[Federal Register: December 9, 1999 (Volume 64, Number 236)]
[Page 69153-69158]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr09de99-169]
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Part V
Department of Education
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National Institute on Disability and Rehabilitation Research; Notice
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DEPARTMENT OF EDUCATION
National Institute on Disability and Rehabilitation Research
AGENCY: Office of Special Education and Rehabilitative Services,
Department of Education.
ACTION: Notice of proposed funding priority for fiscal years 2000-2001
for Model Spinal Cord Injury Centers.
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SUMMARY: The Assistant Secretary for the Office of Special Education
and Rehabilitative Services proposes a funding priority for Model
Spinal Cord Injury Centers under the National Institute on Disability
and Rehabilitation Research (NIDRR) for fiscal years 2000-2001. The
Assistant Secretary takes this action to focus research attention on
areas of national need. We intend this priority to improve the
rehabilitation services and outcomes for individuals with disabilities.
This notice contains a proposed priority under the Special Projects and
Demonstrations for Spinal Cord Injuries Program.
DATES: Comments must be received on or before January 10, 2000.
ADDRESSES: All comments concerning this proposed priority should be
addressed to Donna Nangle, U.S. Department of Education, 400 Maryland
Avenue, SW, room 3418, Switzer Building, Washington, DC 20202-2645.
Comments may also be sent through the Internet: donna__nangle@ed.gov
You must include the term ``Special Projects and Demonstrations for
Spinal Cord Injuries'' in the subject line of your electronic message.
FOR FURTHER INFORMATION CONTACT: Donna Nangle. Telephone: (202) 205-
5880. Individuals who use a telecommunications device for the deaf
(TDD) may call the TDD number at (202) 205-2742. Internet:
donna__nangle@ed.gov
Individuals with disabilities may obtain this document in an
alternate format (e.g., Braille, large print, audiotape, or computer
diskette) on request to the contact person listed in the preceding
paragraph.
SUPPLEMENTARY INFORMATION:
Invitation to comment:
We invite you to submit comments regarding this proposed priority.
We invite you to assist us in complying with the specific
requirements of Executive Order 12866 and its overall requirement of
reducing regulatory burden that might result from this proposed
priority. Please let us know of any further opportunities we should
take to reduce potential costs or increase potential benefits while
preserving the effective and efficient administration of the program.
During and after the comment period, you may inspect all public
comments about this priority in Room 3424, Switzer Building, 330 C
Street SW., Washington, DC, between the hours of 9:00 a.m. and 4:30
p.m., Eastern time, Monday through Friday of each week except Federal
holidays.
Assistance to Individuals With Disabilities in Reviewing the
Rulemaking Record
On request, we will supply an appropriate aid, such as a reader or
print magnifier, to an individual with a disability who needs
assistance to review the comments or other documents in the public
rulemaking record for this proposed priority. If you want to schedule
an appointment for this type of aid, you may call (202) 205-8113 or
(202) 260-9895. If you use a TDD, you may call the Federal Information
Relay Service at 1-800-877-8339.
This proposed priority supports the National Education Goal that
calls for every adult American to possess the skills necessary to
compete in a global economy.
The authority for the Secretary to establish research priorities by
reserving funds to support particular research activities is contained
in sections 202(g) and 204 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. 762(g) and 764). Regulations governing this program
are found in 34 CFR parts 350 and 359.
We will announce the final priority in a notice in the Federal
Register. We will determine the final priority after considering
responses to this notice and other information available to the
Department. This notice does not preclude us from proposing or funding
additional priorities, subject to meeting applicable rulemaking
requirements.
Note: This notice does not solicit applications. In any year in
which the Assistant Secretary chooses to use this proposed priority,
we invite applications through a notice published in the Federal
Register. When inviting applications we designate each priority as
absolute, competitive preference, or invitational.
Special Projects and Demonstrations for Spinal Cord Injury
The authority for Model Spinal Cord Injury Centers is contained in
section 204(b)(4) of the Rehabilitation Act of 1973, as amended (29
U.S.C. 764(b)(4)). The Secretary may make awards for up to 60 months
through grants or cooperative agreements. This program provides
assistance to establish innovative projects for the delivery,
demonstration, and evaluation of comprehensive medical, vocational, and
other rehabilitation services to meet the wide range of needs of
individuals with spinal cord injuries.
Description of Special Projects and Demonstrations for Spinal Cord
Injuries
This program provides assistance for projects that provide
comprehensive rehabilitation services to individuals with spinal cord
injuries and conduct spinal cord research, including clinical research
and the analysis of standardized data in collaboration with other
related projects.
