[Federal Register Volume 63, Number 109 (Monday, June 8, 1998)]
[Notices]
[Pages 31324-31329]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-15166]



[[Page 31323]]

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Part IV





Department of Education





_______________________________________________________________________



National Institute on Disability and Rehabilitation Research: 
Rehabilitation Research and Training Centers Proposed Funding 
Priorities, Fiscal Years 1998-1999; Notice

  Federal Register / Vol. 63, No. 109 / Monday, June 8, 1998 / 
Notices  

[[Page 31324]]



DEPARTMENT OF EDUCATION


National Institute on Disability and Rehabilitation Research; 
Notice of Proposed Funding Priorities for Fiscal Years 1998-1999 for 
Rehabilitation Research and Training Centers

SUMMARY: The Secretary proposes funding priorities for three 
Rehabilitation Research and Training Centers (RRTCs) under the National 
Institute on Disability and Rehabilitation Research (NIDRR) for fiscal 
years 1998-1999. The Secretary takes this action to focus research 
attention on areas of national need. These priorities are intended to 
improve rehabilitation services and outcomes for individuals with 
disabilities.

DATES: Comments must be received on or before July 8, 1998.

ADDRESSES: All comments concerning these proposed priorities should be 
addressed to Donna Nangle, U.S. Department of Education, 600 Maryland 
Avenue, S.W., room 3418, Switzer Building, Washington, D.C. 20202-2645. 
Comments may also be sent through the Internet: [email protected]
    You must include the term ``Employment Opportunities-RRTC's'' in 
the subject line of your electronic message.

FOR FURTHER INFORMATION CONTACT: Donna Nangle. Telephone: (202) 205-
5880. Individuals who use a telecommunications device for the deaf 
(TDD) may call the TDD number at (202) 205-2742.

 Internet: Donna__N[email protected]

    Individuals with disabilities may obtain this document in an 
alternate format (e.g., Braille, large print, audiotape, or computer 
diskette) on request to the contact person listed in the preceding 
paragraph.

SUPPLEMENTARY INFORMATION: This notice contains proposed priorities 
under the Disability and Rehabilitation Research Projects and Centers 
Program for three RRTCs related to: employment opportunities for 
American Indians, community integration for persons with mental 
retardation, and policies affecting families of children with 
disabilities.
    These proposed priorities support the National Education Goal that 
calls for every adult American to possess the skills necessary to 
compete in a global economy.
    The authority for the Secretary to establish research priorities by 
reserving funds to support particular research activities is contained 
in sections 202(g) and 204 of the Rehabilitation Act of 1973, as 
amended (29 U.S.C. 761a(g) and 762).
    The Secretary will announce the final 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 a particular project depends on the final 
priority, 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 the publication of the notice of final priorities.

Rehabilitation Research and Training Centers

    The authority for RRTCs is contained in section 204(b)(2) of the 
Rehabilitation Act of 1973, as amended (29 U.S.C. 760-762). Under this 
program, the Secretary makes awards to public and private 
organizations, including institutions of higher education and Indian 
tribes or tribal organizations, for coordinated research and training 
activities. These entities must be of sufficient size, scope, and 
quality to effectively carry out the activities of the Center in an 
efficient manner consistent with appropriate State and Federal laws. 
They must demonstrate the ability to carry out the training activities 
either directly or through another entity that can provide that 
training.
    The Secretary may make awards for up to 60 months through grants or 
cooperative agreements. The purpose of the awards is for planning and 
conducting research, training, demonstrations, and related activities 
leading to the development of methods, procedures, and devices that 
will benefit individuals with disabilities, especially those with the 
most severe disabilities.

