ADD Announcement, Issued 12/15/2003

New Freedom Initiative
A Progress Report on Fulfilling America’s Promise to American’s with Disabilities.

Introduction

This document serves as the Department of Health and Human Services’ Progress Report on meeting its New Freedom Initiative (NFI) goals and other disability-related programs since the White House publication of the May 2002 Progress Report on Fulfilling America’s Promise to Americans with Disabilities.

President Bush signed Executive Order 13217 on June 18, 2001, “to place qualified individuals with disabilities in community settings whenever appropriate…so as to ensure that all Americans have the opportunity to live close to their families and friends, to live more independently, to engage in productive employment, and to participate in community life.” This Executive Order designated the Department of Health and Human Services (HHS) as the lead agency with responsibility for coordinating the federal response to the Executive Order. Of the 400 solutions identified in the “Delivering on the Promise,” (March 25, 2002), 100 of these solutions pertain to HHS’ agencies. A key solution in addressing the coordination of disability programs across HHS agencies was the creation of the Office on Disability in October 2002 by Secretary Thompson.

The Office on Disability, directed by Margaret Giannini, M.D., F.A.A.P., serves as the focal point within the Department of Health and Human Services for the implementation and coordination of policies, programs and special initiatives related to disabilities. The Office on Disability oversees the implementation of the NFI, enhances federal initiatives among individuals with disabilities and coordinates interagency and interdepartmental actions.

This report presents highlights of the broad-based and diverse programs throughout the Department that address the NFI. These programs are representative of the Department’s commitment to meet the needs of individuals with disabilities.

Increasing Access through Technology

The NFI promotes research in assistive and universally designed technologies to ensure that Americans with disabilities have access to resources at home, work and school. To that end, HHS supported the following initiatives:

• HHS, through the Office on Disability, reorganized the process through which HHS ensures that all of its electronic and information technology meets accessibility standards. The Office on Disability coordinates the Section 508 Program Team, reviews and makes final decisions on agency Section 508 waiver requests, monitors agency adherence and confirms that Section 508 supporting policies are developed and implemented. The Departmental Section 508 policies and procedures are in the process of being published to ensure that all HHS agencies meet Section 508 requirements.
• The Food and Drug Administration (FDA) has an inter-agency agreement with the U.S. Department of Agriculture (USDA) to aid employees with disabilities by providing assistive technologies and ergonomic solutions. Ongoing consultations for managers and procurement officials on cost-effective accommodations will assist employees with disabilities in the workplace. The Office on Disability is working with the Section 508 Program Team, FDA and USDA to expand the FDA agreement to cover all HHS agencies.
• The Administration for Children and Families (ACF) has increased accessibility for individuals with disabilities through technology by implementing web content management software, entitled Documentum.
• The National Cancer Institute (NCI) of the National Institutes of Health (NIH) is developing a manager’s training tool in video and webcast format, called STEP508, to foster understanding and adherence to Section 508 technology standards for HHS and other federal departments. HHS-wide supervisory training is in process.
• Through an inter-agency agreement between the Department of Health and Human Services and the Department of Defense, computer and electronic assistive technology accommodations are being made available to employees through the Computer/Electronic Accommodations Program (CAP). The Office on Disability initiated training programs with CAP for the purpose of continued education of supervisors and managers.
• Assistive Technology for Rehabilitation: Examples
  • The Administration on Developmental Disabilities (ADD) in ACF oversees various Councils on Developmental Disabilities, one of which is in Kentucky. The Kentucky Developmental Disability Council contributed to the Kentucky Assistive Technology Loan Corporation (KATLC) in partnership with Fifth Third Bank of Kentucky to support the purchase of assistive technology. This collaboration resulted in 106 loans, totaling $956,885. In FY 2005, KATLC expects to maintain a level of at least 10 loans per month.
  • The Centers for Medicare and Medicaid Services (CMS) developed a website for consumers and other external users to more easily obtain information about durable medical equipment under Medicare.
  • CMS and the Office on Disability participated in the Interagency Working Group on Assistive Technology Mobility Devices in response to the President’s Executive Memorandum requesting an analysis of how federal programs support assistive mobility. The workgroup provided a report to the President that included recommendations on how the federal agencies can pool funding from existing resources to obtain the assistive technology mobility devices needed to pursue educational and employment goals.
• Assistive Technology Research: Examples
  • In fiscal year 2003, the NIH demonstrated the success of cochlear implants to restore sound perception to deaf individuals. More hearing impairments are now being identified through universal hearing screenings at birth. NIH continues to develop implants designed to be placed directly into the auditory nerve and into the auditory brainstem.
  • The NIH is expanding its initiative, Innovative Technologies for Enhancing Function for Individuals with Disabilities, to encourage multidisciplinary research projects to develop technology to enhance functioning of individuals with low vision and blindness. Assistive technologies minimizing educational problems, social isolation and employment challenges are the expected outcomes.

