FR Doc 04-6725
[Federal Register: March 25, 2004 (Volume 69, Number 58)]
[Notices]
[Page 15305-15308]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr25mr04-40]
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DEPARTMENT OF EDUCATION
RIN 1820 ZA37
National Institute on Disability and Rehabilitation Research;
Notice of Proposed Priorities
AGENCY: Office of Special Education and Rehabilitative Services,
Department of Education.
ACTION: Notice of proposed priorities for health and function outcomes
for individuals with disabilities.
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SUMMARY: The Assistant Secretary for Special Education and
Rehabilitative Services proposes priorities under the Rehabilitation
Research and Training Centers (RRTC) Program for the National Institute
on Disability and Rehabilitation Research (NIDRR). The Assistant
Secretary may use one or more of these priorities for competitions in
fiscal year (FY) 2004 and later years. We take this action to focus
research attention on areas of national need. We intend these
priorities to improve health and function outcomes for individuals with
disabilities.
DATES: We must receive your comments on or before April 27, 2004.
ADDRESSES: Address all comments about these proposed priorities to
Donna Nangle, U.S. Department of Education, 400 Maryland Avenue, SW.,
room 3412, Switzer Building, Washington, DC 20202-2645. If you prefer
to send your comments through the Internet, use the following address:
donna.nangle@ed.gov.
FOR FURTHER INFORMATION CONTACT: Donna Nangle. Telephone: (202) 205-
5880.
If you use a telecommunications device for the deaf (TDD), you may
call the TDD number at (202) 205-4475 or via Internet:
donna.nangle@ed.gov.
Individuals with disabilities may obtain this document in an
alternative format (e.g., Braille, large print, audiotape, or computer
diskette) on request to the contact person listed under FOR FURTHER
INFORMATION CONTACT.
SUPPLEMENTARY INFORMATION:
Invitation To Comment
We invite you to submit comments regarding these proposed
priorities. To ensure that your comments have maximum effect in
developing the notice of final priorities, we urge you to identify
clearly the specific proposed priority that each comment addresses.
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 these proposed
priorities. 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 these proposed priorities in room 3412, Switzer
Building, 330 C Street, SW., Washington, DC, between the hours of 8:30
a.m. and 4 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 these proposed priorities. If you want to
schedule an appointment for this type of aid, please contact the person
listed under FOR FURTHER INFORMATION CONTACT.
We will announce the final priorities in a notice in the Federal
Register. We will determine the final priorities after
[[Page 15306]]
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 we choose to use these proposed priorities, we invite
applications through a notice published in the Federal Register.
When inviting applications, we designate each priority as absolute,
competitive preference, or invitational. The effect of each type of
priority follows:
Absolute priority: Under an absolute priority, we consider only
applications that meet the priority (34 CFR 75.105(c)(3)).
Competitive preference priority: Under a competitive preference
priority, we give competitive preference to an application by either
(1) awarding additional points, depending on how well or the extent to
which the application meets the priority (34 CFR 75.105(c)(2)(i)); or
(2) selecting an application that meets the competitive priority over
an application of comparable merit that does not meet the competitive
priority (34 CFR 75.105(c)(2)(ii)).
Invitational priority: Under an invitational priority, we are
particularly interested in applications that meet the invitational
priority. However, we do not give an application that meets the
invitational priority a competitive or absolute preference over other
applications (34 CFR 75.105(c)(1)).
Note: NIDRR supports the goals of President Bush's New Freedom
Initiative (NFI). The NFI can be accessed on the Internet at the
following site:
http://www.whitehouse.gov/news/freedominitiative/freedominitiative.html
.
These proposed priorities are in concert with NIDRR's 1999-2003
Long-Range Plan (Plan). The Plan is comprehensive and integrates many
issues relating to disability and rehabilitation research topics. While
applicants will find many sections throughout the Plan that support
potential research to be conducted under these proposed priorities, a
specific reference is included for each priority presented in this
notice. The Plan can be accessed on the Internet at the following site:
http://www.ed.gov/rschstat/research/pubs/index.html.
Through the implementation of the NFI and the Plan, NIDRR seeks
to--(1) improve the quality and utility of disability and
rehabilitation research; (2) foster an exchange of expertise,
information, and training to facilitate the advancement of knowledge
and understanding of the unique needs of traditionally underserved
populations; (3) determine best strategies and programs to improve
rehabilitation outcomes for underserved populations; (4) identify
research gaps; (5) identify mechanisms of integrating research and
practice; and (6) disseminate findings.
