selor, these units exemplify the team approach to the problems of disability.

Work classification units in this country increased from only 8 in 1952 to about 30 in mid-1954. This increase is important to the efforts of State agencies for vocational rehabilitation in meeting the needs of clients disabled by heart disease. One factor in the increase was the 1952 agreement between the American Heart Association, the Public Health Service, the U. S. Employment Service, and the Office of Vocational Rehabilitation. Local affiliates of the American Heart Association have assumed major responsibility for organizing work classification units.

In another problem area—that of mental or nervous system disability-State rehabilitation agencies continued their emphasis upon expanding their services. Approximately 3,800 individuals in this category were restored to useful and productive lives during the fiscal year.

In spite of the growing interest on the part of State agencies in the possibilities offered by intensive work with persons who have psychiatric disabilities, small inroads have as yet been made against the problem. Urgent needs of State agencies to meet the challenge posed by this category of disability are now widely recognized. These include specially trained personnel who can assume responsibility for the work, and consulting psychiatrists readily available to all State rehabilitation agencies. There is also a great need for more research, and for a more far-reaching program of information and education directed toward the general public, employers, and physicians.

Rehabilitation Centers

Louisville, Miami, Grand Rapids, Akron, Philadelphia, Chicago, Ann Arbor, and Detroit joined the growing list of communities in which the integrated facilities of comprehensive rehabilitation centers are available for meeting the extensive requirements of the severely disabled. Most of these centers, like many of them which have been. operating in the past, will be used as regional facilities serving severely disabled drawn from wide geographic areas.

Other communities-such as Orlando, Knoxville, and Savannahhave begun planning for rehabilitation centers. Still others, along with several universities, have undertaken studies looking toward the eventual establishment of rehabilitation centers. This group includes Oakland, Mobile, and Tacoma. Surveys are underway at Leland Stanford University, the University of North Carolina, the University of South Carolina, Western Reserve University, and the University of Washington.

Obstacles relating to financing, staffing, and similar requirements must be overcome before a center can be established. This accounts

tional rehabilitation agencies as a byproduct of the operation of the 1954 Social Security Act amendment to preserve the rights to old-age and survivors insurance benefits during disability. Achievement of the goals contemplated in the new legislation will require greatly increased financial support for the program by the Federal Government and by the States.

THE NEW VOCATIONAL REHABILITATION LAW

The Vocational Rehabilitation Amendments of 1954 provide for continuation of the existing State-Federal program, with certain basic changes and additions which are summarized under the headings which follow.

New Grant System

The act provides for a three-part grant structure consisting of grants for the support of basic vocational rehabilitation services, grants for extension and improvement of these services, and grants for special projects.

Support grants will be allotted to the States on the basis of population weighted by per capita income. The law provides for maximum and minimum allotments through an allotment formula similar to that embodied in the Medical Facilities Survey and Construction Act, which authorizes Federal aid for the construction of hospitals, rehabilitation facilities, and other medical facilities. Application of the formula will result in establishing both a minimum and maximum increase in Federal funds each year to all States as compared with 1954, provided that the Federal appropriation for support grants each year exceeds $23 million.

Extension and improvement grants will be allotted to the States on the basis of population, with provision for a minimum allotment of $5,000 or such other sum as the Congress may specify in making appropriations. This type of grant will comprise funds to be used for extending and improving rehabilitation services incorporated in the State plan. A Federal share of 75 percent is authorized for each State, limited to 3 years for any one project.

Special project grants include:

(1) Grants to States and public or other nonprofit organizations and agencies for paying part of the cost of projects for research, demonstrations, training and traineeships, and projects for the establishment of special facilities and services which hold promise of making a substantial contribution to the solution of problems in vocational rehabilitation that are common to several States.

(2) Grants for 1955 and 1956 to aid in a substantial nationwide. expansion of rehabilitation programs in the States. Public Law 565 does not specify any rate at which grant recipients must match

Federal funds, but appropriation language, subsequently enacted, does require that the Federal share of a grant not exceed two-thirds of the total.

Those States which have separate agencies serving the blind are given complete latitude in dividing the allotments between the agencies serving the blind and those serving the sighted disabled, except for that portion of their support grants which constitute their base allotments. This will be divided as the 1954 allotment was divided. Separate Federal shares for matching the base allotment will be used until the new matching provisions are fully in force in 1963.

The amounts authorized for grants in the law are $30 million for 1955, $45 million for 1956, $55 million for 1957, $65 million for 1958, and such sums as the Congress may determine for each succeeding year. The amount for each type of grant is to be specified in the annual appropriation act, except that the first $23 million of the aggregate appropriation will be reserved for basic support grants.

