Page images

Mr. Rogers. I would think you ought to let us know what is definitely needed, because I think the committee will want to look at this rather closely. I presume you would agree that a migrant health center ought to provide primary health services, would you not?


Mr. Rogers. And referral to providers of supplemental health services. Should they help in referring those ?

Dr. BATALDEN. Yes, and even as defined by your bill, some of those supplementary services, for example, dental services, are provided by the migrant projects already.

Mr. ROGERS. I have been impressed with what you have done with what you have in the migrant field. We are talking about improving the program. It is kind of patchwork now. There is probably $300 million needed, I would think, and we are doing it with $24 million.

I presume you agree that some environmental services, including protection and other services concerned with water supply, pest infection, field sanitation and housing conditions and other environmental factors related to health are needed. Isn't that proper?

Dr. BATALDEN. I can't disagree.
Mr. Rogers. How about infectious and parasitic diseases?

Mr. Rogers. Isn't that an appropriate function of a migrant health center?


Mr. ROGERS. Accident prevention, including prevention of excessive pesticide exposure.

Dr. EDWARDS. Some of this requires fairly close cooperation with ΕΡΑ. .

Mr. ROGERS. I would think cooperation is also necessary with the Department of Agriculture. But I would presume it is an appropriate function of a health center to be concerned with that?

Dr. EDWARDS. No question about it.

Mr. ROGERS. How about information on the availability of and proper utilization of health services? Would you agree that we try to do this?

Mr. Rogers. It looks like you approve our bill.
Dr. BATALDEN. No, we don't.

Dr. EDWARDS. Speaking to the latter point on information and education, at the suggestion or recommendation of the recent President's Commission on Consumer Health Education, we have, for the first time, established a focal point for consumer education.

We are spending a large amount of money on the consumer in IIEW on education. There is some question in my mind as to its value.

Mr. ROGERS. Of health education?

Dr. EDWARDS. Yes. We are trying to develop a focal point and see if we can't do a better job. They budgeted some $2 million in fiscal year 1975 for this. This is in addition to all the other money we are spending to see if we can't do a better job of health education.

Mr. Rogers. Where do you disagree with what we are trying to do in a migrant health center?

Mr. BUZZELL. May I respond? Under the current program, it is my judgment that we ought to devote those funds to the primary care and direct services to the migrant. That is where we want to place our priorities.

Mr. ROGERS. Isn't this all directed to that?

Dr. BATALDEN. It is directed there. I think our concern has to do with the prioritization for the high-impact areas and insomuch as that is not necessarily a bad priority, the plain fact is that at the present level of support for the programs with the mandatory percentage of appropriations being spent in high-impact areas, it would force us to close several projects in low-impact areas.

Mr. ROGERS. How many?

Dr. BATALDEN. We think that this year that would mean, or for next year, it would be 19 projects and 30-some the following year.

Mr. Rogers. Then, you are saying you need more money?

Dr. BATALDEN. No, I am saying with the statutory limits requiring a certain percentage of the appropriation to be spent in high-impact areas, we would have to close a certain number of projects.

Mr. Rogers. Then, you want that relaxed some?
Dr. BATALDEN. Yes, I think we may need to have that relaxed.

Mr. Rogers. But you think you ought to do a little something in the high-impact areas?

Dr. BATALDEN. There is no question about that. Of the 44 high-impact counties in the country, with 6,000 or more migrant farmworkers, we have a project in each of those counties.

Dr. EDWARDS. Mr. Chairman, I don't think it is a matter of our disagreeing with anything you wish to accomplish in your bill. There is a need, however, for more administrative discretion than you

Mr. Rogers. We are willing to let you have some administrative flexibility but we want a few guidelines. We want to have some results.

Dr. EDWARDS. I think there might be some question as to whether these are guidelines or regulations.

Mr. ROGERS. We find the Congress very seldom writes regulations sufficient to really control the programs. We find those regulations usually come from the executive and they sometimes pervert the law as intended. That is why these may seem a little more specific in order that regulations will not change the intent.

