be able to focus the limited resources in the areas of greatest needfor example, in poverty areas?

Dr. BOGGS. Let me say, first of all, that every major Federal program which involves activities which have to be carried on at the State and local level should, in our opinion, consist of both formula grant money and project grant money.

The reason there is no project grant provision in title I, I am sure, is that there already exists a broad-by that I mean broad in terms of its applicability-project grant authority available to the Division of Mental Retardation.

Senator KENNEDY. Is that under the Mental Retardation Act?

Dr. BOGGS. No, it derives from a special phrase added in 1968 to section 4 of the Vocational Rehabilitation Act. It was incorporated as an amendment proposed by Senator Hill. It makes possible project grants related to rehabilitation of the retarded without limitation to vocational rehabilitation.

Senator KENNEDY. How much money is involved?

Dr. BOGGS. For fiscal 1970, $4.5 million has been requested. This year is the 1st year under which project grants will be funded under the "section 4" authority. This is called "rehabilitation service projects” in the table we have appended to our prepared statement. It does everything that the administration talks about except provide project grants for construction.

It provides all the other things, training projects, service projects, demonstration projects, and so forth. It is a very useful little thing.

What do they ask for? For $42 million for projects for the entire country for 1970. That could be expanded without any more attention to substantive legislation.

Senator KENNEDY. They have not had a project grant authority before?

Dr. BOGGS. The Division had a project grant authority when it was part of the Bureau of State Services of the Public Health Service. It began in 1963-64 and was gradually built up to $5.5 million in fiscal 1967. Then after the Partnership for Health Act, funds were no longer available specifically for mental retardation, and the Division was without general project authority and leverage in fiscal 1968 and 1969. Senator KENNEDY. Do you believe that there should be a clearly spelled-out project grant authority in S. 2846?

Dr. BOGGS. While not absolutely necessary, such an authority would strengthen the bill if it were not allowed to diminish the basic formula grant provisions.

Senator KENNEDY. Do you believe that project grants are needed to reach the areas of greatest need?

Dr. BOGGS. Not necessarily, not federally administered project grants; with a properly structured formula grant, you can assist the States in doing the job in the areas they identify as high priority areas. Don't think the States don't know where these problems are.

In further response to your question, the important things are, I think, first, the fact that project grant authority alone is not enough; if the project grant authority were big enough to do the job in deprived areas, it should not be a project grant authority. Secondly, Secretary Black yesterday showed a lack of understanding of the nature of the problem in the so-called poverty area when he kept talking about the

necessity for putting facilities "in the places where 75 percent of the retarded are.'

Now, in MR68 there was a map, on page 18, of St. Louis which purported to show, and I think did show to a considerable extent, that there is a correlation between the school enrollment of mildly retarded educable children and the existence of poverty.

It showed the proportion of all schoolchildren who are enrolled in special classes for the educable mentally retarded, by census tract. It showed that the highest concentrations were in areas designated as poverty areas.

The majority of these people, the mildly retarded, don't need specialized facilities for the retarded. They don't need to have a building apart marked "institute for the retarded." They need to have specialized services, from specially trained people, services built into the neighborhood health centers, into the education system, into the social service systems, so that their needs can be met where they naturally come for service.

They do not need to get a big separate installation and a big label "mental retardation" placed on them in that way.

They need to be seen for what they are, if they are indeed mentally retarded, by the people who deal with them, who attempt to assist them professionally with their problems.

Let me digress for a moment and tell you that a recent followup study of the retarded in the public schools of New York City reveals a very interesting thing.

It showed that whereas the enrollment in special classes for the retarded in New York City of Negro children was approximately proportional to the total number of Negro children in the New York public schools, the enrollment of Puerto Rican children in special classes was double and the enrollment of other white children was half, in proportion to their enrollment in the public school system.

What this says is that Puetro Rican children are being identified as mentally retarded under situations that raise grave questions as to whether this is true mental retardation or whether this is the result of their failure to respond to the tests that we give them in a language foreign to them.

