[Federal Register Volume 74, Number 87 (Thursday, May 7, 2009)]
[Notices]
[Pages 21338-21349]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-10653]
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DEPARTMENT OF EDUCATION
National Institute on Disability and Rehabilitation Research
(NIDRR)--Disability and Rehabilitation Research Projects and Centers
Program--Rehabilitation Research and Training Centers (RRTCs) and
Rehabilitation Engineering Research Centers (RERCs)
Catalog of Federal Domestic Assistance (CFDA) Numbers: 84.133B
Rehabilitation Research and Training Centers and 84.133E Rehabilitation
Engineering Research Centers.
AGENCY: Office of Special Education and Rehabilitative Services,
Department of Education.
ACTION: Notice of proposed priorities for RRTCs and RERCs.
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SUMMARY: The Assistant Secretary for Special Education and
Rehabilitative Services proposes certain funding priorities for the
Disability and Rehabilitation Research Projects and Centers Program
administered by NIDRR. Specifically, this notice proposes four
priorities for RRTCs and three priorities for RERCs. The Assistant
Secretary may use these priorities for competitions in fiscal year (FY)
2009 and later years. We take this action to focus research attention
on areas of national need. We intend these priorities to improve
rehabilitation services and outcomes for individuals with disabilities.
DATES: We must receive your comments on or before June 8, 2009.
ADDRESSES: Address all comments about this notice to Donna Nangle, U.S.
Department of Education, 400 Maryland Avenue, SW., Room 6029, Potomac
Center Plaza (PCP), Washington, DC 20202-2700.
If you prefer to send your comments by e-mail, use the following
address: [email protected].
You must include the term ``Proposed Priorities for RRTCs and
RERCs'' and the priority title in the subject line of your electronic
message.
FOR FURTHER INFORMATION CONTACT: Donna Nangle. Telephone: (202) 245-
7462 or by e-mail: [email protected].
If you use a telecommunications device for the deaf (TDD), call the
Federal Relay Service (FRS), toll free, at 1-800-877-8339.
SUPPLEMENTARY INFORMATION: This notice of proposed priorities is in
concert with NIDRR's Final Long-Range Plan for FY 2005-2009 (Plan). The
Plan, which was published in the Federal Register on February 15, 2006
(71 FR 8165), can be accessed on the Internet at the following site:
http://www.ed.gov/about/offices/list/osers/nidrr/policy.html.
Through the implementation of 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.
One of the specific goals established in the Plan is for NIDRR to
publish all of its proposed priorities, and following public comment,
final priorities, annually, in a consolidated notice. Under this
approach, NIDRR's constituents can submit comments at one time rather
than at different times throughout the year, and NIDRR can move toward
a fixed schedule for competitions and more efficient grant-making
operations. This notice proposes priorities that NIDRR intends to use
for RRTC and RERC competitions in FY 2009 and possibly later years.
However, nothing precludes NIDRR from publishing additional priorities,
if needed. Furthermore, NIDRR is under no obligation to make an award
for each of these priorities. The decision to make an award will be
based on the quality of applications received and available funding.
Invitation to Comment: We invite you to submit comments regarding
this notice. 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 ways we could reduce
potential costs or increase potential benefits while preserving the
effective and efficient administration of the program.
[[Page 21339]]
During and after the comment period, you may inspect all public
comments about this notice in room 6029, 550 12th Street, SW., PCP,
Washington, DC, between the hours of 8:30 a.m. and 4:00 p.m.,
Washington, DC time, Monday through Friday of each week except Federal
holidays.
Assistance to Individuals with Disabilities in Reviewing the
Rulemaking Record: On request we will provide an appropriate
accommodation or auxiliary aid to an individual with a disability who
needs assistance to review the comments or other documents in the
public rulemaking record for this notice. If you want to schedule an
appointment for this type of accommodation or auxiliary aid, please
contact the person listed under FOR FURTHER INFORMATION CONTACT.
Purpose of Program: The purpose of the Disability and
Rehabilitation Research Projects and Centers Program is to plan and
conduct research, demonstration projects, training, and related
activities, including international activities, to develop methods,
procedures, and rehabilitation technology, that maximize the full
inclusion and integration into society, employment, independent living,
family support, and economic and social self-sufficiency of individuals
with disabilities, especially individuals with the most severe
disabilities, and to improve the effectiveness of services authorized
under the Rehabilitation Act of 1973, as amended.
Program Authority: 29 U.S.C. 762(g), 764(a), 764(b)(2), and
764(b)(3).
Applicable Program Regulations: 34 CFR part 350.
Proposed Priorities
In this notice, we are proposing four priorities for RRTCs and
three priorities for RERCs.
For RRTCs, the proposed priorities are:
Priority 1--Improved Employment Outcomes for Individuals
with Psychiatric Disabilities.
Priority 2--Transition-Age Youth and Young Adults with
Serious Mental Health Conditions.
Priority 3--Improving Measurement of Medical
Rehabilitation Outcomes.
Priority 4--Developing Strategies to Foster Community
Integration and Participation for Individuals with Traumatic Brain
Injury.
For RERCs, the proposed priorities are:
Priority 5--Telerehabilitation.
Priority 6--Telecommunication.
Priority 7--Cognitive Rehabilitation.
Rehabilitation Research and Training Centers (RRTCs)
The purpose of the RRTCs is to improve the effectiveness of
services authorized under the Rehabilitation Act of 1973, as amended,
through advanced research, training, technical assistance, and
dissemination activities in general problem areas, as specified by
NIDRR. Such activities are designed to benefit rehabilitation service
providers, individuals with disabilities, and the family members or
other authorized representatives of individuals with disabilities. In
addition, NIDRR intends to require all RRTC applicants to meet the
requirements of the General Rehabilitation Research and Training
Centers (RRTC) Requirements priority that it published in a notice of
final priorities in the Federal Register on February 1, 2008 (72 FR
6132). Additional information on the RRTCs can be found at: http://www.ed.gov/rschstat/research/pubs/res-program.html#RRTC.
Statutory and Regulatory Requirements of RRTCs
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 of national excellence in rehabilitation
research for individuals with disabilities, their representatives,
providers, and other interested parties.
Applicants for RRTC grants must also demonstrate in their
applications how they will address, in whole or in part, the needs of
individuals with disabilities from minority backgrounds.
Proposed Priorities
Proposed Priority 1--Improved Employment Outcomes for Individuals With
Psychiatric Disabilities
Background
Individuals with psychiatric disabilities have one of the lowest
rates of employment of any disability group--only one in three of these
individuals is employed (Kaye, 2002). They also comprise the largest
diagnostic category of working-age adults receiving Supplemental
Security Income or Social Security Disability Insurance (Social
Security Administration [SSA], August, 2008; SSA, September, 2008;
McAlpine & Warner, 2001). For individuals with these disabilities who
are employed, job retention is a major challenge (Murphy, Mullen &
Spagnolo, 2005).
For individuals with psychiatric disabilities, there are numerous
barriers to obtaining, retaining, and advancing in meaningful
employment. These barriers include: The stigma associated with these
disabilities; discrimination; disincentives associated with the loss of
Social Security and Medicaid benefits; limits on available and
effective vocational rehabilitation (VR) services for this population;
and ineffective collaboration between VR, SSA, mental health agencies,
and consumer groups (Dew & Alan, 2005; United States Government
Accountability Office, 2005; New Freedom Commission on Mental Health,
2003). For some individuals with psychiatric disabilities, these
barriers to employment are compounded by ineffective services for
addressing the unique needs of individuals from racial, cultural, or
linguistic minorities and individuals with both mental and physical
health conditions (Substance Abuse and Mental Health Services
Administration, 2005; United States Public Health Service Office of the
Surgeon General, 2001). Research is needed to develop and advance
innovative interventions that address these problems and barriers
facing individuals with psychiatric disabilities.