Description of Rehabilitation Research and Training Centers

    RRTCs are operated in collaboration with institutions of higher 
education or providers of rehabilitation services or other appropriate 
services. RRTCs serve as centers of national excellence and national or 
regional resources for providers and individuals with disabilities and 
the parents, family members, guardians, advocates or authorized 
representatives of the individuals.
    RRTCs conduct coordinated, integrated, and advanced programs of 
research in rehabilitation targeted toward the production of new 
knowledge to improve rehabilitation methodology and service delivery 
systems, to alleviate or stabilize disabling conditions, and to promote 
maximum social and economic independence of individuals with 
disabilities.
    RRTCs provide training, including graduate, pre-service, and in-
service training, to assist individuals to more effectively provide 
rehabilitation services. They also provide training including graduate, 
pre-service, and in-service training, for rehabilitation research 
personnel.
    RRTCs serve as informational and technical assistance resources to 
providers, individuals with disabilities, and the parents, family 
members, guardians, advocates, or authorized representatives of these 
individuals through conferences, workshops, public education programs, 
in-service training programs and similar activities.
    RRTCs disseminate materials in alternate formats to ensure that 
they are accessible to individuals with a range of disabling 
conditions.
    NIDRR encourages all Centers to involve individuals with 
disabilities and individuals from minority backgrounds as recipients of 
research training, as well as clinical training.
    The Department is particularly interested in ensuring that the 
expenditure of public funds is justified by the execution of intended 
activities and the advancement of knowledge and, thus, has built this 
accountability into the selection criteria. Not later than three years 
after the establishment of any RRTC, NIDRR will conduct one or more 
reviews of the activities and achievements of the Center. In accordance 
with the provisions of 34 CFR 75.253(a), continued funding depends at 
all times on satisfactory performance and accomplishment.
    Proposed General Requirements: The Secretary proposes that the 
following requirements apply to these RRTCs pursuant to these absolute 
priorities unless noted otherwise. An applicant's proposal to fulfill 
these proposed requirements will be assessed using applicable selection 
criteria in the peer review process:
    The RRTC must provide: (1) applied research experience; (2) 
training on research methodology; and (3) training to persons with 
disabilities and their families, service providers, and other 
appropriate parties in accessible formats

[[Page 31325]]

on knowledge gained from the Center's research activities.
    The RRTC must develop and disseminate informational materials based 
on knowledge gained from the Center's research activities, and 
disseminate the materials to persons with disabilities, their 
representatives, service providers, and other interested parties.
    The RRTC must involve individuals with disabilities and, if 
appropriate, their representatives, in planning and implementing its 
research, training, and dissemination activities, and in evaluating the 
Center.
    The RRTC must conduct a state-of-the-science conference and publish 
a comprehensive report on the final outcomes of the conference. The 
report must be published in the fourth year of the grant.

