[Federal Register Volume 59, Number 194 (Friday, October 7, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-24851]


[[Page Unknown]]

[Federal Register: October 7, 1994]


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Part III





Department of Education





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National Institute on Disability and Rehabilitation Research; Notice
DEPARTMENT OF EDUCATION

 
National Institute on Disability and Rehabilitation Research

AGENCY: Department of Education.

ACTION: Notice of proposed funding priorities for fiscal years 1995 and 
1996.

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SUMMARY: The Secretary proposes funding priorities for Research and 
Demonstration (R&D) projects under the National Institute on Disability 
and Rehabilitation Research (NIDRR) for fiscal years l995-1996. The 
Secretary takes this action to focus research attention on areas of 
national need. These priorities are intended to assist in the solutions 
to problems encountered by individuals with disabilities in their daily 
activities.

DATES: Comments must be received on or before November 7, 1994.

ADDRESSES: All comments concerning these proposed priorities should be 
addressed to David Esquith, U.S. Department of Education, 600 
Independence Avenue, S.W., Switzer Building, Room 3424, Washington, 
D.C. 20202-2601.

FOR FURTHER INFORMATION CONTACT: David Esquith. Telephone: (202) 205-
8801. Individuals who use a telecommunications device for the deaf 
(TDD) may call the TDD number at (202) 205-5516.

SUPPLEMENTARY INFORMATION: This notice contains three proposed 
priorities for the R&D program. These proposed priorities focus on 
accommodations for individuals with disabilities in adult education 
programs, reproductive issues for women with disabilities, and HIV/AIDS 
and disability.
    Authority for the R&D program of NIDRR is contained in section 
204(a) of the Rehabilitation Act of l973, as amended (29 U.S.C. 760-
762). Under this program the Secretary makes awards to public agencies 
and private agencies and organizations, including institutions of 
higher education, Indian tribes, and tribal organizations. This program 
is designed to support discrete research, demonstration, training, and 
related projects to develop methods, procedures, and technology that 
maximize the full inclusion and integration into society, independent 
living, employment, family support, and economic and social self-
sufficiency of individuals with disabilities, especially those with the 
most severe disabilities. Under program regulations at 34 CFR 351.32, 
the Secretary may establish research priorities by reserving funds to 
support the research activities listed in 34 CFR 351.10.
    These proposed priorities support the National Education Goals, one 
of which states that every American will be literate and will possess 
the knowledge and skills necessary to compete in a global economy and 
exercise the rights and responsibilities of citizenship.
    The Secretary will announce the final funding priorities in a 
notice in the Federal Register. The final priorities will be determined 
by responses to this notice, available funds, and other considerations 
of the Department. Funding of particular projects depends on the final 
priorities, the availability of funds, and the quality of the 
applications received. The publication of these proposed priorities 
does not preclude the Secretary from proposing additional priorities, 
nor does it limit the Secretary to funding only these priorities, 
subject to meeting applicable rulemaking requirements.

    Note: This notice of proposed priorities does not solicit 
applications. A notice inviting applications under this competition 
will be published in the Federal Register concurrent with or 
following publication of the notice of final priorities.

Priorities

    Under 34 CFR 75.105(c)(3) the Secretary proposes to give an 
absolute preference to applications that meet one of the following 
priorities. The Secretary proposes to fund under this program only 
applications that meet one of these absolute priorities:

Proposed Priority 1: Accommodations for Individuals With Disabilities 
in Adult Education Programs