Each Spinal Cord Injury Center funded under this program
establishes a multidisciplinary system of providing rehabilitation
services, specifically designed to meet the special needs of
individuals with spinal cord injuries. This includes acute care as well
as periodic inpatient or outpatient follow up and vocational services.
Centers demonstrate and evaluate the benefits and cost effectiveness of
such a system for the care of individuals with spinal cord injury and
demonstrate and evaluate existing, new, and improved methods and
equipment essential to the care, management, and rehabilitation of
individuals with spinal cord injuries. Grantees demonstrate and
evaluate methods of community outreach and education for individuals
with spinal cord injuries in connection with the problems of such
individuals in areas such as housing, transportation, recreation,
employment, and community activities.
Projects funded under this program ensure widespread dissemination
of research findings to all Spinal Cord Injury Centers, and to
rehabilitation practitioners, individuals with spinal cord injury, and
the parents, family members, guardians, advocates, or authorized
representatives of such individuals. They engage in initiatives and new
approaches and maintain close working relationships with other
governmental and voluntary institutions and organizations to unify and
coordinate scientific efforts, encourage joint planning, and promote
the interchange of data and reports among spinal cord injury
researchers.
NIDRR requires all Centers to involve individuals with disabilities
and individuals from minority backgrounds as recipients of research
training, as well as clinical Service and training.
The Department is particularly interested in ensuring that the
expenditure of public funds is justified
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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
Center, 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.
Proposed Priority for Model Spinal Cord Injury Centers
Estimates of the number of people living with traumatic spinal cord
injury (SCI) range from 183,000 to 230,000, with an incidence of
approximately 10,000 new cases each year (``Spinal Cord Injury Facts
and Figures at a Glance,'' National Spinal Cord Injury Statistical
Center (NSCISC), University of Alabama at Birmingham). Although SCI
predominately affects young adults (56% of SCIs occur among people aged
16-30 years), there is an increasing proportion of new SCI cases in the
population over 60 years of age (NSCISC, ibid.). The true significance
of traumatic SCI lies not primarily in the numbers affected, but in the
substantial impact on individuals' lives and the associated substantial
health care costs and living expenses. A traumatic SCI has far-reaching
repercussions on the lives of the injured persons and their families
that can be devastating if not addressed effectively. According to a
report from the Agency for Health Care Policy and Research (Hospital
Inpatient Statistics, 1996, AHCPR Publication No. 99-0034), spinal cord
injury is the most expensive condition or diagnosis treated in U.S.
hospitals. The estimated lifetime costs for an individual injured at
the age of 25 range from $365,000 for an incomplete injury to more than
$1.7 million for an individual with a high cervical injury (NSCISC, op
cit).
The Model SCI program was developed in 1970 to demonstrate the
value of a comprehensive integrated continuum of care for SCI. Twenty-
six sites have been designated, at various times, as Model SCI Centers
through funding initially from the Rehabilitation Services
Administration, and subsequently from the National Institute on
Handicapped Research, and its successor, the National Institute on
Disability and Rehabilitation Research (NIDRR). For the period 1995-
2000 there are 18 funded Model SCI Centers. (Additional information is
available on the World Wide Web at http://www.ncddr.org/mscis/). The
clinical components of the Model Centers are specified in the program
regulations, and include ``. . . emergency medical services, acute
care, vocational and other rehabilitation services, community and job
placement, and long-term community follow up and health maintenance''
(34 CFR 359.11). In addition to demonstrating and evaluating the
benefits of such a system the centers are required to contribute data
on their patients to the National Spinal Cord Injury Database (NSCID),
and engage in research both within the center, and in collaboration
with other centers.
During the past 30 years, there have been substantial improvements
in outcomes following SCI (Stover, S.L, et al., Spinal Cord Injury:
Clinical Outcomes From the Model Systems, and Special Issue, Spinal
Cord Injury: Current Research Outcomes from the Model Spinal Cord
Injury Care Systems, Archives of Physical Medicine and Rehabilitation,
Vol. 80, No. 11, November, 1999). Enhanced emergency medical services
have led to increased preservation of neurologic function. Mortality
during the first year following injury has continuously declined. Life
expectancy, while still below that for those without SCI, has
significantly increased for all levels of injury. The ideal of a
comprehensive multi-disciplinary system of care for SCI has gained
widespread acceptance.
