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f e d e r a l r e g i s t e r

MondayJanuary 4, 1999

Part VIII

Department ofEducation

National Institute on Disability andRehabilitation Research; Notice ofProposed Funding Priorities for FiscalYears 1999–2000 for Certain Centers andProjects; Notice

342

Federal Register

/Vol. 64, No. 1/Monday, January 4, 1999/Notices

DEPARTMENT OF EDUCATIONNational Institute on Disability andRehabilitation Research; FundingPriorities

AGENCY

Department of Education.

ACTION

Notice of Proposed FundingPriorities for Fiscal Years 1999–2000 forCertain Centers and Projects.

SUMMARY

The Secretary proposesfunding priorities for two RehabilitationResearch and Training Centers (RRTCs)and two Disability and RehabilitationResearch Projects (DRRPs) under theNational Institute on Disability andRehabilitation Research (NIDRR) forfiscal years 1999–2000. The Secretarytakes this action to focus researchattention on areas of national need.These priorities are intended to improverehabilitation services and outcomes forindividuals with disabilities.

DATES

Comments must be received onor before February 3, 1999.

ADDRESSES

All comments concerningthese proposed priorities should beaddressed to Donna Nangle, U.S.Department of Education, 600 MarylandAvenue, S.W., room 3418, SwitzerBuilding, Washington, D.C. 20202–2645.Comments may also be sent through theInternet: comments@ed.govYou must include the term ‘‘Disabilityand Rehabilitation Research Projectsand Centers’’ in the subject line of yourelectronic message.

FOR FURTHER INFORMATION CONTACT

Donna Nangle. Telephone: (202) 205–5880. Individuals who use atelecommunications device for the deaf (TDD) may call the TDD number at (202)205–2742. Internet:Donna



Nangle@ed.govIndividuals with disabilities mayobtain this document in an alternateformat (e.g., Braille, large print,audiotape, or computer diskette) onrequest to the contact person listed inthe preceding paragraph.

SUPPLEMENTARY INFORMATION

Thisnotice contains proposed prioritiesunder the Disability and RehabilitationResearch Projects and Centers Programfor two RRTCs related to: measuringrehabilitation outcomes; andrehabilitation of persons withdisabilities from minority backgrounds.The notice also contains proposedpriorities for two DRRPs related to:dissemination of disability andrehabilitation research; and theinternational exchange of informationand experts. There are references in theproposed priorities to NIDRR’s Long-Range Plan (LRP). The LRP can beaccessed on the World Wide Web at:http://www.ed.gov/legislation/ FedRegister/announcements/1998–4/ 102698a.html. These proposed prioritiessupport the National Education Goalthat calls for every adult American topossess the skills necessary to competein a global economy.The authority for the Secretary toestablish research priorities by reservingfunds to support particular researchactivities is contained in sections 202(g)and 204 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 762(g) and764).The Secretary will announce the finalpriorities in a notice in the

FederalRegister

. The final priorities will bedetermined by responses to this notice,available funds, and otherconsiderations of the Department.Funding of a particular project dependson the final priority, the availability of funds, and the quality of theapplications received. The publicationof these proposed priorities does notpreclude the Secretary from proposingadditional priorities, nor does it limitthe Secretary to funding only thesepriorities, subject to meeting applicablerulemaking requirements.

Note:

This notice of proposed prioritiesdoes not solicit applications. A noticeinviting applications under this competitionwill be published in the

Federal Register

concurrent with or following the publicationof the notice of final priorities.

Rehabilitation Research and TrainingCenters

Authority for the RRTC program of NIDRR is contained in section 204(b)(2)of the Rehabilitation Act of 1973, asamended (29 U.S.C. 764(b)(2)). Underthis program the Secretary makesawards to public and privateorganizations, including institutions of higher education and Indian tribes ortribal organizations for coordinatedresearch and training activities. Theseentities must be of sufficient size, scope,and quality to effectively carry out theactivities of the Center in an efficientmanner consistent with appropriateState and Federal laws. They mustdemonstrate the ability to carry out thetraining activities either directly orthrough another entity that can providethat training.The Secretary may make awards forup to 60 months through grants orcooperative agreements. The purpose of the awards is for planning andconducting research, training,demonstrations, and related activitiesleading to the development of methods,procedures, and devices that willbenefit individuals with disabilities,especially those with the most severedisabilities.

