Title I of the 
Rehabilitation Act. Program data for fiscal year 1995 show that 
substance abuse was reported as the primary disabling condition for 
51,339 eligible individuals who exited the program in that year. Of the 
51,339 individuals with a primary disability of substance abuse, 22,708 
persons' primary disabling condition was alcohol abuse and 28,631 
persons' primary disabling condition was drug abuse. Of the 40,766 
eligible individuals with a primary disabling condition of substance 
abuse who received services before exiting the program, 21,718 (53 
percent) achieved an employment outcome (Rehabilitation Services 
Administration, Caseload Services data, 1995).
    There are also individuals with disabilities served by the State VR 
program for whom substance abuse is a co-existing, and sometimes 
hidden, condition. In addition to those individuals who exited the VR 
program in 1995 for whom substance abuse was reported as the primary 
disabling condition, another 33,808 individuals were reported to have a 
secondary disability of substance abuse. Findings from a State-wide 
survey of alcohol, tobacco, illicit drugs, and medication among 
applicants for vocational rehabilitation services from Michigan 
Rehabilitation Services indicate that while alcohol use patterns 
approximate the general population, the percent of applicants who 
report current tobacco use or lifetime use of illicit drugs appear 
considerably higher than the general population (Moore, D. and Li, L., 
``Substance Abuse Among Applicants for Vocational Rehabilitation 
Services,'' Journal of Rehabilitation, Vol. 60, No. 4, pgs. 48-53, 
    Unrecognized or untreated substance abuse as a co-existing 
condition can be a greater barrier to employment than the primary 
disability. Chief among those barriers are complications of 
psychological and social adjustment to the disability, impaired 
learning processes, decreased chances for vocational preparation and 
employment, and increased risk of adverse medical effects from the 
intersection of abused substances with treatment medications.
    One of the primary modes of transmission of HIV is through 
injection drug use when an HIV-infected syringe is shared between 
individuals. The higher incidence of intravenous drug abuse in socio-
economically depressed communities means that resultant HIV is 
concentrated among individuals who lack health care, have low education 
and little prior work experience, and lack access to transportation, 
assistive technology, and other community supports that facilitate 
vocational rehabilitation and job maintenance. Substance abuse also 
leads to more high risk sexual behaviors, further increasing the 
incidence of HIV infection in this population. The presence of HIV 
infection can be a complicating factor in the vocational rehabilitation 
of substance abusers. There is a need for research on the specific 
vocational rehabilitation needs of substance abusers with HIV.
    The need for an expanded understanding of the relationship between 
vocational rehabilitation, substance abuse, and disability has been 
further underscored by recent changes in legislation, including welfare 
reform and discontinuance of Social Security Insurance and Social 
Security Disability Insurance benefits for individuals who previously 
were eligible based on addictions to alcohol and other drugs. The 
removal of substantial numbers of substance abusers from income 

[[Page 19435]]

and medical assistance is likely to cause strains on the vocational 
rehabilitation service delivery system by increasing the demand for 
services, decreasing the ``comparable benefits'' dollars available for 
VR services, decreasing access to general health care during 
rehabilitation, and increasing client financial instability. Changes in 
the management and financing of health care in both the public and 
private sector, including managed care, may also have an impact on VR 
agencies' financial arrangements with third party payers and access to 
comparable benefits for substance abuse treatment.
    Although there is an increasing prevalence of substance abuse among 
a diverse population of individuals undergoing rehabilitation, many 
service providers communicate that they have an inadequate 
understanding about substance abuse and co-existing disability and that 
this adversely impacts their ability to address the problem effectively 
(Heinemann, A. W., ``An Introduction to Substance Abuse and Physical 
Disability,'' Substance Abuse and Physical Disability, New York: The 
Haworth Press, 1993). Practitioners in a growing number of disciplines 
within the rehabilitation field need information about substance abuse 
and co-existing disability, including rehabilitation educators, 
vocational rehabilitation counselors, health care providers, 
independent living specialists, community-based rehabilitation 
providers, rehabilitation administrators, chemical dependence 
counselors, and directors of State vocational rehabilitation programs.
    In order to address this need and because there are other Federal 
agencies that focus significant resources on individuals whose sole or 
primary disability is substance abuse, NIDRR is proposing that this 
RRTC focus its efforts, although not exclusively, on issues affecting 
individuals with co-existing disabilities. Particular emphasis would be 
given to VR eligible individuals for whom substance abuse is not their 
sole or primary disabling condition, but whose substance abuse 
interferes with their ability to benefit from vocational rehabilitation 
services. NIDRR is particularly interested in receiving public comments 
on this emphasis.