Mental health research funded by NIDRR and others has led to
advances in theory development, measurement tools, community-based
supports, and treatment options for individuals with psychiatric
disabilities. One example of an area of research that has led to
advances in community-based supports and treatment options is research
related to supported employment, a VR intervention that places
consumers in integrated job settings and provides on-the-job training
and supports, and salaries at or above minimum wage. Research in this
area contributed to the conclusion that supported employment is an
effective and evidence-based VR intervention for individuals with
psychiatric disabilities (Dew & Alan, 2005; Mueser et al., 2004; New
Freedom Commission on Mental Health, 2003).
Despite advances in theory development, measurement tools,
community-based supports, and treatment options for individuals with
psychiatric disabilities, literature in this
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area indicates that evidence-based and promising approaches for
improving employment outcomes for individuals with psychiatric
disabilities are not being incorporated into existing practice in an
effective and consistent manner (Casper & Carloni, 2007, Dew & Alan,
2005). There is extensive documentation about the need to improve the
incorporation of research findings in mental health service delivery to
improve outcomes for individuals who receive mental health services
(Institute of Medicine, 2001; New Freedom Commission on Mental Health,
2003; Substance Abuse and Mental Health Services Administration, 2005).
Further research is needed in order to address the low employment
rate of individuals with psychiatric disabilities and to find solutions
to the unique barriers these individuals face in obtaining, retaining
and advancing in meaningful employment. This research should include a
focus on improved models, programs, and interventions, and increased
knowledge translation of research findings.
References
Casper, E.S. & Carloni, C. (2007). Assessing the underutilization of
supported employment services. Psychiatric Rehabilitation Journal,
30(3), 182-188.
Dew, D.W. & Alan, G.M. (Eds.). (2005). Innovative methods for
providing VR services to individuals with psychiatric disabilities
(Institute on Rehabilitation Issues Monograph No. 30). Washington,
DC: The George Washington University, Center for Rehabilitation
Counseling Research and Education.
Institute of Medicine. (2001). Crossing the quality chasm: A new
health system for the 21st century. Washington, DC: National Academy
Press.
Kaye, H.S. (2002). Employment and social participation among people
with mental health disabilities. San Francisco, CA: National
Disability Statistics & Policy Forum.
McAlpine, D.D. & Warner, L. (2001). Barriers to Employment Among
Persons with Mental Illness: A Review of the Literature. New
Brunswick, NJ: Institute for Health.
Mueser, K.T., Clark, R.E., Haines, M., Drake, R.E., McHugo, G.J.,
Bond, G., et al. (2004). The Hartford study of supported employment
for persons with severe mental illness. Journal of Consulting and
Clinical Psychology, 72(3), 479-490.
Murphy, A.A., Mullen, M.G., & Spagnolo, A.B. (2005). Enhancing
individual placement and support: Promoting job tenure by
integrating natural supports and supported education. American
Journal of Psychiatric Rehabilitation, 8, 37-61.
New Freedom Commission on Mental Health, U.S. Department of Health
and Human Services. (2003). Achieving the promise: Transforming
mental health care in America. Final Report. (DHHS Publication No.
SMA 03-3832). Rockville, MD: Author.
Office of the Surgeon General, U.S. Public Health Service, U.S.
Department of Health and Human Services. (2001). Mental health:
Culture, race, and ethnicity: A supplement to mental health: A
report of the Surgeon General. Rockville, MD: Author.
Office of Research, Evaluation, and Statistics, Office of Retirement
and Disability Policy, Social Security Administration (2008,
September). Social Security Insurance annual statistical report,
2007. (SSA Publication No. 13-11827). Washington, DC: Author.
Office of Research, Evaluation, and Statistics, Office of Retirement
and Disability Policy, Social Security Administration (2008,
August). Annual statistical report on the Social Security Disability
Insurance program, 2007. (SSA Publication No. 13-11826). Washington,
DC: Author.
Substance Abuse and Mental Health Services Administration, U.S.
Department of Health and Human Services. (2005). Transforming mental
health care in America. Federal action agenda: First steps. (DHHS
Publication No. SMA 05-4060.) Rockville, MD: Author.
U.S. Government Accountability Office. (2005). Vocational
rehabilitation: Better measures and monitoring could improve the
performance of the VR program. (GAO Publication No. 05-865.)
Washington, DC: Author.
Proposed Priority
The Assistant Secretary for Special Education and Rehabilitative
Services proposes a priority for a Rehabilitation Research and Training
Center (RRTC) on Improved Employment Outcomes for Individuals with
Psychiatric Disabilities. The RRTC must conduct rigorous research,
training, technical assistance, and knowledge translation activities
that contribute to improved employment outcomes for individuals with
psychiatric disabilities. Under this priority, the RRTC must be
designed to contribute to the following outcomes:
(a) Improved models, programs, and interventions to enable
individuals with psychiatric disabilities to obtain, retain, and
advance in competitive employment of their choice. The RRTC must
contribute to this outcome by--
(1) Identifying or developing, and testing, innovative
interventions and employment accommodations using scientifically based
research (as this term is defined in section 9101(37) of the Elementary
and Secondary Education Act of 1965, as amended). These interventions
and employment accommodations must include an emphasis on consumer
control, peer supports, and community living, and address the needs of
individuals from traditionally underserved groups (e.g., individuals
from diverse racial, ethnic, and linguistic backgrounds, and different
geographic areas, and individuals with multiple disabilities).
(2) Conducting research to identify barriers to, and facilitators
of, effective partnerships between State vocational rehabilitation (VR)
agencies, the Social Security Administration, State and local mental
health programs, and consumer-directed programs, and collaborating with
these entities to develop new models for effective partnerships.
(3) Developing, testing, and validating adaptations of evidence-
based interventions to enhance the effectiveness of those interventions
for individuals from traditionally underserved groups (e.g.,
individuals from diverse racial, ethnic, and linguistic backgrounds,
and geographic areas, and individuals with multiple disabilities).
Current evidence-based approaches include but are not limited to
supported employment.
(b) Increased incorporation of research findings related to
employment and psychiatric disability into practice or policy. The RRTC
must contribute to this outcome by coordinating with appropriate NIDRR-
funded knowledge translation grantees to advance their work in the
following areas:
(1) Developing, evaluating, or implementing strategies to increase
utilization of research findings related to employment and psychiatric
disability.
(2) Conducting training, technical assistance, and dissemination
activities to increase utilization of research findings related to
employment and psychiatric disability.
In addition to contributing to these outcomes, the RRTC must:
Collaborate with state VR agencies and other stakeholder
groups (e.g., consumers, families, advocates, clinicians, policymakers,
training programs, employer groups, and researchers) in conducting the
work of the RRTC. Research partners in this collaboration must include,
but are not limited to, the NIDRR-funded RRTC for Vocational
Rehabilitation Research, the Disability Rehabilitation Research Project
on Innovative Knowledge Dissemination and Utilization for Disability
and Professional Organizations and Stakeholders, and other relevant
NIDRR grantees.
Proposed Priority 2--Transition-Age Youth and Young Adults With Serious
Mental Health Conditions
Background
The prevalence of serious mental health conditions in youth and
young
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adults transitioning from adolescence to adulthood is conservatively
estimated to range from 1 to 3.2 million (Davis, 2003; Davis & Vander
Stoep, 1997).\1\ This prevalence estimate is difficult to calculate
largely because diagnostic categories applicable to individuals under
the age of 18 differ from those applicable to adults. As defined by the
Substance Abuse and Mental Health Services Administration (SAMHSA), the
term ``serious emotional disturbance'' (SED) refers to diagnosable
mental, behavioral, or emotional disorders resulting in functional
impairment that substantially interferes with major life activities in
individuals from birth to age 18 (SAMHSA, 1993). The term ``serious
mental illness'' is used for comparable disorders in individuals aged
18 and older (SAMHSA, 1993).
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\1\ Because this estimate is based on a narrower age range (16-
25) than the one specified in this priority, we believe it is a
conservative estimate.
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For this priority, we define the target population as individuals
between the ages of 14 and 30 who have been diagnosed with either SED
or serious mental illness, as defined by SAMHSA. We refer to this
target population as youth and young adults with serious mental health
conditions (SMHC). The best estimate of the prevalence of SMHC is based
on the prevalence rates of SED. Estimates of the prevalence of SED are
5 to 9 percent of the population (Davis & Vander Stoep, 1997).
