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Background of the Legislation

A major deterrent to the needed expansion of special education programs for our Nation's handicapped children has been the critical shortage of well-trained teachers and other related professional personnel. It is estimated that we have only one-fourth of the number of special education teachers that are currently needed. That is, we have approximately 60,000 70,000 teachers of handicapped children--many of whom have minimal special training--when we really have a need for about 300,000 such trained teachers.

From 1958 through 1963 the Office of Education administered, under the provisions of P.L. 85-926, a graduate fellowship program in the education of the mentally retarded. In October 1963, this law was expanded by P.L. 88-164 to include not only retardation, but also serious emotional disturbances, hearing deficiencies, crippleness and other health impairments, speech and visual handicaps. In addition, the $1 million authorization was increased to $11.5 million for fiscal year 1964, $14.5 million for fiscal year 1965, and $19.5 million for fiscal year 1966.

In addition to its provisions for training teachers, P.L. 88-164 also authorizes the appropriation of $2 million each fiscal year for a threeyear research and demonstration program in the education of handicapped children. In fiscal year 1964, $1 million of the $2 million was appropriated. During this year, the Office of Education received requests for almost $6 million. Twenty-two percent of the proposals were funded.

In fiscal year 1965, the full authorization was appropriated. Approximately $850,000 was used for continuation costs and $1,150,000 for new research. It is estimated that project applications requesting approximately $7 million were processed this year.

The extension and expansion of the two programs are of tremendous importance to those concerned with the educational opportunities that are available to the mentally retarded. The increased funds for training will make it possible more adequately to meet the need for qualified teachers of the mentally retarded and to close the gap a little more between number of teachers needed and those available.

At the present time there is little objective evidence concerning the most effective methods for meeting the needs of handicapped children. Research is necessary to describe and define their intellectual, emotional, social, and physical needs. If their educational needs are to be met, it is also necessary to develop effective remedial techniques, classroom procedures, new methods of instruction, special materials, appropriate curriculum, and to translate research findings into practical application. The expanded research program should make a significant contribution toward meeting these needs.

The new research center construction program in P.L. 89-105 will further strengthen this effort. These centers will have the major objectives of research, demonstration, and dissemination of information;

concentrating human and financial resources on the critical and difficult problems involved in the education of handicapped children; and bringing together the best researchers and the best teachers. Each facility will include: (1) experimental classrooms, constructed specifically for the children who would occupy them, and incorporating the most modern technological advances with provisions for varied research activities; (2) research equipment centers and laboratories for the development of electronic and other research devices; (3) an instructional materials center for the accumulation and production of modern instructional materials for the teaching of the handicapped; and (4) a component to insure effective dissemination of the products of the center and to encourage the utilization of such products.

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On August 9, before signing into law the Health Research Facilities Amendments

of 1965 in outdoor ceremonies at the Clinical Center of the National Institutes of
Health in Bethesda, Maryland, President Johnson declared that we are attacking
successfully and winning in the war on disease.

COMMUNITY HEALTH SERVICES EXTENSION AMENDMENTS OF 1965 (P.L. 89-109)

On August 5, 1965, President Johnson signed into law the Community Health Services Extension Amendments of 1965 (P.L. 89-109). The amendments extend four current programs of the Public Health Service relating to health services: immunization, migratory worker health services, general health services, and special project grants for community health services.

Immunization Programs

P.L. 89-109 extends the provisions of the Vaccination Assistance Act of 1962 for three years, through fiscal year 1968, with no change in the authorized annual appropriations of $11 million. The amendments also expand the coverage of the program to include assistance in immunization programs against measles and other diseases presenting a major public health problem. Eligible beneficiaries are changed from children "under the age of five years" to children "of preschool age.

During its three-year history, the Vaccination Assistance Act has contributed greatly to the reduction of the incidence of polio. At the time of the Law's enactment, the Public Health Service estimated that only onethird of the children under five years of age had been immunized. Since its enactment in 1962, an estimated 58 million people have received three doses of oral polio vaccine and seven million children have been immunized against diphtheria, tetanus, and whooping cough. By September 1964, some two-thirds. of all children under five years of age had been immunized against polio.

