[Federal Register Volume 73, Number 82 (Monday, April 28, 2008)]
[Notices]
[Pages 22932-22938]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-9237]


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DEPARTMENT OF EDUCATION


National Institute on Disability and Rehabilitation Research--
Disability and Rehabilitation Research Projects and Centers Program--
Rehabilitation Research and Training Centers (RRTCs)

AGENCY: Office of Special Education and Rehabilitative Services, 
Department of Education.

ACTION: Notice of proposed priorities for RRTCs.

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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 the National Institute on Disability and Rehabilitation 
Research (NIDRR). Specifically, this notice proposes four priorities 
for RRTCs. The Assistant Secretary may use these priorities for 
competitions in fiscal year (FY) 2008 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 May 28, 2008.

ADDRESSES: Address all comments about these proposed priorities to 
Donna Nangle, U.S. Department of Education, 400 Maryland Avenue, SW., 
Room 6029, Potomac Center Plaza (PCP), Washington, DC 20204-2700. If 
you prefer to send your comments through the Internet, use the 
following address: [email protected].
    You must include 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), you may 
call the Federal Relay Service (FRS) at 1-800-877-8339.
    Individuals with disabilities may obtain this document in an 
alternative format (e.g., Braille, large print, audiotape, or computer 
diskette) on request to the contact person listed under FOR FURTHER 
INFORMATION CONTACT.

SUPPLEMENTARY INFORMATION: This notice of proposed priorities is in 
concert with President George W. Bush's New Freedom Initiative (NFI) 
and NIDRR's Final Long-Range Plan for FY 2005-2009 (Plan). Background 
information on the NFI can be accessed on the Internet at the following 
site: http://www.whitehouse.gov/infocus/newfreedom.
    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 NFI and the Plan, NIDRR seeks to: 
(1) Improve the quality and utility of disability and rehabilitation 
research; (2) foster an exchange of expertise, information, and 
training to facilitate the advancement of knowledge and understanding 
of the unique needs of traditionally underserved populations; (3) 
determine best strategies and programs to improve rehabilitation 
outcomes for underserved populations; (4) identify research gaps; (5) 
identify mechanisms of integrating research and practice; and (6) 
disseminate findings.

Invitation To Comment

    We invite you to submit comments regarding these proposed 
priorities. To ensure that your comments have maximum effect in 
developing the notice of final priorities, we urge you to identify 
clearly the specific proposed priority or topic that each comment 
addresses.
    We invite you to assist us in complying with the specific 
requirements of Executive Order 12866 and its overall requirement of 
reducing regulatory burden that might result from these proposed 
priorities. Please let us know of any further opportunities we should 
take to reduce potential costs or increase potential benefits while 
preserving the effective and efficient administration of the program.
    During and after the comment period, you may inspect all public 
comments about these proposed priorities in room 6029, 550 12th Street, 
SW., PCP, Washington, DC, between the hours of 8:30 a.m. and 4 p.m., 
Eastern time, Monday through Friday of each week except Federal 
holidays.

Assistance to Individuals With Disabilities in Reviewing the Rulemaking 
Record

    On request, we will supply an appropriate aid, such as a reader or 
print magnifier, to an individual with a disability who needs 
assistance to review the comments or other documents in the public 
rulemaking record for these proposed priorities. If you want to 
schedule an appointment for this type of aid, please contact the person 
listed under FOR FURTHER INFORMATION CONTACT.
    We will announce the final priorities in 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 or 
using additional priorities, subject to meeting applicable rulemaking 
requirements.

    Note: This notice does not solicit applications. In any year in 
which we choose to use these proposed priorities, we invite 
applications through a notice in the Federal Register. When inviting 
applications we designate the priorities as absolute, competitive 
preference, or invitational. The effect of each type of priority 
follows:

    Absolute priority: Under an absolute priority, we consider only 
applications that meet the priority (34 CFR 75.105(c)(3)).
    Competitive preference priority: Under a competitive preference 
priority, we give competitive preference to an application by either 
(1) awarding additional points, depending on how well or the extent to 
which the application meets the competitive preference priority (34 CFR 
75.105(c)(2)(i)); or (2) selecting an application that meets the 
competitive preference 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 invitational 
priority. However, we do not give an application that meets the 
invitational priority a competitive or

[[Page 22933]]

absolute preference over other applications (34 CFR 75.105(c)(1)).

Priorities

    In this notice, we are proposing four priorities for RRTCs.
     Priority 1--Enhancing the Functional and Employment 
Outcomes of Individuals Who Experience a Stroke.
     Priority 2--Enhancing the Functional and Employment 
Outcomes of Individuals With Multiple Sclerosis.
     Priority 3--Aging With Physical Disability: Reducing 
Secondary Conditions and Enhancing Health and Participation, Including 
Employment.
     Priority 4--Participation and Community Living for 
Individuals With Psychiatric Disabilities.

