Senator CRANSTON. We thank you very much for your very important contribution. Our next witness is Dr. Jack G. Wiggins, member, Executive Committee, Council for the Advancement of the Psychological Professions and Sciences. STATEMENT OF JACK G. WIGGINS, PH. D., MEMBER, EXECUTIVE COMMITTEE, COUNCIL FOR THE ADVANCEMENT OF THE PSYCHOLOGICAL PROFESSIONS AND SCIENCES, ACCOMPANIED BY J. F. DONAHUE, EXECUTIVE DIRECTOR Dr. WIGGINS. Thank you. I am accompanied by Mr. J. F. Donahue, our executive director. Senator CRANSTON. If you could summarize briefly, it would be appreciated. Dr. WIGGINS. We have submitted a very short statement, in regard to very detailed language Senator CRANSTON. Proceed as you wish. Dr. WIGGINS. I feel very fortunate to have had an opportunity to listen to the other witnesses who have expressed their interest and concern in the psychological aspects of health care, and in the treatment of the physically ill. The repeated reference to psychology of the individual is the issue to which I would like to address myself. I am Dr. Jack G. Wiggins, a psychologist from Cleveland, Ohio, where I am a founding partner of the Career Development Center. I am a member of the board of governors of the Council for the Advancement of the Psychological Professions and Sciences, and I serve on its executive committee. Vocational rehabilitation has been a major activity of psychology for more than 50 years. Psychologists have helped shape the accomplishments of the Federal-State system operated principally under the Vocational Rehabilitation Act. Thus, we are gratified to see that H.R. 8395, which takes the form of a new Vocational Rehabilitation Act, simultaneously sets forth some innovative, goal-oriented provisions which hold promise of still further progress. We refer especially to the new title III offering comprehensive services to the severely handicapped toward functioning normally at home and in the community. We commend the authors of the bill also for attention in title IV to victims of transportation and environmental barriers, end stage renal disease, and spinal cord injuries. My expertise in the field does not extend to commenting on the funding provided in H.R. 8395; I must leave the judgments in this area to others qualified to make them. I do, however, wish to express intense interest in adequate funding of all the programs authorized in this legislation. They are meaningful programs benefiting the clients of the vocational rehabilitation system and happily generating benefits to the community in several ways. The individual achieving his or her rehabilitation goals may cease to represent a personal burden to family and custodians. The rehabilitated individual may also cease to represent a tax burden to the community. While these are favorable developments in themselves, we should not overlook the additional benefit if the rehabilitated individual becomes able to move into gainful employment. Perhaps I can illustrate this development as it was researched in a 1966 study of more than 400 psychotherapy patients: the mean income at the outset was $83 per week. This increased nearly 40 percent to $112 per week, following treatment. This increased income amounting to about $1,508 per year, means that the individual became substantially more self-reliant. The additional benefit to the community came from his or her likely new role as a taxpayer, and I figure taxation at the 20-percent Federal income tax plateau would represent about $300 potential tax revenue on this new productivity. We are interested in replicating this study, particularly if a followup can be made on the same people included in the 1966 study. We would also like to determine the probable effect on absenteeism, interpersonal relationships among employees, and increases in productivity through such a study. (A copy of the 1966 study report is included with my statement.) Thus, it seems clear why the investment of dollars into the salvation of the disabled who can become productive members of society is extremely important and deserves to be adequately funded. I wish to turn now to our recommendations for changes in the language of H.R. 8395 in several areas. These changes are necessary to introduce appropriate definitive language covering diagnosis of mental handicap conditions, evaluation of rehabilitation potential, and delivery of mental health services in the act and in the consequent regulations whereunder it will be administered. In section 105 (a), the bill sets forth criteria for the State plans for vocational rehabilitation services, and in subsection 105 (a) (7) (A) it specifies that State plans must provide for establishing and maintaining standards for personnel. Mr. Chairman, the several States are responsible for licensing and certifying practitioners of various disciplines involved in delivering rehabilitative services. This is one quality-assurance factor, helping to insure competency and control by the States. It seems advisable for the Vocational Rehabilitation Act to call at least for compliance with any State licensure laws and regulations. Therefore, we