Problems and goals II. MENTAL AND PERSONALITY DISORDERS VRA's research efforts last year, as in previous years, were largely directed to the solution of the problems of two groups of the emotionally disturbed: (1) Institutionalized mental patients who had received maximum medical treatment but were not discharged from hospital care because they were judged incapable of establishing and maintaining an independent living status outside the institution; and (2) ex-mental hospital patients whose social and vocational adjustment was unsatisfactory. Vulnerability of special populations to mental pathology as expressed in symptoms such as alcoholism, narcotic addiction, recidivism, delinquent behavior, and social and mental disjunction has been of special concern. Accomplishments During the past year researh efforts focused on the development of methods complementing treatment provided by medical and custodial institutions to facilitate the discharge of the mentally ill from institutional to community life. Five principal approaches were utilized to effect this transition: (1) Provision of paramedical services designed to develop that minimal degree of social and Vocational readiness in patients requisite for their discharge to the community; (2) development of procedures, evaluative instruments and measures indicating reasonable ability to benefit from prevocational and vocational services available in the community; (3) provision of transitional facilities that offer expatients or former inmates an opportunity to learn under relatively sheltered conditions how to cope with the personal, social and vocational problems whose resolution is essential for later adjustment in the wider community; (4) provision of work therapy and training; and (5) development and coordination of community groups and supportive resources to complete the re-establishment of the mentally recovered patient as a self-regulating and self-sustaining member within the community. In The series of approaches developed by research has had significant influence on rehabilitation practice and on the productivity of the rehabilitation program. The increasing number of mentally ill vocationally rehabilitated by the FederalState program each year supports this view. For example, in 1963, out of a total of 110,000 disabled rehabilitated, 7,827, or 7 percent, were mentally ill. 1964, the most recent year for which figures are available, out of a total of 120,000 rehabilitated, the number of emotionally disturbed rehabilitated was 13,862, or over 11 percent. Substantial increases are predicted for fiscal year 1966 and fiscal year 1967. Psychological research indicates that there is little or no relationship between severity of mental illness and duration of hospitalization. Enhancing the capacity of mental patients to develop and maintain interpersonal relationships and promoting their involvement in meaningful activities are some of the principal methods introduced by rehabilitation research to facilitate or promote the readiness of the mentally ill for egress from an institutional setting. Evaluation, counseling, group therapy, and work conditioning provided within the hospital or custodial institution are some of the specific techniques developed. A demonstration project conducted by the Camarillo State Hospital, Camarillo, Calif., offering patients work assignments in the hospital bakery, followed by vocational counseling, evaluation, skill development, work conditioning in a community workshop, followed by placement in private industry, proved to be another effective method for effecting the transition of the mentally ill from hospital to the community. The benefits of a continuous relationship initially established between severely depressed mental patients and social workers and continued for a period of 2 years after discharge from a hospital was tested by the Massachusetts Mental Health Center, Boston, with the finding that the continuous relationship, as compared to other services, was a significant factor in progress toward rehabilitation. Research demonstrating the advantage of offering rehabilitation services to hospitalized mental patients was tested in other institutional settings. Notable among these are three projects offering rehabilitation services to physically disabled prison and reformatory inmates in preparation for parole. Two of these were successfully completed recently; the third will be completed during the 1967 fiscal year. A number of projects completed last year have tested a variety of promising work therapy and training techniques intended for varied groups of the emotionally disturbed. Notable among these is the project concluded by the Jewish Vocational Service, Chicago. A unique feature of the therapeutic work program offered to former mental patients was exposure in a workshop setting to work at increasing levels of difficulty and complexity. Over time, the ex-mental patient became vocationally hardened and increasingly more able to meet the reality demands and conditions of work prevailing in industry. The 4-year project of the Thresholds, a sheltered workshop established by the National Council of Jewish Women, Chicago, offers, among others, an interesting example of a transitional employment program for ex-mental patients. In this research demonstration emotionally disturbed clients were evaluated and counseled at the workshop. Following this, they were placed for a period of a month in transitional employment in which employers agreed to permit some latitude for deviant behavior and adjustment of expected performance level to ability. Upon successful negotiation of the trial employment, the emotionally disturbed person was placed in competitive employment. Therapy work programs similar to the above also have been conducted for the benefit of disturbed adolescents and other special groups. Noteworthy among completed projects of the latter type is the workstudy program for emotionally disturbed and brain-damaged adolescents conducted by the Board of Cooperative Educational Services, Bedford Hills, N.Y., in cooperation with the local public schools. 