Making the transition to adulthood is especially challenging for
youth and young adults with SMHC. As youth and young adults with SMHC
transition to adulthood, they are at increased risk for a variety of
negative outcomes, including but not limited to arrest, substance
abuse, unplanned pregnancy, dropping out of school, unemployment,
difficulties in family and peer relationships, and difficulties with
independent living (Armstrong et al., 2003; Jonikas et al., 2003).
Individuals with disabilities transitioning from adolescence to
adulthood, particularly youth and young adults with SMHC, who come from
disadvantaged backgrounds (e.g., backgrounds involving foster care,
poverty, histories of abuse, or histories of substance abuse), are at
even greater risk for negative outcomes (Bobier & Warwick, 2005; Geenen
et al., 2005; Lubman et al., 2007; National Council on Disability,
2008).
The New Freedom Commission on Mental Health (Commission) issued a
series of recommendations regarding mental health care and its delivery
in the U.S. (New Freedom Commission on Mental Health, 2003) that have
applicability to programs serving youth and young adults with SMHC.
Based on these recommendations, programs for youth and young adults
with SMHC should be designed to achieve recovery-based outcomes, e.g.,
employment, education, and community integration. In addition, these
programs should be family- and consumer-guided, i.e., consumers would
choose the programs and providers to work with them, and partner with
those providers to develop individualized plans of care and to make
funding decisions (New Freedom Commission on Mental Health, 2003, pp.
28-29).
Previous research has also identified a number of interventions
that show some promise of improving education and employment outcomes
for youth and young adults with SMHC. There is some evidence, for
example, that supported postsecondary education and supported
employment can facilitate positive postsecondary and employment
outcomes for this population (Cook et al., 2005; Weiss et al., 2004).
Nevertheless, currently available services for this population have
a number of problems. First, because interventions are often designed
for either children or adults, the services provided to youth and young
adults with SMHC frequently are not coordinated and are not geared
toward successfully transitioning children into the adult mental health
systems (Davis & Sondheimer, 2005). Second, because service providers
are frequently trained to work either with children or adults, they are
not adequately trained to work with youth and young adults with SMHC
who are transitioning between childhood and adulthood (Davis &
Koyanagi, 2005). Under these conditions, programs and interventions are
often not well suited to helping this target population to acquire
necessary skills for independent living, employment, and community
integration, and to maintain those skills in adulthood. In addition,
many programs fail to provide a developmentally appropriate balance
between the need to involve family members in decision-making and the
need for youth and young adults with SMHC to become independent.
Previous NIDRR-funded work has documented the needs of this target
population and has contributed to the current knowledge of best
practices in transition programs for youth and young adults with SMHC
(Deschenes & Clark, 2001; Jonikas et al., 2003). Other NIDRR-funded
research has identified factors associated with better community
adjustment for this target population, such as initial levels of social
adaptive behavior (Armstrong et al., 2003). However, despite previous
work concerning youth and young adults with SMHC, there is little
scientifically based research demonstrating which interventions are
most likely to overcome the barriers described in the prior paragraph,
and improve transition outcomes for youth and young adults with SMHC.
There is even less scientifically based research on the efficacy of
interventions for individuals from this target population who come from
disadvantaged backgrounds (e.g., backgrounds involving foster care,
poverty, histories of abuse, or histories of substance abuse).
References
Armstrong, K.J., Dedrick, R.F., & Greenbaum, P.E. (2003). Factors
associated with community adjustment of young adults with serious
emotional disturbance: A longitudinal analysis. Journal of Emotional
and Behavioral Disorders, 11, 66-91.
Bobier, C. & Warwick, M. (2005). Factors associated with readmission
to adolescent psychiatric care. Australian and New Zealand Journal
of Psychiatry, 39, 600-606.
Cook, J.A., Lehman, A.F., Drake, R., McFarlane, W.R., Gold, P.B.,
Leff, H.S., et al. (2005). Integration of psychiatric and vocational
services: A multisite randomized, controlled trial of supported
employment. American Journal of Psychiatry, 162, 1948-1956.
Davis, M. (2003). Addressing the needs of youth in transition to
adulthood. Administration and Policy in Mental Health, 30, 495-509.
Davis, M. & Koyanagi, C. (2005). Summary of Center for Mental Health
Services (CMHS) youth transition policy meeting: National Experts
Panel. Technical paper produced by University of Massachusetts
Medical School and the Judge David L. Bazelon Center for Mental
Health Law under contract 280-03-8082 with American
Institutes of Research which was supported by a contract with CMHS
of the Substance Abuse and Mental Health Services Administration.
Davis, M. & Sondheimer, D.L. (2005). State child mental health
efforts to support youth in transition to adulthood. Journal of
Behavioral Health Services & Research, 32, 27-36.
Davis, M., & Vander Stoep, A. (1997). The transition to adulthood
for youth who have serious emotional disturbance: Developmental
transition and young adult outcomes. The Journal of Mental Health
Administration, 24, 400-427.
Deschenes, N. & Clark, H.B. (2001). Best practices in transition
programs for youth with emotional and behavioral difficulties. Focal
Point, 15, 14-17.
Geenen, S., Powers, L.E., & Lopez-Vasquez, A. (2005). Barriers
against and strategies for promoting the involvement of culturally
diverse parents in school-
[[Page 21342]]
based transition planning. Journal for Vocational Special Needs
Education, 27, 4-14.
Jonikas, J.A., Laris, A., & Cook, J.A. (2003). The passage to
adulthood: Psychiatric rehabilitation service and transition-related
needs of young adult women with emotional and psychiatric disorders.
Psychiatric Rehabilitation Journal, 27, 114-121.
Lubman, D.I., Allen, N.B., Rogers, N., Cementon, E., & Bonomor, Y.
(2007). The impact of co-occurring mood and anxiety disorders among
substance-abusing youth. Journal of Affective Disorders, 103, 105-
112.
National Council on Disability (2008). Youth with Disabilities in
the Foster Care System: Barriers to Success and Proposed Policy
Solutions. http://www.ncd.gov/newsroom/publications/2008/FosterCareSystem_Report.html).
New Freedom Commission on Mental Health, U.S. Department of Health
and Human Services. (2003). Achieving the promise: Transforming
mental health care in America. Final Report. Page 29425. DHHS Pub.
No. SMA-03-3832. Rockville, MD: Author.
Substance Abuse and Mental Health Services Administration, U.S.
Department of Health and Human Services. (1993). Final notice.
Federal Register, 58 (96), 29425.
Weiss, J., Maddox, D., Vanderwaeerden, M., & Szilvagyi, S. (2004).
The Tri-County Scholars Program: Bridging the clubhouse and
community college. American Journal of Psychiatric Rehabilitation,
7, 281-300.
Proposed Priority
The Assistant Secretary for Special Education and Rehabilitative
Services proposes a priority for a Rehabilitation Research and Training
Center (RRTC) on Transition-Age Youth and Young Adults with Serious
Mental Health Conditions (SMHC). This RRTC must conduct research that
contributes to improved transition outcomes for youth and young adults
with SMHC, including youth and young adults with SMHC from high-risk,
disadvantaged backgrounds. The research conducted by this RRTC must
focus on family and consumer-guided care. For purposes of this
priority, the term ``youth and young adults with SMHC'' refers to
individuals between the ages of 14 and 30, inclusive, who have been
diagnosed with either serious emotional disturbance (for individuals
under the age of 18 years) or serious mental illness (for those 18
years of age or older). Under this priority, the RRTC must contribute
to the following outcomes:
(a) Improved and developmentally appropriate interventions for
youth and young adults with SMHC. The RRTC must contribute to this
outcome by identifying or developing, and evaluating, innovative
interventions that meet the needs of youth and young adults with SMHC
using scientifically based research (as this term is defined in section
9101(37) of the Elementary and Secondary Education Act of 1965, as
amended). In carrying out this research, the RRTC must utilize
recovery-based outcome measures, including improved employment,
education, and community integration, among youth and young adults with
SMHC. The RRTC must involve youth and young adults with SMHC, and their
families or family surrogates, in the processes of identifying or
developing, and evaluating, interventions.