Background
    In fiscal year 1991 Adult Education (AE) programs funded under the 
Adult Education Act (P.L. 100-297, as amended) served over 3.7 million 
people in Adult Basic Education, Adult Secondary Education, and 
English-as-a-Second-Language programs. Adult Education programs serve 
persons who are educationally disadvantaged, including individuals with 
all types of disabilities. The Office of Vocational and Adult Education 
estimates that at least 30 percent of the persons in AE programs have a 
disability. Adults (aged 16 years or older) with disabilities are 
enrolled in AE programs throughout the States and territories in local 
educational agencies, community colleges, community-based 
organizations, mental hospitals, rehabilitation and correctional 
facilities, and other facilities serving individuals with disabilities 
(U.S. Department of Education, Adult Learning and Literacy 
Clearinghouse, Fact Sheet 9, February 1994).
    Because they are educationally disadvantaged, some individuals with 
disabilities in AE programs may need accommodations. These 
accommodations may involve the modification of policies, practices, or 
procedures, or the provision of auxiliary aids and services (e.g., 
relaxed time requirements for tests, interpreters). Published efforts 
to identify accommodations for adults with disabilities in AE programs 
have focused on administering tests and diagnostic assessments 
(American Council on Education, ``GED Test Accommodations,'' 
Washington, D.C., 1990; American Council on Education, ``External 
Diploma Program Assessment Accommodations and Modifications for Adults 
with Special Learning Needs,'' Washington, D.C., 1990).
    In addition to testing and assessment accommodations, individuals 
with disabilities in AE programs may require accommodations related to 
the presentation of instructional materials, alternative formats to 
print materials, notetakers, alternatives to written assignments, 
practicums, scheduling, and a variety of other educational tasks and 
requirements.
    Adult Education administrators and teachers need to understand not 
only their obligations under section 504 of the Rehabilitation Act, as 
amended, but also the resources that are available to enable them to 
provide the accommodations. Similarly, students with disabilities in AE 
programs need to understand their rights, articulate their needs, and 
identify the accommodations that will assist them to meet the program's 
requirements.
Proposed Priority
    An R&D project on accommodations for individuals with disabilities 
in Adult Education programs shall--
     Survey the nature and extent to which a representative 
sample of AE programs are providing programmatic accommodations to 
students with disabilities and determine the relationship between the 
provision of those accommodations and program outcomes for those 
students (e.g., graduation rates, program completion, career 
advancement, etc.);
     Identify and evaluate effective programmatic 
accommodations for individuals with disabilities in AE programs, and 
develop recommendations for the development of new accommodations, 
including, but not limited to, accommodations related to testing, 
presentation of instructional materials, alternative formats to print 
materials, notetakers, alternatives to written assignments, practicums, 
and scheduling;
     Utilizing existing materials to the maximum extent 
possible, develop guidance for AE staff and students with disabilities 
in AE programs on the rights and duties of covered entities to provide 
appropriate accommodations to individuals with disabilities;
     Utilizing existing material to the maximum extent 
possible, develop information for AE staff and students with 
disabilities on innovative and common accommodations provided to 
students with disabilities, as well as information on resources that 
will assist AE programs provide accommodations;
     Field-test materials to ensure that they address the needs 
of individuals with disabilities from minority backgrounds who are in 
AE programs and that they are available in appropriate accessible 
formats; and
     Coordinate efforts with NIDRR's Disability and Business 
Technical Assistance Centers (ADA technical assistance centers) as well 
as with the Division of Adult Education and Literacy within the U.S. 
Department of Education Office of Vocational and Adult Education.

