This Long-Range Plan, which aims to maximize independence and participation in society by people with disabilities, addresses priorities in five major research areas: employment outcomes, health and function, technology for access and function, independent living and community integration, and associated disability research areas. The plan also addresses priorities in three significant, related areas: knowledge dissemination and utilization, capacity-building for rehabilitation research, and research management.
Employment Outcomes
Two-thirds of working-age people with disabilities are not in the labor force, and those who are employed continue to earn less than their colleagues without disabilities. Reluctance to participate in the labor force often stems from disincentives inherent in social and health insurance policies, from discouragement, and from lack of physical access to jobs. Several other factors affect employment, including economy and labor force issues; the appropriateness and adequacy of the strategies and tools for vocational rehabilitation assessment, counseling, and training; the operation of community-based rehabilitation programs; employer roles and workplace supports; and the transition from school to work.
NIDRR’s employment-related research agenda for the next five years will address these issues. The new research agenda will extend beyond previous research efforts to investigate mechanisms that make the labor market more amenable to full employment for people with disabilities. To address the employment needs of people with disabilities, this research agenda also incorporates economic research, service delivery research, and policy research. Most important, the agenda relates to the context in which employment outcomes are determined.
The purposes of NIDRR’s research in the area of employment are as follows:
- assess the impact of economic policy and labor market trends on the employment outcomes of people with disabilities;
- improve the effectiveness of community-based employment service programs;improve the effectiveness of state employment service systems;
- evaluate the contribution of employer practices and workplace supports to the employment outcomes of people with disabilities; and
- improve school-to-work transition outcomes.
Health and Function
To maintain their independence, individuals with disabilities must be able to maximize their health and function through health care, rehabilitation, and wellness regimens. Health care for people with disabilities encompasses access to care for routine health problems, participation in health promotion and wellness activities, and access to appropriate specialty care, including medical rehabilitation. Medical rehabilitation is the systematic application of modalities, therapies, and techniques to restore, improve, or replace impaired human functioning. It also includes biomedical engineering principles and techniques to improve the functional ability of people with disabilities.
NIDRR is committed to supporting research to improve the overall health and function of people with disabilities. The purposes of NIDRR’s research in the area of health care and medical rehabilitation are as follows:
- identify and evaluate effective models of health care for people with disabilities;
- develop models to promote health and wellness for people with disabilities;
- examine the impact of changes in the health care delivery system on access to care;
- evaluate medical rehabilitation interventions that maximize function for individuals with disabilities;
- develop strategies to help disabled individuals avoid secondary conditions;
- assess delivery of medical rehabilitation services to people with disabilities; and
- evaluate the health and medical rehabilitation needs of people whose impairments are attributed to newly recognized causes or whose conditions are newly recognized as disabilities (e.g., disabilities resulting from interpersonal violence or emergent chronic diseases such as childhood asthma or chronic fatigue immune deficiency syndrome).
Technology for Access and Function
Today, technology plays a vital role in the lives of millions of disabled and older Americans. Federal funds have supported research, development, and training in rehabilitation and biomedical engineering. Useful products have resulted from this research and development activity. These innovations enable people with significant disabilities to achieve and maintain maximum physical function, to live in their own homes, to study and learn, to attain gainful employment, and to participate in and contribute to society in meaningful and resourceful ways.
In planning the future of rehabilitation engineering research, NIDRR and its constituents in the consumer, service, research, and business communities will continue to identify flexible strategies to address emerging issues and technologies, to promote widespread use of research findings, and to maximize the impact of NIDRR programs on the lives of people with disabilities. Research in technology involves issues related to the built environment, information technology and telecommunications, consumer products, and transportation. These technological systems are basic to community integration, education, employment, health, and economic development. Additionally, research in technology must continue to improve the functional capacities of individuals with sensory, mobility, manipulation, and cognitive impairments. The purposes of NIDRR’s research in the area of technology are as follows:
- develop assistive technology that supports people with disabilities to function and live independently and obtain better employment outcomes;
- develop biomedical engineering innovations to improve function for people with disabilities;
- promote the concept and application of universal design;
- improve access to the built environment;
- expand access to telecommunications and information technology;
- ensure the transfer of technological developments to other research sectors, to production, and to the marketplace;
- identify business incentives for manufacturers and distributors;
- identify the best methods of making technology available to people with disabilities;
- ensure that research and development at both the personal and systems levels take into account cultural relevance for diverse ethnic and geographic populations;
- develop rehabilitation engineering science, including a theoretical framework to advance empirical research; and
- raise the visibility of engineering and technological research for people with disabilities as a means of increasing attention to these research areas in national science and technology policy.
Independent Living and Community Integration
NIDRR proposes the continued development of a knowledge base about the meaning and application of independent living and community integration concepts. The concept of independent living recognizes that each individual has the right to exercise maximal control over his or her life, based on the opportunity to make choices in performing everyday activities. Although independent living emphasizes maximal attainable independence, whatever the setting, it is also a concept that promotes participation, especially participation in community settings. For this reason, NIDRR is integrating research agendas in community integration and independent living to encourage interdisciplinary thinking about the commonalities, to achieve successful outcomes for people with disabilities, and to foster the development of innovative methods to achieve these outcomes and to measure the achievements.
NIDRR’s framework for formulating this research agenda recognizes that the term independent living has been used to describe (a) a philosophy—of equity in the right to participate in society, (b) a movement—of people with disabilities who successfully used a civil rights approach to achieve equal access, and (c) a service program—whereby more than 300 centers for independent living foster and enhance independent living for people with disabilities.