(b) New knowledge about interventions for youth and young adults
with SMHC who are from disadvantaged backgrounds (e.g., backgrounds
involving foster care, poverty, abuse, or substance abuse). The RRTC
must contribute to this outcome by conducting scientifically based
research to identify or develop, and evaluate effective interventions,
for these at-risk youth and young adults with SMHC.
(c) Improved coordination between child and adult mental health
services. The RRTC must contribute to this outcome by conducting
research to identify and evaluate innovative approaches that address
financial, policy, and other barriers to smooth system integration
between the child and adult mental health service systems.
(d) Improved capacity building for service providers. The RRTC must
provide training and technical assistance with a particular emphasis on
graduate, pre-service, and in-service training and curriculum
development designed to prepare direct service providers for work with
youth and young adults with SMHC.
(e) Increased translation of findings into practice or policy. The
RRTC must contribute to this outcome by coordinating with the RRTC on
Vocational Rehabilitation and with appropriate NIDRR-funded knowledge
translation grantees to--
(1) Collaborate with State VR agencies and other stakeholder groups
(e.g., State educational agencies, youth and young adults with SMHC,
families, family surrogates, and clinicians) to develop, evaluate, or
implement strategies to increase utilization of findings in programs
targeted to youth and young adults with SMHC; and
(2) Conduct dissemination activities to increase utilization of the
RRTC's findings.
Proposed Priority 3--Improving Measurement of Medical Rehabilitation
Outcomes
Background
One of the central objectives of NIDRR-funded rehabilitation
research is to ``increase the number of validated new or improved
methods for assessing function and health status'' (NIDRR Long-Range
Plan, 2005-2009, Executive Summary, 2007). To achieve this objective,
state-of-the-art methods of measuring medical rehabilitation outcomes
and the personal, clinical, and environmental factors that shape those
outcomes are needed.
Data collection techniques, such as item-response theory and
computerized dynamic assessment technologies, have demonstrated great
potential for increasing the efficiency of data collection and the
precision of measuring rehabilitation outcomes (Ware, 2003). Continued
improvements in data collection and measurement methods will improve
the capacity of practitioners to measure medical rehabilitation
outcomes in a wide variety of settings and across disability groups.
In the past, NIDRR has funded several centers on rehabilitation
outcomes measurement and sponsored numerous conferences and symposiums
on this topic. A recent NIDRR-funded Post-Acute Rehabilitation
Symposium (Symposium) identified a number of emerging outcomes
measurement topics that require a special focus (Heinemann, 2007).
One topic the Symposium identified was the measurement of cognitive
functioning. The ability to learn, as well as to attend to and
participate in self-care, are critical cognitive skills associated with
other successful medical rehabilitation outcomes (Johnston et al.,
2007). Cognition is both a rehabilitation outcome in itself (Sayer et
al., 2008) and a factor that is related to broader functional and
community outcomes for individuals with a wide variety of disabling
conditions (Van Baalen, Odding, & Stam, 2008; Hershkovitz et al.,
2007). Improved capacity to measure cognition is needed (Clohan et al.,
2007). Specifically, improved measures of cognition that can be applied
across rehabilitation populations and settings are needed to improve
clinical practice and to assess the effectiveness of rehabilitation
interventions and programs. Current measures of cognition do not
adequately capture the range of cognitive functions among individuals
in medical rehabilitation settings (Hall et al., 1999; Schepers et al.,
2006), and do not
[[Page 21343]]
always reflect abilities that are relevant to performing activities in
the community (Donovan et al., 2007).
The Symposium also identified the measurement of environmental
factors associated with outcomes as a topic in need of further
investigation. Environmental factors, such as staffing and care
practices, differ across settings, and can influence rehabilitation
treatments and outcomes. Examples of such settings are post-acute care
settings, including rehabilitation facilities, skilled nursing
facilities, long-term care hospitals, home health agencies, and
outpatient settings.
As with the measurement of cognitive functioning, there has been an
increase in the amount of research being conducted on the influence of
environmental factors on medical rehabilitation outcomes in recent
years. For example, research indicates that the environment in which
people live is a prominent predictor of community integration
(Reistetter & Abreu, 2005), and that environmental factors such as the
reduction of physical barriers are associated with community
participation outcomes for children and youth with acquired brain
injuries discharged from inpatient rehabilitation (Bedell, 2004). This
increasing evidence that environmental factors are associated with
rehabilitation outcomes has led to calls for developing health-related
quality of life measures for individuals with disabilities that
consider environmental factors (Schwartz et al., 2007).
There have been some international efforts pertaining to the
measurement of the effects of the environment on rehabilitation
outcomes. The Quebec Model for the Handicap Creation Process
(Fougeyrollas, 1993) was the first disability-related taxonomy to offer
a classification of environmental factors that influence rehabilitation
outcomes. This taxonomy influenced the subsequent inclusion of
environmental factors in the International Classification of
Functioning, Disability and Health (ICF) (World Health Organization,
2001). The Craig Hospital Inventory of Environmental Factors (Craig
Hospital Research Department, 2001) is a measurement tool designed to
implement the ICF's environmental factors taxonomy, but is not
specifically designed to assess differences across rehabilitation
settings. Despite the current research and need in the field, state-of-
the-art measures of cognition and of environmental factors for use
across medical rehabilitation settings and subpopulations have not been
developed.
References
Bedell, G.M. (2004). Developing a follow-up survey focused on
participation of children and youth with acquired brain injuries
after discharge from inpatient rehabilitation. NeuroRehabilitation,
19, 191-205.
Clohan, D.B., Durkin, E.M., Hammel, J., Murray, P., Whyte, J.,
Dijkers, M., et al. (2007). Postacute rehabilitation research and
policy recommendations. Archives of Physical Medicine and
Rehabilitation, 88, 1535-1541.
Craig Hospital Research Department (2001). Craig Hospital Inventory
of Environmental Factors (CHIEF) Manual, Version 3.0. Englewood, CO:
Craig Hospital.
Donovan, N.J., Kendall, D.L., Heaton, S.C., Kwon, S., Velozo, C., &
Duncan, P.W. (2008). Conceptualizing functional cognition in stroke.
Neurorehabilitation and Neural Repair, 22(2), 122-135.
Fougeyrollas, P. (1993). Explanatory models of the consequences of
disease and trauma: The handicap creation process. ICIDH
International Network 6.
Hall, K.M., Cohen, M.E., Wright, J., Call, M., & Werner, P. (1999).
Characteristics of the Functional Independence Measure in traumatic
spinal cord injury. Archives of Physical Medicine and
Rehabilitation, 80(11), 1471-1476.
Heinemann, A.W. (2007). State-of-the-science on postacute
rehabilitation: Setting a research agenda and developing an evidence
base for practice and public policy, an introduction. Archives of
Physical Medicine and Rehabilitation, 88, 1478-1481.
Hershkovitz, A., Kalandariov, Z., Hermush, V., Weiss, R., & Brill,
S. (2007). Factors affecting short-term rehabilitation outcomes of
disabled elderly patients with proximal hip fracture. Archives of
Physical Medicine and Rehabilitation, 88(7), 916-921.
Johnston, M.V., Graves, D, & Greene, M. (2007). The uniform
postacute assessment tool: Systematically evaluating the quality of
measurement evidence. Archives of Physical Medicine and
Rehabilitation, 88, 1505-1512.
National Institute on Disability and Rehabilitation Research.
(2007). Long Range Plan for Fiscal Years 2005-2009: Executive
Summary. http://www.ed.gov/rschstat/research/pubs/nidrr-lrp-05-09-exec-summ.pdf.
Reistetter, T.A. & Abreu, B.C. (2005). Appraising evidence on
community integration following brain injury: A systematic review.
Occupational Therapy International, 12, 196-217.
Sayer, N.A., Chiros, C.E., Sigford, B., Scott, S., Clothier, B.,
Pickett, T., et al. (2008). Characteristics and rehabilitation
outcomes among patients with blast and other injuries sustained
during the Global War on Terror. Archives of Physical Medicine and
Rehabilitation, 89(1), 163-170.