1967 proposed program In 1967, a total of $2,795,000 is needed to support a total of 50 projects. This will permit an increase of one project at a cost of $63,000. Continuing attention will be given to work therapy, one of the more promising ways to prepare the emotionally disturbed to prepare for and accept the reality conditions of work and productivity expected from normals. A variety of programs needed to be provided to prepare patients for work that is not only economically profitable but also personally satisfying. The therapeutic value of work has been acknowledged by limited segments of industry; successful experiences need to be replicated in wider industrial settings. The involvement of coworkers, foremen, and other supervisory personnel in work therapy efforts in behalf of the mentally ill is necessary not only for expansion of vocational opportunities but also because the manifest concern and involvement is a sustaining therapeutic benefit to the emotionally disturbed person. In addition to meeting needs of the mentally ill, transitional facilities may be devised for special groups of emotionally disturbed; the delinquent, narcotic addict, recidivist and alcoholic. Problems and goals III. REHABILITATION OF DEAF PEOPLE Deafness is, in fact, a multiple handicap. Total lack of hearing prevents the individual from using a major way of communicating with others. For those who are born deaf, their handicap imposes a most serious deficit upon their ability to learn language, which is fundamental for future intellectual and educational development. Finally, and perhaps most penalizing of all, deafness is a hidden disability. The deaf person moves and lives in a hearing world. unidentified but isolated. VRA has long given special priority to research and demonstration projects which attempted to define and resolve the many problems of the deaf. Many questions remain to be answered. For instance, how best can the deaf be helped to secure and keep jobs in spite of the fact that their traditional entry jobs in industry are rapidly being eliminated by automation. The deaf ask whether they can realistically hope for job advancement and promotion or whether they must confine their goals to low-level jobs and menial tasks, as at present. On the social front, research is showing many unmet needs for the deaf. Many hearing children of deaf parents seem to develop serious and longlasting psychosocial problems unless concerted efforts are made to provide them with continued, supportive contact with hearing adults. At present, the deaf do not have access to the kinds of medical guidance and advice that are so readily available to all other segments of our society: few physicians know how to communicate through finger spelling and the language of signs and written messages is a poor foundation for an adequate diagnosis. This language barrier is particularly evident in the area of mental health counseling for the deaf. Many deaf individuals who need and could benefit from such guidance will develop serious and incapacitating problems if it remains unavailable. The question of how psychotherapy can be carried on between a psychiatrist and a deaf patient through manual communication is just now beginning to be answered. Basic to all these problems are the unanswered questions about the language development and functioning of the deaf and the yet undiscovered ways that creative and flexible language skills can be taught to them effectively and efficiently. Accomplishments Investigations are being continued and broadened on a national level to determine the actual occupational status of young deaf adults. Two intensive surveys have already been completed in the New England States and the Southwestern States and the findings were combined with those from earlier VRAsponsored studies of the vocational achievement of the deaf in representative urban and rural communities. The most significant findings to emerge from these investigations was documentation of the fact the deaf, as a group, were not receiving vocational training of a type which would prepare them to compete for or retain jobs in the present day labor market. Much of their present training was for jobs which are rapidly being eliminated by automation. An immediate outgrowth of these survey findings will be the newly authorized National Technical Institute for the Deaf. Another of many discoveries to emerge from these research surveys was the fact that most deaf adults who are working are grossly underemployed in view of their inherent intellectual and personal capacities. As a consequence of this finding, VRA-sponsored projects are now underway in St. Louis, Boston, Chicago, and Hot Springs, Ark., to demonstrate the long-term value to society of providing continuing vocational counseling and training to the underemployed deaf adult as well as to the unemployed deaf person. These projects are also investigating the economic and educational feasibility of providing such services for the deaf in existing rehabilitation facilities, under the guidance of specially trained personnel, rather than in more expensive and virtually nonexistent vocation training centers established exclusively