Proposed Priority

    The Secretary proposes to establish an RRTC for the purpose of 
improving vocational rehabilitation outcomes for VR eligible 
individuals whose substance abuse has resulted in a work disability, or 
who have some other disability that results in a substantial impediment 
to employment but whose substance abuse interferes with their ability 
to benefit from vocational rehabilitation services. The RRTC shall:
    (1) Conduct epidemiological studies to advance the understanding of 
the relationship between substance abuse and disability among 
individuals who are eligible for the State Vocational Rehabilitation 
Services program, including determining the relative prevalence of 
substance abuse among persons with more severe disabilities; (2) 
Develop, identify, and evaluate information about effective methods for 
providing vocational rehabilitation services to individuals who are 
substance abusers;
    (3) Investigate the impact of recent legislative changes (including 
welfare reform and SSA eligibility) and changes in health care 
management and financing of substance abuse treatment on the provision 
of vocational rehabilitation services to individuals who are substance 
abusers; and
    (4) Disseminate informational materials and provide technical 
assistance and training to VR eligible individuals whose substance 
abuse has resulted in a work disability, or who have some other 
disability that results in a substantial impediment to employment but 
whose substance abuse interferes with their ability to benefit from 
vocational rehabilitation services, vocational rehabilitation 
personnel, and related rehabilitation disciplines concerning effective 
strategies for providing vocational rehabilitation services.
    In carrying out the purposes of the priority, the RRTC shall:
    * Give special emphasis to issues affecting the vocational
rehabilitation of individuals with co-existing disabilities, 
particularly issues affecting VR eligible individuals for whom 
substance abuse is not their sole or primary disabling condition, but 
whose substance abuse interferes with their ability to benefit from 
vocational rehabilitation services.
    * Address the vocational rehabilitation needs of individuals
with HIV/AIDS who are VR eligible individuals whose substance abuse has 
resulted in a work disability, or who have some other disability that 
results in a substantial impediment to employment but whose substance 
abuse interferes with their ability to benefit from vocational 
rehabilitation services;
    * Where appropriate, address the needs of transitioning
special education students who may have substance abuse problems, their 
special education teachers, and administrators; and
    * Coordinate with projects on substance abuse supported by
the Substance Abuse and Mental Health Services Administration and with 
NIDRR centers and projects on vocational rehabilitation and emerging 
disability populations.

Proposed Priority 3: Improving Employment and Independent Living 
Outcomes for Persons With Disabilities in Rural Areas

    Between 11 and 15 million persons living in rural areas have a 
chronic or permanent disability, a higher per capita rate of disability 
than exists in cities with populations over 50,000 (Young, C. and 
O'Day, B., ``Issues in Rural Independence: Funding,'' Rural Monograph 
Series.'' Compared to their counterparts in metropolitan areas, persons 
with disabilities in rural areas have higher rates of activity 
limitation (16.4% versus 14.6%), work limitation (14.2% versus 10.9%), 
and personal care limitation (4.7% versus 3.8%) (LaPlante, M. et al., 
``Disability Statistics Report #7,'' Disability in the United States: 
Prevalence and Causes, 1992, Institute for Health and Aging, University 
of California, San Francisco, July, 1996). Persons with disabilities in 
rural areas face challenges that are quite different from their peers 
living in and around metropolitan areas. The quality of life for many 
people with disabilities residing in rural America is characterized by:
    (1) Limited job opportunities; (2) inadequate health care; (3) 
isolation and inadequate transportation; (4) lack of accessible 
housing; and (5) underfunded social services.
    For many rural areas, social and economic vitality hinges on 
overcoming the problems posed by remoteness from urban centers--such as 
the lack of easy access to advanced education, medical knowledge, and 
enterprise development opportunities. People with disabilities living 
in rural communities often live a long distance from vocational 
rehabilitation (VR) agencies, independent living centers (ILCs), and 
other social service agencies. Although these resources have great 
potential for reducing the impact of disability, service delivery 
challenges limit their availability in rural areas.
    Currently, Federal, State, and local initiatives such as 
Empowerment Zones (EZ) or Enterprise Communities (EC) are addressing 
community and economic development in rural areas. The Federal 
government, working across agency lines and in a new partnership with 
State and local government and the private sector, has provided 
distressed communities with the tools they need