Now this issue has become a hot one in Los Angeles recently, because of the large Mexican-American population there, to such an extent that the Los Angeles city schools have forbidden the giving of so-called IQ tests to first and second-graders lest the children get a label that they should not have, of mental retardation.

Now I am saying this to point out that when Mr. Black says clearly "75 percent of the retarded are in the poverty areas" he hasn't distinguished the mildly retarded from the severely and profoundly retarded.

In MR69 there is a map showing distribution, showing the number of identified profound and severely retarded persons in Los Angeles County overlaid with an indication of where the poverty areas are.

I think if you remove the overlay on the poverty areas here and if you take account of the density of population in the tracts which concentrate more in the center of the city, the very few people could look at that map and say, "Oh, well, I can tell from that map where the poverty areas are."

We don't deny that there is some correlation between the conditions of poverty and the conditions of severe mental retardation. There is some correlation because lead poisoning, for example, which is a very devastating cause of severe mental retardation, is more common in dilapidated housing areas than in the suburbs. There are other factors. also. But basically, the distribution of severely and profoundly retarded children and adults is not so very, very different in the different socioeconomic groups, and there is desperate need in all of them. Now, if Mr. Black only knew it, we in NARC were among the first to point out to the administration back in 1965 and 1966 that the functioning of Public Law 88-164, for the reasons he outlined, was not resulting in facilities for the retarded being built in the poorer parts of town.

This had to do with the matching formula, the low Federal share in urban States, and with the laissez faire dependence on local private initiative, which was stronger in the more privileged areas, and it had to do with the lack of any visible means of supporting the program after it got going.

We have addressed ourselves to this problem in NARC. Mr. Black didn't tell you that half of the staffing grant money that was awarded in mental retardation, went into areas known to have urban and rural poverty.

Your bill addresses itself to this problem. I think I mentioned in my testimony that the bill requires States to give priority attention to the areas of urban and rural poverty. I also mentioned the proposal for increased Federal matching under the construction provisions in title IV of the act.

It should also be pointed out that many of the existing programsother existing programs-can be brought to bear on the mildly retarded in the poverty area and should be brought to bear.

So this argument seems to me to have been distorted. It is clear that we need to get more facilities for the moderately, severely and profounded retarded in the poverty areas. There is no question about it. Your bill would permit this to be done, would provide incentives for it to be done under a formula grant approach.

Another thing we might mention is that Mr. Black kept saying that the distribution of mental retardation is not equal among the States. If you assume mental retardation is more present in poor States than in wealthy ones, let me point out that the formula for allotting the funds gives attention to that. The per capita income in Mississippi is about half the national average and in Nevada it is about twice the national average.

Fiscal resources of the States are taken into account in the formula for allotting the funds under the present act which would be continued under your bill. I think this is not a good argument for an exclusively project grant approach.

Senator KENNEDY. What about the level and duration of funding under the bill. Do you think it is adequate?

Dr. BOGGS. I would say it is minimal. What we have been getting and are likely to get is less than minimal, however.

Senator KENNEDY. Is there any point in putting in an authorization which is above a realistic level that can realistic level that can be expected for appropriations?

Dr. BOGGS. Yes. I think the authorizing legislation should reflect the need realistically, not grandiosely, but realistically. The limits set in Public Law 88-164 could and can be justified.

For 1970 it authorizes $20 million for part B, enough for six or eight facilities. In S. 2846 you ask for $20 million a year for 5 years. If we could achieve this level we could fund one per State or one per 4 million people by 1975 and be at full production in training professionals by 1985.

For 1970, part C construction is authorized at $50 million. This is the annual level that was proposed by the President's Panel in 1963. Allowing for the fact that we have put up less than 100 million Federal dollars in 5 years, for inflation and for population growth, a level of $75 million rising to $200 million just for construction and just for mental retardation is not out of line.

Costs of services quite properly outweight construction. At present the States and counties are putting up more than a billion dollars a year for the care, training, and rehabilitation of the relatively small group a quarter million of the retarded who require residential care. If Federal aid is to give the desired lift and new directions to this program, more than token dollars will be needed.

