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induce States to develop new aspects of their programs and to extend their services to disability groups and geographical areas previously reached inadequately or not at all. Extension and improvement grants provided up to $3 of Federal funds for each dollar invested by the State, up to a maximum of 3 years for each project.

3. Research and demonstration.-Grants to encourage and support research into better rehabilitation and to conduct demonstration projects to spread the application of new knowledge to communities across the country were also authorized for the first time. These grants are made to public and private nonprofit organizations such as State rehabilitation agencies, voluntary groups, universities, and rehabilitation facilities.

4. Training. Grants to support the training of more professional personnel for rehabilitation services include (1) long-term training grants to educational institutions and rehabilitation agencies for support of basic or advanced professional training, in the form of teaching grants, traineeship grants for students selected by the educational institution, or a combination of these two; (2) short-term grants for training less than a semester in duration; e.g., institutes, workshops, seminars, and other training courses; (3) inservice training grants to State vocational rehabilitation agencies for staff development programs; and (4) rehabilitation research fellowships.

5. Randolph-Sheppard vending stand program for the blind.-The 1954 amendments included features to strengthen the provisions for giving preference to blind persons in the operation of vending stands on Federal and other property.

6. Rehabilitation facilities, centers, and workshops.-The new law also authorized for the first time the use of Federal grants-to-States funds for establishment (alteration or expansion) of rehabilitation facilities and workshops.

1921 1930. 1940__

FIGURE 2.-FEDERAL-STATE VOCATIONAL REHABILITATION PROGRAM
Numbers of disabled persons rehabilitated in selected years

523 1950.

4, 605 1960.

11, 890 1965_.

G. RELATED LEGISLATION

59, 597 88, 275

135, 000

Rehabilitation facilities. Also in 1954 Congress amended the HillBurton Hospital Survey and Construction Act adding authorization of Federal grants to help construct rehabilitation facilities.

Social security.-Beginning in 1954, Congress passed a series of mendments to the Social Security Act involving provisions for protecting the retirement benefits of workers covered by the act who became disabled, and later disability benefits. To carry out these provisions, Congress designated the State vocational rehabilitation agencies as the agencies which should preferably be responsible for reviewing applications for this benefit and for determining whether in fact the individual is disabled, unable to work, and therefore eligible for the benefit. Specific provision was made that all applicants for these benefits should be referred to the State agency in an effort to restore all disabled workers to gainful activity where this is possible.

54-564-65- -3

International research.-With enactment of the International Health Research Act of 1960, in combination with the existing authority in section 104 (k) of the Agricultural Trade Development Assistance Act of 1954 as amended, Vocational Rehabilitation Administration became responsible for a new international rehabilitation research program. Welfare. The landmark 1962 public welfare admendments contained provisions relating to the use of the State vocational rehabilitation agencies in furnishing vocational rehabilitation services to assistance applicants or recipients.

Civil rights.-Vocational Rehabilitation, like all Federal grants-inaid programs, comes under title VI of the Civil Rights Act of 1964, prohibiting discrimination under any activity receiving support under this program, on grounds of race, color, or national origin.

Other technical amendments to the Vocational Rehabilitation Act.Several minor amendments of the Vocational Rehabilitation Act have been passed since 1954, relating to extension of the vocational rehabilitation program provisions to Guam; adjustments of the financing provisions necessitated by statehood for Alaska and Hawaii; extending the ceiling for training to allow physicians pursuing residency training in physical medicine and rehabilitation to be aided for 3 years, rather than 2 years which is the current limit for all other courses of training.

Matching contributed funds for facilities and workshops. A provision of the 1965 appropriation act authorized, as State matching funds, contributions of funds by private organizations or individuals to a State to aid in meeting the costs of establishing a public or other nonprofit workshop or rehabilitation facility, where the contributor imposes a condition limiting the use of such funds to establishment of a particular workshop or facility.

H. VOCATIONAL

REHABILITATION TODAY SPOTLIGHT ON PROGRESS
UNDER THE 1954 AMENDMENTS

1. Organization and functions of the Vocational Rehabilitation Administration

The Vocational Rehabilitation Administration is the focal point in the Department of Health, Education, and Welfare for programs to foster the vocational rehabilitation of disabled persons and their greater utilization in suitable, gainful employment.

In broad perspective, the overall objective is to provide the leadership and the means for furnishing vocational rehabilitation services to all the disabled who need and can be expected to benefit from them. Within this objective, these are the five main objectives of the VRA: To build State vocational rehabilitation agency programs of services for the disabled.

To increase rehabilitation knowledge and techniques and their application to practice.

To increase the Nation's supply of trained rehabilitation manpower which will continue to be in severe shortage.

