As far as the day care programs are concerned, what kind of standards do we have? How many children can go in, what age, what kind of staff-we just don't have them. It will take a tremendous amount of time.

Senator KENNEDY. Dr. Noone, you can tell us about the progress in various States in planning their programs to take advantage of the present legislation.

Are you sufficiently convinced, from your study of what various States have done, that they will be able to develop a program to take advantage of the proposed legislation before us today?

Dr. NOONE. I believe so, Senator.

The 50 States did have an opportunity to plan, through Federal funds which expired a year ago, so they do have at hand some plans. How adequate they are, I can not say, but I think the progressive States have made a big dent in recognizing their problems.

It would seem to me that under a mechanism as envisioned by S. 2846, this would give them added impetus to update and implement their planning.

I think by and large they will be able to do it. I would like to think that our Association and our colleague associations would be in a position to be of great value to the States in this whole effort.

Now, in terms of the standards that we mentioned, I think I was alluding earlier to the great amount of time that our Association devoted to the development of standards.

A monograph came out in 1964 on residential standards. This was followed by an evaluation of State institutions based on these standards. Now, the third leg of that triangle has been completed by the establishment of a Joint Commission on the Accreditation of Residential Facilities under VCAH, in Chicago.

But this took a long period of time, and we need similar standards for day programs.

We could go through the same steps to provide the States and the local communities with standards to assist them in the promulgation of adequate programs.

Senator KENNEDY. What is your feeling about the balance between basic research and research that is being done in terms of training and education?

Dr. NOONE. Quite frankly, not enough.

Senator KENNEDY. Not enough training programs?

Dr. NOONE. Yes. I think we have been enamored of the esoteric research which has gone on in PKU and in genetics.

I don't deny the great efforts that my professional colleagues have made in this field. Certainly it has been most helpful in terms of prevention. But I think this alludes to the small percentage of those who are severely and profoundly retarded.

If one looks at the great number of the moderately retarded and mildly retarded, we need to know more from research findings of how we can work with them.

Talking to an associate recently, he said, "You know, we have all kinds of information on how kids react in school, but we have very little on assessment of the teachers and those who are providing the service." Again, this is a bit of programmatic research that I think is quite necessary.

So in answer to your question, sir, I should say that we should begin to provide a bit more emphasis on the social, educational, and behavioral types of research.

Senator KENNEDY. Thank you very much. I appreciate your appearance here.

Dr. NOONE. It has been a pleasure. Thank you.

Senator KENNEDY. Our final witness in these hearings will be Leonard Ganser, who is Administrator of the Division of Mental Hygiene, Department of Health and Social Services of the State of Wisconsin.

He is accompanied by Mr. Harry C. Schnibbe, Executive Director of the National Association of State and Mental Health Program Directors.

Dr. Ganser is a native of Wisconsin. He served in the Public Health Service during World War II. He has spent almost his entire career in service to the State institutions of Wisconsin, which is nationally recognized as having some of the most progressive mental retardation programs in the country.

Mr. Schnibbe is well known to us as a former administrative assistant to Senator John Carroll of Colorado.

Welcome to both of you.

STATEMENT OF LEONARD J. GANSER, M.D., ADMINISTRATOR, DIVISION OF MENTAL HYGIENE, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, STATE OF WISCONSIN; ACCOMPANIED BY HARRY C. SCHNIBBE, EXECUTIVE DIRECTOR, NATIONAL ASSOCIATION OF STATE MENTAL HEALTH PROGRAM DIRECTORS

Dr. GANSER. Thank you, Senator Kennedy.

I represent an association supported by State mental health and mental retardation agencies. We have administrative responsibility for the majority of the mental retardation programs in the country.

I think you are familiar with the purposes of this association, because members have testified before this committee frequently in the past. I did want to clarify for you our relationship with the association which Dr. Barnett represents.

Dr. Barnett represents the Association of State Mental Retardation Coordinators. These are men who have been designated from a State agency as coordinators of mental retardation programs in a State. In the majority of the States these programs are in the mental health agency.

For instance, the Wisconsin representative in Dr. Barnett's association is a gentleman you know, Mr. Harvey Stevens. Mr. Stevens received the Kennedy Foundation Award for his work in mental retardation. He is the Director of the Bureau of Mental Retardation in my agency.

Our testimony here is in summary form. I would like not to read it, but to make reference to some points in it, so that there would be an opportunity for questions.

This, of course, is all in relationship to the proposed legislation that we are considering here.

The State mental health directors do support very strongly, and feel that we need, long-term Federal support of care and treatment programs, education and rehabilitation of the mentally retarded.

In our testimony we refer to State programs, but this includes support for local programs, especially involving the State agency as the coordinator of those programs.

In the present system of Federal matching, these programs are fragmented. They are difficult to deal with because of inflexibility. They have very specific purposes that may not fit in one State or another. They tend to be competitive, and they are ill planned.

So we are suggesting that these programs be junked in favor of something that is more manageable, something that can result in more effective care for the individuals who are retarded, and more help to their families.

In the Federal agency and in the States there are not well organized programs for the mentally retarded. In part this is because we have not had proper stimulation from the Federal agency that we have had in some other areas.

Items 5 and 6 in my prepared statement-item 5 is a list of FederalState mental retardation services that you are all familiar with.

Item 6 is a listing of existing Federal programs that compete with each other at the State and local level. Again you are familiar with all of them.

We think that as many of these programs as possible should be consolidated into one program at the State level, so that the State can use these effectively in coordinating them and interdigitating them with the State's significant investment in care of the mentally retarded.

We also think it is a good idea to relate the functional problems originating in childhood that this legislation anticipates.