recommend changing this subsection to read as follows: (7) contain (A) provisions relating to the establishment and maintenance of personnel standards which are consistent with any state licensure laws and regulations, including provisions relating to the tenure, selection, appointment, and qualifications of personnel, and (B) * * *. As you know, Mr. Chairman, a large number of individuals with mental handicaps are benefiting from services under the Vocational Rehabilitation Act. One report indicated that the mentally ill, emotionally disturbed, and mentally retarded now constitute as much as 50 percent of the case load in vocational rehabilitation agencies. Another source indicated that even in the general population, about onehalf of the patients treated by general-practice physicians have emotional or behavioral complications. Thus, the list of restorative services in subsection 106 (a) (2) logically should be headed up as: "(A) physical and mental restoration services, including, but not limited to ..." The itemized listing which follows in subsection 106 (a) should be completed by providing for diagnosis and treatment of mental and emotional disorders. To this end, we suggest inserting a new article (w) (on page 25, at the end of line 17) as follows: "*** end stage renal disease, (w) diagnosis and treatment for mental and emotional disorders by a physician or licensed psychologist;" We wish to point out similar incompleteness in section 106(a) in the definition of "vocational rehabilitation services," in determining eligibility for and the nature and scope of servces to be provided. There is a clear need to provide for an examination to evaluate mental and emotional condition. Therefore, we suggest adding language in subsection 106 (a) (1), as follows: (A) evaluation, including diagnostic and related services, incidental to the determination of eligibility for and the nature and scope of services to be provided: And provided further, that in determining whether an individual is mentally or emotionally handicapped, there shall be an examination by a physician skilled in the diagnosis and treatment of emotional disorders and/or by a licensed psychologist; We wish to invite the attention of the subcommittee to specifications for services of a "rehabilitation facility" in section 106 (c). Many of the services of the facilities are not actually provided within the facility or necessarily by personnel on its staff. About three-fourths of the health services are rendered elsewhere-in hospitals and clinics, as well as in the offices of practitioners compensated on a fee-for-service basis. I would note parenthetically that about 40 percent of the money expended in connection herewith goes for mental restorative services. We feel it is in the best interest of the clients, the vocational rehabilitation system, and the providers to include licensed psychologists in new language at the end of subsection 106 (c) (11) as follows: "*** in the State: And provided further, that services to mentally and emotionally handicapped persons may also be provided by a psychologist licensed in the State." Mr. Chairman, my colleagues offer a dedicated, vocational, interest in human development-as researchers, educators, counsellors, clinicians, and many other specialists within psychology-as a resource to you who are charged with revising the Vocational Rehabilitation Act and to others charged with administering it. We would welcome the opportunity to serve on the various commissions and councils in order to bring the expertise of behaviorial scientists to bear on matters of interest. We share the confidence, widely held, that H.R. 8395 is timely, effective legislation which will help ensure attention to the needs of the handicapped constituency it aims to serve. We are glad to add our suggestions for the changes outlined in this statement; to offer our service in the future; and to endorse the bill accordingly. Thank you for this opportunity to testify. Senator CRANSTON. I thank you very much for a very concise and thorough statement. I assure you that we will give very careful consideration to the psychological aspects of rehabilitation. I know how important it is. I would like to ask you if you have any comment on the family involvement in rehabilitation that you heard us discuss earlier. Dr. WIGGINS. It is extremely important, and the degree of family involvement depends on the future of the individual case. It can be quite extensive, or it can be limited. It does depend on the situation. Senator CRANSTON. Do you have any comments on the patient advocacy approach that was discussed this morning? Dr. WIGGINS. The American Psychological Association in its position paper on national health insurance has taken a position similar to this, and I would like to endorse that position. Senator CRANSTON. Can you provide a copy of that for the record? Dr. WIGGINS. Yes, I can. Senator CRANSTON. Thank you very, very much. I assure you that your views will be given very careful consideration as we proceed. (The prepared statement of Mr. Wiggins and additional information supplied follow :) |