Priorities

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

Proposed Priority 1: Employment Opportunities for American Indians

Background

    On August 1, 1997, the U.S. population of American Indians, 
including Alaskan Native and Aleut, was 2.3 million. This population 
has the highest rate of disability of any racial or ethnic group. One 
in three American Indians aged 15 and over reports having a disability; 
about one in seven reports having a ``severe'' disability. One in two 
American Indians aged 65 or over has a severe disability (U.S. 
Department of Commerce, Bureau of the Census, Census Facts For Native 
American Month, October, 1997). American Indians have the highest 
unemployment rates, the lowest family incomes, and highest percentage 
of people living below the poverty level (U.S. Department of Commerce, 
Bureau of the Census, Current Population Reports, Special Studies 
Series, P 23-189, pg. 51, July, 1995). The Nation's several hundred 
reservations have a 50 percent average unemployment rate (Kalt, J. 
``Development Strategies for American Indians,'' Social Policy Research 
Bulletin, pg. 21, fall, 1996).
    In addition, American Indians have the most severe health problems 
of all U.S. groups, including the shortest life expectancy and highest 
infant mortality rate. American Indians experience alcohol and 
substance abuse, sensory impairment, diabetes mellitus, learning 
disabilities, fetal alcohol syndrome, and accidents and injuries at 
alarming rates when compared to the general population (U.S. General 
Accounting Office, Indian Health Service, Basic Services Mostly 
Available; Substance Abuse Problems Need Attention, GAO/HRD-93-48, 
April, 1993). American Indians have the Nation's highest school dropout 
rates and the lowest postsecondary attainment rates. Only 66 percent of 
American Indians have high school diplomas, compared to a 78 percent 
rate for whites and Asian-Americans (U.S. Department of Education, 
Office of Educational Research and Improvement, National Assessment of 
Vocational Education, Final Report to Congress, Volume IV Access to 
Programs and Services for Special Populations, pg. 70, July, 1994).
    Although some data on employment and on disability are available, 
there is little specific information on employment of American Indians 
with disabilities. In addition, although general disability rates are 
available for this population, there is little information on the 
distribution of disability within the population. Many factors may have 
an impact on the employment status of, and the delivery of, employment 
services to American Indians with disabilities. These factors include, 
but are not limited to health status, poverty, educational level, and 
availability of culturally relevant vocational rehabilitation services.
    State vocational rehabilitation (VR) agencies provide employment 
services to American Indians with disabilities who meet the eligibility 
criteria for the Vocational Rehabilitation Services Program authorized 
by the Rehabilitation Act of 1973 (the Act). In 1996, VR agencies 
assisted approximately 1600 American Indians with disabilities to 
achieve an employment outcome. However, data from the Rehabilitation 
Services Administration (RSA) indicate that American Indians served 
under the program achieve employment outcomes at a lower rate compared 
to other populations receiving vocational rehabilitation services (RSA 
Case Service Reports, RSA-911, 1991-1996).
    Geographic, cultural, language, and political factors affect the 
ability of State agencies to deliver services to this population, 
particularly those individuals residing on reservations. Approximately, 
one-third of American Indians live on reservations or trust lands. Most 
reservations have populations of less than one thousand and are located 
in rural areas. Many of these Indian communities are in isolated areas 
where poor roads and populations spread out over many miles. In 
addition, tribes are often sovereign political entities with specific 
powers of self-governance, thus affecting access to populations on 
reservations.
    In recognition of this problem, Congress amended the Act in 1978 to 
authorize grants for American Indian Vocational Rehabilitation Service 
Projects (Section 130 Projects) to support tribal vocational 
rehabilitation programs. These discretionary grant projects, also 
administered by RSA, are awarded to the governing bodies of Indian 
tribes located on Federal and State reservations to provide VR services 
for American Indians who are individuals with disabilities residing on 
reservations. There are currently 39 such projects.
    Nearly two-thirds of American Indians live in urban areas. Much of 
the urban Indian population is assimilated and dispersed throughout 
urban census tracts, making it difficult for Vocational Rehabilitation 
agencies to identify and serve this population (The National Urban 
Indian Policy Coalition, Report to the White House Domestic Policy 
Council, April, 1995). The lack of culturally sensitive definitions of 
disability in national data collection efforts, such as the National 
Health Interview Survey or the Survey of Income and Program 
Participation, further complicates this problem.
    Cultural and language barriers significantly impede delivery of 
employment services, including vocational rehabilitation programs. 
There are 557 federally recognized tribes, speaking about 200 languages 
and dialects. Cultural barriers affect knowledge, understanding, and 
acceptance of disability and contemporary medical and health practices. 
In addition, concepts such as self-sufficiency, self-determination and 
self-advocacy may have very different meanings across Indian cultures.

Proposed Priority 1

    The Secretary proposes to establish a RRTC to improve the 
employment status of American Indians with disabilities. The RRTC 
shall:
    (1) Investigate and analyze existing data, demographic and other, 
relevant to disability and employment outcomes and recommend 
methodological improvements to enhance the usefulness and 
comprehensiveness of such data for the purpose of planning and 
evaluating employment services, including vocational rehabilitation 
services (as described in 34 CFR 361.48), for Indians with 
disabilities;

[[Page 31326]]

    (2) Analyze existing employment and vocational rehabilitation 
service strategies for American Indians with disabilities and identify 
those that have produced successful employment outcomes, taking into 
consideration the actual employment opportunities that exist on and off 
the reservation, and examine how these strategies might be applied to 
the Section 130 Projects;
    (3) Develop and evaluate model employment services, including 
vocational rehabilitation services, for American Indians with 
disabilities, incorporating best practices from the review of existing 
services, taking into account cultural issues and reflecting needs of 
American Indians on and off the reservations as well as the Section 130 
Projects; and
    (4) Disseminate both the recommendations for data collection 
improvements and the results of the evaluation of model employment 
services to a range of relevant audiences, using appropriate accessible 
formats.
    In carrying out the purposes of the priority, the RRTC must:
     As appropriate, carry out separate analyses for Indians 
with disabilities who live on the reservation and for those who live 
off the reservation; and
     Collaborate with the Section 130 Projects, and coordinate 
with the Rehabilitation Services Administration, the Bureau of Indian 
Affairs and the Indian Health Service, the RRTC on Disability 
Statistics, and other entities carrying out related research or 
training activities.

