bia University's College of Physicians and Surgeons and the Psychoanalytic Clinic for Training and Research. He is presently project director of "Essential Aspects of Deafness", an SRS supported collaborative venture in Yugoslavia and the United States that should produce a yield in research and in services in this underdeveloped nation. He is married and has three children. Of his more than 60 books and papers, a sampling of those most pertinent to the present project are listed below.

PUBLICATIONS

Altshuler, K. Z. and Rainer, J. D.: Patterns and course of shizophrenia in the deaf. J. Nerv. Ment. Dis., 127:77, 1958.

Altshuler, K. Z.: Psychiatric considerations in the school age deaf. Am. Ann. Deaf, 107:553, 1962.

Altshuler, K. Z. and Sarlin, M. B.: Deafness and schizophrenia: interrelation of communication stress. maturation lag and schizophrenia risk. In Expanding Goals of Genetics in Psychiatry (F. J. Kailaman, Ed.). Grune & Stratton, New York, 1962.

Rainer, J. D., Altshuler, K. Z. and Kallmann, F. J.: Psychotherapy for the deaf. In Advances in Psychosomatic Medicine, Vol. III (B. Stokvis, Ed.) S. Karger, Basel, 1963.

Rainer, J. D., Altshuler, K. Z. and Kallmann, F. J. (Eds.): Family and Mental Health Problems in a Deaf Population. New York State Psychiatric Institute, New York, 1963.

Altshuler, K. Z.: Personality traits and depressive symptoms in the deaf. In Recent Advances in Biological Psychiatry, Vol. VI (J. Wortis, Ed.) Plenum Press, New York, 1964.

Altshuler, K. Z.: Adolescent deaf students referred to a mental health clinic. In Proceedings of the International Congress on Education of the Deaf and 41st Meeting of the Convention of American Instructors of the Deaf. U.S. Government Printing Office, Washington, D.C., 1964.

Rainer, J. D. and Altshuler, K. Z.: Comprehensive Mental Health Services for the Deaf. New York State Psychiatric Institute, New York, 1966. Altshuler, K. Z. and Deming, W. E.: Interaction measurements in psychiatric patients with early total deafness. Arch. Gen. Psychiat., 17:367, 1967. Altshuler, K. Z.: editor, Education of the Deaf: The Challenge and the Change. The Proceedings of National Conference on Education of Deaf, Colorado Springs, April 13-15, 1967. U.S. Government Printing Office, Washington, D.C., 1968.

Altshuler, K. Z. : Preventive Psychiatric Program at the School Level. In Psychiatry and the Deaf (J. D. Rainer and K. Z. Altshuler, Eds.) U.S. Department of Health. Education, and Welfare, Washington, D.C., 1968. Altshuler, K. Z.: Theoretical Considerations in Development and Psychopathology of the Deaf. In Psychiatry and the Deaf (J. D. Rainer and K. Z. Altshuler, Eds.). U.S. Department of Health, Education, and Welfare, Washington, D.C., 1968. Altshuler, K. Z. and Rainer, J.D. (Eds.): Mental Health and the Deaf: Approaches and Prospects. In Proceedings of the National Conference on Mental Health Services for Deaf People, Houston, Texas, February 14-17, 1969. Altshuler, K. Z.: Reaction to and Management of Sensory Loss: Blindness and Deafness. In Loss and Grief: Psychological Management in Medical Practice (B. Schoenberg et al, Eds.) Columbia University Press, New York, 1970. Rainer, J. D. and Altshuler, K. Z.: Expanded Mental Health Care for the Deaf: Rehabilitation and Prevention, Research Foundation for Mental Hygiene, New York, 1970.

Altshuler, K. Z.: Studies of the deaf: their relevance to psychiatric theory. Am. J. Psychit., 127:1521, 1971.

Rainer, J. D. and Altshuler, K. Z.: A psychiatric program for the deaf: experiences and implications. Am. J. Psychiat., 127:1527, 1971.

STATEMENT OF HON. FRANK ANNUNZIO, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS

Mr. Chairman, as you are no doubt aware, nearly three million disabled American men, women, and youths have benefited from the services rendered by the Vocational Rehabilitation Act since its initial enactment in 1920. These persons have been able to return to productive activities and employment as a direct result of this remarkably successful Federal-State program.

In fiscal year 1971 alone, a record number of 291,272 handicapped Americans were rehabilitated to productive activities. According to estimates made by the Social and Rehabilitation Service in the Department of Health, Education and Welfare nearly three-quarters of a billion dollars was added to the Nation's economy as a result of that record number of rehabilitated clients. Annual earnings of the 291,272 persons rehabilitated increased an estimated $770 million over what they earned the year before entering the vocational rehabilitation program. Average earnings of the individuals rehabilitated were $15.95 per week when they were first accepted into the program, and upon completion, average earnings rose to $68.86 per week.