[[Page 19436]]

and flexibility they desire, in the form of block grants, tax breaks 
and waivers. In return, EZ/EC communities--residents, community 
leaders, businesses, State and local governments and schools--must 
demonstrate that they are taking responsibility for their own futures 
by developing and implementing a plan to utilize these tools. The U.S. 
Department of Agriculture (USDA) is authorized to designate three rural 
EZs and thirty ECs.
    These projects are intended to demonstrate that innovative economic 
development and service delivery approaches can make a difference for 
people with disabilities living in rural areas. It is important for 
individuals with disabilities living in rural communities participate 
in long-range community development planning. Their involvement is 
crucial to ensure that the unique needs of people with disabilities for 
employment, economic self-sufficiency, transportation, affordable and 
accessible housing, and access to generic community facilities are 
addressed. Research is needed to study current approaches, and to 
develop new models, for increasing their participation in public and 
private economic development and services improvement initiatives.
    The health problems experienced by people with disabilities living 
in rural areas are complicated by the burden of travelling long 
distances and the general shortage of primary health care providers. As 
a result, people with disabilities living in rural areas may experience 
a high rate of secondary conditions each year such as pressure sores, 
physical deconditioning, urinary tract infections, depression and pain 
(Seekins, T. et al., ``A Descriptive Study of Secondary Conditions 
Reported by a Population of Adults with Physical Disabilities Served by 
Three Independent Living Centers in a Rural State,'' Journal of 
Rehabilitation, Vol. 60, No. 2, pgs. 47-51, 1994). Proper education, 
support delivered by health clinics and independent living centers, and 
utilization of telemedicine can dramatically improve the health of 
adults with disabilities and reduce medical service utilization.
    The USDA's Rural Utilities Service, which funds telecommunications 
infrastructure in many rural areas, provides grants to link rural 
health clinics with larger hospitals to better serve rural residents. 
The U.S. Department of Health and Human Services' (DHHS') Health Care 
Financing Administration funds Rural Telemedicine Grants which 
demonstrate and collect information on the feasibility, costs, 
appropriateness, and acceptability of telemedicine for improving access 
to health services for rural residents and reducing the isolation of 
rural practitioners. The intended beneficiaries of these grants are 
rural health care providers, patients, and rural communities which gain 
from this program.
    Changes in health care policy, such as managed care, are 
significantly affecting the lives of people with disabilities living in 
rural areas. For example, managed care emphasizes primary care and 
control of access to specialized services. Persons with significant 
disabilities in rural areas, however, have difficulty obtaining primary 
care and often need extensive services and access to highly specialized 
providers to prevent death or further disability (``Medicaid Managed 
Care: Serving the Disabled Challenges State Programs,'' U.S. General 
Accounting Office (GAO)/Health, Education, and Human Services-96-136).
    The use of telecommunications technologies may be a critical 
element in efforts to provide social services as well as maintain and 
foster economic development. Advanced telecommunications technologies--
the Internet, videoconferencing and high-speed data transmission--offer 
rural areas the chance to overcome some of the problems they face as a 
result of their geographic isolation. These technologies can link rural 
areas with other communities and expertise to improve medical services, 
create new jobs, and increase rural residents' access to education 
(``Rural Development: Steps Toward Realizing the Potential of 
Telecommunications Technologies,'' GAO/Resources, Community, and 
Economic Development-96-155).
    Interactive technology can link isolated rural settings with 
comprehensive services at distant facilities. With these linkages, the 
distant facility can review X-rays, CAT scans, and other medical 
evidence to diagnose an illness and prescribe treatment without having 
the patient make long, and sometimes difficult, trips to the larger 
institution. Colleges and schools can offer classes, and even degree 
programs, to students in remote locations. Large businesses can 
establish or maintain branch offices in rural areas by using 
videoconferencing or on-line access to hold meetings and conduct 
business. There is a need to design ways to apply these emerging 
interactive technologies on the lives of people with disabilities 
living in rural areas, particularly as Federal and other public and 
private programs expand their uses of interactive technology.