Rehabilitation Research and Training Centers (RRTCs)

    The purpose of the RRTC program 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, which was published in a notice 
of final priorities in the Federal Register on February 1, 2008 (72 FR 
6132). Additional information on the RRTC program 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;
     Demonstrate in their applications how they will address, 
in whole or in part, the needs of individuals with disabilities from 
minority backgrounds;
     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.

Priority 1--Enhancing the Functional and Employment Outcomes of 
Individuals Who Experience a Stroke

Background

    According to the American Heart Association's most recent 
estimates, each year approximately 780,000 individuals in the United 
States (U.S.) experience a stroke and nearly 5.7 million individuals in 
the U.S. today have survived a stroke. Stroke patients continue to be 
the largest diagnostic group in medical rehabilitation, and stroke is a 
leading cause of serious, long-term physical and cognitive disabilities 
(American Heart Association, 2008).
    Significant progress has been made in the development of 
rehabilitation interventions and in the assessment of outcomes for 
those who experience a stroke. An example of recent advances in 
rehabilitation interventions includes constraint-induced movement 
therapy. This repetitive training of the arms on task-oriented 
activities has been shown to improve the functional abilities of stroke 
survivors (Wolf et al., 2006). Another novel and promising technology 
that is in development is the BION, a family of implantable 
neuromuscular microstimulation devices that are designed to treat 
complications of paralysis and disuse atrophy, including shoulder 
subluxation, hand contractures, drop foot and osteoarthritis (Loeb et 
al., 2006).
    Given the large and growing incidence of stroke in the U.S. and the 
high levels of physical and cognitive disabilities often associated 
with strokes, there is a need for further research on promising new 
interventions, such as CI therapy, bodyweight supported treadmill 
training (BWS-TT), electrical stimulation, and robotic technology 
(Bassett, 2006). In addition, research is needed to develop more 
sensitive measures of neuro-recovery and post-stroke secondary health 
conditions, as well as interventions to prevent a variety of post-
stroke secondary health conditions, such as fatigue (Gladstone et al., 
2002; Roth, 2005; Campbell, Sheets, & Strong, 1999).
    Individuals who experience a stroke are at increased risk for 
depression, and depression among stroke survivors is associated with 
poor functional outcomes (Goodwin & Devanand, 2008).
    Typical clinical assessments of depression ask patients questions 
to detect the presence of negative affect and the absence of positive 
affect. However, the connection between emotional well-being and stroke 
outcomes is not yet very well understood. Additional research is needed 
to investigate whether interventions aimed at improving an individual's 
level of positive affect can improve recovery from stroke.
    Post-stroke rehabilitation interventions that focus on health and 
function and emotional well-being may improve employment outcomes of 
this population. Emotional well-being in the general population is 
related to many positive outcomes, including employment (Seligman, 
1991, 2002). However, this connection has not been validated nor 
explored for the population of individuals with disabilities, including 
individuals who experience a stroke. The employment statistics for the 
post-stroke population are poor. Estimates of rates of return to work 
following stroke vary widely (Wozniak & Kittner, 2002). According to 
the U.S. Department of Education's Rehabilitation Services 
Administration's Case Service Report, also called the RSA-911 database, 
in 2006, of the more than 5,300 individuals with disabilities caused by 
a stroke who exited the State Vocational Rehabilitation Services 
program after receiving services, only about 25 percent were employed 
when they left the program.
References
American Heart Association (AHA) (2008). Heart Disease and Stroke 
Statistics--2008 Update At-A-Glance: Our Guide to Current Statistics 
and the Supplement to our Heart and Stroke Facts. See: http://www.americanheart.org/downloadable/heart/1200078608862HS_Stats%202008.final.pdf.
Bassett, J. (2006). A Lifelong Journey. Advance for Directors in 
Rehabilitation, 15(10), 42-48.
Campbell, M.L., Sheets, D., & Strong, P.S. (1999). Secondary health 
conditions among middle-aged individuals with chronic physical 
disabilities: implications for unmet needs for services. Assistive 
Technology. 11(2): 105-122.
Gladstone, D.J., Danells, C.J., & Black, S.E. (2002). The fugl-meyer 
assessment of motor recovery after stroke: a critical review of its 
measurement properties. Neurorehabilitation and Neural Repairs, 
16(3): 232-40. See: http://www.medscape.com/medline/abstract/12234086.
Goodwin, R.D. & Devanand, D.P. (2008). Stroke, depression, and 
functional health outcomes among adults in the community. Journal of 
Geriatric Psychiatry and Neurology. 21(1): 41-46.