Proposed Priority 2: Community Integration for Persons with Mental 
Retardation

Background

    Since 1965, NIDRR has supported research and demonstrations in the 
area of developmental disabilities, particularly in the area of mental 
retardation. During these years, researchers have addressed issues 
involving deinstitutionalization, special education, transition from 
school to work, supported employment and the overall supports persons 
with mental retardation need to live in the community.
    Based on the 1994-1995 National Health Interview Survey-Disability 
Supplement on adults living in the general household population and 
surveys of people in formal residential support programs, about .78 
percent or 1,250,000 of the population of the U.S. can be identified as 
being limited in a major life activity and having a primary or 
secondary condition of mental retardation. Until the Disability 
Supplement survey was conducted, information was not available about 
individuals with mental retardation who are not participants in 
specialized programs, but live in the community with their families or 
on their own.
    Many persons with mental retardation and their families receive 
long-term services and supports through State developmental disability 
authorities (SDDAs) that are funded primarily by the State or Federal 
Medicaid program. According to the results of a recent membership 
survey conducted by the National Association of State Directors of 
Developmental Disabilities Services (NASDDS), many SDDAs are currently 
designing or launching large scale system change initiatives. This is 
due, in part, to Medicaid reforms, managed care initiatives and budget 
constraints. Seventy-one percent of the respondents said that cost 
containment is a major factor prompting system change. The initiatives 
differ in their specifics but share several common themes: 
decentralizing authority to local managing entities; shifting to less 
categorical budgeting; promoting greater flexibility in the purchase 
and provision of community services and supports; and embracing self 
determination to define a new relationship between the system and 
individuals and their families (NASDDS, Community Services Reporter, 
pg. 3, Jan, 1998).
    Since 1981, the Medicaid Home and Community Based Services (HCBS) 
waiver has facilitated flexibility and service innovation. HCBS waivers 
afford States the flexibility to develop and implement creative 
alternatives to placing Medicaid eligible individuals in facilities 
such as nursing homes. The HCBS waiver program recognizes that many 
individuals at risk of being placed in a long-term care facility can be 
supported in their own homes and communities, preserving their 
independence and ties to family and friends at a cost no higher than 
that of institutional care. Services that may be provided in HCBS 
waiver programs are case management, homemaker services, home health 
aide services, personal care services, adult day health services, 
habilitation, and respite care. Other services States request may 
include transportation and meal services. States have the flexibility 
to design each waiver program and select the mix of waiver services 
that best meet the needs of the population they wish to serve. HCBS 
waiver services may be provided statewide or may be limited to specific 
geographic subdivisions.
    However, in the last several years, States have attempted to 
contain Medicaid spending through the application of managed care 
approaches. Long-term care services, including Medicaid-funded 
intermediate care facilities for persons with mental retardation and 
HCBS waiver services for persons with mental retardation, account for 
35 percent of all Medicaid spending. Programs serving persons with 
mental retardation are not likely to be exempt from these cost 
containment measures (Center on Human Policy, Information Package on 
Managed Care and Long-term Supports for People with Developmental 
Disabilities, pg. 3, June, 1997).
    There is little information available on the use and outcomes of 
managed care practices in providing long-term supports to persons with 
mental retardation. Currently, States are implementing various models 
to consolidate health and long-term care services under one managed 
care organization. This approach is intended to be cost-effective and 
improve service coordination. Under some of these models, support 
networks for persons with mental retardation that now stand alone, 
could become subspecialty branches of larger care delivery systems 
(Ashbaugh, J. and Smith, G., ``MCARE Policy Brief, ``Integration of 
Health and Long-term Care Services: A Cure in Search of and Illness,'' 
No. 1, pg. 12, 1997). Some observers have voiced concern that the use 
of consolidated models may lead to reduced funding for services. 
Organizations representing persons with mental retardation have 
proposed integrated models that combine under a single umbrella 
organization, health and long-term supports in a configuration uniquely 
suitable for this population.
    Emerging practice suggests that people with mental retardation 
should play leading roles in determining the substance of their lives 
and that services should be developed as needed to support their 
preferences. For example, some current service delivery models may 
provide new options for individuals and their families to self manage 
their chosen services through vouchers, individual budgets or cash. The 
field is moving past traditional service delivery approaches to become 
more responsive to the demands of service recipients and to promote 
self determined lifestyles. Services developed around the specific 
needs and choices of an individual may produce better outcomes and cost 
savings.
    There are a number of emerging models for system redesign. 
Participant driven managed supports refer to a variety of strategies 
for administering