Schepers, V.P., Ketelaar, M., Visser-Meily, J.M., Dekker, J., &
Lindeman, E. (2006). Responsiveness of functional health status
measures frequently used in stroke research. Disability and
Rehabilitation, 28(17), 1035-1040.
Schwartz, C.E., Andresen, E.M., Nosek, M.A., & Krahn, G.L. (2007).
Response shift theory: Important implications for measuring quality
of life in people with disability. Archives of Physical Medicine and
Rehabilitation, 88, 529-536.
Van Baalen, B., Odding, E., & Stam, H. (2008). Cognitive status at
discharge from the hospital determines discharge destination in
traumatic brain injury patients. Brain Injury, 22(1), 25-32.
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.
World Health Organization (2001). ICF: International Classification
of Functioning, Disability and Health. Geneva, Switzerland: Author.
Proposed Priority
The Assistant Secretary for Special Education and Rehabilitative
Services proposes a priority for a Rehabilitation Research and Training
Center (RRTC) on Measurement of Medical Rehabilitation Outcomes. This
RRTC must create and implement state-of-the-art measures for medical
rehabilitation outcomes and identify the cognitive and environmental
factors that shape those outcomes. Under this priority, the RRTC must
be designed to contribute to the following outcomes:
(a) New tools and measures that facilitate research to promote
improved clinical practice in the field of medical rehabilitation. The
RRTC must contribute to this outcome by developing valid and reliable
measures of cognitive function for individuals who receive post-acute
medical rehabilitation, as well as measures to assess environmental
factors that affect outcomes among individuals with disabilities living
in the community. The RRTC may also develop medical rehabilitation
outcome measures in other areas where a demonstrated need has been
identified in the literature. In order to promote efficient collection
of outcomes data, this RRTC must develop and apply strategies including
item response theory and computer-adaptive-testing techniques. Measures
developed by the RRTC must be designed to improve the capacity of
researchers and practitioners to measure medical rehabilitation
outcomes in a wide variety of settings and across disability groups.
(b) Improved capacity to conduct rigorous medical rehabilitation
outcomes research. The RRTC must contribute to this capacity by
providing a coordinated and advanced program of training in medical
rehabilitation research that is aimed at increasing the
[[Page 21344]]
number of qualified researchers working in the area of medical
rehabilitation outcomes research. This program must focus on research
methodology and outcomes measurement development, and provide for
experience in conducting applied research.
(c) Collaboration with relevant projects, including NIDRR-sponsored
projects, such as the Disability Rehabilitation Research Project on
Classification and Measurement of Medical Rehabilitation Interventions,
and other projects identified through consultation with the NIDRR
project officer.
Proposed Priority 4--Developing Strategies to Foster Community
Integration and Participation for Individuals with Traumatic Brain
Injury
Background
The Centers for Disease Control and Prevention (CDC) report that at
least 1.4 million individuals sustain a traumatic brain injury (TBI) in
the United States each year (Langlois, Rutland-Brown, & Thomas, 2006).
A substantial number of these individuals subsequently have low levels
of community integration and participation (CIP) (Gordon et al., 2006).
CIP includes: assimilation (the ability to fit in with and be accepted
by other individuals in the community); social support (being part of a
network of family, friends, and acquaintances); occupation (having
meaningful and productive activity during the main part of the day);
and independent living (independence in daily tasks and in making
everyday decisions and life choices) (Winkler, Unsworth, & Sloan,
2006).
Although the findings for CIP for individuals with TBI vary,
research indicates that the unemployment rate among these individuals
is 40 to 50 percent and the rate of social isolation for this group is
50 to 60 percent (Franulic, Carbonell, Pinto, & Sepulveda, 2004). Other
long-term CIP consequences for individuals with TBI include financial
dependence (Dikman, Machamer, & Temkin, 1993); divorce (Lezak, 1995);
various forms of incarceration in places such as lockup care
facilities, State hospitals, and prisons; and inability to perform
instrumental activities of daily living such as driving a car, riding a
bus, balancing a checkbook, and preparing meals.
Over the years, NIDRR has sponsored research to promote a
methodological infrastructure that assists rehabilitation researchers
in generating knowledge about the extent of CIP among individuals with
TBI and the effectiveness of interventions to promote CIP for these
individuals. For example, NIDRR recently funded an initiative to
generate a classification system of medical rehabilitation
interventions that will promote effective CIP research through
improving the field's ability to determine the active ingredients of
rehabilitative care and carry out effective intervention studies.
A TBI-specific classification system that categorizes individuals
according to the physical characteristics of their injury was promoted
by a 2007 workshop sponsored by the National Institute of Neurological
Disorders and Stroke. This classification system will link physical
characteristics of injuries to the brain, with appropriate medical and
rehabilitation interventions (Saatman et al., 2008). Still needed is a
classification system based on symptoms experienced by individuals with
TBI who are living in the community. This classification system can be
used to link the post-rehabilitation consequences of TBI with CIP-
oriented interventions. Such a classification will allow practitioners
and researchers to better match individuals with TBI with specific
interventions, and to better characterize their study samples. This
classification will also advance CIP research by increasing
comparability of findings across studies, and promoting the
replicability and generalizability of findings.
References
Dikmen, S.S., Machamer, J.E., & Temkin, N.R. (1993). Psychosocial
outcomes in patients with moderate to severe head injury: 2-year
follow-up. Brain Injury, 7, 113-124.
Franulic, A., Carbonell, C.G., Pinto, P., & Sepulveda, I. (2004).
Psychosocial adjustment and employment outcome 2, 5 and 10 years
after TBI. Brain Injury, 18, 119-129.
Gordon, W.A., Zafonte, R., Cicerone, K., Cantor, J., Brown, M.,
Lombard, L., et al. (2006). Traumatic brain injury rehabilitation:
State of the science. Archives of Physical Medicine and
Rehabilitation, 84, 343-382.
Langlois, J.A., Rutland-Brown, W., & Thomas, K.E. (2006). Traumatic
brain injury in the United States: Emergency department visits,
hospitalizations, and deaths. Atlanta, GA: Centers for Disease
Control and Prevention, National Center for Injury Prevention and
Control.
Lezak, M.D. (1995). Neuropsychological assessment. New York: Oxford
University Press.
Saatman, K.E., Duhaime, A-C., Bullock, R., Maas, A.I.R., Valadka,
A., Manley, G.T., Workshop Scientific Team, et al. (2008).
Classification of traumatic brain injury for targeted therapies.
Journal of Neurotrauma, 25, 719-738.
Winkler, D., Unsworth, C., & Sloan, S. (2006). Factors that lead to
successful community integration following severe traumatic brain
injury. Journal of Head Trauma Rehabilitation, 21, 8-21.
Proposed Priority
The Assistant Secretary for Special Education and Rehabilitative
Services proposes a priority for a Rehabilitation Research and Training
Center (RRTC) for Developing Strategies to Foster Community Integration
and Participation for Individuals with Traumatic Brain Injury (TBI).
This RRTC must conduct rigorous research to examine barriers to and
facilitators of community integration and participation (CIP) for
individuals with TBI; provide training and technical assistance to
promote and maximize the benefits of this research; develop and
validate a symptom-based, clinically and scientifically useful system
for classifying individuals with TBI after discharge from inpatient
medical or rehabilitative care; and develop, implement, and evaluate
interventions to improve long-term outcomes--including return to work--
for individuals with TBI. Under this priority, the RRTC must be
designed to contribute to the following outcomes:
(a) New knowledge about the full range of symptoms of TBI that are
experienced by individuals with TBI at any time after they exit
inpatient care and re-enter the community. The RRTC must contribute to
this outcome by developing and empirically validating a comprehensive
list of the symptoms of TBI that can exist after inpatient care and
that have the potential to affect CIP, and provide or develop effective
and practical methods for their identification. These symptoms include,
but are not limited to, the following categories: neurological (e.g.,
motor, sensory, autonomic functions, movement disorders, appearance,
seizures, headaches, visual deficits, sleep disorders); medical (e.g.,
pulmonary, metabolic, nutritional, gastrointestinal, musculoskeletal,
dermatologic, degenerative disorders such as Parkinson's disease and
Alzheimer's disease); cognitive (e.g., memory, attention and
concentration, language, perception, executive/front lobe functions,
problem solving, abstract reasoning, poor insight, judgment, planning,
information processing organizational skills); and behavioral (e.g.,
aggression, agitation, impaired initiation, learning difficulties,
impulsivity, social disinhibition, shallow self awareness, altered
sexual
[[Page 21345]]
functioning, mood disorders such as depression).