To increase and improve the physical plants for serving the disabled, including rehabilitation factilities and workshops, training settings, specialized clinics, and other special facilities.

To educate the general public and specific publics-like employers, researchers, public and voluntary agencies-about vocational rehabilitation of the disabled and to disseminate available rehabilitation knowledge.

The Vocational Rehabilitation Administration also maintains continuing liaison with numerous other agencies of the Federal Government, including the Department of Labor in connection with the selective placement activities of the Employment Service and the manpower development and training program; with the President's Committee on the Employment of the Handicapped; with the Office of Economic Opportunity; and with the various other agencies in the Department of Health, Education, and Welfare, with regard to all activities involving the disabled and their vocational rehabilitation, such as special education, vocational education, health, welfare, and social insurance.

The Vocational Rehabilitation Administration staff of some 250 persons in the central office and in the nine regional offices includes experts in the various areas of rehabilitation and program management, such as State program services; research, demonstrations, and training; international research and training; management services, including statistics, reports, and budgeting; legislation and public affairs; and regional operations. With this comparatively small staff, under the direction of Mary E. Switzer as Commissioner for Vocational Rehabilitation, VRA carries a leadership role in relation to the Nation's Federal-State rehabilitation program as well as the voluntary rehabilitation efforts so closely allied with the public efforts.

2. Organization and functions of the State vocational rehabilitation agencies

In the Federal-State program, services are provided to the disabled through 91 State vocational rehabilitation agencies in the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam. Along with the 54 general agencies in each of these jurisdictions serving all the disabled, 37 States have separate agencies serving exclusively the blind. These State agencies maintain some 800 State, district, and local offices over the country. They employ about 7,400 staff, of whom 2,600 are rehabilitation counselors and 1,300 are engaged in disability determinations for the old-age, survivors, and disability insurance program. (See fig. 3 re growth of State agency staff.)

In most States, the vocational rehabilitation agency is organizationally associated with the State education agency, although there are some vocational rehabilitation programs organized as separate commissions or departments. In the majority of States, vocational rehabilitation agencies for the blind are located as part of the welfare

agency.

As already noted, the key staff person who deals directly and continuously with the disabled person is the rehabilitation counselor. From the initial interview-and on through the steps needed to gain a full picture of the person's aptitudes, interests, problems, physical and mental state, through placement and followup in the first weeks of employment to check on success on the job and help with any difficulties or needed adjustments-the counselor guides the individual through the various stages to successful rehabilitation. This is an individualized process with a single person, the rehabilitation counselor, to whom the individual looks, while he is receiving many different services from a number of sources; e.g., private physicians, hospital or clinic staff, prosthetists, psychologists, social workers, and schoolteachers.

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1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964

In response to the needs of the new groups of the disabled to whom rehabilitation services were being extended, in the last decade the State agencies have increased the range of professions represented on their staffs to include social workers, psychologists, physicians, psychiatric consultants, and research directors, among others. They have also ventured increasingly to set up closer ties with institutions for the disabled, frequently assigning rehabilitation counselors to work directly in the institution and often setting up actual rehabilitation units within the institution, such as rehabilitation units in mental hospitals. Counselors with special preparation are assigned to carry specialized caseloads such as the deaf, the mentally ill, the mentally retarded. State agencies have also moved to make vastly increased use of rehabilitation facilities of various kinds and to assist and encourage the establishment and improvement of such facilities. 3. Achievements

Since its beginning, this vocational rehabilitation program has achieved rehabilitation for close to 2 million disabled persons. In the 1954-65 period, the total number of disabled persons rehabilitated was about 1 million. (See fig. 4.)

FIGURE 3.-AGENCY STAFF AND FUNDS REQUIRED FOR THE STATE-FEDERAL PROGRAM OF VOCATIONAL REHABILITATION: 1954-64

Federal and State Funds and Size of Agency Staffs (PL565 Sections 2 and 3)

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FIGURE 4.-FEDERAL LEGISLATION IN RELATION TO NUMBERS REHABILITATED ANNUALLY

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With program growth and the application of new knowledge have come notable changes in the range of disabilities represented among those who have been successfully rehabilitated. State agencies have made great strides in extending rehabilitation services to major disability groups, sometimes in response to highly articulate public interest and sometimes in advance of such public interest. The last decade has seen mounting interest and applied effort devoted to rehabilitating the mentally ill, the mentally retarded, the deaf and hard of hearing, the aging, and those on varied forms of assistance. New lines of emphasis are emerging in relation to those disabled by heart disease, cancer, stroke, epilepsy, alcoholism, narcotics addiction, the disabled youth of school age, and the public offender who is disabled. (See fig. 5.)

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Education:

40 of every 100 had never been to high school.

7 of every 100 had at least 1 year of college level education.

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