While $50 million is authorized in FY 1967 and $150 million in FY 1968 under PL 89-750, thus far no funds have been appropriated for Title VI programs. The Administration has requested $2.5 million in a supplemental FY 1967 request and $15 million for FY 1968. A survey of state directors of special education, conducted by the Council for Exceptional Children, provides ample evidence that state and local educational agencies are prepared to put to wise use a much larger amount of federal funds.

We urge this Subcommittee to significantly increase the Administration request for Title VI funds in FY 1968. Otherwise, much of the vast potential this program offers for improving the quantity and quality of special education programs for mentally retarded and other handicapped youngsters will not be realized.

B. Funds for training teachers of handicapped children

In his recent message to Congress on Health and Education, President Johnson noted that "there are now only 70,000 specially trained teachers of the handicapped-a small fraction of the number the nation requires. In the next decade, five times that number must be trained and put to work" (H. Rept. No. 68, 90th Congress, 1st Session). Yet, in the FY 1968 Budget the Administration has requested $24.5 million for grants to train teachers of handicapped children-the same amount as was requested and appropriated by Congress in FY 1967. This request is $9.5 million less than the $34 million authorized under Section 7 of PL 85-926, as amended.

Not only is the need great but the demand for grants under this program has far exceeded the available funds. During "fiscal year 1967 the requests for funds under this program exceeded the Congressional appropriation by $31,000,000, or a ration of more than 2 to 1" (Mental Retardation Activities of the Department of Health, Education, and Welfare, January 1967).

In view of these facts NARC urges the Subcommittee to appropriate the full authorized amount of $34 million for training of teachers of the handicapped. C. Construction of community facilities for the mentally retarded

The President's Budget includes only half of the $30 million authorized in FY 1968 for the construction of community facilities for the mentally retarded under Part C. Title I, PL 88-164. Based on samples of need as indicated in four state mental retardation facilities construction plans, our Association recently calculated that the cost of constructing community facilities to provide services for all of the mentally retarded not presently receiving services or attending programs conducted in inadequate quarters would be roughly $2.4 billion.

In view of the clear evidence of an overwhelming need for community facilities, we strongly recommend that the full authorized amount of $30 million be appropriated by Congress.

D. Programs in State mental retardation institutions

The Hospital Improvement Program has proven to be a highly effective means of stimulating the development of programs of care and habilitation in state institutions for the retarded. It was originally intended to be escalated at a rate of $6 million annually until all state institutions had an opportunity to qualify. However, if the amount requested for the HIP program in the FY 1968 Budget is approved by Congress, appropriations for this program will have remained almost static for three fiscal years.

This program can not be expanded to the 50 or so state mental retardation institutions which are not presently participating in the program unless FY 1968 appropriations are increased. Ironically, those institutions which need the HIP program most (i.e., the backward, custodially-oriented facilities) are not yet receiving federal grants.

E. Staff and direct operating funds for the Mental Retardation Division, Public Health Service

The total personnel complement proposed for the Mental Retardation Division in 1968 is 72, of which 56 were carried over from the former Branch and 16 carried over with two construction programs formerly with the Division of Hospital and Medical Facilities. This is the same size as the staff assigned to these functions during FY 1966. However, an additional nine million dollar grantin-aid program was transferred on January 1, 1967 from NIMH to DMR without

1 The Budget shows a total of 89 positions but 17 of these are assigned to the President's Committee on Mental Retardation, which has no operational relationship to the Division.

any increase in the Division's personnel complement or direct operating funds. This is the so-called Hospital Improvement (HIP) and In-Service Training Program (HIST), one of the most effective stimulus programs. Why has the Division not been allocated positions to administer these additional responsibilities?

F. Management of noncategorical health project grant funds

Last year Congress enacted PL 89-749, which consolidated the nine categorical project grant programs (including mental retardation project grants) of the Public Health Service. With the abolition of the so-called categorical grant system, funds for such projects have been merged and the administrative authority centralized in the Surgeon General's Office. As yet, the Surgeon General's Office has not indicated how these project funds will be allocated among the competing public health interests. Our questions are: (1) What assurances do we have that project grants related to mental retardation will be evaluated by people knowledgeable in mental retardation, and at what level will this occur? (2) Assuming such a grant proposal is acceptable to experts in its field, what assurance is there that it can compete on its own merits with applications whose content and method is more traditional and better understood by the health professional who might form the majority of a "non-categorical" review committee.

What assurance do we have that valuable programs which have been recently initiated under a categorical heading can be continued under the new system? A case in point is the very successful Student Work, Experience and Training program. The funds previously used by the Mental Retardation Division (formerly Branch) to develop Student Work, Experience and Training, have not been assigned to the Surgeon General's Office.

Another case in point relates to funds for planning new university programs for training personnel to work with children who are mentally retarded or otherwise handicapped. The United States Public Health Service and the Children's Bureau have funds for constructing and staffing university affiliated service facilities for such training. During the last few years, the Mental Retardation Branch, USPHS, has made available some of its project grant funds to permit the interested universities to do advance program planning, based on preliminary in-depth studies, thus assuring more effective use of the larger blocks of federal money to be invested in construction. Such planning grants should continue to be available. Will they? And, if so, where in HEW may our interested applicants go for help?

G. Vocational rehabilitation and sheltered workships

The Vocational Rehabilitation Administration continues to report heartening increases in the numbers of retarded persons who are rehabilitated annually, but we know that we are still far short of reaching our national potential in this respect. In 1965 NARC hailed the passage of PL 89-333 as a major vehicle to accelerate rehab services to the more seriously retarded and also to foster the growth of sheltered workship facilities. We are therefore particularly distressed to note that the President has asked for only $3.85 million for workshop construction in 1968. This is less than half the authorized amount and represents a cut as compared to 1967.