(b) An improved research infrastructure for developing
interventions that facilitate CIP for individuals with TBI. The RRTC
must contribute to this outcome by--
(1) Developing a classification system for use with individuals
with TBI based on the symptoms identified in paragraph (a) of this
priority;
(2) Maximizing the likelihood that the classification system
developed in (b)(1) of this priority will be adopted in TBI
rehabilitation research and practice by: obtaining expert input in
developing the classification system; conducting a comprehensive
literature review to identify the barriers to CIP that are associated
with the list of symptoms developed under paragraph (a) of this
priority and the factors that tend to be effective in reducing these
barriers; providing a practical validated ``short'' version of the
classification system that can be used when there are time constraints;
developing, field testing, and disseminating a comprehensive manual for
using the classification system; and providing technical assistance to
the public in the use of the manual.
(c) New interventions to improve the level of CIP for individuals
with TBI. The RRTC must contribute to this outcome by identifying or
developing, and then evaluating, specific interventions tied to the
classification system developed under paragraph (b)(1) of this priority
and the barriers identified in the literature review conducted under
paragraph (b)(2) of this priority, to improve the CIP of individuals
with TBI using scientifically-based research methods. These
interventions must target individuals in specific categories of TBI as
established by the classification system developed under paragraph
(b)(1) of this priority, as well as the barriers to CIP identified
pursuant to the literature review conducted under paragraph (b)(2) of
this priority; and
(d) Improved levels of CIP for individuals with TBI. The RRTC must
contribute to this outcome by--
(1) Developing a systematic plan for widespread dissemination of
informational materials related to the Center's TBI classification
system and associated interventions to researchers, individuals with
TBI and their family members, clinical practitioners, service
providers, and members of the community. The RRTC must work with its
NIDRR project officer to coordinate outreach and dissemination of
research findings through appropriate venues such as NIDRR's Model
Systems Knowledge Translation Center, State agencies and programs that
administer a range of disability services and resources, the U.S.
Department of Veterans Affairs Veterans Health Administration, the U.S.
Department of Defense, and related veterans' service organizations; and
(2) Establishing and maintaining mechanisms for providing technical
assistance to critical stakeholders, such as researchers, consumers and
their family members, clinical practitioners, service providers, and
members of the community to facilitate the use of knowledge generated
by the RRTC.
Rehabilitation Engineering Research Centers (RERCs)
General Requirements of RERCs
RERCs carry out research or demonstration activities in support of
the Rehabilitation Act of 1973, as amended, by--
Developing and disseminating innovative methods of
applying advanced technology, scientific achievement, and psychological
and social knowledge to: (a) Solve rehabilitation problems and remove
environmental barriers; and (b) study and evaluate new or emerging
technologies, products, or environments and their effectiveness and
benefits; or
Demonstrating and disseminating: (a) Innovative models for
the delivery of cost-effective rehabilitation technology services to
rural and urban areas; and (b) other scientific research to assist in
meeting the employment and independent living needs of individuals with
severe disabilities; and
Facilitating service delivery systems change through: (a)
The development, evaluation, and dissemination of innovative consumer-
responsive and individual- and family-centered models for the delivery
to both rural and urban areas of innovative, cost-effective
rehabilitation technology services; and (b) other scientific research
to assist in meeting the employment and independence needs of
individuals with severe disabilities.
Each RERC must be operated by, or in collaboration with, one or
more institutions of higher education or one or more nonprofit
organizations.
Each RERC must provide training opportunities, in conjunction with
institutions of higher education or nonprofit organizations, to assist
individuals, including individuals with disabilities, to become
rehabilitation technology researchers and practitioners.
Each RERC must emphasize the principles of universal design in its
product research and development. Universal design is ``the design of
products and environments to be usable by all people, to the greatest
extent possible, without the need for adaptation or specialized
design'' (North Carolina State University, 1997. http://www.design.ncsu.edu/cud/about_ud/udprinciplestext.htm).
Additional information on the RERCs can be found at: http://www.ed.gov/rschstat/research/pubs/index.html.
Proposed Priorities 5, 6, and 7--Rehabilitation Engineering Research
Centers (RERCs) on Telerehabilitation (Priority 5), Telecommunication
(Priority 6), and Cognitive Rehabilitation (Priority 7)
Proposed Priority 5--Telerehabilitation
Background
Telerehabilitation is the clinical application of consultative,
preventative, diagnostic, and therapeutic interventions via two-way
interactive audiovisual linkage performed in real time (Scheideman-
Miller et al., 2002). Telerehabilitation was primarily developed to
provide equitable access to rehabilitative therapy for individuals who
are geographically remote, and physically or economically disadvantaged
(Theodoros & Russell, 2008). Telerehabilitation has the potential to
improve rehabilitation care in a cost efficient manner. Results from
Dhurjaty (2004) demonstrate that telerehabilitation is cost effective
and benefits many stakeholders, such as rehabilitation providers,
patients, and payers. Rehabilitation providers benefit from
telerehabilitation because it gives them the ability to see and
evaluate patients remotely. Remote access to patients allows providers
to serve more people, thereby increasing their clinical productivity
and efficiency. Patients benefit from telerehabilitation because they
do not have to travel to remote clinics or rehabilitation facilities.
The use of image-based telerehabilitation (e.g.,
videoconferencing); sensor-based telerehabilitation (e.g., wearable
sensors for monitoring health and activity); and virtual environments
and virtual reality telerehabilitation (e.g., immersive systems with
haptic feedback), has resulted in advances in the fields of physical
therapy, speech-language pathology, occupational therapy, and
biomedical engineering (Russell, 2007; Theodoros & Russell, 2008). For
10 years, NIDRR has contributed to these advances by funding research
and development in telerehabilitation. Recent outcomes from this NIDRR-
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funded research and development include but are not limited to the
following: new technologies to enhance a virtual reality
telerehabilitation system that enables clients to assess the wheelchair
accessibility of building environments (Yue, Kim, Wang, & Hamza, 2007);
allowing occupational or physical therapy practitioners to provide
wheeled mobility and seating interventions to clients in a remote
location via interactive secure videoconferencing (Schein & Schmeler
2007); an evaluation and comparison of seven instant messenger (IM)
systems and remote communication techniques for telerehabilitation use
(Kim & Fuhrman, 2007); and an information technology infrastructure
(i.e., common applications and components that are generalizable across
telerehabilitation applications such as web-conferencing, document
sharing, and data sharing) to support telerehabilitation (Parmanto,
Saptono, Sugiantara, Brienza & Nnaji, 2006).
Much of this work has been done on a small scale, and further work
in this area is needed in order to realize the potential benefits of
telerehabilitation on a larger scale. The viability of
telerehabilitation services in real world environments with large
patient cohorts and the broader issues of costs, benefits, and cost-
effectiveness of telerehabilitation require investigation (Russell,
2007). In addition, there are issues relating to implementation costs,
standards, ethics, and reimbursement that may affect the establishment
and advancement of telerehabilitation within large health care systems
and require further investigation (Feist-Price, 2002; Theodoros &
Russell, 2008). Accordingly, NIDRR seeks to fund an RERC on
Telerehabilitation to develop methods, systems, and technologies that
support consultative, preventative, diagnostic, and therapeutic
interventions in real time and to address barriers to successful
telerehabilitation for individuals who have limited local access to
comprehensive medical and rehabilitation outpatient services.
References
Dhurjaty, S. (2004). The economics of telerehabilitation.
Telemedicine Journal and e-Health, 10(2), 196-199.
Feist-Price, S. (2002, September 22). The use of telerehabilitation
in assistive technology. The Free Library. See http://www.thefreelibrary.com/The use of telerehabilitation in assistive
technology.-a094078142.
