A. A DECADE OF PROGRESS: 1955-64

The years following the 1954 legislation were especially fruitful years in many areas of rehabilitation where new authority was provided:

1. With the impetus of new incentives to the States to broaden and increase support for their rehabilitation activities, the number of disabled persons rehabilitated annually more than doubled, from 55,000 in 1954 to 135,000 in 1965. Čombined Federal and State spending went from $35.4 million in 1954 to $157.5 million in 1965. 2. Under new legislative authority to support research and demonstration projects aimed at solving problems in the rehabilitation of disabled persons, the number of such projects grew from 18 in 1955 to 943 in 1965, with Federal grant funds for this purpose increasing from almost $300,000 in 1955 to $17.1 million in 1965.

3. With new provisions for support of training more professional workers skilled in delivering vocational rehabilitation services, training activities grew from 77 teaching programs and 201 student traineeships supported in 1955 to 526 teaching programs and 3,780 traineeships and research fellowships in 1965. The appropriation for training rose from $900,000 in 1954 to $19.8 million in 1965.

B. WHAT IS "VOCATIONAL REHABILITATION FOR THE DISABLED"?

Vocational rehabilitation is a combination of services provided to a physically or mentally disabled person, as needed, to fit him for employment and productive useful living. These services are provided to disabled persons at or near working age, whose disability is a vocational handicap in that it interferes with getting or keeping employment. (See fig. 1.)

The range of services includes:

Full evaluation, including medical diagnosis, to learn the nature and degree of disability and to help evaluate the individual's work capacities.

Counseling and guidance in achieving good vocational adjust

ment.

Medical, surgical, psychiatric, and hospital care and related therapy, to reduce or remove the disability.

Artificial limbs and other prosthetic and orthotic devices needed to increase work ability.

Training, including training for a vocation, prevocational and personal adjustment training, and remedial education.

Service in comprehensive or specialized rehabilitation facilities, including sheltered workshops and adjustment centers. Maintenance and transportation during rehabilitation.

Tools, equipment, and licenses for work on a job or in establishing a small business.

Placement in a job suited to the individual's highest physical and mental capacities and postplacement followup to see to it that the placement is satisfactory to the employee and the employer.

FIGURE 1.-WHAT STATE REHABILITATION AGENCIES DO FOR CLIENTS ($139 MILLION SPENT IN 1964)

The essence of the program is to marshal all resources, in a coordinated way, to bring the disabled person to his best functioning level. In the Federal-State program the rehabilitation counselor is the key staff member, making the determination as to whether the individual is eligible, arranging with the individual the development of a plan for his rehabilitation, managing the arrangements for the necessary services, counseling and guiding the individual, and staying with him through successful placement on the job.

Services are obtained, often by purchase, from virtually the full span of community resources, depending on what the individual needs. Private physicians, public and private hospitals, specialized clinics, rehabilitation centers, workshops, public and private educational institutions, and employers, are but some of the resources which are regularly drawn into effective rehabilitation.

C. WHAT ARE THE VALUES OF VOCATIONAL REHABILITATION? Expansion of the Nation's vocational rehabilitation program has brought important values and gains to the disabled who are rehabilitated, to their families, and to their communities. Over and above the enhancement of the personal dignity of the disabled individual who is restored to employment, and the value of preserving family life which is often threatened or destroyed by disability, are the calculable values which are mainly economic.

The Nation gains in the man-hours added to its productive effort. The total group of almost 120,000 persons rehabilitated in 1964 will contribute an estimated 167 million man-hours per year to the Nation's productive effort. The manpower pool in the professional occupations, such as engineering, teaching, medicine, and related health activities, was increased by about 5,000 as a result of the disabled persons rehabilitated in 1964. Nearly 14,000 went into the skilled trades, and 8,000 into agriculture.

The 120,000 persons will have paid about $19 million in Federal taxes in the first year after rehabilitation, not including State and local taxes. Estimates are that there will be over $24 million savings in the cost of institutional care and public aid, to which must be added incalculable savings in aid from voluntary agencies and families.

An added dimension becomes graphic with the realization that in the successful rehabilitation of these 120,000 persons in 1964, altogether some 285,000 people were involved, including the disabled persons and their dependents. Many of the disabled individuals were freed from constant attendance and dependence. For many who do not make it to full vocational rehabilitation but who do make it to full mobility, the gain is their ability to participate in family and community life.

In terms of the Nation's drive to bring poverty under control and to prevent poverty where possible, this program of vocational rehabilitation makes a significant contribution. Almost 75 percent of the 120,000 persons rehabilitated in 1964 were not working when they started their rehabilitation. Others were in marginal or otherwise unsatisfactory employment.

About 16,000 of the persons rehabilitated in 1964 were receiving public assistance at the start of or during their rehabilitation, and about 5,200 were living in tax-supported institutions. Public assistance payments to the 16,000 persons were about $18 million annually.

The conversion of most of these persons from tax consumers to economic independence through the public vocational rehabilitation program cost about $16 million, with savings of millions of dollars in Federal and State public assistance funds.