This is a remarkable record of success indeed, and for each of the nearly three million handicapped persons who has undergone a successful rehabilitation, I'm sure it is a dream come true. But for many other handicapped Americans, such a success story is still just a dream. I refer to those severely handicapped persons who have not yet been reached by the vocational rehabilitation program. Because of the severity of their handicaps, and the limitations of the program itself they have not been able to benefit from the many services that have been so helpful to other less handicapped persons.

For many years, as Director of the Illinois Department of Labor, I worked diligently to improve programs for employing the physically handicapped. In my capacity as the top administrator of the Labor Department, I urged the Commissioner of the Illinois Employment Service (which was under my jurisdiction) to participate in all worthwhile programs aimed at increasing employment of the physically handicapped. In order to insure the success of these programs, we worked closely with the disabled veterans organizations and created many new incentives to encourage employers throughout the entire State of Illinois to hire the physically handicapped. Having had this experience with the employers in the State of Illinois and with the outstanding Illinois veterans organizations, I want to say that I have a profound understanding of what it means to the dignity of handicapped people to have access to adequate rehabilitative assistance in order to enable them to lead useful and productive lives. It is for the severely handicapped persons who have been denied the opportunity to receive the special services that will help them to return to productive lives that I am here to speak today. I am grateful for the opportunity to testify before this subcommittee on behalf of H.R. 9847, introduced by Congressman Brademas to improve rehabilitation services for the severely handicapped. I felt so strongly about the necessity for the enactment of this proposal that I cosponsored the measure myself, and my bill is H.R. 12642.

The problem of providing enough services for the severely handicapped has been with the vocational rehabilitation program through its more than a half century of existence. The National Citizens Advisory Committee on Vocational Rehabilitation, in its 1968 report noted that “. . . individuals with certain types of disabilities have had only limited opportunities to receive vocational rehabilitation services. Rehabilitation programs for such individuals are often no more than token efforts. Among the disability categories for which service has been less than adequate are the mentally and emotionally ill, the mentally retarded (despite remarkable advances for both groups in the past decade), the deaf and hard-of-hearing, the multiply handicapped blind (particularly the deafblind), the epileptic, the cerebral palsied, the spinal cord injured and those with other neurological conditions, as well as victims of stroke, cancer, and heart disease."

These severely handicapped individuals cited by the National Citizens Advisory Committee are the ones that will benefit from the provisions of H.R. 9847, H.R. 12642, and similar bills. This legislation contains several provisions which guarantee that there will be specific and sustained attention paid to the special needs and problems of the severely handicapped as they undergo rehabilitation. For instance, this legislation provides that State vocational rehabilitation plans assure a priority in the provision of services to severely handicapped clients, and, in addition, to strengthen this priority, requires the Secretary of Health, Education and Welfare to disapprove any State plan which denies severely handicapped persons a preference in goods and services. This legislation provides for the establishment of a National Advisory Council on the Severely Handicapped to advise the Secretary on project grants and on the planning, delivery, and evaluation of the services offered the severely handicapped. To administer the program for the severely handicapped, this legislation provides for the establishment in the Department of a Division for the Severely Handicapped.

The Federal share of the cost of services under the program at the present time is 80 percent; this legislation continues this percentage, but provides that for services for the severely handicapped, the Federal share will be 100 percent. Provisions such as these provide the emphasis that will be necessary to insure that the severely handicapped will be neglected no longer. Finally, this legislation provides increased authorizations for the vocational rehabilitation program as a whole to help finance the increased cost that the providing of services for the severely handicapped will entail.

The welfare provisions of H.R. 1, the Social Security Amendments of 1971, passed by the House last June, stipulate that all handicapped welfare recipients under the age of 65 must be referred to State vocational rehabilitation agencies for vocational rehabilitation services. The increased authorization levels in this legislation will strengthen these agencies so that they are able to meet the increased load on their resources.

All in all, this proposal is an essential amendment to the Vocational Rehabilitation Act and I commend the gentleman from Indiana (Mr. Brademas) for bringing it before us. I am sure the subcommittee he chairs will give it ail favorable consideration.

STATEMENT OF THE AMERICAN SPEECH AND HEARING ASSOCIATION

The American Speech and Hearing Association (ASHA) is a scientific and professional organization comprising more than 14,000 members and listing these as its major goals: The encouragement of basic scientific study of the processes of human hearing, speech, and language; the promotion of investigation of hearing, speech, and language disorders; and the promotion of improved therapeutic procedures related to such disorders.