for the deaf. Several projects are underway to demonstrate ways in which the hearing community can assist the deaf to become active and well-informed members. Two sociologists from Catholic University are completing their second study of the personal and social interaction of deaf and hearing people within a community in an attempt to discover unmet needs and unrecognized deterents to effective relationships. San Fernando Valley State College in California is also demonstrating the extent to which the State and community can provide such needed assistance to the deaf in obtaining the adequate medical, legal, and business guidance which most citizens take for granted, but which the deaf cannot secure because of their language problems. In addition, DePaul University in Chicago is instituting a metropolitan mental health facility for the deaf. Research scientists from other professional fields are also beginning to turn their interests and talents to the problems of the deaf. Engineers at Northwestern University, Wayne State University, and Gallaudet College are perfecting new teaching machines which should greatly improve methods of teaching intelligible speech to the deaf. Joint research is being conducted by Ohio State University and the University of Zagreb, Yugoslavia, on a dramatically new technique for teaching the totally deaf to utilize sounds for the understanding of speech. Further efforts along these lines relate to a project which is investigating the possible usefulness of technological developments coming from the space program as new sensory aids for the deaf. On another front, research projects at Vanderbilt University, Catholic University, and the Institute for the Deaf in the Netherlands are investigating ways in which the lack of creative language and thinking in the deaf can be overcome. Proposed program, 1967 In 1967, a total of $918,000 is requested for 18 projects. This will permit an increase of one project over 1966 at a cost of $100,000. Emphasis will be given to the establishment of one demonstration center to develop and test better methods of vocational evaluation and assessment of the deaf, techniques for their placement, specific counseling methods, and ways of establishing a closer association with business and industry during on-the-job trials. Efforts to expand the number of professional fields in which the superior deaf adult may find employment will also be made. Supporting these activities, research will continue into ways of improving the language and the psychosocial relationships of the deaf so they may function more effectively and completely on the job. Continued search for new sensory aids for the deaf will be conducted. Problems and goals IV. SPEECH AND HEARING DISORDERS The special needs of stroke victims, particularly those with debilitating language problems due to aphasia, have recently received nationwide attention. Unavailability of crucial specialized services within the aphasic's home community, particularly language therapy, poses insurmountable problems for most aphasics living outside large metropolitan areas. New methods of extending services to those people and/or training other family members to assume the task must receive highest priority. The use of programed teaching machines represents one partial solution to this problem, but self-teaching programs must be developed and evaluated. The spotlight of attention given to this affliction merely highlights the problems which are as yet unsolved. Equal attention has recently been given to cancer victims. In great need of rehabilitation are those who have lost their larynx because of cancer, and thus, their ability to produce voice. Such a sudden handicap usually results in loss of job and loss of family responsibility. Training procedures now exist to help the laryngectomees learn to use esophageal speech, but too often, those methods fail. Many individuals, therefore, go for the rest of their lives without the ability to speak. Reasons for this failure must be found. Better techniques for identifying those people who will be able to learn esophageal speech-and those who will not-are needed. Programed learning methods also need to be considered as possible retraining procedures. Presurgery personality factors deserve investigation as probable reasons for postsurgery response to rehabilitation efforts. Stuttering is another widespread speech handicap which deserves great research attention. Over 1 million people in the United States suffer from this affliction. The problems of the adult stutterer are particularly damaging and cause the individual to lead a restricted and sterile life. Underemployment is perhaps the stutterer's greatest self-imposed affliction. Better ways of helping stutterers achieve and retain more normal speech must be found. To do this. better methods of judging the effectiveness of speech therapy are needed. The goal is doubly worthwhile since if the stutterer's speech can be improved, most of the associated psychosocial and vocational problems which his stuttering creates will also be eliminated. The problems of the hard of hearing require more intensive attention. Deteriorating job performance, eventual loss of job, and gradual withdrawal from family and society are three of the more obvious results of gradual and progressive hearing loss. The problems of the hard of hearing are many. Much remains to be accomplished in helping the hard of hearing person retain the skills he had before the onset of this handicap. Better diagnostic methods need to be developed to permit earlier prediction or identification of hearing loss. Accomplishments Finding ways in which