Rehabilitation Research and Training Centers
RRTCs conduct coordinated and integrated advanced programs of
research targeted toward the production of new knowledge to improve
rehabilitation methodology and service delivery systems, alleviate or
stabilize disability conditions, or promote maximum social and economic
independence for persons with disabilities. Additional information on
the RRTC program can be found at:
http://www.ed.gov/rschstat/research/pubs/res-program.html#RRTC
.
General Requirements of Rehabilitation Research and Training Centers
RRTCs must:
Carry out coordinated advanced programs of
rehabilitation research;
Provide training, including graduate, pre-
service, and in-service training, to help rehabilitation personnel more
effectively provide rehabilitation services to individuals with
disabilities;
Provide technical assistance to individuals with
disabilities, their representatives, providers, and other interested
parties;
Disseminate informational materials to
individuals with disabilities, their representatives, providers, and
other interested parties; and
Serve as centers for national excellence in
rehabilitation research for individuals with disabilities, their
representatives, providers, and other interested parties.
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 RRTC. In accordance
with the provisions of 34 CFR 75.253(a), continued funding depends at
all times on satisfactory performance and accomplishment of approved
grant objectives.
Proposed Priorities
The Assistant Secretary proposes to fund three RRTCs that will
focus on improved outcomes measures, health status, and rehabilitation
of persons with traumatic brain injury to facilitate the ability of
individuals with disabilities to live in the community. Under each of
these priorities, the RRTC must:
(1) Contribute substantially to the scientific knowledge-base
relevant to its respective subject area;
(2) Research, develop, and evaluate interventions or tools to
assist with outcomes for its focus area;
(3) Develop, implement, and evaluate a comprehensive plan for
training critical stakeholders (e.g., consumers/family members,
practitioners, service providers, researchers, and policymakers);
(4) Provide technical assistance, as appropriate, to critical
stakeholders, (e.g., consumers/family members, practitioners, and
service providers) to facilitate utilization of research findings in
its respective area of research; and
(5) Develop a systematic plan for focused dissemination of
informational materials based on knowledge gained from the RRTC's
research activities, and disseminate the materials to persons with
disabilities, their representatives, service providers, and other
interested parties.
In addition to these activities, we propose that under each of the
priorities, the RRTC must:
Conduct a state-of-the-science conference on its
respective area of research in the third year of the grant cycle and
publish a comprehensive report on the final outcomes of the conference
in the fourth year of the grant cycle. This conference must include
materials from experts internal and external to the RRTC;
Coordinate on research projects of mutual
interest with relevant NIDRR-funded projects as identified through
consultation with the NIDRR project officer;
Involve individuals with disabilities, including
those from diverse racial and ethnic backgrounds, in planning and
implementing its research, training, and dissemination activities, and
in evaluating the RRTC;
Demonstrate in its application how it will
address, in whole or in part, the needs of individuals with
disabilities from minority backgrounds; and
Articulate goals, objectives, and expected
outcomes for the proposed research activities. It is critical that
proposals describe expected public benefits, especially benefits for
individuals with disabilities, and propose projects that are designed
to demonstrate outcomes that are consistent with the proposed goals.
Applicants must include information
[[Page 15307]]
describing how they will measure outcomes, including the indicators
that will represent the end-result, the mechanisms that will be used to
evaluate outcomes associated with specific problems or issues, and how
the proposed activities will support new intervention approaches and
strategies, including a discussion of measures of effectiveness.
Priorities
Each RRTC must focus research on one of the following priorities:
Proposed Priority 1--Measuring Rehabilitation Outcomes and
Effectiveness
Background
In a research environment increasingly driven by the demand for
evidence-based practice, it is becoming even more necessary to develop
and use measures to evaluate the effectiveness and efficacy of
interventions and their value to individuals with disabilities. Despite
significant investment in development of measures, there is general
agreement that much remains to be done. This changing environment
necessitates the development, evaluation, and application of the next
generation of rehabilitation outcomes measures. These measures must be
valid, reliable, efficiently collected, relevant to the lives of people
with disabilities, and easily utilized to drive decisions made by key
rehabilitation stakeholders. Changing rehabilitation payment structures
and clinical pathways are necessitating the development of outcome
measures that can be applied across the spectrum of acute and post-
acute care settings. Through their report entitled ``Crossing the
Quality Chasm: A New Health System for the 21st Century,'' the
Institute of Medicine (IOM) emphasizes the importance of transparency
and accountability in the health care delivery system (Institute of
Medicine, 2001. Crossing the Quality Chasm: A New Health System for the
21st Century. Washington, DC: National Academy Press).
