In both teaching grants and traineeships, the preparation of personnel for the expanding State-Federal program of vocational rehabilitation has received first consideration. During the current fiscal year we are placing major emphasis on the preparation of personnel directly related to the day-to-day operation of the State vocational rehabilitation programs. These efforts are directed not merely toward increased supply of trained rehabilitation counselors but also toward the short-term intensive training of newly employed State rehabilitation agency counselors, State agency medical consultants, specialists for the blind, and the like. REHABILITATION COUNSELORS Primary attention is being given in the long-term training progam to the preparation of rehabilitation counselors since this position is the pivotal one in the provision of services to disabled individuals. Prior to the beginning of this training program in 1955, only 4 institutions in the United States were offering specific training in this field: in 1958 it is expected that 35 programs in 21 States will be in operation in the field of rehabilitation counseling. In contrast to 25 individuals graduated from such training programs in 1955, about 510 individuals will be taking training in fiscal year 1958 under our training-grant support aloneand this will represent only about one-half of the indivduals enrolled in rehabilitation counseling. We are proposing for 1958 to make 35 long-term teaching grants in counseling-the same number as were awarded in 1957. Some of the grants, however, must be larger in order to make possible needed improvement in the quality of the instruction and breadth of the curriculum. In June 1956, the first graduates of the 2-year traineeship program in rehabilitation counseling began to enter the State agency staffs and other groups serving the handicapped. We did a spot check by mail of the fields of employment chosen by these graduates. Questionnaires were sent to 92 graduates and we received an 88-percent return. Of those reporting, the great preponderance were either employed or seeking employment with State vocational rehabilitation agencies and other organizations serving the handicapped. Of those not entering the labor market, most had elected to pursue additional graduate work, some working toward doctor of philosophy degrees. These will augment the supply of faculty staff needed now so urgently to provide teaching in counseling. REHABILITATION ASPECTS OF MEDICINE Our training programs in medicine are guided by the advice of our chief medical consultant, Dr. Howard A. Rusk, and a committee of physicians knowledged and experienced in medical eucation and medical rehabilitation. The program has two chief lines of emphasis. First and most important is the production of an ever-increasing number of qualified specialists in physical medicine and rehabilitation. At present, we have 75 traineeships for this residency training and in 1958 we will increase that number to 116 traineeships. The measure of the need may be expressed in several ways. There are 177 residencies in this field of which only 85, or 48 percent, are filled in contrast to 80 percent in medical specialties generally. There are 500 vacant positions requiring a qualified specialist in physical medicine and rehabilitation at the present moment. The key to adequate medical services in rehabilitation centers, hospitals, and many other areas in an ever-increasing supply of adequately trained medical personnel and community leaders. We must provide traineeship support to attract as many physicians as possible into this field. A second important part of our medical training program is graduate instruction in rehabilitation methods and concepts for other medical specialty fields, with an ultimate goal of having rehabilitation principles applied to the care of the disabled people generally in the practice of medicine. This leadership is accomplished primarily through short-term intensive training courses. Perhaps most fundamental of all, as teachers are trained to accomplish this mission, is the training of young physicians in the rehabilitation aspects of medicine. Most of the 4-year medical schools in this country offer no such preparation in their undergraduate medical curricula and only 17 schools offer graduate courses. Since our program of grants to medical schools in this area was established 2 years ago, 10 medical schools which had never offered rehabilitation teaching in their undergraduate programs have now added such teaching to their curricula-and next year we expect the addition of 10 more. SPEECH AND HEARING THERAPISTS In 1958 we must begin to attack the shortage in another rehabilitation field in which the lack of personnel is widespread and pressing-the field of speech and hearing therapy. Demands for adequately trained personnel in this area have reached the point where action has to be taken; otherwise it will not be possible to staff rehabilitation facilities and community programs with individuals who are equipped to deal with the speech and hearing problems of adults disabled by cerebral palsy, hemiplegia with aphasia, and laryngectomy. Immediate support is needed to increase the number of qualified therapists for employment in speech clinics, hearing centers, hospitals, and rehabilitation centers. We have had to defer a major training effort in this field until the right climate could be created for the development of a constructive program. Agreements had to be reached with professional leaders and educators in this field to reach agreement on curriculums, levels of training, and other considerations in a wellplanned program which would emphasize services to the adult disabled. To date, the emphasis has been almost exclusively on the speech problems of children. As a result of a series of conferences with leaders from all over the country, we are ready in 1958 to launch a modest but sound beginning in the preparation of more speech and hearing therapists, with the intention of building up this phase of training in the future. The House committee noted specifically in their report on the 1958 budget that a portion of the requested increase be used to start a program in the field of speech and hearing therapy, and will expect a good program to be presented for fiscal year 1959. We have included in our 1958 budget request approximately $195,000 for the training of speech and hearing therapists. With these funds, we plan to make teaching grants to five universities for the expansion and improvement of their speech and hearing training programs and to provide traineeship grants for about 25 students. The courses financed would give special training in speech and hearing problems of disabled adults by increasing the emphasis on organic speech problems and on experience in a comprehensive rehabilitation center. We would also continue support of short-term intensive courses for speech therapists, in esophageal speech, and hearing therapists seeking additional training in the rehabilitation of the deaf and hard of hearing. SHORT-TERM TRAINING The vital importance of short-term training has been brought home to us time and again during the past 2 years. Through short-term training institutes we are able to give intensive courses to new rehabilitation counselors hired by State agencies. This enabled these new counselors to begin serving more disabled clients promptly, and to serve them much