[[Page 22934]]

Loeb, G.E., Richmond, F.J.R., & Baker, L.L. (2006). The BION 
Devices: Injectable interfaces with peripheral nerves and muscles. 
Neurosurgery Focus, 20(5) E2. See: http://www.medscape.com/viewarticle/542356.
Roth, E. (2005). Aging Issues: Neurological Disorders: crosscutting 
breakout session. Neurorehabilitation and Neural Repair, 10(1), S70.
Seligman, M.E.P. (1991). Learned Optimism. New York: Pocket Books.
Seligman, M.E.P. (2002). Authentic Happiness. Simon & Schuster.
U.S. Department of Education: Case Service Report (RSA-911), FY 
2006. (2006). Washington, DC. Aggregated 911 data by state is 
available. See: http://rsamis.ed.gov.
Wolf, S.L., Weinstein, C.J., Miller, J.P., Taub, E., Uswatte, G., 
Morris, D., Giuliani, C., Light, K.E., & Nichols-Larsen, D. (2006). 
Effect of constraint-induced movement therapy on upper extremity 
function 3 to 9 months after stroke. Journal of the American Medical 
Association, 296(17), 2095-2104.
Wozniak, M. & Kittner, S. (2002). Return to Work After Ischemic 
Stroke: A Methodological Review. Neuroepidemiology, 21, 159-166.

Proposed Priority

    The Assistant Secretary for Special Education and Rehabilitative 
Services proposes a priority for a Rehabilitation Research and Training 
Center (RRTC) on Enhancing the Functional and Employment Outcomes of 
Individuals Who Experience a Stroke. This RRTC must conduct rigorous 
research, training, technical assistance, and dissemination activities 
to enhance the functional and employment outcomes of individuals who 
experience a stroke.
    In doing so, the RRTC must focus on no more than two of the 
following dimensions: Improved mobility; secondary conditions (e.g., 
pain, fatigue); and emotional well-being. Under this priority, the RRTC 
must be designed to contribute to the following outcomes:
    (a) Improved outcome measures for use with individuals who 
experience a stroke. The RRTC must contribute to this outcome by 
identifying or developing and testing methods and measures to assess 
outcomes in the dimensions that the RRTC chooses to focus on (e.g., 
mobility, secondary conditions, emotional well-being).
    (b) Improved medical rehabilitation or community-based 
rehabilitation interventions for individuals who experience a stroke. 
The RRTC must contribute to this outcome by identifying or developing 
and testing new rehabilitation interventions that are designed to 
improve mobility, reduce the onset of secondary conditions, or improve 
emotional well-being among individuals who have experienced a stroke. 
Where possible, the Center must use scientifically based research (as 
this term is defined in section 9101(34) of the Elementary and 
Secondary Education Act of 1965, as amended) methods to test these 
interventions.
    (c) Improved employment outcomes among individuals who experience a 
stroke. The RRTC must contribute to this outcome by conducting research 
on the experiences and outcomes of individuals who experience stroke 
and who seek to return to work. The RRTC's research must include 
research on individuals who are served by the State Vocational 
Rehabilitation Services program or who receive stroke/neuro-
rehabilitation services from other sources, and must identify neuro-
rehabilitation services that are associated with positive outcomes in 
the treatment of specific stroke-related impairments and functional 
limitations thereby allowing individuals to return to work.

Priority 2--Enhancing the Functional and Employment Outcomes of 
Individuals With Multiple Sclerosis