Proposed Priority 3

    The Secretary proposes to establish an RRTC for the purpose of 
examining means to improve the employment status and ability of persons 
with disabilities to live independently in rural areas. The RRTC shall:
    (1) Identify, analyze and evaluate the impact of rural economic 
development strategies in improving the employment outcomes and 
economic status of people with disabilities living in rural 
    (2) Identify and examine issues of access to health care for 
persons with disabilities living in rural areas, particularly those 
issues contributing to the onset of secondary conditions;
    (3) Develop and evaluate strategies to increase the participation 
of people with disabilities in local public planning for community 
    (4) Identify, develop, and evaluate strategies to improve rural 
transportation, accessible housing, and access to generic community 
facilities services for people with disabilities;
    (5) Identify and evaluate strategies to improve the use of 
telecommunications technologies for the delivery of health, employment, 
education, and social services to people with significant disabilities 
living in rural communities; and
    (6) Develop training and informational materials and provide 
training and information to persons with disabilities, and providers of 
health care, vocational rehabilitation, and independent living 
services, on effective strategies for improving the employment, health, 
and independent living outcomes of people with disabilities living in 
rural areas.
    In carrying out the purposes of the priority, the RRTC shall:
    * Coordinate with NIDRR-funded research, training and
demonstration activities on delivery of rehabilitation and independent 
living services in rural areas, including those sponsored by RSA and 
the RRTC on managed care;
    * Where appropriate, address the needs of transitioning
special education students and their special education teachers and 
    * Coordinate with rural projects affecting persons with
disabilities funded by USDA and DHHS; and
    * Address the needs of persons with disabilities in rural
communities in all parts of the country, including persons from ethnic 
and racial minority backgrounds.

[[Page 19437]]