Description of Rehabilitation Researchand Training Centers

RRTCs are operated in collaborationwith institutions of higher education orproviders of rehabilitation services orother appropriate services. RRTCs serveas centers of national excellence andnational or regional resources forproviders and individuals withdisabilities and the parents, familymembers, guardians, advocates orauthorized representatives of theindividuals.RRTCs conduct coordinated,integrated, and advanced programs of research in rehabilitation targetedtoward the production of newknowledge to improve rehabilitationmethodology and service deliverysystems, to alleviate or stabilizedisabling conditions, and to promotemaximum social and economicindependence of individuals withdisabilities.RRTCs provide training, includinggraduate, pre-service, and in-servicetraining, to assist individuals to moreeffectively provide rehabilitationservices. They also provide trainingincluding graduate, pre-service, and in-service training, for rehabilitationresearch personnel and otherrehabilitation personnel.RRTCs serve as informational andtechnical assistance resources toproviders, individuals with disabilities,and the parents, family members,guardians, advocates, or authorizedrepresentatives of these individualsthrough conferences, workshops, publiceducation programs, in-service trainingprograms and similar activities.RRTCs disseminate materials inalternate formats to ensure that they areaccessible to individuals with a range of disabling conditions.NIDRR encourages all Centers toinvolve individuals with disabilitiesand individuals from minoritybackgrounds as recipients of researchtraining, as well as clinical training.The Department is particularlyinterested in ensuring that theexpenditure of public funds is justifiedby the execution of intended activitiesand the advancement of knowledge and,thus, has built this accountability intothe selection criteria. Not later thanthree years after the establishment of any RRTC, NIDRR will conduct one ormore reviews of the activities andachievements of the Center. Inaccordance with the provisions of 34CFR 75.253(a), continued fundingdepends at all times on satisfactoryperformance and accomplishment.

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Proposed General Requirements

The Secretary proposes that thefollowing requirements apply to theseRRTCs pursuant to these absolutepriorities unless noted otherwise. Anapplicant’s proposal to fulfill theseproposed requirements will be assessedusing applicable selection criteria in thepeer review process. The Secretary isinterested in receiving comments onthese proposed requirements:Each RRTC must provide: (1) trainingon research methodology and appliedresearch experience; and (2) training onknowledge gained from the Center’sresearch activities to persons withdisabilities and their families, serviceproviders, and other appropriate parties.Each RRTC must develop anddisseminate informational materialsbased on knowledge gained from theCenter’s research activities, anddisseminate the materials to personswith disabilities, their representatives,service providers, and other interestedparties.Each RRTC must involve individualswith disabilities and, if appropriate,their representatives, in planning andimplementing its research, training, anddissemination activities, and inevaluating the Center.The RRTC must conduct a state-of-the-science conference and publish acomprehensive report on the finaloutcomes of the conference. The reportmust be published in the fourth year of the grant.The RRTC must coordinate with otherentities carrying out related research ortraining activities.

Priorities

Under 34 CFR 75.105(c)(3), theSecretary proposes to give an absolutepreference to applications that meet thefollowing priorities. The Secretaryproposes to fund under this competitiononly applications that meet one of theseabsolute priorities.