more effectively than newly employed staff in the past. Through this device it has also been possible to fill vacancies caused by the transfer of experienced counselors to disability determination units to carry out the disability freeze and cash benefits programs of OASI. In cooperation with OASI we presently are giving special short courses to new staff in the States who will perform the disability determinations and rehabilitation evaluations on applicants for disability cash benefits in such a way that maximum integration of these programs will result in effective rehabilitation programs for the disabled individuals. The short-term courses have been and will be a key part of our plans to provide more and better services for the severely disabled. Already, for example, we have held several institutes for counselors and other State staff on rehabilitation methods for the mentally ill and in selective phases of rehabilitation of the blind. Because of the demands made upon leadership and executive ability on the part of the State directors of vocational rehabilitation occasioned by the rapidly expanding vocational rehabilitation program, a beginning has been made in the conduct of training programs in executive development for such State personnel. In order to increase services in State agencies to older disabled persons, shortterm intensive courses in the rehabilitation of the aging have been established. Of special importance, too, are the short courses which will be held this year for State agency employees who will be assuming responsibility for the development and improvement of the sheltered workshop program. Still other special ized courses on techniques in the vocational rehabilitation of mentally retarded and cerebral palsied youths and adults are scheduled to be held this year. These will do much to raise the present standards of service to these severely disabled people. In 1958 these short courses should be doubled to reach a much larger number of counselors in our State agencies. PROSTHETICS EDUCATION In making appropriations for the current year, the Congress made specific provision for the support of prosthetics education, so that the public program might benefit from existing efforts for fuller development and use of modern techniques in the fitting, training and use of prosthetic appliances. This is fundamental in our overall training plans in an area in which we have a wealth of knowledge we are not applying. So far this year grants and traineeships amounting to $204,000 have been made to support two prosthetic education training programs covering short-term, intensive courses in the making and fitting of artificial limbs. These programs have reached about 250 physicians, therapists, and prosthetists. In the coming year it is hoped that more of these courses can be held for still more professional persons engaged in serving amputees, and that additional courses, designed especially to meet the needs of vocational rehabilitation counselors and other personnel concerned with purchase of protheses, can be created. The 1958 budget carries an estimate of $210,000 for support of prosthetics education. In planning for this proposed increase of $1,450,000 over the 1957 level, we have kept in mind the urgency of the need for better trained personnel. Skilled professional workers are not produced overnight; their courses of study are lengthy. In many areas of the country disabled people do not have skilled rehabilitation services available because of the scarcity of well-trained personnel. Well planplanned, specialized training programs in the field of rehabilitation will alleviate the personnel shortage. APPROPRIATION ESTIMATE "Salaries and expenses: For expenses necessary in carrying out the provisions of the Vocational Rehabilitation Act, as amended, and of the Act approved June 20, 1936 (20 U. S. C., ch. 6A), as amended, [including not to exceed $3,000 for production, purchase, and distribution of educational films; $1,160,000] $1,445,000." NOTE.-Positions exclude commissioned officer positions on reimbursable detail from PHS, EFFECT OF HOUSE ACTION Activity I (State plans, grants, and program evaluation) The House allowance provides $38,988 for mandatory items and $95,450 for 19 new positions in the field including 4 medical consultants who will be commissioned officers on reimbursable detail from the Public Health Service. The House denied an increase of $66,764 and 12 positions. The denial of 8 positions in the field means 4 regions will continue without medical consultants, and 4 regions would not be able to provide for 1 of the staff assistants contemplated in our proposed staffing plan. Medical personnel participating in State and voluntary rehabilitation in these regions as well as lay personnel will continue to operate without the guidance and assistance of a regional medical consultant. Similarily the lack of 1 other team member in 4 regional offices will mean that some reviews of State activities and some requests for staff assistance will have to go unheeded. Three positions for research and statistics-without these positions tabulations and analyses requested by States dealing with special disability groups and special aspects of the program such as intake and types of referrals will not be available to guide the expanded program. One position to assist States in the rehabilitation aspects of the cash disability program-without this position, overall program planning responsibilities will preclude the possibility of giving States organized and up-to-date manual material on the rehabilitation aspects of the cash disability programs, and will preclude response to many requests for assistance in this new large field of State agency activity. Activity II (specialized services to States) The House allowance provides $17,702 for mandatory items and denies an increase of $18,947 for 3 positions to assist in State administrative development; the elimination of these 3 positions will mean that material supplied to the Washington office by the expanded regional offices and the flow of material to these regional offices will not be handled on the basis desired for most efficient use of the office staff. It also will mean that the assistance that regional offices would expect from the central office in making periodic reviews will remain at a minimum level. Activity III (research and special projects) The House allowance provides $800 for mandatory items and denies an increase of $17,633 for 3 positions. The number of applications for research and special projects requiring review, processing and site visits has increased steadily and of necessity this increased workload has to be spread among existing staff. It will be difficult to achieve adequate dissemination of new knowledge and techniques to States and other vocational rehabilitation agencies and develop effective demonstration projects through such knowledge. Activity IV (training and traineeships) The House allowance provides $2,401 for mandatory items and denies an increase of $11,016 for 2 positions; without the 2 additional personnel requested, OVR will be unable to undertake a more extensive study and evaluation of specific training and traineeship programs by competent specialists. Additional technical assistance to the schools, will be lacking. Activity V (administration) The House allowance provides $14,659 for mandatory items. No additional positions were requested. |