Background

    While prevalence estimates vary, according to the National Multiple 
Sclerosis Society, approximately 400,000 Americans have multiple 
sclerosis (MS) (National Multiple Sclerosis Society, 2005). For most 
individuals, the age of onset for the disease is in early adulthood. 
Individuals with MS may have symptoms such as fatigue, motor weakness, 
spasticity, poor balance, heat sensitivity, pain, cognitive 
impairments, and mood disorders (Wynn, 2006; Mikol, 2006). The variety 
of symptoms that an individual with MS may experience and the uncertain 
prognosis of MS can impair an individual's routine activities; 
vocational, social, and interpersonal functioning; and quality of life 
(Kalb, 2004).
    While some research has been conducted regarding the functional 
outcomes of individuals with MS, there is a significant need for 
further research in the areas of outcomes measurement and 
rehabilitation interventions to maximize the health, well-being, and 
community and workplace participation of individuals with MS. 
Experienced MS care providers participating in a recent survey 
identified a number of areas in which clinical consultation and 
continuing medical education (CME) would improve their ability to treat 
individuals with MS, and the wide range of symptoms associated with MS 
(Turner et al., 2006). Fatigue, depression, cognitive impairment, and 
pain were among the most frequently cited areas for consultation and 
CME (Mikol, 2006). Research that addresses the frequent co-occurrence 
of these four symptoms, and the effect of central-nervous-system-active 
medications that are typically used to treat them, is also needed (Oken 
et al., 2006). For individuals with MS, there is a ``continued need for 
effective therapeutic approaches to symptom management'' (Joy & 
Johnston, 2001).
    The relatively early age of onset, the variety of symptoms and 
secondary conditions associated with MS, and the intermittent and 
uncertain course of the disease present a variety of challenges to 
continuous participation by individuals with MS in the labor force. 
Estimates are that as many as 50 percent of individuals with MS report 
they cannot work due to their disabilities (Buchanan et al., 2006). 
Interventions to improve the health and function of individuals with MS 
may improve their employment outcomes. Recent data from the U.S. 
Department of Education's Rehabilitation Services Administration's Case 
Service Report, also called the RSA-911 database, suggest that 
vocational rehabilitation services can be improved for this population. 
According to the RSA-911 database, in 2006, of the more than 3,000 
individuals with MS who exited the State Vocational Rehabilitation 
Services program, after being determined eligible and receiving a 
service, only one-third were employed when they exited the program.
References
Buchanan, R.J., Schiffer, R., Stuifbergen, A., Zhu, L., Wang, S., 
Chakravorty, B.J., & Kim, M. (2006). Demographic and Disease 
Characteristics of People with Multiple Sclerosis Living in Urban 
and Rural Areas. International Journal of MS Care, 8(11), 89-97.
Joy, J.E. & Johnston, R.B. (Eds.). (2001). Multiple Sclerosis: 
Current Status and Strategies for the Future. Washington, D.C.: 
National Academy Press.
Kalb, R.C. (2004). Multiple Sclerosis: The Questions You Have--The 
Answers You Need, 3rd Edition. New York: Demos Medical Publishing.
National Multiple Sclerosis Society (2005). Multiple Sclerosis 
Information Sourcebook. New York: National Multiple Sclerosis 
Society. See: http://www.nationalmssociety.org/Sourcebook-Topic.asp. 

Oken, B.S., Flegal, K., Zajdel, D., Kishiyama, S.S., Lovera, J., 
Bagert, B., & Bourdette, D.N. (2006). Cognition and Fatigue in 
Multiple Sclerosis: Potential Effects of Medications With Central 
Nervous System Activity. Journal of Rehabilitation Research & 
Development, 43(1), 83-90.
Turner, A.P., Martin, C., Williams, R.M.,

[[Page 22935]]

Goudreau, K., Bowen, J.D., Hatzakis, M., Whitham, R.H., Bourdette, 
D.N., Walker, L., & Haselkorn, J.K. (2006). Exploring Educational 
Needs of Multiple Sclerosis Care Providers: Results of a Care-
Provider Survey. Journal of Rehabilitation Research & Development, 
43(1), 25-34.
U.S. Department of Education: Case Service Report (RSA-911), FY 
2006. (2006). Washington, DC: Author.
Wynn, D.R. (2006). Management of Physical Symptoms. International 
Journal of MS Care, 8, Supplement 1, 13-20.

Proposed Priority

    The Assistant Secretary for Special Education and Rehabilitative 
Services proposes a priority for a Rehabilitation Research and Training 
Center (RRTC) on Enhancing the Functional and Employment Outcomes of 
Individuals With Multiple Sclerosis. This RRTC must conduct rigorous 
research, training, technical assistance, and dissemination activities 
to enhance the functional and employment outcomes of individuals with 
multiple sclerosis (MS).
    In doing so, the RRTC must focus on how one or both of the 
following dimensions affect the employment outcomes of individuals with 
MS: The prevention or reduction of secondary conditions (e.g., pain, 
fatigue, depression, cognitive impairment) and improved mobility. Under 
this priority, the RRTC must be designed to contribute to the following 
outcomes:
    (a) Improved outcome measures for use with individuals with MS. The 
RRTC must contribute to this outcome by identifying or developing and 
testing methods and measures to assess outcomes in the dimensions on 
which the RRTC chooses to focus.
    (b) Improved medical rehabilitation or community-based 
rehabilitation interventions. The RRTC must contribute to this outcome 
by improving the ability of individuals with MS to remain in the 
workforce and to live in community-based settings through identifying 
or developing and testing new rehabilitation interventions. Where 
possible, the Center must use scientifically based research (as this 
term is defined in section 9101(34) of the Elementary and Secondary 
Education Act of 1965, as amended) methods to test these interventions.
    (c) Improved employment outcomes among individuals with MS. The 
RRTC must contribute to this outcome by conducting research on the 
experiences and outcomes of individuals with MS who are served by the 
State Vocational Rehabilitation Services program or who receive MS-
rehabilitation services from other sources, and by identifying 
rehabilitation services that are associated with the reduction of 
specific MS-related symptoms and functional limitations. Research must 
include investigation of job modifications and accommodations 
associated with successful employment.

