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Section 603 authorizes the Secretary of HEW to appoint a Committee on Mental Health and Illness of the Elderly to make a study and recommendations concerning the future needs for mental health facilities, manpower, research and training to meet the mental health care needs of elderly persons, the appropriate care of elderly persons who are in mental institutions or who have been discharged from such institutions, and proposals for implementing the recommendations of the 1971 White House Conference on Aging respecting the mental health of the elderly. This nine-member Committee would include at least one member in each of the fields of psychology, psychiatry, social science, social work, and nursing. The Committee would be disbanded 30 days after it had submitted its report. While the purposes of this Section are laudatory, we are of the opinion that the Secretary already has the authority to carry on the activities called for in this proposal. We recommend that this section be deleted.

Section 604 authorizes the Secretary to establish a temporary Commission for the Control of Epilepsy and Its Consequences. This Commission would conduct a comprehensive study of the level of medical and social management of epilepsy in the United States, and would investigate and make recommendations concerning the proper roles of federal and state governments and other agencies in the identification and treatment of epilepsy and its consequences. The Commission would be dissolved following the submission of its report. We believe that this Commission would be beneficial and we recommend support of this Commission.

Section 605 authorizes the Secretary to establish a temporary Commission for the Control of Huntington's Disease and Its Consequences patterned after the proposed Commission for the Control of Epilepsy outlined in Section 604. We would also urge support for this temporary Commission in the expectation that its report would add to the present understanding of Huntington's Disease.

Section 606 of H.R. 2954 amends Title XI of the Public Health Service Act by adding a Part D-Hemophilia Programs. Under this new authority, the Secretary of HEW could make grants to, and enter into contracts with, public and nonprofit private entities for the establishment of comprehensive hemophilia diagnostic and treatment centers. The Secretary would also be authorized to make grants to and enter into contracts with similar entities to develop and expand, within existing facilities, blood-separation centers to separate and make available for distribution blood components to providers of blood services and manufacturers of blood fractions. While we recognize the seriousness of hemophilia, there are already in operation a number of private programs which have been successful in meeting the special needs of this very small group. Present information indicates that there would seem to be no special need presently evident to justify these new federal programs. We recommend that this portion of the legislation be deleted.

This concludes our views on H.R. 2954. We would now like to briefly address ourselves to H.R. 2955-the Developmental Disabilities Amendments of 1975.

H.R. 2955

This legislation provides a two-year extension of existing programs for people with developmental disabilities with a total authorization of $192 million. The bill modifies the existing law by: Creating a new special project authority and raises the present 10 percent requirement to 30 percent of the state allotment for projects of special national significance; requiring that States spend a specified percentage of their allotment for programs for deinstitutionalization of persons with developmental disabilities inappropriately placed in institutions; eliminates the requirement for Federal approval of individual construction projects funded with state grant funds; adds autism specifically to the list of diseases covered by the program; and requires studies by the Secretary of HEW to determine the neurological diseases which should and should not be considered as developmental disabilities and the adequacy of services for persons with diseases not included.

The developmental disabilities program fills a very special need in providing comprehensive services for persons who are mentally retarded or have other developmental disabilities, and in funding research and demonstration projects in this field. As we pointed out in our testimony a year ago, we find lacking any provision for evaluating the effectiveness of this program. We would recmmend that funds be specified for program evaluation both on the part of the retary and the local facility. With this recommendation, we would urge your Dort of H.R. 2955,

This concludes the statement of the American Medical Association on H.R. 2954 and H.R. 2955. We respectfully request that our statement be made a part of the record of your hearing on this legislation.

STATEMENT OF THE AMERICAN OPTOMETRIC ASSOCIATION

H.R. 2954

The American Optometric Association supports the concepts contained in H.R. 2954, which if enacted will revise and extend programs of health revenue sharing and health services.

"Sight is one of man's greatest gifts. The preservation of that gift is one of his greatest challenges." So said the President of the United States in 1969. But what exactly is the challenge?