The work of ASHA and its members is consumer-oriented, and the consumer market is a very large one indeed. Research completed in 1969 termed a population of 236,000 deaf American "a conservative total." The same study estimated that some 8,500,000 Americans have "hearing problems of one type or another which are less severe than deafness but which impair communication and hence social efficiency." American plagued by central communication disorders (i.e., those caused by brain damage primarily resulting from stroke) were estimated at 2,100,000, and those with speech disorders at an astonishing 10 million.3

It is true that some of these communication disorders go unperceived, and that many which are perceived go untreated. It is also true that the treatment of some of these disorders is administered by health professionals other than speech pathologists and audiologists. But the fact remains that close to 21 million Americans, about one-tenth of our national population, are in some way and to some degree communicatively handicapped. And service to these Americans is the primary mission of ASHA and its membership.

COSTS OF COMMUNICATIVE DISORDERS

The national total of direct expenditures made annually by public and private organizations to treat hearing, speech, and language disorders through such essential programs as special education, vocational rehabilitation, the provision of speech pathology and audiology services, and the training of professional personnel was estimated in 1969 at "at least $500 million." Indirect costs, representing the annual deficit in earning power among the communicately impaired, were estimated at 14 billion dollars. Needless to say, no dollar estimate can be given to the serious, often tragic personal and social problems which communicative disorders impose on their victims.

HUMAN AND COST IMPACT OF RSA SPEECH AND HEARING EFFORTS

In 1954, President Eisenhower signed congressionally approved legislation which substantially broadened the scope of the federal rehabilitation program and, at the same time, authorized a series of sweeping changes and reforms. He

1 Report of the Subcommittee on Human Communication and Its Disorders, National Advisory Neurological Diseases and Stroke Council (NIH), Human Communication and Its Disorders-An Overview, Bethesda, Md. (1969), p. 11.

2 Ibid., p. 13.

3 Ibid., pp. 16-17.

4 Ibid., pp. 19-25.

5 Ibid.

called the law noteworthy in two special respects. "In the first place," he said, "it emphasizes to all the world the great value which we in America place upon the dignity and worth of each individual human being. Second, it is a humanitarian investment of great importance, yet it saves substantial sums of money for both federal and state governments."

What was true in 1954 remains true today. And the very fact of this consistency, at a time when public program planners seem to be searchi gnin vain for other bureaucratic success stories, is a special tribute to the Rehabilitation Services Administration (RSA) of the Department of Health, Education, and Welfare, to the foresight of the men and women there who have made its programs productive over the years, and to the Congress, which has consistently provided the means necessary for the continued achievement of our vocational rehabilitation goals.

In fiscal year 1971, some three-quarters of a billion dollars was added to the nation's economy as a result of RSA-funded efforts-efforts which were responsible for returning a record 291,272 disabled adults to productive activity. These rehabilitants earned an estimated $770 million more in fiscal 1971 than they did during the year before they entered the rehabilitation process. Projected as lifetime earnings, these figures exceed $9 billion in increased earnings— just for those rehabilitated in fiscal 1971. And, of course, taxpayers will share substantially in these earnings through increased taxes paid by the rehabilitants and through reduction in tax-supported maintenance had these individuals not received rehabilitation services.8

The role played by hearing, speech, and language professionals in the achievement of these impressive recent figures has been a central one. In the last year (fiscal 1969) for which figures of this type are presently available, for example, 5.4 percent of all rehabilitated adult Americans were persons who, prior to their rehabilitation, were considered "disabled" solely because of serious hearing impairments. The major disabling condition in another one percent was speech impairment. And rehabilitation of the speech and hearing mechanisms figured significantly in the total rehabilitation of the 23.2 percent for whom mental illness was considered the major disabling condition, the 18.5 percent for whom orthopedic impairment was considered the major disabling condition, and the 11.4 percent for whom mental retardation was viewed as the major disabling condition.11

10

So it is that fiscal allocations by the Congress and through the Rehabilitation Services Administration to hearing, speech, and language rehabilitation efforts across the conutry have contributed most significantly to the total vocational rehabilitation picture in this country and thus to both the economic and physical health of American society. But the statistics presented heretofore illustrate only one side of the RSA contribution.

The RSA program is not to be supported because it pays back to American taxpayers every dollar they put into it-or even because, and this is nearer reality, the return represens five or ten times the investment. Rather it is to be supported, and its growth carefully, thoughtfully, and creatively nurtured, because it is right in terms of American society, in terms of human concern for our fellow citizens, and in terms of contributing to our nation's strength and well-being.