Proposed Priority 2: Reproductive Issues for Women With Physical 
Disabilities

Background
    Despite the attention given to disability in general and certain 
impairments in particular, one of the groups within the disabled 
population that has received little recognition or study is women. 
(Doggone, Mary J, Brooks, Nancy A., 1985). Over 3,000,000 women of 
childbearing age in the United States have some type of disability. 
Many women with physical disabilities have been discouraged by their 
families, friends, and health providers from considering the option of 
parenthood. Until very recently, women with many types of physical 
disabilities have not been encouraged or facilitated in exercising that 
option by health care providers and others. Medical professionals have 
often discouraged pregnancy for women with physical disabilities 
because of the limited understanding of the effect of bodily changes 
during pregnancy, labor, and delivery on existing impairments. This 
priority addresses reproductive issues confronted specifically by women 
with physical disabilities.
    Some aspects of women's health maintenance that are an ordinary 
part of life for most women pose significant problems for women with 
physical disabilities. Dependent upon the type of disability, fertility 
may be unaffected but pregnancy may be an increased risk and require 
high-risk management; genetic counseling may be suggested; symptoms of 
chronic disease or impairment may or may not be exacerbated; delivery 
may be difficult; and urinary infections, decubitus ulcers, and 
autonomic hyperreflexia during labor and delivery may be present. 
(Asrael, W., Huberman, B., NAACOG Update Series, Vol. 5, Lesson 11, 
1986).
    Women with physical disabilities often require specialized 
obstetrical attention for a number of possible concerns. The 
interaction of drugs may have a more severe impact on their systems, 
such as the canceling effect of antiseizure medications and oral 
contraceptives, or the multiplying effect of antispasmodics on other 
drugs with depressive side effects. There has been little research on 
the long-term effects of oral contraceptives and other hormonal 
treatments for women who lead sedentary existences and who often have 
compromised circulatory systems. (Nosek, M., Journal of Women's Health, 
Vol. 1, No. 4, 1992). Concerns revolve around the ability to conceive, 
the special problems and risks if any, during pregnancy, the impact on 
the disability itself, and the methods of delivery.
    Elaine Carty and Tali Conine, (Rehabilitation Nursing, Vol. 13, No. 
2, 1988), looked at six important areas of stress that pregnant women 
with physical disabilities experience. Three are role related: 
accepting the new role of childbearing and the impending 
responsibilities of parenthood, accepting extra nurturing and assuming 
a more dependent role, and dealing with fatigue and limitations on 
activity in the perinatal period. Psychosocial issues cannot be 
separated from the woman's general well-being.
    Research supports the conclusion that more extensive education of 
health care providers and consumers in the medical and psychosocial 
aspects of disability and in the area of human sexuality and 
communications regarding this aspect of health care could lead to 
improved health services for women with disabilities. Among the 
problems in providing appropriate reproduction-related services to 
women with disabilities is the limited experience of obstetricians-
gynecologists with health issues of various types of disabilities, and 
the limited involvement of physiatrists and other specialists in 
prenatal care. Physicians who may have been involved in the woman's 
previous care include a physiatrist, orthopedist, neurologist and 
urologist. The proposed project is to investigate appropriate roles for 
these specialists in the pregnancy care team.
    If women with disabilities are to have options for reproductive 
care comparable to those available to women without disabilities, then 
the obstetrical profession and ancillary health care personnel must be 
educated on the special pregnancy-related needs of women with physical 
disabilities. Development and dissemination of current information to 
health care practitioners and to women with disabilities will be a key 
element of any project to be funded under this priority.
    Being informed is one of the best ways for a woman to increase her 
confidence and ensure she is given the same pregnancy-related options 
as her nondisabled peers. (Beckmann, Gittler, Barzansky, and Beckmann, 
Obstetrics and Gynecology, Vol. 74, No. 1, July, 1989). A woman with a 
disability who is pregnant should be aware of major risks, and needs a 
support system that includes an obstetrical team sensitive to the 
specific issues related to her disability. (Freda, Cioschi, Nilson, 
Physical Disabilities, AOTA, Vol. 12, No. 2, June 1989.) For this 
reason, the project to be supported under this priority must address 
the pregnancy-related information needs of women with physical 
disabilities.
    Choices concerning pregnancy and motherhood often have different 
implications for women in diverse cultures, depending upon the 
psychosocial expectations of women and the support systems available to 
them. Expectations and support systems of disabled women from minority 
backgrounds may be quite different from those available to other women. 
A project to be funded under this priority is expected to address the 
research questions concerning disability, pregnancy, and cultural 
competency. Thus, any project must involve not only women with physical 
disabilities, but also disabled women from diverse cultural 
backgrounds, in the design, conduct, and dissemination of the research. 
A grantee funded under this priority is expected to demonstrate 
familiarity and ability to coordinate both research and dissemination 
with other projects and agencies addressing related issues, including 
the Department of Health and Human Services and its grantees.
Proposed Priority
    An R&D project on reproductive issues for women with disabilities 
shall--
     Study the impact and risks of pregnancy and childbirth for 
women with various physical disabilities;
     Identify the current gaps in research and the information 
needed by practitioners and consumers regarding the gynecologic and 
reproductive care of women with physical disabilities;
     Identify and evaluate strategies that foster communication 
and collaboration among the various health care practitioners relevant 
to pregnancy and childbirth in women with physical disabilities;
     Identify and evaluate methods to improve education and 
training for health care providers regarding the medical and 
psychosexual aspects of disability and reproduction issues;
     Incorporate issues pertinent to culturally diverse 
populations in addressing issues of pregnancy and childbirth identified 
by women with disabilities from minority backgrounds; and
     Disseminate the research findings to health care providers 
and women with disabilities through the most effective channels, likely 
to result in maximum impact on practice and training.