[[Page 31327]]

systems to increase their effectiveness and efficiency, while 
maintaining a commitment to community integration and self 
determination (Agosta, J., et al., ``MCARE Policy Brief,'' 
Developmental Disability Services at the Century's End: Facing the 
Challenges Ahead, No. 2, pg. 4, 1997). The consumer managed care 
approach assumes that consumers with limited budgets will spend more 
prudently in order to get the most value for their money and increase 
their use of natural supports in lieu of public supports. Accordingly, 
consumer choice will spawn a competitive market economy where those 
providers representing the most value to all consumers will survive 
(Smith, G. and Ashhbaugh, J., Managed Care and People with 
Developmental Disabilities: A Guidebook, pg. 8, 1996).
    Coupled with States' efforts toward containment of long-term care 
costs, most States have long waiting lists for services. Waiting lists 
are expected to grow in the future due to increased longevity and 
higher expectations of families. After examining State-by-State data 
regarding the status of requests for residential, day care, vocational 
and other community support services, a 1997 Arc study found that 
218,000 requests for community-based support services remained 
unanswered. In addition to individuals living in institutions and 
nursing homes, these waiting lists include students exiting from 
special education programs and individuals living at home with 
caregivers. There is a need to understand the methods and procedures 
that States are using to provide community-based services, as well as 
to identify ways in which service systems can be redesigned to better 
respond to the needs of persons with mental retardation and their 
families.
    Residential direct care providers (e.g., group home staff members, 
foster family members, roommates in supported living arrangements) are 
the primary providers of support, training, supervision and personal 
assistance to persons with mental retardation in home and community 
settings (Larson, S. A., et al., ``Residential Services Personnel,'' 
Challenges for a Service System in Transition, pg. 313, 1994). In 
community residential settings, there have been few attempts to study 
the effects of staff orientation and in-service training programs on 
important outcomes for persons with mental retardation as well as on 
direct service personnel (Larson, S. A., ibid., pg. 326). As the 
service delivery system changes, training for these providers will be 
essential. In addition, it will be important to determine what training 
efforts contribute to the desired outcomes of fuller community 
participation and autonomy for persons with mental retardation.

Proposed Priority 2

    The Secretary proposes to establish an RRTC to improve community 
integration outcomes for individuals with mental retardation. The RRTC 
shall:
    (1) Investigate effective and cost-beneficial approaches to assist 
families to support members with mental retardation at home, or in 
homes of their own;
    (2) Describe and analyze efforts to redesign policy and services in 
selected State systems serving persons with mental retardation and 
their families;
    (3) Identify and analyze State policies and practices in the 
management of Medicaid resources that foster or impede access to 
supports and services;
    (4) Identify and analyze policies that foster or impede (e.g., 
result in individuals being placed on waiting lists for community-based 
services) the full participation and integration of persons with mental 
retardation into their communities;
    (5) Analyze the outcomes of the implementation of consumer-
controlled services, personal assistance, and individual control-of-
service purchasing in areas of quality of life and cost effectiveness; 
and
    (6) Identify outcomes of training for residential direct care 
providers and the long-term costs and benefits of specific training 
strategies.
    In carrying out the purposes of the priority, the RRTC must: 
coordinate with research and demonstration activities sponsored by the 
Health Care Financing Administration, the Administration on 
Developmental Disabilities, the Office of Disability, Aging, and Long-
term Care Policy in the Department of Health and Human Services, and 
other entities carrying out related research or training activities.