Expanding Educational Opportunities for Youth with Disabilities

The President is determined to ensure that no child is left behind, that children with disabilities receive appropriate educational opportunities, and that youth receive support to transition from school to employment. Examples of the HHS support for this commitment are described below.

• The Administration on Developmental Disabilities in ACF funded the Shake-A-Leg Miami Program, which is creating systemic change by developing and delivering an innovative, family-centered mentoring program for children with disabilities through assistance to high school students in an inclusive environment. The program has served 532 participants. This has exceeded the target number of participants.
• The Family and Youth Services Bureau in ACF hosted the Second National Youth Summit, which drew approximately 1,200 participants, including 300 youth leaders. Sessions included information on youth with disabilities making a successful transition from employment to lifelong learning, and highlighted particular youth development projects. This summit laid the foundation for future expansion of educational opportunities for youth with disabilities.
  The Family and Youth Services Bureau in ACF, through its Runaway and Homeless Youth Programs, has also worked to ensure that homeless and runaway youth, including youth who are disabled, have full access to education while receiving the program’s services. A total of $49.5 million in fiscal year 2003 supported these programs.
• In 2003, the Head Start Bureau in ACF helped 1,545 grantees provide inclusive placements for 114,000 children with disabilities, from newborns to five-year olds. This occurred by collaborating with community partners to implement the Individuals with Disabilities Education Act (IDEA) requirements for appropriate services.

Integrating Americans with Disabilities into the Workforce

To augment employment opportunities for individuals with disabilities, HHS supports a strategy that includes simultaneous improvements in training and employer education, creative job accommodations (i.e., tele-working), and accessible transportation. HHS efforts in 2003 include the following.

• In fiscal year 2003, ACF jointly funded the first year of a three-year supported demonstration, with the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Department of Labor (DOL). The first year’s funding of $1 million implemented this demonstration’s attention to employment outcomes for current or former recipients of Temporary Assistance for Needy Families (TANF) who have difficulty finding and keeping jobs, including persons with mental disorders.
• ACF, in collaboration with ASPE, provided technical assistance through Academies for Urban Partnership to ten cities in developing and implementing strategies for helping TANF recipients, including individuals with disabilities, become self-sufficient.
• ADD, through its network of Developmental Disability Councils, promoted initiatives to enhance employment of persons with developmental disabilities. For example, the Illinois Council on Developmental Disabilities funded a three-year project with the Mayor of Chicago’s Office for Workforce Development to increase the capacity of two “one-stop” workforce centers to serve individuals with developmental disabilities.
• CMS plans to release an updated “request for proposals” for the Ticket to Work Demonstration to Maintain Independence and Employment. It will clarify the flexibility states have in providing all the support services needed by individuals struggling to maintain economic self-sufficiency. A priority area under this solicitation will be individuals with a mental illness.
• CMS developed a legislative proposal to continue Medicaid eligibility for spouses of disabled individuals who are eligible for Medicaid services under Section 1619(b) of the Social Security Act and who return to work. This proposal is currently being considered by Congress as part of the President’s proposed New Freedom Initiative Medicaid Demonstration Act of 2003, which was transmitted by the Administration to Congress on July 23, 2003. Under current law, individuals with disabilities might be discouraged from returning to work because the income they earn could jeopardize their spouse’s Medicaid eligibility. This proposal would extend to the spouse the same Medicaid coverage protection now afforded the disabled worker.
• The Health Resources and Services Administration (HRSA), through its Healthy and Ready to Work Initiative, provided $2.8 million in grants, cooperative agreements and contracts to governmental and non-profit entities that focus on youth with special health care needs in the transition to all aspects of adulthood. This includes transition to the adult health care system, employment opportunities, and post-secondary education.
• In fiscal year 2004, NIH will develop a contract with the American Association for the Advancement of Science (AAAS) to offer postsecondary internship positions in NIH laboratories or other programs for students with disabilities majoring in science, mathematics, and other technical fields.