SUPPORT FOR THREE-YEAR EXTENSION

The American Speech and Hearing Association and its more than 14,000 members in all States of the Union wholeheartedly endorse extension of the Vocational Rehabilitation Act's appropriation authority for another three years at authorization levels at least as high as those suggesed in H.R. 8395.

ASHA additionally, and for several reasons it considers determinative, supports the inclusion of specific expressions of appropriation authority in any extension of the Act. First of all, such expressions are tangible representations of the existing level of need in the vocational rehabilitation area, as seen by

• Commissioner Edward Newman, Rehabilitation Services Administration (HEW), cited by Rep. Thaddeus J. Dulski, Congressional Record (January 24, 1972), p. E–349.

7 Ibid.

8 Ibid.

See generally, "Statistical Notes," Division of Statistics and Studies, Rehabilitation Services Administration (HEW), June 1971; and see, "Characteristics of Clients Rehabilitated in Fiscal Years 1965-1969," ibid.

10 Ibid.

11 Ibid.

the committee of Congress most familiar with these needs and the ability of the vocational rehabilitation program to effectively and efficiently meet them. Second, specific funding authority facilitates the work of both state vocational rehabilitation agencies and states themselves in the planning of their budgets. Third, specific appropriation authority designed to expire after a relatively short three-year period necessitates what amounts to an ongoing congressional review of the rehabilitation program's direction, its progress, and, especially, its needs. A program as far-reaching and of such potentially positive impact as this requires and deserves no less.

SUPPORT FOR INCREASED RESEARCH AND TRAINING AUTHORIZATIONS

H.R. 8395 provides appropriation authority for the general research, demonstration, and training programs which are currently financed under Sections 4 and 7 of the Vocational Rehabilitation Act, with authorizations significantly higher than current appropriations. These suggested increases are more than justified insofar as the speech and hearing profession is concerned, as they doubtless are with respect to other areas of rehabilitation expertise.

A half dozen years ago, at the height of RSA program's expansion and impact, 63 teaching grants totaling $1,064,126 were awarded by RSA to college and university speech and hearing programs to help support the research efforts of professionals and their training of students in speech pathology and audiology. Traineeship grants totaling $2,423,963 were awarded to close to 700 graduate students (a two-year's master's degree is required to achieve professional status as a speech pathologist or audiologist). The total 1966 support for speech pathology and audiology programs represented, at $3,488,089, 14.4 percent of all RSA training funds in that year.

In the past fiscal year (1971), teaching grants had risen by only one, to 64; the total amount of such grants had dropped nearly a quarter of a million dollars, to $719,100. Graduate student traineeships had also fallen off drastically-down nearly 200 from the 1966 figures, to 498-with only $2,200,000 being allocated for the training of new manpower in speech pathology and audiology— another reduction of nearly a quarter of a million dollars. Total 1971 RSA support for speech pathology and audiology programs represented, at $2,919,100, 10.5 percent of all RSA training funds, or nearly percent lower than RSA's 1966 commitment.

The Rehabilitation Services Administration expects to see its funded programs achieve some 300,000 rehabilitations in this fiscal year, about 9,000 more than in 1971, and annual increases hereafter. It acknowledges, nevertheless, that even at this rate we are not keeping pace with the ever-rising numbers of newly handicapped which grow at about the same rate our population grows, as a result of the increased hazards of everyday living, such as occupational injuries and highway accidents, and the toll taken by birth defects and disease.12

It would appear that if, in fact, we do increase the number of rehabilitants in the next several years, we will do so in large part because of a past manpower training commitment that is only now showing results. Optimism regarding increased rehabilitation beyond that point will prove sadly unfounded unless we achieve again and then exceed the past level of commitment. The American Speech and Hearing Association supports the increased research, demonstration, and training funding authority authorized by H.R. 8395 as a significant step in this direction.

SUPPORT FOR CONSTRUCTION/IMPROVEMENT OF REHABILITATION FACILITIES

In the last several years the Congress, at the instance of the Administration, has virtually terminated appropriations for the construction and staffing of rehabilitation facilities under Section 12 of the Vocational Rehabilitation Act. What little has been appropriated for these purposes has gone to but a few choice facilities, with apparently no thought given to the urgency of undertaking a nationwide effort to meet rehabilitation facility needs. Appropriations for rehabilitation facility improvement, training grants, and technical assistance, authorized by Section 13 of the Act, have been continued. but at grossly inadequate levels. H.R. 8395 calls for the combination of Sections 12 (construction and staffing) and 13 (facility improvement, training grants, and technical assistance) so as to 12 Commissioner Edward Newman, op cit.