Proposed Priority 4: Medical Rehabilitation Services and Outcomes

    Medical rehabilitation services are provided to individuals with 
disabilities to restore maximum function and independence. 
Traditionally, these services were provided by physicians, nurses, and 
allied health professionals in hospitals and rehabilitation centers. 
Medical rehabilitation service consumers comprise a wide range of 
diagnostic groups including individuals with stroke, orthopedic 
conditions, brain injury, spinal injury, and neurologic conditions. The 
need for medical rehabilitation services for persons with disabilities 
is expected to continue to grow in the coming decades because of 
increased chances of survival after trauma, disease, or birth anomaly, 
increased prevalence of disability related to the general aging of the 
population, and the increased incidence of individuals with 
disabilities acquiring secondary disabilities or chronic conditions as 
a result of increased longevity. Despite large growth projections, the 
impact of the projected increase in need for medical rehabilitation has 
not been extensively investigated in relation to long-term costs and 
    Changes in the organization and delivery of health services issues 
are having a significant impact on the delivery and outcomes of 
comprehensive medical rehabilitation services. Recent trends, such as 
decreased length of stay associated with the high costs of inpatient 
care, have contributed to the growth of rehabilitation programs in sub-
acute facilities, such as skilled nursing homes, and increased use of 
outpatient and home health care. Many rehabilitation hospitals, as well 
as medical rehabilitation programs within hospitals, have been 
influenced significantly by program consolidations, changes in 
ownership, third-party reimbursement provisions, and related factors 
that have decreased the number of beds and the average length of 
patient stay. At the same time, demand is increasing for sub-acute 
rehabilitation and general outpatient physical medicine (``Adapting to 
a Managed Care World: The Challenge for Physical Medicine and 
Rehabilitation,'' Lewin-VHI Workforce Study, American Academy of 
Physical Medicine and Rehabilitation, 1995).
    The effectiveness of the treatments and therapeutic interventions 
that are generally used in clinical practice are, for the most part, 
not evaluated in terms of their impact on long-term functional outcomes 
or their cost. The cost-effectiveness and impact of alternative 
rehabilitative strategies should be evaluated rigorously in order to 
obtain information that will contribute to cost-effective, rational, 
and fair decisions regarding the provision of treatment and services. 
Medical rehabilitation services need an enhanced validated outcome 
measurement system to inform decisions in management issues facing 
health care consumers, providers, and insurers. Increasingly, payers 
are seeking to base decisions of whether to provide coverage for 
selected services or interventions on the basis of proven efficacy or 
cost-effectiveness as determined by rigorous scientific evidence such 
as that gained through randomized controlled trials.
    Functional Assessments (FAs) can be used to evaluate an 
individual's ability to carry out activities of daily living and 
instrumental activities of daily living such as eating, bathing, moving 
from place to place, dressing, doing household chores or other 
necessary business, and taking care of personal hygiene. Data from FAs 
also are used to predict post-rehabilitation functioning, and to 
evaluate rehabilitation services. Improving rehabilitation practices 
and outcomes requires an ability to assess the status and changes in 
function in many areas. Multiple measures of function and activities of 
daily living are needed in all rehabilitation settings, including in 
the home and community. The increased use of telemedicine and 
multimedia technology is rapidly changing the manner in which 
functional assessment measures are generated and shared among members 
of the rehabilitation team. Functional outcome measures are of 
increasing importance in medical economics, benefits planning, managed 
care, and program evaluation (Ikegami, N., ``Functional Assessment and 
Its Place in Health Care,'' New England Journal of Medicine, Vol. 332, 
pgs. 598-599, 1995).
    There is a need to collect and analyze data to determine the 
organization and delivery of rehabilitative care, including such 
parameters as facility and program sizes (i.e., economies of scale) and 
the number and mix of health care providers needed to serve various 
disability groups. Few data are available to define optimal strategies 
for outpatient services, nor are there methods to apply FAs or gather 
patient outcome data in non-hospital settings.
    Improving rehabilitation medicine and ensuring that disabled 
individuals will have access to needed medical rehabilitation in the 
future requires: an ability to assess functional status and changes in 
status in many functional areas; the ability to evaluate rehabilitation 
outcomes for individuals with various diagnoses, characteristics, and 
interventions; and the ability to apply these measures in health 
services policy research in order to affect policy and funding 
decisions in the health care delivery context.
    In the past, NIDRR has supported the development and application of 
the ``Functional Independence Measure'' (FIM), a criterion-referenced 
scale that has been widely accepted in inpatient rehabilitation 
settings, and also the development of the ``Craig Handicap Assessment 
and Reporting Technique'' (CHART), which contains scales for assessing 
the World Health Organization (WHO) dimensions of handicap, and is 
currently being refined to measure cognitive components of handicap. 
NIDRR currently supports an RRTC on Functional Assessment that has 
contributed to the scientific measurement of medical rehabilitation 
through applications of the FIM, refinement of the CHART, and 
management and analysis of the Uniform Data System (UDS), a collection 
of data from the application of FIM measures in many institutions.
    Current measurement systems, such as the FIM and the UDS, have made 
significant contributions, but need modifications to increase their 
utility and applicability in the new environment of rehabilitation 
care. For example, many practitioners and theorists have suggested that 
the FIM does not make adequate provision for the role of assistive 
technology in attaining functional levels. Like the FIM, most 
functional assessment measurement systems were designed for use in an 
inpatient setting. These systems need to be evaluated and modified to 
measure functional status and functional change outside of hospital and 
clinical settings, either in community-based facilities or in real-
world environments of daily living. The FIM, for example, needs further 
refinement to address the social and environmental dimensions of 
disablement. The UDS at present contains data on a limited number of 
disabilities, and those measurements again are not community-based.
    NIDRR also has supported a center on medical rehabilitation 
services that has looked at such factors as supply and demand for 
rehabilitation facilities and practitioners, financing, and evaluation 
of the outcomes of rehabilitation medicine. This center has also 
addressed the changing context for the delivery of medical 
rehabilitation and access to medical rehabilitation by various 
population groups. Both of these

[[Page 19438]]

centers have made contributions to the maturing of the field of medical 
rehabilitation and its ability to evaluate and document its 
interventions and outcomes.
    However, it is now clear that the field needs a larger and more 
integrated effort to refine measures of functional ability, changes in 
ability over the lifespan or in response to medical rehabilitation 
interventions, and to apply the measurement system in the changing 
environment in which medical rehabilitation is delivered. NIDRR 
therefore is proposing a large-scale effort to involve significant 
leaders in the classification and measurement of function, the 
evaluation of rehabilitation interventions, and the broader application 
of knowledge to the organization and management of medical 
rehabilitation services in today's environment.