Priority 3--Aging With Physical Disability: Reducing Secondary 
Conditions and Enhancing Health and Participation, Including Employment

Background

    With recent medical and technological advancements, many 
individuals with early onset of physical disabilities acquired at birth 
or in childhood or young adulthood are surviving long enough to 
experience the rewards and challenges of aging (Campbell, Sheets, & 
Strong, 1999). Determining the size of this emerging segment of the 
disabled population has been difficult due to the lack of sufficient 
population data on age of onset and duration of disability (Kemp, 
2005). The only national estimate available to date comes from a 
secondary analysis of the 1990 U.S. Census data, which suggests that 
there may be as many as 25,000,000 Americans who are aging with various 
long-term physical disabilities (McNeil, 1994).
    As many researchers have documented, a primary challenge associated 
with increased longevity among this population is an increased risk of 
secondary conditions (Kemp & Mosqueda, 2004). Although there is 
widespread agreement that secondary conditions can be debilitating, 
costly in terms of financial and social consequences, and potentially 
fatal in some circumstances, how to define secondary conditions remains 
an active debate within the disability community (Wilber et al., 2002; 
Rimmer, 2005).
    While a precise definition of secondary conditions is still 
evolving, the emerging consensus is that secondary conditions often 
increase the severity of an individual's physical disability (Brandt & 
Pope, 1997). As individuals with long-term physical disabilities age 
into middle and later adulthood, there is an enormous physical and 
psychological burden associated with having to manage various secondary 
health conditions, in addition to managing the chronic health effects 
related to the aging process generally (Rimmer, 2005). There is, 
however, widespread agreement that certain secondary conditions are 
preventable, and that learning how to prevent the onset or reduce the 
severity and impact of these new or increased impairments, functional 
limitations, and age-related health problems is vital to enhancing the 
health and participation of individuals aging with long-term physical 
disabilities (Simeonsson et al., 1999; Lollar, 2002; Wilber et al., 
2002).
    To date there are no national estimates of the number of 
individuals with long-term physical disabilities who are experiencing 
one or more types of secondary conditions. Most of what is known about 
the prevalence and consequences of secondary conditions for health and 
participation comes from clinical studies of patients, a handful of 
community-based studies and secondary analyses of population surveys, 
and the evolving theoretical understanding of the general aging process 
(Cristian, 2005; Kemp, 2005; Seekins et al., 1994; Campbell, Sheets, & 
Strong, 1999; Wilber et al., 2002; Verbrugge & Yang, 2002; Kinne et 
al., 2004).
    Results of these studies underscore the importance of improving 
treatment options to prevent or reduce the consequences of secondary 
conditions. Exercise, lifestyle and behavioral changes, and 
psychosocial and environmental factors are known to influence the 
development of secondary health conditions (Seekins et al., 1994; 
Wilber et al., 2002; Kemp, 2005; Rimmer, 2005). However, research on 
these factors has been limited by the lack of measurement tools to 
characterize the types and severity of secondary conditions experienced 
by individuals aging with physical disabilities, and the lack of 
experimental and quasi-experimental studies to test the effectiveness 
of various intervention strategies (Wilber et al., 2002; Rimmer, 2005).
    The variety of secondary conditions that individuals aging with 
physical disability are at risk of developing, and the relatively early 
age of onset of those conditions, pose challenges to maintaining their 
participation in the labor force. In some cases, secondary conditions 
can lead to premature retirement and the loss of economic self-
sufficiency. The employment consequences of aging with a physical 
disability have yet to be examined in large-scale national surveys. 
However, results of a recent quasi-experimental study indicate that 
those aging with polio, cerebral palsy, rheumatoid arthritis, and 
stroke reported a 50 percent reduction in employment compared to a 35 
percent reduction for the non-disabled comparison group (Mitchell, 
Adkins, & Kemp, 2006). Given the economic consequences of premature 
disruptions in labor force participation, vocational rehabilitation

[[Page 22936]]