Collecting rehabilitation outcomes is labor intensive in any
setting. Applications of item-response theory and computerized dynamic
assessment technologies, which have been successfully applied in the
fields of education and psychology, have great potential to increase
efficiency and precision of rehabilitation outcomes data collection and
measurement (Ware, J. 2003. Conceptualization and Measurement of
Health-Related Quality of Life: Comments on an Evolving Field. Archives
of Physical Medicine and Rehabilitation, 84(4 Suppl 2): S43-S51).
Further application of these state-of-the-art computer-based
measurement and analysis methods in medical rehabilitation will
complement the Institute of Medicine's recommendations for the
development of a national health care information-technology
infrastructure (Institute of Medicine (2003a). Patient Safety:
Achieving a New Standard for Care. Washington, DC: National Academies
Press).
Evolving disability classification frameworks such as the
International Classification of Functioning, Disability, and Health
(ICF) (World Health Organization. International Classification of
Functioning, Disability, and Health; ICF. Geneva: World Health
Organization) emphasize the importance of participation in a wide
variety of life situations. In order to apply such frameworks to
medical rehabilitation services and research, it is necessary to
develop measurement tools that can assess participation and link this
outcome to interventions in the rehabilitation setting.
Priority: This center must conduct research to advance the field of
medical rehabilitation by increasing the utility, efficiency, and
relevance of its outcomes measurement tools and processes. The research
funded under this priority must be designed to contribute to the
following outcomes:
Improved measurement tools that can be used to
track the outcomes of individuals across a wide variety of
rehabilitation settings.
Improved measurement tools that incorporate
consumer perspectives to assess long-term community integration
outcomes within a comprehensive model for evaluating rehabilitation
effectiveness, such as the ICF.
Increased efficiency of rehabilitation outcomes
data collection, through the application of strategies such as item
response theory and computer adaptive testing techniques.
Identification of effective methods for
translating outcomes data into information that can be utilized to
inform decisions made by key rehabilitation stakeholders, including
consumers, payers, provider organizations, and clinicians.
The reference for this topic can be found in the Plan, chapter 4,
Health and Function: Research on Rehabilitation Outcomes, pp. 49-50.
Proposed Priority 2--Health and Wellness in Long-Term Disability
Background
Healthy People 2010 reports on the health status disparity between
people with disabilities and people without disabilities (U.S.
Department of Health and Human Services. Healthy People 2010
Washington, DC: Office of Disease Prevention and Health Promotion,
2001). On average, health status decreases as the severity of one's
disability increases. For older people with disabilities, this
relationship is even stronger. (U.S. Census Bureau. Americans with
Disabilities: Household Economic Status Washington DC: U.S. Census
Bureau, 2001).
Despite this established empirical correlation, health and
disability are separate and distinct concepts that must be measured on
separate scales. Research has demonstrated that concepts of health
status are commonly merged with concepts of disability. New measures of
health status are needed that are relevant to the experiences of
persons with long-term disability to facilitate assessment of health
promotion and wellness activities among this population.
NIDRR-funded research on aging, disability and secondary conditions
has identified factors associated with health and wellness outcomes for
individuals with disabilities. Access to primary (routine) health care
is one factor that may affect health status of individuals with
disabilities. Pain management, exercise, and nutrition counseling are
critical interventions to counteract the results of increasingly
sedentary lifestyles of persons with long-term disability (Campbell,
ML, Sheets, D, Strong, PS. Secondary Health Conditions Among Middle-
Aged Individuals with Chronic Physical Disabilities: Implications for
unmet needs for services. Assistive Technology; 11: 105-122, 1999;
Motszko M, Preventing osteoporosis. Lifelong nutrition and exercise
habits are the most powerful weapons. Advanced Nurse Practitioner; Jul:
10 (7): 41-3, 76, 2002). Rehabilitation researchers have also
identified complementary and alternative therapies that may promote or
contribute to improved health and wellness for persons with
disabilities (Shiffett, SC. Acupuncture and Stroke Rehabilitation.
Stroke; 32(8); 1934-6-9, 2001).
Priority: This center must conduct research that will help to
overcome the health disparities of individuals with disabilities
compared to individuals without disabilities. The research
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funded under this priority must be designed to contribute to the
following outcomes:
Identification of strategies to overcome
barriers that impede access to routine healthcare for individuals with
disabilities.