Expansion of Types of Services

The new law continues the entire range of rehabilitation services now authorized (see p. 227), and provides for some services that are new. The new features include authority for Federal participation in expanding, remodelling, or altering existing buildings to render them suitable for use as public or nonprofit facilities for rehabilitation of the severely disabled, or for sheltered workshops for training and employment of the severely disabled. Under the new law, Federal funds may be used to provide initial equipment and—in the case of rehabilitation facilities-to provide the staff during the first year of operation. This feature of the new law will supplement provisions for construction of rehabilitation facilities under the Medical Facilities Survey and Construction Act of 1954.

Training Professional Personnel

The shortage of trained personnel to work with the disabled constitutes one of the most serious problems in rehabilitation. To meet this problem, the new law authorizes Federal participation in the training of professional personnel in the varied specialized skills demanded in this field. Specific provision has been made for teaching grants and traineeships.

State and Local Administration

The law relaxes previous requirements that responsibility for administering the program must be borne by State boards of vocational education. Henceforth, the States may, at their own option, either continue their rehabilitation programs under their boards of vocational education or place them under separate agencies concerned primarily with rehabilitation.

In each State which has a separate agency serving the blind, this agency henceforth may function as the sole State agency responsible for administering that part of the State plan relating to rehabilitation. of the blind.

Further flexibility is provided under the new law in authority for the States to decentralize administration of their rehabilitation programs to county, municipal, or other governmental agencies. When such decentralization is effected, however, supervision will be exercised by the State agency for vocational rehabilitation.

Coordination Among Public Agencies

The new law encourages strong cooperative relationships between State agencies for vocational rehabilitation and all other agenciessuch as public employment services-which provide services needed in the vocational rehabilitation and job placement processes.

Within the Federal Government, coordinated planning is a requirement of the new law. The Secretary of Labor and the Secretary of Health, Education, and Welfare are directed to develop and recommend to appropriate State agencies policies and procedures which will promote the employment of disabled men and women who have received services under the rehabilitation program. In addition, the Secretaries of these two Departments are directed to work with the Chairman of the President's Committee on Employment of the Physically Handicapped in developing methods to secure the maximum use of services of the Committee and its cooperating State and local organizations in promoting employment opportunities for the disabled.

Federal Administration

The new law continues, with even greater emphasis, the responsibilities of the Department of Health, Education, and Welfare for the exercise of leadership in the rehabilitation program. The Department is required to make studies, investigations, demonstrations, and reports on various aspects of the needs and abilities of handicapped people; to conduct demonstrations of new rehabilitation techniques and methods; to provide technical assistance to the States; to disseminate public information regarding the program; and otherwise to promote the cause of rehabilitation and employment of disabled people.

Amendments to the Randolph-Sheppard Act

The new legislation also strengthens the program of licensing the blind to operate vending stands in Federal buildings. Amendments to the Randolph-Sheppard Act of 1936 extend provisions of that act

to Federal property as well as Federal buildings, and give preference for the establishment of vending stands to licensed blind vending-stand operators. These amendments require heads of Federal agencies in control of Federal property, after consultation with the Secretary of Health, Education, and Welfare and with the approval of the President, to prescribe regulations designed to assure such preference. The assignment of income from vending machines also must be made in a manner to achieve and protect this preference.

HIGHLIGHTS OF 1954

Total expenditures for the public rehabilitation program during 1954 amounted to $35.4 million. Of this sum, $23 million was supplied by the Federal Government, and $12.4 million came from State and local sources.

It is estimated that the disabled persons rehabilitated for gainful work during the year are now paying Federal income taxes on their earnings at a rate of $8.5 million a year. Thus, in less than 3 years they may repay the equivalent of the entire Federal investment in the program during 1954.

The cost of operating the program during 1954 amounted to $634 per individual rehabilitated.

Of the 55,825 disabled men and women restored to productive work during the year, 6,500 had substantial visual defects, including 3,300 who were blind.

At the close of the year, 126,770 disabled men and women were receiving services from the 88 State agencies for vocational rehabilitation.

About 3,000 of the men and women rehabilitated during the year entered professional fields such as education, medicine, and engineering. More than 7,000 of them are in the skilled trades, and about 5,200 are employed in agriculture.

The Nation has gained another 86 million man-hours a year of productive effort through the restoration of this year's group of disabled men and women to gainful employment.

The disabled people who were rehabilitated during the year increased their combined annual earnings from an estimated $15 million prior to their rehabilitation to an annual rate of $102 million after their placement in jobs.

More than 41 percent of the $21.2 million used for the purchase of services for disabled beneficiaries of the program during the year was spent for medical services, which included examinations, treatment, hospital and convalescent care, and prosthetic appliances.