Proposed Priority 4

    The Secretary proposes to establish an RRTC for the purpose of 
examining the impact of changes in the field of rehabilitation medicine 
and developing improved measures for assessing individual function and 
the impact of medical rehabilitation services. The RRTC shall:
    (1) Identify and evaluate validated functional outcome measures 
that can be used or modified for assessing the impact of medical 
rehabilitation services in a wide range of rehabilitation settings, 
with particular emphasis on measures that can be adapted for use in 
outpatient and community-based settings, including those that use 
telemedicine and multimedia technology;
    (2) Develop or improve measures to assess the impact of the social 
and physical environment in achieving quality rehabilitation outcomes, 
including the use of assistive technology in attaining functional 
    (3) Identify or develop uniform database elements and standards 
based on validated individual measures at the person level for 
determining the cost-effectiveness and functional impact of specific 
rehabilitation interventions used by medical rehabilitation and allied-
health disciplines across multiple settings and disability populations;
    (4) Identify obstacles to the use of validated functional outcomes 
measures in a wide range of settings in which medical rehabilitation 
services are provided, and in decisions to provide and assess the 
effectiveness of medical rehabilitation treatments, and develop 
strategies and evaluate pilot projects to overcome those obstacles;
    (5) Identify strategies for determining the long-term results of 
medical rehabilitation care, including use of assistive technology;
    (6) Analyze how models for the organization of medical 
rehabilitation services affect outcomes and costs, and how the 
demographic, economic, and presenting conditions of consumers affect 
their utilization of rehabilitation services and the outcomes that are 
achieved; and
    (7) Develop an information dissemination and training program to 
enable consumers, providers, researchers, policy makers, and relevant 
others in health and rehabilitation settings to assess the quality of 
medical rehabilitation services.
    In carrying out the purposes of the priority, the RRTC shall:
    * Coordinate with rehabilitation medicine research and
demonstration activities sponsored by NIDRR, the National Center on 
Medical Rehabilitation Research, Veterans Affairs, and the Health Care 
Financing Administration; and
    * Support two National Conferences as follows: (1) A
conference on the use of functional outcome measures to improve medical 
rehabilitation practices and interventions, and (2) a conference on 
improving validity and reliability in the measurement of rehabilitation 

Knowledge Dissemination and Utilization Projects

    Authority for the D&U program of NIDRR is contained in sections 202 
and 204(a) of the Rehabilitation Act of 1973, as amended (29 U.S.C. 
760-762). Under this program the Secretary makes awards to public and 
private organizations, including institutions of higher education and 
Indian tribes or tribal organizations. Under the regulations for this 
program (see 34 CFR 355.32), the Secretary may establish research 
priorities by reserving funds to support particular research 


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

Proposed Priority 5: Parenting With a Disability Technical Assistance 

    Approximately one in eleven families with children at home includes 
one or more parents with a disability (LaPlante, M., ``Disability in 
the Family,'' presented at the annual meeting of the American Public 
Health Association, Atlanta, GA, 1991). This proportion can be expected 
to increase as a correlate of the gains that persons with disabilities 
have achieved in their efforts to live and work independently in the 
community. In the course of becoming parents and rearing children, 
persons with disabilities may encounter a variety of attitudinal, 
physical, medical, and legal barriers. They may also find 
misinformation or an absence of information regarding advances in 
fields that address issues related to parenting.
    NIDRR has been addressing the physical barriers and reproductive 
issues faced by parents with disabilities through a variety of research 
and development projects. Since 1993 NIDRR has supported a 
Rehabilitation Research and Training Center on Families in which one or 
more adult parent or guardian has a disability. The Center has 
investigated a wide range of parenting issues, including the assistive 
technology needs of parents with disabilities, training obstetricians 
to deal with the needs of women with disabilities, and needs of mothers 
with visual disabilities. The Center has created and identified a wide 
range of valuable information for parents and professionals. In 
addition, over the last ten years, NIDRR has supported research 
projects on the design and development of new adaptive equipment for 
parents with physical disabilities and parenting assessment techniques. 
A wide array of parenting equipment has been developed, for example, a 
lifting harness and an adapted baby bathing cart. Information is also 
available on the social service needs of parents with disabilities. As 
a result of these and other research, training, and development 
efforts, a substantial body of knowledge now exists related to 
parenting with a disability.
    Persons with disabilities who want to become, or remain parents, 
may need information and technical assistance. A NIDRR-sponsored focus 
group on women and disabilities held in 1994 recommended that NIDRR 
explore issues related to sexuality, reproductive health, pregnancy and 
parenting for women with disabilities, including ``the level of 
information that women have about these topics'' (``Focus Group on 
Women and Disabilities,'' unpublished ``Report of Proceedings,'' NIDRR, 
pg. 8, July, 1994). Parents with disabilities and prospective parents 
with disabilities need information about related advances in the field 
of assistive technology and medicine, public policy