The challenge is . . . more than ten million children need vision care. "Their future will only be as bright as we, the leaders of this generation, are able to make it by minimizing physical impairment or other handicaps to their health." Again, according to the President.

The challenge is . . . at least in families where the breadwinner is visually impaired (and uncorrected), the impairment itself is probably a factor contributing to the low income of the family.

The challenge is . . . up to 80% of delinquents observed in various studies had learning difficulties specifically in reading. Poor vision was found to be a contributing factor in 50% of these cases.

These challenges are particularly compelling for the low income families that are served by the programs covered in the bill before you. The rates for prevalence and degree of vision impairment of low income family members are considerably higher than corresponding rates for any other income group regardless of age.

These challenges present continuing challenges to the doctor of optometry, whose profession is the examination, diagnosis and treatment of conditions of the vision system.

With these challenges in mind, this Association would like to comment briefly on Titles IV (migrant health) and V (community health centers) of the bill.

TITLE IV-MIGRANT HEALTH

Optometrists are already involved in providing vision care to agricultural migrants and their families. We commend the Subcommittee for including children's eye examinations within the scope of primary health services and vision care for adults as a supplementary benefit. Inclusion of vision care will enhance the provision of this needed health service to this group, which is disadvantaged by income and mobility factors.

The American Optometric Association points with pride to the growing number of optometrists who are bringing vision care to migrant families. Programs in Idaho, Oregon and California have been particularly successful and often innovative. But programs such as this have only scratched the surface; a multitude of unmet needs remain.

It is a fact that persons from low income groups, such as migrant families, are most in need of vision care. In testimony before a special New York Department of Health hearing on vision care, Alden N. Haffner, O.D., Ph.D., Executive Director of the Optometric Center of New York, stated: "From the standpoint of his health. . . the person from the low income family is disadvantaged. Adequate evidence exists to detail that that person and that family have higher incidence of disability and disease than exhibited by the more socially advantaged family. Visual disability is no exception. Columbia University's Professor Charlotte Muller, a highly repected health researcher, found visual disability more than 400% higher in the poor family than in the family with an income of more than $7000. The irony of the situation and the melancholy truth are that the poor need more and better care, of all types, and can ill afford it . . ."

William C. Richardson, an instructor in hospital administration at the Graduate School of Business, University of Chicago, reported in the July, 1969 issue of Hospitals, the Journal of the American Hospital Association, that activitylimiting chronic visual impairments are eight times as prevalent among individuals with annual family incomes below $2000 compared with those from families with annual incomes of $7000 or more. His statement was based on the

National Center for Health Statistics Publication, Series 10, Number 45, titled "Limitation of Activity and Mobility Due to Chronic Conditions, United States, July 1965-June 1966."

In its report on "Characteristics of Visually Impaired Persons," Series 10, Number 46, issued August, 1968, the National Center for Health Statistics concluded (page 7): "It is reasonable to assume that, at least in families where the major breadwinner is visually impaired, the impairment itself is probably a factor contributing to the low income."

Providing vision care to low income persons can be a major factor in improving their success in the classroom, their ability to earn a living, and their eventual removal from the welfare roles. It simply makes good sense to include vision care in the migrant health program.

To ensure that all available health care resources, including optometry, may be utilized in providing care under this program, we recommend that the Subcommittee add the following one-sentence paragraph to appear after § 310(b) (3) (K):

"Services included in (2) or (3) may be provided by such health care personnel including but not limited to dentists, optometrists, physicians and podiatrists, as are licensed by the respective states to provide such services."

TITLE V-COMMUNITY HEALTH CENTERS

We urge the Subcommittee to authorize continued appropriations for the operation of community health centers and to retain vision care for children and adults among the services to be provided by these centers. As is the case with migrant health programs, optometrists have been active in providing examination, diagnosis and treatment services for population groups served by these centers. Our Community Health Division recently identified optometric participation in health centers in such states as California, Connecticut, North Carolina, Utah, Washington, Alabama, Illinois, Kentucky, Massachusetts, Missouri, New York and Pennsylvania.