Promoting Full Access to Community Life

The NFI promotes independence and access to the “American Dream” through self-determination, community-based care, accessibility and quality housing for individuals with disabilities. To achieve these objectives, the HHS supported the following programs.

• Home and Community-Based Service Programs
  • The President included $1.75 billion in his fiscal year 2004 budget for the five-year. Individual Rebalancing Demonstration, with $350 million targeted for fiscal year 2004. This demonstration would assist states in re-balancing long-term care systems to support cost-effective choices between institutional and community options, including financing Medicaid services for individuals who transition from institutions to the community. This demonstration was included in the Administration’s proposed New Freedom Initiative Medicaid Demonstrations Act of 2003, which is pending in Congress.
  • CMS awarded approximately $40 million to states and other eligible entities under the Real Choice Systems Change Grants for Community Living to enable individuals with disabilities to reside in their homes and participate fully in community life. States were permitted to use fiscal year 2003 funding for many purposes: planning for any of the demonstrations, including Money Follows the Person Rebalancing Initiative within the President’s proposed NFI Medicaid Demonstrations Act of 2003; implementing quality improvement plans for home and community-based services; developing the Independence Plus initiative which promotes the principles of self-determination; developing improvements to community-integrated personal assistance services delivery systems; creating Family-to-Family health care information centers; and providing technical assistance to grantees and to consumer advisor committees.
  • The Administration on Aging (AOA) and CMS jointly funded the Aging and Disability Resource Center Program. A total of $10 million was awarded to 12 states to develop “one stop” centers to help individuals with disabilities of any age access the full range of long-term support options. The resource centers are designed to be visible and trusted places where people can turn for information on long-term support options, as well as assistance in accessing these options.
  • In fiscal year 2003, CMS developed a multi-pronged strategy to improve the quality of home and community-based services, including strengthening federal and state oversight of these services. Under the CMS Action Plan for Quality, HHS will develop and disseminate tools and technical assistance to states in fiscal year 2004.
  • On November 5, 2003, the Office on Disability (OD) co-sponsored with the Department of Housing and Urban Development (HUD), Fannie Mae, CMS, and NIH the Symposium on Homeownership for Persons with Disabilities. The symposium provided best practices and lessons learned from states that have effectively provided homeownership to individuals with disabilities. It demonstrated to national disability constituent organizations the important role they have in advocating for and/or sponsoring homeownership. Presented as a live webcast, the symposium can be accessed for one year from the OD website, www.hhs.gov/od/. The Office on Disability, along with the homeownership co-sponsors, is continuing to provide information forums and “think tank” meetings targeted to national constituent organizations to help increase the availability of affordable housing for individuals with disabilities. A second homeownership symposium is scheduled for June 2004 in honor of Homeownership Month.
  • CMS has moved ahead aggressively to fulfill its promise to “open the doors” of the agency in order to better hear and interact with beneficiaries, providers and other stakeholders interested in the delivery of quality healthcare. The agency created a popular monthly public information and input program, Open Door Forum, on community-based service policies. Senior-level agency officials chair the forum. Featured topics have included:
  • The Money Follows the Individual
  • Self-Directed Services
  • Quality Home and Community-based Services
  • Home and Community-based Services Future Directions
  • Mental Health Issues/Initiatives
  • Employment
  • Workforce Shortage Solutions
  • Integrated Housing
  • CMS developed a legislative proposal to fund a 10-year demonstration project for respite services for adults. The proposal was included in the New Freedom Initiative Medicaid Demonstration Act, draft legislation submitted by the Administration to Congress on July 23, 2003.
  • The ADD provided 31 planning grants totaling $3.1 million to state and local organizations for Family Support 360, a cutting edge initiative to develop a seamless system of services for underserved families of people with developmental disabilities. The grantees are developing partnerships with agencies providing such support services as health and mental health care, family strengthening, food stamps, childcare, housing, transportation, special education, and job training/employment. The eventual goal is to establish “one-stop” centers where coordinated, outcome-oriented and family-centered services will be delivered.
  • The Indian Health Service (IHS), in collaboration with CMS, is in the process of a launching a three-year demonstration project to ensure that American Indians and Alaska Natives who are eligible for benefits under Medicare, Medicaid, and disability programs receive the appropriate benefits.