I think the examples that Dr. Cooke showed here this morning were excellent examples of the need to relate these disabilities.

I think these are examples that I or anyone else who has worked with the retarded would find very familiar. These are examples of youngsters that we have in many of our institutions. There is an unnatural distinction of these youngsters-mental retardation being the condition that qualifies or excludes them from some very necessary services. I think the developmental disabilities concept is one that makes it possible to be sure that even the relatively rare kind of disability gets the full-scale kind of service that a person has a right to expect.

We also, of course, are especially concerned about the continued care of the adult mentally retarded.

Educational programs, and vocational rehabilitation programs, frequently are related to the disabled who are of school age. They are related to people who have vocational potential.

There are many, many mentally retarded who are in neither one of these groups, and this is a group of mentally retarded who cause their parents a great deal of concern.

One of the most frequent requests that I get in the agency I operate is from parents who have a mentally retarded child who is not a vocational rehabilitation candidate, who is not of school age, and who can live with some degree of independence in the community. They are concerned about what is going to happen to him, when they die. This is a very serious problem for these people.

What we do need is the opportunity to develop a comprehensive program at the State level, and we think it would be most important to have a comprehensive program at the Federal level to provide for leadership in this effort.

This means that we would have to combine the programs that we have talked about here into one kind of consolidated grant, and as many of them as possible.

Obviously, some of them are not going to be combined into a single grant, because there are some very traditional separations, but all of those that are possible, we feel, should be put into one consolidated grant. We think it would be wise to cover all five categories of the developmentally disabled that have been described.

We think this should be a formula grant, that it should be one grant each year to each State. The purpose of it should be to provide on-going Federal assistance for construction, operation, maintenance, staffing, training, transportation, research, planning for residential, day care, out-patient, and the full range of services that are required.

The next item might be somewhat controversial, but we feel rather strongly that there needs to be permanent support. The State legislatures and the State agencies find it very difficult to develop sound programs when the Federal support is on a project basis. They find it very difficult to devlop sound, ongoing programs without stable support to look forward to over a period of time.

The question of how much that support should be in terms of percentages there are a lot of different opinions about that, but it has to be a significant amount.

With this kind of consolidated grant, each State could then be required to have a comprehensive State plan.

We have planning projects, and we have developed some comprehensive plans, but again they were one-shot kinds of affairs.

I think the mechanism that is offered here would provide for consistent planning, for continued review of the State plan and a plan that would encompass recipients other than those involved in construction grants.

Each State should be given the right to determine within limits the allocations of the Federal grant according to its own priorities.

Giving the States the power to review and comment is less than nothing, as far as most of the granting programs are concerned. As a matter of fact, the power to review and comment, as the local community individual might see it, may even weaken their respect for the State agency that has the major responsibility for mental retardation. In my State, for instance, the State expenditures in mental retardation are between $50 and $60 million a year. In order to be sure there is close and proper coordination between those expenditures and the dollars coming from Federal programs, it is clear that the State agency needs to have a considerable force in this kind of consolidated grant. Senator KENNEDY. Did you say that State expenditures for mental retardation in Wisconsin are $50 to $60 million?

Dr. GANSER. $50 to $60 million of money expended.

Senator KENNEDY. On mental retardation?

Dr. GANSER. Yes.

Senator KENNEDY. Then, you must probably go far beyond matching the total Federal funds available to the State for mental retardation programs.

Dr. GANSER. I think this is a case you will find in many States, because we have very expensive institutional operations.

Senator KENNEDY. Will you give us your judgment on the level of funds recommended in this bill? Do you think they are excessive?

Dr. GANSER. I think the funds will have to be sufficient to have a significant impact. Perhaps I can indicate what I mean with another example from Wisconsin.

We now have a construction grant that has been approved which will take our allocation of Federal construction money for the next 3 years. One program. It is in Milwaukee. It is a relatively large program, even though the 3 years' allocation of money is not great in terms of construction of facilities. It does not provide for bedspace. It consists entirely of sheltered workshop programs.

Therefore, in the State of Wisconsin the construction aspects of the present law will have no additional impact for 3 full years. By that time, community programs that are now interested will have lost the impetus to apply for funds.

Another example: We have five staffing grants approved this year. All were funded at somewhere around the 50-percent level.

These are all local programs. None of the construction or staffing in our State goes into the State-operated programs-only local programs. Those five operations had to curtail by 50 percent the programs they had in mind when they made the pplication.

I hope these examples illustrace that there has to be sufficient funding to have an impact, to have a noticeable effect on the speed with which community resources develop.

The $100 million figure in my prepared testimony is as good as I could come up with. I think that would have a significant impact. Whatever figure that is decided on must be in that area.

State investments in mental retardation programs are very largea billion dollars or more each year in all of the 50 States. Because some of our program is tied up in expensive care for the most severely handicapped, we need this Federal money to provide the cutting edge to get community programs going.

I want to make one additional comment about the matter of the public agencies in terms of receiving these funds. I think this is important, but I also think it is especailly important for the private nonprofit agencies to receive these funds.

Again, if I can use Wisconsin as an example, we have a day care MR program which the State funds 40 percent. Since 1963, when that legislation took effect, we have developed 85 day care MR resources in the communities that now use almost $4 million of State money, even at this 40 percent. A good share of the 60 percent of local money is private nonprofit money, especially coming from parent groups and

so on.

They have done a tremendous job of extending these services so that at this point we serve between 3,000 and 4,000 people in day programs. Many of these would be in institutions under other circumstances.

Senator KENNEDY. I ought to know, but how many day care centers do we have in Massachusetts? Do you know, by any chance?

Dr. GANSER. It seems to me I heard Dr. Greenblatt say last week something like 30.