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Senator Hill. Dr. Lee, you will be our first witness. STATEMENT OF PHILIP R. LEE, M.D., ASSISTANT SECRETARY OF

HEALTH AND SCIENTIFIC AFFAIRS; ACCOMPANIED BY MISS MARY E. SWITZER, ADMINISTRATOR, SOCIAL AND REHABILITATION SERVICE; DR. RALPH K. HUITT, ASSISTANT SECRETARY FOR LEGISLATION; DR. JAMES J. GALLAGHER, ASSOCIATE COMMISSIONER, BUREAU OF EDUCATION FOR THE HANDICAPPED, OFFICE OF EDUCATION; DR. ROBERT I. JASLOW, DIRECTOR, DIVISION OF MENTAL RETARDATION; DR. JAMES W. MOSS, OFFICE OF EDUCATION; AND DR. EDWIN MARTIN, OFFICE OF EDUCATION

Dr. LEE. Mr. Chairman, I am grateful for this opportunity to appear before you in support of S. 1099, the Mental Retardation Amendments of 1967, introduced by the distinguished chairman, Senator Hill. I have with me today Miss Mary E. Switzer, Administrator, Social and Rehabilitation Service, Dr. Ralph K. Huitt, Assistant Secretary for Legislation, and Dr. James J. Gallagher, Associate Commissioner, Bureau of Education for the Handicapped, Office of Education. This team indicates the importance the Secretary attaches to this particular program. As you know, he has a committee with representatives of all of the agencies working closely to coordinate the various activities of the Department on behalf of the mentally retarded. This particular Secretary's committee is under the chairmanship of Wallace Babington, and, as you know the President has a Committee on the Mentally Retarded, and this is chaired by the Secretary, which indicates the importance that we all, I think, attach to this effort.

S. 1099 would continue Federal support of community and university-based programs in the area of mental retardation. In spite of the gains made over the past few years, I am confident these hearings will demonstrate that a critical need still exists for continued support of these programs.

Although mental retardation is recognized as the major handicapping condition of childhood, services for the retarded have long been neglected in public programs. The mental retardation legislation enacted in 1963 marked the beginning of our attempt to correct this neglect. It provided a start from which the Department of Health, Education, and Welfare could launch a broad attack on the problems of mental retardation through mechanisms such as research, training, and the provision of services in a community setting.

S. 1099 provides the basis for the extension and expansion of the programs authorized in Public Law 88–164, Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963. It would continue through fiscal year 1972 the construction programs for the university-affiliated and community facilities, as well as the professional training programs in the education of bandicapped children, and research and demonstration activities in this area.

In addition to extending the university-affiliated facilities construction program, S. 1099 expands this authority in two ways:

First, it authorizes construction of facilities which may include services to persons with “other neurological handicapping conditions found by the Secretary to be sufficiently related to mental retardation to warrant inclusion" under the university-affiliated program.

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Second, it allows a portion of the university-affiliated project to be planned and utilized for research activities incidental or related to the purposes spelled out in the existing law. Such a provision will help to assure continuing and well-directed research in mental retardation.

As to community mental retardation facilities, the bill also authorizes a new program of initial staffing grants to help meet a portion of the cost of professional and technical personnel for initial operation.

This grant program, patterned after the staffing support for community mental health centers, provides for declining Federal participation over a period of 4 years and 3 months: 75 percent Federal share for the first 15 months, 60 percent for the next year, 45 percent for the next year, and 30 percent for the last year. Only services in new fed erally financed facilities or services not previously furnished would be eligible for Federal assistance. Federal funds would be used to supplement and increase, to the extent practicable, the level of State, local, and other non-Federal funds for mental retardation services.

I would like to include for the record additional information regarding the need for extension and expansion of the mental retardation programs included in S. 1099.

In conclusion of my direct oral presentation, Mr. Chairman, the effort to mount an effective attack on mental retardation has had the interest and dedication of two Presidents, as well as a record of bipartisan congressional support. Nothing has happened to cause us to doubt the wisdom of these efforts. We, therefore, ask for a reaffirmation of this effort.

I appreciate the opportunity you have accorded me in permitting testimony on S. 1099. Miss Switzer has a brief statement to make regarding this bill. After her statement, if there are any questions, we would be happy to answer them.

Senator Javits. Mr. Chairman, before Miss Switzer speaks, may I just put a short statement in the record ?

The CHAIRMAN. Surely. But for the sake of continuity, we will now receive for the record the supplemental statement by Dr. Lee.

(The supplemental statement of Dr. Lee follows:) SUPPLEMENTAL STATEMENT OF Philip R. LEE, M.D., ASSISTANT SECRETARY OF

HEALTH AND SCIENTIFIC AFFAIRS, DEPARTMENT OF HEALTH, EDICATION, AND WELFARE

S. 1099 would continue Federal support of community and university based services to the retarded. In spite of the gains made over the past few years, I am confident these hearings will demonstrate that a critical need still exists for continued support of these programs.