However, significant challenges and opportunities remain for SCI
rehabilitation. Recent statistics from the National Spinal Cord Injury
Statistical Center (NSCISC) suggest that as the length of stay in
rehabilitation settings has progressively decreased (1993-1998), there
has been an increase in re-hospitalization during the first year after
injury. In addition, mortality after the first anniversary of injury
declined continuously from 1973-1992, but now has increased for the
period 1993-1998. Secondary medical complications, including, but not
limited to, respiratory complications, pressure ulcers and autonomic
dysreflexia, continue to be significant problems. Injuries due to
interpersonal violence have increased as a proportion of the total SCI
incidence and are more likely to be neurologically complete injuries.
There is a need to identify, evaluate, and eliminate barriers in
the natural, built, cultural, and social environments to enable people
with SCI to achieve the goal of fully reintegrating into their
community. Particular focus is required to address the needs of
minority and underserved populations. Although employment for the U.S.
population is at historically high levels, employment for the SCI
population remains low. Individuals with SCI due to inter-personal
violence have an employment rate approximately half of the average for
all individuals with SCI (NSCISC, op cit).
NIDRR shares the concerns of the rehabilitation community about the
impact of changes in health care delivery and financing upon the
continuum of care for SCI. People with SCI often have more difficulty
in obtaining adequate primary health care than non-disabled
individuals. The unique needs of women with SCI in cardiac
rehabilitation, reproductive health, and early cancer screening are
special issues that need to be addressed.
There are also new and developing opportunities for improving SCI
care. Medical and pharmacological therapies show promise for preserving
and enhancing function. There is a need to identify and evaluate
therapeutic interventions, including prevention and wellness programs,
and complementary and alternative therapies using evidence-based
evaluation protocols.
Advancing technology has the potential to enhance access and
function for individuals with SCI. There is a need to develop and
evaluate service delivery models incorporating telerehabilitation
strategies and technologies to provide services for people with SCI.
Assistive technologies may reduce the likelihood of secondary
complications in SCI. For example, improved wheelchair and seating
systems may reduce musculoskeletal trauma associated with long term
wheelchair use. Technological advancement has the promise of providing
greater accessibility to information, telecommunications, and
employment. The adoption of universal design methodologies will enhance
access to the built environment as well as rapidly developing
electronic and information technologies.
The development of strong collaborations by SCI centers with
community and social support organizations has the potential to impact
positively the independence and community integration for individuals
with SCI. Peer support beginning early in the rehabilitation process
may enhance return to participation in the community. The causes of
unemployment in SCI include lack of education and skills, lack of prior
work experience, and policy disincentives. Pending changes in
legislation and policy to permit retention of some medical insurance
during employment, together with the high demand for skilled
individuals in the workforce, represents an opportunity to foster
education and employment of individuals with SCI.
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NIDRR has published a Long-Range Plan (the Plan) that is based upon
a new paradigm for rehabilitation that identifies disability in terms
of the relationship between the individual and the natural, built,
cultural, and social environments (63 FR 57189-57219). The Plan focuses
on both individual and systemic factors that have an impact on the
ability of people to function. The elements of the Plan include
employment outcomes, health and function, technology for access and
function, and independent living and community integration. As part of
the Plan to attain the goals in these areas, NIDRR is committed to
capacity building for research and training, and to ensure knowledge
dissemination and utilization. Each area of the Plan includes
objectives at both the individual and system levels. For example, the
health and function objectives include research to improve medical
rehabilitation interventions, as well as research to ensure access to
an integrated continuum of quality health care services that address
the unique needs of persons with disabilities. It is clear that the
challenges and opportunities for SCI care reflect all of the priority
areas of the Plan.
NIDRR has recently completed Program Reviews of all current Model
SCI Centers. Based upon presentations by the Centers, and discussion
with the external reviewers, NIDRR has concluded that the value of a
comprehensive integrated system of care for SCI has been demonstrated.
Because this conclusion is widely accepted, NIDRR is shifting the focus
of the program from demonstration, to place a greater emphasis upon
research. Participants in the Program Reviews observed that the
comprehensive continuum of quality care should continue to be a
requirement for participation in the Model SCI Centers Program. There
is significant diversity among the Centers, however, in research
interests and capacities. This diversity extends across the priority
areas of the Plan, and represents the strength of the program.