If you need discretion to include a little more in some of the lowimpact areas, I think this committee would consider that. But this is the type information we need.

Would you submit language for that?
Dr. BATALDEN. We certainly will.

[The Department supplied the committee with several loose leaf books of material including information on this committee request for information. The material may be found in the committee's files.]

Mr. Rogers. Mr. Preyer, I think you have some questions. Would you take over a minute here?

Mr. PREYER [presiding]. I had a couple of questions on development disabilities that I would like to ask Dr. Brown.

Is there any real need to add specific references to autism in the definition of developmental disabilities? As I understand it, no other specific disease is listed, but a description is given of which types of diseases should be covered. Does autism fit the description that is given for the other diseases?

Dr. Brown. Mr. Preyer, I would be offering a professional opinion as a psychiatrist and one who for years has been particularly involved in child mental health. I would very much favor the inclusion of autism on its own without any reference to whether it is neurological, psychological or what have you. I would say the reason for not having reference to these other guideposts is that autism's etiology is known. It is a complex syndrome, perhaps encompassing a number of disorders, and probably a result of many factors providing a particular kind of abhorrent behavior.

It is therefore a very complex, serious illness of children sometimes diagnosed as severe retardation or severe psychosis. Not referring to it as a developmental disability results in the exclusion of a large group of very ill children. But the developmental disabilities legislation is not in my immediate area. It comes under SRS. I am simply speaking as a psychiatrist and as the Director of NIMH.

Mr. PREYER. I would agree with you on its seriousness and the need to do something about it. The point I was attempting to make was, if action is not included under the description of these other conditions, then, isn't it different from the law's intent and should we approach it some other way?

Dr. Brown. I would have to take some time to look at the law and its intent. All I can report is that from practical experience, an important group of seriously developmental handicapped children are not receiving the benefit of State services.

Mr. PREYER. As a professional, Dr. Brown, and one experienced in thetreatment of disorders of children, do you believe that autism should, under the proposed legislation, be afforded the same attention and treatment as mental retardation, epilepsy, and cerebral palsy?

Specifically, is autism similar in the complexity of health resources that is needed to treat it to warrant its being considered with metal retardation, epilepsy, and cerebral palsy?

Dr. Brown. The question is long and the answer is short. Yes.

Mr. PREYER. Good. Your judgment on that is certainly one worthy of weighty consideration. I have no further questions at this time.

Mr. Symington, do you have some further questions?
I just want to follow up on the autism, Dr. Brown, just for a second.

Are you familiar with a little place in the St. Louis area called the Judevine Center for Autism, particularly children?

Dr. Brown. I have heard of it but I am not familiar enough to know its programs or details.

Mr. SYMINGTON. This was organized by distressed parents who couldn't seem to find any organized effort so they just set it up themselves. It is private. But it takes children who are deemed to be autistic. They have volunteers. The parents are invited to watch through one-way glass so they can kind of continue at home where the exhausted volunteer leaves off. They work long hours to get just one response.

They have a movie that is about 10 minutes long that telescopes about 1 month or 6 months of effort into getting the child to say "thank you." Then, in many cases, the child begins to improve and other response come along. I was there a year or so ago and was taken care of by about 1 dozen of the youngsters who had come in totally unable to communicate and were then able to say “here's your seat" and “here is your punch" and that sort of thing.

They are quite excited about the results. They are uplifted by it. This is just a tiny little effort made.

How do we share that experience? Is it important that we do? Should we just simply rely on a multiplicity of experience of this kind or should there be some kind of central focus and an opportunity for the big eye of the Federal Government to look and, then, the hand to share in other places some of these ideas? What do you suggest along these lines?

Dr. Brown. I have two responses. One is, if there is any condition which tests the spirit of humanity, which calls for continued effort and hope when things look hopeless, it is the amount of energy, effort and work that parents put into this autism condition, and with results.

Whenever there is progress, it should be shared. There is the National Society for Autistic Children which is active. At NIMH we have worked with the Office of Child Development to disseminate existing information as widely as possible. The problem is that results similar to what you describe come from such a wide variety of efforts, those who are serious and sincere advocates of large doses of vitamins, those who are serious advocates of behavior modification techniques, those who just use compassion and loving.