Proposed Priority 3: Policies Affecting Families of Children with 
Disabilities

Background

    The 1992 National Health Interview Survey (NHIS) estimates that 4 
million children and adolescents, or 6.1 percent of the U.S. population 
under 18 years of age, have disabilities. The NHIS broadly defines 
disability to include any limitation in activity due to a chronic 
health condition or impairment. Among children under age five, 2 
percent are limited in play activities and among children 5-17, 5.5 
percent have school related disabilities. In addition, the NHIS 
estimates that 3.8 million families, or 5.5 percent of all families, 
contain one or more children with disabilities.
    Families of children with disabilities must interact with at least 
three large service systems: health care, human and social services, 
and educational systems. It is often difficult to assess the impact of 
policies, service systems, and service delivery practices because the 
organizational structures and the services provided under the auspices 
of public and private institutions vary. The integration and 
coordination of these systems can be inferred from the patterns of 
interagency relationships involving client referrals, information flows 
and resource exchanges (Morrissey, J.P., et al., ``Methods for System-
Level Evaluations of Child Mental Health Service Networks'' Outcomes 
for Children and Youth with Behavioral and Emotional Disorders and 
Their Families: Programs and Evaluation Best Practices, pg. 299, 1998). 
For the purposes this priority, the policies affecting families of 
children with disabilities include, but are not limited to, those in 
the areas of health care (including mental health), human and social 
services (including legal systems such as juvenile services), and 
public and private education.
    Families of children with disabilities often need assistance with 
accessing and financing services, information about caring for their 
child, support from other families, community-based respite care, and 
case management services. Case management services are intended to 
ensure that services are delivered in an effective and efficient 
manner. Numerous models of case management currently exist. However, 
there is little extant research on the effectiveness, either at the 
family or system level, of case management services for families of 
children with disabilities.
    Numerous methodological problems limit the study of the complex 
service systems surrounding children with disabilities and their 
families. Current methods of measuring service coordination and 
examining roles in service delivery systems are not structured to 
assess the needs of children and their families (Koren, P. E., et al., 
``Service Coordination in Children's Mental Health: An Empirical Study 
from the Caregivers Perspective,'' Journal of Emotional and Behavioral 
Disorders, 5(3), pg. 164, 1997). Measurement issues become even more 
complex when the focus of a study moves from the individual and family 
level to the State and local service system level or when policy 
analysis is required. There is currently a shortage

[[Page 31328]]