Proposed Priority 3: HIV/AIDS and Disability

Background
    The Human Immunodeficiency Virus (HIV) causes a chronic, 
progressive immunologic deficiency disease with a spectrum of 
manifestations. (Atkins, B.J. and Hancock, A.K., American 
Rehabilitation, 1993). The continuum can be seen as four major stages: 
Acute HIV Disease; Chronic Asymptomatic HIV Disease; Chronic 
Symptomatic HIV Disease; and Advanced Disease (AIDS). It is known that 
HIV affects every cultural, social, economic, sexual, racial, and 
geographic group in this country.
    Former Surgeon General C. Everett Koop stated that ``HIV is 
expected to impact every household in America in the 1990s.'' The 
number of people who have AIDS is significant: the Centers for Disease 
Control and Prevention (CDC), in its HIV/AIDS Surveillance Report, 
1994, noted that, as of December, 1993, 361,509 cases of AIDS had been 
reported in the United States. Of these, 138,223 individuals were known 
to be living with AIDS. These figures do not include individuals who 
have been diagnosed as HIV seropositive, but have not yet developed 
full-blown AIDS; that number is estimated to exceed one million. Racial 
and ethnic minority populations have been disproportionately affected 
by HIV infection and AIDS. In 1992, 47 percent of all reported AIDS 
cases were among African-Americans and Hispanics although these two 
groups represent only 21 percent of the entire population (1992 CDC 
Newsletter). HIV infections are also increasing rapidly among women.
    Although HIV disease is chronic, progressive, and, so far, 
ultimately fatal, the average period of time from onset of infection to 
death continues to grow longer, due to improved health care 
interventions, and is now estimated to be 11.5 years (Whitman-Walker 
Clinic). Individuals may well begin to live longer at each stage of the 
disease process. Thus, as the natural course of the disease changes, it 
will be important to track the changing needs for rehabilitation and 
community support services. Most ``Persons Living with AIDS'' (PLWA) 
aspire to maintain as normal a life as possible during the period of 
disease and disability and have both the potential and the right to 
benefit from appropriate service programs. It is extremely critical 
that culturally sensitive, community integrated service systems to 
promote rehabilitation, independence, employment, and community 
integration and to reduce barriers be developed and implemented.
    The Americans with Disabilities Act (ADA) and section 504 of the 
Rehabilitation Act of 1973, as amended, define an individual with a 
disability as one who ``has a physical or mental impairment that 
substantially limits his or her ability to perform one or more major 
life activities, has a record of an impairment that substantially 
limits a major life activity, and/or is regarded by an employer or 
other covered entity as having an impairment that substantially limits 
a major life activity.'' This definition includes people with HIV/AIDS.
    Individuals with HIV/AIDS may be entitled to income transfer 
payments and medical assistance benefits; they also may be eligible, 
depending on specific criteria in the various statutes, for services 
under a number of public service programs, including vocational 
rehabilitation and independent living, mental health and drug abuse 
services, veterans' services, and housing assistance.
    There are many allegations that the traditional social service 
systems, including vocational rehabilitation, are ill-equipped to 
respond to the need for services. For example, the 1991 National Survey 
of Vocational Rehabilitation (VR) and AIDS, distributed to State VR 
agencies by the American Rehabilitation Association (ARA), concludes 
that there are numerous barriers to the delivery of rehabilitative 
services to persons living with HIV/AIDS. These barriers include the 
fears and anxieties of vocational rehabilitation staff, public stigma 
associated with HIV/AIDS, confidentiality issues, lack of knowledge 
about the rehabilitation needs of persons with HIV/AIDS, and the need 
for more extensive services than those currently available through the 
vocational rehabilitation system. Factors in the natural course of the 
disease, including remissions, exacerbations, compounding, rates of 
decline, and many other characteristics that are not well understood in 
terms of their relation to disability and to support services may 
affect the suitability of existing service models to meet the needs of 
PLWA. In addition, there is some indication that the patterns of the 
disease, and the associated service needs, are different for minority 