My own synthesis is that thus for the common denominator is the intenseness of concern and effort. However, it is our job as scientists to tease out substantive information as it develops and disseminate it. That is a more difficult task.

Mr. SYMINGTON. They use a room that can be made dark. If the child gets up and loses his attention, then, the room is dark. When he sits down again, it is light. He doesn't like the dark normally so that tends to get him to sit and to watch. Just the bottom of the line is that a number of these children have gone to school and are now in commensurate levels. I would hope that somebody from your shop could take a peak at that sometime just to be sure that it isn't just a lucky break but they may be developing a useful pattern of experimentation.

Dr. Brown. We will take a specific look. Recently, Dr. Hersch, who is my special assistant for child mental health, and I made a visit to Dr. Leo Kanner in Baltimore to review with him the first professional journal devoted to autistic children. Our visit was a moving experience. Back in the 1930's, Dr. Kanner saw autism as a difficult disorder to understand and treat but not something to be neglected.

In that spirit, I think I would very much like to visit the Judevine Center for Autism.

Mr. SYMINGTON. Thank you.

Mr. Rogers. I don't find much fact information in the testimony, and we need some facts. Let me just ask that written answers be given to the following programs if we may and, then, of course, there may be some oral questions as well. I would like to know in writing the dollars authorized for each program, appropriated and spent by year, 1970 through the proposed, 1975; the number of types of projects funded, copies of appropriate regulations and policies, the results of any evaluations conducted, the number of people served, the results of such

service, and the types of services given, and examples of programs' successes and failures; major problem areas encountered, and suggestions for legislative solutions.

Then, we would like to know who administers the program and what kind of staffing he has. If we could get this information by at least the first of March, it would be helpful because we plan to move on this legislation as quickly as we can.

I also have some questions on developmental disabilities and if we do not get to cover them, I would like to have those answered. Members might have questions they would like to have answered for the record as well.

[The Department supplied the committee with several loose leaf books of material including information on this committee request for information. The material may be found in the committee's files. ]

Mr. Heinz. Dr. Edwards, I notice that in your budget authority request that in a large number of the programs in the community health services area ; namely, comprehensive health grants to States, community, or neighborhood health centers, research and training for maternal and child health, family planning, migrant health, the National Health Service Corporation, that the amount of money that you are requesting is either the same or less as was requested in the previous year. Perhaps it is also less than what was spent in the previous year. I am not clear as to what the figures I have in front of me indicate in that regard.

We also know that health care costs increased 11 percent in 1973. If your goal, and I believe you have described it as such, is to maintain the present capabilities, how can you do it with 1974 or 1975 dollars that are worth a lot less than 1973 dollars ?

Dr. EDWARDS. That is an excellent point. Obviously, if the dollars are constant, we can't. We are doing some things that take our dollars further. Dr. Batalden mentioned some of the new initiatives we are undertaking to upgrade the quality of management, and administration in all of our programs.

At this point in time, we have reason to believe that we are going to have some fairly significant economies. We hopefully can maintain the present level of activity by instituting some of these changes.

Mr. HEINZ. You mean you found a way to save money in the management of a Federal program?

Dr. EDWARDS. These are funded Federal programs. They are also local programs. We have run into many instances whereby we can improve upon the quality of management and administration.

Mr. HEINZ. I think that is an outstanding discovery on your part and one, I think, you should share with us.

Dr. EDWARDS. Let me assure you that that is no discovery.

Mr. HEINZ. I do think, Mr. Chairman, that it would be very helpful to find out what those discoveries have been because I am sure we can find ways to apply them in other areas.

Dr. EDWARDS. Not only is this management but it is also our attempt to bring in as much from third-party reimbursements as we possibly can. Mr. Buzzell may have some specific figures on that.

Mr. BUZZELL. We are getting more money through third-party reimbursements and putting that money back into the center.

Mr. HEINZ. Who is "we" in this case?
Mr. BUZZELL. The projects.

« PreviousContinue »