The promise of this and so much recent substantive legislation is being thwarted and belied by a budget which we can only regard as gravely inadequate as it affects the mentally retarded.

We recognize that this Subcommittee faces an immense challenge in attempting to allocate fairly the restricted amount of funds available for domestic programs in FY 1968 due to the gigantic expenditures on the Vietnam conflict. Nonetheless, a country with the resources of the United States can and must. in our view, maintain a concern about its less fortunate citizens. It would be indeed tragic if we jeopardized the progress which has been made on behalf of the mentally retarded over the past few years by failing to build upon the solid foundation which has been laid.

Thank you for offering us this opportunity to express our views on FY 1968 appropriations for the Departments of Labor and Health, Education, and Welfare.

nance

Mrs. BOGGS. We have a very broad interest in the appropriations bills for both the Department of Health, Education, and Welfare, and Labor, since the disability of mental retardation is a long-term chronic disability and affects so many aspects of the life activity of a person including his employment status. The mentally retarded individual, depending on the severity of his handicap, may require specialized diagnosis, medical care, education, training, vocational rehabilitation, special employment services, income maintenance, or protective services, depending also on the extent of his disability and the life stage at which he is.

At the back of our statement there is a brief table which indicates the distribution of activities by major agencies of HEW and Labor; it will indicate to you how widespread is the involvement of these agencies with mental retardation and our concern for their having adequate support.

I would just like to touch on two or three of the serious concerns we have this year.

Practically all of the recently enacted programs are faced with serious cutbacks in relation to the authorizations for appropriation and this is going to have very serious consequences. We are, of course, aware of the reasons why the present President's budget does not reach the expectations which the Congress had had when they enacted the substantive legislation, but we must say to you that failure to achieve some approximation to the congressional intent in these matters is having a very serious slowdown effect on programs which were new and promising in this decade.

For example, only last fall the Congress passed special new legislation relative to the education of handicapped children, of whom the mentally retarded constitute at least half. The authorization for this year was $50 million and the authorization for next year is $150 million and the request is for about 10 percent of that.

Similarly, the 1968 year was to be the year in which the construction of community facilities for mentally retarded would first hit its stride. It has been going through 2 years of induction. We had hoped that $30 million would be appropriated as authorized. The President's budget asks for only $15 million. When I tell you that, of any appropriation under Public Law 88-164, part C, the first $5 million under the allotment formula is distributed equally among all the States, you will recognize that as long as the appropriation stays low, large States like yours and mine are penalized in respect to the amounts allotted to them.

Similarly, a very promising program was inaugurated in 1963 (originally under the auspices of the National Institute of Mental Health; now transferred to the Division on Mental Retardation), the hospital improvement program as it affects State residential facilities for the retarded, has had a tremendously heartening effect in those institutions which have received project grants for improvement of their services and for demonstrations of the ways in which care can be improved even within the relatively large and, in many cases, outmoded institutions.

But the funding level if the budget is adopted as proposed, will have remained almost static for 3 years, notwithstanding the fact that not all eligible institutions have been funded. Now, what this means is that those who were slowest to move-which are often the ones who

most needed the stimulus and assistance-are the ones which are not being allowed to participate in this program.

Another problem of great concern to us is the staffing of the Division of Mental Retardation which was created January 1, within the new Bureau of Health Services, of the Public Health Service. They now have the responsibility for administering the hospital improvement program. In spite of the fact that its funds are not increasing, there continues to be administrative responsibility connected with this program because the existing grants must be reapproved, yet no staff, no personnel was transferred from NIMH along with this responsibility.

The number of people authorized for the division, if you exclude the people that are technically assigned to the division but are detailed to the President's Committee on Mental Retardation, if you exclude them, the division has the same operating staff it had last year with the exception of the people who are transferred from the Division of Hospital and Medical Facilities to administer the construction program. So that there is no increase, despite the increased responsibilities that this division is asked to assume, and the increased expectations as a result of its elevation from bureau to division status. The failure to meet expectations with respect to the construction of community facilities for the mentally retarded is duplicated with respect to the construction authorization and appropriation for workshops, which is administered by the Rehabilitation Administration. We had looked forward to having something like $9 million this coming year and only $3.85 million has been requested.

We are, of course, very much aware that the administration and the Congress are under great pressure. I think that the domestic program inevitably must be cut below what we would have hoped and expected, but I think that it is important that we all recognize that in some instances we are losing ground and that our efficiency in meeting human needs in this country is being undermined not only temporarily but also for some time into the future by this forced economy.

We appreciate the opportunity of appearing.

Mr. FLOOD. Thank you very much, Mrs. Boggs. You are very understanding.

HEALTH SERVICES

THURSDAY, APRIL 27, 1967.

WITNESSES

DR.

OF

GENERAL

AMOS N. JOHNSON, AMERICAN ACADEMY PRACTICE DR. MURDOCK HEAD, MEMBER, AMERICAN ACADEMY OF GENERAL PRACTICE

Mr. FLOOD. We will now hear Dr. Amos N. Johnson from the American Academy of General Practice.

STATEMENT OF DR. AMOS N. JOHNSON

Dr. JOHNSON. I have with me today Dr. Murdock Head, a member of the American Academy of General Practice, who is a very knowledgeable person in the general area of the provision of health care for people in this country. I asked him to come along with me.