Since the enactment of the 1962 legislation, two measles vaccines have been developed. As other communicable diseases of childhood have increasingly come under control, there has been growing recognition of measles as a major health problem. An estimated four million cases occur each year, resulting in at least 500 deaths and in extensive complications and serious disabilities such as mental retardation, pneumonia, hearing disorders, and measles encephalitis (inflammation of the brain). Despite the availability, since March 1963, of effective vaccines against measles, there has been no decline in the incidence of the disease. During 1964 the number of reported cases rose by more than 100,000. The major barriers to the greater use of the vaccine are considered to be (1) the high cost of the vaccine and (2) lack of public awareness of the seriousness of measles and the need to immunize against the disease. It is estimated that 20 million preschool children will be immunized against measles under the program provided in This legislative summary was prepared by Eugenia Sullivan, Program Analysis Officer, Office of the Under Secretary, U.S. Department of Health, Education, and Welfare. Health, Education, and Welfare Indicators, September 1965

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P.L. 89-109--8 million of the estimated 15 million currently susceptible preschoolers and 12 million newborn infants.

The immunization program envisaged under the new legislation will include:

(1) Planned programs to achieve immunization against measles of
all susceptible preschool children through increased clinic
activity, programs in special problem areas, close cooperation
with private physicians, and stepped-up public information
and health education efforts.

(2)

Simultaneous across-the-board activities to increase the
immunization levels against diphtheria, whooping cough,
tetanus, and polio.

(3) Improved immunization maintenance programs with emphasis on
protecting children during the first year of life but not
ignoring booster programs for school-age children and adults.

Funds will be used to purchase measles vaccine for distribution at the State and local level and for such items as salaries and related expenses of additional State and local health personnel needed to organize and promote comprehensive immunization programs.

This law also authorizes the Surgeon General to make grants for immunization programs against any infectious disease which can be practically eliminated through immunization with preventive agents which may become. available in the future, and which he finds to represent a major public health problem. Under this authority, new immunization programs can be established without further legislative action by the Congress.

Migratory Workers Health Services

The amendments extend for three years, through fiscal year 1968, the project grant program which provides community health services for domestic migratory agricultural workers and their families. A total of $24 million is authorized for the three-year period. Under the Migrant Health Act of 1962, the Public Health Service has assisted 60 county or multicounty projects in 29 States and the Commonwealth of Puerto Rico. Project grants have paid part of the costs in 100 counties of such public health services as immunizations, pre- and post-natal clinics, dental services, and case finding and treatment for communicable diseases. The amendments also explicitly provide that the services that may be financed with Federal assistance include hospitalization in short-term hospitals.

General Health Services

P.L. 89-109 extends for one year, through fiscal year 1967, the program of formula grants for general health services authorized by section 314 (c) of the Public Health Service Act. Funds authorized for general health grants are used largely for establishing and maintaining basic health services in

State and local public health organizations, such as mental health services, radiological health services, dental health services, and services for the chronically ill and aged. Under this authority, grants also are made to schools of public health for the provision of public health training. change was made in the overall annual appropriation ceiling of $50 million, but the subceiling of $2.5 million earmarked for schools of public health is raised to $5 million.

In his Health Message, President Johnson directed the Secretary of the Department of Health, Education, and Welfare to review this program and the special project grant program of section 316 of the Public Health Service Act (mentioned below) and to recommend legislation that would increase the effectiveness of both programs. In accordance with his recommendation, the Congress extended both programs for one year to allow time for their thorough review.

Project Grants for Community Health Services

The Community Health Services and Facilities Act of 1961 added section 316 to the Public Health Service Act, establishing a program of project grants to State or local public agencies or nonprofit private agencies to finance studies, experiments, and demonstrations for the development of improved methods of providing health services, particularly for the chronically ill or aged. This authority, which would have expired June 30, 1966, was extended for one year, with no change in the annual appropriation authorization of $10 million.

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