Inner-city children served by community health centers appear to have a higher incidence of learning disabilities, perceptual difficulties and developmental visual problems than do the more "advantaged" children in other parts of the city. At the same time, their parents suffer a higher incidence of functional vision problems which interfere with employability, job performance and the ability to share the same variety of experiences that are enjoyed by other Americans. Community health centers are playing a vital role in bringing needed health care services, including optometric care, to the residents of the inner city.

Title V of H.R. 2954 proposes that children's eye examinations be included as a preventive primary health service and, in effect, that vision services be offered as a supplementary health service for adults. We endorse the retention of these provisions. In addition, to ensure that all available health care resources, including optometry, may be utilized in community health centers, we urge the addition of the following single-sentence paragraph after § 330(b) (2) (K) :

"Services included in (1) or (2) may be provided by such health care personnel, including but not limited to dentists, optometrists, physicians and podiatrists, as are licensed by the respective states to provide such services."

CONCLUSION

The challenge to preserve the vision of all Americans falls upon every citizen, young or old; but it falls particularly heavy upon those who have chosen to provide vision care services as a career. The American Optometric Association, which represents the profession that provides some 70% of the vision care services in our Nation, recognizes its responsibility to work with the Congress and Administration in meeting that challenge.

Therefore, we are pleased to support the concepts contained in H.R. 2954.

STATEMENT OF THE AMERICAN OPTOMETRIC ASSOCIATION

H.R. 2955

The Developmental Disabilities Services and Facilities Construction Act has served as a fine vehicle to aid those who truly need our help. H.R. 2955, the Developmental Disabilities Amendments of 1975, would extend this program and the American Optometric Association strongly supports passage of this bill.

The Committee has done its work in this area diligently and we hope that the whole Congress will act swiftly on passage of H.R. 2955.

The role of vision to the developmentally disabled is a major one. The importance of vision to any child cannot be minimized. The National Eye Institute has stated that "vision is the most important of the senses, accounting for over 40% of all sensory input to the brain." Vision is involved in 80% of the learning process. Vision-good or bad-affects the education, the social adjustment, the very ability to succeed in life.

Vision problems are not outgrown, they only worsen with time. Despite this overwhelming importance, less than 10% of the children entering our schools have had the opportunity for a vision examination or vision screening.

Optometric services are one step in preventing the improper classification of a child as developmentally disabled, when indeed the problem is one of vision impairment. On the other hand, the child with a developmental disability needs to develop fully whatever senses or abilities are available to him.

The child himself will not know whether he is seeing as he should. Even the normal child cannot determine this. Vision is a learned process, beginning in the fetus and continuing through the early years of childhood. The child does not know how he is supposed to see, he has no basis of comparison.

Children can face a vairety of learning problems. Howard M. Coleman, O.D., M.Ed., and Sarah Taylor Dawson, M.A., relate some of these:

"Young children learn through the development of patterns-perceptual, behavioral, conceptual and combinations thereof. For the child who is lost in space there are no patterns. The world is a confusing, disorganized place filled with a bewildering mass of stimuli that constantly bombard him with incomplete and inaccurate information . . . The senses of the child-particularly the visual and the auditory senses-are amenable to learning (training) as an ongoing process in the life of the individual."

Mort Davis, O.D., of the College of Optometrists in Vision Development and leading optometrist in the field of child vision, explains that "there is a very delicate interplay between the information fed into the brain through the eyes and those adjustments of the eyes that feed information in most efficiently."

As vision affects learning, then, Dr. Davis further explains that "illness, stress, restricted or omitted experience in moving, all can adversely affect vision development."

In addition, "vision is more complex than other sense modalities and takes longer to develop fully. One consequence of this longer maturation period is that there is a greater probability of anomalies developing."

The Department of Health, Education and Welfare reports that "about 250,000 mentally retarded children of school age in our nation are functioning as best they can with uncorrected defects in vision. They very children who can least afford it may well be educationally short-changed because of the handicap poor vision imposes."

