revision in the delivery of community services has become a critical necessity. Leaders in the field of mental retardation must face up to this challenge. The campaign to prevent mental retardation and help the mentally retarded utilize their abilities fully is entering a new phase. Because resources of money and people are short and because human needs are so deeply interrelated, people and organizations interested in specific handicapping conditions will need to work together increasingly. The development of all-inclusive approaches to handicapping conditions will promote more effective services for retarded individuals than can be found in most communities today. Such approaches would end the tragic limbo into which the emotionally disturbed retarded have so often fallen. They would end the frequent neglect of individuals having unusual retardation-allied conditions such as autism. Comprehensive approaches would particularly make it possible to tackle the awesome amount of mental retardation that has social and environmental causes. This retardation is frequently neglected in today's largely biomedically oriented research and treatment programs. The time has come for workers with the retarded to surmount their fears of submergence and neglect in comprehensive programs for the handıcapped. Substantial grounds have often existed for such fears... and still do in many programs. But important changes in knowledge and attitudes about the retarded are combining to make enlightened action possible. The mistaken notion of retardation as an irreversible, unchangeable condition is at last giving way in a score of fields. Replacing this long-frozen view of retardation is a mounting involvement and excitement among scientists, health specialists, educators, psychologists, social workers and therapists This new attitude is bringing attention, respect, and action programs to the field of mental retardation. If wisely cultivated, it will assign retardation as important a priority in comprehensive service planning and programming as that given to any other handicapping condition The protection of the interest of the retarded over the next decade, then, will probably be a matter of two related endeavors. We will need to cultivate the excitement about the possibilities of making important progress in preventing and overcoming human functional disorders. And all groups and individuals concerned about such disorders will need to insist that every handicapped individual get all of the help he needs to grow to the fullest realization of his own abilities and potential. Last year, this Committee pointed out 10 areas in which major action in furthering the national campaign against mental retardation was needed. During the year since submitting its first report, the Committee has focused major effort on studies in three of those areas-residential care of the retarded, manpower for programs working with the retarded, and povertylinked retardation. Reports with recommendations in these areas follow. guiding many institutions IMONVERT chietly covers the traditional force, postponezol type of residential program, however Ittle guidance on day to das wate Taxpavers pay NECES to operate these soften the de toate to idential care if the retarded by all ne it is half a billion dollars paid to perpes Featur inhumane warehousing of time Bell S The dilemma of how to improve the stitutions for the mentally revedeas tangled one The essence of the pote do about buildings budgers power the and pop to tions that have existed in mecleet tid den toe years with little on ros thache sees gro needs by either state officials or the publi Renovation of existing buildings is ofret too costly to undertake But states hesitate to abandon such buildings because at the investiment put into them Finding another use for them is as elle che cult because of them is dated athay A look at instinction budgets can be like in expe dition into a hidden Lind that time for or Needs that were great in 1940 may not vot have been chi structively studied and responded to the hundred different ways of sine residents angad der for flesh our penny pin have a sognel 16-1225 wald appall labor and matheefter Spelers Housed in pian Foldings and sh inadequate ducts, my stu cannot control the sive Thousands of severely retarded individuals are on waiting lists trying to get in. Institutions' budgets, administrative channels and ties with other agencies are too often insufficient. The need is now too great and too long neglected to be solved by the states alone. Massive federal intervention to spur the improvement of present facilities and the development of new, up-to-date selfrenewable systems for the residential care of the mentally retarded is imperative. The recommendations that follow offer a program for beginning the job in a constructive way that will make as much use as possible of existing facili ties and resources. 1. Control of the quality of public, non-profit and private residential care for the retarded is essential. We recommend, therefore, that the appropri ate professional and voluntary organizations, with support from the federal government, take immediate steps to improve the standards for residential care of the retarded and simultaneously develop a system of accreditation of residential care programs and facilities for the retarded. 2. The federal government's Hospital Improvement Program has elicited imaginative new approaches to delivering residential care in state institutions. We recommend that this program now be expanded to effect major change by: A. Greatly increasing funds, with the provision that every state institution for the retarded have opportunity to participate. B. Making awards on the basis of a state plan for bringing present institutions up to acceptable standards and the development of communitybased residences as alternatives to institutions. C. Relating awards to the size, budget, and needs of the institution. Particular effort in this connection must be made to meet the unmet needs of the severely and profoundly retarded. Accommodations and care for them are inhuman in many institutions. 3. The use of outmoded, mass-housing buildings must be ended. Industry has rarely hesitated to abandon and replace obsolete plants; states should be no less firm in developing up-to-date facilities A new geographic distribution of modes and forms of residential care services--including group homes, residential vocational training centers, nurseries and specialized nursing homes--is badly needed. We recommend, therefore, that a new part be added to Public Law 88-164 to establish a construction program for relocating and rebuilding obsolete residential facilities. Safeguards must be included to insure that future institutions do not perpetuate the mass housing and programming patterns of the past, and that the construction be planned for easy modification as new techniques and needs are found. The planning should be carried out in consultation with architects, urbanologists, demographers, community developers and other specialists in environmental sciences. 4. Hospital In-Service Training Program grants should be greatly increased to include significant training for both leadership and direct service personnel in residential care facilities. 5. Public and private social services for children and adults are related to residential care for the retarded in two ways: one. they can suggest alternatives to residential care; two, they have the competency to counsel families during their times of greatest stress ---such as the time of deciding to seek a child's admission to an institution, or that of returning a retarded person to community living. We recommend that federal, state and local welfare agencies, both public and private, clearly identify a portion of their resources for welfare services to the retarded and their families. Such services include casework, adoption, homemaker services, foster care and day care. Immediate strengthening of child welfare services to the retarded through expert staffing, consultation and training is an essential component of this recommendation. 6. We recommend that a federally supported insurance system be established to enable a free choice in selecting residential services. The exercise of free choice in the selection of an institutional home for a retarded individual will bring to the residential care field the improvement motivation of free competitive enterprise. 7. In order to provide a viable choice, we further recommend that a system of loans or grants be developed to assist private non-profit and proprietary organizations to establish alternative forms of residential care for the retarded, such as hostels, group homes, nurseries, residential vocational training centers, nursing homes and extended care facilities. 8. State and local mental health authorities and the National Institute of Mental Health should take active leadership in developing services and programs for emotionally disturbed retarded persons in residential care or community programs. |