  • During fiscal year 2003, HRSA added an estimated 180 new or expanded health care delivery sites to its network of local health centers. These sites provide health care access for those most in need, including individuals with disabilities. This expansion of sites is part of the President's Health Centers Growth Initiative, announced in 2002, to increase the number of health care delivery sites by 1,200 by the end of fiscal year 2008. Through this initiative, HRSA has served more than 11 million persons and is increasing the capability of health centers to deliver needed care to disabled consumers.
  • SAMHSA, in conjunction with the Social Security Administration (SSA), developed a training manual and conducted training for case managers who work with homeless persons to enable them to provide better information and guidance regarding eligibility determinations and benefits available under the Social Security Disability (SSD) and Supplemental Security Income (SSI) programs. The SAMHSA and SSA partnership will continue to update and expand the training so that case managers can ensure that persons eligible for benefits will receive them.
• Direct Service Worker Support
  • In fiscal year 2003, CMS funded a $6 million demonstration grant, Improve the Direct Service Community Workforce, which enables state- and community-based providers to test new strategies for recruiting, training, and retaining direct service workers. An additional $3 million for the demonstration was included in the President’s proposed fiscal year 2004 budget. CMS contracted with the Paraprofessional Healthcare Institute (PHI) to create a return-on-investment model that can be used by states to show the effect of a wage increase for direct service workers on the state’s economy. PHI also developed a supervisory training curriculum to assist in training consumers to supervise their own care.
  • ASPE, with the CMS, HRSA and the DOL, submitted a report to Congress in 2003 entitled The Future Supply of Long-Term Care Workers in Relation to the Aging Baby Boom Generation. The report identified the causes of the shortage of frontline workers (registered and licensed practical nurses, certified nurse aides and other direct care workers) for nursing homes, assisted living facilities and home health care. In order to address the increasing demand for long-term care by an aging baby boomer generation, the report emphasized the critical need to retain existing long-term care workers, attract new workers, support state and local initiatives to increase the long-term care workforce, and test new models of recruitment and retention of care workers to serve older adults and individuals with disabilities.
  • HRSA is now placing a greater emphasis on enhancing the professional capability of medical professionals serving older adults and individuals with disabilities. In fiscal year 2003, HRSA provided $18.8 million to train individuals from a wide variety of professional disciplines to assume leadership roles and ensure high levels of clinical competence in improving the health of children who have, or are at risk of developing, neuro-developmental or other related disabilities, such as autism and mental retardation. The professional disciplines include audiologists, dentists, health administrators, nurses, nutritionists, physicians, social workers, physical and occupational therapists, and others.
  • HRSA expanded its initiative on postdoctoral training support directed at children with special healthcare needs. This included support for Fellows in behavioral pediatrics, which increased by approximately $400,000. It also included a modest increase in support for postdoctoral training for pediatric dentists designed to foster leadership in administration, education, public health and oral health services.
• Self Directed Services
  • HHS and the Robert Wood Johnson Foundation are preparing to award a new round of grants in fiscal year 2004 to enable 10 new states to replicate the innovative Cash and Counseling Demonstration program. This program, funded by ASPE and the Robert Wood Johnson Foundation, determined the feasibility of offering cash allowances in lieu of traditional agency services to Medicaid beneficiaries. It is based on the CMS demonstration that granted waivers under Section 1115 of the Social Security Act to Arkansas, Florida, and New Jersey. Cash allowances, coupled with information services, were paid directly to older persons and/or individuals with disabilities, allowing them to arrange and purchase the services they felt best met their needs. Findings from the Cash and Counseling Demonstration controlled experimental design evaluation were reported in the November 19, 2003, Journal of Health Affairs. Due to the cost effective and flexible solutions for care as learned from the Cash and Counseling Demonstration, CMS expanded self-direction into the Independence Plus waiver templates to guide states in developing programs that allow individuals with disabilities and their families to decide how best to plan, obtain and sustain community-based services, placing control into the hands of the people using the services.
• Children’s Services