Another HEW report indicates at least one-tenth of children aged 6-11 (in noninstitutional settings) have eye muscle imbalance, disease conditions or other abnormalities in one or both eyes. This rate increases dramatically for those children with other handicaps.

The Michigan Health Department reported that vision screening of the mentally retarded revealed a vision problem incidence three times that of the normal child. A study of 103 children with impaired hearing indicated the 59% of those same children had some vision problem. A study of 98 4-10 year old children with cerebral palsy showed over 60% with ocular and/or refractive errors.

The American Optometric Association and the profession of optometry emphasize support for this program and for the bill before the Committee. Optometrists across the nation are participating in such programs. The Association is committed to provide comprehensive optometric care to all Americans and in so doing will continue and expand its work and concern for the developmentally disabled.

STATEMENT OF THE AMERICAN PSYCHIATRIC ASSOCIATION

The American Psychiatric Association, which represents 22,000 of the 25,000 psychiatrists in the United States, urges the expeditious Congressional passage of H.R. 2954.

This association is especially interested in that portion of this bill which renews authorization for community mental health centers,

The original goal of the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 was to build a viable network of Community Mental Health Centers to provide mental health services across the country.

At this point in time, when the Administration has called a halt to federal funding for new starts, we have come only one-third of the way toward the conservative requirement of 1500 centers for this nation.

Officials of this Administration have stated that this program is a demonstration project, and that its success to date obviates the need for any further funding beyond the 8-year obligational period for existing centers. However, the inability of potential centers to become operational without federal funding disproves this theory. Moreover, many centers losing federal funding will not be able to continue services integral to them, such as emergency intervention, consultation and education, outpatient, and other services. The wide spectrum of mental health services envisaged as the operating model of such centers would not be financially feasible in many cases without federal support.

One of the dilemmas we would experience through the inability to complete the community mental health center network would be the creation of a vacuous situation in areas that will have phased out state mental hospitals, leaving few if any alternatives to treatment. Some areas are already experiencing such a crisis in the absence of community mental health centers or other facilities.

Termination of federal support would also leave an inequitable patchwork pattern of community mental health service availability around the nation—a development certainly not anticipated by the architects of the bill. Many areas with weaker funding capability though needing such services more than others have not been able to provide them.

Alternatives to federal support for centers have not sufficiently crystallized at this point so as not to inhibit future expansion of the centers' program. It does not appear that the states would be either able or willing to take up the slack.

H.R. 14214 which was pocket-vetoed by the President, provided a number of improvements in centers' operations, including an appropriate range of mandated services for children, the elderly, and alcohol and drug abuses. Centers must not be forced to retrogress in the provision of comprehensive services. They must be financially nurtured to provide such services.

Community mental health centers are part and parcel of the continuum of the mental health service system. They provide many services to the poor and near poor who suffer from mental and emotional illness, since mental health benefits in health insurance policies are still either nonexistent or extremely limited, and federal health programs still perpetuate discrimination in the treatment of mental illness.

As this association stated last year, we advocate that the Congress place a high priority on this piece of legislation, so that forward planning for the operation of new centers may proceed in a positive, dynamic manner. Also, those centers that have worked so conscientiously to build superior delivery systems should be permitted to operate in the same superior context.

It is vital that we do not become delayed by relatively minor details that impede the principal goal of the building and continuing work of the network.

STATEMENT OF THE NATIONAL ASSOCIATION FOR RETARDED CITIZENS

The National Association for Retarded Citizens is again pleased to have the opportunity to present this statement on the Developmental Disabilities Services and Facilities Construction Act. Our organization was very disheartened when this Committee and your counterparts in the Senate were not able to reach agreement in conference on your Developmental Disabilities bills at the end of the 93rd Congress. We are delighted and greatly encouraged, however, that you have seen fit to make the Developmental Disabilities legislation among the first to be considered in this new Congress.

It is difficult to comment on the provisions of H.R. 2955 without referring occasionally to the Senate Developmental Disabilities bill, S. 462. They differ greatly in certain aspects and, therefore, this statement contains comments on both bills.

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