individuals, who are likely to enter the health care service system 
later in the illness, and for women, for whom not only the support 
needs but also the natural course of the disease appear to differ 
(Campbell, et al., 1989).
    Many rehabilitation experts hypothesize that the approaches and 
techniques that have been developed to address issues regarding other 
types of disability are relevant to, and will be effective in, 
addressing issues regarding HIV/AIDS. These approaches include 
secondary prevention, vocational rehabilitation, job accommodations, 
barrier removal, peer support, independent living, personal assistance 
services, public education, integrated model service systems, job 
sharing, and advocacy.
    However, the most effective application of disability and 
rehabilitative approaches to HIV/AIDS is dependent upon first 
increasing knowledge about the pattern(s) of disabling consequences 
typically associated with the disease process; the functional 
capacities associated with various stages of the disease process; and 
the duration and intensity of various types of supports needed for this 
population at different stages of the disease process. Any research 
designed to address these issues must ensure that findings can be 
applied cross-gender and to culturally diverse populations.
    Any project to be funded under this priority is expected to be 
familiar with, and to coordinate and cooperate with, the relevant AIDS 
research activities of the Centers for Disease Control and the National 
Institute of Allergy and Infectious Diseases, and with other major 
current or planned research initiatives.
Proposed Priority
    An R&D project on HIV/AIDS and disability shall--
     Analyze existing data on HIV/AIDS, prepare population 
estimates and statistical profiles of adults with HIV/AIDS, including 
such factors as: age; age at onset or diagnosis of HIV infection and 
AIDS diagnosis or length of time with the disease; ethnic background; 
gender; educational level; employment experience and current employment 
status; marital and socioeconomic status; patterns of SSI, SSDI, 
Medicaid, and Medicare enrollment; and standard demographic factors;
     Document the natural course of the disability consequences 
of the disease process, including iatrogenic disabilities, and document 
the functional losses associated with various stages of the disease 
process, taking into consideration such factors as age, gender, ethnic 
background, and concomitant disabilities;
     Identify and assess the major disability-related societal 
barriers confronted by adults with HIV/AIDS, including unemployment, 
discrimination, lack of accommodations, and lack of opportunities to 
maintain independent living, distinguishing patterns by age, gender, 
ethnic background, and urban or rural location;
     Identify best practices in rehabilitation, independent 
living, peer support programs, community mental health, housing, job 
accommodations, and related services that have the most potential to 
assist adults with HIV/AIDS to maximize quality of life;
     Demonstrate and evaluate the effectiveness of selected 
rehabilitative techniques that enable PLWA to maintain maximum 
independence in employment and in the community, involving PLWA, 
individuals with other disabilities, and adults from diverse cultural 
backgrounds in the design of the demonstrations; and
     Disseminate the findings from this project to potential 
adapters in other programs, projects, and service facilities that 
provide services to PLWA and through other resources, including the 
National Rehabilitation Information Center (NARIC), the Council of 
State Administrators of Vocational Rehabilitation (CSAVR), and the 
National Council for Independent Living (NCIL), and HIV/AIDS 
information networks.

Invitation to Comment

    Interested persons are invited to submit comments and 
recommendations regarding these proposed priorities.
    All comments submitted in response to this notice will be available 
for public inspection, during and after the comment period, in Room 
3423, Mary Switzer Building, 330 C Street S.W., Washington, D.C., 
between the hours of 8:00 a.m. and 3:30 p.m., Monday through Friday of 
each week except Federal holidays.
    Applicable Program Regulations: 34 CFR Parts 350 and 351.

    Program Authority: 29 U.S.C. 760-762.

(Catalog of Federal Domestic Assistance Number 84.133A, Research and 
Demonstration Projects)

    Dated: October 3, 1994.
Judith E. Heumann,
Assistant Secretary for Special Education and Rehabilitative Services.
[FR Doc. 94-24851 Filed 10-6-94; 8:45 am]
BILLING CODE 4000-01-P