Kim, J. & Fuhrman, Y. (2007). Comparison of web-based
videoconferencing systems for telerehabilitation applications. 30th
Annual RESNA Conference Proceedings. Arlington, VA: Rehabilitation
Engineering Society of North America Press.
Marshall, C.A., Sanderson, P.R., Johnson, S.R., Du Bois, B., &
Kvedar, J.C. (2006). Considering Class, Culture, and Access in
Rehabilitation Intervention Research. In K.J. Hagglund & A.E.
Heinemann (Eds.), Handbook of Applied Disability and Rehabilitation
Research (pp. 26-40). New York: Springer.
Parmanto, B., Saptono, A., Sugiantara, W., Brienza, D., & Nnaji, B.
(2006). Information technology infrastructure for supporting
telerehabilitation. 29th Annual RESNA Conference Proceedings.
Arlington VA: Rehabilitation Engineering Society of North America
Press.
Russell, T.G. (2007). Physical rehabilitation using telemedicine.
Journal of Telemedicine and Telecare, 13 (5), 217-20.
Scheideman-Miller, C., Clark, P.G., Moorad, A., Post, M.L., Hodge,
B.G. & Smeltzer, S. (2003). Efficacy and sustainability of a
telerehabilitation program. Proceedings of the 36th Hawaii
International Conference on System Sciences. New Brunswick, NJ:
Institute for Electrical and Electronic Engineers (IEEE).
Schein, R.M. & Schmeler, M. (2007). Telerehabilitation: A proposed
innovative approach for rural wheelchair service delivery. 30th
Annual RESNA Conference Proceedings. Arlington, VA: Rehabilitation
Engineering Society of North America Press.
Theodoros, D. & Russell, T. (2008). Telerehabilitation: Current
perspectives. In Current Principles and Practices of Telemedicine
and E-Health, 191-209. Washington, DC: IOS press.
Yue, J., Kim, J., Wang, Y., & Hamza, H. (2007). The virtual reality
telerehabilitation system for accessibility of the built
environment: feasibility test of multimedia decision supporting
system, IP camera, and coded targets. Proceeding of RESNA 30th
International Conference, June 2007.
Proposed Priority 6--Telecommunication
Background
Telecommunication is the extension of communication over a distance
through the electronic transmission of signals. Internet Protocol (IP)
technologies and emerging telecommunications technologies offer several
modes of conversation, allow for multiple features in one device, and
have the potential to enable phones to meet the distinct needs of
individuals with disabilities (National Council on Disability, 2006).
However, new telecommunications technologies must be designed to be
accessible and usable by individuals with disabilities in order for
these individuals to fully benefit from their use.
Access to telecommunications technologies by individuals with
disabilities still remains a problem in 2009. To draw more world-wide
attention to this issue, the International Telecommunication Union
adopted the theme, ``Connecting Persons with Disabilities: Information
and Communication Technologies (ICT) Opportunities for All,'' for last
year's World Telecommunication and Information Society Day, May 17,
2008. In addition, the World Summit on the Information Society urged
member States to address the special requirements of persons with
disabilities in their national e-strategies and encouraged the design
and production of ICT equipment and services suited to their needs.
For over 10 years, NIDRR has contributed to advances in
telecommunications access, telecommunications standards development,
and emergency notification and communications for individuals with
disabilities. However, individuals with disabilities continue to face
several barriers to telecommunications access, including the lack of
interoperable communications--electronics systems or items,
teletypewriter (TTY) compatibility issues, inaccessible interfaces, and
inaccessible equipment (National Council on Disability, 2006). Better
product engineering, increased industry and community partnerships,
access to technology and IP, and implementation of standards may help
to alleviate some of the access barriers to telecommunications systems
and products. The use of universal design, i.e., products, services,
and facilities that are designed from their inception to be accessible
to and usable by the greatest range of individuals, regardless of their
ability, and without the need for specialized adaptation, may help to
ensure that access features are incorporated into telecommunications
technologies from the outset (National Council on Disability, 2004).
Integrating accessibility features into standards and maintaining them
as the standards evolve over time may further ensure telecommunications
access for individuals with disabilities (Jaeger, 2006). Accordingly,
NIDRR seeks to fund an RERC on Telecommunication to research and
develop technological solutions to promote universal access to
telecommunications systems and products including strategies for
integrating current accessibility features into newer generations of
telecommunications systems and products.
References
International Telecommunication Union.
[[Page 21347]]
(2008). Theme 2008: Connecting Persons with Disabilities:
Information and Communication Technologies (ICT) Opportunities for
All. Geneva, Switzerland: Author. See http://www.itu.int/wtisd/2008/theme.html.
Jaeger, P.T. (2006). Telecommunications policy and individuals with
disabilities: Issues of accessibility and social inclusion in the
policy and research agenda. Telecommunications Policy, 30, 112-124.
National Council on Disability (2004). Design for Inclusion:
Creating a New Marketplace--Industry White Paper. Publication date:
October 28, 2004. Washington, DC: Author.
National Council on Disability (2006). The Need for Federal
Legislation and Regulation Prohibiting Telecommunications and
Information Services Discrimination. Publication date: December 19,
2006. Washington, DC: Author.
Proposed Priority 7--Cognitive Rehabilitation
Background
Cognitive disabilities affect more than 20 million individuals in
the United States today (Scherer, 2005). The term ``cognitive
disabilities'' describes a range of symptoms and conditions that are
associated with intellectual functions and abilities such as
difficulties in learning, memorizing, information processing, problem
solving, communication, and the ability to adapt to environmental
demands due to orientation difficulties, problems with recognizing and
responding to social cues, and more. The underlying causes of cognitive
disabilities are numerous and include developmental disabilities,
acquired brain injuries, stroke, Alzheimer's disease, and severe mental
illness (Bodine, 2005).
Individuals with cognitive disabilities need assistance with
performing a wide range of tasks and activities in daily life. While
such assistance is provided largely by family members and care givers,
clinicians, researchers, and rehabilitation engineers are developing
technological products and interventions that assist individuals with
cognitive disabilities with learning, memorizing, communicating,
performing tasks and activities at home and work, and getting around in
the community (cognitive assistive technology). Cognitive assistive
technology has become more affordable and more widespread, and NIDRR
has contributed to the research and development of cognitive assistive
technology for five years. Examples of this type of technology include
learning software, handheld data assistants, user interfaces designed
especially for individuals with cognitive disabilities, environmental
control devices, and virtual reality technology (Lopresti et al., 2004;
Mechling, 2007). Anecdotal evidence and data from small-scale studies
show a positive effect of cognitive assistive technology on learning,
communication, independent living skills acquisition, and the
performance of simple work-related tasks (Agran et al., 2005; Man et
al., 2006; Riffel et al., 2005). Larger, scaled-up studies are needed
in the area of cognitive assistive technology. In addition, further
work is needed to ensure that features of cognitive assistive
technology that support individuals with disabilities are fully
integrated and maintained in technology design and can be applied in
vocational rehabilitation settings, career development programs,
postsecondary education facilities, and places of work. Accordingly,
NIDRR seeks to fund an RERC on Cognitive Rehabilitation to research,
develop, and evaluate innovative technologies and approaches that will
improve the ability of individuals with cognitive disabilities to
function independently within their homes, communities, and workplaces.
References
Agran, M., Sinclair, T., Alper, S., Cavin, M., Wehmeyer, M., &
Hughes, C. (2005). Using self-monitoring to increase following-
direction skills of students with moderate to severe disabilities in
general education. Education and Training in Developmental
Disabilities, 40, 3-13.
Bodine, C. (2005). Cognitive impairments, information technology
systems and the workplace. Accessibility and Computing, 83, 25-29.
Lopresti, E.F., Mihailidis, A., & Kirsch, N. (2004). Assistive
technology for cognitive rehabilitation: State of the art.
Neuropsychological Rehabilitation, 14(1/2), 5-39.
Man, D.W., Soong, W.Y., Tam, S.F., & Hui-Chan C.W. (2006). A
randomized clinical trial study on the effectiveness of a tele-
analogy-based problem-solving program for people with acquired brain
injury (ABI). NeuroRehabilitation, 21(3), 205-217.