There are an estimated 6,000,000 mentally retarded in this country, representing 3 percent of our Nation's population. They are persons whose normal intellertual growth has been arrested at some time before during the birth process, or in the early years. Because of their impaired ability to learn, the mentally retarded usually have difficulty meeting the needs of everyday living. Their problems are medical, social, educational and economic, and require broad and unified resources of health, education, and welfare service programs.

Despite the fact that mental retardation is the major handicapping condition of childhood, services for the retarded have long been neglected in public programs. The mental retardation legislation enacted in 1963 marked the beginning of our attempt to correct that neglect. It provided a start from which the Dee partment of Health, Education, and Welfare could launch a broad attack on the problems of mental retardation through mechanisms such as research, training, and the provision of services in a community setting.

S. 1099 provides the basis for the extension and expansion of this intensified national effort to combat mental retardation. It would provide for the first time, Federal support for the initial staffing of community mental retardation facilities. It would continue the construction programs for the university-affiliated and community facilities authorized in the legislation recommended by the Committee in 1963. It would also extend through fiscal year 1972, authority for the professional training programs in the education of handicapped children, and research and demonstration activities in this area.

The Department is presently sponsoring a variety of professional and technical services to assist the mentally retarded. In the current fiscal year, an estimated $103 million will be used for the support of mental retardation programs to be carried out by the operating agencies of the Department. These funds will be used to support research, demonstrations, professional preparation, services and construction. Part of these funds will be used as income maintenance for the mentally retarded. Departmental programs include:

Research projects relating to maternal and child health and handicapped children's services;

Support for extension of diagnostic and health services to mentally retarded children and development of new services for such children;

Support for special projects to help reduce the incidence of mental retardation caused by complications associated with childbearing ;

Preparation of professional personnel for service and research in the field of mental retardation ;

Demonstration of improved methods of care, treatment, and rehabilitation of the mentally retarded in State institutions, and improved and extended in-service training to direct-care personnel in such facilities :

Construction programs which provide support for communities and universities in their efforts to expand and improve the training, research, and service activities in the field of mental retardation ;

Income maintenance programs, administered through the social security program and public assistance, which provide needed support for designated

mental retardation beneficiaries. To coordinate the wide variety of programs relating to mental retardation the Department has established a Secretary's Committee on Mental Retardation composed of representatives from all agencies of the Department with responsibility to the retarded. Departmental activities are thus administered as a unified, total program utilizing every resource at our disposal. A portion of the programs authorized by S. 1099 will be administered by the newly organized Social and Rehabilitation Service directed by Miss Mary Switzer. This agency brings together various services of HEW that deal with special groups—one of these groups being the mentally retarded.

It is the Secretary's intent that "the aged, the handicapped and children should continue to be given special emphasis, and assigning each of these groups special status within the new Service, while preserving their administrative integrity, insures that each will receive the priority attention it needs and deserred." The newly-formed Social and Rehabilitation Service will be building on a firm base of program achievements which have been made under the legislation passed in 1963; namely the "Maternal and Child Health and Mental Retardation Planning Amendments of 1963" (P.L. 88–156) and the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963" (P.L. 88–164). I am pleased to report the following highlights of these achievements :

Every State has completed planning for comprehensive mental retardation services under P.L. 88–156.

Over 160 community facility projects have been funded to date. With the completion of construction of these facilities, about 15,000 persons will receive day care, diagnostic and evaluation services, and residential care in a community setting.

Fourteen university-affiliated facilities have been funded, and when completed will offer services to approximately 8.000 mental retardates. These facilities will offer training to nearly 10,000 professionals.

Twelve mental retardation research (enters have been approved and funded.

Over 32,000 individual grants have been awarded for training in education of the handicapped.

As a result of these achievements, local and State governments have been stimulated through Federal assistance to initiate a variety of new programs for the retarded at the community level. Finally and perhaps most significantly, there seems to be a greater interest, awareness, and concern by the public of the problem of mental retardation.

This progress is encouraging indeed. But, the waiting lists are growing longer and we have not begun to provide enough services to those in need. Construction Grants

Under Title I of the "Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963" (P.L. 88–164) grants are awarded for construction of university-affiliated and community facilities.

UNIVERSITY-AFFILIATED FACILITIES The authorization for appropriations under P.L. 88-164 for the university. affiliated facilities grants expired on June 30, 1967. S. 1099 proposes to extend this program for five years.

Eighteen facilities with colleges and universities have been approved for funding. Fourteen have been funded.

These clinical facilities are designed to provide a full-range of in-patient and out-patient services for the specialized needs of the mentally retarded. The facilities also serve as training centers for professional personel needed to staff community facilities. In the 14 university-affiliated facilities already funded, nearly 10,000 professionals will receive training annually in medical, para medical, educational and other specialties related to the needs of the retarded.