Identification of interventions in areas such as
exercise, nutrition, pain management, or complementary and alternative
therapies, that promote health and wellness and minimize the occurrence
of secondary conditions for persons with disabilities.
Improved health status measurement tool(s) to
assess health and well-being of individuals with disability regardless
of functional ability.
The reference for this topic can be found in the Plan, chapter 4,
Health and Function: Health Care at the Individual Level; Health Care
at the Systems Level, pp. 42-43.
Proposed Priority 3--Traumatic Brain Injury (TBI) Interventions
Background
An estimated 5.3 million Americans currently live with disabilities
resulting from traumatic brain injury (TBI). As stated in the 1998
National Institutes of Health (NIH) Consensus Conference Proceedings,
``TBI may result in lifelong impairment of an individual's physical,
cognitive, and psychosocial functioning.'' Among children up to age 14,
TBI results annually in an estimated 3,000 deaths, 29,000
hospitalizations, and 400,000 emergency department visits. A working
group convened by the National Center for Injury Prevention and Control
at the CDC in October, 2000 called for more research on patterns of
recovery, secondary conditions, effectiveness of treatment, and issues
of measurement for this population. At the September 2003, NIDRR-funded
State of the Science Conference on TBI Interventions, levels of
evidence for many interventions in TBI rehabilitation were
characterized as inconclusive.
Priority: This center must conduct research to improve long-term
outcomes for persons with TBI. The research funded under this priority
must be designed to contribute to one of the following outcomes:
Identification of interventions that demonstrate
efficacy, or effectiveness, or both, in promoting improved
rehabilitation outcomes for adults with TBI; or
Identification of interventions that demonstrate
either efficacy, or effectiveness, or both, in promoting improved
rehabilitation outcomes for children (under age 16) with TBI.
In addition, for either adults or children, the research funded
under this priority must be designed to develop and evaluate improved
techniques for assessing outcomes associated with TBI.
The reference for this topic can be found in the Plan, chapter 4,
Health and Function: Research on Trauma Rehabilitation, p. 47.
Executive Order 12866
This notice of proposed priorities has been reviewed in accordance
with Executive Order 12866. Under the terms of the order, we have
assessed the potential costs and benefits of this regulatory action.
The potential costs associated with the notice of proposed
priorities are those resulting from statutory requirements and those we
have determined as necessary for administering this program effectively
and efficiently.
In assessing the potential costs and benefits--both quantitative
and qualitative--of this notice of proposed priorities, we have
determined that the benefits of the proposed priorities justify the
costs.
Summary of potential costs and benefits: The potential costs
associated with these proposed priorities are minimal while the
benefits are significant. Grantees may anticipate costs associated with
completing the application process in terms of staff time, copying, and
mailing or delivery. The use of e-Application technology reduces
mailing and copying costs significantly.
The benefits of the RRTC Program have been well established over
the years. Similar projects have generated new knowledge and
technologies.
The benefit of these proposed priorities will be the establishment
of new RRTCs, which can be expected to generate new knowledge through
research, dissemination, utilization, training, and technical
assistance projects that will improve the lives of persons with
disabilities and thus improve their ability to live in the community.
Applicable Program Regulations: 34 CFR part 350.
Electronic Access to This Document
You may view this document, as well as all other Department of
Education documents published in the Federal Register, in text or Adobe
Portable Document Format (PDF) on the Internet at the following site:
http://www.ed.gov/news/fedregister.
To use PDF you must have Adobe Acrobat Reader, which is available
free at this site. If you have questions about using PDF, call the U.S.
Government Printing Office (GPO), toll free, at 1-888-293-6498; or in
the Washington, DC, area at (202) 512-1530.
Note: The official version of this document is the document
published in the Federal Register. Free Internet access to the
official edition of the Federal Register and the Code of Federal
Regulations is available on GPO access at:
http://www.gpoaccess.gov/nara/index.html
.
(Catalog of Federal Domestic Assistance Number: 84.133B,
Rehabilitation Research and Training Centers Program)
Program Authority: 29 U.S.C. 762(g) and 764(b)(2).
Dated: March 22, 2004.
Troy R. Justesen,
Acting Deputy Assistant Secretary for Special Education and
Rehabilitative Services.
[FR Doc. 04-6725 Filed 3-24-04; 8:45 am]
BILLING CODE 4000-01-P