Reviewers noted that uniformly comprehensive, high quality care,
together with a common data collection system and administrative
infrastructure makes the Model SCI Centers Program a valuable platform
for various collaborative studies, including multi-center trials of
therapies and technologies. To further the enhancement of the research
mission, participants recommended a separate competition for the
collaborative research portion of the program. A separate competition
will facilitate focused, considered proposals, a higher level of
scientific review, and the development of significant research projects
in the Model SCI Centers. The competition for collaborative research
projects will be conducted subsequent to the identification of the
Model SCI Centers, and funds will be reserved for that purpose.
During the Program Reviews, there was considerable discussion of
the National SCI Database (NSCID). It is clear that the database is a
valuable resource and that participation in the NSCID is an essential
element for the Model SCI Centers. For the purpose of the present
competition, the data collection activities will be maintained without
change. NIDRR expects that applicants will include historical
documentation of numbers of patients as well as expected new patients
and expected annual follow-up submissions based on current eligibility
criteria for the NSCID. However, it is anticipated that, through
discussion among the newly identified Model SCI Centers, NIDRR staff,
and external reviewers, details of data collection may be modified
following the award. This process should not result in increased data
collection workloads above current levels.
Proposed Priority
The Assistant Secretary proposes to establish Model Spinal Cord
Injury Centers for the purpose of generating new knowledge through
research, development, or demonstration to improve outcomes for SCI
through improved interventions and service delivery models. A Model
Spinal Cord Injury Center must:
(1) Establish a multidisciplinary system of providing
rehabilitation services specifically designed to meet the special needs
of individuals with spinal cord injury (SCI), including emergency
medical services, acute care, vocational and other rehabilitation
services, community and job placement, and long-term community follow
up and health maintenance;
(2) Participate as directed by the Assistant Secretary in national
studies of SCI by contributing to a national database and by other
means as required by the Assistant Secretary; and
(3) Conduct a significant and substantial research program in SCI
that will contribute to the advancement of knowledge in one of the goal
areas of the NIDRR Long Range Plan. Applicants may select one of the
following research objectives related to specific areas of the Plan:
* (Chapter 3, Employment Outcomes): Either (1) Assess the
impact of legislative and policy changes on employment outcomes; or (2)
Test direct intervention strategies for improving employment outcomes.
* (Chapter 4, Maintaining Health and Function): Either (1)
Study interventions to improve outcomes in the preservation or
restoration of function or the prevention and treatment of secondary
conditions; or (2) Design and test service delivery models that provide
quality care under constraints imposed by recent changes in the health
care financing system.
* (Chapter 5, Technology for Access and Function): Either
(1) Evaluate the impact of selected innovations in technology and
rehabilitation engineering on service delivery; or (2) Evaluate the
impact of selected innovations in technology and rehabilitation
engineering on outcomes such as function, independence, and employment.
* (Chapter 6, Independent Living and Community Integration):
Assess the value of peer support and early onset of services from
community and social support organizations to improve outcomes such as
independence and community integration, employment function, and health
maintenance.
(4) Provide for the widespread dissemination of research and
demonstration findings to other SCI centers, rehabilitation
practitioners, researchers, individuals with SCI and their families and
representatives, and other public and private organizations involved in
SCI care and rehabilitation. In carrying out these purposes, the SCI
center must:
* Incorporate culturally appropriate methods of community
outreach and education in areas such as health and wellness, housing,
transportation, recreation, employment, and other community activities
for individuals with diverse backgrounds with spinal cord injury;
* Demonstrate the research and clinical capacity to
participate in collaborative projects, clinical trials, or technology
transfer with other model SCI centers, other NIDRR grantees, and
similar programs of other public and private agencies and institutions;
and
* Demonstrate the likelihood of having a sufficient number
of individuals with SCI, including newly injured persons, to conduct
statistically significant research.
Proposed Selection Criteria
The new emphasis on research and NIDRR's Long-Range Plan, plus the
importance of the NSCID, require some modifications to the selection
criteria for this program. The Secretary proposes
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to redistribute points to reflect the increased emphasis on research,
and to add references to the Plan and NSCID.
The Secretary proposes to use the following criteria to evaluate
applications under this program. The maximum score for all the criteria
is 100 points.
(a) Project design (30 points). The Secretary reviews each
application to determine to what degree--
(1) There is a clear description of how the objectives of the
project relate to the purpose of the program and the NIDRR Long Range
Plan;
(2) The research is likely to produce new and useful information;
(3) The need and target population are adequately defined and are
sufficient for meaningful research and demonstration;
(4) The outcomes are likely to benefit the defined target
population;
(5) The research hypotheses are sound; and
(6) The research methodology is sound in the sample design and
selection, the data collection plan, the measurement instruments, and
the data analysis plan.