  • In fiscal year 2003, HRSA funded $25 million in activities to implement, measure and monitor the six components of integrated community-based systems of services for children and youth with special health needs. Children with special healthcare needs are those who have, or are at risk, for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type and amount beyond that required generally by children. These six core components include:   Family Participation and Satisfaction; Access to Medical Homes; Access to Affordable Insurance; Early and Continuous Screening; Easy-to-Access Community-Based Service Systems; and Services Necessary to Transition to Adulthood. These components are in accordance with the President’s New Freedom Initiative. The effort to support the expansion of medical homes has been conducted in collaboration with the American Academy of Pediatrics. The purpose is to ensure that every child with special needs has a medical home, i.e. access to an ongoing, routine source of comprehensive health care that is accessible, family-centered, comprehensive, coordinated, and compassionate.
  • CMS developed a legislative proposal for a ten-year demonstration project that would allow states to test the efficacy and cost-effectiveness of a home and community-based alternative under Medicaid to psychiatric residential treatment for children. The proposal was included in the Administration’s proposed bill entitled The New Freedom Initiative Medicaid Demonstrations Act of 2003. In support of this proposal, ASPE initiated a study of how states organize available federal, state and local funding for community alternatives to institutionalization for children with serious emotional disturbances.
• Health and Health Trends
  • The Office on Disability, with the Women’s Health Bureau, provided planning support for the National Women’s Check-Up Day in 2003. This included addressing for the first time the healthcare issues and needs of women who are disabled by having them receive physical check-ups at some of the national University Centers of Excellence.
  • The Office on Disability has developed a management tool for assessing disability related statutory and discretionary funding for all HHS research, education and service programs to be used as the barometer on how agencies address the priorities of individuals with disabilities.
• President’s New Freedom Commission on Mental Health
  • In July 2003, the President’s New Freedom Commission on Mental Health issued its recommendations in a final report entitled Achieving the Promise, Transforming Mental Health Care in America. The report identifies barriers to care within the mental health system and examples of community-based care models that have proven successful in coordinating and providing treatment services. To support the recommendations in the report, HHS is planning the following:
    • SAMHSA, the lead agency for developing the required action plan, is working with other federal partners and outside stakeholders to develop a National Action Agenda designed to respond to the recommendations in the Achieving the Promise report. SAMHSA also plans to make technical assistance grants available to states to help them implement recommendations from the President’s New Freedom Commission on Mental Health.
    • CMS will release a technical assistance guide on six evidence-based practices (family psycho-education, integrated care of co-occurring disorders, personal illness management, supported employment, assertive community treatment and medication management). The guide will clarify what services are billable under Medicaid.
    • CMS is working with SAMHSA and constituent representatives to configure how a consumer self-direction initiative can address persons with mental disorders, as part of a series of planning meetings resulting in action steps.
    • CMS is working with SAMHSA and constituent representatives to configure how a consumer self-direction initiative can address persons with mental disorders, as part of a series of planning meetings resulting in action steps.
    • In fiscal year 2004, ASPE will complete a handbook that describes and clarifies Medicaid rules and regulations governing application of Medicaid options for people with mental illness.
• Olmstead/Americans with Disabilities Act (ADA)
  • SAMHSA’s three-year grant program, State Coalitions to Promote Community-based Care, supports the work of existing state coalitions with Olmstead planning processes, aimed at inclusion of individuals with disabilities to help eliminate unnecessary institutionalization of children with severe emotional disturbance and adults with serious mental illnesses. SAMHSA plans to make state technical assistance grants available focusing on the implementation of recommendations from the final report of the President’s New Freedom Commission on Mental Health, including consumer and family driven mental health care, eliminating disparities in mental health care, delivery of excellent mental health care, and acceleration of mental health care research.
  • The Centers for Disease Control and Prevention (CDC) has expanded its leadership role in the American Community Survey (ACS) Subcommittee on Disability Questions to re-examine the disability questions used in the United States Census and the subsequent ACS to properly identify the U.S. population with disabilities. The objective is to improve the Census/ACS questions in order to provide necessary data for agencies needing to address service needs and equalization of opportunity under the ADA which will be derived from cognitive and field-testing. This information is expected to become part of the ACS Survey by 2008.
  • The Office for Civil Rights (OCR) continues to provide technical assistance to states in undertaking efforts to develop plans for community integration, as outlined in the Olmstead Decision. To date, OCR has provided technical assistance to approximately 40 states through ADA experts in its headquarters and regional offices and through external experts on long-term care.