Mechling, L.C. (2007). Assistive technology as a self-management
tool for prompting students with intellectual disabilities to
initiate and complete daily tasks: A literature review. Education &
Training in Developmental Disabilities, 42(3), 252-269.
Riffel, L.A., Wehmeyer, M.L., Turnbull, A.P., Lattimore, J., Davies,
D., Stock, S., et al. (2005). Promoting independent performance of
transition-related tasks using a palmtop PC-based self-directed
visual and auditory prompting system. Journal of Special Education
Technology, 20(2), 5-14.
Scherer, M.J. (2005). Assessing the benefits of using assistive
technologies and other supports for thinking, remembering and
learning. Disability and Rehabilitation, 27(13), 731-739.
Proposed Priorities
The Assistant Secretary for Special Education and Rehabilitative
Services proposes the following three priorities for the establishment
of (a) an RERC on Telerehabilitation; (b) an RERC on Telecommunication;
and (c) an RERC on Cognitive Rehabilitation. Within its designated
priority research area, each RERC will focus on innovative
technological solutions, new knowledge, and concepts that will improve
the lives of individuals with disabilities.
(a) RERC on Telerehabilitation (Priority 5). Under this priority,
the RERC must conduct research on and develop methods, systems, and
technologies that support consultative, preventative, diagnostic and
therapeutic interventions in real time and address the barriers to
successful telerehabilitation for individuals who have limited local
access to comprehensive medical and rehabilitation outpatient services.
The RERC must contribute to the continuing development of a
telerehabilitation infrastructure and architecture, conduct research
and development projects on technologies that can be used to deliver
telerehabilitation services, address the barriers to successful
telerehabilitation to individuals who have limited access to
rehabilitation services, participate in the development of
telerehabilitation standards, and contribute, by means of research and
development, to the use of telerehabilitation on a larger scale.
(b) RERC on Telecommunication (Priority 6). Under this priority,
the RERC must research and develop technological solutions to promote
universal access to telecommunications systems and products, including
strategies for integrating current accessibility features into newer
generations of telecommunications systems and products. The RERC must
contribute to the continuing development of interoperable
telecommunications systems, items, and assistive technologies; conduct
research and development projects that enable access to emerging
telecommunications technologies; address the barriers to successful
telecommunication, including emergency communications access; and
participate in the development of telecommunications standards.
(c) RERC on Cognitive Rehabilitation (Priority 7). Under this
priority, the RERC must research and develop methods, systems, and
technologies that
[[Page 21348]]
will improve: existing assistive technology for cognition; the
integration of assistive technology for cognition into assistive
technology design; and the application of this technology in vocational
rehabilitation settings, career development programs, postsecondary
education facilities, and places of work. The RERC must contribute to
the development and testing of assistive technology products that
enhance cognitive functions needed to perform daily tasks and
activities at home, school, work, and in the community; and to the
development, testing, and implementation of cognitive assistive
technology training programs and materials for professional use as well
as for consumer use.
RERC Requirements
Under each priority, the RERC must be designed to contribute to the
following outcomes:
(1) Increased technical and scientific knowledge base relevant to
its designated priority research area. The RERC must contribute to this
outcome by conducting high-quality, rigorous research and development
projects.
(2) Innovative technologies, products, environments, performance
guidelines, and monitoring and assessment tools applicable to its
designated priority research area. The RERC must contribute to this
outcome through the development and testing of these innovations.
(3) Improved research capacity in its designated priority research
area. The RERC must contribute to this outcome by collaborating with
the relevant industry, professional associations, and institutions of
higher education.
(4) Improved focus on cutting edge developments in technologies
within its designated priority research area. The RERC must contribute
to this outcome by identifying and communicating with NIDRR and the
field regarding trends and evolving product concepts related to its
designated priority research area.
(5) Increased impact of research in the designated priority
research area. The RERC must contribute to this outcome by providing
technical assistance to public and private organizations, individuals
with disabilities, and employers on policies, guidelines, and standards
related to its designated priority research area.
(6) Increased transfer of RERC-developed technologies to the
marketplace. The RERC must contribute to this outcome by developing and
implementing a plan for ensuring that all technologies developed by the
RERC are made available to the public. The technology transfer plan
must be developed in the first year of the project period in
consultation with the NIDRR-funded Disability Rehabilitation Research
Project, Center on Knowledge Translation for Technology Transfer.
In addition, under each priority, the RERC must--
Have the capability to design, build, and test prototype
devices and assist in the transfer of successful solutions to relevant
production and service delivery settings;
Evaluate the efficacy and safety of its new products,
instrumentation, or assistive devices;
Provide as part of its proposal, and then implement, a
plan that describes how it will include, as appropriate, individuals
with disabilities or their representatives in all phases of its
activities, including research, development, training, dissemination,
and evaluation;
Provide as part of its proposal, and then implement, in
consultation with the NIDRR-funded National Center for the
Dissemination of Disability Research (NCDDR), a plan to disseminate its
research results to individuals with disabilities, their
representatives, disability organizations, service providers,
professional journals, manufacturers, and other interested parties;
Conduct a state-of-the-science conference on its
designated priority research area in the fourth year of the project
period, and publish a comprehensive report on the final outcomes of the
conference in the fifth year of the project period; and
Coordinate research projects with other relevant projects,
including NIDRR-funded projects, as identified through consultation
with the NIDRR project officer.
Types of Priorities:
When inviting applications for a competition using one or more
priorities, we designate the type of each priority as absolute,
competitive preference, or invitational through a notice in the Federal
Register. 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 (1)
awarding additional points, depending on the extent to which the
application meets the priority (34 CFR 75.105(c)(2)(i)); or (2)
selecting an application that meets the priority over an application of
comparable merit that does not meet the priority (34 CFR
75.105(c)(2)(ii)).
Invitational priority: Under an invitational priority, we are
particularly interested in applications that meet the priority.
However, we do not give an application that meets the priority a
preference over other applications (34 CFR 75.105(c)(1)).
Final Priorities: We will announce the final priorities in one or
more notices in the Federal Register. We will determine the final
priorities after considering responses to this notice and other
information available to the Department. This notice does not preclude
us from proposing additional priorities, requirements, definitions, or
selection criteria, subject to meeting applicable rulemaking
requirements.
Note: This notice does not solicit applications. In any year in
which we choose to use one of more of these priorities, we invite
applications through a notice in the Federal Register.
Executive Order 12866: This notice 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 proposed regulatory
action.
The potential costs associated with this proposed regulatory action
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 proposed regulatory action, we have determined
that the benefits of the proposed priorities justify the costs.
Discussion of costs and benefits:
The benefits of the Disability and Rehabilitation Research Projects
and Centers Programs have been well established over the years in that
similar projects have been completed successfully. These proposed
priorities will generate new knowledge and technologies through
research, development, dissemination, utilization, and technical
assistance projects.
Another benefit of these proposed priorities is that the
establishment of new RRTCs and new RERCs will improve the lives of
individuals with disabilities. The RRTCs and RERCs will generate,
disseminate, and promote the use of new information that will improve
the options for individuals with disabilities to perform regular
activities in the community.
Intergovernmental Review:
This program is not subject to Executive Order 12372 and the
regulations in 34 CFR part 79.
Accessible Format: Individuals with disabilities can obtain this
document in
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an accessible format (e.g., braille, large print, audiotape, or
computer diskette) by contacting the Grants and Contracts Services
Team, U.S. Department of Education, 400 Maryland Avenue, SW., room
5075, PCP, Washington, DC 20202-2550. Telephone: (202) 245-7363. If you
use a TDD, call the FRS, toll-free, at 1-800-877-8339.
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.
Delegation of Authority: The Secretary of Education has delegated
authority to Andrew J. Pepin, Executive Administrator for the Office of
Special Education and Rehabilitative Services to perform the functions
of the Assistant Secretary for Special Education and Rehabilitative
Services.
Dated: May 4, 2009.
Andrew J. Pepin,
Executive Administrator for Special Education and Rehabilitative
Services.
[FR Doc. E9-10653 Filed 5-6-09; 8:45 am]
BILLING CODE 4000-01-P