[[Page 19439]]

and legal developments, and parenting resources.
    One source of information and valuable experience is persons with 
disabilities who are parents. These individuals have a wealth of 
knowledge and can not only share their experiences and practical 
information, but also serve as uniquely qualified sources of support. 
Currently, this ``parent to parent'' networking is primarily informal 
and limited in scope.
    Persons with disabilities may encounter substantial attitudinal and 
legal barriers in their efforts to become pregnant, gain or maintain 
custody, or adopt children. Barbara Faye Waxman, an expert on 
reproductive rights, notes that laws allowing sterilization of persons 
with disabilities remain on the books in some States and that social 
service agencies are often too quick to put the non-disabled children 
of parents with disabilities up for adoption (Mathews, J., ``The 
Disabled Fight to Raise Their Children,'' Washington Post Health 
Section, August 18, 1992). Most States treat disability as prima facie 
evidence of parental unfitness and a possible detriment to the child 
(Conly-Jung, C., ``The Early Parenting Experiences of Mothers with 
Visual Impairments and Blindness,'' Dissertation, California School of 
Professional Psychology, Alameda, CA, pg. 21, May, 1996). One important 
strategy in the effort to overcome these attitudinal and legal barriers 
is providing social service, legal, and medical professionals with 
information that dispels stereotypes and describes advances in the 
related fields that enable persons with disabilities to provide a safe 
and nurturing environment for their children.

Proposed Priority 5

    The Secretary proposes to establish a center for the purpose of 
providing technical assistance and disseminating parenting information 
to persons with disabilities and to social service, medical, and legal 
service providers. The technical assistance center will:
    (1) Identify and disseminate technological, legal, and medical 
information on parenting, pregnancy, custody, and adoption to parents, 
and prospective parents with disabilities, and service providers in 
related field of social services, law, and medicine;
    (2) Develop training materials on parenting with a disability and 
disseminate those materials to organizations and institutions of higher 
education that provide pre-service and in-service training to 
professionals in related fields of social services, law, and medicine, 
as well as to organizations representing persons with disabilities;
    (3) Provide technical assistance on parenting with a disability to 
persons with disabilities and service providers, including making 
referrals and serving as a clearinghouse of technical information; and
    (4) Develop and establish a parent-to-parent network that enables 
experienced parents with disabilities to voluntarily provide 
information and support to persons with disabilities interested in 
becoming or remaining parents.
    In carrying out the purposes of the priority, the technical 
assistance center shall:
    *  Collect and synthesize information from other NIDRR-
funded projects and centers that could be relevant to parenting with a 
disability including, but not limited to, the Assistive Technology 
    * Collaborate with other NIDRR and OSEP-funded projects and
centers that address issues related to parenting and to disability 
rights of persons with disabilities; and
    * Establish a national toll-free telephone hotline and
publish a quarterly newsletter.

Invitation To Comment

    Interested persons are invited to submit comments and 
recommendations regarding these proposed priorities.
    All comments submitted in response to this notice will be available 
for public inspection, during and after the comment period, in Room 
3424, Mary Switzer Building, 330 C Street S.W., Washington, D.C., 
between the hours of 9:00 a.m. and 5:00 p.m., Monday through Friday of 
each week except Federal holidays.

Applicable Program Regulations

    34 CFR Parts 350, 352, and 355.
    Program Authority: 29 U.S.C. 760-762.

(Catalog of Federal Domestic Assistance Numbers: 84.133B, 
Rehabilitation Research and Training Center Program, 84.133D, 
Knowledge Dissemination and Utilization Program)

    Dated: April 11, 1997.
Judith E. Heumann,
Assistant Secretary for Special Education and Rehabilitative Services.
[FR Doc. 97-10200 Filed 4-18-97; 8:45 am]