strategies need to be identified and tested for their effectiveness in 
improving the employment outcomes of the growing segment of the 
population experiencing the challenges of aging with long-term physical 
disabilities.
References
Brandt, E.N. & Pope, A.M. (1997). Enabling America: Assessing the 
Role of Rehabilitation Science and Engineering. Committee on 
Disability Research, Institute of Medicine, National Academy of 
Sciences. Washington, DC: National Academies Press.
Campbell, M.L., Sheets, D.S., & Strong, P.S. (1999). Secondary 
health conditions among middle-aged individuals with chronic 
physical disabilities: Implications for ``unmet needs'' for 
services. Assistive Technology, 11(2), 3-18.
Cristian, A. (Ed.) (2005). Aging with a Disability: Physical 
Medicine and Rehabilitation Clinics of North America 16. Oxford, UK: 
Elsevier.
Kemp, B.J. (2005). What the rehabilitation professional and the 
consumer need to know. In Adrian Cristian (ED), Aging with a 
Disability: Physical Medicine and Rehabilitation Clinics of North 
America, 16 (pp. 1-18). Oxford, UK: Elsevier.
Kemp, B.J. & Mosqueda, L. (Eds.) (2004). Aging with a Disability. 
Baltimore: The Johns Hopkins University Press.
Kinne, S., Patrick, D.L., & Lochner, D.D. (2004). Prevalence of 
secondary conditions among people with disabilities. American 
Journal of Public Health, 94(3), 443-445.
Lollar, D. (2002). Public health and disability: emerging trends. 
Public Health Report, 117, 131-136.
McNeil, J. (1994). Americans with Disabilities, Bureau of the 
Census, Statistical Brief, SB/94-1.
Mitchell, J.M., Adkins, R.H., & Kemp, B.J. (2006). The effects of 
aging on employment of people with and without disabilities. 
Rehabilitation Counseling Bulletin, 49(3), 157-165.
Rimmer, J.L. (2005). Exercise and physical activity in persons aging 
with a physical disability. In A. Cristian (Ed), Aging with a 
Disability: Physical Medicine and Rehabilitation Clinics of North 
America, 16, (pp. 41-56). Oxford, UK: Elsevier.
Seekins, T., Clay, J., & Ravesloot, C.H. (1994). A descriptive study 
of secondary conditions reported by a population of adults with 
physical disabilities served by 3 independent living centers in a 
rural state. Journal of Rehabilitation, 60, 47-51.
Simeonsson, R.J., Bailey, D.B., Scandlin, D., Huntington, G.S., & 
Roth, M. (1999). Disability, health, secondary conditions and 
quality of life: Emerging issues in public health. In R.J. 
Simeonsson & L.N. McDevitt (Eds.), Issues in Disability and Health: 
The Role of Secondary Conditions and Quality of Life (pp. 51-72). 
Chapel Hill: University of North Carolina Press.
Wilber, N., Mitra, M., Walker, D.K., Allen, D., Meyers, A.R., & 
Tupper, P. (2002). Disability as a public health issue: Findings and 
reflections from the Massachusetts Survey of Secondary Conditions. 
Milbank Quarterly, 80, 393-421.
Verbrugge, L.M., & Yang, L. (2002). Aging with Disability and 
Disability with Aging. Journal of Disability Policy Studies, 12(4), 
253-267.

Proposed Priority

    The Assistant Secretary for Special Education and Rehabilitative 
Services proposes a priority for a Rehabilitation Research and Training 
Center (RRTC) on Aging With Physical Disability: Reducing Secondary 
Conditions and Enhancing Health and Participation, Including 
Employment. This RRTC must conduct rigorous research, training, 
technical assistance, and dissemination activities to improve 
rehabilitation outcome measures and rehabilitation interventions that 
can be applied in clinical or community-based settings and used by 
other researchers. The intended outcome of the RRTC is to enhance 
community participation, including employment, of individuals aging 
with long-term physical disabilities by advancing knowledge about the 
identification, assessment, treatment, and improved management of the 
secondary conditions likely experienced by individuals aging with a 
physical disability.
    In addressing this priority, the RRTC must propose a limited number 
of high-quality, cross-disability research projects to address the 
secondary conditions that are most relevant to the lives of individuals 
with physical disabilities. To ensure the feasibility of the RRTC's 
proposed activities and increase the likelihood of achieving planned 
outcomes, the RRTC must focus on two to four discrete impairment groups 
(e.g., spinal cord injury, cerebral palsy, multiple sclerosis, 
rheumatoid arthritis, stroke, post-polio), and must limit intervention 
strategies to no more than two of the following modalities: Exercise, 
health promotion, psychological adaptation, life planning or self-
management skills, and environmental or technological supports. Under 
this priority, the RRTC must be designed to contribute to the following 
outcomes:
    (a) Enhanced understanding of the natural course of aging with a 
physical disability. The RRTC must contribute to this outcome by 
documenting the life trajectories and average age of onset of the major 
types of secondary conditions experienced by individuals living with 
long-term physical disabilities in the selected impairment groups, and 
examining the interrelationships among different types of secondary 
conditions and the consequences of variations in timing of onset for 
health and community participation.
    (b) Improved tools and measures for use with individuals aging with 
long-term physical disabilities. The RRTC must contribute to this 
outcome by identifying, developing or modifying, and testing 
measurement tools that improve the identification and assessment of the 
major types of secondary conditions affecting individuals in the 
selected impairment groups, as well as the outcomes of interventions 
designed to prevent or reduce these conditions.
    (c) Improved rehabilitation or community-based interventions that 
enhance the health and participation in work and the community of 
individuals aging with physical disabilities. The RRTC must contribute 
to this outcome by identifying, developing or modifying, and testing 
interventions that show promise in preventing the onset of or improving 
the management and reducing the impact of secondary conditions on 
individuals in the selected impairment groups. Where possible, the 
Center must use scientifically based research (as this term is defined 
in section 9101(34) of the Elementary and Secondary Education Act of 
1965, as amended) methods to test these interventions.
    (d) Improved employment outcomes among working-age individuals 
aging with long-term physical disabilities. The RRTC must contribute to 
this outcome by conducting research on the experiences, including 
employment outcomes, of individuals aging with long-term physical 
disabilities in the selected impairment groups who are served by the 
State Vocational Rehabilitation Services program or who receive 
rehabilitation services from other sources, and by identifying specific 
secondary conditions that require improved and unique vocational 
rehabilitation services and approaches.