On this basis alone, the $100 million specified for 1971 in S. 2846 is a "barebones" statement of need for the retarded alone. Increases in subsequent years should reflect the expanding attention to needs of the retarded plus a markup, eventually reaching 50 percent, as other developmental disabilities are phased in.

Senator KENNEDY. How about duration; is a 5-year authorization too long?

Dr. BOGGS. Five years is none too long and 3 years is too short-too short to enable the bureaucratic machinery to revolve and produce results before we have to come back to you again to extend the program.

In my State, we used to have required automobile inspections every 6 months—and a jam-up. The law was changed to require annual inspections. The accident rate wasn't accentuated by the jam-up was eliminated. If Congress wants to get home before election day, it can do so by giving some of these programs less congressional oversight and more time on the road between inspections.

Senator KENNEDY. I want to thank you very much, Dr. Boggs. You have covered a number of different areas and it is extremely helpful

to us.

Again, thank you very much. You have been a great help to this committee. The testimony you have given will be extremely valuable to us.

Dr. BOGGS. Thank you for your kind attention and courtesy and for sponsoring the legislation.

Mr. HAYES. Thank you very much.

Senator KENNEDY. Our next witnesses will be Dr. Robert E. Cooke and Dr. Arnold Capute from Johns Hopkins University. Dr. Cooke was trained at Yale in pediatrics and physiology. His first experience with the retarded was in 1944 at the Southberry Training School in Connecticut. He served under President Kennedy on the President's Panel for Mental Retardation, and was a member of the President's Committee on Mental Retardation under President Johnson and

President Nixon. In addition, he was Chairman of the Planning and Steering Committee for the Headstart program. He has two severely retarded children.

Dr. Capute was a practitioner in pediatrics on Long Island before coming to Johns Hopkins. During his practice, he had the opportunity to see the hardships of families with severely retarded children, and he came to Johns Hopkins for special training in this area after many years of private practice.

We want to thank both of you gentlemen for being here today.

STATEMENT OF ROBERT E. COOKE, M.D., PROFESSOR OF PEDIATRICS, THE JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE, AND PEDIATRICIAN IN CHIEF, JOHNS HOPKINS HOSPITAL, BALTIMORE, MD.; ACCOMPANIED BY ARNOLD CAPUTE, M.D., DEPUTY DIRECTOR, JOHN F. KENNEDY INSTITUTE FOR HABILITATION OF THE MENTALLY AND PHYSICALLY HANDICAPPED CHILD, JOHNS HOPKINS UNIVERSITY, BALTIMORE, MD.

Dr. COOKE. Thank you very much, Mr. Chairman. It is a great pleasure and privilege to testify this morning.

I would like to point out that as acting director of the John F. Kennedy Institute for Habilitation of the Mentally and Physically Handicapped Child I have, I think, immediate experience with the problems of the university-affiliated facilities and will address more of my remarks to that problem; but, my remarks are pertinent as far as title I is concerned, also.

It is worth pointing out that the Kennedy Institute which is the university-affiliated arm of the Johns Hopkins Medical Institutions is built in the center of one of the ghettos of Baltimore and does represent an opportunity to provide services to the handicapped who are in addition very impoverished.

I am appearing in support of Senate bill S. 2846, just as I had the pleasure and privilege to appear in support of the Mental Retardation Facilities and Community Mental Health Centers Construction Act of

1963.

As a professor, and as a consultant to the U.S. Public Health Service, and later, as a consultant to the Social and Rehabilitation Services Administration, I have had the opportunity to view the accomplishments of that act.

It led to the creation of mental retardation research centers where concentration on the cause and prevention of serious developmental disabilities, as well as research on diagnosis and treatment, has been carried out.

Since that time, successful work has been carried out on projects such as rubella, and such as the various genetic and chemical abnormalities which produce serious retardation, now called inborn errors of metabolism.

When the previous legislation was passed, there were some 25 serious disorders of unknown cause. It is now known that these are caused by a specific chemical abnormality. Approximately 1 dozen of these can now be treated through chemical, dietary, or other means.

These research centers have given us adequate information to detect the carrier state of serious genetic problems. For example, there is