mental retardation funds increased by reducing our military expenditures.

So I don't think we are trying to get into a situation where we must play mental health off against mental retardation. But I am struck by the fact that when we talk about the level of funding included in this legislation, and the administration officials say we are unrealistic, we also see figures much larger for mental health. We know what the needs are in mental retardation and we realize that the level of funding in S. 2846 is not unrealistic in terms of the need.

Dr. BARNETT. I think you have said it very well. We could look at other examples. Under the provisions of S. 314(d), where 15 percent comes off the top of certain formula awards to States for mental health, it was a great mystery to us at the State level as to why mental retardation was not included in this. We simply feel that there is an inequity as far as the total breakout of money here.

Mr. Chairman, my State and the National Association of Coordinators of State Programs for the Mentally Retarded wish to express to you and your colleagues on the committee our heartfelt thanks for all you are doing and we ask you to continue your assistance and support for millions of individuals who, while they may never know a normal situation as we know of it, can attain new levels of independence, happiness, and productivity.

I thank you very much for your courtesy and the opportunity to share with you these thoughts and observations.

I would like to make one final point. You alluded this morning, after the UAF training demonstration involving the various youngsters, that if the other members of the committee had been here we would have no problem. I will say for the State coordinator group and South Carolina: we will be glad to come back. Just let us know when.

Senator KENNEDY. Very good. That is very helpful testimony. Each Senator will exercise his own best judgment on the questions raised here, but I would hope that your organization, as well as representatives of other groups here, will communicate with your Senators and Congressmen around the country on these questions.

I think your organization could be extremely helpful in communicating and letting us know through your State representatives the kind of program we ought to have.

I would like to hear from the people on these programs. I find that has an impact. In the legislation which is introduced and which is cosponsored here, we have tried to take the best ideas and suggestions that have come to us. I am sure there are many other changes that can be and should be made in the bill. We hope to have those suggestions

too.

Dr. Barnett, you have performed a very useful service, and I hope that you will let us hear from you, and that you and the other members of your association will communicate your views to the rest of my colleagues. Thank you very much.

Dr. BARNETT. Thank you, Mr. Chairman.

Senator KENNEDY. Our next witness is Dr. John Noone.

Dr. Noone served with distinction as Superintendent of the District Training School for the mentally retarded in Laurel, Md., where he gained extensive experience with the problems of retarded children in the Washington metropolitan area. Dr. Noone has had the opportunity

to work closely with parents as well as retarded children, and he has seen firsthand the need for more and better community programs. In addition, Dr. Noone has served as Chief of Mental Retardation at the National Institute of Mental Health, and he has taught at George Washington University and the University of Maryland.

I welcome you, Dr. Noone, and I appreciate your cooperation in rearranging your schedule.

STATEMENT OF JOHN J. NOONE, ED. D., EXECUTIVE DIRECTOR, AMERICAN ASSOCIATION ON MENTAL DEFICIENCY

Dr. NOONE. It is a pleasure, Senator Kennedy.

I am here this afternoon at the request of our president, Dr. Wesley White, who is recovering from a rather serious illness prior to going to the Commonwealth of Massachusetts, my native State, where he will be the first nonmedical superintendent of one of the State schools there.

He has asked me to convey to the members of the committee his regret that he could not be present. He asked that I provide this testimony for the committee.

The American Association on Mental Deficiency, numbering over 9,500 professionals working in all levels of mental retardation, welcomes this opportunity to testify on behalf of S. 2846, the Developmental Disabilities Services and Facilities Act of 1969.

We are wholeheartedly in favor of this bill, and completely support the concept of a mechanism which will allow the States to develop and implement a comprehensive and continuing plan to meet the current and future needs of those affected by developmental disabilities.

We are pleased to note the provisions for the construction of facilities for these services, and the amendments for the expansion of the university-affiliated mental retardation facilities.

We seek here the operational support of these services.

When Congress passed the first major legislation for the mentally retarded in 1963, it gave new hope for the mentally retarded, their families, and those who work with them daily.

The provisions for construction of community facilities, centers for research, and university-affiliated facilities, better staffing patterns, the hospital improvement program, and its complementary hospital in-service training program, and other service-oriented programs have been like an oasis in a desert.

For years professionals had been aware of their inability to cope with tremendous problems in working with the mentally retarded, many of whom have concomitant disabilities rendering their development inadequate.

A grateful community bestows its thanks upon you and your predecessors.

There are still needs to be met, and we believe the provisions of S. 2846 will carry us a long way toward attaining the goal of a much better life for those so handicapped.

We are impressed with several key features of this bill, especially the opportunity for a State to develop a comprehensive plan to assess its program needs, and the authorization of allotments to States based on population, need for services, and finances.

This formula grant program is much more equitable and expeditious, and it should eliminate many of the discrepancies of the previous protect grant programs. It will tend to place responsibility back on the States and the local communities to plan wisely.

However, I think consideration needs to be given for more appropriate time for the States to plan. We note section 139 of the bill suggests that March 1, 1970, be the time when the Secretary will provide standards for the States. I think that the States will need a little more time in which to prepare. I am sure the committee can make the proper adjustments.

On the National Advisory Council, I would agree with my colleague, Dr. Barnett, that the membership be expanded. I think 12 members are now called for. For a program such as this, we need a greatly expanded council.

I suggest also that the university community be represented on the National Advisory Council; and by the same token, when the States establish their advisory councils, that the academic and the college community be represented on this important group.

We are pleased to note the provision for nonprofit agencies, institutions, and organizations to participate in the program by membership on the State council, providing services, and being eligible to receive funds for programs within the purview of the overall State plan. Too often we have not looked to the private sector to serve as a copartner in helping the handicapped and their families.