Priority 4--Participation and Community Living 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 
individuals with psychiatric disabilities in the United States is 
employed (Kaye, 2002). They also comprise the largest diagnostic 
category of working-age adults receiving Supplemental Security Income 
or Social Security Disability Insurance (McAlpine and Warner, 2001).

[[Page 22937]]

    In addition, individuals with psychiatric disabilities constitute a 
large proportion of the homeless population. Of 2 million adults 
experiencing an episode of homelessness, for example, 46 percent have a 
psychiatric disability (Burt, 2001).
    In April 2002, the President signed Executive Order 13263 
establishing a New Freedom Commission on Mental Health, and charged the 
Commission with completing a comprehensive study of the mental health 
service delivery system in the United States. The Commission's report, 
Achieving the Promise: Transforming Mental Health Care in America, set 
the course for public and private efforts across the country to improve 
the state of mental health care (New Freedom Commission on Mental 
Health, 2003). The Commission calls for a transformation of the mental 
health service delivery system, focusing on recovery and resilience for 
individuals with psychiatric disabilities. As stated in the 
Commission's report, recovery is, in part, ``the process in which 
people are able to live, work, learn, and participate fully in their 
communities,'' while resilience indicates ``the personal and community 
qualities that enable us to rebound from adversity, trauma, tragedy, 
threats, or other stresses--and to go on with life with a sense of 
mastery, competence, and hope'' (New Freedom Commission on Mental 
Health, 2003).
    Federal legislation has long aimed to facilitate the full inclusion 
of individuals with psychiatric disabilities into the mainstream of 
society. For example, the centers for independent living, established 
by title VII of the Rehabilitation Act of 1973, as amended, provide 
information and referral, advocacy, peer support, and independent 
living skill building to individuals with disabilities, including 
individuals with psychiatric disabilities. Grantee-reported data from 
the U.S. Department of Education's Centers for Independent Living 
program indicate that nearly 31,000 individuals with psychiatric 
disabilities were served by centers for independent living in 2006. 
However, there is a general lack of evidence on what independent living 
services are most effective in addressing the needs of individuals with 
psychiatric disabilities. Increased knowledge in this area could lead 
to more effective independent living services for individuals with 
psychiatric disabilities, and result in enhanced community living and 
participation for this population.
    In addition, there is a strong need for research on understudied 
aspects of community participation and community living for individuals 
with psychiatric disabilities. Two examples, among many, are emergency 
preparedness and mental health disparities for traditionally 
underserved populations (e.g., individuals from diverse racial, ethnic, 
and linguistic backgrounds, and individuals with multiple disabilities) 
with psychiatric disabilities (National Council on Disability, 2006; 
New Freedom Commission on Mental Health, 2003; U.S. Public Health 
Service, Office of the Surgeon General, 2001).
    According to the Institute on Medicine report, Crossing the Quality 
Chasm: A New Health System for the 21st Century, the time lag between 
the discovery of effective medical treatments and the incorporation of 
those treatments into practice is 15 to 20 years. The President's New 
Freedom Commission on Mental Health called for a reduction in this 
delay as part of an overall transformation of mental health care in 
America (Substance Abuse and Mental Health Services Administration, 
2005; New Freedom Commission on Mental Health, 2003; Institute of 
Medicine, 2001).
References
Burt, M.R. (2001). What will it take to end homelessness? Urban 
Institute Brief. Washington, DC: Urban Institute.
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.
National Council on Disability (July 7, 2006). The Needs of People 
with Psychiatric Disabilities During and After Hurricanes Katrina 
and Rita: Position Paper and Recommendations. Washington, DC: 
Author. http://www.ncd.gov/newsroom/publications/2006/peopleneeds.htm.
Department of Health and Human Services. (2003). New Freedom 
Commission on Mental Health (2003). Achieving the Promise: 
Transforming Mental Health Care in America. (DHHS Pub. No. SMA-03-
3832). Rockville, MD: Author.
U.S. Department of Health and Human Services. (2005). Transforming 
Mental Health Care in America. Federal Action Agenda: First Steps. 
(DHHS Pub. No. SMA-05-4060). Rockville, MD: Author.
U.S. General Accounting Office. (1996, April). SSA disability: 
Program redesign necessary to encourage return to work. (GAO/HEHS 
96-62). Washington, DC: Author.
United States Public Health Service Office of the Surgeon General. 
(2001). Mental Health: Culture, Race, and Ethnicity: A Supplement to 
Mental Health: A Report of the Surgeon General. Rockville, MD: 
Author.