the stroke patient with aphasia can obtain more intensive language retraining is the purpose of a research project being conducted jointly by Ohio State University and the Catholic University of the Sacred Heart in Milan, Italy. Devices and materials are being developed and evaluated which provide the aphasic with opportunities for intensive drill and self-instruction in language during periods in which he is not receiving formal speech and language training from a qualified therapist. A new type of teaching machine, designed specifically with the aphasic's problems in mind, has been developed and is being tested in several clinical settings. This device, utilizing a typewriter keyboard. promises to increase tenfold the amount of self-training opportunities presently available to the aphasic. Several research programs are presently underway to determine between ways of helping adult stutterers obtain normal speech. Speech pathologists at Northwestern University are conducting careful studies of the therapeutic progress of stutterers, and concomitant psychological and physiological changes, in an attempt to determine factors associated with an improvement in speech and to predict the likelihood of a patient's successful rehabilitation. At Western Reserve University, work is underway to develop methods whereby reliable and precise judgments can be made of a stutterer's speech improvement. At present, most of VRA-sponsored projects involving the hard of hearing concern the development of more precise audiologic measures to be used in diagnosis. Two projects, one at the Houston Speech and Hearing Center and the other at the University of California Medical School, are independently investigating audiological findings which are proving to be predictive of the outcome of surgery for patients with particular types of hearing loss. The University of Oklahoma Medical Center, Johns Hopkins University, and Vanderbilt University are undertaking the development of new audiologic tests which promise to provide some of the kinds of specific information State rehabilitation counselors and others need to be of greatest help to their hard of hearing clients. Proposed program 1967 For 1967, $453,000 is requested for 19 projects. This amount represents an increase of one project at a cost of $21,000 over the 1966 program level. Primary emphasis will be given to the development and establishment of better rehabilitation methods for the aphasic patient and the laryngectomized person. Community demonstration projects, involving a multidisciplinary approach, will be encouraged. Research concerning better diagnostic and treatment methods for laryngectomized patients will receive high priority. In the area of stuttering. particular attention will be given to new ways of rehabilitation. Determination of the true vocational significance of partial hearing loss seems to be a most critical need at this time and efforts will be made to find such answers. Problems and goals V. REHABILITATION OF THE BLIND PEOPLE Job opportunities for otherwise intelligent and capable blind people are becoming more restricted. Industrial jobs are usually low level and farming tasks are fast disappearing; professional jobs are aggressively sought by aspiring, sighted workers; and higher education for the blind is an arduous and demanding hurdle. To be able to meet these challenges requires that ways be found to help the blind compensate for and overcome their deprivation. Ways in which new inventions might be of value to the blind and of transmitting this information to manufacturers must be found in order to incorporate technological advances into the design of new prosthetic devices. Also, new fields of employment must be investigated, particularly those in which the blind might have an advantage over a sighted person. Improved ways of testing the true capabilities of the blind individual must be developed. The blind person must also be helped to grow and function as a normal person who has no sight. This is the greatest challenge. It means discovering the emotional pitfalls to which the blind are particularly vulnerable so that they can be predicted and avoided. Accomplishments The American Foundation for the Blind, with support from VRA, has undertaken two projects, the successful completion of which will constitute a major contribution to the improvement of the quality of services to blind children and adults throughout the United States. One project is a major study designed to help raise the performance level of specialized agencies and institutions serving blind presons by identifying and codifying standards for performance in all aspects of rehabilitation services for the blind. Several committees have addressed themselves to this task. The second project is a study of the salaries and education of professional and administrative personnel who work with the blind. Another project, being conducted by the Pennsylvania Department of Public Welfare, is investigating the job placement and performance of the visually handicapped in professional, sales, and managerial work. The purpose of these projects is to provide specific, practical information which will permit blind people to be placed successfully in these various occupations. The Division of Vocational Rehabilitation in the District of Columbia is developing new mechanical modifications for automatic vending machines which will permit blind operators to manage them independently and competitively with a sighted servicement. A new professional field for the blind is being investigated at the University of Cincinnati Medical School and at the University of Southern California. |