of methods for assessing the interrelationship between Federal, State, 
and local policy, service systems, and outcomes for families of 
children with disabilities. The limited availability of data and 
methodological tools needed for scientific measurement of the impact of 
systemic and policy reforms on families of children with disabilities 
serves as a barrier to increasing our understanding of the relationship 
between policy and outcomes. Recent major changes in Federal policies 
for social services, child care, family preservation and support 
services, and related educational and health care services may be 
having profound impacts upon these families.
    Changes at the Federal level may be having an impact at the State 
and local level. However, little is known or documented about the 
effects of Federal policy changes on State and local service systems 
and families of children with disabilities.
    Under new Federal and State legislation, States have more 
flexibility to administer human service programs. Policymakers and 
legislators have new opportunities to shape integrated and flexible 
programs to better serve the needs of families and their children with 
and without disabilities. Some States are experimenting with a 
decategorization of State and Federal funding streams so that local 
communities can reshape their service systems through the use of 
vouchers. Some State and local agencies are conducting demonstrations 
of family support programs that decentralize public services for 
families of children with disabilities.
    The impact of devolution from a system with authority at the 
Federal level and management of public services at the State level, to 
a system of both authority and management at the local level has not 
been documented. Information is needed on these practices and other 
interventions, the family benefits associated with these policies and 
practices, and the consequences of practice and policy change in order 
to facilitate implementation of policies and programs that are 
sensitive to the needs of families of children with disabilities and to 
promote effective models of care for families of children with 
disabilities.
    In addition to policy changes in the social services arena, health 
care systems are changing rapidly the way they provide services to 
consumers. Families of children with disabilities, and the health care 
providers that serve them, are facing many challenges that differ from 
the coverage and access issues that are present for the general 
population. Even families of children with disabilities that use few 
medical services often require special knowledge or accommodations when 
they do access the health care system. Many States have little or no 
experience in assuring that their health care providers meet the 
specialized needs of families of children who have disabilities. These 
challenges are further complicated by the high cost of services for 
children with disabilities.
    Among children enrolled in Medicaid, the average per-person health 
care costs in 1992 were seven times higher for disabled than 
nondisabled children. Compared with nondisabled children in the general 
population, some disabled children use twice as many physician visits 
and five times as many ancillary services, such as physical therapy. 
Under current policies and practices, the potential exists to use 
medical necessity standards to prevent disabled children from receiving 
therapy or equipment when they need it to maintain existing levels of 
functioning (U.S. General Accounting Office, Medicaid Managed Care: 
Serving the Disabled Challenges States Programs, (GAO/HEHS Publication 
No. 96-136) pg. 16, 1996). Research is needed on health care policies 
and service delivery practices in order to develop longterm strategies 
to remove service delivery barriers that exist in the health care 
system and to facilitate establishment of policies that support access 
to services for families of children with disabilities.
    Frequently, children with disabilities who are participating in 
special education programs and their families have needs that are 
addressed by health care or social service agencies. As public schools' 
regular and special education programs restructure, opportunities may 
arise to expand successful service delivery strategies and develop new 
ones to fill in existing gaps in the service delivery systems. The 
development of integrated, community-based services for children with 
disabilities and their families is an essential component of this 
reform effort (Duchnowski, A. J., et al., ``Integrated and 
Collaborative Community Services in Exceptional Student Education,'' 
Special Education Practice: Applying the Knowledge, Affirming the 
Values and Creating the Future, pgs. 177-188, 1997).
    Many communities have begun initiatives to create more responsive 
family-centered service delivery systems. Mechanisms for interagency 
coordination at the State and local levels are necessary to ensure 
optimal service delivery conditions. Service coordination should 
involve linkages between education agencies, health care systems, and 
social services systems. In addition, due to the changing demographics 
of society, little is known about the influence of culture, ethnicity 
and socioeconomics on how families seek and receive services for their 
children with disabilities.
    Basic information sharing, coordination and collaboration between 
agencies that provide services to families of children with 
disabilities is limited. There is a need to evaluate current best 
practices in service delivery coordination and collaboration, develop a 
methodology for analyzing collaboration among agencies, establish 
principles for coordination and collaboration, and develop performance 
indicators that foster partnerships.

Proposed Priority 3

    The Secretary proposes to establish an RRTC to assess the impact of 
policies on service delivery and outcomes for families of children with 
disabilities. The RRTC shall:
    (1) Develop an analytical framework, including tools for assessing: 
family characteristics and policies, structure of service systems, 
service delivery processes, interagency coordination and collaboration, 
and outcomes for families with disabled children;
    (2) Using the methodology developed above, determine the 
effectiveness of specific policies, implementation strategies, service 
delivery procedures, and coordination practices in meeting the needs of 
families of children with disabilities;
    (3) Identify the impact of specific characteristics of interagency 
collaboration and coordination on families of children with 
disabilities; and
    (4) Assess the impact of specific policies on access to services of 
families from diverse cultural, linguistic, ethnic and socioeconomic 
backgrounds.
    In carrying out these purposes, the RRTC must:
     Disseminate materials and coordinate research and training 
activities with the Maternal and Child Health Bureau, the 
Administration on Developmental Disabilities, the Office of Policy and 
Planning in the Department of Health and Human Services, the Office of 
Special Education, the Federal Interagency Coordinating Council, and 
other entities carrying out related research or training activities; 
and
     Establish practical statistical methodologies and 
measurement tools that specifically assess the policies affecting 
families of children with disabilities.

[[Page 31329]]

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    Note: The official version of this document is the document 
published in the Federal Register.

    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 3424, 
Switzer Building, 330 C Street S.W., Washington, D.C., between the 
hours of 9:00 a.m. and 4:30 p.m., Monday through Friday of each week 
except Federal holidays.
    Applicable Program Regulations: 34 CFR Part 350.

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

(Catalog of Federal Domestic Assistance Numbers 84.133B, 
Rehabilitation Research and Training Centers)

    Dated: June 3, 1998.
Curtis L. Richards,
Acting Assistant Secretary for Special Education and Rehabilitative 
Services.
[FR Doc. 98-15166 Filed 6-5-98; 8:45 am]
BILLING CODE 4000-001-P