Proposed Priority

    The Assistant Secretary for Special Education and Rehabilitative 
Services proposes a priority for a Rehabilitation Research and Training 
Center (RRTC) on Participation and Community Living for Individuals 
With Psychiatric Disabilities. The RRTC must conduct rigorous research, 
training, technical assistance, and dissemination activities that 
contribute to improved community participation and community living 
outcomes for individuals with psychiatric disabilities. Under this 
priority, the RRTC must be designed to contribute to the following 
outcomes:
    (a) Improved individual and system capacity to maximize the 
involvement of individuals with psychiatric disabilities in community 
life. The RRTC must contribute to this outcome by:
    (1) Generating new knowledge through research on effective 
strategies to meet the needs of individuals with psychiatric 
disabilities who are served by centers for independent living and 
identifying independent living services and service-delivery approaches 
that meet the unique needs of this population.
    (2) Increasing the knowledge base and advancing the application of 
theories, measures, methods, or interventions that facilitate 
participation and community living of individuals with psychiatric 
disabilities. In this regard, the RRTC must focus its efforts on at 
least three of the following areas: Employment, housing, education, 
health and mental health care, recreation, social relationships, or 
other public and private sector activities related to community living. 
If the Center engages in interventions testing, the Center must use 
scientifically based research (as this term is defined in section 
9101(34) of the Elementary and Secondary Education Act of 1965, as 
amended) methods.
    (3) Reducing disparities in service delivery and program 
development by focusing its work on one or more of the following 
understudied areas: (i) Emergency preparedness for individuals with 
psychiatric disabilities; (ii) individuals with psychiatric 
disabilities from diverse racial, ethnic, and linguistic backgrounds; 
or (iii) individuals with psychiatric disabilities who have co-
occurring sensory or physical disabilities.

[[Page 22938]]

    (b) Increased incorporation of mental health research findings into 
practice or policy. The RRTC must contribute to this outcome by 
coordinating with appropriate NIDRR-funded knowledge translation 
grantees to advance or add to their work in the following areas:
    (1) Developing and implementing procedures to evaluate the 
readiness of mental health research findings for translation into 
practice.
    (2) Collaborating with stakeholder groups to develop, evaluate, or 
implement strategies to increase utilization of mental health research 
findings.
    (3) Conducting training, technical assistance, and dissemination 
activities to increase utilization of mental health research findings.
    Information on knowledge translation projects funded by NIDRR can 
be found at http://www.naric.com/research/pd/priority.cfm.

Executive Order 12866

    This notice of proposed priorities has been reviewed in accordance 
with Executive Order 12866. Under the terms of the order, we have 
assessed the potential costs and benefits of this regulatory action.
    The potential costs associated with this notice of proposed 
priorities are those resulting from statutory requirements and those we 
have determined as necessary for administering this program effectively 
and efficiently.
    In assessing the potential costs and benefits--both quantitative 
and qualitative--of this notice of proposed priorities, we have 
determined that the benefits of the proposed priorities justify the 
costs.

Summary of Potential Costs and Benefits

    The 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 will support the President's NFI and improve 
the lives of individuals with disabilities. The new RRTCs will 
generate, disseminate, and promote the use of new information that will 
improve employment and community living options for individuals with 
disabilities.

Intergovernmental Review

    This program is not subject to Executive Order 12372 and the 
regulations in 34 part 79.
    Applicable Program Regulations: 34 CFR part 350.

Electronic Access to This Document

    You may view this document, as well as all other Department of 
Education documents published in the Federal Register, in text or Adobe 
Portable Document Format (PDF) on the Internet at the following site: 
http://www.ed.gov/news/fedregister.
    To use PDF you must have Adobe Acrobat Reader, which is available 
free at this site. If you have questions about using PDF, call the U.S. 
Government Printing Office (GPO), toll free, at 1-888-293-6498; or in 
the Washington, DC, area at (202) 512-1530.

    Note: The official version of this document is the document 
published in the Federal Register. Free Internet access to the 
official edition of the Federal Register and the Code of Federal 
Regulations is available on GPO Access at: http://www.gpoaccess.gov/nara/index.html.

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

    Program Authority: 29 U.S.C. 762(g) and 764(b)(2).

    Dated: April 23, 2008.
Tracy R. Justesen,
Assistant Secretary for Special Education and Rehabilitative Services.
 [FR Doc. E8-9237 Filed 4-25-08; 8:45 am]
BILLING CODE 4000-01-P