Also not to be overlooked is the reduction or the prevention of disability which can result from the prompt rendering of rehabilitation services. This preventive contribution has been dramatically demonstrated in the case of stroke victims and amputees for example. There is moreover a preventive force at work when a rehabilitated disabled person is able to maintain his gains from rehabilitation and to ward off deterioration of his physical or mental condition.

D. HOW BIG IS THE JOB TO BE DONE?

Among the millions of our citizens who are disabled, the Vocational Rehabilitation Administration estimates that there are over 3.5 million persons of working age who could be rehabilitated to employment. Currently, each year an additional 450,000 people join the group who are disabled and who could be restored to activity and work through vocational rehabilitation services.

This represents a portion of the total group of the disabled in the Nation. The National Health Survey findings indicate that nearly 14 million persons at or near working age who live outside of institutions are limited either partially or totally in their ability to carry out their normal activities, that is, either ability to work, keep house or go to school. The full picture should also include a sizable portion of the 5.5 million mentally retarded persons, a group which is not fully represented in the National Health Survey.

Obviously, the Nation is a long way from meeting the need for vocational rehabilitation for the disabled. Obviously also it will take the combination of public and private rehabilitation efforts to make significant progress toward meeting the total need.

The next immediate goal of the public vocational rehabilitation program is the rehabilitation of 200,000 disabled persons annually. The expansion of the last 11 years has brought the program to the 1965 total of about 135,000 disabled persons rehabilitated. It is therefore apparent that the key to accelerating this commendable progress is a sharp raising of the scale on which this program operates. This will bring an opportunity to apply the extensive knowledge gained over the last 11 years about how to do the rehabilitation job more effectively for far greater numbers of the disabled.

E. GROWTH OF THE PROGRAM FROM 1920 TO 1954

The vocational rehabilitation program, one of the oldest grant-inaid programs for providing services for individuals, had its start when President Wilson signed the Smith-Fess Act in 1920. (See app. A for a list of Federal legislation relating to this program, from 1920 through 1964.) Services under this first act were confined to counseling, job training, artificial limbs and other prosthetic appliances, and job placement. This act provided for an appropriation of $750,000 for fiscal year 1921 and $1 million for fiscal years 1922 to 1924, for payments to States cooperating in vocational rehabilitation of persons disabled in industry. Federal funds were to be matched by the States and were not to be used for institutions for handicapped persons except for special training of individuals entitled to benefits of the act. Federal Board of Vocational Education was given responsibility for carrying out the act. Authorization for the program was renewed in succeeding years.

The

With the Social Security Act in 1935 came the first permanent authorization for this program. The Social Security Act provided for increased aid to vocational rehabilitation in recognition of the importance of such work in a permanent program for economic security. Although the Social Security Act did not amend the Vocational Rehabilitation Act, it did authorize certain appropriations to extend and strengthen the cooperative program of vocational

rehabilitation by providing for increased grants and increased support for Federal administration, and it included for the first time permanent authorization for this program's continuance.

The next major step forward in rehabilitation came with the spur of World War II. In 1943, major amendments to broaden the program authorized for the first time the provision of (1) medical, surgical, and other physical restoration services to eliminate or reduce disabilities; and (2) services for the mentally ill and the mentally retarded. Under this law, the entry of the separate State agencies serving the blind into the Federal-State program marked another "first."

The 1943 law placed the 48 States, Alaska, Hawaii, and Puerto Rico on the same footing with respect to Federal grants. It also marked a significant broadening of the concept of rehabilitation, defining "vocational rehabilitation" and "vocational rehabilitation services" as "any services necessary to render a disabled individual fit to engage in a remunerative occupation."

Under the 1943 act, payments by the Federal Government to States with approved plans for vocational rehabilitation were authorized for (1) the entire expense for vocational rehabilitation of the war disabled; (2) half the expense for vocational rehabilitation of other disabled persons, with the State paying the remaining half; and (3) the entire expense of administration, including guidance and placement services. Up to this time the costs of the program had been shared equally by the States and the Federal Government.

F. THE 1954 AMENDMENTS OF THE VOCATIONAL REHABILITATION ACT

By the early 1950's the vocational rehabilitation program had unmistakably begun to "plateau" in its growth. Program growth was being held back apparently in part by the financing system then in use and in part by the lack of provisions for capitalizing on research, professional training, and other features which brought progress in other fields such as health and science.

Retaining the basic patterns of services for disabled people, the 1954 revisions added sweeping changes in professional, financing, and other aspects to provide the setting for a major forward move.

The 1954 amendments, in fact, included modernized provisions which were added to other Federal grants-in-aid statutes over the next decade, such as authority for research, demonstration, and training activities.

These were the main changes made by the 1954 amendments:

1. Financing provisions.-The State's share under this act was determined by a formula which took into account the individual State's population and its per capita income. The object was to give greater financial support to States with relatively large populations and relatively small per capita income, calling for these States to pay smaller portions of the total cost of the State vocational rehabilitation program than other States with larger financial incomes. The Federal share varied from 50 to 70 percent, with the national average being about 3 Federal dollars to 2 State dollars invested in vocational rehabilitation.

2. Extension and improvement project grants to States.-A new system of project grants to State agencies-extension and improvement grants-provided Federal financial support at more favorable rates to