The total construction cost of the 14 projects already funded is $12 million. of which the Federal share is $30 million. The other four facilities which hare been approved, but not yet funded, require a total Federal share of $9.6 million.

The amendment would extend the duration of the university-affiliated construction program for five years to include fiscal year 1972, with an authorization of $10 million for fiscal year 1968, and such sunis as may be necessary for succeeding fiscal years.

S. 1099 makes two changes in the law relating to university-affiliated facilities.

First, it authorizes construction of facilities which may include services to persons with "other neurological handicapping conditions found by the Secretary to be sufficiently related to mental retardation to warrant inclusion" under the university-affiliated program.

Second, it allows a portion of the university-affiliated project to be planned and utilized for research activities incidental or related to the purposes spelled out in the existing law. Such a provision will help to assure continuing and welldirected research in mental retardation.

COMMUNITY FACILITIES

S. 1099 extends the community mental retardation facilities program for four years to include fiscal year 1972. It continues the present authorization of $30 million for fiscal year 1968. For the four succeeding years, “such sims as may be necessary" would be authorized.

A total of 167 construction projects for community facilities have been approved for funding. These will serve an estimated 45,000 mentally retarded persons 23,500 of whom are not now receiving services. The estimated total construction costs of these facilities is $107 million ; the Federal share is approximately $31 million.

Funds appropriated would be allotted among the States without change from the existing law on the basis of population, extent of need for facilities for the mentally retarded, and financial need of the State. States would set priority among projects competing for approval.

Some examples of projects already funded include facilities which will provide diagnostic and evaluation services, residential care, specialized clinical care, vocational rehabilitation, training and social services.

For example, the Amarillo State Center for Human Development in Texas is adding diagnostic and evaluation services and a day care center to the care and treatment resources for the mentally retarded in Potter County. The new facility will provide education and training services for 140 retarded persons in the day care program, and diagnostic and evaluation services for 150 to 300 mentally retarded persons each year.

New Jersey is establishing a network of six day-care centers at an estimated Federal cost of $731,000. The network will service 302 more retardates. The facilities will provide a daily program of planned activity for mentally retarded persons outside their homes.

In New York City the Maimonides School is constructing a new and expanded facility. About 50 retarded persons will be served. This facility will include residential care, a school and a clinic for diagnostic and treatment services. It also will function as an information and referral center.

An example of a facility which will render diagnostic services for the retarded is the Opportunity Center School to be established in Birmingham, Alabama. The facility when completed will provide services to an additional 100 retarded persons.

STAFFING OF COMMUNITY MENTAL RETARDATION FACILITIES S. 1099 adds a new grant program to assist communities in the initial operation of facilities for the mentally retarded. Such facilities provide all or part of a program of comprehensive services for the mentally retarded, principally designed to service the needs of the community in which the facility is situated. The bill authorizes such grants to meet a portion of the cost of professional and technical personnel for initial operation of new facilities or for new services in existing facilities for the mentally retarded.

The grant program, patterned after the staffing support for Community Mental Health Centers, provides for declining Federal participation over a period of four years and three months : 75 percent Federal share for the first 15 months, 60 percent for the next year, 15 percent for the next year, and 30 percent for the last year.

Only services in new Federally financed facilities or services not previously furnished would be eligible for Federal assistance. Federal funds would be used to supplement and increase, to the extent practicable, the lerel of State, local and other non-Federal funds for mental retardation services.

An appropriation of $7 million would be authorized for fiscal year 1968 and such sums as may be necessary for the next four fiscal years for initial grants.

The bill authorizes such sums as may be necessary to enable the Secretary to make grants for fiscal year 1969 and the next seven years thereafter to facilities which have previously received a grant under this part. State Plans

The bill also would require that State construction plans for community mental retardation facilities provide for enforcement of the States' minimum standards of operation of such facilities. Training and Rescarch and Demonstration Programs in the Education of Handi

capped Children S. 1099 would extend authority through fiscal year 1972 to prepare educational personnel to work with the handicapped. Also extended under this authority is a program of research and demonstration activities being carried on in this area.

These programs are the core activities of the New Bureau of Education for the Handicapped in the U.S, Office of Education which was authorized by Congress in 1966 under Title VI of the Elementary and Secondary Education Act. The purpose of the bureau-to extend educational opportunity to every handicapped child-cannot be fulfilled without trained personnel to serve these children.

The need for trained teachers to work with handicapped children is enormous. Present estimates indicate that we have only 72.000 teachers and specialists in our Nation's school programs for the handicapped—we need over 300,000.

Since the inception of the trainee program over 32,000 individual grants have been awarded for training in the education of the handicapped and 245 colleges and universities have received Federal funds to prepare teachers of the handicapped.

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