Community integration also has conceptual, movement, and service delivery components. As a concept, it incorporates ideas of living in a community setting, as opposed to an institution, and participating in community activities. Issues of consumer direction and control are integral to community integration. As a movement, one of the goals of community integration has been to deinstitutionalize people with mental retardation or mental illness. This effort was successful in moving many individuals from large institutions into the community. At the service system level, community integration has resulted in the development or expansion of a range of services and programs to support people with disabilities to live in their own communities. NIDRR will work toward the continued development of a knowledge base about the meaning and application of independent living and community integration.
The purpose of NIDRR’s research in independent living and community integration is to enable people with disabilities to participate in society by doing the following:
- identifying and evaluating factors or domains of community integration and independent living, especially those aspects that lead to full participation in society;
- identifying and evaluating community support models that promote community integration and independent living outcomes for individuals with all types of disabilities and from a full range of cultural backgrounds;
- providing empirical evidence of the effects of consumer control on outcomes associated with community integration and independent living;
- assessing the impact of environmental factors on individual achievement of community integration and independent living;
- developing and disseminating training on independent living and community integration concepts and methods for consumers, families, service providers, and advocates; and
- developing and evaluating management tools to enable centers for independent living and other community-based programs to support independent living and community integration.
Associated Disability Research Areas
Several important issue areas—disability statistics, disability outcomes measures, disability studies, rehabilitation science, and disability policy research—are integral to the successful completion of a comprehensive agenda in disability and rehabilitation research. The objectives of NIDRR’s research in these associated disability research areas are to create basic knowledge and to support broader research endeavors.
Disability Statistics. NIDRR believes that data about the incidence, prevalence, the distribution of disabilities, and the characteristics and experiences of disabled people are critical to planning research and services, evaluating programs, and formulating public policy. NIDRR has several purposes in advancing work in disability statistics. First, NIDRR believes it is important to maximize the usefulness of data currently collected in reliable national data sets. Second, NIDRR encourages the creation and analysis of research databases, including meta-analyses focused on problems such as employment rates or utilization of health care or social services. Third, NIDRR seeks to understand the composition of a possible emerging universe of disability created by new disabilities or socioeconomic variations in the distribution of existing disabilities. Fourth, NIDRR wants to help provide input to the formulation of a national disability statistics policy, including the incorporation of measures that reflect the new paradigm of disability. Finally, NIDRR recognizes the need for surveys to be conducted in accessible formats, and for disability demographic and statistical data to be readily available to a wide range of audiences.
Disability Outcome Measures. Another essential component of NIDRR’s research agenda is evaluation. The importance of demonstrating outcomes across service settings, programs, and research efforts cannot be over-emphasized, given resource allocation issues and concerns about values that operate at every level of society. NIDRR continues its interest in medical rehabilitation outcomes, an area that has significant experience in measuring outcomes; medical groups have developed and integrated various measures into their service delivery and research settings. Many of these measures, however, have not been validated across disability groups. NIDRR would like to see measures developed for hospital settings revised for use in post-acute programs or in community settings. Additionally, the increasing focus on long-term care outcomes requires measures that can document changes over time. Moreover, NIDRR also will support investigations to identify and develop evaluation methodologies and outcomes measurement models for consumer assessments of assistive devices. Finally, NIDRR will support research that incorporates measures of environment and accommodation, which are critical to the continued implementation of the new paradigm of disability. And distinctly related to medical outcome measures are indicators of the quality of life. A particular challenge in developing these measures is the difficulty in comparing individual perceptions of the quality of life.
Disability Studies. NIDRR uses the term disability studies generally to refer to the holistic study of the phenomenon of disability through a multidisciplinary approach. This approach emphasizes the perspectives of people with disabilities and regards personal experience as valuable data. NIDRR believes that disability studies is a natural complement to the new paradigm, focusing on the study of the complex relationship between various aspects of disability and society. These disciplines include, among others, architecture, economics, history, law, literature, political science, religion, and urban planning.
NIDRR has three basic purposes for supporting a program of disability studies. First, disability and rehabilitation research needs a body of knowledge that is comprehensive and holistic, reflecting a range of disability perspectives, plus a larger cadre of researchers and policy-makers who are familiar with that knowledge base. Second, disability and rehabilitation research needs to develop methodologies and influence the theories and practices of a range of disciplines. The study of disability will enhance the methodologies and knowledge base of each discipline involved in the disability studies framework, thereby enhancing the scientific endeavor. Third, consistent with the goals of the Rehabilitation Act, NIDRR believes it is essential to reflect the perspectives of individuals with disabilities in studies of disability.
Rehabilitation Science. An important focus of NIDRR’s research agenda is to find opportunities to construct and test a theoretical framework for rehabilitation science. Rehabilitation science is the study of the processes by which disability develops and the factors that influence those processes. The field of rehabilitation has produced a body of empirical evidence regarding function and interventions to improve function. The next challenge is to use this evidence to produce a body of scientific and engineering theory that can be used to develop innovative and improved techniques of functional restoration.
Disability Policy Research. Public policy has more significance for people with disabilities and their families than for many segments of the population. This increased interest stems, in part, from the fact that people with disabilities must interface with so many different components of public policy systems, many of which are conflicting or inconsistent. Disability policy research will examine national issues that represent intersections of public interest. Such research will use national data sets, where possible, to determine the affects of policy decisions on people with disabilities.
Knowledge Dissemination and Utilization