• Rights of Individuals with Disabilities
  • Pursuant to Executive Order 13217 that requires swift implementation of the Olmstead Decision, OCR has continued to investigate ADA and Olmstead complaints and to initiate compliance reviews. In Delivering on the Promise, OCR committed to broadly disseminate individual accounts of how its civil rights compliance activities have facilitated community integration. To carry out this commitment, OCR has published on its website and distributed copies of more than 100 cases in which OCR’s Olmstead compliance efforts resulted in preventing unnecessary institutionalization and assisting individuals to leave institutions and return to their communities.
  • Executive Order 13217 also requested HHS and the Department of Justice (DOJ) to resolve Olmstead complaints with alternative dispute resolution techniques whenever possible to achieve a quick and constructive resolution. HHS and DOJ have worked cooperatively to develop and implement an alternative dispute resolution program for complaints filed with OCR alleging a violation of the right to services in the most integrated setting. The program began on a pilot basis in fiscal year 2003 and is being expanded in fiscal year 2004.
  • President Bush signed the Help America Vote Act (HAVA) into law on October 29, 2002. HAVA assigned responsibility to the Secretary of Health and Human Services for implementing a $15 million disability program, designed to ensure that the voting process includes access for individuals with disabilities. HHS awarded $13 million to states to make polling places accessible for individuals with disabilities, to ensure privacy and independence of voting, to train poll workers to meet the needs of individuals with disabilities, and to provide information to individuals with disabilities about their rights of accessibility. The Secretary also awarded $2 million to provide advocacy services to individuals with disabilities on issues related to registering to vote, casting a vote, and accessing voting places. Of this amount, $140,000 was awarded to provide technical assistance to the Protection and Advocacy Systems on how to improve access to the electoral process for individuals with disabilities.
  • OCR and ACF developed the TANF Disability Guidance, which provides a practical tool for TANF programs. The guidance includes a review of key legal requirements contained in the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act of 1973, as well as promising practices in areas of screening and assessment of disabilities, program modifications and improvements in TANF agency policies and procedures. OCR provides technical assistance and training on the guidance to state and local entities, as well as recipients of federal funds and consumers.
  • The Office on Disability chairs the 18-member International Steering Committee, formed in 1995 to guide the planning of the International Children’s Congress on Including Children with Disabilities in their Communities. Core to the International Children’s Congress meetings is a focus on: 1) inclusion of children at the community level; 2) the primacy of families and the importance of their partnership with professionals; and 3) a multi-disciplinary approach to creating and sustaining supports and services at local levels.
• Research and Evaluation of Community Integration
  • In fiscal year 2003, the CDC provided $2.9 million to the Christopher and Dana Reeve Paralysis Resource Center, a facility designed to improve the quality of life of persons living with paralysis. This center provides information services related to paralysis and awards community-based health promotion grants twice a year.
  • CDC funded the Living Well with a Disability program, a health promotion curriculum delivered in consumer controlled Independent Living Centers (ILCs) to address secondary conditions associated with primary disabling conditions (e.g., epilepsy). The curriculum is a theory-based, eight-week modular health promotion and behavior-modifying intervention, implemented nationally at ILCs throughout the country. Participants in the Living Well curriculum engage in interventions delivered by trained peer educators at community-based ILCs. The curriculum focuses on goal-setting, information-seeking, problem-solving strategies, and developing healthy reactions to frustration and stress, overcoming depression, engaging in and maintaining exercise habits, and enhancing nutritional intake. This program’s evaluation found the program to be beneficial and cost-effective.
  • The Agency for Healthcare Research and Quality (AHRQ) is developing a disability research agenda. In 2003, AHRQ categorized its disability research efforts by NFI disability domains. AHRQ designated an estimated $1.8 million of its fiscal year 2004 budget toward NFI related efforts, pending budget approval for research and training grants and collaborative agreements including attention to healthcare, health related assistive and information technology, health related education and community integration and participation of individuals with disabilities. Potential focus areas includes outcome measures, health preference assessment, telemedicine, care collaboration and caregiving.
  • HRSA completed the data analysis from the first National Survey of Children with Special Health Care Needs. This survey provides national prevalence estimates for children and youth with special healthcare needs, and provides a mechanism for reporting and monitoring progress at the national and state levels.