When I went back to the office yesterday afternoon, going through my mail, I came across correspondence from California. Two ladies here are very interested in opening a facility for the mentally retarded. They indicated they had gone through five major steps, received permission from all the respective agencies in the State, but then they say, "Now we have come to a standstill. Because of the tight money, high interest situation, we have been unable to obtain a loan."

I think this brings out the need for the private group to be more involved with the State programs, so that they can have "a piece of the action."

The Developmental Disabilities Services Act will enable States to look closely at local services and perhaps make a fresh beginning at the outset of the problem.

We all know that the sooner the disabling condition is diagnosed and services rendered, the better opportunity the child has for a more normal life, and the less trauma befalls the family. With more adequate services in the community, there is less likelihood that the child will have to leave home for residential or long-term care in a distant facility. Diagnostic evaluation, day care, recreational and counseling services for the child and parents, preschool programs, vocational rehabilitation and training, are but a few of the services needed on the localurban, and rural-level to help the developmentally disabled.

The American Association on Mental Deficiency recognizes the lack of standards in many of these areas for the mentally retarded, and is about to embark on a project to develop guidelines and standards. These should be of some value to all handicaps enumerated in this bill, as States formulate plans to develop programs of service on the community level.

In this context, too, section 139 (2) indicates that there will need to be standards developed for the States.

From experience, our association can point to a rather long and difficult role to develop and pull together adequate standards for facilities. We have had quite a bit of experience on this with our residential programs.

We recognize the great need for standards on day care and community programs.

Residential programs for the mentally retarded continue to concern and worry us. Excellent progress has been made in some States due to the intervention of the hospital improvement program and the hospital in-service training program under progressive leadership.

However, the President's Committee on Mental Retardation in its report, MR 68-The Edge of Change, points to the deplorable conditions: many of the 200,000 residents live where the average age of the buildings is 44 years, and the average daily cost for care is $7.60, with some amounts down to just over $3 per day. Overcrowding, distance from urban centers, poor salary scales for attendants, and insufficiently trained staff are a few of the reasons for the plight of these institutions.

Our association recently studied 134 of 168 public institutions in the country, and found 185,000 residents in these facilities. Thirty-two institutions house from 2,000 to over 3,000 persons and accommodate 94,940 individuals. I think this comes out to something like 2,900 individuals per residential facility.

We drop down to a mid-category of population, 500 to a thousand in 74 of these "average size" installations, where there were 82,400 people living. This comes out to about 1,100 people per institution.

In this study we found that none of the essential standards in the care of residents and only one essential standard in the socio-education section were met by 75 percent of the institutions evaluated.

The literature is rife with examples of dehumanizing conditions in our institutions, and the time has come for us to do something.

It is our hope that S. 2846 will be available to help not only the public facilities, but also the many smaller, private, nonprofit residential centers and homes. Our association has recently granted status to these private residential facilities, and we plan definitive programs to help them attain standards of care for the retarded so they can bring the full force of their particular skills and knowledge to the field. They are a positive influence that must be expanded and utilized.

Manpower is crucial for the development and execution of programs of service. We are grateful for the many provisions for training professionals offered by our colleges and universities in recent years.

I think the examples that we saw this morning, showing the multidisciplinary teams in action, are vivid examples of what can be done with a well-trained staff.

The amendments to Part B of the Mental Retardation Facilities Construction Act indicate an emphasis on interdisciplinary training, and this should prepare the student to participate more meaningfully with his colleagues in the other disciplines as a member of the team.

Too often, many of us see the students in their separate islands, in the universities working by themselves, and with little opportunity to begin to communicate with their follow students in other disciplines. Small wonder, then, when they graduate and come out in the profes

sional world, they do not, in too many cases, know how to talk definitively with their professional colleagues. We think this is a good feature of the bill.

Those with developmental disabilities require a great deal of expertise and knowledge to diagnose, serve, and train. No one profession has a corner on the market. Professionals and para-professionals must all work together.

Title II, section 122 (b), authorizes a more equitable increase in appropriations from $7 million in fiscal year 1971 up to $20 million for the period ending fiscal year 1975. This should give stability to the programs and insure continuity of training. There is noted in recent years a marked decrease in the appropriations compared to what had originally been authorized.

The provision for "administering and operating demonstration facilities and interdisciplinary training programs for personnel," secton 122(a), is a welcome and important facet of this bill.

We still struggle with shortages in manpower training and recruitment. Hopefully we can make possible an invitation for more students to be attracted to the medical, dental, behavioral, social, and educational sciences.

The American Association on Metal Deficiency is pleased to support this bill, and looks forward to its passage by the Congress. We believe it will put the total program for the developmentally disabled on a sound foundation and enable the States to formulate both shortrange and long-range plans.

The greatest benefits will accrue to the handicapped, enabling them to lead fuller lives, to their parents and families, and to the many professionals and para-professional workers in their respective areas of concern.

Thank you very much, Senator, for this opportunity to come before this committee.

Senator KENNEDY. Thank you very much, Dr. Noone.

You made a comment that the States have been extremely slow in developing standards. Could you elaborate on what is being done? Which States have done a good job? What needs to be done in other States?

Dr. NOONE. I think the States have developed parts of their overall planning, but I don't think that planning has involved the actual standards for facilities or programs.

Perhaps the analogy might be for the residential programs. We have institutions dating back to 1847, but not until 1964 did we have actual standards for the provision of care for the residents in the institution.

By the same token, I don't think we have standards in the States for the day care programs.

I think one of the gentlemen this morning indicated that a school would not take one of the children because the child was not dry. Apparently it is felt that children must be dry in order to attend school. I can appreciate the role of the teacher who has to work with the particular disabilities, but also, with standards, with training, many of these children can use toilet facilities adequately, with proper standards, and then they can take full benefit of the educational opportunities in the classroom.