(b) Service comprehensiveness (20 points). The Secretary reviews
each application to determine to what degree--
(1) The services to be provided within the project are
comprehensive in scope, and include emergency medical services,
intensive and acute medical care, rehabilitation management,
psychosocial and community reintegration, and follow up;
(2) A broad range of vocational and other rehabilitation services
will be available to severely handicapped individuals within the
project; and
(3) Services will be coordinated with those services provided by
other appropriate community resources.
(c) Plan of operation (10 points). The Secretary reviews each
application to determine to what degree--
(1) There is an effective plan of operation that ensures proper and
efficient administration of the project;
(2) The applicant's planned use of its resources and personnel is
likely to achieve each objective;
(3) Collaboration between institutions, if proposed, is likely to
be effective;
(4) Participation in the National Spinal Cord Injury Database is
clearly and adequately described; and
(5) There is a clear description of how the applicant will include
eligible project participants who have been traditionally
underrepresented, such as--
(i) Members of racial or ethnic minority groups;
(ii) Women;
(iii) Individuals with disabilities; and
(iv) The elderly.
(d) Quality of key personnel (10 points). The Secretary reviews
each application to determine to what degree--
(1) The principal investigator and other key staff have adequate
training or experience, or both, in spinal cord injury care and
rehabilitation and demonstrate appropriate potential to conduct the
proposed research, demonstration, training, development, or
dissemination activity;
(2) The principal investigator and other key staff are familiar
with pertinent literature or methods, or both;
(3) All the disciplines necessary to establish the
multidisciplinary system described in Sec. 359.11(a) are effectively
represented;
(4) Commitments of staff time are adequate for the project; and
(5) The applicant is likely, as part of its non-discriminatory
employment practices, to encourage applications for employment from
persons who are members of groups that traditionally have been
underrepresented, such as--
(i) Members of racial or ethnic minority groups;
(ii) Women;
(iii) Individuals with disabilities; and
(iv) The elderly.
(e) Adequacy of resources (5 points). The Secretary reviews each
application to determine to what degree--
(1) The facilities planned for use are adequate;
(2) The equipment and supplies planned for use are adequate; and
(3) The commitment of the applicant to provide administrative and
other necessary support is evident.
(f) Budget/cost effectiveness (5 points). The Secretary reviews
each application to determine to what degree--
(1) The budget for the project is adequate to support the
activities;
(2) The costs are reasonable in relation to the objectives of the
project; and
(3) The budget for subcontracts (if required) is detailed and
appropriate.
(g) Dissemination/utilization (10 points). The Secretary reviews
each application to determine to what degree--
(1) There is a clearly defined plan for dissemination and
utilization of project findings;
(2) The research results are likely to become available to others
working in the field;
(3) The means to disseminate and promote utilization by others are
defined; and
(4) The utilization approach is likely to address the defined need.
(h) Evaluation plan (10 points). The Secretary reviews each
application to determine to what degree--
(1) There is a mechanism to evaluate plans, progress, and results;
(2) The evaluation methods and objectives are likely to produce
data that are quantifiable; and
(3) The evaluation results, where relevant, are likely to be
assessed in a service setting.
Within this absolute priority, we will give the following
competitive preference under 34 CFR 75.105(c)(2)(i), to applications
that are otherwise eligible for funding under this priority:
Up to ten (10) points based on the extent to which an application
includes effective strategies for employing and advancing in employment
qualified individuals with disabilities in projects awarded under this
absolute priority. In determining the effectiveness of such strategies,
the Secretary will consider the applicant's success, as described in
the application, in employing and advancing in employment qualified
individuals with disabilities in the project.
For purposes of this competitive preference, applicants can be
awarded up to a total of 10 points in addition to those awarded under
the published selection criteria for this priority. That is, an
applicant meeting this competitive preference could earn a maximum
total of 110 points.
Applicable Program Regulations: 34 CFR part 359.
Program Authority: 29 U.S.C. 762(b)(4).
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(Catalog of Federal Domestic Assistance Numbers 84.133N, Special
Projects and Demonstrations for Spinal Cord Injuries)
Dated: December 6, 1999.
Judith E. Heumann,
Assistant Secretary for Special Education and Rehabilitative Services.
[FR Doc. 99-31952 Filed 12-8-99; 8:45 am]
BILLING CODE 4000-01-U