Proposed Priority 1: Measuring Rehabilitation Outcomes

IntroductionChapter Four of NIDRR’s proposedLRP (63 FR 57204) discusses issues inmedical rehabilitation, includingresearch on rehabilitation outcomes.There is a need to develop moreeffective outcomes measurement tools todetermine the effectiveness, includingthe cost-effectiveness, of medicalrehabilitation interventions andproducts. Chapter Seven of theProposed LRP (63 FR 57211) reviews theimportance of documenting outcomesacross service settings and programs.The proposed LRP identifies long-termoutcomes, such as employment,community integration, and quality of life, as an important component of thenew paradigm of disability that expandsthe focus of research from theindividual to society and theenvironment. NIDRR expects this RRTCto integrate the new paradigm of disability in its research activities. Thenew paradigm maintains that disabilityis a product of an interaction betweencharacteristics of the individual andcharacteristics of the natural, man-made, cultural, social environments.Medical rehabilitation outcomesresearch has focused on function.NIDRR supported the development andapplication of the FunctionalIndependence Measure (FIM), acriterion-referenced scale that has beenwidely accepted in inpatientrehabilitation settings. NIDRR alsosupported the development of the CraigHandicap Assessment and ReportingTechnique that contains scales forassessing the World Health Organizationdimensions of ‘‘handicap’’ (i.e.,participation) and is currently beingrefined to measure cognitivecomponents of disability.While researchers have been able todemonstrate gain in function, asmeasured by instruments like the FIM,there is no conclusive evidenceregarding the specific impact of therapeutic intervention on functionalgain (Heinemann, A. et al., ‘‘Relation of Rehabilitation Intervention toFunctional Outcome,’’

Final Technical Report

, Center for FunctionalAssessment Research, University of Buffalo, pg. 11, 1998). In addition,medical rehabilitation providers arebeing asked to demonstrate therelationship between short-termfunctional gain and long-term outcomesfor persons with disabilities (Wilkerson,D. and Johnston, M., ‘‘Clinical ProgramMonitoring Systems,’’ in

Assessing Medical Rehabilitation Practices—ThePromise of Outcomes Research,

pgs.275–305, 1997).In addition to the widespread use of the FIM as a measure of function, thereare other commonly used measures.Also, there are multiple measuresrelated to other types of outcomes,including quality of life, communityintegration, and consumer satisfaction.Providers, consumers, and otherstakeholders have difficulty comparingoutcomes because use of outcomemeasures across settings is notstandardized (Wilkerson, D. andJohnston, M., ibid.).

Proposed Priority

The Secretary proposes to establish anRRTC for the purpose of developingimproved methods that assess theeffectiveness of medical rehabilitationservices. The RRTC must:(1) Develop and test a theoreticalmodel or models assessing long-termoutcomes as part of a system of evaluating medical rehabilitationeffectiveness;(2) Investigate the extent to which theeffectiveness of medical rehabilitationservices can be determined by applyingfunctional outcomes measures tospecific rehabilitation interventions;(3) Identify gaps in existing measuresof medical rehabilitation effectiveness,assessing not only the FIM’s, but alsoother instruments’ utility as a measureof the impact of therapeuticinterventions on function acrossrehabilitation settings;(4) Revise or develop and testmeasures of medical rehabilitationeffectiveness to address gaps identifiedby (3) above; and(5) Evaluate and describe the uses of medical rehabilitation outcome data bypayers, providers, and consumers.In carrying out these purposes, theRRTC must coordinate with the RRTCon Health Care for Individuals withDisabilities—Issues in Managed HealthCare, the National Center on MedicalRehabilitation Research, the Departmentof Veterans Affairs, and the Health CareFinancing Administration.

Proposed Priority 2: Rehabilitation of Persons With Disabilities From Minority Backgrounds

IntroductionChapter Two of NIDRR’s proposedLRP (63 FR 57194) discusses andhighlights methodological problems inthe categorization and definition of disability, including identifying andmeasuring consequences of disability inminority populations. Disabilities inminority populations may be associatedwith factors such as health, poverty,family structure, environment, aging,substance abuse, chronic disease, andviolence-related trauma in ways that aresubstantially different from non-minority populations. Chapter 3 of theproposed LRP identifies the need forminority populations research thatprovides information about employmentfactors, including identifyingrehabilitation strategies that are basedon knowledge about the characteristicsof racial and ethnic minorities.For the purpose of this proposedpriority, persons for minoritybackgrounds include one or more of thefollowing minorities: Asian-Americans,Hispanics or Latinos, Black or African-Americans, and Native Hawaiians orother Pacific Islanders. American